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.

Thursday, March 2, 2017

Black Coat


Some days I feel like I should be wearing a black coat instead of a white one. Some days I feel like I am ending more lives than I am saving. Some days I really understand the people who tell me that they wanted to be a veterinarian until they learned that you have to euthanize pets.

After 26 years in practice, euthanasia is still the hardest thing I routinely do. I've gotten used to all manner of grim fluids and funky smells and chaotic days and wacky clients and freaked-out pets and hopeless cases, but I have not fully gotten used to euthanasia. Watching the light go out of an animal's eyes as their human companions dissolve into grief is not something that anyone should ever get used to, so it being hard will be a necessary and integral aspect of my job until I retire.

And it is a frequent part of my job as well. I think most of us average maybe two or three euthanasias a week. They tend to cluster so sometimes I can end up performing three or four on a single day. Those are the black coat days. Most pets, probably 80 - 90%, die of euthanasia rather than of "natural causes" at home. If you think about it it makes sense. How many people get to die in their beds at home? The majority of us will die in hospital or by slow degrees in palliative or chronic care facilities. There is no such place for a dog or cat to go once their quality of life is poor at home, and there is no longer any hope of it improving. There is no ward for demented pets to live out their last days, wearing a diaper, unable to walk, unable to feed themselves. There is only a reasonably good life at home, or death.

Seen this way euthanasia is of course, perhaps ironically, one of the best things we do as veterinarians. It allows us to fully focus on quality of life. No animal needs to suffer pointlessly the way some people do. It gives us a powerful tool many on the human side wish they had, if only they could find a clear path through the ethical minefield. We are still far more comfortable wielding the power of life and death over animals, but with that power comes responsibility, and with responsibility inevitably comes stress. It's just the way it is, and the way it must be.

It is interesting to note that I get far more thank you cards after a euthanasia than after any other procedure. Far far more. Some of this is thanks for service over the life of the pet, but some of it is also gratitude for the way the end of the pet's life was handled. It's funny, but veterinarians themselves are always most impressed by their colleague's diagnostic and surgical skills, by the cool cases they figured out and by the new treatments they mastered. Clients never are. They just assume we know how to do all that stuff. What they are most impressed by is our compassion and caring, especially in those terrible emotionally fraught moments at the end of the pet's life.

But all that said, my heart still sinks every time I see a euthanasia booked for me.

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...