Now that I’ve squandered half the essay on terminology, let’s move on to something useful: questions I have been asked about spaying.
The big one: I won’t let my dog out to get pregnant, so why spay?We have a saying: “all pets get spayed, it’s just a question of whether it’s an elective or an emergency procedure.” This is because of something called pyometra. People will sometimes argue that they do not want to spay because it is “unnatural,” forgetting that what nature intends is for the animal to become pregnant with every cycle. When this does not happen, and they unnaturally cycle “empty,” there is a significant risk that the open cervix and waiting uterine bed will invite bacteria in, causing a life-threatening pyometra infection. According to one study, 23% of intact female dogs under the age of ten develop pyometra. The rate goes up quickly over the age of ten.
OK, got it, but why not just a hysterectomy?To begin with, it’s not any easier or quicker as the ovaries are right there by the uterus anyway, and while it would be just as effective in preventing pregnancy, leaving the ovaries behind would allow a dog to continue to have heat cycles. And why is this a problem? In dogs, this is a problem because 12–16% of dogs who have gone through a heat cycle will develop mammary (breast) cancer whereas almost no dogs who are spayed before the first heat develop it. Many of these are benign cancers, but they still require surgery — often many surgeries — and some are malignant. In cats it’s even worse, as 90% of mammary tumours are malignant. Moreover, anyone who is thinking about leaving the ovaries in their cat has not spent any quality time in the company of a cat in heat.
Yeah, but what about the risks?There is always some statistical level of risk with any surgery and general anaesthetic, but this is an extremely routine and safe procedure in veterinary medicine. In the 28 years I have been in practice, I cannot recall seeing a single death related to a spay. That’s not to say that it can’t happen, but the risk of death due to pyometra and mammary tumours is an order of magnitude higher.
But what about these longer-term knee joint risks I’ve been reading about?
Clever you. Nothing in life gets any simpler with time, does it? Everything becomes more complex. Yes, in the last few years more evidence has come to light linking early spaying in some breeds with an elevated risk of tearing the cruciate ligament in the knee. What is meant by early, and how much is the risk elevated? I’m going to be a wimp and tell you to ask your veterinarian. This really does have to be addressed case by case as a number of factors come into play.
So if you’re in Manitoba, or somewhere else that celebrates Spay Day, find the date and mark it on your calendar. I suspect that most of you reading this have pets who are already spayed, so use that day to congratulate them on their spayedness.
Getting Tutored
In a straw poll, veterinarians stated that their favourite Far Side cartoon was the one where a dog being driven to the vet brags to his friend, “I’m going to the vet’s to get tutored!”
This is funny several ways, but the way that is relevant to this piece is that it highlights the confusion around the terminology of spaying and neutering. Even well-educated clients will approach the subject cautiously: “I guess it’s time to get Fred . . . is it spayed, or neutered?”
For my lay readers, neuters are for males and spays are for females. At the risk of sounding unprofessional, a handy mnemonic is that the word “neuters” contains the word “nuts.” Which brings me to the next area of confusion: the widespread misunderstanding of what this procedure actually entails.
So the technical term for neuter is actually orchidectomy. “So, Doc, you’re taking out his . . . orchids???” Yeah, so that’s why we don’t use that term at all. A more descriptive term is castration. Large animal veterinarians routinely and happily call it that. The companion-animal world is different, however. Picture a sweet little old lady with her tiny, fluffy white poodle sitting neatly on her lap. He has a blue bow at the base of each ear and smells faintly of peaches. Now picture me saying, “Yes, Mrs. Butterworth, it’s time to castrate Baby.” Moreover, there are people who think that castration means cutting the penis off. Yikes! Yes, there are people who believe such things. And no, we never do that (except in very special circumstances in cats who have frequent urinary obstructions, but I digress).
What do we do then? We do this: we surgically remove the testicles. (Remember? “Neuters” contains “nuts”?) Sometimes I’m asked why we don’t just perform a vasectomy instead. This is because reproductive control is only one of the reasons to neuter. In many cases, we would also like to remove the ability to produce testosterone in order to eliminate the risk of testicular cancers and chronic prostate infections later in life as well as to help curb marking behaviour, roaming and male-on-male aggression. You’ll note that I wrote “help curb.” Too often people use neutering as a substitute for training. It is not.
Now I’m going to wade into a controversial area. Virtually all pet cats are neutered. The exceptions involve people who have had their own olfactory nerves removed. However, not all dogs are neutered, at least not at the traditional six months of age, and — here is the controversial bit — this might be OK. As I touched on in the last essay, there is evidence now that breeds of dogs that are prone to cruciate knee ligament ruptures (typically large breeds) may be at increased risk if they are neutered before their bodies are fully mature. This might mean waiting until 18 or 24 months for some breeds. There may be other risks associated with early neutering in some dogs as well. This is a complex area of ongoing research, so please (please, please) speak to your veterinarian first before making any decisions based on what you have read here or on the internet. A lot of what we do has evolved from boilerplate one-size-fits-all recommendations to a discussion of options tailored to the risk/benefit ratio specific to your pet. And this is a good thing. A confusing thing, but a good thing.
I guess that was more like toe-dipping than wading.
Finally, I’m going to leave you with one word: “neuticles.” Fake testicles so that he can keep his manly appearance. Go ahead, google it. Yes, they are 100% for real. And endorsed, it seems, by Kim Kardashian. Finally, there is help for the owner who wants to neuter their dog but has an unhealthy personal attachment to the appearance of the dog’s scrotum. Unfortunately, it’s not the help these people actually need. Comes with a nifty bumper sticker though!
Take the Parka Challenge
OK, now that summer is well and truly here, I would like to issue a challenge to dog owners. Those of you whose dogs have long fur or an undercoat, please put a parka on. Those of you with short-furred, single-coated dogs, a spring or fall jacket will do. And if your dog has hairy or floppy ears, pull up the hood or put on a toque. Got it? Now here’s the fun part: leave it on 24 hours a day . . . forever. Anyone up for this? Waiting . . . Waiting . . . Come on, you guys!
To be fair, and to make this challenge realistic, you are permitted to grow a Gene Simmons tongue and to leave it hanging out constantly for cooling.
I think we sometimes forget that our ancestors evolved in the tropics. As a result, we have an amazing cooling system with our ability to both dilate the tiny blood vessels called capillaries and sweat just about anywhere on our (mostly) hairless bodies. Our dogs’ ancestors evolved in the subarctic, which has consequently equipped them for cooling only with a big tongue that drools and a little nose that sweats (and sweaty paw pads, but that’s useless). We’ve created a few more heat-tolerant breeds, such as Chihuahuas, that have much thinner, shorter coats and big, erect ears for some of that capillary dilation action, and there is the occasional goofball black Lab who likes to sprawl in the sun, but the majority of our dogs dislike the heat.
How do you know that your dog is hot? Simple: panting. I get a lot of questions about panting dogs as people sometimes worry that it is a sign of something serious. Very rarely it can be an indication of a fever or of heart or respiratory disease, but if the
re aren’t any other symptoms of those problems, your dog is almost certainly panting for one of three reasons:
He’s hot.
He’s stressed, anxious or excited.
He’s in pain.
You should rule out stress, anxiety, excitement and pain first, but chances are, your dog is simply trying to cool off. This does not necessarily mean that he is suffering, no more so than a person who is sweating is suffering, but it does mean that you should be aware that he is hot and might actually be too hot.
The solutions are hopefully too obvious to bother mentioning, but I’ll do it anyway (in a handy numbered list again!):
Professional grooming.
Early morning and late evening walks.
Access to cool resting areas in the house.
Moving to the Arctic.
The Cats Who Might Be Canaries
I pride myself on knowing stuff, so I hate it when I don’t. And this occurs more often than I would normally care to admit. Consequently, when Abby Matheson, a woman who has owned many, many cats for many, many years asked me why there never used to be any hyperthyroidism, I was both stumped and annoyed with myself.
She was right. It was only in 1979 that reports began to emerge of a new disease in cats. Older cats were losing weight rapidly despite a good appetite. A veterinarian in New York figured out that these cats had developed benign tumours in their thyroid glands that caused the gland to produce excess thyroid hormone — a condition called hyperthyroidism. Soon, hyperthyroid cats were being diagnosed all around the world. By the late 1980s, when I was going to veterinary school, it was estimated that one in ten cats would develop it. Where did this disease come from? New diseases did occasionally arise, but they were always infectious diseases with clear origins, such as canine parvovirus, which was the mutation of the cat distemper virus, and heartworm, which was the northward migration of a tropical disease.
Some speculated that it was just that cats were living so much longer that we were now seeing more geriatric diseases, but this made no sense as the gains in life expectancy were gradual and the apparent emergence of hyperthyroidism was relatively sudden. Veterinarians, being neurotic as a group, also blamed themselves, assuming they had just missed it before. This also made no sense as the disease is dramatic and obvious in its advanced form. One researcher looked through 7,000 old autopsy reports and found no evidence of hyperthyroidism. It really was a new disease.
Various other more reasonable, but still flawed, hypotheses were put forward through the 1990s and 2000s, but to speed the story along, I’ll take you straight to what appears to be the answer. In four letters, it is PBDE. This is the acronym for polybrominated diphenyl ether, a common fire-retardant found especially in furniture foam, carpet underlay, some clothing and bedding and in the plastic housing for some electronics. PBDEs gradually, microscopically, shed into the home environment and become part of the dust. Cats, being close to the ground, are exposed to dust even in relatively clean houses. And crucially, PBDEs have been shown to be endocrine disruptors, meaning that they can interfere with hormonal functions. Thyroid is a hormone. Tellingly, PBDEs first became widespread during the 1970s. This is all circumstantial evidence, but the research evidence is mounting as well with a steady stream of ever more persuasive studies.
PBDEs were declared toxic by the Canadian government in 2004, and their manufacture and import was restricted. Unfortunately though, they are still pervasive in the environment, and industry has side-stepped the regulations by devising new fire-retardant chemicals that may or may not have the same effects. Nobody knows yet. Government regulations are slow to play catch-up. Nonetheless, I think I am seeing fewer cases of hyperthyroidism than I did back in the ’90s. What I am seeing far more of is pancreatitis. Canine pancreatitis is more or less unchanged, but feline pancreatitis has skyrocketed from a very rare diagnosis 20 years ago to a weekly one now. Did we just miss it before? The discussion is starting to sound familiar . . .
Everyone has heard the expression “canary in the coal mine.” Before the advent of modern toxic gas detectors, coal miners did actually bring canaries down into the mines. The birds were far more sensitive to the buildup of carbon monoxide than humans, so when they began showing signs of poisoning, it was an early warning for the miners to get out of there. In this context it may be interesting to note that the incidence of human thyroid cancer has increased more rapidly than most other cancers since the late 1970s. This is far from conclusive and studies are ongoing, but maybe our cats are telling us something. Maybe we should listen more carefully.
The C Word
Yes, cats and dogs get cancer. And turtles, and goldfish, and budgies and rats. Actually, especially rats. As a very general rule, most diseases exist in some form in most animals. We are really all remarkably similar under the hood. Yet people are sometimes surprised to hear it. And of course, they are upset to hear it. It is the most feared diagnosis after all.
But there are some things you should know about cancer. First of all, it is not one disease, but rather a large family of diseases. Really whenever cells begin to divide in an uncontrolled fashion, it is technically cancer. Everything from that gross little warty thing on the top of Buffy’s head right through to the aggressive volleyball-sized thing that caused Duke’s liver to fail. When these dividing cells don’t destroy important tissues or spread through the system, we call it benign cancer. When they do, we call it malignant cancer. Fortunately, most cancers are benign. To reduce confusion, a lot of us try to avoid calling the benign ones cancer at all and will refer to them as tumours or growths, but you should always ask if you are unclear — is it benign or malignant?
The second thing you should know is that even malignant cancer is not a death sentence. In human medicine many cancers are increasingly viewed as chronic diseases that, even if they cannot be cured, can be managed well enough to allow a good quality of life for a reasonable length of time. That is our goal in veterinary medicine too, with a strong overriding emphasis on the quality of life aspect. Ultimately it does not matter what label we put on the disease; what matters is what we can do to provide a good quality of life. The cancer label is not helpful — there are many non-cancer diseases that are worse than many cancers. To be sure, there are too many cancers where we have to move rapidly to a euthanasia conversation, but my point is to not view all cancers the same way as there are some that can be easily managed to provide that good quality of life for some time.
I am sometimes asked, “Aren’t we just prolonging his life?” If I’m in the right mood, and if I know the client well, my answer to that is, “Every time you take a breath, you are prolonging your life!” It’s true. The name of the game for every organism is life prolongation, just so long as it is without suffering. An animal doesn’t know how long it’s supposed to live. It has no thought for tomorrow and no anxiety when I tell their human companion that we can probably only keep it comfortable for another six weeks. Each happy day for an animal is a happy day. It’s that simple. We just want to string together as many of those happy days as we can.
The other stumbling block in treating cancer in pets is the word “chemotherapy.” Some people react quite strongly when I suggest it, as if I’ve now crossed a line into ridiculous territory. But chemotherapy just means drugs to treat cancer, and much like the cancers themselves, there is a huge amount of diversity in these drugs. The most common treatment for a malignant bladder cancer is the same drug we use for arthritis (a non-steroidal anti-inflammatory). Used for cancer, it is “chemotherapy” (oooh! aaah!). Used for arthritis, it is not. Exact same drug, exact same dose. Even aggressive chemotherapy drugs that can have really unpleasant side effects in humans often have far fewer side effects in dogs. (Cats are a different story.) And we have the huge advantage that if one of our patients does become sick on the chemo, we can just stop. At least we tried. The bottom line here is not to dismiss chemotherapy just becaus
e it’s a scary word. It’s not for every pet with cancer, but it is for some.
And finally, I am often asked about cause. People will say, “But we feed her the best food.” Or they will ask about the lawn fertilizer or the water or the neighbour’s treats. The truth is that none of these have any bearing. Cancer in pets (and in people, a few uniquely human high-risk behaviours excepted) is mostly due to three things: genetics, age and bad luck. The genetics is obvious as certain cancers are far more common in certain breeds. This doesn’t mean that Fido’s parents or siblings had to also have it for it to be genetic, it just means that the risk for an individual in that breed is higher, like playing with loaded dice. The age risk should also be obvious. As time goes on, your DNA accumulates damage and errors, like an old car or an old house, and some of that damage and some of those errors could lead to cancer. But the biggest factor is simply luck. The body of even the tiniest animal is inconceivably complex. When you begin to look at that complexity, it starts to seem amazing that diseases and disorders such as cancer aren’t actually even more common. Be thankful for what works and don’t be afraid of what doesn’t. Sometimes it’s not as bad as you think. Be like your pet and ignore the labels and words and just work to make each day as good as possible and then enjoy that day.
Making the Decision
“I don’t want him to suffer.” Mr. Zielinski was looking at Prince, his 13-year-old German shepherd, as he said this. Prince was breathing so heavily that it was almost the only thing he could do. He could barely walk a dozen slow steps before flopping down and heaving his chest again, his mouth half open. Mr. Zielinski was not a sentimental man. He had worked his entire life in a slaughterhouse and clearly prided himself on being practical and no-nonsense. But now his eyes were red, and his voice was barely above a whisper.
The Accidental Veterinarian Page 10
