Your Pet's Best Friend

Removing Painful Teeth is Worth the Trouble

I got excited this week.  I got excited because I got the opportunity to fix something that really needed fixing.  You might think that happens all the time, but you don't always see such a great opportunity to handle a painful situation in such a rapid fashion.

This is Dawson.  When his loving owner "inherited" him three years ago, she asked her regular veterinarian about what she could do to help his awful mouth odor.  Unfortunately, that doctor mis-estimated a couple of things:  the owner's commitment to caring for the pet, and how long this dog would live. 

Mama was told that Dawson was too old to anesthetize, and the other doctor periodically prescribed antibiotics to "control the infection".

We saw him on Thursday.  You could smell his mouth across the room.  He was in constant pain, whining, rubbing his mouth, and at last he was hurting badly enough to  quit eating.  "I just have to do something for him".  I felt the same way.  When I touched his mouth during the exam, he really cried.

Amazingly enough, Dawson hadn't gotten any younger in the last three years.  At fourteen, he's still "too old".  He's a little overweight, and you can hear some fine crackles (like emphysema) all over his lungs. 

The owner was happy to let me assess him for anesthetic risk factors.  His chest X-ray was actually pretty clear, no fluid in his lungs and only mild heart enlargement.  His blood chemistries were nearly normal.  His electrocardiogram was just fine.  I called the teaching hospital at the University of Missouri's veterinary college.  An anesthesiologist was happy to advise me about the best course for Dawson.

We set him up for oral surgery the next morning, and sent him home with pain medicine.  He got the best rest he'd had in weeks.

The next day Dawson was successfully anesthetized, meaning he slept through the procedure without evidence of pain, and he woke up again pretty quickly.  Having good monitoring equipment lets us know when he needs more support (which he didn't, much), and sevoflurane gas lets us adjust his anesthesia rapidly.

We removed these nasty snags and sutured up the gums.  He doesn't have a tooth in his head, but he doesn't need them to eat dog food.  He will need some additiona surgery to close up some old sockets that have been open for a long time.  For now, though, his constant pain has been relieved.  He's not too old for that.

 

Diagnostic Workup Success - that almost wasn't.

This is Molly.  A few days ago she was presented for an examination.  She had been limping a little the night before and just didn't feel well.

There was no lameness when she came in, but she didn't have much mojo.  She didn't seem in any distress really, just no energy.  She also had not wanted to eat much.  There was no fever, nothing seemed swollen or out of place, and I couldn't find a sore spot anywhere.

She lives in a fenced yard, so trauma didn't seem likely, even though she shares it with another pretty big dog.   There just wasn't really anything to put your finger on, but you could tell she was unhappy.

I was about to send her home with some anti-inflammatory medicine, thinking she might have slipped and made a bad landing in the mud the night before.  Then her owner said, "You know she usually chews on everything, but she doesn't want anything today."  I asked, "Everything, as in a lot of things that aren't food?"  She replied in the affirmative.

With that piece of information, I thought of all the dogs with foreign body intestinal blockages I have seen who had no specific outward signs -- they just didn't feel good. "Let's take an X-ray of that belly. We probably won't see anything, but I'd hate to miss a ridiculously obvious foreign object."  Okay, let's do it.

The abdominal X-ray looked normal, but there was a little bit of the chest on the film, too.  When I looked at the whole film, the chest part looked "funny" (funny-strange, not funny-haha).  We took pictures of the chest.

There was what appeared to be a significant amount of fluid in the chest.  That will make you feel bad.  We tapped her chest - it was blood.  Internal bleeding will also make you feel bad.  In your chest, it will squish your lungs and eventually keep you from breathing, even if you don't go into shock first.

Even though there was no history of exposure to rat-poison, we filled her full of vitamin-K (the antidote).  That stuff makes the dog a free bleeder, and bleeding into the chest (hemothorax) is not uncommon.  Since my associate is pretty knowledgeable in Chinese medicine, we also started the herbal preparation called Yunnan Baiyao, as it helps to get the body's own clotting mechanisms into high gear.

The alternatives to rat-poison were not happy ones: a bleeding tumor, some other abnormal structure that had begun to bleed, or some other heretofore unnoticed bleeding disorder in the dog.  All of those have a terrible prognosis, not to mention that referral to a surgical specialist was not in the cards.

Thankfully, Molly has responded well to treatment and seems about normal now.   Who takes a full set of X-rays every time a patient just "doesn't feel good"?  Nobody.  A chance remark, a look at the wrong place, and we got an accidental look at the right place.  And I almost sent her home with some pain-killers.  Serendipity, it's called.

Enlarged Spleen of the century

When a dog-owner calls and says that his dog is dribbling a little urine, you think of the usual suspects: weak bladder sphincter, bladder infection, bladder stones, neurological problems.  You do NOT think of an enlarged spleen.

Max (this is his post-surgery photo) is a Mastiff mix.  He's about 8 years old (a guess, as he was a stray originally), and usually weighs in the low 80's.  For several days, he had been dribbling a few drops of urine after he watered the shrubbery, even though he had a good stream when he let fly.  He had also leaked a puddle where he was lying down on a couple of occasions.

With that kind of history, I usually want a urine specimen first.  You usually need to culture the urine, so a voided sample is not good enough for that.  You just can't get an uncontaminated specimen when the dog pees in a cup.  What you need to do is a cystocentesis -- you lay him down on his back, do a surgical prep on his tummy, use the ultrasound to locate his bladder and insert a sterile needle.  Then you withdraw some urine with a syringe and you're ready to do your culture and urinalysis.  The specimen is not contaminated, and you don't have to follow the dog around the yard with a cup.

We lay Max down and scanned his bladder, and found that it was being compressed by a large mass of tissue. Further scanning showed this to be the tail of his spleen.  An X-ray confirmed that his very large spleen was extending from his stomach all the way back to his bladder.  It was so big and heavy that the weight of the organ was compressing the bladder and causing Max to leak urine.  Sort of like a lady with an advanced pregnancy -- when the baby is bouncing on your bladder, you can have an "accident".

Even in a very large dog like Max, the normal size of the spleen would be about one and one-half times the size of my hand -- ten inches long and 1/2 inch thick would be a big one.  This was just unreal.  [It's the long, curvy red spot in the diagram.]

Your first thought would be cancer, but the ultrasound scan showed no masses or changes in texture.  It just looked like a normal spleen... only huge.  And... why is that?   I sent out the usual panels of blood tests and they were all normal.

I spoke with an internist at the Veterinary Teaching Hospital at the University of Missouri and she said, "There is huge list of differential diagnoses."  So huge, apparently, that she just listed a few for me to get started with.  "Screen for tick-borne diseases". [We sent off the blood tests.]  

"It could just be twisted a little, or have a partial thrombus [blood clot] in the splenic vein." [Blood can get pumped in by the arteries, but can't get out as fast, so the spleen gets gradually bigger and bigger by being inflated with blood.] 

"You should still consider cancer.  Try aspirating the spleen." [Stick a needle in it and see what a syringe will suck up.] Since the spleen is structurally a big sponge full of blood, we'd probably just get blood cells, but she assured me it would be safe.  So I did.

"If you don't find anything on your tests, then you need to take a biopsy specimen.  Well, if you're going to do that, just take out the whole spleen." [You can live without it, if you have to.]

So, no tick-borne diseases.  The cytology report on my needle stick says "suspicious for lymphoma", but could just be some kind of inflammatory reaction.  With a needle aspirate, you're looking at individual cells and you don't see any kind of architecture.  It can be misleading.  And it was.

Next step:  exploratory surgery to remove the spleen.

His spleen was 28 inches long and weighed six and a half pounds.  It wasn't twisted.  It was a lot of work to get out.  This picture reminds me of people with their trophy fish.  In fact, I've seen plenty of trophy fish that weren't this big.  We sent several sections to the pathologist, and it's not cancerous. It's just "severely congested" (i.e. really overfilled with blood). 

It was so "over-inflated" with blood that wherever I bumped it with a finger it would break and start bleeding.  I didn't lose any blood from the major vessels as I tied them off, but the rest of it was bleeding like a cartoon character shot with a shotgun.  He was at no small  risk of the organ rupturing and having severe internal bleeding.

The good news is that his prognosis is good.  We still have to check a few things to look for reasons he might have had a blood clot in the first place, but no deal-breakers so far.  The first picture in the post shows him the day after surgery and he already felt better.  Nine days later he is recovering his energy level and seems to feel really good... and he's not wetting himself.

 

 

Mega-Esophagus and "The Third Opinion"

This is Bear.  He's nibbling at the grass here.  For over one year he has had frequent episodes of vomiting.  Sometimes it's just a little fluid, sometimes undigested food, sometimes a little grass, or a combination of the above.

He came to see us after having numerous unsatisfactory attempts at treatment.  "I'm here for a second opinion." Third, actually.  My associate spent a long time getting the past medical history, everything that has been tried and the results (or lack of them) of those efforts.  That's par for the course when you are giving a "second opinion".

The "second opinion" case is not something I really look forward to, at least not when something has been going on for a year.  This suggests that the problem is not simple nor straightforward, and it probably isn't going to "fix itself".  If any of those were the case, I wouldn't be seeing it. 

So, more often than not, you spend a long time extracting the history, and documenting it, and concluding that the other doctor has been very thorough and done everything you can think of and it did not work.  Oh, I can hardly wait to see one of these cases.  They really ought to be seeing a specialist, but they are seeing me instead.  Hard to be a hero on these.

Of course, sometimes you just have a different point of view than the other guy (gal).  After working with a case for a long time, you can get tunnel-vision.  You have made that initial assessment and it biases everything you do after that.  So, a fresh pair of eyes (and ears) sometimes has an easier time finding a fresh perspective on the case.

My associate started over with basic lab tests.  Some had been done before, some hadn't.  At any rate, we needed to see where Bear was at present.  We might get a clue. [In a referral situation, they recommend a "minimum database", which includes  a complete blood count, biochemistry profile of 12 to 20 tests, a stool exam and a urinalysis.]  In this case, there was nothing in the data to suggest a specific diagnosis.

Bear's owner said, "Just keep him a couple of days until you find out what it is. I'm tired of going round and round with this."  So now it's my turn. Hey, no pressure.

Ah, but here was that rare case.  There is a logical progression of diagnostic tests.  I can see what has already been done, I can see what hasn't worked.  I don't have to do any of that over again myself, and there is a clear next step.

Vomiting food that isn't digested.  Maybe it isn't even getting to the stomach.  "Have you tried feeding him with his dish elevated?  Does it make a difference?"  Well, yes they have, and maybe it does.

So, I take an X-ray of his chest.  You can't tell much about his esophagus, but his trachea (windpipe) looks pushed down out of place a little.  Then I mixed a little barium with some dog food and Bear scarfed it right down.

Now, your esophagus is firm, small, muscular tube (when it's normal).  It squeezes the food right on down to your stomach without the aid of gravity.  If you stand on your head, it squeezes the food right on up to your stomach when you swallow. [I tried that in seventh grade.  I used a pillow under my head, and leaned against a wall so I wouldn't fall, and I used a straw to drink the water.  It worked.]  The food goes right on down (or up) in a hurry.  Unless you have mega-esophagus.[Follow the link to a discussion on Veterinary Partner.]

Bear has mega-esophagus.  He's had it all along.  I found it with the first test I ran.  All that food should be in his stomach, not in his chest.  I look like a genius, but it's just the luck of the draw.  It's one of those rare occasions when being the "third opinion" doesn't turn out to be a major frustration.

Since Bear's esophagus is a big flabby sack (instead of a firm, muscular tube), and further testing shows no thyroid problems and no myasthenia gravis (possible causes), he will have to rely on gravity.  From now on, he gets to eat while standing on his hind legs.  Some fun, huh?  Too bad the "genius" can't cure what I diagnosed.

Diagnosing diabetes... among OTHER things.

Here's Mollie. [Sorry the photo is a little out of focus; our timeline got way out of hand and I didn't take time to check the picture before she left.] She's a complicated case and she got me to violate one of my basic rules, to wit: I'm a doctor for the whole patient, not just one complaint. 

By this I mean that each patient gets a complete physical exam and I try to get a complete medical history. I don't want a patient to come in with three problems and leave with two of them undetected. I didn't realize I was violating it when Mollie first came in, but I did it anyway.

I hadn't seen Mollie before and she had a number of complaints.  She is taking two medications for a seizure disorder (a long-term situation).  She has lost weight.  Her belly is kind of big. She has some lameness problems, which appear to be related to this lump on her left hind leg.  The lump was very hard, so we took this X-ray, and it is not pretty.  It's hard to say whether this is bone cancer or bone infection or what, but it's not pretty. With a possibly cancerous lump and weight loss, our next step was a chest X-ray.  If her lungs were already riddled with cancer, then our other testing would not be quite as important.

Fortunately, the chest X-rays looked great.  Next step would be to biopsy that lump.  PLUS, we really need to assess how the rest of the body is doing.  With that weight loss, other organs could be affected.  We need to X-ray the abdomen and get an ultra-sound scan. And, of course, we should really get some blood-work.  The owner looked at the estimate and decided she wanted the biopsy first and the rest could wait, and I acquiesced.

Now friends, I want to take time out to talk to you about what we call the "minimum database".  Actually, it's what the veterinary teaching hospital calls the "minimum database".  Any patient admitted will have a complete blood count, blood chemistry profile, urinalysis, and stool exam.  That might sound more like a "maximum database" instead of a "minimum database".  I certainly don't always have the opportunity to get all that information with every patient.  Of course, with a referral institution, with cases that have already been worked up elsewhere, you surely don't want to miss anything.  That's what makes this their "minimum database".  Let me repeat the key point here: you surely don't want to miss anything.

So, Mollie returns a few days later for her biopsy.  With her age and condition, I feel that we MUST get pre-anesthetic blood-work.  Just for the record, a blood sugar of 500 is not normal.  The dog has diabetes mellitus ("sugar diabetes").  We collected a urine specimen and it was full of sugar, and worse, full of ketones.  Ketones show up in urine when you've been breaking down fat excessively because you can't use the sugar (because you don't have adequate insulin production).  Too many ketones in the bloodstream can put you into a coma.  By the way, her urine also has a substantial amount of pus present.

Urinary tract infections are common in dogs with diabetes: their urine is full of sugar, and bacteria are happy to grow there.  Oddly enough, while the pet has a bladder infection, it is very hard to get their blood sugar regulated.  Thus we need to culture the urine so that we can treat the bladder infection, so that we can be successful in treating the diabetes.

One thing I didn't show you on Mollie's lab-work was her humongo high alkaline phosphatase.  That could be from liver problems, or from bone damage, or maybe even her seizure meds.  It could also be from Cushing's disease, where the adrenal glands overproduce cortisol (the body's natural form of cortisone).  That disease commonly accompanies diabetes mellitus, and it can cause a pendulous abdomen, due to muscle weakening.  Remember Mollie's big abdomen?

Both diseases cause excessive urine output (by different mechanisms), which requires that the dog drink a ton of water to compensate.  I called the owner to tell him about the diabetes and urinary tract infection, and possible Cushing's disease, and that we would be putting off the biopsy until the diabetes was under control.  By the way, had he noticed that she drinks a lot of water? "Oh, man, you can't keep enough water in front of her.  She drinks gallons of water.  She drinks an amazing amount of water."  Weight loss with a good appetite and excessive urination and water-drinking is classical for diabetes.

Now, why didn't I know this already?  Why didn't I find this out in my initial history-taking?  Because I became a "lump doctor" instead of a "dog doctor".  I looked at that lump, and that X-ray, and I tunnel-visioned in on that.  Sure, I recommended more complete diagnostics, but I was all about that cancer (that may or may not be there), and wasn't really looking for "everything".

Here are the hands of Mollie's owner, giving her the first injection of insulin (first of many to come). Her urine culture is at the lab, and she's taking antibiotics while we await the results.  When we get her diabetes under control, we'll get that biopsy, and then we'll look at the Cushing's disease.

The Take-Home Message:  When your veterinarian recommends what looks to you like a LOT of tests, it might be a good idea to go ahead and do it.  I wish I had.  Then I could be writing this and talking about how smart I am, instead of how I figured it out just in time (even though a little on the late side).

Take an X-ray the FIRST time... it couldn't hurt.

Any time that a young puppy comes in vomiting, I recommend an X-ray.  Puppies are famous for eating non-food items.  Many of the things that they eat are not dense enough to show up on an X-ray: plastic, cloth, string, paper, etc.  Even then, you may see things that make you suspicious of an intestinal blockage. 

For instance, half of the intestines look normal, while the other half are blown up with gas and fluid.  This can be misleading, of course.  Sometimes intestinal infections or inflammations can give the same appearance.  A couple of years ago, I did an exploratory on a patient with such an X-ray, and found a nice plastic ball.  Ta-da!!  ["Thank you, thank you.  No, really, you're too kind.  Can't help it, really, I'm a genius, you know."]

Two weeks later, I opened a patient with a virtually identical X-ray.  Whoo-hoo! I'm on a roll... not.  The intestines were really inflamed, but there was no blockage.  The gut just wasn't working right due to the infection.  Fortunately, the dog recovered in spite of this invasive diagnostic procedure.  Maybe airing out the bowels was therapeutic.  ["You see, it's the only way to be really sure."]

Still, you need to take that X-ray.  I well remember the little 3-pound pup who had been vomiting for 3 days before I saw him.  We took an X-ray right away and found a round metallic foreign object, which turned out to be a penny when we did the exploratory surgery.  Unfortunately, the copper plating was gone and the puppy was suffering from zinc poisoning.  Despite successful surgery, he didn't make it.  I don't want that to happen because I fail to recommend an X-ray.

The funny thing is, many times dogs with intestinal blockages don't have any obvious symptoms.  That was certainly the case when my own dog, Anna, ate a rock bigger than a golf ball.  She'd still eat a treat, but not her regular dog food. She'd play a little, but not much.  Never vomited, never strained, wasn't bloated.  She wound up losing 2 feet of intestine. Fortunately, a rock shows up like gangbusters on an X-ray, so at least I didn't waste too much time getting her open.  [Two days... whoops]

That was the case with Rocky, here, as well.  No specific signs you could point to.  No vomiting, no nothing. He just didn't feel good, wouldn't eat much.  I finally looked at his age (six months = puppy) and asked, "Is he bad to chew on things that aren't food?"  "Oh, yes, we have to take stuff away from him all the time."  Hey, might as well take an X-ray, then, right?  Couldn't hurt, though we probably won't see anything.

Or maybe we will.  That's not a hole in the film.  That's the kind of shadow that a metallic foreign body makes on film.  No radiologist needed here; the neighbor kid could see something wrong from across the street.  We found it, but what is it?  I'll give you a hint.  No matter which direction you take the picture from, the white spot stays perfectly round.

It's the nine-ball, in the corner Chihuahua.  The miniature pool table had been confiscated just days before to keep Rocky from playing with it...  a day late, apparently.  Fortunately (for both of us), the little gum-ball sized billiard ball was made of steel instead of plastic.  Got the diagnosis on the first try (after asking one question after another for twenty minutes before I finally thought of taking the X-ray).

Surgery was successful and he made a complete recovery... because we took the X-ray on the first visit.

Stool Specimens (Part 3)

We've talked about what to bring, and where to find it.  I didn't mention what we do with it after it gets here, though.  There are so many fecal specimens run through our laboratory every day that I just take it for granted.  I shouldn't be doing that, though. 

Here's what happens:  about a teaspoonful of poop gets dissolved in a half-ounce of concentrated zinc sulfate solution.  This will make the microscopic worm eggs float to the top, just like those people you see bobbing on the surface of the Great Salt Lake or the Dead Sea.  Then, the whole mess gets filtered through some gauze into a plastic tube, like those in the foreground. [Yes, that is a messy, nasty job.] The tubes go into the centrifuge, where spinning at high speed puts the heavy poop-stuff down in the bottom of the tube, letting all the cute little eggs float to the top by themselves.  Then you look at the top drop under the microscope.    All the eggs in the whole sample are in that one little drop, so you should be much more likely to find them than if you just took a smear of poop and looked at that under the microscope.

There are some protozoa (microscopic one-celled animals) that are destroyed by the salts in the flotation process, so we do check a smear under the microscope, too.  Overall, though, that's like checking a handful off a truckload -- maybe that truck is full of soybeans, maybe it's full of motorcycles.  You don't know.  That's why we ask for a bigger sample than the tiny smear.

This is Dr. Don Schmidt (one of nature's noblemen), who taught me all of the above about 30 years ago.  That's the way I've always done it.  The centrifuge in the first picture was purchased in 1979 and the old war-horse is still going (the centrifuge, not me... well, me, too, I guess).

Imagine my surprise when I attended the gastro-intestinal disease seminar last week and the presenter was selling this as a new idea.  He didn't exactly say it was new; in fact, he said "We've known this since the seventies".  What was news to me was how few veterinarians have apparently been doing it.  You can just look at smears, or you can just let the little eggs float to the top without centrifuging.  You miss half of what you're looking for, but you could do that. Dr. Todd Tams is a GI specialist, and the chief medical officer for the VCA-Antech chain of corporate veterinary hospitals.  He made flotation with centrifugation standard practice in the chain just five years ago.

Dr. Schmidt told me what to do, and I've been doing it ever since.  Unlike some of my other education, which has been superseded by new information, I find I've been ahead of the curve by just doing what I learned 30 years ago.  How weird is that?

Stool Specimens (Part 2)

Some people tell me that they just can't find where their dog goes to the bathroom.  If they live on a huge farm, then I'm not surprised.  Sure, I'm disappointed, but I'm not surprised.  When they tell me that "Yes, the yard is fenced", but they still can't find it, I've got to wonder just how big this yard is.  If it's that huge, they probably have servants to take care of it.  Perhaps one of the servants could follow the dog around for a day.

Then there are folks who live in little subdivisions, with little houses and little yards, all in a row.  When they tell me that the dog doesn't go in their yard and they just "don't know where he goes", I'm thinking that there is somebody in the neighborhood who does know where he goes.  I'm also thinking that that somebody is not only anxious to show the owner that location, but also to talk to him about it... vigorously!

They should call The Poop Detective.  The video may be a little silly, but the message of being considerate of your neighbors is right on the money.  Leaving fresh crap all over is inconsiderate, unsanitary, and just gross.  Not to mention that it does not make dog-lovers out of the previously undecided group of voters.  If you love your dog, don't help him make enemies.

That's why I've had this sign in my kennel for years.  The deodorizer spray next to it works a lot better than the sign, though.

Stool Specimens

Warning: Bodily Functions are Disgusting

So, the client brings in a ziploc bag with a few leaves just as bright green as these.  "I think that my dog has diarrhea from eating these plants."  "Have you seen him eating some like these?"  "Not like these, these plants right here. See how wet they are? They must have gone right through him."  "Trust me, lady, I'm a professional.  If these plants had gone all the way through your dog's digestive tract, they wouldn't be this bright green."  Of course, the dog had eaten the weeds and vomited them up.  I'm not kidding about that different color thing. I'm not kidding about being a professional, either.

I advise you not to click on this picture to blow it up.  The title "Fecal Scoring System" could also be "Know your s__t".  I never use this chart with clients, though maybe I should.  Typically, when the client says the pet has diarrhea, I ask if the consistency is watery, or like paint, or applesauce.  Sometimes this works... sometimes they swear off applesauce.  In livestock country, you can ask if it's "cow-pie" consistency, but few of our clients have been up close to a cow, much less a cow-pie. 

Here's a picture of a cow.  Here's a picture of a cow-pie.  Happy now?

We always ask clients to bring a stool specimen as part of the pet's examination.  People think I have some kind of poop fetish, because I always ask if they've  brought it.  As I've mentioned in a previous post, a microscopic exam of the stool is best way to check for most intestinal parasites.  Color and consistency can also give you clues about some other types of digestive ailments.

People are reluctant to even talk about the excrement, much less pick it up.  If they do bring a specimen, it's "his job", "a present for you", "his homework" [my favorite].  Many clients (in fact, most clients) would rather not bring in the specimen.  Sure, I could fish some out, but you get a pretty tiny sample that way, and you can miss things just because your sample is so small.  With just a smear, you have the equivalent of pulling a handful off a truck-load -- maybe that truck is full of soybeans... maybe it's full of motorcycles.  You don't know.  Really, we need about a tablespoonful, and we need it the same day it's passed -- within 12 hours; it doesn't have to be steaming (thank goodness).

It's always interesting to note the different responses to my request for the specimen.  Virtually nobody brings in a tablespoon-full.  You might get a smear on a Kleenex or a coffee-can full.  There are people who just forget (and I understand that: it's the kind of thing you'd be happy to forget).  "The secretary didn't tell me to bring one." [Yes, she did.] Then there are other people who just tell you flat out that they are not going to pick up poop and bring it in.  Fair enough, though it may handicap me a little.  And then there are the folks who are sure not going to bring you a sample, but they feel bad about it, because they love their pet and they know they really should.  These are the folks who slap their forehead and say, "Oh, I had one, but I left it sitting on the kitchen table."  In the butter dish, no doubt.

My favorite is the client who lets me fish a specimen out of the dog's exhaust pipe and go through the whole exam.  As we finish, I say, "Now, if you can bring me a bigger specimen, we can do a more accurate check for intestinal parasites."  "Oh... I've got one."  He's had it in his pocket the whole time.   What if I hadn't asked for it?   How long would he have saved it?  Why?  We know how I lost my capacity to feel dirty, but what happened to this guy?

Pet Wellness Exams

The "wellness exam": what is it? It's a good physical examination, plus or minus some diagnostic tests, when you think you're in good shape and don't need it.

In terms of my own health, my insurance company pays for bloodwork each year, sends me a survey to fill out, and then advises me of what they consider to be my risks of developing common diseases for guys in my age group.  I usually see my physician each year because I can't stay at Scout camp without a current physical.  Do I really need a check-up that often?  After a good check-up might I still have a prostate infection or a heart-attack, despite what my risk factor assessment says?  Yeah, maybe.  But what if we find something that keeps me from waking up with the plumbing shut off?  Yeah, that would be good.

When you're young, you have contempt for the frailties of the old.  The older you get, the more obvious it becomes that your body is not as bullet-proof as you thought it was thirty years ago. Sixty doesn't seem nearly as old when you're fifty-four as it did when you were twenty-one. You think that maybe it's okay to let old people keep on living for a while. On the other hand, despite doing a cardio workout every day and lifting weights twice weekly, taking my vitamins -- stuff still happens.  If that "stuff" doesn't get better pretty quick, I will call my doctor.

Animals have a tendency to conceal their problems: it's not very pro-survival to advertise how weak and helpless you are.  We've talked about the tendency of older animals to have more problems.  Why should your apparently healthy pet get a check-up?  The National Pet Wellness site has lots of reasons for you.  Of course, that could be just some marketing gimmick cooked up by veterinarians and drug companies.

On the other hand, maybe you could use some help in assessing your pet's health. 

This week a lady brought in her cat for "a second opinion". This 12-years old cat had been treated with antibiotics for a respiratory infection last week by another doctor, but she was feeling worse again.  Since I had never seen the pet, it took a while to get the complete history.  I start with "When did you get her?" and work through where she stays, what she eats, how many pets in the household, previous medical problems and treatments, and "When was her last check-up?".   "Oh, I never take them to the veterinarian.  My pets live a long time. They don't need check-ups." 

The cat was greater than ten percent dehydrated, and weighed six pounds when she should have weighed eight.  If that were a person, think 160 pounds down to 120 pounds, and shriveled up like a raisin.  This weight loss had been apparent for at least one month.  Now the cat would hardly eat anything.  Something was going on here besides a snotty nose.

We gave her fluid therapy to rehydrate her, and started diagnostic tests the next morning.  Her kidneys were failing, and she had diabetes mellitus (sugar diabetes).  IF she can be successfully managed at this point, we're talking a major project of intensive care in the hospital.  Balancing her fluid needs, and her insulin needs, and getting her to take in food -- not easy...not cheap, either.  Things would have been a lot simpler a month ago, not to mention say, six months ago, before she started "looking sick".

I'm not saying that your observations of your pet are missing as much as this lady was, but I will say that a lot of "wellness exams" turn up findings that show the pet is not so "well" as you thought it was.  I think it's a good idea.