dogtorj

[dogtorj]

Moving Day

This blog has moved to www.dogtorjay.com

[dogtorj]

Monday

It’s Monday. For most Monday is the worst. For me, it’s usually my ‘operating’ day - the day when I get to do most of my procedures and surgeries. Therefore, it’s usually the day I find getting out of bed easiest - I set off ready to fix/scan/remove some things!

First thing on my list to greet me is a cat to be castrated. He’s very cute and he allows the nursing team to put a cannula in his leg with no problem. While preparing for him, I’m warned that my next patient is a dog in for castration who does not take kindly to people trying to poke/prod him (unfortunately this is most of our job!). I work him out a premedication that includes a slightly increased dose of the sedative we use that also works to relieve anxiety. This should leave him chilled enough for us to pop a cannula in. Less stressful for him, and safer for us!

Side note - in most practices including where I work, all general anaesthetics will have cannulas placed unless not possible for some reason. This means one ‘jab’ and medications can be given without too much stress. We sometimes take blood samples from them, we give the initial anaesthetic drug into them; and we also have it in place ready to give any drugs quickly and effectively in case anything were to go wrong. Also a side note - if anybody wants to know more about the process I’m happy to answer! 

The cat castrate goes without a hitch. We also place a microchip while he’s asleep as requested by his owner. He had sore ears which we gave a clean prior to his procedure. Nothing serious going on, but I do spot some bacteria from a swab in his ear under the microscope, and prescribe some ear drops for him to go home with.

The cat goes off to be monitored in recovery while he wakes up, and my next patient walks in, a little unsteady on his legs due to the premedication. He gradually relaxes on a vetbed and doesn’t notice us put the cannula in. His castration is also uncomplicated. His skin looks a little sore from the ‘manscaping’ we had to do in the area, so we apply some sudocrem.

My next patient had been sitting patiently in kennels and he’s very happy to see me when I go to see how he’s getting on following his premedication. He’s a gorgeous little dog. He’s not quite a year old yet and this is his third procedure with us, yet he’s still always happy to come to the clinic. He was neutered, then a few months ago I operated on his right eye as his third eyelid tear gland had prolapsed (also known as a ‘cherry eye’). This had been my first of this procedure and it had gone brilliantly, his eye looks totally normal now. He’s now here because the same has happened in his left eye. The pressure’s on to deliver the same results! We get him asleep, I apply a local anaesthetic drop to his eye, and create a little pocket under his third eyelid for the prolapsed gland to sit in. I stitch it into place (careful not to leave any suture material in contact with the sensitive eye surface), and he also gets taken off to recovery. His third eyelid looks a little red and swollen as is to be expected post-surgery. He has some anti-inflammatory medication and eye drops to go home with, and I will see him for a check-up in 4 days.

Myself and the veterinary nurse I’ve been working with grab a quick cup of coffee and a snack before moving onto our next patient. 

Side note - veterinary nurses in vet practices are anaesthetists, radiographers, theatre nurses, ward nurses, animal handlers, dieticians, dispensary assistants, consultants, administrators, laboratory technicians, phlebotomists, and all-round badasses. They are incredible and deserve all of the recognition and respect.

Our next patient is a little dog with a strange behaviour of pawing at his mouth (or rubbing his paw on his mouth, there’s an uncertainty between all of us). Today is about checking for dental causes and taking a closer look at his foot (a no-go zone while he’s awake!). I scale the tartar off his teeth, and we take x-rays of their roots - they all look great, no problems. I also cannot find much wrong with his foot after clipping the excess fur away. His skin is moderately thickened and inflamed - but is this a cause or a consequence of the behaviour? He goes home on some medications for inflammation and infection, having ruled out major underlying problems; to see me for a recheck at the end of the week to see if it responds to treatment.

Last procedure of the day before moving on to evening consults is an ultrasound scan of a cat. He has recurring problems urinating, which respond to symptomatic treatment but I have advised we look for underlying factors as this is now his third time in a few months. He appears to have some kidney stones and a bladder stone. With the ultrasound probe, if I wobble his belly gently, we can see swirling of bright white stars in a bladder that should be all black with fluid (urine). These represent tiny crystal deposits, like sand. It’s very beautiful to watch. It’s unfortunate for the cat but at least we have a reason for his problems and we can begin to tackle it. I warn that the worst case scenario could be him requiring a surgery to remove the bladder stone, but we are going to have him on a diet designed for stone dissolution first, and recheck if they’re still present in 3-4 weeks. 

My evening consults start with a pregnancy confirmation. On a scan of Mum I can see 4 puppies (though ultrasound scans aren’t the most accurate for numbers), and her owner is thrilled. 

I also see a cat with some strange sight difficulties. I think I see a growth in his left eye, and am concerned about problems with the backs of his eyes. I recommend booking in for some further tests. 

An elderly dog presents with a large mass on his eye and eyelid. We discuss the pros and cons of monitoring alone, or doing a surgery to likely remove his eye as well as the mass, before it gets any bigger.

I revise with a client the medication protocol we have her dog on for arthritis. We chat through the measures we’re taking so far, decide to discontinue one that doesn’t help too much and try a different drug in its place for chronic pain. Generally we use multiple drugs at lower doses rather than high doses of one drug, to minimise side effect risks and to hit the pain in multiple different ways.

My last appointment is unfortunately to put a cat to sleep. The owner is prepared and the family have already said their goodbyes. She is elderly, has accumulated a few minor issues but now her breathing isn’t right, and I’m concerned she may have a heart condition. At her age, rather than put her through treatments and medications, her family made the kind and selfless decision to let her go gently and without suffering. She goes very peacefully and despite her owner being understandably upset, she takes a moment to thank me. The appreciation of the feedback and the satisfaction of making it as smooth as possible clashes with the sadness and weight of the situation.

I head home, feeling exhausted, but accomplished.

#adayinthelife #dayinthelife #vet #veterinary medicine #veterinarian #veterinary #animals #pets #surgery #diary

[dogtorj]

My blog starts with a good day!

I don’t think it’s a surprise to people that the veterinary profession is full of ups and downs. We start (luckily!) with an up kind of day. At least I left work with a smile.

My morning begins as an easier one. I am on a shift that means I am effectively an extra hand. My responsibility is prescriptions, and I can be taken away from this to put a cannula in, take some blood for a blood test, or be a “bum-stop” (to sit behind/scratch a patients bum while other things happen to them, as a distraction and minor restraint). The dogs I need to do this with are easily distracted with a high-pitched tone of voice and a bum scratch; and the morning goes without a hitch. I call a couple of clients to confirm their prescription requests / let them know they will need a prescription review soon as we haven’t seen their pets in a while; and then at 10:30am, it’s time to start consults.

Most of my consults this morning are for vaccinations. Routine, not presenting for a problem, more an opportunity for pets to have a positive interaction with us rather than be scared; and to catch up with the owners too (so important to so many of us in the current pandemic!). One of these patients happens to be a patient I operated on 10 months ago, for being kicked in the head by a horse, leaving a 1-inch-diameter hole in her skull. It’s awesome to see her doing so well, I have to admit I didn’t even recognise her at this stage, as a full-grown adult with all the fur having grown back on her head. I also see a very charming and well-behaved bulldog, called Angus, whose complicated eye ulcer has healed just a week after me debriding it with a diamond burr. I was able to do this without sedation as he sits so still. He gets 3 treats, and I feel pretty chuffed with myself.

Afternoon consults. More booster vaccinations. We are behind with COVID-19 lockdown having halted us a fair bit, and people having been pushed back a few months, so we have some catching up to do. A couple of them are nervous and require muzzling, but we manage to keep them calm in the consult room, and I don’t hear so much as a growl. I must be giving off calm vibes today!

In my afternoon consults, I come across a cat with constipation. He has been trying his hardest to go to the toilet today but to no avail. He is elderly and is already on laxatives to help this problem. I’m concerned that he now has a brain tumour. His owner reports following questioning, that he does tend to walk round in circles, and to me he doesn’t seem as ‘awake’ as his normal self would. He’s a little wobbly on all 4 legs, but gets around ok. I speak to the owner about my concerns. This is a difficult thing to prove. This would require an MRI but he is 18 years old and on discussion we’re not wanting to send him away to a specialist for an anaesthetic to do this. We choose to help with his constipation. I keep him in one of our ‘cat pods’ for the afternoon and give him a suppository to help the muscle contractions required to pass the firm poop I can feel in his abdomen. He requires a little ‘manual’ assistance - but he appears visibly brighter and happier afterwards. He goes home, owner aware of my worry with him longer-term.

Between consulting blocks, I get handed some flowers, a box of chocolates, and a card. In the card are some heartfelt words from a client I have seen for the last 2 years, as long as I’ve been in this particular job. She thanks me for looking after their dear old mini dachsund. I had diagnosed him with congestive heart failure way back when he was already in his teenage years’ and we had managed it since. Every recheck he’d happily plodded his way in to the consult room to see me, and every recheck we’d check in with each other and talk about making the end of his life as good and comfortable as possible. And he just kept going, kept being happy. He had been put to sleep by one of my colleagues while I was away, and yet the owner had felt the need to thank me personally for all we’d done in the last almost two years. A flash of regret waves over me that I hadn’t been there to say goodbye, but I also know that the time would have been right. It doesn’t happen to me often, but I do hold back some tears as I prepare for evening consults.

Evening consults. These are fairly routine. A limping dog I think will get better with some rest. An ear infection that is likely due to an underlying allergy (we discuss how to get this under control and also how to keep it that way). I see one of my surgeries back from 2 weeks ago. This was a removal of a very large lump. The removal left a very big hole (skin really stretches and pulls apart when you cut it). I used suturing techniques that would take some of the tension off the wound, and it so happens that its worked brilliantly. I’m chuffed. This particular dogs’ nipples now sit more on his side than on his underside, but I don’t think it bothers him too much! He’s super happy to see me, and he no longer needs to wear the toddler hoodie he’s had to wear for the last 2 weeks to protect the stitches that I remove.

All in all, I’ve left the day feeling brilliant. I have a bunch of tulips in my hand, and I know I’ve done good. Not every day is like this, not at all. But it’s days like this that make me realise I’m truly in the profession I’m meant to be in and that I’m fairly good at it!

#vet #veterinarian #veterinary medicine #dayinthelife #blog #vetblog #veterinary

[dogtorj]

It’s been awhile….

RAW DIETS

Unfortunately, there’s a lot of misconceptions surrounding raw feeding and alleged health benefits.The American Animal Hospital Association, American Veterinary Medical Association, Canadian Veterinary Medical Association, World Small Animal Veterinary Association, Food & Drug Administration, and Center for Disease Control ALL currently advise against feeding companion animals meats that have not been processed  to eliminate pathogens. Links to their statements can be found at the end of this post. There’s a number of reasons why, but it ultimately boils down to a risk-benefit analysis. We know there are dangers associated with raw feeding, and we have no documented evidence of significant benefit to outweigh those risks. Additionally, many home made raw diets are not appropriately balanced for complete nutrition. If you are interested in feeding a raw diet, you should consult with a boarded Veterinary Nutritionist (DACVN) to discuss options.

I’ve written about raw diets here: https://www.docofalltrades.net/…/pet-food-facts-fiction…

Here are some studies on the subject of raw diets. 

1: “The genomic signature of dog domestication reveals adaptation to a starch-rich diet” www.nature.com/articles/nature11837

2: “Perceptions, practices, and consequences associated with foodborne pathogens and the feeding of raw meat to dogs” www.ncbi.nlm.nih.gov/pmc/articles/PMC2684052/

3: “Raw diets for dogs and cats: a review, with particular reference to microbiological hazards” https://www.ncbi.nlm.nih.gov/m/pubmed/31025713/

4: “Tuberculosis due to Mycobacterium bovis in pet cats associated with feeding a commercial raw food diet” https://journals.sagepub.com/…/10.1177/1098612X19848455

5: “Enteropathogenic Bacteria in Dogs and Cats: Diagnosis, Epidemiology, Treatment, and Control” https://onlinelibrary.wiley.com/…/j.1939-1676.2011.00821.x

6: “Intake of minerals, trace elements and vitamins in bone and raw food rations in adult dogs” https://www.cambridge.org/…/7520574DA173F4DB29330A6F858…

7: “Evaluation of recipes of home-prepared maintenance diets for dogs” https://avmajournals.avma.org/…/10.2460/javma.242.11.1500

8: “Raw food diets in companion animals: A critical review” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003575/

9: “Apparent total tract energy and macronutrient digestibility and fecal fermentative end-product concentrations of domestic cats fed extruded, raw beef-based, and cooked beef-based diets” https://academic.oup.com/jas/article/90/2/515/4764443

10: “Raw meat-based diets for companion animals: a potential source of transmission of pathogenic and antimicrobial-resistant Enterobacteriaceae”https://royalsocietypublishing.org/…/10…/rsos.191170…& “RMBDs have a high risk for contamination with bacteria, parasites, and other pathogens. In addition to the risks of nutritional inadequacy and contamination with bacteria and parasites, other health concerns for an animal eating a RMBD include risks from ingestion of bones if they are included (e.g., constipation, diarrhea, dental fractures, gastrointestinal obstructions) and diet-induced hyperthyroidism from excessive ingestion of thyroid tissue. There is currently no properly documented evidence of health benefits for RMBD, but there are well documented risks. As such, the World Small Animal Veterinary Association Global Nutrition Committee recommends that RMBD not be fed to dogs and cats. ”https://www.wsava.org/…/WSAVA-GNC-raw-diet-statement-12…

“At this time, the vast majority of purported benefits of feeding raw foods remain unproven, while the risks and consequences have been documented. It is best to discuss the choice of feeding raw foods with your veterinarian so that an informed decision can be made with regard to your pet’s diet. https://acvn.org/frequently-asked-questions/#canned

"The AVMA discourages the feeding to cats and dogs of any animal-source protein that has not first been subjected to a process to eliminate pathogens because of the risk of illness to cats and dogs as well as humans. https://www.avma.org/…/Raw-or-Undercooked-Animal-Source…

“RAW PROTEIN DIET Past proponents of raw food diets believed that this was the healthiest food choice for pets. It was also assumed that feeding such a diet would cause no harm to other animals or to humans. There have subsequently been multiple studies showing both these premises to be false. Based on overwhelming scientific evidence, AAHA does not advocate nor endorse feeding pets any raw or dehydrated nonsterilized foods, including treats that are of animal origin.” https://www.aaha.org/…/aaha-position…/raw-protein-diet/”

The Canadian Veterinary Medical Association (CVMA) accepts the evidence for potential health risks to pets fed raw meat-based diets (RMBDs), and to humans who are in contact with RMBDs, or with pets fed RMBDs. The CVMA holds that the documented scientific evidence of potential animal and public health risks in feeding RMBDs outweighs any perceived benefits of this feeding practice. “https://www.canadianveterinarians.net/…/raw-meat-based…

Source: DocOfAllTrades 

[dogtorj]

What You Don’t See

-What you see: A too young veterinarian that surely can’t be qualified to treat your animal.   

-What you don’t see: A young veterinarian that busted her butt through 8 years of schooling and while she might not have the experience of a 60 year old veterinarian, she knows more than you think and she knows where to look for help if needed. 

-What you see: A hospital and staff that are only in this for the money.

-What you don’t see: Multiple veterinary team members putting their heads together to create a treatment plan that is best for your pet but still fits in your budget. Multiple people searching through donated medications or secretly using a bag of fluids for free because your pet’s health is WAY more important than our production numbers.

-What you see: A far too long room wait time.

-What you don’t see: The plethora of other critical patients in the treatment room that are being managed at the same time as your pet. Timely examinations of all animals is important and we try to get to everyone as soon as possible. Unfortunately, the actively seizing dog, the cat who just coded, the respiratory distress rabbit, and the dog who just collapsed from an Addisonian crisis will need to be addressed before your dog’s ear infection of three months duration. 

[dogtorj]

Vet Diaries

I am Dogtor J. I work in the UK as a small animal vet

Follow me for updates on what a day in the life of a first opinion small animal vet is like. Things get weird, things get sad, things get amazing, and things get downright gross and sometimes hilarious.

My job is both the best and the worst.

I do what I love, I meet the four-legged (and occasionally 2-legged and feathered) beings that I love. But I also have to say goodbye to said beings, witness the pain that I myself have felt with my own four-legged family members. I have to work to limitations, feel limited in myself, feel isolated; and wish that I could help people more. I feel undervalued by both who I work for and society. Then I get love-mauled by a puppy, or a client thanks me for all I’ve done; and all is right with the world again.

I am weird. I am incoordinated at times. I am professional. I am smart. I am stupid. I am human. I have a degree in veterinary medicine and yet yesterday could not work out how to use what turned out to be a sliding door.

I am a vet, and if you want to know what that’s like in real life, following me is for you!

#vet #veterinary medicine #veterinarian #animal #birds #cats #dogs #diary #euthanasia #pets #happy pets #love #profession #university #student #vet student #help