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.)

Wednesday, September 7, 2016

Why Hasn't The Doctor Called Me Back Yet!?!?

My father was dying of brain cancer. He had a glioblastoma removed from his left prefrontal cortex and was given months to live. He was a physicist and his intellectual capabilities were unimpaired but his judgment and social graces, such as they were, had been annihilated. Told by the surgeon that they removed the tumour using suction my father delighted in pointing to the large scar on his forehead and loudly telling strangers that his brain had been removed by a vacuum cleaner. There were other surprising moments of levity, but otherwise this was a bleak time. He was too young for this and we were not ready to lose him. Not nearly.

A few weeks after the surgery an issue arose regarding one of his medications. I don't recall which or why, but I do recall being quite anxious about it. It was not an emergency by any stretch, but the problem was beginning to spiral in our minds, so I phoned his oncologist to ask about it. He was unable to come to the phone, so his receptionist took a message. Ten minutes went by, then twenty, thirty, forty, fifty... By the time a full hour rolled around I had checked twice to make sure the phone was working (dial tone? yes) and my pacing had become obsessive. I couldn't read. I couldn't listen to music. I couldn't concentrate on chores. I couldn't think about anything except a recursive loop of 'Why hasn't he called me back yet!?!?'
'It would only take a minute!'
At the two hour mark my tone had darkened . I was much quicker to anger in those days.
'I can't effing believe this! He can't find a minute to help a dying man?'
'The arrogant prick!!'
I was beside myself. I left another message, trying to make my voice sound like cold steel, gleaming with sarcastic fury.
But at least another hour passed before he called. When he did his tone was disarmingly pleasant and empathetic. He took the time needed to properly answer my questions and the problem was sorted.

All these many years later I still cringe when I think of how I reacted that day. I cringe in part in recognition of the different person I was then and I cringe in part in imagining how my own clients must sometimes feel when I am slow returning their calls. I know that most people are reasonable and understanding, but I know that some must be just like I was - in a vulnerable and slightly irrational emotional state or perhaps even just unaware of the workflow in a busy clinical setting.

So for the latter group, it is probably worthwhile explaining the "type of busy" that we often are. In some jobs you can be very busy doing one thing. You have a single important task in front of you that is fully occupying your time, but you can take regular breaks from it to quickly address other matters as they arise. Veterinary (and presumably human medical) practice is not like that. We generally have numerous simultaneous demands on our attention throughout our entire shift. We are constantly in triage mode, figuring out in what order to do things so that the least number of people with urgent problems are left waiting the least amount of time. Moreover, for telephone messages specifically, in some cases it may be a few hours before we even see the message, let alone try to fit it into our triage. Another factor is that estimating the length of a phone call is notoriously difficult, for either the client or the doctor, so we are sometimes unwilling to take the risk and will leave it until a gap opens in our schedule or to the end of our shift. This is almost certainly what happened with my father's oncologist. It was closer to ten minutes than one and he was wise enough to leave it for the end of his day.

So, "How To Contact Your Veterinarian":
- By all means please phone if you have any questions.
- If you feel the question is urgent, tell the receptionist so.
- Ask for a realistic guesstimate on when you are likely to hear back.
- Please make sure the receptionist knows which phone number you can be reached at. Many files list multiple work and cell numbers for multiple family members in addition to the home landline.
- Please make sure you specify if there are times you will not be available to be called back.
- Please use email sparingly and only if you are ok with waiting for a day or two for a response. Sometimes we're quick with email, but sometimes we're not. For a variety of practical reasons it is not given a high priority.

(my dad and my brother, ~1970)

Monday, July 25, 2016

He Ate What...??? (Part 1)

This will be the first in an occasional series of short posts detailing the bizarre things pets will eat. Of course they will also eat terrible and harmful things, but I will stick to the more amusing stories that have a good outcome, so you can happily read without fear of needing to keep a box of tissues nearby.

The most recent entrant into the "He Ate What...???" Hall of Fame was Bouncer Rodgers. Bouncer is an aptly named young black Lab cross who was actually seen by one of my colleagues in the practice rather than me, but I was there and heard everything and I know she won't mind me using this story.

Bouncer was rushed in by Mrs. Rodgers one otherwise quiet Monday afternoon.
"I don't what's wrong with him! He was fine this morning and then just now I found him staggering, barely able to stand!"

Sure enough, although Bouncer could walk, he was extremely wobbly and kept falling over. His pupils were dilated and he had a facial expression that could only be read as pathetic confusion. As Bouncer was young and otherwise healthy my colleague immediately suspected poisoning and told Mrs. Rodgers that the next step was to induce vomiting. Mrs Rodgers readily agreed and the hapless Bouncer was taken into the treatment area to have his stomach emptied.

It's not always that easy to induce vomiting (nor is it always recommended - check with a veterinarian before trying to do it yourself), but with Bouncer it was gratifyingly easy and gratifyingly productive. Out came an enormous wad of green plant material and a small shiny tan coloured object.

Marijuana and a condom.

My colleague debated briefly how to present this information to Mrs. Rodgers, a conservative looking middle aged woman, but decided that the direct approach is always the best. There was a moment of silence as Mrs. Rodgers processed this. After being reassured that Bouncer would quickly make a full recovery her facial expression changed from concern to bewilderment to dawning realization to anger in a matter of seconds. It was like watching time lapse video of weather systems.
"My son! My son's room is in the basement. Bouncer was down there this morning..."

An hour or so later a very tall, very skinny, very ashen faced red-haired teenager came in to check on Bouncer. He didn't say anything to his mother and he studiously avoided making eye contact with any of the staff...