Friday, August 26, 2011

Head shaking - mine!

I'm feeling a little frustrated at the moment. In the past month, I've had a few of my clients get angry at a common policy Alberta veterinarians need to abide by. In order to prescribe a medication, there must be a current veterinary-client-patient-relationship. Current means that we have seen your pet in the past year.

These clients say that I am just being a money grabber. (If I wanted a more comfy lifestyle I would have become an orthodontist!!!) I simply want to practice high quality veterinary medicine and keep my license to practice. No license = no jobs for me and my staff. Plus, I am not going to give up my life's dream to practice veterinary medicine for anybody!!!

Put yourself in my shoes. A dog, let's call her Daisy, comes in for her yearly physical and medication refill for her arthritis. On the physical exam, I discover that her liver is enlarged. Bloodwork is done and we find that her liver enzymes are elevated due to the medication. We can change the medication to one that has minimal interference with the liver. Success!

Now, let's say that Petunia is brought in for her yearly exam. I also discover an enlarged liver but in this case, Petunia's owner can't afford the bloodwork at the moment due to a family emergency. I can go over a number of options so her owner can make an informed decision. A bloodwork refusal form is signed and medication can be dispensed. Success, I have an informed client who knows what to look for in case it becomes obvious that Petunia is getting sick.

Scary scenario. I've decided that I don't need to abide by the rules and just dispense the medication to Daisy and Petunia. I don't know there is anything wrong because there is no physical done. Guess who gets in trouble when either one gets sick and/or dies? Since I was negligent, that would be me!

Our animals age much more quickly than we do so at minimum, we need to be doing yearly physicals. A number of my seniors see me twice a year for physical exams.

Saturday, August 20, 2011

Captain's First Down

A few years ago I took a dog in for training. This is something I rarely do anymore due to my hectic schedule. Captain was an 11 month old Whippet and a cousin to my Whippet, Jazzy. When they started to run around the house, all you could do was flatten yourself against the wall or jump for a piece of furniture so you wouldn’t get run over.

I feel it is always a good idea for the owners to train their own dogs. It strengthens the bond and should be a lot of fun. In this case, he was a young teenage dog with a busy owner who I knew quite well. So, in he came for his sixty days of training. Of course, operant conditioning behaviour analysis (clicker training) was the only method of choice. That should be of no surprise to anyone who knows me even a little bit.

I started with conditioning the clicker (pairing the sound with something he loved – his kibble). The next step was to teach him to offer behaviour on his own. I almost always go with a head turn because you can never just tell them what to do, you have to be patient and wait for them to turn their head. As that happens, you click and treat. We got that in one short session. Target training went off without a hitch as well.

I was thrilled to have such a motivated dog to work with. My only concern was his down. I tried a variety of ways to get him to offer the down but the light bulb just never went off in his brain. By day five, I still didn’t have him offering a down. That may not sound like a big deal unless you only have sixty days to get all the desired behaviours fluent, on cue and can occur in any situation regardless of the distractions. Remember this is also a sight hound. They can get distracted by a piece of fluff flying in air and if they see a small, fur bearing animal in the shape of a rabbit…well…good luck!

I took him to the basement so I could video myself. I wanted to see if and what I was doing wrong as the trainer that he was not picking up this behaviour. As I was setting up the camera, I decided to try pure shaping. I was just going to stand there and wait for him to start offering anything that even remotely could be tied to the down.

As you will see, it only took four minutes to get the desired behaviour, there was a minute and a half of celebration then he had the down behaviour on lock down! When he comes to visit, that is always one of the first behaviours he offers just in case he can get me to click and treat him.

Thursday, August 18, 2011

Oh Rocky! Really?

About a month ago, I had a client bring in a barn cat because he’d become non-weightbearing lame on his right hind leg. Rocky sauntered around the exam room but was quite uncomfortable when I palpated his hip. We took a radiograph of his pelvis and there was a pathological fracture of the femoral neck.

Legg-Calve-Perthes disease is usually found in small breed dogs between the ages of 5 to 8 months. It is considered an inherited disease where the femoral head doesn’t develop normally. The bone becomes fragile and breaks easily. Now, this is where I know Rocky did not read the correct textbook. He is a two year old cat.

The picture shows the fracture outlined in red on the right hip. The blue line shows where the surgical excision needs to be performed. The green lines show what a femoral neck should look like. I will get to the yellow arrow in short order.

The only treatment is a femoral head and neck ostectomy which is surgery to remove the head and neck of the femur. The patient does well after surgery because the major supporting muscles are not involved and a pain free false joint is created with the scar tissue. I was up front with the owner as to the number of these surgeries I’d done – three. I prefer my surgeries to involve soft tissue not bone. We went forward with surgery. I have included a link to a really great video on this procedure. I would have loved the electro-cautery unit (it instantly zaps bleeders) and the drill. Since the neck was already broken, I had to use bone rongeurs (type of bone cutter) to remove and smooth the bone. (Sorry but I couldn't get the link to work so feel free to cut and paste to see the surgery)

The surgery was routine and recovery was going well until he got startled one day in the house (yup, he batted his cute eyes and landed himself in the house). He jumped up, twisted then fell on his left hip. The yellow arrow is pointing at what I'd warned the owner about. He had this disease in both hips and it was a matter of time until the second hip became a problem. I never dreamed my fourth AND fifth femoral head and neck excision would be on the same animal in the same month!!!

Sunday, August 7, 2011

Cryptorchid Deception

Sometimes our cryptorchid neuters can be a bit on the frustrating side. We had a dog in for a pre-surgical exam and he was unilaterally cryptorchid. This means that only one testicle is in the scrotum. Interesting fact, the right testicle is usually the one that is retained (just like it was in this case).

There are two kinds of cryptorchid testicles, those that are retained in the abdomen and the other in the inguinal canal. In this case it felt as though it was in the inguinal canal and I would be able to bring it over to the incision. Well, that mass turned out to be a whole bunch of fat with no testicle in sight. Agh! Into the abdomen I went and there it was just waiting for me. Success!!

In the picture, the testicle on the left is the one that was retained. Retained testicles have a much higher incidence of cancer and torsion. We always want to remove both testicles as we do not want to breed an animal with this heritable defect. My sister, Melissa, who is a geneticist would also want me to add that it is an X linked autosomal recessive trait.