Saturday, October 18, 2008

The foreign body that wasn't


GIT foreign bodies are common in veterinary practice, and most patients suffering from these are dogs thanks to their greater propensity for dietary indiscretion (that phrase is so proper). Obstructive intestinal foreign bodies normally cause vomiting, but if they remain in the gut for too lung they cause pressure necrosis and destruction of the gut, gut perforation and peritonitis, and all kinds of systemic effects including sepsis. I had a lovely dog present to me a few weeks ago for vomiting. She didn't have a painful abdomen and was very bright but she was dehydrated so I admitted her to hospital and gave her IV fluids. The owner suspected the dog might have eaten pantyhose, as this dog was a serial pantyhose-eater (more on serial underwear eaters later - although there is one schnauzer I know who has had THREE separate surgeries to remove THREE separate pairs of underpants). This patient, we'll call her S, didn't vomit in hospital and seemed to improve once we hydrated her. So before removing the drip I test fed her with some bland food - and she pushed out the longest poo I've ever seen. It looked like a chocolate-coated licorice stick (see above), but on closer inspection I was able to confirm the presence of pantyhose. I think rehydrating the gut lubricated the passage of the offending pantyhose - which was fortunate. Many dog's aren't so lucky.
I thought this was an amazing poo story until I spoke to a client whose labrador (its no coincidence that labs are so often implicated - they eat anything) had eaten a doll. During a walk, the dog passed a stool and when the responsible owner went to pick it up off the footpath she observed - much to her horror - a single doll's eye, positioned in the centre of the stool, looking back up at her. At the time she wasn't aware of the fate of the doll so it wasn't something she had expected. Fortunately the remainder of the dog was not inside the dog so there were no complications. Just a very scary poo!

Friday, October 17, 2008

Ticks are back


The number of blog entries inversely corresponds to the length and frequency of my shifts...apologies all. One of my cases yesterday was a 30kg dog presented for tick paralysis. We found 6 Ixodes holocyclus ticks on her. So just a warning people - if you're out and about, you need protection. A lengthier entry on this later, but just so everyone knows, this is what an engorged paralysis tick looks like. Remember that even after you remove the tick the toxin continues to circulate in the blood for an additional 48 hours - meaning the animal will get worse. Even if it has not yet developed signs. Affected animals are at a high risk of aspiration so food and water must be withheld. Your vet can treat with tick antiserum.

Tuesday, October 14, 2008

Testicular implants for dogs are out

Clients often jokingly ask whether I do plastic surgery on animals. The Australian Veterinary Association's draft policy on "Surgical Alteration to the Natural State of Animals" states that cosmetic procedures (ie those not necessary to the health and welfare of the animal) are unacceptable. In fact it states that "Performance of any surgical procedure for other than sound medical reasons is unacceptable." This includes procedures like declawing cats (common in the US but not here), dewclaw removal in dogs, tail docking, ear cropping, de-barking, removing venom glands in snakes and demusking ferrets. Justification for performing one of the above has to be on the grounds that the animal may suffer without surgical prophylaxis.

All of the above means that testicular implants, or Neuticles http://www.neuticles.com/ as their inventor calls them, are a no-go over here. Some time ago I wrote a light-hearted article in The Veterinarian Magazine regarding these implants but failed to mention the above policy as I wasn't aware it existed at the time. I've had quite a few male pet owners concerned about neutering because they like their dog's undercarriage on display - even though neutering eliminates the risk of testicular cancer (no testicles, no cancer) and reduces the risk of developing perineal hernias. Anyway, for those fascinated by the topic I've pasted my original article below. BTW our model here, Dr Phil, has been castrated and does not appear to have been traumatised by the experience.

@ARE SOME DOG OWNERS NUTS
Neuter-hesitant: the term used to describe a client (usually male) who cannot bring themselves to have a male dog desexed due to anxiety about removing its manhood.

The man who coined the term is also responsible for coming up with the solution. Gregg Miller, a US inventor, developed and patented testicular implants (Neuticles) to simultaneously restore the undercarriage of male pets to pre-castration glory and allay the insecurities of their owners.

Miller says he came up with the idea when he booked his seven-month-old bloodhound in to the local vet to be desexed. He admits he was shocked to learn that the procedure involved removing the dog’s testicles.

“Many compare [neutering] to emasculation, turning their beloved male pet into a eunich,” says Miller.

In a book he penned about the process of inventing Neuticles, Miller claims that his own dog became depressed after castration.

“He looked down at his private area,” he wrote in Going Going Nuts. “…Buck looked up at me with a puzzled expression. He looked back down again – and then back at me a second time with an expression of ‘where did they go – what has happened to me?’ He didn’t clean himself – only had that look of bewilderment. Buck knew they were gone and for over a week seemed sluggish and depressed.”

Concerned that removal of testicles robs dogs of their self-esteem, Miller got together with a team of vets to design implants that replicate the exact appearance, weight and texture of genuine canine testicles. He sank over $US1.5million into research and development. When the first implants were installed in a nine-month-old Rottweiler in 1995, it made international headlines. One magazine boldly listed the procedure as one of the top ten news events of the year – the same year that 168 people were killed by a terrorist bombing in Oklahoma city, ceasefires ended the bloodshed in Bosnia and OJ Simpson was acquitted.

Neuticles are now available in three models. NeuticlesOriginals are made from non-porous polypropylene homopolymere, to deliver a “rigid firmness,” costing $US73 a pair. For owners who prefer their dog’s privates to retain a more natural firmness, NeuticleNaturals are made from solid silicone ($US159).

For the more discerning owner, NeuticlesUltraPLUS ($US329), also made from solid silicone, is a precise reproduction of the pet’s organ including featuring an etched exterior which manufacturers claim retards scar tissue development. Then there is the Rolls Royce model: the NeuticlesUltraPLUS with epididymus. This exact replica of the testicle also incorporates the pampiniform plexus and ductus deferens, for the exceedingly discerning, quite possibly obsessional owner.

Including the cost of implantation, US pet owners are paying from $US119 to $889 a pair. Ideally implantation is performed immediately following castration, before the scrotum recoils and loses any holding capacity. Other indications include scrotal asymmetry in cryptorchids.

The procedure is performed mostly on dogs, but implants have been used in cats, horses, prairie dogs, rats, bulls and, reportedly, an elephant. Miller claims the procedure is safe and almost complication free, with no reports of implants bursting. The most common complication is post-operative scrotal swelling, which usually resolves in two to four days.

“Post operative care is nothing more than the post operative care employed when you neuter the old way,” he says. “Restrict pet’s activity and don’t allow him to lick the incision area.”

New-York based veterinarian Dr Richard Green, who has implanted several pairs of Neuticles, says that the procedure is purely cosmetic. “Dogs do just fine without their testicles.”
Miller claims that since Neuticles hit the market in 1995, more than 230,000 pets in 49 countries, including Australia and New Zealand, have received the implants at 17,000 veterinary clinics worldwide.

“Above all, Neuticles are encouraging pet owners to neuter that simply would not have before,” he says. “As a result, pet overpopulation is being reduced and pets are living happier, healthier, longer lives.”

The invention earned Miller the 2005 Ig Nobel Prize for Medicine. Buck, the bloodhound whose testicles were the inspiration behind the invention, succumbed to complications of liver cancer at the age of eight.

Those keen to learn more can download and view a video demonstrating implantation technique at http://www.neuticles.com/, or order a range of bizarre merchandise including Neuticles tee-shirts, caps, tote-bags, key-rings and a Neuticle-on-a-necklace. Miller’s company, CTI (Canine Testicular Implant) Corporation also sells silicone eye implants for small animals as well as horses.
@ENDS

Treating burns

The Centre for Veterinary Education (it used to be called the Postgraduate Foundation in Veterinary Science) is currently taking enrollments for its online course on Treating Burns in Wildlife. The course is open to vets but also wildlife carers and anyone with an interest in wildlife. I just finished the modules on the weekend - its not too taxing, if you wanted to you could complete all seven modules in a day, the quizzes are extremely easy etc. To enroll go to www.pgf.edu.au (they're not paying me I'm just caring and sharing. Besides I want more people to post on the course discussion board so I have someone to talk to!!!). It costs $355 for members, more if you're not a member, but if you work with animals its tax deductible.

Although the focus is wildlife the course gives a good overview of assessing and staging burns in any animal, pathophysiology of burns, and some practical tips on first aid and treating burns. I don't see much wildlife in my practice because we're right in the middle of the city. There's some really useful stuff on bandaging and dressing burns and also decision making re long term prognosis of patients. Skin is something so easily taken for granted, but once burnt the patient is subject to a myriad of potentially life-threatening sequelae such as dehydration, shock, sepsis, renal failure and disseminated intravascular coagulation - not to mention complications of smoke inhalation (asphyxia, pneumonia). Burns can be very challenging to treat and animals often have a poorer prognosis than their human counterparts with similar burns due to a range of factors.

Common sources of burns in domestic animals include thermal burns from heaters and heat pads (pet reptiles are especially susceptible). I had a cat who singed her fur because she sat that close to the heater and would not move. I think they can get a bit "heat drunk" so we need to look out for them.

Other good burns resources:

Merck M (ed) (2007) Veterinary Forensics: Animal Cruelty Investigations. Blackwell Publishing, Iowa USA. Chapter 7 "Patterns of non-accidental injury: Burns" contains some good information about pathophysiology of different kinds of burns and recognising these in animals.

Scott DW, Miller WH, Griffin CE (eds) Muller & Kirk's Small Animal Dermatology, 6th edition. WB Saunders, Philadelphia. Chapter 16 "Environmental Skin Diseases" has a brief section on burns that raises some interesting points.

Monday, October 13, 2008

When to say goodbye and the HHHHHMM scale

One of the most difficult things as a veterinarian is advising an owner when to say "goodbye" to their pet. Thanks to excellent nutrition, more responsible ownership (leash laws, cat curfews) and advances in medicine, we now see a lot of geriatric animals with chronic diseases. We can manage cardiac disease and renal insufficiency - to a point of course. The sad fact is that animals don't tend to just die quietly in their sleep at the right time. They may become gravely ill, inappetent and experience suffering for some time. Euthanasia gives them a dignified, peaceful death and prevents ongoing suffering. But picking the right moment is a hard call: is the animal in the terminal stages, or is it having a major "crash" from which it can recover? Sometimes its a matter of instituting treatment and monitoring the response.

Ultimately the owner needs to make the decision, its our job to provide information about the animal's physical status and prognosis. One of the most common questions I'm asked is "how long do you think he has got?" The truth is this can be very difficult to predict in old, unwell animals. The owner is often concerned that they do not want to steal any "good days" by letting their animal go too early. It boils down to the quality of life of that animal. One of my colleagues often asks the owner to list five things their pet really loves to do eg eat fish, walk in the park, lay in the sun etc. If they can't do these things, or will be unlikely to do these things with treatment, that is when to let them go.

I was doing some research today and found that Dr Alice Villalobos, a US Veterinarian, has developed a quality of life scale called the "HHHHHMM Scalehttp://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx" - this stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad. The owner and vet ascribe a score for each. I think this is an excellent framework for determining a humane end-point and it incorporates all of the things most vets would discuss with clients when talking about euthanasia. Doesn't make it easier and it doesn't mean you shouldn't grieve. I was inconsolable when a very special companion earlier this year, even though I'd done everything I could for him and he had a terminal condition, and I still miss him. I had to get my colleague to administer the final injection and I cried like a baby.
And peeps - the cat in the photo is not nearing his end or requiring euthanasia. He's just lying around. I just thought it would be much nicer to accompany the post with a picture (if you have a pic you want to see online - with your name acknowledged of course - submit a comment! I won't post your email address).

Sunday, October 12, 2008

Cat Tat #2

Here's another "less is more" feline tattoo...it has special significance because three of my friends visited the tattoo parlour on our last day at university. They got the same design - created by one of my very talented friends.

Cat Tat #1


I haven't got a tattoo, I think I'd be one of those people for whom the novelty would wear off and the thought of having ink burned off with a laser doesn't sound too inviting. But I take my hat off to those who sport them, and I have to say if I were ever inked I'd most likely find myself sporting a feline image of some kind. This masterpiece, worn by one of my vetty friends - who also happens to be an awesome cartoonist - almost tempted me.