Lyme disease vs. “Blue Dot” disease

April 19th, 2017

I had two patients seen by another office recently for possible Lyme disease.  One was a little terrier dog who was feeling well, but her owner discovered an attached tick on her undercarriage, removed it, and noticed a ring of reddened skin around the attachment site.  Because the owner was concerned about the “bullseye” lesion of Lyme disease, off she and the terrier went to Hospital Big (it was a Saturday, my office is closed).  Lyme (and heartworm, Erhlichia, Anaplasma) test, doxycycline (antibiotic), and some other stuff (owner did not share an invoice with me):  $500.  Terrier (with no symptoms of Lyme disease) did well on a course of antibiotics.

Doggie number 2 (a fancy Italian breed)  was presented to Hospital Big, again on a Saturday, for extreme lameness, poor appetite, fever, and a mild ear infection.  Giardia test, exam, ear cleaning, ear potion, Lyme (etc.) test, NSAID, doxycycline, anti-nausea injection:  $555.67.  Fancy dog responded very well to treatment and made a full recovery.

Some highly opinionated thoughts on these two cases.  In the first case, the terrier simply had an attached tick–something that is dead common this time of year in Bucks County.  Even pets that are using great tick products (and there are now many great tick products), ticks may still attach before they become ex-ticks.  Ticks bites can result in a non-specific red circular rash, but dogs do not develop the erythema chronica migrans that humans do with exposure to the Lyme organism (Borrelia burgdorferi).  So when a client brings a dog to my office with an attached tick and accompanying rash, I will tell the owner that this is a perfectly normal and perfectly innocent lesion, and that absolutely no treatment of any sort is required.  Someone ought to have told the owner that, IMO.  Instead, hundreds of dollars was spent on a nothingburger of misplaced worry on the part of the dog’s very caring owner.  Dogs are, BTW, extremely resistant to symptomatic Lyme disease–only a small fraction of infected dogs will develop any problem related to their infection, in contrast to humans, who are highly vulnerable to symptomatic Lyme disease (although many only develop the pathonognomic erythema chronica migrans rash).  Incidentally, cats, deer, sheep–lots of species are completely immune to Lyme disease despite ease of becoming infected with the causative organism).  My office has stopped using the 4-way diagnostic Heartworm/Lyme/Ehrlichia/Anaplasma test for routine HW screening because of the very common Lyme positive results in perfectly normal dogs.  And treating “blue dot” positive “Lyme disease” is not safer in any way than not treating.  There is absolutely no evidence that feeding antibiotics to dogs with blue dots and no symptoms does anything helpful (other than to pharmacy revenues).

The second dog, our Italian friend, is quite a different story.  He was very sick (his owner told me she thought he was dying) and had several of the classic symptoms of canine Lyme disease.  Fever, dramatic lameness (we sometimes call them fracture lame–as bad as a broken bone), poor appetite.  For this patient, Lyme testing is clearly indicated, and quite reasonably antibiotics, too.  Pain relief–definitely.  Some of these dogs are in need of NSAID and tramadol (an opiate analog).  For this patient, full credit for the medical approach and a very happy outcome for the dog (and owners).

Screening for infectious diseases sometimes produces results that are worrying but not relevant to the patient and its symptoms.  There is considerable science/epidemiology around the use of tests for screening vs. sick patient diagnosis.  In general, tests perform better (they are more accurate) when disease-appropriate symptoms or risk factors are present, and perform considerably more poorly when they are absent.  This is a fact of almost all tests, though it sometimes frustrates dog owners who insist that their dog was “diagnosed with Lyme disease” (or something else) absent a single symptom of said disease.  I would call that “Blue Dot” disease, an incurable though expensive condition brought on by inappropriate testing.

 

http://www.VeterinaryPartner.com/Content.plx?P=A&A=1588

Snake Oil

January 1st, 2014

There has always been fertile ground for those selling hope to those most desperate for it, witness the $30 billion spent each year on weight loss products in the USA alone (sadly, for most of us, it’s making sure calories in = calories burned;  a pill would be a lot easier since I drive by Krispy Kreme every day).  Hair replacement pills, hair removing potions (if only we could figure out a useful exchange there, huh?).  These have proved to be staples of hucksters for over a hundred years, and while the individual products come and go, the categories themselves are perhaps timeless.  In addition to those, I add much of what passes for nutraceutical/herbal/holistic products–these are not regulated for efficacy, and indeed–holistic remedies are defended by their proponents are being very useful/excellent, but inconveniently immune to traditional demonstrations of efficacy.  That is, you cannot conventionally prove they work.  Let that sink in a bit–”please give me $$ for this highly effective remedy that cannot be shown to be effective by any traditional scientific inquiry”.  Nice work if you can get it, right?  Here’s a great resource for debunking a host of quasi-medical scams:  http://www.quackwatch.com

A little about veterinary holistic medicine.  There is no “holistic veterinary school”, so any knowledge about this topic must be acquired from sources other than traditional Western veterinary schools.  That means a rather substantial lack of academic rigor in the “certificate” courses that allow you to graft extra capital letters behind your name.  Colleges must meet certain educational standards–certificate programs have no such oversight, and are often nothing more than a pretty piece of paper in exchange for some amount of cash–sure, you have to attend 125 hours of coursework, but nothing more than buzzwords and nonsense about “ancient healing techniques”, “energy balance”, etc.  BTW–for all the references to “ancient healing” methods, the ancients had, in about 3,000 years of trying, not improved human lifespan by any great degree.  http://en.wikipedia.org/wiki/Life_expectancy  Please notice that lifespan chart–in just over one hundred years of interventive, problem-based (non-holistic) Western medicine, discovery of the germ theory, clean water, disinfection, aseptic surgery, antibiotics, and vaccines DOUBLED human life expectancy.  Take that reiki, Chi, herbs and spices!

So imagine my head explosion when I was sent a link to Galaxy Jackson’s line of cat holistic remedies.  Things like “Bully Remedy”, formulated for “all species”  (really–marmosets, oryx, cat, dog?) composed of “natural spring water, alcohol, essence of Lotus (presumably not the British sports car Lotus, unless you want your cat to leak oil, too), Full Color Spectrum (um, light?), Reiki Energy–in a bottle (?!?), gem infusion, plus other various essences. The sales page is festooned with testimonials from users singing the praises of how effective these remedies have been, so it must be true, right?  Deep breath.  I’m sorry, but you can’t bottle reiki energy, whatever that is or isn’t.  Or “gem infusion”.  And while there may or may not be other herbs and spices present in infinitestimally dilute concentrations, this, pardon the term and apologies to Penn and Teller, is bull**** in a bottle.  There is no potion or lotion or scent that will make your cat less of a bully or more tolerant/resistant to bullying.  It’s not possible.  There are behavioral modification techniques, environmental modification and optimization techniques, enrichment and play techniques that can be helpful, but the preying upon false hope that goes along with the sale of voodoo quack medicines is unconscionable.  Outrageous.  Shameful.  This creeps into other areas, too, as there are countless topical products or nutraceutical products for decreasing shedding, solving complex skin/allergy issues, slowing the development of cataracts (nothing, nothing slows cataract development, sorry folks).  At least once a week I treat an ear infection that has been smoldering for a while despite an over-the-counter potion (often for ear mites, which are pretty uncommon in dogs, BTW).  Oh–I also see a lot of improper treatment technique on the part of owners;  there is a skill level required for the successful treatment of ear disease, not a hard skill, but a particularly important one to learn well.  In a lot of cases, these product are not actually harmful, but they delay or substitute for proper treatment and therefore contribute to pet discomfort and decreased quality of life.  That’s frustrating to see, and sad for the pet to endure.  I’m sorry to see Galaxy Jackson prostitute himself in this way, when the cat owners buying and trying these bottles of false hope will be utterly scammed and their cats’ problems untreated.  Sad, but it is Mr. Jackson who deserves to be ashamed.

If your cat does have a problem getting along well with other cats, not using a litterbox correctly, human-directed aggression, destruction of furniture, etc., there are in fact treatments that can be helpful.  It’s just not in a little bottle.

 

 

 

Lost and Found (by Lisa)

December 19th, 2013
P1020523

“Idaho”

Christmas came early for one very special kitten.

It must have been fate that I left my apartment early to get to my job at Bridgewater Veterinary Hospital; if I had not left at that time, I don’t think this story would have the happy ending that it does.  I was walking along a very busy street at about 7:55am when I thought I heard a cat meowing sadly.   I stopped walking and took off my ear buds to listen more intently.  I heard such a plaintive cry that I turned instinctively towards where I thought the sad voice was coming from.  There, across the street by some bushes, was a small striped kitty, mewling pathetically at me.  As we made eye contact, this little kitty started walking towards me and right into the street.  My only thought was that this poor thing was going to be hit by a car, so I broke eye contact hoping that the cat would not try to get to me.  Then I could cross the street and see about helping the little guy out. However, the cat had other ideas.  He darted right out into traffic, trying to get to me.  He narrowly missed being hit by a couple of cars. I will be forever thankful that the drivers had such good reflexes & applied their brakes in time!  This scared little kitty skittered back onto his side of the road and hid under a shrub.  Once the cars passed, I crossed the street to see if the kitty would come to me.  No sooner did I squat down, that the kitten peaked out from under the shrub, saw me squatting down, and raced over & leapt into my lap.  The purring this kitten was doing was non-stop; he was rubbing his face against my face, snuggling his head into my chest, kneading my lap and coat.  Kitty was very cold – it must have been about 30 degrees – and he was so very happy to have a warm lap to snuggle into and the human contact he was so clearly craving.

So here I am, with a strange kitty on my lap, on the side of a super busy road.  While snuggling the kitty to my chest with my one arm, I called my amazing practice manager, Ann, who was already at our hospital.  I briefly described what happened and she dropped everything she was doing, grabbed a spare cat carrier, and jumped in her car to come to our rescue.  The entire time this kitty was just purring away and rubbing my face, licking me and clearly showing his thanks for being rescued on this very cold morning!

Ann arrives, we get the kitty into the carrier, and we go to work.  Once there, we take our new foundling into our warm and cozy cat ward, get the kitty, who Ann has nicknamed “Gabriel”  (we can’t keep calling him ‘kitty’ after all), into his new roomy crate with some fleece blankets to snuggle in.  We can tell that even though “Gabriel” was very cold and hungry, he must have been someone’s beloved pet as he was just such a sweet little man.  Once “Gabriel” was settled in, we pulled out our universal microchip scanner and scanned our little guest.  We cannot describe how thrilled we were to find a microchip number!  Now we just needed to look up the number and hope that the owner’s kept the information accurate.

We went to AAHA’s universal microchip site (www.petmicrochiplookup.org) and that let us know that this little guy was microchipped with a 24 PetWatch microchip (www.24petwatch.com). Knowing that they have representatives manning their phones 24 hours a day/7 days a week, we immediately called them.  I spoke to a very helpful lady there named Jennifer, who looked up the number we gave her.

Thankfully, this kitty had current information! Jennifer was able to give us the name of our guest, Idaho, as well as his owner’s name, address, and phone number. She even went so far as to call the owner, hoping to connect us directly, and then e-mailed the owner when she had to leave a voicemail with our hospital’s information.

Within 10 minutes, we received a phone call from one very relieved and extremely happy owner!  She just received an e-mail from 24 PetWatch letting her know that her kitty was found.  It turns out that Idaho was missing for almost 2 months!  Idaho has a loving home with a little girl who was heartbroken when he went missing one snowy afternoon.  This little guy thought it would be a good idea to explore the outdoors when a family member opened the door.  Quick as lightening, Idaho streaked through the door and by the time the family raced out after him, he was gone.  The owner called both 24 PetWatch and the humane society where she adopted Idaho frequently, hoping that someone either turned Idaho in or called to say they found him through his microchip. Her daughter would look for Idaho in their apartment complex constantly, always telling her mom that she thought he must be there somewhere.

The joy in this woman’s voice on learning that her kitty was found was undeniable; the fact that the little girl will have her beloved kitten back in time for the Christmas holiday is a miracle for her  – and for Idaho!

Working in the veterinary field can be many things; there are a multitude of emotions that we feel on a daily basis just doing our jobs – and sometimes it can be heartbreaking and sad.  Today, though, is a triumphant day for us though; because of 24 PetWatch, we were able to quickly find Idaho’s owner and we were lucky enough to be instrumental in making a family whole again.  Christmas has come early for one family!

Dog and Cat Lifespan and spay/castration

July 13th, 2013

I have a professional and academic interest in spay/castration for dogs and cats, and have read extensively on the subject.  Obviously, we do a fair bit of it in the practice, and I taught spay/castration at Penn full-time for seven years.  So it’s not just part of the job for me–I want to know how to optimize the procedure (small wounds, lots of pain control, short surgical times, good process), optimize the benefits (when is the best time to do in in a dog’s career), and understand any negative effects.  While the advantages for spay (female surgical sterilization) for dogs and cats is unequivocal (so clearly advantageous as to be beyond reasonable debate) and the advantages for male cat surgical sterilization–castration–was similarly overwhelming, the case with male dogs was less clear.  There were some likely behavioral advantages, there were some diminished health risks, but there was more limited data.  When asked by owners, I would describe my bias as being pro-surgery, but that I lacked data to show why I believed in that approach.  Until now.

In the same issue of the Journal of the American Veterinary Medical Association, there was mention of two independent studies looking at (among other things) longevity of pets.  One by the Banfield group of veterinary hospitals found that spayed and castrated dogs and cats live significantly longer than their un-spayed/castrated counterparts.  Another study looked at dog patients in veterinary teaching hospitals and found that castrated males lived (on average) 13.8% longer than intact (not castrated) dogs, and that the benefit for female dogs is even greater–26.3% longer lived if spayed vs. intact!  That is more than a year for males and can be several extra years for females.  Wow!  Both of these studies were quite large numbers across many breed types, and their findings are in alignment with respect to a consistent magnitude and direction of the benefit (in the Banfield study, castrated male dogs did even better, at 18% longer lived vs. intact).

This is great news for pet owners who have followed our advice to spay and castrate all these years–you can credit those procedures for tacking on an additional 1 or 2 years to your pet’s life.  Give yourself a nice big pat on the head from your dog or cat for that.

(I’d provide a link right here, but WordPress has decided to become slightly difficult–the “insert link” radio button is inactive, and numerous repair suggestions have failed to restore it to functionality.  There is a link just to the right titled “Banfield State of Pet Health 2013″.  Lifespan and Cause of Death link is the other study referenced).

 

Recycled Cats

July 13th, 2012

Recycled Cats "Desmond" and "Dasher"

The thing about cats is, they’re wonderful, funny, cute, some are cuddly, others are not, but sometimes they just aren’t working out for a particular household.  I know this from my practice, and recent experience with re-homing (hence, recycling) of some really special cats.

“Desmond” and “Dasher” are my cats, they have to be full brothers, but about a year apart in age.  They were both found by the same vet student near his apartment and passed through other student hands before ending up with me.  I met “Desmond” (his earlier name has been withheld for security purposes) as a four month old kitten–he spend a few hours in my office at Penn in a carrier before going to “foster” home with a vet student.  I got a call from her a day or so later, when she described the kitten as being unable to jump up on her lap, though he was wanting to pull himself up with his forefeet;  since he had looked so darned normal just a short time before, we both thought this was odd.  I suggested an exam, and met her and “C” at my practice.  He was painful on his  mid-back, and it was deemed best to sedate to do a proper exam.  A growing abscess was disclosed, the area prepped, and the abscess drained.  I am pretty sure we castrated him at that time, too.  We started him on antibiotics, and he proceeded to win his household over to the point of becoming what we in the shelter world call a “foster failure”–he became one more cat in this cat-rich household (three Savannahs, two other DSH’s, for  a total of 6, plus a rotation of foster cats and kittens).  “C” was remarkable for his willingness to play with their newest Savannah, a very large specimen who was quite intimidating to the other cats.  In a multi-cat household, there are often cats who are stressed enough to begin “thinking outside the box”–using other surfaces/textures to eliminate, most commonly urinate.  So, after over a year of keeping him, although “C” was a plus in some ways, the household cats were not 100% reliable in their litter habits, and there were challenges around how to manage the group.  Ultimately, and luckily for me, “C” was offered to me, I stashed him at the practice for a bit, and then brought him home to meet “Dasher” (found about a year after “C”, “Dasher” stayed at the practice and with my staff for about a week before being voted into the Moyer household).

The short version of the story is that “Desmond” and “Dasher” are absolutely perfect cats here, amazingly well-adapted to three young children, perfectly happy with the 85 lb. Labrador.  “Desmond” loves to be picked up and carried, often upside-down, and is uncanny at detecting fleece or warm laps.  He needs to be watched, though, when hungry, as he’s famous for biting your feet in the kitchen if you haven’t fed him yet in the morning.  He is, in my professional and personal opinion, the world’s most perfect cat (except for the biting feet in the morning).

If there is an action step for you to consider, it would be giving cats a shot at recycling–they may do very well with you in your household, even if they were not perfect (or were destabilizing) in another household.  Also, if you like cats–have at least two;  they are much better at playing with each other, and that social play outlet is crucial for their enrichment in your home.  And it makes for cuter pictures, too.

Animal Hoarding: Too Much of a Good Thing

July 19th, 2010

My full time job at Penn Vet is a focus on animals in shelters, and some of the very unusual circumstances that send them there. One of the most fascinating is the world of animal hoarding.  Those of you in the Philadelphia area know that within the past week, several remarkable examples of animal hoarding made the news.  Animal hoarding is a shelter medicine subject because once the household is discovered, there is usually a need to rapidly remove the animals and to provide triage, medical assessment, and hopefully–rehabilitative care for those pets that can be saved.  Locally, Penn Vet has been helping to plan a full-day symposium for social workers, mental heathcare, elder care, child welfare, and animal welfare professionals on the subject of animal hoarding and hoarding intervention resources.  Because of the numbers of animals involved in some of these cases (not to mention the range of species that can be encountered), these could easily overwhelm a single agency.  A large intervention in rural Pennsylvania last month netted just under 400 cats from one sanctuary–there is no way that would have ended well for the cats without huge investments of human, infrastructural, and dollar resources.  In that instance, the ASPCA, American Humane Association, local humane society, and Penn Vet collaborated to safely remove, examine, test, temporarily shelter, and ultimately adopt out the vast majority of the cats.

For those of us learning about animal hoarding from the veterinary or animal sheltering side of the equation, I confess that there is often no understanding of the mental health challenges which result in a hoarding personality disorder, and there is often little or no sympathy for the human perpetrators.  Often, there is anger and a lot of talk about what punishment should be meted out, not much talk about how to integrate a mental health intervention into the plan. But to live in abjectly squalid, filthy conditions and to profess love and care for the animals dying and dead all around you, is pretty compelling evidence of a mental health deficit.  And those of us centered in the animal care arena of often constitutionally ill-equipped to muster sympathy for people who willingly or not, harm animals.

But punishment isn’t a great protector of animals in this case;  punishment alone will be limted to fines and prohibitions against animal ownership.  The fines are largely uncollectable (these are often destitute individuals with no attachable assets, and prohibitions against pet acquisition are easily circumvented.   Recidivism is nearly 100%, if other measures aren’t taken. Think about it–the most powerful source of comfort and identity for these troubled people is their pets (I know, I know–they’re not living up to their end of the care equation), and a judge is ruling that they may not own pets.  A more successful approach has been used by Anne Irwin of the Bucks County SPCA where they’ve negotiated a number of pets that can be reasonably well-maintained by the individual, and make sure that the pets are appropriated spayed or castrated, in a state of health that is stable and not unduly burdensome, and then maintain a connection over time with them to make sure they have access to resources that are vital (pet food, a source of ongoing veterinary support).  This approach has allowed a number of hoarding interventions to resolve with very positive outcomes, all around.

Next week, several hundred (registration is limited to 300, and we’re bumping against the 200 level right now) professionals will be learning about the problem and also exploring the intervention strategies and resources available for animal hoarding.  I am excited to know that so many are interested and might be recruited to help make the solution more effective, to have far more positive resolutions in the future.

Canine Flu

May 5th, 2010

An acknowledgement up front–I am a compensated speaker for Intervet Schering Plough Animal Health, makers of the canine influenza vaccine currently on the market (there may be others on the way).  But my interest in canine flu preceded Intervet having a product on the market.  My interest began in the intake facility in Philadelphia’s animal control facility, where part of my world of shelter medicine took place for several years.  Canine infectious respiratory disease complex, overly-reduced to “kennel cough”, troubles every shelter from time to time.  In very high volume shelters, it is more or less persistent.  There isn’t much control over the intake numbers of dogs, and given the strain on the facilities, upper respiratory disease (sneezing, nasal discharge, spontaneous cough) is pretty common, and the risk increases with each successive day in the shelter.  Such was the environment in 2007.  And then, the number of dogs increased dramatically, and the persistence and severity of the cough changed, too.

Flashback to Florida, 2004.  An outbreak of severe Canine Infectious Respiratory Disease Complex was under investigation in a Greyhound kennel in Florida.  An influenza virus was isolated, related to equine influenza, but now established infectious agent of dogs, complete with dog-to-dog transmission.  This was the first description of influenza jumping from horses to dogs and staying to dogs.  The lead investigator,

Cynda Crawford, is in the Maddies’ Shelter Medicine program at the University of Florida.  What she found was that influenza of horses somehow got transmitted to these Greyhounds and then changed-mutated, and became a stable infectious influenza of dogs.  Since that initial description in a Florida Greyhound kennel, the virus has been confirmed in 30 states, and is considered endemic (common) in Pennsylvania, New Jersey, New York, Colorado, and Florida.

With consultative assistance from the ASPCA, canine influenza was confirmed in Philadelphia.  At the Vet School at Penn, we also saw cases coming in from the shelter, and did develop some experience in treating these patients as part of our student surgery program and from cases seen through the Ryan Hospital.

Canine Influenza Virus is highly contagious from dog to dog, and since most dogs are not vaccinated and are considered immunologically naive (no prior “street” virus exposure), most dogs are susceptible.  There is no breed, age, or sex predeliction

Michael Moyer and Cynda Crawford

, and vaccination statue (apart from influenza vaccination status) is not important.  Dogs vaccinated for Bordetella and parainfluenza are still highly susceptible to canine influenza virus.

In my mind, I always thought of respiratory flu as primarily an upper respiratory (cough, sneezing) problem, until I saw the pathology wrought by canine influenza in the lungs of affected dogs.  This is a profound lower respiratory disease, and can easily result in pneumonia. When I saw the lung pathology images, it was no surprise that these dogs cough and will not typically respond to cough suppression–huge amounts of goo and damage lung bits means lots of coughing for a long time.  With luck and support, most dogs will survive, but a very small unlucky few will decline in their breathing to a point where ventilatory support is needed.

So, is Dr. Moyer recommending vaccination across the board for all dogs?  No, but if you think that your dog’s risk for plain old Bordetella was worth the vaccination, you should probably add Canine Influenza Virus vaccination to your “To Do” list for Fido.  Dogs that kennel, go to doggie day care, high traffic dog parks in at risk communities (it isn’t in every community, but it is certainly in and around Philadelphia).  I pose some mild risk to my own dog, because I see the students’ pets at the Vet School, many of which are rescued from very high risk environments.  Please note–it is not a disease of shelters, but one that is more likely diagnosed and detected in shelters, owing to their constant intake and turnover.  But it is a disease of the community of dogs in an area, and other dogs are also at risk.

For my clients’ dogs, I recommend consideration if the dog kennels or is going to doggie day care facilities.  Some grooming facilities are requiring it, as are many boarding kennels. Oh, and I’d make sure the Bordetella and parainfluenza was updated by the intranasal spray vaccine, too.  Canine flu is new;  not every vet has experience with it yet, and the jury is still out on how widely this thing will spread.  Virologists familiar with influenza are watching this one carefully;  it isn’t behaving quite as aggressively as other flu viruses–if it changes, it may become more “successful” at infecting dogs.  Until then, though, it looks as though it has restricted itself to a handful of states, with Pennsylvania being one of those lucky few.

Community Cats

March 14th, 2010

L to R: M. Moyer, Cynda Crawford, Julie Levy at UF CatNip, Jan 2010

I’ve been involved with feral cat issues in Pennsylvania since 2003, when (as I began ascending the Pennsylvania Veterinary Medical Association’s chairs of office) I initiated “Feral Cat Summits”. All stakeholders to that issue were invited by the PVMA to discuss, debate, and argue the merits and deficiencies of Trap Neuter Return work. For those of you unfamiliar with feral cats, now more properly dubbed “Community Cats”, there are believed to be as many free-roaming cats as there may be pet cats in the United States. That’s a lot of cats. While that sounds unlikely, bear in mind that “domestic” cats have enjoyed a rather free-roaming relationship with humans for thousands of years, and this phenomenon of strictly indoor cats is an entirely man-made construct. These cats can be owned cats, stray cats, abandoned cats, or cats that were born outside, are poorly socialized with people (“feral”), and will spend their entire lives outside.

Enter—TNR. Trap Neuter Return. Very highly motivated, dedicated volunteers Trap, temporarily house the cats until they are surgically Neuter-ed, and then Return-ed them to their original site. They are not creating outdoor cats; they are merely interrupting their reproductive cycle-permanently. They are not “dumping” cats-these cats were there to begin with, and without intervention, would be producing kittens each year. These kittens face very high mortality and a rough first year; those that survive will begin reproducing as early as August or September of the year they were born (typically February/March/April). Despite claims to the contrary, many of these outdoor cats, once past the high risk of kitten hood, can live long, stable, comfortable lives, with overall health, parasitism, and infectious disease issues comparable to indoor/outdoor pet cats.

I describe myself as a reluctant proponent of TNR. Reluctant, because it is unsatisfying to release a cat to its own devices post-operatively. Yes, it is now vaccinated, yes, she won’t reproduce, but still, it isn’t the life I’d want for my cats. The alternatives, unfortunately, are very limited. When I discuss this with my Penn Vet students, I mention the alternatives as 1) Ignore Community Cats or 2) Trap and Euthanize, which is what happens in shelters that accept Community Cats/Feral Cats but do not have a TNR program to release them. Presently, there are no effective non-surgical methods of controlling cat reproduction. So, after years of leading discussions, listening to the back and forth, seeing the TNR clinics in action, and talking with some of the best minds on this subject (Julie Levy of University of Florida, for example), I have moved over to the proponent side of the fence.

This is an incredibly complicated problem, and even the success stories of TNR (Ocean Reef Club, Merrimack River) were successes with a lot of sustained effort. I can tell you that the extermination/euthanasia approach is extraordinarily expensive, does not attract a large volunteer base to sustain it, does not attract private humane philanthropy to support it, and does not invoke warm and fuzzy public relations with members of your community (upwards of 25 to 35% of community members report themselves as feeding outside cats on some sort of basis).

I’ve provided a sampling of links; I particularly love this vague, un-helpful sentiment (in the third link):

We recommend that advocates of cat colonies seek a long-term solution to the pet overpopulation issue by redirecting their efforts toward the underlying problem of managing irresponsible pet owners.

Of the three options extant, 1) TNR, 2) Ignore, 3) Trap and Euthanize, I’ll let you decide which option they’re rooting for. For my part, I’m siding with the option that gives these cats a chance-TNR.

Operation Catnip

Merrimack River Feline Rescue Society

Natural Areas Journal – Trap/Neuter/Release Methods Ineffective in Controlling Domestic Cat “Colonies” on Public Lands

Daily Record Article – Animal groups: Could ruling lead to hunters shooting cats?

Technology updates

March 13th, 2010

While I like to write, I am not a blogger by design. This space-the blogosphere—is slightly un-natural for me, but I believe in the incredible power of information, of connection, and hope to provide the occasional odd bit of knowledge in these posts.

So, what great big thought have I got to share today? I had a good day in surgery with the Penn Vet students yesterday (3 dog castrations, one dog spay, two cat spays). The students are in class of 2010—just four months away from graduation, and exactly twenty years after I finished at Penn Vet.

I’m writing this from home, where it used to be impossible to conduct any sort of office work or medical text research (my veterinary library was at my practice); now, I can access journals, texts, veterinary school resources, and veterinary specific networking sites that allow exchange of current clinical information. When I graduated, if I could not find the answer to a problem, I would call a former professor in Medicine or Surgery and ask. Now, from my phone, I can find answers I would have waited days to receive. I am able to connect with specialists and colleagues not just from a practice or two away, but from a coast or a continent away. No longer is absence of information an acceptable state of affairs. We can get to information (the trick remains how to make decisions with imperfect information in a way that is rational, timely, and helpful).

We’re making some leaps in technology at Bridgewater Veterinary Hospital, a new website with exciting new functionality. We’ll be introducing email reminders, web-based medication refills, and other communications enhancements. We look forward to improved accessibility, and improved service to our clients.

A funny thing

February 20th, 2010

Happened the other day in surgery.  We had a dog presented for spay in our student program, and she was discovered to have a large (3 by 2 by 1 inch) lump on her gum under her tongue.  It was attached by a very narrow stalk, but it was a very tough, fibrous attachment to the interdental space (inter=between, dental space=tooth gap).  A quick conference of the minds lead us to decide to remove it surgically before we continued onto the spay.  Since it was odd, I asked one of my students to take some pictures with my camera in “macro” mode (one never knows when close up high resolution photos of things icky might be useful for a lecture or a dull cocktail party).  Proceeding with the lump dissection, I encountered a bit of a snag;  I couldn’t fit a scalpel blade in the interdental space, where the root of the mass was originating.  And I couldn’t send for the laser for a while.  What to do?

You should know that surgery is sometimes a bit extemporaneous, and often quite physical.  Orthopaedics comes to mind.  In some surgeries, deft digital manipulation is the key to good outcome.  Or, sometimes, ya’ gotta’ rip it out.

Back to our mouth mass.  Having determined that our mass wanted to exit the mouth, but was temporarily unyielding to use of surgical tools, I began to stretch the attachment of the mass to the gum.  The three students watching were slightly troubled by the sound of stretching connective tissue;  my camera-wielding student was in close by my right shoulder, when the mass abruptly exited the stage, and somewhat forcibly ricocheted off the left hand of my photographer (I thought I had a better grip on it, really!).

We proceeded to the spay with our students, and at the end of the procedure, used a laser to finish the removal of the mass’s stalk.  It looks like it will be good news for the doggie, best news of all is that this sweet little pit mix has a great home.

Gingival MassProjectile