Wednesday, December 19, 2012

Diary of a shelter medicine veterinary intern: late fall

I seem to have spent two months with no time to blog. What in the world was I doing?

The last you heard from me, dear readers, I was in the first week of our month-long shelter consult. The first week we digested a lot (a LOT) of data from the shelter. The second week we wrote up what we thought about that data. How many dogs did this shelter take in over the last few years? Cats? Are there changes in intake? How many of each species were euthanized? Why? What is the average length of stay for each species? Are pit bull type dogs treated differently? Etc.

The week after that, we were on site, crawling all over that poor shelter. That was a very busy week; in the evenings we were scrambling to write up everything we had seen and photographed during the day. On the last night of the consult, we generated our exit report, which was an overview of our findings. What did we think were this shelter’s greatest strengths? Its greatest challenges? What did we think they should address first? How? What was our five year plan for them?

The week after that, we were back on campus, writing, writing, writing. The complete consult report is traditionally quite a long document; in previous years it has been hundreds of pages long. The shelter medicine residents (the veterinarians who are specializing in shelter medicine) worked on the report for another week after that, but we interns were released after just one writing week.

After that, I spent two weeks at a truly lovely limited admission, adoption guarantee shelter about an hour and a half from home. I shadowed the shelter vet some of the time, and worked on my own some of the time. I did a lot of physical exams and surgeries! I also helped one day to select animals from the local municipal shelter (lots more animals, lots more euthanasias) for transfer to the adoption guarantee shelter. Our truck was almost full of animals when shelter staff pointed out an ancient, arthritic collie mix and asked if we might consider taking her. I argued against it, saying she was too old and decrepit to be adoptable. But in the end we felt sorry for her and took her (another dog had to ride on my lap on the way home to make room). Then I felt too bad for her to put her in the shelter kennels — her arthritis was so bad and she seemed so depressed. So I took her back to my room for the night. And the next night. And home over the weekend. And hung on to her my second week in the shelter. I officially adopted her on the last day. Her name is Rosie.

In mid November, I spent two weeks on campus, working with veterinary students as they learned how to spay and neuter animals. I am getting more and more confident in my own spay/neuter skills, but teaching still feels scary. Will I be able to tell ahead of time before someone does something wrong? I also got to amputate a badly broken leg off of a kitten. My first amputation! Terrifying. There are big arteries in there.

After Thanksgiving, I was on campus again for our shelter behavior course. This was a blast. A lot of reading about behavior (one of my favorite things to do), and a surprising amount of hands on work. We learned about different temperament tests for dogs and tried them out, both on shelter dogs and on our own dogs. We visited some different shelters in the area and talked about how they handled their dogs, and at the end of the two weeks we spent two days at one shelter, getting hands-on helping some of their dogs: setting up play groups, putting up cage barriers for those dogs who were over-stimulated by their surroundings, hanging treat buckets, etc.

Now I am in the hospital on the dermatology service. Skin problems are really, really common in shelter animals, particularly in the South. Flea allergies! Pollen allergies! Allergies allergies allergies! Also mites.

And that brings me to today. I finish up my dermatology rotation next week and head on to another week in the emergency room. And that is what I have been up to. I have been quiet, but I have not forgotten you guys.

Sunday, December 16, 2012

Will we ever be able to measure cortisol in real time?

In my Copious Free Time (CFT), I sometimes like to try to figure out how close we are to implementing some of the crazy technology I’d love to use in research. I want to learn more about the canid stress response, as a way of learning about canid domestication (domesticated animals have blunted stress responses, and this may be part of why they are so accepting of novelty and so easy to socialize). The hormone that most people use to study the stress response is cortisol.

I have written in the past about some of the many problems with studying cortisol. Two of those problems are
  • Getting hold of cortisol (from blood or even saliva) without increasing the animal’s stress and therefore invalidating your study, and
  • Measuring cortisol frequently enough to actually be able to track its very rapid changes in the bloodstream (changes on the order of minutes, continuing to occur and be important over the course of hours).
What we really need, obviously, is a Star Trek-style tricorder that we can point at an animal and ask “what is this animal’s blood cortisol level just now? And how about now?” So recently I was wondering how close we were to this technology.

I asked a friend who works in research imaging. She obligingly sent me a review paper to read, about studying dopamine levels in humans using PET. The problem this paper addresses is getting at the dopamine levels in the brain without having to slice open the skull (something we definitely don’t like to do in humans — and although we might be willing to do it in rats or mice, it is going to be hard to retest the same animal later to see how its dopamine levels have changed, seeing as how a common side effect of skull sliceage is death). This is a pretty cool technology. It goes something like this:
  • Inject the individual with a radiotracer which is attached to dopamine agonist or antagonist. The agonist or antagonist will attach to dopamine receptors, and the radiotracer will allow us to use PET to monitor how much of it is attached in the part of the brain that we care about.
  • Monitor the changes in the radiotracer in the region of interest. As dopamine levels in that region increase, the unlabelled dopamine will bump more and more labelled agonist or antagonist off of the receptors, which will mean there will be less radiotracer in the region. Less tracer implies more actual dopamine. Do math.

Egerton A., Mehta M.A., Montgomery A.J., Lappin J.M., Howes O.D., Reeves S.J., Cunningham V.J. & Grasby P.M. (2009). The dopaminergic basis of human behaviors: A review of molecular imaging studies, Neuroscience & Biobehavioral Reviews, 33 (7) 1109-1132. DOI:

You could use something similar to monitor cortisol binding in the brains of dogs. That would be very interesting, actually, but the studies I tend to envision are more concerned with cortisol amounts that are released from the adrenals. We are actually in a better position here with cortisol, compared to the suckers studying dopamine in the brain: dopamine is released in the brain and stays in the brain, so you never get a chance to see it in the bloodstream. The bloodstream is actually easier to get at than the brain, obviously.

Conversely, cortisol comes from the adrenal glands (way down near the kidneys, far from the brain). The brain sends a signal to the adrenals via very long nerves, and then the adrenals release more or less cortisol, for a longer or shorter period of time. It’s the “more” or “less”, “longer” or “shorter” that are interesting. I actually don’t know enough about where cortisol binds to say if using a radiotracer-labelled cortisol agonist or antagonist, to sit on binding sites, would be interesting, but I suspect this is not the right direction for this technology. Cortisol binds in organs all over the body and affects a lot of processes. Unlike with dopamine, where researchers are interested in very specific (hence small) brain areas, we would want to scan the whole body for cortisol binding.

The radiotracer idea is interesting, though. Maybe we could attach a radiotracer to one of the precursors of cortisol, like cholesterol? We would inject labelled cholesterol. The adrenals would take it up and convert it to cortisol. Then when they released cortisol, we could see the label spreading across the body. No need to measure binding. We could in fact just scan one part of the body where there is a lot of blood — a vein coming out of the adrenals? — to watch cortisol levels rise and fall. The downside: the use of PET to monitor the changes in the radiotracer label. PET is expensive and it requires the subject to hold... perfectly... still. Something dogs are not very good at doing.

What I really wanted, I decided, was something that works sort of the way a pulse oximeter works. Pulse oxes are little devices that you hook up to an animal while it is under anesthesia to monitor their blood oxygenation (you know, to tell if they are dying or not, something which ironically is often easier to tell just by looking at the animal, but we use the things anyways). These devices work by shining a light through an area of non-pigmented skin (such as the tongue, an unpigmented paw pad, or if all else fails, a vulva) and measuring how much hemoglobin (hence oxygen) is in the blood based on color. Could some such device measure amounts of tracer label?

I was letting these ideas percolate and considering how I might write them up for you, dear readers, when I completely by chance came across the following announcement: Sano Intelligence is working on a wearable patch which will continuously monitor blood chemistry.

A wearable patch! That’s actually a much better solution to this problem. It operates wirelessly, so you slap it on (at a cost of $1-2 per patch for materials, though much more in the end to the company to pay for development costs, I imagine) and then remotely monitor changes in blood sugar, electrolytes, and — cortisol? Of course the company does not mention cortisol as one of the substances the patch would monitor. I wonder if there is any reason it couldn’t be included, though. It would help if I had any idea how this patch worked. The company asserts that it’s non-invasive and does not hurt to apply. So how does it get at the substances in the bloodstream? Apparently the company isn’t saying until the patch is released.

So now I wait. If any of you out there in internet land know more, or have thoughts on how this might work, let me know!

Monday, October 1, 2012

When the patient is a shelter: week one

The next question I get after “what do you do?” is always “what’s shelter medicine?” I have been playing around with different ways to sum up a complicated veterinary specialty in a few sentences, suitable for cocktail party conversation. (No, I do not actually go to cocktail parties.) Recently I found an answer I liked: shelter medicine is where the patient is an animal shelter, not an animal.

For the next four weeks, my shelter medicine program will be working on a consultation with a particular animal shelter. This week, we are analyzing data from the shelter, which is a large municipal animal care and control facility in the South. As such, it will be open admission (take in almost any animal offered to it) and therefore likely to perform euthanasia of potentially healthy animals to free up space for more animals, rather than solely for behavioral or medical purposes.

Step one: analyze what this shelter takes in. I have received spreadsheets of data from the last five years. I will be building data tables to tell us how many animals of each species it accepted (we’re only looking at cats and dogs); how many animals of each age category it accepted (kitten/puppy, adult, and the always dreaded “unknown,” of which there are more than you would expect at most shelters even though it isn’t hard to tell if an animal is an adult or not); why the animals came to it (surrendered by owner, stray, confiscation, returned by an adopter, return from foster care, other). This will help us understand where most animals in the shelter have come from, which will be key data in making recommendations to the shelter about how to work to reduce their intake numbers.

One of the residents in my program is simultaneously looking at what happens to the animals who are in the shelter, by age and species: euthanized? Died in the shelter? Adopted out or transferred to a rescue (“live release”)? This will help us make recommendations about how to increase live release. For example, which kinds of animals are most at risk of euthanasia: feral cats? (Does the shelter have a trap-neuter-return program?) Adoptable puppies? (Do they have a program to transfer to other groups which might have more resources to put towards finding homes?) Adoptable kittens? (There are always too many kittens!) Sick animals? (It may be acceptable to euthanize sick animals, but why did the animal become sick? Does the shelter have a problem with communicable disease?) And, of course, we will look at how many animals died in the shelter. (That is the worst outcome. That should rarely happen. If it happens too often, it is a huge red flag.)

So wish me luck with all my spreadsheets. Luckily, I used to be a computer programmer. I may call on some old skills to help me out this week.

Saturday, September 29, 2012

Cuteness interlude

You all like photos of foster kittens, right?

You can only see four of them there. For some reason one is always off doing something else (always a different kitten).

They are probably around three weeks old. They had not quite gotten the concept of solid food yet and were not eating well in the shelter where I was working last week, and were underweight. One of them had a bad upper respiratory infection, which was manifesting as bad conjunctivitis (inflammation around her eyes). She looks much better today after meds and someone willing to mix up juuuust the right concoction of milk replacer plus canned food.


It’s hard to tell in this photo, but her eyes are still pretty red. I’m not worried about her any more, though. She will do fine.

Monday, September 24, 2012

The Feral Freedom program: leave outdoor cats where they are!

Even in parts of the country in which the dog overpopulation problem is mostly under control, the cat overpopulation problem is still rampant. Cats entering shelters often have a less than 50% chance of adoption, down to 10% or less in many communities. Certainly, unfriendly feral cats coming in to shelters have a miniscule chance of adoption, so small that most shelters euthanize them rather than trying to find them a barn home.

On the other hand, cats living outdoors often do very well for themselves. Contrary to the popular assumption that the life of an outdoor cat is nasty, brutish, and short, most of the cats coming through trap-neuter-return (TNR) programs are healthy. They may not live as long as indoor cats, but they are not miserable. To some people, the idea of euthanizing a cat rather than run the risk of its being hit by a car in a year seems silly or even a little mean.

The city of Jacksonville, Florida, recognized that the choice for outdoor cats, feral or not, was either to be spayed/neutered and returned to their territory, or euthanized. That was it. Certainly feral cats stood no chance of adoption, and the influx of friendly cats was so great that their chances weren’t much better. That realization was the seed of Jacksonville’s Feral Freedom program. This program facilitates the sterilization, vaccination, and return of all healthy outdoor cats that are presented to the shelter. These cats come from the surrender of “stray” cats and from active trapping. Rather than become shelter inhabitants, they are returned to the location where they were originally trapped or picked up.

Does it cost a lot? Because the city was holding all cats for five days in case an owner came to reclaim them, and paying for euthanasia and disposal of the body, the program costs the same as the previous policy, or a little less.

Do owners fail to find actual stray cats when they are not held in a shelter? Research has shown that stray cats are less likely to be reunited with their owners in shelters than if they are left outside to find their own way home. Many owners do not expect to see their outdoor cats daily, and may not start looking for a missing cat until after it has already been euthanized in a shelter.

Are outdoor cats nuisances? Some certainly can be, although sterilization does reduce nuisance behavior, and vaccination reduces disease. (Cats are much more likely to get sick in a shelter than outdoors.) Feral Freedom provides assistance to people with complaints about individual cats. They will trap, sterilize/vaccinate, and return the cat, and then suggest that people who want it off their property try methods like motion-sensitive sprinklers. (And hilarity ensues.)

Do the good citizens of Jacksonville approve of this program? Jacksonville initially implemented the program on the sly without a lot of publicity, but did publicize it once it had proven to reduce cat euthanasia rates in shelters. The city receives complaints about individual cats, but rarely about the program as a whole. Most people, when they understand that the cat’s choice is euthanasia or return, accept that putting the cat in a shelter is not a humane option. (Some people do disagree. That will be true of almost any public policy, except maybe the one where every new baby gets a chocolate eclair.) But cats will not be relocated, even problem cats. Aside from the question of how well a cat will do when dropped down into a new territory, there is nowhere for them to go. There are no places that want more outdoor cats.

And, of course, the ethical questions. Isn’t it the job of a shelter to provide care for homeless animals? Of course it is. But if the shelter does not have the resources to provide for all of them, does it become the job of the shelter to kill them when they are not otherwise suffering? And aren’t cats better off in a good home? Of course they are. But if there is no good home available (or even bad one), are they better off dead?

I certainly recognize that this approach to cat overpopulation is a controversial one and that many will disagree with it. (If there is interest, I may blog later about the questions of communicable disease in outdoor cats, or predation of wildlife by outdoor cats.) But I think we have reached the point in dealing with the pet overpopulation problem where revolutionary ideas are worth trying, because we have tried almost everything that is non-revolutionary. Don’t get me wrong: euthanasia of healthy domesticated animals has certainly decreased in the past decades. But there is still a long way to go. As one of my faculty advisors said to me recently, “It’s an exciting time in shelter medicine. Everything’s on the table.”

For more information:

Monday, September 17, 2012

Hey, want to get rid of those ovaries, cheap?

A few months ago I was watching a general practice veterinarian perform a dog spay. And I was surprised by how slow he was. He seemed hesitant, not confident in his technique, and he took a good forty minutes to finish the surgery. He commented to me, “I only do about one spay a month. Most of the animals we see these days were spayed before they left the animal shelter.” This made me wonder: if I had a dog that I wanted to have spayed, where would I take her? To someone who only performed this complicated surgery once a month? Or would I actually rather have her spayed at a shelter, by someone who does multiple surgeries a day, even though she is less likely to have high quality anesthesia management and individual attention there?

The answer to the question of how to offer high quality, high volume spay and neuter services to the general public is veterinary clinics focusing entirely on spay and neuter, and not offering general health care. One model clinic of this type is Humane Alliance in Asheville, NC. This sucessful non-profit clinic was founded in 1994, before much of the rest of the shelter community had woken up to the fact that high volume spay/neuter is an important component of reducing pet overpopulation. Today, 25% of the animals they surgerize are privately owned and come in on appointment. The other 75% come from shelters, rescues, and feral cat trap-neuter-return operations within a sixty mile radius of the clinic (transportation is provided by the clinic). On any given day they may have 100-125 animals in the building receiving surgery.

The Humane Alliance model was so successful that other clinics began coming to them for help. In 2005, Humane Alliance began accepting applications for National Spay/Neuter Response Team (NSNRT) members, member clinics designed on the Humane Alliance high volume model. They define “high volume” as at least 5,000 surgeries per year, though they note that most clinics perform at least 7,000. With a profit margin of about $2-3/surgery, this nets the clinics a profit of about $10,000/year, which is enough to keep them afloat. Today, there are 110 NSNRT clinics, and five more are expected to be operational before the end of the year. Humane Alliance helps the clinics every step of the way, from the design of their business plan, to the list of medications to have on hand on opening day, to sending staff members out to work on site at the new clinic for the first week.

Do these clinics provide spay/neuter surgery in the style of shelter surgeons? In some ways, yes, because their protocols are very much oriented to high volume, with the expectation that one surgeon will handle up to dozens of animals a day. But the quality of the care is extremely high. Arguably the most dangerous part of surgery is going under general anesthesia, and these clinics do not skimp on their management of this aspect of surgery, down to the details of keeping the animals extra warm on a heating blanket while they wake up.

I like this vision of the future: veterinarians who are specialists in spay/neuter surgery, working in clinics that are focused on this one complicated procedure, providing services of higher quality and for lower cost. Making spay/neuter more affordable and more accessible can only be a good thing for pet overpopulation. Unfortunately, the reaction of many general practice veterinarians is not so enthusiastic. Because these types of clinics charge much less for surgeries (often well under $100), veterinarians at full service clinics often fear that their clients will be stolen from them by clinics offering less expensive services.

Is it a realistic fear? I don’t think so. Full service veterinarians offer full service: wellness care, and management of sick animals. Spay/neuter clinics offer a one-time interaction with the client. Full service veterinarians may indeed lose spay/neuter business, but I contend that those services don’t comprise a large part of their income to begin with. The rest of their services aren’t threatened.

I think these clinics are going to continue to expand, and become an accepted part of the way veterinary medicine is practiced. The old adage “good, cheap, fast: pick two” is disproven here. This is the place I would take a beloved animal to have surgery.

Monday, September 10, 2012

What breed is my shelter dog?

I am weekly asked the question “so what kinds of dogs do you have?” People don’t ask this about cats. But it is the first question they ask about a dog. We use a dog’s breed as shorthand to tell us the dog’s size, color, build, and to make predictions about its temperament and energy level.

I usually describe my dogs as a “golden” (one word) and a “32 pound something or other, probably a border collie/retriever mix“ (11 words, and I didn’t even get her color in there). Some dogs, like my golden, can easily be pointed to and called a purebred, even if they aren’t registered (which is the technical definition of a purebred). But once you start mixing purebreds, it rapidly becomes surprisingly difficult to predict the heritage of the puppies. Traits that you think of as the defining characteristic of a particular breed, like that rich golden color, are often recessive and disappear in the first generation of mixed breed puppies. Look at pictures of puppies of known mixed breed heritage and you’ll be surprised again and again at how impossible it is to guess the parents’ breeds.

Now, I do make guesses about breed heritage when I describe my little mutt. But is she really a mix of breeds? Is it possible that there are a lot of dogs out there that owe more of their heritage to a pool of dogs that never got sucked into the closed breeding groups of registered breeds, and were always just something or others?

So why do I persist in making up breeds for her? Because it is shorthand. People understand it. It gives them a handle to use in building their imaginary picture of this dog I’m describing: her general size and shape and, of course, temperament. Of course, what a dog looks like does not predict very much about its temperament (except maybe that little dogs often have Napolean complexes — and that is nurture, not nature!).

As for the rest of it, we don’t have to say that a dog is a breed. We can say that it is a type. This is really what we are doing in a shelter when we guess the breed of a dog to write on its adoption card. No one really thinks that all those “lab mixes” definitely have Labrador Retriever in them, but it lets potential adopters browsing on the internet to know what to expect and to make a decision about whether to come in to the shelter meet the dog.

So what is my little mutt? Maybe next time I will say she is a “collie type” dog. As for the rest of it, describing her exact color and personality always makes for a fun conversation.

Tuesday, September 4, 2012

Team Dog Zombie shirt

As requested, shots of the Team Dog Zombie shirt. Every team member had a shirt which had some variation on this theme. My husband kindly offered to edit out any identifying information (my name and my team members’ names) from the photos.

The front of the shirt has a stylized cat face on it and says “have you seen my cool tattoo?” This is a reference to the habit of shelter veterinarians of tattooing any animal whom they spay/neuter, to avoid later unnecessary surgeries if the animal is later lost and ends up back in a shelter. (All vets should do this! You never know who will get lost! Dude, I lost my dog the other day. But found him again in two hours.) You can see the little green line down by my belly area, which is the cool tattoo. Yes, I have considered giving myself this exact tattoo, but have decided it is not as cool on girls as it is on cats.

The back of the shirt has the team name, and all the team members signed it (my husband blurred out their names). We were originally Team C, and you can see a reference to this on the shirt.

Me: Don’t include my whole butt in the picture!
My husband: Don’t worry, there’s no way that could happen.

We have such a healthy relationship.

Monday, September 3, 2012

Felicia Day and dog training

I was a geek before I was a dog zombie. I am a fan of The Guild, which is a web-based show produced by Felicia Day. Day also has a YouTube channel called Geek and Sundry (I am a geek and I am sundry!) and on a recent episode of The Flog (which is a video blog type thing — Felicia’s Blog, Flog, get it?) she has a professional training session with her dog, Cubby. Who is super cute, but not the cutest dog ever

It was a nice segment. The trainer did some basic agility work with Day and Cubby, a good choice for a dog who looks like he has the genetic background (herding breeds) to have some smarts. She instructs Day to do a lot of luring with Cubby — using a food reward to guide him where she wants him to go. A lot of agility trainers use shaping instead, in which they set the dog up to do the right thing, let him figure it out, and then reward the right choice. This method can be a little slower up front, but produces a dog who learns how to learn, learns how to experiment in order to figure out what you want him to do, and in the end gets the concept you’re trying to communicate a little better. (Theoretically, anyways. Every trainer has their own opinion about what’s the best way to train.) One reason to choose luring over shaping for a YouTube show is that you need to have quick results. As fun as I think a shaping demo would have been, that wasn’t what this show was about.

The trainer concludes by saying that Cubby needs some mental stimulation every day. She had to pick one message to get across in a short segment, and I think she picked a great one. Yes, mental stimulation is important, especially in dogs who have to sit home all day when their owner is out working! Agility is loads of fun and I highly recommend it as a great partner sport that works your dog’s brain and muscles. In Cubby’s case, since Day described him as an older dog, he might benefit from a quick vet check to make sure he is up for the exertion of an agility class. In fact, it is always a good idea to check with your vet before starting a new exercise program for your dog, to make sure your dog is up for it. Some dogs need to lose a little weight before embarking on jumping over obstacles, for example.

If you want to get involved in agility, look up your local dog training clubs and schools and ask about local agility organizations, and take a class. When I was getting into agility, I found a local agility trial and volunteered at it. Then I asked all the competitiors what school they recommended locally. They all said the same one, so my choice was easy.

If your dog isn’t up for that kind of activity, you can give him mental stimulation other ways. Train him tricks. Leave him with toys stuffed with food for him to work out during the day. When you feed him kibble, scatter it in the grass for him to hunt for it. Everyone needs a little brain exercise from time to time, even dogs.

Sunday, September 2, 2012

Ten's company for cats in shelters

Austin Bouck at Animal Science Review recently posted about the benefits of group housing for cats in shelters. (Well, sort of recently. I meant to write about this two weeks ago!) Apparently adopters prefer group-housed cats as adoption prospects. Decreasing the length of an animal’s stay in a shelter is a very important tool in decreasing shelter overcrowding, so this is good information for shelters. Austin adds, “Arguments against housing cats in groups are primarily based on disease management,” citing upper respiratory infection (URI) as the most common disease seen in sheltered cats. (Too true.) So is group housing a good idea for cats in shelters, then? What should shelters be considering if they are designing a plan for cat group housing? I turned to my new bible, the Association of Shelter VeterinariansGuidelines for Standards of Care in Animal Shelters, to see what it had to say about group housing. It has an entire section on this topic.

Risks and benefits of group housing
Absolutely, group housed animals can pass infectious disease back and forth. A quick Dog Zombie sidenote about infectious diseases of cats in shelters, not covered by the Guidelines in this particular section: about half of shelter cats will get a URI within two weeks of their introduction to the shelter, and they may well pass that URI to other cats with whom they come in contact. However, the main cause of URI in shelters is stress, which causes viruses which the cats have been carrying without trouble for years to reactivate. So if the group housing is lower stress than individual housing, I am less concerned about URI. I would be concerned about ringworm (highly contagious!), as well as FIV (feline AIDS) and FeLV (feline leukemia). These last two are less infectious, but very serious (life shortening) if acquired. All animals should be tested for FIV/FeLV and inspected for ringworm lesions before they are put in with other cats. The Guidelines do cover these diseases, but not in the group housing section.

Aside from risk of infectious diseases, what else should we be concerned about? “Stress, fear, and anxiety.” Some cats like group housing. Some don’t. Make sure you don’t put a timid cat in with bullies. It can be easy to miss these kinds of social interactions in a busy shelter, but if you are group housing animals, you have to take the time to make sure everyone gets along.

Speaking of which, it can be difficult to keep an eye on everyone in a group housing situation. A cat in a cage is easy to check up on. But if you have 10 cats in one room, it is easy to miss the little one who hides in her hide box all day. It is even harder to tell who is not eating, or who had that stinky diarrhea in the litter box. So group housing can be a lot of work to manage. But the consequences are serious if some cats become sick and early signs are missed.

There are benefits, though, even aside from increased attractiveness to adopters. Many cats very much enjoy the company of other cats. They like the opportunity to sleep together, groom each other, and play together. Shelters can be very sterile environments, and there’s little that is as enriching to a social animal as a well-matched member of your own species.

One danger of group housing is that an overcrowded shelter might see it as a way to save space. Well designed group housing won’t actually save any space, although it may redistribute space (enabling more vertical space, which cats enjoy so much). The Guidelines recommend at least 18 square feet per cat. That’s a lot, but it provides cats with room to get away from each other when they need to. Of course, you also need enough feeding stations, litter boxes, hide boxes, and elevated perches. I have been told that it’s a good idea to have more elevated perches than cats so no one is fighting over the best one! If you look at cats in group housing, it is often true that most of them are off the ground at any one time.

We already talked about some selection criteria for cats being put into group housing: do they like other cats? Are they sick? Cats should be grouped by age (no energetic kittens in with old codgers). Obviously, intact males should not be put in with intact females (you’d be surprised, but some facilities don’t take these simplest of precautions against breeding).

Since we’re worrying about disease, it’s worth mentioning that a lot of population turnover (a new cat put in to an enclosure whenever an old one is removed) is a prime cause of disease. Remember, a cat is liable to come down with URI soon after it arrives at the shelter. Do you want to put it in with a population of healthy cats? (I said that the cats came down with URI because they were stressed, but that doesn’t mean that the virus that reactivates isn’t infectious to other cats, not to mention bacteria that take advantage and colonize a sick animal.) It is an excellent idea to have stable populations per group room, let the group size diminish as animals are adopted out, and then start an entirely new group periodically. Animals who stay in the shelter for a very short period of time may never make it in to a group housing situation, which is fine. This “all in, all out” method of group management is also used in farm animal husbandry, by the way.

Group size? With cats, 10-12 is a good group size. More than that can be really unmanageable. The shelters I have seen that do cat group housing well have multiple rooms with groups about this size. It can be tempting to have one large room with all your cats in it. I have seen this done as well. It was a disaster, with rampant disease and fighting.

Is group housing a good thing?
I definitely think group housing is a good thing for cats in shelters when done well. But it does have to be done thoughtfully and with planning. It is good for the cats, but it is not a way to save time or money.

I haven’t seen group housing for dogs in a shelter yet. Word on the street is that there is a shelter a few hours from me that does this, and I really want to check it out. I will report back if I do!

Saturday, September 1, 2012

Diary of a shelter medicine intern: August

Oh my god do I miss blogging. But I have been flat out all month. Let’s see, what have I been doing?

When last I wrote, dear diary, I was finishing up the course on how to handle community (feral/outdoor) cats. My team did trap a handful of cats (if I remember right, it was around five), and won the Best Dressed Trappers award for the t-shirts that one team member put together saying “Team Dog Zombie” on them. I am pretty sure that I wasn’t the one to inspire the team spirit (I have always been a little deficient in the team spirit category), but they were awesome people to work with and the t-shirts really amused me.

The next week I was on an emergency room/intensive care unit rotation. The hours were very long, but I really love emergency medicine, so I didn’t mind. I got a puppy with parvovirus midway through the week. Parvo is a highly contagious disease, associated with (but not unique to) the shelter environment, so I was extremely pleased to get to work on this case. The puppy lived in the isolation unit for five days, and I was essentially barred from the rest of the ER in case I carried germs back, so it was just him and me for the duration. Oh, and a bunch of very competent technicians and very hard-working students, of course. I learned a lot about parvo. How to get a parvo puppy who still feels nauseated to eat: buy him a roast chicken from Publix! Mmm.

The last two weeks have been didactic, a strange throwback to veterinary school. I am not in shape for sitting on butt for hours a day anymore! We would read frantically, then go in to listen to lectures about the readings. The class was small (the handful of shelter medicine interns and residents, plus a few more distance learners), so it wasn’t like your traditional large lecture course, but it was still an odd experience to spend four hours a day sitting in front of PowerPoint slides again. How did I manage it for eight hours a day, back in school? But I learned a lot about shelter medicine: do microchips cause cancer? How likely is it that an unchipped animal will find its way home again? How do you wash your hands? (Yes, really.) What kind of animal are you most likely to get rabies from (and how likely are you to get rabies)? How do you calculate how many animals you might expect to have in a shelter on a given day, and what are your best methods to reduce that population? And, of course, our favorite, what color is this cat?

For these first few months I have felt my brain being gradually remolded to fit the perspectives of the faculty members in this school’s shelter medicine department. I can almost no longer remember how it felt to have different beliefs about how to approach cat overpopulation than I do now. Here’s hoping I find the time to blog it all out!

Thursday, August 9, 2012

Diary of a shelter medicine intern: the first few weeks

At my last report I had finished about two days of my internship and was still giddy with joy. During the rest of that week, I got to work on site at a major cat hoarding case. Hundreds of cats at a cat sanctuary gone bad had been seized by a large rescue organization, and were being managed in a previously abandoned animal control facility which had been patched up to manage all these cats. My team swooped in to help with spay/neuter. We surgerized about 200 cats over two days. We also got to see how the facility, originally designed for dogs, had been fixed up to house so many cats. Quite a bit of creativity had gone into making dog runs inviting to feline inhabitants. I was impressed.

The following week, I was oriented to my new job (even though I had already been working for several days). There were lots of lectures about things I now have no recollection of, and lots of tours of the hospital.

Then I started two weeks of Primary Care service, which represents the first of six or so rotations in the main hospital, so that I can be exposed to other kinds of medicine besides shelter medicine. Primary Care is different this far south than it was in New England. I learned so much about flea control. I was completely unprepared to deal with animals who were on flea preventatives and still crawling with bugs. Fleas down here have become resistant to preventatives; who knew? I also had my first interactions with veterinary students since I stopped being one. They would not call me by my first name no matter how much I asked. Being called “Dr. Dog Zombie” still feels odd and stilted to me. They were also all mildly afraid that I would give them a bad grade whenever I asked them a question.

The week after that was a hodge podge of stuff. All the interns (3) and new residents (2) dove in to studying the Guidelines for Care in Animal Shelters: we watched webinars, read consulting reports from when our department had visited shelters and given recommendations for improvement, discussed, and of course read the actual guidelines. We also had an ophthalmology lab, in which we practiced common eye surgeries which we might have to do in shelters, using cadavers. And, fortuitously for us but not for the shelter, we consulted on a small outbreak of panleukopenia in a nearby shelter. I really want to blog more about all of those things, but may not find the time, as they are working us hard. If there are any particular things you guys want to know more about, please ask! Getting feedback on what interests you will definitely influence what I choose to spend blogging time on.

Which brings us to this week. This week, I’m at a course on campus about managing feral cat colonies. Am I a student? Sort of, because I have to attend all the lectures and take the tests. Am I an instructor? Sort of, because I run a station during the clinical section of the course and teach the course participants how to prep anesthetized cats for surgery. Perhaps I have gotten the worst of both worlds!

Tonight, I am off to learn how to trap feral cats. Despite never having done this before, I will be a team leader. But how hard can it be?

[ETA: So far we have trapped three cats, out of a reported ten. Go Team Dog Zombie!]

Sunday, July 15, 2012

Animal shelter surgery: autoligation

When I watched my first video on how to spay a dog, lo these many (two) years ago, I kept saying “what’s a pedicle?” Apparently it was very important to tie the suture around the pedicle very tightly. And from context it was clear that the pedicle was the bit of tissue connecting the ovary to the body wall. But what was it?

I finally figured it out. The pedicle is the bit of tissue connecting the ovary to the body wall. It isn’t really anything in particular, it isn’t any actual anatomical structure, it just holds the ovary in place. But blood vessels run through it, so when you cut it in order to remove the ovary from the animal, lots of bleeding can happen. Bleeding is bad, particularly if it continues after the animal is closed up. So one of the hardest and most important parts of spaying a dog or cat is to make sure that you wrap some suture really, really tightly around the pedicle and tie it in a really, really secure knot so that no blood can get out.

Or not.

In shelter spays, the goal is speed. Most importantly, the less time spent under anesthesia, the better. This is particularly true in the case of feral cat spays, in which the cat can’t receive optimal post-op care because she can’t be handled. Also, of course, shorter spays means you can move more animals through in a day, sometimes dozens of animals per surgeon. We are not keeping up with the cat population with surgical sterilization as it is, so the high volume spay/neuter operations really try to keep as many animals as possible moving through.

One way that shelter vets try to make surgery time shorter is with autoligation. Instead of tying suture around the pedicle before cutting it, the pedicle is actually tied to itself. It’s a lot faster once you learn to do it. There is no futzing with getting the suture around the little cat pedicle with all the big clamps around it (oops! I looped the suture around a clamp! Time to start over). Tie the pedicle to itself, cut, inspect, let it sink back into the abdomen and move on. This is a pedicle tie, also known as autoligation (in other words, ligating the pedicle with itself).

Why don’t all vets do this? I suspect some private practice vets do. However, the technique takes a little learning, so if you’re not doing at least a few spays a week, it’s not really worth the investment. One vet recently told me that his private practice only performed about one spay a month. The rest were done in shelters, and that was fine by them.

And that’s one of the ways in which shelter surgery is different from general surgery.

This post written in celebration of my first unsupervised pedicle tie.

Wednesday, July 4, 2012

Day Two

I didn’t really feel like a vet until the second day of my veterinary internship in shelter medicine. I spent the first day being driven from department to department in the blazing heat to get my email address working (it still doesn’t), turn in medical records (not yet successful), and get my ID (the photo isn’t great, but a lot better than what I had managed on my first day of vet school).

The second day was different.

My alarm went off at 4:45 am. In New England this close to the summer solstice it would have been at least dawn if not full light at that time of the morning, but here it was still pitch black out. This may be due to being closer to the equator or to being farther west in the time zone, take your pick. Exercising the dogs was a little scary, because this town is home to the largest (flying) cockroaches you have ever seen, and they come out at night. (I survived.) My intern-mate arrived at my house at 6:15, and just as the sky was lightening we got in the car.

We drove for an hour and a half, getting to know each other on the way. We have known each other for a little less than a week now, but expect to be spending long hours together, so our relationship is sort of on the fast track. We talked about family and vet school. While I drove, she read aloud off her smartphone about a large hoarding case we will be working on in a few days.

We arrived at the shelter/hospital complex a little before 8 am. The senior resident drove up a few minutes later, fresh from the coffee shop. Warm drinks were distributed. I am still amazed that people down here drink hot drinks at this time of the year. At 8 am it was not yet sweltering, but well on its way.

We started the morning in the veterinary clinic, doing surgeries on shelter animals. Dr. Intern-mate and I had both gotten married after graduation from veterinary school but before the beginning of this internship, and we shared a moment of surprise when scrubbing in for surgery at discovering that now we had to deal with what to do with our wedding rings. It is a common problem with surgeons that rings get removed and then lost; neither of us had come up with a good plan yet for dealing with ours, and just stuck them in our pockets.

I neutered a cat and two dogs. I declined to spay a cat who was pregnant; I have spayed pregnant cats before and I will do it again, but it still makes me uncomfortable, and since I was offered a choice of two animals, I took the male. I may regret the decision, as spays are much more difficult than neuters, and I could have gotten some valuable instruction from Dr. Senior Resident on a new technique I’m learning.

While I only participated in sterilization surgeries that day, I observed two tail amputations. Why were so many cats with severe tail trauma coming in that day? (I saw a third get scheduled for an amputation as well.) Just lucky, I guess. I saw a dog get two stones the diameter of quarters pulled out of her bladder. (Ouch.) Then a technician appeared with a tiny kitten in a carrier, and announced that the kitten had some sort of wound in its neck which appeared to be infested with maggots. Dr. Intern-mate and I immediately bailed on surgery observation and went to give the kitten a physical exam.

She was a tiny grey kitten with a head way too big for her body. While an outsized head is somewhat normal for a kitten of this age, four to five weeks, she was clearly undernourished. Most of the fur was gone from the right side of her neck, and the nearby fur on her shoulders and chin was matted. She had a huge swollen mass on her neck, with a hole in her skin maybe 2 cm in diameter, and a dark mouth sticking out. It looked like a curled worm to me at first (though clearly not a maggot), but Dr. Intern-mate had seen this kind of thing before and declared it to be a fly bot. The mouth was pressed up against the hole for it to breathe. We cleaned the skin as best we could, and as we pressed against the bot it retracted deeper into the skin. (Everyone who encountered this bot reacted by exclaiming that it was gross, but after that you can divide the reactions into two camps: Tell me more! and I’m leaving the room now. Which are you?)

Image provided by Wikimedia

Dr. Senior Resident finished up her surgery and came over to see the kitten. We sedated her, then, when her eyes remained wide and her head remained up, put a mask on her to deliver anesthesia gas. When she was out we dripped a little local painkiller on to the area, and Dr. Senior Resident opened the hole up with scissors. She pulled the bot out with forceps. It was huge, almost as long as but much fatter than my thumb, and especially large to have been pulled out of such a tiny kitten. It was very definitely alive, and undulated sluggishly around the table while I filmed it on my smartphone. (Smartphones are the star of today’s story.)

Dr. Intern-mate and I also tried to draw blood from a stone, er, a very dry cat. She was dehydrated and sick but sweet. I felt bad poking her and wished once again that I was better at it. A tech saw how long the draw was taking, came over, and in the way of all techs, slipped the needle in and extracted plenty of blood in very little time. I try hard to get as much experience as I can with blood draws, because I think being able to do them is important, but it’s always hard when I feel that I am hurting an animal with my inexperienced prodding. I did fulfill my doctorly duties by reporting the cat’s dehydrated and flea-infested status to Dr. Senior Resident and making sure that both things would get taken care of, but I felt very much like a student at the moment.

After lunch, we began the medical (rather than surgical) portion of the day. Much of this consisted of checkups on animals who were either healthy (but we didn’t know that yet as they had just arrived at the shelter) or being treated for something previously diagnosed. I did physical exams on two teenage kittens. Both looked great, but one had a little bit of red around her eye. This is a good example of how shelter medicine differs from general practice. In general practice, a slightly red eye is not really worthy of note unless it goes on for a few days or gets worse. In a shelter, it is a sign of impending upper respiratory infection (URI), which about half of cats will come down with while in the shelter environment. URIs don’t kill very many animals, but they do keep animals from being adopted out of shelters while sick, and they of course add expense to managing animals. I recommended just keeping a close eye on this kitten, and Dr. Senior Resident agreed.

As the afternoon got hotter, Dr. Intern-mate and I headed over to the dog kennels to do some physical exams and give some rabies vaccinations. One dog was recovering from kennel cough, so we had to don Personal Protective Equipment (PPE) to go in to his run. This entailed putting on booties, a gown, and gloves over our scrubs. The dog runs were not air conditioned. On an already miserably hot day, it was almost unbearable: welcome to the South. Hopefully I will toughen up as this summer goes on.

Finally, Dr. Intern-mate and I headed over the the kitten house. Kitten house! It is an entire little house, a few blocks from the main shelter, entirely dedicated to housing kittens. It is staffed by volunteers, and the main room has rocking chairs for them to sit in with kittens on their chests. The cuteness was unbearable. Dr. Intern-mate and I were sent in to the Upper Respiratory Infection room (again in PPE, but this time there was A/C) to weigh, feed, and medicate about 40 kittens. They were in a rack of cages against the wall, and as they were mostly feeling pretty good with their medications (yay) they were all bouncing off the walls of their cages. It was hilarious. The next hour or two were populated by the sounds of kitten bodies hitting all possible sides of the cage (including the top), and Dr. Intern-mate saying things like “oh no, you mustn’t bite me in the face” and “it’s not nice to beat up on your sister like that.” My favorite moment was possibly when one kitten escaped from her and got under the rack of cages. I closed the door to the room while she fished him out. As she went to put him back, we realized from the records that he had come out of the wrong cage (which cleared up some confusion as to why there had been only two kittens in the previous cage, when the records suggested there should be three). So far as we could tell he had been in the wrong cage for several days. With the level of chaos in the room, we could easily see how it had happened. We had a good-natured argument about which cage to leave him in. I won with the argument that his original cagemates were on medications which he was supposed to be getting as well.

Finally the day was over. I was exhausted, hot, and hungry; we had been working for eleven hours. We piled back into the car and set off on the hour and a half drive for home. Twenty minutes in, Dr. Intern-mate realized her wedding ring was not in her scrub top any more. It must have fallen out. Yes, we turned around, and it was right were she suspected it would be, but at this point I was not sure I would survive the trek home without food. I pulled the hero of the story out of my pocket, and it told me that an excellent “fit for foodies” restaurant was very near by. We went, and ate the best fried zucchini you can imagine, along with a very good noodle dish which I could barely stuff in after the amazing appetizer. We finally got back on the road, missed a turn, drove for quite a while in the middle of very dark nowhere under a lovely harvest moon, hanging on every word of the smartphone as it guided us back to civilization.

I got home sixteen hours after I had left. I think this day was a sign of good things to come in the internship. I’ll let you know how it goes.

Monday, June 25, 2012

Where I'm coming from

In his keynote address to the second UK Conference of Science Journalists, Jay Rosen wrote, “I think every writer, every journalist, every scholar, should tell you where he’s coming from before he tells you what he knows.” And proceeded to do so.

Culturally, I’m a New Englander. I grew up all over the country, but felt the most at home in New England and moved back there as soon as I was an adult. Of course, I am currently an expat living in the South. Demographically, I am the child of baby boomers. Socially, I can’t say it any better than Jay did: I’m an introvert who has learned to fake conviviality. Politically, I am a social liberal and a fiscal conservative, sometimes libertarianish. Musically, I am a child of the 80s. Intellectually, I am a learner and a doer. I really like learning for learning’s sake, but I am obsessed with starting new projects to change the world (and not always finishing them).

To Jay’s list, I’ll add this: professionally, I am a veterinarian; however, I suspect that after my internship I won’t be a practicing one, but one who teaches and researches and makes herself a pest about public policy. I believe we should treat our pets with as much respect as we treat each other; that our food animals should have room to walk around, and that we should be aware of where our food comes from and make thoughtful choices; and that there is a lot more going on in the brains of animals than a lot of people think, but less than some other people think.

So, other bloggers out there: what about you?

Sunday, June 24, 2012

Generation Anthropocene: a review

The Generation Anthropocene podcasts, interviews of Stanford faculty by Stanford students, were published back in May. I didn’t get around to listening to them right away; I was busy finishing up veterinary school. I did listen to the compilation overview, which includes snippets of interviews from all 14 podcasts, in May, which incited me to download the whole lot onto a thumbdrive. During the 21 hour drive from Massachusetts to Florida, I stuck the drive in my car stereo and listened to it. I loved the podcast so much that when I got to Florida, I handed the thumbdrive to my husband and told him to listen to it. Of course, he has not gotten around to it, so this morning I played him the first part of the overview to get him psyched.

Listening to the overview again after listening to all the interviews has been an interesting experience. The compilation podcast originally left me feeling that humans are affecting the planet in even more ways than I had realized before, and that we are plunging towards a crisis which it may already be too late to avert. I’ve heard that before and, as with so many listeners before me, sometimes avoid the details of our imminent destruction. But there were snippets in the compilation that I really wanted to know more about, mostly from people interested in sustainable agriculture. And exploring the variety of answers to the question asked in every interview — “When do you think the Anthropocene began?” — intruiged me.

The first thing I noticed when listening to the individual interviews was the genders of the interviewers and the interviewees. The compilation mixes the interview snippets together, removes all comments from interviewers so that it appears to just be free association from a bunch of Stanford professors, and draws heavily on particular interviewees, one woman in particular. When I listened to the actual interviews, I was struck by the fact that 12 out of 14 of the interviewers (the students) were young women, while 12 out of 14 of the interviewees (the faculty) were men. The gender bias hadn’t been at all apparent in the compilation, but it was an interesting one, since one of the themes of the podcast is how the next generation will live in a world that differs so much from today’s. The next generation, apparently, will differ too: many more faculty will be women. Or, as my husband suggested, perhaps faculty gender ratios will not change, and the two male students are the only ones on track to get PhDs. (In fact, if I recall correctly, the only graduate student on the podcast was one of the men.)

The second thing I noticed was how almost universally optimistic these experts in their fields were about their future. There were exceptions, but for the most part I did not come away from the interviews feeling alarmed about our future. I felt energized: there’s lots to do! And we have lots of tools and lots of smart people with which to do it! Let’s get going! Before listening to the podcast, I felt that humans needed to back off and leave the world alone a little more. My appreciation for the value of thoughtful stewardship has increased enormously.

So when do I think the Anthropocene began? I would have answered differently before listening to these interviews, but now I will confidently say that I think it began when humans ventured out of Africa and began affecting environments which were not prepared for them. Long before the Industrial Revolution (a favorite starting point of the Anthropocene for many), we were already causing mass extinctions with new hunting methods. And we were creating new species using domestication. We’ve been changing the face of the world for a very long time.

I loved listening to these interviews. I would love to see more like this: more interviews between students and faculty at other schools, on other topics. Want to communicate science to the world, but don’t have the time to start a blog? Get interviewed by a student and let them publicize what you have to say. There’s lots to talk about, so let’s get going.

Thursday, June 21, 2012

Organic standards and animal welfare

Over on Animal Science Review, Austin J. Bouck just posted his paper, Do organic animal operations encourage management decisions that negatively impact animal welfare? Personally, I do tend to buy organic dairy products when I can in hopes that I’m contributing to improved animal welfare, even though deep in my heart I suspect I’m doing no such thing. In veterinary school, classmates told me they avoided buying organic because of things they had seen on organic farms. I’ve argued before that the best way to ensure the welfare of the animals whose products you consume is to make your purchases at a local farmer’s market, but of course not everyone has access to those. So this question of whether organic is good for animal welfare or not is a pressing one.

Austin starts out with a discussion of terminology. The word “organic” has a legal meaning, but many producers also use terms like “natural” and “free-range,” which don’t. What do these terms mean to producers and what do they mean to consumers? I have heard veterinarians dismiss these terms as meaningless, but Austin describes a tendency among organic producers to view their ecocentric model of farm management as a way of managing their animals “naturally.” In an ecocentric model, overall sustainability of the farm and interactions with the environment take priority over individual health.

If that’s the case, what are the consequences to individual health of prioritizing the environment over the individual? Austin uses as his examples dairy cows, focusing on the use of antibiotics to treat infected udders, and chickens, focusing on the use of medication for parasite infection. In both cases, he describes the strong incentives for organic farmers to withhold treatment for disease, as once an animal has been treated with an antibiotic or antiparasitic, its products (milk, meat, or eggs) can no longer be considered organic. Austin explores alternative treatments and concludes that none are effective. He notes that in Europe, use of antibiotics and antiparasitics to treat clinical disease is legal in organic production; only preventive use is banned. He advocates a change in U.S. regulations to imitate the European model, on the reasonable theory that if incentive to withhold treatment is removed, then more sick animals will be treated.

I agree! I would have been very interested to hear some statistics about how many animals go untreated on organic farms, or how far illness on these farms might be allowed to progress before animals are treated, compared farms using conventional methods. Austin doesn’t say, and I think this is because no one really knows. It would be an interesting line of research, and possibly a necessary one if we want to get the American public fired up to support change in the current regulations. If a video of a sick cow being moved by a forklift was invigorating to the animal welfare community, maybe some videos of untreated sick animals on organic farms would be as well.

Check out the paper. It’s an interesting read.

Sunday, June 17, 2012

Mobile veterinary practice and federal drug restrictions

Mostly, when I took my cats to the vet, I would cram them into a carrier while they protested and drive them to a clinic. It was a rough trip for them, so rough that at one point I called a travelling vet to come see them at home. What a difference: they were more confident in their own territory, and got to deal with the stressful physical exam without having first been stressed by a car ride and a wait in a room full of dogs. More and more small animal mobile practices are cropping up these days. Of course, a significant percentage of large animal practices have always been mobile. It is prohibitively expensive to transport cows to a clinic, hugely stressful for the animal, and may be impossible if the cow is too sick to walk. Most horses are also treated on site rather than at a clinic, except for referral cases which are seeing specialists.

So in my mind, mobile practice is good for small animals and essential for large ones. Unfortunately, the Controlled Substances Act, passed by Congress in 1970, limits where controlled substances can be carried. The act apparently has not been applied to mobile veterinary practices until recently, but the Drug Enforcement Agency (DEA) appears to be changing its practice this year, as mobile veterinarians in California report that they have received notices that their activities are illegal.

Mobile veterinarians, both small and large animal, routinely carry controlled substances for pain relief and euthanasia. Non-controlled alternatives do exist, but are much less effective. For example, one cow vet reported that to remove a cow’s eye, he was no longer able to use sedation or powerful systemic pain relief in the form of an opioid, but would have to rely on local anesthesia (lidocaine), which he felt was insufficient to manage the animal’s discomfort during the procedure. Another cow vet reported that he was falling back to using a .22 Magnum for euthanasia.

The regulations do allow for veterinarians to carry the amount of medication that they expect to need during the current day for a planned procedure. This does not allow for unplanned procedures (the animal who unexpectedly requires euthanasia) or unexpected increases in dosage (the animal whose pain is clearly not controlled by the expected amount of medication, or, worse, who requires more than the expected amount of euthanasia solution). Veterinarians also cannot predict how much sedation and pain relieving medications to bring for a day in a mobile spay neuter clinic, to which animals may arrive without appointments.

The DEA contends that only Congress has the power to change the wording of the Controlled Substances Act. Obviously, we can ’t expect such change to happen any time soon. In the meantime, we can wait and see how the DEA proceeds.

Journal of the American Veterinary Medical Association
June 15, 2012, Vol. 240, No. 12, Pages 1384-1407
doi: 10.2460/javma.240.12.1384

Saturday, May 26, 2012

Perceptions of snoring pugs

Researchers at a veterinary hospital were studying the prevalence of particular diseases in different breeds of dogs, and owner recognition of the diseases. They asked the owners of 285 dogs about a particular respiratory disease. 31 dogs met the criteria for the disease, and 19 had difficulty breathing according to the owners’ answers, but only 18 (of 31) owners believed that their dogs had respiratory disease. So far, so good — veterinarians need to educate better about this disease (and I’m here today to help with that). But the really interesting part is this: of the 17 dogs that had been referred to the hospital for suspicion of this exact disease, 7 owners (41%) stated that their dogs did not have respiratory disease — the disease that they were seeing a specialist for that day.

What is the disease? Brachycephalic obstructive airway syndrome (BOAS). This is a common disease among the flat-faced dog breeds, especially pugs, bulldogs, and Pekinese. These dogs have been bred to have flatter, more human-like faces, but as their muzzles have shortened, the soft tissue in the back of their mouths has not. They are left with excess tissue in the back of their throats which significantly blocks airflow (elongated soft palate). They also often have tiny nostrils (stenotic nares). These two physiologic handicaps together cause so much resistance in the path of the air moving from nose to lung that eventually the inside of their throat can become further deformed, increasing the resistance to airflow (everted laryngeal saccules).

Points used to measure the length of a dog’s skull (A,B) and muzzle (B,C). Compare the labrador retriever’s B,C length (top) with the pug’s (bottom).

So yes, this makes it hard to breathe, and if you want to see for yourself, try this experiment: squeeze your nostrils shut so that only about 1/4 of the normal space is left. Keep your mouth closed. Now exercise. And imagine breathing that way for your entire life.

I think it is probably a lot like when you are very congested and trying to sleep: you can’t sleep with your mouth open, but when you close it you can’t get enough oxygen. A lot of these dogs constantly pant in order to get enough air. 100% of them snore at night, and 32% snore while awake, compared to 21% of normal dogs who snore at night. The noises pugs make are certainly unusual — when I walk in to a veterinary clinic I know if a pug is in the room before I see it. A lot of people find these noises cute. What these researchers found surprising was how many people found the noises normal.

Normal for the breed, that is; the owners who stated that their dogs did not have respiratory disease wrote things like “No, but he is a pug!” Breed-specific problems have come to be considered not problems simply because they are expected. I have had veterinarians tell me that they recommend dogs for corrective surgery for BOAS simply based on the breed. When I asked one surgeon what criteria she had used to recommend surgery for our six month old patient, she replied, “He’s a bulldog.” (Those owners agreed to the surgery, but initially hesitated because they were concerned that widening their dog’s nostrils would change his appearance.)

Where to place the blame? I feel that veterinarians are doing very little to make this problem clear to owners (as much as we will shake our heads in despair in the back room when the owner is not around). One of my daily tasks in veterinary school was to write up an assessment of the health status of my patients. If I had a flat-faced patient with loud breathing, I would certainly note that in my list of physical characteristics. But I did not include it in my list of problems which needed to be addressed. The dog was invariably in the hospital for some other problem, and I knew that I’d be considered obnoxious, if not a troublemaker, if I called out this other problem which everyone was aware of and no one was trying to address.

I’ll do better in the future, and I hope that other veterinarians will start talking more to their clients about the reality of the problems these dogs face. It is upsetting that a veterinarian can refer an owner to a specialist for dealing with BOAS without making clear to the owner that the dog has a disease. Just because the dog has always had the problem, and just because the problem was intentionally selected for, does not mean it is not a disease. Dog owners need to start pushing back on breeders and buying only puppies who breathe quietly (awake and asleep!). Breeders need to start selecting for somewhat longer muzzles, long enough that dogs can breathe properly.

And the dogs who are already out there with breathing problems? If your flat-faced dog makes loud noises when he breathes, particularly when he is awake, he probably isn’t breathing comfortably. If your primary care veterinarian doesn’t think your dog has a problem, get a second opinion from a veterinary surgeon (someone who preferably has a title ending in “DACVS” to indicate that they are a surgical specialist). Dogs who can’t breathe comfortably don’t have a good quality of life. It seems obvious, but sometimes we need to say it.

Packer, R. (2012). Do dog owners perceive the clinical signs related to conformational inherited disorders as 'normal' for the breed? A potential constraint to improving canine welfare, Animal Welfare, 21 (1s) DOI: 10.7120/096272812X13345905673809

Thursday, May 24, 2012

Antimicrobial oversight in veterinary news

Antibiotic resistance is growing, and we’ve all heard that doctors should prescribe fewer antibiotics. But the bulk of antibiotic use in the United States is in food animals. Producers feed antibiotics not only to sick animals, but to promote growth. This is a potential issue for human health, but the solution isn’t immediately clear. Which antibiotics specifically should be limited? Where exactly should we draw the line between use to prevent disease and use to promote growth?

A news article in the June 1 issue of the Journal of the American Veterinary Medical Association (JAVMA), “Proposal calls for changes in antimicrobial use,” (not open access) describes guidance documents published by the Food and Drug Administration about the use of antibiotics in food animals. The FDA’s plan for managing antibiotic use in livestock involves:
  • voluntary compliance by producers and pharmaceutical companies
  • cessation of use of antibiotics for growth
  • “judicious” use of antibiotics for prevention and treatment of disease
  • involvement of veterinarians in the decisions to use or not use antibtiotics in particular cases
Voluntary compliance, of course, means that new regulation is not currently intended. Producers and pharmaceutical companies could choose to ignore these guidelines. The guidelines recommend that antibiotics no longer be fed for any reason except “for uses necessary for animal health.” The JAVMA article gives specific examples of some borderline cases. For example, antibiotics might be appropriate prophylactically in the case of stressed cattle which are therefore more susceptible to particular diseases. Additionally, the guidelines suggest that pharmaceutical companies should refrain from selling certain antibiotics directly to producers, requiring that a veterinarian provide a prescription first.

What’s good here is veterinary involvement, though I’m biased in that area. Veterinarians are the group who best understand the implications of the use of particular antibiotics, both from the perspective of benefits to human health when antibiotic use is reduced, as well as benefits to animal health and producer finances when it is increased. Veterinarians will be able to make decisions more flexibly about how and when to use antimicrobials in the absence of regulations. As our understanding of appropriate use changes, changes in practice will not be delayed by the syrup-slow process of changing regulations.

What’s disappointing, but not surprising, is the failure of the JAVMA article to discuss a reduction in the need for antibiotic use in food animals to reduce disease. Conventional food animal husbandry, in my opinion, can be highly stressful for animals, with crowded housing and long-distance transportation. Antibiotics are useful to keep these highly stressed animals from succumbing to disease, but shouldn’t we also be talking about reducing their stress to reduce their susceptibility in the first place?

What’s worrisome about the proposed guidelines, of course, is obvious: will producers and pharmaceutical companies voluntarily comply? The FDA proposes a three year window to see if they do. After that, it seems likely that they will pursue a regulatory solution. I very much hope that the voluntary solution works. As I said above, I believe it’s a more agile solution, able to adapt more flexibly to changes in our understanding of antibiotic use in food animals. However, I hope the FDA is not overly optimistic about human nature by making the guidelines entirely voluntary.

June 1, 2012, Vol. 240, No. 11, Pages 1266-1277
doi: 10.2460/javma.240.11.1266

Tuesday, May 22, 2012

The Dog Zombie, DVM, MS!

Yes, that is a Pet Doctor Barbie graduation cake. I graduated! You may now call me Dr. Dog Zombie.

Next: shelter medicine internship in Florida!

Sunday, May 6, 2012

The science and policy of contraception... in cats

[Reposted from the Scientific American Guest Blog on May 4th, 2012.]

Sometimes when I come home from work there is a big orange cat sunning himself on my front porch. He ambles away as soon as he sees me – not a panicked dash, because he’s used to humans, but there is certainly no way I’d ever get close enough to pet him. No one owns this cat, although my next door neighbors sometimes feed him, and he clearly lives in the neighborhood; he and my dogs know each other well from high-volume interactions across the fence. He is a feral cat, sometimes known as a community cat. He probably lives in a small colony, and indeed there are several other individuals that I have seen around, although this is the only one who likes to sleep on my front step.

This orange cat seems to have a pretty good life, which is often true for cats living in colonies that are managed. This colony, as I’ve said, is at least getting fed regularly. However, his life is liable to be shorter than that of an owned cat, and in fact I have already taken two badly-injured community cats the local veterinary hospital for euthanasia. (As the neighborhood veterinary student I find that one of my responsibilities is dealing with cats who have been hit by cars or attacked by other animals.) He is also at risk of disease, such as feline leukemia or feline AIDS, because he has probably never been vaccinated. He is not the only one at risk; his colony may maintain a reservoir of these feline diseases which can then be transmitted into the population of owned cats who are allowed outside to interact with their feral cousins. Moreover, community cats are often sexually intact and certainly contribute to the overwhelming number of kittens that my community sees every spring and summer. And, of course, bird lovers complain of the depredations of community cats on the local wildlife.

Time was, people trapped community cats and euthanized them as a means of population control. This didn’t work as well as you might think, because when a colony of cats was depleted, new cats would move in to take their place. It turns out that maintaining a healthy colony keeps new cats out. In the last decade or so, volunteers and animal shelters have been implementing trap/neuter/return (TNR) programs. Cats are trapped and brought to veterinary clinics, where they are vaccinated and spayed or neutered. They are returned to their colonies, which are managed by caretakers. In this way, colonies are kept small but healthy.

However, TNR programs are maintained at great expense. Veterinary surgeons are not cheap, and even with volunteer veterinarians, a surgical suite also has to be acquired. Cats have to be trapped on a specific day when a TNR clinic is scheduled, not an easy task itself, transported to the clinic and then transported back. The expense slows down the process, and it’s not clear that we can spay and neuter fast enough to keep up with the population.

A simple medical intervention would be much more efficient than surgery. The ideal chemical contraceptive would be inexpensive to make and easy to administer; a single treatment would have a long term or even permanent effect; it would have a wide margin of safety for both cats and the environment (you wouldn’t want a dead cat to be full of some toxin that would endanger other animals); and it would have a rapid onset of action. Ideally, it would not just prevent litters, but would also reduce the nuisance behaviors associated with breeding, because cats having sex are extremely noisy. The contraceptive should be widely effective, although studies suggest that it only needs to affect 70-80% of female cats in order to achieve population reduction.

There are some possibilities already being studied. Both are vaccines – it’s an amusing idea to vaccinate against pregnancy, but of course vaccines do have a long term effect, so they're logical choices for this situation. One vaccination target is the zona pellucida. This is the coating around the egg which allows in one, and only one, sperm; vaccinated animals produce antibodies which attack the ZP and therefore inactivate the egg. The nice thing about ZP vaccination is that is is highly species-specific – the ZP is, in fact, part of the mechanism that keeps species from being able to interbreed with each other. Unfortunately, the ZP vaccine which is currently available was not developed specifically against cat ZP, and does not work well in cats. A cat-specific ZP has also been tested but, surprisingly, is not highly effective either. Perhaps more research will sort the problem out, but for now this is not a viable alternative. Additionally, as you might guess from the mechanism, ZP vaccination doesn’t affect mating behaviors even when it works; it only affects conception. So cats will still yowl during sex after ZP vaccination.

A more promising alternative is vaccination against GnRH, the master hormone of the sex hormones. Through minion hormones, GnRH controls production of sperm and ovulation of eggs. Unlike the ZP vaccine, the GnRH vaccine reduces both pregnancy and mating behaviors. Its effectiveness is somewhat unpredictable, so some vaccinated animals keep right on getting pregnant. Its length of effectiveness is also somewhat variable, but can last up to several years in some studies. Although your housecat might live into its late teens, several years of birth control are probably sufficient in shorter-lived community cats.

A commerical GnRH vaccine, GonaCon, is approved in cervids and has been successfully used in white-tailed deer. It has been tested in cats in laboratory settings, but not in the field. The idea is enticing: volunteers could trap cats, then vaccinate them with GonaCon and the usual array of anti-disease vaccines right in the trap, then release them, never having had to bring them in to a veterinary clinic. Efficiency would be hugely increased. Hopefully initial trials would show that GonaCon is effective at population reduction in cats, something that hasn’t yet been proven.

Real life is never so simple, of course. I talked about contraceptive vaccination with a few vet techs at an animal shelter recently. They loved the idea, but pointed out that in our state, once you are providing any medical care for a cat, such as contraception, you have to make sure they are vaccinated for rabies, which legally requires the presence of a veterinarian. Once you have to bring in a vet, of course, the expense starts going up again. We batted around some ideas – maybe you could distribute an oral form of a vaccine in bait form, and get around the rabies vaccination requirement by dint of never actually touching the cat. In this case, the ZP vaccine might be better, as it is more species-specific and presumably could be eaten by other species without effect, but of course the ZP vaccine requires more work before it will be effective in cats.

So chemical contraceptives for community cats aren’t quite ready for prime time, but there are some promising candidates. My suspicion is that the biggest problem is simply willingness on the part of society to commit the resources necessary to develop a workable solution. Cat rescuers and animal shelters, both with notorious money problems, can’t possibly represent attractive markets to drug companies. Who will fund the necessary research and the advocacy for policy changes that are necessary? You can stay up to date with news as the story unfolds at the Alliance for Contraception in Cats and Dogs. You can even donate to them. Community cats may be our responsibility, as domesticated animals gone feral, or they may not be, but either way they affect us and the animals we live with. Efficient and humane management of their populations benefits both them and us.


Sunday, April 22, 2012

Book Review: Plenty in Life is Free

I just finished Plenty in Life is Free: reflections on dogs, training and finding grace, by Kathy Sdao. It was revelatory. It is funny to say that I had trouble putting down a dog training book, but I did (I put off email and sleep to finish it). It’s a short book, but truly lovely. The two Sdao seminars I’ve attended have both stuck with me years later and informed my training, and Sdao is as engaging and thoughtful an author as she is a speaker.

This book seems to be written for an audience of dog trainers, but it has plenty in it to appeal to the dog owner as well. Don’t expect it to walk you through how to train your dog to sit, or to provide details on how to handle a new puppy or to turn around dog-dog aggression. It’s really a philosophy book about how to approach dog training: we don’t have to control our dog’s every move and obsess about leadership. We can be our dog’s parents, protecting and guiding but leaving them a reasonable amount of independence too.

Sdao discusses the concept of “sticky stories,” stories that stick in people’s minds, such as the story that dogs evolved from wolves and therefore a good dog owner acts like the alpha wolf. She provides an alternate version of a story that is more accurate and hopefully just as sticky: dogs evolved from scavengers and we should be their parents, doling out resources as good parents do. I like her proactive approach; let’s hope that the new, improved sticky story takes root.

Sdao also constructs a sticky meme in the same vein as Michael Pollan’s famous advice about how to eat (“Eat food, not too much, mostly plants”). Hers goes “Reinforce behaviors you like; remove reinforcement for behaviors you don’t like.” She correctly identifies that, while pithy, this is probably not catchy enough to be sticky, and goes on to describe a SMART (see, mark, and reward training) system, in which you train your dog by doing little more than rewarding the dog 50 times a day for doing cute or useful things. (I may be oversimplifying, but not by much; the point is that it’s simple.)

It’s a short, fun, useful read. I cannot recommend this book highly enough. Available at Dogwise.