Saturday, March 31, 2012

Puppy Dewclaws & Tails

Of all the things I faced as a new Vet the thing I thought might be the hardest on me to do was puppy dewclaws and tail docking.

I don't think of myself as being especially maternal but there is some internal switch that flips if I hear a puppy or kitten crying. (OK, throw onto that calf, lamb and piglet too). I had only seen tails and dewclaws at vet school done once before I went to work at a private vet practice. I remember when some client brought in her new litter of 6 handful sized puppies to the vet school. None of us knew why she brought them here? Didn't she have a "normal vet" she saw for the routine stuff?

Quickly a large mass of students, interns and residents gathered round to watch and cuddle.  I was 1 student in a sea of 30 people, all eager to see "how it was done." Based on my rank, (bottom of the bucket), I had a nose bleed seat. Because of  the rarity this event, there was only 1 person in the building that had ever actually done this procedure before. She was an intern who had spent 4 years working in private practice medicine before she "came back to school" at the vet school. She was, of course, unanimously elected to be the instructor to the group. The rest of us fought for holding duties.

It isn't that dewclaw removal is all that uncommon, it was that in this venue, a teaching hospital, it was a very very rare event. (At some point someone should tell the public you don't bring puppies to a university for such a simple mundane procedure).

I wasn't entering the real working world with a firm understanding as to how to do these. And the emotional weight of cutting off puppy tails seemed a very difficult task to bear.

Dewclaw removal and tail docking is recommended to be done on puppies between 3-5 days old. At this age they are stable from the stressful birthing process, able to stand some tiny bit of blood loss, and the cartilage and bone is still soft. The big disadvantage is that anesthesia and pain meds are not used. And then there is the whole crying baby trauma.

I had a client call me last week to report to me that her Rottweiler had just had her babies and she wanted me to arrange a time for the two puppies to have their dewclaws and tails done. I am always very grateful for an owner to alert me as soon as possible after the puppies have been born so we can arrange the procedure within the confines of puppy age and clinic appointments. For many reasons I need a big block of time to do tails and dewclaws. (There needs to be some puppy cuddling time, and I want to be super positive no one leaves bleeding, so we watch them for at least 20 minutes after, (more cuddling time)).

I have had owners call me and ask me to set up an appointment for them and when I asked "when the puppies were born?" I was told "4 months ago." I explained to her that she was pretty far outside of the very narrow window we had to perform this. I also reminded her that we were supposed to start vaccines at 8 weeks old, and that was assuming that mom was all up-to-date on her vaccines so that she was able to pass on her maternal antibodies to her babies to supply them with the first 8 weeks of immunity coverage. There is a TON of important information owners need to know BEFORE they breed their dog.

When we recommend 3-5 days after birth to do these procedures I remind clients there are ALWAYS exceptions to the rules.  I am always a little reluctant and uneasy to supply exact dates, or weights, or numbers to medical procedures and recommendations because not every pup, dog, procedure, or treatment works the same for everyone.

The 2 Rottie puppies that I saw last week were one of the exceptions. These puppies were just 3 days old, but they were WHOPPERS! They were so big that we couldn't have waited 2 more days. I have also seen a Yorkie and a Sheltie that we waited a week to do because they were so small and puny.

For the new breeders I always suggest you talk to your vet before the whole delivery process. It is really helpful to have an x-ray at day 50 or so, (you have about 63 days between mating and delivery), to identify how many babies are expected to be delivered. Now I know this step sounds easy but I always say "I think I see..." and remind my clients that sometimes if there are many (like over 7) fetuses it can be hard to identify a small barely bony 3 dimension structure on a flat film. I have said "I think I see 7 or 8 babies" and had the dog deliver 11. But it is really nice to see 3 skeletons on an x-ray and then when the owner calls to say she only had 2 we know to re-check our x-ray, because there is probably 1 still in there.

Back to those 2 Rottie puppies.

I schedule tails and dewclaws for a quiet time of the day. I don't want to leave the puppies in the hospital or away from their mom for too long. I always speak to the owner about what she wants the tails to look like and make sure that she wants both the front and rear dewclaws removed. You want to be very clear about what you are doing and what the owners' expectations are. There are always breed standards that you can review (to see what length the tails are supposed to be), but some breeders like the tails on the short side and some on the long side. I often ask the breeder to bring mom along so we are both talking the same length, long for her might be short for me.

I have one very good friend who breeds Boxers. She was taught by her mentor to instruct the Vet to use a brand new nickel as the guide for tail length. She instructed me to place the nickel under the tail snug up to her butt and cut on the other side of the nickel. I was instructed to make "nickel length tails." Every time she needs her puppies done she brings me a brand new shiny nickel, that I "get to keep."

The owner for these two Rottie pups had to drop the puppies off and then had to run an errand while I removed their dewclaws and docked their tails. She also told the Receptionists that she "couldn't bear to be in the building and hear them cry." Because I didn't get to go over any of the specifics while she was here dropping off I called her.

I explained and confirmed what she wanted done and how the tails were to be done. "She said to me, "I will be praying for you, I know how hard this must be for you to do." I was a little taken back by her empathy for me. As much as we all complain and say a million "I'm sorry's" to the puppies as we hear them scream, no one has ever said sorry to me. I did confess to her that I didn't enjoy this procedure.

It is difficult to remove yourself enough from these babies to perform the task without feeling sad. And I do think tails and ears add much more personality to a pet. Nothing makes me happier than seeing my little Jekyl-pup wag his tail at me. Or watching those big ears flop in the wind as he runs.

Like every other surgery I perform I examine the patient pre-op, think about the entire procedure in my head before I ever reach for the scalpel and I go over from start to finish what needs to be done, what I am trying to accomplish, (like getting a cancer free tumor removal, or functionally part, etc), and I also think about what i hope the pet will look like post-op. If I can make the after result look great I always think of this before hand and aim for it. With puppies I want them to have no evidence of a scar and I want the tails to be healing quickly. I also want them to look as pretty as possible for the rest of their lives. I feel like I am practicing a little bit of  plastic surgery. 

I know that I am not supposed to be politically incorrect and I know that I will someday be reprimanded by my peers or the hard core AKC people, but I do think that de-clawing, tail docking and especially ear docking is a bit barbaric and old fashioned. I have been told that we are the only civilized country left in the world who still does these to pets.

I hope that one day I am only being asked to do cosmetic surgeries in the interest of patient well being. And they got lots and lots of cuddling!

The Rottie puppies did great, and their feet and tails healed beautifully and quickly just as I hoped they would.

Friday, March 30, 2012

The Third Annual MSBA Animal Law Symposium

I spent the day surrounded by lawyers.

I know, to a Veterinarian this sounds like either a nightmare, a death sentence (aka hearing), punishment, probation, or plain old craziness.

But I wasn't the only Vet in the house (actually it was in a fine old beautiful church, Westminster in downtown Baltimore to be precise). There were actually 4 of us.

OK, to stay honest, 1 was there just to get her CE before her baby is born, (due any day). I don't think that she enjoyed the lecturers as much as I did, or the baby belly is keeping her from getting a good nights sleep at her house, she seemed excessively bored and tired.

The other was, umm, well, I don't really know. She was sitting at a table and seemed to know everyone. I guess I should have introduced myself, because I knew no one.

And the last was a retiring Vet who practices in the clinic my parents go to, waaay down in southwestern VA. I was scared to mention my name (see my old Cait blog for that explanation). He is about to retire from a long 30 plus years of practicing and is going to take a class on forensic investigation for animal abuse. I thought that was soo interesting. Can you imagine the wealth of information and ability he will bring to the law? How amazing to be in an age where things like this are now jobs, and you can take classes to be trained? It's like the modern day Dr. Doolittle meets Quincy, (or for all of you less than 30, CSI).

The symposium had a wide diverse group of lawyers all working in some area or another of animal law.

The gamut ran from animal rights lawyers to those trying to get civil rights for animals. Did you know that the law views your pets as property? So if your pet dies by the negligence or abuse of anyone else you can only collect damages in the amount of replacement value? So if your dear Fluffy is shot by your neighbor during target practice you might get $50 to get a new one. This is a VERY heated topic amongst vets, lawyers, and the general public. My cats mean everything to me. They could never be replaced, and I don't think of them as my property, they are my companions. Well, it is a very interesting topic that is sure to bring about great debate.

There was also a lawyer who acts as a mediator for couples divorcing. She tries to help decide who gets custody when both parties want the pet. She also does some work for clients who want to sue their Vet for wrongful death. Lots to learn from her!

The next lecturer was a lawyer in the area of "Equine Law." She helps advise for cases of horse racing drug use and abuse, estate planning for estates of huge BIG money horse farms, (where some of the horses are worth hundreds of thousands of dollars), to overseeing the horse racing commissions guidelines and advising on many equine related topics.

There were lecturers from law firms trying to get federal protection of endangered species, like salmon,  California sea lions, factory farming issues, and protecting big cats.

One lawyer from the International Fund for Animal Welfare (IFAW)  is trying to get the laws changed so that private citizens cannot own a big cat. A big cat is a lion or a tiger. It is estimated that somewhere between 10 to 20,000 big cats reside in personal homes, usually hidden form the public and in sub par, inferior, if not deplorable living conditions. These magnificent creatures have no reason to be hidden away in a basement or a barn, or a garage.

I also met Jeffrey Flocken from the IFAW who just published a book called "Wildlife Heroes." He signed a copy of his book for me and reminded me how lucky I am to be living my dream. I can't wait to read his book. I will be going to bed early tonight to start it.

About halfway through he lectures I wrote the following in my notebook; "I think I am the only one here at the verge of tears and trying to maintain a professional decorum. I am sitting here in a sea of animal abuse stories, the protocols and procedures the lawyers are supposed to follow in these cases, and every single person is here because they want to help a pet who needs them." It was so humbling and encouraging to see all of these professional people united to help the animals.

So at the end of the day I think I actually bonded with the lawyers. See anything is possible if you dare to believe.

Off to bed with my book!

Thursday, March 29, 2012

How To Trim Nails

I see a lot of clients who come in for nail assistance. 

They all walk in the door saying the same thing. "Can you trim Max's nails?"

The answer is always "Yes."

And in many cases the conversation stops there. But it shouldn't.

We should ALL always ask, "What's your concern about you doing them?"

But I think the reason that we don't ask more often is that we know in most cases what the response is going to be.

Here is the most common answer that we get. "Max doesn't like his nails trimmed and I am afraid to cut them too close."  (I should put the clause in here, "if I had a nickel for every time I heard this.")

My response ALWAYS wants to be; "I am sure that Max doesn't like his nails being cut, and we all worry about cutting the nail too short because this certainly does happen no matter how experienced the trimmer is, or how careful we are, but Max shouldn't be the one who gets to decide what does and doesn't get done to him when we are talking about his health. Max needs his nails trimmed so that they don't get caught on things and then tear out from the nail, or scratch you."

I find it silly how many people will come rushing into the clinic for an emergency broken nail petrified that their pet is "bleeding out!" and pay for the emergency fee, sedation, bandaging, lidocaine, and know that the nail broke because it was so treacherously long, curled, or sharp that it literally ripped out of the nail bed. But don't want to try to avoid this from ever happening again by learning to over come their fear of trimming nails.

I know that most, (OK, ALL) pet's do not like to have their nails trimmed. And I also know that ALMOST all of you are afraid to cut the nail to short, (we call it "quick the nail"). When you cut the nail too short it's just like cutting your own nail too short, you bleed. Any your pet will jump and yelp, and then you will feel so bad that you will abandon the thought of ever attempting to cut the nails "ever again!" So you will tell yourself that you "can't hold your pet," and "you can't see where to cut," and you are "terrified of hurting them," so you in very short order give up and decide to leave it to the pros, us.

And because you come to the Vet's office so rarely the nails will get put on the back burner to all of the other important stuff in your life and the nails will grow, and grow, and grow. The longer your pet goes between nail trims the longer the quick grows out, and therefore, the harder it is to keep them trimmed.

In an effort to make nail trimming easier for all of you, I want to go over what I think about when I approach nail trimming.

First some dogs never need their nails trimmed. Some dogs wear them down by running on hard surfaces or living on hard surfaces so the nails get filed by themselves. BUT, remember some dogs and cats (especially the polydactyl cats) have nails in places that don't touch the ground, like the dewclaws, or the "extra" cat toes, so these need to be kept trimmed.

Second, we all quick a nail. It happens no matter how experienced you are, and how hard you try to avoid it. So my advice is to just be prepared for it, and address it if it happens, and then jump back in the saddle and keep going. Please don't give up after the first time you quick the nail and it bleeds. You can call me and I will confess to you that it happens to me, and yes, I feel bad, but you can pick up those nail trimmers and push on. You are not a bad person, your pet will not be traumatized for the rest of their lives, and they won't bleed to death from a nail trim.

Third, the right tools are a must! You can't do a good job without the right tools.

Cat trimmers with white handles on the left, Quik-stop in the bottle, and large dog nail trimmers with the orange handles.

Fourth, (and most importantly): If you can't hold your pet safely, (this is called proper pet restraint) then you can't safely cut their nails. I would say that 95% of the time the owners who come in asking for help with trimming the nails don't really have a problem with nail trimming they have a problem with pet restraint. Their problem has everything to do with the fact that they simply can't hold their pet safely or securely, and it has nothing to do with their ability or inability to cut the nails.

I have one very good client who brings his dog in every 6 months for sedation just so we can trim his nails.

I have another client who came in monthly for 6 months just so we could train them how to hold their dog. We didn't even touch the feet until the 5th practice session.

I have also had many clients who come in for lessons on how to trim nails and when I see how helpless they are to restrain their pet we all give up. (I should never admit to this. I should take my own advice and say to all, "we never let the pet win, we work through it, and we persevere with unfailing conviction," but that would be a lie).

OK, first thing first: learn how to properly restrain your dog, (or cat, or pet). If you are not sure, or are uncomfortable with this, call your vet and ask them to give you a "How-To" session on proper pet restraint. In almost all cases the Vet Techs can help you with this lesson, they are the masters at holding. This is a 2 person job. So convince (or bribe) your spouse to come with you. One person is the "determined, brave, strong, and don't give up easily," holder and the other is the "nail trimmer."

This is how nail trimming goes at my house; I have my dogs sit, then lay down, and then roll over. They then have to let me have their feet and not move while I trim them all. Savannah, and Jekyll are terrible with this. They still to this day, hate it, but they do it because they know I won't let them go until we are done. I don't yell, or fight, or be mean, I am just determined and stubborn. (Anyone who knows me will say I am like this regardless of the task. That's a compliment, right? Please say yes?) I have trained them to tolerate this without making it a stressful arduous task. It is always done patiently and purposefully. I give lots of praise and reassurance as they try to convince me to let them go. I will stop the trimming and just hold the foot if they start to struggle too much. I want them to understand that this is not a scary terrible punishment. I take my time, I remain calm and in control and it is over quickly and with minimal stress. It takes practice, patience, determination and love.

VERY IMPORTANT! Don't force, yell, scream, fight, or make this a difficult process. Because if it is neither one of you will ever willingly do it over again. The first objective is to be able to trim the nails easily and safely. If your dog, cat, pet, is fighting you get help with proper restraint and deal with the trust issues your pet is telling you that they have. And leave the nails to the pros until the restraint issue is resolved. Often the fighting to be restrained is the bigger issue, not the nails.


For cats I recommend that you get the cat on your lap, get them very clam and start holding the foot gently. Many Cats will initially resist their feet being touched but if you can keep your cat calm this can be a quick and easy procedure. If your cat starts to struggle or get aggressive stop and let them go. The cat approach is different than the dog approach, A dog should never be allowed to win and a cat will never be convinced to give up without you bleeding significantly. If you really have a tough cat, then try to wrap them in a towel so their face is hidden and do one foot at a time. Your Vet or their staff can also show you how to properly scruff and hold. This tends to induce more fear than I think is necessary so I usually avoid recommending scruffing.

To expose a cat's nails just press the toe between your fingers.
The nail will be forced put of its sheath and it is usually very easy to identify the quick in cats.
Some older cats have very thick nails so a few trims are needed to find the quick.

Trimmed nails. Midnight is modeling.

By pressing on the underside of the foot, or each individual toe you can expose the nail.


On the topic of nails. I often recommend that the pups with the "dangling dewclaws" (you know those funny insignificant toes that dangle in the breeze and look as if they were last minute additions) be surgically removed at spay/neuter time. These nails often get caught on clothing and bedding and need to be trimmed more often.

Here are my suggestions for trimming dogs nails.

I recommend that one person be the designated holder and the other the trimmer. IMPORTANT note; once the holder takes hold they DO NOT LET GO! This is a training lesson. Training you to be calm, patient, gentle, and effective as a care-giver. For your dog it is training lesson that they are safe, and that occasionally things they do not like still need to be done. The more times you fail at this, whether it be by yelling, screaming, being forceful, intimidating, or giving up, the harder you are going to have to try the next time. There is always a next time. You are also telling your dog that they are in charge and they will continue to challenge you every time they are being asked to do something they do not want to do. You are the parent, act like a good one.

The trimmer will hold the foot firmly and look at the nail from the side. Hold the foot with the toe pointing directly to the left or right. Use your dominant hand to hold the trimmers. Use only good quality spring loaded sharp nail cutters. I have included a picture of the trimmers I use for dogs and cats. DO not use the guillotine trimmers, and do not use dirty or rusty or hard to use trimmers. Always have Quik-stop out and ready to use. (See picture).

Savannah's nail. I view the nail from the side so I can identify where to cut.

Properly trimmed nails. And no blood!

Jekyll's nails. His are easier because they are white and we can see the quick (pink) clearly.

Avoid the pink area of the nails, aka "the quick." This is what bleeds if you cut to close. For those pets with black or dark nails if you look at the nail from below, the fat, bulbous part of the nail is the area where the quick is, so avoid cutting there.

For dark nails sometimes it helps to look at the nail from below to see where the quick ends.

As a general rule we start clipping conservatively and will often make a few cuts working up the nail towards the toe. Don't start high, start low on the nail. Your pet will thank-you for being gentle.

Here is a good You Tube video, with tips and pointers.

Wednesday, March 28, 2012

Our New Years Resolutions

My husband and I made a New Years Resolution to get our health items back on track.

You know how it happens you get the rest of life's to-do's and tasks taking over your day to day life and you don't really forget, but you do not prioritize the really important thing in life, (if not THE most important thing in life), your health.

So as of Jan 1, 2012, we changed our health care provider, got ourselves into a new (and better) network, and found a general practitioner who we not only like but also is close to our home (big feat!).

Together we drew up a list of all the things we were delinquent on in the health department and started a plan to get them all crossed off.

For my husband the list has been a little longer and a little more cumbersome.

Today was "resolve the chronic knee pain."

Off to Johns Hopkins Bayview campus we went at 6 am bleery-eyed, tired, and a little nervous. In a small effort to support Joe's restrictions I went without my morning cup of coffee, (big mistake said my day long headache).

We knew that we were in very good hands when we signed up to be under the Johns Hopkins University umbrella, but what I didn't realize was how incredibly organized, efficient, and friendly they would be.

I was utterly impressed every tiny step of the way. I was also grateful to be in such an incredible institution and at ease because we are so lucky to have a great health care plan.

As Joe signed over consent for his surgery I was again humbled to be able to be a part of the best that modern medicine has to offer.

His left knee has been bothering him off and on for the last year. But over the last two months it has forced him to walk every step with a limp and taken his activity level from running daily to being able to perform basic routine daily tasks only.

Under the excellent care of  Dr. Trice Joe had a arthroscopic knee surgery today.

Ready for surgery, although with a little pre-op jitters, that for us turned into giggles.

Post-op recovery. Cookies and an orange juice.

The peek in his knee revealed that he had a tear to the cartilage, that was repaired, but also some of the dreaded osteoarthritis. So there is a very good chance that this is the first chapter in the left knee saga.

A very big Thanks to all of the ASU at JHU Bayview, and to all of the JHU personnel who made us feel welcome and at ease.

Just home with trusted walker in the lead.

Diedra sent a care package to help with the recovery boredom.
(Although I think this is on loan from her son Cody)

Joe will be home on the couch with the kitties for the next few days. But so far he feels great!
(Although I am not sure I can handle three consecutive days of the SciFi channel.)