Your Pet's Best Friend

Second opinions via the Internet

I have posted on this once before, but I believe it bears re-visiting.  Lately I have had quite a few readers asking for advice on their personal pet's problem.   These are folks who have been doing an internet search about their pet's problem and accidentally arrived at my spot here.  I'm glad that they feel they have been helped enough by my information to ask for my opinion.  The thing is, I'm still limited to giving general advice and information; I still haven't perfected the psychic abilities that would allow me reach out and get in touch with the problem over the ether.

This is a particularly difficult situation when I am asked to second-guess the doctor who is actually seeing the pet.  Chances are, he has some information about the case that I don't have.  My goal would be to actually help the client and the pet's regular doctor by opening a common ground for communication about the situation.

If you're reading this, you know that when you search the internet, you can find that your search expression will yield an awful lot of results.  It's difficult to know which one to trust when they are in conflict.  What is it that makes a reliable site?  If I wanted to put up a site that says the Pope has three illegitimate children and won't pay alimony, I could do it.  It would be utter rubbish, but you could "find it on the internet".  I can tell you that there many doctors who dread nothing more than "...I've been researching this on the internet."  People who are perfectly reasonable and intelligent in other respects will bring in a print-out that just makes no sense whatever and wave it about like a talisman.

I'm happy to answer your questions as best that I can.  If I'm not as specific as you would like me to be, at least you'll have something that's a discussion point for you and your pet's doctor, and I don't think it will make him/her crazy.  That is a positive point.  So keep reading, and keep those emails coming.

Kitty Success Story

It's been a busy week.  I worked three nights at the Kiwanis youth soccer tournament (and yes, I have had enough cold rain to suit me... more than I can really enjoy, to tell you the truth).  Wednesday after work I drove to Cape Girardeau to help interview candidates for a new District Executive for the Cherokee District (if you look at the website, our friend Josh Chumbley is leaving us).  It was a late night, but we have a gentleman hired, and he should hit the ground running in November.  I certainly feel like I've been getting a lot done, but it hasn't left much time for blogging.  I've been busy in the clinic with several cases that have given me some dramatic "before" pictures.  Now I've got to get them to that "after" stage, which brings us to today's success story.

Kitty is about three months old, and should weigh three pounds.  When she came in on October 15, she weighed 1.6 pounds.  She was terribly thin, dehydrated, and hypothermic (and this was before things cooled off; her body temperature was room temperature).  Imagine a furry little raisin and you get the picture.  She really looks a lot better in the photo than in real-life. 

There's always cat food out at the barn and the barn cats usually fend for themselves pretty much.  Not Kitty, though.  They noticed she wasn't feeling too well and brought her inside.  She still wouldn't eat.  After four days of this, the folks decided they needed professional help, and not a moment too soon.  I had grave doubts as to whether she were salvageable. 

To get started, we gave her a careful de-flea-ing (she couldn't stand much chemical), de-worming, a low-heat warming pad, and sub-cutaneous fluids [You hook them up like an I.V., but the fluids are injected under the skin -- not bad if your circulation is okay.  On a kid this small, I'd never be able to get an I.V. started.  When they are critical, you can stick a needle down the middle of their thigh-bone, but that's no fun.]  Once she warmed up, the real work started.  She really would not eat.  The whole staff (mostly Greg and Shannon) began hand-feeding her little bits of Nutri-Cal (a high-energy content supplement with vitamins and minerals) about every 10 to 15 minutes.  That went on for two days.  Late on the second day, she would eat a little solid food when hand-fed. Day 3 saw continued improvement and we started to get hopeful.  On the fourth day she began eating by herself, and on day five she was eating eagerly and we sent her home.  She had gained from 1.6 up to 2 pounds (still one pound underweight, or 33% underweight).

Here we are today (day 11) up to 2.7 pounds, playing hard, eating well, having a big time.  Sure, she needed some medical care, but what brought her around was the nursing care.  You can't stick enough needles and pills in somebody to fix them.  It takes that tender, loving care (and lots of it, in a case this bad).  Hats off to the staff and the nursing care they delivered, and to Kitty's owners for being willing to commit to bring her back from the edge.  She's out of the woods and on her way to bigger and better things.

De-clawing Cats -- What do you mean, you "don't think he's hurting?"

Some days I think I am a great communicator.  Heaven knows, I love to listen to me talking.  Then there are days like today.

De-clawing is a major surgery for the cat (pretty routine for me).  I don't feel it is something to be entered into lightly, or to be considered "minor" in any way.  You are amputating the last bone (digit, third phalanx, whatever you want to call it) on every toe that is being de-clawed.  This is not crippling to a cat, as they walk on the next bone up, with that last bone and claw flipped up out of the way -- the old, retractable claw business.  On the other hand, just imagine having the ends of all your fingers cut off...  Ouch!   Okay, you can stop imagining now.

There are definitely times when de-clawing is indicated.  Sometimes either the claws have got to go or the cat has got to go.  I don't want the kitty to lose his home, and I know that it won't be long before he's able to walk normally and pain-free again.  Sometimes you just have to make the best choice you can. The important thing is to make the surgery and recovery as pain-free as possible.  In addition to general anesthesia, we use local anesthetic to block the nerves to the paw.  This prevents some of the pain perception mechanism from ever getting triggered.  We use a lot of buprenorphine post-operatively.  It's a mild narcotic that cats tolerate well, and you can give a tiny volume simply by squirting it in the mouth.  They don't actually have to swallow it, as it absorbs across the cheeks and tongue.  We send home enough to give every 6 to 8 hours for at least three days.

It's unusual to de-claw an adult cat, but when folks have adopted a cat who needed a home desperately and the cat starts shredding his new home...  This was a big cat: fourteen pounds.  We talked about what a major surgery this is. I told the folks that he would stay in the hospital an extra day with his bandages on to protect his paws, and that we would be using extra pain medication to be sure that he had enough when he went home.  An adult doesn't heal as fast as a growing kitten.

When we called to check on him, we found that they weren't giving him his pain medicine.  "Well, we didn't think he needed it.  We had a cat before, and when he was hurting, he did a lot of panting and crying."  [As cats have a strong tendency to conceal signs of pain or illness, I wish we had had the presence of mind to ask what was wrong with their previous cat to get him panting and crying.]

Here's a predicament for you: If the people listen to me now, they have to admit they were wrong and were letting the cat suffer without his meds.  To be right, they have to hold on to their previous mindset and wait for him to pant and cry.  The best I could think of was to remind them that some cats try very hard to conceal their weakness.  It's a survival instinct.  Don't show your weakness, as other predators may take advantage of you.  "Just in case he is one of those cats, let's go ahead and give the medicine... just to be on the safe side, you know.  It won't hurt him." [Since it's, whaddayacallit? ... pain medicine]

It's just another reminder that animals (and people) don't always show their feelings in the same way.  One cat purrs only when happy, the next purrs like a machine when he's about to come unglued and take the room apart.  I have to keep falling back on, "Would I be hurting if this were me?"

Riding the Elephant

When I was about eight, an elephant came to the Delta Fair.   She also walked the parade route, carrying "Baby Jack" Allen, DJ and local radio personality on KBXM.  If you looked hard enough through the DDD archives, I believe you could find the picture of a smiling Baby Jack waving from atop the pachyderm. 

Two teen-age guys were hired with a proposal only slighty better than the one Fay Wray got in "King Kong".  "How would you guys like to get paid to be in the parade?"  They got clown costumes, big shovels and even bigger wheelbarrows, and they followed the elephant.

On arriving at the fairgrounds, we found that elephant rides were available, for a very reasonable fee. We used to spend Saturday afternoons watching Tarzan (aka Johnny Weissmuller) ride the elephants.  Who could pass this up? 

I joined the very long line with my money clutched in my hot little hand.  When my turn came, I was miraculously at the front of the line.  We climbed a wooden stepladder and mounted.  Being first in line, my seat was on the elephant's neck, just like Tarzan, like the mahouts, the place that was just made to ride on.  It was like riding a horse, only so much better.  I was the lord of the jungle, lord of all I surveyed.  The elephant's handler gently led her around in a circle, occasionally giving her a light touch with his ankus, saying "Come on, Kerry, come on girl."  "Is this your elephant, mister?"  "She's mine while I got her."  I felt like Sabu and I didn't even know who Sabu was.  It was wonderful.

As soon as we dismounted, I rushed to rejoin the line for a second ride.  Alas, I found myself in the middle of the six or eight riders this time.  This meant I was riding somewhere about the middle of Kerry's mighty back.  It was a mighty back, but it was a little boney.  Imagine a two-by-four placed on edge atop a four-foot diameter culvert.  Pencil-lead sized wires protrude at random every few inches. I had on short pants.  All I could survey was the back of an unwashed head.  Perhaps I was filthy and sweaty myself, but certainly the boys jammed together with me were.  It was miserable, and I didn't line up for a third ride.

Ever since then, when an elephant ride has been available at a circus or zoo, I've taken advantage of it, but it isn't the same.  First of all, you climb some sturdy platform with hand-rails and an attendant.  Then you are helped onto the howdah with its cushions and guardrails and safety chains. You're on top of the elephant, sure, but you're riding the saddle, not the elephant.  The other riders are little kids.

It's not the same.

When the Circus comes to town

The "Mighty Carson & Barnes Circus" was in town yesterday.  The three-ring, big-tent show has visited Kennett twice before over the last twenty years and I, for one, was glad to see it again.  After a rather dry year, Wednesday brought us as big a toad-strangling, gully-washing, street-filling rain as you could wish for (or wish to avoid).  The canvas was pitched on a rather low spot of ground, so everything was pretty mushy underfoot, and it was easy to find ankle-deep water between your car and the big-top.  It wasn't too hard to find it under the big-top.

The tent only leaked in a few places, and the performers beamed as though the weather were perfect and they were entertaining the crowned heads of Europe.  This despite sprays of water emanating from the toes of the acrobats' leotards as they flew above our heads.

One of my staff asked earlier in the day, "Well, how much does a ticket cost?"  To which I replied, "Who cares?  IT'S THE CIRCUS!"  I wasn't the only person to feel that way, either.  While the grandstands weren't full during the downpour, there was a respectable crowd.  Later, someone told me he had skipped it: "I've seen the Ringling Brothers big show in a huge hall, so I didn't need to see this -- I've seen the real thing."  I'm all in favor of "The Greatest Show on Earth" myself, but in my opinion, my experience last night was much more of a "real thing".  I walked in the same mud as those performers who were close enough to reach out and touch.  I gave my reserved seat ticket to a lady who was spinning on the web above my head a few minutes later.  You can't smell the elephants from the second tier of the coliseum.

As the rain continued, the lowest areas bordering the grounds were covered with about 14 inches of water, more in some places.  This morning the elephants were trumpeting as they rolled and played in the water, spraying each other, and having a great time.  I wish I had a video.

Stay tuned for the story of the time I rode the elephant.

Demodectic Mange again

Some time back I wrote a post on demodectic mange.  I had a great "before" picture, but the case was lost to follow-up.  This is a different case, and this time I do have the "before" and the "after" pictures.

Shadow is a youngster who suffered a grievous injury to her left front leg.  After a period of two weeks of trying to salvage the limb, her immune system was shot, and the demodex mites had gone crazy.  Many hair follicles were damaged and secondarily infected and bleeding. This is the kind of case that lets you know where the term "red mange" came from.  Her leg had to be amputated, and treatment was begun for the demodex.   She had been treated for several weeks at this point, but the treatment regimen wasn't really intensive enough.  This picture was taken on her first visit to KVC.  She looks miserable, and she was.

We started her on a higher dose of cephalexin (antibiotics) than the previous doctor, daily dosage of ivermectin, and medicated baths twice weekly.  I also prescribed a nutritional supplement called Immuplex.  It's supposed to boost the body defense system and she surely needed that.

Shadow is much happier these days.   She will probably remain a carrier of the mites in small numbers (as most normal dogs are), and we will try to minimize stressful events in her life that might get her resistance down.  Motherhood is out of the question for her, as she would likely relapse, plus producing puppies with the same problem... plus she might lose her sweet, girlish figure.

Airport security doesn't understand Luddites

I really don't consider myself a Luddite.  I have a cell-phone, write a blog, my motorcycle has a shaft drive, I like central heat and air.  On the other hand, I like some traditional things like acoustic instruments, and early music (baroque, renaissance, medieval) played on period-type instruments -- I own a harpsichord and a consort of recorders.  I also have a wind-up pocket-watch.

When I was a kid, I'd see those Timex commercials where they strapped the wristwatch to a horse's leg, or an outboard motor, or the ankle of a skater who jumps a dozen barrels. "It takes a licking and keeps on ticking."  You never saw them put one in a washing-machine, though, and for good reason.  I'd ask for a watch for Christmas or my birthday, and the folks would come through with a nifty little "waterproof, shock-resistant" model.  After a while, it would irritate my wrist and I'd take it off and put it in my pocket... and forget about it.  When it re-appeared at the end of its trip through the washer and dryer, it would have changed from a watch into a small paper-weight.

Since the watch always wound up in my pocket anyway, I decided to go for a pocket-watch.  If it had a strap around your belt, you probably wouldn't put it through the laundry.  At the age of fourteen, I started carrying a pocket-watch, and haven't been without one these last forty years.  In fact, I have several.

I've carried this Wyler "Skipper" watch for 25 years, off and on, and it's been a dandy. It came with a lifetime guarantee, but the company went out of business the next year, so it's a bit hard to say how significant that is.  The back is engraved with two lines: "T. Everett Mobley, D.V.M." above "The Singing Veterinarian".  The engraving is almost worn away after all these years.  When we were coming back from Orlando, this watch got me stopped in the security check-in.   

I had taken off my shoes and emptied my pockets, taken off my belt, and put everything in the little pan to go through the X-ray, followed by my carry-on.  I breezed through the metal detector (despite my eye-glasses and mouthful of fillings and crowns) and stepped over to reclaim my belongings.  They weren't coming through, though.  The inspector had them stopped and had called for his supervisor.  When the supervisor arrived, the inspector pointed at the "Skipper" and asked, "Is this some kind of stop-watch?"  Fortunately, the supervisor was more experienced, and waved me on through.

The inspector had not seen many pocket-watches, and had never seen a watch full of gears and springs.  He expected to see a battery and a microchip, and they weren't there.  I guess he thought it might have been a wind-up explosive.  There's something that would appeal to a Luddite.

Get a Second Opinion, revisited

A while back, I posted some thoughts on getting a second opinion, and today I follow up with some more.   The bottom line is (if you don't believe it, scroll down to the bottom): If you want a second opinion, let me help you get the most out of it.

Yesterday I examined a little Schnauzer who had been throwing up for a couple of days.  This breed is famous for being overly susceptible to pancreatitis, so that was my first thought.  Her outward physical examination looked pretty much okay, eyes, ears, mouth, heart and lungs, etc.  She had no abdominal tenderness.   The most striking findings were a high fever (105.6) and that she had lost a significant amount of weight since her last visit in July -- from 25 pounds down to 20.  I asked the owners if she had been on a diet (she actually looks better at 20 than at 25), but no, really they hadn't been working at any kind of a weight loss program.  A significant and unexplained weight loss is a little disturbing.  Put that together with the vomiting and you start worrying about a lot of potential internal organ problems -- liver disease, kidney disease, cancer (and pancreatitis, too, of course).

We did a complete blood count and biochemistry profile, revealing a high white blood cell count, with lots of immature infection fighters ("band cells" -- they're kicked out before they're ready when the body has a sudden demand for them).  Her kidneys were not functioning well, either.  Blood Urea Nitrogen was two times normal (which can happen pretty fast) and Creatinine was three times normal (which takes a few days).  This little gal was a lot sicker than I had hoped to find.   

At this point, I felt we needed to get a urine specimen for microscopic analysis and culture, and an ultrasound exam of the abdomen to get a better look at her kidneys (and whatever else; that weight loss may have other factors).  She also needed to be on intravenous fluids and antibiotics to flush those kidneys and get those wastes eliminated -- the high waste in the bloodstream was the most likely cause of the nausea she had been showing.

At this point, her owners felt that they were reaching the limit of their financial commitment, so I was compelled to stop the diagnostics and do second-best therapy, with subcutaneous fluids, and oral antibiotics to send home.  This is one of the unpleasant realities of veterinary medicine. 

I was definitely concerned about how well the dog would do on this second-best regimen, so we called to check on her this morning.  Lo and behold, while the dog does seem to be feeling better, the owners were at another clinic seeking a second opinion -- they wanted to be sure it wasn't an ear infection making the dog nauseated.

Now you might think that I would be hurt by this lack of trust.  After all, I did examine the dog's ears and they were okay.  We had clear evidence of other, serious problems, which we began treating as best we could within the limitations set by the owner.  And truly, I can't say that it made me feel good.

Here's the thing, though: I understand that any time you give someone an answer they don't want to hear (like "your dog is really sick and needs intensive diagnostics and intensive treatment"), people are going to be looking for a happier answer.  That is very natural.  Also, you don't have to believe something just because I say it. 

What is important in these situations is to do what is in the best interest of the patient, and seeking a second opinion can certainly fit that category.  BUT... if that's what you want to do, just say so.  That way I can give you copies of your medical records and lab-work so that the other doctor isn't operating at a disadvantage.  Making him or her see the case with no knowledge of what went before can give them a skewed picture of what's going on.  Aside from re-running tests you've already paid for somewhere else, the new results mean a lot more in relation to previous results and treatment than they do standing on their own.  [Fortunately, in this case we were able to fax copies to the second doctor.]

My job is to do what's best for your pet. That's the first priority, and delivering the service you want is the second.  If you want a second opinion, let me help you get the most out of it.

Back from EPCOT

It's good to be getting back to a little bit of a normal routine again.  The blog has been rather neglected as we prepared for, went on, and recovered from a trip to Orlando, Florida.  I hadn't been away from my office for 24 hours since April, so I was indeed glad of a break.

My daughter is in the midst of a seven-month graduate internship at "The Land" in EPCOT at Disney World.  We'll miss seeing her at Thanksgiving and Christmas, so we made the pilgrimage to visit her last week.  She's having a great time, but also working very hard.  The Mouse is a stern master.

Most of her hands-on work is in the experimental greenhouse, home of "aeroponics".  She takes her turn at  tour-desk duty, and at giving the "Behind the Seeds" tour through all the green-house facilities, including the aquaculture displays.  Here she is with the baby gators (just a little outside her field of plant science).

We spent two and a half days at Disney, spending the evenings with Blair, and of course, taking her tour (which was terrific!).  I also got to take the Jungle Cruise (my childhood dream) and hear the Dapper Dans (barbershop quartet -- my favorite a capella close harmony music).  No telling what we spent, even though we didn't buy any souvenirs.    Seeing my daughter in her current habitat -- priceless, as they say.

Any day you can sing is a good day.

A day when someone actually ASKS you to sing is even better. Today a client asked how my brothers and their families were getting along.  I had to regale him with the story of my nephew Max and the Wild West Arts Convention and the his Guinness Book of Records appearance.  That then got into how Max is really more interested in "Ice Road Truckers" than he is in cowboys.  In turn, that led to reminiscing about all the old westerns that were on TV when we were growing up and how kids nowadays don't see any of that. They don't grow up steeped in the mythos of the Great American West.

That brought the client to reminisce about the TV shows that HE missed, specifically the George Reeves "Superman" shows and the Mighty Mouse cartoons.  Then he made the mistake of trying to feebly hit a few bars of the Mighty Mouse theme. "I can sing that, you know, but I won't subject you to it."  "I'd kind of like to hear it."  Man, you don't have to ask me twice.

How often does someone actually ask you to sing the Mighty Mouse theme song?

"Here I come to save the day!" It certainly went a long way towards saving mine.