They don’t see the point because the pet looks healthy to them.
They don’t see the value in vaccination or other preventative measures.
They worry that it is going to be too expensive.
They worry that it is too stressful for their pet.
They feel that they can sort out a lot of issues on their own with the help of the internet.
Ah, the internet. You’re probably expecting me to launch into a diatribe about the dangers of consulting with good old Dr. Google, DVM, but in fact there is a lot of helpful information out there. And a lot of harmful information too. And a lot of information that is outdated because it has just been cut and pasted from site to site over the years. Your veterinarian can help you sort out which information is valid, and which is not. I like to send people to VeterinaryPartner.com, and there are other similar sites as well that your veterinarian might recommend. But even the best information, regardless of the source, cannot replace experience and judgment and hands-on assessment. This should be obvious, but evidently it is not always.
If you’re reading this, you’re probably a reasonably regular visitor to your local vet clinic, so I imagine that I am, as the saying goes, preaching to the choir. Nonetheless, it bears stating clearly why regular veterinary visits are important. To begin with, animals age at anywhere from five to seven times the rate of humans, so our recommendation of annual visits is like saying you should go to your own doctor roughly a couple times a decade. Or to put it another way, the average healthy pet might see us a dozen to 15 times in their life. Hardly too often.
The next point is a blindingly obvious one. Animals don’t talk. Veterinarians are not necessarily better at interpreting barks and meows, but we are trained to look for subtle clues regarding the animal’s health. Often in life it is difficult to pick up on gradual changes in the familiar. Most parents have experienced the phenomenon of suddenly noticing how their child has grown when in fact it was of course happening every day, just a little bit. Animals instinctively hide signs of illness more so than humans, so without attention to these small chronic changes, something can be missed that might have been easier to treat before it became obvious.
Thirdly, there is a less obvious factor: building a relationship with a clinic and its veterinarians. If we know your pet and have seen it regularly, it makes it so much easier to quickly arrive at a competent response to a crisis. And a crisis will likely happen someday. How many people manage to get through their own lives without at least one urgent medical visit? Also, I would like to say that we treat absolutely everyone equally, and I know most of us really strive to, but we are human, and given the sometimes extreme demands on our time and attention, we will focus more on the pets we know than on the ones we don’t. And we are more likely to do special favours, whether it’s regarding the bill, or a possible house call, or an extra phone call, or more research, when we know the people and the pet. It’s just the way it is.
All of the above is just in reference to check-ups. I haven’t even mentioned the importance of regular preventative medicine, whether it be vaccines or treatments to prevent fleas or ticks or heartworm. These are all topics that I will explore in more depth in this section on the science of veterinary medicine. I will also share some stories on other (sometimes vaguely) scientific and medical subjects as an alternative to that charming but capricious Dr. Google, DVM, but of course never as a replacement for conversation with your own veterinarian. And if I can ask a favour of you: if you know somebody who has an “unknown unknown” pet, and you are done with this book, please pass it along to them. Maybe they will learn something about veterinarians and veterinary medicine that will surprise them. And maybe, just maybe, this will lead to their pet becoming a happier and healthier “known known.”
The Purr
Let’s start our discussion of science with a cat story. A little one about one of this mysterious species’ most asked-about mysteries: the purr.
Few things gladden the heart of a veterinarian like a healthy kitten check-up, especially if it is after a long series of messy, complex, sad, smelly or chaotic appointments (in other words, a normal day). You walk into the room, introduce yourself and then proceed to stroke a fluffy, happy kitten while discussing various easy kitten care subjects with the happy owners. I imagine that when some of you picture the life of the small animal veterinarian, you picture something like this. Well, it represents somewhere between 2 and 3% of what we do (see reference to sad, messy, complex, etc. above), but it is a lovely 2 to 3%. After the stroking and chatting you begin to examine said kitten. This is also pleasant as it hasn’t learned to hate you yet. Then you place the stethoscope on the kitten’s chest and hear . . . amplified purring. This may sound cute, but it is annoying as you really do want to hear the heart and lungs. There are a few different tricks to get them to stop, but my favourite is to carry the kitten with the stethoscope still in place over to the sink and then turn on the tap (slowly and carefully lest you freak the kitten out and the visit shifts into the messy, complex, chaotic column). This almost always surprises them enough to make them stop purring for a few seconds.
The owners typically chuckle about this and then sometimes ask, “So why do they purr?”
My answer: “We don’t know.”
I was tempted to end the story there, just for dramatic effect, but that would be irritatingly glib. And also disingenuous because although we don’t know for sure, we do have some decent guesses now.
First of all, what actually is a purr? There used to be all kinds of wacky theories, but the answer ends up being the most obvious one: the purr comes from a vibration in the larynx (voice box) controlled by the rhythmic pulses of a neural oscillator in the brain. OK, the neural oscillator part may not be that obvious, but you might have guessed at the voice box. Cats with laryngeal paralysis can’t purr. Some of you may have a cat that doesn’t seem to purr. This does not mean that they have laryngeal paralysis, which is quite rare; rather, the thinking is that some purr so quietly that you cannot hear it. These cats will still have a vibrating larynx, but you would have to know exactly where to feel, how to feel and, most importantly, when to feel in order to detect this. The number who truly never purr is likely really very small, like people who truly never smile.
Which brings me to the main question, the why. Is it like smiling? The answer that is emerging from the fray of competing theories is that purring does resemble smiling in that it is used for social bonding, especially between kittens and their mothers (and cats and their owners with can openers). Moreover, like smiling, it results in endorphins being released. This also explains why cats don’t just purr when they’re happy, but also when they are injured or in pain. The endorphins provide natural internal pain relief. (Does this mean you should smile when someone punches you in the gut? Of course it does.) Even cooler, to my mind, is the well-supported suggestion that the vibrations from the 25–50 Hz frequency range of a cat’s purr actually encourage tissue healing. The time may not be far off when we are told to strap a cat to our knee when we tear a ligament. Obviously some practicalities would have to be worked out first.
So is there any downside to purring? Potentially, yes. Search for “Smokey — The loudest cat in the world, 80 dB” on YouTube.
The Wild Arctic Chihuahua
Mr. Jackson came in the other day with Bruiser, a 120-pound mound of muscle and fur who eats squirrels for lunch and begs to go outside when it’s –40°C. Mr. Jackson was perplexed because Bruiser’s DNA breed test had marked him as having rather a lot of chihuahua in him. Bruiser resembles a chihuahua the same way Mike Tyson resembles me.
By far and away the two most common questions I am asked by new puppy owners are “How big will he get?” and “What breed is he?” These are not subjects we are taught in veterinary school, and although with experience our educated guesses improve, they are still just educated guesses. The frustrating part is that some c
lients judge our overall skill and knowledge as veterinarians based on these guesses, and it can take years to live down a bad one. Consequently, I’ve honed the art of being vague while sounding knowledgeable.
The question of breed guessing was coincidentally on my mind that day as my own DNA test results had just come in. My wife had given me a 23andMe analysis as a gift, and one of the findings was that I am 3.2% Neanderthal, which puts me in the 99th percentile of all people tested. I like to think that nobody would have guessed this, but my wife disagrees.
Mr. Jackson had used a similar test that is available online for dogs (they mail you a cheek swab). He was not the first. I have had numerous clients over the years test their mixed-breed dogs, perhaps frustrated by my knowledgeable vagueness.
The most popular of these tests purports to identify a truly astonishing range of breeds, from Affenpinscher to Yorkshire terrier, including such oddities as Bergamasco, Glen of Imaal terrier and Xoloitzcuintli. I cannot vouch for the accuracy of this apparent extreme specificity, and in fact, at the risk of hearing from someone’s lawyer, I will confess to a tiny bit of skepticism. In contrast, 23andMe is only willing to express confidence that I am generically “European,” despite the fact that most of my known ancestors, back 13 generations in some cases, are specifically German. But getting back to dog breeds, I can say that despite the impressive list, the tests are missing one type of dog, and that gap trips people up here, and I suspect throughout western and northern Canada.
So here’s the thing:
The thing is that many of our clients, including Mr. Jackson, get their dogs from shelters, and the shelters here are full of dogs from remote First Nations in the North. So, am I saying that the northern Manitoba bush is seething with packs of wild Arctic Chihuahuas? No. What I am saying is that when the Indigenous people came to North America across the Bering land bridge around 15,000 years ago, they brought dogs with them. These dogs were not any particular breed; they were simply, and quite beautifully, I might add, “dogs.” The Aztecs began breeding these dogs into a specific line that became what we now know as chihuahuas. The DNA test then sometimes picks this up as the closest match for Bruiser and his friends. Look carefully at the next chihuahua you see and take note of the curled tail. The other breeds with curled tails are all northern breeds in the family group sometimes called the spitz type. Other members of this group are chows and Akitas, and their DNA sometimes also cross-reacts with our reserve dogs.
Fortunately for Mr. Jackson’s ego, Bruiser’s test also highlighted husky and Lab. Chihuahuas are actually very tough, but they do have an image problem with some people. Especially people who name their dog Bruiser.
The Nature of Nature
Nature is not your friend, or your pet’s friend. It is not your enemy either, but it is not your friend. It is simply indifferent. Like that cool, funny, attractive, intelligent person you wish you could get to know better, but they’re too busy being themselves.
I’m probably going to get some hate mail for this, so let me first reassure the reader that I actually do love nature, regardless of how it feels about me. I spend as much time in the wilderness as possible, I contribute to environmental causes, I make my own yogurt, I buy eggs from pasture-grazed chickens direct from the farmer, I can distinguish the two species of nuthatch at 50 paces and I have been known to wear Birkenstocks. With socks.
Unfortunately, however, for some people, including some pet owners, love of nature has become confused with believing that medications and foods labelled “natural” are better for their pet’s health. There are two distinct problems with this belief.
The first, as I indicated above, is that nature is not your pet’s friend. The most potent cancer-causing agent yet identified anywhere is aflatoxin, which is produced by a certain mould on peanuts, rice and a few other foods. Tiny amounts that are undetectable to the eye, nose or taste buds are enough to cause a problem. Aflatoxin is perfectly natural and has been around since we were still living in trees and grunting at each other. And it has cropped up in some small-batch dog foods with poor quality control. This is just one example. There are many, many more.
Another way to look at this is to consider the lifespan of wild animals living fully natural lives. Wolves, for example, generally average around seven years, not much more than half the lifespan of many domestic dogs. Middle-aged and older readers may wish to shield their eyes, but if nature is indifferent to our fate, it is supremely indifferent to the point of negligent about our fate once we are past reproductive age.
The second problem with seeking out products labelled “natural” for health purposes is that the term is unregulated and effectively meaningless. I have no particular affection for the giant pharmaceutical corporations and their profit-seeking distortions of science, but if you believe that a product that happens to have a smiling Peruvian on the label and uses a funky, earthy font is truly natural and, moreover, is somehow made by a non-profit collective that only has your pet’s very best interest at heart, then you are naïve. Ditto for pet foods named Purple Antelope or Green Beaver or some other marketing department–driven bewilderment. The only difference is scale. It’s almost all profit driven, and it’s almost all designed to sell as much product as possible.
If you can gather it or grow it or raise it or hunt it yourself, and if you have solid research (statistics, not anecdotes, please!) to back up its safety and efficacy, by all means, go natural! But if you are buying it packaged, be wary, be skeptical. It’s not necessarily bad, but it’s certainly not necessarily good either.
Many people have the charming belief that something wouldn’t be allowed to be sold if it wasn’t safe and at least a little bit effective. The truth is that if it doesn’t require a prescription, it is either very loosely regulated or not regulated at all. A giant firehose of over-the-counter nutraceuticals, supplements, herbal remedies and “natural” cures of all description is aimed at us, and nobody has the resources to test and double-check even a fraction of it.
And as I write this, nature is producing –43°C wind chills out there. So please keep your pets in the unnatural confines of the house until the natural winds subside.
The Stoic and the Cassandra
“He’s not in pain, Doc. I checked him all over. Felt everything and he didn’t react. I don’t know why he’s walking like that. Maybe there’s something stuck in his paw that I can’t see?”
Jake had come in with a pronounced limp, and Mr. Hudson had done exactly what any concerned pet owner would do and tried to find the sore spot. Some variation of this scenario plays out every day in the average small animal practice, sometimes several times a day.
I knelt down and greeted Jake, a friendly collie/Lab/shepherd mix, and gave him a couple of his favourite liver treats. He wagged his tail and was going to try to lick my face, but I moved his head aside to begin my exam before he could. I don’t mind the occasional dog “kiss,” but I knew that Jake was also a notorious poop eater. I began to palpate and manipulate each limb from the toes to the top, starting with the apparently normal ones and finishing with his right hind leg, the one he was limping on. (Incidentally, everyone thinks there is something stuck in the paw, but that is very rarely the case unless you see the dog chewing at the paw.)
“Like I said, Doc, I already did that, and I couldn’t find anything that hurt.”
Jake didn’t react for me either, but I did feel a subtle swelling in his right knee joint, and he had what we call a “positive drawer sign,” in which the tibia (shin bone) is able to slide forward relative to the femur (thigh bone), a bit like a drawer opening slightly. This meant that Jake had torn his cranial cruciate ligament, called the anterior cruciate ligament, or ACL, in humans. So, isn’t that painful? If so, why wasn’t Jake reacting? Yes, it is painful, and Jake was not reacting because he is a stoic.
Not that many dogs or cats have human “ouch, that spot hurts” reactions to pain. Some
do, but most don’t. Most are either stoics or Cassandras. The stoics, like Jake, prefer not to show any sign of pain. This is in part because in nature, showing pain can make you an easy target. This is especially true of prey species such as rabbits, who are ultra-stoic, but it is also true of social predators such as dogs, who might be in danger of losing status. That said, there is tremendous variation among breeds and among individual dogs.
So if stoics won’t let you identify the location of the injury because they won’t show pain, what do Cassandras do? In their most extreme form, Cassandras scream if you take a small step in their general direction. If they do let you examine them, they will show what seems like pain (more screaming) even if you are only vaguely in the vicinity of the problem area. You might be able to generally localize the problem as front end versus back end — maybe — but that’s not all that helpful.
As a sweeping generalization, dogs are more likely to be stoics, and cats are more likely to be Cassandras, but there is a lot of crossover.
What is the poor veterinarian to do with the patient that not only refuses to speak English, but is likely a stoic or a Cassandra? As Jake’s story illustrates, we perform a specialized kind of physical exam where we feel for what might be swollen, out of place, loose and yes, in some cases, sore. Sometimes X-rays are needed. And sometimes even then, we have to make educated guesses. Thank goodness for education!
Pilling the Cat
For your amusement, I invite you to type “pilling the cat cartoon” into the image-finding feature of your search engine. Have you looked at a few? Lots of lavishly bandaged people, right? Ha ha ha, right? Yes, all very funny — unless you have actually tried to administer a pill to your cat and have sustained multiple lacerations in the effort. So, in the interest of public service, I’m going to offer you two different injury-free strategies for pilling the cat.
The Accidental Veterinarian Page 7
