Thursday, June 8, 2017

All The Crazy People


Summer is the time for light things. Light food. Light clothing. Light conversation. Light work schedules (hopefully). And light reading. My most popular posts by far have been the heaviest and darkest ones. I'm not sure what to make of that. Regardless though, it is summer now and you are hopefully on your deck with a gin and tonic and, damn it, you should read something light.

As I've mentioned before, veterinary medicine may be fundamentally about animals, but it is also far more about people than you might expect. The world is full of all manner of interesting people, but it seems that the "most interesting" ones all own animals. This is why veterinarians make great dinner party guests. If you can prevent them from telling gross-out stories (oh, but the urge is so strong...), they often have some fantastic crazy people stories. Before I tell a few of mine (in point form to keep it light!) I should make a couple disclaimers.

First Disclaimer:
Don't be alarmed. If you are reading this you are almost certainly not featured in the stories below. None involve regular clients. If you think you are crazy you are probably not. The truly crazy generally don't realize it.

Second Disclaimer:
The use of the word "crazy" is a shameless and amateurish attempt at click-bait. Most of these people have something else going on like intense grief, or intense anger, or intense stupidity. But some are definitely full-on bat poo.

So, in no particular order, here are the inductees to my Crazy People Hall of Fame:

- The young man who had his beloved dead ferret freeze-dried and mounted on the mantlepiece in what he described as a "heroic pose".

- The elderly woman who kept an astonishingly detailed diary of her perfectly healthy cat's eliminations on reams of loose leaf and then would proceed to try to read two months worth aloud to me. "On March 13 he had one regular sized bowel movement at 6:03 in the morning and then..."

- The man who threatened to punch my partner when he remarked that the man's dog was overweight. The man was seriously going to assault Bob. The dog was seriously obese. Bob calmed him down. The man never came back.

- The man who missed his appointment because the bus driver wouldn't let him on. He had had his sick four foot long ball python draped around his shoulders.

- The woman who came to visit her dead dog the day after the euthanasia in order to groom him before the crematorium picked him up. He was a very large dog. She bathed him, shampooed him, blow-dried him and brushed him out, humming all along. It was heartbreaking.

- The young woman who began to un-button her pants, saying she wanted me to tell her whether the bites she had were from fleas. I declined saying that all bug bites look the same.

- The woman who brought her budgie in wanting to know why it wouldn't sing or eat. It was dead. Cue the Monty Python sketch...

- The couple who were astonished to find out that their young cat was pregnant. "How could that happen? She doesn't go outside and the only male around her is her brother!" (I'm sure every vet has run into this at least once.)

-  The woman who phoned and in a very high squeaky voice said, "I have always had the ability to smell cancer. All my friends say I can smell cancer. And I smell it on Billy. I want to bring him in so you can find it and get rid of it."

The last one and one that you may not want to read aloud to the kids:
- The woman who, with an entirely straight face, asked whether venereal diseases are transmissible between humans and dogs.

I have left the very best one off this list because it deserves an entire post of its own, and I'm still wresting with whether to let it out into the public domain yet or not. Let's just say that it involves a teddy bear. Don't even try to guess - you'll be wrong. I apologize for the cruel teaser.

Now you can return to your gin and tonic and the next piece of click-bate.

Thursday, June 1, 2017

Supersonic Octopus


June 1.
First receptionist, "Philipp, Mrs Patterson is late, can I set up Mr. Cho instead?"
"Uh, sure." I'm trotting down the hall, hoping to get to my computer to catch up on files.
Then it occurs to me, "Mr. Cho? I don't remember seeing him in the schedule."
"No, he's a squeeze in. Killer collapsed and he says 'stuff is coming out of him'!"
"Oh, ok."
I turn around and head to the exam room.
Second receptionist, "Mrs. Patterson just showed up. She apologizes, it was the traffic, but she has to see you today. And your next appointment is here too. They're a bit early."
"Ok, well I'll look in quickly on Killer and then I'll see Mrs. Patterson's dog."
First technologist, "Philipp, can you come into the back, I think Dodo is having a seizure."
Third receptionist, "Can you pick up the phone first please, Mrs. Wilson says she has left three messages and needs to talk to you right now before they leave for the cottage."
"Um."
First receptionist back again, "Before you see Cho and Patterson, Samsons are here to pick up those prescriptions you told them you'd have ready..."
First colleague, "Philipp, can you squeeze in an ultrasound soon? I think Buzz Firth is bleeding internally..."
Second technologist, "Buzz's owners are here now visiting him and want to know what's going on. Did you do that ultrasound yet?"
Second receptionist again, "I set up Mrs. Patterson, she brought her other dog too, hoping that after you see Marvin for his chronic diarrhea you'd have time to discuss Melvin's chronic skin condition which has gotten a lot worse."
(Yes, a pair of cockers named Marvin and Melvin.)
Third receptionist again, "Before you talk to Mrs. Wilson, can you quickly answer a question from your last appointment? Mr Schmidt's at the counter still and has his wife on the phone who reminded him what he was supposed to ask."

I haven't checked phone messages in two hours.
I haven't written on files in three hours.
I haven't been to the bathroom since I got to work...

Then my brain began to liquefy and I slumped into a gibbering vibrating heap on the floor.

Ok, that last bit isn't precisely true. And the very first line is misleading too - June 1 is truly the epicenter of our ultra-busy heartworm season, but I'm not at the clinic today. Today is my day off. Today I am mowing the lawn, drinking beer and writing this.

When the kids were small and they would pepper me with a series of complex overlapping requests I would joke with them that I was not a "supersonic octopus". This expression comes back to me frequently this time of year...

A Public Service Announcement Postscript:
It is critical that you give your dog heartworm preventative medication.
It is not critical that you give the first dose right on June 1. Please do not phone your clinic in a panic today or tomorrow. As long as the first dose is given within a month or so of the first mosquito bite it will still work well. The medications kill the first larval stages of heartworm in the bloodstream before they can do any harm.

Thursday, May 18, 2017

The Cats Who Might Be Canaries


Everyone has heard the expression "canary in the coal mine". Before the advent of modern toxic gas detectors coal miners did actually bring canaries down into the mines. The birds were far more sensitive to the build-up of carbon monoxide than humans, so when they began showing signs of poisoning it was an early warning for the miners to get out out of there.

In 1979 reports began to emerge of a new disease in cats. Older cats were losing weight rapidly despite a good appetite. A veterinarian in New York figured out that these cats had developed benign tumours in their thyroid glands that caused the gland to produce excess thyroid hormone - a condition called hyperthyroidism. Soon hyperthyroid cats were being diagnosed all around the world. By the late 1980s, when I was going to veterinary school, it was estimated that 1 in 10 cats would develop it. Where did this disease come from? New diseases did occasionally arise, but they were always infectious diseases with clear origins, such as canine parvovirus, which was the mutation of the cat distemper virus, and heartworm, which was the northward migration of a tropical disease.

Some speculated that it was just that cats were living so much longer that we were now seeing more geriatric diseases, but this made no sense as the gains in life expectancy were gradual and the apparent emergence of hyperthyroidism was relatively sudden. Veterinarians, being neurotic as a group, also blamed themselves, assuming they had just missed it before. This also made no sense as the disease is dramatic and obvious in its advanced form. One researcher looked through 7000 old autopsy reports and found no evidence of hyperthyroidism. It really was a new disease.

So various other more reasonable, but still flawed, hypotheses were put forward through the 1990s and 2000s, but to speed the story along I'll take you straight to what appears to be the answer. In four letters it is PBDE. This is the acronym for polybrominated diphenyl ether, a common fire retardant found especially in furniture foam, carpet underlay, some clothing and bedding, and in the plastic housing for some electronics. PBDEs gradually, microscopically, shed into the home environment and become part of the dust. Cats, being close to the ground, are exposed to dust even in relatively clean houses. And crucially, PBDEs have been shown to be endocrine disruptors, meaning that they can interfere with hormonal functions. Thyroid is a hormone. Tellingly, for this story, PBDEs first became wide-spread during the 1970s. This is all circumstantial evidence, but the research evidence is mounting as well with a steady stream of ever more persuasive studies, the most recent just in 2016.

PBDEs were declared "toxic" by the Canadian government in 2004 and their manufacture and import was restricted. Unfortunately though they are still pervasive in the environment and industry has side-stepped the regulations by devising new fire retardant chemicals which may or may not have the same effects. Nobody knows yet. Government regulations are slow to play catch-up. Nonetheless, I think I am seeing  fewer cases of hyperthyroidism than I did back in the 90s. What I am seeing far more of is pancreatitis. Canine pancreatitis is more or less unchanged, but feline pancreatitis is sky-rocketing from a very rare diagnosis twenty years ago, to a weekly one now. Did we just miss it before? The discussion is starting to sound familiar...

So back to the canary metaphor. The incidence  of human thyroid cancer has increased more rapidly than most other cancers since the late 1970s. This is far from conclusive and studies are ongoing, but maybe our cats are telling us something. Maybe we should listen more carefully.

Wednesday, April 26, 2017

The Ugly

The Good:
Fluffy kittens, puppies who wag their whole hind-ends, difficult cases solved, lives saved, tricky procedures mastered, grateful clients, happy staff, appointments all running on time and so much more. Did I mention fluffy kittens?

The Bad:
Screaming cats, biting dogs, cases gone sideways, lives lost, procedures failed, angry clients, grumpy staff, running three appointments behind and so much more.

The Ugly:
This is what I want to talk about today. Briefly. Briefly because it aggravates me too much. "The Bad" is part of what we signed up for and honestly, it is swamped by "The Good", so most of us shake off "The Bad" pretty easily. But we didn't sign up for "The Ugly". "The Ugly" is clients who are not only angry, but who are unreasonable, disruptive and abusive.

In the past I might have slotted them under "The Bad" as generally these stressful encounters were face to face, more or less private and blew over quickly. Now these abusive clients take to social media and vet ratings sites to become trolls and give their venom a sustained public life online. This is thankfully extremely rare, but even one can have a dramatic impact on a veterinarian's peace of mind. These people generally have mental health issues which most readers of their rants will spot, but nonetheless even the most ridiculous slander, once out there, will have some impact. I've been lucky, but a couple of my colleagues have been attacked this way recently.

Maybe eventually social media and ratings sites will find a way to weed this out, but in the meantime, if you like your veterinarian the very kindest thing you can do is to go on Google, Facebook and "vetratingz" and write positive reviews. And bring in a fluffy kitten. Or two.


Thursday, April 20, 2017

Feeling Ticklish?


I apologize for the egregious use of a lame pun as a post title. I am defenseless against the ease with which one can make puns with the word "tick". Even the national veterinary association has launched a "Tick Talk" (I can hear your groans from here) awareness campaign, complete with an entirely over-the-top horror themed ad:
https://www.youtube.com/watch?v=177IXkA7iEM&feature=youtu.be

I imagine that you have already heard a fair bit about ticks and about the diseases they transmit, so I'm not going to repackage that information for you here. The "Veterinary Partner" website (https://www.veterinarypartner.com) is a trustworthy resource if you have specific questions. Instead I'm going to highlight a less often discussed aspect that is alluded to in the title: ticks going on people. More specifically, ticks going from your dog onto you.

Ticks are potential vectors for disease. The word vector just means transporter, a kind of living vessel that carries a disease causing organism from one animal to another. Most famously the deer, or black-legged, tick is a vector for the Borrelia organism that causes Lyme disease. But what we don't often consider is that your dog (and potentially, although quite rarely, your cat) could be a "vector for the vector", a kind of meta-vector, to coin a term. Most people with tick-magnet dogs - you know, the dogs that disappear into the tall grass and come back with twenty ticks on them - are already familiar with the phenomenon of later finding ticks in the house, presumably having fallen off the dog. This could theoretically happen with any dog, particularly if they have darker or longer fur, as ticks can be very difficult to spot unless you are making a point of checking carefully. While I could find no studies that looked at the actual incidence of this, it is reasonable to assume that any dog could accidentally bring a deer tick home that could then infect you with Lyme disease. 80% of humans who contract Lyme become ill, sometimes quite severely, whereas only ~10% of dogs do.

And if this isn't enough to make your skin begin to crawl*, the less harmful but equally creepy "brown dog tick" can actually reproduce and complete it's entire life cycle inside your house, causing a serious infestation. They like to crawl up walls and hang upside down. The good news for local readers here in Manitoba is that that tick is not, to the best of my knowledge, reported here ("wood ticks" are the other ones we see besides deer ticks), but we should remain alert as the American CDC considers it endemic in North Dakota and Minnesota, and it is common in Ontario.

Now I have totally freaked you out.

So let me conclude by trying to unfreak you. Fortunately this comes at a time when we finally have good tick medication. For years when people were concerned about ticks we would more or less shrug and say something along the lines of, "well, you could try this, it helps a bit". In the last two or three years new products have come along that are easy to administer, very safe and far more effective than the previous generation. I'll leave the specific recommendations regarding which product is best for your dog to your veterinarian. None are 100% perfect though, so I still recommend checking your dog over carefully after a walk on anything other than just the sidewalk, but at least now you have far less reason to feel... ticklish.


*Actually that crawling sensation you are feeling on your leg right now, or possibly in your scalp, is almost certainly not a tick as people generally can't feel them moving about. Sorry, I think I might have freaked you out again...;-)

Thursday, April 6, 2017

The Lonesome Zebra


Eddie pants nervously as I part his fur and examine the lump that Mr. Williamson is concerned about.
I'm about to comment on it when Mr. Williamson asks the inevitable question, "Have you seen something like this before?"
To which I reply, "Yes, I have. Many times. Daily in fact. But that doesn't mean much." And then I explain myself briefly. But as you and I have a lot more time right now, and as you are presumably more interested in these things than the average person, I will explain myself at much greater length here.

It begins with the fact that humans are excellent at pattern recognition. This is largely a good thing and it is one of reasons our distant ancestors were able to avoid being eaten on the savannas of Africa. Our brains are strongly wired to match everything new we encounter with past experience, whether consciously or unconsciously. That particular type of rustle in the tall grass? Could be a lion. Better keep quiet and slowly retreat.

However, in medical diagnosis pattern recognition is a problem. Some symptoms are what we call "pathognomic", meaning that they are specific to one particular disease, but the great majority are not. A red eye can be due to dozens of conditions. Coughing has scores of causes. And poor appetite can quite literally have hundreds of explanations. In veterinary school they try to beat pattern recognition out of us and replace it with a "problem oriented" diagnostic process. I won't explain what that is. Trust me that it is as boring as it is important.

Eddie's lump is small, loose under the skin, smooth in contour and slightly rubbery in firmness. Pattern recognition dictates that this is almost certainly a lipoma, which is a benign fatty growth. But only "almost certainly". Eddie has never had one before - most dogs with lipomas have several - so I am wary of falling into that trap as a type of cancer called a mast cell tumour can feel very similar. I suggest collecting a few cells with a needle. Eddie is good for this as he is far more worried that I might be planning to trim his nails, which he hates more than anything in life. The needle aspirate just produces fat cells, so thankfully it is just a lipoma.

So what about the zebra advertised in the post title? I apologize if you read this hoping for another wacky patient story,  but no, nobody has consulted me about their zebra problems. Which is a good thing (see my previous post: "A Mile Wide"). Instead I am referring to an old aphorism taught to every medical and veterinary student which highlights the flip-side of this issue: "When you hear hoof-beats, don't think of zebras." In other words, although a set of symptoms could be the result of a bizarre rare disease, the common diseases are far more... common. Consequently veterinarians have to exercise some balance and judgment and avoid freaking pet owners out with a laundry list of horrible possibilities, accompanied by a wildly expensive diagnostic program.

Balance. Judgment. Tricky things. Don't obsess about the zebras, but don't ignore them either.

Thursday, March 16, 2017

Spunky Swings Low


Pity poor Spunky, the captive sugar glider. Pity his adorable big black eyes. Pity his cuddly soft grey fur. Pity his delightful cupped-handful size. Pity him because these features make him irresistible as a pet - a little plush toy come to vigorous life - and pity him because he does not want to be a pet. Ok, "want" is a tricky concept in a creature with the brain the size of a chickpea. He is unlikely to be conscious of the fact that his kind lives in the forests of Australia, not the apartments of Canada, and he is unlikely to be conscious of the fact that his kind lives in large family groups of other sugar gliders, not in a household of enormous loud and smelly primates and possibly one or two four-legged predators. He is also unlikely to give much real thought to the problems inherent in wanting to be busy and noisy at night when the primates are sleeping, and then trying to sleep in the day when the primates are themselves busy and noisy. Even though he does not think about these things, there is no doubt that he would be far happier if he were ugly and were left alone to glide from eucalyptus tree to eucalyptus tree, with his family, at night.  

Further pity poor Spunky, for I have been asked to castrate him. As with many cute and fluffy creatures, Spunky does not know that "cute and fluffy" also means "passive and gentle" to his primate captors. In his mind he is fierce and he is tough and he has had it with you and all your b.s.. Tiny cuddly creatures with big baby eyes can still bite hard. And these ones in particular can swoop down on you from above. His owners were members of the online sugar glider community and had tried all the recommended behavioural and environmental modifications, but at the end of the day Spunky was still too... "spunky".

The medical care of captive non-domesticated species can present the veterinarian with an ethical and moral quandary. My approach is to strongly discourage ownership of such animals but also to recognize that an animal like Spunky is now stuck with this situation as he cannot be released into the wild, so I have an obligation to do what I can to help make his life as pleasant as possible, under the circumstances. And on balance, in this case, it meant trying surgery.

So Spunky was presented on the appointed day and the nurses handled him gently, gave him pain medication and then carefully induced general anesthesia, at which point I was called into the o.r. for the procedure. While I had given the ethical  and moral dimensions of this some considerable thought, I hadn't really done the same for the technical aspects. Neuters are, after all, really pretty similar from species to species.

Pretty similar, except in sugar gliders as it happens. They are marsupials and marsupials are strange. And before I get hate mail from Australia, I don't mean strange in the pejorative sense. I mean it in the strict traditional sense of the word - "unusual or surprising" - as seen from the perspective of someone whose practice includes no marsupials at all. Except Spunky.

So what was strange? His scrotum. Spunky's scrotum was strange. It dangled down between his hind legs on a long thread-like stalk like a teensy weensy little tetherball.

Now consider this carefully for a moment. Here is a creature that glides from tree to tree in the dark, presumably dodging twigs and branches, his scrotum dangling free beneath him all the while. Doesn't it strike you as problematic from an evolutionary perspective? Men reading this are feeling a little queasy now as they picture what must be a common mishap...

In any case, there he was, deep asleep, and there I was, scalpel in hand. I glanced at my nurse. She shrugged. I looked back at Spunky's scrotum and it's breathtakingly long and narrow attachment. I will spare you the technical details, but ultimately I had to abandon the normal approach which involves a lot of careful dissection, transection and ligation and instead... just lopped it off. I snipped the stalk, sewed it up and that was that. Ten minutes of pondering and ten seconds of actual surgery.

Somehow simultaneously both the easiest and the hardest neuter I have ever performed.