Thursday, January 24, 2008

Careful pet owners, charlatans now target your pets!

Charlatans have been around since the beginning of human history. They use your love of health and well being for yourself and your loved ones to convince you that their concoctions born of quackery and pseudoscience are the answer to good health. They tag their so called remedies with titles like "homeopathy," "alternative medicine," and "naturopathy" to give them legitimacy, while never seeking real scientific credence through thorough objective study following the princicples of the scientific method.

Charlatans are indeed gifted in their ability to sell. They stir up distrust of doctors, insisting on our great conspiracy to use our positions to keep these health potions from being known. They are such good sales people that they know and take advantage of the placebo effect to at least temporarily convince people that their remedies work. Sadly, some people, having been successfully duped by charlatans, go about life distrusting doctors and forsaking legitimate medicine for quackery and false promises. Even more sadly, charlatans are sometimes successful in using greed as motivation to get actual doctors to promote their nonsense and create undeserved credibility to their products.

With pet owners becoming ever increasingly concerned with the health of their pets, the new frontier for charlatans is the relatively untapped pet industry. The inspiration for this post and prime example of what a charlatan is, can be seen on the web page below that showcases the unveiling of a miracle herbal cure for canine Cushings Disease:

If this ridiculous advertisement was not enough convince you of the danger of charlatans, perhaps one my own experiences with this kind will help drive the point home. Two years ago, a lady brought very emaciated 8 year old cat to see me. The cat had been declining over the past year and on the advice of a friend, she brought the cat to see a nearby homeopathic vet. Still new to my area, I had heard of this man, but I did not fully understand how dangerous he was until this case was presented to me. Since following this case I tagged this homeopathic vet with the name Dr. Yin Yang, I will refer to him as this for the sake of this short story.

Fully brainwashed by her friend and by Dr. Yin Yang, this sweet lady explained to me how the cat kept getting sicker and sicker despite several herbal concoctions that Dr. Yin Yang had maintained the cat on, and if not for his best efforts, she would have died a long time ago. Reading directly from his notes (I can't make this stuff up), I ascertained that Dr. Yin Yang had arrived at the necessity for this herbal regimen by determining that the cat had "Yin and Yang kidney and thyroid imbalance." Dr. Yin Yang arrived at this diagnosis by simply examining the cat, never having ordered even one diagnostic test.

One blood test and an abdominal ultrasound later, I quickly determined that this cat's kidneys and thyroid were just fine. The cat actually had intestinal lymphoma which, if diagnosed early, is a type of cancer that offers a favorable remission rate with treatment, approaching 13 months and longer.

Unfortunately for this owner and this kitty, having wasted nearly a year treating with herbs, the lymphoma was very advanced, infiltrating a large portion of her intestines, liver, and spleen. With her advanced cancer and her now debilitated state, she was a poor candidate for aggressive treatment. Dr. Yin Yang did a great job of ensuring this result.

Still, however, the owner did not bring her cat to us entirely too late. Forgoing conventional chemotherapy for less invasive high dose steroid therapy, the kitty responded remarkably. She began eating, regained most of her body weight, and had a good quality of life for 4 months, after which time she had to be euthanized when the cancer once again got hold of her.

Much to the relief of every legitimate veterinarian in my area, Dr. Yin Yang has retired. Amazingly enough, he left behind a rather substantial following that misses him dearly, despite this being but one example of many Dr. Yin Yang charlatan-esque cases that ended up in my, as well as other, legitimate veterinary clinics.

Roger L. Welton, DVM
Founder, WebDVM

Thursday, January 17, 2008

Incredible but true. . .

This is a little segment I like write periodically about recent experiences that seem hard to believe. Whether funny, inspirational, despicable, stupid, or miraculous, as incredible as these short stories may seem, they are oh so true. . .

The Horny Pit bull

A nice senior age gentleman brought his pit bull in for having a right sided head tilt. He explained that despite the tilt of the head, he seemed otherwise fine. His appetite was great, energy levels fine, and his sexual appetite as strong as ever. The gentleman then proceeded to tell me how his dog has blissfully spent his life wandering about his and other farms, mating with every female dog he comes in contact with - often multiple times per day. He then asked, "So what do you think happened to him, Doc, did he just screw his brains out?"

The World's Cheapest Cat Owner

A lady called about a cat that she had adopted 4 years ago that she had never gotten around to getting spayed. The discharge from the cat's most recent heat cycle seemed to have a milky component to it this time, plus it was persisting for much longer than typical. My receptionist explained to her that this could be the result of a abnormal hormonal cycle, but it could also be the result of a dangerous uterine disease called pyometra. The client then asked, "If the doctor examines the cat and finds that it is just a heat cycle, I don't have to pay for the visit, right?" My receptionist explained to her that it is my time she is paying for and that she will be assessed an exam fee regardless of the ultimate diagnosis.

The lady brought the cat in, and after I examined the patient and took an x-ray, I determined that there is a good chance that the cat had pyometra, and that we should proceed with surgery ASAP. I explained that prognosis is good if I can removed the uterus without spillage of uterine contents, a circumstance that is dependent on the severity of the disease. However, if there is spillage or rupture, then the prognosis is very guarded. The lady then asked, "Okay, there is spillage she ends up dying, I don't have to pay for the surgery, right?" To this I explained, that whether she live or dies, O/R time will have been booked, anesthesia, fluids and drugs will have been administered, and my time will have been dedicated to working on her pet. I told her that, while I expect the cat to live, in the less likely event that she did not, she will be responsible for her bill nonetheless.

Well, the surgery went fine with no spillage. However, I like to keep pyometra patients for 2-3 days on IV fluid an antibiotics to flush out toxins and control bacteria that may have contaminated the surgery on a microscopic level. This gives the patient the best odds of survival, and well as decrease complications. Already having fully known that this is the method by which pyometra surgeries proceed, not wanting to pay for the hospitalization, the owner changed her mind right after surgery, and demanded that we release the cat in her care.

Luckily, the cat survived with no complications.

Check His Teeth???

A cat who is notoriously a VERY fractious patient in the office came in for bloodwork to monitor his thyroid due to a long history of hyperthyroidism. Following the typical hissing, growling, swatting, biting, urinating, defecating ordeal that requires three technicians to successfully obtain blood from this patient, they quickly got the patient back into his carrier, barely escaping with their fingers intact. The owner who has witnessed all of this, as well as a long history of this kind of behavior from her cat, with all seriousness asked, "Oh, I forgot, his breath is stinky these days, will you pull him back out and check his teeth." I answered, "You must be joking."

Roger L. Welton, DVM
Founder, WebDVM

Wednesday, January 9, 2008

Missouri, you should be ashamed!

The puppy mill situation in our nation is appalling beyond comprehension. For those of you that are not aware of what a puppy mill is, it is a facility where tens to hundreds of dogs are kept in cages and repeatedly bred to continuously pump out litters of puppies. In many cases, the breeding animals are let out of the cages very infrequently or not at all. Puppy mill dogs are treated as production machinery, often with more neglect than one would treat machinery - it is less expensive replace a dog then it is production machinery, and money is the bottom line for the despicable individuals that run such places. The cages are found to be unsanitary, with wire floors that cut the pads, kept outside at the mercy of the severe extremes of summer heat, winter cold, and biting insects. Vaccines and other preventive care are not given, and the rate of mother/puppy death is very high. It doesn't matter, with little to no investment in caring for these dogs and puppies, and hundreds more dogs to keep putting puppies out there to replace the ones that regularly die, it is all profit. Profit is the bottom line regardless of the suffering involved in achieving their profit.

Puppy mills are the primary means by which many (if not the majority of) pet stores obtain their puppies that they sell. This explains why pet store puppies are commonly associated with being sick and immune system depressed, with a high incidence of congenital disease from inbreeding. It costs money to bring in unrelated, novel breeding animals to create genetic diversity. Puppy mill owners, regardless of the tragedy for puppies and owners they create, solve this economic dilemma by just continuously inbreeding from the population they have.

Puppy mills are an ever present problem in rural America in general, but I single out Missouri in this article, because in my experience, pet store puppy mill puppies most commonly come from Missouri, whether when I practiced in NY or here in Florida. Missouri is known for this in our industry, considered by many to be the capitol of puppy mills in our country. When people come in with their new pet store puppy pridefully inform me that their puppy was shipped in from out of state, I always ask them, "Let me guess, was he shipped in from Missouri?" The answer eight out of ten times is yes. The remaining two out of ten that come from elsewhere include other offending states that turn a blind eye to the cruelty of puppy mills, including: Nebraska, Kansas, Arkansas, and Georgia. For a clear picture of what these puppy mills and their "inmates" look like, please visit Prisoners Of Greed.

The citizens of these states that read this article may say that it is unfair of me to blame an entire state's population for the relatively small minority of their population that engage in and/or condone the cruelty of puppy mills. To that I maintain that I and the rest of the country are completely justified in holding all of you responsible for the actions of these individuals. I blame you for not demanding that state officials regulate and closely monitor to ensure that breeding facilities provide shelter from the elements, clean living conditions, preventive medicine, adequate exercise and social interaction, adequate rest between litters, and a max age where breeding females are retired, spayed and offered for adoption. I blame you for not listening to the pleading of countless Americans for your state to act and band together to lobby your state legislature to stop the cruelty of puppy mills. I blame you for having no passion for compassion and turn a blind eye to atrocities that occur to living, emotional, feeling, social creatures, right in your back yard.

If you wish to help countless puppy mill dogs and puppies and maybe one day put an end to the suffering of these animals, you can start by visiting the aforementioned Prisoners Of Greed, to join and contribute to the coalition to put an end to puppy mills. Do not purchase pet store puppies, as this contributes to, and supports the puppy mill industry. Educate others that when they purchase pet store puppies, there is a strong likelihood that puppy will be inbred and genetically deficient, and it will have come from parents that are confined, neglected, and grossly mistreated. Remember, greed is the bottom line - if there is little demand for pet store puppies and subsequently no money in puppy mill peddling, they will be less numerous. Finally, if you live in Missouri or other states known for puppy mills, band together with like minded people to force your state legislature to make laws to have facilities closely regulat, monitor, regularly inspect, and fine heavily or have facilites closed down when humane requirements are not met.

Roger L, Welton, DVM
Founder, WebDVM

Wednesday, January 2, 2008

"But doc, isn't he too old for anesthesia?"

This is a question I get at least once, some times several times a day in daily practice, following my recommendation for a senior age patient to undergo a necessary procedure that requires anesthesia. Whether it is a severely needed dental prophylaxis, tumor removal, or castration for an enlarged prostate, pet owners tend to have serious trepidation toward the administration of anesthesia in canine and feline patients over the age of 7. They generally seem to fear anesthesia with their pets more so than for human loved ones or even for themselves.

I find it both curious and frustrating that people can have no qualms about 78 year old Grandma going under for a hip replacement, but they are terrified to let Fluffy go under to have desperately needed dental work for teeth that are causing serious pain, infection, immune suppression, and could potentially lead to life threatening heart and kidney infection. The result of this fear of anesthesia is that many patients whose quality of life would benefit greatly from anesthetic procedures, live on in pain, discomfort, or other diminished quality, because their owners fear that the greater danger beyond everything is the anesthesia itself.

Please let me assure you that anesthesia is not the enemy. Anesthesia technology, monitoring equipment, and pharmacological and other life support measures in veterinary medicine, rival that of its human counterpart. Anesthesia is statistically very safe, with incidence of anesthetic death very low. Dental disease, enlarged prostates, rapidly growing tumors, orthopedic injuries, and a host of other ailments that can be treated with the aid of anesthesia, are real the enemy.

To be fair, however, not all veterinarians are created equal, and not all may be necessarily keeping up with the most current anesthesia protocols, induction agents, and monitoring equipment. While the majority of veterinarians make staying current and maintaining the utmost safety for the patient a top priority, vets like the former are out there - I know, I have worked with a few of them in the past. Therefore, in order for you to proceed with that procedure Fluffy so desperately needs with the least possible risk of anesthetic incident, I have compiled a list points you should address with your vet prior to anesthesia:

1.) Even if healthy, any patient age 5 years or older should have a routine blood panel run prior to anesthesia, to include at a minimum, blood chemistry and complete blood count. This enables the veterinarian to rule out any increased anesthetic risk due to organ compromise or anemia.

2.) Preanesthetic pain/anxiety injections are good medicine. Pain and/or anxiety can lead to stress hormone induced cardiac arrhythmias and other anesthesia complications. Reducing pain and anxiety is not just the right thing to do for the comfort of the patient, but it is also good medicine. A good preanesthetic injection protocol should include an opioid pain reliever (I like morphine, butorphanol, or buprenorphine) and a neuroleptic anxiety reducer (I like acepromazine or metetomidine).

3.) Safe induction agents (intravenous injections that get the patient into a sufficient plane of anesthesia to insert the breathing tube) are an important aspect for safe anesthesia. My induction agent of choice is propofol, a drug that is metabolized and eliminated easily and efficiently by the body, leading to the smoothest possible recovery.

4.) The anesthetic gasses halothane and methoxyflurane are partially metabolized by the liver and therefore associated with a higher degree of toxicity. Thus, these should be avoided. Isoflurane for use in both dogs and cats; and sevoflurane for cats are much safer and better choices for gas maintenance of anesthesia.

5.) At a minimum, a patient should be hooked up to a pulse oximeter to monitor blood oxygen saturation level and audible heart rate. However, the more monitoring equipment the patient is on the better. In addition to pulse oximetry, EKG, doppler blood pressure monitoring in addition are invaluable tools to monitor the cardiac and circulatory stability.

While it is impossible to guarantee that an anesthetic incident will not occur, taking the proper precautions reduces the risk considerably. Administered correctly, anesthesia is a far safer option than letting a patient live with an injury, ailment, or illness that can be treated or even eliminated with the help of anesthesia.