Thursday, December 16, 2010

Letting Go...or the "B" side of being a vet...

What is 14 years in doggy time? A lot?
When I was a young vet, still with the "smell of textbooks" on me, I used to think that it was equivalent to like 80-90 human years but along the years I have come realise that it is all subjective to the animal.
Loufi - 14 yrs old black lab,on treatment for mammary tumour, runs and bounces around like a puppy; Luka - 15 yr old cat, still behaves normally even after after amputation of her left hind paw; Pongo - First ever adopted doggy from PAWS, found dumped in a trash bin, living its 11th year with the people who adopted him and still puts up a serious "resistance" when it comes to go to the vet...
Then there are the ones that come to the clinic in such a drastic and debilitated state, even at younger ages...with fully matured cataracts, with diabetes, with pot bellies etc...not to mention the ones with severe gingivitis and teeth practically falling off.
Just as humans, dogs do not age at the same rate.How many times have I been brought dogs that were on their "last breath" with the owner struggling to keep them alive; dogs who were visibly suffering but in trying "everything to save his pet", the owner was just doing everything to prolong his sufferings...
That is when, as a veterinarian, our role is to judge what is best for the animal and counsel the owners on how to alleviate this animal's sufferings, even if that entails euthanasia. Difficult task, I must say...some owners are so bonded to the animal that their emotions "cloud" their rational and logical thinking. Oh..and there are also some vets who find it ethical to continue to treat, propose ways to keep the animal alive (but still suffering)for some period of time...just to make a little more money!
Yesterday, I had 2 cases where I had to advise euthanasia. One was a walk-in emergency with a blind poodle, with evident signs of diabetes (pot belly, drinking and eating a lot). Animal was in hypoglycaemic shock and had started seizuring. 15 yrs of being a loyal companion and now its general system was breaking down.This had been going on for like a week and he'd been to 3 other vets before. Owner was somewhat prepared for the euthanasia option and he himself admitted: " I was being selfish, just satisfying myself by keeping him alive in atrocious sufferings"
Second case was a more problematic one for me...I have known this dog and his owner for a long time and during the day she called me to tell me that 14 yr old doggy is lying down, had lost bowel control and was not well.Her whole family had already opted for euthanasia. My first reaction was to "evade" this but I quickly realised that this person was in distress too and needed to go through all this with someone they know. I finally reached her place at around 19:00 and proceeded with the euthanasia of this poor soul.
No matter how many such humane euthanasia I have performed in my life, it is always a hard moment for me. It might be so hard to decide that all you can do, as a vet,to alleviate an animal's suffering is to euthanise it; but gosh it is harder when you are pushing the plunger of that syringe and you feel the life leaving that animal. Worst moments being a vet!
Today I read an article about the Veterinarian's Oath being amended (
For all those of you who did not know...yes there exists an Oath for the newly graduated veterinarians and it now reads as follows:
"Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge."
Oath or is all based on our sense of responsibility; if the owner feels responsible enough for the life of his animal and if the vet feels responsible enough to be the guardian of the animal's welfare.
"Prevention and alleviation of animal suffering"...I wish every owner and vet in this country wrote this to themselves and applied it.

Sunday, December 12, 2010

Swirls and Swings of Emotions...

"The veterinarian must be a good observer"...My lecturers told me that and I have learnt it the first day I started seeing my first cases 17 years ago. A veterinarian's patient does not talk and all assessment and diagnoses must be based on objective measurements and sometimes subjective observations. But what happens with the years, is that you start observing the people start unintentionally recording body language and behaviour of the owners. Everything is based on emotions or the lack of it; here is a brief overview of the past few emotion-laden days of consulting at the Island Vet Clinic:

Wednesday - Oversized 8 month old dog brought to the clinic with a midshaft fracture of the right femur. Whole family came and a six year old boy kept asking me if his "bhaya" would be ok; if "bjaya" would be able to run again...and my heart just melted! For those not understanding, "bhaya" means brother in hindi. Turns out Rex is a full member of the family and is the companion of little boy."Bhaya" went home with a fixed leg at practically no costs!

Thursday - Old friend from University days calls me in panic and asking for help because he ran over his own dog whilst reversing in his alley. "Ru-ruz" is 14 yrs old and had some difficulty ambulating before the he was just lying down in shock!I was going to a meeting at PAWS; so scheduled an intervention there itself. During all the procedure and surgery (broken leg again!)he kept saying "I could never be a vet...I would never be have been able to do what you are doing"..."I want to help but I cannot...not feeling well, must be the smell". This guy is a tough-built triathlon athlete known to be the "rock" in our group of friends...but I guess guilt and seeing his dog under the scalpel overruled all this...Emotional phone call again the next day to tell me Ru-Ruz is doing fine and even trying to walk!

Friday - Dog Breeder brings in a cute Rott pup and when asked to hold the baby up for me to inspect the belly, he violently grabbed the latter by the loose skin at the scruff and the rump to lift it up!Like a mere sack of meat. Wow! I was irritated by such lack of compassion and made him understand that he should respect the animal. Answer I got was: "I read that it was not painful! His dog trainer always does this too!" My answer to him was:I guess those idiots who wrote that it was not painful do not know that there are pain sensors in the skin; and that "trainer" should be grabbed in the same way and kicked in his butt to learn to treat animals with respect ! Angry Dr Sam moment.
Well...that was yet another Dog Breeder who believes dogs are just commodities...just ways to earn easy money.

Saturday - "Poupoune" comes back to the clinic after one week supportive therapy and a battery of blood tests...still not eating; vomiting, difficult breathing and somewhat distended abdomen. Every night I have been receiving phone calls about her and I could sense that this animal was very important to that couple. So Poupoune sitting and breathing heavily on the exam table; Dr Sam analysing the blood results...definitely some infection going on but what? Palpation reveals very painful abdomen. So I decide to go in for abdominal exploratory laparotomy...lady starts crying and told me that they do not have any children and that this dog is all she has!
Talk about putting more pressure on me now!! Anyways, I am not the type to "grope in the dark" and give medications arbitrarily and keep my fingers crossed that one of them will work...and I still manage to make them understand that exploratory surgery is the best option; that if something is wrong inside the abdomen, I should go in and try fix it.
Good call!! Upon opening of the abdomen, a massive uterus, full of pus, litterally "popped out" onto my drapes!Amazing how this animal was carrying that infected uterus! Anyways, surgery went well and Poupoune recovered "relieved from a big weight"

Saturday itself - Very beautiful lady walks in with her daughters carrying a carton box with a cat in drastic state. Later, I learnt that the lady was Miss Mauritius 1989 and she is now a senior lecturer at the University of Mauritius. I googled her and I must say that she is far more beautiful now in her late forties than in 1989 when she wore the Crown!
Hmmm!Okay...visibly, Miss Mauritius triggered some emotions here...but lets get back to "kitty-in-carton-box"! She was found on the street by one of the daughters and had a purulent nasty wound on her right hind leg and she seemed to have been starving.As if all of this was not enough, she had a bad respiratory infection and ocular discharges. tried my best for this cat but I have a guarded prognosis on this one. We'll see what are the news tomorrow....when Miss Mauritius brings her back for follow up.
Did I mention that the lady was dressed with rare taste? No? Looool! Well she was...and that was like adding sugar to honey!

Today (Sunday)- Went out to the clinic to clean but had an early appointment for a "pawicure" for an old friend. "Pongo" is the very first dog adopted out at PAWS. He was found in a garbage bin in 1999 by one of the founder members and has grown up along the years from a mangy skinny puppy into a fiersty little "survivor"full of energy...taking on even Rotts as per the "tales" of the owner. I had to sedate the animal to be able to cut his nails properly. During that process, Pongo had to be restrained and was putting on a whole vocal show. Diazepam did the trick but as soon as the dog was lying down sedated...the daughter of the owner fainted!Gosh!I guess that seeing our own animal being stressed gets us all "upside down" too.
My "Emergency Red Bull" went into the human reanimation process and both Pongo and Michaela went home safe!

So...being a vet is not just smelling like a dog, treating all sorts of animals,spending lots of hours away from your family, walking in cow dung,getting scratches and bites also involves,at least for me, a good dose of emotions; positive and negative ones. If you really are into being a veterinarian out of compassion to animals then you will be flooded with these emotions. The trick is how you react to them...and sometimes it is so hard to rationalise or find any logic in them. I chose to accept them and try to make a change wherever I can. I really appreciate the positive emotions coming from more and more owners these days...making me think that there is light at the end of the tunnel!

In the choice of being a Vet, I guess the heart has to have the last word...

Wednesday, December 8, 2010

A MidSummer's Nightmare...

It's that time of the year again in Mauritius!!

I am not talking about the blazing sun; the packed beaches nor the short skirts of the girls...but what I mean is: It's Fly invasion time...and for a vet it means long sessions bent over maggot infested wounds!!
Yup! Got 2 last week and I know they will keep coming (especially at PAWS. The tiniest wound could be the deadliest one!
People have the bad habit of bringing their animals to the vet when they have time...not when the animal is wounded. So a minor trauma that happened Monday would eventually be seen by a vet on Saturday; and by that time flies have done their reproductive aerial trick; laid eggs in the wound and the animal is now being EATEN ALIVE by the maggots! And the stink!!! Gosh!It stays in your sinuses for like days!
Poor animals...can't even imagine how it feels to have maggots eating their way through my flesh!One good thing about maggots though, is that they keep a wound "clean".i.e. a maggot infested wound will never be infected by bacteria nor have pus in it.
So what's the routine for maggot-infested wound? Anaesthesia of course; forceps; some cypermethrin solution and call the owner to watch you pull the wriggling little devils out of the wound...guaranteed sensational impact!"Waaaah!"; "Oh My God!"; "Can't believe that there are so many!"; "lemme get a pic of that with my phone camera!"
For the owner, it might seem like a great thing to witness and a great story to tell the buddies but from the Veterinarian's standpoint, it's such a pain in the neck (literally!)to manage such wounds! Ok, you've removed (or you think you've removed)all of them; then what? You cannot close such a wound. Doggy needs at least 3-4 days of wet-dry bandaging to get granulation of tissues going and when you are satisfied and wound ready to be stitched up, you realise that there is very little skin left to appose; all gone in the big hole eaten out by the maggots. Tough call!
Special plea to all pet owners out not wait to attend to a wound on your animal.Merciless flies are lurking around and just waiting to lay their eggs in them!
Clean and disinfect with Betadine Solution; apply some "Healing Oil" - that will sure keep the flies away and accelerate resolution of trauma and despite me being a "non-spray" person...I would recommend Supona spray.It is something you would want to have handy in these summer days. The only problem with Supona is that it masks all underlying tissues; you do not know for sure if the tissue is healing or necrotising underneath the blue coating Supona leaves...and the animals hate the stinging sensation of the spray too.
Be wary, pet owners; for, as Shakespeare puts it in A Midsummer's Night Dream:
Over hill, over dale,
Thorough bush, thorough brier,
Over park, over pale,
Thorough flood, thorough fire,
I do wander everywhere

...and that applies to flies too!
Get your dog the medical attention it needs when it really needs it; do not wait for complications.

Tuesday, December 7, 2010

The Price of Rice...

Wow! More than a week without blogging!!

Yep! That is December!More work; too much distractions on holidays!
I was thinking of "How much fat is too fat" as title for this blog but hey...after the budget and all the price rises...

Last Wednesday, someone comes in with a dog with difficult breathing and a somewhat taut and round belly. Dog had stopped eating "normally" and was sulking; barely picking bits and pieces from her bowl.One round, fat-rumped little mongrel uneasily made its way to my exam table
After assessment it appeared that the dog had a bad uterine infection and we decided to go in surgery immediately.The uterus was thrice normal size; full of pus and it was a delicate piece of work to detach and excise this organ from its adjacent abdominal fat!Wow!Liver was infiltrated with fat; kidneys were embedded in a thick layer and all the intestines were heavily laden too.
This got me thinking that the heart must be struggling to throb in a nice thick fatty envelope too; and the bigger space the heart occupies in the thorax, the less space there must be for the lungs to inflate properly. No wonder this lady was having trouble breathing.

As expected, she took ages to come out of the aneasthesia after surgery. The injectable compound we use is what we call "lipophillic";i.e. is attracted to and deposits into fat and thus takes longer to be excreted from there too.So I used that time to chat a little with the owner about what was her diet and how it should be from now on. She was on rice and canned food daily with occasional meat and chicken "derivatives" (li cou and la patte). I love it when I get the standard answer from the owners about changing their dog's diet: " But Doc, she would never eat that!She would come whine at us!Oh Poor thing, she loved her fatty foods!" Dogs do all that because they have the choice and when really hungry, they will eat what you propose.

There was a time when our little Mauritian doggies were being fed table left overs only; when there was no left overs they had some stale bread to eat or went to the neighbours. This time is long gone and most of us do prepare special food for our dogs and cats daily; but still what food? Rice of course! Rice with tuna, rice with chicken; rice with meat; rice with anything! That is what WE eat us Mauritians. Staple food is..rice! Must be a legacy from our mostly Asian origins.Ever wondered who eats most of the lower grade "ration" rice in Mauritius? Surely not human! But what about dogs? Their system has not evolved to process rice and other carbohydrates like pasta, "roti" etc. Whatever slow carb that is not used goes straight into fat depots all over the body.

Practically, 7 out of 10 dogs that come to the vet clinic are overweight and the older they get; the worse it is. Worse because then diabetes kicks in; along with joint problems. Vicious circle it is...the heavier the doggy gets the more pressure is on the joints and the more inflamed the joints become; the less the animal walks and the fatter it becomes.
There is also that enigmatic disease in obese cats called the "Fatty Liver Syndrome". Fat cat just stops eating from one day to the other and dies of inanition and general organ failure. Upon necropsy all the fat of its body degenerated into an oily, viscous liquid in a process called saponification; just like that, all of a sudden; as if a signal had been given for that.

So all of you out there reading this blog, rice is okay but alternate with dog pellets.At least the animal gets some fiber. For the ones willing to make an extra effort for their loved ones; half the rice rations and add cooked vegetable peels to their food; i.e. fill their stomach but with non caloric food. Exercise your dog if he/she is of the "couch potato" type; sporty dogs are much more interactive and smarty ones. Mens Sana in Corpore Sano they say...applies to dogs and cats too I guess!

Bear in mind that there is a health price to pay for feeding your pet too much rice and it is well above the tag on the bag at the Supermarket...It might cost your beloved one its life.