Hidden value

It's been slow around the office. Weird, because it was really busy the first two weeks of January, when you think people would stay at home to ponder their big Christmas bills. It was feast then, famine now.

We have started a senior pet program at least. We sent clients letters telling them of the offer - an exam, bloodwork, chest Xrays, and urinalysis at a discounted price for January and February. A few days after collecting the samples, we sit down with the owners and present them with a folder of the results of our findings.

Business-wise, its a good time to run a promotion like this. But we honestly don't do it just for the income. The workup at least gives us a baseline for aging pets. For a lot of them, it's a good preanesthetic work-up, as most of them need to return for a professional dental cleaning.

I also have uncovered serious hidden problems. Its common to find early kidney failure in a geriatric cat. We can recommend a simple diet change that will significantly extend their life.

Once, I worked up a old golden retriever who had no complaints. His bloodwork came back normal except for a screaming high thyroid level. This is really bizarre - dogs often get hypothyroidism (too low of thyroid level), but almost never high thyroid level.

I asked the owners to bring the dog back. On re-examination, I felt a mass in his right thyroid gland, in the neck just next to the larynx. I had missed it on my first exam because of his thick, exuberant golden coat. The bloodtest helped me locate the tumor.

I removed the entire tumorous gland surgically. The pathology report was a carcinoma, a really aggressive tumor. With the labwork I caught it early before it had spread.

We often treat sick patients, and help them get better. Often I really feel like I am just aiding the body in the healing process. The immune system itself often does the real work. However, I know I saved this dog's life. It's a marvelous feeling, especially since the dog is awesome, beautiful, and as devoted to his owners as they are to him. All this happened a few months after I lost my own beautiful golden, Montana, to a brain tumor.

Guess who came to see me today for a senior workup? Yep, that same gorgeous dog. His owners know the value of testing a normal-looking senior pet. Seeing him still looking so good gives me that happy feeling all over again.

Government Warning

Here's a joke from my MIL:



Do Not Swallow Bubble Gum!

Offspring update

Colin: Loves the Beatles, probably because they are ALL BOYS. Singing over and over, "I am the eggman! I am the eggman! I am the walrus! Koo-koo-ka-choo!"

Also, the lesser known version, "I am the acorn! I am the acorn! I am the bottom! Toot-toot-ta-toot!"

Anna: Comes out of her bedroom long after bedtime, presents me with an adorable "My book of storys tollde by my mom, of her cat and dog pashints (patients)." Four tales so far, including, "One day a cat was brot dead. His name was J--. He was 4 years old. And dead. So my mom cut him open. And his heart musle was to big."

Comes out again 10 minutes later and says, "I don't think my heart is beating. I can't hear it, and it hurts."

Mini Me

Last Friday, Anna was off of school (teacher in-service). Colin's school was open, and Anthony had an inspection. "What are we going to do with her?" he asked me.

"I'll just take her to work with me, then you can pick her up when you're done." Anna is very self-sufficient. I knew she would be quiet and polite, and could keep herself entertained with writing, drawing, and movies.

Colin was heartbroken that I left him behind - and I wisely didn't tell him until 10 minutes before I left with his sister - but there is no way I could have left him without direct supervision for hours at a time. Not without expensive equipment being pulled off the walls or fires being started.

Anna was bored on the long drive to work, but settled in happily once we got there. It was a surgery morning for me, so I asked her if she'd like to observe. "Oh, yes!" she said. "Do I get gloves?"

I put a mask and cap on her (the gloves were way too big) and sat her on a stool in surgery. "The first rule of surgery," I told her, "is don't touch anything."

Anna obeyed, sitting on her stool watching everything. My first surgery was a cryptorchid - a cat with a hidden testicle. I explained that the cat had been neutered somewhere else, and they removed the descended testicle, opened his abdomen and couldn't find the undescended testicle, decided it didn't exist, and closed him up. (You are not supposed to remove the descended testicle until you have found and removed the hidden one, but they did anyway). The smell in the litter box soon let the owner knew the testicle was there, somewhere, making testosterone.

I told Anna is was like a treasure hunt; I just had to be patient and keep looking until I found it. She caught on pretty quickly to the fact that the other vet had not done a quality job. She also figured out how to read our monitor, and could tell me when the heart rate went up or the respiratory rate went down. "Mommy, why-- oh, I shouldn't be asking you so many questions!" she said, but I encouraged her. She was a delight. She couldn't believe the big size of the bladder, the thing I've been telling her for years holds her "tinkle." "Is mine that big?" she asked.

I did find and removed the testicle, then closed the incision. "Good job, Mommy," she said, "That looks good." I asked her if she wanted to go color or watch another surgery, and she said, "I want to watch more surgery!"

She was very enthusiastic and not at all grossed out. She did say she thought some of her classmates would have been disgusted. My coworkers were impressed with her fortitude, too, and asked if she was going to be a surgeon when she grew up. "No, I want to be a singer," she said.

She also watched me do a cat spay and a tumor removal from a dachsund's leg. She was disappointed that surgeries were over, but did watch me change a bandage on a nasty wound, and comforted the patient. I was so busy, but I didn't have to mind her much. After lunch we went to Starbuck's for a treat. She cried when her dad took her home at 3pm.

Why did he die?

Last week I had to do a necropsy. (Dissecting a dead human is an AUTOPSY, since it is like cutting yourself. For animals we say NECROPSY, cutting the dead, a species other than ours). A new client called and said her healthy 4 year old cat was found suddenly dead, and she wanted to know why.

I don't really enjoy doing necropsies, I must admit. It's not the squeamish factor, or the smell (which is daunting). It's just that I don't get a thrill from figuring out what went wrong. People who do this for a living - they're called pathologists - have a real passion for figuring out the reason the patient died, the progression of disease, the cascade that happened after injury. They have so much passion for it they will spend all their days with dead patients that they never met alive, surrounded by tissues pickled in formaldehyde, cutting up pristine bodies getting down to the answer.

It's not for me. My mission is to relieve animal suffering. I also like interacting with the people who love these animals enough to seek good care for them. Dead animals are gross, but I do lots of gross things everyday. Already dead animals just leave me cold.

My least favorite thing about necropsies, though, is that I can do them and still not know why the animal died. Anthony was shocked by this when we were first married. "You mean you can't figure it out, like Quincy always did?" Yeah, Quincy always figured out the one toxin that caused everything, and within 50 minutes. I'm sure CSI is doing similar damage to today's audiences.

If a dog dies of a toxin, I'm not likely to see it on a gross dissection, and it costs a lot of money to test randomly for all the toxins you can think of. Subtle lesions are likely to get past me, since I am not a trained pathologist (thank God).

So, my dead patient this day was a robust black Persian. Externally, he was male, he had big yellow eyes, he had a shiny coat, and he was quite stiff.

His abdomen was pretty normal, except for the kidneys. The left one was completely normal, but I couldn't find the right one. I found the bladder, found the ureter, and followed it up to a tiny shriveled pea of an organ. This was the hypoplastic kidney, smaller than a lymph node. It had never developed.

However, this was not the cause of death. Anyone can live with just one kidney. It was really interesting, but not the culprit.

I cracked his chest. Lungs looked good. The heart looked a little large nestled in the lungs, but it was beautiful. Hearts are so complex, so amazing how they generate their own electrical charge. This one was a little iridescent, a marvel to me. I cut it open. The valves were pristine, crisp webs. The muscle was meaty and thick. Too thick. I measured the ventricular wall thickness. It should be 5.5 - 6 mm at the most. This kitty's heart measured 11 mm.

I had a diagnosis: hypertrophic cardiomyopathy. This cat's heart muscle was pathologically sick. It had to work harder, and any muscle that works harder gets pumped up. This cat probably died from a blood clot that formed in the abnormal heart or developed a fatal arrhythmia.

I called the owner. I expressed my sympathies, and told her my findings. She was relieved to know what had happened, and that she had not done anything to lead to his death. She was still a little in shock that her friend was suddenly gone.

She called this week to make an appointment to see me with her new kitten. I am glad I will finally get to meet her and her new living pet.

Full Steam Ahead

Life continues at full tilt around here. This Saturday we had a great birthday party for my great Aunt Sudie, who turned 93.


It was wonderful seeing so much extended family, and to enjoy a great meal together. I got to make the cupcakes.

We got away without the kids to have some fun with friends later in the long holiday weekend. Time to get caught up on the laundry and food prep fronts as the work and school week resumes tomorrow. More later...

More from la boca de Colin-O

Colin: "Hey, Anna, let's sing that dog song. 'Feliz Navi-dog! Feliz Navi-dog!' "

I'm sure the singing chihuahua my parents have didn't help!



He also asked me tonight, "Mommy, how do people make a toot?"

Also, soup's on!

Survival instinct + sleep deprivation

I could see a man carrying a furry black dog into the clinic as I finished up my second to last appointment. "I just found her like this," I heard him say, "I've still got kids in the car..." Leah took the dog from him, and I met her in the back.

The poor dog was extremely painful, she wasn't moving anything except her eyes. She had a huge gaping laceration on her midline belly, from just below her ribs nearly to her pubic bone. I put on gloves and as gently as possible examined the wound. The gaping hole was huge, but it seemed to be just in the skin; I saw no holes going into her abdomen. The wound was full of leaves and dirt, and the dog looked pretty scruffy.

We started fluids immediately and gave her a big morphine shot. I went to talk to the owner. He had a boisterous 2 year old son, and a wheezy, stuffy 4 month old baby with him. He explained that the baby kept them up all night with the flu. When he'd gotten home late from his job as a chef, the baby was crying, and the dog snuck out without them noticing. They were up all night with the baby, but were relieved to see the dog come back in the morning. They left to take the baby to the pediatrician. In the afternoon, the dad realized the dog had been in the back yard all day. He went to check on her, and saw a small cut on her wrist. Then he was horrified to see the huge wound on her abdomen. He piled everyone into the car and drove to my hospital.

"I feel so bad. I didn't mean to ignore her! Do whatever you need to," he said. Hey, I know my powers of observation are not that great when I'm sleep deprived. I also know that animals are excellent at hiding illness and injury. I'm sure that's why she hunkered down in the leaves all day. I sent the dad and the kids home.

After my last appointment, we sedated the dog and used over 2 liters of saline flushing out the huge, dirty wound. I was shocked to find that in addition to the foot long laceration on her belly, the skin was pulled completely away from her body wall on the right side of her body. The skin was intact but not touching her trunk all the way up to her dorsal midline, from her shoulder to her hip. Bits of dried brown leaves were spread all along her trunk. Amazingly, there was still no compromise of the abdominal wall.

The other doctors and I discussed her injury. Initially I thought it was a dog or coyote bite-and-pull, but she had no puncture wounds like you would expect to see from a fight. Could be a hit-by-car, but there was no telltale road rash. We decided she must've gotten hung up on a fence. The laceration had a 3-corner tear type shape. She had gotten hung on a sharp point of the fence, then panicked and struggled, tearing the flesh off her body. The small clean cut on her wrist made sense, too.

The receptionists came back and told me the wife had stopped by on her way home from work. "You'd better go up there and talk to her," one said. "I think her daughter was just in a car accident." What? Can anything else go wrong for this poor person?

I talked with the woman and said, "I'm sorry you're having such a bad day." Actually, it was her niece and sister in a car accident. She did not have a daughter. The niece had to be cut out of the car, but was largely unhurt. I explained her dog's injuries to her. "Man, I thought the baby having the flu was bad; now all this! I didn't even know she snuck out last night, and I was so tired I didn't even check her this morning..." I assured her we understood how it happened. She said the dog likes to go explore in an area with a chain link fence, so the injuries fit with a fence hanging. I sent her home while I did surgery.

It took over an hour to tack the skin back down to the trunk from the back midline to the abdomen midline. I also placed a drain from the back down to her belly, because a big physiological space like that is going to naturally accumulate a lot of fluid. Also, it was so contaminated that the body needed a way to drain infection out.

I gave her lots of pain meds after surgery, but still my patient was moving nothing but her eyes. We carried her out on a stretcher and to the owner's car, to transfer to the emergency clinic for overnight care. "Thank you so much for staying late and taking care of her!" the owner said. It was 8:15 pm.

The next morning my patient came back, and I saw her standing for the first time. She had a sweet nature and was much more stoic than some of our other patients with very minor injuries we saw that day. She refused to eat until about 4pm, when she took three bites of AD from my hand (it's like liver pate for dogs). I sent her home with antibiotics, but warned the owner that she still might get an infection, and hoped that the skin would not be so devitalized that it might die and slough off. "Expect lots of drainage," I told them.

Four days later, she is still doing well, no sign of infection, still lots of drainage. Healing is happening!



In other news, I called the cops again on the leash-free dog walker today. And, new food post.

More on dogs off leash

Francesca and I enjoyed our jog this morning without seeing the miscreant dog. We did see two great blue herons, grebes, sandpipers, and other waterfowl, and a soaring hawk.

As I drove away from the lake, I spotted the guy again with his two off-leash dogs, so I called the non-emergency police line. Hopefully they got him.

I remembered that I have seen some other dogs off leash near the lake, specifically two different women who walk their dogs in the fields far from the granite path, and their dogs listen to their owners and never come near us. One woman even has some sort of field training device (it makes a noise and possibly delivers a shock?).

We also have a large field behind our house that I will occasionally let Francesca run across when we are jogging around our neighborhood. I only let her go at off-peak hours if there is no one anywhere near the trails that might distract her, and definitely not if there are any dogs. I make her do a down-stay before I release her, and we always have the same pattern - jog across the field diagonally, and I pick up her leash at the other end of the trail.

This is to say I don't believe there is never a time to let your dog off leash. My golden retriever Montana was a dog who didn't need a leash most of the time, but still I didn't flaunt leash laws. Certainly, if the dude at the lake wanted to walk his dogs off leash in the fields far from dog traffic, I wouldn't have an issue with it.

The problem is that most dog owners like to indulge their dog in a little freedom, and then the dog takes this as a sign of his increased status. Then the dog travels far away enough to be out of the control of the owner, who futilely is calling the dog, who ignores him, and the dog learns to ignore the calls. Most people would like to have a perfectly obedient dog, but few put in the daily training that is necessary.

I actually believe ALL dogs can learn to be good off-leash. It takes a large investment of time and some knowledge of training dogs. The training facility where we took obedience classes has large fenced fields to build up to this skill. I do not think that 95% of owners can achieve it, however. I am currently in this failing category with Francesca - we were invited to go to the next level of classes to work off leash, but I did not have the time to commit. (I'll bet Laura is in the top 5%).

You may be surprised to know that most vet clinic employees are not fans of Dog Parks, either (places where dogs are allowed off leash to romp around together). The reason is that so many injuries occur there, because many dogs there are not well socialized or under their owners control. I think of Dog Parks like a preschool playground for children, where the caretakers are blind and over-indulgent. They cannot see their dog's behavior (because they don't know enough about dog communication and are blinded by love). Fights happen, and we sew them up. (Also, viruses are passed around, but that's not a behavior issue.)

So what's your opinion of all this? When and where should dogs be off leash, and how to determine which dogs can handle it?

Also, new post at Mia Cucina.

Appreciation

Today Francesca and I jogged around the lake. We usually go on Mondays and Wednesdays directly after I drop the kids off at school. Its a perfect flat 5K on crushed granite. We both love seeing all the birds and getting the exercise.

I often see a guy walking his two dogs off leash. Mind you, there are signs everywhere that say "ALL ANIMALS MUST BE ON A LEASH," and everyone obeys, except this guy. One time he didn't hear me coming (damn iPod) and his chow mix rushed Francesca, barking aggressively and physically touching her. She backed off on her owner's command, but continued to stare and posture very aggressively. Since then the owner always gives me a wide berth, but the chow always veers toward us and stares provocatively. It makes me nervous.

Today, his wife was walking the dogs - off leash - and the chow got really close (striking distance) to Francesca at the beginning of our run. She didn't listen to the woman as well as she did to the man. Francesca, btw, was looking at the dog but running nicely beside me. At the end of our run, we passed the woman again as she was crossing the narrow bridge (only 6ft wide with tall chainlink fence on either side) with the dogs, still no leash. I had to wait until they crossed, because there was no way I was going to get that close to that dog in that confined space.

As she passed me, I said, "That dog needs to be on a leash. She's come at my dog twice now. I don't appreciate you guys walking her without a leash."

She said in a surly voice, "I don't appreciate you telling me what to do with my dog."

By then I had started to jog away, but I turned back to shout, "It's the law! It's the law!" (My hackles were up a bit at this point!)

When I got to my car, the husband was now walking the same dog back across the bridge. So I got on my cell phone and called the police, who said they would send an officer out. Hopefully they got there in a timely manner.

I plan to carry my cell phone with me from now on, and I'll call every time I see them with no leash. If it was just the other placid dog, I wouldn't bother, but this dog seriously scares me. I'm not worried about it attacking me, but I am worried about Francesca.

Afterwards of course I thought of a better comeback to the woman. "Lady, I tell people what to do with their dogs for a living!"

Hey Now, Hey Now, Don't Dream Its Over

Anthony loves me, and loves technology. We weren't supposed to get each other Christmas gifts, since we got the new Macs. But he still got me a Ipod Mini in my favorite color, green. This thing is amazing - so tiny, as big as 20 business cards stacked together. And it plays beautiful video.

So last night I finally get around to checking out the ITunes store, and I'm searching for some new music, listening to lots of song samples.

What do end up downloading? Crowded House and Howard Jones. So I am basically picking up with my IPod where I left off with my Walkman at age 15.

No one, no one, no one ever is to blame.

Helping dogs, helping clients

Hooray, I was spot on with the droopy dog. Her thyroid level was undetectable by the lab.

I called the owner with the news. She is really warming up to the idea, and is looking forward to seeing the potential change in her dog. "How come no one ever caught this before?" she asked me. Uh, maybe because you never let us run the routine bloodwork we recommend for your dogs?


Anyway, also at work today I convinced a pet owner to euthanize her old decrepit dog. He's been declining for a year now, and she's in total denial. He had a neurological disorder that was making him weaker and weaker. He was in a diaper and dragging himself around her house. "He's just lazy," she told me yesterday. "He can walk if I prop him up." "He's not lazy, he's weak," I explained to her. Then I made her cry by talking about how he was near the end. "I want you to tell me he's going to get better," she said. I could not betray my patient and give her false hope.

He's been at the clinic for 2 days because his epilepsy was out of control. He was having a seizure at least every 4 hours, which left him physically exhausted and mentally gone for hours. Today he didn't even recover cognizance between events. I called her and told her like it is. She may hate me but she did consent to come in and euthanize. I was so relieved that she agreed, for a moment I felt like celebrating. Except, of course, my patient was going to die, and the client would be in grief.

After the injection was administered, his little body finally relaxed. He had been suffering, and now he was clearly at peace. I told the owner, "You did the right thing. It was hard, but you make the right decision." I hope she could hear me.

Something's lacking

I saw two 8 year old labs, littermates, for their annual exams today. The male was bouncy, perky, with a glossy coat. His sister looked at least 3 years older. "She's always been mellow," her owner said, "and always had dandruff." She had incredible dandruff, and now she had a "rat tail" - her tail was scaly and sparsely haired, with a big ugly bald patch on top. Her heart rate was slow.

"Seriously, we call her Eeyore, because that's how she acts." She had Eeyore's posture, head drooping, tail slack. The difference was striking compared to her alert, tail wagging brother.

"I really think she has hypothyroidism," I said. "It's common in older dogs, especially labs, that as they age their thyroid glands don't produce enough of the hormone that allow them to set their metabolism. They seem like they've aged rapidly, have lower energy levels, often have dull scaly haircoats and dandruff. The rat tail is a classic sign. They also gain weight while on a diet."

When she said the dog was eating a lot less than usual but her weight hadn't changed. A thyroid blood test is $50, although I'd prefer a senior panel for $100.

"What is that really going to tell me?" the owner asked.

Well, if she's hypothyroid, it's an easy cure, she just takes a pill twice a day that replaces the hormone. A three month supply of pills is $20.

"Yeah, but seriously, what difference is that going to make for her?" she asked again.

Well, her skin will look much better, she'll have more energy, she'll be less prone to infections. When I've put dogs on thyroid supplement, their owners say they act so much younger. People who are hypothyroid say they have low energy and are cold all the time without treatment.

"I know," she said, "I'm hypothyroid. I just don't think it would make that much difference for her. These dogs are costing us a lot of money. I just don't think we would treat her."

What is wrong with this woman? Her female dog is so different from her male. It's probably been coming on slowly for years, so she hasn't noticed it. But, when I'm pointing it out to her, with a perfect normal control for comparison, how can she deny it? Hypothyroidism is one of the easiest, cheapest, and most rewarding diseases to treat.

I gave her some space to think about it, and fortunately at the end of the exam she consented to the thyroid level. "You should have told her you'd refund her money if it wasn't low," my tech said. I can't really do that, but it crossed my mind. I feel confident enough that I posted it here. Hopefully results will tell tomorrow.

Happy New Year!

We've had a nice long break together. Tomorrow I go back to work and Colin goes back to school. They changed Anna's school schedule so she actually is still off Thursday and Friday.

On the way home from dinner, Colin was moaning about not wanting to go to school. I reminded him about being in the "big kids" class, and that he'd get to play with his new best friends. He changed his tune.

Then I heard Anna whispering conspiratorially to him. "I don't feel good," Colin moaned.

"No, Colin, you're supposed to say that tomorrow when Mommy wakes you up, so you can stay home," Anna told him.

"But I want to go play with my friends," Colin said.

"I want you to stay with me. I love my little brother!" So sweet! She will have to settle with spending her day with her fun cousin Beverly instead.