Young Again Pet Food

Monday, June 11, 2012

Taking a Life

Today was "Just One Day," a day when shelters all over the country pledged not to kill any adoptable animals, while making a greater effort than usual to get them adopted instead.  The concept was developed by Nathan Winograd and his No Kill Nation group as part of their ongoing effort to get everyone involved in dealing with "unwanted" animals to recognize that there is actually a home available for every adoptable dog and cat currently being killed in the US.  NKN has conducted surveys and compiled data showing that the number of people planning on getting a pet in the coming year is actually greater than the average number of cats, dogs, kittens, and puppies that are being killed every year.  Based on the FaceBook posts today, it looks like Just One Day was a great success--and I will hope the point has been made that Just One Day can become just one more day, and then another day, and another day, and another day, with all shelters becoming No Kill shelters.

For me, ironically, Just One Day/No Kill Day occurs the day after I killed my first cat.

Yesterday, I volunteered with the Feral Cat Coalition of San Diego (along with my husband--it was awesome--we helped with the surgical preparation of 113 homeless, feral cats and kittens brought in for spay or neuter to be returned to their colonies), but I was also given my first opportunity to euthanize two of the cats.

I had not imagined I would be taking cat lives during my work yesterday, but I figured it was as good a place as any (maybe even a better place than most) to check that box off of things I hadn't done yet as a veterinary student.  What's really bothering me is how unemotional I feel about it.  Yes, I got a little choked up when I was asked if I wanted to do it, but when on assessing Cat #57 I saw he was in truly horrible shape--emaciated, bleeding out both ends, Cheyne-Stokes respiration--I probably barely got the solution into him before he would have died on his own.  There was nothing to it, and afterwards I was sort of glad to have been able to take a few minutes of his suffering away.

The second cat (Cat #4) should have been a little more difficult: a rather beat-up, but otherwise healthy tom who had the misfortune of coming up positive for FIV on a snap-test, and a feral cat colony manager who was trying to keep her colony disease-free.  My mind ran through the case of Butterscotch, an FIV positive stray we had in veterinary school this past year--Cat #4 could live a fairly long and normal life until his immune system lets him down.  But every time he bites another cat, he could transmit FIV.  But he'd be neutered now and WAY less likely to want to bite anybody... I debated in my head like this for several minutes.  If Cat #4 was an owned cat, we would draw blood for a more accurate test to confirm that he was positive, and re-check in six months, but Cat #4 would not have that luxury.  It's possible he received FIV antibodies from his mother's colostrum as a kitten, or that he had once been owned and was given the FIV vaccine--either possibility would cause him to have a positive snap-test without having the actual disease.   In the end, I realized that if I didn't do it, someone else would--it was the "owner's" wish that this unowned cat be put down, and for me in that moment it would be another (rare) opportunity to find a vein and perform the administration, confirm the cat's death, etc.  I went into unemotional clinician mode and took the cat's life.

The term euthanasia means "good death" and basically describes a "mercy killing" when an animal's condition is so bad that killing it will put it out of its misery.  Its use has been broadly expanded now so that even the killing of adoptable animals in shelters is inappropriately referred to as euthanasia.  I'm confident there could be no argument that Cat #57 was euthanized, but I'm much less certain that the killing of Cat #4, though feral and unadoptable, truly fits within the narrow parameters of a merciful and good death.

And I'm pretty sure that's what's really bothering me.

Wednesday, December 14, 2011

Vet School Is Hard


Veterinary school is hard.

This should not come as a shock, but I never really imagined just how hard it would be.

I just figured all those years in undergrad (and believe me, for me there were many, many years of undergrad) would have prepared me beyond a shadow for the veterinary school curriculum.  After all, you have to get mostly A’s to get into veterinary school (my GPA was a 3.6) which means you must know how to learn, take tests, etc., right?

Truth be told, throughout my 150+ units of undergrad education, graduating cum laude with bachelor’s degrees in biology and literature, and a minor in French, I never really learned how to study.  I learned how to take great lecture notes and regurgitate that which was handed to me as What Needed To Be Learned in Order to Pass, but semester after semester my always-new textbooks remained mostly unopened, and other than reviewing my notes prior to exams I really never studied outside of class lectures:  listen and regurgitate—I was a pro at it.  I will take credit for always reading my literature assignments—you can’t have a meaningful discussion without doing so—so I can safely say I did more “studying” for literature than I ever did for science, but other than a few margin notes, studying literature is not the same as studying science on your own.

Now I’m learning to be a veterinary doctor (which is a doctor to every species of animal on earth except one, just to keep this in perspective), and the program I’m in requires that I teach myself how to be a veterinary doctor.  It’s called Problem Based Learning (or PBL for short) and I was excited about learning this way because I learned physics in a PBL format in undergrad, which I thought was a terrific way to learn: no lectures and note-taking, but rather seeking answers and problem-solving as a means of learning.  Learning how to be a lifelong learner seemed like a good idea since information is doubling every couple of years now and what I learn today may be obsolete by the time I graduate.

And so far, I love it.  Every eight weeks—a Block in PBL lingo—we assemble in groups of seven and week-by-week we are doled out little bits of real-life veterinary cases which serve as the catalyst for learning all of our basic sciences, or the –ologies as they’re better know: physiology, pathology, histology, pharmacology, nutrition, anatomy, etc.  So far we’ve covered musculoskeletal, integument, gastrointestinal, and reproduction via PBL, with a week of exams every eight weeks to check our learning.  The learning is fast, furious, and voluminous, but I’m already 1/8th of my way to being a veterinary doctor and it feels like I’ve barely scratched the surface if what I need to know, so the pace won’t be slowing any time soon.

The trouble for me (and many of my colleagues) has been the fact that this sort of actual studying—selecting a reference resource, deciding what depth to go to on the Learning Issue at hand, and even knowing what notes to take for later reference—is new for me; I’ve always relied on my professors to tell me what I needed to know and having to figure it out for myself isn’t easy.  The first eight weeks I went crazy for studying the clinical aspects of our cases—I even read a book on doing skin flap procedures for what are known as “degloving” injuries—ones where a lot of skin has been lost due to an accident, burns, etc. During the tests for that Block there weren’t any questions about skin flaps or pedicles or ensuring a good blood supply or why a good canine plastic surgeon will make little slices in the skin flap before suturing it in (it’s done when the flap is in an area with a lot of movement—like a limb—because during healing, myofibroblasts will pull the edges of the wound closer together, contracting it to speed up the healing and repair process.  The slices help prevent the skin from becoming too tight, potentially rendering the limb immovable.  There were quite a few pictures and case studies of veterinarians who didn’t know what they were doing, and a dog or cat ended up losing the limb because of it—I don’t want to be that vet.)  The lesson from that first Block was that clinical knowledge would be needed in my third and fourth years, not years one and two, so stick with the basic sciences, for now; I hadn’t learned bone, muscle, and skin growth, repair, and anatomy well enough to be studying skin flap surgery yet.  Lesson learned.

For Block 2 (the Block for which I took my sixth final in as many days yesterday) I stuck to the basics and only dabbled in the clinical stuff.  I studied the GI from lips to teeth to tongue and all the way through to the nether regions, I looked at slide after slide of what the various regions of the GI look like histologically, and I finally learned what makes ruminants so special.  I also studied male and female reproduction, reading chapter after chapter about some of the subtle differences in reproductive cycling, pregnancy and parturition among a variety species. I took as many notes as time would allow, scanned the learning issues write-ups shared by my colleagues, and basically did everything possible to learn as much as possible in the time I had.  Taking my lumps from the midterms, I felt much better prepared for finals, having stuck with the basic sciences this time.

But finals didn’t go much, if at all better than mid-terms, which is why I was compelled to write this blog entry today.  The other reason why veterinary school is hard, and the particular curriculum at my school is especially hard, are the difficulties inherent in testing when there is no “standard” resource, or even standardized Learning Issues: how do you test 105 people who all used different textbooks, primary literature, online resources, etc. to determine what they know or don’t know?  The faculty keeps telling us not to focus our studies on what will be on the exams, but rather what we think we’ll need to be good doctors—all well and good, but if I don’t pass the exams I won’t get the opportunity to show how great a doctor I would have been.

So here I sit, nineteen days of winter break ahead of me before the next semester starts the day after New Year’s.  As it stands today I am a little over one point below the grade required for passing.  I have been told to take a deep breath, not all adjustments have been made yet, and I think there may be an error in the entry of one of my section points totals.  But that doesn’t make the not knowing any easier. 

It seems impossible that moi, a Mensa-certified, “A” student, product of private school and the gifted program, finally realizing my dream of a veterinary education would be in this situation.  But like I said, veterinary school is hard.

Thursday, July 21, 2011

My Cat Has Diabetes… Now What?

Learning that your beloved feline family member has diabetes may seem devastating, but in reality diabetes is very treatable in cats, and proper treatment will allow your pet to live a longer and healthier life.

If your veterinarian diagnosed diabetes in your cat during his routine annual examination and blood work, then congratulate yourself for being a responsible pet owner and saving your precious baby the suffering involved when the condition remains undiagnosed.  But if your beloved cat has been suffering from excessive thirst and urination, a poor appetite, lethargy, and weight loss, you may also congratulate yourself on being an observant cat owner and getting kitty the help he needs.  (They certainly don’t make it easy for us to know when they aren’t feeling well!)  Left untreated, diabetes can result in wasting of the back muscles and back leg weakness, depression, vomiting, diarrhea, coat and skin problems,  an enlarged liver, jaundice, and even neuropathy (a loss of feeling in the extremities.) (4, 6)

Diabetes is considered a metabolic disease because a lack of insulin affects the body’s ability to process food properly for energy and growth.  Insulin is a hormone released by the pancreas in response to glucose or sugar in the bloodstream, which lets the cells of muscles and organs know they need to take up the glucose and convert it into energy. (1, 4)   When there is not enough insulin present, the body ends up with too much glucose in the blood, or high blood sugar.  Obesity is the most common condition that predisposes a cat to developing diabetes, but other diseases such as pancreatitis, hyperthyroidism, and steroid use have also been linked to diabetes. (2, 4)

Diabetes comes in two forms in cats just like it does in humans.  Type I, or insulin dependent diabetes, and Type II, or non-insulin dependent diabetes.  Both forms will generally require insulin injections to maintain blood sugar balance in your cat, though some cats will do well on oral medications. (4, 6)

While your veterinarian will determine a treatment plan specific to your cat’s unique needs, treating diabetes in cats often means administering insulin.  If the idea of injecting your cat with insulin on a regular basis frightens you, it shouldn’t; the vast majority of cats can be dosed quickly and painlessly, and mastery of this skill is really very easy.  Your veterinarian will help you learn the proper technique, but there are a few key concepts to keep in mind that will ensure success for both you and your cat. (3, 4)

The proper care and handling of insulin and the syringes you’ll be injecting it with is important.  Insulin is a fairly delicate medication that has storage requirements that affect its stability (some types require refrigeration, others need to be stored away from light), so be sure to follow the manufacturer’s recommendations.  The insulin itself is actually a powder that has been suspended in the liquid you see in the vial, so the vial should never be vigorously shaken as this will result in the formation of air bubbles that can degrade the insulin particles.  Instead of shaking, simply roll the vial between your palms a few times, or gently invert the vial up and down prior to each use to ensure even suspension of the insulin within the liquid. (1) To prepare the injection, always use a new sterile syringe and needle to prevent infection.  Wipe the vial stopper with an alcohol swab, pull the plunger on the syringe to approximately the same volume as the insulin you will be withdrawing, uncap the needle and gently insert it into the plunger, keeping the bevel or flat side of the needle up (this is also how you will want to position the needle when you inject your cat, so it’s a good practice to always keep the bevel on the needle facing upwards.)  Making sure the tip of the needle is within the liquid inside the inverted (upside-down) vial, slowly push out the air from the syringe, and then draw insulin into it to the correct volume for the dose required.  Remember that insulin dosages are always very small, so you will never have more than a drop or two in the syringe.  Before removing the needle from the vial, check the syringe for air bubbles.  A gentle tap on the syringe while holding the inverted vial will allow you to expel the air bubbles.  Withdraw the needle and recap it, put away the insulin vial, and you’re ready to prepare kitty for his injection.

If daily injections are necessary then you’ll want to establish a pleasant routine with your cat at about the same time every day.  Whether your cat is more comfortable on your lap, in a favorite sleeping spot, or resting on his perch, precede the injection with some loving physical contact.  When kitty is ready, pinch up a little tent of skin in the belly region, uncap the syringe with your teeth, turn the syringe so the needle bevel is up (that’s the flat side of the tip of the needle), insert the needle into the skin parallel to the cat’s body at the base of the ‘tent,’ depress the plunger, slide the needle from the skin and let go of the skin.  Insulin needles are very small and chances are kitty didn’t feel a thing!  Finish up with lots of praise, love, and a treat and kitty may even look forward to his next injection. (3)

A few more suggestions for success—don’t inject kitty in the same spot every day.  Shift sides and injection sites each time to prevent formation of granulomas (a knot of tissue): the belly, hips, and sides are all good injection sites.  Remember this is a subcutaneous or under-the-skin injection, not intramuscular, so keep the syringe parallel to the cat’s body and not perpendicular.  Warming up the syringe in your hands prior to injection might make kitty’s experience more pleasant.  If kitty has dense or long hair you might try spreading the hair apart to ensure the needle enters the skin and doesn’t just end up on the coat where it won’t do kitty any good.  If you have trouble controlling the syringe with your thumb on the plunger consider switching to the ‘dart’ hold, with your index finger on the plunger.  And remember to be confident and quick with the injection and kitty will appreciate your effort! (3)

Proper disposal of the used syringes (also known as sharps) is an important part of your routine, as well, and several convenient products are available from Sharps Compliance, Inc. to help you.  The 1-Quart Sharps Recovery SystemTM  and 1-Gallon Sharps Recovery SystemTM  allow you to protect your family and community from needlestick injuries by providing a collection container, shipping box, and a pre-paid return postage label for the ultimate convenience in sharps disposal.  Not only will these products protect your family’s safety, they serve to protect the environment, as well, by diverting medical waste from landfills, ensuring their proper handling, treatment, and even recycling. (5)

A potential complication of treating your cat with insulin is too little blood sugar or hypoglycemia, so watch your cat for signs of this potentially dangerous condition: lack of coordination, listlessness, weakness, convulsions, or coma.  Keep corn syrup handy and if you observe signs of hypoglycemia contact your veterinarian for treatment advice.  A bit of corn syrup rubbed onto your cat’s gums can avoid immediate complications, but your vet will want to alter his treatment plan. (6)

In addition to administration of insulin, your veterinarian may recommend changes to your cat’s diet and exercise regimen, and regular monitoring of his glucose levels to ensure that he is receiving all the benefits of insulin therapy.  Monitoring your cat’s weight, food and water intake, and cat box usage will also help your veterinarian in optimizing your cat’s treatment plan. (4, 6)

While there is no cure for diabetes, your cat can still enjoy a long and healthy life.  If obesity was a factor in your cat’s diabetes, the condition may improve or even resolve itself once the cat reaches a healthy weight.  Some non-obese cats will have a transient form of Type II diabetes and will simply stop needing insulin after some time, while others will need treatment throughout their lives. (6)  Whether your cat requires treatment for months, years, or the rest of his life, your active participation in his treatment will ensure the best result.

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