Musings of a Veterinarian

Archive for January, 2010

Appalling Case of Animal Abuse

January 31, 2010 By: Dr. K Category: Opinion

An appalling case of animal abuse occurred near my alma mater this week and it sickens me. The local news reported a 33 year old Philadelphia father, surrounded by his small children, decided to teach his young pit bull a lesson after the puppy nipped at him. His solution involved dousing the animal in alcohol and setting him on fire. The man’s children reported the incident to school officials. The dog has apparently survived but has a tenuous recovery from severe burns to his face and neck.

This type of cruelty stirs a nauseating anger that grows the more I think about it. Pennsylvania Animal Cruelty laws state “It is a Misdemeanor in the first degree if a person: “Kills, maims, mutilates, tortures or disfigures any dog or cat, whether belonging to himself or otherwise; or administers poison to or exposes any poisonous substance with the intent to administer such poison to any dog or cat, whether belonging to himself or otherwise”  This is punishable by a fine of not less than $1,000 and/or imprisonment for up to 2 years.” This particular suspect is facing many other charges such as child endangerment and arson.

Remove children from the situation and this guy (or a similar perpetrator) could get a slap on the wrist. A $1000 fine is insufficient for this type of malicious disregard for life. Imprisonment up to 2 years is reasonable, but very rarely do the courts drop the hammer on animal abusers. This confuses me given the known ties between animal cruelty and domestic violence. It has long been understood that animal abusers often graduate to domestic violence. Regardless of personal beliefs about treatment of animals, it would be prudent of the courts to look at “gateway abuses” critically. I wonder how this man responds to his small children when they misbehave.

We need to seriously consider the way we handle perpetrators of heinous acts of animal cruelty. Anger management, domestic violence classes, and compulsory prison sentences should be mandated. Psychological evaluations could help prevent future abuses and should be incorporated. Perhaps the courts should even  require community service in an animal shelter. A small fine for first time offenders equates to a slap on the wrist and does nothing to prevent further abuses of both animals and people. Drop the hammer. Please.

Does Your Pet Affect Your Relationships?

January 28, 2010 By: Dr. K Category: Opinion

A recent article in the Wall Street Journal made me evaluate how my own pets affect my relationships. The article highlights how distorted priorities can lead to marital problems and dysfunction in the family. My husband knew what he was getting into when he married a vet, so I almost get a free pass when it comes to me lavishing my pets and treating them like the infallible monsters they are. With my own pet-to-husband balance in check (I admit to the occasional argument on who cleans the litter), I mulled on the ways my pets affect everyday life.

I just recently realized how disruptive the cats are to our sleep during their recent month of confinement. Both have been banished to the basement due to Winston’s inappropriate elimination (before you think I’m mean, it’s a finished basement with all the kitty amenities). With the cats safely locked away, there was no more waking up in the middle of the night to ax-like paws digging into my sternum. No more 3am howling in triumph after killing the toy mouse for the 1000th time. No early morning meowing alarm clock nervous we’d forget to feed him breakfast. I must say, I’ve been sleeping quite well.

In addition, the cats definitely affect the relationship with my in-laws. My father-in-law is dreadfully allergic to cats and despite my cleaning, vacuuming, dusting, and sterilization of the house, his visits can only comfortably last about 2 hours despite allergy medications. Summer visits lend themselves to sitting outside but winter visits result in trips to the movies or going out for dinner. I have no plans on ridding the house of cats in the future so I guess I have agreed to awkward visits.

I’m wondering how your own pets affect your day to day and extended relationships?

Tear Stain Products: More than Meets the Eye

January 24, 2010 By: Dr. K Category: Opinion

I’ve gotten a number of questions about Angels’ Eyes, the oral product that proclaims to rid little white dogs of their unsightly red-brown tear stains. Small breed dogs and brachycephalic cats commonly experience epiphora, or excessive tearing. Products like Angels’ Eyes promise to rid a pet of its tear stains with a daily oral supplement. I typically consider such claims nothing more than another gimmick. However, it seems as though this product might actually work for little Fluffy. I researched the miracle product and was surprised to find the secret ingredient is Tylosin.

Tylosin is a macrolide antibiotic commonly used in food animals but can also be used to treat campylobacter and mycoplasma spp infections among others in dogs and cats. It is also used as an anti-inflammatory to treat colitis, much like metronidazole. It is in the same drug family as erythromycin and azithromycin (Z-Pak). The company claims the product kills yeast, which they mistakenly call a bacterial infection, that are responsible for producing red pigment. Tylosin actually kills the bacteria that, when interacting with the yeast, cause the formation of pigment and subsequent stain.

I have some major issues with this product:

Tylosin tartrate is labeled by the FDA for OTC use in food animals. When it comes to use in dogs and cats, the FDA notes federal law restricts this drug to use by or on the order of a licensed veterinarian. This drug should not be sold OTC for pets. Period. Loopholes in the supplement labeling system allow companies like the manufacturers of Angels’ Eyes to sneak around FDA regulations with the disclaimer: These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. This disclaimer does not make the act of dispensing this drug legal, it merely allows the manufacturer to make the product without going through the expensive and arduous process of FDA approval. Because the FDA typically has bigger fish to fry, companies like this cruise under the radar.

Antibiotic resistance is a problem that affects all facets of medicine. Many common antibiotics have dual use in both veterinary and human medicine. While tylosin is a veterinary only drug, drug resistance to one drug can potentially result in resistance to an entire class of antibiotic.  I am concerned there are voices on the web who say that, because tylosin is a narrow-spectrum antibiotic, resistance is not a worry. Say what? First of all, tylosin has broad spectrum coverage against gram positive bacteria. Second, if an antibiotic has activity against ANY bacteria that bacteria can become resistant. Those same voices also claim tear staining leads to eye infections. Sorry, wrong again. Staining leads to unhappy owners; Improper tear production and tear flow coupled with shallow orbits, bulging globes, and underlying pathology leads to infection.

I also have serious concerns for any use of an antibiotic to treat a cosmetic issue. This is bad medicine no matter which way you slice it. Angels’ Eyes gets my stamp of disapproval.

The Art of Delivering Bad News: What I Wish I’d Known

January 22, 2010 By: Dr. K Category: Opinion

I was recently unpleasantly surprised with the diagnosis of a bone tumor in a young golden retriever I was convinced had a cruciate ligament tear. The ensuing conversation blindsided the pet owners and I was reminded of the importance of delivering bad news properly. I’m not the most articulate person but as I travel along in my veterinary career I have learned invaluable lessons in the delicate art of breaking bad news. Below is a short list of insights that may help an unsuspecting new veterinarian.

Be honest and forthright.

I am not a fan of the question “What would you do if he was your pet?” While I offer my opinion when solicited, I always note that I have a bias. That bias is what makes me a veterinarian. My job is to cure and treat disease, alleviate pain, and want to find the diagnosis. If you think an animal is suffering, kindly say so. Veterinarians sometimes better recognize the signs of pain, discomfort, and failing quality of life.

Get to the point. Repeat.

When delivering bad news to an owner, like the diagnosis of a tumor, it is tempting to talk about normal results and how the animal arrived at this point before giving the diagnosis. It just doesn’t work. Most people are perceptive enough to sense something is dramatically wrong and their minds begin racing as soon as you don’t say everything is okay. I find the most effective way to deliver the blow is with a soft voice, caring personal tone, and preface the entire conversation with “I’m afraid I have some very bad news for you, it appears as though Fluffy has a tumor in his abdomen that looks as though it has spread to his chest. I know this is a lot to handle but I’d like to discuss it with you.”

Further discussion at that time is completely dependent on the owner. Some owners want to discuss all options then and there. Others need time to digest the information and will need to call or visit later. Determining what the owner needs is a skill a vet develops over time. Too many times I have tried to plow through a discussion of what we do next only to realize the owner hasn’t moved beyond the word “cancer”. Once you deliver the news, summarize the findings again. In a state of shock, owners may remember only a fraction of what you tell them.

Don’t Use Euphemisms

It may be tempting to sugar coat findings to try to spare emotions but you will do a disservice to your patient if you fail to adequately explain the dire situation to its owner. A gentle apologetic tone prevents you from sounding too calloused. For suddenly deceased pets, using terms like “moved on”, “passed on”, and “no longer with us” are not definitive for a reeling mind. Use the terms “death” and “died” at least once in conversation and supplement the conversation with the other terms.  For the terminal diagnosis, terms like “life-ending”, “end-stage”, and “not recoverable” are warranted. In addition, “uncomfortable” does not mean the same thing as “suffering” to most owners so choose your descriptors wisely.

Offer Follow-Up

Once you’ve delivered the news, acknowledge there will be more questions. Suggest owners write them down, sleep on it, and call you the next day with questions. Make yourself available for a consulation appointment as some owners prefer speaking in person.

Be Compassionate

You’ve just rocked someone’s world. Remember what it is like to be confused and stunned. Don’t be afraid to reach out and hug a client in need.

How Many Times Do I Have To Ask?

January 20, 2010 By: Dr. K Category: For Vets

Apparently only one. At least that’s what the civil court said in a recent civil complaint against my practice. Let me give you some history.

Mrs. Notesta brought her young cats to our clinic years ago, well before I worked there. At the time, she declined Felv/FIV testing saying, in what typically amounts to a “never”, she wouldn’t test today and that she’d have to think about it. Thankfully, the veterinarian at the time noted this in the record. She declined testing the other 2 cats as well. Fast forward to eight years later when one of Mrs. Notesta’s indoor only cats, Lucky, becomes very ill. She is seen at a local referral center where, over the course of a couple of days she deteriorates and is euthanized. Lab results revealed she had Feline Leukemia Virus (Felv) and it was believed this lead to her death. Felv is not curable or even treatable, leaving cats with a compromised immune system and more likely to develop cancer. Fortunately, none of the other cats in the home were infected.

Mrs. Notesta wrote a letter to the hospital with accusations of negligence and malpractice because her cat was never tested for Felv. She contends that, because Lucky wasn’t tested, the hospital is liable for all medical bills incurred at the referral center, loss of salary for her time off, and other bills accrued during the cat’s illness. Despite having copies of the records with multiple documented refusals and repeated telephone conversations with the practice owner, she announces she will pursue a civil suit against the practice to recover her expenses.

A couple of issues come to mind with this situation:

1. Had the original veterinarian not recommended testing or failed to document her refusal, would Mrs. Notesta have a case?

  • Consider how the cat’s medical care would have evolved had veterinarians known she was Felv positive. Perhaps she would have received more aggressive antibiotic treatment when infections were evident. More aggressive treatment early on may have staved off inevitable illness a little longer.
  • Would Mrs. Notesta have pursued expensive diagnostics and treatments at the referral center had she known the cat was Felv positive and likely suffering complications of endstage Felv? Probably not. Even if the cat was not tested, testing would not have necessary affected the overall outcome. In the above scenario, is the hospital responsible for her bills if it failed to recommend testing?

I don’t know the answers to these questions but I sure look forward to hearing your opinions

2. How many times should you ask an owner about a specific diagnostic or treatment modality, especially if they say “I’ll have to think about it?”

  • The civil court judge  in this case ruled that one instance of documentation of the owner’s refusal for Felv/FIV testing 8 years ago was enough even though there were multiple documented refusals. The lawsuit was dropped, the owner paid her bill to the practice, and we haven’t heard from her again.

I think one additional inquiry about testing is warranted from a medical standpoint, if not a legal standpoint, especially if the owner left the conversation with “I need to think about it.”

3. Can clients construe repeated questioning about testing be construed as bullying?

  • Maybe. It depends on your approach and the client. If a client senses you’re uncomfortable pressing for an answer they usually become uncomfortable themselves. If a client says no, a reasonable response is “Well, if you ever change your mind and want to do that test let us know” or at an annual visit “Are we still holding off on that heartworm test like we did at your last visit? I certainly recommend the test for Fluffy.”

I am not legal expert and can rarely predict which way the court will rule, but I think veterinarians are probably “safe” recommending testing one time for diseases like heartworm and Felv/FIV provided the recommendation is recorded. Informed owners are key; It’s not enough to merely suggest a test but to explain why that test is important. I talk about heartworm disease in depth at least once, typically at a puppy’s final vaccine appointment. I still recommend testing to owners who have repeatedly declined heartworm testing for their dogs. I also discuss the long term affects of Felv/FIV with new kitten owners prior to recommending testing. I am sure to mention testing twice (if needed) and recommend the test strongly for all strays and all never-previously-seen cats.

Perhaps my approach is overkill, but I feel confident that when Mrs. Notesta writes me a letter, I have myself adequately protected.

Silly Saturday: Cat Congress Proves Ineffectual

January 16, 2010 By: Dr. K Category: Just For Fun

If you’re a cat lover and enjoy dry humor, you’ll chuckle at this article from one of my favorite satire news sites! Have a Silly Saturday!

WASHINGTON—The current session of the 111th Cat Congress was once again suspended Tuesday following the sudden introduction of a sunbeam onto the Senate floor, a development that has left a majority of transfixed lawmakers unable to move forward. Read the full article here at The Onion News.com!

Pfizer, You’re Killing Me!

January 15, 2010 By: Dr. K Category: Opinion

Here’s a little public grievance for my friends at Pfizer Animal Health: Stop jacking up the cost of veterinary medications on a quarterly basis and pricing my clients out of treatment!  There, I said it. Pfizer, creator of wonderful drugs like Convenia and Zeniquin, has been increasing the cost of its medications exponentially since early last year. I grimace as I prep owners for the financial shock when these medications are indicated. Don’t even get me started on the price of Rimadyl and Clavamox.

Perhaps the recession hit the drug giant hard and their financial loss is being passed along to distributors and veterinarians. This is capitalism in action and money makes the world go round, yada yada. My problem is not with profit, but the repetitive precipitous increases in cost that get passed on to my clients. It’s not that the price is rising, it’s how fast and how much the price is rising each time. In some instances, the price rises nearly $0.10/pill every quarter. That sounds like small potatoes until you take into account that’s $10/quarter and $40/year on every bottle of medication we dispense.  I recently wanted to prescribe 10 days of Zeniquin to a large German Shepherd for an ascending infection arising from a nail bed. Cost to owner would have been about $150. Yikes! Talk about seeking an alternative drug therapy!

Rising prices mean changing treatment plans to accommodate an owner who doesn’t have $150 to spend on medications. I will write a prescription for antibiotics so owners can get them for a better price at a local pharmacy. However, there are only a finite number of medications, particularly broad spectrum antibiotics, available to treat these common conditions so options are limited for a serious infection.  I lament providing the “suboptimal” treatment because, quite frankly, drug companies like Pfizer can’t put a cap on their prices for more than four months.

Top Five Reasons To Have Your Pet Spayed

January 14, 2010 By: Dr. K Category: Opinion

This one’s for the girls. Recent discussions on my friend Dr. Khuly’s blog, Dolittler, have compelled me to beg, plead, and grovel for you to please have your female cat or dog spayed. A recent discussion about a pregnancy gone awry topped with an article released from USA today about attitudes toward sterilization of pets have burdened my heart with the age old problem of pet overpopulation and unnecessary suffering. Despite advocacy to have pets spayed or neutered in a push to curb pet overpopulation, a staggering number of animals acquired last year have NOT gone under the knife! Granted, some animals were too young for surgery at the time of the survey but 24% of respondents who hadn’t altered their pets stated they “hadn’t gotten around to it” while another 14% stated they “didn’t feel it was necessary.” Irksome at best, but potentially a red flag for a bigger problem: Lack of proper communication and education between the veterinary profession and pet owners.

Top Five Reason to Spay

1. Pet overpopulation
An estimated 4 to 6 million unwanted and stray animals are euthanized in shelters every year. The world, quite honestly, doesn’t need anymore dogs and cats to add to the mix. There will always be pet overpopulation (I’m not so naive to believe the problem will ever go away) but every person can do his/her part by making sure the cycle ends with their pets. This is NOT to say responsible breeding should be outlawed or discouraged. I guesstimate responsible breeders (AKA not puppy mills, not backyard breeders, not accidental breeders) minimally affect the overall pet population.

2. Pyometra
An all too common affliction of older dogs is a condition known as pyometra, or an infected uterus. This is a life threatening condition that can lead to sepsis and death if untreated. A uterus filled with infection can rupture in the abdomen leading to peritonitis. This condition is 100% preventable with a spay. Spaying your pet as a youngster is significantly less expensive than emergency surgery years down the road, so you’ve got no room to complain about cost.

3. Mammary Cancer
Mammary cancer develops commonly in unspayed females later in life. About 45% of mammary tumors are malignant in dogs, whereas around 90% are malignant in cats, and dogs have a much higher number of complex and mixed tumors than do cats. Spaying dramatically reduces the risk of mammary cancer in both dogs and cats. In dogs the risk has been reported as 0.5% when spayed before the first heat, 8% if spayed before the second heat, and 26% if spayed after the second heat. For a listing of scientific findings check out SkeptVet.com’s summary of research regarding companion animal mammary tumors.

4. Unwanted/Unplanned/Poorly Planned Pregnancy
I’ve heard the “I just want her to have one litter” line too many times. She doesn’t need to have a litter. Period. In addition, accidental breeding can result in a size mismatch and a possible dystocia (read: stuck puppies) during labor. Raising a litter of puppies or kittens is expensive when you consider all the time, effort, or finance that goes into caring for them for 8 weeks. The bitch or queen should be examined following labor. The puppies or kittens will need to be examined, dewormed, and vaccinated prior to being sold or adopted. Lack of planning or foresight can set the unsuspecting owner back a pretty penny.

Dolittler describes a case of at best, egregious ignorance in pet owners who “married” two dogs, missed all the signs of pregnancy and labor, and allowed their poor Maltese to have a dead puppy in her uterus for 24 hours – a move that may have ultimately lead to the dog’s death. “Back yard breeders” must be discouraged. Back yard breeders are folks who decide they want to breed their dog, know little about doing it properly, and typically do it with dreams of profit. It seems as though those breeders always seem to find the sickliest, poorest-doing dog with multiple congenital and genetic problems and breed her. And don’t even dream of those dogs having been vaccinated. I actually had one couple ask if a puppy would come out of their Chihuahua’s “who who”. That’s biology 101 folks. If you don’t know where babies come from perhaps you should avoiding breeding. That applies to both dogs and people.

Proper breeders will have their dogs or cats tested for contagious diseases, examined for general health, radiographed to see the approximate number of puppies/kittens, and are prepared for whelping/queening. They will follow-up with a veterinarian and have all puppies/kittens examined, dewormed, and vaccinated prior to placing them in appropriate homes.

5. Stop that Heat Cycle
Blood, howling, nervousness, lingering males. Need I say more.

Antifreeze Intoxication: What You Really Need to Know

January 13, 2010 By: Dr. K Category: General

Cold weather means snow, hot chocolate, and car problems. That puddle of antifreeze in the driveway could mean more than car trouble. Dogs can’t resist the sugary taste of antifreeze and consumption can lead to big problems for your pooch. Cats are less likely to lap up antifreeze but, if they do, the same fate awaits.

The main ingredient in antifreeze is ethylene glycol, an alcohol. Once ingested, ethylene glycol is rapidly absorbed in the GI tract, typically within 1-3 hours. The first 12 hours after ingestion pets will be intoxicated by the alcohol and therefore, may behave like they’re drunk. Ataxia (stumbling and falling), seizures, stupor, and coma can occur.  Ethylene glycol is then broken down to glycoaldehyde → glycolic acid→ glyoxylic acid → oxalic acid, with different stages of disease occurring with the different metabolites.

Glycolic acid is highly toxic as it inhibits cellular energy metabolism and causes a severe metabolic acidosis. This can lead to cardiovascular collapse evidenced by high heart rate, pulmonary edema, and heart failure. If your pet survives these first two stages, it will contend with kidney failure caused by the end product of ethylene glycol metabolism, oxalic acid. Kidney failure typically occurs 24-72 hours following ingestion in dogs and 12-24 hours in cats. Oxalic acid causes kidney necrosis, or death, along with swelling. All three stages of toxicity can overlap making it difficult for the veterinarian to determine exactly where the pet is in the disease process.

If you suspect your pet has consumed antifreeze, you need to contact your veterinarian immediately. Diagnosis of ethylene glycol ingestion is made largely based on history and clinical signs as well as laboratory abnormalities. Metabolic acidosis, low blood calcium, and calcium oxalate crystals in the urine are typically diagnostic. These urine crystals can be present in the urine of nonaffected dogs and cats but should be held in high suspicion in animals with other symptoms. A blood or urine test exists for ethylene glycol, but is only available at certain laboratories and results may not be timely. Additionally, these levels are only detectable for up to 76 hours post ingestion.

Aggressive medical therapy is required. Aggressive diuresis with intravenous fluids is indicated. If ingestion recently occurred, the metabolism of ethylene glycol should be prevented by using compounds like 4-methylpyrazole (more widely used) or ethanol. Both compounds inhibit alcohol dehydrogenase, the main enzyme that begins the breakdown of ethylene glycol. In addition, drugs like thiamine and pyridoxine are used to prevent oxalate crystal formation. Urine output must be monitored closely. Some patients require hemodialysis or peritoneal dialysis.

Prognosis for animals treated in the early stage of ethylene glycol intoxication is guarded to good when appropriate treatment is instituted. Prognosis is poor for animals who have already developed kidney failure.

VMDiva is on Twitter!

January 11, 2010 By: Dr. K Category: Opinion

I have followed through with one of my New Year’s resolutions! And yes, I am proud of it!

You can now follow me on Twitter: @VMDiva. New blog posts will be listed on my Twitter page. Follow along for more personal updates and get to know your VMDiva!