Category Archives: Cat Health

Feline health issues

The internet is not the enemy

Knowledge has never been so readily and easily available. It is instant, mobile and has the power to revolutionise how we operate as vets and work together with clients on their pets’ healthcare.

phone, knowledgeThe problem is NOT that people look on the web; they will continue to do so more and more. The issue will not cease to be and nor should it. The internet is the ultimate learning resource.

What is at fault is that we are generally POOR at knowing HOW to LEARN and critically appraise the quality and reliability of information, especially that found on the internet.

A classic example is that of dog breeding/ puppies. I saw a Pug owner the other night whose female had been ‘accidentally’ mated (there are no accidents in these situations as there is a widely advocated option known as neutering) and so we are now looking at said bitch being due to whelp in the next 2 weeks. The owner in question admitted that they had never had any experience of breeding dogs but had “looked online” and was alarmed to “learn” various things, all of which were quite frankly sensationalist at best and downright incorrect at worst. The advice I gave, in addition to dealing with the immediate issue for which the dog had been presented to me in the middle of the night, was to advise the owner – nay, urge the owner – to visit their nearest well-stocked book store, buy and READ a comprehensive guide to dog breeding, especially the sections pertaining to whelping and puppy care. Books are great in as much as they generally still do undergo some degree of review before publication and so it is less likely that the information contained is plainly wrong, in contrast to much of what can be found online with the universal ability for anyone with a connection, voice and opinion to fire their musings out into the world. Hell, I am one of those same people as demonstrated by virtue of this very blog! How can you be sure that what I write on here isn’t just a load of inaccurate bollocks? You can’t is the truth of it. The same goes for much of what is published online, especially that found on forums/ discussion boards and blogs. Therein lays the challenge and risk associated with relying blindly on “the internet.”

I was fortunate enough to benefit from a rigorous training in the importance of critically appraising information for reliability and so do feel that I am able to mix my information sources (online versus print, etc) relatively safely. Many, unfortunately, do not and in the veterinary profession we still hear “but the breeder said..” or “a website I looked at said this (completely fanciful/ sensational/ wrong) thing…” again and again. Our battle is becoming more and more against the swathe of half-truths and inaccuracies that swirl around in the electronic ether and set against a client base that is becoming generally less trusting and more questioning of what we do, which is not necessarily a bad thing in and of itself.

I love the internet and the educational power that it contains. From TED talks to online courses, blogs from recognised experts and amateur enthusiasts alike, to social networks and their power to engage in real-time conversations and information dissemination, the web is and will continue to be utterly transformative. It is vital, therefore, that in order to get the most value out of this precious resource people know HOW to LEARN, what information to accept and what to question and potentially reject. Part of our role as modern day veterinary professionals is more and more going to be as information curators and sign-posters, directing our clients and the wider animal-owning and caring population toward sources of information that will lead to sound healthcare decisions and outcomes. As old-fashioned as it may sound, books do still serve as a good place to start and this is why I often still direct my clients to their local bookstore.

Nothing is ever as simple as it first seems

Today served up one of those true examples of something not quite being as simple as one might initially have expected, this time in the form of a tricky case of hide and seek. Clinical hide and seek that is.

The afternoon saw a stray cat presented with a history of a swollen paw, with the concern being that it was broken. The fact that the cat was weight bearing and had a discharging wound on the front of the paw did make me doubt whether we were dealing with a fracture or, as I suspected, simply a bad case of infection on account of a cat fight. Anyway, the cat was duly tested for FeLV and FIV, both unfortunately common among the stray cat population, and was thankfully found to be negative for both. Examination of the paw under anaesthetic (it was too painful to examine thoroughly conscious) resulted in pus being expressed – so clearly an abscess was present – but there was something about the level of swelling that didn’t quite fit with a simple cat bite abscess. As such, x-

paw, cat, foreign body
You can see the object between the bones clearly on this view of the paw

rays were taken after all and the cause of the swelling and discharging tract soon identified: a small radio-opaque foreign body present in the paw, sitting, based on the views taken, right in between the metacarpal bones, the equivalent in humans being the bones in the main body of the hand. The object was suspected to be a tooth and was, according to the images, in line with the open puncture wound on the paw.

Consent was received from the owners to take the cat to surgery in order to remove the mystery item; a simple procedure that I would be able to complete within thirty minutes before my afternoon consults. Or so I thought. As is often the case in all walks of life, from professional veterinary practice to business, and life in general, the initial simple imagined scenario – ie, I open the wound a little, find said object quickly and heroically remove it from the paw thus effecting a rapid resolution of the cat’s problems – ended up being anything but. Do you think we could find the mystery object? No. No we could not! For what felt like ages I found myself frustratingly exploring the area, having to extend my initial incisions to open the region up more and all the while wondering why on earth I was not able to locate the offending article. Further radiography, this time making use of needles and the mobile dental x-ray unit in order to more accurately ascertain the precise coordinates of the object, which was very clearly visible on the films, eventually led me to see what ended up being the tiniest of pieces of tooth lodged firmly between the two middle metacarpal bones and virtually imperceptible to the naked eye. With the tip of what was clearly a cat canine tooth finally extracated from our patient’s paw, I was able to finally close the area, dress it and let the owner know the result.

My team of nurses were, as ever, superb and the entire operation ended up being a lot more challenging that any of us had initially imagined it would be. Thankfully the fact that the surgery took longer than anticipated was not a major issue as my colleague was able to handle consults whilst I rooted around delicately but purposefully in search of a biological needle in a fleshy haystack.

The main lessons that I took away from the experience include the fact that apparently simple situations can sometimes become more complicated or time consuming than first imagined and being prepared to cope with and adapt to changing circumstances is vital. Everyone on my team remained calm and acted in a really smooth and professional manner during the entire process and it ended up being a great example of effective teamwork. Remaining calm in a stressful situation is so vital as you need to be able to think clearly and make decisions, actions which are difficult if stress is at high levels. Trusting the evidence gathered is also important as in this case I knew that there had to be something to be found, due to the unequivocal radiographic evidence, meaning that persistence was simpler to adopt than if doubt had been allowed to creep into the scenario.

All in all, a testing afternoon but ultimately a triumph of appropriate clinical process, access to decent, reliable diagnostic equipment, trust in one’s own ‘gut instinct, and the superb dynamics of a great team. A great result all round, with a more comfortable and happy patient as a result.

Emergency!

The past two weeks have seen the launch of our 24-hour service, meaning that the clinic is now open round the clock, with a vet available any time of the day or night, much as we are used to having in the UK.

With two new vets enlisted to take it in turns being on overnight on alternate weeks, backed up by a night nurse and our existing night animal care staff, the service officially kicked off at the start of the month and has so far proven to be popular. There have, inevitably, been some adjustments to the way the rest of us regular day staff operate, such as some new shifts and a few later than expected or usual finishes, but we’re all optimistic that once the initial adjustment period is complete it will actually make our lives less hectic and stressful.

One of the changes has been that naturally we need to do a handover with the night vet going into the day shift, and so one of the vets is assigned to the hospital for the week. This basically means that they come in for an earlier start at 7am, which gives them an hour to effect a detailed handover with the night team, before being in charge of checking, planning, updating and generally doing what is required by the various in-patients. Given that our wards are usually pretty well populated, this can result in quite an intense shift, with the hospital vet then consulting from about half ten until their finish time at 4pm. The early finish clearly makes for a nice end to the day, although that does assume that they get to actually walk out at four, which so far I don’t think has really happened.

The other vets come in as usual for an 8am start and crack on as before with admitting surgeries and seeing consults, or getting on with the various procedures booked in for the day. Trying to get our full compliment of two hours of lunch (sounds like a lot but bear in mind we are in from 8am to 7pm) is still a challenge, although when it happens it really does help to set us up for the afternoon/ evening consulting period, which is usually pretty busy. One change that certainly seems to have occurred is that the couple of hours leading up to 7pm have become a lot busier, with more of what we can refer to as the genuinely ‘sick’ animals booking in. As such the final couple of hours have been, on the whole, very busy. With the consults being booked up to, and even beyond 8pm, it does mean that when 7pm, and hence our scheduled home time, comes round it is usually the case that we either have results pending for a case we have seen in the afternoon, or there are simply more clients waiting to be seen than would be fair to leave the late vet to deal with solo – after all, we’re all nice people and we’re not the kind of individuals who can knowingly walk out leaving both clients and our colleagues delayed and inconvenienced. That has meant several late finishes which, again, I am sure will even out as the new system becomes established and when we get some new vets on the team.

Last night was a particularly intense affair, with both an in-patient requiring a blood transfusion at the end of the day – never a quick process – and a ‘sick, off-colour’ dog coming in which turned out to have some seriously nasty business going on internally and so required surgery that evening, including, again, a blood transfusion. As such we all stayed on until gone 10pm, well into the night shift, although sustenance was provided by a much welcomed, and oh so chocolatey cake, that one of my colleague’s clients had dropped off earlier.

The cases in question, for those of you with an interest in such gory details, were a cat with a severe immune mediated haemolytic anaemia, most likely secondary to tick-borne disease and not helped at all by being FeLV positive. A lovely little young cat, she was presented the evening before with, again, a history of just not being herself and was found to be very pale. Her bloods revealed the true extent of her predicament, as she was sadly diagnosed with FeLV (Feline Leukaemia Virus) and had both a severe anaemia, with a red blood cell percentage very much on the borderline of needing an immediate transfusion, and a raging high white cell count. Aggressive treatment was started but the response was not enough to prevent needing a blood transfusion last night.

The second case was that of a geriatric dog who, as with the cat, was presented with a history of just being quieter than normal. Again, pale and lethargic, bloods revealed a low red cell count and concerns about possible internal bleeding were confirmed by ultrasound, as we found her abdomen to be full of blood due to a ruptured splenic mass. As such, the options were starkly binary: euthanase or operate to try and save her. Her owners opted to try and save her so after bringing in a blood donor we took her to surgery and removed her spleen, complete with nasty, ruptured splenic mass which was the cause of her abdomen being full of blood. The surgery went well and at the time of writing the patient was recovering well, although is certainly not yet out of danger.

So there we have it…. the next chapter in the vetty adventures here in Dubai, complete with a new 24-7 element. Things should continue to be very interesting and, I daresay, remain intense.

If your pet does need to be seen overnight, then Al Safa Veterinary Clinic, on Al Wasl Road, Dubai, is now open 24 hours, 7 days a week, and can be contacted on +971 (0) 4 348 3799.

No such thing as stupidity? Not true!

I am used to seeing examples of simple, innocent ignorance doing the job I do, and it is actually gratifying to a certain degree when you can make a difference to both the lives of an animal and their owners by filling in the obvious gaps in their knowledge. However, there are also occasions when you just despair of people and the fact that they can possibly be so blinkin’ stupid!

Friday at our clinic is mental – no other word for it. The hours, officially anyway, are 9am until 5pm, but considering that during that time, which is normally fully booked with appointments and with at least one or two ‘walk-ins’ plus ’emergencies’ plus repeat prescriptions to attend to, the vet on duty also has to deal with all of the clinic’s in-patients, the day actually has to start much earlier and inevitably ends much later, with lunch but a pleasant idea. As such, by the time you find yourself getting towards the end of the day tolerance levels are waning and the last thing you want to find yourself dealing with is a problem that really shouldn’t exist.

The clients I called in to my room were new to us, having purchased two kittens only the evening before. All fine so far. We see many new puppies and kittens and I actually quite enjoy seeing them for their initial check-ups. What I don’t enjoy however is being faced with underage, underweight, clearly disease-riddled specimens and to then be informed that 5000 AED (roughly equivalent to about £1000) was spent on said kittens. I just wanted to scream at these people and ask them how they could have been so bloody stupid to have parted with so much cash for cats that were, even to an untrained child, clearly not right. I have a deep rooted disdain for the fact that people pay so much for pets anyway, especially when there are so many perfectly good, healthy animals in adoption centres. In fact, we have a clinic full of kittens all looking for homes. The best part? They had purchased the kittens for their young child! OMG!

Needless to say the scumbag who duped these two, not on the face of it unintelligent people, refused point blank to take them back or refund them. As shitty as that is I guess it was to be expected. If you’re unscrupulous enough to advertise and trade in diseased babies, which is what we’re effectively talking about here, and you find someone dumb enough to hand you their money, then of course you’re unlikely to have the moral fibre that dictates you do the right thing by them after they discover their mistake. The fault lies with the idiots who seek out and then pay obscene amounts of money for these animals – they are creating the demand for such a disgusting trade.

Anyway, I thus had the pleasure of informing my clients that they had paid a lot for two kittens who had, in no particular order, ringworm (a fungal skin disease that is zoonotic – ie, we can get it), worms, raging upper respiratory infections, with one of the kittens having awfully gummed up eyes, ear mites, and were both very underweight and in poor general body condition. There may well be additional health issues which come to light, such as the risk of diseases such as giardia (again, something we can pick up) and FIE (Feline Infectious Enteritis, a form of feline parvovirus and bad news). To even attempt to rectify the various health issues they had was going to take considerable time, effort and more money. Oh, and with no guarantee of having healthy, alive kittens by the end of it. Always a fun conversation to have at the end of a crazy Friday!

If anything I would like this post to serve as a wake-up call to those looking to acquire a kitten, or indeed any animal: THINK! It isn’t rocket science. If you’re buying a young animal from a man in a van, with no paperwork, previous history and it clearly looks underweight, in poor condition and has physical evidence of disease – I think we can all recognise a snotty nose and eyes when we see them – then think really long and hard about whether it is a good idea to part with a wedge load of cash, because all you’re going to end up doing is doubling that amount on vet fees and giving the dodgy seller ample good incentive to go out and ‘replenish his stock’ with more sickly specimens to flog to unsuspecting suckers. If you really must get a kitten or puppy then I urge you to, first of all, consider rehoming an animal from a shelter or vet clinic – they will have been vet checked, passed as healthy and probably already wormed, vaccinated and, depending on their age, neutered. If, however, money is simply burning a hole in your pocket or you must have a specific breed (!?) then seek out a reputable breeder, insist on seeing the mother and, if possible, the father too, and go and view the puppies or kittens with the rest of the litter before going back and forking out money. As for pet shops, don’t go near them. Period.

The depressing thing is that I daresay I am going to see many more such cases, especially if the past week has been any guide to future events.

The Overcharging Vets Myth

I was a little disappointed recently to read a certain celebrity vet’s blog post about ‘overcharging vets.’ Despite a couple of sentences that attempted to act as somewhat of a balancer by ‘hoping that their view is coloured by bad personal experience’ and acknowledging that not all vets overcharge, I couldn’t help but feel that the comments were misguided, unhelpful and may simply act to further add to the list of grievances, both reasonable and unreasonable, that some may wish to level at the veterinary profession, whom the vast majority of the general public still imagine rake it in and live the lives of monied privilege, whilst the opposite is usually the case.

Although it is undoubtedly true that some vets may be tempted to propose additional tests and treatments that may ultimately, in hindsight, prove to be somewhat superfluous, I firmly believe that the motives for 99.9% of vets to make recommendations and suggest preventatives, procedures and other treatments are clinical, sound and ethical, with little or no concern for their own material gain. Granted that with the introduction by some veterinary employers of incentive schemes and bonuses linked to things like turnover, some individuals may feel the pressure to over-emphasise certain options in the pursuit of a boost to their salaries. However, if the vet in question is paid appropriately for their skills and expertise then I don’t see how the potential promise of a few extra quid in the monthly pay packet can really lead to their clinical morals becoming corrupted. If they’re the kind of person who is overly motivated by money then they probably wont spend a lengthy career in veterinary anyway and will probably work out that there are significantly easier, and possibly less stressful, ways of making themselves rich than trying to fleece the pet owning public. Personally I don’t view financial incentive schemes as being a particularly great idea in veterinary as I fear that they do introduce the risk of conflicts of interest developing, even if those conflicts never actually manifest themselves. Most organisations that employ turnover based bonus schemes use them as a means by which to justify keeping base salaries towards the lower end of the scale, especially as vets on lower salaries can “earn more of a bonus as a result if they exceed their monthly turnover targets,” due to the difference between the target monthly turnover figure, usually based on the current salary and the actual monthly turnover figure achieved, which can ultimately vary with the cases that walk in the door that month. I had a debate about exactly this when trying to negotiate a perfectly reasonable salary increase with my first employer a year after graduating and starting work as a vet. I ultimately left as a result of their refusal to appropriately value my training, skills and experience, preferring to espouse the apparent merits and “additional earning power” of the bonus scheme. Myself and my colleagues at that practice, and others that I have since worked at, did not make clinical recommendations because option A was going to make us an extra £15 compared to option B, but instead used our training and judgement as vets to discuss the various options with the owner and ultimately make recommendations, with the owner ultimately making the decision having felt satisfied that they were getting value for money.

The example given by the author of a friend whose dog was taken to the vets suffering from “mild intermittent digestive upsets for a while” and subsequently received a bill for £1700, which was then derided for being unjustifiable and clearly motivated by profit seemed to me to be one-sided, emotive and jumped to a number of conclusions, which was unfair to air publically without offering the vet in question the opportunity to justify the charges. There was no mention of the dog’s previous treatments or the nature of the digestive upsets that had been the problem. Nor did it make clear whether the owner had been involved in any discussion about the investigation options, including potential costs, and thus whether in spite of the final amount being quite a lot and the ultimate diagnosis – note that a diagnosis was reached – being fairly benign (hindsight is a wonderful thing), the owner knowingly consented to the range of investigations carried out and their cost. If not then yes, there is a problem, but that problem is one of proper client communication and customer care, not of profiteering. £1700 is not a lot of money for such an exhaustive, all encompassing investigation into a problem that by the sounds of it had been grumbling on for a good while. The alternative, of course, could have been to conduct the various tests over a longer period of time, but then that may have involved having to administer multiple anaesthetics (additional cost and risk to the patient), and may have simply served to prolong the period that the animal was suffering from the problem and the course of supportive therapy, such as prescription diets, that may have been used in the interim. The result? That the final bill would have potentially been significantly greater than £1700 and that the vet is accused of dragging the entire process out in order to maximise profit. Damned if you do and damned if you don’t.

People talk a lot more with each other than they ever used to and one result of this is that if there is something that people don’t like, whether it be poor service or excessive charging, then it is not long before everyone is made aware and if the issue is not addressed then the individual or organisation runs the risk of being adversely affected, especially if the messages are consistently poor. Vets that overcharge – and it is easy to ascertain whether this is the case by comparison with other vets, offering a similar service – will find that word gets out and they will either have to bring their prices and practices in line with their professional peers or risk not remaining in business for very long. As such, I simply don’t believe that overcharging is a real problem in veterinary medicine. In fact, I think that pet owners get a very good deal considering that they have access to exceptional standards of private medicine, often with the convenience, clinical and cost advantages of same-day diagnoses and treatments, especially when you compare that humans pay many times more for similar tests and procedures privately themselves.

I will be very interested to hear the kind of stories that are submitted to the author and predict that he will undoubtedly receive an electronic sackful of complaints and countless accounts of “profiteering” within the veterinary profession. However, what I suspect won’t be accompanying those stories are clear, detailed explanations for why various treatments, tests and procedures were advised, what the animals’ previous histories were, or whether the options were clearly discussed, explained and ultimately consented to, including knowledge of potential costs. Incidentally, you don’t see many vets driving Aston Martins, living in mansions or sending their kids to Eton, so I do wonder where all of these scurulous profiteers are hiding out?

Big cats, Big surprises

lion, leopard, tigerThe standout feature of this week’s Safari Vet School – other than ITV’s incredible ability to massively over-dramatise everything –  was the lion dart, transport and release experience. As in previous posts most of the fun adventures that the students get up to manage to trigger some memory I have that I am able to draw parallels from with the safari experience. After all, in spite of being born in South Africa there are not too many Lions roaming the streets of Hampshire for me to get my clinical teeth into. Plenty of unpredictable, oft grumpy and sharp moggies though.

The students had to administer sedation to the two lions in question, in order to safely transport them across the reserve, and had to remain vigilant during the process due to the risk of the lions waking up. It highlighted the inherent unpredictability of sedation in general and how not all of our patients take note of the dose charts. We had a feline patient in yesterday who it was suspected may have had a foreign body impaction (ie may have had something stuck in his guts) as he had not been to the toilet and had been seen for vomiting previously. In order to fully assess him, including taking an xray of his abdomen, we opted to admit him for sedation and to start him on a drip in order to rehydrate him. In the end we needed to sedate him before we were able to place an i/v line as he was a bit of a flighty chap. The sedation worked a treat and within a few minutes our bouncy feline customer was a pliable bundle of fluff. This proved two points for me: 1. it is often preferable, both in terms of reducing stress on the patient and for making sure you, as the vet, are able to do the best job possible in the least amount of time, to sedate animals that are making life a little tricky when it comes to examining them; and 2. the response to sedation is such an inherently unpredictable game – another cat of the same weight may not have been touched by the dose we gave whilst the cat yesterday responded perfectly. Having top-up drugs, reversal agents, and additional medications and supportive treatments, such as oxygen, on hand is therefore essential, so that you are able to respond in real time to what is actually happening with your patient, rather than relying on what is ‘supposed’ to happen, as it rarely goes the way it should. The other thing to remember is that even though our patient wasn’t a 300kg lion, it could still have caused a decent amount of damage to either myself or one of my colleagues, especially during the recovery phase when animals are often very disorientated and confused. Anyone who has been on the sharp ends of a cat will certainly know what I mean. In terms of what was wrong with the cat, it turned out he was massively constipated and so a decent period of rehydration and an enema later and he was right as rain, including being significantly lighter than before! Ah, the glamour.

As a footnote, I just wanted to commend Fitz on her rather spectacular feat of acrobatics in diving out of the way of the zebra’s flailing hoof, which would have made quite a dent in her head if it had hit. Vets do seem to have to develop the reactions of a wired cat as, again, the unpredictability of our patients means that danger can literally fly at you from any direction at any time. Another feature of vets, and indeed nurses, seems to be our ability to contort ourselves into the oddest of positions and maintain said postures for lengthy periods of time in the course of administering to our patients. It sometimes feels like being a vet instantly puts you in contention for the title of World Twister Champion. Maybe compulsory yoga classes should form a part of the vetty curriculum?!

 

Probably one of the most genius uses of a single bit of plastic ever.

I wasn’t sure if this was really even worthy of a blog post but you know what, I think it is. Every pet owner needs one of these things. They could save you a load of money and hassle, and keep both you and your pets safe and healthy. They are easy to use, cheap, and once you get used to them (which takes moments) are actually quite fun, in a weird way I guess, to use.

What on earth am I yabbering on about? A tick hook. Brilliant bit of ‘tech.’

Aortic thrombo-Embolism in cats – a tragic condition

I had the tragic task of dealing with a case of aortic thrombo-embolism in the emergency clinic at the weekend, in a beautiful cat who had been presented by her owner after suddenly going off her back-legs.

This condition, which results in a blood clot forming and blocking the major blood vessels to the legs – most usually at the point where the body’s main artery, the aorta, branches to supply the hindlimbs – results in cat suddenly losing the use of their back legs, with the legs often feeling cold to the touch and with the absence of any normal sensation. This was confirmed when I performed a test to see whether there was any blood flow to the back legs by making a small needle impression in the pads (which normally results in a small spot of blood, as you would get if you pricked your finger with a needle) and by cutting the nail back past the quick, which is the equivalent of the very tip of our fingers and usually results in bleeding. The absence of any blood after both these tests confirmed the diagnosis and as a result the decision was made to put the cat to sleep.

There can be many reasons for such a clot to form in cats, with the most common reason being an underlying heart condition which if left undiagnosed and untreated can result in abnormal blood flow and potentially a clot forming, with some devastating and sudden effects. It is therefore important to ensure that you take your cat to the vet for regular check-ups, which will include the vet listening to their heart. Sometimes, however, as in the case yesterday, there is no apparent reason and it it just makes the situation that much more tragic.

Click here to read some more information about emergency situations with cats.