There Are Worms In My Heart

An old but timely post:



Ok, not technically right in the heart itself, but more on that later. And not technically my heart, at least probably not, but more on that later too.

It is "Heartworm Season" in Manitoba. Yes, it is. If you work in a veterinary clinic it is unmissable, unmistakable, unforgettable. It's not that our wards are packed full of dogs sick with heartworm disease, rather it's that the testing for and prevention of has to occur in a fairly narrow calendar window. Compounding this, for most people, it's convenient to get all the other annual stuff done at the same time since they've dragged Fido in anyway (incidentally, no actual dogs are named Fido, or Rover, or Rex, or Spot; some cats are though). Consequently, most of us see as many patients in a week in the spring as during a month in the winter.

I don't want to waste time spewing Basic Heartworm Facts. You can get those from, gulp, the internet (try www.veterinarypartner.com) or, better still, from your friendly neighbourhood veterinarian. Some of you even are "your friendly neighbourhood veterinarian", in which case said spewing would be even more time wasting. Instead, I want to touch on a few of the more unusual Cool Heartworm Facts (ok, some of you will consider these Gross Heartworm Facts, but I think they're cool).

Cool Heartworm Fact #1
Heartworm has probably been around forever (or a very long time that may as well be forever) with possible reports in the 1500s. It was first positively identified as such in 1847 in South America and then 1856 in the southeast USA. It has gradually been spreading north and west since, arriving in Manitoba in the 1980s.

Cool Heartworm Fact #2
However, despite that spread, large areas such as Saskatchewan, the Arctic and the West Coast do not have it. Not necessarily because of a lack of mosquitoes, but because of a lack of positive dogs already there. Mosquitoes are just flying syringes moving heartworm from one dog to another. This is why the mosquito paradise of northern Manitoba is heartworm free.

Cool Heartworm Fact #3
Heartworms can be huge, up to 35 cm / 14 inches. And they can be numerous, with infestations of over 100 worms reported.

Cool Heartworm Fact #4
The above-reported size and numbers are very rare, so most of the time "heartworm" is a misnomer. Most of the time the worms are hanging out in the pulmonary arteries leading away from the heart. Only if there are more than about 25 do they actually back up into the heart. But pulmonaryarteryworm is so much more unwieldy. Unless you are German like me, in which case you prefer more accurate but long and unwieldy words.

Cool Heartworm Fact #5
Wildlife can get heartworm. Logically foxes, coyotes, and wolves are most at risk, but it has also been reported in bears, raccoons, leopards, sea lions and, oddly enough, beavers. Cats and ferrets are at some potential risk as well depending on where you live, but that is a big subject best addressed separately.

Cool Heartworm Fact #6
Perhaps the coolest fact. Humans can also get heartworm. Heartworm positive mosquitoes bite us all the time and release microfilaria (baby heartworms) into our bloodstream all the time, but fortunately, we are not good hosts so 99.9%  (and probably a few more 9s after that) of the time they die. However, there have been at least 80 cases reported in humans in the US, mostly in the lungs but occasionally - shield your eyes if you are squeamish - the eyes and the testicles (!). These have mostly been mild infections. The main problem is that on lung x-rays a heartworm lesion looks very much like a tumour, prompting further invasive tests. Radiologists call it a "coin lesion". So if you overhear the interns whispering about this while they shoot sideways glances at you, ask about heartworm...

Blog Update

The two or three of you who regularly read this blog may be wondering what is happening. The last few years I have posted more or less regularly every two weeks, but now it's been over a month! Have I run out of things to say? Have I retired? Has the success of the book killed the blog? No, no and no.

I have plenty more things to say, I am far from retired and the book, while successful, will probably serve to drive more readers to the blog (four or five, instead of two or three! ;-) ) rather than kill it. But, all that said, launching the book and the associated media work is taking some time, plus it's the busy season at work and, most critically, I would like to focus on a few other writing projects right now, so Vetography is going to go into light hibernation for a short while. 

So, much like a bear or a raccoon who snoozes through most of the winter, but still wakes up at random intervals to sniff the air and feed, Vetography will still wake up from time to time to share a brief post or perhaps re-post an old essay that seems relevant. Although this will be for the summer rather than the winter, and posting to a blog is not at all like feeding. Come to think of it, it's really a pretty shaky metaphor. I apologize.

Thank you for being one of those two or three and, as the saying goes, watch this space!

Launching "The Accidental Veterinarian"

For those of you who are unaware, parts of this blog have been turned into a book that is being published by ECW Press in Toronto. The official launch is at McNally Robinson this Thursday evening (April 25) at 7:30 pm, and everyone is invited! RSVPs to caroline@ecwpress.com are preferred but not required.
After that, the book will be available at McNally, Chapters, on Amazon and at independent booksellers throughout North America (and, curiously, Poland, Russia, and Hungary as translations have been sold there). 

Vets Abroad

We've just returned from vacation overseas and although we saw loads of animals (mostly sheep if you're interested in trying to guess where we were), happily none of them were visibly ill or injured so we were able to comprehensively disengage our veterinary brains. That is not always the case. Over the years in various countries Lorraine and I have tried to help goats with infected udders and cats who were bleeding internally. However, the most memorable vet abroad episode occurred twenty years ago in the Philippines when Leeann insisted we spay her dogs on her kitchen table. Let me explain.

Lorraine and I had found our way to a little island called Malapacao, off Palawan in the southwest corner of the Philippines. This was a tropical paradise straight from the tourist posters and, in fact, the view from our beach was used as the cover photo of the Lonely Planet guide to the Philippines. Yet it was very quiet there as it was hard to get to and there was only one place to stay, a resort consisting of a cluster of thatched huts run by an older Australian woman named Leeann. A polite one-word description for Leeann would be "eccentric". To begin with, she regularly practiced naked yoga on the beach near our hut. This is not nearly as cool as it sounds, and it probably doesn't sound all that cool. Also, she had strict no alcohol and no smoking policies. The latter wasn't a problem for us or for the only other guests, John and Jesse, a gay couple from New York City (fun guys - one a Pulitzer Prize-winning journalist and the other a fashion show producer), but it was a problem for a number of people who attempted to come and were consequently turned away. In fact, we got really good at spotting them as their boats approached the beach. Middle-aged dude in a speedo with a paunch: probably a smoker. Cool. We liked this because Leeann let us have the "premium" huts at the regular price so long as nobody else came who wanted them.

The no alcohol was an issue though. Leeann would make her "Malapacao Special" virgin punch for us every evening before the group dinner, but it so desperately needed a kick. We quickly found a workaround though. Malapacao is a saddle-shaped island with dramatic limestone cliffs to the east and west, Leeann's postcard beach to the north and then, over the jungle-clad saddle, a little Filipino fishing village to the south, only a 15 minute walk away. One of us would sneak over with John or Jesse and buy a small bottle of the local hooch, small enough to slip into a pocket in our shorts, so we could quickly spike the drinks while Leeann rambled on about chakras and cosmic vibrations and whatever. Dinner was a lot more fun this way.

This is where we begin to approach the veterinary portion of the story for you patient readers because the same village supplied not only liquor, but also randy male dogs (so drugs and sex, only the rock and roll was missing).

Leeann had two lovely female dogs. They were the classic "beach dogs" one sees the world over - lean, lanky, short fur, curled tails, a bit wary, but ultimately super pleased to receive kind human attention. And they were not spayed. There were no veterinary services anywhere nearby. As soon as Leeann found out that we were veterinarians her already unnaturally lit eyes became even brighter.

"You can spay the girls for me!"

I laughed and took another sip from my drink.

"No, really, I mean it! What do you need?"

"No Leeann, it's just not possible. A spay involves abdominal surgery so we need general anesthetic and sterile conditions, as well as all the surgical tools etc."
I was going to change the conversation, but Leeann persisted.

"No problem. I have connections on the main island. It's the Philippines. I can get anything you need. Anything. Just give me the list." She pulled out a pad of paper and a pencil and looked at me eagerly.

"Ha, no! Really, we use gas anesthetic which involves complicated equipment although..." I began to waver a little, "... I suppose injectable anesthetic might be possible..."

Lorraine shook her head vigorously no. I looked at the two dogs and their giant nipples and deep-chested shape and considered that these would be tough spays at home even. I know that some of my colleagues are guffawing now (I'm looking at you, Colleen and Jonas) as you have probably done spays in Mexico using a Swiss Army knife, a headlamp and some dodgy expired ketamine for anesthesia, but Lorraine and I were (are) spoiled and soft. There was no way we were going to do this.

"But it's just so risky Leeann. You love these girls. You don't want to take that chance. In addition to the considerable anesthetic risks, there's the fact that we can't sterilize the equipment or create clean enough conditions here."

At this point Lucas, the cook, flashed one of his enormous smiles and chimed in, "No problem! I clean the kitchen table very well Mr. Philipp!" He made a vigorous wiping motion with his right hand.

The argument went back and forth for a while, but we were determined not to attempt a tropical kitchen spay. We felt bad though, so when we returned to Canada I bought a large tub of a medication that can work as an oral contraceptive in dogs and shipped it to her. I never heard back. To this day, twenty years later, I still sometimes wonder whether we could have pulled off those kitchen spays after all.

Incidentally, I just Googled Malacapao and Leeann is still there and is still as eccentric as ever.

The 80%

Yesterday was International Women's Day, so I thought I'd take a moment to point out a fact that you might not have noticed or considered: no other profession has experienced as great a shift in gender balance as veterinary medicine.

In 1970 barely 10% of veterinary school students were female, now over 80% are. And the trendline is continuing upwards. In some schools, it's 90%. In contrast, medical school is still 50% male, as is law school, and dental school is 62% male. The 50:50 crossover point for veterinary medicine occurred in the mid-1980s. My own school, the Western College of Veterinary Medicine in Saskatoon, was ahead of the curve as my first year class in 1986 was already about 70% women.

In 1970, a tiny number of practicing veterinarians in Canada were women, now 60% are. These women are on average 10 years younger than their male colleagues, so this number will steadily rise as the men retire and are replaced by the 80% of graduates who are female. In the span of a half century the profession has gone from being overwhelmingly male to being overwhelming female.

Why is this? Part of the answer lies in the changing nature of the work. Over the same time period as the gender shift, the profession experienced a parallel shift from rural and farm animal oriented to urban and companion animal oriented. The fact that women continue to bear the primary responsibility for childcare in many families makes the more regular and predictable hours of the latter much more accessible and attractive. Farm practice can be 24 hours a day, 7 days a week at times, with hours and hours on the road away from home. But that factor alone should have only lifted barriers and given more equal opportunity to women, not pushed them to a predominant position. Why have they shot past the 50:50 equilibrium one might otherwise predict?

It's complicated. One factor is that competition to get a spot in veterinary school is ferocious, more ferocious than for any other profession, and young women are increasingly in a better position to win that competition. Women now dominate in academics, often occupying the top rungs in the lists of the best students in any given class. The reason for this is beyond the scope of this post, but just Google the subject and you'll see that the falling academic performance of young men is the cause of much hand-wringing.

Another factor is that veterinary medicine pays less well and is perhaps less prestigious than many of the other professions. This is a terrible statement about the state of gender relations in our society, but women historically have accepted lower pay and men historically have been encouraged to seek prestige. These things are changing, but some ingrained cultural norms will take a long time to truly fade away.

And finally, veterinary medicine requires more empathy than any other profession. If you are reading this blog then you already know why this is true. Again, this is likely more a statement about our culture than anything else as I don't think I am any less empathetic than my female colleagues, but perhaps I am less concerned about those subtle cultural signals. This is not to absolutely deny the influence of biology. In a survey of very anxious dogs, 7 out of 10 preferred a female veterinarian. Something about men's deeper voices and harder features freaks them out. (I'm joking, of course. To the researcher's endless frustration the dogs were unable or unwilling to answer the questions. But the observation is generally true.)

None of this is black and white, all of this is just tendencies and trends. But look where those tendencies and trends have brought us. When I think back to when I graduated in 1990, it's astonishing how things have changed. Even though I looked like I was 12 years old, I was male and I was immediately assumed to be the doctor, whereas many of my female classmates struggled for years with reactions along the lines of, "When is the real doctor coming in?"

Veterinary medicine has changed and it is thriving like never before. I'll let you draw your own conclusions.

Caturday

The downside of the whole nine lives situation with cats is that when they have run through all nine and have come to the natural end of their lives and no longer find any pleasure in their daily routine they tend not to just pass away peacefully in their sleep. They tend to need to come into the clinic to be given that final gentle nudge into the great beyond. Cats are that tough. Consequently, we see a lot of really ancient, really skinny, really creaky cats come in for euthanasia. Often they are accompanied by entire families, sometimes including older teenagers who have never known life without that cat.

It's been a long time since I've had to say goodbye to my own cat, but after the last old cat euthanasia at the clinic - an 18-year-old torti named Kitten - it's been on my mind. Kitten reminded me a lot of our oldest cat,  Lucy, also a torti. I recalled that Caturday would soon be upon us. Lucy was a stray and we have no idea when exactly she was born, so making an educated guess we assigned her birthday to the first of March. Gabi, the second oldest cat, has her birthday in September (we think...), but the newest beast, Lily was probably also born in early March. It was then that we decided to make the first Saturday in March "Caturday" to mark both Lucy and Lily's birthday. This Caturday Lucy will be thirteen and will officially be an old cat. Not ancient by any means, but old. Old enough that I look at her a little differently.

I came home after Kitten's euthanasia, made myself a mug of tea and sat in my usual spot on my usual couch. Lucy was sleeping on the other couch but stirred when I sat down. She looked over at me, stretched, leapt down and made her way over, purring loudly. Oh yes, she definitely still can leap. In fact, there's nothing about her that would hint at her age except for the fact that she has become thin. She was always the fat cat - the fat boss cat who would prowl about the house, keeping the other pets in line, handing out swats and issuing hisses as she deemed necessary and appropriate. But in the last couple of months, she has very gradually become thinner. She seems healthy enough in every other respect and she is still just as bossy with the other animals, but the other change is that she has become friendlier to me. She was never unfriendly, but she always favoured Isabel and Lorraine. However, the arrival of Lily (aka The Hellbeast, aka The FK - I'll let you figure that one out) resulted in a slow-motion shuffling of loyalties. From the start, Lily was Isabel's kitten. Lucy still wanted to be with Isabel, but she could not be in the same room with Lily, so after a few months of cats screaming at other cats, she stopped trying as hard. In the meantime, Gabi, the "middle cat", cemented her position as Lorraine's cat. Lucy and Gabi could have shared that role as they used to be best friends, but some subtle cat politics were at play wherein Lily's arrival cooled their relationship.

Enter me. I don't mind being third string.

I petted Lucy absentmindedly while checking my emails. When I was finished I looked more carefully at her. Yes, she was definitely not just thinner in the sense of happily no longer being fat, but thinner in the sense of possibly being too thin, making her look older than her almost thirteen years.

My thoughts then drifted to how she was snuggling. She never used to do that, at least not with me. It made me think of Kato, the cat Lorraine had when she was a student. Kato was a Siamese cross and was named for Inspector Clouseau's sidekick in the old Pink Panther movies. Like her film character counterpart, she would ambush you with frightening savagery at the most unexpected moments. I learned to enter Lorraine's place with extreme caution. When we moved in together it was to a pet free apartment and Kato went to live with Lorraine's parents. It was only much later, when we had a house and Lorraine's parents had passed on, that Kato came back to live with us. By this point she was a very old cat and she was a completely changed cat. No more ambushes. No more savagery. In her old age Kato had become mellow and affectionate. Letting her go when her time finally came tore our hearts out.

Lucy apparently had enough snuggling and stretched and sat up, looking about her. Lily had entered the far side of the room. Lucy tensed and jumped down. As she stalked towards Lily I took note for the first time how boney her hips were. Yes, I would have to take her to the clinic and run some tests. She had had a full check-up and blood tests within the last year, but a lot can change quickly in an old cat. Old cats need special attention and special love.

My grandfather lived to the age of 93. Shortly after he died I was talking to one of my uncles. I don't recall exactly what I said, but I must have implied that it is easier to let go when the deceased is very old. I may not remember what I said, but I do remember my uncle's reply very clearly:
"Philipp, just because someone is very old doesn't mean that you love them less. In fact, the older they are, the longer they have been part of your life and it is possible that you love them even more."

Happy Caturday Lucy, my old cat.

Fido v The World

Urban wildlife encounters in three parts:

Part One - Sprayed

Before I even saw him, I could smell Brownie. The whole clinic could smell Brownie. Probably the neighbours could smell Brownie. Maybe even the people driving by on Portage Avenue could smell Brownie. But Brownie didn't care. He was still the same old happy tail wagging chocolate Lab we loved, or at least we used to love until he came in and made everyone go, "Oh my God! What is that smell? Is that skunk??"

Yes, it was. Brownie had been skunked. He may not have cared but his owner was in a state of some considerable distress. She kept apologizing for bringing him in, but she didn't want him in the house and he had met the skunk in the yard, so she didn't want him there either until she was sure that it was safe, and it was a hot summer day, so she couldn't leave him in the car. The only place left to go was the clinic, where she was desperately hoping we could help. We did have "Skunk-Off" in stock, so a brave vet tech put on a large smock and led Brownie, tail still wagging, to a distant room to apply it. Brownie was lucky because he hadn't gotten it in the eyes, where it can be quite irritating, and he was lucky because he was up to date on rabies vaccines and it didn't look like he had actually come in direct contact with the skunk. Skunks are the most common carriers of rabies in Manitoba.

Now some of you, especially those of my generation and older, will be thinking about all those old classic television shows where skunked dogs were bathed in tomato juice. Don't do it. First of all, it is easily more expensive than an enzymatic cleaner, secondly, it is ridiculously messy, and thirdly it doesn't actually work. It only seems to work because of something called olfactory fatigue wherein your nose has become overwhelmed by the combined tomato-skunk stench and calls it quits. Anyone new encountering the dog will still smell the skunk until their nose packs it in too. And then the competing tomato smell wears off and you have a pink stinky dog. If you really need a home remedy, the recipe you'll see online for 3% peroxide, baking soda and dishwashing soap does work. (If you're reading this you presumably have internet access, so just Google "skunk spray peroxide recipe" for detailed instructions.)

But on the plus side you and your dog have been exposed to a marvel of nature. Skunks can spray three metres from their little anal sac nozzles, their spray odour can be detected up to 5 km away and it only takes 10 parts per billion to make a stink. So mix a little wonder into your horror.


Part Two - Poked

In porcupine country, every clinic has these. In the city perhaps only one or two, but in rural areas probably quite a few. I'm talking about "quill dogs". We call them quill dogs because there appears to be a circuit in the canine brain that is dedicated to solving The Mystery of the Spiky Beast. You would think that getting a faceful of quills would be a deterrent to approaching the Spiky Beast again, and that's certainly what said beast intends, but to a quill dog, this is just a mystery that absolutely needs to be solved. A puzzle that needs to be figured out. An enigmatic opponent who needs to be bested. And this mystery is almost never solved. The Spiky Beast almost always makes a getaway.

The practical consequence of all this is that these quill dogs will present again and again to the vet to have the quills removed. This is rarely medically serious, but it is often a significant nuisance. On the rare occasions where it is serious, it is because a quill has gotten in the eye, or deep in the throat. In even more rare occasions they can migrate deeper into the body. Usually though it's just a matter of giving the poor bewildered dog an anesthetic and painstakingly searching for the quills. Once you find them they're easy to remove. "Once you find them..." Please do not be upset at your vet if he or she missed a few quills! Ones that have broken off at the surface can be very difficult to find. And please do not consider this a DIY project - you will miss far more if your dog is not sedated or anesthetized, and it will be painful.

On the upside, porcupine quills are coated in an antibiotic substance. We will still often prescribe an antibiotic as a precaution, but getting quilled leads to far less infection than you might expect. You might wonder why the porcupine is being so kind to others? It's not. It's being kind to itself because the animal most commonly poked by a porcupine is the porcupine itself when it accidentally falls out of a tree! This is more common than you might think. They are not especially elegant creatures.

And before we move on to Part Three I want to dispell a porcupine myth. They cannot shoot or even toss their quills. What they can do is jump very quickly towards their opponent and then lash out with their tail before jumping away again. Not elegant, but lightning fast.


Part Three - Chomped

As the saying goes, there's a first time for everything. And I suspect that this may also be the last time I see something like this. Mrs Bernard brought Duffy, her beautiful golden retriever, in after he had fought with a beaver and lost. He had a set of perfectly chisel shaped puncture wounds on his paw. Yes, a beaver. Yes, fighting with it and losing. And yes, right here in the city of Winnipeg.

So let's unpack that.

Last thing first. Winnipeg is a city of rivers and streams and beavers are actually quite plentiful here. They keep to themselves though and I suspect that the majority of Winnipeggers have never seen one, but if they walk their dogs near these rivers and streams, their dogs almost certainly have smelled them and are almost certainly intrigued. Well, Duffy was intrigued. He was intrigued enough to dive into the creek and investigate the source of that smell.

This brings me to the next thing, beavers and fighting. There is a general prejudice about beavers that they are amiable but dull-witted. People have a cartoon image of a good-natured, hard-working, basically passive animal going about its business without paying attention to much else. Well, they are hard-working, but they are as mentally sharp as any rodent and they are only amiable, good-natured and passive if you leave them alone. Duffy did not leave the beaver alone. The beaver tried to swim away, but Duffy followed until they got close to the lodge when the beaver decided to make a stand. It whipped around and chomped the surprised dog on the paw. It was a one-sided fight. Duffy may have intended to bite the beaver, but quickly changed his mind and splashed back to his shocked owner.

In 2013 a beaver attacked a 60-year-old fisherman in Belarus. The bite severed an artery and the man died. Kind of gives you new respect for our supposedly comical national animal...