Sunday, February 26, 2012

Do dogs have rhythm?

My friend Kevin just pointed me at this YouTube video, which shows a dog grooving to some guitar music.

The dog is definitely appreciating the music (and Kevin was particularly interested in the fact that he smiles while the music is playing). I, on the other hand, am curious about the fact that the dog seems to actually be moving his head in time to the music. This could just be coincidence, and the human tendency to anthropomorphize. Or the dog could be reacting to motions of the guarist off-screen. Or it could be real.

I have never seen a dog demonstrate an understanding of musical rhythm before (though I saw a parrot do so on another YouTube video). Of course dogs will howl along, but feeling the beat is something different. I can’t remember ever seeing a journal article about the rhythmic abilities of canids!

Saturday, February 25, 2012

Should veterinarians recommend pet heath insurance?

Over the last few days I have been privy to what I’ll describe as a “lively discussion” on a veterinary ethics mailing list. One vet on this list commented that she felt that more veterinarians should encourage pet owners to carry pet health insurance policies. She was frustrated by the number of animals she sees euthanized for financial reasons. Other veterinarians responded that health insurance policies are a waste of money: owners are likely to pay out much more over the course of the animal’s life than they will regain in payouts. After all, the insurance company has to make money.

There are several ways of looking at this issue. One is to argue that the question is not whether a pet health insurance policy saves an owner money, but whether it saves the animal’s life. Does it matter if the owner spends $2000 over ten years, so long as the necessary $1500 is available when the dog is hit by a car? Who is the veterinarian advocating for — the owner or the pet?

Of course, even if a pet insurance policy costs more than it returns, it may still have a benefit. Many people have trouble saving money for “just in case” scenarios, and a policy makes sure the money is available when it’s needed. And of course, even if you’re an excellent saver, your pet may have an unexpected health crisis before you’ve had time to save enough to cover it.

I feel that the real problem, though, is that so many people just don’t realize how much veterinary care can cost, particularly because their own health insurance shields them from the true cost of human medical care. Veterinarians can be hesitant to broach these issues with new owners; after all, discussing finances is always awkward, particularly when you tell someone that you might end up charging them a great deal of money some day. But I think veterinarians do owners a disservice to withhold this information. Far too many owners are deeply shocked by the cost of care when their animal has a broken leg, and are completely unprepared to find the money. I don’t know how many of them would have saved some money just in case if they had known, but they should at least have been given the chance.

As I said on the mailing list, I imagine a poster in a veterinary clinic:

Pet insurance: $20/month
One broken leg repair: $3000

Stomach bloat/twist surgery: $4000
Serious "hit by car" patient: $5000
Knowing you will always be able to afford your pet's emergency
medical care: priceless

The more I think about it, the more I realize how very little information is out there about the effectiveness of pet health insurance in saving animal lives. I propose a study. In two veterinary clinics, record the number of euthanasia decisions influenced by financial reasons for several months. (This would be difficult to do, but I think possible, if one could get owner cooperation.) Also record the number of insurance claims submitted through each clinic. (These claims usually require a veterinarian’s signature, so should be easy to track.) Then provide information, using handouts or posters, about pet health insurance in one of the clinics. Record the same data for several more months, and look for changes.

But even without evidence that providing information about costs and payment options is effective, I think it is part of a veterinarian’s job to educate owners about the responsibilities of pet ownership. Finding ways to afford health care is part of that. Provide owners with the information about costs, and let them make their own decisions about how to prepare for the worst.

Tuesday, February 21, 2012

Spaying dogs and cats: how much should I take out?

Spaying of dogs and cats is such a common and important procedure that it is the only surgery you are guaranteed to get to do all by yourself (twice!) at my veterinary school. Traditionally, vets have taken out the whole package (the uterus and both ovaries). Leave the ovaries in, and the animal still goes into heat, even if she can’t get pregnant, and you are liable to have an irritated owner on your hands. But is there a good reason to take the uterus out, or can you leave it in? More and more veterinarians are starting to think that less is more. The commentary “Ovariohysterectomy versus ovariectomy for elective sterilization of female dogs and cats: is removal of the uterus necessary?” provides an overview of the current arguments for and against ovariectomy (removing only the ovaries, abbreviated OVE) versus the more traditional ovariohysterectomy (removing the uterus and the ovaries, abbreviated OVH).

The reasons to leave the uterus in are pretty obvious. You can make a smaller incision if you are only taking out the ovaries, and smaller incisions are obviously preferable where possible. While you’re at it, you can center your incision over the ovaries instead of having to center it further towards the animal’s tail so as to get the uterus as well. The ovaries can be difficult to fully visualize, as they can be tucked deep into the abdomen; placing the incision further towards the animal’s head makes it easier to see what you’re doing, so you can be sure to get the whole thing and not leave little bits of ovary behind. If you leave little bits behind, the animal can still go through heat cycles. This happens more often than you might think.

Finally, removing fewer organs leaves fewer chances for the surgeon to make a mistake. Mistakes do happen, especially with less experienced surgeons. Specifically, a surgeon could ligate (tie a suture around) something that should not be ligated, like a ureter. (Tie a suture around a ureter and the animal is going to have significant problems with one kidney, to say the least.) Alternatively, a surgeon could fail to sufficiently ligate something that needed that ligation to stop bleeding, resulting in hemorrhage into the abdomen. These complications would theoretically be somewhat less common with OVE than with OVH, because, with fewer organs to tie off before removal in OVE, fewer ligations are required.

Unfortunately, research has not yet been done to assess the frequency of such complications with OVE, so the benefit is just theoretical. Moreover, we have no evidence that the smaller incision in OVE makes any difference to the animal’s pain levels. Post-spay animals do not appear to require less pain medication after OVE compared to OVH.

Another consideration in choosing OVH over OVE is pyometra, a disease most commonly found in unspayed animals. As an animal ages, its uterus becomes less able to fight off bacterial invaders, and infection of the uterus can be a big (life-threatening) deal. To avoid the problem, remove the uterus.

However, although the causes of pyometra are not fully understood, we do know that it doesn’t happen unless progesterone levels are elevated, as happens during the estrous cycle. And animals without ovaries don’t get elevated progesterone levels unless we give them progesterone, something we don’t generally do to dogs and cats. This means that animals who have only their ovaries removed won’t get pyometra, even though the uterus (the infected organ in this disease) is left behind, because they won’t be going through heat cycles which result in elevated progesterone levels.

In practice, veterinarians do sometimes see animals who had only their ovaries removed get pyometra — but only if little bits of ovary were mistakenly left behind (ovarian remnant syndrome). So if you remove the ovaries properly, the animal will not be at risk for pyometra. And, as discussed earlier, it’s theoretically easier to remove the ovaries properly if you center your incision over them and leave the uterus in place.

The authors conclude by arguing that OVE is the preferable procedure, due to the theoretically reduced complication rate. Personally, I really like the less is more approach to surgery; if you can leave it in, I think you should. But I do wish we had some more solid evidence in support of OVE. Time for some clinical studies comparing the two procedures!

DeTora, M., & McCarthy, R. (2011). Ovariohysterectomy versus ovariectomy for elective sterilization of female dogs and cats: is removal of the uterus necessary? Journal of the American Veterinary Medical Association, 239 (11), 1409-1412 DOI: 10.2460/javma.239.11.1409

Thursday, February 16, 2012

Future of the Zombieverse

I matched at an academic shelter medicine internship in Florida! But I bet you don’t completely know what that means.

Internship: Like human doctors, many veterinarians do internships their first year out of school (I am graduating in May). Unlike human doctors, veterinarians are legally able to go straight into practice without passing through an internship first. Veterinarians who do this tend to try to find practices which are prepared to mentor them for a year or two. Internships provide loads of good clinicial experience, and are offered by hospitals or larger private practices with a high case load and access to specialists and expensive toys like advanced imaging modalities. This gives the intern a chance to see a variety of diseases and to work with a variety of specialists, to be very prepared to practice on their own if need be. Similarly to human medicine internships, veterinary internships are very poorly paid.

Match: As in human medicine, veterinarians don’t apply to internships as to a regular job. You apply through a match program. After you have filled out your applications, you rank the internships to which you’ve applied in your order of interest. They do the same for their applicants. Then a third party matches you with the internship you most want, which also most wants you (in theory).

Academic: Internships are offered by either veterinary schools or by private practices. The internships at veterinary schools are “academic” internships and do tend to be more academically oriented, with more emphasis on things like journal clubs, publishing, etc.

Shelter medicine: Traditionally, veterinary internships allowed the intern to specialize in small animals vs large animals, but nothing more specific than that. These rotating internships allow the intern to rotate through various sub-specialties (cardiology, neurology, ophthalmology...) with plenty of time spent as the primary clinician in the emergency room for a more general view of medicine. Recently, however, specialty internships have sprung up. Most of these are intended for veterinarians who have finished a rotating internship and want a year of specialization to make them more competitive for their residency application; competitive specialties like surgery and radiology were some of the first to have specialty internships. Shelter medicine internships started appearing a few years ago, with two new ones being offered for the first time this year, for a total of five that I know of in the US. It is fairly common for shelter medicine interns to approach their specialty internship less as a bridge between rotating internship and residency, and more as a year’s experience to allow them to go straight into shelter practice. This is what I am doing, except that I expect to continue my education in other ways after my internship. Shelter medicine residency programs do exist and some shelter medicine interns go on to those.

Florida: As an inveterate New Englander I am a little nervous about Florida. But it’s just for one year.

What kinds of things will I be learning about? Community cats (also known as feral cats), animal hoarders, veterinary forensics, managing disease outbreaks, disaster response... I will do my best to cover it all here.