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.

clulessmedic:

Sigmoid Volvulus

  • occurs mainly in elderly constipated patients
  • colicky abdominal pain, rapid dilation of sigmoid loop
  • abdominal distension
  • AXR - "coffee bean sign" = dilated sigmoid colon
  • Risk of necrosis and perforationif left untreated
  • Management - passage of rectal tube (causes passage of flatus + faeces), if this fails surgical untwisting of volvulus
  • Repeated sigmoid volvulus = elective resection of sigmoid loop

HUMANS CAN BLOAT TOO? *aghast*

Also in dogs it’s not a coffee bean, it’s Popeye’s arm

Popeye

(via nursingisinmyblood)

asker

chevko asked: About what age would you say spaying/neutering is best with dogs? We have three puppies that will need this. We've also got a 12-13 year old momma. Is it... bad choice of words, but is it worth it to get her spayed, too?

For non-giant breed dogs, I typically recommend 4-6 months of age before the reproductive organs have fully developed.  For giant breeds like Great Danes and Newfoundlands spaying and neutering at an early age can cause growth to be too rapid, so I will usually wait until at least a year with those ones.  You can definitely still get Mama Dog spayed to prevent pyometra (an infected uterus, which can be fatal) and any more puppies :)

asker

thelittlestavenger asked: Are you allowed to have visible tattoos?

It depends on your workplace.  I have no tattoos, so I can’t say for sure, and haven’t worked with any vets who have them.  However I have seen many technicians with various tattoos and as long as they aren’t offensive, and could be covered up if they had to, I think it’s probably not a huge problem unless the workplace is very conservative.

asker

Anonymous asked: Is it possible to "get used to" surgery gore? I have been wanting to be a vet, I'm a junior in high school, so I think it's tile I start looking for a career path. I am just worried the gore will bother me... I go to go see a kitten be spayed, but it wasn't a very bloody procedure... Was it hard for you to get used to?

I was always excited to see surgery, but I wasn’t sure if that excitement would actually hold up when I was faced with real blood and a real animal.  When I was a vet assistant I was a little nervous before my first surgery that I saw.  However, I did well and was eager for more.  Check out the post I just reblogged for some advice from someone who needed to take some time to adjust to it :)