Thursday, January 12, 2017

The Nature Of Nature

Nature is not your friend, or your pet's friend. It is not your enemy either, but it is not your friend. It is simply indifferent. Like that cool, funny, attractive, intelligent person you wish you could get to know better, but they're too busy being themselves.

I'm probably going to get some hate mail for this, so let me first reassure the reader that I actually do love nature, regardless of how it feels about me. I spend as much time in the wilderness as possible, I contribute to environmental causes, I make my own yogurt, I buy eggs from pasture-grazed chickens direct from the farmer, I can distinguish the two species of nuthatch at fifty paces and I have been known to wear Birkenstocks.

Unfortunately however, for some people, including some pet owners, love of nature has become confused with believing that medications and foods labeled "natural" are better for their pet's health. There are two distinct problems with this belief.

The first is, as I indicated above, nature is not your pet's friend. The most potent cancer causing agent yet identified anywhere is aflatoxin, which is produced by a certain mold on peanuts, rice and a few other foods. Tiny amounts that are undetectable to the eye, nose or tastebuds are enough to cause a problem. This is perfectly natural and has been around since we were still living in trees and grunting at each other. And it has cropped up in some small batch dog foods with poor quality control. This is just one example. There are many many more.

Another way to look at this is to consider the life span of wild animals living fully natural lives. Wolves, for example, generally average around 7 years, not much more than half that of many domestic dogs. Middle aged and older readers may wish to shield their eyes, but if nature is indifferent to our fate, it is supremely indifferent to the point of negligence about our fate once we are past reproductive age.

The second problem with seeking out "natural" labeled products for health purposes is that the term is unregulated and effectively meaningless. I have no particular affection for the giant pharmaceutical corporations and their profit-seeking distortions of science, but if you believe that a product that happens to have a smiling Peruvian native on the label and uses a funky earthy font is truly "natural" and, moreover, is somehow made by a non-profit collective that only has your pet's very best interest at heart, then you are naive. Ditto for pet foods named purple antelope or green beaver or some other marketing department driven bewilderment. The only difference is scale. It's almost all profit driven and it's almost all designed to sell as much product as possible.

If you can gather it or grow it or raise it or hunt it yourself, and if you have solid research (statistics not anecdotes please!) to back up its safety and efficacy, by all means, go natural! But if you are buying it packaged, be wary, be skeptical. It's not necessarily bad, but it's certainly not necessarily good either.

Many people have the charming belief that something wouldn't be allowed to be sold if it wasn't safe and at least a little bit effective. The truth is that if it doesn't require a prescription it is either very loosely regulated or not regulated at all. A giant firehose of over-the-counter nutraceuticals, supplements, herbal remedies and "natural" cures of all description is aimed at us and nobody has the resources to test and double-check even a fraction of it.

And right now nature is producing -43C wind chills out there. So please keep your pets in the unnatural confines of the house until the natural winds subside.

Thursday, December 15, 2016

Do They Know It's Christmas?

The short answer is no.

The longer answer also features the word no but has more shading and nuance. But before I get into that let me reassure you (or warn you?) that this is not a typical veterinary Christmas blog post. I will not be discussing the health hazards of chocolate and tinsel, as you are all smart people and know this stuff already. Nor will I be discussing the moral hazards of forcing your cat to wear a little Santa suit or strapping reindeer antlers to your dog's head, as I know I will not be able to dissuade you from doing so anyway. (It's an uncontrollable urge made worse by the advent of social media. Laws are needed. Blog posts are helpless against this urge.)

No, instead I will explore the question in the title. "Do they know it's Christmas?" No, they do not know it's Christmas, but they do know that "something" is up. And it makes them nervous. Now, to be fair, some of that "something" is can be exciting and fun. Social dogs will enjoy sniffing the unusual people coming over and self-confident cats will enjoy secretly licking the turkey. These are the exceptions though. Most pets are merely confused and confusion leads to stress. Moreover, the majority of adult dogs and cats are deeply conservative (in the "small c" sense). Bliss for them is every day unfolding precisely like every day before it did. Bliss for them is the glorious routine. Everything. The. Same. Every. Day. Everything!  You know this already. God forbid you get up at 7:05 instead of 7:00.

Christmas has the potential to mess with every element of this glorious routine. Furniture is moved. A giant tree is placed in the house and covered with a myriad temptations you are forbidden to touch. A freaking giant tree! Festooned with shiny toys for Pete's sake! Your walks are changed or - gasp - cancelled. Your mealtimes become more erratic. Random people come and go. Uncle Darryl keeps insisting that yes you do love to have your furry tummy rubbed, but you don't and you bite him and people call you crazy. And your humans stay up late and sleep late. And all kinds of stuff is left laying around that you get yelled at for checking out. The list goes on. Christmas is stressful enough for many people, so just imagine how bizarre and unsettling it is for your dog or cat since they do not even know it's Christmas.

So what can you do? Cancel Christmas? Sure, go for it. "Vet Approved". However, that's going to be unrealistic for most of you, so instead my recommendation is that you simply keep an eye on the importance of routine. Feed the same foods at the same times in the same amounts. Go for the same walks at as close to the same times as you can manage. Keep scooping that litter box. Set reminder alarms on your phone if you are worried you will forget or get distracted by the Christmas chaos.

And if you are going to put reindeer antlers on your dog, don't tell too many people, least of all your veterinarian.

Saturday, November 26, 2016

Bottom Ten Countdown

Today marks exactly one year since my first Vetography post. I am very grateful to all my readers and for the support they have given the blog. In celebration of Vetography's first birthday I am going to list the ten least popular posts. If this seems strange, here is my logic - I figure that if you're reading this you are probably already familiar with the most popular posts. Now I know that some, or even many, of the least popular posts have probably earned their low rank, but perhaps some just slid under the metaphorical radar.
So, the Bottom Ten Countdown!

10. Distemper: it might not be what you think it is.

9. Flealess in Winnipeg.

8. A useful liquor finding dog.

7. Of thunder phobias and doggles.

6. Too many big words and what to do about them.

5. Cool heartworm facts.

4. Mostly about my first pet and partly about a savage pocket gopher.

3. Respect the tough bunny.

2. The fish that almost killed me.

And least popular of all!
1. Why your 100 lb hairy northern rescue dog is related to a chihuahua.

For those who really want to know, there's a list of the top ten on the side of the desktop version of the blog...

Thursday, November 24, 2016

The Stoic And The Cassandra

"He's not in pain doc. I checked him all over. Felt everything and he didn't react. I don't know why he's walking like that. Maybe there's something stuck in his paw that I can't see?"
Jake had come in with a pronounced limp and Mr. Hudson had done exactly what any concerned pet owner would do and tried to find the sore spot. Some variation of this scenario plays out every day in the average small animal practice, sometimes several times a day.

I knelt down and greeted Jake, a friendly collie / lab / shepherd mix, and gave him a couple of his favorite liver treats. He wagged his tail and was going to try to lick my face, but I moved his head aside to begin my exam before he could. I don't mind the occasional dog "kiss", but I knew that Jake was also a notorious poop eater. I began to palpate and manipulate each limb from the toes to the top, starting with the apparently normal ones and finishing with his right hind leg, the one he was limping on. (Incidentally, everyone thinks there is something stuck in the paw, but that is very rarely the case unless you see the dog chewing at the paw.)

"Like I said doc, I already did that and I couldn't find anything that hurt."
Jake didn't react for me either, but I did feel a subtle swelling in his right knee joint and he had what we call a "positive drawer sign", in which the tibia (shin bone) is able to slide forward relative to the femur (thigh bone), a bit like a drawer opening slightly. This meant that Jake had torn his cranial cruciate ligament, called the anterior cruciate ligament, or "ACL", in humans. So, isn't that painful? If so, why wasn't Jake reacting? Yes, it is painful and Jake was not reacting because he is a stoic.

Not that many dogs or cats have human "ouch, that spot hurts" reactions to pain. Some do, but most don't. Most are either stoics or Cassandras. The stoics, like Jake, prefer not to show any sign of pain. This is in part because in nature showing pain can make you an easy target. This is especially true of prey species such as rabbits who are ultra-stoic, but it is also true of social predators, such as dogs, who might be in danger of losing status. That said, there is tremendous individual variation and tremendous breed variation.

So, if stoics won't let you identify the location of the injury because they won't show pain, what do Cassandras do? In their most extreme form Cassandras scream if you take a small step in their general direction. If they do let you examine them, they will show what seems like pain (more screaming) even if you are only vaguely in the vicinity the problem area. You might be able to generally localize the problem as "front end versus back end", maybe, but that's not all that helpful.

As a sweeping generalization, dogs are more likely to be stoics and cats are more likely to be Cassandras, but there is a lot of cross-over.

What is the poor veterinarian to do with the patient that not only refuses to speak English but is likely a stoic or a Cassandra? As Jake's story illustrated, we perform a specialized kind of physical exam where we feel for what might be swollen, out of place, loose and yes, in some cases sore. Sometimes xrays are needed. And sometimes even then we have to make educated guesses. Thank goodness for education!

Saturday, October 29, 2016

Spay Day

This November 2 the Manitoba Veterinary Medical Association is sponsoring "Spay Day". Assuming the Hudson Bay Company's lawyers remain quiet the event will feature significant discounts on spaying and neutering at participating clinics.

I've written about neutering before ( Spay Day is the perfect opportunity to address the other half. Let's start with that weird word, "spay". It's made a long journey from the Latin "spatha", meaning broad sword (kind of alarming...), and from which we also get spade and spatula, to the Old French "espeer", meaning to cut with a blade, and then over to England where it turns up as "spaier and spaied" and where things get... weird. There it was first used to describe a specific way of dispatching a deer with a thin blade during the hunt, but in 1410 there also is reference to "oon spaied biche lesteth lengere in hure bounte than other ii that byn not spaied". How they managed to "spaied" the "biche" and have her survive in 1410 is unclear, but henceforth the word was associated with the removal of ovaries from prized hunting dogs, and from which the evolution to the modern usage is obvious.

I'm sorry, that's probably way more than you wanted to know about that, but I was on a roll. In any case, yes, it's a weird word.

The technical term is clearer though: ovariohysterectomy. How is that clear? Just break it down: ovario = ovaries, hyster = uterus (ok, that bit's not clear) and ectomy = removal. In fact, this may be a useful thing to know. Any surgery ending in the suffix "ectomy" involves removing something. So when your own doctor starts saying blahblahectomy, pay close attention. For the record, the suffix "otomy" means making a temporary hole somewhere and "ostomy" means making a permanent or semi-permanent hole somewhere. Come to think of it, you should probably also tune in when the doctor says blahblahostomy...

Now that I've squandered half the post on terminology, let's move on to something useful - questions I have been asked about spaying.

The big one: I won't let my dog out to get pregnant, so why spay?
We have a saying, "all pets get spayed, it's just a question of whether it's an elective or an emergency procedure." This is because of something called pyometra. People will sometimes argue that they do not want to spay because it is "unnatural", forgetting that what nature intends is for the animal to become pregnant with every cycle. When this does not happen and they unnaturally cycle "empty" there is a significant risk that the open cervix and waiting uterine bed will invite bacteria in, causing a life threatening pyometra infection. According to one study 23% of intact female dogs under the age of 10 develop pyometra. The rate goes up quickly over the age of 10.

Ok, got it, but why not just a hysterectomy?
To begin with, it's not any easier or quicker as the ovaries are right there by the uterus anyway and while it would be just as effective in preventing pregnancy, leaving the ovaries behind would allow her to continue to have heat cycles. And why is this a problem? In dogs this is a problem because 12 to 16% of dogs who have gone through a heat cycle will develop mammary (breast) cancer whereas almost no dogs who are spayed before the first heat develop this. Many of these are benign cancers, but they still require surgery, often many surgeries, and some are malignant. In cats it's even worse as 90% of mammary tumours are malignant. Moreover, anyone who is thinking about leaving the ovaries in their cat has not spent quality time in the company of a cat in heat.

Yeah, but what about the risks?
There is always some statistical level of risk with any surgery and general anesthetic, but this is an extremely routine and safe procedure in veterinary medicine. In the 26 years I have been in practice I cannot recall seeing a single death related to a spay. That's not to say that it can't happen, but the risk of death due to pyometra and mammary tumours are an order of magnitude higher.

But what about these longer term knee joint risks I've been reading about?
Clever you. Nothing in the world or in life gets any simpler with time, does it? Everything becomes more complex. Yes, in the last few years more evidence has come to light linking early spaying in some breeds with an elevated risk of tearing the cruciate ligament in the knee (called the ACL in humans). What is meant by early and how much is the risk elevated? I'm going to be a wimp and tell you to ask your veterinarian. This really does have to be addressed case by case as a number of factors come into play.

So, mark it in your calendar: Manitoba Spay Day, November 2, 2016. I suspect most of you reading this have pets who are already spayed, so use that day to congratulate them on their spayedness.

Thursday, October 13, 2016

A Dog's Mind

"What do you suppose is going on in his mind?" Mr. Reynolds asked, smiling at Alf. Alf, his twelve year old lab cross, sat primly beside him, staring at me, not blinking, his eyes tracking my every move.
"We can only guess," I replied lamely, as I leafed through Alf's file trying to decipher the scribbles.
"He's totally focused on you. Paying close attention to everything you do. Watching to see if you reach for a needle or a treat!"

Focus, attention, watching. Fully conscious and aware. Mr. Reynolds was absolutely right.

For most of Western history we believed that animals were not conscious in the same way that humans were. We believed that they did not have a "mind". We believed that their behaviours were only the products of unthinking reflexes. In the 17th century Renee Descartes famously stated that an animal crying in pain did not actually feel it the way we did, no more than a machine felt the noisy grinding of gears. Denial of animal consciousness persisted deep into the 20th century. In fact, I am ashamed for my profession that up until the 1980s it was unusual for veterinary schools to teach much about pain control, in part because of lingering doubts regarding animal consciousness.

But here's the funny twist to the story: it is actually our own consciousness that we should be doubting.

Our species developed language that allowed us to organize complex societies, create astonishing technologies and, ultimately, conquer the world. However, this language ability lies like a heavy blanket on top of our consciousness, often smothering it. What we call "thinking" is often just a garbled torrent of words inside our head. Usually these words are just pointless rehashes of old conversations, rehearsals for future conversations, looping snatches of song lyrics, half remembered to-do lists etc.. Honestly, what was the last truly useful thought you had? And chances are it popped up unbidden in a rare quiet moment rather than out of the churning river of internal chatter.

Animals, on the other hand, do not have words. They do not plan conversations or construct lists of chores. They exist in a state of pure consciousness and pure awareness, with absolute focus and attention. Their minds are filled with what is right in front of them, right now. This is akin to what people who meditate attempt to achieve. Sure, memories and anticipations intrude for them too, probably in the form of smell pictures, but far more than us they are present in the real world in real time, moment by moment, while we unconsciously drift along and then wonder where all the time went. Or wonder whether those last few traffic lights really were green.

I gave Alf both a needle and a treat. And then I went back to trying to figure out the file while wondering whether my next appointment was set up and what that thing was that I forgot to say and then remembered and then forgot again.

Alf was looking at the door.

Monday, September 26, 2016

Cat Goes Mad

While hiking in England last week a headline in a small town paper caught my eye: "COW BRUTALLY ATTACKS OAP". Yes, it was all caps. In fact, those four words were the only thing on the front page. (By the way, "OAP" means "old age pensioner". I had to look it up.) In any case it brought to mind a story my wife told me about a similarly startling headline in the Winnipeg Sun when she was growing up. Apparently the front page screamed, "CAT GOES MAD", accompanied by a picture of a suitably concerned looking elderly woman sitting on a couch festooned with doilies. And this got me thinking about rabies in cats. That's how that funky old train of thought sometimes goes. One minute you're thinking about oaps and the next you're thinking about feline rabies.

Rabid cats came so readily to mind because just prior to leaving for England I had a telephone conversation with a client about the subject. As I outlined in the last post I don't always have a minute-by-minute overview of my telephone messages. In fact an hour or more can easily go by before I see them. On this particular morning I opened the message center on my computer to find a series of increasingly frantic sounding messages from Mr. Stirling:
-Please call. Thinks Buttons has rabies.
-Urgent: Very concerned about his rabid cat.
-Called again!!
Intrigued, I called Mr. Stirling back.
"Hello, I understand you are worried that Buttons might have rabies?"
"Yes! She's not acting like herself at all!"
"How so? Can you describe what she is doing please?"
"Usually I keep the bedroom door closed at night, but two nights ago I left it open and she came into my room in the middle of the night."
"And then she jumped on me and sat there for a while. I woke up but I didn't move. Then she bit me!"
"Oh dear. Did she break the skin?"
"No. I guess it was more of a nibble than a bite."
"Hmm. Anything else?"
"Yes! Then last night she did the same thing, except without the bite. That time she just purred loudly."
This was beginning to shape up like a Monty Python sketch.

I have a great deal of faith in the shrewdness of my readership, so I'm confident you can more or less reconstruct my response and the rest of the conversation. No, Buttons did not have rabies. Buttons was bored and lonely and wanted to play. Mr. Stirling was relieved. He called back the next day to apologize for overreacting. There was no need to apologize. I would much rather people took rabies "too seriously" than not seriously enough, because that side of the coin is all too prevalent.

I am sometimes asked how many cases of rabies I have seen in my patients. The answer is zero. Shallow thinkers will take that as evidence that vaccination is not necessary. This is of course the wrong conclusion. The right conclusion is that it is evidence for the effectiveness of the vaccination program. Otherwise it's a bit like saying, "See my house has never burnt down so I can start letting the kids play with blowtorches." Countries without comprehensive rabies vaccination programs have shockingly high rates of the disease. 20,000 people die of rabies every year in India. Twenty thousand people die.
It is one of the ugliest deaths imaginable. And the number of animals dying of it must be an order of magnitude higher.

So please, if you are at all concerned that your cat or dog (or cow) has gone mad, please do not hesitate to call. We won't laugh. (Unless you use a Michael Palin voice.)