A Vet’s Guide To Life

I’m currently sitting in the airport in Portland, Oregon, waiting for my flight.  It’s already been delayed by an hour, and may get delayed even longer, which is never a fun thing.  I’m frustrated by that, and I haven’t even gotten on the plane yet.  It’s especially hard considering how long I’ll be traveling.  A straight-line trip from here to my home is about 2200 miles.  For perspective (especially for non-Americans), that’s about the distance from Perth to Brisbane, or from London to Beirut.  A pretty long trip by any means.  I’m going to finally make it home about 2AM local time, and that’s assuming no further delays.  Yeesh!

This is not the first time I’ve been delayed in an airport, though.  I’ve traveled enough that I’ve had to spend the night in the airport on two occasions.  It’s never a desired outcome, but to a certain degree you learn to deal with it.  And honestly, it’s pretty amazing that we have such fast, reliable travel.  Just 100 years ago, it would have taken close to a week to sail across the Atlantic from London to New York (a distance of about 3500 miles).  Now we can do the same thing in a matter of hours.  Around the same time it would take days or a week to get a letter across the country.  Now we can send an email in fractions of a second.

We in the 21st century have become very spoiled with the speed of our lives, and I count myself in that group.  I have high-speed internet access and am using it multiple times per day.  I have satellite TV, a cell phone, and a car.  I am used to being able to go anywhere or get in touch with anyone pretty quickly.  So when it takes me a full minute to download a web page, I’m feeling my blood pressure rise and getting ready to yell at the computer.  If my wife can’t get in touch with her parents within a few rings of their cell phone, she gets frustrated at not being able to reach them.  When a 30 minute drive gets delayed because of traffic and turns into a 90 minute drive, we start to rant and rave about how horrible that is.  And when a cross-country flight gets delayed by an hour or two, we start to pull our hair out and have to resist going and yelling at the completely innocent people at the airline’s desk.

I guess what I’m trying to say is that we should put things into perspective.  We are so used to extremes in speed and convenience, that even a slight delay causes great frustration and anger.  Rather than looking at how much things have changed even within our own lifetimes, we react strongly to such situations and can’t stand a slower pace.  Frankly, I think we could all benefit from slowing down a bit.  How much do we miss because we’re always rushing about in a hurry?  Why do we really need that song to download in less than a minute?  What’s so important about being able to view a movie on-demand rather than going to the rental store?  Are we setting ourselves up for even more frustration as our technology and speed improves even more?

So let’s all take the time to take a deep breath and relax.  Sometime today, stop what you’re doing and look around.  Take a pause from your hectic schedule and try to appreciate how easy we have things, even in hard economic times.  Let’s learn the often forgotten art of patience, and spread it around a little.

But even so….I REALLY hope my flight isn’t delayed any further….

I arrived in Portland, Oregon yesterday for a continuing education meeting.  As usual for a place so far from home, I’m staying in a hotel.  And like most modern hotels, they have internet access.  However, unlike most modern hotels, they charge for it.  And frankly, I have an issue with that.

I’m staying in the Downtown Marriott in Portland (no, I’m not afraid to mention it by name), which is otherwise a very nice hotel.  I’ve been here many times, and have always found the facilities impecable and the staff outstanding.  I have also stayed in many other hotels within the Marriott “family” of hotels, at one point having a “frequent guest” membership.  In my travels I have stayed in hotels other than Marriotts, some as nice and some not as nice.  Of all of those hotels, this particular one is the only one where I have been charged for internet service.  I have been in hotels that are just as upscale as this one, and ones that charge a third of the nightly rate, and in all of them internet service was included in the room. 

Not so for this one!  They charge $12.95 per day!  That’s the equivalent of $388.50 for a month’s worth of service for a single person!!!  My normal internet service at home is about $60 per month.  In this day and age, where internet service is cheap, many restaurants have it for free to their customers, and even cities are setting up free wi-fi networks, charging for it in a hotel seems outrageous.  This is the kind of hotel used by frequent travelers, who are normally business people.  These guests are usually on the internet frequently as part of their business.  Charging this much is completely taking advantage of them.

Now, if hotels in general charged, I could understand better.  But out of the dozens of hotels I’ve stayed at, including other Marriotts, this is the only one where I have had to pay.  And that’s why I have an issue with it.  Last night I asked the concierge why there was a charge, and he seemed to have questions about it also.  He said that the corporate offices made the decision because the other downtown hotels also charged for it.  In his words, when the Hyatt started giving free internet access, so would they.  This means that the actual cost of the access to the hotel is really not important.  It only matters what they can get away with.

And this is why I refuse to do it.  Luckily, the conference has a couple of computers that they allow people to use to check email.  I’m pushing it a little by blogging, but I’m trying to do it at times when other people are less likely to be here (unforutnately, there are only two computers and about 400 attendees).  But I will not pay this hotel such an outrageous price to get something that I could get for free if there was a local Panera Bread or a Holiday Inn.

Okay, I’m done ranting for now.

Gena sent in a question about her dog’s arthritis.  Apparently, little Piglet has problems with his knees bothering him.  Many pets of all sizes suffer from osteoarthritis, so this is a good topic for discussion.

When most people say “arthritis”, they are meaning what doctors call osteoarthritis.  This is different than rheumatoid arthritis, which is a disorder of the immune system.  Osteoarthritis is wearing and tearing on the joint surfaces over time.  Certain breeds can be prone to this and orthopedic injuries can increase a dog’s risk of it developing.  Within a joint there are some basic structures:  synovial fluid, which acts as a cushion and lubricant; hyaline cartilage, which covers the bone and helps with smooth, low-friction movement; ligaments and tendons, holding bones together; and the bone itself, underlying these tissues.  As a joint deteriorates, the cartilage begins to wear off.  As it does, it exposes the underlying bone.  When bone contacts cartilage or another bone, that touch and movement causes pain and inflammation.

Once degerative changes begin in the joint, they are pretty much irreversible.  Truly degenerative joint disease (DJD) will never return to normal, and can result in some extensive changes in the shape of the bone as the body tries to compensate for abnormal movement or instability.  Even surgery can only do limited things to improve the condition, and are usually small changes such as removing bone spurs.

The keys to improving the lives of arthritic patients lies in helping with pain and inflammation.  This can be accomplished through several means.  One that most people are familiar with is prescription anti-inflammatory medications.  The category of drugs is called “non-steroidal anti-inflammatory drugs” and is commonly abbreviated as “NSAIDs”.  You are already familiar with these products for human use as acetominophen, ibuprofen, naproxen, and many others.  In veterinary medicine we have Rimadyl, Etogesic, Deramaxx, Melicam, and several others.  Though they are all in the same category of drugs, they have slightly different efficacies between patients, and slightly different potential side-effects.  That’s why Tylenol works better for some people than Advil, or vice-versa.  These medications help to reduce pain and inflammation, and can be the only thing to really help pets.  They are not without potential dangers, though, especially with continual, long-term use.  Currently these medications are available only by prescription (at least, in the US), and you should consult with your vet on these options.  I do not recommend using human medications in dogs unless you are under a vet’s instructions to do so.  Dogs and cats are more susceptible to the side-effects than humans are.

Besides prescription analgesics, there are other things that can help, and I usually recommend them as a first choice unless the patient’s pain is extremely bad.  Glucosamine and chondroitin supplements can work wonders, and are readily available over-the-counter.  They help to increase the lubrication of the joint, and can rebuild some of the cartilage.  Numerous studies have shown their efficacy, and I have seen many of my patients dramaticly improve on them.  They will take 2-4 weeks to show an effect, so don’t give up on them after a few days.  Many pet foods now have them included in the diet, especially for large breeds.  There really are no side-effects, so they’re a great supplement to use.  Make sure to use one designed for pets, though.  Even if the basic ingredients are the same as a human equivalent, we have a different digestive system and so the ingredients may not be absorbed as well if you use a human product.

Along the same lines is MSM, a natural dietary sulfur.  This is another nutritional supplement, and works differently than glucosamine.  MSM will act as a natural anti-inflammatory, which can help reduce discomfort.  Using glucosamine and MSM together form a two-pronged approach that may eliminate or prevent the need for NSAIDs.

It is also very, very important to get your dog to a normal weight.  Obesity can dramatically increase the pain of arthritis.  First, there is extra pressure on the joints that the body was not designed to hold.  Second, fatty tissue has been found to produce numerous hormones and biochemicals.  Rather than being an inert substance, it actually is a very active one.  These chemicals have been shown to increase inflammatory reponses in the body, which is one of the problems with arthritis.

If you have a pet with arthritis problems, talk to your vet.  They may recommend x-rays to assess the amount of damage, and whether or not surgery is an option (as it may be in certain types of hip disease).  They will also help design a management program that best suits your pet’s needs.

And the questions keep coming!  This one is from Steve…

I had a question regarding ear function in dogs.  If pricked ears allow dogs to in general hear better, why would the majority of breeds not have ears of this type?  For example, labs which are obviously used for hunting purposes, could benefit from the improved hearing while listening for game in the brush.  My only speculation was that the floppy ears on sporting dogs may be beneficial to prevent poking the sensitive inner workings of the ear, but this theory does not hold as much weight after remembering that most wild canines have pricked ears.  Unfortunately, I fear the answer may be simply “selective breeding” but was hoping you could offer a different insight.
I hate do disappoint you, but selective breeding is indeed the correct answer.  Dogs in general have much more sensitive hearing than we do, and can hear more into the ultrasonic range than humans.  Upright ears do help, but not necessarily how you would expect.

The actual hearing organs are in the inner ear.  Let’s trace a sound going to the brain.  The sound wave comes from the source and travels to the ear.  The outer portion of the ear, called the pinna, serves to capture and focus the sound into the ear canal.  When you see a dog or cat swivel their ears, they are trying to isolate where the sound is loudest, which helps them determine in what direction the sound is originating (called “triangulation”).  The sound travels down the ear canal and strikes the ear drum (tympanic membrane).  This membrane vibrates at the amplitude and frequency of the sound.  This vibration is transmitted through three connected bones, collectively called the auditory (or acoustic) ossicles.  These connect to a structure in the inner ear, the cochlea.  As the ossicles vibrate, they move a membrane on the cochlea back and forth (similar to the movement of the tympanic membrane).  Inside the cochlea there is fluid, which will move in waves because of this vibration.  Imagine pushing against the side of a plastic bucket filled with water and you have the idea.  Inside the cochlea are tiny hair-like structures, that will move back and forth as the fluid moves over them.  When these hairs move, they cause nerve impulses to travel in patterns along the vestibulocochlear nerve and into the brain.  The brain takes these raw impulses and interprets them with our memories to help us recognize the sound.  This basic process is true regardless of the species of higher animal.  Different sensitivities and hearing abilities are determined by the number and type of structures within the cochlea.  So really “hearing” takes place within the cochlea, and not in the part of the ear that we can actually see.

Since the pinna helps to focus sound, upright and mobile ears do help an animal hear better.  However, it doesn’t help too significantly.  Wild canines have upright ears because it serves a benefit to them.  We have selectively bred the different breeds of dogs in large part because of our own preference in appearance.  Dogs with floppy ears came to be this way because people liked the way they look and bred dogs until they had this appearance.  It doesn’t make them hear better, but truthfully it doesn’t hurt them either.

Labradors also don’t hunt like you might think.  The key is the “retriever” in their name.  They were primarily bred to go into the water and retrieve game that had already been found and killed.  They weren’t designed to find and track prey.  Other breeds have been bred for this trait, but not based on hearing.  Beagles, bloodhounds, and similar breeds hunt and track based on their sense of smell.  “Sight hounds”, such as greyhounds and wolfhounds, hunt based on vision.

I hope that this explains it a little better!

Here is a question from Christina…

I recently took a stray cat in to the vet for a checkup, vaccinations, etc. The vet discovered that he was “loaded with roundworms” and gave me a topical dewormer to administer when we got home, which I did. It’s been about 36 hours and the cat has had 2 bowel movements, but I have yet to see any worms in his feces. Should I be worried? He is eating, drinking, and eliminating normally. How long after the dewormer was applied should I expect to see the worms being expelled?

A great question, Christina.  Roundworms are a common parasite, and no surprise to find in a stray.  They live within the intestinal tract, and you will rarely see them come out in the stool.  If the infestation is bad enough, they will sometimes vomit worms, but that’s uncommon.  As long as the worms are alive, they will stay within the intestinal tract, and there may not be any obvious signs that they have them.  When we examine a fecal sample, we are looking for the worms’ eggs, not the worms themselves.  The numbers of eggs we find will depend on several factors:  the number of worms in the pet, the current state of the reproductive cycle when we get the sample, the amount of fecal material collected, and the method of preparation of the sample prior to microscopic examination.  Studies have shown that it’s possible to have a “negative” result, even if worms are present.  In fact, there can be as high as a 20% chance that we can miss worm eggs even if the worms are present.  I mention all of this because quantification of the worm eggs doesn’t always correlate with the actual numbers of adult worms.

When the worms die, they may not be released into the feces all at once.  It is completely normal for a cat or dog to “poop spaghetti” after a deworming, but this is less common than seeing normal feces.  Just because you don’t see any worms coming out doesn’t mean that it isn’t working.  If you took each defecation and teased apart the feces, you would probably find the worms.  However, I doubt that you would have an interest in doing that, and I wouldn’t blame you.  I wouldn’t do it myself.

Hopefully your vet talked about potential human infections, as it is possible for humans to be infected.  Transmission is “fecal-oral”, which means that you have to ingest the eggs.  This occurs most commonly through touching areas contaminated with infected feces, and then touching your mouth or food without having washed your hands.  Simple hygiene will prevent transmission, such as wearing gloves or washing your hands after cleaning the litterbox.  Here are some resources from the American Veterinary Medical Association….
Internal Parasites, Larval Migrans

So to answer your question, Christina, this is a perfectly normal situation.  You shouldn’t expect to see any worms, even if it is working.  And it sounds like your cat is not in any health danger. If you want to be certain that the worms are gone, talk to your vet and have the fecal exam repeated in about 3-4 weeks.

Keep the questions coming!  I really enjoy answering them!

Mary sends in this question…

I am writing you a question for my mom who just inherited 2 cats. One of the cats had only one eyebrow whisker on one side when she moved in, and now she has none on one side. Is this a problem? Also, is there such a thing as fake cat eyelashes?

The long whiskers on a cat’s face are used as sensors, and have clusters of nerves at the base. They detect subtle touch and movement, allowing a cat to more easily detect their surroundings, especially in dim light or darkness. Your average pet cat won’t be harmed by their loss, and will continue in their daily lives without any problems. The whiskers are a specialized form of hair, but are still hair. Therefore they will grow, live a period of time, fall out, and be replaced like any other hair.

Missing whiskers for a short period of time isn’t really a concern. However, this may be the first sign of something wrong with the skin or coat. Common reasons for hair loss in cats are fleas, skin mites, and allergies. These normally don’t start with just the whiskers, so I don’ t know that this would be a concern if it’s limited to them. My recommendation would be to have her observe the kitty closely, and if this spreads to other whiskers or other hairs begin to fall out she should take her to a vet to be evaluated.

And no, there are no kitty false eyelashes.

Yesterday we in the United States of America celebrated the Martin Luther King, Jr. Holiday.  We honor this leader of civil rights who helped change the direction of our country and race relations within it.  He was a wise man who deserves honor and respect, and we should remember his words.  As much as he thought he would accomplish, I’m not sure if he could have truly believed today would happen.  Today we inaugurated the first president of black descent.

“I have a dream that one day on the red hills of Georgia, the sons of former slaves and the sons of former slave owners will be able to sit together at the table of brotherhood. “
Martin Luther King, Jr.

Regardless of our personal political beliefs, we should step back and recognize what we as a nation and a culture have accomplished.  Though we still have racial tensions, we have put many of them aside, and have matured enough that we can elect someone of a race that was once enslaved and discriminated against.  This is truly remarkable, and I am glad to see that our country has grown to the point where this can happen.

“I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character. “
Martin Luther King, Jr.

However, I think that the pendulum has started swinging in the other direction.  Can we truly say that the Reverend King’s dream of a color-blind society has been reached?  All I seem to hear about lately is related to Barack Obama’s skin.  Now, it should be celebrated that we have stepped beyond race in our choices for a national leader.  However, we shouldn’t get so caught up in Obama’s color that we ignore the man inside that skin.  Obama isn’t the messiah or the savior of the country.  He is a man, and is as fallible as any other man.  We will see what happens in the coming months and years, and see what the content of his character really is.

“Have we not come to such an impasse in the modern world that we must love our enemies - or else? The chain reaction of evil - hate begetting hate, wars producing more wars - must be broken, or else we shall be plunged into the dark abyss of annihilation.“
Martin Luther King, Jr.

However, now is not the time to dwell on differences.  As a country we need to put our issues aside, and try to come together to face some very serious challenges.  There is a lot of work that needs to be done and it will take all of us to get there.  I know that we will still have disagreements on how to reach that goal, but for now we have the potential of a new start where we can blaze a new path.  Democrats and Republicans must both stop hating each other, former President Bush, and incoming President Obama.

“He who passively accepts evil is as much involved in it as he who helps to perpetrate it. He who accepts evil without protesting against it is really cooperating with it.“
Martin Luther King, Jr.

I am proud of our country for the fact that we have elected a man that just over 40 years ago would not have been allowed in some restaurants and would have had to drink at a different public fountain than I would.  That is a great accomplishment.  But acknowledging our development as a nation does not mean that I have to agree with the policies and ideals of Obama.  I do have some serious reservations and concerns about some of his goals and policies.  I disagree with him in many areas, and did not vote for him.  But my opinions have nothing to do with the color of his skin, but rather the content of his character.  If he surprises me, none will be happier than myself.  Let’s see where we are this time next year, and see if anyone’s opinions have changed, and if the seeming cult of personality has died down.

Did the title grab your attention?  With the state of the world’s economies nowadays, it probably did.  Everybody (myself included) is trying to find ways to pinch pennies and save a little money.  That also includes at the vet.  I have spoken to many clients in the past week that are price-shopping or trying to cut corners.  They skip many vaccines, take their dogs off heartworm prevention, decline recommended services, and so on.  Honestly, that doesn’t save money in the long run.  Let me give you several examples.

Heartworm prevention for an average dog will cost about $40 every 6 months ($80 per year).  Treatment for heartworm disease can easily cost $800-1000 without complications.  Treatment is also rough on the body and carries risks.  Do the math really quick and you’ll find that for the cost of treating it once, you could have bought prevention for at least 10 years.  Which is the most cost-effective or saves you the most money?  Which could you more easily afford?

A vaccine for parvo will cost about $30-40.  Treatment for parvo can easily cost $600-1000 or more.  Which one can you  most easily afford?  Remember that parvo is usually fatal without treatment, so this is only counting the financial aspects and not the emotional ones.

Taking a less serious example, a vaccine for bordetella (kennel cough) is about $25.  This isn’t a fatal disease, but does require antibiotics to clear the infection.  Between the office visit, cough medications, antibiotics and simple blood cell counts, you can easily spend over $100.  Is that more affordable than the vaccine?

Remember that health care is about value, not about actual cost.  I know that times are tough, and you have to make sacrifices in order to make ends meet.  I’m also fully supportive of making sure that your human family members are taken care of before the furry, feathery, or scaley ones.  However, when you’re “counting the cost”, make sure to look at the ultimate, long-term cost and not just the immediate one.  You might find that spending a little money now will save you a lot in the long run.

One of my clients today had a friend who lost their dog recently.  The friend’s dog was spayed on Friday, and died Saturday, apparently from excessive bleeding.  My client has a 14 week old boxer puppy, and was very concerned about her safety when she was spayed.  That’s a valid concern, and one worth talking about.

Routine surgeries such as spays and neuters are considered very safe.  Now realize that not all veterinarians do them the same way.  I always recommend pre-anesthetic blood testing, an IV catheter, monitoring with an ECG and pulse oximeter (measuring blood oxygen), sevoflurane anesthetic, and perioperative antibiotics and pain medication.  Not all vets will use these.  Believe me, I’ve seen it, and at one point even did it.  If blood tests are not performed, you might miss hidden health problems, even in young dogs.  I’ve discovered many subclinical problems this way.  An IV catheter and fluids not only helps to maintain blood pressure, but if the patient begins to have problems, you already have a direct line to the cardiovascular system, and don’t have to waste precious minutes placing a catheter in a critical patient.  Proper monitoring of the heart allows you to catch problems during the procedure that could lead to cardiac arrest.  Sevoflurane is currently the safest veterinary gas anesthesia in the US, and patients recover very quickly for it.  There are many valid reasons for vets making these recommendations, and making money really has nothing to do with it.

The puppy that died did have all of these precautions. Yet something bad still happened.  Unfortunately, nobody can say that surgery carries no risk.  This is true of human medicine as well.  People do die of routine procedures, and this is a risk you acknowledge when you sign the authorization forms at the hospital (read the fine print sometime…one of the lines usually states something about you understanding that the procedure carries a risk of death).  The nature of medicine, surgery, and physiology is that we can’t predict or control 100% of possible factors.  There will be circumstances where a patient will have complications or even die despite every precaution being taken.  That’s very scary to consider, and something nobody wants to contemplate.

Thankfully, complications are very rare.  The best veterinary facilities normally run a complication rate of 1 case per 10,000 procedures, which mirrors the rate among human surgeries.  I have calcuated my own cases, and I have easily done over 3,000 routine spays and neuters in my career so far.  I have lost only one patient to a routine procedure, and that was traced to a failure in the anesthetic machine.  Keep in mind that I’m talking about risks in routine procedures.  I have other patients during or shortly after surgery, but those were serious cases that carried many more risks.  A major surgery such as removing a spleen, relieving an intestinal impaction, or repairing a ruptured diaphragm carries much more potential for complications.  The risks for a spay, neuter, or dental cleaning are considered minimal.

If you have concerns about your pet being anesthetized, ask your vet to detail the procedure.  Good vets will be happy to describe in detail how they do it and will try to allay your fears.  We do spays, neuters, and dentals multiple times each day and rarely think twice about it.  Any risks are minimal, even in very old dogs and cats (assuming the pet is generally healthy), and are far outweighed by the benefits of the surgery.

And the client whose friend lost her dog after spaying?  She’s still going to have her boxer puppy spayed.

Ready for me to get myself into really hot water?  I’m about to tell you the type of client that veterinarians dread most.  Nurses.  Human nurses.

Once again, keep in mind that I’m generalizing.  I have had some nurses that are great clients.  I have nurses in my family.  And one of my receptionists is currently in school to become a nurse.  Unfortunately, the good ones are the minority.

Nurses are just about the worst kind of client vets see, and you can ask any vet about that.  I have had more problems and arguments with nurses than with any other type of client.  They seem to think that because they know a lot about human medicine that they know as much or more about animal medicine.  They question a vet’s judgment and diagnosis, argue on the necessity of basic tests, make their own decisions about which medications to use, and generally make life difficult.  There is a certain arrogance in they way the talk to you and expect to know as much or more than the vet.  I know I’m not the only one with this opinion, as I have yet to find a vet or veterinary staff in 11 years that doesn’t agree.

Remember my receptionist who is a nursing student?  I asked her about it yesterday, and she shares the opinion.  She said that this is even a problem in human hospitals, and they put notes on the medical directors that the client’s relative is a nurse.  In the hospitals nurses will argue with the doctors and even change their orders.  I was recently speaking to another vet who’s brother is a nurse, and she agreed.  She said that he was a horrible veterinary client, making his own diagnoses and choosing his own treatment, even if his sister the vet disagreed.

I wish I could tell you why this happens.  Nurses are highly skilled, intelligent, and necessary people.  Doctors would be in trouble without them, and they serve a crucial need in the human health field.  They are very important to our health and well-being, and have chosen a very difficult profession that requires a lot of patience of compassion and is often thankless.  Perhaps knowing that we need them and knowing that they are great with medicine creates a degree of arrogance.  Maybe such strong will and opinion is necessary as a defense mechanism for dealing with their own difficult clients and patients.

To any nurses reading this, please realize that neither I nor my colleagues hate you as people.  We just wish you would realize that vets are not second-class doctors.  We have gone into this profession by choice, and not because we couldn’t get into a human medical school.  We also wish you would realize that animals are not people, and do not have the same anatomies or physiologies.  You can’t take the same knowledge about human medicine and make direct correlations to animals.  Please realize that your knowledge in your profession doesn’t extend to your pets.  Vets really are trying to do the best thing for your dogs and cats, and really do know more about their health than you do.

And honestly, please chill out and take the chip off your shoulder!