Monday, March 12, 2018

Hogwarts on the South Saskatchewan

Should you ever find yourself in Saskatoon you must make a point of visiting the University of Saskatchewan. It is widely considered one of Canada's prettiest universities with its leafy riverside setting and its hundred year old neo-Gothic limestone clad buildings clustered around a lovely central green. And while you're there, please wander over to the northeast corner of campus, past the Physics building, towards the College of Agriculture, where the more modern buildings squat in exile. There you'll see it. Just past the grey cement bunker of the College of Engineering you will see a castle. You will have to squint a little and you will have to use your imagination a little, but take note of the bridge, and of the turrets, and of the asymmetrical wings. It is a castle, a modern castle. And, in my view, it is not just any castle. In my view this is what Hogwarts Castle would look like had it been designed by the mid-century modernist architect, Le Corbusier*. This castle is actually the Western College of Veterinary Medicine (WCVM).

At this point in the story I should offer a disclaimer. It doesn't matter at all if you have no idea who Le Corbusier is, but it probably does matter if you don't know what Hogwarts is, in which case you should probably stop reading here as the rest of this is not going to make any sense. In fact, it will seem like the very opposite of sense - it will seem like nonsense.

I came to Harry Potter later in life than many people, courtesy of my daughter, so the resemblance between WCVM and Hogwarts only occurred to me recently. In fact, as it happens, JK Rowling had her famous inspiration on that delayed train from Manchester to London at almost the exact same time as I was graduating from vet college, so the stories weren't written yet when I was there. Once I made the connection though I realized that it's not just the vaguely castle-like exterior that evokes Hogwarts. The interior has dungeons (pathology and necropsy labs), a great hall (the cafeteria), dark labs and lecture halls, curious things floating in jars and set on dusty display shelves, skeletons mounted on pedestals, a maze-like layout, several confusing winding staircases, a remote headmaster's (dean's) office in a tower, strange smells and sounds, and a library with a separate mezzanine level that resembles the restricted section of the Hogwarts library.

As soon as I had this epiphany several other pieces rapidly fell into place. It felt a bit like looking at that optical illusion where, depending on your perspective, it can either be a young woman looking away or an old hag looking down. I had been seeing the old hag all my life and then suddenly I saw the young woman.

Pharmacology class was Potions. Animal Science was Care of Magical Creatures (Care of Agricultural Creatures), and I suppose Parasitology was also Care of Magical Creatures. Toxicology was Herbology. Small Animal Medicine was Charms. Anesthesia was Defence Against The Dark Arts. And Clinical Pathology was Divination. Clearly we had some classes that weren't offered at Hogwarts (Large Animal Surgery, Immunology, Histology etc.) and vice versa (Flying, Transfiguration and History of Magic come to mind), but the parallels are still striking given that one school was turning out veterinarians and the other witches and wizards. In retrospect, even the faculty and staff were eerily similar with their idiosyncrasies and strong personalities. And there were more than few with English or Scottish accents.

Hogwarts students (and fans...) are sorted into four houses**, while WCVM students come presorted from the four western provinces. I haven't worked out all the equivalents, but Manitoba is clearly Hufflepuff. Even the fact that the great majority of the students are from elsewhere, often away from home for the first time, sets WCVM apart from the other university colleges and puts it more in line with the Hogwarts experience. In my year only four students were from the city of Saskatoon itself. Although most students didn't actually sleep in the building (note - I said "most"), we all felt like we essentially lived there and many did live together nearby, sharing rent.

And then when you graduate you feel like you belong to an obscure and semi-secret separate society. There is an arcane lore, a special language, specific skills, weird knowledge and, at times, an air of mystery when viewed from the outside. When you meet other veterinarians there is an immediate feeling of kinship, of sharing something that outsiders will never really understand. And honestly, sometimes the rest of you seem like muggles to us. But I say that with abundant respect and affection. Most of us are far more Arthur Weasley than Lucius Malfoy...

*WCVM was not designed by Le Corbusier, but I mention him for those of you who know him so that you have approximately the right mental image.

**I am apparently in Ravenclaw.

That is the very last I will mention of Harry Potter. I promise. You can safely keep reading this blog.

Thursday, March 8, 2018

Bread and Ears

Whack, whack, whack - the metronome of Timmy's tail kept striking the wall beside him, speeding up as I approached with the expected liver treat. You know how some dogs smile? Timmy definitely smiled. An ultra-wide happy black Labrador retriever smile.

"He really loves those treats!" Mrs. Singh said.

Timmy doesn't just love these treats, I thought to myself, regarding his beer keg shaped torso. But he was a happy dog and a good patient and we weren't going to discuss his weight again today. Today we were going to discuss his ears again.

"So, his ears are bugging him again?" I asked as I crouched down to scratch Timmy's neck and then carefully lift up his right ear flap. The tail metronome slowed down a little.

"Yes, he started shaking his head again yesterday and I don't have any drops for him anymore."

Timmy's right ear was bright red and the ear canal was filled with a sharp smelling black substance. I gently inserted the tip of my otoscope to look a little deeper down the canal. The whack, whack, whack of Timmy's tail stopped entirely. He wasn't smiling anymore either, but he stayed still and let me perform the examination. When I was done I straightened up, gave Timmy another treat and told Mrs Singh, "I'm afraid it's a yeast infection again."

Often I will swab the ear and look under the microscope to make sure that I know what is growing in there, but in this case it was so characteristic and it had happened so many times before that it wasn't necessary. Mrs. Singh was horrified the first time Timmy developed a yeast infection because she associated it with yeast infections in people, but it is a very different situation in dog's ears.

Yeast are normally resident on their skin and in their ears in low numbers. We all have a beneficial ecosystem of bacteria and yeast living on us in balance with our system. The yeast are however similar to baker's yeast in that they will multiply rapidly in warm or moist conditions. If a dog's ear canal becomes inflamed it is like turning the oven on when you're getting ready to bake bread. This is especially true for dogs with big ear flaps (closing the oven door!). Dogs with more erect ears do occasionally also get these sorts of infections, but they are much less common. As the yeast multiply they create that strong smelly waxy discharge and they further inflame the ear, creating a vicious circle of ever worsening inflammation and yeast infection.

Ok, you say, that makes sense, but why are the ears inflamed in the first place? In a word - allergies. While there are some other triggers, allergies account for the great majority of these. This sometimes surprises people because they we were unaware that dogs could get allergies and they are surprised that the allergies would only affect the ears. Regarding first surprise, indeed dogs do get allergies. Do they ever! Allergies are in fact extremely common, especially in some breeds. There is a whole separate lengthy conversation that can be had about allergies, but for the purposes of the ear discussion, suffice it to say that they are usually environmental allergies to house dust, pollen or mould, and occasionally food related allergies to the primary source of protein in the diet. Allergies can come on at any age and can change over a pet's life. And with respect to only affecting the ears, in part this is because the ears have the most sensitive skin in the body, and in part it is because the closed-oven-door feedback loop makes allergies there far more obvious.

Incidentally, you'll recall that I mentioned that moist conditions can also encourage yeast to grow, so occasionally we will see these infections after a dog has been swimming or been bathed.

I had explained all this to Mrs. Singh before, but she found she just couldn't stick to a diet for Timmy to try to address a possible food allergy, and she wasn't that interested in going down the more complex path of pursuing environmental allergies. The drops worked well and she prefered to just refill them as needed. I explained again the need to clean the ears regularly as the normal self-cleaning mechanism had been damaged by the repeated infections. And I explained again the need to finish the entire course of drops rather than stopping as soon as the symptoms subsided, but I could see that she was beginning to tune me out. I was refilling the drops and that's what she came for. And you know what? To be honest, do I follow each and every piece of advice my doctor or dentist gives me? Just ask me about flossing... Everyone just does their best. All we doctors can do is try to nudge the definition of "their best" a little further along.

Now that the poke, poke, poke and the blah, blah, blah had stopped, the whack, whack, whack began in earnest again. Timmy knew we were done and he was wagging and smiling and so clearly hoping for a good-bye liver treat that I had to smile right along with him.

Thursday, February 22, 2018

The Naming

One of the unsung minor perks of being in small animal practice is the exposure to the ever-changing landscape of pet names. This might not seem like a "perk", but I enjoy learning the names and, for the unusual ones, asking how they came up with them. For obvious reasons people allow themselves far more latitude for creativity with pet's names than with their children's. That said, there is also a lot of overlap and there has been more than one family where I have had to be very careful not to refer to the dog by the daughter's name because, honestly, Bailey is a far more common dog name than human name (with all due respect to you wonderful human Baileys out there).

The range of pet names is breathtaking. I normally change all the names in the blog, but for the purposes of this discussion I'm sure nobody will object if I just list the names of all the animals I saw at work yesterday as an example of what I mean:
Tikka, Snerkle, Junie, Gunner, Silvester, Kayne, Kirby, Annabell, Maggie, Milkshake, Poppy, Stewie, Ben, Wimbley, Rico and Castle.
This is absolutely typical. Nothing crazy, but clearly a lot of thought and some creativity there. And each of them an individual perfectly suited to their name.

Some common names are presumably easy and quick to give - Tigger for a tabby cat, Blackie for a black Labrador - but many probably involved a lot of debate in the family. For those of you for whom this was the case, isn't it interesting how a name that was so difficult to come up with, and that you were a bit uncertain about at first, now seems so inevitable and perfect in retrospect? This even happens for objectively inappropriate names. I had a cat patient named Bob for a number of years. Bob was a girl. They had been told that she was a he when they got him/her and didn't think to double-check. I had to break the news to them when they brought Bob in for the first shots, at which point the name had already stuck. They didn't try to feminize it to Bobbie or Roberta, saying that she still "looked like a Bob". And you know what, they were right. I now can't imagine her being called anything else.

My own dog's name of Orbit came about after trying on several others that just didn't feel right. One day we were watching him rocket around the house in circles and we started saying Sputnik. Yeah, I know, that would have been wrong so many ways, but it did get us going on that theme, from which Orbit emerged. It also helped that he ate everything in sight and that roadside trash containers in Manitoba when we were growing up were called "Orbit", as in "Put your trash in Orbit!" (see photo above). Our one cat, Lucy, was named by my daughter after a second cousin in Germany who had made a strong impression on her. We got the second cat shortly after and Isabel though she should have a German human name as well. For fairness and symmetry you know. Many were considered and rejected until she settled on Gabriella, which instantly became Gabi.

But of course the best part of discussing pet names are the weird ones and the funny ones. Unfortunately although my memory is generally really very good, it has a glitch when it comes to names. They appear to reside in the mental equivalent of a sock drawer. So, while I originally intended to present something like a "Top Twenty Fun & Wacky Pet Names I Have Encountered", sitting here right now I can only come up with three... In no particular order then:

1) Russell Bertrand - As in, the cat's name was Russell and the owner's last name was Bertrand. The fact that this amuses me speaks strongly to my geekness. The reverse, Bertrand Russell, was an important English philosopher, writer and Nobel prize winner who lived from 1872 - 1970.

2) Maximillian Samba-socks - Another cat. I don't know why, but this one still cracks me up years later. Even this bizarre name suited him perfectly. Maximillian Samba-socks could only be Maximillian Samba-socks.

3) Satan - They thought it was hilarious naming their their little black poodle Satan. At least they thought it was hilarious until they found out that he had a habit of disappearing deep into their big yard at night and often had to be loudly and repeatedly called back to the house, "Satan! Satan come here!"

As I can only offer you three of these right now, I will crowd-source a longer list. I'll solicit comments from colleagues and friends on Facebook and paste their responses below. Also please feel free to leave a comment on the blog!

Thank you!

From Facebook:

"Morsel the mouse is one of my favourites. A 15 gram mini hamster named Jaws. 60kg Rottie named Peanut. A stray taken in named Spare Cat all come to mind . Oh, and a female pug named Frankie. Owners last name is Money. Frankie Money... sounds like a rock star to me."

"Daycare hamster named by committee - Princess Monster Truck."

" I had a dog by the name of "Porsha"... Everyone wants to "Porscha"! Had a dog called "Nad"... when they wanted the dog to leave the room they thought it was hysterical to say go- Nad. I personally thought the name I gave my dog was awesome it was vetoed by my receptionists though... Called the dog "Bumpkin" one of the characters in The Hobbit. When the dog behaved well I said "good bum" when the dog misbehaved I said "bad bum" ... Probably just as well with the me-too movement. My receptionist brother's dog is called Askem... when you ask for the dog's name he says Askem... people always give you a funny look!"

"My favorite are the ones where the kids don't agree so they have two or three names strung together."

"for a short while we had a Rabbit we named Stewie, we also had a mouse called Morsel, 2 rats named Stinky and Tim (Brothers) and two budgies named Bert & Ernie"

"Piggy, Puddles and Potato the pugs. Alliterative AND descriptive"

"Whenever this question comes up, my mind always goes to "Stirfry" the cat."

"Deeogi the dog. Get it? D-o-g spells dog. When I saw that written on the file I was all,"oh...what an interesting name. How do you pronounce it?""

"I also really like the cat named Pierre Trudeau (PT for short)...when I enquired why, the owner replied that the cat was handsome and arrogant"

"Not so much the name of the pet but an oops moment as a third year student at the Portage Animal Hospital. Small cards were easily misread. The inappetent Iguana came in for a recheck and I asked "Raymond" "How is your lizard:? Turns out the lizard was Raymond!"

"Also a favourite...a cat named "Franz Joseph" (named after an Austrian emperor) which also happened to be the name of my late grandfather who immigrated from Austria."

"Deefor (D for dog), Mimi the cat (after the tragic character in La Boheme, but should have been Me me, because that's all she cared about). A common human name, but unfortunate dog name, is Jack. I was at the offleash park when a dog started jumping up on me. His owner was yelling from far away, "Jack off!" Over and over...  At the age of 5 I named our first dog Sally Anne Stephenson. She just went by Sally."

""Airmail" The Airedale.. Usually known as the whole phrase "Look! Here comes 'Airmail the Airedale'". A Chow, "Mr Kurt Russell". I was told when we first met that it is MR(!) Kurt Russell " ! (No "Kurt" or "Russell" or even "Mister" ). A budgie named "Lil' Shit". I always laughed thinking if the owner had to call for him loudly..."

"The Chihuahuas win out for me - Princess Taco, Mr Timothy Bits (although the owner said she might have to shorten his name after he was neutered)."

"Cat named Quincy Turtle!"

"Saw a Pug yesterday called “We Z”"

"A cat named Hey You."

"A sweet Golden Retriever named 'Dexter'... after the serial killer."

"A rabbit named Bunny and her owner’s last name is Hopp."

"My very favourite: Seiko, "because she's a watch dog", said my friend who named her. Also: Matic, a black Lab. As in "dogmatic" for those not quite in the zone. For a while we gave our barn cats names beginning with "cat", therefore Catalpa and Catalan. There are endless ones to choose from in that category (sorry): Catastrophe, Catalina, Catamaran...We drew the line at Catamite. When we named our black and white tuxedo cat Orca (pretty obvious, but irresistible), our daughter was a little disappointed, but pointed out that he could still have a "cat" name by adding a "t" to the end: Orcat."

"I don't know if I ever told you what a fiasco it was getting to the name Gibson! I had had a name in mind that I was set on and it became clear I should've used 'executive order' and not asked anyone else....but....I didn't...sigh.... A day and a 1/2 of calling this little puppy "Puppy...come here, Puppy!" while my young adult children rejected every name I offered up (and some of them were REALLY good ones, in my mind! ie: Griffin, short for Griffyndor!) and gave a laundry list of 'reasons' why each name was no good...too common, too lame, too much reminding them of this, that and the other thing, too this, too that...GRRRRR! If I went thru 50-100 names that would not be an exaggeration! Then my parents got in on rejecting each name...And of course, each person offered up all their own names, none of which I liked because they were from favorite shows (Walking Dead, Breaking Bad, Game of Thrones) or from the 50's - Rusty, etc. There are few things MORE "fun" than trying to name MY new dog, with 3 different generations, lemme tell you! LOL Exasperated and ready to drink the basement bar dry after 36 hours of this and no end in sight, as I was standing in the basement declaring "oh my God, you 2...this poor puppy needs a name before he thinks his name IS "Puppy"!! what should happen? A beam of light suddenly shone thru the bottle of Gibson rye sitting on top of the bar,(that I might've been greedily devouring straight out of the bottle in my mind at that point! lol) and the color of the rye? Almost identical to the color of my puppy! I suddenly and excitedly said "Gibson!!" He's the same color as that Gibson rye, his name should be Gibson! It's not common, it's different but not insane and it has a hard letter sound!" (which was important to me for reasons I don't fully understand!) They shrugged and made faces, I said next time I took him out, I was going to try it out...just like I tried out all THEIR names - Magnus and other ill-fitting names. We made our trek outside, I called him by a few other names still being considered but which I didn't love at all and the minute I called "Gibson" he stopped and turned and came right to me....and in that moment, he became Gibson! I marched inside, told EVERYONE, every opinionated person that I was making an executive decision on the spot - he shall be known as Gibson! The End! And while the boys were ambivalent, they didn't hate parents didn't really like it (in fact, my dad insisted he'd call him by the name HE liked better! So that had to be stopped before starting!) but now.....1 yr later - no one can imagine him being anything other than Gibson..inspired by how much I was eyeing that bottle of rye that morning! ";)

Thursday, February 8, 2018

Fiddling With The Dials

I remember clearly the first time it happened. It was about two years ago when a good client who I had known for a long time told me that she had heard I was retiring. I was touched that she looked concerned, but disconcerted by the question. Since then I have been asked at least a half dozen times about my alleged imminent retirement.

First things first, no I am not retiring soon. Quite aside from any question about how long I want to work, the plain mathematical fact is that I am very unlikely to be able to afford it for at least another ten years. If I retire now we are moving into a trailer and the kids, and possibly the pets, will have to find jobs. Also, I am only 52 years old after all! Yes, that's right, I said "only".

At first I was quite taken aback by these rumours, thinking that they related to my grey hair and my admittedly at times somewhat haggard appearance. It honestly feels like no time elapsed between the last time I looked too young to be a doctor and the first time I was asked whether I qualified for a senior's discount at Shoppers Drug Mart (to be fair to myself, the clerk was so young that I'm sure anyone over 30 looked impossibly ancient to him). From Doogie Howser to Marcus Welby overnight. And before anyone makes any snide remarks, no, I am too young to have watched Marcus Welby MD on TV - I just happen to know who he is.

But when I calmed down I realized it probably wasn't my appearance so much as it was my schedule. Two years ago I cut back to three days a week. At the same time I adjusted the shifts so that in those three days I work 70% of full-time. I had gone to working four days a week a long time ago and back then the transition from five to four hardly attracted any comment, but at three I seem to have crossed a line. Now it looked to some like I was beginning the process of easing my way out of practice.

That is, however, not the case.

The reason has far more to do with my work-life balance than with my career trajectory. When I worked four days a week the one day off was designated for errands, appointments, housework and childcare. Although both children are teenagers now, both have some special needs that require additional attention. Consequently this day off is as busy as my work days. Therefore I took the additional day off when I turned 50 to have a day to pursue other interests, such as writing, and to go for long walks, and to have delicious stretches of unscheduled unplanned hours. I am well aware that a "me day" like this is a luxury that few people enjoy, and I am very grateful for it. And this finally brings me to my point. My point is that one of the great beauties of veterinary medicine as a career choice is the freedom to chose your hours and thereby also, to a limit, chose you income.

It's like there are two linked dials: one for hours and one for income, and in many multi-doctor small animal practices you have the ability to fiddle with these dials. You want to work less? You turn the hours dial down and the income dial turns down automatically. You want to earn more? You turn the income dial up and the hours dial turns up automatically. In theory you could work as little as eight hours a week or as many as eighty. Not many people have that sort of freedom. To be accurate though, some veterinarians don't either. In smaller practices you may be forced to work full-time just to be able to keep all the shifts covered and for many large animal veterinarians freedom and flexibility, or the lack thereof, is tied to the dramatic seasonality of the practice. But many of us now work in practices where flexible scheduling is possible. For those wanting to start a family this can be very attractive (so long as the spouse earns enough...). And for those greyhairs like me who want to do the things they put off for decades but don't want to (or can't) leave the profession, this can be very attractive too.

Thursday, January 18, 2018

In The Dark

This is not a metaphor. I mean it literally. Ok, I'll confess, sometimes it would be an appropriate metaphor, but that's not what I'm writing about today. Today I'm writing about the curious fact that I now spend roughly half my time at work in a dark room.

After ten years in general small animal practice I could begin to see the rough outlines of burnout approaching on the distant horizon, like a cloud of dust way down a gravel road. I didn't know whether that cloud of dust signified a puttering tractor or a careening semi-trailer truck, but I didn't want to wait to find out. It wasn't anything I could put my finger on, just a growing sense that I needed a different challenge. Don't get me wrong, general practice is extremely challenging, but it is made up of thousands of individual challenges, case by case, that keep you running like a proverbial hamster on a treadmill, but for me there was increasingly no sense of progress on something "bigger".

At around that time we were starting to find more and more uses for ultrasound, but no small animal veterinarians in Manitoba were doing it routinely, so we had to get a human ultrasonographer in who moonlighted going from vet clinic to vet clinic with her portable machine. She was great, but the limitations of that set-up were obvious. Moreover, I found the technology fascinating, so whenever I had time I would peer over her shoulder and annoy her by saying, "That's liver, right?" and "What's that grey bit there? Beside the other grey bit?"

I was not a partner yet, so I approached my boss at the time with a proposal to buy an ultrasound machine for the clinic. It was a very big ticket item and even with creative math I could not make a solid financial case for it, but Bob was a remarkably wise man and could both sense the implications to the practice of my restlessness and see beyond what the immediate numbers showed.

So in 2001 we bought an ultrasound machine and I went to Calgary for a course. It was a revelation. Here was a world I could deep dive into that combined a fun technological toy with live anatomy, physiology and pathology, the subjects I loved in school. Blood tests and urine tests and xrays are cool in their own way, but they are static and removed and abstracted from the animal. Ultrasound was more like an extension of the physical exam. It was a live real-time exploration of the interior of my patients. Another exciting thing about ultrasound for me was how it was turning one of our weaker senses as a species, sound, into one of our stronger senses, vision. With ultrasound I was becoming like a dolphin or a bat and was seeing with sound. The hand-eye-brain coordination was going to take time to get consistently right, but the first few times that that grey mess on the screen automatically crystallized into a 3D organ in my mind were exhilarating. Furthermore, because it is done in a dark room, and because I drone on in a monotone, the animals were usually calm and the whole experience felt soothing and peaceful to me. I was hooked.

Over time I took more courses, in California and New York, but it became clear early on that the key to becoming proficient was case load. You just had to practice a lot. It was more like learning to play a musical instrument or a new sport than anything else I had encountered in practice. So I began to set aside time to scan healthy patients who were in for spays and neuters. This also helped me build up a strong sense as to what normal looks like, as well as how much variation there is in normal.

And then the first referral came in. Another practice across town had heard I was doing this and wanted to send a patient over. I was terrified. I agreed on the condition that the pet owner understood that I was still learning. But it went well and I failed to humiliate myself as expected. And then there were a few more referrals from that practice and then some from a second practice and then from a third and....

In the last fifteen years I have done over 12,000 ultrasound studies for close to 40 clinics from southern Saskatchewan through to Northwest Ontario. Now there are many veterinarians as well as an excellent human ultrasonographer doing it, but I am still busy enough with ultrasound that it takes up about half my time. And I still love it and it is still helping keep the burnout at bay.

Wednesday, January 3, 2018

Begins With The Letter "A"

This post carries a mature content warning. Seriously.


Yes gentle readers, today we are going to talk about your pet's anus. Frightened yet? If so, it's not too late to bail out and check if anything new has happened on Facebook in the last fifteen seconds. But if you're still with me, you're in for a special treat, because we are not just going to be talking about the anus generally. Nope, we're going to be specifically talking about anal sacs.

Most people call them anal glands, but technically they are not glands, so veterinarians are taught to refer to them by their correct name: anal sacs. However, most veterinarians soon encounter the situation I did after just a couple years in practice.
"The problem is with Bella's anal sacs," I said.

The client raised her eyebrows and said with a smile, "You have to be very careful how you pronounce that..."

Indeed.  Naively, I hadn't considered this before. I don't often blush, but this was an exception. Not long after that a colleague told me that he had decided to start an explanation of why there was inflammation around a dog's hind-end by first describing the basic anatomy: "So, your dog has anal sacs..."
Outraged, the client interrupted, "He most certainly does not!"

So be very careful how you enunciate that "a". Or just call them anal glands.

And why do they have these bizarre little structures you ask? They have them primarily to use for scent marking. All carnivores have them. Skunks have the most famous anal sacs, having turned a communication device into a weapon. But for our dogs and cats the stinky secretion contains information about them. What specifically we don't know, but we can guess gender and perhaps some individual identification markers. This is why dogs in particular will sniff poop. They are not necessarily interested in the poop itself, but rather in the bit of anal sac material that it is on it.

This then leads to the question of how they normally empty. They empty when the animal has an appropriately sized bowel movement. The pressure of this passing through the anus squeezes the anal sacs. When this does not happen, perhaps because there has been diarrhea or unusually small stools or just at random in some individuals, then the material can gradually build up and lead to problems. Typically a dog or cat with full sacs will lick at the area or begin to "scoot" in an unmistakable fashion whereby they sit down and then drag their bottom across the ground by pulling themselves along with their front legs. Note: scooting is not caused by worms! This old myth is remarkably persistent.

If they are successful in emptying their sacs by scooting or licking you will know - the smell is memorable. Gram for gram anal sac secretion is one of the most potently vile substances on the planet. However, if they are unsuccessful, you should call your veterinarian. One of the more glamorous parts of our job is to put on a latex glove, apply a little lubricant and "manually express" full anal sacs. And here's the cool part - if your dog has frequent issues with full anal sacs we can teach you how to express them at home!* No medical degree required! It's clearly not for everyone though...

If the sacs remain too full for too long the material can thicken and become difficult to express. This thickened material can also become infected, leading to the formation of an anal sac abscess. Some dogs do not give clear warning signs like scooting so unfortunately the first thing you may notice is blood near the anus when the abscess ruptures. Luckily this is usually easily treated with antibiotics, but it can be an alarming mess in the meantime.

Prevention is of course always better than treatment. There is no fool-proof way to prevent anal sacs from filling up, but adding fibre to the diet can help. A source of fibre, such as metamucil, oat bran or canned pumpkin, can increase the bulk of the stools and thus encourage the sacs to empty naturally. Appropriate amounts vary with the source of fibre and the size of your dog, so check with your veterinarian. Incidentally, we generally do not add fibre to a cat's diet but cats fortunately are much less likely to have issues with their anal sacs. One final note is that in some animals food allergies may play a role in anal sac disease, so ask your vet about that possibility.

I got through that without even telling my grossest anal sac story! I'm proud of myself.

 *What a bizarre world we live in. The "For Dummies" series actually has a tutorial on this: