#7- where's my tricorder?

"Here's a pet peeve: owners who don't want to pay for diagnostic tests but then cop an attitude because you don't know what's wrong with the animal. Since you won't let me do the blood work or x-rays, how the heck do you expect me to know?"

Yep, I think we've all been there. Look, gentle readers, we vets are good at what we do, but we are not psychic, we do not have magic 8 balls with all the answers. What we have is years of training, years of experience, and great testing (diagnostic) options available to us.

Many of us would love to provide the diagnostics (and our time, and our technician's time, and our receptionist's time, and the light and the heat, etc) to you for free, but we can't, any more than you provide your services or time for free at your place of employment.

Here's the thing- excellent veterinary medical care is expensive. We can't get past it.

Step back- actually, excellent veterinary care is a really good bargain. Like I have said in a previous post, each of my c-sections cost over $15,000. The last c-section/spay I performed cost the owner $800. Cheap.

But here's the point the vet in the above quote is making- unlike human medicine, where it is between the doc and the insurance company which tests will be performed, in my office you are the responsible party. You say yes or no to the testing. You are faced with the budgeting.

Most of us vets understand living on a budget. We have it down. We will not berate you for not being able to afford something. Just don't act like it's our fault you can't afford it.

And don't get mad when we give you options for finding out what the issue at hand is, but cannot give you a definite answer when you can't agree to the diagnostics. It would be like calling my car repair place complaining of a noise in the engine, but not allowing them to open the hood or use a diagnostic tool. How can I expect them to know what's going on, let alone fix it, without all the information?

So until that great day when I get my tricorder, diagnostic testing like radiography, blood work and ultrasound will have to do. At a price.

Enjoy your pets!

Secret #1: Big Dog/Small Dog

The quote:

"People always ask: 'How do you handle pit bulls and rottweilers and big german shepherds?' The truth is, the dogs that scare me most are the little chihuahuas. They're much more likely to bite."

I have jokingly said for years- ever since my stint as "kennel crew" that I am more worried about the small breed dogs that are aggressive than the bigger ones. The small dogs seem like they are more likely to bite without warning. They lunge fast. Sometimes they insist on biting my shoes even when we are all done with the doctor stuff.



But...big dogs that are aggressive tend to cause worse injuries. I have the scars to prove it. They can be much harder to restrain- imagine a 100 lb vet tech trying to hold a 150 lb dog, who does not want to be held, for a blood draw. Or a nail trim. It can get hairy.

I think the larger point is this- we all prefer to see the well-mannered, well trained dog come into the practice. Sure, we can deal with the nasty ones. We have muzzles and medication. But there is very little reason to joke- a bite from any pet can be terrible. And yes, this includes cats, ferrets, iguanas and birds.

Enjoy your pets!

No shots for you!

So, let's say you are totally, completely against vaccines. Or you are the proud pet parent of a dog who has allergic reactions to vaccines. Now what?

This is where the art of medicine starts to play more of a role. Each pet is an individual. And we, as veterinarians, need to keep this in mind and be ready to tailor protocols to meet the individual's needs, keeping health and safety in mind at all times. This, folks, is the basis of the concept of holistic medicine- treating the whole patient. We vets do it almost without thinking every day. There is very little that is set in stone for us.

Vaccines are very important. They keep our pets protected from life-threatening diseases, and some diseases that may not be life-threatening, but can be debilitating. These same vaccines also help protect the people in our pets' lives, as well. There are several diseases that we can catch from the animals in our lives. Rabies is one obvious one. Leptospirosis, a bacteria that affects the liver and kidneys, is another. If a pet is able to get a recommended vaccine, I strongly urge owners to comply.



But some won't, and some can't. So now what?

There are a few options for vaccines. If you have a dog or cat that gets a mild reaction to the vaccine (like hives or mild vomiting) we can pre-medicate with a steroid and Benadryl, or a steroid or Benadryl. This helps to decrease the immune system's response to the perceived immune trigger. Most of the time this seems to help.

If, however, your pet has had a more severe reaction, or has had a reaction despite pre-medication, we may consider other options. One option is to choose to stop giving vaccines. I cringe a little as I type this, because discontinuing the vaccines carries inherent risks. Therefore, anytime I have this discussion with a pet's people, I try to make it very clear that we are balancing risks and benefits, and in choosing to not vaccinate we are incurring some risks that need to be known. We are knowingly leaving a gap in out pet's immunity. The risk of life-threatening parvo or distemper in an adult, otherwise healthy dog that has at least had the puppy series of vaccines is probably fairly low. But it does exist. There is always a risk of being exposed to, and contracting, kennel cough. Or lepto.

Choosing to stop vaccines means most kennels and pet resorts will not board your pet. You may need to make other arrangements when you go out of town. Some groomers require up to date vaccines for grooming appointments. Don't be mad at them- they have responsibility to keep all of the pets in their care safe.

There are tests for the level of immunity in a pet's system. You may have heard of titer tests. If you are against vaccines on principle, you may have discussed them with your vet. Titer tests can be helpful, but they are not perfect.

A titer is the concentration of something. A titer test is a test to determine the concentration of that thing. The way this works with immunity, a blood sample is drawn at the vet's and sent to a laboratory. The lab technicians (or a machine) place drops of the blood sample into small vials. They serially dilute each sample. In other words, the vials will have all blood, 1/2 blood. 1/4 blood, 1/16 blood, 1/32 blood, etc. They then check to see at what dilution the blood sample stops reacting to an analog for the disease. The last one to react is reported back to us. I get a report that says something like- titer IgG parvo 1:400 (making up the details here). Then I compare that ratio number to what is generally considered to be protective immunity. This gives us a yes or know answer to the question: is my pet protected from this disease?
Sounds cool, right? Blood test says yes, there is protection, then there is no need to vaccinate this year. Blood test says no, then we need the shot. Great. Next patient, please....

Problem is this- titer immunity does not necessarily correlate to true protection. UGH

We use the test anyway. I get titer tested periodically to see if my rabies vaccines I got a decade ago are still effective. We send blood to Kansas to be tested for pets going to Hawaii or Europe- they must be rabies titered. But I don't titer my own pets in place of vaccines. I give the shots.

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Why? I believe that the immunity given by the shots is important. I believe that the titers are useful, but not absolute. I believe that the risk associated with vaccines is much smaller than the risk of disease. I want to take advantage of the amazing, incredible protection modern medicine is able to provide. But that's my decision, for my pets. If you want to discuss the ins and outs of vaccines for your pets, I will. I have many pets that have altered vaccine schedules, a few that I do not vaccinate at all. Holistic. Individual. Tailored.

Enjoy your pets!

puppy shots

"The breeder told me he had all his shots."


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There are few things clients say to me that aggravate me more. This one isn't the clients fault. Breeders who give out wrong information or are deliberately misleading about needed vaccines drive me nuts. Please don't get me wrong. There are many really good breeders, people who breed because they love a certain type of dog or cat and want to do it right- breeding for temperament, health and longevity.

But there are some people who don't know what they are doing. And they seem to delight in putting really bad information out there like it is gospel truth. For example- "the pup has had all needed shots" at 8 weeks of age. UGH

OK here are the facts. Puppies and kittens get antibodies (infection fighters) from their mother, if the mother was properly vaccinated. These antibodies provide immunity to the puppies. Newborns drink these antibodies in their mother's milk. The antibodies cross over the intestinal lining intact and get to work keeping the babies safe from common diseases. This is good.

This immunity from mom doesn't last forever. And thanks to some amazing scientists over the years, we have developed ways to re-create immunity. Our immune systems have memory. Once you have been exposed to and defeated a disease, the body keeps a blueprint of the successful disease-fighting agents on file. Then, if the same disease is found later, it can be fought off faster, sometimes before we realize we are sick. Vaccines take the place of the initial disease encounter. They are tailored to stimulate the immune system to fight off an invader that doesn't actually make us sick, but then the blueprint is still available to fight off the real thing, should it ever be encountered. Obviously, I'm trying to simplify a bit. I'm sure you can find more complete explanations, I just didn't want to copy an immunology text onto the blog. Maybe just one picture, for kicks and giggles:


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Back to the puppies and kittens. Mom's immunity in their systems lasts a few weeks. But somewhere between six and fourteen weeks of age, that immunity goes away. The babies are now susceptible to diseases. Nasty, life-threatening things like parvovirus. This is where we step in.

Most puppies and kittens will start getting vaccines about 6-8 weeks of age. They really don't need them any earlier, except perhaps if they were never nursed. This is not a random age choice. This is the early end of the loss of mom's immunity. We will then booster the vaccine (re-vaccinate) every 3-4 weeks until the puppy or kitten is over 14-16 weeks old. There is science to this, I swear. The vaccine provides better immunity that mom's alone in this time frame, but the lingering effects of mom's immunity and the immature state of the immune system don't allow the blueprints to be stored long-term. So we have to remind the system what it needs to be prepared to fight.

One the puppy or kitten is over that 14-16 week mark, the immune system can be expected to store the blueprint longer, generally for about a year for most diseases. So we usually give the last set of vaccines at about 4-5 months of age. Then we can schedule spay or neuter (but that's a discussion for another day).

So there you have it. This is why I go slightly nuts when I am presented with a cute, fuzzy, 10 week old puppy and am told that he had all his shots.

Or picture this scene:

Pitiful puppy on the exam table, about 5 months old, thin, tired, dehydrated because she has spent the last few hours/days vomiting and having severe diarrhea. The parvovirus test is positive for the disease.


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Me: "Parvo is a virus that causes life-threatening vomiting and diarrhea. I can't treat the virus. All we can do now is support her system and hope that she can fight the virus off herself. She may die. And the treatment to try to save her life will be expensive."

Owner: "But the breeder said she had all her shots! They gave her her parvo shots!"

Me: "How long have you had her?"

Owner: "Since she was 8 weeks old."

See the reason for my anxiety? This is a preventable disease. Now the person in the above scene will need to find money to pay for treatment that might not work. The owner didn't know. She was making decisions based on the information she was given when she bought the puppy. If the breeder had done the responsible thing, recommended monthly visits to the vet to discuss care and get shots, this could have been completely avoided.

Enjoy your pets!

SHOOT!

Let's talk shots.

I like lemon drops. And my brother once got smashed on something called a Louisiana leg-spreader.

But that's not really what I want to discuss. Sorry. Instead, let's talk about the shots we vets give your pets. The vaccines.

Some people will have you believe that vaccines are not important for health. Some will tell you that vaccines are actually dangerous. Some will tell you that they are absolutely essential at every annual or semi-annual vet visit. So what is the truth?

The truth is fluid. We are constantly re-evaluating the risks and benefits of all vaccines. This is actually true on the human side of medicine as well as on my side. So there may be changes in the recommendations of which vaccines to give, when in life and how often to give them. Even the best methods to administer them. Vets "in the trenches" are left to shuffle through the evidence and the recommendations and develop protocols for our patients that we are comfortable with.

And herein lies one of the basic issues. I'm not exactly sure just how it works with people, but at the pediatrician level at least there appears to be one set code of rules for vaccines. These are set by a group and are followed by all pediatricians. Schools require that these codes are followed. There is consistency. Vets get recommendations from groups such as the American Animal Hospital Association or the Association of Feline Practitioners, but we don't have a group that we allow to set the rules that we all follow. Veterinarians are pretty independent by nature, and we don't like to be dictated to.

So this leaves us in something of a quandary. Where do we get our information? Who do we trust? Do we trust the companies that make the vaccines to have the best, unbiased information? We need to know the agenda of whomever we are trusting for the data that we use to set our vaccine schedules. We hope that our associations will look at all the evidence available and help develop recommendations that are based on good science. Are they?

This is why the protocols we all follow may change from time to time. We are all, as a group and as individual veterinarians within our own practices, continually re-examining the evidence we have at hand. We are sometimes slow to change, but that is because we need to be convinced that the change is safe and effective. So this month I want to talk shots. I will not claim to have all the answers. I may well ruffle some feathers. I hope to make you think just a little about some of the blanket statements you hear.

Then maybe we can go out for a lemon drop or two.

addendum

Helpful treat dispensers!  One way to help increase exercise for both cats and dogs is to get toys that make them move. There's an amazing variety of toys out there that will stimutate pets' brains, and keep their interest by occasionally popping out a treat. How cool is that? You can even consider putting the whole day's calorie content in a treat ball and letting your pet "hunt" for food all day long. Awesome!

5 reasons to own a black dog

I love my dogs. Let's face it, I'm a veterinarian, I like pets. I like them big, I like them small, I like them short, I like them tall. (Can you tell I'm also mom to two youngsters?)

Currently, I live with two dogs. Spiker is a collie/aussie mix, and is a beautiful long-coated blue merle, with white feet and nose. He is truly stunning to look at. Bella is our 9 year old black lab. Bella came to us as a stray when she was very young. She's going grey now in the face, but she's still beautiful. And practical. Here are the five reasons to have a black dog in your house. (Disclaimer- pictures were all found on the web, I take no credit for them.)

5. Black fur doesn't show on black pants. Now, you could argue that black fur does show on white and khaki pants, and you would not be wrong. But, frankly, all fur shows on white and khaki. Trust me. I have had every color of fur on my pants at one time or another. But I wear black when I want to dress up, and having a light dog rub against me before I walk out the door leaves a trail on the pants. The black dog's fur just blends right in.

4. You can see black fur dustbunnies on the floor. I know, this doesn't sound like a good thing. But I am an indifferent housekeeper, and seeing the problem areas helps me spot-clean before people come to visit. The lighter fur will escape my attention until a 3 foot fur tumblweed blows across the floor in front of guests.

3. It's kind of fun when a black dog stands outside the kitchen door at night and all you see are her eyes reflecting the light from inside. Camoflage.

2. No one will every think it's a good idea to dye her an odd color. Pink and purple poodles may be fun to look at, but I like my Bella undyed.

1. The dirt doesn't show. Spiker is currently a muddy, muddy mess. Bella is equally muddy (I think), but it just doesn't show up on her. I don't look at her and think it's shower time. Spiker, on the other hand, is threatened with a shower on a daily basis. Which is not to say he gets one. 

So there you go. Enjoy your pets. Even if they show dirt. Or are pink.