Thursday, August 9, 2018

Bee Med


One of the most fascinating aspects of this profession is the range of creatures veterinarians treat. Personally I have cared for animals from as small as a hummingbird to as large as a bull moose, although I will confess that both were while I was still in vet school. In my own pet practice the range is somewhat more restricted, running from mice to mastiffs. But my colleagues out there will attend to the full spectrum, from bees to whales. Whales, ok, you can probably picture that. Sort of. But bees? Surely I must be exaggerating or joking. I am not.

I am aware of at least three conferences this year that featured sessions on honey bee medicine. The Honey Bee Veterinary Consortium now has 345 American veterinarians listed in its database and there is also a British Bee Veterinary Association with a cool website (britishbeevets.com), as well as a Veterinary Invertebrate Society. The latter appears to be more focused on spiders and lobsters, but it is certainly interested in anything which creepeth or crawleth or buzzeth.

Ok, you can get the obvious jokes out of the way now. You must have a very tiny xray machine! It must be hard to give it a pill without getting stung! How do you take its temperature?! Har har. Nope, nope and nope. Bee medicine is like the medicine of many other food producing animals and is directed towards diagnosis and treatment of large groups at once rather than individuals. Dead bees are tested and then, if appropriate, something is prescribed for the entire swarm.

What has changed recently and made this something more than an obscure reference buried deep in the veterinary literature is a change in the laws governing antibiotics. Since 2017 in the US, and as of the end of this year in Canada, the regulatory authorities will require a veterinary prescription for most antibiotic use in bees. And a veterinary prescription requires a valid "veterinary - client - patient" relationship. Yes, the vet will have to have a relationship with the bee (bees). He or she will have to see them and make a diagnosis before anything is prescribed. This is because in the past bee keepers were able to buy the antibiotics over the counter and misuse, largely due to lack of knowledge and training rather than actual negligence, has led to antibiotic resistance and residues appearing in the honey.

So now vets will have to learn about "varroa mites" and "acarine mites" and "nosema fungus" and "small hive beetles" and "Israeli acute paralysis virus" and "black queen cell virus" and the wonderfully medieval sounding "chalkbrood" and "foulbrood", among many other bee ailments. Foulbrood, a highly infectious bacterial disease killing bee larvae, now affects about 25% of hives in Canada and is the main reason for antibiotic use. With correct diagnosis and careful prescription of appropriate antibiotics at the appropriate doses and times this can be managed better than it has in the past. Veterinarians to the rescue! Other veterinarians though - I'll stick to my mice and my mastiffs, and most of what's in-between. 

Thursday, July 26, 2018

The C Word


Yes, cats and dogs get cancer. And turtles, and goldfish, and budgies, and rats. Actually, especially rats. As a very general rule most diseases exist in some form in most animals. We are all really remarkably similar under the hood. Yet people are sometimes surprised to hear it. And of course they are upset to hear it. It is the most feared diagnosis after all.

But there are some things you should know about cancer. First of all, it is not one disease, but rather it is a large family of diseases. Really whenever cells begin to divide in an uncontrolled fashion it is technically cancer. Everything from that gross little warty thing on the top of Buffy's head, right through to the aggressive volleyball sized thing that caused Duke's liver to fail. When these dividing cells don't destroy important tissues or spread through the system we call it benign cancer. When they do, we call it malignant cancer. Fortunately most cancers are benign. To reduce confusion a lot of us try to avoid calling the benign ones cancer at all and will refer to them as tumours or growths, but you should always ask if you are unclear – is it benign or malignant?

The second thing you should know is that even malignant cancer is not a death sentence. In human medicine many cancers are increasingly viewed as chronic diseases that even if they cannot be cured, can be managed well enough to allow a good quality of life for a reasonable length of time. That is our goal in veterinary medicine too, with a strong overriding emphasis on the quality of life aspect. Ultimately it does not matter what label we put on the disease, what matters is what we can do to provide a good quality of life. The cancer label is not helpful – there are many non-cancer diseases that are worse than many cancers. To be sure, there are too many cancers where we have to move rapidly to a euthanasia conversation, but my point is to not view all cancers the same way as there are some that can be easily managed to provide that good quality of life for some time.

I am sometimes asked, “Aren't we just prolonging his life?” If I'm in the right mood and if I know the client well, my answer to that is, “Everytime you take a breath you are prolonging your life!” It's true. The name of the game for every organism is life prolongation, just so long as it is without suffering. An animal doesn't know how long it's supposed to live. It has no thought for tomorrow and no anxiety when I tell their human companion that we can probably only keep it comfortable for another six weeks. Each happy day for an animal during those six weeks is a happy day. It's that simple. We just want to string together as many of those happy days as we can.

The other stumbling block in treating cancer in pets is the word “chemotherapy”. Some people react quite strongly when I suggest that, as if I've now crossed a line into ridiculous territory. But chemotherapy just means drugs to treat cancer, and much like the cancers themselves, there is a huge amount of diversity in these drugs. The most common treatment for a malignant bladder cancer is the same drug we use for arthritis (a non-steroidal antiinflammatory). Used for cancer it is “chemotherapy” (oooh... aaah...). Used for arthritis it is not. Exact same drug, exact same dose. Even aggressive chemotherapy drugs that can have really unpleasant side effects in humans often have far fewer side effects in dogs (cats are a different story). And we have the huge advantage that if one of our patients does become sick on the chemo, we can just stop. At least we tried. The bottom line here is not to dismiss chemotherapy just because of the scary word. It's not for every pet with cancer, but it is for some.

And finally, I am often asked about cause. People will say, “But we feed her the best food.” Or they will ask about the lawn chemicals or the water or the neighbour's treats. The truth is that none of these have any bearing. Cancer in pets (and in people, a few uniquely human high risk beahviours excepted) is mostly due to three things: genetics, age and bad luck. The genetics is obvious as certain cancers are far more common in certain breeds. This doesn't mean that Fido's parents or siblings had to also have it for it to be genetic, it just means that the risk for an individual in that breed is higher, like playing with loaded dice. The age risk should also be obvious. As time goes on your DNA accumulates damage and errors, like an old car or old house, and some of that damage and some of those errors could lead to cancer. But the biggest factor is simply luck. The body of even the tiniest animal is inconceivably complex. When you begin to look at that complexity it is amazing that diseases and disorders such as cancer aren't actually even more common. Be thankful for what works and don't be afraid of what doesn't. Sometimes it's not as bad as you think. Be like your pet and ignore the labels and words and just work to make each day as good as possible and then enjoy that day.

Thursday, June 28, 2018

It's A Hell New World


When Isabel was little she wrote a short book called "Cat School". The first chapter was entitled, "Kitten Chaos - It's A Hell New World". Yes, she spelled "chaos" correctly, but was hilariously off with her attempt at "whole". Yet, weirdly she was also unintentionally perceptive.

Up until a month ago we had one dog and two cats. The two cats got along with each other well, united in their hatred of the dog, and the dog generally stayed out of their way, so it was a reasonably balanced little domestic ecosystem. Then Lily arrived. It's a hell new world.

Lily is an incredibly beautiful little Siamese cross and she is also the living embodiment of Leo Tolstoy's wise maxim, "It is amazing how complete is the delusion that beauty is goodness." Lily is badness, pure badness. From the very first day these few small ounces of cuddly fluff launched a terror campaign of such energy and ferocity that everyone - the cats, the dog, the kids, Lorraine and me - were caught completely unprepared. She moves so quickly that she appears to teleport. One second I am eating my dinner peacefully, the next second Lily's face is in my plate. Toss her off the table and instantly she is back. Again. And again. And again. One second Gabi is grooming herself peacefully, the next second Lily is on top of her, biting her ears. One second Orbit is munching his breakfast, the next second Lily is in his bowl and he is looking up me, mournfully. One second a picture is on the wall, the next second it is on the floor. One second a vase is... well, you get the idea.

As the internet people say, O... M... G... So, Lorraine and I are both veterinarians and between us we have 56 years of experience. Yesiree. For those combined 56 years we have given all sorts of calm, reasoned, sage advice to pet owners in similar straits. I am here right now to confess that none of this advice works in my own home. At least not yet. Doors are being kept shut to provide refuges to the other cats, toys are being accumulated at a manic pace, kids are being coached to occupy her, but it's still a demented circus around here. Probably the smartest suggestion we got was to get a second kitten to occupy the first. Intellectually I know that this would likely help, but I tell you, psychologically, it feels like we would be pulling the pin on a second grenade after stupidly doing so once already. Not happening.

So to bring this full circle, why did we get a kitten at all? Some of you have heard me advise that two cats is ideal and that three or more is pretty dicey, so what gives? We got her for Isabel. Isabel went from being that happy little girl, singing to herself and writing wacky stories, to being a teenager laid low by crippling anxiety and depression. She has missed so much school that the year is a wash-out. It's the last thing I expected and it's the hardest thing to watch. The sense of helplessness is immense. And then Lily came into Lorraine's clinic from a rescue shelter. Any other time I would have said no. Any other time. But Isabel was at her very lowest and the only spark I had seen in her in weeks was when she saw Lily's picture. And despite all her kitteny badness, Isabel loves her, really really loves her.

This isn't a tidy heart-string pulling story where the kitten saves the girl. If only depression were so simple. Isabel still has many bad days, but you know, there are some good ones now too. Is Lily responsible for any of this possible progress? I have no idea. For the rest of us it's still a hell new world, but for Isabel, hopefully perhaps the first steps to a whole new one.

Monday, June 18, 2018

Dogs Getting High


Ralph was certainly not himself. It was hard to tell how he actually felt, but the old shepherd was barely able to walk, stumbling and swaying each time he tried to take a step. And his eyes had a glassy far-away look.

"His arthritis is so much worse today!" Mrs Sorensen said, clearly upset and worried.
Although he was obviously having trouble getting up and walking, this did not look at all like arthritis symptoms.

"Have you been giving him anything for the arthritis?" I asked, a suspicion beginning to form.

"He gets his glucosamine and fish oil and then recently I started to give him a little CBD oil. Just a little doctor."

Suspicion confirmed - Ralph was stoned.

In theory this shouldn't happen with CBD, also called cannabidiol, because, in theory, it should not contain any THC, the psychoactive component of cannabis. But that's just in theory.

In one year CBD has gone from a "what's that" obscurity to an every day conversation with pet owners. Quite literally every day. I have been in practice long enough to have seen this phenomenon before. Just in recent memory vitamin E, eichinacea, grain-free diets and coconut oil have all had their moment in the sun as potential panaceas. The internet age spreads the word so much faster while amplifying the most improbable stories. In each case these remedies did not end up curing cancer, reversing kidney disease or noticeably "boosting the immune system", but each did end up finding a place in the array of options for some specific conditions in some specific patients. It's just a much smaller place than the enthusiasts had hoped for. If medicine were only so simple!

And so it will be for CBD oil. The range of disorders that people want to try it on their pets for is breathtaking, but the best evidence we have is that it might be useful for three things: epilepsy, nausea and, yes, arthritic pain. There are some problems though.

The first problem is that the research is lacking. There is a lot of work being done right now though, so hopefully we'll have some more clarity soon, but for the time being everything we know is based on anecdote and extrapolation from humans. There are plenty of examples in other areas of medicine where anecdotes and extrapolations have misled us, so some caution is warranted.

The second problem, as illustrated by Ralph's experience, is that quality control and regulation are also lacking. Contamination with THC is not that rare. I haven't seen numbers on that, but I did see another stoned dog with the same story soon after Ralph. Also, some reports indicate that the majority of commercially available CBD oil is contaminated with pesticides and other troubling substances. Google "contaminated CBD" if you're in the mood to be alarmed. Also, when tested, some of the products contain either very little or even no CBD oil at all. Moreover, all of this can vary from batch to batch, so just because Aunt Marge's corgi is like a pup again after three drops of "Doctor Good Earth's All Natural Holistic Small-Batch Artisanal CBD Oil", doesn't mean that your dog will have the same experience.

Patience people. My own dog is epileptic and I'll probably try CBD, but only once the science is in and the quality is truly assured (i.e. not just by the dude at the health food store). If your dog suffers from epilepsy, chronic nausea or arthritic pain and you feel like you can't be patient because nothing else has worked, please check with your vet first before winging it with CBD. New information is coming out regularly.

Ralph was better after about a day. Mrs Sorensen is going to be patient now.

Monday, June 4, 2018

The Shoemaker's Children


A few months ago my wife, who is also a veterinarian, and I began noticing that Gabi, our 11 year old little black and white cat, was becoming even more aggressive about stealing food. I say "even more" because our three cats and one dog are an unruly, barely trained lot who climb on tables and surf counter-tops with impunity. Ok, impunity is an exaggeration because we do shout at them, but this is apparently just a bunch of monkey noise as far as they're concerned. It is, of course, entirely our fault and we have more or less made peace with the situation, but Gabi had become so much worse that it got our attention. She was also yelling more and beginning to look a bit skinny, despite her impressive appetite.

Now those of you with some knowledge of cat diseases are beginning to go, "hmm..." However, Lorraine and I, despite having considerably more than "some" knowledge of cat diseases did not go, "hmm..." We just shrugged and didn't make much of the changes. She seemed fine otherwise.

Fortunately Gabi was due to have some dental work done, so I took her into the clinic for that. I was ordering routine pre-anesthetic bloodwork for her when the penny finally dropped. Seeing her in a clinical setting caused a sudden shift in my perspective. I asked them to run a thyroid level as well. Yup. Our cat was hyperthyroid and had probably been hyperthyroid for several months, displaying textbook symptoms right under our noses.

Most of you have heard the proverb regarding the shoemaker's children. The shoemaker is so focused on making beautiful shoes for his customers that he doesn't notice that his own family is shoe-less. It's not anywhere that extreme for most veterinarians most of the time, but at times the shoemaker's children phenomenon is quite real and it is downright embarrassing.

This is an interesting subject (I hope...) because many clients when faced with a difficult decision will ask us what we would do for our own pets. This is a fair question. In fact, when I first started out in practice I didn't have any pets of my own, but in giving advice I had "if this was my mother's pet" as a mantra to guide me. I can obviously only speak for myself  and I may well be a freakish outlier, but despite that mantra I have to confess that I do sometimes treat my own pets differently than my clients' pets. Often worse, as in Gabi's story, but sometimes better too. Maybe it's instructive to see where I deviate, so I've made a list:

- I never stop vaccinating due to age, because immune function can decline, and I never worry about reactions because they are so very rare, but I am not good at keeping to an exact vaccine schedule. A three year vaccine might sometimes be done in four years when I finally remember. I'm not recommending this slack approach, but it does illustrate that there is some flexibility. Thorough annual exams are important though as pets age five to seven human-equivalent years for every calendar year. If the experience with Gabi has taught me anything it's that I need to do this religiously for my own pets and not rely on those casual assessments that occur because I happen to live with them.

- The moment I finally recognize that something is wrong with one of my animals, I run every test that might conceivably be helpful. With clients we're often concerned about the cost of running lots of tests, but we should give them the option of doing more than the minimum if they can afford it and want the peace of mind.

- When one of my pets is deathly ill I am tempted to try heroics, and have in at least one case done more than was in retrospect sensible to do. I think we do a better job counselling our clients on end of life decisions than we do for ourselves.

- My family feeds more treats and "people food" than I recommend, so I understand what those soft brown eyes and purring leg rubs can do to a person's willpower. This is not an excuse though - you can and should be stronger willed than me (or my family)!

- Ditto for brushing their teeth. We don't do it and I really do know we should and I really do believe in the benefits of it. But it's supposed to be my kids' job. That's my excuse and I'm sticking to it.

Gabi is on medication now for her hyperthyroidism and is doing well, so no harm done. But it was valuable lesson and one that I hope I will actually remember this time!

Thursday, May 24, 2018

Mismatch


Among the more venerable internet memes are the photos of people who look like their pets. Or who allegedly look like their pets. Honestly, in most case it seems to come down to some similarity in hair/fur and being photographed when they happened to have (or, more probably, have been coached to have) comparable facial expressions. Put a little wig on a potato and you could just as easily come up with photos of people who look like their potatoes. That being said, there certainly are a few pudgy flat-faced people with pudgy flat-faced dogs, as there are a few tall elegant people with long noses who have tall elegant dogs with long noses. It is safe to say however that the overwhelming majority of people do not resemble their pets at all. And this, you'll agree, is a good thing.

What strikes me as far more interesting than owners who match their pets are owners who are wild mismatches for their pets, not only in appearance, but in temperament. It goes without saying that veterinarians see all kinds of combinations of animals and people, but the ones that get our attention are the ones that seem the most improbable. I'll share two short stories with you about such mismatches.

The first pair is Tim and Mindy. Tim is the owner and Mindy is the dog. I suppose that's obvious, but you'd be surprised. I can't count the number of times I have accidentally called the owner by their pet's name and vice versa. Consider yourself forewarned if you give your pet a conceivably human name. But I digress. Tim made a vivid first impression with his considerable size, his forceful handshake, his loud expletive laden style of talking and the impressive array of smudgy blue tattoos that looked suspiciously like they had been done in prison. But, as we all know, first impressions can be misleading. Two facts immediately emerged that ran counter to that impression. First of all, Tim turned out to be very friendly and very eager to learn everything he could about looking after his pet. And secondly, his pet was a small quiet female Shih Tzu named Mindy, who sported pink bows in her beautifully groomed fur. There were no pink bows anywhere on Tim. Nor was he especially beautifully groomed. They did not resemble each other in the slightest. In fact, they could be considered opposites.

Tim was a long distance truck driver and Mindy was his companion on the road. "Been with me to 43 states and 8 provinces!" It appeared that Mindy was his only family as well. To see Tim transform instantly from brash and boisterous with me to tender and calm with her was as astonishing as it was heart-warming. Utterly unselfconscious, he would gently and repeatedly kiss Mindy on the top her head while I explained something to him. Almost everybody loves their pets, but Tim's devotion to Mindy was in a category of its own. All of us adults know by now that love is a strange thing that cannot be predicted or judged. This was a prime example of that truth.

I typically saw Mindy once a year in the early spring for a check-up and to make sure that her shots and paperwork were in order for the frequent border crossings. Tim was also one of the few clients who insisted on regular bloodwork to follow baselines on her organ functions. He explained that he wanted the peace of mind and pressed me whether there was anything else we could do to ensure Mindy's health. He gave up smoking when he got Mindy because he was worried about second hand smoke, and he planned his rest stops around where it was best to walk her. I said he was devoted and I meant it.

You might be girding yourself for a heartbreaking ending to this story, but fortunately, to the best of my knowledge, Mindy remains healthy as I write this and I expect to see her again next year. One day there may be an anguished phone-call from Alabama or Arizona, but it hasn't happened yet and, I tell you, I don't even want to think about it.

The second mismatched pair is Mrs Abrams and Max. Max was a German Shepherd. Actually, "Max" is almost always a German Shepherd, unless he is a Boxer or a black cat. I picked this pair for the second story because it is in many ways the inverse of Tim and Mindy. Mrs Abrams was small, quiet, elderly and fragile looking. Max, on the other hand, was large and loud and  rambunctious. He weighed as much as Mrs Abrams, if not even a little more. Her son had given him to her for protection. I suppose this was effective as Max would lunge and bark furiously whenever someone other than Mrs Abrams moved towards him. Actually, he would lunge and bark furiously whenever the wind blew a scrap of plastic towards him as well. Fortunately he was a classic example the bark being worse than the bite and there was no need to be afraid of him, but unfortunately all that lunging made walking him dangerous for Mrs Abrams.

One day she came in sporting a cast on her wrist. Max had pulled her down again. Apparently he had seen a particularly irritating squirrel. Mrs Abrams always excused his behaviour with a chuckle and a 'dogs will be dogs' remark. After I addressed the rash that he had been brought in for I talked to her about safer options for walking him. I had talked to her about this before, about halter types of collars and training methods, but the answer was always the same. In her soft voice she would say, "Oh no, he wouldn't like that." And that was the end of the discussion. What Max liked and did not like was always the decisive factor.

Eventually it came out that Max was also pooping in the house. Here too excuses were made and any type of training that would inconvenience Max in any way was dismissed out of hand. She would smile at Max like all the light in the world emanated from him. Like with Tim and Mindy, this was clearly also love and love that should not be judged, but my God, it was hard not to judge. Max was so manifestly the wrong pet for her. Wrong size, wrong temperament, wrong breed, wrong everything. But she felt safe with him and she loved him with all her heart and these two things obviously made broken wrists and poopy carpets seem like trifling inconveniences to her.

When Max eventually passed away I didn't think I'd see Mrs Abrams again. She seemed incalculably ancient and there sadly comes a time in many people's lives when looking after an animal is just too difficult. I was surprised then to hear that she had booked an appointment with a new pet. Perhaps a cat, I thought, or a little Yorkie? Nope. Another German Shepherd. Also named Max.
  

Monday, May 7, 2018

Incoming!

A number of metaphors have been used to describe veterinary practice, but when it is busy the most enduring one is the battlefield metaphor. I'm sure that people in the human medical field will recognize this as well. I want to be very careful though and point out that this metaphor does have limitations, chief among them is that it should not be taken to imply that the patients and the clients are the enemy. They are not the enemy, but more like civilians caught in the cross-fire with the enemy simply being "circumstances". (Ok, most of the time they are not the enemy...) It's more that the metaphor gives the flavour of what it's like to try to function at a high level of competence in an environment of chaos, noise, confusion and occasional random unpleasantness.

And if the practice can be like a battlefield, it is the receptionists who stand at the front lines. When clients start surging through the doors and all the telephone lines are ringing and the doctors are standing around, getting in the way, and the dogs are competitively peeing on the welcome mat and the couriers are waving documents to sign and the computer system is malevolently generating random errors, then, at those times, to be a receptionist must feel like it feels for soldiers advancing through fire, hearing mortar rounds whistling towards them... "Incoming!"

To be fair, it can be just as stressful and busy at these times for the doctors and the veterinary technicians, but there are important differences. The doctors and techs can withdraw into quieter places to work with patients and clients one-on-one, and, more importantly, the doctors especially benefit enormously from one key thing. That key thing is the client's respect. This makes all the difference. I know that the great majority of clients are decent and sensitive people who do respect the receptionists, but sadly, sometimes it doesn't show. And when it doesn't show, it can really hurt them when they are just trying their best to do their jobs and often don't have the power to change things for the clients. Society is gradually evolving in the right direction, but some old habits persist, and one of these old habits is to automatically, probably unconsciously, assign more respect to the person in the lab coat with the title and a series of initials behind their name than to the person in scrubs sitting behind the reception counter who you call by their first name.

Specifically how does this manifest? The classic scenario is where the receptionist warns the doctor that the client is really angry about something, having just been yelled at by them, and then when the doctor and client are in the exam room together the client is sweet and polite to the doctor. The reverse also occurs wherein the doctor says something upsetting to the client in the exam room, like recommending an expensive procedure, and the client nods and smiles and then leaves the room and, once the doctor is out of earshot, proceeds to freak out at the receptionist about what a rip-off the recommendation is.

I am not suggesting that clients vent anger at the doctors instead, but I am suggesting that they not do so at the receptionists. As in all other areas of life, the best approach when you're angry is to take a few deep breaths, calm down and then politely and respectfully address the concern. But I don't mean to lecture any of you on manners - if you are reading this I expect you are likely not one of the shouters or freaker-outers (to coin a clumsy term). I have seen receptionists in tears after one of these encounters and I have had some threaten to quit. I have had to fire a couple of clients over the years when this sort of behaviour really got out of hand. Yup, I can do that.

Other than basic human decency, why do receptionists deserve respect? They deserve respect because of what they do. Not only is there management of the battlefield as described above when there is so much "incoming", but there is management of the doctor's needs ("Can you print this?" "Can you fill this prescription?" "Can you call so-and-so?" "What's that weird smell in room 2?" etc) and mastery of a remarkable range of skills. Some receptionists have college training in the field, but many do not. Even for those that do, the training is often generic medical reception, and not specific to the veterinary environment. There is a complex (and wacky...) computer system, terminology galore, arcane practice protocols, animal handling and, of course, basic veterinary knowledge. Imagine how daunting it is to have to triage every phone call... Is this person's concern serious enough to warrant an immediate squeeze-in appointment? A later appointment? A return call from the doctor? Or just advice I can give as a receptionist? And imagine the stress of treating something as urgent that isn't and having the doctor complain that it put them behind, and, conversely, the stress of not treating something as urgent enough and having the patient suffer. It is all a bit of a high wire balancing act.

High wire over a battlefield...? Sorry for mixing my metaphors. Whatever it is, we are so very lucky in my clinic to have a group of receptionists who do this so well that they make it look easy. It is not easy. Please respect them for it.

Thank you Barb and Cheryl and Tara and Amber and Cam and Brandi and Lisa! We in the officer's tents and on the sidelines salute you on the front lines!




Monday, April 30, 2018

The Book


What book? Most of you probably know by now, but some of you don't as it occurs to me that I haven't actually formally announced this on the blog, only on social media. So here it is: ECW Press in Toronto (https://ecwpress.com/) will be publishing a book version of "Vetography" in the spring of 2019!

It will initially be released in Canada, the USA and the UK, with formal book launches and readings in several cities. Illustrations by a well-known cartoonist are being discussed (no, I can't tell you who yet...) and an audio book version may be released as well. About 80% of the book will be drawn from the blog posts and about 20% will be new stories and essays that won't appear in the blog.

I just met the publisher again yesterday and we have settled on the title: "Confessions of an Accidental Veterinarian - Inside the Curious World of Pet Medicine"!

As the saying goes, stay tuned...

Monday, April 16, 2018

An Hour Spent Sitting At A Fork In The Road


2:00 pm, Friday, January 13, 1989.

I had promised him I would call with my decision by 3:00 at the very latest. I had exactly one hour left and I felt no closer to making up my mind than when the problem was first presented a month ago. My brain was beginning to whir uselessly like my rusted out Honda Civic spinning its wheels, stuck in a snowdrift, just polishing the snow to ice under the tires. A lot of noise, a lot of vibration, a faint burning smell, but no forward motion.

To remove myself from all possible distractions I headed up to the mezzanine level of the library at the veterinary college. This was the home of obscure unread journals and a clutch of spartan study carrels. Nobody else was up there. I picked out a carrel and proceeded to stare at the bare wood partitions in the hope of clearing my mind and coming to a decision.

Nope. No decision. Just more whirring and wheel spinning and, to extend the Honda metaphor, now also regular puffs of black smoke.

Aargh! 2:20 pm! Only 40 minutes left!

The decision was at one level just about my summer job for the four months between third year and fourth year vet school. But at another level it was about my entire career and working future. This was the problem. Summer job decision? Easy. Done it many times before. Entire career and working future decision? Not so easy. Even the decision to enter vet school wasn't as hard as it offered a wide range of career options, including my original plan of going into research and teaching. But with this decision I could feel the funneling beginning in earnest, and it was freaking me out a little.

2:40 pm.

The choice was between a job offer at the Veterinary Infectious Disease Organisation (VIDO), where I would assist in cutting-edge research and make contacts with scientists and their post-graduate programs, and a job offer at the Small Animal Clinic at the vet college where I would gain practical hands-on experience in a clinic setting and get to know my instructors for fourth year. To that point I hadn't worked in a clinic yet and felt profoundly unready for fourth year, which was very clinically oriented. Almost all of my classmates had worked in vet clinics before, often for years. But VIDO was an incredible opportunity for someone who was focused on a research career. My mind began flipping back and forth, like putting the car into forwards and reverse, forwards and reverse, forwards and...

2:55 pm.

I continued to stare at the partition. My heart rate was high and my palms were damp with sweat. People, especially at that age, can sometimes attach far too much importance to decisions they need to make and get far too stressed about them, but all these years later when I look back at that moment it is even more clear now that it was in fact an absolutely key decision, easily one of the three or four decisions I have made in my life that have had the most profound long term impact. The stress was unhelpful, but understandable. I needed a couple minutes to walk to the phone (pre- cellphone days) and as I did that I still didn't know what I was going to say.

3:00 pm.

I called the director of VIDO and declined the offer. You already guessed this outcome, but I sure didn't. I don't recall a conscious decision having been made. It was as if my subconscious mind directed my mouth.

The summer at the vet college Small Animal Clinic was a fantastic experience and after fourth year I followed my future wife to Winnipeg and began to work in a private practice, temporarily I said...




Monday, April 9, 2018

Pet 911


There isn't one. No doubt some people call 911 when they have a pet health emergency on their hands, but I don't know what the operators tell them beyond "call your vet". The real "911" for such emergencies is obviously your veterinary clinic's phone number. If your clinic is not open it will (or should...) have information on the answering machine regarding who you should contact when they're closed: sometimes an on-call veterinarian and sometimes an emergency hospital that your clinic refers to.

You probably knew all this already, but it never hurts to cover the basics. Now that I know that you know what to do when there is an emergency we can move on to the more interesting question of what actually constitutes an emergency.

Fortunately, true emergencies are much less common in pets than in humans. If you look at the eight most common emergencies in people - chest pain, stroke symptoms, accidents, choking, abdominal pain, seziures and shortness of breath - really only the last two are at all common and easy to recognize in pets. They do get abdominal pain, but it's harder to tell and is fortunately less often life threatening (no appendix in there to burst). Dogs and cats rarely have strokes and even more rarely have "heart attacks". In fact, coronary artery disease is unknown in our pets. Yes, they do get other kinds of heart diseases, but these tend to be chronic and do not often result in a sudden worsening constituting an emergency. True choking (i.e. not coughing or gagging that sounds like choking) is also less common than you might think. And pets do have accidents, but far less frequently than people, maybe because they don't drink or drive or ski or cycle or take showers or clean their guns or play with matches or rewire their homes or try to create viral videos...

As an aside, when I started in practice in the early 1990s "HBC" was a fairly regular emergency presentation. This had nothing to do with the Hudson's Bay Company, but rather it is our abbreviation for "Hit By Car". These days far more dogs are on leash and far more cats are kept indoors, so we may only have a handful of HBCs a year. Similarly, "BD-LD" is on the decline. Can't guess? "Big Dog - Little Dog", which is a traumatic dog fight injury where the size and strength differential leads to serious wounds in the "LD". We still see this, but people generally seem to be more aware of dog behaviour (generally - not universally), and again, more dogs are on leash. That being said, the increasing popularity of off-leash dog parks is preventing BD-LD from declining as quickly as HBC. Cat fights are far less common though than they once were. (Unfortunately we do not have an acronym for those.)

So now that you know what not to worry too much about, what should you worry about? When should you call "Pet 911"? The AVMA has provided a useful list. I will summarize an amended version here:

1. Severe bleeding or bleeding that doesn't stop within five minutes.
2. Choking, difficulty breathing or nonstop coughing and gagging.
3. Inability to urinate or obvious pain associated with urinating.
4. Eye injuries.
5. You suspect or know your pet has eaten something poisonous such as antifreeze, xylitol (in sugar free gum), chocolate, grapes, rodent poison, etc.
6. Seizures and/or staggering.
7. Fractured bones, severe lameness or inability to move leg(s).
8. Obvious signs of pain or extreme anxiety.
9. Heat stress or heatstroke.
10. Severe vomiting – more than two major bouts in a 24-hour period, or combined with obvious illness or any of the other problems listed here.
11. Refusal to drink for 24 hours or more.
12. Unconsciousness.

I worked in an emergency clinic for a little while after I graduated, which is a story unto itself, and I can tell you that 90% of what called and came in was not on that list. But that's absolutely ok. A good emergency service provides peace of mind. They can often triage on the phone whether your pet needs to be seen or not. Consequently I can give you a greatly simplified list of when to call:

1. Your pet appears to be in distress (or, conversely, very lethargic).
2. You are in distress about something regarding your pet.

Don't hesitate to call. You're not bothering someone. It's their job to help and they are happy to do it. Unless you are drunk and it's 2:00 am and you want to ask why your cat is staring at the wall (true story). Then reconsider.





Wednesday, March 28, 2018

Pilling The Cat



For your amusement I invite you to type “pilling the cat cartoon” into the image finding feature of your favourite search engine. Have you looked at a few? Lots of lavsihly bandaged people, right? Ha ha ha, right? Yes, all very funny unless you have actually tried to administer a pill to your cat and have sustained multiple lacerations in the effort. So in the interest of public service I'm going to offer you two different injury-free strategies for pilling the cat.

Strategy #1: Don't. Don't pill the cat. No, I'm not telling you to toss your veterinarian's prescription in the bin and hope that thoughts and prayers will cure the illness instead. Rather, I am telling you that there are alternatives. Sometimes. People often assume that liquid medication is the main alternative, but I don't actually recommend that in most cases. There are a few drugs on the market that are flavoured with cats in mind and that require only small volumes to be administered and these may be realistic, but many others are disastrous. At least with a pill you know where you stand – either it's in or it's out. With liquid, if they spit some out you don't know how much of the dose they got. And it's messy. And your cat will hate you even more because the flavours of liquids are often more intense.

No, instead I suggest you ask whether the recommended medication comes as a long acting injection (mostly applies to antibiotics), or whether it can be made into a flavoured chewable treat. Quite a few drugs can be reformulated as treats in a surprising range of flavours. Tuna and chicken are the most popular in our practice. There's also beef, liver, bacon, salmon and the curiously non-specific “seafood”. These can then be crumbled into similarly flavoured soft food if the cat doesn't take it directly as a treat. The main downside of flavoured chews is that they need to be made by a compounding pharmacist, so there can be an extra wait and some extra expense.

Some people have luck with a product called “Pill Pockets” which are ultra-tasty soft treats with a hollow part you hide the pill in when your cat is not looking. Incidentally, just hiding a pill in food very rarely works for cats. Some can tell even when you're just thinking about putting a pill in there and will refuse to eat until you stop thinking about it. Even if this works at first, they usually catch on fairly soon, so it's only really feasible to try for short courses of medication.

Another don't-pill-the-cat solution is trans-dermal gel. Some drugs can be made into a gel, again by a compounding pharmacist, which is then applied to the ear and absorbs through the skin that way. This would be absolutely ideal if it weren't for the fact that skin absorption varies somewhat between individuals, so more monitoring is often needed. Also, it only works for a few medications. Nonetheless, it's worth asking your veterinarian about this option, especially for chronic meds.

Strategy #2: If you have to pill your cat, or for some dark reason actually prefer to pill your cat, there is a trick to it. I'm right handed, so I'll put the cat up on a table on my left side, with my left elbow keeping him against my body. I will have the pill ready between the thumb and forefinger of my right hand. I will then hold the top of his head with my left hand and gently tilt his head up. Next I will use the middle finger of my right hand to pry his mouth open by pushing it into the space behind his fang teeth. (Stop laughing, I'm being serious.) As soon as he opens his mouth you need to put the pill as far back over his tongue as you can and then immediately close the mouth. You should have a syringe or eye-dropper ready with two or three mls of water. Squirt that in quickly by pushing it into the corner of his mouth, into his cheek. Blowing on the nose sometimes encourages him to swallow. And sometimes it encourages him to swat you. But the water is important, not only to make him swallow, but also because pills can otherwise sometimes become lodged partway down the esopahagus (food tube), which can lead to serious complications.

Incidentally, as you are probably aware, most dogs are totally different. An article entitled “Pilling The Dog” would be exactly four words long: “Wiener. Cheese. Peanut Butter.”




Monday, March 12, 2018

Hogwarts on the South Saskatchewan




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

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

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

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

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

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

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


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

**I am apparently in Ravenclaw.

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

Thursday, March 8, 2018

Bread and Ears


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

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

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

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

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

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

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

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

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

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

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

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

Thursday, February 22, 2018

The Naming


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

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

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

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

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

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

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

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

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

Thank you!


From Facebook:



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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Cat named Quincy Turtle!"

"Saw a Pug yesterday called “We Z”"

"A cat named Hey You."

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

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

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

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

Thursday, February 8, 2018

Fiddling With The Dials


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

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

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

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

That is, however, not the case.

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

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


Thursday, January 18, 2018

In The Dark


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

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

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

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

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

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

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

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


Wednesday, January 3, 2018

Begins With The Letter "A"

This post carries a mature content warning. Seriously.

  

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

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

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

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

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

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

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

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

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

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

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

 *What a bizarre world we live in. The "For Dummies" series actually has a tutorial on this:
http://www.dummies.com/pets/dogs/how-to-empty-your-dogs-anal-sacs/