Thursday, 21 May 2015

Doctor of what?

Consulting is an art, not a science. No matter how well you know your medicine (and I am certainly not claiming any special expertise in that department), a consultation can often be spun in an unexpected direction by what we shall charitably call 'the human factor'.

Yesterday afternoon, I opened up the medical file of my next consultation - a booster vaccination for a cat. Something about the surname rang a bell, but I hadn't seen this cat before, and the client didn't seem to own any other animals. Something still nagged at me, however, so I clicked another button in the top right-hand corner of the screen. The button is marked 'Show deceased'.

Three more animals appeared under the clients name, all cats. The names all sounded familiar. Sure enough, I had seen all of them. Not only had I seen all of them, it was me that had been with them for their final consultation. I had put all of the owner's previous cats to sleep. The most recent had been several years ago, and try as I might I was saddened to find that I couldn't bring any of the cases to mind, or the client. Nevertheless, I was glad I had checked; I didn't remember the client, but it was a fair bet that they would remember me, having euthanised three of their previous pets. Now, at least, I could show a little tact, caring and diplomacy in the consulting room, even though I was just vaccinating their last remaining pet.

I stepped out into the waiting room, and quickly located a tall man sitting with his daughter, a cat box on his knee. I smiled at him, and with a quiet, respectful demeanor I called his cat's name.

The man looked up, smiled, and nudged his daughter in the ribs. 'Oh hello!' he called, cheerfully. 'It's Doctor Death!' He stood up and cheerfully walked towards me, while his daughter and I competed on which of us would rather a hole opened up in the ground and swallowed us up.

The man continued his own brand of peculiar gallows humour all the way through the consultation. 'Careful, Misty,' he said as I plucked the black and white cat from it's box. 'He should have a scythe, not a stethoscope!' I smiled politely while his daughter rolled her eyes and folded her arms, staring at the floor.

'Yes,' I said, trying to lighten the mood as I drew up my vaccination. 'It's a happier occasion, today, isn't it?'

'I'll say!' said the man. 'At least we won't need a coffin at the end of it!' I felt like saying that if he kept this up, then I couldn't promise anything, but I remained as ever, calm and professional. Still, it was a surprise that I had no memory of this man. If he was like this during a vaccination, God knew what he was like during an actual euthanasia.

'All done,' I said, putting his surviving cat back in it's box and closing the door behind it. 'There,' I said, smiling at the man, 'All of us made it through in one piece!' The man smiled and winked at me. His surprising attitude was growing on me. There was no malice at all in him. Why not be cheerful? The cats weren't suffering, and I had done a professional job. Doesn't joking about a dark subject make it something less to fear? Maybe we could all learn something from his attitude. I was starting to decide that perhaps I rather liked him.

I opened the door and let the man, his embarrassed daughter and his still-alive cat out to reception, where upon he announced loudly to the packed waiting room, 'This is the first time one of my pets has seen that vet and come out alive!'

I shut the door, and decided that maybe the best thing would be if a hole opened up in the ground and swallowed him instead.

Monday, 4 May 2015

Doctor, doctor, gimme the news...

Alright, I will. Because I am. A doctor, that is - as of last week.

You see, unlike many of our overseas colleagues, veterinary surgeons in the UK have long languished under tedious titles of Mrs, Miss or Mr. Not only do these titles call upon people to make a snap judgement on whether we're married or not, they simply don't sound quite as sexy as 'Doctor'. If anything, they make us sound more sinister - 'Mr Kildare' just sounds creepy, doesn't it?

There are those in my profession that will try to tell you that the vanilla title is right and proper. Human surgeons are known by them, after all - it's something of a badge of honour for them to go from Dr to Mr, in fact, and is a right granted them by the Royal College of Surgeons.

'Well,' say the misguided (and slightly less cool) vets of the UK, 'we're surgeons too, aren't we? So we should be Mr or Mrs too!'

Well, I disagree. For one thing, human surgeons undergo a metric craptonne more training than veterinary surgeons do - years and years more, in fact - so if they want to call themselves Mrs, I think they're quite entitled to. Secondly, as vets, we never got called 'Doctor' at any stage of our training, so it doesn't feel so much like a promotion as a, uh, nothing at all. Thirdly, I think I'd be more on board with it if surgeons had an entirely different title again, something like... I don't know. Powerman/woman? That would work. I could cope with being Powerman Marsh. (Pwn. Marsh - except if you're familiar with internet l33tspeak, that does sound a little like I just got my ass handed to me in an online game. I'll keep thinking).

Anyway, this particular powerman has strayed from the point a little. A couple of months ago, the RCVS - the august body that oversees veterinary surgeons in the UK - decided that vets are now entitled to use the title 'Doctor' - with a couple of caveats.

Firstly, when we use it in full we should add 'MRCVS' after our name, to signify that we are members of the Royal College, and not actually licensed to poke about inside another human being (well, not with surgical instruments, at least). Secondly, it is a courtesy title - it's up to us whether we use it or not.

When I heard about the news, this last point threw me into a dilemma. Was it really that important, I wondered, to be called a doctor? Is it something we deserve?

My point about training above wasn't just true of surgeons. It's a fallacy that it takes longer to train as a vet than as a doctor. The veterinary degree takes five years, just as the medical degree does, but then medical doctors have at least another two years of on-the-job training before they are fully qualified. Vets are just thrown in at the deep end, though the RCVS is considering changing this too.

In my career, occasionally a client would start a consultation with a 'Well, what it is, doc, is that...,'. Even on the rare occasions when I would point out that this title wasn't one that I had been granted, I would do it with a bashful grin (and possibly even come-to-bed eyes) that indicated I was not at all unhappy on being accidentally promoted, and it always gave me a little thrill.

But still. Doctor. I have been a veterinary surgeon for fifteen years, and a change in my title wouldn't change my experience, or my skills, or my simple honest-to-goodness dashing good looks. A courtesy title. If I actually changed it, would it just make me appear vain? Would my colleagues consider me so? Would there be two tiers of vets now? Ones that were secure in their own skills, and ones that needed something more? A veterinary surgeon, by any other name, would still smell of anal glands and hibiscrub, after all. This was a decision that required careful, considered thought.

Thirty microseconds later, I was logging in to the website of the RCVS, and ticking a box on my profile that indicated now, and forever more, I would be known as 'Doctor Nick Marsh MRCVS.'

Such decisions come at a cost. Households have been split on the issue. My wife, for instance, remains plain old Mrs Marsh - although this has less to do with any high-minded ethical stance, and more to do with the fact that she has forgotten her login details for the website.

As for myself, I find I am much the same person - with one added bonus. Thank you, The Simpsons. You have made me a very happy man.


Yours

Doctor Nick Marsh, MRCVS

Friday, 24 April 2015

For the blood is the life... Part one

Watch out, haemophobes! This one is about blood - specifically, blood transfusions in dogs and cats. For the first of this two-parter, we're going to have a look at how you might end up wanting to give a transfusion in the first place, before we get down to the meaty stuff in part two. Before we get too carried away learning about motion lotion, though, here's a quote from one of the true horror greats to get us in the mood:

'Something was pouring from his mouth. He examined his sleeve. Blood!? Blood. Crimson copper-smelling blood, his blood. Blood. Blood. Blood. And bits of sick.' 
Garth Marenghi, Slicer


Thank you, Garth. Blood. We all have it (unless you're a 13th generation cyber-mind reading this in the thirty-fifth century, but I can only cover so many angles with my writing) and we all have an idea of what it's for: to take oxygen out of your lungs and transport it to all your other bits to prevent them from being dead. It has other uses too, but this is the one you will be most concerned about if you start to run out.

Let's do a bit of jargon de-tangling here - us medical types love our jargon (see this post on the subject). The medical prefix for blood is 'haem' (or heme if you prefer; you know who you are. Go on then, just this once, I will do you a favor and leave the 'u' out of that favour. Happy now?). So: haemophobia - fear of blood; haemorrhage - blood loss; haematuria - bloody pee - and so on. Lack of blood - specially red blood cells, the Werther's original-shaped cells packed with the oxygen-loving haemoglobin that do the donkey work of moving oxygen around - is known as anaemia (presumably because anhaemia is awkward to say), and in its severe forms is what is going to make us reach for the blood bags.

Anaemia (and, so y'know, there's a lot more to know about anaemia, but let's keep it simple) is the most likely reason that you're going to find yourself at the business end of a blood giving set, and my extensive study of human literature has revealed that commonest form of human blood loss is, of course, vampiric attack. For dogs and cats it's a little different. We are not, at least in general practice, ER (my close resemblance to George Clooney to the contrary). If an animal has suffered such severe blood loss in an accident that it is in immediate need of a blood transfusion, then I'm afraid it is very unlikely to survive - principally because in general practice we are not allowed to store animal blood products, and so the dog or cat is going to have to wait for us to find a donor animal and drain it before it gets a snifter of the good red stuff, by which time it is highly likely to have given up waiting in a terminal fashion.

So, for vets in general practice at least, the most likely reason we are going to want to give a blood transfusion is either due to a slow semi-controlled bleed (like a ruptured splenic tumour) or expected blood loss (which reminds me of one of my lecturers telling us about attempted surgery to remove a tumour from a dog's aorta - the main artery from the left side of the heart; the vessel ruptured and our lecturer, a master of understatement, told us that the dog 'experienced brisk haemorrhage' which later had to be scrubbed off the ceiling of the op theatre), or because of IMHA.

IMHA

IMHA stands for 'Immune-mediated haemolytic anaemia' - please don't switch off, we can get through this, don't worry. Haemolytic anaemia we can already work out - lysis is the medical term for cells breaking down, so 'haemolytic anaemia' just means 'red blood cells breaking down, leading to a lack of blood cells'. I think HA is punchier, though.

As for Immune-mediated - well, as it sounds, this just means the disease is mediated by (i.e. caused by) the immune system going a bit tits up. Lots and lots of diseases are immune-mediated - all allergies, for instance. Just like The Force, the immune system is a powerful tool, but it can be used for evil as well as good. In IMHA, the immune system has decided that red blood cells are invaders and must be destroyed without mercy. Anything that stimulates the immune system - infections, drugs, and yes, sadly even vaccinations can trigger the immune system off in the wrong direction. Regardless of the In a grim parody of the Russian Revolution, all throughout the blood vessels, red cells square off against white. And red always loses.

The treatment for IMHA, like many of the immune mediated diseases, will be familiar to IT professionals. Switch the immune system off as quickly as possible, then let it come back online slowly and hope it's calmed down a bit. Steroids are the cheapest and most-frequently used drugs to do this, though there are a number of others. The problem is, it takes time for the immune system to stop popping the red-blood cells like an overactive needle-armed toddler in a balloon shop, and during that time the anaemia can reach severely (and frequently fatally) low levels.

PCV

Another definition for you (sorry) -Anaemia is - or at least can be - measured by the Packed Cell Volume - or PCV. If you spin down blood in a centrifuge, all the red cells will squish up together at the bottom of the tube, and the PCV is just the percentage of tube that is filled by these red cells - the lower the PCV, the fewer red blood cells you have. Dogs and cats normally have a PCV in the 30-40% range. Unless they're planning to run a marathon any time soon, they're going to be fine until it drops below 20%, where they're going to start looking a little tired. By the time it drops below 12% they're heading into trouble and are probably going to need a transfusion very soon. For dogs, if it drops much below, say, seven or eight percent, they are in serious danger of death. Cats seem to tolerate very low PCVs a little better, and I've know a few survive even with PCVs of five or six - but it's still brown-trousers territory for the clinician involved.


So, for whatever reason, we have a dog or cat with a worryingly pale gum colour and a PCV that is making us sweat. What now?

Let's talk about that in part two (although - spoilers - it involves sticking more blood into the animal).

Wednesday, 1 January 2014

A Disease of Economic Importance - Reflections on the Foot and Mouth Crisis of 2001



One afternoon in early 2001, Kate and I were sitting watching a news report about a disease outbreak on a farm in Essex.

            'Foot and mouth disease,' Kate said. 'That rings a bell. Which one is that?'
            I shrugged. 'Um... is it... it's the one with... er. It's notifiable, isn't it?'
            Kate looked pointedly back at the telly. 'Obviously.'
            I shrugged again. 'Well, I'm sure it'll be okay.'

            Hitherto, my sole encounter with the disease that would cause such destruction in Devon was while I was failing my public health examination in the fourth year. On the next page from the fabled 'Write short notes on the process of cheese making,' there had been an essay question on foot and mouth disease. In the exam I had wracked my brain to try and remember my crib notes, and splurged it all out onto the blank sheet in front of me: A viral disease - a picornavirus, to be precise. Very stable in the environment and highly contagious - the virus can potentially travel miles as an airborne particle - possibly even across the English Channel[1]. Predominantly affects ungulates. Causes fever, followed by ulcers in the mouth and around the feet. Rarely fatal in adults, but can cause heart problems in neonates. Otherwise self-limiting[2] in a few weeks. Not present in the UK at this time.

            I surrounded these bare bones with a fair amount of waffle, but that covered most of the things I knew about the disease... which is another reason I failed the public health exam. I had written my notes as if I was looking at an individual animal. I wrote (and knew) almost nothing about the economic implications of the disease.

            That was going to change in the Spring of 2001.

*
           
            Events moved quickly from that first diagnosis. A few days after the disease was confirmed in Essex, movement restrictions were placed in a five-mile radius around the site - no one could move animals in or out of the zone. By then, of course, it was already too late. A few days after that, a case was confirmed in Northumberland. The EU imposed a ban on the UK exporting any meat or meat products, and shortly after that, foot and mouth arrived in Devon. Within a week, cases had been confirmed in Scotland, Cornwall and Cumbria. It was becoming clear that the country was in the grip of a full-blown epidemic.

            The Ministry of Agriculture, Food and Fisheries (MAFF) appeared to be moving swiftly to combat the disease. They quickly instigated movement restrictions all over the country - not just for cattle, sheep and pigs, but for horses and dogs and humans too. Very soon into the crisis, they adopted a policy known as the 'contiguous cull' - every time a new case of foot and mouth was discovered, every cow, pig and sheep within a three mile radius was to be slaughtered.

            Kate and I watched the news unravel with some confusion. Foot and Mouth (and, from here on I'm going to use the accepted abbreviation FMD) was, in my mind, stored in a category along with kennel cough - highly contagious, but low severity. FMD wasn't a zoonosis - humans can't catch it.[3] It wasn't a pleasant disease to suffer from - what disease is?  - but it certainly wasn't in the same league as the horrors of rabies, or anthrax, or any number of other diseases that I could think of without even reaching for my large animal medicine notes. It was incredibly contagious, of course - but there was a vaccine available, wasn't there? I was sure there was. Quite an effective one, as I remembered. Why was the government behaving as if the dead had risen from the earth to feast upon the living?

            Nevertheless, with outbreaks popping up all over the place, and with us being repeatedly told what a dreadful disease the government was dealing with, we assumed there were good reasons behind all the measures. I had failed that exam, after all - I was hardly an authority on the subject.

            Within weeks it became clear that two counties had been particularly badly hit by the disease - Cumbria, and Devon. MAFF was rapidly running out of staff to help with the crisis, and the call went out for veterinary surgeons to assist in combating the disease. Locuming at the time, there was no reason for me not to help out - no reason, except that I was not an experienced cattle vet, and I was concerned that I wasn't really the sort of person that the ministry was looking for. I really wasn't sure that I wanted to be involved in this 'contiguous cull', however necessary it was. I was, after all, a vegetarian[4], and so to some extent had opted out of the system already - although I still drunk milk, and ate cheese, and I knew I was fooling myself if I thought that didn't make me complicit in a lot of the problems of modern farming. Nevertheless, it didn't seem like something I could help with.

            A few weeks into March, I changed my mind. I would dearly love to recount here that it was out of a sense of patriotism, or 'Blitz spirit'- wanting to do my part for the country. I would, more dearly, like to announce that the reason I became a Temporary Veterinary Inspector (TVI) for the Ministry of Agriculture, Fisheries and Food was because, if more slaughter was necessary, then I would do what I could to ensure the welfare of those to be killed was as good as it could be. There's some truth to both of these, but here's the main, rather depressing one: MAFF were so desperate that they announced they were doubling the pay of TVIs from £125 per day to £250. A fortune for me - a week's pay for working a couple of days.

            I applied, was accepted, fast-tracked, and within a few days found myself standing outside the MAFF building near Exeter, hoping that someone in charge would explain to me, in very simple terms, exactly what the hell I was supposed to do.

            While I was sitting in a large conference room, amongst many other vets - some large animal veterans, some dyed-in the wool small animal-types, some new graduates, and many, many Spanish vets, taking advantage of the sudden opportunity for work and pay far better than anything they might find in their home country - experiencing a very short induction lecture, arguments were raging across the county and the political landscape. The countryside had been, by this point, effectively shut down. People weren't supposed to travel into it unless absolutely necessary. Tourists stopped coming to the UK. Opposition party leaders were asking why MAFF hadn't imposed restrictions as soon as they had confirmed the disease in the Essex abattoir - as reports on the 1967 Northumberland epidemic were very clear that speed was of the essence in controlling the disease. Many members of the general public started asking the same question that had crossed my mind - what was so terrible about this disease that demanded the extreme response of the contiguous cull?

            As I sat, flipping through my induction pack, listening to the explanation of the disease control policy, a line from one of my favourite childhood films ran through my mind. In Aliens, when Ellen Ripley discovers that the colony on LV421 has been overrun by the terrifying creatures that wiped out her entire crew in the first film, her solution is simple but effective.

            'I say we take off, and nuke the site from orbit. It's the only way to be sure.'

            It occurred to me that someone high up in the ministry was a fan of the film too.

*

Despite my worries, the job itself was simple - far simpler than my normal day job. Every day we (myself and a technician) would be assigned a number of farms to check in Devon. We would drive to the farm entrances in our MAFF-assigned vehicles, park outside, then don disposable boiler suits, hats and masks, dunk our white Government-issue wellies into virucidal solution, and inspect every single animal on the farm for symptoms of FMD. If all was well, we would move on to the next farm. If we found anything suspicious, however, we would call in the back-up, who would slaughter the suspected animals and test them for the disease. If it was confirmed, then the contiguous cull would come into force - every cow, sheep and pig in a three-mile radius would be culled, and their bodies burned to prevent spread of infection.

            By the time I started at MAFF, there were a lot of bodies burning in Devon.

            If we ever found FMD, then we would be, from that point on, classified as 'dirty', and my veterinary services would then be required to assist with the culling, and the clean-up afterwards. By this stage, with up to fifty new cases being found every day, there was a lot of culling that needed to be done. The military had been called in to help, and 'clean' vets were becoming harder to find; hence the pay increase to attract new TVIs. Within a few hours of my training video, I was inspecting sheep on a farm near Okehampton, worrying that the few slides I had seen wouldn't be enough preparation for me to tell the difference between FMD and footrot. By now, the epidemic was at its height, and MAFF had introduced a 'suspected slaughter policy' - no more waiting for confirmation of the disease. If I saw lameness, would I be confident enough to cry wolf - and thus potentially condemn every livestock animal within a three mile radius to death?

            I was in a better position than some, however. A lot of the Spanish vets had never seen a case of orf - a relatively common disease of sheep in Devon, that caused blistering lesions around the teats, mouth and feet. If they suspected FMD, it didn't matter how many times the farmer pointed out they were actually looking at orf. All the animals on the farm would then be slaughtered, and if the case was deemed suspect enough, everything within three kilometres.

            Visiting a farm as a MAFF vet was a very different experience from visiting one as a normal vet. Some farmers were friendly and welcoming, but these were the exceptions. The majority were scared that we would find something on their farm, or suspicious that despite our extravagant precautions at their gate, we would bring the disease to them. Who could blame them? Farmers were compensated for the loss of their animals, but money doesn't go very far in alleviating the distress caused by watching everything on your farm get slaughtered and burned. Those were uncomfortable visits, farmers nervously showing you their animals, silently praying that you didn't suddenly order them to stop, to take a closer look at something, and speak the words that would mean destruction of everything they had built up.

            A couple of weeks into my work as a TVI, the Ministry for Agriculture, Food and Fisheries transformed into the Department of Environment, Food and Rural Affairs, or DEFRA. It must have been in the pipeline before the outbreak started - the wheels of government turn slowly - but at the time it felt like a response to the perception of poor handling of the crisis in the media. Don't worry - MAFF are no longer in charge of fighting the disease! DEFRA is on the case now. What it meant, in practical terms, was that one day I went to work to discover that all the headed paper had been changed from one logo to another.

            I worked for about two months as a TVI during the crisis, travelling from farm to farm - usually three or four a day, but some of the big units, especially large sheep farms, took up a whole day or more. I was lucky. The farmers I visited were lucky. I saw plenty of lameness; I saw footrot, and I saw orf, but I never saw anything that resembled foot and mouth disease. I made it through clean.

*

The final case of the outbreak was reported on a Cumbrian farm at the end of September. Movement restrictions were finally lifted in 2002, a year after the first case. DEFRA's contiguous cull policy had worked. FMD was once again eradicated from the United Kingdom, after the slaughter of around ten million sheep, cattle and pigs.

            I kept turning it over in my mind. FMD was a relatively mild, self-limiting disease in adult cattle. That was a hard thing to reconcile with the huge pyres of blackened, burning bodies that I, thankfully, only ever encountered on the news. The contiguous cull policy had worked. So would have taking off, and nuking the site from orbit.

            Here's the reason that FMD was taken so seriously by the Government: the economy, stupid. Affected cows suffer 'milk drop' - a reduction in the milk that they produce. This milk drop is usually temporary, but it can be permanent.

            There is, as I had suspected, all those years ago, a vaccine available for FMD. It's very effective, and relatively cheap. However, once you've vaccinated an animal, it is then impossible to test for the disease itself - the animal will test positive if the vaccine was effective. For this reason, the World Health Organization classifies countries according to their FMD status thusly: 1 - FMD present; 2 - FMD-free with vaccination; 3 - FMD-free without vaccination. The third and last group gets better access to export markets, so countries in this group work hard to stay there; it's fair to say that, in 2001, the UK worked very, very hard to stay there.

            There have been a lot of studies on the economies of the 2001 FMD outbreak - some of which say it was worth it, in economic terms, some of which strongly argue that it wasn't. It seems to be a close-run thing.[5] DEFRA has, since the outbreak, acknowledged that vaccination might be a sensible policy move faced with such an outbreak next time - vaccinations are allowed in some circumstances by the WHO in order to bring an epidemic under control.

            In case you missed it, I'll say it again - ten million animals were slaughtered during the FMD crisis of 2001 - the vast majority of them being sheep. It's since been confirmed that roughly one in three of the 'suspect' diagnoses were correct. Thanks to the contiguous cull policy, with the three-mile 'protection' zone, this means that something like ninety percent of those slaughtered were uninfected.

            Now, there's an argument to be made that all these animals would have been slaughtered anyway - we eat them, after all. As a counterpoint to that argument, consider this: slaughter in an abattoir is tightly regulated and controlled in order to minimise distress and discomfort to the animals. I have visited a number of abattoirs in my time. When it goes smoothly, the killing is painless, and very quick. It doesn't always go smoothly.

            At the height of the disease in Devon, ninety thousand animals were being slaughtered a day. Ninety thousand. On farms. By vets, by technicians, and by the army. If you think that it went smoothly, then I would suggest you are a poor student of human nature. None of the abattoir regulations were in place. Animals were not stunned prior to slaughter. They were not insensible at the moment of death, nor were they ignorant of the deaths around them. They were distressed, they were terrified, and then they were killed. Vets did what they could. Farmers did what they could. But that stark number of ten million animals, I can assure you, blurs an immense amount of suffering, fear, pain, and death into an easy-to-swallow statistic.

            Foot and Mouth is a disease of economic importance. I stayed clean during the epidemic of 2001. Somehow, I still feel dirty.






[1] I was very proud of remembering this point - it must have appealed to the SF writer in me; also, I honestly did remember that it was a picornavirus.
[2] a medical term, meaning 'it goes away by itself'
[3] Not strictly true - there have been a few reports of direct transmission from animals to humans, but these cases are very rare, not confirmed, and (just like FMD itself), get better very quickly.
[4] I won't mention it again, I promise!
[5] Here's some figures for the interested: getting the outbreak under control cost £8-10 billion pounds. Lost revenue for allowing FMD unchecked across the UK (and so ending up in the 'FMD present' group) could be £1.2 billion/year. Vaccination of all herds in the country would probably cost about £150 million. I can't find any figures for what the UK being downgraded to Group 2 would be.

Thursday, 5 December 2013

Breeding Difficulties part three - Breeders, and what to do about it all

In the last couple of blog posts, I've talked a lot about dog breeding, and the problems associated with it. In this final part of my epic trilogy. I'd like to briefly discuss the people responsible (and I do use the term very loosely) for producing puppies - breeders.

You can, I think, break breeders down into several types (rather than, say, their component atoms, which readers of my previous blogs may suspect would be my preference). Let's start with the type most commonly encountered by vets in general practice: the 'responsible' breeder.

'Responsible' breeders

The reason we encounter this type of breeder more frequently is, sadly, not because they are more common than any other type, but simply because these are the breeders who do everything possible for the pups that they produce - vaccinations, worming, flea treatment, nutritional advice, hip scores (or whatever test other the breed needs to pass to make it's suffering less than it otherwise would be) - and so they're the ones who come to the vets. Often. Very often. In general practice, you'll often be on first-name terms with them.

'Responsible' breeders occupy a strange position in many veterinary practices; generally liked (or at least tolerated) by practice owners, and largely resented by all the other vets, nurses and support staff - and by resented, I mean that their faces are likely to be pinned to a dartboard in the coffee room.

Here's the problem in a nutshell: breeders bring in a lot of money to the practice - both directly and indirectly, because if they like you, they're going to recommend you as the vets to go to. They are well aware of this, and as a consequence of this they frequently feel (not entirely without reason) like specially valued customers, which usually translates into them behaving as if they own the practice.

Responsible breeders have a tendency to be inpatient with (if not downright rude to) the receptionists, nurses, and junior vets who have the temerity to obstruct them in their quest to be immediately seen by the senior partner. They'll assume their particular problem is going to be more important to the practice than any other client's, and they'll be very ready to write a complaint letter if it isn't treated as such. They'll expect vets to drop everything to kowtow to their wishes, and they will usually hold the views of younger vets in disdain.

I can't tell you how many times I've heard some variant of the mantra 'I've been breeding dogs for thirty years, young man,' , with the strong silent implication that my own decade or so of treating sick animals every single day of my working life preceded by five years at university is worthless in comparison to this enormous achievement. Being my usual diplomatic self, at times like these I bite my tongue rather than point out that it's really not too difficult to produce a dog (if you're not familiar with the procedure, the main requirement is to have two dogs - ideally of opposite sexes, but I am clearly not an expert in such matters, as I am often reminded). Even if they personally haven't been breeding dogs for very long, they will almost certainly be accompanied by a friend who has been, and with whom every single statement you make as a vet must be checked and verified.

Now, I'm being unfair here, because for every two obnoxious, rude and demanding responsible breeder, there is one that is extremely pleasant (yes, that's the correct ratio as far as I can make out). Not only that, these are, and I mean this genuinely, people who care about what they are doing. They care about the puppies that they breed, and the mothers, and they want to see them go to good homes. They want to do the very best medically for their animals, and they would be horrified to think that they were causing any degree of animal suffering at all.

However horrified they might be, however, they are most certainly causing suffering. Quite apart from the severe, dreadful misery caused by inbreeding (which I wrote about in part two of this post), for every puppy sold to a new home, there is a dog in a rescue centre denied one. A dog that will either ultimately get put to sleep, or will spend the rest of its life in a kennel. Every single puppy. They don't mean to cause misery, but I am here to tell you that even the most caring, responsible, well-read and clued in breeder is causing it nevertheless.

And these are the good ones.

Irresponsible Breeders

If responsible breeders are likely to find their faces on dartboards in vet practices, then irresponsible ones are more likely to find their way onto the toilet roll. Irresponsible breeders don't really care about vaccinations, or worming, or nutrition. All of those cut into the profit margins. They care about mum, in so far as they need the bitch to keep producing puppies, but when she's past breeding age they'll pass her on, or put her to sleep (vets are not very commonly involved in this last procedure).

Irresponsible breeders are the type who lead to situations like my first blog post. They may attempt lip-service to the fact that they're dealing with a living creature rather than, say, a money-printing machine, but their actions belie their motives.

Breeders like this are frequently encountered for the first time in the middle of the night, having 'just moved to the area' or 'not registered the dog before', both statements being euphemisms for having run up a huge bill at one of the other vets in the area and having no intention to pay it. It's considered unprofessional for vet practices to inform other vets in the area that such clients haven't paid their bill, but you usually get the idea pretty quickly.

Despite the fact that a single puppy from a pedigree breed would generally cover more than double the cost of a caesarian, irresponsible breeders forget to bring their wallets with them surprisingly often - and frequently find them again very quickly when they are informed they must pay at the time they collect the dog.

Such breeders are the cause of immense amounts of suffering - principally to the deformed, unhealthy puppies that they produce, the females of which are destined to become dog-shaped money machines like their mother, but also to vets and nurses. Being faced with a client that simply refuses to pay and an animal that is in severe pain and in need of a caesarian is every vet's nightmare scenario. Yes, we can, in principle, simply offer to euthanase the animal on humane grounds, but if anyone else can manage to do that an still get to sleep at night, I'd appreciate some tips.

Not only this, breeders of this type are far, far more likely to report your actions to the Royal College of Veterinary Surgeons - so for those people who suggested to me, after reading my first blog, that performing the caesarian described without speying the poor bulldog was unethical, all I can say to you is this: not according to the Royal College. Performing a surgical procedure on an animal without consent is very definitely going to get a vet struck off, and so is the 'whoops, the uterus broke so I had to take it out' strategy that has been whispered about behind closed doors.

As time goes on, and I become (yes, I admit it!) more of a fundamentalist about breeding in general, I am starting to include anyone who breeds dogs of such obvious anatomical unhealthiness as pugs, bulldogs, basset hounds and so on as automatically, and by definition, irresponsible (yes, I know pugs are beloved by the internet. I also know that, because of their shape, they suffer; perhaps if you had treated several that prolapsed their eyeballs because they had a nasty coughing fit, you might feel similarly).

Puppy Farms

It is with sorrow that I even have to include this category, as I would have thought these would have died out years ago, but nope, they're still going strong. Puppy farmers are, effectively, irresponsible breeders who have embraced the principles of battery farming, and applied it to dogs.

A lot of vets know very little about what goes on in puppy farms, because the never visit them, and they never hear from the breeders. The first they know anything at all about such places is when they are presented with a puppy that someone has bought from them. Even by pedigree standards, puppies from here are going to be in pretty poor states. Often these puppies are bought on the internet, and while it boggles my mind that anyone could be so stupid as to order a puppy in the same way that your order your shopping, it still happens. Thankfully, a recent petition requesting the banning of the such places by the excellent PupAid charity has very recently topped 100,000 signatures, which means the issue must now be debated in parliament.

I haven't got much to say about puppy farms at all, to be honest, other than to say that they are vile, evil places, which cause about as much suffering and death as anywhere I can think of outside of... well, outside of a battery farm. Which does spur me to make one last point about them - if, like me, you can't stand the thought of a helpless dog, trapped for its whole life and forced into repeated pregnancies to produce animals simply for profit - then please stop and consider what you're doing when you buy cheap eggs, or pork, or veal.

What to do?

Now, I promised that this last blog in my trilogy would be proactive. So far I have, I hope, given a pretty clear indication of the suffering that is caused by the puppy trade. Is there anything that can be done to prevent it?

Well, fortunately for me, I've saved the easiest part of my blog for last. Yes. Yes there is. It's really very, very simple.

I could give some simple advice here about never, ever ordering a puppy if you haven't seen and visited it's mother, and made sure it's in comfortable surroundings, and healthy, and well. Never even think about buying a puppy online, and don't ever, ever get anyone a puppy for a present, no matter how good an idea it seems. But, y'know, typing out the words 'ordering a puppy' makes me feel a little queasy. Here's my much simpler advice (and I warned you I'm a fundamentalist on the topic):

Don't buy puppies. Don't breed puppies. Get your animals from rescue and rehoming centres. Always.

That's it. That's the sum total of my advice. Follow it, and I can guarantee you'll be reducing animal suffering, and you will have a wonderful new addition to your family.

As to the rebuttals to that advice that may have sprung instantly to your mind, then I'll deal with them below.

But... if everyone did that, there wouldn't be any pet dogs! Is that what you want?

No, it isn't, but... don't be silly. Rescue centres are absolutely full. Animals are getting put to sleep right now. Read my blog post Dog #86324.
You know what, if they ever get even close to emptying, I'll change my advice. I suspect that I won't ever have to do that. Don't spring your reducto ad absurdum on me, it's a logical fallacy.

But... I want to know what I'm going to get!

Well, I can tell you what you're going to get with a pedigree dog, but let's not go there. You can, and I hope I'm not sounding rude here, possibly get a reasonable idea of what you're going to get by, y'know, looking at the dog you're rescuing, as opposed to assuming that a dog that you've ordered from a breeder and that doesn't yet exist is going to be fine.

But what if the rescue dog is aggressive?

What if the pedigree dog is? At least the rescue dog will have been screened for its behaviour. The pedigree one won't. I've met plenty of 'well-bred' dogs that took a disliking to my nose too (maybe it's my nose that is the problem here...)

But I want a dog that won't shed any hair, I'm sort of allergic to dog hair. Think of my children!

Well, labradoodles need to be rescued too, y'know. Failing that, buy a better vacuum cleaner, or, if you and/or your child is allergic to dog hair then, am I'm only suggesting this, possibly a dog isn't really the pet for you. I'm extremely uncomfortable with this idea of getting a pet 'to order' - it's this sort of thinking that got dog breeds where they are today, which is to say, suffering.

But... my Brunhilde is amazing, I just want one litter of pups from her.

I understand this impulse. You love your dog. You don't want that to be it when they're gone. Listen, no one in the world loved their dog more than I loved Geri - but I wouldn't have bred from her, even if I had the option. Why? Because there are thousands of dogs like Geri, and yes, like Brunhilde, already waiting for a home. The world doesn't need more of them. It really doesn't.

I'll be happy to answer any more queries, but until then, here's my final word on the subject... once more, with feeling...

Don't buy puppies. Don't breed puppies. Get your animals from rescue and rehoming centres. Always.





Saturday, 16 November 2013

Breeding Difficulties part two - breed predipositions

As a vet student, and as a new vet, I hadn't really thought much about dog breeding. Dog breeds, to me, meant a list of predisposed diseases that I had memorised by rote as part of my training - something a little like this:

            West Highland White Terriers: Atopy, Lens Luxation
            King Charles Spaniels: Mitral valve insufficiency, syringomyelia
            Boxers: Aortic stenois, neoplasia, idopathic syncope          
            German Shepherds: Anal furunculosis, atopy, pannus, dilated cardiomyopathy, hip dysplasia, chronic degenerative radiculomyopathy[1]

 ... and so on. Questions on this would pop up all the time in exams, so you needed to know this stuff[2], but I never really considered what this list meant. It was just something else to learn: parathyroid hormone is responsible for the regulation of calcium levels within the body, the average pH of a pigeon's rectum is 6.3, and greyhounds are predisposed to develop osteosarcomas.

 Our family pet when I had been growing up was a cocker spaniel, Silky[3]. I loved her dearly, as you would expect. It was harder for my dad to; she was extremely protective of her bed, and would growl and snap at him whenever he approached. She did the same to all of us if she ever wriggled under the bed, and she once bit me quite badly on the finger when I tried to extract her. At university, I learned that this was in inbred trait of spaniels - rage, it's called[4]. So, it turns out, was the heart disease that claimed her life. Still, these things never really connected; by the time I qualified, Silky had been dead a long time, and my parents had another spaniel at home[5]. We knew the breed, you see. We liked them.

In practice, this knowledge of breed diseases was very helpful. Young labrador, unsteady on its back legs? Definitely worth x-raying the hips for dysplasia. Westie with breathing difficulties and crackling noises on auscultation of the chest? Need to investigate the possibility of pulmonary fibrosis. Very helpful. Essential, in fact.

In those first few months, I was living from one consultation to the next, terrified that I was just one slip of the needle away from making some colossal mistake. Eventually, though, as the terror of being a new graduate slowly settled into a dull, lurking fear, and I started to see consultations that weren't wholly new to me, I began to notice just how much of my time was being taken up treating diseases that were on that list. Even for someone as slow on the uptake as me, when faced with my third westie in the same week with severely inflamed and infected skin due to its chronic allergic skin disease, I started to ask myself questions about whether there might be a better way of dealing with this stuff.

Suffering. It's a word that's followed me through my life, and through my career. As vets, we use it a lot. We are, we like to think, its enemy. Our whole raison d'etre, our vocation, is to reduce it whenever and wherever we can. It's the reason we can euthanase five animals in a day, and still get to sleep at night  - we didn't want them to suffer any more.

Working in general practice, it finally started to click with me - this rottweiler with entropion wasn't helping me out by presenting me with a disease I knew it was predisposed to. It was in pain, because its eyelashes were pressing onto its cornea. This springer spaniel with purulent otitis externa was yelping when I examined it because it hurt. That great dane that I put to sleep last week due to dilated cardiomyopathy wasn't just another tick box on my mental list of breed diseases. It was dead, because it's heart gave out. Because it was a great dane.

That's when I started to wonder about that list. Breed predisposition. It meant that, genetically, these breeds paid a price for their long ears, or their curly tails, or their short, cute, forelimbs. It meant that they were more likely to get certain diseases - and, from my experience in practice, I was realising that this didn't just mean a bit more likely. Something like fifty percent of westies have atopy. The same proportion of bulldogs can't give birth without a caesarian. I was coming to understand that the price a dog pays for being a certain breed is that it suffers.
          
I finally started to think very seriously about dog breeds, and just what we were doing to man's best friend. 

The bulldog caesarian I described in my last post is, I don't deny, an extreme example - but the point of this post is to demonstrate that no breed is immune. The pedigree dogs we have now are not the same creatures that existed fifty years ago; through more and more inbreeding, they've become caricatures of themselves.

Next time, I'm going to talk about breeders, puppy farms, rescue centres, and what we can do to try to fix this problem, and therefore stop me blogging about it - something I think that we can all agree would be a good thing ;).








[1] This is not, by any means an exhaustive list for any of these breeds.
[2] And why, due to a particulcarly stressful 'steeplechase' exam in my fourth year, I will remember to my deathbed that Belgian Shepherds are predsiposed to gastric adenocarcinomas.
[3] This is what happens when you allow your children to come up with names for your family pets, of course. We all liked the name, anyway. Don't judge us.
[4] Which puts me in mind of the excellent not-zombie film, 28 Days Later. Definitely worth seeing! But I digress - I suppose I'm allowed to in a footnote, now I think about it...
[5] Bilbo, if you must know. Hey, I like The Hobbit, okay? (The book, obviously).

Thursday, 14 November 2013

Breeding Difficulties Part One - The Truth about Breeding


Heidi, the three-year old bulldog, waddles across the floor of the prep room. She tries to sit, but her hugely distended abdomen makes that uncomfortable for her, so instead she stands, and pants. Her thick eyelids droop with weariness. Sam and I lift her onto the prep table with some difficulty. Heidi gurgles and splutters as we set her down, then starts panting again. Green viscous fluid drips from her vulva, onto the table. We haven't much time.

            Sam raises Heidi's vein with some difficulty; this is uncomfortable for Heidi too. Not because of her distended abdomen, this time, but because her elbow dysplasia makes it hard for her to stretch her leg forward. I look sadly down at her. Her whole life is a struggle with her own body - whenever she tries to walk, or eat, or defecate, or breathe, she has to wrestle against her own bizarre anatomy. I inject the propofol into her vein, her eyes roll downwards, and she starts to sink to the table.

            'We'll take it from here, love,' I say, and Sam smiles. Placing an E-T tube is difficult too - Heidi's soft palate is too long for her mouth, and it takes some searching before I manage to locate her epiglottis - but the moment it's in place, Heidi's tongue loses its alarming bluish tinge and turns a reassuring pink.

            'Probably the best lungful she's had for a while,' Sam says, as she ties the tube in. We roll Heidi onto her side and start prepping her abdomen for surgery. I don't want to roll her on her back until absolutely necessary; her abdomen is so bloated I'm worried what the weight of it would do to the spine, and the blood vessels that run below it. We can't support her blood pressure nearly as well as I would like - Heidi's owner has declined intravenous fluids on cost grounds - and so I just want to get on with the caesarean as quickly as possible.

            It's late on Monday night. Heidi was booked in for an elective caesarean this Thursday, which would have been her 63rd day of pregnancy; a sensible precaution, because fewer than fifty percent of bulldogs manage to give birth without the operation, but in the last few days Heidi's abdomen has swelled to alarming proportions, and over the course of the day it's become clear that the pups need to come out, ready or not, or Heidi isn't even going to make it to Thursday. The green discharge, which started in the last hour, generally indicates that the placentas have started to separate from the wall of the uterus.

            Sam and I carry now extremely-heavy dog into theatre, and I only swear and complain about my back once; something of a record, as Sam, who is just over half my size, politely points out. I look at Heidi's immense abdomen, and suggest there is probably more swearing to come. I'm right.

            As I scrub, my mind wanders back to a consultation I had with Heidi and her owner, three years ago. It was her first adult vaccination, when she was about fourteen months old. Heidi's owner, a short, likeable man, tells me that he was thinking of breeding from Heidi, and wants to know what I think. I glance at Heidi's clinical notes, and try to hide the expression of dismay that must have crept across my face. Despite her tender years, Heidi has had surgery four times - twice to replace prolapsed tear glands, once to correct her entropion (a condition where her eyelids are so fleshy that they scroll inwards, allowing her fur to press against her eyeball, leading to chronic pain and frequent eye ulcers), and once to surgically remove her tail, which is so deformed it has formed a tight-corkscrew shape, leading to repeated severe infections around her back end and, again, chronic pain. I wonder how I can delicately state that Heidi is about the worst candidate I can imagine to have more progeny. I want to grab him by the lapels, and scream 'No, no! A thousand times, no! Can't you see how much she is suffering, just trying to walk?', but I feel that's not very professional.

            While I am thinking, the hitherto likeable owner, who seems slightly surprised that I am not immediately excited at the prospect of Heidi producing puppies, says, 'I'll have all the tests, you know. I want to make sure I'm doing the right thing.'

            This gives me an in. I calmly, and, I think, quite logically, explain that I don't need to do any 'tests' to tell me that Heidi is a poor choice of mother, both medically and genetically. All the conditions that she has had surgically corrected, as well as the many she has which can't be, are heritable conditions, and any puppies that she has is likely to suffer from them too. I further explain that the Kennel Club, finally drawing a line in the sand long after the country behind the line has been invaded and razed, wouldn't allow any pups to be registered, due to the number of corrective procedures that Heidi has had to endure.

            As I talk, I see Heidi's owners attention start to wander. I'm not saying what he wants to hear, so he's stopped listening. I say it again, in a slightly different way, and then again, finally ending with an extremely strong recommendation that Heidi is speyed as soon as possible. This last is too much for Heidi's owner. At reception, I hear him asking never to see 'that vet' again.

            Now, three years later, Heidi's owner doesn't have much choice, because I'm the vet on duty tonight. When I admitted her tonight, he didn't mention his request not to see me, and I didn't mention my advice never to breed from her. There didn't seem like much point.

            Now scrubbed up, I enter theatre and don my surgical gloves. Heidi's abdomen already has a long scar along it; this isn't her first caesarean. In fact, it's her third. Heidi's owner says he won't let her have another litter after this one. He said that last time, too.

            I open her abdomen with a large incision, cutting through the scar tissue of her previous surgeries, and ease the huge, bloated uterus out of the wound. Incising it, I remove the first puppy in its amniotic sack. It is enormous: truly a camel would have more chance passing through the eye of a needle than this puppy would have had of passing through Heidi's pelvis. I hand the puppy to Sam, who quickly breaks the sac, clearing the fluid, while I start to milk the next puppy towards the incision in the uterus.

            'Nick...,' Sam says. I look up, and understand why Heidi was so bloated. The puppy looks like someone has been at it with a bicycle pump, bearing more resemblance to a hippo that a bulldog. The skin is thickened and distorted with fluid, and has torn in a number of places around the mouth. As Sam gently shifts the puppy's position, its abdomen splits open, and she gasps in dismay. Fortunately, was dead before I ever removed it from the uterus.

            'Anasarca,' I mutter. Also known as 'water' or 'walrus' puppies: a condition of bulldog pups that causes severe oedema in the days leading up to birth. Mild cases might, just might, survive. The pup I have so far removed is not a mild case.

            So it goes for the remaining four puppies that I extract. All of them are severely affected. Two of them have weak heart beats, so I ask Sam to euthanase them for me.

            Heidi's colour has improved dramatically now that we have reduced the load on her uterus. I wish, once again, that we had her on fluids, but she seems to be doing well now that all the puppies are out. I start to suture up the uterus. When I admitted Heidi, I asked the owner if he would like me to spey her at the same time, as he already had suggested that Heidi wouldn't have any more litters. He declined.

            Suturing up a caesarean is often done to the noise of puppies crying for their mum's milk, but tonight Sam and I finish the operation in silence. Afterwards, Sam stays with Heidi while I telephone the owner with the news. He's annoyed and depressed. Of course he is: a single live pup would have recouped double the cost of the caesarean. He wants to know how many of the pups were female. We didn't think to check at the time, and I do so now. Only one of the five was a bitch, which seems to be some comfort to Heidi's owner. Bitches are worth more than dogs. Finally, with genuine concern, he asks how Heidi is. I reassure him that she's fine, and he sounds relieved. He thanks me for my help. I put the phone down, and sit down in dispensary, looking up at all the medicines I have at my disposal to treat sick animals, and wonder just how complicit in Heidi's suffering I am.

*

Well... this was going to be a short introduction to a post that discussed dog breeding, breeders, and some of the difficulties I encounter in practice... but I'm afraid it rather got away with me! I'm going to follow this post up, hopefully at the weekend, with a (hopefully) less emotive piece discuss some of the points I touch upon above. The above caesarian is an extreme case, but the details are not, I'm afraid, exaggerated. This exact scenario was occurred, with minor variations, to me personally, on three occasions, and I suspect it won't be entirely unfamiliar to any vets reading it, either.