A sad case

A young, two year-old cat presented to me in severe and acute respiratory distress, severely hypotensive (low blood pressure), and vomiting clear fluid. The cat's gums were extremely pale and his temperature was a freezing 34.5 degree C (94.1 degrees F), indicating that the cat's extremities were very poorly perfused (no/little blood flow). The owner brought the cat in immediately after hearing the cat suddenly screech. There were no toxins to which the cat was exposed.

On examination, the cat's veins were hair-thin, so tiny that it was difficult getting an iv catheter in one of them - but we did. After giving the poor gasping cat a tiny dose of a sedative to calm him down, I administered a shock dose of iv fluids, which was touchy, as chest x-rays indicated that the lungs were full of fluid (could be blood, infection, edema, whatever), but I had to get his blood pressure up.
A presumptive diagnosis of anaphylactic shock or pulmonary embolus was made (the latter very difficult to diagnose in animals and people ante-mortem). I administered oxygen, injections of dexamethasone, epinephrine, famotidine (an antihistamine/H2 blocker for all you meddies out there), and Benadryl). Epinephrine was repeated twice in the next two hours.
Within ten minutes, the cat improved clinically with this treatment. The fluid rate was dropped, an injection of a diuretic was then given to relieve the fluid in the lungs, all the while the cat had watery fluid coming up from his lungs and pouring out from his mouth and nasal cavities.
Soon afterward, the cat turned blue indicating hypoxemia (low blood saturation in oxygen), so we gave him a low dose of milk of amnesia (propofol), intubated the cat, and manually ventilated him for over two hours. Watery fluid continued to pour from his nose. His gums returned to a normal pink with us manually ventilating him, but every time we extubated him to seet how he would do alone, he turned blue - not good.
We continued to intubate and extubate him but he could not ventilate on his own.
I advised the owners that he would need mechanical ventilation but such therapy in the ICU at the referral practice would have cost thousands, which he understandably didn't have. We extubated the cat, his breathing became severely labored so we put him out of his suffering and humanely euthanized him.
One of my technicians broke down crying... we were all so upset. I like to think that our efforts were noble. As vets, though, we always question ourselves: "Was my diagnosis correct?" "Did I do something wrong?" "Could I have saved this kitty?"
Fudge, this case didn't end well... but we tried.

Not the cat in question, but a cat receiving oxygen therapy.

Coming out...

...as depressed may be more difficult than coming out of the closet. As some of my regular readers may know, I have not posted very recently in many months, since the rupture of a long-term relationship. Since then, I have entered into a "circumstantial" depression, call it what you will...
Right now, I am actually on my way out of it.
My life from the outside is fully functional, I continue to work, and to love work. In fact, in all modesty I don't think I have ever been a more caring and empathetic veterinarian, and have never felt like such a good diagnostician.
A part of me is hiding, though. A significant part of me hides behind a very thick veil of diversions, activities, and (sometimes) feigning of happiness. Another part of me is truly happy, truly functional, truly "me."
My friends and family in whom I can confide have been nothing but supportive, loving, and caring, though there is only so much they can do. It goes without saying that I am also receiving professional help...
I am discovering that my true purpose is not to be someone's better half, though I must confide I don't always buy this. Then what is my true purpose? There must be something, someone, waiting for me, and for whom I am also waiting.
I have decided to "come out" so that perhaps others may realize they are not alone, that we are all human, and that through suffering we can achieve greatness.

Pet foods: where to begin?

I've wanted to write on the topic of pet food for ages, but I didn't really know where to start. Frankly, there is such a huge variety of pet foods on the market today, it is impossible for me to know each of them in detail.
I am often asked, "What is the best food for my cat/dog/kitten/puppy?" That is the million-dollar question. What is the best food for our pets? Is it kibble? canned? what brands? raw food?
I don't have the scientific answer, sorry everyone. However, I do have some facts to share, which everyone should consider when choosing what to feed their pet.
Dogs are omnivorous, which means their gastro-intestinal tracts have evolved to digest meat and plant material. Wild dogs are mostly carnivorous but will also eat berries and plant material when available, though one study showed the latter did not exceed 1% of the material in their stomachs. Domestic dogs likely branched off from wild dogs about 100,000 years ago, though this date is highly controversial with hypotheses ranging from 12,000 to 140,000 years ago. I suspect it is closer to the latter, though I certainly have no proof of this. My point is that humans and canines co-evolved in symbiosis, with the humans benefiting from having canines as protection, while their canine counterparts adapted by taking scraps from humans, and with time, precluding the need for the group hunt.
We know from canine behaviour that dogs are quite the indiscriminate eaters, and will often eat things they are not supposed to, including non-food items. Therefore, just because a dog will eat a loaf of bread or your favourite pantyhose, does not mean it should be doing so. Domestic dogs are not wild dogs, but their biology is constrained by their relationship to them. This means that things like their eating habits and behaviour (amongst many other things), evolved from the eating habits and behaviour of wild dogs.
I apologize for my loquaciousness, but having said all of this, and with the knowledge that at least 50% of our companion dogs are obese, I think that dog foods should closely approximate those foods eaten by their ancestors: diets high in protein and low in carbohydrate (such as wheat, corn, etc), and balanced in vitamins and minerals (such as calcium and phosphorus). Protein contains less energy than carbohydrate and carbs are diabetogenic, more so than protein. Combine all of this with a strict calorie-counting diet, and our dogs would be in much better shape (i.e., not the shape of a coffee table).

Cats are obligate carnivores, plain and simple. Their diets should approximate the nutritional make-up of, say, the small rodents they eat. Throw a mouse into a blender and voilà: high-quality canned food! I know the comparison is quite macabre, but it's true.
Most diabetic cats fed a diet that is exclusively a high-protein CANNED diet, will have their insulin requirements decreased and often go into remission.
Personally and professionally, I believe that cats should be fed as much (high-quality) canned food as possible.

More on pet foods in the future...

Not funny, folks...

Psychological unhealth... in dogs

Okay, okay, I'm giving in to the masses! A New Year, a new post...

It took me years as a practicing veterinarian to begin thinking about the psychological well-being of dogs. A healthy person is one who is free of disease: both physical and mental. A human patient suffering from general anxiety disorder, schizophrenia, or even a serious phobia, without cancer or diabetes, is still a sick patient, n'est-ce pas?
Therefore a dog who is hyperactive, untrained, phobic, or suffering from aggression (for example, fear aggression), is not a healthy dog. These conditions need to be recognized (the hardest part), discussed (the second hardest part), and treatment needs to be instituted.
How many vets recognize this? This is why the consultation starts in the waiting room. Veterinarians must recognize these issues immediately. The disservice is to let such patients go without having addressed the (sometimes easily) manifestations of poor doggy mental health. "Ok, he's now vaccinated, bloodwork is normal, no parasites..." Nope, not enough.
I want my patients to trot into the consultation room, be calm (to a realistic extent), sit when they're told to sit, and who obey their owners.
The dog who wants to take my face off will be given a poor bill of health as far as I'm concerned. That said, his prognosis is far from grave.

Depending on the context, this dog may require treatment.

It's been a month...

... since I've posted. My sincere apologies. I'm afraid I was not being completely honest in my last post. The difficult time I have been going through was much greater than the euthanasia of my cat, Isaac. My seven-year relationship had just ended as well, sending me into a state of shock, confusion, and near-depression. Here I was thrown a massive obstacle, completely out of nowhere, knocking me completely off a course of apparent bliss. Only very recently have I rediscovered my path, or at least a path, on which I have began to walk.

It is only natural, normal, to take these things personally when they occur. My ego was smashed, sent flying into a wall by a gargantuan frying pan. -smack!-

Through thought and meditation, I have come to realize that I am still the same caring and warm person that I was before, and that the behaviour of one person on another does not negate or undermine the importance of another. We all have our paths: some converge and others diverge.

Though I cannot see it now, I suspect that Oz will be at the end of this yellow-brick road.


Stay tuned for less drama and more veterinary-related topics.

My apologies....

... for not having posted for quite some time. Suffice it to say that I have been going through a very difficult personal period and that it has been extremely difficult to find the strength to do some of the things I enjoy most, like blogging and painting.
I will overcome this. This post is not to garner pity from anyone, but rather to express that, as all of us have experienced at some point, I am trying to overcome an unexpected curve ball that has recently been pitched at me.

This difficult period has been exacerbated by the recent euthanasia of my wonderful cat, Isaac, seen in the photo at the top of this page. I had been treating him for diabetes for about two years, and following a relatively recent additional diagnosis of acromegaly, it was evident his diabetes became uncontrolled. While he was not overtly suffering, his consumption of water had increased significantly and his voracious appetite, while I had previously written about it in my blog somewhat humorously, was really the only thing that was defining this cat. He lived to eat, would rarely leave his empty food bowl, and beg for food like a starving roadside village waif. His urine and stool were foul, reeking the house to a point where guests could not come over unless the house were fully aired out. The decision to euthanize him was based not only on condition, but on our suffering. Callous it may sound, but this is fact. While I could not predict exactly when, I knew that at some point he would start showing overt signs of suffering: he would develop ketoacidosis from uncontrolled diabetes, as well as the likelihood of starting to manifest neurological symptoms like behavioural changes and seizures secondary to acromegaly (caused by a pituitary tumor, which was spilling excessive growth hormone into his bloodstream). I was resolved it was his time, our time.
It was performed by me, peaceably, lovingly, painlessly, while he purred away in his owners' arms, knowing that they loved him as much as a human being can love anything.
Isaac was buried in a quiet corner of the backyard, with a large flagstone covering the earth over his grave, in which his body now lies still, while his spirit is meowing, hunting, and craving pizza somewhere above us.

Isaac, the cat: RIP 1995-2009

The veterinary consultation starts here:

While veterinary consultations typically involve physical ailments and diseases, normal mental or psychological health is just as important in our canine companions. These things can and should be addressed by the veterinarian as soon as the client is greeted in the waiting or consultation room.
I feel this involves greeting the client and taking a brief period of time taking a history, while virtually ignoring the dog. The vet should deliberate approach the dog, while still ignoring it. This allows the dog to not feel like the focus of attention, reducing its anxiety and allowing it to remain calm. Should the dog cower behind the owner or stand up begging to be picked up, the owner should gently correct the dog and have it sit beside or just in front of him/her. Constant whining or attempts to get the owner's attention should be gently corrected. I feel that these steps are mandatory to ensure a successful and relatively pleasant visit to the veterinarian, and should be applied to every situation in which a pet is stressed or anxiety-laden when going somewhere (groomer, vet, boarding facility, etc.).
Small dogs are over-represented here not because they're "prone" to anxiety or fear, but because their owners think that this is the case. Nothing is further from the truth. In fact, they are easier to correct physically (and I'm not deathly afraid of getting mauled by them), making them great candidates to work on during their visit. Like Cesar Millan, the dog whisperer, I like to "train" the pet owners as well and I find them so wonderfully open to it!
I'll leave it up to professionals to deal with large, aggressive dogs, as I impart much importance to my fingers and other body parts. With these rarely-seen patients, we do the best we can.
Enjoy your next trip to the vet!

Does it get any better than this?!

Long days... and loving it.

After nearly three weeks at my new full-time position, I continue to look forward to going in to work, to working long days, to a fantastic, talented, and industrious group of employees, to a friendly and down-to-earth clientele, to a plethora of challenging cases, to learning, to sharing my knowledge, and to invest in this position.

Though my hours are long, my schedule allows for plenty of days off during the week, allowing me to enjoy all of my personal activities.


Malassezia (yeast) infections: something extremely common in cats and dogs, especially during allergy season. These little buggers can cause nasty ear infections, and if you look for them properly, can be found anywhere on the skin.
Incidentally, our microscope in the clinic is suberb, but not an electron microscope (as what has taken this image).

Antibiotics do not suppress the immune system

If somebody asks me one more time, "Aren't antibiotics bad for the immune system?", I'm going to blow a gasket.
As a veterinarian trained in the West, I've been trained to use antibiotics for bacterial infections, not homeopathic remedies, nothing freshly grown and picked from the earth.
I believe I am diligent about the prescription of antibiotics... a pill-pusher I am not, unless of course pills need to be pushed.
If a dog, cat, or human being, has a bacterial infection (pneumonia, for example), the infection itself stimulates the body's immune system (because the bacteria are antigens - unrecognized by the body's immune system), while the stress of the entire infection on the body can eventually weaken the immune system. Immunity does not always deal with an infection by itself, especially with serious infections. Antibiotics, when properly prescribed, will kill bacteria, render them unable to multiply, or make them more susceptible to the body's natural immune defenses. Antibiotics are nothing but synergistic allies with the body's immune system. This doesn't mean that physicians should have carte-blanche when faced with treating infections in patients. Pros and cons need to be heavily weighed so that 1) the patient has the greatest chance of recovering and 2) the greatest care is given so that drug resistance does not occur (too late for many types of infections, unfortunately).
If an overwhelming bacterial infection kills the organism, well then, there's no immune system left now, is there?

Pneumonia-causing bacteria.

When used judiciously, these will deal with those above.

Cats don't normally....

... consume much carbohydrate. Felis catus, like the larger Felidae, are strict carnivores. The only carbs the large cats consume come from the gut contents of their prey (herbivores). Felines typically don't eat bread, grains, seeds, pasta, rice, couscous... you get the point. Not to say that they won't eat these things, right? Cats, though much more discriminate than dogs, also enjoy food!
So I came home to find my cat chowing down on a zucchini-carrot muffin, which he stole from the bottom of my gym bag. Especially for a diabetic cat, muffins are really not the way to go!
He's voracious all right.

Things he'd eat in a second. How 'bout your cat?

Air France crash

Apparently, a member of a royal Brazilian family, a dancer from the famed "Riverdance" group, and a couple of CEOs from some big company, were amongst the 228 killed in the Air France crash.
Everyone on that plane was someone's "royal," someone's dancer, someone's boss or employee, someone's love.
They were all human and every death caused as much devastation to a family as the next. Who cares what the ---- they did for a living or how popular they were in society... all mattered equally to somebody.
My thoughts are with the grieving families.

Humane Society Woes

Many years ago, soon after I moved to Toronto, I visited the Toronto Humane Society. I told them that I recently graduated as a vet, and management took me on a personal tour of the facilities, which had impressed me greatly at the time. Granted, there were exponentially less cats there at that time than today, but the wards were spotless, the dogs appeared clean and friendly, their runs were well-kept, and the cats lazily purred away while their owners-to-be agonized over which ones to choose. Upon questioning the manager about the THS's long and altruistic history, she reached for her bookcase and provided me with a copy of the THS Calendar, published in 1887, explaining and beautifully illustrating the Society's raison d'être.
Now we read in the Globe and Mail about the Globe's investigation into allegations that the THS has been ignoring the pleas of employees and volunteers to provide them with the necessary means to prevent suffering of their animals.
There appears to be compelling evidence thus far, even after reading just two articles on the subject. Witnesses seem to be coming out of the woodwork to expose their rather shocking personal experiences, while citations from THS management reminded me of the wind gushing from the mouths of yet unelected politicians (or managers who don't know what the ---- is going on in their businesses or institutions). I would have lent far less credence to the nauseatingly lefty writings of the Toronto Star (see last week's coverage regarding dog getting shot by cop - of course let's blame the man) - glad to be reading about this in the Globe.
Whatever occurs, the reputation of the THS must be restored so that its modus operandi not be eschewed for petty politics. Its mandate: to help alleviate the pain and suffering of (people and) animals.

Detail from an image in a previous post, from the Calendar of the Toronto Humane Society, 1887.
Update: OSPCA executes search warrants at Toronto Humane Society. Read here.

Cute AND tasty?

I could almost hear the collective "awwwwwwwww..." after the country learned of the piglet that wiggled its way from the confines of a transport truck onto the shiny asphalt of North America's busiest freeway, the 401, to then be saved by a good Samaritan who brought the pretty porcine to the THS. The piglet was examined by veterinarians there and will be treated for a broken leg.

Though admittedly adorable, I cannot but think of the piglet's fate, had it not fallen from the truck: it would have arrived at a pig farm, to grow and be fattened up over a few months or more, to then be slaughtered and used for our consumption, the beings so willing to wolf down menu items of pork chops, bacon, and pancetta, and yet with hearts so warm as to rescue this pre-fab menu item in order to alleviate its suffering. This story should be both heart-warming and also a reminder of the thousands, no, millions of adorable piglets and pigs being led to slaughter at this very moment.
Is this blatant hypocrisy or rather a more innocent manifestation of our contemporary human condition?

Humans eat pork products willingly. Our hearts also warm when seeing images such as this.

Carrying your dog around

I've blogged about this before: how inappropriate it is to conduct your day with your dog in a purse or other semi-capacious item not normally used to tote living things.
How it has come to incense me so, I do not know, but that I feel sorry for the dogs is clear.
Humans had it right millenia ago. Their behavior towards humans has changed little since then, while ours towards them has inexorably led to the very many doggie behavioral issues that need to be eschewed from the development of our intimate human-canine relationships.
I will continue to bring this topic up, as I would like to drill it into the minds of as many people as possible, in an effort for all of us to achieve the healthiest human-canine bond possible.
It's work, but well worth it!

The skull of what may be the earliest known dog, which dates to 31,700 years ago. The prehistoric skull was excavated at Goyet Cave in Belgium ( photo: Mietje Germonpre).

Human rights

Unrelated to veterinary issues, I am ashamed by the most heinous violations committed by Russia against the gay community during a pride rally in Moscow. Activists were arrested during this peaceful rally, hours before the all-inclusive Eurovision finals were to take place (which was won in 1998 by Dana International, an Israeli transsexual). As GPOC writes on his blog: an attack on the liberties of one group is an attack against us all. Where are Toronto's lefty protests now? We must all decry Russia's devolution to barbarism.

It's 2009 and this is still occurring on this planet.

Training Tips

I knew Twitter was good for something: I would never have found this page with 12 excellent tips (I think they're essentially mandatory) every dog owner should follow.
Click here for an obedient dog.

Lookee the photo I found online.

Twitter

I joined Twitter yesterday in order to boost readership of this blog. I have many great followers and readers (for which I am grateful), but I would love to reach out to more people out there in the blogosphere. Is it egotistical to want this? To want thousands and thousands of people following what I have to say? My training as a vet has helped bring me to this: a practitioner, a blogger... someone who is opinionated and isn't afraid to share it.
By joining this ultra-popular networking site, I, too, have been introduced to some spectacularly interesting blogs - there are some darn incredible writers out there!
My quirkiness notwithstanding, there are important things to bring to the forefront and I hope that this blog, my writing, my opinions, will evolve towards something more important, more intelligent, and of course, remain relevant to all of us.

Tweet.

Spring is here!

Spring is a time when many people take their pets to the vet for their yearly check-up. The snow has melted - in areas that receive snow - and pets become exposed to different things, like plants, dirt, baseball fields (and therefore baseballs), fossils, fault lines, fleas, ticks, and trolls (where they're indigenous).

Ok, jokes aside: dogs (and cats - cats are more complicated with respect to heartworm disease) require heartworm testing, monthly flea, tick and heartworm prevention, and possibly vaccines/boosters.
You should always your vet which vaccines are being administered to your pet and why. Ensure that a rabies vaccine is not given more frequently than what is labeled by the company (i.e., 1 year vs 3 years for rabies) or less frequently than required by law (which often correlates with manufacturer's recommendations. "Core" vaccines, like distemper and parvovirus (for dogs) and panleukopenia and rhinotracheitis (for cats) have been shown to provide immunity for at least several years, if not lifelong immunity. That's right: lifelong protection. I am confident that my patients are protected if their titers are sufficient. Vaccine titers are therefore becoming ever more popular. This entails the measurement of antibody against a certain disease (virus or bacteria). My recommendation is to check titers every year (if affordable - remember, the more people ask for this service, the more vets will offer it, and certainly vice versa - prices should go down as a result). I do not subscribe to yearly vaccines - this practice is outdated and medically unsound.
This does not mean that I don't believe in vaccines! In fact, the opposite is true. I would convince every owner whose puppy/kitten or naive pet (naive in the immune sense, meaning never vaccinated) that their pet MUST be vaccinated and booster a year later.
Dogs living in areas where Leptospirosis and Lyme disease are endemic should discuss these vaccines with their vet.
Not all dogs are candidates for all vaccines. So ask your vet, you've got the right to know!

Which one is right for your pet? Find out more by reading the American Animal Hospital Association (AAHA) canine vaccination guidelines here.
Guidelines for cats can be found here.
Lotsa reading, folks and may be complicated - my apologies!

Voracious cat

As you now know, my cat is acromegalic and diabetic. This means his diabetes is difficult to control and his high levels of circulating growth hormone (and uncontrolled diabetes) means he's constantly hungry. As I blog, he is bothering me for crackers and peanut butter, and is slowly making his way towards the New York style banana pudding (courtesy of Red Rocket Coffee).
Aside from a lick, which he now and then steals, I do not let him eat these things.
While slightly humorous, I must remember that not long ago, he would never have wanted to eat these things. Isaac, I must remember, is sick. This fact I have accepted.

Not Isaac, but I haven't ruled this scenario out.

More "Dog Whispering"

At my favorite neighborhood café, I kindly asked two young ladies if I could give them a short training lesson, after their dominant Chihuahua became aggressive when I introduced myself to him. It seemed he had a combination of dominance, fear, and territorial aggression. After the dog bit my fist (which I made so that fingers would be spared), I quickly put my left index finger around his tiny collar, and constrained him on my lap in this painless manner. After expressing his stinky anal glands and urinating all over me, I used my right hand to gently correct him until he was calm and submissive.
The two young ladies were very pleased. I made sure the dog could not see his owners (both sitting to my right), and would allow him to see them only once he was calm. He did not dare show me his teeth, growl, or bite afterward.
After his owners told me that this tough, little guy showed aggression towards larger dogs, I had another dog owner walk by a few times with both of her tail-wagging black Labs, as I held the little guy on the ground. The Labs very kindly introduced themselves to the Chihuahua, with barely a peep from the latter. We did this about a half dozen times.
This was the first time his owners could remember that he did not lunge or bark at the larger dogs. I insisted, rather drilled it into them, that these corrections must continue with them, lest his aggressive behaviour persist. I hope the bite on my knuckle and ensuing sepsis were not in vain.

An absolutely adorable Chihuahua.

Horner's syndrome

.... revisited, again, for the third time. Not that I'm complaining or anything, it seems Horner's is quite common. With over 70 million dogs in the US and 4 million in Canada, I would imagine that a significant number have been afflicted with Horner's syndrome at some point in their life. Have you heard of this syndrome? Has your dog or cat (or you) had Horner's? If so, tell me about it. Any questions? I'll try to help you out the best I can.
PS: See my post "Iranian kisses woman's breast," and the comments. By golly, I've been branded a racist.

A woman with Horner's syndrome (see previous two posts for photos of cat with Horner's).
Addendum: The eyes of two different colors, called heterochromia, is NOT part of Horner's syndrome. Note the small pupil and droopy eyelids. In cats and dogs, we'd also see the 3rd eyelid protruding. A sunken eyeball is often a subtler sign of Horner's.

Polo horses drop dead

It appears a pharmacy's mixing error is to blame for the death of 21 horses in Florida this week. Many of the horses started dropping like flies at a prestigious Polo Club in Palm Beach. Five horses not given a mixture of vitamins were the only ones that survived.
How utterly devastating. While this does not appear to be a deliberate intoxication of the animals, it is nonetheless heart-wrenching.
If I can digress: I'd rather see a horse running free in a field than chasing a ball in one.

I'm ok with this.

Painting

"Guppy," 48 inches X 36 inches, acrylic and mixed media on wood panel.
Not vet stuff, sorry.

Prolific

Not in the bunny rabbit sense. However, I have been busy painting my butt off the last few weeks. Some of my artwork will be going up at Red Rocket Coffee May 1st. How exciting!

Untitled, 36 X 24 inches, acrylic and mixed media on wood panel.

Puppies from China

Today the Toronto Star reported that a Toronto woman has spent thousands of dollars bringing seven puppies from China to Canada. Our country (continent actually) has enough rescue organizations which could have used that money to save a few cats and dogs. Perhaps a few fractures could have been repaired on a few Canadian rescue dogs (who will now have to be euthanized)? I am certain that this woman could have expended the same energy to find them a home in China.
Of course, most of us are gaga over the (never-ending) sensationalist Star coverage: adorable, happy little puppies in their recent Canadian photo-op. This story and photo likely turned thousands into doting, sniveling mashed potatoes.
This woman thought with her heart, not her head.

Dogs that could use a few bucks.