Pyometra in a dog, seen during surgery. The uterus is distended with pus. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia CommonsLast week I removed one of the largest, most pus-filled uteri from a large breed dog that I have ever seen.
I’m a bit long in the tooth now, but I still found the whole procedure a bit scary given the size and vascularity of the uterus – and this made me reflect on the benefits of early neutering.
We routinely spay bitches in our practice from five months of age with minimal long-term complications, and it’s so much easier.
I am aware that recent research indicates early neutering may have some long-term implications in certain breeds, but the procedure is so much safer in young dogs, and anything that prevents them developing pyometra in later life has got to be an advantage.
I’ve not long come across a case of a middle-aged dog that had suddenly become unaccustomedly grumpy and started snapping at its poor owners.
This was uncharacteristic, as it had no previous history of behavioural problems. There were no other obvious clinical signs – perhaps it had become lazy of late, but there was nothing to put your finger on.
I recalled having attended a CPD event a while before when the speaker mentioned hypothyroidism leading to aggression. I thought this was worth a punt, and low and behold it had a very high thyroid-stimulating hormone level and very low thyroxine result. Our friend is now on thyroid supplementation and is much happier, although at the time of writing some two to three months into therapy, it was not completely better.
So, it may be worthwhile considering a blood profile when presented with signs of aggression in middle-aged dogs.
I now try to avoid running food trials in mid-summer. Certainly on first presentation, with no previous history of allergic dermatitis, I tend to treat accordingly and wait to see what happens later in the year as vegetation dies back.
Food allergic dermatitis does not have a seasonal basis, so if the signs resolve or exacerbate over the course of the year, food allergy is not the primary cause (although some cases can confuse us as they have both an element of food allergy and atopic dermatitis).
I have also seen cases started on food trials in the summer months that appear to get better as the year progresses, only for the owner to become reluctant to challenge as the dog is “better” – whereas, in reality, the improvement is the result of reduced exposure to an environmental allergen.
So I usually wait and see if the signs persist to suggest a non-seasonal allergic dermatitis, and THEN do a food trial.
“Canine Atopy” with dermatitis around the eye, caused by rubbing. Via Wikipedia Commons.
My colleagues and I use immunotherapy on a fair number of dogs to treat atopic dermatitis. Research tells us it can be a valuable tool in some dogs, but at the same time up to a third of dogs respond poorly.
We are lucky in our practice as anecdotally we find the majority of dogs do well, and we only get 10% to 15% that do not respond. This may be because:
We are really hot on parasite control in our practice – we have a large urban fox population and see cases of angiostrongylosis – so we advise Advocate on a regular, monthly basis. So it is unusual for us to see atopic dogs that flare due to concurrent parasite infestation.
We strongly advise owners to do and/or preserve with food trials – and some, okay, just one or two, do respond and relapse on challenge.
We also try to make sure we keep the perpetuating factors, for example, pyoderma and Malassezia dermatitis, to a minimum with medicated wipes and shampoos.
The older the dog when it starts immunotherapy the less likely it is to respond and we advise our owners accordingly.
Good luck with those frustrating allergy cases – hopefully there are some tips here to help. And cats also do well on immunotherapy.
This line always makes me think of the James Herriot books – and I recently thought of this when I had a poor cavalier King Charles that presented with a colon impacted with numerous shards of cooked lamb bones.
The poor chap was in quite a bit of discomfort and was straining without any production. It took ages to flush out his colon and, to be honest, more than one attempt.
Eventually some warm soapy water and repeated flushing with a cut dog-urinary catheter did the trick and he’s now feeling much better.
Vet school doesn’t prepare you for making a complete idiot out of yourself.
At vet school, you learn some basic clinical skills and are taught how to conduct a general clinical examination to prepare you for EMS placements in veterinary surgeries. What they don’t prepare you for is making a complete idiot out of yourself.
Before my first clinical placement I told the vets I would be working with that I had only just finished second year and had no pharmacological knowledge as of yet, non-existent surgical experience and very little understanding of small animal medicine in general.
Luckily, all the vets in the practice were very good at judging the level of my understanding and seemed to find the right balance between patience and pushing me for answers.
Things seemed to be going OK. I’d successfully taken blood samples and started to make sense of abdominal palpation. However, applying clinical skills taught at vet school isn’t necessarily straightforward – cadavers have a distinct lack of weapons in the form of claws and teeth, but I was coping with that reasonably well and taking note of the vets’ advice on particular techniques.
This was until a few days in, when I found myself working with the head vet…
In the same morning, I managed to spray penicillin all over my face while trying to administer an injection, incorrectly insert an endotracheal tube despite being 99% sure it was OK, and cover myself in guinea-pig blood while clipping nails, leaving me to wear the stained tabard for the rest of the day.
To add insult to injury, I later misread the scales and recited the incorrect weight without thinking (it didn’t occur to me that there’s no way a fully grown border collie could weigh 10kg).
Isolated, these incidents might not seem like the end of the world, but when they all happen in the same day in front of the head vet and when one of the clients involved is your neighbour, you do feel like shouting “I am a vet student – honest”, despite feeling like a complete moron.
This was, however, followed by days of mini-triumph, such as inserting an IV catheter correctly for the first time or scaling and polishing a dog’s teeth myself.
The important thing to remember is that you are inexperienced, and you just have to accept there will be days when nothing seems to go your way, get past them and carry on with your head held high – even if it is covered in yellow spots of penicillin.
Sarcoptes scabei – a parasitic arthropod that burrows into skin and causes scabies. Image by Kalumet. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Have you ever had an atopic dog that’s really well managed but suddenly flares, becomes very pruritic and seems to stop responding to therapy? I had one such case just a couple of months ago.
Skin scrapes did not reveal the presence of any ectoparasites and cytology was pretty unexciting (a bit of bacterial colonisation but otherwise unremarkable).
However, noticing the pruritus to be primarily around the head, ears and ventral abdomen tipped me off to think about Sarcoptes scabei – particularly as we have a very prolific and confident urban fox population in our practice area.
A serum sample was duly sent off and – lo and behold – proved positive for Sarcoptes antibodies.
The client then confessed to missing “a dose” of Advocate but, upon reapplication, management was readily restored.
Noel Fitzpatrick runs one of the most advanced veterinary practices in the UK.
In my interview for Glasgow vet school, I was asked the question “how far is too far?”, and recent episodes of The Supervet on TV had me musing on the topic again, particularly as I had used The Bionic Vet as an example in my answer.
At the time I discussed kidney transplants in cats in the US and, in the UK, the inspiring work and pioneering techniques being carried out at Fitzpatrick Referrals.
Arguably the most famous patient of Noel Fitzpatrick’s is Oscar the cat who, after having both back paws cut off by a combine harvester, had prosthetic legs specially engineered and fitted (see video below). Oscar’s surgery was the first of its kind, and a huge step for orthopaedic veterinary medicine worldwide.
While this type of surgery was a world first in cats, prosthetic limbs are not an alien concept in human medicine – and, at a time when the emphasis on “One Health” becomes stronger every day, why shouldn’t routine or even rare human procedures extend their applications to our domestic species too?
But at what point do we say that medical advances are not ethically suitable for animals? A person may have a reasonable quality of life in a wheelchair, but that doesn’t mean a dog with wheels for back legs would. Such a “cart” would dramatically effect the quality of life of cats like Oscar, but his new legs have given him the freedom to continue to “be a cat”.
Each individual case is different, and the benefits and risks of undertaking a new, advanced technique would have to be weighed up accordingly. I don’t believe the point at which we draw the line on “going too far” is set in stone – every case is unique.
Kidney transplants in humans are life saving, and yet not seen in the UK in cats. A cat with kidney failure would gain a lot from a transplant, providing the risk of rejection was reduced to minimal. The ethical issue here lies with the health and welfare of the donor cat and the fact the donor can’t consent to its healthy organ being taken.
Answering the question “how far is too far?”, Stephen King’s classic 1989 film Pet Sematary is available to buy from www.amazon.co.uk
In the US, donors are often cats from rescue shelters and the recipient cat not only gains a new organ, but also an adopted friend who will come to live with them after the surgery. I think this is an excellent compromise on the consent dilemma – both cats get a second chance at life.
But it is not just the ethical question of whether we should perform such surgeries on our pets, we also have to consider the practical aspects of these procedures (i.e whether we could carry them out if we decided it was ethically acceptable).
There will be a limited number of vets with sufficient surgical experience to attempt such innovations, especially if a certain type of procedure has never been attempted in a particular species yet (such as Oscar’s legs). Financial constraints are also extremely relevant – owners that would love to give their animals the chance to receive such surgery if needed may be limited by the cost that comes with them.
Personally, I think the work of the surgeons at Fitzpatrick Referrals is exceptional and a real inspiration to vets across the country. I would love to see the day that treatment options for our animals routinely match those available in human medicine, and really hope the work of Noel and his team encourages those interested in such developments to continue and further research in order to make it a possibility – within ethical limits, of course.
Missing her cats, Jordan ponders the feasibility of owning a pet while at university.
I’ve always had cats at home, and they often played the role of revision buddy/lap warmer. That was one of the things I missed most when I first went to university.
Pets aren’t allowed in student halls, but now that I live in a flat with other vet students, pet ownership becomes a possibility (landlord permitting).
As a student, I meticulously budget in order to ensure I eat well, am able to enjoy myself and get some travelling in without blowing all of my cash the first week that student loan comes in. But even with this amount of planning, could I find some spare to pay to feed a cat as well as myself? Probably. Could I find the money if something went wrong, if said cat needed lifetime insulin or thyroxine treatment or broke a limb in a road traffic accident? Probably not.
Pet insurance would extinguish the worry surrounding the “what ifs”, and I do know other students with pets that are insured. Even then, premiums that cover long-term conditions come at a fair price, and I wouldn’t want to find myself in a financial position forcing me to cancel insurance and risk my pet requiring costly treatment.
Money is not the only commitment that you make to a pet though. The other major consideration is time – although this is more of a concern with dogs, which require a greater time commitment than cats.
I often feel that owning a dog would be excellent stress relief, but as idillic as dog walking seems, could I commit several hours a day, every day, including around exam time?
Even if I could commit the time while I’m around, I know that I don’t stay permanently in one place. For the majority of the time I’m in Glasgow, but during the holidays I’m at home (Leicestershire), on EMS or travelling. Who would look after the pet then? Since I live with vets, they have similarly busy lifestyles and it would be unfair to expect them to pet-sit while I’m away.
And what would happen when I graduate? I don’t know where I’ll be living, where my first job might take me, or whether it will be feasible to take a pet along for the ride.
An alternative to pet owning is fostering. The Glasgow branch of Cats Protection has recently advertised their fostering service to vet students at Glasgow. The fostering scheme encourages taking on a cat, with bedding, litter and food provided. They will provide all veterinary care and will even take back the cats if you go on holiday.
I think fostering is a great way of caring for cats without a lot of the concerns outlined above, and perhaps the only option I’d consider while at university with regards to pets. As much as I’d love to own a pet in Glasgow, I think it would be unfair on the animal if I could not offer the money and time to give it a great quality if life.
It’s unfortunate that many people do not undertake greater consideration when deciding to own a pet. Perhaps many of the day-to-day ethical issues faced in practice could be avoided if they did.
Intraoral view of a dog with bilateral laryngeal paralysis during inspiration. The arytenoid cartilages (a) are immobile and the vocal folds (b) are medially displaced. Credit: Daniela Murgia.
Anaesthesia normally depresses laryngeal movements, making diagnosis of laryngeal paralysis challenging. The animal should be anaesthetised to the point at which the mouth can be easily opened but a laryngeal reflex is still present.
If jaw tone is such that you are afraid of being bitten during the examination, then the plane of anaesthesia is appropriate. If the GA is too deep, the patient will not have normal vocal fold movement and even a normal larynx may appear paralysed. In this case you should wait for drug redistribution allowing the patient to approach consciousness and repeat the examination.
Exposure of the larynx is more readily accomplished with thiopental or propofol than with diazepam-ketamine.
