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.
  

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!

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...

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...

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.

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.”

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.