Late night emergencies...

Wednesdays I work until 7 pm and am on call that evening. As we approach the busy season and I am not getting home until well after 8 or 9 some evenings I'm realizing that Wednesday might not be the best day for this. Look for me on Sundays starting this Sunday April, 3.

 

When troubles arise.

You wake up to the sound of your dog whining to go out and once you get her outside she has explosive diarrhea all over your yard. After silently thanking the intestinal gods for allowing your dog to make it outside you notice that there are bright red streaks in Cuddle's stool. You panic and think of all of the terrible things that might happen to your dog, carpet or night's sleep.

Here's where people take one of two paths. Some people wait it out, taking their dog outside every 2 or3 hours to paint the lawn and hoping that it doesn't become too serious before morning. They may look up a few things online and maybe they find some good information and then again maybe they find some pretty terrible information. Meanwhile that person's canine companion is losing electrolytes, protein and precious fluid every few hours.The person is losing sleep and stressing about the health of their beloved pet.

The other type of person picks up the telephone and dials the number to their veterinarian's office or a local emergency clinic. Once they get a veterinarian on the phone a series of questions will be asked by the vet and the owner and vet will decide if the pet should be seen or if it can wait until morning.

Here's the part that many people don't seem to believe. The people who wait it out and suffer through a night with their dog, they drive me (and vets like me) crazy. I want to be on call. I don't have to be on call. If I weren't on call other area vet clinics would be on call for us or someone would open a 24 hour facility near us. I'm on call because I actually want to be there at 3 in the morning for my clients and their pets. I might groan a bit when my pager or cell phone goes off after midnight but by the time I'm on the phone with someone having a problem I'm ready to go. It's nice when I can solve a person's problem over the phone but going in after hours isn't a bother either. In fact, being available to my clients after hours is one of my favorite parts of my job. I love taking in a patient who is having a really hard time, making them more comfortable and then getting them set up for the following day. After the work is done; I still have paperwork to finish up, a chart to fill out and a treatment sheet to plan. I sit in our treatment area to write up my charts then before I take a quick walk around and visit with all of the hospitalized patients for a bit. Those are the moments that remind me why I do this. 

So please if you are up worrying about your pet don't hesitate to call your vet. The call is free and you might just need to hear someone who deals with these sort of things professionally to tell you it's all going to be ok.

 

Specialists.

Your dog has been sick for awhile, or maybe your dog has just recently developed a problem but it seems to be really bad. Your veterinarian mentions that you might want to see someone who has specialized in the area of medicine that your pet's problem would fall under.

The American Veterinary Medical Association recognizes dozens of medical specialties from surgery and medicine to ophthalmology and nutrition. Veterinarians who choose to specialize have typically completed a one year internship after graduation. This exposes them to the various aspects of specialty practice and gives them a chance to get some experience in those situations. They also work incredibly long hours for very little pay. Some specialists haven't done an internship and come out of private practice. Veterinarians wishing to specialize have to complete an approved residency program in the field that they want to specialize in. Most of the approved programs are three years long and take place in large specialty hospitals such as those found at colleges of veterinary medicine or in large cities. During their residency a veterinarian will have to perform under the supervision of a veterinarian who has already achieved board certification in that field. They also will have to meet and discuss the latest articles in the scientific literature involving their discipline and may even have to publish a study of their own. They may be required to spend some time improving their skills in other areas of veterinary medicine as well. For example, surgeons have to spend some time in anesthesia, medicine and imaging (x rays, ultrasound and MRI) during their residency. At the end of the three years residents sit for a qualifying examination and if they pass then they are inducted into the college that represents their specific discipline.

In those three years these veterinarians focus all of their time and energy into becoming extremely proficient in one area of medicine. This experience enables them to make decisions and come up with treatment plans for injuries, illnesses or issues that your general practice veterinarian is unable to manage.

Your veterinarian isn't sending you to another vet because he or she doesn't know how to handle skin cases or replace a hip joint. They certainly aren't sending you to that person simply because they have better equipment or better diagnostic facilities. We recommend referral to specialists because often they are the best tool for controlling the problem we are facing. My goal as a veterinarian is to provide you and your pet with the absolute best veterinary service available. Sometimes that means bringing in someone with more expertise than me.

 

Back on track

These past two weeks have been life changing for me in more than a few ways. My wife and I welcomed our first child, Emily Rose into the world. In truth my wife did all the work and I just cried at the end!

 

With a new baby comes a stay in the hospital. During our stay the staff was extremely accommodating and very compassionate. We didn't have the most routine experience and many things didn't go the way we would have liked but because of the kind and compassionate staff the experience was a wonderful one.

 

With a new baby also comes visits to the pediatrician and this has been an eye opening experience for me. I've never been on the other side of the table answering questions for someone or something else. It made me realize that there are more than a few things I would like to change about the way I do things in the exam room.

 

It also made me wonder why no veterinary office I have ever been in has the rooms set up like a doctor's office. The exam rooms at most doctor's offices I have been in lately have been in a square with the rooms on the outside of the square. Everyone walks to their room from the same side and has to leave from the other end of the square. It seems to control the flow of normal appointments, gives the appointment doctor some space to write up records in the center of everything and everyone from the nurses to the receptionists are in the same area. This could lead to better communication and a more positive work environment for all of the appointment staff. Maybe that is something to look into!

 

I also thought about this blog a lot during those two weeks. Ok that is a bit of a lie but I did think about it at least twice. I thought about what I want to get out of it and contribute to the public and my profession. I enjoy attempting to educate people about the various things their pets face in life but more than that I want this to offer perspective. Granted it will be my perspective and as a young veterinarian that is subject to change but if these words make a few animals lives better because the owners were able to get more out of their vet visits then I will see it as a success.

 

The Cost of Pet Ownership.

 

Pets are a unique part of our lives in the developed world. Here in the United States they are still viewed as property, though many people would like the to achieve dependent status. If I can write my dogs off on my taxes I might even get behind that idea!

 

As a veterinarian I see many aspects of your pet's life. I see them as puppies or kittens when they are coming in for their first rounds of vaccines. I am there when they wake up from their first surgeries, hopefully a spay or a neuter and not something more serious. I am also there when something goes wrong and of course at the very end. In this role I encounter all kinds of attitudes and perspectives about the place pet healthcare has in an individuals priorities. Most people, in my opinion are reasonable. Many of them do what is required to keep a pet healthy and comfortable far into old age. Some people are indifferent and view pets as disposable and some people are pathologically attached to their pets but far and wide most individuals are reasonable.

 

The one perspective I see far too commonly is the impulse pet purchase. It is far too common for people to not take into account all of the costs associated with owning a dog, cat or even a turtle and the animals end up paying the highest cost.

 

For illustration puposes, I am going to use a dog but the same scenario is possibly more often true with the "free" kitten. Purchasing a dog from a breeder costs approximately $400-1200. Most breeders will require that you spay or neuter unless you have paid extra for breeding rights. Very few breeders have all of the vaccines completed before selling puppies, the reason for this is because puppies are ready to be weaned and removed from their mother at the same time they are ready to begin vaccines. Most breeders will have the first distemper vaccine completed at purchase. This means that the first year of your new puppy's life you can expect to spend (at the hospital where I work at 2011 prices) between $300 and $550 for veterinary care if you do the bare minimum suggested by the breeder. If you adopt a dog from the humane society many of these things have already been completed and if you come to me the first exam is free. That doesn't mean, however that your dog isn't going to cost you money at some point down the road.

 

The average cost of owning a dog in the United States is around $2,000 a year (includes food, toys, veterinary care, etc.) This means over the course of a 14 year old dog's life you can expect to have spent $28,000! Pets cost money.

 

Skimping out on basic care is a gamble that can cost far more in the long run. Puppies being treated for parvovirus in my hospital require a minimum deposit of $500 before we can begin treatment. It never costs less than $500 to treat parvo and many of them don't survive in spite of our best efforts. Heartworm treatment for a small breed dog costs $500 and can kill a dog. Heartworm prevention for a small breed dog costs less than $100 a year and is perfectly safe.

 

Many veterinarians are willing to offer free ten to fifteen minute consultations with people before they purchase or adopt a pet to be certain they are going to end up with the right pet for them. Call around before you get a pet, find a vet that will sit and plan with you and use their advice as a starting point. It could end up saving you hundreds of dollars and plenty of heartache.

 

Which Vet?

 

As a general practice veterinarian I play several roles in any given day. Just today I was a pediatrician, a physician, a dentist, a surgeon, a radiologist and a dermatologist. It's this part of the job that I love the most. No two days are exactly alike and some days seem to come from a parallel universe!

 

There is also another area of my job where playing several roles comes in handy and that is in the exam room. Different clients have different expectations of their veterinarian and if I am going to offer service to everyone I have to understand that. Some people want to do everything possible for their pet no matter the expense and on the other end of the spectrum some people look at things very economically and may opt to let an illness run its course or may choose not to continue to treat an aging dog's arthritis and elect humane euthanasia instead. Both are valid perspectives and most of us fall somewhere in the middle.

 

When I am presented with an animal that is not feeling well and I need further diagnostics to determine a proper treatment plan I often present people with three options. In school whoever taught me the options of care labeled each option as a type of car. There is the luxury car, the family car and the economy car. I don't like this because the luxury car is never necessary and if a test or diagnostic procedure weren’t necessary I wouldn't suggest it. I look at it more as options for the type of vet you as the client want me to be. Some people want a vet who is going to try the newest techniques and run the best diagnostics and some clients simply want that "itchy shot". For illustrative purposes we will use the scientist, day job and cowboy treatment plans.

 

The scientist plan is the absolute best diagnostic shot I have available to me. It often involves several different types of testing and if we go down this road I may even bring up referral to a specialist if the case seems to be headed in a direction that would be better served by a veterinarian than has chosen to dedicate their service to one specific area of medicine. These plans usually often involve more aggressive treatment as well. This plan usually has the highest price tag but is going to lend itself best to giving us an answer.

 

The day job treatment plan is the basics. I will do some testing and may reach a diagnosis but will at least be able to formulate a good treatment plan. We run a slight risk of missing some of the things we might have caught with the scientist plan but economically speaking this plan is often adequate and may offer the most bang for your buck in many situations.

 

The cowboy plan is old school veterinary medicine. I may not run any tests or I might narrow it down to the one test that will give me the most information. Many times I make a simple problem list and treat the problems I can with the knowledge I have available to me. With the cowboy plan we run the risk of missing a lot of things but we also don't spend much money. When finances are a serious concern this might be the best way to get something started and see where it takes us.

 

The thing about all three of these plans is that no one plan is right or wrong for every situation. While I do my best to practice medicine more as a scientist there are times and situations that call for me to be a bit of a cowboy. I can think of several dogs and cats that have benefited greatly from the cowboy form of treatment.

 

It is your job as the client to determine what kind of veterinarian you want me to be that day and I'll be happy to wear the hat you choose.

 

 

 

 

These two weeks.

You may have noticed i missed last week. I'm going to be missing this week as well. My wife and i are home welcoming the arrival of our baby girl. Emily Rose McNutt was born at 4:34 the afternoon of March 7 and we have been home getting into a routine. Both mom and baby are healthy and happy.

Vet's view will be back in a slightly new format on March 23.

Thanks.

International travel...fibersarcomas

Traveling internationally.

Taking your dog or cat along with you on a trip overseas has become more popular in recent years. Many countries are open to people traveling with pets and most will simply require proof of vaccination and a recent visit to a veterinarian. Some countries consider themselves to be rabies free and may require titers or may not allow your pet into their country at all. It is probably a good idea to find out where your destination country stands before arriving at the airport!

A good place to start would be contacting the embassy or consulate of the country you are planning to visit. A list of all of the embassies or foreign consulates and their respective addresses can be found here: Foreign Consular Offices

Most countries are going to require you to have an APHIS form (APHIS FORM 7001 - "United States Interstate & International Certificate of Health Examination for Small Animals") filled out by an APHIS accredited veterinarian upon arrival. You can find information on that form and look for accredited veterinarians at this website: USDA

That same website also has a list of all of the countries and their individual importation laws regarding domestic and companion animals. For example, if you want to bring a cat to Jamaica it had better be from the UNited Kingdom or Ireland otherwise it is not allowed. Here is a quick link to that list: Nation List

You will also want to contact your airline and be sure you have met all of their requirements for flight before you leave. Nothing would be worse than arriving at the airport and realizing that the carrier you have is not appropriate or that they do not allow two dogs in the same carrier. While airline rules change quite frequently you can get a good idea of the current regulations here: Airlines and Pets

Recently I have heard several questions about a pet passport. There is not currently an official pet passport available to any pet outside of the European Union. In the EU pets can be issued a Blue Pet Passport that contains a photo of the pet and all of their pertinent medical history. These passports can only be issued by veterinarians within the EU.

I'm sure Fluffy will enjoy his or her trip to Italy. Just be sure you have all of the right documents filled out and the right people contacted or your trip may end at the airport!

Fibrosarcomas.

You may or may not have noticed that your veterinarian gives all of your Kitty's vaccines in his or her legs instead of the nice loose skin on their back. Very few of my clients have asked me why we vaccinate there rather than the scruff. Maybe people assume we like the challenge!

The sad truth is that while vaccines are an important part of disease prevention they also carry a certain amount of risk. One of those risks is a type of soft tissue cancer that arises at the injection site. This can be several different specific types of tumor but most often it is a tumor called fibrosarcoma.

It used to be called vaccine induced sarcoma, this is because it was researchers noticed an increase in occurrence after the rabies vaccine was made legally mandatory in the late 1980's. The tumors were showing up in vaccine sites on cats and when they looked at microscopic sections of the tumors some parts of the vaccine could be identified within the cells.

Then the tumors started showing up in areas of the cats where vaccines were not given. Sometimes it was an area where another injection was recorded in the animals medical record. Other times it was an area that had sustained varying degrees of trauma.

Recent research has identified a genetic mutation in cats predisposed to developing fibrosarcomas. This indicates that at least some part of the problem is genetics.

I am going to use the vaccine as a mechanism to illustrate our current understanding of inflammatory induced fibrosarcomas.

A vaccine is given and creates a localized inflammatory reaction. This is the intention of every vaccine as this is how antibodies are formed. In a normal animal this localized reaction recedes and is gone between one to two weeks following the vaccination. In an animal with the wrong type of mutation the body is not able to properly control the inflammation and is smolders under the surface longer than would be expected. This is the part that gets scary. Every day as our cells divide small would be cancers arise. These cancer cells are typically dealt with by the immune system without any repercussion. In any inflammatory reaction the mechanism by which the body deals with cancer cells is going to be disrupted. Typically the inflammation either recedes and the body takes care of the would be tumor or the would be tumor sends out a strong enough signal for the body to take drastic action against it. In cats with the wrong type of mutation that inflammation is allowed to linger and the body can not respond appropriately. In these cats those tumor cells are allowed to flourish and grow. After some time, sometimes years after the vaccine was given, a tumor will take shape. Once they develop a blood supply these tumors grow very fast.

Treatment is multifactorial. The standard course of treatment is surgical resection of the tumor with generous margins. 5 centimeters (almost two inches) is the recommended surgical margin.This has to be done in 3 dimeinsions so it also requires removing a fair amount of muscle. It is recommended that the surgery be followed with raditation therapy with or without chemotherapy. Your only chance at a cure is to have a perfect surgery.

Many of these tumors recur after surgery because they have very long microscopic tendrils that migrate through tissue, they do not typically metastasize.

We give all of our vaccines in the limbs because if we ever have to go after a tumor we are far more likely to have a curative surgery if we remove the entire limb.

Cats that have had a fibrosarcoma removed, in my opinion, are not to receive another subcutaneous injection again. That means they are not going to be vaccinated, they can not receive some medications and should never receive fluids under the skin. Owners should also be aware that any type of trauma that causes inflammation could lead to another problem.I will not, however, accept concern about this disease as an excuse to not vaccinate an animal for rabies. The risk of cancer is still going to be far lower than the risk related to rabies.