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.
Sunday, July 15, 2012
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?)
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.
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?
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.
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.
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.
JAVMA News
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.
JAVMA News
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).
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
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
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