Your Pet's Best Friend

Calm before the storm.

Yesterday morning, our schedule was unusually light.  It put me in mind of a conversation between the legendary masked rider of the plains and his faithful Indian companion."Ugh, plenty quiet around here, Kemo Sabe.  Yes, Tonto, too quiet." 

That was not a problem today.  Combine a full appointment schedule, plus people who are afraid you won't be here on the weekend (I will), and a couple of genuine emergencies, and you've got a full day.  Yes, we were open twice as many hours today, but we saw five times as many patients, and did ten times the work.    Okay, we were open a little more than twice as many hours - 20 minutes for lunch and a 10-hour day. Kudos to the staff -- I couldn't do it without them.

You know what they say: Better to wear out than to rust out.  No rust here, kids.

Ups and downs

The downer today was finding out that a long-time client has terminal cancer.   I went to visit her in the nursing home and she really didn't recognize me.  We talked for a while and she finally associated me with her dog.  Though she didn't really remember me, she talked about the instructions for her dog's medicine (now being cared for by her grandson).  "I give it at six and six, every 12 hours." (She was right.) She also wanted to be sure that I had been paid (I had).  I thought we might visit, but between her illness and her medication, it wasn't much of a visit.

Then I opened my mail and found this nice card.  It was from a new client whose dog we had just met last week.  In addition to the lovely pre-printed sentiments, she had added a very nice message: "Thanks so much for the prompt and professional way our dog (Penny) and I were treated.  She has never in her 5 years been examined so completely.  All of you were so very kind."

Of course, everybody loves an "attaboy".  This was a little different, though.  For one thing, thank heavens her service was prompt on her first visit -- we run behind so often.  For another, there wasn't anything particularly wrong with Penny; she was just in for a check-up.  We took the same kind of (we hope) complete history that we do on every new patient, and she received the same complete physical exam that we (try to) give everybody. 

In other words, we weren't doing anytyhing we thought was out of the ordinary, but our new client felt it was special.  Sometimes we're getting it right, and that's nice to hear. 

Things I shouldn't say.

You always need to keep the compassion turned on, for the owner as well as the animal.  Sometimes the animal just doesn't have enough sense to stay out of trouble, and sometimes we've just provided such a dangerous environment that it's hard to stay safe. It's really not fair to blame a pet for his problems (with the exception of the few dogs in the "stupid hall of fame", anyway).  If the owner didn't care about the pet, you wouldn't be seeing it.  And yet...

Today my (as usual) full schedule got rearranged by the sudden and previously unexpected appearance of a new client whose little dog had returned from it's bathroom trip with a serious injury.  No, the yard isn't fenced, and no, they weren't watching him, but he always just goes out and right back in with no problem... until today, that is. While we were working to stabilize him, I can hear through the exam room door, "My dog just got hit by a car!".  I momentarily think to myself, "Well, who's dying the fastest here?", but my thoughts are interrupted by the first dog's owner saying, "Bad day for dogs."   Before I could run it by my editorial review board, I popped out with "Bad day for dogs who run loose."

Sometimes things are true enough, but there's little to be gained by saying them.  No point in making people feel worse than they already do.  Early in my career I thought that these occasions would be good for teaching people to be more responsible.  If you could just show them how wrong they are, they would change their ways.  The flaw in this is that people don't want to be wrong.  Making them feel wrong just puts them on the defensive and less receptive to whatever you have to say.  It's not a very effective way to educate.  You might as well wag your finger at the smoker with lung cancer and say "I told you so".  It won't help the cancer and it won't get you in their will, either.

Pelvic Fractures

They say that cases come in threes, but that's not one of my personal superstitions (and I do have a few).  On Sunday I saw two hit-by-car cases, both with a broken pelvis.  Quite a coincidence, and two was enough for one day, thank you.

The pelvic bones, the pelvis (as in Elvis), the pelvic girdle, the birth canal. Everybody's got one.  It's what your legs hook into on the bottom and your backbone on the top. ["The Leg-bone connected to the -- Hip-bone..."]  If a dog or cat gets hit by a car on the rear, the pelvis often takes the impact.  The patient can't get up and can't walk, even though his legs are okay and his back is not broken.

Here's how it looks from the rear. Notice how irregularly shaped and twisty these bones are.  What you can't see on our little plastic skeleton is the tremendous amount of muscle and tendon that surrounds it.  Both those factors make it very difficult to approach the bones surgically, or to bend and contour a bone-repair plate to fit it.  It takes one heck of a good orthopedic surgeon to get in there and put a pelvis back together.

Fortunately, when the hip joints are intact, you usually don't need to surgically repair things.  All those muscles and tendons that make the bones so inaccesible will also act as a "self-cast".  They will hold it together well enough that most cases will knit back in two to four weeks.  If the spine is okay and the hips and legs are okay, the only treatment needed may be bed-rest and nursing care (including pain control, of course).  This is Sunday morning's dog patient.

This is Sunday afternoon's cat patient.  These patients need help with their toilet work.  Personal hygiene is a little difficult for them.  You'll have to bring them their food and water -- we don't want them dragging themselves around the room.  You have to be alert to be sure that they are able to eliminate, as some individuals have damage to either the bladder, the rectum, or the nerves that control them.  Sometimes the sciatic nerve is damaged along with the bones and the animal loses the use of a hind leg, even though all the bones heal up okay.

Also, while these bones usually knit back together well enough for the patient to walk and go potty okay, the "birth canal" will very likely be deformed.  If the pet is an intact female, it's important to have her spayed, as she will probably be unanble to give birth naturally.

It's a pretty tough injury, but the prognosis is usually good.

I wear many hats.

A veterinarian in general practice has to wear a lot of hats, especially when you're a solo act (with a great back-up group of staff).  I'm the internist, surgeon, dentist, radiologist, pharmacist, sonographer, clinical pathologist, behavior counselor, grief counselor, office manager and I forget what else.  But that's not what I came here to talk about, as Arlo Guthrie says in "Alice's Restaurant".

When I was a kid I was a faithful watcher of Captain Kangaroo.  One of my favorite things about the Treasure House was the hat tree, adorned with all manner of hats: a fireman's hat, a policeman's hat, a cowboy hat, indeed a hat for every occupation.  I coveted that hat tree.

At this stage of my life I'm more into figuring out how to travel light instead of accumulating things.  For years, though, I built up the costume closet, especially hats.  At Christmas my mom had it easy -- my head size wasn't changing and she just had to find a new hat to add to the collection.  The costume closet has been a resource for SEMO Little Theater, for high school thespians, Halloween, Fourth of July  galas, guerilla theater, and strange video productions by my offspring his friends.  It was once well organized, but the depradations of outsiders have jumbled it a bit.  At this point, the only catalog of its contents would be my fuzzy memory.

Last night I was looking for my fez. Mom got it for me many years ago direct from the official supplier to the Moolah Shrine.  Actually, that was the second night I was looking for it (a long story) and inexplicably found it in a sack of Pilgrim costumes.  It was accompanied (also inexplicably) by the Mad Scientist goggles.  Oh well, all's well that ends well.

Dog-Fighting

Regular readers may remember that some time back I expounded on the pit bull dog.  Generally speaking, most of the ones I see (who admittedly don't belong to drug-dealers and dog-fighters) are family pets with good dispositions.

The big story on NFL star Michael Vick's dog-fighting operation has brought these concerns to the forefront for a lot of folks.  My friend, Dr. Sheila Hellman, is a great animal lover and activist.  Her career as a physician sometimes seems almost secondary to the amount of time and energy she devotes to rescuing and caring for a large number of animals.    Her letter to me asking me to blog on the dog-fighting subject is eloquent enough for me to just quote it here.

     "...I would like to ask you to consider a blog entry about the recently popularized "sport" of dog-fighting. I have been amazed at the number of well-educated people in my circle (doctors, lawyers, teachers) who had no idea what this was all about, how the dogs are trained and selected, and had no idea that family pets can wind up as bait dogs. I am especially distressed for this reason when I see dogs given away for free by owners who naively believe that only well-meaning folks would come adopt them. They have no idea about bunchers, no idea about dog auctions, no idea that dog fighters will collect them for bait and lie about their intentions.

You may remember my delightful little long-haired dachshund, PoohBear. After he died, I was called by somebody who had been to a puppy mill auction, to come get Oscar, another long-haired dachshund who looked and acted virtually identical to PoohBear. As a senior, he had been for sale for only $5 at the auction when a great dane rescuer realized who was buying him. He was about to be bought by a bait buncher, a guy out to buy as many dirt-cheap dogs as he could to use as bait for training fighting pits. Fortunately, this lady had the presence of mind to run his bid up to $20, and bought him. She then did this for a whole van full of little dogs, shutting down the bait buncher for the day. But you and I know they always have a supply of dogs given away for free.

I am writing to ask you to please use the latest publicity about dog fighting to educate the readers of your blog about this grisly form of torture that awaits many dogs that are given away without careful screening of the new owner. Some very basic screening and a modest adoption fee (one that is more than bunchers want to pay) can help a lot. It turns my stomach that my precious Oscar would have met this fate, and that many other animals meet this fate daily.

Although Michael Vick's carefully prepared statement read by his attorney claims he would like to apologize to everyone who may have been affected by this affair, what I can't figure out is: How do you apologize to dead, tortured dogs?? "

Does Michael Vick think it's okay because what he does for a living is so similar?  It's the only sport where you have to wear body armor.  I well remember a high-school football coach speaking to Kiwanis and saying, "This game is about hitting.  I tell those boys that it's not about strategy or running or throwing. It's about hitting. If you don't have bruises after practice, you're not hitting hard enough." He's not coaching here anymore... recruiting problems.

The fact that you can goad a dog into an aggressive frenzy does not make fighting to the death a "natural activity" for him, as proponents of blood-sport would have you believe. 

I must confess that I am mystified by people who receive vicarious pleasure from the sufferings of others.  As a society, we have an obligation to appeal to the finest in human nature, rather than pandering to its baser appetites. 

The men in Ultimate Fighting competitions may appear to act like the dogs in these fights, but they weren't plucked from the womb and deprived of a normal life in order to make them contestants.

It's time to make "being human" a virtue instead of a failing.

Pet Food Recall Rises from the Grave

Two different issues this time.  A couple of different foods recalled due to possible Salmonella (the germ that causes "food poisoning") contamination: Krasdale Gravy dry, and Red Flannel large breed dry foods.  Check out the Mars Pet Care site.

For more  Salmonella opportunities, try "Eight in One" chicken jerky.  Here's the FDA listing on those products and how to get them.

On the melamine front (our regular, reliable, Chinese poisonous contamination), Wal-Mart has removed some fabulous Chinese chicken jerky from their shelves.  Their official statement is more about what responsible merchants they are than anything else, but it does list the product. 

It's always good to know that people are learning from their mistakes.  By people, I mean US, not Wal-Mart. 

My first pericardiocentesis.

Percardiocentesis - a big word.  You'll know what it means by the end of the post.

The phone rings at 6:00 AM.   "I didn't mean to wake you".  [How could I answer the phone if I weren't awake?] It turns out that Coco had had a tough night.  So had her folks.

I had seen her the day before. Coco is a little Poodle, around eleven years old, weighs 18 pounds, has always been pretty healthy.  She had come in for her annual check-up, no problems... well, she'd been coughing a little, and seemed to breathe heavily, but just in the last few days.  When we X-rayed her chest, her heart looked like a basketball.  Ultrasound (echocardiogram) revealed a normal heart inside a pericardial sac filled with fluid -- a LOT of fluid.  Coco's folks said that referral to the specialists in Memphis was out of the question.  When I consulted with the cardiologist by phone, he felt that since Coco wasn't in much distress, we didn't need to have the folks make an emergency trip back for drainage of the fluid.  "Don't wait 'til next week, though."   As it turned out, waiting overnight had been a bad idea.

Her breathing was much more labored this morning.  It was obvious that she would be moving to the front of the line.  The heart is normally surrounded by a membranous sac containing a small amount of fluid to lubricate the heart surface so that it's not rubbing on things as it beats.  This pericardial sac had to be drained.  In twenty-nine years of practice, it was my first time.  I've done similar procedures to remove fluid from the abdomen and chest, but poking around the heart is a bit more delicate.  There's a great description of "how to do it" in Ettinger's Textbook of Internal Medicine.  How'd you like to have your family doctor poke a big needle in your chest after "reading up on it a little"?  The cardiologist also gave me some pointers, and I had the ultrasound to help guide me.  It went fine, and after removing 5 ounces of fluid from around her heart, Coco immediately felt better.  She trotted out of the clinic like a puppy.

The bad news is, the source of the fluid is probably a tumor.  It's hard to say how soon the fluid will return, but we're pretty sure it will.  Even if her owners were up for a big exploratory chest surgery (and they are not), the outlook is pretty grim.  We'll just hope for some happy days in the meantime.

Max Mobley makes the Guinness Book of Records

I hadn't seen the old Guinness Book of World Records in many a year.  It seems to me that it just came out of nowhere when I was in high school, and everybody was reading it.  Then I've sort of lost sight of it, much like the fading of Trivial Pursuit. 

My recollection was of a small, chunky book, printed on cheap newsprint, with pictures about the size of postage stamps.  Look at the current version.  The cover reflects like the facets of a ruby, and it has "glow in the dark" features.  Can't get THAT in the on-line version.  And why do I care?

When I was a kid, we didn't take many vacations, and we went where my Dad wanted to go.  When I was about twelve, I went with him to his Army reunion at Fort Knox, Kentucky.  I had fun climbing on a tank, and the hotel had the first mezzanine I had ever seen.  Other than that, I just remember it being a long trip, and pretty boring.  Most of the time, when your Dad hauls you someplace that he wants to go on vacation, you're lucky to come home with anything better than a bad case of chiggers.  If you're really lucky, maybe you get a cool T-shirt.  If you're not so lucky, perhaps a poisonous Chinese souvenir toy.

Then there's my nephew, Max.  If you're a regular reader, you know that we all went to the Wild West Arts Convention in April.  My brother, Matt, was the main motivator for that trip.  His son, Max, was the youngest registered competitor there.  As it happened, the Guinness World Records people were there to document the largest gathering of Wild West Artists.  Lots of records were set there and they took lots of pictures.  With only two pages devoted to the WWAC, we knew that it wouldn't be possible to include a picture of every record-holder.  Lo and behold, the editor's whim put Max right there on page 260.

The local newspaper did a feature article on Max's appearance in the book, and KFVS-12  television in Cape Girardeau did a very nice piece on today's five o'clock news.  Their reporter, Ms. Cassidy, spent about an hour getting two minutes worth of talk out of Max.  He's a tough interview, and here are some pictures of the work in progress.  Here's a link to the video.

The attention hasn't gone to Max's head, though.  He really doesn't have an appreciation for the number of people who have gone to extreme lengths in an attempt to leave their mark on the world.  How fast can you eat a bicycle?  How many fish-hooks can you put in your ear-lobe?  How long can you pogo-stick naked before passing out?  All Max had to do was get hauled along on vacation with his family and have fun with ropes, whips, knives and tomahawks.

They used some of my pictures on the TV spot, but you can't beat this one. Max is working on learning more rope tricks and western skills.  He's figured out that he can't top this year's record by getting even younger.

Lock up your iodine.

I don't use a lot of strong tincture of iodine.  This bottle is so old, that I'm not sure just how old it is. Strong iodine is very caustic -- in fact, about the only thing I use it for would be some type of chemical cautery, like sealing the navel cord on a newborn foal.  When we want iodine activity in an antiseptic, we would use a tamed iodine.  Povidone iodine (Betadine being the most well-known trade name) has the iodine bound to another molecule that makes it less traumatic to tissue.    Even with the tamed iodine, we use very low concentrations.  0.5% (that's one half of one percent -- looks like weak tea) is plenty to kill germs.  Any stronger, and you begin to kill the tissue you're trying to protect.  All that stuff that burns when you pour it on is burning for a reason. It's not just hurting your feelings, it's hurting the tissue that you were trying to help.  If it burns like crazy, don't pour it in an open wound.

It's a good thing I don't use much of it, as it is being declared a "controlled substance"; I'll have to keep records on its purchase and use, just like a narcotic.  It seems that iodine crystals are used as a catalyst in methamphetamine manufacture.  So, just as cold-pills with pseudo-ephedrine got moved behind the counter, and you can only buy two lithium batteries at a time, the meth-heads (with help from federal regulators, of course) have now created a hassle for legitimate users of iodine. [ This is just for the strong stuff, strong tincture, crystals, and so forth. You can still buy the weak stuff without a problem.]

Of course, there are people who shouldn't have access to iodine, I suppose.  This past week a lady brought in her little Dachshund who had been vomiting a bit.  Her uncle had told her that the dog might have parvovirus (it didn't) and that she could kill the virus by putting a drop of iodine on the dog's tongue. This is not the dumbest thing I've ever heard, but it will make the semi-finals.  NOT a good idea.

Apparently her uncle thinks that the skull and crossbones refer to some sort of pirate-themed party.  "Poison" is only one letter off from "poisson", which is French for fish, and again you've got your nautical reference.  My client was made a little uneasy by this warning, but ... she trusted her uncle.  She compromised by touching the dog's tongue with a cotton-swab moistened in iodine.  It was a bit like our Presbyterian approach to baptism: sort of a promise of moisture, rather than immersion.

Probably didn't taste too good, but not enough to poison the dog, thank goodness.