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:

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 ( 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.