Wednesday 19 August 2009

The Youth in Asia - part one

There I was, writing my last blog about drug reps - bit dull, wasn't it? I even bored myself, writing it. But a small part of it stuck with me.

It was the bit where I mentioned that people often say to me 'It must be the worst part of your job, putting things to sleep' - I followed this with a facetious comment about how seeing drug reps was really the worst part of my job.

That's a lie, of course. Never let the facts get in the way of a good blog, I say! (Or a crappy blog, in the case of my last entry). In fact, that isn't really the case.

I genuinely used to feel this. When people hear you're a vet, the first thing they tend to say (well, second thing - the first is 'Oh yeah, had your hand up a cow's arse, recently?' Look, if that's your first response, I would respectfully suggest that it's you that have got the bovine anus fetish, not me, okay? I just do it for a living, all right? Not for fun) is 'Oh, I couldn't do that. I couldn't put things to sleep.' And I used to think they were wrong. I used to feel that it wasn't that bad. Why? Because I was relieving suffering. Because there was nothing but misery left for the animal, and because it was probably the kindest thing I would do for that animal.

Now, ten years down the line, I'm not so sure. Not that I was wrong about it being kind, I still think that's true. In fact, I believe it's the greatest gift I have, to ease an animal's final moments. But nothing is ever quite as simple as it first appears, is it?

There are a number of problems associated with the act of killing. The first is this - the inappropriate euthanasia.

The most obvious case of this is - the healthy animal. The animal that would otherwise get better, but because the owner can't pay/won't pay/doesn't want the animal 'to suffer', they make you put their pet to sleep anyway.

The most blatant example of this that comes to mind is a cat that I saw with a fractured hip. The hip really needed an operation to heal properly. The owner couldn't afford the operation. I suggested that the owner telephone the RSPCA and the PDSA, two organisations that will readily help with financial problems. The owner didn't want to do this. Not having hearts entirely made of stone, we then offered to treat the cat at a cut price. The owner still couldn't afford to it.

Getting a sinking feeling of where this was going, I next offered to treat the cat for free. No. The owner didn't want the cat to go for surgery - it would be 'too much for it'. Okay. Deep breath. Y'know what, even without surgery, the cat would probably walk again. He would need 6 weeks rest in a cage, but he would be able to get back to a relatively normal life afterwards.

No. The owner didn't want the cat to 'go through' 6 weeks of cage rest. It wouldn't be fair. (This was, I may have neglected to mention, a two year old cat. It had, in all probability, ten to fourteen years of life left to it. Maybe it might have been prepared to spend 6 weeks in a cage.)

Would they consider rehoming the cat? No. It 'wouldn't be fair' on the cat. What they wanted was to have their cat put to sleep.

It was me that ended up doing it. I ended up with it because my colleague was hoping against hope that having someone else suggest to them they were doing the wrong thing might change their mind. It didn't. They were adamant. The owners, a young couple with two children, came in to speak to me one final time. Towards the end of the consultation I gave up any pretense of being polite and asked them if they wanted me to 'kill their cat.' They said that they did. I said that I would, hoping, secretly, and very illegally, that I would just be able to rehome the cat. They wanted to stay with it whilst I put the cat to sleep. So, my next plan was that I would sedate the cat whilst they were there, revive it and rehome it when it awoke. The owners wanted to take the cat home and bury it.

So, I did it. I killed a cat with a broken bone that would have healed in three weeks with surgery, and six weeks without. After I listened to the cat's heart beat its last with my stethoscope, the lady's daughter started crying over the dead body. The lady asked me 'Do you think we did the right thing?'

I could not speak, and I left the room.

The memory of that moment is with me strongly now as I write these words. I was the instrument of that cat's destruction. What good would it have done me to refuse? Vets have been struck off by the Royal College for refusing to perform euthanasia. I had no power to seize the cat - this would have been technically theft, and I could have gone to prison.

So I killed the cat.

I'm sure many vets have similar stories to this. Obviously hyperthyroid cats that the owner doesn't want to 'go through' being given tablets. Arthritic dogs that, instead of being given painkillers, the owner would rather that they 'didn't suffer'. Problem behaviour dogs that the owner has never given a thought to dog training, and that they are now scared of.

It always surprises me that people are arrogant enough to assume that they look after their pet so well, that rehoming can not be thought of even for a second - no one else could possibly look after this pet at all! Death is preferable than life without me!

Well, ask yourself - who are telling this lie to? And who is really going to come out worse because of it?

Okay, that's the first problem with euthanasia, and I have many more things to say on this subject. Part two in a few weeks. Stay happy!

Bad Rep-utation

A Rep came to see me today (by this I mean a drug rep, not a holiday rep, or a repo-man, or a reptile) and commented that I must be very hard working, as of all the vets he knows, I am the most difficult to come and see.

Well....he's sort of right. In the sense that I will find any excuse not to see a rep. People always say to me that euthanasia must be the worst part of my job. They're wrong. It's drug Reps.

(What's that? An infected anal gland? Oh dear, we'd better cancel the Pfizer rep. A constipated cat, that needs the poo hand picked out of it's rectum? Better ring Bob and tell him I can't make my appointment.)

Why? I hear the cry echo across the internet! What could possibly be wrong with spending time with a nicely suited man (or woman) that often brings along with him (or her) doughnuts and free sandwiches?

Why? I'll tell you why. Because I didn't become a vet to prostitute myself to drug companies, that's why. What these sneaky well-manicured men (or women) (why are you always going on about women, Stan?) are doing with their sneaky free foodstuffs is bribing me to use whichever drug they think is in vogue at the minute.

Some vets love it. My boss loves it. My wife loves it. (It's free food! She's muttering at me. Are you mad?) I do not. I like to choose my drugs based on evidence, and there's nothing more likely to get my goat than a drug rep flashing a glossy piece of paper at me with an impressive looking graph showing that n number of dogs would rather be doused in cooking oil and set alight than be denied their latest wonder-drug (where n is usually < id="SPELLING_ERROR_2" class="blsp-spelling-corrected">privilege. The nature of my work is to make money out of pain and suffering. But I like to think I have some ethics, and prostituting myself for the sake of a drug company leaves a distinctly sour taste in my mouth (or maybe that's just the Rum & Raisin doughnuts I was fed by an enthusiastic rep recently)

Consider this - I can, off the top of my head, think of seven very effective flea products on the market for dogs and cats. There is no licenced painkiller for rabbits. Why? Because there's more money in selling flea products than there is selling painkillers to rabbits. (Ehh...what's up with that, Doc?)

(This is not that we don't have effective painkillers we can use in rabbits - they're just off-licence, that's all. Sooner or later some bright spark in a drug company will licence a painkiller that we already use, and charge is ten times the price for the privilege - as has happened recently with Zitac (Tagamet) and Atopica (Cyclosporin) in dogs and cats)

So, I don't like spending my afternoons with drug reps. In fact, I'd rather spend my afternoons arm-deep in pus than watch one more audio-visual presentation about why this NSAID is ever so slightly better than that one, so long you don't mind getting diarrhoea and stomach ulcers.

Drug reps? Bring on the anal glands!

Sunday 9 August 2009

Jenner-ation Ex

I had a client in a few months ago who told me that she didn't need her papillon vaccinated. Why? Because she used homeopathic vaccines, that's why.

I took a deep breath. Now, I don't want to get particularly preachy with this blog - there's little more annoying in this world than being told what to do by someone who thinks they know better than you. But tough, I'm going to do it anyway.

Let's leave the whole subject of homeopathy for another blog, shall we? But homeopathic vaccinations? Really? The whole idea of a vaccination is to introduce something into the body that stimulates the immune system, and provokes a reaction that is protective against future infections. Now imagine giving a product which, if it were scaled up to a globe the size of the solar system, would contain one molecule of the active substance. (Which is equivalent to a 200c dilution, the standard I believe for homeopathic prophylaxis). Maybe it's just me, but I think my immune system might find that one a little tricky to find. In fact, if I had an immune system that tough, we could have simply sent my white blood cells into Afghanistan and saved the country a lot of money, lives, and ethical misery.

(In their defence, I believe that most homeopaths posit the theory that homeopathic vaccination works on a 'deeper' level than that of stimulating antibody production. If they ever feel like sharing this deeper understanding of the immune system with conventional medics, I'm sure we'd all be a lot happier and healthier. Whenever you're ready, guys!)

I'm sure you're all familiar with the story of vaccination. It is one of the greatest success stories of modern medicine. Edward Jenner was born into a world where 1 in 5 people who died, died of smallpox. He noted - it was probably common knowledge amongst agricultural families -that people who had been infected with cowpox tended not to get smallpox. Presumably being a silver-tongued devil, he somehow managed to convince a young boy - James Phipps - that it would be a good idea if he let Jenner scrape some pus from a milkmaid infected with cowpox, and inject it under Phipp's skin. (Accomplished with scratching his arms open with bits of wood).

Phipp's possibly received a lollipop for his troubles. He also received immunity to smallpox, probably a better present. 250 years later, smallpox is all but extinct (not counting the many samples held by various Evil Genius's in their Evil, Evil Lairs - but I'm sure James Bond will get round to them eventually).

Vaccines save lives. Remember the great MMR hoax a few years ago? Not much talked about now, is it? Somehow (nothing at all to do with Britain's wonderful newspaper journalists, I'm sure) we were convinced on the basis of no evidence whatsoever that the MMR jab could cause autism. Now let me be clear about this - people have died because of this hoax.

On the dog and cat front - I personally have never seen a single case of distemper, and for that I am grateful, because it sounds bloody horrible.

(This may not be very appropriate but it reminds me of a joke. One of the symptoms of distemper is that dogs get very thickened, hard pads. Vets used to treat this by applying lubricant to all the paws, but after that patients tended to go downhill very quickly. Aheh. Sorry.)

I have, however, sadly seen cases of leptospirosis, hepatitis, parvovirus, feline leukaemia, and many, many cases of cat flu. None of which I ever want to see again, thank you very much. For those who feel that as vets we over-vaccinate, bear in mind that the only disease your dog will be vaccinated against annually is leptospirosis - the rest are pretty much on a biannual or more usually triannual rotation. Leptospirosis immunity often only lasts for twelve months.

Are vaccines perfect? No. They don't always work. Cat flu vaccination in particular is often only partially effective - much like the human influenza vaccine. Very very rarely, you will get a vaccine reaction. If you think about it this is not unnatural considering what you are trying to do is stimulate the immune system.

In my career I have seen two fibrosarcomas develop on the back of cat's necks, one of which ended in the untimely euthanasia of that patient. These sarcomas were almost certainly due to vaccination against feline leukaemia virus. Has that shaken my faith in vaccinations? Not at all. Why? Because I have also seen more cases of feline leukaemia virus itself than I can sensibly count (but is definitely in excess of 100) - every single one of which ended in the premature euthanasia of the unfortunate animal concerned.

Right, preachy mode over. Does my story at the beginning have a coda? Yes, it does. I persuaded the said owner of the papillion to vaccinate her treasured pet, using similar arguments to above.

The papillion had a vaccine reaction. Thank you, sod's law. The back of the dog's neck swelled up, and was bruised for a few days. He needed three days worth of painkillers. The owner of the dog now refuses to see me, believing (I'm not quite sure why) that I injected her dog directly into it's spinal column. She probably thinks that I torture kittens for fun, too. (In reality, I only torture them as part of my day job, of course).

Hence this blog post, which has two morals. Firstly, you can't win 'em all. Secondly, vaccinate yourself, and vaccinate your animals!