Empathy for dentists

Every once in awhile, I like to throw in a "day in the life" blog. Two days ago, my day ended with me having great empathy for my professional cousin - the dentist. I have nothing but respect for dentists. It has to be a hard job because does anyone really like to go to the dentist? But fortunately for dentists they are the most likable people. I noticed this trend in college too. The med school student parties were fun. The vet school student parties were fun and unique. But the dental school parties were the BEST! So you can see that early on, I have developed this theory about dentistry attracting the most fun loving people on the planet. I think this personality trait makes them better able to cope with the fact that all their patients hate coming to see them.

Thursday morning seemed like a normal morning at the beginning. Mostly routine annual physical exams with some itching and diarrhea thrown in for good measure. Then one after another it happened. Every single dog I examined lifted its lip and growled at me. I even had a 12 week old puppy snap at me. WHAT? Are you kidding me? That happens so rarely I can't even remember the last time it happened. There is always the occasional growling dog that comes along, but every single one? After 24 years of doing this, I'd like to think I have a pretty good vibe with my patients. The vast majority of dogs that growl or snap at me do so out of fear. Which is actually the good thing about being a woman since a lot of dogs tend to be less fearful of women than of men. They don't, however, like coming to the clinic any more than I like going to the dentist. But most dogs show some modest amount of restraint when it comes to showing their fear. Usually it's just a little shaking, a lowering of the head or tucking the tail. It certainly left me wondering what just happened. It was probably just luck of the draw as the saying goes, but I did have a cat pee down my pant leg earlier so maybe it was a reaction to my eau de cat urine parfum that I carried into the room with me. Fortunately the growling stopped in the afternoon. But unfortunately, there were three euthanasias. That always makes a day stressful for both me and the staff.

At the end of the day, I sat an pondered about how dentists deal with all their patients "growling" back at them all day long. In typical stream of consciousness thought, I remembered a conversation I had with a human surgeon. He had brought his dog into me to have neutered. During the follow up visit for booster vaccinations and suture removal, we got into a discussion of the differences between human surgery and veterinary surgery. I said that I bet he never had a patient chew their stitches out. Must have hit a funny bone with him because he just burst into hysterical laughter. He was probably having a vision of one of his patients licking their incision. I guess you might say I had that surgeon in stitches. Always good to end the day with a happy thought.

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On a final note, I take back everything I said in last week's blog about not seeing many fleas yet. With the first day of summer has come fleas out the wazoo! This is REALLY early for northeastern Ohio. Usually flea season doesn't get cranked up until the end of July/beginning of August. I guess all the warm wet weather has sped up the flea life cycle compared to what is usual for this time of year. So get those dogs and cats on flea prevention now because the summer has just begun.

Some like it hot

What better thing to do on a hot summer afternoon than escape the heat outside and do a little writing. Now some may argue that northeast Ohio is never all that hot and for all but a few days of the year, I would agree. Still, upper 80's with dew points in the upper 60's is just downright uncomfortable for this northern girl. For some odd reason I decided to take a quick walk back to the blueberry patch on my farm and waited until the sun was blazing high in the sky. My beagles are lounging in the shade of the big maple in the back yard, but the Brittany decided she needed to see the blueberries too. Fortunately for her (but not for my house) she has access to the creek and a quick dip was definitely in order as we walked back to the house. She really is as dorky as she looks in the picture of her just getting out of the creek.

In honor of the heat, I thought I would list some of the big summertime mishaps I see every year at the clinic.

• Heat stroke: most commonly seen in animals left in parked cars or dogs that run (or even just walk in some breeds) when temperatures are above 70 degrees. Remember dogs and cats do not get rid of heat from their bodies as well as people do.
• Insect bites: deer flies, bees, wasps and many more. Be especially careful to watch for the tips of ears on dogs that spend a lot of time outside. There are insect repellents made just for the purpose of applying to dogs so ask your vet. I really hate seeing bit up ear tips.
• Hives: little welts all over the body, swollen faces. Can be caused by insect bites, but I think more likely from plants that are ingested. Most of the time we never do find out what the trigger is.
• Maggots: oh yes, a favorite, NOT! Maggots should not happen, but they do every summer. Heavy coated breeds such as Chow Chows and Saint Bernards are especially at risk. Senior pets that aren't as mobile and may soil themselves with feces or urine are especially prone. Check your furry and old dogs that are outside EVERYDAY!!! Don't' forget your rabbits. I see a couple maggot infested rabbits each summer. You may have to lift up the fur and check the skin to even see them. Maggots aren't just a nuisance. Maggots kill.
• Animal bite wounds: cat fights, dogs cornering groundhogs, raccoons, possums and just about anything else with teeth. Please make sure your pets are vaccinated for Rabies.
• Skunk spray: this one is oh so fun. From personal experience, the solution made from 1 quart 3% hydrogen peroxide, 1/4 cup baking soda and 1 teaspoon of liquid soap works pretty good. Tomato juice isn't half bad either in a pinch and at least my dog enjoyed licking her fur afterwards even though I rinsed it pretty well. Just be warned that even thought the smell is reduced, your dog will probably give off a faint skunk aroma every time it gets wet for 3-6 months.
• Poison Ivy: no, dogs and cats do not get a rash (I get asked this all the time), well, I never say never, but it's almost never. But they can pick up the oil on their fur and then share it with their human friends. Again, personal experience here.
• Hit by car, tractor, brush hog, motorcycle, 4 wheeler, golf cart, etc.: be careful out there and don't let your dogs and cats play in the road. Be careful about senior pets that may be hard of hearing and like to lounge in the driveway.
• Ticks: I live in an area that is not heavily populated with ticks. Thank goodness, because I really hate ticks. They carry all sorts of bad diseases and they are just gross. At least I don't freak out any more when I see them like I did as a teenager. I guess I'm so used to them now. Still, if your dog and cat picks up a lot of ticks, it is worthwhile to use a product such as Frontline or Preventic collar on them. You do not want to see what happens when an animal gets a full blown tick transmitted disease.
• Fleas: it's June. Starting to see the first cases of flea bite dermatitis this past week. With most of the dogs and cats I am seeing, I have to search long and hard to find a flea because there just aren't a whole lot of fleas hatching. Yet. Wait 2 months. If your dog or cat is losing fur and scratching, even if you don't see any fleas, it may be flea allergy. Itchy pet = treat for fleas. And please used something that works well and is safe. I get tired of cats coming into the clinic seizuring because someone has used an over the counter flea product on the cat incorrectly (or sometimes not even incorrectly, just a sensitive cat). Ask your vet for recommendations. Many of the good flea products are being sold over the counter now. Just do the research. AND TREAT ALL THE PETS IN THE HOUSEHOLD EVEN THE CATS THAT NEVER GO OUTSIDE!!!!!!!! Did I say that loud enough? Put yourself in your pet's place. Would you like to feel things crawling over you and biting you every day, all day long?
• Heartworms: should not ever ever ever happen except in some instances in the lower Mississippi River Valley, but that is not here. Should not ever happen in northeastern Ohio. Remember cats can get heartworms too. Ask your vet. And also, for those who say their dog never goes outside, heartworms are spread my mosquitoes and yes, I am sorry, but mosquitoes do find their way into our homes and apartments. Several years back, I had a client with a little toy poodle that lived in a high rise and did its doggy duty on pee pads. This dog never went outside. Guess what? Yep, it got heartworm. ALL DOGS SHOULD BE ON HEARTWORM PREVENTION!!!!! Did I say that loud enough?
• Gunshot wounds: OK this is directed at the jerks that shoot other people's animals. I am not talking about dogs that kill livestock/other people's pets or aggressive dogs. I am talking dogs and cats that roam the neighborhood. Yeah, well maybe they shouldn't be roaming the neighborhood, but don't shoot them. Sorry, that is just mean and stupid. There are better solutions (and I am not talking poisoning you jerks!). Sorry if I got carried away there, but this subject just makes me mad.
• Cuts, scrapes, impalement on sticks, etc. OK these sometimes just happen. I guess if we lived in cages they wouldn't. I chalk most of these up to the scars of life. Don't worry so much about these. Living life is a risk. Go have fun!

Guess I'll be having a busy summer as usual.

What is that lump anyway?

Seems to be a lumpy bumpy kind of week here at the clinic, but I had two of my lump removal surgeries decline a biopsy this week so I thought I would do a little discussion of lumps and bumps that are found on our pets.

First let me say that lumps on or under the skin are REALLY common in dogs. Not so much in cats, but they can get them too. But dogs love to grow lumps and bumps. Fortunately probably 90% of skin bumps in dogs are benign meaning that they don't spread into the surrounding tissue and they don't spread throughout the body. Most benign lumps are harmless, but some can grow quite large and then they can cause a problem. I once removed an 11 pound benign lipoma from the rear leg of a dog that weighed 17 pounds after surgery. The dog sure could walk better after that surgery! The most common lumps I see in dogs are sebaceous cysts (they sometimes can rupture and ooze a cottage cheese like material), sebaceous adenomas (I call these "moles" to use a common slang term and most owners tend to call these "warts") and lipomas (which are fatty tumors that form a smooth lump under the skin).

Now if 90% of lumps and bumps are benign, that would mean 10% are cancerous growths. These growths are more aggressive and have the potential to either invade into the surrounding tissue or spread throughout the entire body. I know the word "cancer" scares a lot of people (heck it does me too), but surgeons all over the world are curing patients from cancer every day. A cancerous lump grows. The lump is removed before any of it spreads. Patient is cured. Now there are aggressive cancers that don't follow this plan, but when it comes to lumps on the skin, those lumps have the best chance for cure because they can be found when they are small.

Before I go any further, I am going to answer the most common question I get in regards to lumps. What causes a lump to grow in the first place? The answer: I don't know. That is the one million dollar question now isn't it? Lots of research going on right now and the puzzle is slowly being solved. But I am the practical sort and for me, it really doesn't matter why a lump grew because I have no means to stop them from growing. What matters to me is what to do about a lump now that it is already here.

Unfortunately, it can sometimes be hard to tell a benign lump from a cancerous lump by just look and/or feel. I'm not going to go into great detail about ways to tell the difference other than to say they vary from needle biopsies to surgical biopsies with some differences in between. But if I feel strongly enough that a lump or bump be surgically removed, then 95.7582% of the time I am going to recommend that the lump be sent to the lab so the folks in the white coats can look at it under the microscope and determine if it is benign or malignant. Now I know that a biopsy is not cheap, but believe me, sending lumps off to the lab is not a big money maker for the clinic. Most of the fee covers how much the lab charges us with a little tacked on to cover the cost of the vet tech preparing the sample to be sent and the doctor interpreting and calling the owner with the results. I can't even say that I am purposely sending business to the lab. I don't even know the folks at the lab. I said they wore white coats, but I really don't even know if that is true or not. What is true is that if I recommend that a lump be sent out to be biopsied, I truly want this information in order to best care for my patient.

But I will sometimes get someone who says that they do not want to know the results because if their dog has cancer, they aren't going to treat it anyway. Fair enough. But let me give you two real life scenarios that I have personally encountered.

#1 A cute little beagle comes in to have a growth removed and it turns out to be cancer. The pathologist says that this cancer is invading into the surrounding skin and that little microscopic fingers of cancer cells are spreading outward and not all of them were removed at the time of surgery. So I go back to surgery and remove more tissue. This time the pathologist says all the cancer was removed. Three years later the dog is cancer free with no recurrence. What if we had not sent the lump out to be tested? The dog would have had its cancer return and maybe spread throughout the body. Then it might be too late to do anything.

#2 Sharpei with an ugly nasty mass on the front of one front leg. I took off the mass and the owner refused to pay for a biopsy. 3 or 4 months later, the mass grew back and she brought the dog in and asked what should be done? Hmmmm? I have no idea what to do because you didn't want the lump biopsied the first time around. So back to surgery, remove the lump again, and this time send it to the lab. Turns out the mass was a kind of deep seated infection that could have been treated with long term antibiotics instead of another surgery. The first biopsy could have saved that dog a second surgery and saved the owner a lot of money.

Now I am not so anal retentive as to say every lump that is removed should be biopsied. I don't send out sebaceous cysts most of the time and known lipomas don't need sent out either. In general though, if a lump is important enough to be surgically removed then it is important enough to find out what is that lump anyway?

Banging head against a brick wall

According to the free dictionary online, the definition of "banging head against a brick wall" is to keep asking someone to do something that they never do. Sometimes there are very valid reasons why someone doesn't listen to what you are asking them to do. You wouldn't go play out in traffic or jump of a cliff just because someone asked you to, right? Right. But most of the time when I am talking to clients in the exam room, I am not asking for anything so extreme. You see, I love my animals very much and I assume that everyone loves their pets as much as I do. I want my animals to live happy and healthy lives and I want that for my patients. So why do have I such a hard time convincing people to put their overweight pets on a diet? I know this isn't just a "me" problem because my friends who are vets have the same problem. But why is this a problem? That's what I am here to explore today.

The facts are there. We are bombarded in the news media about the health risks of obesity in people. We know that obesity speeds the aging process. Purina did a cool study in Labrador Retrievers a few years back that showed that lean dogs live almost 2 years longer than dogs that were overweight. We know fat cats get diabetes. We know that fat dogs develop arthritis much earlier than lean dogs. We know that too much fat in the body causes inflammation throughout the body.

Now I know the issues dealing with obesity in people are complex and I guess they are in dogs too, BUT. Don't you just love the "but" part. Two days ago I was talking to a client in the exam room about how we take better medical care of our pets than we do ourselves. I can totally relate to this. I will bring my own dogs into the clinic every year to get their teeth cleaned, but I won't get my own teeth looked at unless there is a problem. From my reasoning, I think I do this because I see my pets as very innocent. They need me to feed them and look after them. I can choose to have rotten teeth if I want to. They cannot choose. It is up to me to make those decisions and I choose to take care of their routine medical needs to the best of my ability. You would think obesity would be a simpler solution then regular medical/dental care. After all, health care costs money and in this economy, sometimes money is hard to come by. But we all have to feed our pets. In fact if we feed them less, that would save MONEY! But yet pet obesity is rampant.

As I started typing this blog, I found myself reaching into the box of chocolates sitting on my desk next to me. I can choose to do this. My dogs cannot choose how much they eat because I choose the amount for them. They cannot go to the grocery store, or the drive-through burger joint, or open the refrigerator or even open the locked-as-tight-as-a-drum container that holds their dog food. If they would they could, but they can't. How much they eat is my decision. I am the ruler of the household. Ok, only on this one subject, but hey, I'll take what I can get.

Back to the banging head part. Case #1 Just this month I saw a little dog owned by a woman who lives by herself. She came to me because her dog couldn't walk and wanted to put it to sleep. I could tell how attached she was to this dog. She thought the dog couldn't walk because it was getting old and had some disease. Well, the dog did have bad arthritis, but 90% of the reason this dog couldn't walk was because it was obese. I put it on medicine for the arthritis and talked long and hard about weight loss. But how does this happen? How can someone feed their dog so much that it gains weight until it can't walk? And how can they not know this is happening? Someone please explain this to me.

Case #2 I'm in the exam room seeing a dog for its annual physical exam and notice that every year it has gained weight and every year we have counselled the owner on feeding and weight loss. So the conversation goes like this. Client: "But doc, I only feed Muffy 1/2 cup of food twice a day like you told me last year." Me: "It doesn't matter what I told you last year. If that is what she is eating and she is still gaining weight, then she needs to eat less.". Client: "But if I feed her any less, she will starve to death.". Ok, tell me how this makes the slightest bit of sense?

Case #3 Seen by Dr. C. this month. A couple with an obese Chihuahua. The dog can hardly breath and has heart problems. They go on and on about how much they love this little dog and what this dog means to them. Really? They are slowing KILLING their dog. Why is reality so hard to grasp?

All this head banging though will go on. I will continue because there are successes. In fact I wrote about a couple of them in a November 2009 blog on obesity. I also know that what works well for one person doesn't work so well for another. The one thing I will not do though is shut up about this. This is too important. Pets' lives are at stake. I am their advocate. Their voice. I want them to live long healthy lives. That is what I want for my own animals. I expect no less for all animals that I see at the clinic.

If anyone has an overweight pet and would like help, I am an email away. Or you can wander over to Dr. Ernie Ward's web site on pet obesity prevention. LOTS of good information over there. Maybe you have your own story of what works and what doesn't for you and your pets. And if you have any suggestions on how to motivate people to get their pets to lose weight, I am all ears.

ps I wrote this blog last week and just yesterday I saw a patient that had lost 8 pound from last year. Looked great! So yes, there are successes. That was a very nice part of my day.