The Ineffable Weirdness of Dentistry

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

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

Why is this?

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

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

So then, what is my theory?

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

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

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

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

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

When Darkness Overwhelms

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

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

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

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

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

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

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

This post is for Terry and Craig and Sophia.

Chomp Chomp

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

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

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

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

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

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

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

The Purr

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

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

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

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

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

So, is there any downside to purring? Potentially yes:
https://www.youtube.com/watch?v=akcALE_R7-o

The Ballad of the Prairie Flea

I have listened to my restless readers who have been quietly grumbling, "Ostriches, seeing eye dogs, killer rabbits, Christmas gerbils... that's all well and good, but when are you finally going to tell us something useful Schott? When??" When is now. My intent is to balance the blog between quirky animal stories, insights into the experience of being a veterinarian and actual pet health information.

Which brings me to fleas.

I'm willing to wager that if you were visiting your psychiatrist and he said "What's the first word that comes to mind when I say 'dog'?", a reasonable percentage of you would say "fleas" (those of you who didn't say "bone", which is worthy of a post on its own). Most cartoon dogs have fleas and children tune ukuleles to "my dog has fleas". An itchy dog is presumed by many to have fleas. But not so fast. Most of you reading this live on the Canadian Prairies, and woe betide the poor Prairie flea. You see, fleas love heat and fleas love humidity. Consequently there are many many many fleas in Tallahassee and no fleas at all in Tuktoyuktuk. For better or worse Winnipeg, and the rest of the Prairies, is a lot more like Tuktoyuktuk than Tallahassee. Next time you're in Florida pay attention to how many veterinary clinics you see. A lot, right? Fleas. It's all because of fleas.

Despite this ground truth the culture still teaches people to assume that an itchy dog or cat has fleas. It used to be the number one myth I would bust. We would see the occasional case of fleas, perhaps two or three a year, versus the literally hundreds and hundreds of dogs and cats itchy because of allergies (yes, allergies - extremely common). I would marvel at this tough or perhaps misguided little Prairie flea and wonder how she got here and what her plan for the winter was. A year ago this would have been a quick and simple post to write - your pet does not have fleas. Done. This last fall however... something has changed. They are still very rare, but we had perhaps eight or ten cases, quadruple the average. We're not becoming Tallahassee any time soon, but we seem to be inching a little closer. Add fleas to your running list of climate change consequences. Al Gore didn't warn us about this.


And how do you know your pet has fleas? Ideally you see the mighty flea itself, but they are tiny and astonishingly quick and they are only on the animal to feed, the rest of the time they are - gulp - out and about in your house. Instead we rely on a gross flea fact. Fleas drink blood and then poop out the digested blood. Consequently flea poop looks like little black dirt particles in your pet's fur. Take one of these particles, place it on a white sheet of paper, wet it slightly and then streak it with your finger. If it streaks reddish brown, like the "Indian Red" in the old Laurentian pencil crayons, then you, my friend, have fleas in your house and it is time for you to panic. No, I'm kidding, you should never panic, but you should be very slightly grossed out. (Note: cats may groom the flea dirt off, complicating matters somewhat.)

I won't go into treatment in any detail except to say, perhaps predictably, that you should talk to your veterinarian as it is a bit complicated. However I will say a word about flea collars. That word is "useless". I have had clients come in and declare that the flea collar works well because Bozo doesn't have any fleas. This is akin to the man wearing the tinfoil hat declaring that it's working because aliens have not been able to zap him with mind control beams. The Prairie flea may have a little more swagger these days, but your pet would still have to be extraordinarily unlucky to encounter one.

Bobo, The Christmas Gerbil

Like most children and almost every veterinarian (but only almost....), I was fascinated with animals from a very young age. And like most children this fascination spawned a relentless campaign to obtain a pet. My parents were, however, not "pet people". Far from it. A dog was so clearly out of the question that I never actually dared to ask and I understood that the suggestion of a cat would be received no differently than a suggestion of a warthog or a rhesus monkey. So I set my sights lower and began the work of building up the Mongolian gerbil as the ideal pet in my parents' minds.

This prolonged effort had no discernible effect whatsoever until the Christmas of 1977 when a large rectangular object covered by a decidedly non-festive grey tablecloth appeared under the tree. I had more or less given up on the gerbil campaign by that point. I was actually afraid that that large rectangular object would be a gigantic Meccano set as part of my father's own campaign to get me interested in something "practical". But no, to my astonishment, the object revealed itself to be a cage. A large cage, hand-built by my father out of heavy gauge one inch galvanized steel mesh. This cage was solid. It appeared to be designed to help its occupant withstand earthquakes, tornadoes, mortar attacks and significant civil unrest.
But there was no occupant. 

"Oh wow! Thank you, thank you! It's a... It's a... It's an empty cage..."

My parents peered closely at the cage and then looked at each other. There had been a gerbil in there just half an hour ago. Now there was no gerbil in there. My father, the physicist, expressed astonishment and disbelief that a gerbil could pop through one inch mesh. But pop through it evidently did, like a button through a button hole. The remaining gift openings and assorted Christmas rituals were abandoned and the hunt was on. Two bewildered adults and two manic children scoured the house until eventually the gerbil was found, pooping silently in a corner under a cabinet. 

Incidentally, as an aside for the uninitiated, a Mongolian gerbil is a small desert rodent (incidentally, I first wrote "dessert rodent"; good thing I reread this before posting...) with tan-coloured fur and long tail ending in a fuzzy tuft, a bit like a lion's tail. They bite a lot less than hamsters and they stink a lot less than mice. 

Back to the story though, as soon as the gerbil was captured my father set to work covering the cage in fly screen. This was effective for a day or two, but then the gerbil chewed through the fly-screen. The fly-screen was patched and patched again, but the gerbil was nothing if not relentless. What eventually put a stop to his repeated escapes were sunflower seeds. Or more precisely, the morbid obesity caused by the continuous intake of high fat sunflower seeds. He soon became unable to squeeze his bulk through that one inch mesh anymore. So he stayed in the cage, exchanging his freedom for tasty snacks. A trade-off familiar to Doritos addicts everywhere.

Over time the gerbil and I became close. Or, more accurately I should say that I became close to him, for his part I think it's safe to say that the gerbil was largely indifferent to me or really anything other than his sunflower seeds. I originally named him "Berbil", but this morphed into "Berbo" and then "Bobo", which is ultimately the version that stuck.

EPILOGUE

Eventually Bobo died and was not replaced. The cage ended up in the basement with the suitcases and old coffee makers and was forgotten until one bitterly cold January morning when my father found a pocket gopher, an essentially blind burrowing animal that should have been hibernating but was out wandering in disoriented circles on a snowy field. My father dusted off the cage and then, to our collective astonishment, walked out onto the field to scoop up the surprised rodent. Failing to recognize the good deed it bit him savagely, but my father persisted and brought him inside and placed him carefully in the cage. Ultimately over the course of the next three or four months he and the pocket gopher developed a peculiar and, it seems, mutually beneficial relationship. The gopher was released in the spring and the cage never saw use again. In my mind's eye I picture it in some deep substratum of the Saskatoon landfill, intact, unbroken, still sturdy like the day my father made it.

"Nasty Big Pointy Teeth"

The Monty Python fans among you will immediately recognize from the title that I'm going to write about rabbits today. And not just any rabbits. Not the fluffy, gentle, innocent rabbits almost everyone imagines. No, I'm going to write about the vicious ones. Vicious rabbits? How is that possible you ask? Remember this - the rabbit has no idea that he is cute and cuddly and harmless looking to a human. He may seem a nervous, timid creature much of the time because he is a prey species after all, but in an environment where he has learned to become confident, his true self may emerge.

As evidence I offer the following telephone conversation I had with a client a few years ago:

Ms. Fitzsimmons, "Dr. Schott, thank you for coming to the phone right away. I'm calling from my bedroom."
This seemed like an unnecessary detail. I became faintly alarmed.
"Yes?" I offered cautiously.
"It's Mr. Cuddles, I don't know what's wrong with him!"
Mr. Cuddles was a small floppy-eared grey rabbit that she had had for about a year.
Relieved, I asked, "what symptoms are you seeing?"
"He's gone crazy!"
"Oh? What is he doing that seems crazy?"
"My bedroom is at the end of the hall where his little house is. He won't let me past his house!"
"Won't let you past?"
"Yes! He attacks me and bites me!"
"Um... how long has this been going on?"
"All morning! He just gets madder and madder every time I try! I don't know what to do! I need to get out! What's wrong with him?"

What was wrong with Mr. Cuddles? Nothing really. He was just a highly territorial male rabbit allowed to roam free whose "lair" had been set up in the hallway. With time he became confident enough to defend his lair. I told Ms. Fitzsimmons to come out of her room holding a blanket in front of her and then to toss the blanket onto Mr. Cuddles so that she could quickly sprint past. I told her that once things settled down she should wait until he was sleeping in his house and then scoop him up with a towel, put him in a cage and bring him in to be neutered. Neutering doesn't always help, but in this case taking the testosterone out of him plus moving his house to a far corner of an unused room seemed to do the trick.

The words of Leo Tolstoy come to mind: "It is amazing how complete is the delusion that beauty is goodness."
Or, in case of killer rabbits: "It is amazing how complete is the delusion that cuteness is innocence."


For those few and misguided that have not seen 
"Monty Python and The Holy Grail", it offers a more
graphic illustration of what rabbits are capable of.