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.