A surprising source for gratitude…

Can you stop and think of all you take for granted?

You wake up. You rise from bed. You feel tired. You shower and dress yourself. You make your own breakfast. You drive to work. You have a job. You feed yourself lunch. You make phone calls and write e-mails and speak fluently to your colleagues. You hear the world around you. You drive home and sit with your family. You brush your teeth. You go to sleep.

Your day may or may not resemble what I’ve described above, but chances are, if you are able to perform even just a few of those basic tasks, you do so with little regard to their significance.

What if you couldn’t do a few of those things on your own?

What if you couldn’t do any of those things on your own?

What if you depended on someone else to help you dress yourself or brush your teeth, or transport yourself? What if you couldn’t turn on a light switch or pick up your keys when you dropped them?

We face an infinite series of “what ifs” that we take for granted during our daily lives that we barely give any attention to.

Though I possess many valuable attributes, I’m the first to admit that I have more than a few serious flaws. One I am continually working on is my lack of mindfulness and the ability to retain gratitude for all that I have. I’m often embarrassed by my incessant search for “more” and “better” when I should be content with the comforts of my immediate surroundings.

When you work with animals, it’s easy to be humbled by their approach to life. Sure, a dog may wish for “more” food or a cat may long for a “better” belly rub, but overall, pets are happy just being alive. Though there’s certainly reciprocity in the connection between an owner and his or her pet, as they require humans to provide them with shelter, food, and love, ultimately things are significantly lopsided when you consider how little they ask for in return.

Now consider service animals. Those legitimately trained to perform specific tasks for people who would otherwise be unable to do so, or aid in their ability to withstand certain social and professional situations. Think of the nature of the relationship between the handler and the animal in those cases.

I’ve encountered service animals on occasion during my professional and personal life, but only recently had the privilege of learning firsthand how remarkable the bond between handler and animal truly is.

Canine Companions for Independence (CCI) is a non-profit organization that trains and provides assistance dogs for individuals with disabilities. Dogs are trained in one of four categories: service, hearing, skilled companion, and facility.

CCI responsibly breeds its own puppies, selecting for traits that include intelligence, calmness, and willingness to help. “Puppy Raisers” are responsible for their initial training and socialization from about 8 weeks of age to 18 months. At that time, dogs enter into their advanced training stage, which is performed at one of six regional training centers located across the United States.

Certified CCI dogs have been in training for over two years and know approximately 40 commands including opening doors, activating light switches, and retrieving dropped objects.

On May 15th, each of the regional training centers for CCI held their quarterly graduation ceremony. The event is the culmination of an intensive, residential, two-week Team Training course for each of the new human/canine partners.

The day is also significant as it is the time when “Puppy Raisers” return their dogs to CCI so they may begin their formal training period.

I was invited to attend the ceremony held at the CCI training center of the Northeast region as part of a networking opportunity. These events are free and open to the public without reservations, so my attendance wasn’t anything particularly unusual.

It would be impossible for me to catalog the magnitude of inspiration and emotion I felt just from my simple role as a casual observer of the day. I’ve had a surprisingly difficult time describing the event — a thoroughly unusual attribute for a writer.

There were typical feelings of recognizing all I have that I take for granted each day and the associated “guilt” about my self-centered tendencies.

I felt empathy and sadness for the people giving up their dogs to be trained

I felt overwhelmed with happiness at the joy expressed by the human partners receiving their dogs.

I felt enlightened to experience something so intimate and meaningful, yet also felt as though I barely understood the depth of emotions I witnessed.

And most of all, I wondered how I could help.

The few short hours I spent alongside the numerous volunteers, staff, handlers, etc., was nothing short of exceptional. We tend to take so much for granted every day. It’s surprisingly easy to have your mind reset to a more grateful plane when surrounded by those who remember all you tend to forget.

In the days that have transpired since I attended the event, more than once I’ve caught myself settling all to easily back into my self-centered ways. I know it shouldn’t be such a struggle to remember that I have nothing to complain about.

Fortunately I spend my days around four-legged comrades who constantly figure out ways to remind me of just that.

For more information on CCI please visit Canine Companions for Independence

When an injection leads to cancer…

Injection site sarcomas (ISSs), as the name implies, are tumors of the skin and subcutaneous tissue that develop in cats secondary to a previous injection. They are most often implicated with vaccinations, however they could develop secondary to any prior injection, including those related to administration of drugs or even microchips.

I dislike all forms of cancer, but if I were forced to pick the one I despise the most, ISS would rank among my most loathed. When a pet develops a devastating and deadly tumor, as a consequence of something its owner did to try to keep it healthy and free from disease, it’s more than a terrible or unfortunate set of circumstances.

An essential part of treatment for a cat with an ISS is a carefully planned first surgery designed to remove the tumor with very wide margins. The current recommendation is to measure a 5cm radius of tissue around the tumor, and use this as the “edge” of where surgery should be done.

With this radical surgery, tumor recurrence is dramatically reduced and, consequently, patient’s survival times are longer than expected, as compared with the typical outcomes of more conservative surgeries.

Despite the better outcome, this form of surgery is rarely initially pursued because either the person performing the surgery is unable or unwilling to perform this aggressive procedure, or owners are unwilling to subject their cats to this type of treatment.

More frequently, tumors are removed with narrower planned margins, leading to disappointing outcomes. Narrowly excised tumors are extremely likely to recur without additional local control in the form of radiation therapy (RT). Even with aggressive pre- or post-operative RT, a decent proportion of tumors will regrow.

ISSs also have a modest chance for spreading to distant sites in the body, including organs such as lungs and regional lymph nodes. Chemotherapy is offered to try to prevent or delay this process from occurring; however, results are inconclusive as to providing a clear-cut benefit.

The treatment of feline ISS has recently shifted gears towards capitalizing on the patient’s own immune system to fight the tumor cells by using a novel protocol entailing the administration of Interleukin-2 (IL-2). IL-2 is a special type of protein that regulates the activity of white blood cells as part of an immune response.

The National Cancer Institute defines interleukin-2 (IL-2) as a biological response modifier, which is a substance that can improve the body’s natural response to infection and disease. IL-2 stimulates the growth of disease-fighting blood cells in the immune system.

Kevin Whelan, Merial’s Technical Manager, explains the mechanism of action of how IL-2 works:

Following injection around the tumor surgery site, the recombinant canarypox vector virus enters the cat’s cells, which then produce interleukin-2. The presence of this cytokine stimulates an anti-tumor immune response by a variety of mechanisms, including the induction of T-lymphocytes and natural killer cells.

There is limited data regarding the efficacy of IL-2 for treating ISS in cats. One study showed a significantly longer time to tumor regrowth in cats treated with surgery, superficial radiation therapy, and IL-2 as compared to a reference group of cats treated with surgery and radiation therapy alone. This same study showed cats receiving IL-2 had a significant reduction of the risk of tumor relapse by 56% at one year and 65% at two years after initial treatment compared to cats not receiving IL-2.

I have no personal experience using the IL-2 immunotherapy, but I am always encouraged to try innovative anti-cancer treatments, especially for those diseases where options can be limited and outcomes can be poor.

I’ll admit it’s hard to talk to an owner about giving their cat a series of injections as a treatment for a tumor we believe was caused by an injection. It’s also difficult to discuss because the IL-2 treatment is manufactured by the same company that makes vaccines, the very substances that are implicated in the tumor formation in the first place.

Those issues aside, I think this represents an exciting new therapeutic for an otherwise devastating disease. I look forward to what the data will reveal regarding its success and implementing it in my clinic in the near future.

What’s the scariest diagnosis I’ve ever faced?

I recently faced a case diagnosed with the most frightening disease known to the medical community. Once I learned the patient’s signalment (age, breed, and gender) and the description of his presenting signs (cough, congestion, restlessness, agitation, and poor appetite), I knew I was in for an incredible diagnostic and therapeutic challenge.

Surprisingly, my patient didn’t have an aggressive form of cancer. He also didn’t have outrageously complicated blood work abnormalities or questionable biopsy results. There were no broken bones or bleeding wounds to tend to. The patient wasn’t even a companion animal.

The subject I speak of was my husband.

And the diagnosis was the dreaded “Man Cold.”

Women around the globe are well aware of the enormous gap between what transpires physiologically when they are sick with a cold versus what transpires when a man is stricken with the same illness.

What will debilitate the male species to a puddle of trembling, feverish flesh is what woman bravely face on a Tuesday morning when pollen counts are up. My own research has found that “sick” men require approximately 75% more sleep, 50% more couch time, and 85% more take out food than their healthy counterparts. Sick women seem to require no such adjustments, and show quicker recovery times when they actually take on more than their usual workload.

In fact, most men insist that human MDs consistently underestimate the severity of a runny nose, swollen glands, and watery eyes in those possessing a Y chromosome, inexplicably confusing surefire signs of imminent death with those of the common cold.

My ill husband’s constant wincing, sighing, tossing and turning, and overall grumpiness led me to consider the outward signs of illness I see in my own patients.

As “serious” as we humans should be about Man Colds, I know this fictional disease biologically contrasts significantly with what sick animals encounter during the diagnosis and treatment of cancer.

When I paused to consider the disparities, I concluded that although women handle illness far more gracefully than men, when it comes to the mental and physical toughness required to face a truly devastating diagnosis, it’s animals that really show us humans up, regardless of our gender.

Most newly diagnosed dogs with cancer actually show no life-threatening signs. They also maintain their stoicism while undergoing aggressive treatments such as chemotherapy or radiation therapy. When illness develops, they are rarely prone to protests or changes in attitude.

Cats, on the other hand, are typically diagnosed at more advanced disease stages. In turn, they are more likely to show signs of affliction. However, they aren’t particularly creative in their repertoire of symptoms, as most sick cats show identical signs, like hiding, constantly sleeping, or refusing to eat or drink regardless of the underlying cause. I wouldn’t consider any of outward these to be overly remarkable though.

From a strictly biological perspective, it’s not surprising that companion animals are adept at hiding signs of disease. Domesticated cats and dogs, for the most part, retain at lease some semblance of the survival instincts of their wild ancestors, who are forced to mask signs of pain or sickness or otherwise be considered easy targets for other species to prey on them.

This certainly isn’t true for all animals, however, and owners must be careful when approaching their pets when they are sick, as their behavior can be unpredictable. Even the calmest pet could react by biting or scratching out of fear or pain when their more primitive reflexes overtake learned submissive behaviors.

Those patients are the most challenging from a veterinarian’s perspective as well. We are trained in the art of healing, yet this cannot be directly communicated to the animals we work with. We may be faced with an animal that behaves aggressively because it is scared, or put ourselves in danger in order to help treat a pet that ultimately views us as a threat.

Certain dogs will always wag their tails, no matter the amount of pain or suffering they endure. Purring can be a sign of affection or anxiety in cats, and may occur despite severe sickness and debilitation. Whether their actions are a result of nature or nurture is debatable. We are fortunate that the vast majority of our patients tolerate disease in a way that allows us to provide comfort, with zero complaint.

What matters more are the lessons humans could stand to learn from our veterinary counterparts when it comes to dealing with adversities related to our own health. We should be more patient, more tolerant, and keep negative thoughts from pervading our mindset in order to allow for the chance to heal.
Though there were touch and go moments this past weekend, it appears the Man Cold has completely resolved, with my subject making a near complete recovery. And I’m blowing off my newly developed annoying running nose and persistent cough because I really don’t have time to be sick myself.

Ladies — Please tell me you understand what I mean…

Do you love your vet?

This is a tough time to be a vet.

In September 2014, Dr. Sophia Yin, a vibrant, compassionate, world-renowned veterinarian and veterinary behaviorist, committed suicide at the age of 48. Her death shocked the veterinary community. A remarkable outpouring from within the veterinary profession soon followed to raise awareness of depression, compassion fatigue, and suicide prevention.

In March 2015, two veterinary students (one at U.C. Davis and one at Michigan State University) died suddenly within the same week. The loss of these bright and talented individuals far too early in their career paths was the next significant loss experienced among our peers.

In early April 2015, we dealt with the backlash of criticism surrounding a veterinarian in Texas who bragged on social media about successfully killing a cat by shooting it with a bow and arrow. Fortunately, most people recognized that the thoughtless, selfish, and reprehensible actions of a single doctor do not reflect the spirit of an entire profession. Not everyone felt this way, unfortunately, and many saw it as an opportunity to express their contempt for the veterinary profession.

Soon after, an article was published in the Washington Post entitled “Vets are too expensive, and it’s putting pets at risk.” The writer suggested that doctors take advantage of the emotional aspect of pet care by “jacking up prices” and not offering payment plans, ending with the snarky sentence, “veterinarians shouldn’t take advantage of our devotion to enhance their bottom lines.”

A few days ago, I received a copy of DVM360 magazine, a source of current events, news, and product information related to veterinary medicine. A quick glance at the table of contents revealed negative titles such as:

The burden of care: Know the risks to your mental health
The current state of veterinary job satisfaction
Burnout, compassion fatigue, depression – What’s the difference?
Tips and tools to be a happier veterinarian
3 reasons to start your exit plan today
Internships: A new tax on veterinarians?

And on the morning of writing this article, I happened to randomly respond to a thread on my community’s Facebook page regarding a dog owner inquiring about suggested solutions for dry skin. I read reply after reply of various home remedies, ranging from swearing by switching to a grain-free, gluten-free diet to bathing the dog in Dawn dishwashing soap. I felt compelled to offer a professional opinion.
I simply suggested that the original poster contact their veterinarian, or better yet, consider speaking with a veterinary dermatologist, as they would better be able to discern the cause of the itchy skin, rather than treat just the symptom. My response was rapidly overshadowed by a suggestion to use coconut oil as a cure-all. Granted, I didn’t post my answer as a veterinarian, but I truly don’t think it would have made any difference in how quickly my reply was dismissed.

In the midst of all these negative posts, articles, and news snippets, I came across a blog entry written by a veterinarian entitled, “Does anyone out there love their vet?”

The author described each of the same stories I’ve written about above, and how they impacted her specifically with regard to her professional morale. I immediately connected with her message. She ended the piece by asking for a very humble task from those who believe in veterinarians and veterinary medicine.

She simply asked her readers to tell her that they loved their vet.

Her goal was simple: to eradicate disapproval and hate by having people show an outpouring of support and love and appreciation for those veterinarians they are happy with. The responses to her request were overwhelmingly positive.

In the end, my job isn’t about arguing about prices and it’s not about focusing on the sadness. It’s about the moments where I know I’ve made a difference in my patients’ lives.
It’s about knowing I’ve helped so many pets live longer and happier lives because of my capabilities.

During this tough time in our profession, I hope my colleagues will find the time to think of the owners who are truly appreciative of their work and try to lessen their focus on those who don’t.

I want them to think of their successes, and I want to remind them to remember that despite our most valiant efforts, we simply cannot help every patient we see.

And I want to emphasize that sometimes it’s okay to turn off the media channels when they are telling you that you’re doing anything less than your best.

Our jobs are tough enough as it is. We don’t need to make it tougher by being anything less than gentle on ourselves.
Tell me? What do you love about your vet? Leave a positive message for us and continue the original poster’s message. You might be surprised to know how much it means to us!