Thursday, December 15, 2016

Do They Know It's Christmas?

The short answer is no.

The longer answer also features the word no but has more shading and nuance. But before I get into that let me reassure you (or warn you?) that this is not a typical veterinary Christmas blog post. I will not be discussing the health hazards of chocolate and tinsel, as you are all smart people and know this stuff already. Nor will I be discussing the moral hazards of forcing your cat to wear a little Santa suit or strapping reindeer antlers to your dog's head, as I know I will not be able to dissuade you from doing so anyway. (It's an uncontrollable urge made worse by the advent of social media. Laws are needed. Blog posts are helpless against this urge.)

No, instead I will explore the question in the title. "Do they know it's Christmas?" No, they do not know it's Christmas, but they do know that "something" is up. And it makes them nervous. Now, to be fair, some of that "something" is can be exciting and fun. Social dogs will enjoy sniffing the unusual people coming over and self-confident cats will enjoy secretly licking the turkey. These are the exceptions though. Most pets are merely confused and confusion leads to stress. Moreover, the majority of adult dogs and cats are deeply conservative (in the "small c" sense). Bliss for them is every day unfolding precisely like every day before it did. Bliss for them is the glorious routine. Everything. The. Same. Every. Day. Everything!  You know this already. God forbid you get up at 7:05 instead of 7:00.

Christmas has the potential to mess with every element of this glorious routine. Furniture is moved. A giant tree is placed in the house and covered with a myriad temptations you are forbidden to touch. A freaking giant tree! Festooned with shiny toys for Pete's sake! Your walks are changed or - gasp - cancelled. Your mealtimes become more erratic. Random people come and go. Uncle Darryl keeps insisting that yes you do love to have your furry tummy rubbed, but you don't and you bite him and people call you crazy. And your humans stay up late and sleep late. And all kinds of stuff is left laying around that you get yelled at for checking out. The list goes on. Christmas is stressful enough for many people, so just imagine how bizarre and unsettling it is for your dog or cat since they do not even know it's Christmas.

So what can you do? Cancel Christmas? Sure, go for it. "Vet Approved". However, that's going to be unrealistic for most of you, so instead my recommendation is that you simply keep an eye on the importance of routine. Feed the same foods at the same times in the same amounts. Go for the same walks at as close to the same times as you can manage. Keep scooping that litter box. Set reminder alarms on your phone if you are worried you will forget or get distracted by the Christmas chaos.

And if you are going to put reindeer antlers on your dog, don't tell too many people, least of all your veterinarian.

Saturday, November 26, 2016

Bottom Ten Countdown

Today marks exactly one year since my first Vetography post. I am very grateful to all my readers and for the support they have given the blog. In celebration of Vetography's first birthday I am going to list the ten least popular posts. If this seems strange, here is my logic - I figure that if you're reading this you are probably already familiar with the most popular posts. Now I know that some, or even many, of the least popular posts have probably earned their low rank, but perhaps some just slid under the metaphorical radar.
So, the Bottom Ten Countdown!

10. Distemper: it might not be what you think it is.

9. Flealess in Winnipeg.

8. A useful liquor finding dog.

7. Of thunder phobias and doggles.

6. Too many big words and what to do about them.

5. Cool heartworm facts.

4. Mostly about my first pet and partly about a savage pocket gopher.

3. Respect the tough bunny.

2. The fish that almost killed me.

And least popular of all!
1. Why your 100 lb hairy northern rescue dog is related to a chihuahua.

For those who really want to know, there's a list of the top ten on the side of the desktop version of the blog...

Thursday, November 24, 2016

The Stoic And The Cassandra

"He's not in pain doc. I checked him all over. Felt everything and he didn't react. I don't know why he's walking like that. Maybe there's something stuck in his paw that I can't see?"
Jake had come in with a pronounced limp and Mr. Hudson had done exactly what any concerned pet owner would do and tried to find the sore spot. Some variation of this scenario plays out every day in the average small animal practice, sometimes several times a day.

I knelt down and greeted Jake, a friendly collie / lab / shepherd mix, and gave him a couple of his favorite liver treats. He wagged his tail and was going to try to lick my face, but I moved his head aside to begin my exam before he could. I don't mind the occasional dog "kiss", but I knew that Jake was also a notorious poop eater. I began to palpate and manipulate each limb from the toes to the top, starting with the apparently normal ones and finishing with his right hind leg, the one he was limping on. (Incidentally, everyone thinks there is something stuck in the paw, but that is very rarely the case unless you see the dog chewing at the paw.)

"Like I said doc, I already did that and I couldn't find anything that hurt."
Jake didn't react for me either, but I did feel a subtle swelling in his right knee joint and he had what we call a "positive drawer sign", in which the tibia (shin bone) is able to slide forward relative to the femur (thigh bone), a bit like a drawer opening slightly. This meant that Jake had torn his cranial cruciate ligament, called the anterior cruciate ligament, or "ACL", in humans. So, isn't that painful? If so, why wasn't Jake reacting? Yes, it is painful and Jake was not reacting because he is a stoic.

Not that many dogs or cats have human "ouch, that spot hurts" reactions to pain. Some do, but most don't. Most are either stoics or Cassandras. The stoics, like Jake, prefer not to show any sign of pain. This is in part because in nature showing pain can make you an easy target. This is especially true of prey species such as rabbits who are ultra-stoic, but it is also true of social predators, such as dogs, who might be in danger of losing status. That said, there is tremendous individual variation and tremendous breed variation.

So, if stoics won't let you identify the location of the injury because they won't show pain, what do Cassandras do? In their most extreme form Cassandras scream if you take a small step in their general direction. If they do let you examine them, they will show what seems like pain (more screaming) even if you are only vaguely in the vicinity the problem area. You might be able to generally localize the problem as "front end versus back end", maybe, but that's not all that helpful.

As a sweeping generalization, dogs are more likely to be stoics and cats are more likely to be Cassandras, but there is a lot of cross-over.

What is the poor veterinarian to do with the patient that not only refuses to speak English but is likely a stoic or a Cassandra? As Jake's story illustrated, we perform a specialized kind of physical exam where we feel for what might be swollen, out of place, loose and yes, in some cases sore. Sometimes xrays are needed. And sometimes even then we have to make educated guesses. Thank goodness for education!

Saturday, October 29, 2016

Spay Day

This November 2 the Manitoba Veterinary Medical Association is sponsoring "Spay Day". Assuming the Hudson Bay Company's lawyers remain quiet the event will feature significant discounts on spaying and neutering at participating clinics.

I've written about neutering before ( Spay Day is the perfect opportunity to address the other half. Let's start with that weird word, "spay". It's made a long journey from the Latin "spatha", meaning broad sword (kind of alarming...), and from which we also get spade and spatula, to the Old French "espeer", meaning to cut with a blade, and then over to England where it turns up as "spaier and spaied" and where things get... weird. There it was first used to describe a specific way of dispatching a deer with a thin blade during the hunt, but in 1410 there also is reference to "oon spaied biche lesteth lengere in hure bounte than other ii that byn not spaied". How they managed to "spaied" the "biche" and have her survive in 1410 is unclear, but henceforth the word was associated with the removal of ovaries from prized hunting dogs, and from which the evolution to the modern usage is obvious.

I'm sorry, that's probably way more than you wanted to know about that, but I was on a roll. In any case, yes, it's a weird word.

The technical term is clearer though: ovariohysterectomy. How is that clear? Just break it down: ovario = ovaries, hyster = uterus (ok, that bit's not clear) and ectomy = removal. In fact, this may be a useful thing to know. Any surgery ending in the suffix "ectomy" involves removing something. So when your own doctor starts saying blahblahectomy, pay close attention. For the record, the suffix "otomy" means making a temporary hole somewhere and "ostomy" means making a permanent or semi-permanent hole somewhere. Come to think of it, you should probably also tune in when the doctor says blahblahostomy...

Now that I've squandered half the post on terminology, let's move on to something useful - questions I have been asked about spaying.

The big one: I won't let my dog out to get pregnant, so why spay?
We have a saying, "all pets get spayed, it's just a question of whether it's an elective or an emergency procedure." This is because of something called pyometra. People will sometimes argue that they do not want to spay because it is "unnatural", forgetting that what nature intends is for the animal to become pregnant with every cycle. When this does not happen and they unnaturally cycle "empty" there is a significant risk that the open cervix and waiting uterine bed will invite bacteria in, causing a life threatening pyometra infection. According to one study 23% of intact female dogs under the age of 10 develop pyometra. The rate goes up quickly over the age of 10.

Ok, got it, but why not just a hysterectomy?
To begin with, it's not any easier or quicker as the ovaries are right there by the uterus anyway and while it would be just as effective in preventing pregnancy, leaving the ovaries behind would allow her to continue to have heat cycles. And why is this a problem? In dogs this is a problem because 12 to 16% of dogs who have gone through a heat cycle will develop mammary (breast) cancer whereas almost no dogs who are spayed before the first heat develop this. Many of these are benign cancers, but they still require surgery, often many surgeries, and some are malignant. In cats it's even worse as 90% of mammary tumours are malignant. Moreover, anyone who is thinking about leaving the ovaries in their cat has not spent quality time in the company of a cat in heat.

Yeah, but what about the risks?
There is always some statistical level of risk with any surgery and general anesthetic, but this is an extremely routine and safe procedure in veterinary medicine. In the 26 years I have been in practice I cannot recall seeing a single death related to a spay. That's not to say that it can't happen, but the risk of death due to pyometra and mammary tumours are an order of magnitude higher.

But what about these longer term knee joint risks I've been reading about?
Clever you. Nothing in the world or in life gets any simpler with time, does it? Everything becomes more complex. Yes, in the last few years more evidence has come to light linking early spaying in some breeds with an elevated risk of tearing the cruciate ligament in the knee (called the ACL in humans). What is meant by early and how much is the risk elevated? I'm going to be a wimp and tell you to ask your veterinarian. This really does have to be addressed case by case as a number of factors come into play.

So, mark it in your calendar: Manitoba Spay Day, November 2, 2016. I suspect most of you reading this have pets who are already spayed, so use that day to congratulate them on their spayedness.

Thursday, October 13, 2016

A Dog's Mind

"What do you suppose is going on in his mind?" Mr. Reynolds asked, smiling at Alf. Alf, his twelve year old lab cross, sat primly beside him, staring at me, not blinking, his eyes tracking my every move.
"We can only guess," I replied lamely, as I leafed through Alf's file trying to decipher the scribbles.
"He's totally focused on you. Paying close attention to everything you do. Watching to see if you reach for a needle or a treat!"

Focus, attention, watching. Fully conscious and aware. Mr. Reynolds was absolutely right.

For most of Western history we believed that animals were not conscious in the same way that humans were. We believed that they did not have a "mind". We believed that their behaviours were only the products of unthinking reflexes. In the 17th century Renee Descartes famously stated that an animal crying in pain did not actually feel it the way we did, no more than a machine felt the noisy grinding of gears. Denial of animal consciousness persisted deep into the 20th century. In fact, I am ashamed for my profession that up until the 1980s it was unusual for veterinary schools to teach much about pain control, in part because of lingering doubts regarding animal consciousness.

But here's the funny twist to the story: it is actually our own consciousness that we should be doubting.

Our species developed language that allowed us to organize complex societies, create astonishing technologies and, ultimately, conquer the world. However, this language ability lies like a heavy blanket on top of our consciousness, often smothering it. What we call "thinking" is often just a garbled torrent of words inside our head. Usually these words are just pointless rehashes of old conversations, rehearsals for future conversations, looping snatches of song lyrics, half remembered to-do lists etc.. Honestly, what was the last truly useful thought you had? And chances are it popped up unbidden in a rare quiet moment rather than out of the churning river of internal chatter.

Animals, on the other hand, do not have words. They do not plan conversations or construct lists of chores. They exist in a state of pure consciousness and pure awareness, with absolute focus and attention. Their minds are filled with what is right in front of them, right now. This is akin to what people who meditate attempt to achieve. Sure, memories and anticipations intrude for them too, probably in the form of smell pictures, but far more than us they are present in the real world in real time, moment by moment, while we unconsciously drift along and then wonder where all the time went. Or wonder whether those last few traffic lights really were green.

I gave Alf both a needle and a treat. And then I went back to trying to figure out the file while wondering whether my next appointment was set up and what that thing was that I forgot to say and then remembered and then forgot again.

Alf was looking at the door.

Monday, September 26, 2016

Cat Goes Mad

While hiking in England a headline in a small town paper caught my eye: "COW BRUTALLY ATTACKS OAP". Yes, it was all caps. In fact, those four words were the only thing on the front page. (By the way, "OAP" means "old age pensioner". I had to look it up.) In any case it brought to mind a story my wife told me about a similarly startling headline in the Winnipeg Sun when she was growing up. Apparently the front page screamed, "CAT GOES MAD", accompanied by a picture of a suitably concerned looking elderly woman sitting on a couch festooned with doilies. And this got me thinking about rabies in cats. That's how that funky old train of thought sometimes goes. One minute you're thinking about oaps and the next you're thinking about feline rabies.

Rabid cats came so readily to mind because just prior to leaving for England I had a telephone conversation with a client about the subject. As I outlined in the last post I don't always have a minute-by-minute overview of my telephone messages. In fact an hour or more can easily go by before I see them. On this particular morning I opened the message center on my computer to find a series of increasingly frantic sounding messages from Mr. Stirling:
-Please call. Thinks Buttons has rabies.
-Urgent: Very concerned about his rabid cat.
-Called again!!
Intrigued, I called Mr. Stirling back.
"Hello, I understand you are worried that Buttons might have rabies?"
"Yes! She's not acting like herself at all!"
"How so? Can you describe what she is doing please?"
"Usually I keep the bedroom door closed at night, but two nights ago I left it open and she came into my room in the middle of the night."
"And then she jumped on me and sat there for a while. I woke up but I didn't move. Then she bit me!"
"Oh dear. Did she break the skin?"
"No. I guess it was more of a nibble than a bite."
"Hmm. Anything else?"
"Yes! Then last night she did the same thing, except without the bite. That time she just purred loudly."
This was beginning to shape up like a Monty Python sketch.

I have a great deal of faith in the shrewdness of my readership, so I'm confident you can more or less reconstruct my response and the rest of the conversation. No, Buttons did not have rabies. Buttons was bored and lonely and wanted to play. Mr. Stirling was relieved. He called back the next day to apologize for overreacting. There was no need to apologize. I would much rather people took rabies "too seriously" than not seriously enough, because that side of the coin is all too prevalent.

I am sometimes asked how many cases of rabies I have seen in my patients. The answer is zero. Shallow thinkers will take that as evidence that vaccination is not necessary. This is of course the wrong conclusion. The right conclusion is that it is evidence for the effectiveness of the vaccination program. Otherwise it's a bit like saying, "See my house has never burnt down so I can start letting the kids play with blowtorches." Countries without comprehensive rabies vaccination programs have shockingly high rates of the disease. 20,000 people die of rabies every year in India. Twenty thousand people die.
It is one of the ugliest deaths imaginable. And the number of animals dying of it must be an order of magnitude higher.

So please, if you are at all concerned that your cat or dog (or cow) has gone mad, please do not hesitate to call. We won't laugh. (Unless you use a Michael Palin voice.)

Wednesday, September 7, 2016

Why Hasn't The Doctor Called Me Back Yet!?!?

My father was dying of brain cancer. He had a glioblastoma removed from his left prefrontal cortex and was given months to live. He was a physicist and his intellectual capabilities were unimpaired but his judgment and social graces, such as they were, had been annihilated. Told by the surgeon that they removed the tumour using suction my father delighted in pointing to the large scar on his forehead and loudly telling strangers that his brain had been removed by a vacuum cleaner. There were other surprising moments of levity, but otherwise this was a bleak time. He was too young for this and we were not ready to lose him. Not nearly.

A few weeks after the surgery an issue arose regarding one of his medications. I don't recall which or why, but I do recall being quite anxious about it. It was not an emergency by any stretch, but the problem was beginning to spiral in our minds, so I phoned his oncologist to ask about it. He was unable to come to the phone, so his receptionist took a message. Ten minutes went by, then twenty, thirty, forty, fifty... By the time a full hour rolled around I had checked twice to make sure the phone was working (dial tone? yes) and my pacing had become obsessive. I couldn't read. I couldn't listen to music. I couldn't concentrate on chores. I couldn't think about anything except a recursive loop of 'Why hasn't he called me back yet!?!?'
'It would only take a minute!'
At the two hour mark my tone had darkened . I was much quicker to anger in those days.
'I can't effing believe this! He can't find a minute to help a dying man?'
'The arrogant prick!!'
I was beside myself. I left another message, trying to make my voice sound like cold steel, gleaming with sarcastic fury.
But at least another hour passed before he called. When he did his tone was disarmingly pleasant and empathetic. He took the time needed to properly answer my questions and the problem was sorted.

All these many years later I still cringe when I think of how I reacted that day. I cringe in part in recognition of the different person I was then and I cringe in part in imagining how my own clients must sometimes feel when I am slow returning their calls. I know that most people are reasonable and understanding, but I know that some must be just like I was - in a vulnerable and slightly irrational emotional state or perhaps even just unaware of the workflow in a busy clinical setting.

So for the latter group, it is probably worthwhile explaining the "type of busy" that we often are. In some jobs you can be very busy doing one thing. You have a single important task in front of you that is fully occupying your time, but you can take regular breaks from it to quickly address other matters as they arise. Veterinary (and presumably human medical) practice is not like that. We generally have numerous simultaneous demands on our attention throughout our entire shift. We are constantly in triage mode, figuring out in what order to do things so that the least number of people with urgent problems are left waiting the least amount of time. Moreover, for telephone messages specifically, in some cases it may be a few hours before we even see the message, let alone try to fit it into our triage. Another factor is that estimating the length of a phone call is notoriously difficult, for either the client or the doctor, so we are sometimes unwilling to take the risk and will leave it until a gap opens in our schedule or to the end of our shift. This is almost certainly what happened with my father's oncologist. It was closer to ten minutes than one and he was wise enough to leave it for the end of his day.

So, "How To Contact Your Veterinarian":
- By all means please phone if you have any questions.
- If you feel the question is urgent, tell the receptionist so.
- Ask for a realistic guesstimate on when you are likely to hear back.
- Please make sure the receptionist knows which phone number you can be reached at. Many files list multiple work and cell numbers for multiple family members in addition to the home landline.
- Please make sure you specify if there are times you will not be available to be called back.
- Please use email sparingly and only if you are ok with waiting for a day or two for a response. Sometimes we're quick with email, but sometimes we're not. For a variety of practical reasons it is not given a high priority.

(my dad and my brother, ~1970)

Monday, July 25, 2016

He Ate What...??? (Part 1)

This will be the first in an occasional series of short posts detailing the bizarre things pets will eat. Of course they will also eat terrible and harmful things, but I will stick to the more amusing stories that have a good outcome, so you can happily read without fear of needing to keep a box of tissues nearby.

The most recent entrant into the "He Ate What...???" Hall of Fame was Bouncer Rodgers. Bouncer is an aptly named young black Lab cross who was actually seen by one of my colleagues in the practice rather than me, but I was there and heard everything and I know she won't mind me using this story.

Bouncer was rushed in by Mrs. Rodgers one otherwise quiet Monday afternoon.
"I don't what's wrong with him! He was fine this morning and then just now I found him staggering, barely able to stand!"

Sure enough, although Bouncer could walk, he was extremely wobbly and kept falling over. His pupils were dilated and he had a facial expression that could only be read as pathetic confusion. As Bouncer was young and otherwise healthy my colleague immediately suspected poisoning and told Mrs. Rodgers that the next step was to induce vomiting. Mrs Rodgers readily agreed and the hapless Bouncer was taken into the treatment area to have his stomach emptied.

It's not always that easy to induce vomiting (nor is it always recommended - check with a veterinarian before trying to do it yourself), but with Bouncer it was gratifyingly easy and gratifyingly productive. Out came an enormous wad of green plant material and a small shiny tan coloured object.

Marijuana and a condom.

My colleague debated briefly how to present this information to Mrs. Rodgers, a conservative looking middle aged woman, but decided that the direct approach is always the best. There was a moment of silence as Mrs. Rodgers processed this. After being reassured that Bouncer would quickly make a full recovery her facial expression changed from concern to bewilderment to dawning realization to anger in a matter of seconds. It was like watching time lapse video of weather systems.
"My son! My son's room is in the basement. Bouncer was down there this morning..."

An hour or so later a very tall, very skinny, very ashen faced red-haired teenager came in to check on Bouncer. He didn't say anything to his mother and he studiously avoided making eye contact with any of the staff...

Thursday, July 7, 2016

Be Kind To Your Veterinarian

I came into this profession because of the animals and I have stayed because of the people. Not that the animals have become any less enjoyable, far from it, but because the people have become more enjoyable. Or perhaps more accurately my capacity to enjoy the people has improved. Regardless, it is the interaction with clients that "makes or breaks" most veterinary careers. So in aid of this, here is a list of the top seven ways clients can be kind to their veterinarian and improve that key interaction (listed from silliest to most serious):

1) Please do not talk to me while I am using the stethoscope. It is a listening device. I cannot listen to two things at once and make reasonable sense of either. 1 + 1 = 0. For the play along at home version, try following what your friend is quietly saying on the telephone while your toddler simultaneously tries to tell you a story about a problem in the bathroom.

2) Please do not take personal offense if I tell you that your pet is overweight. A client once threatened to punch one of my partners for saying this. It is merely a statement of objectively measurable fact. I am not judging you. I have a volleyball shaped cat. I get it.

3) Please avoid introducing multiple chronic medical concerns in an appointment you have booked for a simple check ear. My schedule is generally full and the receptionist has booked enough time for you for what she understood the visit to be about. Normally I am delighted to discuss the multiple chronic medical concerns, but we do need warning at the time of booking so that enough time is set aside. The domino effect of falling behind because of this can turn a pleasant day (sunshine! bunnies! roses!) into a hellish simulation of a combat zone (darkness! terror! chaos!).

4) Please do not show up at random hoping to catch me "when I have a minute" to ask me some questions. I never have a minute that is not scheduled (see above). And we are too polite to tell you that, so I will squeeze this conversation in and fall behind in my appointment schedule (see above again). Please make an appointment, leave a phone message or email if you have a question.

5) Please do not ask me why I can't figure out what's wrong with your pet moments after you've declined most of the tests I've recommended. For every set of symptoms and physical exam findings there are dozens of possible causes. My crystal ball is broken today. In fact, it is broken every day and I see little chance of it being fixed any time soon...

6) Please do not confuse anecdotes with statistics. Making decisions about your pet's health based on anecdotes would be like me taking up heavy drinking and smoking because my grandfather drank an entire bottle of wine by himself every day and smoked steadily and lived in great health to 93 years of age (a true story actually). So when I say, "vaccinations are proven to be very effective at preventing disease" (statistic), do not reply with "our farm dogs never had shots and they got pretty old" (anecdote). Statistics get a bad rap when they are used to mislead, but without them we'd still be chanting and sacrificing chickens whenever anything went wrong.

7) Please do not bring me your pet when you've already made up your mind to euthanize, telling me that you've "tried everything" when what you've actually done is "tried everything you and your neighbour whose daughter used to work at a kennel could think of and everything on the first page of Google hits". Maybe I could have helped if you'd contacted me much earlier before things went this far, or maybe not. We'll never know now will we? This makes me very sad.

And who wants to be sad?

Fortunately the above applies to a small minority of clients, so I'm not sad very much. And I've never been punched by a client. And I only drink part of a bottle of wine.

Monday, June 20, 2016

When The Sky Goes Boom

Eddie sat beside Mr. Parker and looked at me expectantly. Expectantly because I had already give him three of his favorite liver treats. 'If three, why not four, or even fourteen?' he seemed to be thinking. Regardless, he did not look especially nervous or anxious today.  However, two days prior this 30 kilo lab border collie cross put a dog shaped hole in the Parkers' kitchen screen door. Then he ran flat out for at least four kilometers, through the hammering rain and deepening mud. The Parkers found him several hours later, limping down a grid road, panting, bedraggled, exhausted. They brought him in to get him checked over because he still had a bit of a limp and because they didn't want this to happen again. Eddie had a storm phobia and it was the start of the summer storm season.

Many dogs have storm phobias and noise phobias. These are actually two different things, although there is considerable overlap. About 90% of storm phobia dogs also have a noise phobia to sudden loud sounds such as fireworks and cars backfiring. Curiously, the reverse is only true 75% of the time (noise phobia dogs who also have a storm phobia). Many also have other anxieties such as separation anxiety, but certainly a large number, like Eddie, do not. There is evidence that storm phobic dogs may also be reacting to the change in atmospheric pressure and to the flashing light in addition to the noise of the thunder. It is well known that dogs can hear the thunder approaching long before we do. This is a key part of the problem as many anxieties are worse when there is a wind up anticipatory phase.

I talked to Mr. Parker about three types of solutions: training, tricks and drugs. Most of the time you have to use at least two out of the three. Eddie needed all three.

Training is the best long term solution if you can get it to work. The chances of success are higher if you can consistently put the time needed into it. That said, I don't judge people who are unable to. My own dog still chases cars, steals entire cakes and barks at the vacuum like its the anti-Christ. There are a few training approaches, but the one I like best is counter-conditioning. For this find a long thunder storm sound clip. Start to play it very quietly and briefly while feeding your dog treats or his meal. Keep it below the level that sparks anxiety. Over time gradually increase the volume and duration, but always backing off immediately if he shows any signs of being worried. You are trying to create a deep association between a temporary bad thing, storms, and a permanent good thing, food. For most dogs the goodness of food will overpower the badness of storms, just so long as you take an extremely careful and gradual approach. This is best done well before storm season.

The tricks are fun. Get out you credit card and start surfing:
There are Mutt Muffs to block sound:
There are ThunderHuts, also to block sound:
There are Doggles in case the lightning flashes are part of the problem:
And there are ThunderShirts, to calm by creating a secure feeling "hug":

Of these I have only seen the latter in action. My observation has been that the ThunderShirt seems to help many dogs, but that's it's unusual for it to be the sole answer. Looks cool though. Especially when matched with doggles and mutt muffs. A cheap DYI solution is to let the dog tell you what reduces the noise and flashes for him. This means leaving all your (inside!) doors open and letting him find a bed to crawl under or closet to stuff himself into.

And then finally the drugs. Some clients glaze over for all the above and radiate a strong "just give me the drugs" vibe. There are several but none are perfect and all require you to be very watchful of the weather forecast as they won't work once the anxiety is already building up. It is good to have some medication on hand for when you know that a storm is predicted later in the day. Most drugs are given an hour or so before the expected onset of anxiety. In severe cases it may even be worth having anti-anxiety meds prescribed to be given on a daily basis right through the storm season. Regardless, talk to your veterinarian as there is definitely no "one size fits all answer".

Ultimately some counter-conditioning, a ThunderShirt and an alprazolam prescription were the ticket for Eddie. He had a great summer until they went camping in an aluminum trailer and were caught in a hail storm...

Monday, June 6, 2016

An Open Letter To The Client In The Park Whose Name I Forgot

Dear Client,

It will come to me. Just give me a little longer and it will come to me. But in the meantime I do apologize. It was clearly awkward for both of us. You saying a friendly and hearty "Hi Dr. Schott!" and me an, I hope, equally friendly but unfortunately slightly less hearty "Hi.....!".

I recognized you for sure. I just couldn't remember your name. Or that of your pet. Or pets. Or their species. Or whether they were still alive. So I had to substitute "How's insert name of pet(s) here doing?" with "How are you?", which is ok, but not as good. I wish you had your dog(s) with you. That would have helped jog my memory. Should that have been a clue? Maybe you don't have dogs?

But the awkward bit was when it was obvious after you stopped to chat that I should introduce my family. This is when I could tell from your face that you realized I didn't remember your name. You're a kind and understanding person so you weren't hurt or disappointed, rather you felt bad that you put me in the position of having to try to remember. And I felt bad that you felt bad on top of the feeling bad that I couldn't remember. And now you probably feel bad that I felt bad that.... Never mind.

So here's the thing. I'm sure that you are smart in addition to being kind and understanding, so you know this already, but it still bears explaining. The thing is that you have a box in your brain marked "veterinarian" and another marked "dentist" and another marked "piano teacher" and so on. Each of these boxes contains one, or perhaps at most a handful, of names and faces. Pretty straight-forward to connect those names and faces. I have a box in my brain marked "clients". It contains upwards of 6,000 names and faces.  I have a decent memory, but... Well, you get it.

What you might not get though is that you don't even necessarily want to be one of the names I can connect to faces. Just like with a newspaper where far more bad news gets printed than good, far more names connect to faces when they are associated with something bad. It's just more memorable.

So, if I do remember your name it often means one of two things:
(a) You are one of those wacky clients staff talk about all the time.
(b) Your pets are way too sick way too often.

In other words, you should feel really good that I didn't remember your name. But give me a bit more time and I will remember. It's on the tip of my tongue. Just like when you're trying to remember that actor who was in that movie with what's-her-name who use to be married to what's-his-name in that other movie, you know? Right? Yes, that one.

Once again, my apologies.


Dr. Philipp Schott BSc DVM

Thursday, May 26, 2016

There Are Worms In My Heart

Ok, not technically right in the heart itself, but more on that later. And not technically my heart, at least probably not, but more on that later too.

It is "Heartworm Season" in Manitoba. Yes it is. If you work in a veterinary clinic it is unmissable, unmistakable, unforgettable. It's not that our wards are packed full of dogs sick with heartworm disease, rather it's that the testing for and prevention of has to occur in a fairly narrow calendar window. Compounding this, for most people it's convenient to get all the other annual stuff done at the same time since they've dragged Fido in anyway (incidentally, no actual dogs are named Fido, or Rover, or Rex, or Spot; some cats are though). Consequently most of us see as many patients in a week in the spring as during a month in the winter.

I don't want to waste time spewing Basic Heartworm Facts. You can get those from, gulp, the internet (try or, better still, from your friendly neighbourhood veterinarian. Some of you even are "your friendly neighbourhood veterinarian", in which case said spewing would be even more time wasting. Instead I want to touch on a few of the more unusual Cool Heartworm Facts (ok, some of you will consider these Gross Heartworm Facts, but I think they're cool).

Cool Heartworm Fact #1
Heartworm has probably been around forever (or a very long time that may as well be forever) with possible reports in the 1500s. It was first positively identified as such in 1847 in South America and then 1856 in the southeast USA. It has gradually been spreading north and west since, arriving in Manitoba in the 1980s.

Cool Heartworm Fact #2
However, despite that spread, large areas such as Saskatchewan, the Arctic and the West Coast do not have it. Not necessarily because of a lack of mosquitoes, but because of a lack of positive dogs already there. Mosquitoes are just flying syringes moving heartworm from one dog to another. This is why the mosquito paradise of northern Manitoba is heartworm free.

Cool Heartworm Fact #3
Heartworms can be huge, up to 35 cm / 14 inches. And they can be numerous, with infestations of over 100 worms reported.

Cool Heartworm Fact #4
The above reported size and numbers are very rare, so most of the time "heartworm" is a misnomer. Most of the time the worms are hanging out in the pulmonary arteries leading away from the heart. Only if there are more than about 25 do they actually back up into the heart. But pulmonaryarteryworm is so much more unwieldly. Unless you are German like me, in which case you prefer more accurate long unwieldly words.

Cool Heartworm Fact #5
Wildlife can get heartworm. Logically foxes, coyotes and wolves are most at risk, but it has also been reported in bears, raccoons, leopards, sea lions and, oddly enough, beavers. Cats and ferrets are at some potential risk as well depending on where you live, but that is a big subject best addressed separately.

Cool Heartworm Fact #6
Perhaps the coolest fact. Humans can also get heartworm. Heartworm positive mosquitoes bite us all the time and release microfilaria (baby heartworms) into our bloodstream all the time, but fortunately we are not good hosts so 99.9%  (and probably a few more 9s after that) of the time they die. However, there have been at least 80 cases reported in humans in the US, mostly in the lungs but occasionally - shield your eyes if you are squeamish - the eyes and the testicles (!). These have mostly been mild infections. The main problem is that on lung x-rays a heartworm lesion looks very much like a tumour, prompting further invasive tests. Radiologist call it a "coin lesion". So if you overhear the interns whispering about this while they shoot sideways glances at you, ask about heartworm...

Thursday, May 5, 2016

So You Want To Be A Veterinarian

Veterinarians love animals. This is a fundamental axiomatic truth, much like pilots loving airplanes, chefs loving food and librarians loving books. Given that the love of animals is widespread, the ambition to become a veterinarian is widespread as well. This spawns tremendous competition for the few spots in the veterinary schools, meaning that very high marks are required to get in. Consequently, and quite logically, it is animal lovers with excellent grades who populate the ranks of future veterinarians. But sometimes a third essential ingredient is missing. In fact, this ingredient is rarely even discussed, but it is the one element that more than any other determines whether these keen and idealistic students ultimately become happy veterinarians who maintain some of that keenness and idealism or whether they become disillusioned veterinarians who burn out and succumb to cynicism and regret.

That third essential ingredient is a love of people. The same high marks would easily get any prospective veterinary student into human medical school, but for many this is ruled out not just by the pull of their love for animals but, unfortunately, by the push of their, shall we say, discomfort around people. This is a problem. I tell every prospective veterinary student that comes through our clinic that veterinary medicine is not an animal business that happens to involve people, but a people business that happens to involve animals. I tell them that the sooner they understand this and accept this and embrace this, the sooner they will come to love their profession.

And why is that? The answer should be obvious. Until the dogs and cats and guinea pigs and rabbits and all others come marching in on their own replete with the ability to talk (and pay) we will have to work through their owners and keepers and guardians. You can only help animals by communicating clearly and empathetically with people. Moreover, even when this miraculous Dr. Dolittle day arrives we will still have staff to deal with. And staff are most assuredly people.

I have been chair of our professional disciplinary body for a number of years and can attest without a flicker of hesitation that far far more veterinarians come to grief through an inability to connect with people than through any failings in their surgical skills or medical knowledge.

And once you "get it" you see how fabulously interesting people are in all their freakish variety. And you see that we are a privileged profession as we are permitted to help people who are ironically often at their most human around animals. I remember with startling clarity the specific moment when this dawned on me. I was just about to enter the clinic through the back door. It was a sunny summer morning and as I opened the door I realized for the first time that I was looking forward to seeing the clients who were starting to become my regulars as much as I was looking forward to seeing their pets. It was at this moment that I decided to stay in practice and not go back to school to pursue research, which had been my original plan.

But all that said, the love of animals is still at the heart of things. I often think of a card we got many years ago from a young child who boldly wrote "I want to be a vat!" Yes, I too once aspired to be a large container, but I became an animal doctor instead and I have never regretted that decision.

Monday, April 18, 2016

That Distemperment Shot

You don't have to be in practice very long before you have someone come in with an out of control puppy, expressing relief that the puppy is about to get his "distemperment shot".
"He's getting that distemperment shot today, right doc? I can't wait until he settles down..."
"Um... yeah..."

To be fair it is an odd and confusing name. Its origins reach back to before the advent of modern medicine. Before the mid 19th century the prevailing theory was that good health resulted from a balance between the four "humors", also called "tempers": blood, yellow bile, black bile and phlegm. You can still see it in the language today - melancholy is Greek for black bile and indeed depressed people were thought to suffer from an imbalance of the humors with an excess of black bile. (For the record, actual bile is a greenish yellow, but you probably already knew that.) Dogs stricken with distemper were so profoundly ill and could potentially spew phlegm, bile and blood (in the stool), so they were though to be dis-tempered.

And what is it actually? Distemper is a disease caused by a virus that is related to the human measles virus, although the symptoms are very different. Dogs with distemper often have a constellation of symptoms including fever, heavy nasal discharge, breathing difficulties, vomiting, diarrhea, blindness and eventually nervous system symptoms up to and including seizures in some cases. It is spread through the discharge from a sick dog. The incubation period is up to about five days between exposure and first symptoms. There is no specific treatment, only supportive care which often has to be quite intensive to prevent the patient from succumbing and even so, about half of infected dogs will die.

Confusingly, "feline distemper", more correctly called panleukopenia, is not related to canine distemper. It is in fact a close cousin of canine parvo virus.

Incidentally though, canine distemper can also spread to wildlife. Foxes, coyotes and wolves are definitely susceptible and a mutated form has spread to seals as well where it has devastated some populations. Oddly, some marsupials are also vulnerable and distemper is theorized to have played a role in the extinction of the magnificent Tasmanian Tiger (also called the Thylacine).

That's all the bad news, but the good news is that the vaccines are extremely effective and safe. Consequently distemper is now very rare in areas where vaccination is common, such as here in the city. When we do see cases it is usually in puppies from remote communities. In the Arctic and in isolated First Nations communities it is still rampant.

Actually, I lied. That wasn't all the bad news. There is a worrying trend among some pet owners to refuse vaccination. How often to booster is a subject of some legitimate debate, but not to vaccinate at all is foolhardy (to be polite). It is still a small minority and fortunately their pets are protected by the fact that the majority of their neighbours are more sensible and responsible, so the virus cannot yet gain a foothold, but this could change. On the humans side whooping cough outbreaks are beginning to become more frequent in areas where vaccination rates are dropping. Whooping cough is sometimes fatal in babies.

Distemper is not just sometimes fatal.

And training is the remedy for "distemperment". Now, if we had a shot for that...

Monday, April 4, 2016

The Wild Boreal Chihuahua

By far and away the two most common questions I am asked by new puppy owners are "how big will he get?" and "what breed is he?". These are not subjects we are taught in veterinary school and although with experience our educated guesses improve, they are still just educated guesses. The frustrating part is that some clients judge our overall skill and knowledge as veterinarians based on these guesses and it can take years to live down a bad one. Consequently I've honed the art of being vague while sounding knowledgeable.

The question of breed guessing came to mind the other day when my own DNA test results came in. My wife had given me a "23 And Me" analysis as a gift and one of the findings was that I am 3.2% Neanderthal, which puts me in the 99th percentile of all people tested. I like to think that nobody would have guessed this, but my wife disagrees.

A similar test exists for dogs and I have had numerous clients over the years test their mixed breed dogs, perhaps frustrated by my knowledgeable vagueness.

The most popular of these tests purports to identify a truly astonishing range of breeds, from Affenpinscher to Yorkshire Terrier, including such oddities as Bergamasco, Glen of Imaal Terrier and Xolitzcuintli. I cannot vouch for the accuracy of this apparent extreme specificity and in fact, at the risk of hearing from someone's lawyer, I will confess to a tiny bit of skepticism. In contrast, for the majority of my DNA "23 And Me" is only willing to express confidence that it is generically "European", despite the fact that most of my known ancestors, back 13 generations in some cases, are German. But back to dog breeds I can say that despite the impressive list, the tests are missing one type and that that gap trips people up here, and I suspect throughout western and northern Canada.

For example, Mr. Jackson came in the other day with Bruiser, a 120 lb mound of muscle and fur that eats squirrels for lunch and begs to go outside when it's -40C. Mr. Jackson was perplexed because Bruiser's DNA breed test marked him as having a lot of Chihuahua. Bruiser resembles a Chihuahua the same way Mike Tyson resembles me.

So here's the thing.

The thing is that many of our clients get their dogs from shelters and the shelters here are full of dogs from remote First Nations communities in the north. So, am I saying that the northern Manitoba bush is seething with packs of wild boreal Chihuahuas? No. What I am saying is that when the indigenous people came to North America across the Bering land bridge around 15,000 years ago they brought dogs with them. These dogs are not any particular breed, they are simply, and beautifully I might add, "dogs". The Aztecs began breeding these dogs into a specific line that became what we now know as Chihuahuas. The DNA test then sometimes picks this up as the closest match for Bruiser and his friends. Look carefully at the next Chihuahua you see and take note of the curled tail. The other breeds with curled tales are all northern breeds in the family group sometimes called the Spitz type. Other members of this group are Chows and Akitas, who's DNA  sometimes also cross-reacts with our reserve dogs.

Fortunately for Mr. Jackson's ego Bruiser's test also highlighted husky and lab. Chihuahuas are actually very tough, but they do have an image problem with some people. Especially people who name their dog Bruiser.

I have a lot more to say about purebreds, crossbreds, mixed breeds etc., but I'll save that for another day.

Wednesday, March 23, 2016

Fish Of Death

Or at least "Fish Of Extreme Pain".
Soon after I graduated I decided to try to develop a sideline in fish medicine as way to  make myself more useful to the practice. Or at least less useless. The sensible among you will immediately see the logical flaws in trying to get people to bring their pet fish into the clinic. There are several such flaws. But my employers, bless them, were indulgent and patient with me. To give myself some credit, I was nothing if not enthusiastic. I made sure I had the best text books and I set to work writing brochures on a variety of fish health subjects. And then I waited for patients... and waited...

Until one day the owner of a nearby pet shop came in carrying a large ice cream pail. I'll call her Carla because that's her name and because even on the very off chance that she'll read this I don't think she'd be at all fazed by an implicit accusation of attempted murder.
"What have you got in the bucket Carla?"
"A fish! Actually two of them."
Imagine my excitement. Just imagine it.
I strode over to Carla and her bucket. Not walked, but strode. I peered into the bucket. Two fish indeed: a large, roughly eggplant sized, colourful fish with bold orange and white stripes and long feather-like things sticking out all over it, and a small, roughly walnut sized, dull brown coloured fish. There were two really interesting things about this scene. The first was that the big fish was a lionfish. (More on why that's really interesting in a moment.) The second was that the little fish was head-first halfway into the lionfish's mouth.

"Carla, that's a lionfish!"
"Yes, it's really expensive and it's choking on that stupid catfish!"
Which fish was more stupid struck me as a debatable point.
"I see..."
"Can you get the catfish out?"

So this is where I should explain what's really interesting about lionfish. Those cool looking feathery things are actually sharp spines (easily sharp enough to slice exam gloves) and are covered in venom. The venom has an entertaining array of potential effects including, and I quote, "extreme pain, nausea, vomiting, fever, breathing difficulties, convulsions, dizziness, redness on the affected area, headache, numbness, paresthesia (pins and needles), heartburn, diarrhea, and sweating. Rarely, such stings can cause temporary paralysis of the limbs, heart failure, and even death". Well, only "rarely" death, so that's ok.

"Well, can you?"
The lionfish actually looked distressed. The catfish was presumably even more distressed, but it was hard to tell.
There was no way to grasp the lionfish without touching the venomous spines and the standard aquarium wrangler's net wouldn't help, so, after a bit of pondering I came up with an idea. I found two long pieces of wood - this was a while ago, so I don't remember exactly, but they might have been leftover molding from a reno - and a large pair of surgical forceps. I wielded the wood pieces with my left hand like giant chopsticks to restrain the lionfish while carefully submerging my right hand with the forceps to firmly grasp the tail of the catfish.
Deep breath.
Then I yanked.
The catfish was free! However, I am sad to report that it did not live to enjoy its freedom. The catfish immediately succumbed to its injuries, or to the shock of the whole unpleasant event.  But the lionfish survived. And I survived. A mortality rate of only 33%. Not bad for a novice fish vet.

But that was pretty much the end of my short-lived fish vet career.

Years later we were in the Cayman Islands and met a local with a boat full of lionfish. It turns out that they are an invasive and aggressive species that is decimating native fish populations. The government there was paying a bounty on them. And they are steadily spreading northwards...

Monday, March 14, 2016

Please Repeat That In English

Every veterinarian gets this from time to time. We have just finished painstakingly explaining a complex medical condition to a client and then, after a brief silence, the client says, "Please repeat that in English!".
We have failed to communicate clearly. We have used jargon or at least we have used words that didn't seem like jargon to us, but clearly seemed that way to the client.

Why does this happen? Three reasons:

1) When we are first starting in practice we sometimes use big words and convoluted explanations to demonstrate our knowledge and win the client's trust in our competence. I looked very young when I graduated in 1990. I got called Doogie Howser a lot (the reference itself tells you how long ago that was...). Consequently I tried to impress with Latin. Look, I really am a doctor! I don't do that anymore. I don't need to. Now I get called "the old guy". I'm undecided which is better...

2) We don't want to insult clients by "dumbing it down". In reality only crazy people are insulted and there is no pleasing them anyway. Most clients who prefer that you use more technical language will politely tell you so, and often be pleased that they have the opportunity to tell you so.

3) We have "The Curse of Knowledge". This is the big one and the hardest one to overcome. A Stanford University researcher conducted an experiment whereby she asked people to tap out the rhythm of a well known song, like Happy Birthday or Mary Had A Little Lamb, and then asked other people to guess what the song was based on the tapping. The tappers predicted that 50% of the time the listeners would guess correctly. In reality only 3% of the listeners did! The tappers had "The Curse of Knowledge". It was impossible for them not to hear the tune in their minds while tapping and it was almost as impossible for them to be able to imagine someone not hearing it. Once you know something it is very difficult to recreate the state of mind that exists when you do not know it.

So, veterinarians can no longer put themselves in the minds of people who don't know the difference between a colon and a duodenum, or between an antibiotic and an anti-inflammatory or, my favorite, between the abdomen and the stomach. We're not alone though. All professionals do this. Actually, all people with specialized knowledge do. Car mechanics and accountants are the worst in my experience.

What can we do about this? If we have certain regular spiels we should try them out on our unsuspecting family members or friends. And we should try to put ourselves in that unknowing frame of mind as often as possible. For my part, I am trying to learn to play the mountain dulcimer (yeah, yeah, whatever) and whenever my musical friends start talking about "the key of..." and "quarter tones" and whatnot they have The Curse of Knowledge and I feel like the drooling guy in the wool cap who delivers the fliers. This make me humble. This gives me empathy, and empathy is a key ingredient in effective communication.

I'll close with an illustrative anecdote. A few years ago an elderly lady came in with a little white fluffy dog. We'll call her Mrs. Winterbottom and the dog Priscilla. Mrs. Winterbottom was a very elegantly dressed woman with a lovely summer dress, matching shoes, matching handbag and even a matching hat. She spoke very properly and politely.
"Mrs. Winterbottom, we're going to need to run a fecal on Priscilla."
Blank look.
"I'd like to do a stool test."
Still blank.
"Um, so, do you think you can collect one of her... um... bowel movements?"
Dawning comprehension and a big smile.
"You mean bring her shit!"
I think I'll stick with "bowel movement".

Monday, February 29, 2016

Getting Tutored

In a straw poll veterinarians stated that their favorite The Far Side cartoon was the one where a dog being driven to the vet brags to his friend, "I'm going to the vets to get tutored!".
This is funny several ways, but the way that is relevant to this post is that it highlights the confusion around the terminology. Even well educated clients will approach the subject cautiously, "I guess it's time to get Fred... is it spayed, or neutered?".

For my lay readers, neuters are for males and spays are for females. At the risk of sounding unprofessional, a handy mnemonic is that the word neuters contains the word "nuts". Which brings me to the next area of confusion: the widespread misunderstanding of what this procedure actually entails. I'll focus on neutering and leaving spaying for another post lest I blather on too long.

So, the technical term neuter is actually orchidectomy. "So doc, you're taking out his... orchids???" Yeah, so that's why we don't use that term at all. A more descriptive term is castration. Large animal veterinarians routinely and happily call it that. The companion animal world is different however. Picture a sweet little old lady with her tiny fluffy white poodle sitting primly on her lap. He has a blue bow at the base of each ear and smells faintly of peaches. Now picture me saying, "Yes, Mrs. Butterworth, it's time to castrate Baby." Moreover, there are people who think that castration means cutting the penis off. Yikes! Yes, there are such people who believe such things. And no, we never do that (except in very special circumstances in cats who have frequent urinary obstructions, but I digress).

What do we do then? We do this: we surgically remove the testicles (remember? neuters contains nuts?). Sometimes I'm asked why we don't just perform a vasectomy instead. This is because reproductive control is only one of the reasons to neuter. In many cases we would also like to remove the ability to produce testosterone in order to eliminate the risk of testicular cancers and chronic prostate infections later in life, as well as to help curb marking behaviour, roaming and male-on-male aggression. You'll note that I wrote "help curb". Too often people use neutering as a substitute for training. It is not. 

Now I'm going to wade into a controversial area. Virtually all cats are neutered. The exceptions involve people who have had their own olfactory nerves removed. However, not all dogs are neutered, at least not at the traditional six months of age, and - here is the controversial bit - this might be ok. There is evidence now that breeds of dogs that are prone to cruciate knee ligament ruptures (typically large breeds) may be at increased risk if they are neutered before their bodies are fully mature. This might mean waiting until 18 or 24 months for some breeds. There may be other risks associated with early neutering in some dogs as well. This is a complex area of ongoing research, so please (please please) speak to your veterinarian first before making any decisions based on what you have read here or elsewhere on the internet. A lot of what we do has evolved from boilerplate "one size fits all" recommendations to a discussion of options tailored to the risk/benefit ratio specific to your pet. And this is a good thing. A confusing thing, but a good thing.
I guess that was more like toe-dipping rather than wading...

Finally, I'm going to leave you with this:
This 100% for real. And endorsed, it seems, by Kim Kardashian. Yes, finally there is help for the owner who wants to neuter their dog, but has an unhealthy attachment to the appearance of his scrotum. Unfortunately it's not the help these people actually need.

Comes with a nifty bumper sticker though!


Thursday, February 18, 2016

The Ineffable Weirdness of Dentistry

A routine part of small animal practice is recommending dental work and then having the pet owner react as if you have just recommended Spanish guitar lessons for their dog or a set of encyclopedias for their cat. Some people view veterinary dentistry as evidence that we've gone too far in treating pets like people. These people (thankfully increasingly a minority, but a very annoying one) put it in the same category as pink leather jackets for chihuahuas and spa days for cats.

This can even be true when you show the client gum lesions that are exuding pus. Guaranteed if you showed them lesions exuding pus anywhere else on the body they would be horrified. They would expect immediate curative action. But not so for the teeth.

Why is this?

In part it is because the teeth are generally not visible. That being said, I would like to note that sometimes the same people will then go on to show me a minuscule lump somewhere deep in the dog's groin or be genuinely concerned when blood tests reveal a more minor issue in an internal organ that is definitely not visible.

Another factor is that animals do not show dental pain. This sometimes results in the reverse problem wherein the client will absolutely insist the cat isn't eating because his teeth are bad. There are 968 common reasons for a cat not to eat and that is not one of them. It is a very uncommon reason for them not to eat. But the pain question is also only a partial answer as many other conditions that are not painful elicit far more interest from the dental skeptical clients.

So then, what is my theory?

My theory is that we must blame the weird history of the human dental profession. Objectively speaking teeth are part of your body. Actually, subjectively too. Teeth are part of your body: objectively, subjectively, factually. Agreed? Why then is it the only part of your body to have an entirely separate profession devoted to its care? It turns out to merely be an accident of history. We could have just as logically ended up with a separate profession focused on our fingers and toes. "I'm off to the digitist dear!"

Before the 20th century there was a division between physicians who examined sick people and prescribed primarily quack remedies and "barber surgeons" who used their sharp razors and steady hands to perform surgeries ranging from lancing boils to amputating limbs as a sideline between hair appointments. Some also had a set of pliers handy to pull teeth (as did some blacksmiths). That was the sum total of historical dentistry - yanking festering molars. Carpenters and other tradesmen made false teeth. As regulations began to gel the more ambitious of the razor wielding barber surgeons craved the prestige the physicians enjoyed and those professions gradually merged, more or less accidentally leaving tooth pulling behind and unregulated. Later on the medical colleges who began to shut down all manner of other trades that were "practicing medicine without a license" (midwives come to mind) ignored the tooth pullers because they didn't seem to be a threat and, some will darkly say, because they were of similar social backgrounds.

This has left us with a situation where in Canada medicare will pay to operate on your infected toe, but not to operate on your infected tooth. A situation where you have two incompatible sets of records regarding your health. A situation where some people see their teeth as being divorced from the big picture of their health. Arbitrary and weird. Dentistry is weird.

And for us poor veterinarians who have successfully kept the entire body of our patients under one umbrella, it is a situation where some pet owners have a different mental box for teeth than for the rest of Fido/Fluffy's body.

p.s. My dentist is great and not all that weird. I just think if he were an MD dental specialist my life as a veterinarian would be simpler.

Monday, February 8, 2016

When Darkness Overwhelms

This post is going to be a departure from my usual lighthearted (or lame attempt at lighthearted) tone. This post is going to be about suicide in the veterinary profession. Statistics are not available for Canada, but in Britain two separate studies found the suicide rate among veterinarians to be four times that of the general population.  I personally knew two colleagues here in Manitoba who took their own lives, and in 2014 a prominent and very well liked behaviour specialist killed herself, drawing some media attention to this little known aspect of the profession.

To the casual outside observer this will be unexpected and possibly even slightly bizarre news. Aren't veterinarians generally well respected? Isn't it a secure, interesting and rewarding career? Isn't it a dream job for so many people? Isn't it wonderful to heal innocent animals and get paid to play with fluffy kittens? All of that is true. Except the part about the fluffy kittens. Why then does darkness overwhelm so many of my colleagues? There are three significant reasons.

The first reason is that veterinary medicine attracts a disproportionate number of idealistic, introspective and sensitive people. Sensitive to the point of neurosis. This is true of all of the health professions, but it is more so in veterinary medicine. Some of these introspective people are more comfortable around animals than around other people. They do not fully understand that it is actually a people job that happens to involve animals rather than the other way around. Grappling with this reality can be very problematic for some. Add to this the fact that competition to get into veterinary college is extremely high and success favours perfectionists who can produce high marks. Perfectionism and idealism are fated to be brutally ground down by the chaos of reality in practice. And then their innate sensitivity lays them wide open to the second reason.

The second reason is the inherent and often surprising multi-factorial stress of the job. Of immediate relevance to sensitive people is the fact that a veterinarian is at times marinated in death and grief. There are weeks, many weeks in fact, where I perform one or more euthanasias each day. Sobbing, crying, wailing, grief-stricken people, some of whom we've known for many years, are a routine part of our day. And for those of you who think this is simply a question of overwrought crazy cat ladies or frou-frou poodle people who too much resemble their dogs, I have two things to say to you. The first is that if you have not experienced a deep bond with an animal then you are missing out on a key human experience, one shared by people from all walks of life, all backgrounds, all levels of intellect. It is one of the richest threads we weave. The second is that you have no more right to judge this than a blind man has to judge a photography exhibit. Simply trust me that these are normal people with legitimate and intensely felt grief.  Additionally, a veterinarian is expected to be competent across a range of species and a range of disciplines from dentistry to radiology to dermatology to... you name it, wedging the door wide open to so many opportunities to fail. And remember: "sensitive". Mix sensitive and failure and see what happens. And I haven't even discussed the financial stress of trying to be affordable to clients yet still be able to service sometimes enormous debt burdens and meet payroll etc.. Or the stress of being a manager when you went to school to be a vet, not a manager. Or the angry clients. Or the angry spouse because you're stuck late again.

The third reason is that we know how easy it is. How easy it is to die. Those daily euthanasias are consistently peaceful, painless, quick and reliable. One hundred percent reliable. We know the dose. We know the delivery methods. We have the drug right there. Can you see now why it happens too much?

What can you, the reader, do? You can't do much about the first or third reason, but you can do something about the second. If your friend or family member is a veterinarian, do not trivialize their stress. Understand that James Herriot is a crock and that the real job is far more complex and serious than you imagine. Offer to listen with an open heart.

And what about me? Well, fortunately I had a "happy optimist" chip deeply implanted at birth. The zombie apocalypse could roll into town and I would say, "Cool, this will make for some excellent photos!" And, "Maybe brains are better with a bit of smoked paprika?" I have painted a bleak picture when in fact most veterinarians are fine, even better than fine, but burn-out is very real and for a small tragic minority, suicide is very real too.

This post is for Terry and Craig and Sophia.

Monday, January 25, 2016

Chomp Chomp

Many people assume that veterinarians get bitten a lot. In the ultrasound referral part of my practice where I don't know the patients I often get comments accompanied by a wry chuckle along the lines of, "It's a good thing you're seeing 'Killer' today, 'Precious' would take your arm off!" (This also illustrates a general principle that there is an inverse correlation between the name of the patient and its behaviour.) I'll sometimes catch people mentally counting my ten intact fingers. The truth is that I've only been badly bitten twice. I've been in practice 25 years and see somewhere in the neighborhood of a couple thousand patients a year. These are much better odds than you probably guessed.

That being said, the exceptions form an indelible mental rogue's gallery. Every veterinarian has one of these.  At the top of mine is Oscar Westenheimer. Oscar was a little chihuahua cross (of course he was) who resembled a baked potato with four toothpicks stuck in for legs and an angry walnut for a head. Oscar was in for a nail trim. We knew that he had anger issues so we were careful to muzzle him. The nail trim was done up on a table and afterwards Oscar was set back on the floor and then the muzzle was taken off. Have you guys been to Sea World? Or at least seen a video clip of when the trainer stands on a high platform and holds a fish out for Shamu who leaps cleanly out of the water to get the fish? Well, Oscar was Shamu, I was the inadvertent trainer and my right index finger was the fish. How that little baked potato could catch so much air astonishes me to this day, but as soon as the muzzle was off, up he came. Sailing through the air, fangs sharpened and then chomp, right through the fingernail. Off it came. This hurt. Fortunately the client wasn't there so I was able to verbally express myself in an honest and uncensored fashion.

The second time was more surprising. Despite the name I generally trusted Peaches so I thought nothing of examining her mouth. I carefully opened her mouth, holding the upper jaw steady with my left hand while gently levering the lower jaw down with that poor right index finger. Chomp. I still don't know why. She always wondered what it would be like? I didn't wash my hands thoroughly after lunch? Early onset doggie dementia?  

This is why we get bitten so rarely (relatively). The great majority of dogs will warn you using body language. I was probably too intent on chatting with the owner and on Peaches' tartar to tune into her warnings.

Occasionally though you will encounter a sociopathic dog. A dog who does not conform to the norms of dog communication. A dog who is going to bite you just for the heck of it. So although it was not a "bad bite" (i.e. no wound dressings and antibiotics required), Daffodil deserves honorable mention in my rogue's gallery. She was a Brazilian German shepherd. Very expensive, very fancy. She sat perfectly beside the owner in the waiting room, just as a very expensive, very fancy dog is expected to. The owner and I were talking and I was leaning on the reception counter, perhaps as far away from them as the distance across the average living room. Daffodil looked very relaxed and at ease. And then, before I could flinch or even blink, she was across the room with her jaw clamped on my thigh. Half a second later she was back beside the owner, sitting primly again, as if nothing had happened. The owner seemed unfazed. I, however, was thoroughly fazed and excused myself to go take my pants off in the washroom. She hadn't broken the skin, but had given me temporary red dental chart tattoo.  

What about cats? I've been lucky. Cats also generally give plenty of warning. A cat that is going to bite you radiates tension like a force field. I've also become very adept at carrying them gingerly like unexploded ordinance and handing them over to my staff, who are almost magical in their ability to manage the exploding cat. Usually. I do get scratched with tiresome regularity though. Once the nails went right through my lab coat and through my shirt, raking me across the chest and giving me a faintly piratical scar that I bear to this day.

But Oscar, oh Oscar, when I am one hundred years old and drooling and cannot remember that shoes go on my feet and not on my hands I will remember you.

Monday, January 18, 2016

The Purr

It's time for a cat story. Just a little one. A little one about one of this mysterious species' most asked about mysteries: the purr.

Little gladdens the heart of a veterinarian like a healthy kitten check-up, especially if it is after a long series of messy, complex, sad, smelly or chaotic appointments (in other words - a normal day). You walk into the room, introduce yourself and then proceed to stroke a fluffy happy kitten while discussing various easy kitten care subjects with the happy owners. I imagine that when some of you picture the life of the small animal veterinarian you picture something like this. Well, it represents somewhere between 2 to 3% of what we do (see reference to sad, messy, complex etc. above), but it is a lovely 2 to 3%. After the stroking and chatting you begin to examine said kitten. This is also pleasant as it hasn't learned to hate you yet. Then you place the stethoscope on the kitten's chest and hear.... amplified purring. This may sound cute, but it is annoying as you really do want to hear the heart and lungs. There are a few different tricks to get them to stop,  but my favorite is to carry the kitten with the stethoscope still in place over to the sink and then turn on the tap (slowly and carefully, lest you freak the kitten out and the visit shifts into the messy, complex, chaotic column). This almost always surprises them enough to make them stop purring for a few seconds.

The owners typically chuckle about this and then sometimes ask, "So why do they purr?"
My answer: "We don't know."
I was tempted to end the post there, just for dramatic effect, but that would be irritatingly glib. And it is also disingenuous as although we don't know for sure, we do have some decent guesses now.

First of all, what actually is a purr? There used to be all kinds of wacky theories, but the answer ends up being the most obvious one: the purr comes from a vibration in the larynx (voice box) controlled by the rhythmic pulses of a neural oscillator in the brain. Ok, the "neural oscillator" part may not be that obvious, but you might have guessed at the voice box. Cats with laryngeal paralysis can't purr. Some of you may have a cat that doesn't seem to purr. This does not mean that they have laryngeal paralysis as that is quite rare, but rather the thinking is that some purr so quietly that you cannot hear it. These cats will still have a vibrating larynx, but you would have to know exactly where to feel, how to feel and, most importantly, when to feel in order to detect this. The number who truly never purr is likely really very small, like people who truly never smile.

Which brings me to the main question, the why. Is it like smiling? The answer that is emerging from the fray of competing theories is that purring does resemble smiling in that it is used for social bonding, especially between kittens and their mothers (and cats and their owners with can openers). Moreover, like smiling, it results in endorphins being released. This also explains why cats don't just purr when they're happy, but also when they are injured or in pain. The endorphins provide natural internal pain relief. (Does this means you should smile when someone punches you in the gut? Of course it does.) Even cooler, to my mind, is the well supported suggestion that the vibrations from the 25 - 50 Hz frequency range of a cats' purr actually encourage tissue healing. The time may not be far off when we are told to strap a cat to our knee when we tear our ACL. Obviously some practicalities would have to be worked out first.

So, is there any downside to purring? Potentially yes: