Informative and reassuring, or overwhelming and off-putting...

I ask myself this after nearly every new puppy or kitten appointment.  There is just so much information to share with a new owner, especially if they have never had a pet before.  If the new puppy or kitten came from a shelter then I feel like I am overwhelming and off-putting.  If the person went to a breeder or pet store, then I feel like I am informative and reassuring.  That is a bummer, because I really love when people can rescue their new addition from a bad situation, but I feel like they never get enough information.  So as frustrating as breeders and pet stores can be sometimes, they do make that new kitten and puppy appointment easier somehow. 

Here is some support for how I am feeling.  Yesterday, I saw a friend in an appointment with her new kitten. The kitten is absolutely adorable and she and her 3rd grade daughter are in love with him after only one short week.  They made an appointment for a check up just so that they could be sure that they knew what they were supposed to be doing even though the foster family said "that everything has been done already" at the adoption event where they went to rescue him.  Well, if "everything" means neutering and a Rabies vaccination, then sure, everything was done. I cannot even be 100% sure that the Rabies vaccine was done, the paperwork just didn't jive in some instances.   For example, his birth date was October 20th, and the first vaccine was given on October 27th.  I doubt it.  That would be pretty strange.  So, after examining this sweet thing and reviewing all of the paperwork, and checking for the microchip that was supposed to be there and wasn't, we discussed all of the findings and the to-do list. 

The findings:  He is an adorable kitten with a lovely disposition.  He has the usual complement of shelter/rescue cat problems which are; ear mites, worms, a resolving cold, and very stinky gas.  I can fix all of that with relative ease most likely by asking his new owners to employ my to-do list, but is that overwhelming and off-putting?  Do I seem like I must have some vested interest in a pharmaceutical company (nobody is mentioning Pfizer in particular, here...). 

The to-do list:  First of all, consider a Leukemia and FIV test and consider a series of Feline Leukemia vaccinations and installing a Microchip since he didn't have one like he was supposed to have had.  However, with the remainder of the must do items on this to-do list, maybe we should spend the money elsewhere.  Treat the ear mites, send out a few serial stool samples to ensure that we eventually eliminate the scary zoonotic (transmissible to people, even 3rd graders!) parasites, deworm him right away before even waiting for a stool sample, begin applying topical applications of Revolution monthly to maintain a parasite free environment, start a special diet with prebiotics to help eliminate the stinky poops while we wait for the parasites to go away and for his little belly to straighten itself out, and go from there. When I say go from there, I hope that it doesn't mean test him for FeLV and FIV because he isn't getting better.

Can I really expect this person to now have a discussion about routine care and wellness after all of this has been thrown at them?  Would it be ridiculous to suggest that they come back for another appointment in two or three weeks just to discuss wellness since we had to gloss over wellness so quickly? 

Why do foster families and shelters mislead people by saying that everything is done, you just need to make a donation and you are good to go?  Most often, these pets are far from "good to go" and the people end up spending about as much as they would have if they had purchased their pet in the first few weeks.   I am not suggesting that people purchase rather than rescue their pets, I just wish that they were made aware of the potential problems and expenses that they may incur.  In this case, I am lucky, because my friend wants to do the right thing, and without even knowing there was a problem, made an appointment.  But what if she had just waited until the Rabies vaccine was due next year?  Well, chances are she would have never made it that far before the diarrhea began, but if she did, that poor little guy would have suffered with ear mites for a whole year!  I am willing to bet that his ears would never recover to a completely normal state if it had gone untreated.

I hope that I was informative and reassuring, but I am afraid that I was overwhelming and off-putting. 

I can finally get some sleep

Cats and dogs eat crazy things, and those crazy things can occasionally get stuck somewhere in the middle.  When this happens, we call it a Foreign Body Obstruction (FBO) and they can be pretty simple to remove or a total disaster.  If the foreign object hasn't been in there for very long and it is visible on an xray, that usually results in a good outcome, but if Fluffy isn't telling her owner just how sick she really is, and the item is not visible on an xray (metal, bone or some other dense object), then things can start running downhill quickly. 

This is Cookie, he looks like a good boy, right?



This is Cookie's story. What Cookie swallowed wasn't that big, but he isn't much of a complainer and didn't start to act like he was sick until about a week after eating a large bead from a child's jewelry making kit.  I have to imagine that most of the time, these things are swallowed by accident, I can just picture him playing with it, carrying it around in his mouth and then, GULP, down it went.  At first his owner wasn't worried,  she hadn't seen him swallow the bead. Eventually she brought him in and we were able to figure it out pretty quickly.  I didn't know what he had swallowed, but I knew that we were going to find something.  Well, that bead managed to get out of the stomach, but got stuck in the duodenum, right next to the pancreas.  Ugh, the pancreas is so sensitive, I don't even like to look at it.  Well, with it having been there for a week or so, that piece of duodenum was pretty grumpy.  If it is questionable whether or not a piece of intestine is going to survive, we just take out the whole section and put the good, healthy ends back together.  But in this case, I really wasn't willing to take out that section of duodenum because of its proximity to the pancreas unless it had already fallen apart, so I made an incision into the duodenum, took out the bead and closed it back up. I put in my usual "sleeper stitch", which is that last stitch that you put in when you are asking yourself or your assistant, "do these look like they are close enough together?" so that you can sleep knowing that the sutures were definitely not too far apart.  That didn't really work for getting sleep though, like its name suggests. 

I have a friend who is an amazing human cardio-thoracic surgeon, so as usual, I told him about the case and asked, as if he had a crystal ball, did he think that the duodenum would live.  His answer, of course, was that he didn't know, but he would have made the same decision and in fact used to go running from any procedure involving the duodenum and pancreas as a general surgery resident.  That made me feel better, but not better enough to sleep well for about 10 days.

It was finally at that 12th day when Cookie came in to have his sutures removed that I had a good night sleep.  Any problems from here on out couldn't be a direct result of my surgery.  I also let my kids off the hook during bedtime prayers, they could pray for whoever they wanted instead of saying "God, please let Cookie get better". 

This is the bead that Cookie swallowed.

Cookie is back to his playful self, as lovable as ever.  Now his owners are probably the ones losing sleep trying to keep their house Cookie proofed.  That is not going to be an easy job!

 

Good Luck

Today I found a cat whisker while I was sitting on the couch reading a story to my son.  I love when this happens because there is an old wives tale that says finding a cat whisker is good luck.  I have always chosen to believe this, and so far, it seems to me that every time I find one something good happens soon afterward. 

I don't find them often, and you really shouldn't.  Cat whiskers, or vibrissae, do shed occasionally, but generally shouldn't break and shouldn't all fall out at once.  If they do, there is usually a problem of some type worthy of a trip to see me.

I save my cat whiskers in my jewelry box, but I could even buy a piece of jewelry designed for just such a purpose.  How surprising!    Cat Whisker Charm Bottle

My cat's BFF is a dog

I adopted Teddy in 1999.  She was a pretty sad little kitten, rescued from a parking lot in Brooklyn known for it's population of feral cats.  She was only 4 weeks old, and not completely feral.  She tolerated being held and medicated for 2 weeks in the animal hospital that I worked at part time on weekends.  When I left her the first weekend, I felt sorry for her and thought that she was pretty cute.  By the second weekend, she was definitely a little less friendly, tired of being medicated for her upper respiratory infection.  By the third weekend, she was actually disgusting.  The cornea of her left eye had ruptured and what used to be an eyeball looked like nothing I could describe without turning the average person's stomach.  The busy staff did little more than medicate her and feed her as there were many other needy patients that were far more appreciative of their efforts.  So, as any young veterinarian would, I decided that I'd have to take her home.  I surgically removed the horribly infected eye, and a few hours later boarded the Amtrak from NYC where I was weekend moonlighting  to Philly where I lived. 

At only 6 weeks old, she made fast friends with my yellow lab.  She really could not have cared less about me.  For the first 12 years, she hung out with the dog, ate the cat food that I provided and politely used the litter box, but really didn't care for human attention.  In December 2003, her friend died.  I think that she was really sad, because that was the first time that she decided to try and make friends with me.  About 6 months later we adopted a dog, and I think that I heard her breathe a sigh of relief.  She just loves dogs!  She doesn't need me anymore.  Oh well.

Watch Teddy give Ozzie a massage, she does this several times daily.

Age is not a disease

I always say that.  Age is not a disease.  Often I see geriatric pets who are presented for a regular check up.  Frequently, I find a problem that can be addressed but their owner may think that there is nothing wrong, because they think that certain things are normal for old animals.  Or, they know that there is a problem, but because their pet is old, they think that there is nothing that can or should be done. 

I can think of a lot of examples, and I am sure that other veterinarians would have similar stories.  One situation that I see all of the time is older dogs slowing down.  People think that it is normal.  Age doesn't make it hard for a dog to stand up, age related diseases do.  One of the most common age related diseases in a dog is arthritis.  Dogs who slow down probably have advanced arthritis, and deserve some treatment for that.  I always think of it this way, I would have to be in pretty severe pain before I would choose not to go up or down the stairs at my house, and I am pretty sure that I would have taken some pain medicine long before it got to that point.  It is reported that people with arthritis seek medical help long before they become immobile.  I am lucky, many of my clients are very attached to their pets, and ask for help early enough to get good results.  Sometimes, though, people just don't know there is a problem.  They think that their dog is just old.  The earlier I can diagnose and try to manage arthritis for a dog, the better the outcome is likely to be.   Check out this link to see if your dog might have arthritis. 

 www.deramaxx.com

I just saw a cat yesterday who is 17 years old.  His owner loves him dearly.  I met them 2 years ago.  His owner was terrified to bring him in, because she thought that he was too old to survive the kind of stress a veterinary appointment might cause.  I guess she had some bad experiences in the past.  We figured a lot of things out for that old guy, and he had been happily ticking along with a few medicines and a couple of check ups until a few weeks ago.  He stopped eating well and was getting pretty skinny.  He would go to the food, take a bite, then quickly walk away.  His problem was a horrible tooth root that had the pulp exposed.  His owner was so afraid to do anything about it, because he "is so old".  Luckily, I was able to convince her that age was not Cougar's disease, a tooth with the pulp exposed was.  Luckily, he did great and was happy to savor a meal without tooth pain this morning.
 

Thank God you pulled that tooth, now can I eat in peace?

Old animals are pretty cool, they don't usually complain about their age related disease.  Owners have to let me look for it, and fix the things that we can and don't let them suffer when we can't.  Sometimes I even have to remind myself that age is not a disease, when I do that my advice is always better.

Your dog has fleas, and I do not think that you are dirty.

It is shaping up to be a terrible flea season.  In the last two weeks alone, I have seen more flea infestations than I have seen all summer.  This isn't a surprise to me, after thirteen years in practice, I know that fall is the worst time of year for fleas, but it seems particularly bad this fall.  The frustrating thing is that owners make it hard for me to fix their problem.  I think that it is because they are in denial, lots of people think that they can't possibly have fleas, or if they do, it can't be that many so they don't have to worry.  They must feel this way because they think that if they have fleas, they are dirty.  Nobody wants to think of themselves as dirty.  Here's the deal: having a pet with fleas does not make you dirty.

Maybe knowing this story will help make you feel better.  In January, 2004 I was at home with my second infant on maternity leave.  While  we were snuggled up in a rocking chair with one of the cats on a snowy afternoon, I saw a flea run across her perfect little peach fuzzy scalp.  Yes, it is true.  I had a dog and two cats that had received the usual flea treatments throughout the summer and like most people, I got lazy in November or so as the temperatures dropped and the holidays began.  I was able to fix the problem, but that is because I didn't say to myself..."Hmmm, that couldn't have been a flea, it is January and my house is clean, I just washed the sheets and vacuumed like I do every week." 

I had a flea on my head when I was a baby, do I look dirty?


Fleas are a pretty clever parasite, they have been around for centuries.  Don't forget, they are responsible for spreading the plague all over Europe in the 14th century, so while you are not dirty, fleas are and you don't want them around.  Some animals are a great host for fleas, they don't even get itchy with literally hundreds of fleas infesting their coats.  Others are allergic to the bite and will be furiously itchy with even one flea bite.  Those are the animals that it is hard to find the proof on because they fastidiously groom the fleas away, swallowing them while licking and biting at themselves.  If your animal is itchy and you and your vet cannot find the fleas or flea dirt, please just listen to the vet and apply some Frontline Plus or whatever  the vet recommended.  We are not making this up. 

Here is what I use to keep fleas from ever becoming a problem on my own pets:
On my dog Ozzie, I apply Certifect topically to treat adult fleas and ticks every month and I give him a Sentinel tablet every month for heartworm, intestinal parasites and prevention of fleas.  Sentinel has a chemical specific to an insect system in it that doesn't allow a flea to lay a viable egg, pretty cool.  On my cats, Peggy and Teddy, I apply Revolution every month.  If anybody stops mid stride to turn around and bite at their skin with their front teeth, I am suspicious despite our great preventative plan and they all get some Capstar orally a few times a week for 3 weeks, just in case.  The only thing that I don't do is use over the counter products, those can be very toxic, especially to cats.

Check out this website for some flea facts: www.sentinelpet.com.  One adult flea can lay 50 eggs a day, in 30 days, with 10 fleas to start you could have 250,000 fleas in the house.  Pretty gross.

My dog is miserable

Whose idea was it to take me to the dermatologist?

I have always been proud of the fact that I never judge an owner for over-reacting or under-reacting about the condition of their pet.  After all, I am not living in their home experiencing what they are experiencing.  Sometimes though, I have an eye opening personal experience, that helps me to remember that it can be very upsetting when your dog doesn't feel good. 

Ozzie has been itchy for about two years.  I have treated him exactly like I would have told any owner to treat one of my patients.  He has had antibiotics for skin infections, flea and tick treatments religiously, treatments for possible mites, hypoallergenic diets...the works.  He still scratches.  After all of those treatments failed, just like I would have told my clients, I decided that he has atopy.  That is the term for environmental allergies.  I blood tested him with the hope of formulating an allergy shot, but the blood test came up with nothing.  That left us scheduling a trip to the veterinary dermatologist for skin testing, something that I cannot do myself in general practice.  We saw Dr. Brian Palmeiro, a board certified veterinary dermatologist, who, by the way, is fantastic.  Ozzie was a great candidate for skin testing, as he really only had a rash on his belly, and his sides where allergy testing is done still had perfectly beautiful, healthy skin.  As Dr. Palmeiro injected 66 allergens under the skin of my sleepy little dog, I was happy and excited when I saw hive after hive appear at most of the locations.  Finally, I would be able to start allergy shots with the hope of making him eventually comfortable.  Once he was awake, I comforted him and told him that all would be well,  slathered a little hydrocortisone on the skin test site (his entire left side)  and we went home with three vials of hope in a bottle.



I hope that these work!

 Well, he hasn't stopped scratching what I can only imagine feels like the world's largest mosquito bite for three and a half days now.  He yelps, he runs under chairs trying to get away from his skin, he cries, he trembles.  His side is bruised, swollen, hot and horrible.  There is nothing that I have given him that seems to help, and believe me, I have given him plenty of tablets, sprays, lotions, shampoos and creams.  The only thing that I haven't given, which would probably work but would mess with our allergy shots and what I have already given, is a steroid.  So, now all I can do is feel terrible for him.  I think that my feeling terrible is a good part of the treatment plan.  Maybe it will help.

My rash hurts.

None of this is helping.

These are the experiences that I hope make me a better veterinarian.