"Adapt or perish, now as ever, is nature's inexorable imperative." - H. G. Wells

Every day I hear about more disgruntled veterinarians who are angry about the persistent, overwhelming and ever mounting pressure from big box stores now selling what were once ‘exclusively veterinary’ wares. Or, from ambiguous on-line stores that seem to magically sprout up overnight like some fairy tale beanstalk in our own back yard. To the latest craze of on-line veterinary advice networks where for a comparatively nominal fee you can receive a diagnosis and treatment plan from a veterinarian reside somewhere in the nethers-phere.  Who are these vets? Where are their credentials? How do they circumvent the necessary client-patient relationship? And how can they possibly even begin to diagnose without the benefit of their eyes, ears, nose, and verbal exchange?

These were all of the questions that I found myself asking as I tried to comprehend the ever evolving market place that my own veterinary clinic was not only competing with but also trying to coexist with.

Perhaps I should take a moment to explain to you how I got here? I am a small animal veterinarian who graduated with a beaming smile of self pride at the culmination of over two decades of determination. It had been a long serpentine road of self-doubt, delay, and self-sacrifice. My story is not unique. We vets work tirelessly against a turbid strong current of adversity and challenge. Everyday most of us are accosted by the public asking for free services, shirking responsibility, and expecting that we will provide their demands based on the civic duty of our profession. It is a long road of both emotional and financial demand. Compounded by the reality that many new graduates face ever increasing mountains of debt to graduate and make half of what professionals of our educational counterparts do.

When I left veterinary school the world was my oyster. With my newly minted degree in my back pocket I was going to re-assign my determination into the arena of practice ownership. With a new suit, new hat, and firm resolve to slay this next beast I forged into the new territory of ownership.

My intent was to stay true to my purpose of helping people and their pets. But in this new open intense marketplace how do I manage to make a decent living when so many hands are open around me or slipping into my pockets to try to snag my spare change?  The writing is on the wall. It is time for us to diversify, understand our competitors, stay true to our strengths and do what we do best, educate our clients about why it is imperative to get help from those trained and able to do so best.

The landscape is changing and we can either sit back and watch as others shape it around us, or we can join forces and take charge of our own destiny.

Pawbly was the brain child of this dilemma. It is a place where anyone can ask any question and receive answers. As a practice owner it is a way for me to place a safety net around my clients who, like it or not, are out seeking information away from the security of my clinics walls. Whether the public is seeking assistance that is naively or financially motivated it is happening. So Pawbly.com was created to help provide a safe place for answers to be found. Pawbly.com is NOT a place to circumvent or supersede the other most important person in a pets life, the veterinary hospital, it is a place to help support the veterinary community.

Pawbly is an open unbiased platform to help pets. It is a place where credentials are provided and all are allowed to participate. Pawbly will help you keep your clients, find new clients, and most vitally do what you do best, help others. Pawbly strengthens bonds extends assistance and guidance between existing relationships. It also provides access vertically to other pet centered people.

There are resources out there that exist and can help pets, Pawbly provides the platform for the exchange. This is a new age of medicine, and information exchange. The world is still the proverbial oyster..

Best yet, Pawbly is free for everyone to use.

For me personally, it is a place that I can tell my clients they are safe using, it is a way to help me extend my services, and it is a constant reminder about how I enrich and protect their lives and the lives of those they care about.

If you would like to join our crusade please visit us at Pawbly.com.

Woody's Honk and Wink. Eyelid agenesis and cleft palate defect in a cat.

This is Woody. He is about 4 months old. He was brought to me last week from the good people at Animal Rescue, Inc. in New Freedom PA.

They originally thought that he might have a nasopharyngeal polyp because he had this constant funny little nasal sound. It sounded a bit like a cross between a stuffy nose and a goose honk. It was a very good guess on their part. They were almost right on the money with their presumption. They were in the right anatomical area, but Woody was missing something, instead of in possession of something extra.

Woody is about as sweet, gentle, loving, affectionate, and adorable as a kitten can be. His story is like so many other kittens at the rescue. Brought in as a baby, raised by volunteers, and now old enough to be looking for a home of his own.

But his path is not so simple and straightforward.

This is Woody.
He is missing the lateral (outside) 2/3rds of his upper eyelid.

Woody was born without complete eyelids.

Sounds crazy, doesn't it?

It is actually a condition called eyelid agenesis.

Eyelid agenesis is very rare in dogs but seen occassionally in cats. In some cases the loss of the lid is mild and only appears to be a cosmetic defect. But for some cats it causes pain, ocular discharge and can even lead to blindness as the hair sweeps over the sensitive cornea with each blink.

This is a picture of my kitty Magpie.
Her eyelids are normal.

I used pictures of my cat Magpie to illustrate what normal looks like. So you will see a picture of Woody and then followed by it will be a picture of either Magpie, or another normal kitten.

This is Woody's right eye.
It too is missing the lateral 2/3rds of the upper eyelid.

Magpie.

Magpie, falling asleep despite my annoying obsessive picture taking.

Woody's eyelid abnormality are what we call an incidental finding. They are not causing him any problems, and although they are not normal, they do not require any intervention on our part, YET.

But the honking sound, that we have to identify.

With a very quick peak, and  a calm gentle tolerant patient we got our first look at the source of the noise.

Woody's mouth.

The above two photos are of the inside of Woody's mouth. What the vet would call an "oral cavity" exam.

Woody is fully awake and this shot is incredibly hard to without drugs.

The right side (it is actually Woody's left side) of the roof of his mouth has a huge open defect.

 This is a sedated kitten before I put the endotracheal tube in their mouth and hook them up to the general anesthesia gas that we use to provide a well controlled plane of anesthesia.The left and right sides of the tissue above the tongue are uniform and symmetrical. The round opening is the soft palate that guides food and water to the back of the mouth. During eating and swallowing the arytenoids shut off the vocal/air tube that goes to the trachea so food doesn't go down the wrong pipe.

The structures of the base of the back of the mouth are specifically designed to direct food, water, and air into the correct tube.

The little pointed tip like structure visible just above the center of the tongue is the epiglottis.
This is looking down into the larynx from the mouth.

Woody is scheduled for surgery in two weeks. I will try to rebuild the soft palate, pharynx, and larynx into a functioning tunnel that will prohibit him from getting food and water pushed up into his nose and segregate these anatomical areas so he won't be prone to regurgitation, oral and nasal cavity aspiration and disease.

Have I ever done this before? No.

Does he need to have this surgery done? Yes.

Am I a little scared? Yes.

I will keep you all posted. Cross your fingers for me.

If the surgery is successful Woody will be looking for a home. If you are interested in adopting him, OR, if you have any pet questions, OR, if you are a surgeon and you would like to assist, (or perform Woody's surgery,,I am happy to pass him off to an expert ;-)), please find me at Pawbly.com. on Twitter @FreePetAdvice, or @pawbly.

Woody had surgery yesterday (September 30, 2013).

He did great!

I closed most of the soft palate defect. I was unable to close it completely for three reasons. First, it is almost impossible to get far enough back in the throat to place sutures and get access to the tissue with the needle. Second, he didn't have a tear for me to correct. He was missing the tissue that was supposed to be there. I couldn't just sew up the two halves of a laceration. I had to use what he was given, and that was not much. He had a hole, and no extra loose ends to collect and package. Third, The tissue swells with trauma, even the precise surgical trauma of a scalpel. I was very concerned that Woody be able to breathe on his own, and if needed I had to be able to replace his endotracheal tube if needed. The tube has to be placed in the very back of the throat. If there is severe or significant swelling you cannot visualize the opening of the trachea from the esophagus.

This is Woody's left eye from above. He is missing the lateral (outside) half of the upper eyelid. This is beginning to cause a few problems. He has hair rubbing on the cornea. Every time he blinks those hairs brush across the cornea, and over time this will cause irritation and could cause eventual scarring. He also has an incomplete blink. There literally isn't enough eyelid to close over the eye. Over time the area that isn't covered by the eyelids will scar and dry out. This will cause an ulcer and this can significantly impact his vision. 

Woody's left eye is worse than the right.

The closure of the cleft palate.

The correction of the left eye.
A conjunctival flap was taken from the bottom lid to create an eyelid and fill the missing gap of tissue.
To be completely honest I have never done this before. If it fails miserably I will let you know..(I always have a plan B ready. I haven't made it yet, but I will if I have to).

LOOK!! the eye closes!

Waking up. 

Thank you to everyone who sent well wishes!

Woody will be back in two weeks for a re-check.

Romania Approves Dog Slaughter.

Recently I have been doing a great deal of tweeting about the recent events in Romania where a boy was mauled to death by a pack of stray dogs. In light of these incidents, and with the further excuse of preventing disease, the government has decided it is best to resolve the issue by rounding up the estimated 60,000 stray dogs and killing them. The term one paper used was "cull," (next to pith, this is the most awful word in the English language). There have been massive protests by Romanian citizens, along with world wide outcry, and some of the most horrible pictures imaginable. 

What is the answer? Well, from someone who has traveled the world over I will personally testify that I cannot go to many of these countries any longer because the number of homeless pets brings me to tears, until I look closer and realize that many of the two legged inhabitants are just as destitute and desperate as the four legged residents.I don't know how you protect people when desperate unloved and uncared for domestic pets are cast aside and expected to fend for themselves. I also do not know the scenario that ensued to cause a pack of dogs to attack. But I know dogs well enough to know that there was likely a reason. I know that in just about every single act of violence from a pet to a person there is some person who ultimately is the original source and/or exacerbated it.

Let's talk about this. Dogs are domestic creatures. They were bred, raised, and are still a human beings responsibility. We are responsible for keeping them tame, trained, obedient, healthy, and a member of human society. A stray dog is a persons failure. This implies they remain a human beings problem should their original guardian fail them. It is the continual dilemma of every veterinarian, behaviorist, rescuer, and society at large.  

Ask the largest, wealthiest super power in the world how we do it? Well, we just keep the streets cleaner by humanely (?) and more inconspicuously ridding our pe(s)ts from the public view. Is the US any better? Well, instead of 60,000 dogs, we euthanize millions, estimates of over 4 million, every year. 

We just don't call it slaughter.

Here is Steve Dale's article;

Romania Approves Dog Slaughter

2 comments

By Steve Dale, Saturday at 3:29 pm

(Photo: Daniel Mihailescu, AFP/Getty Images)

Romania's answer to solve a stray dog problem is to round them up and kill them, which was just voted into law by Parlaiment September 10. This follows a report that  a 4-year-old boy has died and his 6-year-old brother was injured after they were attacked by a pack of stray dogs outside a park in Romania. And in 2011, a woman was attacked a ultimately died of injuries suffered as a result of stray dogs.

The law allows the state to round up the city's estimated 60,000 strays and have them put down. Despite hundreds of protesters urging parliamentarians to vote against it, the law was overwhelmingly approved -- by a vote of 266 to 23 (with 10 abstentions). Bucharest Mayor Sorin Oprescu had announced that a referendum would be held on Oct. 6 before deciding whether to go ahead with the plan.

Gabriel Paun, director for animal rights group 4Pfoten, told BBC News, a nation-wide sterilization strategy is necessary to control the burgeoning dog population.

"In the last few years we've castrated 100,000 dogs in Romania altogether, 10,600 of them in Bucharest," he said. "But it's not enough, this is a voluntary private project -- we need them to do the same thing at national level."

According to rescue group Any Dog, the cost of killing a street dog may be considerably higher than sterilizing.

Still, one can understand the breath of the problem - which apparently ballooned after the fall of communism. A Bucharest hospital spokesman told The Associated Press 9,760 people have been treated for dog bites in the first eight months of this year alone.

Certainly, living on the streets and scrounging meals, competing against so many dogs isn't a impressive quality of life for the dogs either, and many are mange ridden, there's canine distemper and likely rabies. The parliament acted after protests Sunday in which several hundred people came out with banners reading, "My country is not a kennel."

 Steve Dale, Chicago Now.

If you have a pet question, or any other pet related item that you would like to discuss with me, you can find me +Krista Magnifico, @pawbly, or at Pawbly.com

NY passes a law allowing people to be buried with their pets

New York pet cemeteries will soon accept cremated remains of humans

By

Associated Press

Saturday, September 14, 2013

LBANY, N.Y. — New regulations will allow New York animal lovers to spend eternity with their pets.

The Daily News reports that officials have finalized rules allowing pet cemeteries to accept the cremated remains of humans.

---

The cemeteries can bury pet owners’ ashes as long as they don’t charge a fee for it and don’t advertise human burial services.

New York's Division of Cemeteries put a halt to human burials at pet cemeteries in 2011 after an Associated Press story about the practice. It later relaxed the ban on a limited basis and began working on permanent rules.

Ed Martin, owner of the 117-year-old Hartsdale Pet Cemetery in Westchester County, says he gets five or six requests a year from humans who want to have their ashes buried with their pets.

Read more: http://www.washingtontimes.com/news/2013/sep/14/new-york-pet-cemeteries-will-soon-accept-cremated-//#ixzz2f5QFbg98 

Washington Times Article
Follow us: @washtimes on Twitter

Kiki and his Terrible Tussive Tickle

He arrived as they all do.

In a small carrier hidden from view in a dark enclosed plastic box.

Designed to be light weight, these carriers are like a little treasure chest to a veterinarian. You really never know what you are going to find inside. Sometimes the smell gives you a big hint, but I’ll get to that later.

Every vet has learned to take a tiny peek inside these boxes before opening the door, or even contemplate daring to stick your hand in. We have all learned the hard way that there are sometimes ferocious little lions hidden beneath a seemingly gentle puff of orange fluff.

Today's fortune cookie was Kiki.

Kiki is a part of the over 700 cats living in the Animal Rescue Farm just along the Pa-Md border, in a little town called New Freedom. They are the most devoted bunch of amazing, inspiring, compassionate people I have ever met.

To begin, Kiki is a boy, (I know it’s confusing. I can’t really explain why, but that’s a lot of cats they have to manage so some of those cats get some pretty funky, or down right mis-appropriated, names). We have learned to just accept them and go with it.

As I approached his carrier and peeked inside I noticed that he wasn't moving. Kiki just sat in his little plastic cat carrier box hidden quietly in the back. As I opened the door he didn't lift his head, he didn't move, he didn't care about me, or where he was, nor did his internal survival drive tell him to even care about pretty much anything anymore. I could see and hear his rattle and crackle of the all to common ailment of rescue cats “chronic upper respiratory disease”.

How many of these rescues cats do I see? A LOT! You put too many of anything together, and you know what you get? A lot of disease. Send your kids back to school with a whole cackle of other little kids, none of them washing their hands, and be prepared to grab the tissues, because you’ll need them soon.

Kiki had yellow-green snot just caking his nose. Some of it had dried leaving a crust, but more was right behind that cascading down the chute like a slow flow of yellow-green lava. He could barely breathe, and when you can barely breathe you barely move. I lifted his lifeless thin black body out of the carrier. He didn't fight, or protest, or struggle even a little.

I gingerly placed him on the scale. He weighed in at a paltry 5 pounds. That’s was least 2 pounds less then he should have based on his age. When you only weigh 5 pounds those 2 pounds really count.

We quickly made up a very basic treatment plan for him. The good ole basic stand-by treatment plan of fluids, food, and antibiotics. I instructed them to feed him any damned thing he wanted and to try to make it as smelly as possible. Because when you have a whole nasal cavity full of snot it takes a smelly-smelly morsel to convince you to open your mouth and eat.

 We also started him on the antibiotic I call “the big guns”. “The big guns” are those antibiotics that we reserve for the severe cases, the cases that have previously been treated to little or no avail, and they are also expensive. (Funny how life always works that way?) I was going to hit him hard with these drugs and keep him on them for at least a month. My hope was that the previous treatments  were either not the strong enough, or they weren't used long enough. I was covering my bases and stacking the deck.

We put Kiki in a hospital cage with my treatment plan in place and I moved onto the next little plastic chest of mysterious disease.

I told myself coyly that I didn't really need 12 years of college to treat this guy, and I moved onto the next carrier in the processional line.

 Over the next few weeks we cleaned more slung snot from the walls, the doors, and the ceiling than anyone could imagine a 5 pound creature could produce. Kiki sneezed, spit, and re-painted our walls. If any of you are ever thinking of working at a vets office, and need to start at the bottom, (aka kennel), be prepared to not only pick up poop, scoop litter, but also to scrape snot off of walls. After 4 weeks of “the big guns” he still looked puny and miserable.

I called the rescue director and confessed that my hopes had fallen far short for poor Kiki. I asked if I could put him under general anesthesia, look in his mouth, flush his nose, take head x-rays, and pretty much make any stab in the dark that was listed in my text book under ”chronic upper respiratory disease." I heard the pause in her voice, (that little jab of falling short of expectations, I get used to it), and a reluctant “OK”.

 The next day, I said "good morning" to Kiki with a little quiet prayer, crossed my fingers and put him under general anesthesia. We took some x-rays of his head. The x-rays showed the damage to the very fine bony turbinates, years of snot eating your nasal passages, but no tumor. Score 1 for Kiki.

We next flushed his nasal passages, until the snot ran from a thick ropy yellow string to a clear saline. Score 2. He can breathe clearly when he wakes up, at least for a little while, I thought.

We next took a peak behind his soft palate. This is the area where the hard bony roof of your mouth transitions to the soft part then heads down into your larynx.

And there it was an enormous irregular cluster of grape like tissue the size of your thumb!!! I was never so happy to see such a hideous structure. The veterinary treatment for a big wad of tissue growing in the back of your throat? grab, yank, and pull. (And, hope it doesn't grow back). Kiki and that hideously huge throat mass was the center stage curiosity of every staff member in the building. We were all so happy to finally have a clear culprit to assassinate for him and yanking that bugger out was one of the most rewarding moments of my opprobrious career.

 Kiki woke up without any complications and since then he has put on 4 pounds and become the most extroverted, playful, and rambunctious kitty you have ever seen. He decides when it is time to start playing, when you are done playing, and he will slap you if you walk away without his permission. He has become one of our resident cats. And he reminds me everyday why I do what I do.

If you would like more information on this topic; Nasopharyngeal polyps.

Kiki lived with us at Jarrettsville Vet for almost a year. He was then adopted by one of our veterinarians and moved in with his own family. A few months later he developed an inner ear infection that was treated by yet another surgery. He has been happy and well since. He will always be a unique kitty even with with his signature perma-wink and ear bow.

Best wishes Kiki!

If you have any questions about Kiki, polyps, respiratory infection, or anything else pet related please visit me, and the rest of the Pawbly people and ask us! We are here to help you and your pet!.

You can also find me on Twitter! 

Pet Flipping. In the News

In the news this week..a new way to beat a faltering economy..."pet flipping."

Remember the days when it was widely publicized that people were robbing trains, hit and run insurance fraud, and using arson to make a little spare change? Well, today in the animal world 'pet flipping' is the latest scam.

How is it done?

Your pet is simply stolen and then sold on Craigs List, or you get a phone call from some seemingly concerned citizen who "found" your pet and is now wiling to return it for a reward.

Sad, horrible, shameful, and despicable.

What can you do to keep your pet safe?

1. Never let them out of your sight.

2. Keep them leashed at all times.

3. Micro-chip your pet.

4. Keep a collar, tags, and identification on the.

What should you do if your pet goes missing?

1. Start searching every shelter.

2. Start monitoring Craigs List listings. 

3. Call your microchip manufacturer to report your pet missing.

4. Hang flyers everywhere

5. Notify all of the local veterinary clinics.

6. Report your pet as stolen on Craigs List

Why is a microchip so vital?

Well, simply it is the safest and most effective way to get your pet back to you. Not only that, but, if your pet is microchipped and if it goes missing the microchip can be used as the foundation for criminal charges. A microchipped pet that goes missing and is in another persons possession is considered stolen property.

If you are interested in microchipping your pet please see your veterinarian. If you are in the Jarrettsville MD area stop by Jarrettsville Vet, we microchip with every examination for FREE!

Dude, You Are Stressing Me OUT!

Cooper

Stress.

I say this word frequently during my routine veterinary day. 

Every time I do I have to take pause and explain. 

Stress in medical terms is something that causes an upset or disturbance.

For people when we say the word "stress" and we think "bad," but a disturbance isn't always a bad thing. So I start throwing out examples, like, "remember when you got married, or you moved, or got excited for your birthday? Well, those weren't necessarily bad things but they got your body worked up. And you might have had cramps, diarrhea, or not been able to eat because you were nervous? Well, that was stress and your body reacted to it."

Cooper is a 4 month old effervescent dynamo puppy. He came to see me last week because he had had diarrhea for the last two or three days and his mom was worried. 

I listened to her tell me about Coopers routine and what changes had occurred over the last few days to weeks. She told me that Cooper was normally a very happy energetic puppy. He loved to play, he had a huge assortment of toys, he had been kept current on his vaccines, was on heartworm and flea & tick preventatives and except for the 2 or 3 daily episodes of abnormal loose stool was acting just fine. 

There are a few key points to Cooper's moms statement. In an effort to help educate you all I am going to take a moment to review them.

1. Cooper is acting normally. Always listen to your patient before anyone or anything else.
2. Cooper is current on heartworm medication prescribed by his vet. Dogs kept on heartworm medication are less likely to have intestinal worms. 
3. He was an acute case of diarrhea (clinical signs lasting less than 72 hours). It is so important to seek help inside of this window.

I asked Cooper's mom about his activities and home environment. Specifically I wanted to know if he was being given table food, or snacks, and what type they were, if he tended to eat things he shouldn't like garbage, things outside, etc., and if there had been any changes in his home life.

Here's why I asked. Many healthy young puppies (dogs under 1 year old) have episodes of acute diarrhea because of one of two things; they got into something that they shouldn't have (think garbage can raid or the delicacies of wild animal poop), or they got stressed about something.

In veterinary medicine we call the latter item "stress colitis."

Stress colitis causes large bowel diarrhea which is an increased frequency of having to defecate, straining to defecate (many people incorrectly think their dog is constipated because they are straining), soft to watery stool, sometimes with blood visible in it, and is most often affecting young dogs.

For all young dogs with diarrhea it is important to examine a fecal sample. Intestinal parasites are a common cause of diarrhea in dogs and can cause significant weight loss, anemia, and even death. 

For Cooper his stressor was re-visiting crate training.

Cooper, like many young, newly adopted puppies had been started on crate training when he first arrived at his new home. But over the last few weeks he was left out for longer and longer periods of time.

Then his mom had to go back to work and his daily routine changed from having not been in his cage for any measurable period of time, to in the cage for a work shift.

His mom said that she felt terrible leaving him alone all day. But she wanted him to be safe (CRUCIALLY IMPORTANT!!), so she was taking him for walks in the morning before she left and playing with him when she got back home. She wasn't sure that my presumption about Cooper being stressed in his cage so I recommended that she try to leave a video camera on him when she leaves to monitor him. 

She also had a few other clues that made me suspect that Cooper was having a hard time getting all of his needs met.

Cooper was a young very energetic puppy in a household with a couple who were past retirement age but still working. His mom admitted that she was having a very hard time keeping up with him and was unable to play with him to the point if him being tired. So Cooper was being put in a cage with extra energy left over and being left alone all day. His needs for exercise and social interaction were not being met fully.

Cooper is 4 months old and he is stressed already. Worse is that he doesn't have a clear way to start having his unmet needs resolved.

Coopers treatment plan was five fold.

1. Check a fecal and address any intestinal parasites. Remember some intestinal worms are what we call "intermittent shedders" so I will not declare a pet parasite free until we have three consecutive negative fecals.
2. A bland gi diet. This can be either boiled boneless, skinless chicken, or boiled ground beef and rice, OR a commercially available prescription food like Science Diets I/D for 5 to 7 days. A bland diet is designed to not only be easy to digest but also to not over work a body system that is trying to recover. This is done by offering small amounts of the bland diet with an increased frequency. So, instead of feeding a large meal twice a day feed four small meals every 6 hours.
3. Probiotics to help replace the good gut flora that aids in the bodies ability to remove excess water from the feces.
4. A plan to address his future stress.
5. A monitoring protocol to insure that his acute colitis did not evolve into the more difficult to treat and resolve chronic diarrhea.

My advice; Get Cooper a puppy, or something he can exhaust and that will in turn exhaust him.

If you have any questions about this, or any other pet related item, you can ask me at Pawbly.com, or find me on Twitter @pawbly, or FreePetAdvice, or Google+ +Krista Magnifico.

Thanks for reading!

And remember Always Be Kind.