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.