Making replacement nipples

Kittens like to nurse on things. It is best to nurse on mom, but orphaned kittens will nurse on other things. A favorite option for many orphans is the belly and genitals of their siblings. This can be physically traumatic for the recipient. One solution to the problem is to separate the kittens, but a lonely kitten is a stressed and pathetic creature (and stress leaves them more susceptible to disease). Another solution is to offer something better to nurse on!

Today I got mad when a newly arrived kitten was nursing on his littermate, and as I had a little free time, I decided to make an offering for him. Materials: nipples for kitten bottles; some soft fleece; needle and thread; rice; a plastic bag; a binder clip. I sewed the nipples into the fleece, sewed the edges of the fleece together to make a fleece bag, warmed up the plastic bag full of rice in the microwave, and put the warm rice into the fleece bag. I secured it closed with the binder clip.

I predict the kitten will hate it, because cats always hate things that you put a lot of work into.

The fake mom, in production

The fake mom, in place, being ignored by kittens

Keeping score of kittens

Last week I worked in a kitten nursery — a small building off of a larger shelter, full of underage kittens (mostly orphans, some with moms). Although this shelter has literally hundreds of kittens out in foster care, kitten season in the South is so intense that they have this separate building just as a nursery, with its own staff and volunteers (and for these two weeks, its own vet! With consultations from the main shelter vet, of course).

Cats seem to take the approach to reproduction that you should make as many babies as possible, and if not all of them make it, that’s life. Outdoor, unowned kittens have about a 75% mortality rate. Cats are mostly very good moms, but kittens are just so little and fragile. After a few days of kitten deaths I became almost manic. I would not lose more kittens! I started keeping score, me versus kitten death.

• Feral mom is too scared to take care of her neonatal kittens. I give her a place to hide and some time to figure it out. I give her too long, and her three kittens die. Three points to kitten death.
• A cat is brought in while in labor. It becomes clear that things are not proceeding, so we take her to surgery. Three kittens survive. I sit with them for two hours trying to get them to nurse. They do, a little bit, but their mom doesn’t recognize them as hers since she wasn’t awake when they came out. One dies. I foster the other two onto a receptive mom with her own four kittens and spend another hour making sure they learn to nurse on her and can defend their nipples from their week-older foster siblings. So far, they are still alive. Two points to the Dog Zombie, one point to kitten death.
• Six kittens in a little cage feel funky for several days, just sitting around and not playing like normal little fiends. I give them fluids for several days but they don’t perk up. We start them on antibiotics that are good for GI disease, because they have diarrhea and deworming hasn’t helped. When a new cage opens up, I move three of them into it, so everyone will have more space. I coddle them with fluids and medication to make them not feel sick to their stomach. At the end of the week, two of them are playing and three of them are eating. Three points to the Dog Zombie. (The other three are holding steady. We’ll see.)
• One kitten is a little lethargic and dehydrated one evening. I give her fluids, but I am not worried about her. The next morning she is found dead. I do a necropsy and find that she had pneumonia. This is weird, because she didn’t have an upper respiratory infection, so where did it come from? But her lungs were definitely funky. I panic and give her cagemate antibiotics that are good for pneumonia, since whatever happened to her, it happened so fast that I want to prevent it rather than wait and see. One point to the Dog Zombie?
• One kitten fades fast and dies. (One point to kitten death.) His cage mate starts to fade the next day, lethargic and dehydrated. I necropsy her brother and find a bad infection in his GI tract. I start the living kitten on antibiotics that are good for GI infections and leave orders for lots of warming pads and fluids. She does not survive the night. A second point to kitten death.

Those are only some of the stories. I have learned all about antibiotics for head colds and stomach bugs, I tell you what. And I have learned that a roomful of kittens becomes much less cute after the first hour of dealing with it. But they will still make you manic trying desperately to save them all. You can’t save them all. But you also can’t stop trying.

Dog training is sexy

Tonight I tweeted: “Dog training is sexy. I wish more people understood how cool it is to train.” And then I thought: but who better than me to tell them?

So why is dog training so sexy?

• Dog training is communication with an alien being. Dogs really are “other nations,” as Beston’s famous quote goes. They have their own understanding of the world. In fact, the world they live in is not the world we live in: they live in a completely different mess of colors (fewer) and smells (many many many more) and sounds. Their understanding of the world is different from ours, and we still have no real idea how they perceive things or what is going on in their brains. But we can communicate with them by gentle pairing of signals (“sit”) with actions (their butt goes on the floor) and consequences (cookies). And once we become really good trainers, we can start exploring their dictionary, maybe discover that the translation isn’t what we thought it was (we think “ball” is a noun, meaning that spherical thing, while they think it is a verb, meaning to get something throwable). We get insights into their brains, and maybe they get some into ours.
• Dog training is brain remodelling. When I am desensitizing my shy dog to the presence of strangers, I am actually helping her form new connections in her brain. In fact, I am influencing which new connections form, and which old ones atrophy. I am modifying her brain. I am a brain architect!
• Dog training is an art. My shy dog is afraid to leave the house, so we take very short walks on which I reward her a lot and make sure she doesn’t become overly stressed (in dog training geek talk, I am trying to keep her “under threshold”). She can be unpredictable, and some days keeping her under threshold is difficult. So I try different approaches: more food, more sniffing of grass, not so far from the house, moving more, moving less. I don’t know what is going to work for her on a particular day. Sometimes I don’t even know why I stop trying one approach and switch to another. It’s a gut feeling. I have been working with this dog for so long that it isn’t just an intellectual exercise. It is the art of playing with my dog.
• Dog training is a science. In years past, we didn’t think of training as a science. We approached it with Just So stories, such as “Dogs evolved from wolves, and wolf packs have a dominance hierarchy, so the trainer should make sure to behave like an alpha wolf.” But then science started making itself heard. Trainers started geeking out on learning theory, using terms like “the four quadrants of learning” and “extinction bursts.” Read Don’t Shoot the Dog by Karen Pryor if you want a digestible but fascinating introduction to learning theory. Or Excel-erated Learning by Pam Reid. You can’t remodel brains without the proper tools, after all. You need good tools to create fine art, too.
• Dog training deepens your relationship with your best friend. That is, if you do it right. Good training is fun for you and fun for your dog. It is not a chore, used temporarily to create a good dog and then set aside. It is an ongoing, integral part of a relationship that is built on communication between two very different species.

Training improves my life and the lives of my dogs. I love training my dogs, and they love being trained.

Shelter makeover: porthole edition

Yes, that’s a shelter veterinarian using a plasma saw.

Shelter veterinarians wear many hats: they are infectious disease specialists, behaviorists, surgeons… and handymen? Actually, usually the plasma saw is wielded by someone brought in from outside the shelter, but this time we did it ourselves.

Like many shelters, this small county shelter had upgraded the cat housing in its public adoptions area, but couldn’t afford to do so in the back rooms, where cats lived before going up for adoptions. These cages were small, just big enough for a litter box, a food bowl, and a water bowl — not enough room for a cat to stretch out to her full length, or take a few steps. Cats sometimes lived here for weeks; when the shelter got full, these rooms became adoption rooms as well, and cats lost their chance to get moved up to the better housing. But the cages were built into the wall, so replacing them would be extremely expensive. When I walked into this room, my heart always hurt a little for the cats crowded into it.

The solution: installing portholes to turn single cages into double rooms. It is a stroke of genius -- just cut a hole between two cages, and suddenly the cat has twice the space. His litterbox can be in a separate room from his food bowl! He gets space to stretch out, to walk around a little. This can make a huge difference not just in a cat’s quality of life, but even in his risk for succumbing to infectious disease (and healthy cats get out the door to their new home faster than sick ones). As an added bonus, you get to use a plasma saw. Of course, the next steps include installing PVC portholes, so the cats aren’t walking through bare metal. Detailed instructions are online. My fellow shelter medicine interns and residents and I got to put in a bunch of portholes ourselves. It was fun, but the best part was seeing the reaction of the first cat who was moved into the new digs. He immediately stretched out on his side and began to knead with his paws in deep happiness.

But double cages for each cat means there is housing for only half as many cats. The first question I am always asked about this project is “Can the shelter close the portholes again if they need the extra space?” Yes, that’s possible (you can install doors), but it’s not recommended. Current thinking is that no one should be taking in animals which they cannot house appropriately — if you have to overcrowd, then you need to find some other alternative to taking in more animals. Do whatever you did before when you were full — hopefully that means running an adoptathon, contacting rescue groups to help transfer animals out of the shelter, or closing the shelter to intakes.

An interesting fact in the housing capacity controversy is this: offering up more animals for adoption doesn't mean you'll adopt out animals any faster. In other words, if you are adopting out an average of 10 animals a day, then that is the average you’re going to adopt out whether you have 20 or 100 animals on the adoption floor. There are ways to increase adoptions, but putting more animals on the floor isn’t one of them. In fact, adoptions may actually decrease when you have a greater selection, because of the Paradox of Choice: more choice can overwhelm people and cause them fail to choose anything at all. Meanwhile, those animals who are in the shelter, in overcrowded housing, not getting adopted, are more likely to get sick, or develop behavior problems from their long incarceration. Simply resisting the pressure to overcrowd can solve many of a shelter's problems.

It isn’t easy to say no to overcrowding, of course. There are so many animals out there who need help, that realizing that you don’t have the resources to help them yourself can be tough. Irreversibly reducing the number of housing units, and simultaneously increasing the size of each unit, can help shelters maintain their commitment not to overcrowd. Portholes are good things. When I stepped into the finished room with its newly enlarged cages, I felt an almost physical release in my chest. Being in a shelter is no fun for a cat, but these cats were going to have a much easier time of it from now on.

Spaying big things, spaying small things

You would think that spaying something big would be a lot easier than spaying something small. With something big, you can visualize everything more easily, right? It turns out to be the exact opposite, actually. The smallest thing I've spayed is a two pound kitten, and oh boy is that uterus easy to find and manage. The biggest thing I have spayed is a hundred something pound Great Dane, and wow was that uterus deep in a deep abdomen and so covered in fat that it was hard to see where it stopped and the ovaries started. Big things bleed a lot; big things have ligaments that are really hard to break down (as in, you will get out of breath); big things have all kinds of extra fat and tissue and such that get in the way. Little kittens (and cats and puppies) have pristine little uteruses that pop right out at you.

This is something that vet schools don't make clear enough, in my opinion -- at least, not the one I went to and not the one that I work at now. I was supervising some beginning surgeons recently. Day Two was amusing: everyone who had spayed a cat the day before was spaying a dog, and they were all complaining about how hard it was. Everyone who had spayed a dog the day before was spaying a cat, and they were saying things like "I'm so much better at this than I thought I was!" No, you're just spaying a much smaller animal.

Given all of that, it bewilders me that vet schools seem to tend to start students off on dog spays. Why not cat spays? They are so much easier. Why start a beginning student on the hardest possible case? This is yet another brick in the wall that stands between me and understanding how veterinary education makes any sense at all.

Community-based veterinary public health

My public health class in veterinary school was a revelation to me: veterinarians could prevent problems from happening in the first place rather than playing catch-up and trying to fix things after they are broken. I still remember sitting in the class and thinking “This is what I want to do.”

When it was first born as a profession, human public health was about infectious disease: preventing cholera by cleaning up the water supply, preventing tuberculosis by vaccination. But in recent decades, public health has come to be more and more about lifestyle changes: improving nutritional choices, encouraging increased exercise. I’m obsessed with animal welfare and behavior, so I love the idea of a veterinary public health specialty focused on improving what we might call “lifestyle problems” in animals. Here’s my list of what some companion animal lifestyle problems might be:

• Obesity
• Behavior problems, such as separation anxiety or aggression
• Dogs on chains in yards
• Dog fighting rings
• High rates of surrender of animals to the local shelter
• Low rates of adoption from the local shelter
• Lack of veterinary care, either because community members cannot afford it, or because it is simply not available

Basically, I figured, veterinarians would work to improve animal husbandry (the way animals are kept and fed). Education of animal owners and handlers! Projects focused on making it easier for owners to get regular veterinary care, take their dogs for more walks, or stop chaining their animals in yards! Let’s go!

But check out the articles in the Journal of Preventive Veterinary Medicine: articles about disease, articles about food animals, articles about disease in food animals. Any articles about disease in dogs are most likely to get published if they are about diseases that threaten humans. Articles about lifetyle problems in pets are few and far between, and I have yet to find an article about an initiative proactively addressing one of these problems. Of course preventing infectious disease is important, but isn’t changing poor husbandry important too? Is veterinary public health actually decades behind human public health in its reluctance to focus on lifestyle diseases?

I asked myself what questions a public health veterinarian might ask about a particular community. Smaller communities are probably more manageable than large communities, but in theory a community could range from a neighborhood to a city to a country. Of course, remember that I am not a public health specialist — I don't have a Masters in public health and I don’t work in public health — so please take my ideas with a grain of salt. But here goes.

1. What are the most significant problems of animals in the chosen community?
2. Why are these problems happening? What does the community need to do in order to solve the problems, and does it have the resources it needs in order to make those changes?
3. How can we work with the community, providing it support in bringing about change? How can we provide the community a path to self-sustaining change, rather than coming in from the outside and mandating change?

One such outreach project, arguably, is HSUS’s Pets for Life. This program focuses on working with community members, building trust by bringing food and pet supplies into under-served communities, and progressing to providing vaccination, spay/neuter, and training services. It is an inspiring program, but I have found no peer reviewed publications about it. This is the sort of thing I'd like to see a case study on in a veterinary journal. Rather than reading a glowing report about a program written by the creators of the program, I want to read an objective discussion of it by an outsider who also happens to be an expert in the area. It would be nice to be wrong about this (except for that naturally it would be a little embarrassing), but I have been unable to find any such publications in veterinary journals.

And there are more and more such efforts out there, programs to address canine and feline obesity, to help build fences for yards to help owners stop chaining up their dogs. I’ve been calling such initiatives “community-based public health,” and I want to know more about them from experts. Randomized controlled trials are going to be impractical if not impossible in these situations, but I want case studies!

...or you could zeuter the dog, instead

The dog was on his back, sedated on a table. I was not wearing a surgical cap or a sterile gown. I held the first testicle between two fingers, pushed the needle in, and injected a little less than a milliliter of a mixture of zinc gluconate and L-arginine. Then the second testicle. And now the dog was non-surgically castrated. In a few weeks, once he was rid of the sperm he had already made, he would be sterile for the rest of his life.

This product, Zeuterin, is newly released in the US market, just starting to make its way into veterinary clinics. I was part of a one-day training at a low cost spay/neuter clinic which has partnered with the company as an early adopter. On the one hand: if we can avoid doing surgery on dogs, why wouldn't we? Isn't an injection better than cutting? On the other hand: if you have to sedate the dog for the procedure anyways, and surgical castration is so very quick and simple, what's the benefit of zeutering rather than surgically neutering them? And is the benefit to the dog (healthier) or to the human (faster and/or cheaper)?

I'm considering a few different populations of dogs: owned dogs being brought to a clinic, shelter dogs being altered on site, and owned dogs being altered on an outpatient basis. The answers to the above questions will differ for each population.

• Sedation versus anesthesia: Surgical castration of a dog requires full anesthesia. Zeutering requires only sedation, and in some calm dogs can be done without even that. A dog will recover more quickly from sedation than from anesthesia, so he'll be able to go home earlier in the day. (Important in a clinic and for outpatients; not important for most shelters.)
  
• Time: You'd think that an injection would be faster than surgery, but it isn't clear that this is so. A trained high volume surgeon will perform a castration (a very simple surgery) in just a minute or two. The injection has to be given slowly and the needle has to be positioned precisely. The time difference may not be significant.
  
• Cost: Zeuterin is expensive! It costs $10-25 to neuter a dog with this product, depending on the size of the dog. I don't think anyone really knows how this compares to surgical castration, which doesn't have clear costs per animal. How much is your surgical suite costing you, and how valuable is it to keep a dog out of it? How much does it cost to sterilize a pack of surgical instruments? For shelters where every penny is counted, the cost of the product will matter more than in a veterinary clinic where an owner may not mind a difference of $10 one way or the other.
  
• Using technicians: Technicians can't perform surgery. That requires a veterinarian. But a technician can give an injection. The spay/neuter clinic where I learned to zeuter are currently only allowing vets to zeuter, but they expect to start using technicians in this role as they become more comfortable with the procedure. Saving the veterinarian's time is a big bonus. Vets are expensive!
  
• Testosterone reduction: Surgically neutering a male dog reduces his testosterone level by 100%. Zeutering him reduces it by 50%. Which is better? Hard to say! We don't really know yet whether zeutering will reduce unwanted behaviors (roaming, peeing on things) the way neutering sometimes does. (But we tell people that really training is better for that sort of thing anyway.) And is it healthier for a dog to have all of its testosterone, or only half? Testosterone is a steroid which affects metabolism and various physiologic process in many ways. I'm guessing that it does some good things for dogs and some bad things, and only time and a lot of research will tell whether it's better to have 50% or 0% of normal levels.
  
• Aesthetics: Zeutered dogs still have their testicles, although atrophied and therefore somewhat smaller in size. Good or bad? Opinions will differ on that one.
  
• Complications: Surgical complications can include anesthetic death and bleeding, but complication rates for this simple surgery in healthy dogs are very low. Complications with zeutering include the development of ulcerations or even necrosis of the scrotum. These complications are also expected to be low when the procedure is done correctly, but again, it's too soon to know exactly how that will shake out.

So is there a place for zeutering in veterinary medicine? I think there is, but it's not clear yet exactly what it will be. I'm not convinced that that place is in a shelter (though some shelter vets disagree with me). I'm also not convinced it's in a general practice veterinary clinic for the average owner, although I think some owners will prefer Zeuterin both for avoiding general anesthesia and for maintaining a higher testosterone level, and of course for keeping the dog's balls. The place I really see this product is for performing neutering outside of the veterinary clinic, for example, in low income areas of the US where the population has difficulty getting their animals to a veterinary clinic, either for lack of transportation or for lack of enough committment to follow through with an appointment for surgery. In other countries, trap-neuter-release programs may also find a great benefit to being able to do this procedure in the field.

(Posted by a bleary DZ at the fabulous but overwhelming ScienceOnline 2013 unconference.)