Thursday, March 21, 2013

Spaying big things, spaying small things

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

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

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

Saturday, March 2, 2013

Community-based veterinary public health

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

When it was first born as a profession, human public health was about infectious disease: preventing cholera by cleaning up the water supply, preventing tuberculosis by vaccination. But in recent decades, public health has come to be more and more about lifestyle changes: improving nutritional choices, encouraging increased exercise. I’m obsessed with animal welfare and behavior, so I love the idea of a veterinary public health specialty focused on improving what we might call “lifestyle problems” in animals. Here’s my list of what some companion animal lifestyle problems might be:
  • Obesity
  • Behavior problems, such as separation anxiety or aggression
  • Dogs on chains in yards
  • Dog fighting rings
  • High rates of surrender of animals to the local shelter
  • Low rates of adoption from the local shelter
  • Lack of veterinary care, either because community members cannot afford it, or because it is simply not available
Basically, I figured, veterinarians would work to improve animal husbandry (the way animals are kept and fed). Education of animal owners and handlers! Projects focused on making it easier for owners to get regular veterinary care, take their dogs for more walks, or stop chaining their animals in yards! Let’s go!

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

I asked myself what questions a public health veterinarian might ask about a particular community. Smaller communities are probably more manageable than large communities, but in theory a community could range from a neighborhood to a city to a country. Of course, remember that I am not a public health specialist — I don't have a Masters in public health and I don’t work in public health — so please take my ideas with a grain of salt. But here goes.
  1. What are the most significant problems of animals in the chosen community?
  2. Why are these problems happening? What does the community need to do in order to solve the problems, and does it have the resources it needs in order to make those changes?
  3. How can we work with the community, providing it support in bringing about change? How can we provide the community a path to self-sustaining change, rather than coming in from the outside and mandating change?
One such outreach project, arguably, is HSUS’s Pets for Life. This program focuses on working with community members, building trust by bringing food and pet supplies into under-served communities, and progressing to providing vaccination, spay/neuter, and training services. It is an inspiring program, but I have found no peer reviewed publications about it. This is the sort of thing I'd like to see a case study on in a veterinary journal. Rather than reading a glowing report about a program written by the creators of the program, I want to read an objective discussion of it by an outsider who also happens to be an expert in the area. It would be nice to be wrong about this (except for that naturally it would be a little embarrassing), but I have been unable to find any such publications in veterinary journals.

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