Vet Blog
10/22/09
As I was driving home from work this morning after a night shift I heard a story about the health care debate on the radio news. The topic was one of the most poorly understood concepts in the debate: unnecessary diagnostic testing.
Many people have cited the elimination of unnecessary tests as a way to reduce health care costs. As a medical clinician I would like to know how an unnecessary test is defined.
It is not possible to know whether a diagnostic test is necessary without knowing the results. In other words, it is not possible to know whether a diagnostic test is necessary without running it. Only with hindsight can one determine whether the test was needed.
Consider the following example from veterinary medicine. Imagine your dog has suffered a two day period of lethargy and poor appetite. You authorize your veterinarian to run basic blood tests. The results are normal, but the ratio of blood sodium and potassium levels is on the low end of what is considered normal.
In cases such as this, the overwhelming majority of dogs do not have a serious condition. Transient gastrointestinal upset due to dietary indiscretion is most likely. An adverse reaction to a mild toxin also may be to blame. A self-limiting viral infection or dozens of other mild pathologies could be the cause of the issue. All of these problems generally resolve on their own.
But a much more serious problem can cause the symptoms and initial test results I have described: Addison’s disease. Addison’s disease is much less common than the milder problems I have described above. But if it is not detected and treated it is deadly.
The test for Addison’s disease is specialized and expensive. It is non-invasive and low risk. Without the test, it is not possible to know whether the syndrome is causing the symptoms. The treatment for Addison’s disease can be harmful to dogs who don’t have the syndrome.
Imagine that one out of every thousand dogs with lethargy, poor appetite, and a borderline sodium to potassium ratio has Addison’s disease. If a thousand dogs develop the symptoms I have described (and initial test results are as I have described), 999 of them will get better without treatment. One will die.
Those may sound like good odds. But what if your dog is the one?
If you think a one-in-a-thousand chance isn’t bad, I hope you don’t buy lottery tickets. The odds of hitting the mega jackpot make one-in-a-thousand look almost certain.
When I treat dogs like the imaginary one in this post, I always recommend the test for Addison’s disease. After I get the results, I usually learn that the test was not necessary. But every once in a while the test saves a dog’s life. In those instances the test was very necessary indeed.
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10/03/09
I came across this web page yesterday. After looking at it, I don’t think I’ll ever leave my pal Buster unattended with a small child again.
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07/29/09
 When I was reviewing the Health and Science section of the July 31, 2009 issue of The Week for Monday’s article about cats purring, another blurb caught my eye. It’s totally off topic, but I can’t resist commenting. I’ll return to juicy veterinary topics tomorrow.
The content in the short article has been published thousands (or perhaps hundreds of thousands) of times over the last ten years. It keeps being repackaged as a new story and sold to the public as a revolutionary discovery–even though it is old, old news. I guess the editors believe that the human quest to live forever will make us forget that this story was published in one form or another last year, and the year before, and the year before, and . . .
Living longer by going hungry
If we eat a lot less, will we live longer? It works for monkeys, says The New York Times. After studying a group of rhesus monkeys for 20 years, scientists found that those that were fed one-third less food aged much more slowly than their peers, which were allowed to eat as much as they wanted. The calorie-restricted monkeys also showed less deterioration of muscle and brain matter, conditions that typically come with aging, and appeared to be on course to live up to 20 percent longer than the norm. For humans, that might mean extending life spans by seven to 15 years. “We were frankly blown away by these findings,” says lead research Richard Weindruch, of the University of Wisconsin School of Medicine and Public Health.
Dr. Weindruch, were you set up to look silly in that quote? Surely a researcher in your field is aware of the dozens of studies and countless (dare I say mercilessly incessant stream of) news articles documenting this completely unsurprising fact in basically every species imaginable–except humans (more on that soon). You could not plausibly have been “blown away” by this new set of results.
The article continues . . .
The results dovetail with other research indicating that caloric restriction can extend the lives of mice, dogs, yeast, fruit flies, and worms.
You don’t say?
I remember a decade or so ago when the first study showed that calorie restriction increased life span in rodents. I realized that I might be able extend my life span significantly, if only someone would lock me in a cage and starve me.
No study of this matter has been performed in humans, because almost nobody willingly starves him- or herself. In fact, people who voluntarily refuse to eat are considered to suffer from pathology: anorexia nervosa.
The hope of these types of studies is that chronic starvation activates genes that extend life span. Ideally, some day we will be able to activate these genes without having to go hungry. Then we can all live to be 130, and collect Social Security for half of our lives. (My apologies to the youthful Americans who will be stuck paying for this. One day you also will have the opportunity to stick it to a younger generation.)
Meanwhile, I’m going to start my day with an omelette.
Photo: say goodbye to longevity! By Mattia Luigi Nappi.
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07/21/09
From Gulliver’s blog at Economist.com:
PET AIRWAYS has flown its first passengers. (Unlike most other media outlets, Gulliver winces at the prospect of referring to the animals as “pawsengers”, Pet Airways’ preferred designation.) The airline, which transports dogs and cats in the main cabin of modified planes, made its inaugural flight from New York yesterday.
We first wrote about Pet Airways in April, and the response was universally positive. Indeed, Pet Airways could well be onto a good thing, since its services do not cost much more than less comfortable transport in the cabin of a regular plane. Success may depend on how quickly the company can expand its operations: it currently links New York, Washington, Chicago, Denver and Los Angeles, but has designs on serving 25 cities in the next three years. The public’s attention has certainly been piqued; now all Pet Airways needs to do is invest a bit more money in its website. When Gulliver recently looked, the site wasn’t working because of “Over Capacity”. Not what you want on day two of operations.
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07/14/09
 A paper published in the July 1, 2009 Journal of the American Veterinary Medical Association caught my eye. Here are some excerpts from the abstract.
Case Description–An 8-month-old sexually intact male rabbit was examined because of a 2-day history of [inappetance], [watering] of the left eye, [tooth grinding], [drooling], and [dizziness].
Despite aggressive diagnostics and treatments, the rabbit could not be saved. His condition deteriorated, and after seven days of treatment he was put to sleep. The cause of death was unknown until an autopsy was performed.
Histologic evaluation of brain tissue revealed [multiple irregularities]. The DNA of human herpesvirus-1 was detected in [nerve cells] . . . The rabbit’s owner, who reported having had a severe labial and facial herbesvirus infection 5 days before the onset of clinical signs in the rabbit, was suspected to be the origin of the infection for the rabbit.
(J Am Vet Med Assoc 2009;235:66-69)
In other words, the rabbit’s owner suffered from a severe cold sore (human herpesvirus-1 is the cold sore virus; herpesvirus-2 causes genital herpes). During the outbreak, it appears that the rabbit contracted the virus and subsequently suffered a fatal neurological infection.
Human herpesvirus-1 is ubiquitous. The vast majority of people in the world are infected. A small portion of infected humans suffer from intermittent cold sores (I am one such unlucky individual). If you own a rabbit and suffer from cold sores, be aware that your pet may be at risk during your outbreaks.
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06/09/09
 From the Gulliver Blog over at The Economist:
SOUTHWEST AIRLINES’ announcement that it would allow small pets inside the cabins of its aircraft from June 17th has not been universally welcomed. Or rather, it was not welcomed by people quoted in a report in the Denver Post, which was subsequently picked up by several other media outlets. These interviewees voiced concerns about allergic reactions and the noise the animals would make.
I have a hunch that the announcement will be welcomed by Vet Blog readers who are on the lookout for more pet travel options. When people fly with pets, I always recommend keeping them in the cabin if possible.
Gulliver continues:
It’s unfair to single out Southwest in this context as several other American carriers already allow pets to fly in planes with their owners. And a company spokesman played down the possibility of strife: “We will quickly make accommodations if a pet is causing any disruption in flight,” he said. “This is similar to the peanut allergy, and we do have experience in accommodating customers.”
Well said. And finally, I must agree with the comment writers cited by Gulliver in an e-mail he sent out announcing the post.
Many commenters say they would rather share a cabin with dogs than children.
Hear, hear!
Photo: Paul Carter. Photo license: CC
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06/06/09
As I was walking home from work the other day I saw the following scene.
“CAUTION: THIS LAWN HAS BEEN TREATED WITH A PESTICIDE THAT MAY BE HARMFUL OR FATAL TO YOUR PET”
Perhaps the person who tends the lawn in question had recently applied some horrific pesticide such as snail bait to the lawn. Or perhaps he simply didn’t want dogs or cats on his grass.
My money’s on the latter option. But I wouldn’t bet my pal Buster’s life on it.
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05/29/09
 Almost every day someone asks me if there is a way to make her pet shed less hair. If I had an easy answer to that question, I would not have time to write this blog–I’d be too busy sipping margaritas on my private island’s beach. The person who devises a way to make pets stop shedding will be very rich indeed!
Shedding is natural. And, as long as baldness does not develop, any amount of shedding should be considered normal. Brushing your pet daily may help to reduce shedding marginally. But in reality, there is really only one truly effective way to deal with canine and feline shedding: buy a good vacuum cleaner.
Speaking of which, the kind folks at Dyson recently sent me one of their new vacuums, the DC 28 Animal, to try out. It is designed specifically for households with pets.
The Dyson was simple to set up, and I have been very impressed with its power and ease of use. My pal Buster appreciates the fact that it is much quieter than my previous, bachelor-style vacuum cleaner.
The Dyson definitely does a number on pet hair–on the floor and on furniture. Of course, Buster easily rises to the challenge of providing more hair for the vacuum cleaner to pick up each day.
My only complaint with the vacuum cleaner is that its transparent debris collection chamber has led to an unpleasant bit of self-revelation. I had previously been blissfully oblivious to the amount of dust that accumulates on my carpet. That ignorance has been blown away by the large dust bunnies that have been gathered by the Dyson and displayed in full view.
In all, I have been very satisfied with the DC 28 Animal. I highly recommend it to anyone who has pets. Or dust.
Photo: I’ll bet Yara’s parents would love to own a DC 28!
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03/29/09
 At a recent meeting with the powers-that-be at Dogster and Catster it was suggested that I join Twitter. I had heard of the site, but I didn’t really know what it was all about.
Veterinarians generally reject new developments and trends. This can have disastrous consequences for the practice of medicine: it is the cause of the “if rubbing turpentine on a dog’s scrotum to cure a cough was good enough in 1947, it’s good enough today” mentality that is disturbingly prevalent among older veterinary practitioners.
I therefore try to fight the change-averse veterinary frame of mind. And, in that vein, I set up a Twitter account. You can find it at:
http://twitter.com/drbarchas
I often come across links and stories that are interesting but not truly bloggable. I’ll use the Twitter account to share those links as well keep followers up-to-date on happenings here at the Vet Blog.
And you never know. If you follow me, I might follow you back.
Photo: Amos T Fairchild.
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03/27/09
 It’s completely off topic, but I can’t resist posting a story from the March 27, 2009 issue of The Week.
The chimp who plans for the future
Human beings can imagine and plan for future events– a capability that scientists have long believed makes us unique among living creatures. But an angry chimpanzee in a Swedish zoo has shown that his species is capable of meticulous preparations for the future: He stockpiles rocks, shapes them into aerodynamic discs, and then waits hours for zoo visitors to come into range so he can pelt them. Every morning before visitors start to trickle in, [the chimp, named] Santino roams his outdoor enclosure, searching for small stones. He’s learned to make his own stones, too, by knocking pieces off the concrete walls. At times, Santino shapes his weapons into discs, so they sail through the air more accurately. The chimp stacks the stones in small piles, so that when he becomes irritated by visitors invading his territory, he has an ammunition store on hand and can begin hurling his missiles. No one has been hurt.
I have a few thoughts on the story.
Although humans are capable of imagining and planning for future events, a huge number of us don’t.
The story makes me question the ethics of keeping chimps in enclosures such as Santino’s. Generally, an animal must be quite stressed before it will act aggressively as described in the blurb (although maybe Santino throws the rocks simply to enjoy the reaction the missiles elicit from zoo visitiors).
Chimps may be smart, but Santino clearly isn’t the brightest ape on earth. If he were, he wouldn’t waste his time stockpiling rocks. He’d stockpile his own feces.
Photo credit: Richard. Photo license: CC.
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