Your Pet's Best Friend

100 Years of Scouting

Today is the 100th anniversary of the founding of the Boy Scouts of America.  There are all kinds of places to learn about Scouting.  I wore my uniform to work all day today to celebrate.  It appears I'm having a bad hair day... or a not-very-much hair day.  Oh, well...

I never thought I'd be a "lifer".  I (like most people) got roped into being Scoutmaster because "somebody needed to do it".  There was no doubt in mind that as soon as my son got out, so would I.  When I said as much at a Pioneering training, old Cliff said, "No, you're a lifer."  "Hide and watch, buddy", sez I.  Well, we see who was right.

So here I am, 12 years later (nine years after my son quit), still dressing up like Barney Fife.  It's the friends you make, and the values of Scouting that keep me here. 

There are far too many sad messages being drummed into people from all quarters these days: "If it feels good, do it."  "The one who dies with the most toys wins."  "Life is short: Have an affair." 

The world will be better off for every person who is Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrifty, Brave, Clean and Reverent.

Cataracts in Diabetic Dogs

The appointment schedule says, "Check Eyes".  His owner says, "He was just fine on Friday, and on Saturday he started bumping into things.  He falls off the curb, he can't find the steps.  I put his treat on the floor and he couldn't find it until I put it up where he could smell it."  Well, that sure sounds like he can't see.

When a dog goes gradually blind with age-related cataracts, he becomes accustomed to blurry, ever-worsening vision and learns to compensate.  I have had clients whose dogs had been stone-blind for who-knows-how-long and they never knew it until they rearranged the furniture and Fido plowed into the coffee-table.  They apparently have a pretty decent quality of life.

When dogs go blind suddenly, they are bumping into everything and they are pretty distressed, just as you would be if somebody suddenly turned out all the lights... permanently (or even just a couple of weeks, as in last year's ice storm aftermath). 

So what could make a dog suddenly go blind?  He might have a detached retina from trauma or high blood pressure, but that's pretty uncommon.  He could have an infection or inflammation in his eye that flared up rapidly. We often see that with Blastomycosis, a systemic fungus that's not uncommon in our area.

OR, he could have cataracts, where the lens inside the eye becomes opaque.  This is a close-up of Jackson's eye.  I could see his cataracts from across the room -- the pupil of his eye is all white and sparkly.  The thing is, cataracts don't usually develop overnight.  That is, they don't unless you have Diabetes Mellitus ("sugar diabetes").

"So, Jackson weighs 12 pounds.  Has he lost weight?"  "He weighed 14 pounds four weeks ago."

"Does he drink a lot of water?"   "He is constantly at the water bowl. I can't keep it full."

"How is he feeling?  Any vomiting?"  "He really doesn't feel good.  He doesn't vomit, but he's not eating so well."

And, sure enough, his blood sugar is 434 (should be close to 100), and his urine is full of sugar.  Worse, his urine is full of ketones.  Without adequate insulin, he has been unable to utilize sugars and starches normally for a long time.  So, he has had super-high blood sugar for a long time.  This produces the rapid development of cataracts, maybe not totally overnight, but fast.  [Check out Veterinary Partner for a more thorough explanation.]

Since he couldn't utilize sugar, he had to break down body fat (and probably some muscle and such, as well), hence the rapid weight loss.  Imagine dropping from 140 to 120 in four weeks.  This excessive breakdown of fat has produced a lot of the ketone as byproduct.  It was making Jackson feel kind of sick. [Here's another link to a diabetes discussion on Veterinary Partner.]

Fortunately, he was still eating (though not well) and not vomiting.  Another couple of days and he would have required hospitalization and intensive care.  We started him on insulin, and he was already starting to feel a little better the next morning.  It will probably take a few weeks to really get him regulated, but he should be enjoying life again pretty soon.

What a difference a year makes.

One year ago, the Ice Storm of Aught-Nine was moving in.  Today, the temperature was in the mid fifties.  Of course, the prettiest part of the day, with the most sunshine, and the least wind, was between 10:30AM and noon -- i.e. church time.  Coincidentally, Don Rollins, the guru of the Docs-a-Cyclin' veterinary motorcycle gang, emailed me a list of "Things my motorcycle taught me" today.  My favorite?  "I'd rather be on my motorcycle thinking about God than in church thinking about my motorcycle."  Ain't it the truth, brother? 

As consolation, we had a great anthem in church today.  I love Haydn, and we sang a real rouser: "The Heavens are Telling" (the glory of God).  As another consolation, the weather was still decent this afternoon.  I intended to see my CASA cases (two different towns now).  Contacting them by phone is iffy, so I usually just drop in at a semi-regular time.  Missed them both today, BUT I was on the motorcycle instead of in the mini-van, so the I enjoyed 90 minutes and 50 miles of soul-freeing flight (instead of a wasted afternoon).

Lots of N.C. Wyeth type cumulus clouds today.  It was a little dark and cool underneath them (and occasionally a little sprinkly), but beautiful when you were in the sun and seeing them in the distance.  May this be a harbinger of a great year to come.

Bacon of the Future

 When I was a kid I used to read a lot of science fiction.   Most of what our library had was anthologies of stories from the 1950’s.  A common theme of dystopian futures was the need to feed the overpopulated planet with mass-produced sustenance.  The Soylent Green method wasn’t popular, but huge vats of genetically modified yeast would crop up in story after story, much like flying cars in the Popular Science magazines of that era.  It would be called beef-o-plast or yeast-steak or something similar.  The common thread was that it was some kind of artificial (if nutritious) gunk that was an inferior substitute for the real thing.

If you’re a fan of bacon, you know that there is no substitute.  Almost any vegetable (and most meat) is improved by the addition of bacon.  Sure, it’s full of fat (eek!) and couldn’t be good for your arteries (See City Slickers:  “The man ate bacon three times a day; you can’t DO that.”), but it's good for the soul.

The pig of the future may be leaner, with no trans-fat, but Robo-Pig will never be popular.  You will note that there is no bacon around the gears.  So what will the bacon of the future look like?

If these researchers get their way, it will apparently look a lot like this.  They are growing “pork” from pig stem cells.  So far they have produced (and I quote) only “spongy lab meat” which the researchers themselves are afraid to eat.  This doesn’t stop them from talking about the great potential here.  Why, you could engineer all sorts of healthy food like this.  And if it’s disgusting-looking, you can grind it up into sausage or something.  How well I remember the days when my wife loved to serve veggie-burgers made with “textured soy protein”.  To almost quote Crocodile Dundee, “You can live on it, but it tastes like _____.”

I’d rather have a flying car.

Dislocated Hips

Apparently, I have written about dislocated hips before, but I can't find my original post right now. I received an email on the subject from Ireland today.  [These diagrams are lifted from Brinker, Piermatti & Flo (orthopedic text).]

On Tue, 19 Jan 2010 20:18:56 -0000, Paddy from Wicklow, Ireland  wrote

  I have a 4 year old very intelligent border collie bitch.   She is a great sheepdog, but more important she is my best friend and companion after my wife. I want the best treatment for her.

 She was hit by a jeep wheel on the left hindquarters on 12th December 2009. Our vet immediately gave painkilling injections and supplied tablets for pain. I brought her back to him several times and he said not to worry and kept giving painkiller tablets.

I was not happy and I suspected a dislocated hip.I changed vets and the new vet x-rayed the hip yesterday 18th Jan.  The hip is dislocated and nothing else wrong. She is still mobile on 3 legs.

The vet said it was too long out to put back and it would be a big job. She recommended surgery to remove the femoral knob. I think that is very drastic and extreme and also she has never done it before. She will not try manipulation as I have asked her.

 Your article on hip dislocations has given me hope if only I could get a vet to do it. Under anesthetic it is at least worth a try.   We have a bonesetter in the next County. Would you think it advisable to let him see her?

Doc Mobley replies:

Hello, Paddy,

If by "bonesetter" you mean a doctor (vet) who specializes in orthopedics (fractures, dislocations, or other bone surgery), then yes, I think that's a good idea.

The longer that the hip stays out of socket, the less likely it is that simply replacing it will be successful.  The socket will have a bunch of clot-like material filling it up.  That could have been displaced if the hip had been put back soon after the injury.  Now it is more organized, and probably won't just "push out of the way".  

Also, the other structures that support the hip, the muscles and ligaments will have shrunk or stretched to accommodate the new position of the thigh-bone.  This would have a tendency to pull the ball back out of the socket.

Removal of the femoral head (the "ball" in the ball and socket joint) is not a terrible thing to do.  There is enough muscle and tendon to support the dog's weight in this area.  Sometimes they will form a "false joint", where the ball sort of "nests" in some other area.  They may get around fine.  However, if there is bone-on-bone contact, this causes pain.  Removal of the femoral head relieves that pain.

To replace the hip joint back in socket and keep it there would (almost certainly) require a good orthopedic surgeon who could stabilize the joint with some type of implant (screws, wires, etc.)

Good luck in caring for your second-best friend.

 
  

Heartworm Treatment Drug Shortage

I treat a LOT of dogs for heartworm disease.  The treatment is not complicated to perform, but managing the dog's six to ten weeks of convalescence can be quite complicated. That's why I took the trouble to produce my own brochure to help explain the process to clients.  There are lots of ready-made sources of information on the disease process, but it was a little harder to find an explanation of the nuts and bolts of what goes on inside the dog -- why you might have complications, and how to recognize them, and what to do about them.

Since we treat a lot of dogs for heartworm disease, we use an awful lot of this medication.  Immiticide is the only drug available to treat dogs to kill the adult heartworms.  It is made by only one company, Merial. [There was an older drug called Caparsolate - Merial bought the patent and deep-sixed it.] There are five little vials in the box.  Once you mix them up, they are only good for 24 hours, so there's not a lot of medicine in each vial -- you wouldn't want to waste it.  An average big dog will take 3 or 4 vials to treat.  A really big dog could take five.  It's not uncommon for me to go through fifteen bottles in a week.  Whenever my stock drops below fifteen bottles, I re-order.

That is, I try to re-order.  While I used to order everything by phone (I'm such a Luddite), I recently started ordering on-line from my main distributor.   I was really hacked off when Immiticide would not come up on my screen Wednesday evening, and I sent them a very sharp e-mail.  I had to order by phone the next day.  That is, I tried.  My distributor apologized, saying that there's no problem with the way I use their website -- they just cannot sell the product right now.  There is a shortage, and I would have to order direct from the manufacturer. 

Today I received a form letter recapitulating the information I got when I contacted Merial yesterday.  "As a result of unforeseen technical difficulties during a planned manufacturing site transfer..." [overseas, perhaps?  Maybe they are relocating production to Afghanistan?]  Anyhow, they are rationing the stock they have, as they don't expect to be back in production before APRIL.  If I have a dog I need to treat right now, and I'm totally out of medicine, and I beg really hard, and if I'm a really good boy for Christmas, they might sell me one box of five bottles.  BUT ONLY ONE BOX AT A TIME, and only if I can prove I really need it, and only once per week. 

So now I have to beg Merial before I can schedule a treatment.  I'd love to know what those actual "technical difficulties" are... and where they are relocating the production site.

Herd Health for the Human Herd - Update

UPDATE - 11/21/09

Well, I should have gone to the original report instead of listening to the news media.  Today's Wall Street Journal says "We probably, in retrospect, could have been more clear." This from Dr. Diana Petitti, vice-chairwoman of the U.S. Preventive Services Task Force.  "The task force is not against women having mammograms in their 40s."  Instead, she said, it is in favor of women in that age range deciding on their own, after consulting with their doctors, whether to undergo regular screenings.   Similarly, they did not mean to deter women from practicing self-examination.  They merely intended to signal primary-care physicians that they no longer need to teach women how to do it.  Now there's a fine distinction.

On the one hand, it's easy to conclude that this is just a case of the media sensationalizing a poorly understood scientific report.  On the other hand, if I were a conspiracy theorist, I could see this as a trial balloon to see how easily the sheep go to the slaughter.  Apparently, the sheep are not so eager to lie down and die.  Good.

Herd Health for the Human Herd

Back in 1978 when I graduated from veterinary school, there were still a lot veterinarians practicing what was called "fire engine" medicine.  The farmer has one sick animal, so you drive right over to take care of that one sick animal.  That's sort of analogous to "putting out a fire". This is my mentor and first employer, Dr. Dwight O. Creach.  He and I spent half our time on the road, going from farm to farm.  Even then, though, it was becoming apparent that this approach was not making economic sense.

 The trend was already turning away from running to tend one sick animal, and turning toward the “herd health” concept.  If you have a limited number of dollars to spend on medical care for your livestock, you want to take the approach that will yield the greatest number of healthy, marketable individuals. 

I take my dollars and use them to set up pasture rotation, vaccination programs, de-worming programs, nutritional supplementation and other preventive medical procedures.  If this doesn’t leave me enough dollars for the animals that get sick,  I may have to just cull them out.   If this program leaves me with an increased number of salable animals at market time, then it is a cost-effective approach. 

True, I may lose a few animals, but the better overall care has still left me with more animals to sell than if I had concentrated on just dealing with sick ones on an individual basis.  The concept is to treat the herd as one big entity, and to get the best results while spending the least money.  This holds true whether we are talking about so-called "factory farming", or the organic, free-range variety.

A large-scale poultry operation is even more dramatic when we talk about sacrificing the few for the good of the many.  With ten thousand birds in one big building, infections can really spread quickly, leading to the loss of hundreds, even thousands of birds.  When you see one sick bird, he gets gathered up out of the building, along with anybody else who looks cross-eyed or was just standing nearby.  Those birds are sacrificed to get an immediate post-mortem so that the diagnostic test results will be as accurate and fast as possible.  That way the vast majority of the birds can be treated preventively and saved from illness (and lost production). How well I remember those  interesting hours spent with the late, great Dr. Emmett “Peck” McCune, our poultry pathology instructor.

And now, the herd-health concept has come to the fight against breast cancer in women.  Since so few women between the ages of forty and fifty show up with breast cancer, we’re told that it’s a big waste of money to do all those mammograms and biopsies.  It costs untold millions, and you only save a few hundred women each year by doing so.  Obviously, it’s not cost effective, and we should spend the money elsewhere.  On NPR tonight, I heard "There are some cancers we don't need to find."  Also, "People can become so stressed by diagnostic procedures that it makes them sick.  They might even die from the stress."

Of course, this doesn’t come from medical specialists who deal with cancer and women’s health.  It comes from the folks who are trying to come up with an explanation about how “health care reform” will save the country money. There's a scary trend.

Well, I planned on working till I drop dead, anyhow.  I just have to be sure to drop dead suddenly instead of getting sick.  That’s why I ride a motorcycle.

UPDATE 11/21/09: Well, I should have gone to the original report instead of listening to the news media.  Today's Wall Street Journal says "We probably, in retrospect, could have been more clear." This from Dr. Diana Petitti, vice-chairwoman of the U.S. Preventive Services Task Force.  "The task force is not against women having mammograms in their 40s."  Instead, she said, it is in favor of women in that age range deciding on their own, after consulting with their doctors, whether to undergo regular screenings.   Similarly, they did not mean to deter women from practicing self-examination.  They merely intended to signal primary-care physicians that they no longer need to teach women how to do it.  Now there's a fine distinction.

On the one hand, it's easy to conclude that this is just a case of the media sensationalizing a poorly understood scientific report.  On the other hand, if I were a conspiracy theorist, I could see this as a trial balloon to see how easily the sheep go to the slaughter.  Apparently, the sheep are not so eager to lie down and die.  Good.

Scouting for Food

I've got that bag full of food hung on the doorknob.  The Boy Scouts (and Cub Scouts) will be out early tomorrow morning picking up those canned goods.  It's the biggest nationwide good turn ever, with millions of food items collected for food pantries to feed the hungry.

Our Troop was out in the cold rain hanging those empty bags on doorknobs, and they will be out bright and early to collect on Saturday morning.

It's an easy way for you to help your fellow man.

My Far-flung Readers

It's amazing what you can come to take for granted.  I can't remember the name of the story, but there is a great science fiction story written in the 1950s.  It is set in the 1890s.  The protagonist invents a time machine and visits the 1950s.  Upon his return, he writes an account of his experiences in the future and submits it to a magazine in the guise of science fiction.

The publisher rejects it out of hand.  "Too unbelievable.  Automobiles that travel a mile a minute, people traveling across the country in huge airplanes, pictures come out of the air...  True, these amazing things might someday occur, but in your story the people simply take these things for granted.  Unbelievable!"

That's the way the internet is becoming for us.  This week, in addition to the usual questions on Aural Hematoma (I'm thinking about starting an Aural Hematoma.com site, just for that problem), I've answered questions about pelvic fractures from a gentlemen in Karachi, Pakistan.  He just searches the internet for information about his dog's injury, and finds me in Kennett, Missouri, and gets an answer.  Omar says "thanks". Simple, right? 

I've posted a "veterinarian wanted" notice on the clinic website and today I got an email from a veterinarian in Serbia.  He's thinking about selling his practice there and moving to the USA.  Kennett sounds good to him.  Serbia, forsooth.

And we just take it for granted.