Thursday, February 16, 2017

A Mile Wide


When people say that it must be harder to be a veterinarian than an MD they often make two observations. The first is that our patients don't talk. (As an aside, this is actually not always a bad thing. It's difficult enough to sort through contradictory information between the husband and the wife without the cat talking too...) The second observation is that we have to deal with so many different species. This is correct for the profession as a whole but in truth there aren't very many James Herriot "All Creatures Great And Small"* types around any more. More and more of us restrict our practices to a handful of species. Which is of course still more than one.

However, what people often don't consider, and what is truly difficult (but fun), is the range of what we can do. Physicians are usually limited to family practice or a specific specialty, whereas as a veterinarian in general practice I am a "family doctor", an internist, a general surgeon, a dentist, an anesthesiologist, a radiologist, a behaviorist, a nutritionist, an oncologist, a cardiologist, an ophthalmologist, a dermatologist, a pharmacist, an obstetrician, a pediatrician, a gerontologist and a bereavement counselor.

I am a mile wide.

And, as the aphorism goes, unfortunately sometimes (often?) just an inch deep. To be fair, the depth does vary. Most of us are deepest in the general medicine / family doctor, internal medicine and general surgery categories and then have a handful of other areas of interest where our depth exceeds the proverbial inch. Three things save us from malpractice in the shallow zones.:

1) Colleagues. Veterinarians, as a rule, get along well together and veterinarians, as a rule, know their own limits. Strengths and weaknesses tend to balance each other out within a group of veterinarians working together so cases are discussed and shared. And when this is not enough, or for those in solo practice, referral to specialists or to colleagues in other practices with particular training, experience or equipment, is common.

2) Continuing Education. In order to maintain our license we have to attend conferences where new information is presented and where refresher courses are offered. I was just at a conference in Florida last week for exactly that reason. Sure Philipp, a "conference" in Florida... in February... how convenient... Ok, we did tack on a holiday after, but honestly, during the conference time the warmth and sunshine outside were an abstraction when considered from the artificially lit, aggressively air conditioned interior of massive lecture halls. But it was fun! For those of you youngsters out there, here's a fact that may surprise you - learning is big fun when there are no exams or assignments or pressures of any sort.

3) The Internet. There, I said it in a public forum. Vets look stuff up on the internet. However, I don't mean the wide open internet, but specifically the Veterinary Information Network, or as we all call it, "vin". Vin is a life saver - literally for some of my patients - and it is something other professions are jealous of. It's an online subscription service that allows us access to scores of specialists to whom we can post questions on open forums**. It also has an impressive array of tools and resource materials and, as it has been running for about 15 years, it now has such a massive searchable database of past questions that I am often hard pressed to think of anything new to ask. Here's a secret: when your pet has something odd and your veterinarian pops out of the room for any reason or excuse, chances are they are also quickly logging into vin...

Being wide keeps things interesting. Being shallow keeps things scary. As with most things in life the key is in getting the balance right. And in leaving the hippos to the specialists.

*Widely referred to among veterinarians as "All Creatures Grunt And Smell".

**The free public access sister site is https://www.veterinarypartner.com/ , which is a reliable and highly recommended source of information when you are tempted to check in with Dr. Google.

Thursday, January 26, 2017

Rainbow Of Poo


Easily offended readers, or those with good taste, have probably not made it past the title to get to this warning, but as a precaution here is the warning anyway: this post is entirely devoted to discussing the whys and wherefores of dog poop colour.

I did not have a dog growing up so my earliest dog memories are of my friend's and relative's dogs. In particular I remember Antje, the beautiful big black standard poodle owned by my friend Derwin Rovers' family. Derwin lived in the next block and we were back and forth at each other's houses a lot. They were Dutch and loved the Dutch style red cabbage that is stewed with apples and turns a vibrant purple colour. Derwin's Oma was visiting from the Netherlands and she loved Antje. Antje loved her too. Antje loved her because Oma would feed her from the table whenever Derwin's parents weren't looking. One day they had this red cabbage and Oma gave Antje rather a lot of it, plus some pork and mashed potatoes. The diarrhea was purple. Right on their white shag carpet (this was the early 1970s after all). Brilliant, vivid purple. I cannot begin to explain how deeply impressive this was to a pair of 6 year old boys. Eyes wide, mouth hanging open, fingers pointing... this made our day. Heck it made our month. Purple poo. Derwin, your dog had purple poo.

Fast forward forty-five years and I am still grappling with dog poo colour as not a week goes by without a question from a client about what it all means. So here, for your edification is a field guide to the spectrum:

Brown: Let's start with an easy one. Any shade of brown is normal. It may vary from dark to light from time to time for no particular reason, but it's all good.

Yellow, Green or Orange: These are generally muted brownish versions of these colours, but these are also fine. You are just seeing more bile coming through. This may happen when the gut is contracting a little faster or with certain foods, but as long as it is firm it is fine.

Red: This generates the most calls and visits as it is understandably alarming. Yes, red does mean blood. Generally, however, the red blood is in spots or streaks or as a small amount at the end of the bowel movement and should not be a cause for alarm. (If, on the other hand, the entire bowel movement is red you are right to be alarmed and you should call your veterinarian forthwith.) The spots and streaks just mean that anus, rectum or last part of the colon are irritated and that perhaps there was some straining to break a small blood vessel. If it only happens once or twice and the feces are otherwise ok or just a little soft, don't worry. If it happens several times, call your veterinarian.

Purple: See Antje's story above.

Blue: Never seen that. I have no idea. Call you veterinarian immediately.

White or Grey: Likely your dog was given a barium swallow test and you are seeing the barium pass through. If this was not the case... you know what I'm going to say... call your veterinarian!

Black: This is the important one, really the only colour you need to watch for. If the stool is jet black like tar or molasses and especially if it is soft and glistening and sticky, your dog may have what is called "melena". That is digested blood and is coming from higher up in the system like the stomach or small intestine. This can be very serious as it may indicate a bleeding ulcer or tumour. Please note however that pepto-bismol can also turn the stool black.

So there you have it. While consistency, size, frequency and effort to produce are all important pieces of information regarding your dog's stool, colour, perhaps surprisingly, is generally not. Unless it is black.

And for the cat people reading I'll say that more or less the same applies although for some reason you don't ask about it nearly as often as dog people do. A fun fact though is that if you have multiple cats and someone is pooping out of the box but you don't know who you can put non-toxic sparkles in one cat's food at a time until you see who makes sparkly poo!

No, I have not lost my mind. Yes, I am absolutely serious about all of this. 

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.
http://vetography.blogspot.ca/2016/04/that-distemperment-shot.html

9. Flealess in Winnipeg.
http://vetography.blogspot.ca/2016/01/the-ballad-of-prairie-flea.html

8. A useful liquor finding dog.
http://vetography.blogspot.ca/2015/11/what-seeing-eye-dog-saw.html

7. Of thunder phobias and doggles.
http://vetography.blogspot.ca/2016/06/when-sky-goes-boom.html

6. Too many big words and what to do about them.
http://vetography.blogspot.ca/2016/03/doogie-and-me.html

5. Cool heartworm facts.
http://vetography.blogspot.ca/2016/05/there-are-worms-in-my-heart.html

4. Mostly about my first pet and partly about a savage pocket gopher.
http://vetography.blogspot.ca/2015/12/bobo-christmas-gerbil.html

3. Respect the tough bunny.
http://vetography.blogspot.ca/2015/12/nasty-big-pointy-teeth.html

2. The fish that almost killed me.
http://vetography.blogspot.ca/2016/03/fish-of-death.html

And least popular of all!
1. Why your 100 lb hairy northern rescue dog is related to a chihuahua.
http://vetography.blogspot.ca/2016/04/the-wild-boreal-chihuahua.html

p.s.
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 (http://vetography.blogspot.ca/2016/02/getting-tutored.html). 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.