VMDiva

Is your local pharmacy advertising free antibiotics? Many in my area are. While I condone the judicious use of antibiotics, I am alarmed when seeing advertisements for prescription medications equating them to 5 for a $1 lemons and buy one get one crackers.  Offering a product for free removes any intrinsic value from it.  Antibiotic use should be taken very seriously.  With the emergence of Methicillin Resistant Staph Aureus (MRSA) and Multidrug Resistant bacterias (MDR), the medical community should only prescribe antibiotics to treat bacterial infections. Animals and humans must complete a course of antibiotics as prescribed. Finally, medical professionals must convey the seriousness of antibiotic use.

Get Smart: Know When Antibiotics Work

Veterinary medicine has long been limiting antibiotic use. There are only 5 antibiotics used in food animal production and high level broad spectrum antibiotics are reserved for humans only.  Precautions are taken to ensure any food animal treated with antibiotics has no trace left in the system before it is taken to market. Small animal veterinarians should prescribe antibiotics only when warranted. I, for one, will NEVER give away antibiotics.

It will take the entire medical community to slow the development of bacterial resistance.

I’m the first to admit I find chubby cat bellies irresistible.  Magical, squishy, gooey. As a veterinarian, however, I see a dangerous epidemic. Obesity in our pets runs rampant. Among other diseases, overweight/obese cats are predisposed to diabetes, heart disease, hepatic lipidosis (fatty liver disease), and osteoarthritis. Maintaining your cat’s weight in the ideal range can potentially add years to his life. I grade both dogs and cats using a Body Condition Score system on a scale of 1 to 9: 1 is emaciated, 5 is healthy, 9 is morbidly obese. Cats with a healthy weight have a tucked in waist and easily palpable ribs covered by a thin layer of fat. The area over the ribs should feel like the back of your hand. Your cat should be able to groom easily.

Your cat has a body condition score ranging from 6 to 9. Now what? First, consult your veterinarian prior to instituting a weight loss plan. Too little food can cause big problems for big cats. Your veterinarian can suggest changes right for your cat and will prescribe the appropriate rate and amount of weight loss. The most important thing to remember is you control your cat’s diet.

Diet

The basics to weight loss are always diet and exercise.  These are never easy feats. Here are some general guidelines for dietary change:

• Eliminate table scraps. Small pieces of cheese and meat seem like a treat but can provide a large percentage of your cat’s daily caloric need.
• Feed your cat set meals with exactly measured volumes of food. Free choice feeding, where a full bowl of food is left out and allows cats to graze, allows overeaters to pack on the pounds.
• Know exactly how much you are feeding your cat. A cup can mean many things to many people: a coffee cup, a measuring cup, a styrofoam cup. I recommend scoops/cups with volume markers.
• In most cases it is acceptable to simply decrease the volume of food you feed your cat.  A reasonable start is decreasing the total volume of food by 1/4. Example: You feed your cat 1 cup of dry food daily. Decrease that to 3/4 cup and watch for changes in body condition over the next couple of months.
• Remember: Dry food has many more calories than wet food. If you change the ratio of wet to dry food, be sure you are NOT removing too many calories.
• Ask your veterinarian if a prescription weight loss food is right for your cat.
• Monitor your cat’s weight AND body condition.
• Be strong! You control your cat’s food consumption. Tolerate begging. Don’t give in.

Exercise

Now I know what you’re thinking: Dr. K, you want me to take my cat for a walk? Not exactly.

• Give your cat plenty of toys to promote physical activity.
• Play with your cat! It will certainly benefit both of you.
• Try a laser pointer. Some cats can’t get enough of the little red light.
• Incite their predatory instinct. Take a small amount of dry food from a meal. Throw one piece at a time in different directions across the floor. Your cat loves chasing food and you secretly enjoy watching him exercise.

Work closely with your veterinarian and remember an ideal weight is attainable!

ANIMAL RIGHTS

The push for Animal Rights by such extreme organizations such as People for the Ethical Treatment of Animals (PETA) is one of my greatest concerns for veterinary medicine’s future. A common misunderstanding circulating publicly is animal rights are designed merely for the protection of animals from cruelty and neglect. These are, of course, admirable aspirations. Alarming ideas emerge among PETA’s relatively reasonable mission statement, pro population control position, and pictures of abused pit bulls. The agenda is much larger. They believe no animal should be involved in the food, fiber, labor, or research arena. Animal rights activists place animal life equivalent to human life. From PETA’s website: “Only prejudice allows us to deny others the rights that we expect to have for ourselves. Whether it’s based on race, gender, sexual orientation, or species, prejudice is morally unacceptable.” In addition, extreme animal rights activists believe imposing pet status on our domestic friends is a violation of their rights.

No meat, no wool, no service animals, crippled medical research. These add up to a weakened economy, revoked freedom of handicapped people, and stunted medical research for many animal models of disease resulting in continued loss of human quality and quantity of life. Let’s get it straight: I hate animal suffering. I hate seeing livestock mistreated. I eagerly await better computer simulated models for medical research. However, I also hate human suffering. And if I had to choose between the two, I always have to side with human life. Rational people would save mom from a burning building before Fluffy.

NOTE: PETA does not condemn pet ownership.

GUARDIANSHIP

More concerning still, animal rights activists (the ones who don’t completely abhor pet status) seek to elevate pet owners to pet guardians. On the surface, the idea of gaurdianship seems like a step in the right direction in imposing harsher penalties on animal abusers. However, guardianship would place animals at the same LEGAL status as a child.

Hypothetical headache: Fluffy is dying from congestive heart failure. She’s now developed kidney failure. She’s on every medication possible for the treatment of her diseases but her condition is worsening. She arrives at the vet in severe respiratory distress because her lungs have filled with fluid. The normal treatment of diuretics won’t work because Fluffy has compromised kidney function. Present day common sense says this is a time to euthanize Fluffy. With gaurdianship, euthanasia is no longer an option. You can’t euthanize a child; You can’t euthanize a pet.

Worsening the hypothetical headache: Now let’s say there is a legal loophole in the definition of gaurdianship allowing for euthanasia. Who gets to make a decision? The guardian wants to keep trying to treat Fluffy but the veterinarian believes continuing treatment will result in unnecessary suffering. The guardian now faces accusations of cruelty.  As with children, a third party animal services agency becomes involved to determine what course of action is in the best interest in the animal. Fluffy drowns in pulmonary edema during mediation.

ANIMAL WELFARE

The idea of animal welfare instead of animal rights provides a middle ground for responsible use and care of animals. The AVMA states, “Animal welfare is the ethical responsibility of ensuring animal well-being. Animal well-being is the condition in which animals experience good health, are able to effectively cope with their environment, and are able to express a diversity of species-typical behaviors. Protecting an animal’s welfare means providing for its physical and mental needs.”  Check out the rest of AVMA‘s definition and stance.

It’s a procedure receiving increased scrutiny and notoriety in the 21st century. It has also been highly publicized during various attempts to outlaw it.  It’s the cat declaw. Many heated opinions and myths surround the procedure. When I discuss declawing their kitten with owners, I anticipate one of two responses: “Can you do it today!?!” or “Oh no, that’s so cruel.” That’s hyperbole but it illustrates there are two greatly opposed positions on the matter. I’m not much of a middle-of-the-road minded veterinarian but this topic certainly falls in my gray zone.  Here’s to controversy: I perform declaws and I am not ethically opposed to the procedure. And here’s why:

Common Myths:

• Declawing removes the entire toe.
• The bone is always cut during the procedure causing tremendous pain.
• Declawing causes life-long pain.
• Declawing is painless.
• Declawing breaks the human-animal bond.
• Laser surgery is painless surgery.
• The cat will begin biting because it has lost its defenses.
• Most declawed cats will develop some type of severe behavior complication as a result of the surgery.
• The cat will certainly get an infection post-operatively.
• Cats cannot be trained to use a scratching post. They will definitely destroy your furniture if you don’t have them declawed.

The Facts:

• Declawing is painful. There is no such thing as a painless declaw. The degree of discomfort is up for debate.
• Declawing removes part or all of the 3rd phalanx (P3), or tip of the toe.
• The bone and claw can be spared with a tendonectomy, a procedure that cuts the tendons supporting the nail, though cats are more likely to get their nails caught in scratching materials due to lack of the ability to retract their claws. With this procedure there is a chance the nail, when not properly trimmed, can curl into the toe pads.
• Declawed cats usually completely recover in 1-2 weeks but in rare cases discomfort can be seen for up to two months following surgery.
• Most veterinarians are conscientious of the varying degrees of pain declawing may cause and use strict prolonged hospitalization and pain medication protocols. My own practice requires a three night stay with cats receiving continuous narcotic pain patches.
• Having had laser surgery myself, I assure you it is not painless. It may allow for decreased pain or a faster recovery time, but it is NOT painless. Laser surgery is more expensive due to the cost of the technology.
• Most declawed cats have no idea they are declawed. Felines credited with advanced cognitive ability are the same ones standing up “scratching” the molding, sofa, drapes.  Perhaps a higher thinking human would resort to biting, cats generally do not. No significant correlation has been shown between declawing and inappropriate behaviors like biting and urinating outside the box. This was shown in a 2001 study published in the Journal of the American Veterinary Medical Association. (1) Plenty of anecdotal evidence circulates the web concerning development of severe behavior problems, but to the best of the author’s knowledge, no scientific evidence has been reported.
  
• There is a small chance of complications following surgery. Infection, excessive bleeding, and an extended recovery period are rare.
• Older cats tend to take longer to return to normal function than younger cats. Extra weight probably makes weight-bearing more uncomfortable in the initial post-op period.
• Scratching is a natural behavior all cats engage in and that behavior won’t be stopped, however, a cat can be trained to scratch on appropriate substrates. It is typically easier to train a kitten than an older cat who may have developed an affinity for furniture.

The Procedure:  There are multiple ways to perform a declaw but whatever way you choose proves a simple procedure. I prefer the disarticulation method using a scalpel blade to incise the digit on the soft tissue fold at the joint between the 2nd and 3rd phalanx. I cut the ligaments on either side of the joint. When performed properly, the bone itself is not cut unlike what can occur using the guillotine method where P3 is cut at the base removing the nail but sometimes leaving a small piece of bone behind. P3 is then completely removed and surgical tissue glue, sutures, and/or  bandages can be used post-op. Laser surgery involves burning tissue and sealing the hemorrhage while cutting through the digit.

The Opinion: Declawing cats is an elective procedure. Most owners know whether or not they want to declaw their cat before the surgery is discussed. For those who don’t and seek an opinion, I offer the above facts and myths concerning declawing. I encourage them to begin trimming their new kitten’s nails regularly, encourage scratching posts, and encourage environmental enrichment prior to making the decision. I always address the surgical procedure in depth with my clients. Once the decision to declaw is made, I recommend declawing at spay/castration in order to minimize the number of anesthetic procedures and because kittens/young cats recover faster.

It is critically important to ensure proper pain management post-op. Because we can never be sure how painful the procedure truly is, all cats who are declawed should have post-op pain medication.

The temporary discomfort post-op far outweighs relinquishment to the shelter because the cat is destructive. Having been in a shelter situation in the past, it is heart breaking to see owners relinquish their pets due to destructive behavior knowing those animals have an equal shot at certain death versus a new home. The discomfort even outweighs making the cat an “outdoor” cat who runs the risk of being hit-by-car, contracting FelV or FIV, coming home with bite wounds, or not returning home at all – all things I see much more commonly than severe post-operative complications from a declaw.

The Alternatives: Nail trims every couple of weeks and appropriate scratching substrates are the two easiest ways to squelch inappropriate scratching. These are best implemented in young kittens who are learning behaviors. Another alternative is the application of nail caps, the most popular brand called Soft Paws, which are glued on the nail and fall off after a period of time much like a woman’s acrylic nails. These work very well in cats patient enough to sit through the application process. Soft Paws are not always the answer. The major issues I have encountered with them include: cats removing caps, individual caps falling off leaving some nails exposed and some capped, and the length of time it takes to apply them. If you have a cat patient enough to sit through a Soft Paws application, you most likely have a cat who will tolerate a nail trim instead. Nail trims are much easier and less time consuming.

(1) Attitudes of owners regarding tendonectomy and onychectomy in cats. Seong C. Yeon , James A. Flanders , Janet M. Scarlett , Stacey Ayers , Katherine A. Houpt Journal of  the American Veterinary Medical Association Jan 2001, Vol. 218, No. 1: 43-47.

Beginning the blog with a discussion of the end. Euthanasia of family pets is certainly the greatest burden of pet ownership. Pet owners, frequently at a loss for words during the death of their animal, often utter the same simple phrases. Many thank me for compassion and helping the passing of their pet. Many more state their belief that euthanasia must be the most difficult part of my job. I often console never daring to thread my ideas into such a sensitive situation.

As a veterinarian, I have seen degrees of suffering only imaginable for most people. I provide hospice care, see neglect leading to maggot infestations, watch animals starve themselves to death over weeks, and manage cases of “just one more day”.  Death is painful for most animals burdened with chronic diseases. Euthanasia provides relief of suffering. Many owners describe it as a “peaceful” process and express relief when it’s over. Then why do we wait so long? Why too often do I see animals minutes to hours from natural death finally arrive at my practice? The answer is wrought with complexity but comes down to human nature.  The human-animal bond is evolving such that pets are now considered family members held in the same regard as a child. This makes the loss of a pet equivalent to a human for many. Pets can also represent a passed loved one or any number of personal issues. Veterinarians are always trying to be sensitive to the underlying dynamic of the family which affects the decision. We know no owner wants to see a pet die. The truth is neither does the veterinarian.

I encourage veterinarians to be sensitive to the difficult choice owners make in euthanizing a pet. The veterinary oath states “the relief of animal suffering” is one of the highest responsibilities of a veterinarian. In turn, I encourage pet owners to provide a timely gift of euthanasia to an ailing pet. In truth, euthanasia is not the most difficult part of my job. Witnessing animal suffering is.

Goodbye World.

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.
I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.
I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.