Veterinarians Behaving Badly

White Lightning

2012-03-11T21:29:00.000-07:00

In the record of humanity’s past on this world, one of the earliest known uses of written language was to preserve the recipe for making beer. Shortly thereafter, writing stuff down was applied to commerce, to keep track of the talents, shekels, and such. Only much later did penning religion, history, philosophy, poetry, and sports scores use up of most of the words. Clearly, as a species we valued getting loaded and figuring how to pay for this took precedence over a lot of that other extraneous stuff.

With luck, we can return to getting loaded in a moment, but I wanted to briefly talk about commerce, the paying for things that we want or need. You may have noticed that we will be having an election soon, and those old arguments concerning whether we are better off by being victimized by the greed and criminality of banks, insurance companies, and big business, or instead by the incompetence, inefficiency, and criminality of government seem to dominate the whole process. And in the middle of all this sausage making, the yelling over who should pay for health care seems to fit right in.

I hope you aren’t holding your breath waiting for my solution to the health care issues in America, because I don’t have the answer for that. Most of the solutions folks are proposing will cost me more and deliver to me less, so I don’t know…maybe I don’t see these as solutions.

So I simply look instead at the little picture, the one on one exchanges that take place in the exam rooms of veterinary hospitals every day, as the doctors negotiate diagnostic and treatment costs with the clients, and some decision is reached that ultimately helps, or doesn’t help, our patients. Our thinking is not muddled much by governments, insurance companies, unions, organized crime, Marx or Rush, or any of the other influences that come into play in the big picture. It’s just us and you all, with Fido in the middle.

I once had a middle aged couple as clients. They had no children. They did have an older Yorkshire terrier. When the time came to purchase a new motorhome, they let the little dog chose the model. They wanted him to be happy with the decision. Needless to say, they never hesitated to authorize whatever it took to assure their little pooch the best in medical care. When the time came that they had to decide whether or not to spring for the brain surgery up at the university for his nasty tumor, they simply said “do what it takes” to try to save the little guy. Sadly, money was not the answer for that particular problem.

For every client like this, I’ve had hundreds who would neglect or even kill their pet rather than dig into the cigarette money, or that weekend in Vegas.

In the middle between these extremes live all those folks with the common realities: budgets, sick kids, fixed retirement incomes, bad luck, bad jobs, bad bosses, layoffs, repossessions, asshole spouses, and all those other reasons why they cannot simply write a check to cover whatever expense Fido might require. Each and every time I’ve stood on my side of the exam room table as they stood on their side, and we’ve tried to find a way to help. This, from time to time, has led to some interesting stories….

Every young doctor mentored by the wise old one has heard the suggestion that you cannot judge what a client can and will do to help their animals by the way they look. Never have I seen this to be more true than when a character direct from central casting arrived with poodle in hand. This man walked right out of an optimistic young doctor’s worst nightmare. Long stringy oily hair, full untrimmed beard with some of breakfast still aboard, filthy denim bib overalls with no shirt and only one shoulder strap fastened, and bare feet that looked like they had never met a shoe. Oh, and the subtle odor of man. No way was this guy going to grasp the concept of paying for the medical care of a dog. He didn’t look like he could afford a nail trim, much less a significant problem. And the dog he held had two broken front legs.

I began formulating a plan to try explaining to this guy the ramifications of this dog’s injuries, when he interrupted me. He pulled out a ROLL of $100 bills, and just flat OK’ed the entire treatment, without even hearing about it. No questions asked. And despite the presence of Murphy in the world, the dog healed perfectly.

Then there was the day the young lady showed up with her version of the dog with broken leg. She opened the discussion across the table with the statement that she didn’t have any money, but that she was good for it. I had fallen off the turnip truck quite some time earlier, so I was a mite suspicious of this promise, but she proved me wrong. I had asked for a $100 deposit to begin treatment, for in those days that got you halfway through the care needed. Five times that afternoon she came back to the hospital with $20 each trip. I didn’t ask, and she didn’t tell. This dog also healed up just fine.

But the strangest experience of my career involved a very distant house call, and a very different owner. It was three plus hours up the interstate, then turn left into the mountains for another two hours and 40 miles along narrow, winding, clinging to the cliff above the river, mostly unpaved road, dodging logging trucks and trying to stay on the track while gawking at the scenery.

My friend lived in a dilapidated ancient trailer house haphazardly sited on a flat shelf above the white water river. The nearest veterinary hospital was two hours away, so she often lined up a few of her neighbors’ animals for me to treat while I was there visitin’. The town, if you could call it that, was a few cabins spread along five miles of river, and some dirt floored hand built log homes set up the mountain in the trees by various creeks. Most folks got their electrical power from Pelton wheels set in those streams. The area and its people were just a tad bit behind the times.

On an earlier trip, I had arrived with the notion that we might be trimming the overgrown hooves of a local deer. The old man and woman who lived in one of those log cabins were in the habit of feeding the deer, so their neighborhood was filled with the lovely things. The locals all hunted deer, but they knew the unwritten law…ya didn’t hunt around their place.

Anyway, there was this old doe with hooves so overgrown that they curled up like a genie’s slipper. So I brought the drugs that would induce cooperation, and the old lady would lure in the doe, who she could pet, and I’d poke her and when the drugs kicked in, trim her hooves. It was an optimistic plan, doomed to failure, so when the doe didn’t show that day, no doubt psychically warned away, we weren’t surprised.

The old woman was an artist, and to thank me for taking the time to try to help, she gave me a product of her genius. It was a tree fungus, those shelves that growth off the side of dead trees, with a curved side on top and a flat bottom. On that flat bottom she had painted a snow scene, with trees and rocks, and a doe standing there, just looking through you like they can do. Nearly forty years later, I still have that painting. It is far more precious to me than any talent or shekel I’ve ever earned in this deal.

Picture my friend’s trailer kitchen, vinyl sheet covered floor tilting slightly toward the river, an old table centered in the room, and the young cat anesthetized on said table. It was time for him to be neutered, and that was my job. Oh, and the owner wanted to watch. She was not the type to take no for an answer. A woman of indeterminate age, somewhere between thirty and sixty, she wore a dress that would have done the madam of a nineteenth century French brothel proud. Silver studded high top leather boots, long ribbons in her hair, and a hand tooled western style belt and double holster, with two pearl handled Colt single action army revolvers, loaded, completed her ensemble. She was thrilled when I finished and her kitty was just fine. And yes, I made a point to take special care of the little tyke, standard of practice notwithstanding.

For services rendered, the kitty’s owner offered up some local favorite, a fifth of triple distilled moonshine whiskey, in a used booze bottle. What could I say? A few years later the local currency become more herbal, but that is yet another story.

So see, I did get back to getting loaded, and I tied it in with commerce, too. Not bad for a Sunday.

2 Live Crew: A lesson in female anatomy.

2012-03-10T16:59:00.002-08:00

This is not a veterinary story in any way, though it does reference an alternative word for cat and well as the word “vagina.” I wish I could tell the story in person, because the pronunciation is key.

I used to work for a very funny man…. He often said wildly inappropriate things and I think he even made a joke and rubbed his nipples at my job interview. But as he reminded me of Baloo the bear and when he said “I love you” to his staff (and meant it), I never took offense.

His recounting of stories was amazing, often including spot on imitations as well as bursting out into operatic song. This is one of his stories.

While he was in vet school, his wife was a teacher at an inner city school in the late 1980’s. This was about the time the group 2 Live Crew was pumping out songs destined to be banned. If you know 2 Live Crew, you know where this story is heading.

A kindergartener was skipping along the halls of the school singing, “Hey, hey, we want some puuussssy….” (click for full lyrics)

Said kindergartener was promptly tagged and bagged by his teacher and he was taken into the principal’s office. There the principal demanded if he knew what “a pussy is.”

The kid looked down and shuffled his feet, “I dunno, something you eat?”

Fo rizzal, to quote someone slightly more contemporary Luther Campbell. He said that. Well, at least he was getting some sexual education.

The icing on the cake was when the principal, a rather buttoned up woman shouted, “It’s not pussy, the word is VAG-in- A, VAG-in-A.”

Life, it is real and it is weird.

A few things they never taught in Vet school.

2012-03-08T17:49:00.000-08:00

This was given to a colleague in a day practice by a client who bought a wolf hybrid from a breeder & I thought I'd pass it on for interested parties. These are things I was never taught in Vet school & am sorely disappointed in said school. All the time & money I spent there....wasted. :P

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CARE INSTRUCTIONS FOR VETS

Here are some helpful tips when one of our clients brings in their wolves for check ups or with problems:

They have a very high metabolism.
Parvo shots could kill them or make them ill.
Wolves are prone to have diarrhea because of their metabolism.
Can be caused by drinking too much water or not getting filtered water (as we always recommend)
Too much moisture in their system. Wolves absorb moisture through their skin.
Too much food, they should be eating one time per day.
Eating the wrong types of food. They need a high protein diet, 27% or higher. Should not be eating any fruits or vegetables, can not digest them, it make rake the colon and make them bleed.
Require dirt in their diet. This comes from years of eating a kill that gets dirty on the ground. It makes their stool solid. Food should be fed on the ground or a small amount of dirt/pebbles added to it.

They do not get parvo or heartworm.
Diarrhea is more than likely caused by the above mentioned items.

No flea products. These products are made for hair not fur. It can burn the fur and cause their skin to be irritated.

They are from the feline family, non the canine as taught. This is why they have a high metabolism. the same as lions, bears and tigers.
So no dog shots, feline shots only.

The skin is about 1 inch thick and so a mosquito can not lay larva under the skin so they do not get heartworm. Because of this they also do not get fleas or ticks because they can not penetrate it. Meds for heartworm could cause them to become sick.
Because of their fur coats they tend to get hotter faster than dogs. They can easily get heat stronke so if it is hot outside they need a cool area they can get to.

Please feel free to contact us with any questions .

When Did I Know?

2012-03-07T10:13:00.001-08:00

Most of us knew that we wanted to be a vet when we were children. I did not. I dreamt of being 1. a shepherd in New Zealand 2. a stripper, and then 3. a radiologist. I have since realized that I became a veterinarian as reparations for my family’s sins against animals.

My parents were not responsible with any pet they had and they collected several dogs, snakes and even a raccoon. None of the animals were properly vaccinated, neutered or on any heartworm prevention (obviously snakes need none of this). Their pets ran loose and were frequently killed by cars. I was repeatedly traumatized by my pets’ horrible deaths.

The real trauma was due to my baby sister. She was not a psychopath-in-training but she had a very “experimental” mind. This did not end well for our pets. At six, she made parachutes out of napkins, attached them to her hamsters and threw them from the second story to their deaths. None of their napkins opened. I couldn’t sleep for many nights.

In earlier years, she had tried to lower a dog from the second story by his leash. Leashes didn’t reach from the second story in the ’70s. The poor dog did not survive.

She once caught about four anoles. She has always been fascinated by lizards. I have a weakness for them, myself. She cut all of the blonde synthetic hair from her Barbie dolls, glued the hair to the heads of the anoles and made clothes for them. I later found them dead in a change purse with pieces of hotdog interspersed amongst them; they were all blonde and wearing the latest in lizard fashion.

I am still haunted by the unnecessary suffering that all of these animals endured because of my family. I think about them frequently and hope that they would forgive our ignorance had they survived.

I have to say that my sister developed into one of nicest people that ever lived. She owns a dog and she is a very responsible owner. She even brushes her dog’s teeth daily. I hope that I have been able to educate my family on how to make a pet’s life better.

We've Been Robbed!

2012-03-07T06:46:00.000-08:00

Let me tell you a little about Sally. Sally is a 2 year old Labrador Retriever who has the energy of 10 dogs. She can't focus, she has ADD and she is just all-around naughty. But she's a sweetheart, a marshmallow to the core, and we love her.

She had parvo as a pup and we barely saved her. It took nearly 10 days in the hospital to do it, but she came through with flying colors.

She ate a battery once and ended up in the ER. Survived that.

She ate plastic once and survived that.

She ate a plastic pencil sharpener once. Survived that.

Yesterday her owner called and said, "Sally ate a quarter! She picked it up and before the owner could get it back, down it went. So they called us, and we had her come down.

She also grabbed a whole bunch of dog food right before leaving the house. Vacuum cleaner, I tell ya.

Anyway, we induced emesis (vomiting) when she arrived. Given her history, we weren't even sure it was JUST a quarter. Sally's owner waited in the lobby for us to tell him what we found, and whether or not we needed to do xrays.

Up came the vomit. My techs had the wonderful job of digging through the warm pile of frothy dog food, looking for foreign bodies and quarters.

We found a nickel. A nickel amidst a smelly pile of partially digested dog food. Yay!

So I went up to the lobby to tell the owner that it was actually a nickel she'd eaten, not a quarter. But she would be fine and could go home.

The owner laughed and said, "Oh my! We've been robbed! It was a nickel, not a quarter!"

Damned dog.

The Geico Panther. IRL

2012-03-06T18:52:00.001-08:00

A member vet of the ER used to do the local Zoo, and heavy exotics. Had a client in about an hour out of town with a dehydrated panther. I tried to get out of it, but no go. So in it came. All I had to do was place a catheter and run IV's overnight. I asked the RDVM how I'd know if it was improving. "Easy", he said. "When it wants to kill you." Fucking swell. The panther was calm when we placed the cath. I rigged the IV lines so they could be disconnected with just a tug. If the panther pulled them out, too bad. We put the panther back into it's own crate, since I didn't want to handle it any more than necessary.

Unfortunately that night we had also hospitalized a very young pup, first time away from mom. The pup was feeling better, and developed a bad case of the lonely's. And cried. and cried. And cried.

My tech, trying to convince the pup to sleep, turned out the lights in the ward. And the light switch was on the tech's side of the room, not the side of the Dr.'s room. And by now the panther was feeling better.

A brief time later I came out check on the patients. Now an irritated panther has a growl that will make your blood run backward and make you want to shit food you haven't even eaten yet. And it was growling. I had to cross a dark room with an agitated 90 lb. predator that had been in a flimsy airline crate. Was it still there?

I claim courage for very few incidents in my life. This is one of them. The walk across the room was one of the longest walks of my life.

Fortunately, all was well. But I never, ever wanted to do anything with a big cat again. And now you know why there's grey hair in my beard.

When you take them out, but leave them in.

2012-03-06T14:40:00.000-08:00

I had an interesting conversation today.

Actually, I had a lot of interesting conversations today, for the definitions of “interesting” that include “seriously unpleasant, yet necessary,” “horribly painful and depressing,” “same old family drama, different day,” and “you can’t make this shit up.” The one I want to discuss right now, though, was interesting to me because it reminded me yet again how perception differs between individuals, and how the most obvious fact to me can be completely non-obvious to someone else.

Today I saw the new puppy of a long-time client. The puppy was adorable, as puppies generally are. He did take issue with the whole temperature-taking thing, but I’m not 100% sure it was an inappropriate response. We’ll see how he does over the next few weeks. So, I did my exam, and chatted with his people, and was basically wrapping things up as I tend to do by explaining what had been done in the past, what I had found on my exam today, what other things I’d done today, and what needed to be done in the future and when, and I mentioned that generally speaking, I like to neuter male pups at about 6 months old.

Well, that led to a discussion of the fact that the breeder wanted them to neuter the puppy at one year old or later. For the first time ever, y’all, I replied brightly “Oh! The breeder’s a vet? Where did she go to vet school?” They looked at me blankly for a moment and then started laughing. “No, doc. She’s no vet. She wants to breed him is the thing.” “Oh, ok. I didn’t realize he was such a fine genetic specimen. I’m not an expert in the miniature schnoodlehunden breed standard, or anything. I had thought your breeder was one of those breeders who just prefers to neuter everyone really late because they think neutering sooner causes cancer, or growth problems, or whatever it is that they think it causes. You know, there are a couple of issues that have been looked at that may be influenced by pre-pubertal neutering, but generally having reviewed the available data, I think neutering males at 6 months is reasonable and results in a healthy pet with appropriate pet behaviors.” The other owner then said “actually, you’re right. She IS one of those breeders.” I just smiled and said “well, regardless, you have plenty of time to think about it and decide. I’ll have the front desk print you a handout about neutering to take with you.” And THAT is when it got interesting.

The man said “by the way doc, our last dog, you know, Cheeksie - we had him neutered, but they left the testicles in. Can we do that again?” I looked at him blankly this time. “I’m sorry, there must be some misunderstanding. The point of neutering is to remove that hormone source. The testicles are not left in.” He said “well, it was more like a vasectomy then. You know.” I said “I do know what a vasectomy is, but most vets don’t do them.” He tried to tell me we’d done it at our hospital and I told him there was no way that happened. Then a lightbulb went off over my head. “Is it possible that you were simply seeing the empty scrotum, without the testes in place?” and he said “yes! that’s what it was! So, you don’t take that part off then, just the inside?” and I explained that yes, generally speaking, we don’t remove the scrotum. He asked me what made it hang down like it was full, and after a couple of failed attempts to explain I said “forgive me for being crass, but - imagine a breast, after the removal of a breast implant. Wouldn’t there just be an empty breast hanging down, kinda flat?” And then his lightbulb went off and he nodded yes. “That’s great!” he said. “Because I was afraid, you know, you were gonna mutilate him.”

I just laughed and said that generally speaking, we preferred to avoid mutilation at our hospital. He laughed too and everyone was happy.

**Please note: my choice of breast implant as teaching model should in no way suggest any dislike of, disdain for, or other negative attitude directed at any woman who may have had or considered having placement or removal of breast implants at any time. No breasts were harmed in the writing of this blog post.**

Flea-bite-us

2012-03-05T15:02:00.003-08:00

Warning: this is not a strictly veterinary post

My mom and my dad both graduated from college. My dad and uncle were the first people in their family to do this while my mom and her siblings followed my maternal grandfather in getting a college education. My dad died suddenly when I was a teenager, so my mom raised my sister and me once it got to the pretty complicated stage (13 and 16, respectively). Education beyond high school, and even beyond college, was expected in our family.

When my mom, a very medically savvy and medically educated woman, married into a family of people with a pretty low educational background, it created a new job for her. I am in no way discounting intelligence: my step father does not have a college education but I consider him to be someone that is a genius in his own right. However, her in laws (my step grandparents) have an education that tops out at 8th grade. I think they had to drop out...my step dad's mom because she had to take care of the other kids in the family and my step dad's father because he had to go to work to help with his family's bills. I don't think that the initial education was any great shakes either: think of a place where "You gotta a pretty mouth, boy" might be uttered. That is the kind of place I am talking about. My step grandmother can create a meal that will make you cry with joy. And Papaw is the kind of guy that can take parts from 20 different cars and build a vehicle that would make most people clap their hands with delight.

However, my step grandparents have a distinct lack of understanding of biology. And a lack of ability to read with comprehension much better than my 6 year old daughter. So, my mother has become the person that reads everything from warranties for appliances to information about health. Which is fine with her...that is part of being a family.

A couple of days ago, Mamaw told my mom that her doctor told her she had "Flea-bite-us" but she had no idea how this could happen: she couldn't find any fleas. The answer was of course she doesn't have fleas...she has phlebitis. Now, since neither my mother nor I was there, I have no idea if the doctor explained what he meant. I don't know if he gave handouts (though my mom usually interprets this for the inlaws). However, I do think that it illustrates things that we can all take home.

As a vet, I always make sure that my clients have oral and written information on disease processes. I give actual handouts, I give internet addresses where clients can find "vetted" information. I have given out my phone number to some clients if I know we are going into a weekend and the patient has a serious problem. And other vets that follow this site, likely do similar things. If you are a vet and you are reading this and you don't do this, start. It is not very hard to link a diagnosis in your computer system to a blurb on something....hell, take it straight from Veterinary Partner.com (please cite it). The Homeless Parrot in our side bar also has great information on diseases and terms.

If you are a non-vet reader, please ASK for an explanation from your MD/DO or DVM. Please ask for the spelling of the problem. And while you can google the information, please take all information with a grain of salt. The initial exam can often feel rushed...but if you approach your health care provider with real questions....real interest without agenda, you should be welcomed...even if they tell you they will need to look into it (NOT a sign of weakness...a sign of strength). If you are not taken seriously, find a new doctor/NP/DVM. As a doctor, I want to CURE my patients. I assume my clients will research something online. Fine... I will evaluate this and I might find it FOS or I might take it seriously...and some will be a combination of the two.

Don't be a passive doctor or nurse/tech: every question is a chance to critically evaluate why you believe and advise the things that you do. And others, don't be a passive consumer of your health. The only way for a health system to work is to be honest about the things that you don't understand. The health care providers will do a better job if you tell them what you don't understand.

As much as I initially wanted to snicker at the word "flea-bite-us," it really just makes me mad. Someone failed. And I don't think it was the woman with an 8th grade education.

Or, we could not do that...

2012-03-02T11:57:00.001-08:00

Because life doesn't put itself on hold in troubled times, even though VBB central is under a lot of stress today, I still had to walk the puppy. We walked up the street through the neighborhood for about 40 minutes this morning. Oh neighborhood. Why hast thou forsaken me?

Believe it or not, I expect people to be nice. I expect polite, intelligent, kind people to populate my world. I am constantly disappointed, by the way.

The guy with the obstructed dog wasn't out, though I saw his dog pee yesterday, so there's that. But a few homes past him is "my dog wants to play with your dog" man. This man drives me to drink. His dog is a land shark and shouldn't be allowed in polite society. But today his dog was not home (it's at the groomer! Yay!) so instead he just wanted to chat about his new "invention." He insisted that he was going to create a dog food system that involved feeding the dog a capsule and then 20 minutes later, dog food. The capsule dissolves to reveal a baggie that waits in the rectum to be filled with stool. Then the dog poops out a bag of stool. Honestly I was LMAO but he became quite put out & insisted he was "extremely not kidding." Then he said "you know I hadn't thought of it but we'd make a great team. We could market this in your clinic." I just looked at him, & raised one eyebrow, and left. He's probably blogging now about his bitchy-ass neighbor, the vet who blew off his big business idea.

Priorities

2012-03-02T08:28:00.001-08:00

Yesterday we had to call the plumber out to our house to rooter the pipe that drains the washing machine. Apparently it was full of gunk, a.k.a. dog fur. The plumber spent about 15 or 20 minutes and charged us $350, which I didn’t have. I thought about all the things my clients have said to me over the years when presented with treatment bills for their pets:

“If you really cared about animals you wouldn’t charge so much.”
“You should name a wing of this hospital after me, for all the money I’ve spent.”
“I don’t get paid until next Friday. Can you hold a check?”
“Is that the lowest you can go?”
“You vets are only in it for the money.”
“I bet you drive a Porsche.”

For about a tenth of a second I thought about trying out one of those lines on the plumber: “If you really cared about washers you wouldn’t charge me,” or, “Think of my poor children! They won’t have clean clothes to wear to school!” But I didn’t, because I’m a decent person. Instead, I handed over the credit card.

For most people who claim they “can’t” afford veterinary care, it’s really that they choose not to spend money on veterinary care. It’s all a matter of priorities. If your priorities are an iPhone, shiny new SUV, and cigarettes, don’t try to make me feel guilty. I feel sorry for your pet that he is stuck with you as an owner, but I don’t feel sorry for you and your poor decisions.

And for the record, I drive a ’99 Subaru with 209,000 miles on it, having upgraded from an ’88 Blazer with 180,000 miles that couldn’t turn left in the cold without stalling.

Playing Doctor

2012-02-29T13:27:00.003-08:00

It was a lovely sunny day at the VBB hospital. The trees were getting some new green as the spring rolled in and there was the slight scent of wet earth that remained from an early morning shower. My day was ticking by, surgery in the morning, followed by afternoon appointments, when suddenly a gaunt figure in a large flowered hat careened into the front lobby.

By large flowered hat, I mean it was a hat with HUGE fuzzy flowers on it, worn by the famous "hat lady" in our little town in recognition of the first official day of spring. This particular lady had hats for all sorts of occasions, all worn as a partial jest and partial personality tic of the wearer.

On this day, the normally sunny countenance of Hat Lady was marred by a look of horror. She was holding an equally flowered handkerchief wound around her wrist. As I walked into the reception area, I could hear her demanding to know the rabies vaccination status of one of our patients. I explained that we were not allowed to release that information to her since she was the owner. However, after looking at the record and seeing that the patient, Teeth, had his last rabies vaccination within the year, I felt pretty comfortable telling her that I didn't think she had anything to worry about with regards to rabies. I advised her to go to the doctor to have the wound looked at and maybe a tetanus shot.

It was at this point that the Hat Lady started yelling that I had to give her a rabies vaccination. I told her that A) I didn't have vaccines for humans and B) I was not licensed to give a vaccine to a human. She kept saying that a rabies vaccine is a rabies vaccine and that she "demanded" that I give her one. When I told her that she would need to talk with her doctor and animal control about that, she got super dooper mad. She threatened to call my boss...I offered to dial the number for her. She threatened to call the board...again, I offered to dial the number for her.

When the police showed up (she had called them about the dog bite), both the officer and I were finally able to get her to calm down. As the dog in question was current on vaccines, he was quarantined for 10 days in the home of his owner and the Hat Lady never required a rabies vaccine (at least not yet).

This brings up some important things: One, a vaccine approved for dogs, cats, goats, cows, horses, etc is not necessarily approved for humans. In fact, I am struggling to think of one off of the top of my head. Two, most vets would rather you call the vet board because they refused to work on you rather than to have a board report for working on you. Hell, the vet at my undergrad even refused to pull a splinter out of the hand of a fellow student because he didn't want to get in trouble for working on a human.

The last thing to let everyone know is that rabies vaccines are important. It is against the law to not have your dogs and cats vaccinated and it is a bad idea to not vaccinate other animals. In the US, there are not large numbers of animals identified as being rabid nor are there large amounts of people dying from rabies. However, in places like China and India, those numbers increase exponentially. We can thank our relatively low rabies incidence to the efforts of the public health departments and veterinarians. That does not mean that we can relax our attitudes towards rabies. We have global travel of animals, including the adoption and importation of animals from places in the middle east, where soldiers are falling for homeless animals and trying to help them. Some of these animals can come to the US with rabies. So, thinking that you can extend the time between rabies vaccines beyond the scope of the vaccine is both illegal and dangerous.

A family in Florida just found this out. Their dog came in contact with a raccoon. The dog had not been vaccinated for rabies within the allotted time. Most rabies vaccines are either considered to be effective for 1 year or for 3 years. This dog had been vaccinated 7 years prior to the incident. Because of the lack of protection from the rabies vaccination and the contact with a raccoon, this dog contracted rabies. Rabies is diagnosed post mortem (after death) via a certain test on the brain cells. Once this dog was diagnosed with rabies, the humans in the household had to be vaccinated and the other family dogs were euthanized. In reality, after the unvaccinated dog came into contact with a raccoon, an animal species known to harbor rabies, the dog should have been euthanized or at the very least quarantined for 6 months or so. Rabies viral particles have to travel up the nerves from the site of the bite/contact into the brain, which can take a long time. Thus an animal can be infected, but not start showing signs or being able to transmit rabies for weeks to months, depending on the site of the bite.

As for the 1 year versus 3 year protocol, I am split on this. For animals that are likely to come into contact with wild life regularly, I would stick with the yearly protocol. I have read a report of a dog that contracted rabies in spite of being within the 3 year interval per his rabies vaccine. For those patients that are less likely to see hot wild life action (like my indoor, couch potato old lady dog), I would go with an extended, 3 year protocol. And just because your cat does not go outside, do not assume it is safe. There are enough people that find random bats in the house...and a bat bite often goes unnoticed, even when they bite a human. So, obey the law....and use some common sense. Some of my colleagues might disagree and they are welcome to do that. However, a classmate of mine told me that they just had a dog diagnosed with rabies in Virginia and there was also a recent report of a horse that was diagnosed with rabies in Tennessee.

Musings

2012-02-27T16:45:00.005-08:00

So today I’m feeling a bit sad and reflective. I have to do something I am NOT looking forward to for a number of reasons. But it does give me the opportunity to look back and realize that I am reaching a milestone in my career as a “Family Practitioner” Veterinarian. It’s almost as if my career is reaching real maturity.

Eleven years ago I graduated from Vet school, feeling proud, hopeful, excited, and yes, even a little relieved that I’d managed to get through it. I had an incredible stroke of luck and found an amazing family in a small town who took me and the Hubs in as one of their own immediately. They were looking for an associate Veterinarian for their small-town practice. The practice and the family hiring were such a perfect fit we flew back to VBB College Town, loaded up our meager possessions into a Ryder truck and drove across the country on the biggest adventure of our lives.

I was getting settled into being a Vet quite nicely the day about 10 years ago when I met the Andersons. They are a great couple, about my age. Joe is probably the biggest guy I’ve ever met….the size of a redwood practically. But he’s gentle, quiet, reserved, and when he speaks he has something to say. His questions are probing and thoughtful. He listens carefully to my answer, mulls it over, and GETS it. Rita is sweet and caring, the family worrier, but also keenly intelligent. She’s funny and friendly and dramatic at times (in a good way). I love to see them on my schedule; it makes my day knowing I get to see them.

That first appointment was to see the new addition to the couples’ lives, Ike and Ivan. They were brothers, Labrador mixes- with what, who knows? But they both have pensive, wrinkly, adorable hound dog faces and long, droopy ears. At the time they were about 6-7 weeks old, and there was NO predicting they’d each top 100 pounds when fully-grown. They were each small enough to fit in one hand! Ike was nearly white-blonde, and Ivan black with white on his feet. New puppies have always been my favorite type of appointment. I take my time- nearly an hour usually to meet the family and puppy, do a physical exam, and talk about all the things it takes to raise a healthy, happy, social, well-behaved family member. Our puppies visit every week or two as they grow up so we can love on them and bond- I’d say 95% of my canine patients drag their owners into the clinic from the parking lot. Ike and Ivan are no exception. Ivan has always been a bit more shy than his brother…he comes in, hides a bit behind Mom, and peeks around her legs. Ike is the brave one….in my face schnuffling on me the moment I enter the room. Then Ivan sidles up and says hi while he thinks my attention is on Ike. Funny boys. They ALWAYS visit together, even if only one of them needs to see me.

Over the years, I’ve seen the brothers welcome two baby boys into the family (the two-legged kind). Brendan is the baby- a bit young for me to really get to know yet, but Joey is about 7-8 years old now. He’s a perfect mix of his parents. He’s friendly and funny like Rita, and he asks great questions and listens like Joe. He’s got a round cherub face and a mass of mahogany colored curls. I think he’d be a great Vet. One time he brought in a plastic dinosaur (he was about 5) and explained to me some medical problem it had and his treatment plan for it. I don't usually enjoy kids…..THIS is a kid I LIKE. I could hang out with him and have fun.

Ivan and Ike are like all dogs with the best families- medical disasters! I don’t think there is a problem common to labs that at least ONE of them hasn’t had in the last 10 years. They’ve both been to see specialists multiple times. Ivan has had both knees re-built. Ike once ate an ENTIRE tin of popcorn on Christmas Eve morning (you know, those HUGE tins with the Christmas scenes on the outside and three flavors of popcorn inside?) I usually see appointments until noon on December 24th, but somehow I’d gotten REALLY lucky and nobody needed to come in. I was planning to stay home, but I got a call from the office- Rita had called in a panic, thinking Ike would rupture his gut from the popcorn! I went in to examine him, he was stable, happy, tail wagging, face grinning, belly HUGE! He belched NOT so softly as I palpated his belly…..he felt like a plastic trash bag STUFFED full of popcorn! Rita felt so bad about calling me in on Christmas Eve she brought coffee AND Starbuck’s gift cards.

Ivan and Ike survived the popcorn and various similar disasters over the past decade…and there was NEVER any question from Joe & Rita that they were going to choose the best recommended tests and treatment every time. But they are also 10 year old BIG dogs. They’ve really started to show their age the past couple of years.

Ivan has always had some lameness issues from his bad knees, but then Ike started having trouble with arthritis in one of his shoulders. We’ve tried a number of therapies, all of which are either ineffective or they make him ill. He can barely get up and down the stairs now, and the loss of the muscle tone of that leg is obvious from yards away. He simply can’t use the leg any more.

Then about a week and a half ago Ivan was on my appointment schedule. He wasn’t eating, seemed really lethargic. Rita brought in Ivan (Ike waiting in the truck this time) and Joey. As I bent over to say hello to Ivan my heart sank. I stroked him under the chin, only to find the lymph nodes there were the size of large eggs. Moving down along his neck I found more enlarged lymph nodes in front of his shoulderblades, and again in his calf muscles in his rear legs. “Rita,” I said…”You guys fish a lot, right? Could he have possibly eaten any raw salmon or trout?” (I knew the answer was no…Joe and Rita have learned over the years NOT to let the dogs have anything out of the ordinary because Ike has a particularly sensitive stomach). She confirmed that, though they’d been fishing, there was no way the dogs had eaten any fish… Damn. Not salmon poisoning.

I looked up at her, "All his lymph nodes are enlarged. This worries me. I am NOT happy to find this.” I could see her start to mist. She’d known. She sent Joey out of the room to sit in the lobby. He protested- he’s always well-behaved and has NEVER had to leave the room before. But she asked him again quietly, and he nodded, and left the room. I think he knew, too…even at 8. I told her my fear was that this was lymphoma. I needed to take some samples to send to the lab to confirm it…then we talked about cancer. If I HAD to pick a kind of cancer for my dog, it would probably be lymphoma- chemotherapy protocols these days can do amazing things…remission is common and many times you can get good quality of life for years. Then she dropped the bombshell. She asked if it would be wrong, and could I do it if she asked, to put the boys to sleep together. Ike hasn’t been doing well, and now Ivan is really uncomfortable and not eating. They’ve NEVER been apart. There was crying. And talking. Lots of talking. We decided to wait for lab results, then we’d take it from there.

Unfortunately (as I’m sure all the DVM readers have already guessed) the lab confirmed small cell lymphosarcoma. Ivan did ok during the weekend while we awaited the results, but his appetite was down again Monday. I spoke with Joe and Rita probably four or five times on the phone last week…deciding whether to go see the internist for a consultation, then deciding whether to give prednisone a try, then deciding when it’s time….

It’s time. Today. This afternoon. Ivan is not doing well- won’t eat, won’t play. Ike is plugging along but in constant pain from his shoulder. I imagine the whole family will be there. There will be tears. There will be hugs. They want the boys cremated together, their ashes mingled in a single container. It will be hard. But I will do it, because I love them and they are my friends and I have the privilege of sparing them from a horrible end. So is the life of a family Vet.

There’s a poem called “The Rainbow Bridge” we send to clients at the loss of a pet. It’s quite lovely, a nice sentiment….Heaven for animals, essentially. I’m glad it gives people solace. At times I wish I could believe in those things. But I am a naturalist, realist, scientist, atheist. I believe that the end is, well…the end. Now, before you go feeling all sorry for me, or disappointed, take a moment to think about what that can mean:

We have this life, and ONLY this life. Enjoy it. Make the world better for yourself and the others around you. Heaven is not some mystical reward to be given to you in the afterlife. It’s an ideal, a dream, a goal. It’s something we all need to work together to MAKE for OURSELVES. Love well, love deeply, love many. Find humor. Find beauty. Find joy. SHARE it. Share your defeats and tragedies as well, for without sorrow there is no joy, and pain shared is pain halved. Smile, laugh, cry, dance. Live.

I can't haz bloggie :(

2012-02-27T16:45:00.004-08:00

Well, thanks so much, but, we were beaten by that other animal blog - I Can Haz Cheezburger. I suppose it's kinda crazy we were even in the same category. Maybe 2013 will be our year? Vote early and often! Ha ha.

In other news, I've been taking care of a family member's pet lately. As previously discussed, I hate, loathe, and detest this type of situation. That said, so far, it's going ok (fingers crossed, ptui ptui ptui, salt over shoulder, etc etc). The kitty in question has fatty liver disease, and his liver enzymes have decreased by half in 3 weeks, and he's maintained his weight and hydration status nicely. It's an interesting situation, because without going into too much detail there is a somewhat complicated backstory on both the kitty side and the human owner side. Here's hoping he continues to do well.

Post-Vegas re-entry kind of sucked. That's probably why it's a little quiet here at VBB central. Jet lag, wishing I were back in Fantasyland, you know how it is.

Today when I walked the puppy, she picked up a dead snake on the sidewalk and tried to give it to me. I've pretty much stayed in that kind of mood all day.

Voicemail of the Day

2012-02-25T05:37:00.001-08:00

"Uh, hi. I'm calling because - well, I got a 20-dog hoarding situation here in [place 500 miles from World's Best Animal Hospital]. Basically I'm calling all the vets I can find, just hoping to find someone who can, you know, donate some supplies and stuff to help my dogs. If you can help, please call me back at [number]."

Clients behaving badly

2012-02-24T08:52:00.000-08:00

I think this behavior is a little over the top. Your dog dies so you beat up your veterinarian? Really?

I remember when I was in school, we had a dog in our ICU who was hanging on by a thread pretty much during my entire ICU rotation. I don't recall specifically what was wrong with him, just that I had to check his vitals every 15 minutes all night for several nights in a row, and they were never good, and I frequently had to page my resident, which is never fun, and it didn't at the time seem to me that this dog had any real chance of going home.

At some point toward the end of my rotation, this dog started actively trying to die again. This time, for whatever reason, the owner of the dog got mad. Having received yet again a phone call from the supervising veterinarian asking him if he wanted full resuscitation or if we should euthanize or let the dog go, he apparently hung up the phone without answering, and arrived at the building moments later (he must have been on his way in for a visit or something). He stormed past the security desk and headed into the ICU and just started pushing and shoving and yelling and knocking over IV poles and basically clearing a path to the dog - in whose cage I was sitting, because I was bagging him at the time. Luckily the security team was right behind him and they had him out of there pretty fast, because all I could think at the time was how upset my mom was going to be if I was killed by some maniac client before I even graduated.

Anyone else ever find themselves on the wrong side of a client's fists? Officer Cynical, I'm not talking to you here :) (though I'm sure you can share plenty of fun stories) (and you should feel free to do so)

Taking a Break

2012-02-23T21:13:00.000-08:00

Tomorrow is a half day for me, and then I have the entire weekend off. Off meaning not working, and not answering the phone, and trying really hard not to have even one thought relating to my hospital slip inside my head, for two entire days. So of course, I have a bandage that runs nearly from wrist to elbow. This one supplants the one I took off this morning from the other arm, which replaced the one on this arm that I needed last week.

I work with dogs and cats, and each comes fully equipped with teeth and toenails, weapons designed to help them capture and kill prey, and also to defend their very lives from others of their species, and those bigger ones who would kill and eat them. They are born willing and able to use these weapons. Yet I can go weeks without so much as a nick on my precious skin. That’s the norm for me, and I’m proud of it. Decades of this work, dedication to making my patients comfortable in an uncomfortable situation, and lessons learned from all those mistakes have taught me how to stay healthy in this work. So yeah, I can expect to go weeks without getting injured. Until I take some time off. That is my Achilles heel.

The bite and scratch gods lay in wait for me to plan a day off. Their eyes light up at the prospect. And they turn loose upon me the nasty dogs, the evil cats, and those resoundingly clueless people that were somehow placed on this earth with no higher calling than to let their animals maul me.

It is no one’s fault that I chose a circumstance that mandates long hours and dedication to folks and their pets. I picked this deal at a tender age, and I rarely regret the decision. But after a few months of 60 hour weeks, I crave some time away. I recharge in really nice places, mountains and deserts and seashores, places of beauty, solitude, and quiet and fresh air. I look forward to these moments of respite, away from the pathos and tragedy that is the inevitable dark side to the work I love. And when these places have done their work on me, I return to my calling renewed, happy, and frankly a lot more effective.

But something happens as I approach these moments away from my work. I change somehow. And the bite and scratch gods sense this, and they make me pay. Maybe after working myself ragged, my reflexes just aren’t up to the challenge. Or maybe that negative side of me, that I’m-not-perfect-and-thus-deserve-punishment side just folds and lets the harm happen. I don’t know… maybe I’m just tired.

This time it was the 7 month old puppy that never read the directions, the directions that state that puppies should love everybody and kiss the world. And this tyke lives with people who expect it to snarl, bark, and maul pretty much everyone it comes into contact with, so they yelled at me when their dog tore me apart.

This time it was the man with a career in education, the man with the geranium IQ, and the life skills of a four year old, who brought in the 108 pound dog wearing the harness. Every veterinarian knows that the dog wearing a harness will bite you, for the harness is the owner’s concession that the dog need never mind. The bite missed, but the claws have left their scars forever on my arm.

And this time it was the cat that reminds us that cats are only semi-domesticated animals, and he lived up to that potential.

So I’m going to leave tomorrow wearing a bandage again. But the coast beckons, and I will nap and read and write and relax, and the only thing that might go wrong is the other same thing that happens whenever I take a day off. It will probably rain.

Who are the people in your neighborhood?

2012-02-23T08:24:00.000-08:00

I took my puppy out for a walk this morning, as one does, you know. We were walking up the hill, stopping to sniff around and check things out, the way a puppy does when walking somewhere new, when I noticed up ahead there was a dog straining to urinate on his front lawn. It caught my eye really only because the dog was maintaining that position for so long. He seemed uncomfortable, stressed out, and oddly postured. Hmmm.

As we approached, I noticed the dog, whom I knew to be the type of dog who typically runs up and jumps on everything that approaches him, was on a tether, but that the tether was long enough that the dog could easily reach our spot on the sidewalk. Still, the dog did not move from his spot. He kept straining. My puppy sat on the sidewalk next to me, head cocked, looking at the dog. I stood there and wondered what to do.

Luckily, seconds later the dog's owner came outside and stood in his driveway. "Oh hey there!" he said. "That must be your new puppy! What a cutie!"

I smiled and thanked him and before I could even say anything else he said "Yeah, Brashly isn't doing so hot you know. He's had a kidney thing for a while, I think this might be it." I said "oh, you're aware. Good. I was worried about him and had actually been standing here thinking about whether I should knock on your door because it sure seems like he's having trouble urinating. He looks very uncomfortable to me." "Oh - trouble urinating? well, we had him at the vet last year because he was peeing small amounts all over, you know? and the vet said it might be stones and maybe we could fix it with diet change or maybe surgery - but also he said it might be a tumor, or even something else. He wanted to do an xray, but, you know - Brashly's eleven years old. We ended up taking him home to think about it and then just forgot about it for a while, it was kind of inconvenient all the walks but it didn't seem like that big a deal, but now you know we have to leave him tethered out here all day because he just drips urine now and then and never really actually pees. And a couple of days ago he pretty much stopped eating, so - I think we'll get him to the vet soon, but, I'm not sure he'll come home. See how he's standing there with that look on his face? He does that all the time. He'll stay like that for hours."

Readers with a medical background can probably feel my blood pressure rising through their keyboards at this point. This poor dog has been suffering progressive urinary tract disease for a YEAR, and is now at the point where he literally can not pee more than a couple of drops even when he stands there and strains FOR HOURS, and he's dying in front of them slowly and painfully and - here's what really blows my mind - IT IS COMPLETELY DUE TO IGNORANCE (with a small side of average intelligence).

I *know* these people. They have a child the same age as one of my children. That child desperately wants to be good friends with my child, but my child isn't so interested because "that kid is really kind of boring." Oh well, you know, kids. But these people are friendly, charitable, service-minded, professional people. I see them at local charity functions, doing volunteer work at the library, all kinds of things like that. They definitely love their dog and have expressed their feelings of love for the dog to me on more than one occasion.

I spent about five minutes standing there, with a smile and look of concern on my face, telling this dog's owner that regardless of the cause of the obstruction, at this point, their dog is suffering, and he needs to go to the veterinarian TODAY. He asked me if they should have done the recommended xrays last year and maybe this wouldn't be happening and I told him the truth - if diagnostics had, for example, revealed stones in the bladder and they had been surgically removed and the dog maintained on an appropriate diet, then hey, maybe it would be fine today. But, I have no retrospectoscope nor do I have a crystal ball, so I can't say for sure what would have or will happen. Regardless, as soon as I finished talking to him, he whipped out his cell phone and made an appointment for later this morning with his dog's veterinarian. So, there is that.

Gun Control

2012-02-22T13:15:00.002-08:00

Now, I am sure that people can debate whether or not private citizens should own firearms all day long, but that is not the kind of gun control I am talking about. I am talking about not leaving your loaded shot gun leaning up against the wall in your house. It could lead to something getting shot off...like the nose of your dog.

I had a couple carrying a profusely bleeding pit bull careen into the hospital. The dog was sneezing and snorting blood everywhere, but the tail was wagging a mile a minute. The owners were both crying and generally freaking out. I took a quick look at the dog and determined that the damage was not too bad: the dog was a young healthy dog that was apparently happy and stable in spite of his injuries. The owners kept freaking out and I had a hard time getting sense out of them. I finally grabbed the husband by the shoulders and looked into his eyes and said, "It's not that bad...I should be able to put that back together." The both settled down and relayed the story.

Apparently, they had left a loaded shot gun leaning against the wall....not locked up, not in a gun rack, just leaning against the wall. The happy dog's overactive tail knocked the gun over. When the husband picked up the gun, the dog was investigating the hubbub when the gun went off, catching his nose. Given the (relative) lack of damage, it looked like most of what got the nose was scatter. It was bleeding like crazy, but there was enough tissue that I could get it all back together.

After I fixed the dog, I ascertained that there were no children in the house. As nice as the owners seemed, if they had kids, I would have reported the accident. While I would shake my head and be a little down trodden if I heard about another animal in the house getting accidentally shot, I would have had a hard time living with myself if a child had been involved. This may not be completely legal per se, but if it isn't, it is a clear example of what is right versus what is legal. Human physicians don't really have this quandary: they are required to report gun shots.

A couple of weeks later, I got a thank you letter with pictures from the owner. There was a picture of a dog happily grinning at the camera as well as a close up of the healed nose.

Things we learned in Vegas (open thread)

2012-02-21T12:00:00.001-08:00

1. One can walk down the Strip at any hour, bwak-ing like a chicken pretty loudly, and no one will even look at you funny in any way.

2. Loudly saying "pus-filled uterus" at dinner probably gets you written up on the Busboys Behaving Badly blog.

3. Champagne cocktails TID would make the average workday a lot more tolerable.

4. There are a lot of people who don't own mirrors or have any true friends to stop them from being seen in public looking like that.

5. If you're gonna boldly wear that micro-micro-minidress without any panties, do us all a favor & get a bikini wax first.

Tell us, esteemed colleague: what are your lessons from Vegas?

Someone seems confused around here

2012-02-21T10:18:00.001-08:00

Now, I don't know if it's just me - but, I thought that given our blog title, and the general tenor of our posts thus far, the subject of our blog was pretty clear. I don't know too much about how Google's back-end works with respect to their search algorithms or anything, so maybe that's why this is coming as such a surprise to me, but - well, take a look at these search terms used to find our friendly little blog:

Seriously, people? SERIOUSLY?

Just in case you can't read that last one - some poor misguided soul ended up here after searching for "pissing in vagina." PISSING IN VAGINA! I really do not think that the subject of "pissing in vagina" has been under discussion here at VBB central, so I suppose the poor soul in question left disappointed. I'd like to try to remedy that.

Assuming that the searcher was actually interested in finding out about pissing THROUGH the vagina, rather than some type of sex-play involving pissing IN someone ELSE'S vagina (which, now that I think about it, could totally be what he or she was going for in which case EW, OMG, please pass the brain bleach!), then this person would have been better off googling "female urogenital fistula," or "vesicovaginal fistula." These are real conditions. You may, if you were an Oprah fan like my mom, even have seen an episode of Oprah about poor women in Africa with these problems and gone around for the next six weeks grossing everyone out by bringing up the subject while they were trying to eat. Anyway, in case our poor searching person comes back here looking for information about it, suffice it to say - sometimes, for a variety of causes including botched surgery, problems with pregnancy/labor/delivery, malnutrition, etc, a tunnel of sorts opens up between the urinary bladder and the vagina (or sometimes the uterus or cervix) resulting in uncontrolled leakage of urine out through the vagina. Affected women are incontinent and often malodorous.

Please see the informative article here: http://emedicine.medscape.com/article/267943-overview for additional information on this unfortunate malady.

Thus endeth today's VBB foray into medical problems in the one species we are not licensed to diagnose or treat. Please don't report us to the medical board for practicing without a license. Thanks for stopping by!

How to Save Money on Vet Bills

2012-02-21T09:01:00.003-08:00

You can find a lot of articles online about how to save money on your pet care bills, like by buying Old Ranch Genuine By-Products dog food or getting your pets’ vaccines at the feed store or cornering your neighbor veterinarian in her garden rather than taking your pet to her office. I’m here to say: Don’t do any of those. Instead, if you want to save money on pet care, keep your pet healthy by using common sense and following these rules:

Keep your dog on a leash (with the other end of the leash attached to your person) or in a fenced yard.
Keep your cat indoors.
Spay or neuter your pets, preferably by one year of age. This reduces or eliminates the risk of many health problems (breast tumors, uterine infections, testicular tumors, prostate infections, etc.), prevents pregnancy complications, and reduces the urge to wander. Think of unspayed/ unneutered pets as teenagers with raging hormones but without even the tiniest modicum of sense to avoid moving vehicles.
Don’t give your pet any human medications or supplements without first consulting with your veterinarian.
Don’t let your pet get into illicit drugs.
Check out the ASPCA Animal Poison Control Center website for a list of poisonous plants to keep away from pets. Big ones are lilies for cats (including Easter lily flowers in floral arrangements this spring) and grapevines for dogs.
Don’t keep any rodenticides (rat bait, mouse poison, gopher bait) on your property, even if you think they’re out of reach of the dog. There are various types of rat bait, which cause fatal hemorrhage, fatal kidney failure, or fatal brain swelling. Call an exterminator or use old-fashioned mouse traps.
Don’t keep snail/slug bait (metaldehyde) on your property. Let the snails eat your hostas, or put out small saucers of beer to trap the snails. (We vets don’t want your dog drinking beer, either, but mild intoxication is preferable to fatal muscle tremors, seizures and hyperthermia.)
Use only “pet safe” antifreeze.
Don’t let your dog ride in the back of the pickup truck.
Don’t ever leave a pet in a closed vehicle in the summer.
Don’t feed your pet real bones. Real bones can break teeth and perforate intestines.
Keep your pet on year-round parasite prevention (heartworm, intestinal parasites, fleas and ticks).
Don’t let your pets eat these people foods: grapes, raisins, onions, garlic, chocolate, macadamia nuts, or anything spicy or fatty.

MMS Awareness

2012-02-20T11:43:00.001-08:00

MMS is Marley and Me Syndrome. Marley and Me, the book, was a great favorite with many of my clients. This book basically gives an account of a yellow lab’s life with all of his faults. Most lab owners could tell similar stories as read in this book. Marley was not as unique as one might think and that is why I hated this book. For me, a veterinarian, it was like listening to a client for a long time—hours, days.

To be clear, I love stories about pets: short stories. I love to hear one or two anecdotes about my patients as I examine them. It is what adds flavor to my day and usually makes me smile. There is the dog that separates out his kibble, by shape, and then eats one shape at a time. There is the dog that brushes his own teeth if you give him a tooth brush. There is the hound who decided, untrained, to monitor his owner’s glucose and wake her if she dropped too low. Who wouldn’t love hearing about all of these cool things?

People who have MMS usually are talking about a dog, have no time restraints, do not rely on communication for an income and are possibly lonely. They usually relate one story after another and another and another, with no room for me to excuse myself. They rarely relate anything unique—they are stories of regular dog behavior, like Marley, that the owner does not realize is common. If you are worried that you may be bogging your vet down by some MMS, here are the signs:

Your vet quits asking you questions.
Your vet is painfully smiling like a baby with gas.
Staff randomly enter the room, repeatedly, asking if anything is needed (the staff is flagging your chart, I promise).
Your dog is no longer nervous and is in fact curled up and is snoring.
A visit has lasted 40 minutes longer (or more) than the 15 minutes for which you were scheduled.

I am sure that there is rehab or a pill out there for MMS sufferers. Admitting the problem is the first step….

Good Thing He's Got Big Paws

2012-02-20T06:40:00.001-08:00

I really enjoy my seasoned citizen clients. Especially the ones, like my grandma, who have reached the stage of life where the filter has come off and they just don't care.

Had a nice old lady recently with her beagle mix that she adopted from the local shelter when her husband died. She needed company, and this guy was the perfect fit for her. She brought him in, along with her adult daughter and son-in-law... a real family visit.

The exam started with my looking at the dogs eyes and ears, then looking in the dogs mouth. We all were making small talk until the nice old lady said, "His penis is small." Not knowing how to respond, I just smiled and shook my head. Her daughter responded with, "Mom!"

Then the nice old lady said, "But at least his paws are big!" (I still refuse to believe that nice old ladies think like this.) At this point everyone in the exam room was laughing.

I looked her square in the eyes and said, "It's a good thing he only needs his penis to urinate."

God bless our senior citizens. We're all gonna be there someday.

Truth or Consequences

2012-02-19T18:28:00.000-08:00

A veterinarian of my acquaintance related the story of a new client visit. Middle aged male owner with a dog. The tech who had led the client to the room and performed the usual temperature, respiration, pulse count met the doctor in the hall as she headed toward the exam room.

“The pulse and respiratory rate are up, but he won’t tell me anything. No history. No nothing. I’m sorry. That’s all I have.”

“Well….he’s a big help. OK, thanks. Not your fault. Hang close while I talk with this guy.”

The doctor enters the room, the client standing next to the exam table, the mixed breed thirty pound dog in repose upon it.

“Good afternoon Mr. Quiet. I’m Dr. VBB. Pleased to meet you. So, what’s up with Friskie today?”

“You tell me.”

“Excuse me?”

“You tell me. Show me how smart you are.”

A moment’s pause as the doctor regrouped.

“OK, Mr. Q…Is Friskie sick, or do you think he has been injured?”

“You tell me.”

“Excuse me for a moment, please.”

The doctor leaves the room and wanders over to the receptionist’s desk.

“Mr. Quiet…Did he give you any reason why he brought his dog in today?”

"Nope, not a clue."

Dr. VBB walks to her office and then back to the exam room. She re- enters the room and Mr. Q is standing there, arms folded across his chest. She plops the old snow globe onto the exam table next to Friskie. There is no water in the globe. The large crack in the glass is obvious.

“See….it’s broken. My crystal ball is broken. So you have to help me a little here, Mr. Q. Why did you bring in Friskie today?”

“You are the second vet I seen today. The last guy couldn’t tell me anything neither. You people have a lot of nerve charging us for the nothin’ you do.”

“The best doctor in the world is the veterinarian. He can’t ask his patients what is the matter-he’s just got to know.”

“What?”

“Will Rogers said that. Smart man, Will Rogers. But he had that one wrong. We don’t ‘just gotta know’. We need a little information to help us figure out what’s wrong with our patients. We are not psychic. And we don’t have a crystal ball. Now, if you won’t give me any information about Friskie, I’ll just thank you for wasting my time and move on to my next patient.”

“I think Friskie has cancer.”

“OK, what is Friskie doing that makes you think he has cancer?”

Mr. Quiet finally rattled off the list of things Friskie was or was not doing that suggested he wasn’t quite right. Dr. VBB asked a few questions, which Mr. Q answered. Then the doctor did her physical exam, noting that the poor dog’s gums were pale and his pulses were in fact too rapid. The doctor got permission to run some blood tests and take an abdominal radiograph. Mr. Q took a seat.

The blood count showed anemia, and the odd cells present suggested a hemolytic anemia. And the spleen was enlarged on the xray. Friskie had immune mediated hemolytic anemia. Very serious, but treatable. After treatment, Friskie is doing much better now.

Veterinarians are quite skilled at reaching a diagnosis when a patient like Friskie shows up in our office ill. We utilize three sources of information. We take a careful history of the problem from the owner, perform a thorough physical exam, and reap the answers that our tests can yield. These three sources of information feed into our brains and generally a diagnosis flows out.

If we get bad information, if the owner for instance, gives us bad information, we get sent down the wrong path, and that does not help. What we need from owners are their observations, but not their conclusions. Pardon the ego, but we are better equipped to form conclusions once we have the three sources of information, than the pet owner armed only with their knowledge. That’s what all those years of training, and retraining, and experience nets us. But the real skill we acquire over the years is the ability to coax observations out of a client who only wants to give us their conclusions.

One of my oldest friends, and most difficult client, is a retired physician I’ll call Dr. R. He was a skilled physician, but through all the decades I’ve known him, he has never noticed that his knowledge of human medicine doesn’t always translate well into veterinary medicine. Each and every time he has brought an animal to me with a problem, he has already reached a conclusion about the cause of the problem, and of course, already laid out his preferred treatment. And over all these years, and all those pets of his, he has yet to be correct. And no, this has not altered his style one lick.

Many years ago, Dr. R brought in a kitten he had found. The little tyke was not doing well, and he had that all figured out. He had even picked out the antibiotic he wanted to use. All he needed from me was to be the source of the drug he wanted. I of course, wanted to do an actual physical exam after he told me how the kitten was acting. The heart murmur surprised me, for I had never heard such in a kitten. I was convinced the poor thing had a birth defect, a heart problem called a PDA. I had heard the classic sound of a machinery murmur. Dr. R didn’t believe me, and off he went with his kitten.

The phone call came a few days later. The kitten had died with classic signs of congestive heart failure. Dr. R thought it was pneumonia, and he was going to show me the error of my ways. Would I be willing to do an autopsy? Meet me at the clinic.

Tiny thing on that big table, with the big light shining down. Dr. R standing beside me as I opened the chest. The lungs were severely congested. And right there, at the top of the heart, that extra blood vessel that is a patent ductus arteriosus, and it kills by causing lung congestion. Dr. R wasn’t convinced, but there it was.

Years later he called. He thought his old poodle had suffered a stroke. Bring it on down, and I’ll take a look.

“So, why do you think FIFI has had a stroke?”

“Well, it’s obvious. She has been eliminating in the closet for a week. She won’t go outside to poop or pee, but does it in the closet. She clearly isn’t acting right. She must have had a stroke.”

My physical exam was normal. All the blood tests were fine too. I gave him call and asked a few more questions. Turned out FIFI didn’t want to go through the doggie door to the back yard. And so she was pooping and peeing in the closet.

“Anything happen to FIFI in the back yard recently? Could she have been spooked by a raccoon or a coyote? Did she get injured by the doggie door?”

“No, of course not.”

“What happens when you let her out the front door?”

“Haven’t tried that. What’s the use; she’s had a stroke.”

“Let me know what happens when you let her out the front door.”

Turns out, FIFI was just fine in the front yard, and this continues to this day. Don’t know what spooked her out of the back yard, but I doubt it was a stroke.

Las Vegas Baby!!

2012-02-18T13:35:00.002-08:00

If you notice that posting is a bit, um...light, that is because a large number of us are in the process of converging on Las Vegas for a vet conference. I heard a rumor that some might even be wearing a VBB t-shirt. Yes, we have t-shirts.

Those of us that were not able to ̶g̶o̶ ̶b̶l̶o̶w̶ ̶a̶ ̶w̶a̶d̶ ̶o̶f̶ ̶c̶a̶s̶h̶ ̶i̶n̶ ̶a̶ ̶c̶a̶s̶i̶n̶o̶ attend a really huge continuing education conference will try to make up for this.