On Saturday I saw two cats in need of help and was able to help only one of them. The owner of the other cat was entirely unprepared for the financial reality of treating a sick cat in our day and age. I highly suspected the cat had pancreatitis with the attending host of problems that afflict its digestive tract, and she was not going to get better without aggressive measures. There was no guarantee that the cat would fully recover after a hospitalization on fluids and IV medications, which already was too much in financial terms. Cats are not cars and we are not mechanics, we don't "fix" living beings. Most definitely she would need some degree of followup treatment, at least monitoring, even if it was only pancreatitis (which it rarely is). As a veterinarian I would be careless to offer anything less. As a person who lives in the real world I cannot possibly criticize people for refusing to put a cat through these measures, whether for financial or emotional reasons. To my credit - or shame - I was not about to blame the owner for deciding on euthanasia, had no impulse to do so. Part of me agreed with her. And to the owner's credit, she did not suggest taking the cat home to see if it would get better by itself. She understood very well that it would not.
In my everyday work there is a lack of middle ground between two extremes: doing everything possible for an animal with a serious condition, and hearing "it's just a cat." We seem to have forgotten to say "it is a cat." Not a fur person, not a feline patient, but an animal, with all the dignity of being one. And their dignity may well preclude the involved, often invasive, and undoubtedly troubling (to the cat) measures we are trained to take. We do not know what is going through the animal's mind in the period of medical treatment and recovery - or deferring imminent death, - and tend to forget that they cannot possibly understand that "it's all for their own good." Certainly the animal is alarmed, anxious, and confused - unless it's so ill that indifference and withdrawal have set in.
The fact that we've forgotten to say "it's a cat" was brought home to me in a much lighter context on the same day. Our receptionist has several cats, and one is an avid hunter. Her daughter called to report that the cat had likely eaten a squirrel: she brought home the head and feet, with the rest of the squirrel missing and presumed ingested. The receptionist asked me with a good deal of alarm: what should they do? I said, nothing can or needs to be done now besides keeping a good eye on the cat's appetite and comportment. I thought, how did we arrive at a point when a cat's normal behaviour is pounced on as a potential cause for medical intervention?
Dandelions in a meadow outside Thunder Bay, ON
Monday, October 25, 2010
Saturday, October 2, 2010
Leave your gonads at the door.
Last week I said to my employer that I miss doing surgery (business has been much slower than usual lately), and the next day they called the new branch of the SPCA - conveniently located almost across the highway - to bring in cats in desperate need of sterilization. The SPCA is inundated with cats. We are not the cheapest clinic in the area, probably the most expensive after the emergency hospital, but we have a discount policy for the SPCA as well as for our clients: the "public service discount," meaning that spay and neuter are for the public's benefit and not just the owner's and the animal's. I will give these cats a chance at longer lives in people's homes, as they have no future unless they are spayed and neutered. Spaying and neutering has become the standard of veterinary care in the New World, so much so that people and vets who fail to do it are looked down upon as morally lacking. Of course, an exception is made for breeders - those who breed more or less healthy animals in good conditions.
The standard of care is a curious concept. It is supposed to be determined by the patient's best interests in terms of health and welfare. Our society does not accept packs of feral dogs or colonies of feral cats sharing living space with people - this is considered barbaric, unsanitary, and unsafe. But another way to look at them is no-kill shelters under the open sky, and this is how it works in many countries and communities where these animals are trapped, sterilized and vaccinated, and released. Not all of them, of course. Many continue to multiply, so the arrangement is far from perfect. Moscow has many colonies of feral cats who live in basements of apartment buildings (the city has no private homes, these are all brand-new and on the outskirts). They access the basements through small ground-level ventilation holes and live in safety and warmth by the hot-water pipes, taking care of any incipient rodent problem in the building. Packs of dogs live in the city parks and take shelter in subway entrances. The animals are fed by self-appointed caretakers. They are much smaller and thinner than the animals we are used to seeing in North America - they do not eat as much food and do not grow as big. Aggression is not an issue if the animals are not deliberately bothered by stupid or cruel people. But Russia is not a culture where the stupid are protected from themselves. The animals have each other's companionship, something shelter animals do not have even if they are fortunate to spend only a short time there before finding a home. In a shelter they smell and hear each other, but cannot interact, which I imagine contributes to considerable anxiety and stress. So there is no reason to think that these feral animals suffer any more, or even nearly as much, as millions of shelter animals awaiting adoption - or death. It is another culture's acceptance of the fact that some animals will never live in homes with humans, that this is an acceptable albeit imperfect way to live, and is no reason to destroy the animals.
What about health as a criterion of standard of care? We are taught in veterinary school that spaying and neutering are beneficial for the animal's health. Spaying a dog before her first heat pretty much protects her from breast cancer; after the first heat her risk of this disease increases but is still not very high if she is spayed before the second heat. After that, a spay is protecting her from pyometra and ovarian cancer but no longer from breast cancer. Dogs who are not neutered are at risk of developing prostatic hyperplasia that is often bad enough to squeeze the urethra shut so the dog can't pee. And there are, of course, behavioural issues that hormones contribute to - but habit and training have as much to do with this as hormones. We are also taught that a neutered male dog is more likely to develop cancer of the prostate than an intact one, but this latter piece of information is rarely if ever shared with owners when we discuss reasons for neuter. Stories of testicular cancer, urethral obstruction from prostatic hyperplasia, perianal tumours, and dogs getting hit by cars while seeking a date, are the usual fare dished out to owners in preparation for neuter. Cats may be a slightly different story. Spaying a cat has roughly the same benefits as spaying a dog, and neutering a male averts spraying and roaming. Recently I had the satisfaction but also the challenge of spaying an 8 year-old cat who had never had a litter. Her uterus was warped and her ovaries fragile as butter, tearing with the slightest pull - all that hormonal influence over the years! A confined tomcat makes a very unhappy animal indeed (which is quite different from a male dog kept from mating), while letting him outside guarantees that he will sow his seed and populate the world with more kittens. I don't know of any increased health risks for neutered cats compared to intact ones. Urethral obstruction is a frequent condition in neutered males fed dry diets, but we don't know how this compares to tomcats and whether they are at risk too - they don't stick around to be observed, or to survive when afflicted. All spayed and neutered animals have a tendency to put on weight much easier than intact animals, but - look at our human population. Obesity has more to do with how much a body, animal or human, is eating than with presence or absence of gonads.
So, what is it that really determines the standard of care - health, or demographics?
The standard of care is a curious concept. It is supposed to be determined by the patient's best interests in terms of health and welfare. Our society does not accept packs of feral dogs or colonies of feral cats sharing living space with people - this is considered barbaric, unsanitary, and unsafe. But another way to look at them is no-kill shelters under the open sky, and this is how it works in many countries and communities where these animals are trapped, sterilized and vaccinated, and released. Not all of them, of course. Many continue to multiply, so the arrangement is far from perfect. Moscow has many colonies of feral cats who live in basements of apartment buildings (the city has no private homes, these are all brand-new and on the outskirts). They access the basements through small ground-level ventilation holes and live in safety and warmth by the hot-water pipes, taking care of any incipient rodent problem in the building. Packs of dogs live in the city parks and take shelter in subway entrances. The animals are fed by self-appointed caretakers. They are much smaller and thinner than the animals we are used to seeing in North America - they do not eat as much food and do not grow as big. Aggression is not an issue if the animals are not deliberately bothered by stupid or cruel people. But Russia is not a culture where the stupid are protected from themselves. The animals have each other's companionship, something shelter animals do not have even if they are fortunate to spend only a short time there before finding a home. In a shelter they smell and hear each other, but cannot interact, which I imagine contributes to considerable anxiety and stress. So there is no reason to think that these feral animals suffer any more, or even nearly as much, as millions of shelter animals awaiting adoption - or death. It is another culture's acceptance of the fact that some animals will never live in homes with humans, that this is an acceptable albeit imperfect way to live, and is no reason to destroy the animals.
What about health as a criterion of standard of care? We are taught in veterinary school that spaying and neutering are beneficial for the animal's health. Spaying a dog before her first heat pretty much protects her from breast cancer; after the first heat her risk of this disease increases but is still not very high if she is spayed before the second heat. After that, a spay is protecting her from pyometra and ovarian cancer but no longer from breast cancer. Dogs who are not neutered are at risk of developing prostatic hyperplasia that is often bad enough to squeeze the urethra shut so the dog can't pee. And there are, of course, behavioural issues that hormones contribute to - but habit and training have as much to do with this as hormones. We are also taught that a neutered male dog is more likely to develop cancer of the prostate than an intact one, but this latter piece of information is rarely if ever shared with owners when we discuss reasons for neuter. Stories of testicular cancer, urethral obstruction from prostatic hyperplasia, perianal tumours, and dogs getting hit by cars while seeking a date, are the usual fare dished out to owners in preparation for neuter. Cats may be a slightly different story. Spaying a cat has roughly the same benefits as spaying a dog, and neutering a male averts spraying and roaming. Recently I had the satisfaction but also the challenge of spaying an 8 year-old cat who had never had a litter. Her uterus was warped and her ovaries fragile as butter, tearing with the slightest pull - all that hormonal influence over the years! A confined tomcat makes a very unhappy animal indeed (which is quite different from a male dog kept from mating), while letting him outside guarantees that he will sow his seed and populate the world with more kittens. I don't know of any increased health risks for neutered cats compared to intact ones. Urethral obstruction is a frequent condition in neutered males fed dry diets, but we don't know how this compares to tomcats and whether they are at risk too - they don't stick around to be observed, or to survive when afflicted. All spayed and neutered animals have a tendency to put on weight much easier than intact animals, but - look at our human population. Obesity has more to do with how much a body, animal or human, is eating than with presence or absence of gonads.
So, what is it that really determines the standard of care - health, or demographics?
Sunday, September 26, 2010
The Price of Cuteness.
Three cats I saw this past week have brought me closer to understanding why I have chosen to work with this animal exclusively. (I still feel obligated to justify my preferences rationally. Still feel an envious nostalgia for "Real doctors treat more than one species" T-shirt I never bought and never will now :-) One is a Persian who came in vomiting, not eating, overall miserable and sick. Nothing new about any of these circumstances. But this little Persian was an extreme example of what breeding can do to an animal. She has no face to speak of, and her tongue is forever sticking out of a mouth too short to close over it. The canals that drain tears from her eyes into her nose are twisted shut, so the tears trickle out and soak the fur under her eyes. And I have yet to meet a Persian cat that is not extremely alarmed by a physical exam or any kind of holding for treatment - they are hypersensitive animals, disturbed and upset by the smallest of changes in their surroundings. I can't help thinking that this has something to do with cramming the brain into a box much too short to house it. If you had never seen a Persian before, you'd think this cat survived some horrible accident that chopped off her face and flattened what was left of it. That's pretty much what happened, except it took a few decades of dedicated human effort instead of a head-on collision with a speeding car - which in the end would have been more merciful.
There is only one fortunate circumstance to this story: this little cat and her breed are an exception, in that cats as a species have been allowed to remain much closer to their wild ancestors than have dogs. In dogs, there is just too much variety of human-induced abominations and woes for a wimp like me to push to the back of my mind. Delivering a litter of Boston terriers by C-section did not fill me with joy and dreams for the future, only with sadness and concern. Nor I do not ever wish to excel at being a glorified janitor, at cleaning up a mess I have no power to prevent. (Vets have no official say in what animals can or should be bred.) I'd like to practice in a way that would make my profession obsolete and redundant. I'd like cats to be eating good canned food or well-balanced and carefully prepared raw food, I'd like to see cat kibble outlawed as something bordering on animal cruelty - with special penalties for the label "Natural", but of course I can only afford this attitude on Sundays after sleeping in :-) On working days I diagnose and treat cats with inflammatory bowel disease, cats with failing kidneys, cats who can't pee because they are plugged up by crystals or stones. I get good at doing this, and I take pride in my skills - as long as I remember not to look at the big picture.
The second encounter was with a little animal at a local PetSmart. My boyfriend fell in love with him and started joking about buying or kidnapping him, so of course we had to go see this cat. He was a young Cornish Rex lad, alone in his cage as his brothers and sisters had been sold. He alternated between staring into space and pouncing at his toys, playing with abandon. He had the wrinkled face of a newborn baby - or an old man. Ever so slightly disconcerting. We asked to meet him and an assistant opened the cage and picked up the kitten and gave him to us. He was very quiet and dignified in his affection. A covert ten-second physical exam told me he had both his little testicles well in place, and a umbilical hernia - not necessarily dangerous by itself, but a likely sign that something else might be amiss inside. We asked his price, and were told that it was $1198. I have only heard of such prices for breeding-quality animals, not for pet-quality, no matter how pure-bred. There is no moral to this story, only questions. Such as, will the people who eventually buy him, allow him to breed and pass on his possibly not harmless imperfections? Once again, I completely failed to go "aaaaaah, how cuuuuuuute!" at the sight of this wrinkled little creature. All I wanted was to hold and shelter him from his very uncertain future.
The third cat was a magnificent snow-white Oriental Shorthair - a breed that resembles the Siamese, but is more extreme in the prominence of its long muzzle and cheekbones. Unlike Siamese, Oriental Shorthairs are quiet, sometimes perfectly silent, demand nothing, and seem to forgive everything. It is scary to think what can happen to these uncomplaining cats in the wrong hands. This cat's owner, a very old gentleman who dotes on him but has less-than-perfect vision, had cut his nails to the quick, and apparently the cat had not protested once. The only loud thing about this cat was his heart. This cat had the loudest heart murmur I have heard on any animal thus far: it was difficult to hear the heartbeat behind the whooshing noise. And yet - at home he runs and jumps and flies like the Avro Arrow he's named after, and shows no signs of illness. I shall see him again this week for a heart ultrasound that will show his heart and the work of its valves from the inside. No moral to this story either. None needed.
There is only one fortunate circumstance to this story: this little cat and her breed are an exception, in that cats as a species have been allowed to remain much closer to their wild ancestors than have dogs. In dogs, there is just too much variety of human-induced abominations and woes for a wimp like me to push to the back of my mind. Delivering a litter of Boston terriers by C-section did not fill me with joy and dreams for the future, only with sadness and concern. Nor I do not ever wish to excel at being a glorified janitor, at cleaning up a mess I have no power to prevent. (Vets have no official say in what animals can or should be bred.) I'd like to practice in a way that would make my profession obsolete and redundant. I'd like cats to be eating good canned food or well-balanced and carefully prepared raw food, I'd like to see cat kibble outlawed as something bordering on animal cruelty - with special penalties for the label "Natural", but of course I can only afford this attitude on Sundays after sleeping in :-) On working days I diagnose and treat cats with inflammatory bowel disease, cats with failing kidneys, cats who can't pee because they are plugged up by crystals or stones. I get good at doing this, and I take pride in my skills - as long as I remember not to look at the big picture.
The second encounter was with a little animal at a local PetSmart. My boyfriend fell in love with him and started joking about buying or kidnapping him, so of course we had to go see this cat. He was a young Cornish Rex lad, alone in his cage as his brothers and sisters had been sold. He alternated between staring into space and pouncing at his toys, playing with abandon. He had the wrinkled face of a newborn baby - or an old man. Ever so slightly disconcerting. We asked to meet him and an assistant opened the cage and picked up the kitten and gave him to us. He was very quiet and dignified in his affection. A covert ten-second physical exam told me he had both his little testicles well in place, and a umbilical hernia - not necessarily dangerous by itself, but a likely sign that something else might be amiss inside. We asked his price, and were told that it was $1198. I have only heard of such prices for breeding-quality animals, not for pet-quality, no matter how pure-bred. There is no moral to this story, only questions. Such as, will the people who eventually buy him, allow him to breed and pass on his possibly not harmless imperfections? Once again, I completely failed to go "aaaaaah, how cuuuuuuute!" at the sight of this wrinkled little creature. All I wanted was to hold and shelter him from his very uncertain future.
The third cat was a magnificent snow-white Oriental Shorthair - a breed that resembles the Siamese, but is more extreme in the prominence of its long muzzle and cheekbones. Unlike Siamese, Oriental Shorthairs are quiet, sometimes perfectly silent, demand nothing, and seem to forgive everything. It is scary to think what can happen to these uncomplaining cats in the wrong hands. This cat's owner, a very old gentleman who dotes on him but has less-than-perfect vision, had cut his nails to the quick, and apparently the cat had not protested once. The only loud thing about this cat was his heart. This cat had the loudest heart murmur I have heard on any animal thus far: it was difficult to hear the heartbeat behind the whooshing noise. And yet - at home he runs and jumps and flies like the Avro Arrow he's named after, and shows no signs of illness. I shall see him again this week for a heart ultrasound that will show his heart and the work of its valves from the inside. No moral to this story either. None needed.
Monday, July 19, 2010
Unexpectedly Home.
What was supposed to be a 3-week stay in the Old Country was cut short by an unusually persistent heat wave that affected a large part of the entire Old World. The peat bogs outside the city began smouldering, and the smoke was trapped in the windless hot air for days. It was not an easy time to feel patriotic nostalgia for the city of my birth; yet even the heat and smoke brought memories of a similar heat wave in my distant childhood in 1972, when such calamities were the care of adults and did not bother me at all. I studied the cover of my Canadian passport in detail and read the Latin inscription in full for the first time: Desiderantes meiorem patriam, a mari usque ad mare. Wishing for a better homeland, from sea to sea - and it was already mine. I called Air Canada, waited on hold for the requisite 15-odd minutes, and was never more grateful to pay $750 to have my return trip advanced by an entire 9 days. I can now pretend that I am on a luxury 9-day holiday for a mere $87 a day, sitting on the balcony looking at the snow on the peaks of distant mountains, planning a drive down to the ocean, a walk through the forest redolent with fragrant pine resin and a swim in a lake filled with clear glacier waters. And the sheer luxury of breathing crisp fresh air. This gratitude may not last much longer than the 9 days I "paid" for, it rarely does, but it is always very strong after a visit to the Old Country.
I had cut my visit short for very selfish reasons: the stay was no longer enjoyable (this was new), and I had nothing to give to my mother or country by sticking around (this was nothing new, and one of the reasons I had emigrated in the first place). I was brought up to understand that my relaxed and meandering way of doing things would make me a loser if not an outright victim in a country that does not suffer fools gladly. Fortunately, Canada does; Canada is paradise for ...people of modest ambitions, shall we say. And after a good decade and a half of catching my breath and being left in peace, I understand that it was never Russia that was merciless to me and my choices. It was my own dear mother who, of course, "only ever wanted the best for me" but whose stern authority I had mistaken for the attitude of an entire country.
Monday, June 14, 2010
Thirty-Eight Ways to Say "Most Congenial"
Just when I had thought for a while that no one was reading this yarn, I saw with surprise "1 comment" under the last posting. To my shame I have not posted in - months? I had made a promise to myself, and almost weaseled out of keeping it. And apparently someone was reading. Thank you for the kind words, Elizabeth. You may be responsible for enabling another mediocre writer this world badly needs :-) But truly your comment brought me great joy.
I have worked at my new job for two weeks now. A few days before starting, I went through my vet school notes and the research articles I accumulated since school to separate those relevant to cats, and cats alone. Anything pertaining to other species was put in a separate pile as a potential contaminant to the rarefied atmosphere of specialty medicine which I was to breathe from now on. But I mentioned before that life is wiser than our best laid plans. In these past two weeks my feline patients have included two dogs. The first was a Jack Russell terrier whose owner is the senior veterinarian, herself a boarded surgeon. He was sent my way to have a small lump removed from his arm and to test my surgical skills. It was flattering to be trusted with him. The second was a Bichon Frise belonging to the bubbly young receptionist and suffering from bad teeth, a loose kneecap apt to pop out of its groove, and lower back pain. (She had bargained for only one problem - the back pain, - but was sold three, each of which will need attention.)
My other patients were, quite predictably, cats. Quiet and patient cats, loud and alarmed cats, healthy and ill cats. But no ugly or morally objectionable cats. I marvel at the skill of the hospital manager in handling what are surely unhandleable cats in anyone else's hands. A large powerful ginger male chased around his home by a toddler and taking these torments with maturity and magnanimity, turned into a wild sputtering animal lashing out through the mesh of his carrier as soon as he arrived at the hospital. As he stepped out of the carrier he was quickly and decisively scoop-embraced by Jim, using a thick folded towel. He shouted and howled at a volume that was harmful to hearing, especially for Jim who was bracing him with his entire upper body and head. Somehow, everything got done: the cat's teeth examined, his heart listened to, his tummy felt over for anything alarming, his temperature taken, and vaccines injected. The cat was rumbling with indignation, but not frantic. So far I have not once felt at a loss on this new job. I know that between all of us we will get things done, and done with the least stress to the animal.
At the end of my working week I drive home, 100 miles away, to rejoin my own two cats. (I rent a room close to the hospital so as not to commute that distance on workdays.) The cats have a new best friend - an automatic Le Bistro feeder that dumps a preset amount of kibble three times daily. They still greet me at the door, but are not frantic for their food. In fact, our relations are better than ever. When the cats start trumpeting in the morning, I know it is because they miss me and not because they need to be fed - the machine will have served breakfast by then. So my annoyance at not getting to sleep in is short-lived.
I have a rotten and thankless task to perform this coming Thursday. I must judge a photo contest. Pictures of cats submitted by their owners. I must decide which cat is the most congenial. But I will find a way out of this corner yet: there shall be as many categories as there are entries in the contest. This is when my long-forgotten linguistics training will be dusted off and put to good use.
I have worked at my new job for two weeks now. A few days before starting, I went through my vet school notes and the research articles I accumulated since school to separate those relevant to cats, and cats alone. Anything pertaining to other species was put in a separate pile as a potential contaminant to the rarefied atmosphere of specialty medicine which I was to breathe from now on. But I mentioned before that life is wiser than our best laid plans. In these past two weeks my feline patients have included two dogs. The first was a Jack Russell terrier whose owner is the senior veterinarian, herself a boarded surgeon. He was sent my way to have a small lump removed from his arm and to test my surgical skills. It was flattering to be trusted with him. The second was a Bichon Frise belonging to the bubbly young receptionist and suffering from bad teeth, a loose kneecap apt to pop out of its groove, and lower back pain. (She had bargained for only one problem - the back pain, - but was sold three, each of which will need attention.)
My other patients were, quite predictably, cats. Quiet and patient cats, loud and alarmed cats, healthy and ill cats. But no ugly or morally objectionable cats. I marvel at the skill of the hospital manager in handling what are surely unhandleable cats in anyone else's hands. A large powerful ginger male chased around his home by a toddler and taking these torments with maturity and magnanimity, turned into a wild sputtering animal lashing out through the mesh of his carrier as soon as he arrived at the hospital. As he stepped out of the carrier he was quickly and decisively scoop-embraced by Jim, using a thick folded towel. He shouted and howled at a volume that was harmful to hearing, especially for Jim who was bracing him with his entire upper body and head. Somehow, everything got done: the cat's teeth examined, his heart listened to, his tummy felt over for anything alarming, his temperature taken, and vaccines injected. The cat was rumbling with indignation, but not frantic. So far I have not once felt at a loss on this new job. I know that between all of us we will get things done, and done with the least stress to the animal.
At the end of my working week I drive home, 100 miles away, to rejoin my own two cats. (I rent a room close to the hospital so as not to commute that distance on workdays.) The cats have a new best friend - an automatic Le Bistro feeder that dumps a preset amount of kibble three times daily. They still greet me at the door, but are not frantic for their food. In fact, our relations are better than ever. When the cats start trumpeting in the morning, I know it is because they miss me and not because they need to be fed - the machine will have served breakfast by then. So my annoyance at not getting to sleep in is short-lived.
I have a rotten and thankless task to perform this coming Thursday. I must judge a photo contest. Pictures of cats submitted by their owners. I must decide which cat is the most congenial. But I will find a way out of this corner yet: there shall be as many categories as there are entries in the contest. This is when my long-forgotten linguistics training will be dusted off and put to good use.
Friday, March 12, 2010
Winner, or just plain old adequate?
One step closer to a definitive diagnosis for the coughing/stumbling dog, I felt something close to satisfaction at the end of the day. Back in my TV-less home I turned on the radio while I enjoyed a glass of Bear Flag wine, a very enjoyable blend of this, that and the other. It challenged my prejudice against blended wines as coverup for unsuccessful vintages from various vineyards and various years. But maybe I liked it simply because I know nothing about wines. Anyhow, the radio programme covered the latest development in the Canada Reads contest. Books, and very good books at that, are gradually being voted off the list to whittle it down to an eventual winner. What a White Liberal concept: winner vs. everyone else! So many pursuits and endeavours are no longer perceived to be worthwhile unless a winner can be identified in the end. How else do people know if they are any good?! Well, not everyone is a loser either; there is such a thing as a shortlist: the winners among losers? Now translate this into the culture of dog shows and cat shows... . How did the poor animals get pulled into this vortex of human vanity? Never mind that animals chosen to represent a pure breed are often far from fit - they are often far from viable. But as long as these animals are helped along by the humans who bred them, their existence does represent a form of evolution we have taken into our hands. Darwin wrote of the "survival of the adequate" (my italics), not survival of the fittest (a term coined by Herbert Spencer, nor Darwin).
This coughing/stumbling/occasionally vomiting/occasionally drooling dog's diagnosis has been a thorn in my side since it became clear this is not a simple case of kennel cough. I suspect him of a neuropathy that translates into laryngeal paralysis, possibly esophageal weakness, and hindlimb weakness (Ockham's razor tells me to find the simplest - in this case, the most inclusive - explanation). I also suspect him of hypothyroidism which would likewise explain his symptoms, and a comprehensive test in underway to rule that out. But I am warned, by wise and learned people, that treatment for either neuropathy or hypothyroidism may not alleviate his presenting symptoms. I do not live or work in the ivory tower; I will treat him anyway once I know what ails him. I don't care about winning; I just want to do a thorough, adequate, job.
This coughing/stumbling/occasionally vomiting/occasionally drooling dog's diagnosis has been a thorn in my side since it became clear this is not a simple case of kennel cough. I suspect him of a neuropathy that translates into laryngeal paralysis, possibly esophageal weakness, and hindlimb weakness (Ockham's razor tells me to find the simplest - in this case, the most inclusive - explanation). I also suspect him of hypothyroidism which would likewise explain his symptoms, and a comprehensive test in underway to rule that out. But I am warned, by wise and learned people, that treatment for either neuropathy or hypothyroidism may not alleviate his presenting symptoms. I do not live or work in the ivory tower; I will treat him anyway once I know what ails him. I don't care about winning; I just want to do a thorough, adequate, job.
Monday, March 8, 2010
The comparative virtues of aspirins, and an Old Country idealist.
Yesterday I got reassurance that if I never treat another animal they will still be well taken care of, I will not be missed. A woman ahead of me at the checkout started telling the cashier that her breeder had recommended this coated aspirin for her dog who had pulled a muscle. She was very proud of her breeder and very pleased with the advice she had received from her over the years. Upstart that I am, I had to pipe in and say that she needs to be very careful about giving aspirin to a dog and that buffered is better than coated because that will just slip through the dog's stomach before it has time to uncoat. I chose to remain undercover as to my profession; it would have been awkward to announce it. She said that mine was very good advice but she would stick with what her breeder had suggested. I keep forgetting that my answer needs to be voted "best answer" before it can be accepted. What kind of dictator do I think I am, to expect members of a free society to accept my word without putting the matter to a vote? A similar level of consumer freedom and empowerment applies to the diagnoses I put forth; these are often perceived as initial offers met with counter-offers fished out on the internet or suggested by breeders or people who own similar animals. As a former prof I explain my reasoning in as much detail as the owner will tolerate. On exhausting days I often feel tempted to choose one or two diagnoses from my differentials list that are most pleasing and comforting to the client; I have never given in to this temptation. As for prognoses, I will err in the "glass is half-empty" direction and prepare the owner for that, cushioning the blow of a sad outcome that I foresaw at least as a possibility. So far I have been able to maintain the dignity of a doctor while still ministering to the customer service aspect of my work. But I will admit that life, a.k.a. that which is not in our control, is often far wiser than some of our best laid plans, and in hindsight I am very glad the woman bought the coated aspirin which will hopefully just slide through her dog's digestive tract.
Yesterday I also got reassurance of another kind. This was on the way to the store with its aspirin encounter. Outside the store is a gas station, and outside this gas station a man was speaking on the payphone very loudly and articulately. He spoke loudly because he was passionate, and because his voice needed to carry across the ocean to Russia where his friend was listening. For once I was not embarrassed to see a fellow Russian in Canada; I was elated and proud. Because the subject of this man's monologue were the flowers he saw in Vancouver. He declared with the solemnity of a nuclear scientist presenting his discovery that never before had he seen such a variety of tulips in bloom. Fifteen minutes later, as we walked out of the store, the man was still there and still speaking. And the chestnuts, he said. A whole street lined with chestnuts! When I translated the eavesdropped conversation to my boyfriend he had to be cynical and suggest that this was all code for drugs and their delivery times, and no wonder he was using a payphone and not a cell phone, etc. But I'm confident the man really was talking about flowers; it's impossible for a Russian to fake this.
Yesterday I also got reassurance of another kind. This was on the way to the store with its aspirin encounter. Outside the store is a gas station, and outside this gas station a man was speaking on the payphone very loudly and articulately. He spoke loudly because he was passionate, and because his voice needed to carry across the ocean to Russia where his friend was listening. For once I was not embarrassed to see a fellow Russian in Canada; I was elated and proud. Because the subject of this man's monologue were the flowers he saw in Vancouver. He declared with the solemnity of a nuclear scientist presenting his discovery that never before had he seen such a variety of tulips in bloom. Fifteen minutes later, as we walked out of the store, the man was still there and still speaking. And the chestnuts, he said. A whole street lined with chestnuts! When I translated the eavesdropped conversation to my boyfriend he had to be cynical and suggest that this was all code for drugs and their delivery times, and no wonder he was using a payphone and not a cell phone, etc. But I'm confident the man really was talking about flowers; it's impossible for a Russian to fake this.
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