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Hypertrophic Cardiomyopathy – A Silent Ambush Killer of Young Cats: A Warning and Words of Advice.

As some of you may know, we recently lost our sweet little 2 yo kitty named Toad. This heart-wrenching loss had my 10yo daughter in tears for weeks. She still draws pictures of him and talks about him like an old friend that she misses. Toad was a very social cat who loved my daughter, hung out in her room, and slept with her every night. One morning, Tony came downstairs and announced that Toad was no longer using his back legs. We rushed him to work, gave him all the pain medications, and determined his back legs would likely never work again and would start to die due to lack of blood flow – they were cold and hard and PAINFUL! This led to a very tearful euthanasia where I had to watch my daughter clutch his sedated (due to the level of pain he was in) body against her chest and sob into his soft fur. And then I gave the final injection.

While Toad probably would have never lived a long kitty life, we possibly could have kept him going much longer than we did had we known what was coming. Toad died of a young cat disease known as “Hypertrophic Cardiomyopathy” (HCM) where the heart muscle becomes TOO thick and, therefore very little blood is pumped each time and the increased turbulence increases the risk for clots. Toad’s presentation is the most common way to discover this disease in young cats – a fatal blood clot to the aorta at the point where it splits off into the hind legs. The clots can partially or fully block blood flow to the back legs. In Toad’s case, the legs were cold and hard, therefore, no blood was getting to them.

So, how can you prevent this tragedy from happening to your family?

  1. Have your new cat/kitten evaluated by a vet for a heart murmur. (Toad never had one, but it’s good to know anyway)
  2. Have your new feline check for a chemical that is released when the heart is stressed. It’s a test called proBNP.
  3. If 1 and 2 are normal, GREAT! Keep an eye on your kitty.
  4. If #1 is not normal, but #2 is normal, keep an eye on your kitty and watch for early signs of heart disease like when they’re completely asleep (and not twitching with a dream or something) count the number of times they breathe in a minute – it should be less than 30 breaths per minute. If it’s more, contact your vet.
  5. If #2 is not normal, think about having an echocardiogram (ultrasound of the heart) or a work up at a cardiologist to determine what the next step is and whether your kitty needs to be on medication.

If you’re rescuing a cat from the shelter or from the streets, there’s not a lot you can do to prevent this condition other than making sure to feed it a commercial cat diet that’s balanced for cats and has the amino acids required to keep the heart healthy – but if genetics are in play, the diet won’t really change the outcome. If you’re purchasing a cat breed (specifically Ragdoll and Maine Coon), make sure you find out if the breed is predisposed to heart conditions and then grill the snot out of the breeder and make sure the parents and grandparents have been tested for heart conditions before purchasing. After this whole ordeal, we got his sister, Popcorn (pictured with him as a kitten) and she’s all okay with no signs of heart disease. Now, I’m trying to encourage people to avoid this horribly traumatic experience themselves by recommending testing for young cats.

After his death, I performed a necropsy to confirm my suspicions and give myself solace for putting him down (sometimes, even when you’re sure, you still doubt “Did I just kill my daughter’s cat for the wrong reason???”). Sure, enough, I found a very large clot wedged in the descending aorta along with branches of the clot going into both femoral arteries, effectively shutting off all blood supply to both legs. I also found his heart, which was greatly enlarged with the left ventricle (the one that makes the big pump to the whole body) grossly thickened to the point where almost no blood could be pumped each time. The only thing I can even remotely think of as far as symptoms that I missed was that he was a very active kitten and eventually got to be a sleepy/cuddly cat while his sister continued her tortuous reign on the outdoor small rodent population. I thought this was just his personality, but, looking back, he was probably tired all the time due to lack of oxygen/blood to his body.

***** Warning! Pictures of Toad’s necropsy (autopsy) to follow ******

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#grosspictures coming!

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STOP SCROLLING IF YOU ARE EASILY GROSSED OUT

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Seriously! STOP! Blood! Gore!

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But it’s a REALLY good visual of how everything failed for poor Toad

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This is a picture of the clot sitting in the fork at the end of the descending aorta. It splits into right and left hind legs.
This is a cross section through the middle of the heart – see how little space there is to fill with blood to be pumped?
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Fat Cats Cost Fat Stacks

I’m not good at estimating things, but I’d say about 90% of the pets I see are overweight to obese. Owners don’t like to hear this, though. If they could just have a big eyed, furry thing to pet and feed forever, that would be their ideal life. The animal wants the food, it makes them “happy” and if baby is happy, owner is happy, but the animal doesn’t seem to really ENJOY the food typically and just wolfs it down and looks for more like “I can’t believe that’s all you’re going to give me” and the big eyes instill guilt, we feed, feel happy, then guilt for not giving more, and so the cycle continues. Unfortunately as they get older, or even some at a much younger age, the extra weight can cause so many more problems.

Dan, the office cat: OBESE 19.5lb – should be about 12lb

People tend to judge how much their pet should weigh based on their breed (or perceived breed) and their parents’ sizes. I often hear “well, how big should he be for his breed?” or “well, his daddy was HUGE – with a head *THIS* big and was 195lb!!” There are a few problems with this theory. 1: every breed has a wide range of what can be normal (height, thickness, etc) , 2: every individual gets different genetics and may not end up as large as their parents (or could be larger) – My parents were both 5’11” and I ended up 5’8″. 3: just because the parent was 195lb, that doesn’t tell me if that parent was an ideal body condition and not also obese.

X-ray of a very obese dog. Looks like a baked potato with legs

In general, you should be able to feel your pet’s ribs, but not see them. So, especially with those super fluffy critters, you’ll have to put your hands on them to decide if they’re too fat/skinny. Have them stand up, then run your fingers down their ribs. You should be able to easily feel the ribs without pressing, but not feel any depressions between them, like the back of your hand. If you have to push through flesh to feel the bones like you would on your wrist, your pet needs to lose weight. If you can feel spaces between their ribs like your fingers, your pet needs to gain weight.

Here’s an equation to figure out how much your pet needs to eat in a day (not just their pet food, but you have to include EVERY calorie that goes in their mouths – food dropped, just a little snack while cooking, kids feeding them, treats every time they go outside and use the bathroom, the cat’s food when you leave it out for them to steal, etc, etc). Remember, a 100 calorie snack for an adult human could be 50% of a small animal’s daily needs. So, even just a little bite for you could be enormous for our pets. And don’t be fooled by the pet who is ALWAYS hungry. Unlike us, they have no concept of “being healthy” other than “EAT WHEN YOU CAN BECAUSE YOU NEVER KNOW WHEN THERE WILL BE FOOD AGAIN!!!!” Remember, a dog/cat has about the intelligence of a three year old child, so we have to be their brains and think of their health for them.

Catina is a small framed cat. She weighs about 8.5lb but should be about 6lb.

Daily calorie needs for your pet = 70 x (Ideal body weight in kg)^0.75

*********DOG FOOD BAGS LIE!!!!! DON’T FOLLOW THOSE INSTRUCTIONS!!!!!**************

** weight in lb/2.2 = weight in kg

** Ideal weight = body weight – (body weight x %overweight)

  • with % overweight = anywhere from 10-40% overweight (ask your vet)
  • So, 42lb beagle that is OBESE is about 40% over weight, so ideal body weight = 42 – (42×0.4) = 25.2lb
  • So, a 42lb beagle that should only weight 25lbs, 25/2.2 = 11.4kg
  • calories = 70 x (11.4kg)^0.75 = 70(6.2) = 434 calories per day
  • To make it a little easier for you, here’s a chart (This is for ADULT animals, not growing/lactating/pregnant – Also, this is IDEAL weight, not their current weight if they’re obese)
  • Talk to your vet to get your pet’s ideal weight
Popcorn is a perfect weight – she’s an average frame cat and weighs about 9lb

Our pets do not live very long (10-15 years for most dogs; 15-20 years for most cats), so giving them the healthiest lifestyle keeps them happier for those years. Arthritis and diabetes are common sequelae to being overweight as well and breathing difficulty in the short squat dogs like French and English bulldogs. Osteoarthritis leads to many many euthanasias and dogs that are overweight are GOING to have more mobility issues and will start getting them much earlier in their lives. Mobility issue leads to being unable to get up from laying down, walk over hard floors, navigate stairs – making owners have to carry dogs to go outside to the bathroom (think apartment living), bed sores, other injuries from slipping and falling, infections around skin folds around rectum, penis, vulva. Diabetes treatment requires twice daily insulin injections, multiple vet visits to get insulin regulated, regimented note taking and nursing care, and, of course, more money. (Just think of all the money you could have saved by NOT feeding your dog all those extra treats AND diabetes/arthritis therapy!)

This hippo is a bit on the thin side…

Cats that are overweight will start with arthritis, but you may not see it (see my last blog on pet pain) until you start noticing your cat urinating or defecating outside the litterbox. Inappropriate urinating and defecating is one of the leading causes of cat euthanasia – and it all could just be because it hurts to walk into the litterbox or get into position to poop. Obese cats will also develop diabetes ($$$$), stop being able to groom themselves, leading to mats in the hair, grumpy cats, and infections around their rear from feces and urine sitting on their skin.

The most loving and money saving thing you can do for your pets is to stay ahead of the problems – flea/tick/heartworm preventative, vaccines, and keeping them at a healthy weight are the absolute minimum for giving your pet the healthiest and longest life you can. You may feel like they love you more if you feed them, but they don’t really associate food with love. Over feeding them can border on cruelty and abuse. You are their caretaker. You control what they eat – 100% – you can show your love more than anything in the world by keeping them at a healthy weight. You can do this!

Happy healthy dog!
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His leg fell off, but I don’t think he’s in PAIN! W.T.F.

Sick kitty – she’s down and out in the middle of the kitchen where the dogs normally eat – she was euthanized this day

I recently had a case where an animal had all the skin stripped off it’s paws which were now red, bleeding, and swollen. I comforted the owner after they asked me if I was going to close the wounds and informed them we would be unable to close due to all the flesh being torn from the pads, but not to worry, we would get the animal on antibiotics and pain meds until it heals. The owner looked at me like I was crazy and said “well, I don’t think he’s in any pain, except where your assistant took his temperature in his butt”.

Whale eye – the pain to come when leg knocked off

Unfortunately, this wasn’t the first time I’ve had an owner deny their pets’ pain. It wasn’t even, likely, the first time that day. I have made a Tiktok video about it:

https://www.tiktok.com/@dremilythomas/video/7186334895428488491?is_from_webapp=1&sender_device=pc&web_id=7239346327908697642

So, let’s talk about pain for a second. Animals are different than us. Not in that they don’t feel pain, but that they are NOT going to show pain like we will. We live in a society where 1. we expect a fix for every ailment we have thanks to modern medicine and 2. others in our circle will take care of us if we are out of commission. Animals, on the other hand are 1. Not going to ask for help because they don’t even know help is an option (my eye fell out? oh, well, guess we’ll try to eat and not die from it) and 2. are fighting for survival, or, at least feel like they are, even with us. House cats, believe it or not, are actually prey for many animals – large birds, foxes, coyotes, wolves, etc. but aren’t the easiest prey, so showing pain could mean being more likely hunted or targeted by those predators. Dogs, going back to pack mentality, may be taken out of the pack if they show pain or at least taken down on the totem pole of hierarchy. If you’ve ever had multiple dogs in a household and seen what happens when one cries out or whimpers and the other dogs run up on him, not to see if he’s okay, but to hover over him intimidatingly and possibly attack depending on the personality.

Whale eye #2 – this indicates stress OR pain. Like the stress and pain of being crushed by your self-obsessed sibling

So, animals have good reasons NOT to show pain. They don’t know if they show pain, you will help them. They may be thinking we’ll get rid of them if they do or they might not get fed, or who knows what they’re thinking. Animals will also, notoriously, get 99% better when they go out in public or come to the vet. We see it all the time, animals who are reportedly dying at home, show up to the clinic, running around, wagging their tail. I don’t automatically think the owner was lying, I just think the adrenaline and survival skills of the animal has kicked in and they animal doesn’t want to show weakness. Just like me and you when you’re not feeling well, but good enough to go to work and you pretend to be peppy and spry around your co-workers or clients. Why? I’m not sure. Am I afraid someone will send me home?? Please! Am I afraid people won’t like me if I’m not 100%? Maybe. But we all do it, so why not expect animals to do the same thing?

Hiding – if this cat were in pain I would expect more curled up tight in the back, avoiding contact

So, here’s a list of signs that your animal is sick or in pain. Some will seem simple and straight forward, but I wouldn’t be making this list if people didn’t have a hard time seeing it.

  1. Not using a body part. Limping but not whining? Still in pain. Squinting, or closing the eye. I’ve seen dogs walk into the clinic, tail wagging, with the obviously fractured leg just dangling in the wind and STILL not vocalizing.
  2. Change in behavior. Suddenly avoiding you or other animals in the household, more fearful or aggressive, not wanting to eat, play, not jumping up when you’re about to go for a walk. Going in and out of the house or litterbox several times (could indicate diarrhea or urinary issues)
  3. Change in posture. Hunching, lowered ears, head, tail, curled up tight in a ball, not wanting to lay down, pacing, trying to lay, then pacing again. Standing with chest on the ground and butt in the air – typical of stomach pain.
  4. Panting, pacing, trembling, shaking, wide “whale eye” where you can see the whites of their eyes like they’re worried.
  5. Overgrooming/licking an area. This is super common with cats who will groom their under bellies bald if they have abdominal or urinary pain. Also, allergy areas of the paws, a wound, swelling. Sometimes they will even aggressively bite at and rip hair out of a body part that is hurting or irritating them.
  6. Teeth grinding or bruxism – this horrible sound from their mouth can indicate stomach pain.
  7. Drooling, eyes tearing, or liquid generally seeping out when or where it’s not supposed to.
  8. Swelling, bleeding, redness, hot to the touch (make sure to compare both sides of the body to make sure it’s not just you – you’d be surprised how many perfectly normal fat pads over the hips I’ve diagnosed when the owner only noticed one side being big)
Squinting (this is a cheat – Catina has no eyes)
A cat who hangs out by or near the litterbox more often
This bear avoiding the family and heat seeking (just a stuffed bear but doesn’t he look forlorn?)
Laying in the coffin can be another sign.

I’m sure there’s more signs that I’m not thinking of right now, but this is a good list for now. Basically, animals don’t show pain very much – always playing it cool – and if you ever notice anything different, take them to the vet and have them evaluate them. I’d much rather tell you you’re crazy, the animal is fine than have you wait until the leg is rotted off before you decide it might need attention.

**Side note** – a lot of orthopedic pain issues can be helped by having your animal at the ideal body weight – unlike this obese clinic cat who is likely contributing to orthopedic/musculoskeletal pain of the small child trying to hold him. #weloveyoudan

Here’s a picture of a very healthy, non-painful dog – happily just finished a 4 mile mountain trail run. Head, ears, tail up, back straight, wide based stance.

Also, for the love of all that is holy, DO NOT give your animal human pain medication unless under the direction of a veterinarian. Most of them cause significant and immediate liver and/or kidney failure. This goes for you, too, Dr. Human Orthopedic surgeon, NO Celebrex! Even if all your human patients are on it! No!

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Cats: They’re Sensitive (and they’d like to stay that way)

Cats are funny creatures. So independent and in your face with their needs and desires. They seem so low maintenance. You just get a cat, some food and a litterbox and you’re set! Easiest pet you ever had!

Sweet Toad – the perfect cat – except that he’s a nasty bully to the other cats.

Oops, no! Sure, some cats are ridiculously low maintenance and use their litterbox all the time, eat, drink, don’t vomit on your important documents or pee on your laundry or chew on your electrical cords. But getting one that great from the get go and their staying that way is a gamble much like life insurance (or worse, short term disability insurance).

Spicy Penelope – except to other cats – she’s the target of their aggression

Litterbox habits: This is the number one behavioral complaint we get with cats. Now, I am no behaviorist, but will try to explain what I tell clients when they’re having trouble with urinating or defecating outside the litter box. First thing’s first: as a vet, I definitely want to make sure there’s nothing medical that is causing this issue. Urinary tract infections, cystitis (which can also be behavioral), arthritis, diabetes, kidney disease, crystals or stones, other health issues. So, we will start with bloodwork and urinalysis to rule out the easy ones. For arthritis, we may, next try X-rays or pain medication trial. Once we’ve ruled out medical reasons the cat may be giving you the fluffy finger, we’ll move on to behavior/social/psychological issues.

This is Delphi – she’s 18 and hyperthyroid and pees on our counters and herself – hence the bath.
  1. There’s a rule of thumb that you should have 1 litterbox per cat plus 1. So, if you are like me and have 5 cats, you should have a minimum of 6 litterboxes.
  2. If you have multiple cats, make sure to spread out the litterboxes in case one cat is secretly bullying another cat and chasing them out of the litterbox. I have multiple litterboxes on each level of my house, including the basement. If you have dogs, make sure the cat can get to the litterbox without a dogs nose up their butt waiting for the “fresh from the oven” treats. Consider a baby gate raised to 5-6 inches off the floor to allow the cat to scoot under, but not the dog – or if you have a small dog and young cat, baby gate on the floor.
  3. Some cats like the covered litterboxes, some feel claustrophobic. You’ll have to try different ones. Give different options. Regular open ones, closed ones, tupperware bin with a hole cut in the side, deep ones, shallow ones. Who cares? Cats. They care. A lot.
  4. Clean the boxes VERY regularly. At least once daily. Cats are bourgeoise and don’t want to use a dirty bathroom just like you.
  5. Try different litters. Some like the clumping, some don’t, mine hated the pelleted recycled stuff that was supposed to save the environment. Like many people, cats are more about themselves – tiny, soft, fluffy narcissists. (My cats really LOVE Dr. Elsey “Cat Attract” litter)
  6. Don’t keep the boxes where there’s a lot of noise, or commotion. Or, God forbid, change what’s in the room. My sister’s cat stopped using the litterbox in the laundry room when she got a new washing machine.
  7. A cat’s stress organ is their bladder. So, if something is stressing them out, the bladder will get inflamed and can even make them urinate blood without their having a bacterial urinary tract infection.

Food and water secrets: In general, cats are desert animals and are prone to not drinking enough which can lead to urinary and kidney issues.

  1. Offer water in several forms. Beautiful bowl you tediously picked out online that perfectly matches your décor and your cat’s unique personality? Complete garbage. Try leaving a disgusting dish in your shower to collect water haphazardly – they LOVE it! Leave a faucet dripping, leave a cup of water on the counter – they’ll drink it.. then dump it. Pretend to fix yourself a glass of ice water and look away for a few minutes. Run the shower for just a second and watch them happily clean the droplets off the walls. Cats are bougie, but also sometimes hipster.
  2. If you’re ever in the position to need to try to force feed your sick cat – remember this: whatever food you decide to use, your cat will HATE that food forever! So have an alternate food to offer to see if they will eat on their own and don’t use their regular food if they have special prescription diets that they need. Talk to your vet about options.
  3. Cats DON’T NEED MUCH FOOD. Really, most domestic animals are obese these days, but for the most part, cats only need about 200 kcal per day (average for a 10 lb/4.5kg cat +/- weight for tiny cats or TRUE Maine coons – talk to your vet to get an idea of what your cat should weigh). Look at your bag of cat food and figure out how many kcal/cup of food and calculate from there. Overweight cats lead to unhappy, sedentary, arthritic, diabetic kitties who can’t even groom themselves and have to get shaved or develop sores on their rears from excrement sticking to them.
This is Dan the clinic cat. Dan is 20 lb. Dan has an eating problem and needs to be on a diet.

Social order:

  1. Don’t TOUCH me! For a cat, the only acceptable place to be touched (until consent is fully achieved and a safe word is established) is the top of the head. This is the only place that they cannot groom themselves and will more readily accept touch on this area. So, if you’re first meeting a cat or trying to gain it’s trust, start with a little scratch on top of the head and then move on from there.
  2. Cats are like potato chips, you can’t just stop at one. Buuuuut… maybe you should. Yes, some cats LOVE companions, but for the most part, cats are solitary creatures that really need their own territory. If your cats aren’t getting along, you may need to establish their own territory complete with their own food, water, litter boxes, beds, toys, humans, etc. I recently thought I would be smart and get two kittens from the same litter so they would “love each other” and it totally worked for about a year. Now, they hate each other and break out in full on screaming, hair flying battles. We have 5 cats now and have to rotate who gets to be around humans between the main floor, the basement, and even the outdoors. Only my 18 year old dirty hippie kitty is accepted/picked on equally by the other four.
  3. Kitties seem like couch potatoes once they reach adulthood – happy to eat, drink, and sleep. In reality, cats get really bored really easily and to keep them mentally as well as physically healthy, it’s very important to keep them stimulated in their very controlled environment. My household does not allow for toys on the floor (per poodles), but a cat tree next to a window, a bird feeder to watch, laser pointers, SCRATCHING toys (flood them with scratching toys to keep them from shredding your furniture), toys with moving parts, there’s some mouse toys you can put their regular food in and hide throughout the house instead of in a bowl so they can feel like they’re hunting, there’s compressed catnip in a ball you can hang on the wall and they can rub/lick/play with it. Cats like tunnels, ramps to get to high places. Leave Amazon boxes on the floor for a few days, plastic or paper bags from shopping, kids’ canvas tunnels, tents, etc.
Popcorn, sibling to Toad. Hates Toad. And Penelope.

Dr. Elsey’s Cat attract litter: https://www.drelseys.com/products/cat-attract-litter/

Cat toy: https://www.chewy.com/doc-phoebes-cat-co-indoor-hunting-cat/dp/179101

Cat nip balls: https://www.amazon.com/Potaroma-Silvervine-Catnip-Healthy-Cleaning/dp/B08T7493WJ/ref=sr_1_2_sspa?crid=2MIY8OB36U2B0&keywords=catnip%2Bballs&qid=1663263254&sprefix=catnip%2Bball%2Caps%2C118&sr=8-2-spons&th=1

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“The Good Death”

The weird, complicated process that is ending suffering and why it’s NOT the worst part of my job.

***Since euthanasia can be a really sad subject, the pictures in this blog are animals who were saved from euthanasia***

I was going on my usual neighborhood run with the dogs and was coming up on a neighbor’s house who had a dog that I had treated recently. In my tired, oxygen deprived brain, I was thinking – like I had been for the past several weeks – “I wonder how Axle is doing? I should call them.” Then, I remembered with a sinking sensation: “Axle is gone, stupid, you euthanized him last week.” Then, of course, I spent the last agonizing miles going through all of his labs and imaging in my brain trying to figure out what had been wrong with him and if I had missed anything or if I could have done better somehow. This all got me to thinking though about the oddity that is euthanasia and all the weird components that go into it.

Merlin was brought in for euthanasia after his mother mangled his back leg when he was 3 days old. After a leg amputation that was like surgery on a chicken wing, he grew up and lived another 8.5 years before he succumbed to his joint issues.

The most common assumption about my job that I get is that euthanasias must be the hardest part of the job. For ME, for the vast majority of the cases, euthanasias are (and you’re going to hate me for this) actually one of the easier parts of the job. You don’t have to figure anything out, I have a set way I do it EVERY time, and the only challenge is hitting a vein – which I’ve gotten pretty good at. So, between the 19 year old cat that weighs 3lbs here for euthanasia or the 8 year old english bulldog with all the skin, ear, and eye problems and the owner who refuses to keep up on treatment and wanted to know why you couldn’t just give them antibiotics every 2 weeks? I’ll take that euthanasia, thank you.

Catina was brought in for euthanasia as a feral barn kitten with two ruptured eyes from a viral infection. After months of just sitting and reading a book aloud, her anger, fear, violent hissing/biting when handled went away and she is now the sweetest cat who loves attention

So, what’s wrong with me? Am I souless? Do I not care about the love and devotion people have put into their life time companion? Why do I not break down crying and sobbing with the owners every time I have to stop an animal’s heart with an injection and wonder if, when I die I will be punished or not? So, hear me out.

Penelope was saved from death after being brought in as a frozen kitten found in a ditch. Her heart stopped during revival and had to be resuscitated. Now she’s an ungrateful spicy kitty that is well loved.
  1. The vast majority of euthanasias are a good thing. Animals who have reached their limits of life’s comfort and are mostly miserable everyday. Pets and friends who no longer want to get out of bed, can’t keep food down, get confused about where they are, are becoming skeletal despite a good appetite, have a mass that is taking over their body or has ruptured and is bleeding out. Basically, giving these pets the gift of taking away their pain is almost relieving. It is difficult for the client because they are struggling with the decision to euthanize – something we don’t have to deal with (though would like to) in the human world – and are losing their best friend. But, as an outsider, looking in, all I see is a pet that has run out of options for seeking comfort and I’m just sparing them the agonizing wait of slowly withering into nothing, starving to death, bed sores, fear and anxiety as they slowly suffocate from heart failure, daily pain that prevents them from any normal functions.
  2. Vets, especially the ones who have been practicing awhile, have established deep, dark pits of space where they take hard emotions and bury them down deep. We get all the emotions thrown at us on a daily basis – happy, sad, stress, guilt, anger, frustration, irritation, self loathing, client loathing, patient loathing, public loathing, loathing (generic), annoyance, etc, etc, and if we actually take the time out of our day to process these emotions, we would never get all the patients seen that we are required to see (not to mention the ones that get shoved in when there is no time and the ones we have to send away that hate us and write terrible things about us). Therefore, to survive as a professional and a human, who then has to have functioning relationships with real people away from work, we have gotten super good at flaring with that emotion and then shoving it down into our deep dark caves of oblivion. When you’ve dealt with all that in a day and then you have to euthanize something. This is straightforward. And….
  3. We euthanize animals ALL THE TIME. All day, everyday, with extra ones being added right before holidays for some reason. Eventually, a thick callous is formed and it just becomes another task in our day. If we’ve been working with a patient for a long time, if the need for euthanasia is sudden and traumatic, sure, it’s way harder on us emotionally, we’re not monsters.
  4. If we feel that a euthanasia is NOT warranted, we will talk to the owner and try to convince them that maybe this is a treatable or completely fabricated illness (I had one cat euthanasia on a 4 yo cat who was just prancing around the euth room, purring, rubbing my hands and the complaint was she hadn’t pooped in 4 months. I finally convinced them that if that were the case, she would be dead and that she was very likely pooping in a place they haven’t found). I have stopped euthanasia on animals that were being put down for being “miserably itchy all the time” and had no hair. Turns out, they just needed flea medication. Sometimes, medications haven’t been tried and even chronic diseased patients can get several more months of relief with the introduction of these meds. Sometimes, the owner is just not equipped to care for the patient and another owner can afford and dedicate the time to give the animal a great quality of life. But, I’ll tell you what, broaching the topic is somewhat a delicate thing as the owner has likely already been stewing over this decision and introducing even a tinge of doubt can be traumatic for the owner especially if it comes down to a money issue. At the same time, we can’t afford to rescue every animal ourselves and the animal has to be pretty “sellable” (super sweet, not a sketch ball, not super complicated) to convince other people to adopt (as bad as that sounds.)
  5. Finally, yes, euthanasias affect us. We are not monsters. I can walk into a room, connect with the owners and feel their sadness, feel their depression and their guilt. I make it my priority (after confirming that the animal needs to be euthanized) to make the owner not feel guilt or regret. I talk to them and console and re and reaffirm that this IS the BEST decision they could be making and that it is the RIGHT decision. My job is to the client at this point and once they have rightfully decided to end a patient’s suffering, they need to know that a professional in this field 100% agrees with them. But the WORST euthanasias, by far, besides the obvious when you have worked with a patient for a long time and know the animal and the owner and their full life story, is when there is either an old man, a hardened Clint Eastwood type man, or children in the room. I have a very hard time when that old, withered man who looks like he hasn’t cried since he was a toddler and is ashamed of even that time, has big fat tears welling up and he doesn’t want you to see him. It’s okay, you can cry, I won’t tell anyone. Or children when they seemingly understand what’s going on and then once I say the patient has passed then they get a wild, panicked look in their eyes and ask “You mean he’s DEAD!?!” and then burst into tears or screaming.
Wicket was saved from euthanasia after she was born with no bones in her front legs.

Euthanasia is easily the saddest part of the human/animal bond. Whether it’s saying goodbye to a best friend you’ve had since you were a child, or the only thing left you have to link you to your husband who died last year, or even in an unexpected emergency, it’s never any easier, but it is also a sense of relief. Our job as veterinarians is to make sure you make the best decision for the animal and make sure you feel okay with it. When it’s clear cut, nothing could be easier for me than to decide to end the suffering of the animal and to be it’s advocate when the owner’s mind and heart are understandably muddled with emotion.

Heggie – saved from euthanasia and rehomed with a clinic employee.

That all being said, it still sucks.

Anything but bad luck for Dan, the office cat. Saved from euthanasia after being hit by a car and left at the clinic with a broken tail and jaw. Now demands attention (and food) all day from employees and clients alike.
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Is this an Emergency?! Common Over- and Under Reactions

Veterinary offices everywhere are struggling to keep up with the demand of the needs of pets lately and some folks are having to wait a couple of weeks to months to get things addressed. This is causing excessive spill over into the Emergency Clinic world. Suddenly, a place that was designed for the super severe, complicated, or tragic cases that happen in the middle of the night are now clogged up with ear infections and dogs that have been limping for 2 hours. Then, they are getting horrible reviews and dragged through the mud on social media for owners having to wait 8 hours and having to pay hundreds of dollars more than they would at their regular vet (if they have one). People sometimes forget how much money it costs to keep a top tier facility like that open 24 hours a day and fully staffed to be able to drop everything and take your dog to surgery for a bleeding abdominal mass. They also forget that a non-emergency is going to continue to get bumped by the actual emergencies that may not live through the night. So, I decided to come up with a list of things that are absolutely not an emergency to save numerous angry owners from the long waits and heavy fees of going to a place that is currently doing CPR on a dying dog. Then, I will have a list of things that are absolute emergencies that some owners might wait a little too long to address which could lead to more money spent, but more importantly, a poorer outcome for your pet. Also, please read my previous post “5 ridiculously easy ways to avoid pet emergencies and BIG bills that your vet doesn’t want you to know… oh, wait.”

Things that often present as emergency, but are not.

  1. Ear infections. Yes, these can be painful and itchy, but save your trip to the ER. It can wait until regular business hours. Ear infections in dogs and (lesser) cats are not like infant/child ear infections in that they typically don’t cause fever and significant internal pain. The vast majority of ear infections in dogs and cats are external to the ear drum and therefore, not as serious. Most ear infections can be prevented with diligent observation of the dog’s ears every now and then – are they red? Do they smell bad? Is your dog shaking/scratching ears more often? Your vet has some amazing ear cleaners that can prevent the infections to begin with if your dog produces excessive ear wax. Most infections are caused by breed (Here’s looking at you, Cockers) and allergies. Dogs can be kept on allergy meds (talk to your vet for recommendations) to prevent the excessive wax production that the little buggers (bacteria and yeast) love to thrive on. Your dog suddenly have fire-red ears on a Saturday night and won’t stop digging/shaking? Give 1mg/lb benadryl (So, 50lb dog will get 50mg benadryl – DON’T Give children’s liquid if it has xylitol in it) every 8 hours and wait for Monday morning to call your vet.
  2. Limping. Ugh, so many. Unless you feel like the leg is broken ie. dangling, bent in unnatural way, bleeding, largely swollen, or dog screams if you touch the leg (30min after injury) it can probably wait until normal business hours or may even resolve by that time. Yes, occasionally we will get a broken leg, more often, a torn cruciate (ACL tear) – big dog playing hard, screams, holding back leg up – but more often than not, it’s a sprain or strain and will not show up on an x-ray and will get better with rest.
  3. Bleeding toe nail. There’s a saying in medicine “the farther from the heart, the more likely to live”. Your dog is MORE than likely not going to exsanguinate from a bleeding toenail. If your dog will let you, elevate the leg, apply pressure with your fingers to either side of the toe involved, apply cornstarch or flour (all purpose, cake, self rising, I don’t care) until you get the bleeding to stop. If he won’t let you, send him out in the yard and forget about him for an hour.
  4. Vomiting…. once. We see it all the time. Client rushes into the clinic on emergency for vomiting dog. We’re all geared up for the next train wreck foreign body surgery, blocking off appointments to make sure we have enough time, and when we get into the room, we find out the dog vomited once last night – but ate breakfast this morning. Or vomiting three times 10 days ago. Or had diarrhea once. Would you rush yourself to the ER if you had diarrhea last night, but felt fine today? Or if you vomited three times last week, but have been fine since? Now, if a patient has been vomiting several times in a day, absolutely it could be an emergency, especially if they can’t keep anything, including water, down.
  5. Any skin issues. When I was working shifts at the ER, we would get someone waiting 8 hours to be seen for skin issues and end up paying 10x the amount they would at their regular vet due to increased costs of running a 24/7 clinic. Flea prevention goes a REALLY long way in preventing these, but even then, likely it can wait until normal business hours. Hot, inflamed skin that pops up all of the sudden and is oozing and terribly itchy? Trim the hair away from it, clean it with mild soap (Dog oatmeal shampoo if you have it, baby shampoo if not), give 1mg/lb benadryl every 8 hours until you can get to your regular vet.

Things that ARE an emergency but people don’t always take seriously

  1. Eyes! Eyes are always an emergency. Even when they’re not, you should still treat them like one until proven otherwise. One eye squinty? Redness, swelling? Drainage with squinting? Bluish color or cloudiness to the eyes? Any wound involving eyelids? Take to the vet NOW. Could it be something simple like conjunctivitis? Sure! But it could also be an ulcer or scratch or hole in the cornea that causes your pet’s eye to rupture and have to have their eye removed. Lacerated eyelids need to be repaired ASAP to make sure they are aligned correctly without too much “shrinkage”. If the repaired lids do not line up pretty perfectly, it will lead to problems in the future – like increased risk of corneal ulcers. Sometimes animals get foreign bodies in their eye that need to be either flushed out, or the eye needs to be numbed and the vet will look behind the third eyelid for sticks, grass, bugs, etc that will continue to scratch the eye every time the animal blinks. Eyes will either heal up like nothing ever happened or can turn into a train wreck in just a matter of hours.
  2. A male cat (neutered or not) that is straining or vocalizing in the litterbox. Male cats, as you can imagine, have VERY tiny penises with even tinier urethras. Any amount of crystals can get caught in that very tiny urethra as it twists and turns around the pelvis to get to the end of the penis. Once the crystals get backed up to the point of blocking the flow of urine, the bladder starts to fill like a water balloon left on the spigot. Not only will this put extraordinary pressure on the kidneys, but if the bladder eventually pops, your kitty is pretty much done.
  3. Bloated dog that is not eating or is vomiting/retching or is really really sad looking. Especially deep chested dogs. You can even thump on the belly and if it sounds like an empty drum, it’s gas. Big belly, happy, wagging tail, jumping around? Likely just got into something and ate too much (food bloat) but still, take in for radiographs to just make sure. Gastric dilatation volvulus GDV is a condition where the stomach bloats with gas, then flips over, cutting off the blood supply to itself and the spleen. This means you have mere minutes to jump in the car and get to a facility capable of dealing with these. You will likely need to get to a 24 hour emergency clinic as the dog will need surgery, then intensive hospitalization care as the dog can literally just drop dead hours to days after the surgery due to toxins released when the stomach is righted and the effects of those toxins on the heart. It will be vital to have your dog at a facility that can constantly monitor electrolytes and the heart to prevent this. Most small clinics likely will not be able to handle this entire procedure correctly. Ask your regular veterinarian if they are capable of performing a GDV after hours before it ever happens so that you don’t have to waste time calling them only to have them tell you to get to the ER. Get your dog in the car, start driving, have someone call the ER to give them a heads up on the way. This way they will be set up and prepared to properly treat your dog in an expedited fashion.
  4. Vomiting and unable to keep anything down. Sure, dogs sometimes throw up and it’s no big deal. They go out, eat some grass, vomit, but later, will eat a whole bowl of food and never look back. But if the dog has vomited multiple times, seems lethargic, and/or anytime he eats or drinks anything, it comes back up – DO NOT wait to bring these in. These could be a multitude of issues, but all need to be taken care of ASAP. It could be a foreign body, intestinal blockage, intussusception, intestinal torsion, pancreatitis, etc. Some are surgical, some need intensive hospitalization, but one thing is for sure: the longer you wait, the much much worse it will be. Waiting could result in severe dehydration with multiple organ damage, intestines dying or rupturing, causing deadly infection of the abdomen and body, and a general rapid regression in the overall prognosis of your pet. Foreign body caught right away – simple incision into intestines, suture back up, go home that night. Foreign body after three days: possible inches to feet of intestines removed, infection, days in the hospital, possible death. You may expect to pay a bit more for an emergency visit, but the longer you wait, the more exponential the bill will increase.
  5. Intact female dog doing almost anything. Vomiting? Drinking and peeing a lot? Lethargic? Vaginal discharge? Swollen abdomen? Any or all of the above? Not currently in heat or knowingly pregnant? Intact female dog (and sometimes cat – but more rare) coming in sick for almost ANY reason is a pyometra until proven otherwise. I discussed this a little before on how to save big bucks on major vet bills (spay and neuter), but a pyometra is where the uterus gets an infection and because it’s just a huge sack of pus hanging out in your dog’s abdomen, it causes grave sickness and if it leaks or ruptures, likely death. It’s easy to diagnose and easy(ish) to treat. Notice your intact female sick and take her in right away, if she is diagnosed with a pyometra, they will take her straight to surgery, remove the entire sack of pus without leakage and she will be a new dog when she wakes up. Wait a few days or try to nurse her at home, she will quickly become septic (whole body infection) and require prolonged hospitalization and a much greater risk the sack of pus will leak or rupture during surgery (all that bacteria, inflammation, and stretching of the uterus makes it super weak and friable) and that will lead to an even poorer prognosis.

In the end, if you aren’t sure, try calling the ER and finding out how emergent your pet’s issue is.

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Vet Medicine: the greatest career on Earth

So, you read about all my whining and complaining in the last blog. Being a vet is TOUGH. Understanding that you can treat an animal without having the exact diagnosis and without choosing the same treatment as any other vet (there will never be full consensus on treatments for any disease, ever) takes a long time of feeling like a failure, staying up nights worrying that you didn’t treat something right, wondering if you should have gone with the high dose, short therapy or the lower dose long therapy. Are you causing antibiotic resistance? If you don’t send an antibiotic home, will the owners hate you? Will you get a bad review because, even though you spent hours researching and worrying, the animal didn’t get better, or another vet threw you under the bus? So, why even try? Why enter this field?

Because it’s FREAKING AMAZING!! That’s why!

Reasons it’s FA (freaking amazing): The animals, obviously. Granted, you LOVE animals, but must accept that they hate you. You must just understand that you’re doing it for your love for them, and not to win their love (though I handily try with multiple treats and a slow approach). It’s much like being a mom or a religious leader. You care for and are responsible for others, but they might not like what you have to say or do. Occasionally you get the adorable puppy/kitten, but sometimes you have to deal with the jack-wad pet. If you are companion animal, most of your patients will be middle to older aged animals with skin, ear, endocrine issues. If you are large animal, most will be reproductive, preventative health, and emergency. Most of the animals are happy with you anyway, especially if you keep pushing the treats.

The SCIENCE – if you love science and seeing things work like you read about, you will love vet med. It doesn’t always work out, but when it does, it feels MAGICAL – and it works out most of the time. You get a rush of dopamine (this is not proven, just theorized) when you hear back from a patient you’d been working on and hear that they’re SO much better! Even when it’s just an older dog with probable arthritis and the owner didn’t think it was pain but was willing to do a trial of pain meds. They call back and go on and on about how much like a puppy their old Bella has become. It makes my insides smile.

Not arthritis

You can FIX things! Sometimes this feeling is amazing! Female intact dog walks in, sick as, well, a dog, you find it’s a pyometra (uterus is huge and full of pus). The dog looks like death, but with a 30 minute surgery (spay), the dog is back to almost 100% overnight! Laceration repair can be tedious, but is like creating a work of art. Indoor/outdoor cat comes in with a swelling and a fever – cat bite abscess – super rewarding to drain the abscess and the cat is back to normal by the next day. There’s nothing like the feeling “hey, your animal has this problem, but don’t worry, I’ll fix it!” The feeling only gets super frustrating when the owner chooses not to treat for one reason or another (finances, chronic issues that require multiple rechecks, long-term medication). Then, this leaves you totally frustrated – “but I can fix it…”

Learning all the time. You may think this sounds tedious and awful, but it’s not. Again, learning something new that you can immediately apply to a case, whether it’s researching for a current case and finding an actual answer or going to continuing education conferences and learning a new fabulous (and low cost) new treatment regimen, actually gives you a rush. As a vet you are (or should be) CONSTANTLY learning, researching, RE-learning and it’s actually fun. There are always new things to learn and ways to check your pride and try a different methods and while you’ll find yourself frustrated in the moment, and may take awhile to institute the change, you’ll be elated when it all falls into place. Because – science.

The clients! (okay, there are some sour lemons, but with the current demand for vets and long waiting list to get an appointment, we have the luxury to “rehome” clients who are naughty) Are you a people pleaser? Do you get a physical giddy sensation when you make someone happy? Vet med *can be* for YOU! For the most part, clients are extremely polite, understanding, and grateful for what you do. I think it helped my client communication skills to be a large animal vet for awhile. When you’re stuck standing over a newly gelded colt, waiting for him to get up, you learn how to chat with people and not feel awkward. Depending on the client’s attitude toward me (the more positive, they more they get), I will go to all sorts of lengths to make sure they and their animal are getting free samples, internet sources, brochures, under the table treatments (slip in a free nail trim), etc. If a client is cold and dismissive, they will get what they ask for and that is it.

Then there’s the not so obvious perks to being a vet; Comradery – Everyone in the vet world is stressed and many take it out with a twisted sense of humor. When you find the right clinic, it’s like getting together with your friends every day – joking, griping together, getting excited over gross things, inappropriate humor. Everyone working in your field (or at least the vast majority) love animals and share the common goal to help people and their animals. I’m sure there are others, but how many other work places do you have where everyone in the company has the same interest? Want to talk about your cat’s cute way she chirps to you? So does your co-worker!

Rescues will be a commonality in your field. This pup was born with no bones in her forelegs and now belongs to a co-worker

Something for everyone. You like working with your hands? Large animal is perfect for you, prefer indoors with more meticulous skill? Surgery is for you! Like both? Do both!! Don’t like working with your hands? Medicine. Pathology. Teaching. Like people? General or referral practice. Don’t like people? Pathology, lab animal medicine. Want to practice medicine everyday, great! Don’t? Government work! Like people, but only your kind, and not general public? Become a drug representative, traveling to clinics telling them about all the new products coming out! Want to work all day everyday, and be on call – don’t worry, there’s plenty for you! Only want to work 3 days a week? Pick up relief shifts! Night owl? Work emergency overnight shifts. ***These examples are all highly generalized, and I’m 100% sure vets working in all of these fields will have something to say, but my point is there’s a job out there for anyone with a Veterinary degree, don’t just envision working at a clinic***