I apologize for the terrible photos but I still haven’t gotten around to reading the user manual to our ultrasound machine, so phone caps of the ultrasound will have to do.  This was a dog who had free fluid in the abdomen (the black area in the first photo), a large splenic mass (the irregular, bumpy mass in the second photo), and a large liver mass (the round object in the center of the third photo).  When the black liquid was tapped through the abddomen, free blood was removed, indicating that one of the masses had likely ruptured and was bleeding into the abdomen.  The owners considered surgery to find and repair the bleeding and remove the masses, but ultimately decided on euthanasia instead, given that the chance the tumors were malignant was good.

My attitude towards school

shouldersdeepinvetschool:

At the beginning of the semester:

image

At the end of the semester:

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Sweet memories of vet school….

Ear mite sexytimes.  They don’t care who’s watching!

Ear mite sexytimes.  They don’t care who’s watching!

A few months ago I worked with a very kind elderly woman and her utterly sweet ruddy Abyssinian cat who had a large abdominal mass.  We were able to buy him a few more weeks of time with medical therapy, but ultimately she chose to put him to sleep before he declined further.  A month or two after that, I met another kind elderly woman and her ruddy Abyssinian cat, a diabetic who had had occasional bloody urine that we had treated as a UTI in the past, since diabetics are very prone to them.  She was concerned she would not have funds to treat him.  Unfortunately when I examined him his bladder was severely firm and distended, indicating a total urinary blockage.  With a heavy heart I realized that he most likely had a bladder mass.  As I gave her the bad news, the kitty climbed off the exam table and into my lap, and started purring as my eyes welled with tears.  I euthanized him, too, and the owner and I cried together.

The next day off I had I realized how sad I still was about these two sweet, charming cats who were both dealt such a tough hand.  So I found a stock photo of an Abyssinian and drew this little fellow in marker.  I sent a copy to both owners, thanking them for letting me know their gentle kitties.  It was sad, but also an affirmation of the bond between humans and animals.

Fluorescein stain applied to eyes under UV light shows scrapes and ulcerations to superficial eye ulcers like a charm.  Here were two recent huge ones!  Everywhere that is green on the surface of the eye is where the cornea has been scraped away.

In dogs who are prone to severe ear infections, such as cocker spaniels and bulldogs, the constant inflammation and infection in the ear can result in thickening of the ear skin and cartilage over time.  The abnormally thickened tissue makes it harder to treat the ear infection inside, and the inflammation continues.  The upper ear still has an opening into the ear canal, though the opening is swollen and difficult to insert medication into.  The lower ear, however, is an end-stage ear.  No amount of anti-inflammatory steroids or medications or antibiotics will fix that ear now.  At this stage, surgery such as a total ear canal ablation to remove the ruined ear canal and bones of the middle ear is warranted.  This option was discussed with this owner, but they have declined at this time.

Herein is the value of a thorough oral exam, which cannot be performed on an awake animal.  Anesthetic dental procedures allow for complete oral examination and dental x-rays, which allows you to discover dental disease that is not visible to the naked eye.  
This dog’s carnassial tooth (the large tooth to the right) and the molar (the smaller tooth behind it) look normal.  There is no excessive gum recession, and the tartar has been cleaned off the tooth, leaving a pearly white surface.  The first photo shows the length of the dental probe.  While probing the large carnassial tooth, the probe barely slips underneath the gumline because the gum is firmly attached to the bone underneath the tooth, as it should be. 
A gentle probe to the molar behind it, though?  WTF did my probe go?????  It fell into a bottomless black hole!  This is what is called a periodontal pocket, which is where the gum’s attachment to the bone has been eaten away, and the bone is typically in a state of destruction as well due to infection.  The carnassial tooth was not extracted, but the molar behind it was.  
The picture in the lower right shows a small premolar tooth.  Premolars have two roots, and the gap between the two roots is filled in with bone.  However, when the bone is eaten away, the furcation (the split between the roots) can become visible.  In this case I could not see the furcation because the gum still came up to the bottom of the tooth.  But when I tapped that area with the probe, it went all the way through to the other side of the tooth, which is a grade III furcation exposure (out of 3) and an indication for extraction.
Dentistry has an endlessly steep learning curve to it but I am constantly finding new things to be interested in about it all the time.  Even if your pet seems to have clean teeth, things like this can lurk beneath the surface!

Herein is the value of a thorough oral exam, which cannot be performed on an awake animal. Anesthetic dental procedures allow for complete oral examination and dental x-rays, which allows you to discover dental disease that is not visible to the naked eye.

This dog’s carnassial tooth (the large tooth to the right) and the molar (the smaller tooth behind it) look normal. There is no excessive gum recession, and the tartar has been cleaned off the tooth, leaving a pearly white surface. The first photo shows the length of the dental probe. While probing the large carnassial tooth, the probe barely slips underneath the gumline because the gum is firmly attached to the bone underneath the tooth, as it should be.

A gentle probe to the molar behind it, though? WTF did my probe go????? It fell into a bottomless black hole! This is what is called a periodontal pocket, which is where the gum’s attachment to the bone has been eaten away, and the bone is typically in a state of destruction as well due to infection. The carnassial tooth was not extracted, but the molar behind it was.

The picture in the lower right shows a small premolar tooth. Premolars have two roots, and the gap between the two roots is filled in with bone. However, when the bone is eaten away, the furcation (the split between the roots) can become visible. In this case I could not see the furcation because the gum still came up to the bottom of the tooth. But when I tapped that area with the probe, it went all the way through to the other side of the tooth, which is a grade III furcation exposure (out of 3) and an indication for extraction.

Dentistry has an endlessly steep learning curve to it but I am constantly finding new things to be interested in about it all the time. Even if your pet seems to have clean teeth, things like this can lurk beneath the surface!

Guess who finally queued up a whole bunch of posts for the next 2 weeks?

veterinaryrambles:

Ugh…. that feel when your back is killing you because you extracted 21 teeth today from one tiny dog and you were crouched over his little mouth for 4 hours plucking tooth after tooth….  Tied my personal record today though, so there’s that.  I sort of dread, yet welcome the day when I hit 25 teeth from one dog…..

 glamvetchic said: What anesthesia protocol were you using for that long of a time?

We gave a presedative of morphine with a touch of acepromazine; morphine for its sedative and analgesic properties, acepromazine for sedation.  We induced with propofol and maintained on a low rate of isoflurane.  He was very stable for the entire procedure, being maintained on IV fluids and thermal support.  He received lidocaine blocks in his mouth to reduce pain and an injection of Metacam for NSAID pain relief.  He woke up quickly and once he was sternal and awake I gave him some buprenorphine for more pain management.

Ugh…. that feel when your back is killing you because you extracted 21 teeth today from one tiny dog and you were crouched over his little mouth for 4 hours plucking tooth after tooth….  Tied my personal record today though, so there’s that.  I sort of dread, yet welcome the day when I hit 25 teeth from one dog…..

iheartvmt:

Cat bite. 

I’d cleaned the wounds with just about every disinfectant we have in the clinic, and let it bleed to flush out the wound, but cat bites are nasty and even with good first aid about 80% of cat bites will become infected.

Top pic: My hand yesterday, a few hours after the bite occurred. Note the mild swelling localized around the two puncture wounds.

Middle pic: I’m to take ibuprofen, amoxicillin/clavulanic acid (better known as Augmentin or Clavamox), and do the whole RICE regimen… Also got a tetanus booster because oops last time I had one was 2005. Man I’m old. Fortunately both the cat and I are up to date on our rabies vaccinations so we’re golden there :D

Bottom pic: My hand 24 hours later, even following the doctor’s treatment plan. Yikes! The swelling has spread to include my entire hand, including fingers, and I can’t make a fist because it’s too stiff and painful. If it keeps getting worse instead of better, it’s back to el doctor for me. Ugh.

Doc said last time she got bit, she ended up needing IV antibiotics. Praying it doesn’t get that bad!

Anyways, sharing this so folks — especially cat owners and future vet staff — can see why we take cat bites so seriously. 

Thank you for sharing.  I have been bitten many, many times (mostly by my own pet cats) and have never had an infection somehow, but this is a good reminder.  The last time I was bitten at work I went to the doctor for an antibiotic script just in case it started swelling.  Luckily I didn’t need them but this can happen easily due to the Pasteurella multocida bacteria that cats carry in their mouths.

Greetings from Nashville, Tennessee! I’m at the American Animal Hospital Association (AAHA) veterinary conference doing my continuing education. CE is required to maintain a current veterinary license. CE is usually fun because a ton of vets get together at once in a big city and spend the time learning and exploring the town. So far I’ve been learning about canine vaccine updates and listening to live country music, which is around every corner! I’ve never been to Nashville before and am having a blast :)

asker

mangogochutney asked: What is your take on the Vet, Shirely Koshi, that committed suicide. Do you think vets face this level of abuse daily ?

listen-look-feel:

drferox:

Dr Shirley Koshi was a veterinarian on the other side of the world, I did not know her personally. For those unfamiliar with the story, there are articles here and here. I would recommend against googling or reading the comments, as cyber bullying and harassment were major factors that contributed to this veterinarian’s suicide, so please don’t feed the trolls.

The short version of the story, as far as I can tell from published facts and discussion boards with professionals that actually knew her:

  • Nice lady finds a sick cat in the park, and takes her to Dr Koshi. Nice lady pays for diagnostics for this ‘stray’ and they find he needs some extended treatment. Nice lady surrenders cat to Dr Koshi, who continues to treat him, at her own expense, and essentially adopts him as her pet. (Adopting sick animals that nobody will pay for is a common way for veterinary staff to gain their pets)
  • Approximately 3-4 months later Gwen Jurmark, a lady who ‘adopts’ cats from the local shelter to then release them in ‘colonies’ on the streets, took Dr Koshi to court over ownership of the cat. As I understand it, Gewn had no legal proof of ownership, or permission to create these cat ‘colonies’.
  • The court battle was long and financially draining. In addition, Gwen Jurmark organized protests outside Dr Koshi’s clinic and an online slander and harassment campaign, reducing business.
  • As a result, Dr Koshi committed suicide. I believe there is still a coroner’s report pending, but it is claimed she left a note thanking her staff for their service, so it seems likely. 
  • After all this, with no kin claiming the cat in question, he was returned to the shelter and adopted…by Gwen Jurmark…and probably dumped in a park again.

Personally I think Gwen Jurmark should be trialed for manslaughter, and I hope she gets what’s coming to her. I’m not religious, but part of me hopes she is reincarnated as the cat in question in order to be ‘adopted’, dumped in a park, get sick, be nursed to health and given a home, only to have that home taken away from you again and be ‘adopted’ again to go back to the park, in the freezing New York Winter.

Putting aside my visceral hatred of Gwen Jurmark, in answer to your question this would be an extreme example of the abuse veterinarians routinely face.

We often see people who claim to ‘rescue’ animals, but are unable to afford even basic parasite treatments, yell at us and accuse us of being “Only in it for the money” when we decline to give these animal hoarders a discount or free treatment. The fact is that those of us who were in it for the money do the maths and figure out that they’re better off switching careers to human medicine or dentistry. Those of us who stay are actually here for the love of animals, but we need a paycheck to pay our rent too. Veterinary medicine degrees routinely rank in the worst 10 value for money degrees. It’s just a fact of the industry.

(As an aside, I would give a discount to a registered charity if I knew for a fact they weren’t crazy hoarders. The key here being registered charity.)

It wasn’t so long ago that I was screamed at and almost hit by a crazy woman that that found a perfectly groomed bichon frise and brought him in as a stray. He had a microchip, but because the owners didn’t answer the phone straight away she wanted to take him home, which is illegal. I was abused because I wanted to send it to the council for holding instead of letting her keep it at home. She literally ran out of the clinic after screaming at me and took the dog with her. I called the council, the ranger went to her house, fined her, seized the dog and returned him to his real owners approximately 20 minutes after picking him up. It’s worth mentioning that council rangers and RSPCA cruelty investigators cop a lot of unfair abuse too.

The particular difficulty for us vets seems to be that we are empathic perfectionists, we want to get things right all the time and we take any and all criticism to heart. It’s hard to make sense of it all when we’re being told that we’re selfish and cruel and only in it for the money, and yet working long hours, losing sleep over our patients and wondering why we can’t afford to pay all our bills this month. Nobody tells Woolworths that they’re “Only in it for the money and not really Fresh Food People”, yet as a profession we get that sort of abuse it all the time.

We can’t stop crazy people getting pets, and we wont deny those pets care if they come through our doors, but should that care cost money then we have to be prepared for an ear bashing.

A little bit every day does wear you down, especially when the emotional bullying and financial pressures couple with familiarity with death, burnout and compassion fatigue.

Fortunately, nobody has ever tried to take me to court. However, I have had one person threaten to sue me for malpractice because her cat was clipped too short. (Despite specifying in mm how long the coat would be.) It was all threats because we wouldn’t discount the bill for her ‘distress’.

It is an emotionally and intellectually draining job, and we set our own standards high. Dr Koshi’s story is a tragic one, and I do hope someone has the ability to bring Gwen Jurmark to justice for her death. I worry about my own colleagues sometimes, some more than others, and am always worrying if not hearing from them in a while might be a sign.

For those in the veterinary industry, or those that would like to be, who are reading this I implore you: Watch your colleagues. Ask them if they are okay.

And if someone asks you, for goodness sake answer honestly.

Every prof at school knows at least one colleague who has taken his / her own life..

Vets have the highest suicide rate of everyone working in the medical field..

If you appreciate your vet, please let them know.. Sometimes your one good word will be the only uplifting thing they’ve heard all week..

I don’t know any veterinarians yet who have killed themselves.  I hope that remains the case for decades to come but I also accept that it probably won’t.  :-/

asker

Anonymous asked: hi so my chi is under meds (secnidazole) i'm administrating them with a syringe but after i gave them to him tonight he started doing some sort of duck sounds with his throat and that really freaked me out. i don't know if it's some sort of reaction or maybe he was kind of choking with the med? how can i help him to stop doing that? since he's still occasionally doing it. I started to think that it could be some sort of reverse sneezing but i don't know if it could be caused by the meds. thanks.

I have actually never prescribed this medication before, but it appears to be related to metronidazole, which has an awful taste.  You could try getting him to drink some water from a bowl or with a syringe in case the bad taste is bothering him or he got it stuck in his throat, but if he doesn’t improve I would definitely call your vet who gave you the prescription.