The tissue paper that hides under your skin. Subcutaneous Emphysema.

There are the conditions that we read and learn about in vet school and can't fully understand until you see and feel it in person.

We learn about goose stepping and what kind of neurological condition it implies, but until you see a dog do it is just a foot note in the big cranial waste basket. You have to see it in person to appreciate that it does look exactly like it sounds.

Or, how about raspberry jam diarrhea. Yep, it looks exactly like the real thing.

The other day we saw Yeager, a Humane Society rescue dog with an abnormal facial swelling. Because veterinary medicine is practiced by the law of averages we assumed that Yeager, an older dog, had a bad tooth.

One of the most common ways that a pet with severe dental disease presents is with a swelling under the eye. (The other obvious way that a parent knows their pet has bad teeth is bad breath. IF your pet has bad breath I am willing to bet money that they have bad teeth. Have them checked ASAP, dental disease is the most common and most over looked pet health issue.)

How does this happen? Well, the tooth roots which are anchored in bone which is adjacent to the sinus cavity. The most classic facial swelling vets see is a periapical abscess of the upper fourth premolar, (the biggest tooth with the largest number of roots in the mouth). When the root gets an abscess it starts to swell and the easiest place for it to go is up toward the eye. If the swelling is allowed to continue it will eventually rupture and a draining tract will result.

Yeager is a difficult dog. He has abandoned the ability to provide a stranger the benefit of doubt. He prefers to growl, snarl, lunge and bite as an introductory "hello."

Unfortunately his demeanor required a muzzle for most of the handling he gets at the vets office. It is impossible to examine a dogs mouth with a muzzle on. And, for those patients with teeth that look bad the true test for the extent of dental disease, decay, and decisions lie in the dental x-rays.

Yeager was put under general anesthesia and the source of his swelling was at this point discovered to be a cut on the head from a fight.

Yeagers forehead sounded like tissue paper when you touched it. Commonly, we compare it to bubble wrap. When you press on the skin you can hear and feel a layer of popping crunching tissue just beneath the skin.

It is almost addicting to poke at.

What happens to produce this?

It is actually air trapped under the skin. And it crackles and pops when you press on it.

Air can be trapped by either trauma, where the skin is pulled from the subcutaneous tissue. Like separating layers of phyllo dough in baklava. If the skin is pulled out of its roots from the lower tissue layers and if there is a hole somewhere close that lets air in that air can get trapped between these layers.

It is called subcutaneous emphysema.

We see it in bite wounds, trauma, and tears in the trachea. Tears in the trachea can occur with intubation for anesthesia or bite wounds.

If the tear is a wound and the trachea is intact we usually can just watch, wait and provide pain management and antibiotics. We prescribe antibiotics because the air can actually be produced by bacteria that are trapped under the skin. Those bugs are trapped and they do what they always must do to survive. They eat, they replicate and their by-product is waste in the form of gas. 

For tears in the trachea surgical intervention is warranted. The thorax (chest cavity) needs to stay at a constant negative pressure for the lungs to bellow in their normal rhythmic in-and-out motion.

Any pet with subq emphysema, abnormal swelling, difficulty breathing, bad breath, or any signs of trauma should be seen by a veterinarian as soon as possible. Difficulty breathing is ALWAYS an emergency and should be seen immediately!

Yeager went back to the rescue with antibiotics and a careful note to monitor closely.

He is expected to make a full and uneventful recovery.

Related stories; 

A Good Deed and Two Bad Dogs

Abby's Story

If you have any pet related questions you can ask me, (and a whole bunch of incredibly smart people), at Pawbly.com. We are happy to help you and your pet and we are always free to use!

Or You can find me @FreePetAdvice on Twitter.

Have a wonderful weekend everyone! And please always be kind! And, one last thing, November is Adopt A Senior Pet Month. Please consider finding a place in your heart and your home for a pet in need.

Pheobe, adopted in the autumn of her life.
It saved her life and made her companion a happier less anxious pup.
Adopting an older pet will SAVE their life and it might enrich yours in more ways than you can imagine.
It is never about the length of your journey, but instead the steps you take along the way.

Don't Make Me Call Your Mom

The hardest part of this job is feeling like you are responsible for every pet that needs help.

Saying "No," is a very hard, and very uncomfortable thing to do when someone asks you for help because they love and care about their pet but cannot afford to provide for them.

I have been helping a thirty-somethingish man who is obviously having some internal struggles with his 12 year old unspayed sweet German Shepherd for about 6 months.

He calls me about every 60 days to tell me that he is concerned about the mass that is growing more and more pendulous on the caudal aspect of her ventrum. It is most likely a mammary tumor and it is most likely a bad one.

Every time he calls he tells me that he loves his girl, and that he knows it needs to be surgically removed and he wants to know "how much that is going to cost?"

Everytime I speak to him my answer is always the same, "Well, I can't give an estimate over the phone without seeing her first, and even then it is sometimes hard to pin it right on the dollar."

"Well, I can't afford to do both the exam and the surgery, and I don't know how much surgery is going to cost?"

So every time I offer him a free exam.

He brings her in each time with a larger and larger mass and a more disparaging grimmace on his face. Every exam the estimate gets larger, and every exam her prognosis worsens. And every time he leaves feeling more determined to find the resources to fix his dog.

Last night I got another call.

"Doc, the tumor is about twice the size of the softball it was last time. How much is it gonna cost me to take it off her?"

"Well, its very hard to give an estimate. Surgery cost is dependent on time and I don't..."

"DOC! You saw it last time! You don't need to see her! It's bigger! She needs it removed!" He was upset, he was sounding desperate, and he was beginning to get belligerent.

And so began yet another conversation with yet another client who is peachy-keen-sweet-as-pie to you when they want and think they are going to get something from you, until you try to stand your ground, and then the beast gets unleashed and they become a raging, cursing, guilt placing menace.

I loathe the parts of my day where I find myself blitheringly spouting off excuses about "why I can't give payment plans," and "that I am not a financial instituition," as I am assaulted with guilt ridden pleadings about why I should be doing/providing/caring for...blah..blah..blah..

Oh god its awful. Nothing in the world sucks more than someone making you feel guilty.

He repeatedly reminded me that he had no credit, couldnt get credit, and had no one to help him.

He repeatedly told me that "If you can't help then I have to put her down. Is that what you want me to do? Put her down!"

Theres no recovery from these remarks. There is nowhere to go. There is nothing that you can say to turn an angry desperate person who loves their pet into an understanding accepting person.

He hung up on me as I tried to offer some rescue organizations names that I knew would likely not call him back,and likely not be able to help sufficiently if they did.

Phone clicks, I say "hello?, hello?" knowing full well that I have been hung up on.

OK, fork in the road. What do you do next?

I take a deep breathe, I get angry, I feel awful, I let the wave of guilt crash upon me, and I pick the phone back up.

And I call his mother.

And I explain the whole thing to her. This is a small town, and I have a memory like an elephant. I know who is related to whom, and that there is more than one way to skin...(ugh! terrible saying).. a potato?.

And she apologizes. Which I am grateful for, and feel even more guilty about.

She asks me if I can give him a payment plan?

I reply, "Well, we don't offer payment plans (because they NEVER! EVER! work!), I'm sorry."

Can every vet offer a payment plan? Well, yes, of course. But you do not get paid back. Expect it, and if you are silly enough to offer it, expect to write those accounts off, and then be inundated by people asking for more "free" services. That's what you will get.

His mom pushes on, "But you could give one, couldn't you?"

I reply, "If I did could he pay me back?"

"No," she replies without a hesitation.

The conversation ends with her telling me that her son loves his dog, and that he has "some troubles" and that she will talk to him. She will call back and she will help him find the answers to his dear dogs issues.

The chain of guilt is one link lighter.

And tomorrow is another day.

If you have any pet related questions you can find me @FreePetAdvice, and Pawbly.com. I am happy to help, no guilt, PLEASE!!

When You Think A Pet Is In Danger What Do You Do?

We are a people of many races, religions, and beliefs. The encapsulated melting pot. But our single greatest attribute is our passion. Can you imagine the world without this? No love, no joy, no fashion, architecture, or giggling? I think I could live without anything else before I could give up passion.

One of the things we are most passionate about is our animals. Kids and animals they sell almost every product on t.v. (pulling out the beer commercials, although if its not boobs its dogs in them too).

SO, what happened when the slugs at the FDA didn't get answers or take action fast enough against chicken jerky treats that are believed to be the cause of thousands of deaths and illnesses in dogs and cats?. Well, in the USA a few people decided to take action and help pets. They invoked their First Amendment right and opened their mouth and took action. They posted warning labels on jerky products that are still sitting on shelves for sale in stores.

I LOVE IT!!

It may not be completely legal, nor welcomed in the stores that are being paraphernalia-ized, but the intent is so spot on, and so clearly centered on protecting pets that I want to give a big high five AND thumbs up to  the Animal Parents Against Food and Pet Treats Made in China for having the gumption, passion, and follow through to help those who cannot help themselves.

Animal Parents Against Pet Treats and Food Made in China applied warning cards to pet treats at BJ's Wholesale Club

Read More: http://supermarketnews.com/center-store/pet-activists-distribute-jerky-warnings-shelf#ixzz2jz8frH9L

Photo courtesy SN Supermarket News, Julie Gallagher

Ok, the official advice of this vet is;

1. Buy products made in the USA, with all USA ingredients. 
2. Buy from a large, established pet food manufacturer.
3. Follow the AVMA Pet food Recall and Alert page.
4. Seek veterinary attention if you believe your pet is sick. 
5. Call the product manufacturer, be persistent and proactive for your pets health, and the others that might have been exposed.
6. Report any concerns to the FDA, use their online reporting form.
7. In the event that your pet is affected be a voice, take a stand, and ask for help. I have seen many clients compensated for their pets care. I understand that it is not about the monetary compensation but it will help your pet get better and it will help the pet food industry understand how passionate we are about our pets health and safety. 

Could there be a glimmer of hope that these illnesses and deaths might be less likely to recur? Hopefully. The FDA is currently proposing that all pet food manufacturers be required to meet the current Good Food Manufacturing Practices Rule and therefore be subject to higher standards and better written procedures to insure better quality control and oversight of the foods being fed to US pets.

If you have any pet related questions you can find me at Pawbly.com, where I answer questions for free, or visit me on Twitter @FreePetAdvice

Fresh From The OMG Department

Opossums.

In the great state of Ohio there is a bill that just passed the Senate making it legal to carry a carcass home after your assault vehicle kills it.

Of course you are required to report it, but then its yours to...well..I guess people are eating it?

Part of me wants to send accolades for not wasting or littering, and part of me wants to hope that my husband never thinks of turning the car around opening the trunk and pitching any recently, or otherwise, piece of road kill, to head home and search the library of Epicurious for recipes via a slow cooker.

But just to cover my bases, and because I am well aware of how life likes to throw me a challenge when I taunt and tempt it,..Honey, should you have the misfortune to hit a critter please do stop the car and tend to them. Give me a call I'll come and take a look at it, humanely euthanize it for you, (or call the appropriate authorities who can laugh at me for asking them to take a break from their busy schedule to end suffering) and we can bury it at home after a small funeral service together.

Ohio Roadkill Bill

Compassion Fatigue. When the candle you are burning at both ends consumes you.

“The Lord giveth and the Lord taketh away.”  BUT in the case of our pets,  should it be “the Lord giveth and the vet taketh away?” How does the responsibility, the quest for providing a service, and the weight of the burden that this profession puts upon you keep you from becoming exhausted? And how does the emotional stress not accumulate to the point where that stress breaks you?

In the trade we coin it “compassion fatigue.”

It is the burden of the beast.

I read somewhere that something like one-third of US women are on some sort of tricyclic antidepressant. If the general public can’t make it through their normal day without some help how is our profession not supposed to end up not heavily self- medicated, depressed, or seeking a way out from under the mountain of emotional turmoil and  strain?

There is a common belief amongst vets that our profession has the highest suicide rate. We know what death from the end of hot pink syringe looks like. We talk about ‘quality of life,” “making hard decisions,” “letting go,” “saying goodbye,” and ending suffering” enough times to almost believe it ourselves.  And there is a knowing that if the cards are stacked against us, and the chips are really down we do what we practice, we take matters into our own hands, we end suffering.

How do we get here? It’s a long road and many small steps, heart aches, and tears on the way  to Oz.

Being a veterinarian can be exhausting. You can get to the marrow tired. It can eat you from the inside out to the point of being all consuming. A gluttonous feast of your soul until there is nothing left to give and nowhere to seek salvation. A curse? Yes, it can be a curse. To care so much, to invest your whole heart, which is what many of our clients want for us as we care for their family members, and then there are the clients who ask you to remove a pet that they see as a burden. To juggle these emotions, these responses, and these ends of the emotional spectrum make it hard to navigate through each day.

We are all provided preservation mechanisms to protect our most precious inner self. Your choices are yours. Mask the difficulty of dealing with the stress with drugs, alcohol, and addiction, withdraw and leave the profession, start caring less, investing less of yourself, or burn out. Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Wear your heart on your sleeve long enough and someone will take it. But like every other thing in the universe with enough wear and tear on the system it will break down.

Four years at a school learning about the biggest, heaviest, and bulkiest transport vehicles in the world, steel ships, and I know that one big wave, one scrape on the bottom, or a swipe from an iceberg and that tin can will crumble, crack and sink. Nothing is impenetrable or unbreakable. Ask the Titanic or the Costa Concordia.

Did I learn about burn out, or compassion fatigue in vet school? No, you learn it in the field with those tiny sacrifices, those tiny blows, and those moments between the lines. You wake up one day and you realize that your life, your dream, and your reality are not one in the same. You dread work, you can't process the grief, the exhaustion, and the demands placed upon you.

Compassion fatigue is burnout when the candle that you are burning at both ends runs out of wax and wick. The profession can put unrealistic expectations on us. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. Our ability to wear every hat, mirror every clients expectations, and maintain a personal protective zone requires a strict code of rationing emotional handsels. 

Palmer

How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a sychopath and a schizophrenic. And we do it every single day.

I will be the first to freely admit that I grapple every single day of my professional life with compassion fatigue. When you invest so much into one thing you expose yourself to being bankrupt should your house of cards fall. Can I tell myself that this is just a job, yes? Do I believe that being a vet is just performing a job? No.

How do I keep going? I pay attention. All the time.

I try to put myself first, I have to. I say no, a lot. I stay true to who I am. If you don’t care about your pet I am not the right vet for you. I stand by my core values.

I am also very honest. I tell my clients when I have just had to say goodbye to an old friend, and that I might need a moment to collect myself, refocus and devote the time and attention that I want to to their pet. I also invest my whole heart into what I do. I know that I cannot practice any other way. To do this I have to understand that there are clients that I am not right for. I can’t care more for their pet than they do, and I can’t be a compassionate vet any other way. I give termination letters to clients that do not share my perspective and I stand by my true clients come thick or thin, hell or high water.

And every day I remind myself how much I love to be a part of my client’s family, and how lucky I am to be living my dream.

Here is the advice from the professionals;  

1. Put yourself first. 
2. Stay an active student. Learn, grow, and challenge.
3. Exercise, eat well, take care of your temple. 
4. Be realistic with your expectations.
5. Attitude is everything, keep your chin up. 
6. Seek help if you feel overwhelmed.

Help, and seeking help, is something the doctors often feel embarrassed, ashamed, or beneath us to do. We are comfortable and expected to always be giving the medical advice and unable, unwilling, and mute to ask for it when it applies to ourselves.

Symptoms of compassion fatigue include excessive complaining, isolation, compulsive behaviors, poor sleep habits, poor hygiene, apathy, difficulty concentrating, chronic physical ailments, and withdrawal from friends, family, or prior interests.*

The next time you see your vet, tell them that you appreciate them, and remind them that you know that we are real people with real hearts. And for as many times as we vets tell our clients who say to us that they "will never get another pet because it's too hard to say goodbye when we lose them," the same goes for us. Don't lose your compassion in the trenches of our daily life. Remembering to love, care for, and maintain our empathy is what keeps us human.

*This blog was based on the facts presented at the 2009 CVC Baltimore lecture given by Renee Rucinsky, DVM, DABVP of the Cat Hospital of the Eastern Shore in Cordova MD.

Wordless Wednesday. November 6, 2013

Boo and Beast. Who have become fast friends.
Everybody needs a buddy.

Cordova, mom of the Iditarod puppies, was spayed last Tuesday.
She is the biggest cutie-pie, I am in love with her.

Teddy, here for a weird bump in the armpit (always something to have looked at immediately), also has a thin hair coat and an abnormal liver value.
He is a case in progress. It may be nothing, it may be something.
His mom and I are running more tests to figure this out.
But ask him how he is feeling and he will tell you "I'm fabulous! You?"

Boomer the voracious, mischievous, but, oh so happy and sweet, Lab in his Halloween costume.
Fitting because he has had three trips to the ER for eating massive amounts of unattended, unsecured foodstuffs in the kitchen. If you leave him alone he will keep himself entertained, ruin your kitchen, and bankrupt you with ER charges.

Hailey and Quest, soccer teammates.

Emmy May, aka "Elbow" in her bright shiny smiley face!

Phoebe, who is here for her annual exam.
She is Beau's best bud and is helping to keep the peace.
Once again, it proves that our pets need a buddy.
When Beau lost Brea his parents adopted Phoebe.
Phoebe was the dog of a client entering long term hospital care.
She was brought to us to be put down because they thought that no one would want her.
Thankfully, they were wrong.

Henry. Growing up, now 6 months old. In his first Halloween costume!
SOO cute!

Palmer. One of Cordova's puppies.
In her first Halloween costume.
How can this not bring a smile to your face?

Me, in costume, at No Kill Harfords Howl-0-ween party.

Me and my date.
I am the Black Widow Spider Bride, and my hubby is my new recently deceased groom.
He is a great sport! Not every husband allows make-up and cocooning.

My beloved and Kelly, our Jarrettsville Vet kennel manager and No Kill Harford founder.

Not a patient, I promise.
Although I would be curious to know if he is on a well rounded commercially available kibble?
Someone needs to enter that on the recall list.

Tootsie came to say "hello" on Sunday, and get her nails trimmed.
She gets them trimmed monthly at the groomer, but they grow abnormally due to her bad skin and need more aggressive trimming to keep them from curling under making it painful for her to walk.

Bruna and Fredo. An interesting pair.
Fredo the new puppy tries desperately to befriend the reserved, somewhat cranky old lady other King Charles Cavalier, of the house, Bruna,
who will  not give him a second glance.
Yes, we all need a buddy, but sometimes it has to be the right buddy.

My favorite feline, Rizzy, with Angela, our receptionist.

Rizzy, and Lulu, who both refuse to forego claiming their spot under the front desk.

Sam, the Addisonian, caution dog (always needs a muzzle) here on Monday to fix his cruciate rupture.
For the first week of November 2013 he is the patient I am most grateful that did well.
These can be hard cases to manage.
He was a double whammy!

Zoey, now 7 months old, was spayed on Monday.
She has an appointment in two weeks to get her bad hip looked at again.
She will be at VOSM soon to get this corrected.

Harley and Brutus, at 6 months old, neutered and spayed on Monday.

Savannah (in her modest Halloween attire) and Jekyll on Thursday.
Savannah is doing well, eating, happy and getting around.
Fingers crossed and feeling grateful.

If you have any pet related questions you can find me, and a whole host of incredibly helpful people at Pawbly.com, or on Twitter @FreePetAdvice.

Have a wonderful week everyone!

Boo Gets Better

This is Boo.

He came to us a week ago looking pretty sad. He had been found by some very caring kids who knew that he was very sick but didn't really know how to care for him. So they brought him to us. 

He was about one month old. He had so much snot in his nose that he almost couldn't breathe. He also had so much gunk in his eyes that they couldn't open. 

He had what most sick kittens do; an upper respiratory infection. When a kitten gets stuffed up they can't smell their food, and when they can't smell they do not eat.

He also had a very low body temperature. 

But the biggest challenge he was facing was fleas. He had so many fleas that he was anemic. The fleas can, and will literally suck the life out of a pet.  

The best way to treat a young puppy or kitten with fleas is to remove them with a flea comb. Comb the pet and with each pass of the comb rinse it in warm soapy water. When all of the fleas have been removed dry the pet gently with a towel or a blow dryer on low or cool heat. A wet pet will get cold, and an anemic undernourished pet is always tempting hypothermia. Keep them warm and dry and free of parasites.

Kitten care is about a few very basic things;

1. Keep them warm.
2. Keep fleas off.
3. Keep them eating.
4. If you see snot and goop, you have infection, so go to the vet IMMEDIATELY!

Here is Boo about three days later!

And five days later.

Boo is happy, playful, eating like gangbusters, and breathing easy.

He is so comfortable that he actively seeks attention. A very sick pet will just lay there. They do not interact, they do not play, and when they stop eating its time to get medical attention!

This is Boo and Beast. 

Beast came to us from the local Humane Society because there were too many cats an litters for them to be able to care for. They are both recovering from their upper respiratory infections but the companionship does miracles in itself. Kittens need someone to play with and snuggle with. They keep each other warm and are less likely to have behavioral issues down the road. I swear by the two pet principle. Two is better, easy, and more fun, than one.


This is Boo at two weeks. There is no sign of infection anymore.

Cats and kittens are miracles. They have an incredible ability to heal.

Never, ever, underestimate them. But give them a chance by seeking veterinary attention should you see signs of infection.

A special Thank-You to Dr. Hubbard of Jarrettsville Vet for being such a good foster mom to the kittens. It takes a special person to be willing to get up multiple times a night to feed and care for kittens. Those miracles had some helpers and those happy healthy kittens are lucky to have found such devoted feline fanciers!

If you have any questions on pet care you can find me at Pawbly.com. Questions are free to ask, and anyone and everyone is invited to ask or answer. It's all about helping pets.

Or you can find me on Twitter @FreePetAdvice.

Please consider adopting a cat or kitten at your local shelter, and please remember to spay and neuter.

Thanks!