A Vet’s Guide To Life

Here’s a tough situation sent in by Jackie.

I have an elderly cat,17 years old, and showing signs of her age - cataracts, vomiting, limping, dull coat, but she still has an appetite. She has always been a very anxious cat, does not like to be touched, but will lay next to you. I am moving from a home in Florida to an apartment in Colorado and fear the 3-day trip, by car, will be too hard for her and then the adjustment there, as well. She has never been outside except for the necessary vet appointments. I feel that euthanization would be more humane and would like your view on this. Thank you.

I know this is a hard situation for you Jackie, and I’ll try to help you out.  But realize that this may be a discussion to also have with your personal vet, as he or she will know your cat’s health status better.  If there are some strong health-related reasons for a poor quality of life, then euthanasia may be a valid option regardless of your situation with moving.

As I’ve mentioned in previous entries, I believe that euthanasia is an option of last resort, and should never be done for convenience.  Seventeen is very elderly for a cat, and most don’t make it to this age.  What you have mentioned of her condition is not uncommon for a cat of her advanced age, but also doesn’t mean that she is at the end of her life.  Your vet may be able to help you with supplements, diets, or medications that can help with any digestive, arthritis or coat problems.  Simple things may help improve her quality of life.

Most cats don’t adjust to new situations easily, and a long move to a new location can be difficult even for a young cat.  An older cat may have a harder time with this situation.  However, the key word here is “may”.  We don’t know how she will react to the trip or the move.  She may completely freak out and begin having behavioral problems.  Or she may settle in and make the adjustment just fine.  We don’t know what will happen until it happens.  And to me, making the decision to euthanize her based on a “maybe” is not the right decision if she is otherwise in good condition.  Euthanization is an irreversible decision, and not an easy one.  Even if she hasn’t been the most overtly friendly of cats, she has still been your companion for almost two decades, and I don’t feel you should give up on her just yet.

You asked for my thoughts, so here they are.  I would recommend getting her used to the cat carrier for several weeks prior to the move.  Leave it out all day and night, and put her food and water bowls in the back of it.  This way she has to walk in and out throughout the day, and learns to see it as just another piece of furniture.  About a week before the move go to your local pet supply store and buy spray and plug-in Feliway (often under the brand name Comfort Zone).  For the last week prior to the move, spray the carrier with the Feliway every couple of days.  Once you get to your new place, plug in the diffuser in an area she will likely spend the most time.  Feliway is designed to help reduce stress in cats, and can help in situations like this.

If you get to your new apartment and see that she has become frantic and is showing a complete mental breakdown, you can always make the decision to euthanize her later.  But if she turns out to make the move easier than you thought, you will be able to keep her in your life for a longer period of time.

Good luck, Jackie!

Here’s a recent comment that I thought warranted further discussion.

I’m quite surprised they don’t offer more specialization since as a vet it seems you can go into a variety of different speciality areas (my neighbor is a large animal vet). Do you think if they retained the basics for every major area, but included more specialization it might increase the productivity of vets?

Veterinary medicine has changed a lot in the last 100 years.  When our society was more rural, veterinarians were mostly working on the farm animals, and would see the dogs and cats while they happened to be on the farm.  In the last 50-60 years, our culture has dramatically shifted to animals being pets and family members, not livestock and workers.  This has also changed the focus of veterinarians and where you find most of them.  In 1909 most vets will have been found working the farms.  In 2009 most of them will be working on companion animals.

Almost every veterinary school in the US started with an agriculture land grant and that bias still shows.  Vets are also the leading experts in diagnosing emerging serious diseases in animals, especially those transmittable to humans (swine flu, avian flu, etc.).  By having the knowledge of all species, we have a better ability to observe and report these diseases, thus upholding the part of our veterinary oath that involves protecting the public health.  As a secondary point, having the training we receive in school allows us much more flexibility to pursue a myriad of career options, often different from where we thought we would be when we graduated.

On the flip side is the argument that we simply have to know too much.  Think about everything a MD has to know about human anatomy, physiology, and medicine.  Now take that same depth of knowledge and apply it to a dozen different species that have radical differences.  Cram all of this training in the same time it takes human medical students to learn their one species, and you get an idea of the difficulty involved in obtaining a veterinary degree.  Many people argue that because the nature of veterinary practice has changed, there should be a “limited licensure” that allows vets to practice on certain species to the exclusion of others.  For example, I would have a license that allowed me to practice on companion animals and pets, but not livestock.

There are good arguments on both sides of the issue, and it has been a hot-button topic in the field for several years now.  On one side I can understand the historic and current need for vets to monitor all kinds of animals for diseases and general public health (including food inspection).  Yet on the other side I remember only tiny details of my training in livestock, and can never see myself working with those animals again.  I’m not sure that that part of my training has ever been useful to me.

So back to the comment…we already get basic training in all major areas, and do have the opportunity for certain amounts of electives to direct part of our interests and education.  For example, I took electives in ultrasound, avian medicine, and exotic pets because I had interests in these areas.  Some of my classmates took extra classes on equine or large animal medicine and surgery.  I can’t say that any of this “specialization” is really going to increase our productivity greatly, though it did help me start off with more knowledge in the areas I thought I might practice.

By the time I retire in another 25-30 years, I fully expect the profession to be radically changed from what it is today.  We’ll see what changes happen and how future veterinarians are trained.

Here’s a common scenario that many vets face.  A pet comes in for an illness.  Sometimes it may be for something relatively minor like a skin or ear infection.  But more likely it will be a potentially serious problem such as profuse vomiting, not eating, being extremely lethargic, and so on.  Chances are good that this problem has been going on for a while, and it seems that these cases happen in pets that rarely get veterinary care.  So there we are with a pet that might have a very serious illness when the next question comes up.

“Hey, doc.  While we’re here could you give him his shots?”

Sometimes I can’t completely understand some people.  Their pet is sick and I’m talking about having to do a battery of tests to determine if it may be life-threatening.  Yet they seem more concerned about the fact that they haven’t brought this pet to a vet for vaccinations in a few years.  These people seem to find the lapsed vaccines a greater concern than the illness that just happened to motivate them to come through our doors.  So let’s have a little lesson in immunology.

The immune system in a living creature is a truly remarkable and complex thing.  When an animal or person becomes sick there is a cascade of events and chemicals within the body as the organism tries to correct or heal the illness.  Antibodies may be produced, inflammatory mediators are released, white blood cells are released from the bone marrow, blood vessels become leaky, and many other things can happen.  All of this is a normal response whether it’s due to an injury or infectious disease.  However, this normal response can lead to adverse effects on the body depending on the severity of the response.  The immune system is also not limitless.  There are only so many white blood cells that can be produced at one time.  There are only so many resources the body has.  And there is only so much a body can take at one time.

This is where vaccines come into the picture.  When we give immunizations, we are stimulating the immune system to have many of the above effects.  However, if the immune system is already “busy” trying to fight off another problem, it may not respond properly to the vaccine.  This might mean that the body doesn’t develop proper immunity and the shot ends up being worthless.  Or, the stress of this secondary response on the immune system may make it harder to fight off the primary infection.

Put simply, we don’t vaccinate seriously ill pets or people.  It’s simply not a good idea.  A minor, local illness (such as an ear infection or small wound) isn’t a big deal and we can still immunize.  But vets aren’t going to do this if there is a serious or wide-spread problem.

So the next time you take your pet to the vet for an illness, please don’t ask them to vaccinate him or her until the problem is corrected.  And make sure to visit your vet regularly so that you don’t get behind on vaccines and physical exams to put you in this situation.

Emily has asked a series of questions, and I’m going to answer each in turn.

So why am I considering becoming a vet? I have been an animal activist for years, lost hope in people and kept it all to myself. Until I met the vet for my two dogs who inspired me to look into the Vet programs as a way for me to help animals. I believe that not enough owners are properly educated about nutrition and care for their animals- their front line for information is from their Vets. No other job field inspires me quite like this one…yet no other scares me as much. Ergo, I have questions….if you’d be so kind to answer?

Emily, I think it’s great that you’ve found a vet that inspires you so much.  However, if you lost hope in people beforehand, you may be in for a rude awakening as a vet.  If you’ve followed some of my discussions (especially my pet peeves) you’ll see that there are a lot of people out there who don’t do what they should with their pets.  This will frustrate you incredibly, and you will need to learn how to deal with it.  This is NOT a profession to get in if you don’t like people or can’t handle them well.  You’ll be talking to people and trying to get them to do your recommendations.  The owners make the decisions, not the pets, and you’ll have to face that.

(1) I know a science background is preferred for acceptance. Is there anything I can do to improve my odds and show that I am a smart potential candidate?

(2) If I become a vet tec, does that certification translate into becoming a vet, ie: would I have to take less classes? Thought that being a vet tec first might be a good way to ease myself into the profession.

Whether or not you are a veterinary technician has no bearing on veterinary school.   Having that certification won’t reduce the classes one tiny bit.  You may find some of the classes easier than your fellow students, but you’ll still have to take the same ones as everyone else.  Being a tech doesn’t keep you out of medical training any more than being a human nurse keeps you out of part of human medical school.  If you truly want to be a vet, I would recommend skipping the tech degree and going straight for the doctorate.

(3) In the school part, how important would you say math/chemistry skills are? If it doesn’t come naturally to you, perhaps extra studying involved, is it possible to succeed?

(4) Are there any resources available which might give me a sense of what material will be covered during Vet school?

Good luck with your studies, Emily!

My recent entry on how to talk about fat cats brought up a couple of other questions from readers that I thought I would address.

Is it more common for a cat to be free feeding? I thought this was discouraged in dogs, but is it more acceptable in cats?
This is an area of a lot of discussion among veterinarians.  In the wild, cats are considered to be “grazers”, meaning that they tend to eat small prey throughout the day rather than one large prey once or twice per day.  Therefore, pet cats should have the opportunity to eat throughout the day as well.  The problem is that many people equate “free feeding” with keeping a bowl constantly full, which promotes obesity.  The main issue to look at is not really how often they feed, but how much they eat.

Cats should get a certain amount of calories per day based on their size and activity level.  Just like humans, less active cats should eat less because they are burning fewer calories.  More active cats can get away with eating larger amounts.  To me, how often they feed is irrelevant if you control the calories.  If you have a single cat, you can put a measured amount of food in a bowl and leave it out for the entire day.  However, DO NOT refill the bowl if the cat eats it before the next feeding time.  Doing so will give them more calories than they need.

If you have multiple cats it gets more difficult.  Invariably you will have one cat that eats more than another, finishing the food more quickly.  If you then refill the bowl, at least one cat will become overweight.  In cases like this, I recommend feeding only 1-2 times per day, and possibly separating the cats to feed.  Now before anyone says “I just can’t separate them”, let me bluntly say in response “bull-hockey”.  At one point I had three cats on three different foods (weight loss, adult, and kitten).  I put each in a separate room, put the food down, and after 20 minutes took any leftover food up and let them back out.  If someone says that they “can’t” separate their cats to feed it really means that they don’t want to take the extra five minutes it takes to do it.  And I don’t understand that mindset.  It’s something very achievable.

Just wondering, what do you feed your cats? I have 2 cats- 1 is overweight and we have gone from free-feeding to measuring “indoor” dry food twice a day for the last 9 months with only a 1lb weight loss-the other cat has maintained her healthy weight. My friend swears that feeding canned food would help with weight loss. Thanks for your help.
Personally, I feed my cats either Nutro or Royal Canin indoor formulas, and the two adult cats get 1/2-2/3 cups once daily (they’re not very active).  Tristan (the kitten) currently gets 1/3 cup daily of Royal Canin Babycat.

You may not realize it, but the indoor formulas and low-calorie formulas of foods are not intended for weight loss.  They are designed to help manage a lower weight on less active cats.  To achieve significant weight loss on these foods you’ll have to feed such small amounts that you may also give too few vitamins and other nutrients.  Instead, you should talk to your vet about using a food designed for weight loss (Science Diet R/D, Royal Canin Calorie control, and several others).

Canned food actually can help weight loss, but again you need to feed the proper amount and the right kind.  The principle is that canned foods have more protein and less carbohydrates than dry food.  A cat’s natural diet is strictly carnivorous, with a high-pro, low-carb balance.  There is evidence in human medicine that this kind of diet can help promote weight loss.  Taking the name of this human diet, veterinarians sometimes jokingly refer to this in felines as the “Catkins” diet.  There is good evidence that this kind of food can help promote healthy weight, as well as improve blood glucose management in cats.  So your friend is actually right.  However, that doesn’t mean that you can feed as much canned food as you like.  You should still follow the recommended amounts.

Good questions, everyone.  Keep them coming.

Dan sends in this scenario.

Hello there, I have a small Terrier who is about to turn 9 years old. He never had anal gland issues until about 6 months ago, when I noticed him scooting. I have taken him to my vet and the techs expressed his glands (one was impacted and came out like paste). Since then I have returned monthly and had them expressed, no problems.

My question is this….

 His normal defecation isn’t nearly as large and firm (not runny but soft). I asked the vet tech if he needed more dietary fiber to increase his stool volume and if that would help his glands. She told me no but in my research of the issue it appears that many vets do believe that fiber seems to help.  What is your opinion of fiber offering any aid in anal gland maintenance and also will it help his loose stools?

Anal sacs are normal structures in dogs and cats, one on either side of the anus.  In wild canines and felines the secretions from the sacs normally express onto the stool during defecation and are used for scent marking.  In pets there really is no purpose for them.  Most animals never have any problems with them at all.  Small breed dogs tend to have a much higher chance of impaction or difficulty expressing the material than other dogs, and anal sac issues are very rare in cats.

The most obvious sign of full anal sacs are when a dog sits on their hind end and “scoots”, or drags their bottom along the ground.  Many people have the impression that this indicates worms, but this is rarely the case, and “scooting” is  a classic sign of full anal sacs.  In most cases having them expressed at the vet is a very simple and straightforward procedure.  However, sometimes the secretions can be unusually thick and cause impactions.  In very severe cases infection can occur, and can then cause the sac to rupture through the skin next to the anus.

Truthfully, there are still a lot of unknown things about why pets have problems.  We do know that it happens almost exclusively in dogs, and most commonly in small breeds.  Overweight pets seem to have a higher tendency for issues, so losing weight may help.  Anatomical differences can cause the sac opening to be malpositioned, making natural expression difficult.  And some pets naturally begin to produce unusually thick secretions, making it diffcult to express on their own.

There really aren’t any good and accepted ways to prevent or reduce problems.  Like you found, Dan, many vets (myself included) do believe that increasing the fiber in the diet may help.  However, there are no studies to support this belief and it’s purely anecdotal.  I do think that I’ve seen cases in which it has helped, and it surely doesn’t hurt to try as it the fiber doesn’t cause any harm.  Most often I recommend adding some canned pumpkin to the dog’s food, usually anywhere from a few teaspoons to a few tablespoons (there isn’t a generally accepted amount) depending on the size of the dog.  Canned pumpkin is cheap, easy to obtain, and they like the taste of it.  Another option is adding a few teaspons of Metamucil or similar fiber supplements to the food.  The fiber may or may not help with the soft stools, so you may want to ask your vet about special foods to help with digestive issues.
The only other options are regular expression (most commonly by a vet or their staff), or surgical removal of the glands.  Surgery is an option of last resort, and usually only recommended when there are repeated impactions or infections, or you have to have them expressed monthly or more frequently.  The reason it’s not done more commonly is that there is a slight risk of permanent post-operative complications with fecal incontinence.  It’s probably in only 10-20% of the cases, but there can be some damage to the muscles or nerves of the anal sphincter, making it difficult for the dog to hold feces inside, potentially leading to stool coming out at any time without any control.

If you want to discuss this further, I would recommend talking to your vet rather than the tech.  My own techs normally do the expressions also, so it’s not necessary for the vet to be involved in routine expression.  However, if you want to discuss the surgery and other options, you’ll need to talk to the vet.

Good luck!

Regular reader Mary sends in another question.

I recently saw a person who means very much to me. This person has two cats. In all the time that I have known this family, they have always taken very good care of their pets, but since they have had children, their cats have been banished to the basement where they are fed from a giant trough. (Before this time, their cats were a reasonable weight.) While I was visiting this person, I got to see the cats. It had been a while since I had seen the animals, but they have become ENORMOUS! I am concerned, because I’m pretty sure these cats have got to be pushing 30 pounds. I don’t know how to talk to this person about the unhealthy condition of their pets, or how to urge them to put their cats on a diet. I know they have lots on their plates (pardon the expression), I know I haven’t always been the best pet owner, but I feel really terrible for their poor cats. It’s probably easier for a vet to express concern about the condition of someone’s pets.  It’s part of the job, and you have a certain authority that we lay people don’t have (besides, you can probably be more frank about it and get away with it, you are a doctor after all). Are there any suggestions you can give me about how to handle this situation?

This is a tough situation, as you want to help out their cats, but you also don’t want to upset a friend.  I think how you handle this depends on which you feel is more important.  But in the end, I always think that honesty is the best policy, and it sounds like these cats are in a serious health condition.

Obesity in cats is a serious health condition.  They are much more prone to diabetes and liver disease, as well as causing stress on their joints.  Most cats should weigh about 9-11 pounds, with certain breeds (Maine Coons and Norwegian Forest cats) weighing 15-20 pounds.  Your average cat weighing 30 pounds is like a person who should weigh 150 pounds actually weighing over 400.   People can usually understand this kind of analogy better than simply saying that their pet is overweight.

Here’s how I would recommend approaching them.  The next time you’re over look at the cats and say something like “Wow, those are pretty big cats.  I’m not sure I’ve ever seen cats that big.  What did your vet say about their size?”  Then let them answer the question.  If they say “Yeah, she said they needed to loose weight,” you can then talk about it a little more.  “Yeah, I’ve heard that obesity is a really serious problem in cats and can cause a lot of health problems.  So I guess you’re working on that, right?”  Then see where the conversation leads.

Now, if the discussion takes a different turn, such as them replying “No, we haven’t taken them to a vet in years”, or “Yeah, the vet said they were a little fluffy but I really don’t believe it”, then you’ll have more difficulty.  Depending on how comfortable you are with them, you can just jump into “You know, I heard that overweight cats can die of diabetes or liver disease.  Aren’t you worried about that?”

Now, if you still don’t feel comfortable with that, I have another, maybe easier option for you.  “You know, I’ve been reading this really cool blog written by a vet.  It’s has funny stories and free veterinary advice.  Oh, and you can ask him questions for free!  Oh, I know, why don’t you ask him about health problems in cats and talk about your own cats.”  I’ll be very happy to be the meanie and tell them how they’re basically killing their cats.

Good luck!

Here’s a consequence of being in veterinary medicine that nobody seems aware of.  When you’re around animals on a daily basis you WILL get “stuff” on you.  There is literally not a bodily excretion or fluid that I haven’t had on me at one time or another.  Most of the time you just get used to it since it all washes off.  To someone in this profession, it’s really not a big deal to get blood, pus, urine, feces, etc. on you.  If that kind of thing really bothered you or disgusted you, you simply wouldn’t last long.

Some days, however, are worse than others.  Like today.  The very first pet I handled was a dog that had been dropped off to be neutered.  And apparently he wasn’t too happy about it as he tried to bite my tech.  I managed to get ahold of him so that she could put a muzzle on, but this was not easy.  He was fighting me and flailing and really putting up a struggle.  A 30 pound dog really isn’t too hard for me to manage, and I was able to keep him relatively still.  However, when a pet is really scared and stressed, they will often release their bowels and bladder.  And he did so.  In abundance.  By the time we got him muzzled the floor and my legs were covered in feces and urine.  He had managed to defecate right on my shoe, leaving a really big turd right in the middle.  His struggles had also managed to get feces up and down both of my legs and one of my socks.

Many people reading this are probably completely disgusted and would have even thrown up if they had been that covered in poop.  But not a vet.  Oh, I was really ticked off, but it was because of the inconvenience.  A little poop can be washed off, but this was too much to easily clean, and I couldn’t exactly spend the day seeing clients with feces-covered pants.  So I had to reschedule my appointments for an hour or so, drive home, change clothing, and drive back to work.  So I was more ticked that I had to change clothes and interrupt my schedule than I was about what exactly I had gotten on me.  And that’s the mindset of a vet.  Yeah, we’re not exactly normal.

Oh, and I got my revenge.  He still got neutered.

It surprises me how many people consider diarrhea a dire emergency.  A pet can be coughing for weeks and I never see them, but they have diarrhea on the owner’s floor one time and they’re right in.  Most of the time these are cases that would resolve on their own, and there isn’t really a need to see the vet.  However, there are some guidelines to follow, as diarrhea can also indicate some health problems that should be addressed.

If your pet has diarrhea for 1-2 days but is otherwise acting normal and eating, it probably doesn’t need to be seen.  If there is vomiting at the same time and the pet isn’t eating, I would definitely recommend a vet visit.  If the diarrhea continues for 3 days or more, you should see the vet, even if it turns out to be minor.

Most people are highly concerned about dehydration when their pet is vomiting or having diarrhea.  Honestly, dehydration doesn’t happen that quickly in most cases.  Unless the symptoms are severe, a pet isn’t going to easily dehydrate from a little diarrhea.

Another concern is if there is blood in the stool.  This really freaks people out, even though it’s usually minor.  Most commonly this is small drops or streaks of blood in the feces or some small clots of blood.  Even though the sight of blood panics people it’s not always a cause for concern.  When the colon is irritated, the lining might bleed a little bit.  This is merely a sign of irritation (colitis) and usually not a serious problem.  However, if the blood is profuse or if there is any bleeding from anywhere else, it can indicated more serious problems.

So keep this in mind the next time your pet has a little loose stool.  You may be okay to wait it out for a few days rather than rushing right to the vet.

Something I always try to tell my clients is that vaccines can cause soreness and lethargy.  Unfortunately, some people seem to get very upset if this happens.  I occasionally have clients who bring their dogs back to me the day after being given vaccines because their pet is just laying around and not eating.  In probably better than 99% of the cases, there is nothing to worry about, and they never needed to come back in the first place.  So I thought I would spend a little time telling everyone about this so maybe you won’t worry about your own pets and won’t bug your vets.

When we give a vaccine we are stimulating the immune system.  The goal is to create antibodies so that if the pet (or person) is exposed to that disease, their body will be prepared to fight it off.  Vaccines stimulate the immune system in a controlled way that should cause antibody formation without causing the actual disease.  However, being infected with a disease will also stimulate the immune system.  When it becomes active, more happens than just antibody production.  The cells that produce antibodies also release biochemicals that cause a cascade of events throughout the body.  Some of these chemicals can cause inflammation (locally or systemically), raise the body temperature, and similar effects.  Know how you feel sore and drowsy and just “blah” when you have a cold?  That’s the effect of these biochemicals.  The same ones can be released by vaccines, and all it means is that the immune system is working properly.

Each individual’s immune system reacts differently with illnesses and vaccines.  When getting a tetanus or flu shot some people will be just a little sore at the injection site.  Some people will be really sore in their whole arm.  And some will run a low-grade fever and feel achy.  The same thing happens with dogs and cats.  Many have no side-effects whatsoever.  But some can feel various degrees of lethargy and soreness for 24-48 hours.

This is not a vaccine “reaction”.  Instead, it is a vaccine “response”, and is normal.  True adverse reactions usually cause excessive vomiting, facial swelling, or hives along the body.  In a true anaphylactic reaction, the pet (or person) will suffer a very quick reaction and will generally collapse as the blood pressure drops.  In 12 years of practice, I have seen this happen 3-4 times out of the thousands and thousands of pets I’ve vaccinated.

So if your pet is sore or lethargic for a day or two after vaccines, don’t worry.  This is nothing to be concerned about, and if you just wait another day or so, everything should be back to normal.  But if you have any doubts or questions, please contact your vet.