A Day in the Life of a Veterinarian

A Day in the Life of a Veterinarian

 

A lot of people have always asked, “how do you do it?”  Most often, they are referring to the act of euthanasia and relieving animals suffering.  But our profession is more than that.  And no, it’s not just playing with puppies and kittens though sometimes that is the best part of our day.  All this in consideration, I thought I would take you through a recent 24HourIconday I had with all the ups & downs that may come with it.  Just to preface this, it will try to be like an episode of “24” except no explosions, car chases, or Kiefer Sutherland.

 

My job at the Kingston Veterinary Clinic is scheduled from 9am to 6pm every Tuesday.  The particular Tuesday we’re looking back at happened like this…

 

Charlie Taylor waiting7:00am – The buzzing of the alarm goes off.  Yes, it’s good to be alive but the sound is still unpleasant.  The morning begins as I get ready for work and take care of all 5 of our own family pets.  Then I leave the house with 30 minutes to go before work.

 

9:00am – I arrive at the Kingston Veterinary Clinic and have a quick look at the schedule.  It’s a full morning as I’m completely booked up with appointments from then until noon.  Alright, time to start!  The first appointment looks to be a simple one – a dog with an ear infection.  But the owner just cleaned the ears at home!  This makes a diagnosis more difficult but we agree on a symptomatic treatment plan and they depart.  In the next room, a family awaits with their kitten they just adopted from the humane society.  No problems but they want to establish a relationship and just have a general health check up.  I examine the kitten and deem her healthy so we have a discussion on feeding & litterbox use before they depart.

 

A healthy puppy I vaccinated

A healthy puppy I vaccinated

This continues over the next few hours.  Vaccines on a middle-aged dog, itching & scratching for 3 weeks on another dog (he had fleas!), a cat urinating outside of the litterbox and her owners are frustrated by it…that was just the next hour.  I had a few more appointments involving a mixture of vaccines, skin & ear problems (which are very common in the summer), and a case of diarrhea in a dog that eats whatever he wants.

 

11:30am – I came to my last appointment of the morning which was a cat who had a 3 day history of being lethargic and breathing a little heavier than normal.  His owners were concerned but had not felt this was an emergency so he was not brought in earlier.  As I examined this kitty, I could see an abnormal movement in his breathing pattern and I could hardly hear any lung sounds.  I was suspicious of a pleural effusion, which is a build up of fluid in the chest surrounding the lungs which makes it difficult to breathe.  I was given consent to take an x-ray (radiograph) and the diagnosis was confirmed.  I went over the possible causes and prognosis with the owner then explained how we would have to drain the chest which they agreed to do.

 

More normal lung capacity in a cat

More normal lung capacity in a cat

Pleural effusion in a cat

Pleural effusion in a cat

12:15pm – I spent the next 45 minutes getting the patient ready and doing the procedure of tapping the chest.  The intricate details of this will be told at another time.  Once we were finished, the cat was breathing much better and I called his owners with an update.

 

1pm to 3pm – This is the time of day on Tuesdays when I can get caught up on records, phone calls, filling prescriptions, maybe have a bite to eat, or take my dogs out if I brought them to work that day.  On rare occasions, I’ll end up seeing an emergency if the other doctors are fully booked or I could get an emergency surgery (which everyone I work with knows I would drop everything in a heartbeat to help a patient).

 

3pm to 5pm – Appointments start up again with another mixture and variety of vaccines, a limping dog that we determined was a likely sprain, and a check eye.  For the check eye, the owners aren’t sure what happened but this particular cat is squinting and has a discharge.  I try to get a look at the eye but this particular cat is not very happy,

Example of fluorescein stain

Example of fluorescein stain

possibly because he is in pain.  I get one of the veterinary technicians to hold onto the cat by wrapping him in a blanket.  We are able to get his eyelids open and put some numbing drops in there.  When I look again, I can see some cloudiness and we decide to stain the eye.  I explain the findings to his family and we get him set up with some antibiotics and pain medication to go home.

 

5:30pm – Appointments have run over by a bit and my pleural effusion patient is waiting to be discharged.  The prognosis is not great but they are going to take him home for as long they can keep him comfortable.   I would dearly love to get out on time and get home to my dogs as I know my wife will be at work late (her shift runs an hour later than mine this day) but a few more medication refills have been added to the list as well as the records I still have to do.  I’m also reminded that a client is waiting by the phone to hear about some blood tests we did yesterday.

 

By the time I’m done, admittedly with a brief social break to chat with a co-worker, I’m finally done just after 7pm and begin the commute home.  It’s time to take care of my own pets with a walk outside, some food for both them and my wife & I, and then I settle in with some television as I put the final touches on my next blog post.  It was a busy day and I’m thankful that I didn’t have to euthanize an animal.  And sometime around 11pm I’ll finally get some sleep and rest up for the next day.  Not everyday is like this where it can be a bit hectic but everyday is different which is part of the fun and enjoyment of being a veterinarian.

Jennifer & I with Charlie & Taylor...the cats don't pose well

Jennifer & I with Charlie & Taylor…the cats don’t pose well

To see what else I might be up to on a more daily basis, be sure to like my Facebook page or follow me on Twitter!  Also comment below if there is something you would like to know more about or hear my perspective on.  Thanks for reading & sharing!

When Your Cat Has To Go…But Can’t

When Your Cat Has To Go…But Can’t

Imagine yourself on a cross country road trip.  Now come to the realization you have a small child in the back who needs to use the bathroom really, really bad.  Incessant cries come from the back seat, “I gotta go to the bathroom!” ringing out every 2 minutes.  Do you remember what it was like when you were that kid?  Good, now you know what some male cats may experience.  Yes, this is all about blocked cats, or more appropriately named, urethral obstruction.fresh step cat

This is a condition that is almost exclusively involving male cats but we do see a rare female urinary obstruction.  It also can occur in dogs but with less frequency.  There may be some warning signs before a full blown obstruction and you should heed them to potentially avoid more significant health problems and to help lower the costs of veterinary care.

Causes

The cause of a urethral obstruction can take some time to figure out and the cause may not always be apparent.  A urinalysis will need to be done to help rule out causes.  Urinary tract infection (UTI), idiopathic cystitis (bladder inflammation for an uknown reason), and mucus plugs can be some causes.  More commonly, we will find urinary crystals or even bladder stones as the main cause for obstruction.

food-bowlOne of the main things I find when I take a history on these patients is the type of diet these cats are on tends to be a poorer quality diet.  By this I mean, less expensive diets that are readily available in most grocery chain stores.  Now this is not to say that the type of food is the primary or only cause for crystals & stones.  In dogs, UTIs contribute to formation of struvite stones but we do not see the same phenomenon in cats (there are multiple types of stones/crystals but for now we will focus on struvites).  Over-saturated urine, alkaline urine levels (the opposite of acidic), and increased magnesium & phosphorous levels are also implicated in the development of struvite crystalluria.

blocked cat diagram
Signs

So back to our road trip analogy…  The first sign people may notice is their cat crying when it is in the litterbox.  This can be an incredibly painful condition.  Sometimes they will still be able to urinate and maybe just producing a few drops but it is not enough.  The urine may also be bloody which owners may notice if their cat is not using the litterbox, which is often the first sign of many urinary tract problems.  Cats can also be found making frequent trips to the litterbox.blocked_cat

The longer the obstruction lasts, more severe illness will follow.  Essentially, we will see the signs of kidney failure.  For cats that are not presented to a veterinarian as soon as signs are noted, their bladder obstruction will cause a back up affecting the kidneys.  Lethargy, vomiting, decreased appetite, and trouble breathing can all be seen.  Some heart arrhythmias can also be noted with significant electrolyte imbalances.  These cats can still be helped but the road to recovery may be a bit rougher.   In the worst case I’ve known, the bladder ruptured and the patient died within minutes but the family had waited 3 days to bring this cat in.

Treatment

By now, cats like these should be at the hospital.  But what exactly will happen now?  After the initial examination & going over an estimate of costs, we will get the patient sedated and place an intravenous catheter.  IV fluids are necessary to help a patient produce enough urine to clear out their bladder as well as to help correct electrolyte imbalances which can be common with a blocked cat.  Next, they are placed under general anesthesia and the process of unblocking begins.  A urinary catheter is passed to relieve the obstruction and then the bladder is emptied.  A urine sample is kept for analysis and the bladder is flushed out before a new catheter is placed that will remain in place for 24 hours.  I always recommend a radiograph as well to see if there are stones that may be contributing to the problem.

hospitalized catAfter 24 hours with the catheter running well and a return of normal blood values, we remove the catheter and monitor the patient for another 24 hours.  If all is going well, they can go home with appropriate medications that were started in hospital or diet changes dependent on the urinalysis findings.  Medications will often include pain medications and urethral muscle relaxants.  But if they re-block, which is certainly a fair possibility, another catheter must be placed and the whole process repeated.  If they reblock again, a surgery may be discussed called a perineal urethrostomy in which the urethra is actually widened.  Simply put, it’s sort of like a sex change for a cat…but that’s a discussion for another time.

Final Thoughts

Long term care of these patients doesn’t have to be complicated.  Follow your veterinarian’s recommendations regarding diet choices and follow up visits for rechecking a urinalysis (can be as often as every 3-6 months).  Good compliance on your part can keep your cat happy & healthy.  If you see your cat straining in the litterbox, passing small amounts of bloody urine, or vocalizing while trying to pee, get them to the veterinarian as soon as possible.  The longer you wait, the worse it will be for your cat and your wallet.  Remember what it was like a kid to have to wait on that road trip and don’t put your cat through the same experience.

Annual Examinations – Not “Just Shots”

Annual Examinations – Not “Just Shots”

 

I’ve seen two animals in the past week that unfortunately were euthanized.  But they didn’t have to be.  The first was a diabetic cat who presented to me in a dehydrated, lethargic state.  He also was showing signs of diabetic neuropathy and had lost half of his weight.  His family mentioned that he was peeing buckets and the litterbox was flooding.  He had been sick for some time.  The second was a cat who came in paralyzed in the back legs.  She had not been seen by a vet for at least 3-4 years and was now in immense pain and unable to move.  She had a heart murmur and I suspect her heart disease had been chronic.  Her back legs were cold and now at 10 years of age, she was going to leave this world at an age when most cats are considered middle aged.  Two distraught families…two lives cut short when their health issues could have been prevented or managed.

 

dog exam

Yep, we veterinarians can sometimes make miracles happen and prevent death.  We can help your pets live happy and healthy lives.  The secret to making this happen is the annual exam.  There are almost 160 million owned cats & dogs in the USA (1).  Approximately, 37% of homes in Canada have cat & dogs totalling around some 15 million pets.  The problem lies in that many of these pets don’t get seen by their veterinarian except once a year (sometimes) or when they are sick.  Cats are half as likely to be examined than the family dog.

 

feline physical examFor many of these pets, they are often only brought in for vaccines every few years.  One of the most common things I can hear from clients when they come in is that “he just needs his shots.”  Well, I have to break the news to these people that it’s “not just shots.”  The annual physical exam is just as important, if not more so, than the vaccines.  We need to run our hands over the dog and feel for lumps that could be tumors.  We need to listen to that Fluffy’s heart for any signs of a murmur.  And how about those teeth in Rover’s mouth?  Dental disease, or rather the smell of bad breath, is one of the main complaints about animal health along with pet obesity and skin issues.  As pets become older, an annual exam or even twice yearly exam is even more important.

old dog 2

In many areas, before medications can be dispensed, a valid veterinarian-client-patient relationship (VCPR) must be established.  The definition of this means that we as the veterinarian have examined your pet and had a discussion regarding our exam findings.  So for pets who are on long term medications, even if they are not due for vaccines, they need to be examined annually for this relationship to persist.  We would be in violation of our licensing body if we did not uphold this portion of the laws.  It’s not just good sense to have your pet examined annually, but from our standpoint, we have a legal obligation.

 

Image courtesy of TheSocialDVM.com

Image courtesy of TheSocialDVM.com

Back to our patients from before…  The diabetic cat could have been diagnosed earlier and perhaps his family may have been better able to treat him even though treating a diabetic is not as difficult as one might think.  The second cat had a fairly significant heart murmur that had likely led to thickening of the heart walls and also changes in blood pressure.  She had thrown a clot to her back legs, commonly known as a saddle thrombus.  Had she been seen earlier and her heart disease treated, the current problem could have been avoided and her quality of life could have been better over the past while.  Remember, our job is to advocate for your pet’s health.  When we encourage and remind you to bring them in for an annual check up, it is only for their benefit.  And yes, everything might be normal and healthy, but for every completely healthy animal, I see at least 10 more that have at least one addressable health problem.

Tips For Your Veterinary Clinic Visit

Tips for Your Veterinary Clinic Visit

 

How many of us like waiting around in our doctor’s office?  Not many of us I can imagine…  Now what about the length of time you spend in the veterinary clinic?  Honestly, I have always found veterinary clinics to be more personable than most human doctor offices or hospitals so maybe your time in a vet clinic isn’t as bothersome.  On the other side of the coin though, we don’t like running behind and we want to give you the best service possible to keep your pets happy & healthy.  So I’ve got some tips, or maybe they can be seen as unwritten rules, to make you & your pets’ visit safer and more efficient.  Not only that, it will make your fellow pet owners and the veterinary staff happier.

 

cat in carrier

Cats should be brought in carriers and dogs kept on leashes – This is for their safety and yours.  I’ve lost track of how many times I’ve seen one pet get too close to another and a bite or scratch ensues.  Additionally, I’ve known a few clients who either got caught in the middle of the scrum or were clawed by their cat they were holding as it became frightened from all the noise.

 

ear mitesCleaning your pets’ ears before the appointment you made for us to check their ears – We certainly do appreciate you looking after your pets’ health.  However, if the problem your are bringing them in for is related to the ears, we really do need to see what’s going on in there.  Oftentimes, it can be easier to make the diagnosis by looking or smelling the ear.  Words can’t describe the awesomeness in seeing those ear mites crawling around in the ear and knowing that I can help that patient definitively!

 

Know what food you are feeding your cat or dog – When I ask what food your pet is eating, I get an “I don’t know” pet food supplyanswer probably about 60% of the time.  Sometimes I get told “my wife buys it” or “we feed him from the blue bag.”  It’s important for us to know what your pet is eating especially if we are discussing a pet that is over or under weight.  Many weight problems can be helped by feeding the proper diet.  By knowing what they are eating, we can help ensure your pet is eating properly.  Tip: Bringing the empty bag is best but a picture of the front will do.

 

3 dogsWhen you have an appointment for 1 pet, but bring in an extra pet for us to look at – We understand that your time is precious and that you enjoy the convenience of squeezing in multiple vet visits in one trip.  And we have no issue with Sparky coming along to keep Rover company.  But when an innocent question such as, “by the way, Sparky also is scratching at his ears, could you have a look?” is asked, it sets us further behind which isn’t fair to the next patient and their family.  Most of the time we will graciously consent because we take pride in our profession and the service we offer but it really does throw a monkey wrench in our schedule.  So if both pets need to come in, ask us on the phone if we have time for them both.

 

wet dog shaking

Giving your dog a bath right before the appointment – Don’t get me wrong; we love clean dogs and knowing that they are well cared for.  However, when a wet dog comes in for an exam, it can create a few problems.  First, any water they drip or shake can make for a slippery floor.  Secondly, as we are palpating a wet pet fur can get clumped which may obscure small skin masses and as we remove our hands we are more likely to look like the Wolfman rather than a veterinarian.  And of course, happy wet retrievers just love to snuggle us which then makes us look like we’ve wet ourselves.  So let’s hold off on the baths until after the exam, we won’t pass judgement if they are a little dirty – dogs will be dogs!

 

Well, I hope these few tips will help your visit to your veterinarian run more smoothly and efficiently.  If anything, these small little things will often go a long way towards making your relationship with your veterinarian better.  I’ll be revisiting this topic as several of my colleagues have offered further suggestions so this is just part one for now.  Don’t hesitate to leave a comment below and thanks for reading & sharing!

How a Cat Picked a Veterinarian

How a Cat Picked a Veterinarian

 

I want to tell you a story.  The story of how a cat found a soul mate and her own veterinarian.  It’s also a reminder of why you should spay or neuter your pets because there is just no way we can find homes for them all.  You see, sometimes at a veterinary clinic, animals are left on our doorsteps.  No, this doesn’t happen everyday but it’s less common now because there are more shelters that people can abandon, errr surrender, their pets.  Then there was this one time I was happy to know that one cat probably got away from her family.

 

First days at home

First days at home

In the summer of 2001, I was working at Shores Animal Hospital in Gainesville, Florida.  I had been there for a little over a year and was waiting to hear about veterinary school applications.  We had arrived at the clinic in the morning to find a box…with a kitten in it…and a note.  The note said, “We found it in the bathtub of our construction site.”  The kitten was a small, scrawny, brown tabby.  We took her into the clinic and she was fed, cleaned up, and monitored for the day.  My boss and his technician examined her and gave her a presumptive diagnosis of ringworm.  Ringworm is not an actual worm but a fungus.  Being the compassionate people that veterinary professionals are, they couldn’t do anything but get this kitty some help.

 

Not so innocent but irresistibly cute

Not so innocent but irresistibly cute

As ringworm, or properly called dermatophytosis, can be a highly contagious skin infection, it was decided that she should be sent home with someone who didn’t have any pets so she could be treated and then we could adopt her out to a client.  And then John, our licensed technician, came and found me quietly doing my work.  I had been chosen to care for this little kitten as I was an eager pre-veterinary student and I was without any pets.  I was given a bottle of shampoo, cat litter, a bag of kitten food, and a little bundle of fur.

 

When I arrived home, I set her up in my bathroom as I had not kitten proofed the bedroom.  I went to check on her and she had vanished!  A frantic search ensued thinking I had lost my hospital’s cat and in a call to my mother I was greeted with her telling me, “congrats, you have a cat!”  It came to pass that she had wedged herself behind the bathroom vanity in her frightened state and only reaching into the dark hole was she able to be removed.  Later that night, she got her first bath and the screams were horribly saddening.  I could only relate the sound to that from a classic 1984 film….then I welcomed Gremlin to my family. Gremlins-Poster

 

Gremlin grew up and a year later we had moved to Illinois for veterinary school.  She became my own personal physical exam practice cat during first year and dutifully, though sometimes very wiggly, gave in to weekly abdominal palpations and thoracic auscultations.  Gremlin would sleep at my side at night and sit on my desk while I studied.  During my third year of school, a heart murmur was discovered and she was diagnosed with hypertrophic cardiomyopathy (more on this later). 

Living in Illinois 2004

Living in Illinois 2004

 

The years came and went.  We’ve gotten her heart issues under control.  She’s survived multiple moves across states & countries and finally to our home in Kingston, Ontario.  I even had a couple more scares with her getting lost when she just really had good hiding spaces including under a gas stove and behind a desk.  She even approved of my wife…true story but before Jennifer, any time a girlfriend came over or was mentioned, Gremlin would vomit.  She’s truly warmed up to Jennifer, though it may be the bribery Jennifer would offer her with treats or maybe she just gave up and accepted that she wouldn’t be the only girl in my life.

 

Admittedly, Gremlin is daddy’s little girl and is a spoiled cat…and she deserves it.  She was one of the first our pets to come and see what was going on with Charlie after his surgery.  She also gives the greatest snuggles since our previous family cat Zorro which helps me unwind and have a good sleep at night so I can rest up for helping more patients the next day.  Gremlin knows when Jennifer or I have had a bad day and comes to comfort us.  So I guess these things makes her a caretaker.  I’m extremely grateful to have her in my life just like all our pets (another cat of ours, Louie, was also brought into the clinic & surrendered).  But we can’t take them all and it’s not right to dump them on a doorstep, so we’re serious when we talk about spaying & neutering.  Sometimes the pieces just fall into place and we welcome them into our home.  So in case you’ve ever wondered how veterinarians pick a pet, just remember that it’s usually the pet that picks us, usually by a stroke of fate.  

Snuggling on the couch with her dad

Snuggling on the couch with her dad

Treating a Diabetic Pet – Not as Bad as You Think

Treating a Diabetic Pet – Not as Bad as You Think

 

So your cat or dog has just been diagnosed with diabetes…now what?  Certainly the first few minutes of being told this and the subsequent discussion with your veterinarian can seem like a gigantic mountain of information and work but it’s something you’re willing to do for your pet right?  It is important that you and your veterinarian get on the same page with regards to your diabetic pet.  Some patients will be straight-forward in their beginning management while others will be more complicated.

Diabetics are often sorted into two broad categories (which I’ll relate to human medical terminology).  Insulin dependent diabetes, which primarily affects dogs, and non-insulin dependent diabetes which a majority of the time affects cats.  Non-insulin dependent doesn’t however mean that your cat won’t need insulin injections.  Aside from the part about insulin, we also need to address potential diet changes and continued monitoring.  If you are a diabetic patient yourself, you already have a headstart on understanding this condition.  But take note that your cat or dog is clearly not a small version of a person.

 

Insulin Injections
pet insulins

Some insulin varieties

Most patients will need insulin especially at the beginning.  All dogs will need insulin but some cats will start on it and may go into remission and it could be discontinued.  The first thing I must say is that you should NEVER change your pet’s insulin dose without discussing it with your veterinarian.  There are very few exceptions to this rule.  There are several different types of insulin and it will be up to your veterinarian to decide which to use based on the individual patients’ health and with the vets knowledge and comfort level with the particular insulin.  Personally, I prefer Caninsulin (or Vetsulin) for dogs as it is porcine based and is identical to the canine structure.  For cats, the general consensus is to use Lantus (glargine) as with some cases it has been known to help cause remission of the diabetes.  These are all primarily used as twice daily insulins though others do last for varying amounts of time.

 

insulin syringes comparisonFor lots of people, the thought of having to give their pet an insulin injection is a terrifying thought.  Let me assure you, most pets won’t mind the poke as it makes them feel so much better.  Also, it’s not as bad as you might think…it’s a very tiny needle!  Another thing to note is that there are two types of syringes and it is very important to not use the wrong one with the insulin you are using.  Some insulins are classified as U-40 (or 40 units per milliliter) while others are U-100 (100 units/mL).  Switching up of the syringes can lead to overdosing which can be fatal.  When you first learn about treating your cat or dog, your vet clinic should take the time to discuss with you how to measure up the dose and properly give the injection.

 

Most veterinarians will not start dosing insulin on the weekend in case of any problems (over-sensitive patient) or accidental overdosing.  But what happens if there is an overdose?  You will notice your pet seem lethargic and in some corn syrupcases they may seizure of the blood glucose levels drop too low.  You should always have some corn syrup on hand to rub onto your pet’s gums if this is noted and then get them to a veterinarian for an assessment.  If your pet is seizuring, do not reach into their mouth as you will get bitten; take them to a veterinarian immediately.  Overdosing can happen from improper measurement of the insulin, improper mixing of the insulin, not eating their food but getting a full dose, or concurrent treatment of other diseases.  It will take some time especially at the beginning to get your pet on the proper insulin dose and some recheck glucose curves will be needed to see what effect the insulin is having on the body.

 

Dietary Changes

Feeding your newly diabetic cat or dog also typically requires a change both in diet and routine.  If you aren’t giving your pets food only at mealtimes, now is the time to start.  The insulin should be given to your pet immediately after they eat their meal and as most insulins will be dosed every 12 hours, twice a day meals for your pet will be necessary.  Again, there are a few exceptions in some patients that might need a mid-day snack and I typically advise people to call me if their pet didn’t eat all of their food or none at all and will give either a lower dose or advise them to bring their pet in for a recheck.

 

Diets for diabetic dogs are not as stringent as cats.  Dogs may not need any change in their diet, however, better control of the glucose levels may be achieved with diets that have higher levels of both soluble and insoluble fiber.  Cats on the other hand have more stringent dietary needs due to their status as obligate carnivores.  Felines should avoid excessive carbohydrates and more of a focus should be higher protein diets.  High protein/low carbohydrate diets when fed to cats have a better chance of lowering or eliminating insulin requirements.  Canned foods are better at this as dry foods tend to rely more on carbohydrates when formulated.  There are some dry diets however that are Purina DMappropriate in terms of protein, fat, and carbohydrate content and one in particular is the Dietetic Management (DM) from Purina Veterinary Diets which I typically start almost every diabetic cat on in as it comes in both canned and dry forms.  Your veterinarian will have additional recommendations, likely with some diets that are over the counter and more easily accessible.

 

Monitoring & Follow-up

So once you’ve got the insulin and the new feeding schedule, we need to talk about monitoring.  Typically 7-10 days after starting the insulin, your vet will have you bring in your cat or dog for a glucose curve.  This is where we will take blood every few hours while your cat or dog stays with us for the day.  Each time we take blood, we are checking for what the glucose levels are doing in response to the insulin so that we can make proper dose adjustments.  Some pets will respond quickly but others may need a few visits to get regulated.  Can you do this testing yourself?  It is possible home BG testingfor you to do this testing at home but it does not remove the need to consult with your veterinarian and again you should NOT change the insulin dose without talking to your vet.  We will still need to see the numbers and still need to examine your pet 1-2 times a year and keep the weight updated in the record.

 

example glucose from courtesy of Caninsulin

example glucose from courtesy of Caninsulin

Let’s talk about oral hypoglycemic drugs which many people may be familiar with if they use them personally or if they know someone who does.  Dogs need to be on insulin.  Cats need to have a functional amount of cells called beta cells in their pancreas to be able to utilize these medications.  In general, these medications most typically do not work in cats as well as it requires you to give your cat pills twice daily.  I’ve only met one cat that it does work for and I typically would not recommend them unless euthanasia was being considered and giving insulin was refused.

 

Another thing to note is that often times, dogs will develop cataracts.  Pets will often times put back on some of the insulin dogweight they had lost so it will be important to properly measure the amount of food being fed.  Sometimes diabetic pets don’t seem to get their disease under control.  This may mean that they have other diseases going on in their body or there may be problems at home with actually giving the insulin.  It may take some time and working with your veterinarian but we will do everything we can to get your pets back to feeling at their best!  The important thing to take from all this is to have patience and communicate with your veterinarian to give your pet the best life possible!

 

Helpful Links

www.petdiabetes.com (a list of multiple helpful links)

Feline Diabetes (one of the best resources, be sure to check the diet section and also a video clip on home testing)

Canine Diabetes (a collection of useful resources as you treat your diabetic dog)

“Pour Some Sugar On Me” or Diabetes in Pets

“Pour Some Sugar On Me” or Diabetes in Pets

 

Somebody's thirsty!

Somebody’s thirsty!

“My dog won’t stop drinking water,” says one client.  “My cat is peeing all over the house!” says another.  “My dog isn’t eating much; and he NEVER turns down food,” says yet another.  “Kitty vomits everyday and it’s been going on for a few weeks now,” is another statement I’ve heard.  So which disease is it?  Yes, you can name a bunch of diseases that sound like this.  This is where blood & urine tests are necessary to determine how the best way to help your pet is.

 

It’s time to get down to the nitty gritty of the one disease that made me the person I am today (but that’s a separate post).  This is why I’m choosing to start with diabetes mellitus as the first of the chronic or older age diseases.  However, there won’t be anyway to cover it all in this post so I’ll revisit it later with regards to certain sub-topics.  I’m also going to try to keep this easy to understand and not get into too much of the science behind it all.

 

Cats & dogs can both become diabetics but they both present similarly.  Most patients will first be noted to be urinating more, especially with accidents in the house.  They will all also drink more and probably eat a little less.  Some astute owners will notice weight loss, especially if their cat was obese before as excessive weight is a risk factor for developing diabetes.  Other signs you might see can include dehydration, weakness, abnormal walking (specifically diabetic neuropathy), and a change in their breath.

 

Diabetics have either become resistant to the insulin the body produces or the pancreas stops producing insulin in sufficient quantities.  Insulin is necessary for the body to break down glucose in order for it be utilized by the body.  So why are these pets losing weight and urinating all over the place?  When the body can’t break down the glucose your body ingests or produces, it starts to utilize the fat and muscle tissue already there for energy and this leads to the dog peeing computerweight loss and muscle wasting you can see.  As the body becomes diabetic, the blood glucose levels will rise due to decreased uptake.  When it reaches a certain level, it will start dumping this extra glucose into the urine where this sugar sits in there and creates a nice breeding ground for bacteria creating a urinary tract infection.  Along with the increased water intake, this makes your pet urinate more.

blood test

To diagnose your cat or dog as diabetic, your vet will need to do a blood test to check for high levels of glucose.  We are also looking for changes in electrolytes and liver values.  Additionally, a urinalysis is recommended to check for an infection as well as ketones.  Oh great, another thing we’re looking for is what you’re thinking.  What are ketones you ask?  Ketones are the product we see in the urine from the body breaking down fat to use for energy but more is produced than can be used and this leads to an acidic state in the blood and leads to the increased urination.  This will cause some patients to become severely ill and present in a semi-comatose state, they may be jaundiced, have abdominal pain, or trouble breathing.  In my experience, I’ve seen more cats than dogs present this way.  A noticeable acetone smell may also be noted on their breath.

 

fat cat2Fortunately, many cats and dogs do not present to us in this advanced state and even if they are, they can be helped.  If there are no ketones in the urine, this is ideal in terms of treatment but still not always an easy fix.  This is the reason that having your pets’ blood tested at least once a year once they reach a senior age.  Early detection is the key to keeping your pets healthy and happy for many years.  So those are the basics of diabetes in cats & dogs.  I know I don’t have everything here but we could spend hours discussing all the intricacies of diabetes mellitus.  I’ll be discussing treatment in the next post so be sure to check back and in the meantime, share to help inform your friends and get your senior pets checked out in general!

 

Senior Pets: Not “Just Getting Old”

Senior Pets: Not “Just Getting Old”

In front of me lies a very familiar cat.  She has hundreds of names and many different owners.  No this isn’t the story of a cat who lives anywhere special, this one cat represents all of the other patients that come in just like her.  She is older by old cat 2several years than the kitten I just finished examining.   Her owners tell me that she has lost weight, she’s not eating (and she always loved to eat!), and she has a glossy look in her eyes.  My next question is one of the most important and sometimes when I hear the answer I cringe.  How long has this been going on?  “One week with he appetite but she has been eating less and losing weight for a couple of months,” they reply. 

I’ve heard this story before.  Last week with the dog who has been having trouble walking for a month and difficulty using the stairs.  Before that, the cat who was peeing all over the house for 3 months and now can’t walk.  This is why I’m trying to help educate everyone so that your pets can get the care they deserve as part of your family.  A lot of people still also use the phrase that their pet is “just getting old.”  Well yes, your pets are getting older and they are living longer these days.  With that territory comes more potential for more health care issues, some of which are manageable to improve your pet’s quality of life.

old dog

Over the course of this blog, I’ll address lots of these issues but we’re generalizing for the moment.  Again, I must state that my writing cannot replace the value of an examination and visit with your regular veterinarian.  I consider senior pets to be dogs over 8 years old and cats over 10 years of age.  These are the pets that I feel should be visiting your veterinarian no less than 1-2 times a year.  If they already have been diagnosed with a chronic condition (diabetes, kidney disease, thyroid disease, etc.), these visits should be at least 2-3 times per year.  There are a few patients who we don’t see unless it’s serious or only every few years.  These pets still need regular care despite being indoor cats, bully breed dogs whose owners are afraid their veterinarian will turn them in because of the laws, and pets who aren’t due for vaccines at that particular time.  First, indoor cats can still develop problems such as dental disease, diabetes, obesity, and arthritis.  Sure old catbeing indoors and solitary can protect them from viral diseases and bite wounds but as they age, they can still have health issues.  Secondly, I don’t know any vet who would turn in an owner for going against Ontario or other municipality breed ban laws – we’re not the police nor do most of us agree with the law; we just want your dog to be healthy.  And lastly, many people are mistaken that pets “just need their shots” every few years.  The real purpose and value of the trip to the vet is the examination to be able to detect early signs of problems that may become more harmful (and unfortunately more expensive) the longer that they go undiagnosed.

So the long and short of it is, there is no pet that can go without veterinary care.  I can understand and appreciate the cost associated with a visit to the vet but in the same vein as saving on veterinary costs, proper preventative care for your seniorold dog 2 pet can help save on finances in the long run.  Remember, the overall goal is for a happy and healthy life for your pet & you to share.  Be sure to check back here periodically for specific conditions I’ll review and if you’re wanting something specific, be sure to leave a note here in the comments!

Euthanasia: The Pet Owner Viewpoint

Euthanasia: The Pet Owner Viewpoint

 

The room is quiet except for the gentle breathing of a dog and the sobbing of their beloved family.  They are here to say goodbye for now and to give their pet a gift of freedom from an uncomfortable life.  She has been a loyal dog for 13 years, giving her family unconditional love and devotion.  I remain as quiet and still as possible so as not to distract the family from this moment.  I ask them if they are ready…which is really asking if they want me to start the euthanasia process, one that will only take 15-20 seconds and dim the brightness in the eyes of their beloved friend.  The truth is, you’re never ready; as the pet owner or the veterinarian.  But how did we get to this moment?hugging dog2

 

This is one of the conundrums of veterinary medicine.  One of the hardest questions I get asked is “how do I know when it’s time?”  Certainly, some cases are obvious that letting go is in the best interest of the patient.  What we don’t want is people hanging on too long and inadvertently causing unnecessary or prolonged suffering.  The truth is, there is no easy answer to this question and the answer really is different for every person.

 

In the Disney ending, I’d like to believe that each animal will tell you when it is time.  But ultimately, we have to make that decision.  There is typically a few criteria that I try to outline for clients trying to make these decisions.

resting cat

First and foremost, what is your pet’s quality of life?  Are they eating and drinking?  Can they walk around on their own?  Do they still have that occasional burst of energy?  If you are noticing that they just aren’t acting like they used to, you should have them checked out by your veterinarian.  After a discussion with your vet, it may be decided that euthanasia is a reasonable course of action.  It is best to review what options you may have before making a decision.

 

Next, do they have a history of chronic diseases?  For many people, this is where a lot of pets are.  If they have already been diagnosed and treated with a condition, and have now become sick, these may be signs of the diseases’ progression and humane euthanasia may be the best option.

 

See, I told you this was tough…I’m not sure that I’ve clearly answered the question.  As I said before, it’s a very personal decision.  What it really boils down to sometimes, I think, is when you ask yourself if Sparky or Fluffy are themselves anymore.  You know your pet best, and you know when things are out of sorts.  If you’ve done your best to care for them by exploring reasonable options, and you’ve given them a fair chance at a happy life, then you should take solace in knowing that you are making the right decision to let them go.

 

When preparing for a euthanasia, I always discuss two things with owners.  One is the option to be present with their beloved pet.  Choosing to stay with your pet is an intensely personal decision; a decision I can’t help you make.  You alone must choose if you want to be there until your pet’s final breath or if you want to say goodbye and not be

My sweet cat Gremlin...daddy's little girl

My sweet cat Gremlin…daddy’s little girl

present for the end.  And that is okay!  You should not feel guilty nor let anyone make you feel guilty about it.  Losing a loved one is intensely emotional and everyone handles it differently.  Personally, I could not imagine not being there for any of my pets.  They have given me unconditional love & companionship that I feel I owe them those final moments, no matter the heartache.

 

The second discussion (if they wish to stay) is the euthanasia process.  We place an IV catheter to avoid having to struggle to find a blood vessel in compromised patients.  I feel that you witnessing your pet get poked with a needle can only potentially add to the emotional trauma; as well as if they move, the vessel sometimes gets damaged.  It’s also important to give you the time you need to say goodbye, or “until we meet again,” so it’s up to you to let us know when you are ready to begin.  The drug we use is essentially an anesthetic, in a highly concentrated dose.  Once the injection is given, after 10-20 seconds, the heart stops followed by the nervous system.  Sometimes this is where you may witness a reflexive breath or some twitching after their heart has stopped.  This can be a startling sight which is why it is usually recommended to give sedation before hand as it can limit this reaction.  Lastly, it’s important to know that the eyes don’t close like in the movies.

 

holding paw

Treasuring the bond

Back in the exam room, my patient’s family has been recalling stories of her first day at home as a puppy, how she would hide her toys in the couch, and the holiday dinner she helped eat the turkey by pulling it off the counter.  These are the happy memories they recall and this is how they cherish her memory.  “We’re ready now,” they tell me.  I join them on the floor, take her paw in my hand, and tell her that she’s free from any pain.  I give the injection and she slowly lowers her head.  Her breathing has stopped and I listen to her chest to confirm that her heart is stopped.  Once I have heard silence, I let the family know, give my condolences, and quietly step out of the room.  Outside of the room, I let out a sigh over the thought that I’ve lost another patient but then I realize it’s more because I know a family is heartbroken over the loss of a family member.

 

Here is some information (literature or hotlines) to help those who are grieving the loss of a pet:

ASPCA Pet Loss resources

University of Illinois CARE Pet Loss info

Ontario Veterinary College Pet Loss Support

additional pet loss resources by state

Pet Loss Canada

 

When the body that lived at your single will,
With its whimper of welcome, is stilled (how still!).
When the spirit that answered your every mood
Is gone—wherever it goes—for good,
You will discover how much you care,
And will give your heart to a dog to tear
-- Rudyard Kipling

Euthanasia From the Veterinarian’s Perspective

Euthanasia From the Veterinarian’s Perspective

 

I want to clear up a misconception about veterinarians.  A lot people, including myself, think veterinarians have the greatest job in the world – we do!  And one of the biggest reasons they have this thought is that our days are spent OLYMPUS DIGITAL CAMERAsnuggling puppies & kittens (sometimes they are!).  On the flip side of the coin, many people do realize that it’s not always a happy or easy profession.  We can see 10-20 pets & their people in a day and oftentimes they are sick animals that can sometimes lead to euthanasia.

 

Euthanasia is one of the hardest parts of the job.  I’m not going to lie…it sucks.  It is one of the best acts of kindness people can do for animals.  We know that it is an sometimes an incredibly hard decision to make when your pets are like your family members.  And as difficult as it is for pet owners, it too can be ravaging on the emotions of the veterinarians & the technicians when sometimes we do this 2-3 times (or more) a day.  By nature, we are caring & emotionally invested in your pets health because we understand how much they mean to you.  It’s the reason many of us are veterinarians so that we can help you strengthen the bond you share.

 

hugging dog

How do we do it?  Each of us is different.  It may not look like we’re torn up when we are helping your pet free from it’s suffering but that’s because we have to shut off a part of our emotions to help you get through it.  Believe me it hurts inside every time I help a patient pass on.  Veterinarians, along with their technicians, have an inner turmoil worrying about their patients overnight and hoping they don’t have to call you with bad news the next day.  Knowing that letting go of your pet is a very tough process, it would be unreasonable for us to break down into tears while your are saying goodbye.  And certainly, when I have spent significant amounts of time and energy, or have formed a special bond with you & your pet, I have shed a few tears; but I know that this is your time.  When those patients are euthanized, I sometimes feel helpless in that I’m not able to help them get well.  Then I’m reminded that the relieving of pain or suffering might be the most humane thing I can do.

 

Over time, I can’t say that it becomes easier.  You build up a tougher skin but at the end of the day, sometimes you just have to break down.  If you don’t, you end up burning out from compassion fatigue for caring too much and then we aren’t any good to you or your pet.  Fortunately, there is help for medical professionals who are experiencing these issues.  But I think one of the best things to help veterinarians & technicians continue to help your pets is an understanding that we also have feelings and to let us know “thank you for helping.”  We understand that there will be a period of grief that can include anger and denial so we are okay with your venting; we know you don’t mean to hold us responsible.  No matter what, we’ll always be there for you.

TenderMoment

 

This is part 1 of a 2 part look at euthanasia.  Come back in a few days when I discuss the topic from a pet owner perspective.  Please leave comments in the section below if there’s anything specific you’d like me to address.  Thank you!

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