Clients Say the Strangest Things

Often, in the course of veterinary medicine, it becomes necessary for one party to dissolve not the bands of connection but into soundless mirth. I'm referring to those times when clients say things so utterly beyond reason or the realm of common sense that I am rendered politely speechless. Some examples:

During an exam of a mature Rottweiler with dermatitis and a particularly powerful doggie odor suggesting his last bath had been from his dam shortly after birth the owner left no doubt about his dog-owning acumen with the following statement,
"...Well, I know you're not supposed to give a Rottweiler a bath because it's bad for their skin."
Here I questioned, "Oh?"
He then assured me there were several studies showing Rotties have special glands in their skin and never need bathed. Sigh. I think I made a comment about not being able to believe everything you read online and that regular grooming and bathing with a moisturizing shampoo made for dogs would considerably improve his pet's "houseability."

Around the same time I was firmly informed that the reason so many pit bulls are involved in aggressive incidents is because, "...their heads stop growing before their brains." I'm not sure what his logic actually was but, if this were true, I could imagine the hellacious headaches ensuing prior to death from brain stem compression could lead to behavioral issues. However, careful assessment of the speaker led me conclude he knew whereof he spoke, perhaps even on a personal basis, and I chose not to comment on the absurdity of the statement.

On another occasion a pet had to be hospitalized and the owner inquired as to where he would be in the clinic. I explained we had individual cages and kennels with comfortable blankets and cushions. he then said, in all seriousness and with great concern in his voice, "He won't stay." I first clarified that he meant the dog wouldn't stay in a cage and then gently assured him that I didn't intend to give his dog a choice in the matter.

There are also owners who, despite assurances to the contrary, cling to impossible concerns, like the gentleman who repeatedly asked if the hematoma in his dog's ear would explode. The answer is, "No." Even if the aural hematoma is not surgically treated and the ear flap becomes extremely distended, bruised, and/or deformed, it will not spontaneously "explode."

Similarly, while admitting a young tom cat for neutering, I had the following conversation,
"When will I need to bring him back?"
"He'll go home this evening, there aren't any sutures to remove so unless you have any concerns we won't need to see him again until his next physical and vaccines are due."
And then the client clarified, "No I mean how long before I have to have him re-neutered?"
Clearly there was a significant anatomical misunderstanding. I explained "they" do not grow back.

The latest addition to the category of strange utterings involved a young ferret who presented for immobility after a fall. Further questioning revealed the owner's boyfriend had been bathing the jill when she bit him and he dropped her from a height of about 5 feet. Onto the shower floor. Approximately 8 hours earlier. At 3:00 a.m. It not being directly relevant to the current state of the little fur ball I didn't pursue why a teenage boy was bathing a ferret at 3 in the morning but it does conjure questions. She had sustained a dislocated elbow in the fall and likely some head trauma but at last check was doing well.

It's not just clients who struggle with the obvious. Several years ago I testifed in an animal abuse case regarding the existence of animal pain and suffering with respect to a puppy who had allegedly been thrown against a wall. After tedious grilling as to my education, licensing, and experience and no doubt to the dismay of the defense attorney, the judge qualified me as an expert witness. In answer to a question from the prosecutor, I asserted it is generally accepted in veterinary medicine that an injury or procedure known to cause pain in a person is reasonably assumed to cause a similar degree of pain in an animal and the pain itself ethically requires prevention or treatment. The defense attorney objected and there ensued a verbal barrage ending in the prosecutor appealing to the judge by saying, "It's common sense, your Honor!"
To which the defense attorney replied entirely without irony, "Common sense doesn't work for the defense your Honor!"
I don't recall the judge's exact response but it was very close to my own thought, which was, "Clearly."

Most veterinarians will tell you a sense of humor is vital to clinical practice and although we may cringe at some of the the nonsensical things pet parents do and say, they are an unending source of comic relief. I'll close with these words from philosopher William James, "Common sense and a sense of humor are the same thing moving at different speeds. A sense of humor is just common sense dancing."

 

 

Welcoming a New Cat Home

As promised, some thoughts on various approaches to introducing a new cat or kitten to an established cat-bearing household.

All In
Frequently the preference of men and boys not entirely fond of cats but appreciative of a good scuffle, this method involves unceremoniously dropping the new comer into the midst of the established feline family. Trouble almost always ensues and fur often flies. All manner of bad manners are possible, including inappropriate urination, which I broadly define as anything outside the litter pan or designated equivalent. Additionally, the spread of parasites, like fleas and intestinal worms or communicable diseases ranging from upper respiratory infections to fatal leukemia or immunodeficiency viruses is possible without proper quarantine and testing. And, it's just  not a kind thing to do to a cat or kitten already stressed by a new environment, new food, new smells, new people....or to the established residents who thought they had it all figured out. Don't gamble this way.

Never the Twain Shall Meet
At the other extreme is complete isolation of the new cat from everyone else. Sometimes this is necessary for reasons of temperament or viral status but otherwise not required.

A Happy Medium
Aren't we all looking for the "just right" Goldilocks solution?
What I usually recommend to clients and actually tried myself with the recent addition of the best little grey tiger kitten ever, aka Scout, (her story's here), is the following:

1. Test for Feline Leukemia and Feline Immunodeficiency Viruses. A negative result is great but bear in mind that recently exposed cats and kittens may  not actually test positive for up to 12 weeks. There are two good options. The first is to test and re-test in 12 weeks. The second is to confine and quarantine the new addition for 12 weeks and then test once. This offers some assurance that the resident cats aren't exposed to a potentially deadly disease and you don't get your hopes up for a decades long relationship. (The management of a kitten or cat with a positive test for either virus can be controversial. Suffice to say for now that a single positive test in an otherwise healthy feline is not an immediate death sentence.)

2. Treat for parasites. Like puppies, kittens can acquire intestinal worms even before they're weaned. In the case of an adult cat with an unknown history, deworming and a stool check for intestinal worms is good sense. Any flea & tick infestations should be addressed so your new pet doesn't bring along pets of her own.

3. Update vaccines. Depending on the age and known history of the new feline, do the best you can to ensure good health and immunity. Consider boostering the upper respiratory complex and feline leukemia vaccines for any current residents, just in case.

4. Create a safe zone. This was key in making Scout's transition smooth. It was also facilitated by an "extra" bedroom thanks to a non-resident college sophomore. Scout moved into her own space, complete with food & water bowls, an exclusive litter pan, a pillow & comforter-laden bed, and two big windows featuring birdsntreesnsquirrels oh my! That first night home she circled the room twice, (counter-clockwise we noted for whatever reason but suspect may have something to do with our cats having a tendency to be left-pawed), then settled in for dinner and a nap. Three months later, Scout still naps on that bed after her mad morning romp. (The college sophomore is resigned to sharing her room. I console her by noting it's better than a dormitory.)

5. Gradual introductions. The sounds emanating from the bedroom , (primarily the crunching of kitten kibble and the occasional crash of a gravity check), not to mention the loathed existence of a closed door, riveted the attention of Minerva Jayne who appointed herself hallway sentinel extraordinaire. Similarly, they roused the suspicions of Holly who sulked behind a poofy tail which I attribute to her remembering the assault upon her sensibilities when Minerva arrived a few years ago. After a few days of auditory acclimation and the occasional glimpse, paws began reaching under the door from both sides.

6. Cat nip, treats and toys. Many kittens aren't fazed by cat nip but both of my older girls find it irresistible. The initial frenzy of rolling is soon followed by a mellow-cat kinda vibe, the perfect state of mind for an introduction. Pairing the new comer with some tuna water or special treats can create an aura of good feeling, or at least distract and lead to an intense grooming session.  (I did refrain from dousing Scout in tuna but the thought did occur to me...) New toys also attract some attention and enrich the environment.

7. Sufficient resources. Separate food and water dishes are a good idea. Everyone should be able to eat in peace, cats included. Enough litter pans, (i.e. the number of cats plus one is ideal), in enough places that there's always a "vacancy" if needed. Laps for napping and windows with sunlight are important too.


8. Accept the inevitable. It's not going to be entirely conflict-free. Someone will get too close and invoke a hiss. Someone else will say something worse, leading to some paw swipes and potential injury. If hostilities escalate or simply don't resolve with time, consider backing up to step 4 or consulting your veterinarian for some additional stress-reducing ideas. I'm a fan of Feliway, especially if there are any issues with proper litter pan use.

And that's the recipe that worked for me. Good luck on your own new additions, especially if there's something soft and meowy under your Christmas tree...

Speaking of which, I'm sure the resources here will happily find a kitten or cat to own you.

How's 'at? Veterinary Terms & Abbreviations I

Like other professions, veterinary medicine has its share of abbreviations and slang. Most are legitimate short hand for disease conditions, however many disguise a dire prognosis or allow veterinary team members to humorously communicate a less than flattering assessment.

Feed Me...or Not

Agroceryosis - Lack of groceries, i.e. owner hasn't been feeding the animal. Sadly this is too common in outdoor dogs in the winter.
Garbageitis-Dietary indiscretion, almost always applied to a dog eating something he shouldn't have, e.g. old socks, spoiled food, rocks, disposable razor blades, (all true.)   Cats know better.

(Courtesy of www.freeclipart.com)

CFT - Chronic food toxicity i.e. obese

Cat and a half-Similar to cft but, like under-tall, often used to gently suggest to the owner that perhaps they've been feeding more than a little too much.


History Matters

Veterinary patients can't actually tell us what's wrong or where it hurts and when a problem isn't obvious a good history from their owners is often crucial to making an accurate diagnosis. It makes our jobs so much easier when owners have been paying attention and know what's normal for their pet...

BDLDLDL- Big dog, little dog, little dog lost. Picture an 80 pound dog in a 15-20 pound body, that's a Jack Russell Terrorist. Now imagine the terrier charging into the air space of an actual 80 pound dog, say a disgruntled Rottenweiler. No contest. And yet, those little dogs that fling themselves into the jaws of destruction once seem to keep at it so it's not unusual to see this collection of letters multiple times in a chart.

ADR-Ain't Doin' Right. Sometimes an owner just can't quite articulate what the problem is and the appointment book says, "adr."  Or, conversely, the receptionist surrendered in self defense because the person making the appointment has presented a plethora of unrelated information,

"Well, he's coughing but only after eating grass and vomiting but I think that's because he has a rash from the new food but he hasn't really been eating all week since we sprayed the yard but my brother-in-law's dog was fine and they both had the same hair cut after they were boarded at a new kennel do you think he can get his vaccines today?"

This could be anything from a simple case of a picky eater with kennel cough, to a serious case of skin and gastrointestinal chemical poisoning. What I know for sure is that I would not want my flu or tetanus vaccine if I had a cold or had been poisoned and hadn't eaten all week...

Out Of A Limb

Unfortunately for one small tabby cat, that's not a typo in the title.

On a blustery morning the week before a Thanksgiving past we were still gathered at the front desk warming after the 20 foot walk from the parking lot. It was one of those deceptively sunny days with a finger-numbing wind chill. The first surgical appointment of the day was still checking in when a young woman rushed in the door holding her hands to her chest.
Reaching into her coat she produced a kitten while saying,
"I found him on the side of the road."
Holding up her other hand she finished,
"And here's his leg."

I already had the little dark grey tiger in my hands by the time I realized that everyone else in the room had sensibly taken a step back and now stood wide-eyed and motionless, especially the scheduled surgery's mom who was several shades paler than when she entered!

Tossing a quick, "We'll take care of him," over my shoulder I headed to the treatment area.

An inventory of the little stray's injuries revealed it was the distal 1/3 of his left rear leg that was severed with additonal leg and hip fractures, his right hip was dislocated, his tail was limp and fractured and he had multiple other laceratons. No more than 12 weeks old, cold and shocky from hypothermia and the pain of his injuries, he started to purr. I knew I had to give that kind of character a chance, even if his prognosis was guarded.

(As an aside, I should note that we disposed of the "leg" so optimistically supplied by our Good Samaritan. I'm pretty good in the operating room, but not that good. The nature and extent of his injuries suggested he'd been napping under the hood of a car and had gotten caught in the fan and/or belts when the engine was started.)



(Courtesy of Rulingcatsanddogs)

 On frosty mornings it never hurts to give the hood a few raps to rouse and remove any snoozing neighborhood critters.


(Courtesy of catsguru)

    










Intravenous fluids, antibiotics, pain medication and a warm meal did wonders. By morning I deemed him stable enough for anesthetic and surgery but not for too long. In order to keep the surgical time to a minimum I opted for a non-standard amputation of his left hind leg at the stifle or knee joint, amputated the tail beyond the injury, reduced the hip dislocation, sutured numerous lacerations and called it a day. The little guy's recovery was smooth but it was several days before he managed to balance himself and a few weeks before he learned to walk.

We initially toyed with calling him "Tripod" but Pirates of the Carribean was popular and his lop-sided gait and one swollen eye, not to mention abundance of personality, earned him the moniker "Captain Jack." CJ was adopted by a retired couple who supply regular updates on his progress. To their delight, and occasional consternation, he learned to fly through the house and navigate furniture like a pro. Now 6 years old, Captain Jack has become an especially handsome boy cat.

Bladder Stones, The Case of Princess and the Pee

Bladder stones, (also called urocystoliths), are an all too common affliction of our canine and feline companions. The how and why of their development varies by species and breed and even by individual.

(X-ray of bladder stones. Courtesy of enpevet.de)

Almost 50% of bladder stones in dogs involve a urinary tract infection. The microscopic bacteria in the urine do two things that promote urolith formation. First, they alter the pH of the urine, making it more alkaline and causing minerals to precipitate or solidify out of solution. Second, the bacteria themselves provide a nidus or starting point for crystal formation. The remainder of bladder stones form due to a combination of an individual's genetics, metabolism, and diet.




(Courtesy of caninehealthanswers.com)

Urinary crystals can grow into visible and sometimes huge stones causing trauma to the bladder, frequent and/or bloody urination, and occasionally life-threatening urethral blockage. For many years, treatment of bladder stones involved a combination of antibiotics, dietary management and surgery. However, thanks to voiding urohydropropulsion, a technique developed by Dr. Jody Lulich of the University of Minnesota Urolith Cnter, there's a non-surgical option to resolve small bladder stones. And that's where Princess comes in.

 


Princess is a 9 year old Rat Terrier owned by Mrs. Maria Wethington and our Case of the Month.


To say that Princess and her housemates Prince and Baby are doted upon or that Ms. Wethington is merely a concerned pet owner would be serious understatements. They travel on pillows, lots and lots of pillows. Originally from Germany, Mrs. Wethington has lived in the United States for 45 years. She retains a charming accent and, despite some serious health concerns of her own, the indomitable courage and sense of humor of a woman who's seen too much difficulty not to appreciate every sunrise.

Careful as she is with her canine babies, it's no surprise that when Princess began to act a little oddly Mrs. Wethington was quick to seek veterinary care. It was that early intervention that made voiding urohydropropulsion an option. Briefly, the technique involves placing a urinary catheter and instilling sterile saline into the bladder to gently distend it. A finger is placed over the urethra to prevent leakage while the dog is held upright, tipping the bladder stones down. The bladder is gently squeezed, the finger pressure is released and the stones are flushed to the outside. This technique works if the stones are relatively small, (which usually means of short duration), in relation to the dog.

And that's exactly how it worked in Princess's case. The initial flush produced almost two dozen tiny stones, and a subsequent flush 2 more. Following a post-procedure x-ray she was still a little sleepy but sitting up and back in her mom's arms in less than an hour.

As you can see Princess is relatively large for a Rat Terrier, but nonetheless loved by her mom. An analysis of her bladder stones is pending. With those results and careful monitoring for recurrence we hope to keep Princess healthy and out of surgery in the future.

Veterinary Requirements--The Ick Factor

A pair of scrubs, $30.00.
A stethoscope, $199.00.
Four years of veterinary tuition, $120,000.
That warm, wet feeling you get from a puppy...peeing directly into your shoe, priceless!

Well, not exactly priceless in a good way. But the above incident really happened to a co-worker, last month in fact, and it does illustrate an important truth about clinical veterinary medicine. Namely, you're going to get wet. And smelly. And quite possibly sick or injured at some point.


(Courtesy of funnyvet.com)

There are many options for someone with a veterinary degree: fundamental research, education, food safety and regulation, journalism, politics and organization, public health, bio-terrorism and epidemiology, sales and pharmaceuticals among them. The most common public perception of a veterinarian, clinical practice, is not for the faint of heart or the weak of stomach.

Basic, routine, every day appointments include the blood and guts of abdominal surgery and rectal temperature taking. That's before you get to the putrid stench of a pyometra, (uterine infection), cat bite abscess, anal gland expression, foot rot, chronic ear infection, rotten tooth, parvovirus diarrhea puppy or absolutely anything, (including driving through without actually stopping), to do with a swine operation. Sadly, I know whereof I speak.



(Courtesy of www.funyvet.com)

Not that I'd necessarily do something else at this point. It is, after all, something of a point of pride among veterinarians that we hold dinner meetings and lunch and learn seminars with titles like, "Vomiting and Diarrhea, a case review" or "How I treat Foul-Smelling Ears." It's quite possible for us to enjoy meals which include bean dip and melted cheese or pools of gravy while gazing at power point presentations about aberrant bodily fluids.

Need someone to help with something disgusting on short notice? A veterinarian is probably up to the job.



(Courtesy of funnyvet.com)

I had a pathology instructor who claimed he pranked senior veterinary students by surreptitiously placing a dollop of yogurt in the floating abdominal contents of a cow opened for necropsy and asking them what they thought it could be. When they inevitably professed bafflement he would stick his finger in for a big taste, swallow, and to their stupefied horror pronounce his diagnosis, "Vanilla!"

His field of research included hematology and platelet function. Platelets are the blood components partially responsible for our ability to form a clot and thus not bleed to death on a daily basis. They have a tendency to rapidly clump, it's their job actually, but that also hindered his research. To get around the inevitable delay involved in requisitioning blood from the resident Basset Hound colony he drew his own...i.e from his own arm. We loved him.

Veterinary students are funny that way.

Special thanks to Dr. Dean Scott of funnyvet.com, for so accurately capturing the realities of veterinary school and practice and especially for making me smile out loud.

A Vote's a Vote For A' That

With apologies to Robert Burns' Is There For Honest Poverty , and a link to an analysis of the Scottish anthem that champions honesty and character over wealth and finery and ends with the verse below hoping that goodness and sense will lead us to mutual respect.

If you're a U.S. citizen, one way or another you're a participant in an amazing democracy. You consume and you contribute, you benefit and you assist, you vote or you vanish.

Please vote.
                                       
Here's Why
Vaccinate your pets against rabies or yourself against the flu?
Welcome to the public health system.

If you get up in the morning and turn on the lights or the water, you benefit from public utilities and government regulation. (Unless you live "off the grid" and dug your own well.)

Michigan voters have an opportunity to influence the future of our energy sources by casting educated votes on Proposal 3.  Proposal 3 Text here.

If at some point in your day you have a cup of coffee, get dressed or purchase gasoline you're a participant in international trade and the global economy. (Unless of course you harvest coffee beans in your back yard, knit your home-loomed clothing, fashion shoes from hand-tanned hide or rubber and have an independent oil well and refinery next to the java plants and rubber trees.)

Michigan voters have an opportunity to influence international trade by casting educated votes on Proposal 6. Reading the Proposal 6 Text may help.

Following a breakfast which may include FDA and USDA if not American Heart Association approved foods you may then leave home, drive on city streets, deliver children to a public school and maybe show up for a licensed doctor's appointment.

If you're among the U.S. work force, 92.2% of whom ARE EMPLOYED, you may then get to work a bit late, but you probably negotiated time off in some fashion and you do in fact have a job.


Do all these things, or simply breathe,  and you've benefited from public works projects and education efforts, government oversight and medical research. Additionally, via your tax dollars, you have directly contributed to Social Security, national defense, retiree and veteran's programs and medical care for low income seniors, children and those with disabilities. Know any retired disabled veterans with sick kids? Help them get to the polls!

Michigan voters may want to weigh in on the Proposal 1 referendum, or read some Emergency Manager Law Background and the Proposal 1 Text. Similarly, Proposal 2 issues are worth a look, as is the Proposal 2 Text.


Helping an elderly parent or disabled relative? See a discussion of Michigan's Proposal 4 and Proposal 4 Text.  The discussion posts after the article were especially interesting.

Interested in tax issues? Check out a discussion of Michigan's Proposal 5 and Proposal 5 Text.

Don't live in Michigan? You may still vote, (if you registered.) You don't even need photo i.d., is this a great country or what?

There's a troop, (troupe?), planning to run the country with or without your input. Take a lesson from your favorite pet and speak up about what matters; a warm bed, healthy meals, regular health care, education...


                                       "Then let us pray that come it may,
                                       (As come it will for a' that,)
                                       That Sense and Worth, o'er a' the earth,
                                       Shall bear the gree, an' a' that.
                                       For a' that, an' a' that,
                                       It's comin yet for a' that
                                       That man to man, the world o'er,
                                       Shall brithers be for a' that."

I'm Kerry E. McKinney DVM, and I approved this message!