Friday, July 31, 2015

Why Can't I Call A Fat Pet Fat? Why is the truth so offensive?

Tip toeing through a minefield is not a talent I hold innately close to my heart. I see my job as your veterinarian as being an advocate for your pet. But, alas, as hard as I try I cannot find it in my toolbox to lie. I can't even seem to find it in myself to sugar coat. There are easy truths and the hard to accept truths. Weight issues in pets is at epidemic proportions. And, it is just as much as an epidemic for ourselves. No matter which end of the leash you are on, if you live in the USA, chances are on of us meets the criteria for being classified as overweight. The hard truth is that there are fat owners with fat pets and neither one of them wants to be honest with each other. Am I really your pets advocate if I consciously decide to forego hurting you feelings so that the reality mirror doesn't make you feel guilty?

Feelings, those damnable anthropomorphic sticky sentimental drivle that cripples our ability to see the black and white of life and deal with it.

Doctors are slaves to science. No emotional excuses to sway the numbers and the data never lies. I like black and white. I love numbers, raw, unadulterated bar graphs. They are the doctors apparition to the reality that allows us to shut the door on emotions.

But, the rest of the world lives in well sheltered 'spare my feelings' bubble.

So goes the course of diabetes, heart disease, and cancer. You can numb yourself with the short lived delight provided by a Milk Bone but the grim reaper of obesity will find you sooner than he should if you do. Death and obesity are best of friends. If you want to thwart the pearly gates for as long as possible I recommend that you try to out run obesity. One of the easiest ways to add quality years is to stay lean and healthy.

And such is the dilemma that leads me to my most recent drama du jour....

I am hearing from my staff that there are clients who "don't want to see me because  I tell them that their pet is fat." In my defense, their pet is fat. In their defense they can choose to see whichever vet they want to. But, do I fail to deliver my purpose if I can't get my patients to see me? Probably. I can't practice my passion if I can't get them to drive on over to see me.

Here's how I see the obligation of the doctor in treating their patients;
If your doctor is not telling you the truth about your weight and the damage it is doing to your body they are negligent. Writing you a prescription without clearly explaining to you to the root of the problem, your role in it, and how you can resolve your own disease, without the drug is my PRIMARY responsibility. Excusing your difficulties and sheltering your feelings, responsibilities, and participation in the problem is the very foundation of why we are bound to the gripping strangulation hold of tobacco, fast food, drugs, and addiction. A drug to help you maintain a longer happier relationship with your drug is not medicine as it should be practiced.

Telling my clients that they can use, or need, more pain management to curb the aches in their pets joints while they buy boxes of biscuits and spend more time on the couch is selling their parenting skills and affection for their pets short. I may lose a client to the associate who doesn't want to hurt any feelings, but I stayed true to my belief that my primary obligation is to your pet. Further, I have never met a pet who didn't prefer a walk over a biscuit and t.v. We have a great deal to learn from our pets. Those mucky feelings aside our pets remind us what living and loving life looks like. All you have to do is put on a leash and head outside. Your pets smile is something that exists in nature alone.

My job is to empower you to save your pets life.

I saw a client last week who had elected to see another vet after her dog added on another 5 pounds to her already 20 over ideal. Once again I was prescribing an NSAID course for sore elbows. Once again I was feeling uneasy about why we needed pain management, what long term NSAID use might do to her kidneys, liver and how to get off the endless weight gain. At 7 years old I was going to be euthanizing this dog in a year or two, 4 or 5 years before she should be, simply because her frame couldn't support her weight. I have sat through too many of these. I am euthanizing too many fat pets because their owners are loving them to death.

How do I convince you to love in a healthy manner? I suppose I can only keep opening my mouth and trying? How do I tip toe through the feelings? Well, clearly I need to ask my associate how she does it.

I sent a letter to that dogs mom. Apologizing for hurting  her feelings, and asking for help in keeping their dog healthy. She avoided me for 6 months. On the next visit for NSAID's she pulled me aside and said "Thanks for your note. I know you care, and I know it is a problem. I was too embarrassed to talk to you. But I don't want my dog to suffer any longer. My husband and I are working on ways to help her eat less and exercise more. Thankfully she is still a happy energetic dog and I think we can love her without over feeding her."

So, maybe I can help without hurting? Maybe I just need to start training my patients how to drive to see me and take their humans for a walk?

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If you have any advice for me, or want me to try to navigate around helping your pet without hurting your feelings, you can find me at Jarrettsville Vet in Harford County, Maryland.

I am also contributing to Everyday Health and on Twitter @FreePetAdvice.

Friday, July 17, 2015

Pieces of Me.

The  pieces of me.

There are pieces of me everywhere.

The tiny specks of dust from a piece that was once alive and vibrant. 

The soul in the shadow of the departed friends I leave behind in a somber quiet place of a memory.

To say goodbye, to be the bearer of that last breath when your heart was meant to heal, costs you.

A toll you delay for a tomorrow you hope to never face, or a quiet moment at the end of each day when you ask yourself if it was all worth it?

There is always a wrinkle in time during each push of the pink where I add a personal wish for a peaceful journey. There is a soft whisper of “Goodbye” and an “I’m sorry” for each of those hundreds of souls I have helped lay to rest. 

Some I knew and loved as my own and others that were never named and never loved, but at that moment they are all the same.

I am always sorry for the ending – the loss of a tiny heartbeat in a world of often over looked possibilities. The loss of someone who might have mattered, or who mattered more than life can measure. The passing of a being that was miraculous and fleeting like hope in a prayer.

There is always a moment of being grateful to know them and always a relief of a peaceful ending. 

They are the pieces given away that keep me whole and human.

Related Blogs;
Compassion Fatigue

'Tis Better To Have Loved and Lost

Taking A Stand and Facing Consequences

If you have a pet question, want to share your pet health care experience, love animals and want to help others, please join us on Pawbly is a place where information is exchanged to help pets around the globe live longer, happier and healthier lives.

If you want to talk to me personally about your pets needs I can be found at the clinic, Jarrettsville Vet in Jarrettsville Maryland.

I am also posting pictures, blogs, and my patients on Twitter @FreePetAdvice.

Saturday, July 11, 2015

The Most Common Cat Mass. Abscesses in Felines. How to treat and costs associated with it.

I thought that it might be helpful if I started to blog about the most common stuff that I see in practice and I get TONS of questions about assisting people in figuring out what is wrong with their pet. I also get tons of questions about lumps, bumps, and everything in between the tiny unrecognizable specks of pigment and enormous life threatening cancerous leeching lesions. 

We all get bumps. A bump, however, is not a mass. A mass is bigger and more substantial. A bump can be a simple bug bite, a cosmetic lesion, or something similar to a pimple or a wart, and, in general, these can wait until  the weekend is over and then be reported to the vet.

A mass on the other hand is usually not arising from, but rather, underneath the skin. It forms a larger palpable swelling. Masses are often more troublesome to the patient and worrisome to the parent. A mass is a more alarming finding and therefore needs more attention and follow up. It is the size, chronicity and behavior of the mass that helps us identify its cause and subsequent treatment.

When a mass arises suddenly and is painful it is much more likely to be an infection. Jerry came to see me for a large mass in his neck area. He was also not eating, not playing, and seemed very depressed.

Here is my cat pearl (vet lingo for lessons learned in the trenches of practice), for
Cats Masses;

"Every (OK, I should never say every), acutely limping, sick cat that was otherwise healthy yesterday and has swelling and a fever today most likely has an abscess."

Jerry fits the billet perfectly for my primary suspicion in a young healthy cats with acute swelling that are ADR (vet lingo for "ain't doin right"). A cat with a mass, a sudden lameness, and a change in behavior (like not eating and not acting like their normal playful self) almost always has an infection. Jerry has an abscess and a closed, walled off infection is an abscess.

My fingers surround Jerry's mass.
With a tiny amount of pressure the mass reveals itself.
Shaving the area helps identify the size and identity of the infection.
Cats love to abscess.
Here's why;

1. They are very good at getting them. Cats are sharp pointy beings at all ends of the weapons spectrum. Sharp teeth, sharp nails. They are designed to pierce and when they do, they pierce deeply.

2. Cats inherent body armor has adapted to this by healing incredibly quickly after a puncture is delivered.

3. Now if those nails and teeth were sterile we wouldn't have a problem. A puncture with a sterile instrument, say for example a hypodermic needle like I use a million times a day to give vaccines is sterile. That's why a vaccine rarely gives a patient an infection. But, teeth and nails are dirty and those piercing little daggers bury bacteria deep in the tissue as they swipe or bite into their prey or enemy.

4. Tissue is full of life giving magical stuff. Ample blood supply (food), oxygen (life breathing stuff) and warmth is all the bacteria needs to have a new luxury home to settle into.

5. A few days, sometimes even weeks later, that few bacteria now has a whole colony of festering puss living under your cats thick protective skin. Pesto! There is now an abscess!

Infections hurt.
Here's why;

1. That bacteria causes pain by taking up space under the skin and growing. We have all had a splinter in our skin that gets stuck and starts to fester. Ouch!

2. Your body does an amazing job at mounting a response to an invader. It will send all of its immune system warriors to go fight infection, fever results as the immune system kicks into over drive. This is fine for a little while but after that it gets incredibly taxing on the body and we get lethargic, or ADR.

3. Fever causes inappetance as our body puts its efforts into fighting not acquiring or digesting food.

Always pay attention to your cat!

A cat that is looking and acting sick, is sick! I don't care if you can't find the reason, and neither I, nor your sick cat, cares why you cannot get to a vet, your cat is telling you that they are sick. So, go to the vet now!

Jerry had a fever of 103.3 degrees Fahrenheit, (high normal is about 102.5). Of course he doesn't feel good. He has a fever, an infection, and is uncomfortable. 

What we did;

1. Shave the area. I always warn my clients that it will make things look worse, but knowing what we are dealing with allows us to better understand and monitor it.

2. Look for any wounds. Jerry had a small puncture wound at the top of the mass and with gentle pressure it leaked thick blood tinged purulent (puss) material. Not finding a wound does not exclude a mass from being an infection or abscess. (Go back to my point about cats healing so quickly). If I am not sure what lies beneath I use a sterile large bore needle to get an aspirate. You cannot accurately treat something unless you know what it is!

3. Gave subcutaneous fluids to help with both the fever and infection. I find that this helps immensely. Every, (there I go again), pyrexic (fever) pet NEEDS either i.v. or subq fluids! 

4. Gave an injection of an NSAID. This helps break the fever quickly, and helps with both pain and inflammation.

5. Antibiotics are the answer! We started with an injectable, because he wasn't eating antibiotic that lasts 10 days. (Note; after 3 days we changed to a stronger daily antibiotic because the infection was not acquiescing. 

Cost at our clinic; $50 for the examination. $30 antibiotics, $20 NSAID. $25 SQ fluids, daily antibiotic $30.

At home care guidelines; 

1. Keep Jerry inside (flies will lay eggs in any open wound and you get maggots!).

2. Monitor Jerry closely. If your cat is not acting like they are feeling better within 24 hours they return to the vet for a re-check.

3. Provide an e-collar to prevent rubbing, scratching and traumatizing to the infection.

4. If the abscess returns somewhere down the road do a surgical exploratory. It might sound crazy but I have seen infections return months, yes, months, later. I usually recommend that we get more aggressive and go in for a look and try to flush out, or surgically remove the offender. And/Or, place a drain to keep the area open until it looks as if it has completely resolved.

This is Jerry at his two week re-check. The mass is gone, he is acting like his normal self.

A few last side notes;
  • We also boosted Jerry's rabies vaccine. We don't know who caused this and he is an indoor-outdoor cat. Better safe than sorry.
  • I checked Jerry for ear mites and fleas. I have seen some cats cause their own abscesses due to itching. Any scratches by the head especially should be investigated for ear mites, ear infections and fleas. Don't ever treat the clinical sign without identifying and addressing the underlying cause. It would be awful to treat for Jerry's abscess and ignore the reason he got it.
  • Lancing. People love to lance wounds. I am a bit hesitant to recommend this. Remember the body is trying very hard to wall off and fight this wound. Opening the skin up (again) leaves you back at square one of trying to fight infection. If you cannot adequately safely and effectively clean out and treat an abscess adding more holes to the situation leaves more opportunity for more bugs (i.e. infection)  to crawl in and establish residency. The last thing your cat needs is more infection. 
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Wednesday, July 1, 2015

Preparing Your Pet for the Fourth of July

Wonderful question from Pawbly user

"With the Fourth of July coming up, what kind of precautions should we take to make sure our pets are safe and happy?" 

Charlie and Jekyll in their traditional 4th of July attire.
Here is my answer;

Hello Kaelin,
What an excellent question!
Here is what I tell clients.
First and foremost, leave your pets at home. Preferably, under lock and key. 
If you are having friends over leave the pets in a safe, familiar, closed, well barricaded from the outside AND labeled door. At our house we close the dogs in our bedroom (the place where their crate is and they are already used to), put a chair infront of the door and hang a sheet of paper that says "dogs, please do not disturb" sign. This keeps everyone looking for the coat room or extra bathroom out, and my rambunctious pups in. If they still get loud I crate them.
Crate your nervous pups IF, and ONLY IF, they are comfortable and happy in the crate. My dogs are crated whenever I am away. They act like raccoon stuck in a candy store if I don't. If they are not used to being in a crate put them in a closed, preferably windowless, familiar spot that has a place they can hide in. For some fearful dogs this is a clothes closet or under the bed. Let a pet hide if they want to hide. Don't try to force them to leave unless it is for their own safety. A scared pet will do irrational things, like run into a door, a tree, or out a window (regardless if it is open or shut). They will also pull you with them, so be careful.
Pets that like to hide usually prefer dark and quiet too. Put heavy blankets on the crate to buffer noise.
Your pet might benefit from a calming coat too. The most popular is the Thundershirt, but my personal favorite is the Rein Coat.
Wren, my cat, photobombs.
If they want to be with you, or, if you aren't in a safe place to keep them, keep your pet on a very short leash, preferably leashed to a harness versus a collar to allow you better grip and hold. Collars often slip off and then your pet is not only loose he has no visible identification. Find the quietest place possible and try to stay seated until the noise or excitement passes.
Have an identification tag on your pets collar/harness. Have them micro-chipped, and make sure both list current phone numbers and addresses. 
Keep your cell phone with you. If your pet gets away call for help and start plastering social media and local animal hospitals, shelters, and rescues with a current clear photo.
Remember to that there are fireworks and loud noises that start days before, and last days after the 4th. Be prepared for these unexpected firework celebrations.
Even dogs who are normally comfortable with loud noises and crowds get spooked with fireworks. Please keep them at home.
If you have a pet with a noise phobia please ask your vet for help early. Many pets phobias and anxieties intensify and worsen with time. Your pets frantic fearful 4th of July could turn into a manic Memorial Day, loathesome Labor Day, and really unthankful for family visitors come next Thanksgiving. 
Be Safe Everyone!

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