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Wednesday, January 18, 2017

Poisonous Plants To Keep Away From Pets

Recently contacted me about an infographic they have on their website which lists nearly 200 poisonous plants, how toxic they are, which parts or toxic, and which species to keep away from them.  Honestly, this is one of the best summaries I've ever seen, so I'm sharing it here.  Please pass this around to your friends and other pet owners.  If you're having a hard time viewing it, click on the original link above.

Saturday, January 14, 2017

What To Do With FIV Positive Cats

A few weeks ago I received the following email:
We just had a stray cat euthanized because he had FIV and the vet recommend this because we couldn't bring him in with out cats and we couldn't keep him outside to spread the disease and he would have been hard to adopt out because of the FIV and he was a fighter.  He was sweet to us but had been in fights with area cats.  I am feeling extreme guilt over this.  Did we do the right thing?  It seems like we did what was best for us and maybe not the cat.  I am devastated and am feeling like a horrible person.
I've had this exact same situation come up a few times in the past.  It's never easy to handle, and always a tough decision.
Feline immunodeficiency virus (FIV) is very similar to HIV in humans.  In fact, some veterinary researchers on the disease have collaborated with HIV researchers and vice-versa.  The virus can lay dormant in a body for years and become active at any time.  Once it activates and affects the body it proceeds very similar to AIDS in humans, suppressing the immune system, lowering white blood cell counts, and making the patient much more susceptible to infections.  When the virus starts along this path there really isn't anything we can do.  We don't have a wide range of antiviral drugs in animals like there are in humans, so essentially a diagnosis of FIV is a ticking time bomb and an eventual death sentence.
Once a diagnosis of FIV is made, the cat may live a few more weeks or several more years.  There is no way to predict what their lifespan will be.  But we know that they won't live as long as an uninfected cat and will be more prone to health problems.  At some point in the cat's life the virus will lead to its death.  Unfortunately there is currently no treatment or cure for FIV, so once a cat has it they are infected for life and are at risk of spreading it to other cats.
So what do you do when a cat is diagnosed?
I 100% feel that these cats need to be isolated indoors.  If you allow them to continue to roam outside they are most likely spreading the virus to other cats and therefore giving more animals a death sentence.  When they are "fighters" as in the email above this is much more likely, and every time it fights with another cat it is probably passing along FIV.  If a cat can be kept indoors they can still live a good life until they become seriously ill, and I've known many FIV positive cats who have lived more than five years indoors before succumbing to the disease.  So I don't think that a cat with FIV but no symptoms automatically needs to be euthanized.
Some people can't keep the cat inside for various reasons.  Maybe they have other cats, and there is certainly a risk of passing FIV to the ones that person already has.  Some outdoor cats won't tolerate being kept inside and will be destructive with scratching and spraying.  So there are certainly situations where that cat can't be kept in the home.
What do we do then?  We can't keep the cat inside, but we can't let it outside to be a vector of infection.
As harsh as it may sound, the best option is often humane euthanasia.
Stop and think about it.  Is keeping that cat alive worth having a dozen more cats develop FIV?  While it sounds pretty cold and unfeeling I do believe in this situation we have to look at the greater good and the potential for the most harm.  It is a bit of an ethical dilemma, but I personally think that gently ending the infected cat's life to prevent infection in 20 other cats is justifiable.  It's not easy, but it's the best option in a bad situation.
With a stray cat kept outside a person also not know when that animal becomes sick.  A cat with active FIV may slowly die a miserable death somewhere in the woods or under a porch.  Do we leave them outside to have this eventually happen, or do we give them a quick, peaceful death before they suffer?
I have euthanized a few FIV positive cats in the exact situation described in the email.  I haven't enjoyed it but I also haven't felt guilty about it afterwards.  I don't think any pet owner should feel bad about making this choice, even if it's not ideal.  In the words of Spock in Star Trek: The Wrath of Khan, "The needs of the many outweigh the needs of the few, or the one."

Wednesday, January 11, 2017

Predator Birds And Small Dogs

Here's a question that in over eight years of blogging I haven't been asked!
We saw a bald eagle fly over our house the other day.  We've also seen hawks and owls.  My concern is our 13 lb dog's safety.  I was wondering if she wore a piece of clothing outside if that would somehow make her look less like an animal they would want to pick up.  I was just looking online and found this page that mentions different products that are on the market.  Do you know if any of these products are helpful?  At the end of the article it said eagles can only pick up 4-5 lbs but other places I read much larger.  Would love to know your thoughts.
When you think of a large raptor such as a hawk or eagle, you wouldn't think of them as a potential concern for your pets.  After all, that's just Hollywood, right?  You might think of it happening in a movie such as The Proposal (Ryan Reynolds & Sandra Bullock) but not in real life.  Isn't it a myth?
I'm sorry to say that it's not.  While rare, birds of prey will occasionally try and take off with a small dog.  I've had at least one client who lost a small dog to a hawk.  So this is one that is definitely not a myth.
Bald eagles prefer fish over small mammals, but other kinds of eagles may have more variety in their diet so it depends on what is native to your area.  Hawks and owls do prefer small mammals, but will eat just about anything they can get their claws on.  Since some of the larger raptors feed on rabbits, which can weigh 4-6 pounds or more, a dog about that size certainly isn't safe.  I don't have information on exactly how much weight a large predatory bird can carry, so I'm not going to try and hazard a guess.  Keep in mind that they don't always carry their prey away, and sometimes will kill and eat it on the same place.
What can a pet owner do?  The link above is pretty interesting, and I think those products have some potential.  It's the first time I've ever heard of them so I can't say whether or not they are effective, and I've never known anyone to try them.  But if I had a small dog in this situation it sounds like it probably wouldn't hurt to give it a try.  I would be slightly skeptical that a reflective surface would always work, as I would imagine it being less effective on a very cloudy day.  But the dog probably wouldn't look like prey with this on, so that's a good thing.  If we're merely going by whether or not it looks like prey to a raptor, you might achieve a similar effect with a colorful shirt or jacket designed for dogs.
I do recommend being aware of the types of high level predators you might have in your area, and for birds I would be cautious with any dog or cat under 15 pounds.  Ones under 10 pounds are more at risk.  If you know you have hawks, eagles, and owls in the area I wouldn't let your dog go outside unsupervised, and if you are in a very rural area you may consider only ever taking your dog out on a leash.  A raptor isn't likely to try and kill or capture a dog when a human is a few feet away, and if for some reason it did happen you'd  have your dog on the leash, preventing the bird from flying away with him or her.
Those of you who have small dogs living in the same area as raptors, I wouldn't panic.  These predators tend to prefer hunting without humans nearby, so most dogs will be safe.  The risk exists, but even then the incidents of this happening are very rare.  I still recommend taking some precautions because you don't want to lose your dog to a situation like this.

Tuesday, January 3, 2017

Case Management--Anxiety, Fear, Then Relief

As I've mentioned before, most vets (and medical professionals in general) really do worry about their patients.  I know that I do.  It's not uncommon for me to fret over a case for days, especially if it's complicated or doesn't go well.  Most of the time it's not my fault if things go bad, but I will worry anyway because I'm my own worst critic.
One of the surgeries that I occasionally do is to correct "cherry eye".  For those not familiar with the disorder, it is common in certain breeds (English bulldogs, Shar-peis, Shih-tzus, and cocker spaniels are the most prone) and results when the tear gland under the third eyelid becomes inflamed and prolapses.  This causes a very obvious red, fleshy bump on the inside corner of the eye.  If untreated there is a risk of chronic inflammation and damage to the gland, which is responsible for the majority of tear production in the eye.  We don't want to remove the gland because we would decrease the tear film and cause dry eye problems.  The only real fix is surgery.
The most common method, and the one that I do, involves making an incision on either side of the gland, forming a pocket under the tissues, placing the gland within this pocket, and then closing the edges over the gland with sutures.  Because the eye is so sensitive we use very small suture material, typically about the thickness of a human hair or smaller.  While the surgery is typically successful there is about a 20-30% "failure" or recurrence rate even with the best surgeon.  The gland can re-prolapse because the suture breaks, the technique was poor, the tissues fail to heal, or the inflammation is too persistent.  Most of these reasons have nothing to do with the doctor, which is why the failure rate is so high compared to other surgeries.
I've been performing this procedure for all of my nearly 20 years in practice and have become pretty proficient with it.  Though I haven't specifically tracked the numbers I would say that my recurrence rate is around 20-25%, right within expectations.  Even so, I really hate it when one of my patients has a relapse and I worry about whether or not my technique was correct or if somehow I had failed as a surgeon which led to the failure of the surgery.
A couple of months ago I had that happen.  About three days after the surgery the client called to say that it had prolapsed again.  I had her bring the dog in and it looked like the suture had broken.  We would have to repeat the surgery, and I said that I'd give her a $100 discount on the second procedure due to the inconvenience.  Even though it didn't look like it was my fault, I worried about it, and started to doubt myself.  I promised that the next time I did this type of surgery I would be even more careful with my steps and method.
That opportunity came in late November, with a shar-pei puppy who had both glands prolapse.  When I did the surgery I was extra-careful about my incisions, suture placement, knots, and generally everything that I could potentially control.  The surgery went well and the patient looked great post-operatively.  I was very hopeful that this one would be successful but I remembered my last case.
About 10 days after the surgery I came in to work and there was a note for me that the client had called and I should check the medical records.  My heart dropped into my stomach and my first thought was "crap, one or both of the eyes failed and relapsed".  I first saw the note around 8:15 am.  I didn't actually look at the record until around 5:00 in the afternoon.  I had time to do so, but was worrying about it the whole day.  I just knew that the client was calling to say that it had happened again and perhaps be angry that it had done so.  I always tell my clients two or three times what the rate of failure is, but that doesn't always stop people from being upset when it happens.  I dreaded what I would see in the notes.
As the day went on I started thinking and worrying even more, to the point of being a bit sick to my stomach.  I doubted my abilities, and even started thinking that maybe I should stop doing this particular surgery if I was going to have a high recurrence rate.  Maybe I should be referring them out if I wasn't going to get it right the first time.  Maybe I should never have attempted it in the first place.
So I finally steeled myself, gritted my teeth, and pulled out the medical records to read the notes from the previous day, preparing myself for the worst.
The client had called to ask if they could take the Elizabethan collar (e-collar or cone collar) off.
That was it!  The client wasn't reporting any problems, only asking if it was okay to stop using the e-collar!
I breathed a deep sigh of relief and called the client.  The dog was doing great and the eyes were perfectly fine.  There was no sign of any problems or any recurrence and his puppy was acting like nothing had happened to her.  We talked about taking the e-collar off and watching her for any other problems.
I had worried for nothing.  I spent almost nine hours being anxious for no reason whatsoever.  I had doubted my abilities when my personal success rate in these cases is right in line with the profession.
That's not uncommon for me and many of my colleagues.  Most of us care deeply to the point of doubting ourselves if something doesn't go exactly right.  It's easy to forget all of the "good" cases when we are presented with a "bad" one.  Many of us worry ourselves sick for things that are beyond our control.  Because of this veterinarians have a high rate of clinical anxiety and depression.  It's not easy having someone's beloved pet depend on you for their life and health.

Sunday, January 1, 2017

Welcome to 2017! Let's Hope It's better Than 2016....

It is now officially 2017.  Happy New Year!

As I look back and reflect on 2016, I can say that it has been successful and good for me and my family.  However, that hasn't been the case for the USA or the world. 

An incredible number of celebrities and musicians passed away last year, some of them particularly tragic whether due to their young age or because they were so beloved.  We had the most divisive, contentious, and horrible presidential election that I can ever remember, and most people are unhappy with the final result (and would have been even if Clinton had won).  Many of my clients lost old, cherished pets over year, including ones I've been seeing for many years.  For many people 2016 was pretty tough, and anyone on Facebook has surely seen the complaints and memes going around.

But 2017 is a new year.  Even though January 1st really isn't that different from December 31st and the days go on as normal, psychologically we look at the date as a turning of the page and a new beginning.

Let's hope that 2017 is better than 2016 was!  And if you had a great year, I hope that the new one is even better!

Tuesday, December 27, 2016

Reflecting On Great Clients

As 2016 winds down to a close I've been thinking about some of my really great clients.  I've been at my current clinic for almost 6 years, and some clients followed me over from my previous one.  This means I have a few clients whose pets I've been seeing for nearly a decade.  During that time you can really get to know people and develop a close relationship.  

Many small animal vets thrive on these relationships. It's certainly something that I enjoy, and it helps when I know not just the pets but the human family members as well.  While I can't say that I really like every single one of my clients (nobody can say that), there are many that with whom I have a special relationship.  For example I had one of my long-term clients invite me and my wife to a Christmas party at their home.  Unfortunately I couldn't attend due to other commitments, but it meant a lot to me that they thought to consider us.  Because I've moved around a lot during my career I haven't had these lengthy relationships with clients until now.

This time of year we typically have clients bring us Christmas cards and cookies, and they are always very much appreciated.  It really means a lot to me and my staff when somebody takes the time to stop by and deliver a card and food just to let us know that they appreciate us and what we do.  These kinds of clients really help make up for the difficult ones and are a large part of the reason why we as vets tolerate long hours, difficult work, and comparably low pay.  

When I was younger I said that I didn't like people, and for the most part I still don't.  People as a whole are rather difficult, and being an introvert I want to minimize interactions.  However, when I was in vet school I realized that I did like "good" clients and enjoyed helping them and their pets.  I am very nice and outgoing to all of my clients, even ones I'd rather not see, because my responsibility is to care for their pets and I believe in treating people as I want to be treated, not how they treat me.  But there are some clients that I look forward to seeing because I've known them for so long, they take good care of their pets, and they're fun to be around.  It's these clients that give me the motivation to come to work every day and make the effort in my job worthwhile.

So a big "THANKS" to all of my great clients that I've met and had over the year (and previous years).  You make my job easier and keep me smiling.

Saturday, December 24, 2016

Merry Christmas!

I hope that everyone has a very joyous Christmas season, however you may celebrate it.  Spend time with family, enjoy some gift-giving, and don't leave your pets out of the fun (though limit any treats to those specifically for pets).  But remember that the main reason we recognize this holiday is because of the birth of Jesus Christ, and what He has done for the world.
Merry Christmas, everyone!