Ugh... I hate prong collars. What I hate more than prong collars, is the pet owners that put them on their puppies. PUPPIES! Come on people!! You don’t put a choke collar on your baby! You don’t use pieces of metal around their necks to prevent your child from running off! So why would you put that on your puppy? Ignorance. But I guess that's why we’re here! To educate! First off, I've spoken on other harmful topics in the past. Veterinarians need to take an oath that first, to do no harm. Is what we are doing causing more harm than good to the pet? Puppies are innocent. That need to be worked with in order to become members of a household. How to walk on a leash without lunging at the nearest squirrel or squirrel-like dog on a leash coming towards them. Every puppy has the ability to perform appropriate leash behaviours, when in the hands of the right owner. Remember, puppies need appropriate socialization early on. Here is the Canadian Veterinary Medical Associations take on humane training methods. Reward-based methods are highly recommended. Aversive methods are strongly discouraged as they may cause fear, distress, anxiety, pain or physical injury to the dog. the use of aversive devices such as choke, pinch, or prong collars are strongly discouraged in favour of more humane alternatives such as head halters. Devices such as electronic collars should only be used by a certified and/or experienced trainer or behaviourist, and only after all other training and/or behaviour modification methods have failed Prong collars Ask yourself why you want to put this piece of metal around the puppy's neck. Then, ask yourself is there an alternative to this. Usually it is leash pulling that an owner is attempting to diminish. These are just a few samples of the metal prongs that get stabbed into a dog's neck when they are forced to wear one of these. Do I really need to tell you that this is wrong? Just in case it isn't obvious to you. Here is a statement from the SFSPCA. Myth: A prong collar isn’t inhumane if it fits right. Fact: Sadly, this is a false statement that’s been perpetuated by aversive trainers. Even properly fitted prong collars dig into the sensitive skin around the neck, risking severe damage to the thyroid, esophagus, and trachea. Here are three alternatives! The Sense-ation harness: recommended by a trainer I met in Toronto. I highly recommend this type of front clip harness. Halti head halter: a head halter works when the dog goes to pull, the nose of the dog then will be turned back towards the owner who is holding the lead. See how to use a Halti through a lot of YouTube videos or read here. Gentle Leader head halter is another alternative. Shock Collars While we are on the topic of collars... Can we ban shock collars?? Seriously antiquated methods of fear-based training. What can you do? Well, I found a website that has a lot of information on reasons against shock collars. Can we just say that shock collars cause fear, anxiety and pain for our animals that we deem to be our fur family - that it is wrong to contribute to the fear and anxiety of these animals? Sadly, with social media, there is always spread of misinformation. People just cannot help themselves. Take note that, with more people understanding how wrong fear and punishment based training is on the psychology of children, the more people are understanding that it is wrong for pets as well. This month people are speaking out on the inhumane videos on YouTube from shock collar use by trainers. I would never allow someone to put that on my dog. Ever. What are the solutions? It's all well and good to say, don't use a prong collar or shock collar to train your dog. Puppy owners want an easy fix. Oh, but he does so well on walks with the trainer while using a shock collar. Or, I've sent him away for board and train and he did so well. But I just don't know why he is doing this. And so on. Just as there are good veterinarians and bad ones, there are good trainers and bad ones. So what is a good trainer? How do you know? It's not about the cost of the training. First off, the trainer is training the human. The dog is smart. The dog will learn. But the human does not speak dog, while dog's do not know human language. The human needs to learn to understand the dog. A good trainer will teach the human how to train their dog. A good trainer will understand what positive and reward based training is. Ahhh... and a good trainer should be willing to collaborate with your veterinarian when it comes to fear, anxiety and aggression in your dog. You as the pet parent need to be willing to learn and work with your fur baby. Here's a link on how to choose a trainer. Dogs show signs of distress when using shock collars. If they are misused, this can lead to fear-aggression. See this article for more information. The #1 thing that I wish for you to take from all this is: Be humane. It's Science If you are like me, and you want to see the science. Here's an article on the efficacy of positive reinforcement compared with using shock collars. The BCSPCA's statement on the use of shock collars. Countries (jurisdictions) where shock collars are banned. Let's follow their lead! Austria, Denmark, Finland, Germany, Norway, Slovenia, Scotland, Sweden, Wales, and parts of Australia (from dvm360). 2010: Wales - 2014: Quebec, Canada - 2018: Scotland -
If you have been snooping around my website, you may have noticed this section that is under construction. I wanted to wait until I was a "real" mom. Not just a woman who miscarried. Not just a cat mom. But my hubby made this logo for me, and he has been pushing me to get started. So... I am starting an audio podcast! The Intro-Dog-tion is streaming on here and on a few other platforms. I hope you enjoy.
Veterinarians are more likely to commit suicide than the general public. Actually, I think it is: Veterinarians are more likely to die of their suicide attempts than the general public. Because we know how to kill things. Yes, I said it. Euthanasia is a part of our job, whether we like it or not. We have a right to say no. We have a right to protect our mental health. So what spurred yet another Mental Health post? Dr. Josh Smith, a veterinarian and critical care specialist has recently committed suicide, spiking the talk amongst the veterinary community on social media platforms and trying to bring awareness to the struggles of our profession. Visit the GoFundMe page for his fiancée and family. Mental health awareness is not meant for one day. It's not meant for one week or a month. It's every day. Every day that we put on our scrubs, and every day we are at home, trying to give ourselves a respite from the stressors at work. Our inner critic does not take a rest after we clock out. That voice inside our heads is our worst enemy. So what can we do about it? Keep talking. Here are a few resources for the veterinary community: Not One More Vet Founded in 2014 following the death of Dr. Sophia Yin, world renowned veterinarian and animal behaviorist. Veterinary Mental Health Awareness a Facebook community group founded by a veterinary student MentalHealthDVM on Instagram CDC Report: Suicide Risk for Veterinarians and Veterinary Technicians CVMA Mental Health Awareness Week Sept 5-11, 2021 World Small Animal Veterinary Association Professional Wellness Group AVMA articles Be kind to yourself. Here is another recent interview and article on Dr. Josh Smith on dvm360.com posted on March 12, 2021. Crisis prevention course with AVMA here. A great video produced by a Canadian veterinarian. This TED talk by Dr. Bowden.
Ovarian Rejuvenation: using platelet-rich plasma injections into ovaries
The topic of today's post is fertility related. Some human fertility practitioners are performing injections of platelet-rich plasma (PRP) into ovaries and having an increase in IVF success for their patients, while others say it does nothing to help. Ok folks, this topic has been controversial. Medical Doctors (MD) and Veterinary Medical Doctors (VMD/DVM) learn to practice evidence-based medicine. This means that there needs to be objective, non-biased scientific evidence in order for a doctor to prescribe or make recommendations for treatment or management of a condition. First, however, is to do no harm. Is our recommendation going to cause harm to our patient? Are the benefits of the treatment outweighing the risks? The scientific research is still new, but when you are a woman of late reproductive age, and you have been struggling for years to conceive your own biological child, you are then faced with the decision of obtaining eggs from a donor so that you can build your family. Personally, I would go either way, but my husband would like to try for our own joint biological child first. I think I mentioned before, I am on all sorts of online forums and groups with women sharing their stories and looking for insight. Some of these women go through 3 or 5, or sometimes 10 IVF cycles without a successful pregnancy and birth of a child at the end. This hurts women in more ways than we can count - money, time lost, the envy and emotional anguish of watching your friend's children grow up, while you have nothing to show for the struggles you have been through, many women suffer in silence. Some women feel really depressed, honestly, we cannot even come up with the words, but they feel defeated when they are faced with the question, do I try another round with my own eggs, or try for a child with donor eggs? No one can answer that question for you. So, if there was a way for you to recruit additional follicles, in an attempt to get more embryos for IVF, you would probably do it, money aside. What if there was a way to improve your oocyte quality? What if there was a way to take you from minimal antral follicular count, to having multiple follicles to be aspirated for IVF? I certainly would be willing to try! There has been a number of research reports, prospective clinical trials and case reports, on the use of autologous platelet-rich plasma injected into the ovaries in women who have diminished ovarian reserve. They call it Ovarian Rejuvenation. Where it started: It seems to have all started in Athens, Greece with a pilot study published in 2016 . The full research was published in May 2020 , which gives you an idea of how long it takes for scientific research to be published (I know from personal experience). Women in the study had an average age of 45 years, all older than 40 years, without a menstrual cycle for 4-5 months. This is considered perimenopausal (or nearing menopause). All eight women in the pilot study had eggs retrieved. 1-2 eggs were mature, and 1-2 embryos developed to be able to freeze for each woman. Yes, 1-2 eggs is not a lot, nor is 1-2 embryos a lot. But think about it this way: if you have zero follicles available, because you are no longer cycling, and you receive a treatment that allows you to get 1-2 embryos - that's 100-200% increase from what you had previously! The risks: The risks are similar to egg retrieval using ultrasound-guided follicular aspiration. Instead of the needle going into the ovary to collect fluid, the fluid is injected into the ovary. The fluid that is being injected is from your own blood, so taking it from the blood in your arm, filtering it and removing the red blood cells, and taking the proteins that are left and injecting it into your ovaries. Women going through IVF are already aware of the risks of sedation and oocyte collection, and we go through it because the benefit (potential baby) outweighs the risks. The benefits: Ovarian Rejuvenation is kind of a funny term. But however you want to call it, the benefits thus far have been the recruitment of more antral follicles from that dormant collection of primordial follicles. Remember primordial follicles are the early stage follicles, well, there is no fluid in those follicles at that stage, just a layer of cells and a dormant oocyte. Perhaps they do not know all the proteins or growth factors involved in improving the oocyte quality and recruitment or activation of growth of more primordial follicles, but if you are successful, the benefit is your own biological child. To me, the benefits far exceed the risks. Yes, there is a possibility that it wouldn't work. So, definitely do your research to see which practitioners are experienced with this and what the laboratory success is like. Research in Autologous Platelet-Rich Plasma As a veterinarian, we use a patient’s own (autologous) serum to help with healing corneal ulcers. We take the blood from the patient, spin the blood so that the heavier red blood cells drop to the bottom of the test tube, and then remove the clear serum from this test tube, placing it alone into a dropper for eye drops on a patient’s injured eye. For serum, you wait for a clot to form in the blood sample, and you spin it removing the clot and platelets. For plasma, you are not allowing it to clot, but filter the cells out and take the proteins with the fluid. In Ovarian Rejuvenation, researchers take a patient’s blood, spin out the red blood cells, and take the remaining plasma (fluid left over with proteins including platelets) and inject it into the recipients ovaries. Studies show that the higher the platelet count, the higher the success of the treatment. In simple terms, platelets release many growth factors (see below). Once in the ovary, these growth factors regulate folliculogenesis (follicle growth). Growth and differentiation factor 9 appears to be one of the important ones in preventing follicle atresia and granulosa cell death (important cells in the follicles that assist with ovulation) . This factor also assist with energy production prior to the LH surge and ovulation, which requires a significant amount of cell energy. There are several other factors in PRP, and their importance in follicle activation and growth is more complicated than this list makes it seem. Due to the complexity of cell signaling pathways, there is unlikely one single growth factor that is the key to increasing ovarian activity. Gene activation is not a simple A to B to C, there are co-factors involved for enzyme function, molecules that can bind to several different receptors, and cells with many receptors that can bind different molecules, amongst so many other activities! Yes, the technique and protocols are new. Five to six years in research is still considered new, but by the standards of the technological world, five to six months is old. Let's take a look at some of the published research on PRP for ovarian rejuvenation. When you are scouring the internet, primary literature is going to be the go to for the evidence of whether something works or does not. A personal blog, or even a company website, isn't where you want to find your evidence. Remember, the plural of anecdote is not data! You want to be looking for peer-reviewed scientific research. Not all journals are treated the same, some being highly regarded and others have yet to prove themselves. A note on journal ranking: Journals are ranked based on how much their research impacts the overall scientific community. How often is a single article used as the nidus of another researcher's work? Journal rankings can be found online. Certainly that plays a role on whether you think your research is pivotal, and should be published in a highly reputable journal, or if your research is a small addition to the scientific community. When I was in school and completing my Master of Science I had access to a lot of primary literature through our online library. Sadly, I do not have access to this now that I have graduated, however, Google Scholar is a great free resource, with links to abstracts and sometimes there are free full text articles online. Yay, science! The most recent article I found was published in January 2021 in the journal Endocrines (it's a newer, open access journal, no impact factor listed). This article reviews the studies that are completed to date, as well as theories of how PRP works to increase oocyte quality and the number of follicles recruited for egg retrieval. The full text is available online and you can download a pdf copy if you so desire. Success Rates: People want to know what the success rate is. Do 100% of women who receive the treatment have an increase in follicles? Not always. While the pilot study  mentioned 8 out of 8 women succeeded to the embryo stage, it is not always the case. In a larger study , the women selected for PRP treatment were women with low ovarian reserve that had attempted at least two previous IVF cycles unsuccessfully. Of the 38 women who were treated, 4 conceived naturally (10.5%). Seventy-five percent (15/20) of women who went through IVF demonstrated successful retrieval of one to three eggs. Eight of these were fresh embryo transfers with 5 pregnancies from these (62.5%). The other seven had frozen embryos. Five were transferred, with 2 pregnancies (28.6%). Overall, 28% (11/38) of women had a successful pregnancy following PRP treatment. Not bad for these women who suffered for years of trying to conceive. The chart below may make it easier than words. Women have seen improvement in ovarian parameters including an increase in their AMH [4,5] and a decrease in their FSH . Those that had significant responses were patients who had more platelets in their blood sample to be injected [3,4,5]. Case reports, while only demonstrating a single patient, provide a little glimmer of hope. This one , showing a women at 41 year of age, having 10 unsuccessful IVF cycles, undergoing PRP injections, and then subsequently fell pregnant natural, with the successful birth of a healthy baby. Or this case report  of a women with improvement in the chromosomes of her embryos. Need I say more? Further Research As I mentioned, this protocol is new. Which means that it has to go through government health bodies prior to it being officially available mainstream. In September 2020 , a group published a commentary in the journal Reproductive Sciences stating that there were 13 clinical trials registered or in progress. It is always promising to see that funding and time is going towards new ways to improve our fertility. Where can you get the procedure? I cannot find anywhere in Canada (currently) offering the service. If you know of any, please point me in that direction! So what are your options? Obviously traveling abroad or even out of country across the border is not really feasible during a global pandemic! As things improve in our world, then perhaps these will be safely available. U.S. Clinics California: Center For Reproductive Health & Gynecology - - Two locations in California (Beverly Hills and Sherman Oaks) - Dr. Najmabadi also founded the CRHG Mexico Fertility Center in Punta Mita, Mexico Gen 5 Fertility Center - - San Diego (Research published ?) Hanabusa IVF - New York: CNY Fertility - New Hope Fertility - Rejuvenating Fertility Center - Clinical Trials in the U.S. In case you are interested in participating in a clinical trial (Last updated Feb 28, 2021). Search here for updated trials. New Jersey - New York - Tennessee - Tennessee Reproductive Medicine - Abroad Greece: Genesis Athens Clinic - Mexico: Punta Mita Fertility Center - Clinical trials abroad: Abu Dhabi - Egypt - Greece - Obviously you should discuss this with your doctor prior to making any decisions! Check the clinics success rate with the procedure as that may help your decision. And of course, stay safe during these COVID times. Looking for more information? Check out the links. The Facebook Support Group: Ovarian Rejuvenation/PRP Citations:  Pantos, K., Nitsos, N., Kokkali, G., Vaxevanoglou, T., Markomichali, C., Pantou, A., ... & Sfakianoudis, K. (2016, July). Ovarian rejuvenation and folliculogenesis reactivation in peri-menopausal women after autologous platelet-rich plasma treatment. In Abstracts, ESHRE 32nd Annual Meeting (pp. 3-6).  Sfakianoudis, K., Simopoulou, M., Grigoriadis, S., Pantou, A., Tsioulou, P., Maziotis, E., ... & Pantos, K. (2020). Reactivating ovarian function through autologous platelet-rich plasma intraovarian infusion: pilot data on premature ovarian insufficiency, perimenopausal, menopausal, and poor responder women. Journal of Clinical Medicine, 9(6), 1809.  Vo, T. K. C., Tanaka, Y., & Kawamura, K. (2021). Ovarian Rejuvenation Using Autologous Platelet-Rich Plasma. Endocrines, 2(1), 15-27.  Petryk, N., & Petryk, M. (2020). Ovarian Rejuvenation Through Platelet-Rich Autologous Plasma (PRP)—a Chance to Have a Baby Without Donor Eggs, Improving the Life Quality of Women Suffering from Early Menopause Without Synthetic Hormonal Treatment. Reproductive Sciences, 27(11), 1975-1982.  Sills, E. S., Rickers, N. S., Petersen, J. L., Li, X., & Wood, S. H. (2020). Regenerative Effect of Intraovarian Injection of Activated Autologous Platelet Rich Plasma: Serum Anti-Mullerian Hormone Levels Measured Among Poor-Prognosis In Vitro Fertilization Patients. International Journal of Regenerative Medicine, 1(2), 2-5.  Sills, E. S., Rickers, N. S., & Wood, S. H. (2020). Intraovarian insertion of autologous platelet growth factors as cell-free concentrate: Fertility recovery and first unassisted conception with term delivery at age over 40. International Journal of Reproductive BioMedicine, 18(12), 1081.  Sills, E. S., Rickers, N. S., Svid, C. S., Rickers, J. M., & Wood, S. H. (2019). Normalized ploidy following 20 consecutive blastocysts with chromosomal error: healthy 46, XY pregnancy with IVF after intraovarian injection of autologous enriched platelet-derived growth factors. International journal of molecular and cellular medicine, 8(1), 84.  Park, H. S., Ulin, M., & Cetin, E. (2020). Ovarian Rejuvenation Using Platelet-Rich Plasma: a Promising Option for Women in Early Menopause to Have a Baby. Reproductive Sciences, 27(11), 1983-1984.
If you have a male intact mastiff-type dog with blood in its urine, you should assume there is a bladder stone, until proven otherwise. Veterinarians know that step one for all urinary tract issues is getting a urine sample. Oftentimes, when you see bacteria and pyuria (white blood cells) you are suspicious of a urinary tract infection. If you have a female dog, absolutely a UTI is going to be your primary concern. But there is a subset of intact male dogs that you do not want to jump to just prescribing antibiotics after you see this on your urinalysis report. Even if you do not see crystals in the urine, you cannot assume that there is no bladder stone. The majority of the time, when you have a male dog, and you are suspicious of a urinary tract infection based on your urinalysis, the pyuria and bacteriuria ends up being secondary to something else, like a stone in the bladder, or cystitis from having a stone rolling around on the bladder wall. If the signalment fits, you want to be doing x-rays or a bladder ultrasound. Or both, to be honest, because there are some uroliths that are less obvious than others. This will depend on the equipment in your clinic, and on your skillset, but you can always refer. Cystine and urate stones are sometimes described as radiolucent, or more difficult to see on x-rays. One thing to note: Do NOT assume it is struvite or calcium oxalate just because you can see it on x-rays. So what is your signalment? A youngish (age 2-8) intact male mastiff-type breed, English and French bulldogs, occasionally pitbull type dogs. Here are three cases that I had in the past 6 months, as well as one at a referral practice that I a shadowing. Case 1: A 2-year-old male intact mastiff presenting for stranguria and hematuria The first patient is a 2-year-old intact male mastiff who presented due to straining and blood in his urine. In our patient, radiographs revealed that he had a bladder stone. We discussed that if he wasn't going to be a breeding male, that we should do a joint cystotomy (bladder surgery to remove the urolith) and castration (a preventive measure - to prevent future uroliths from forming). All of non-breeding males should be castrated. The owner, however, declined the castration, against medical recommendations. So what do you do when your client declines castration? Well, you need to send the stone off for analysis. If the stone comes back as a cystine or urate based stone, you're going to discuss a long term low purine diet; if it comes back as a struvite or calcium oxalate stone, then the standard urinary s/o indexed foods should suffice. This stone came back as a cystine based stone, and the owner struggled to try to get the dog on the low purine diet. Maybe they don't taste as good because they are low protein, not that I have tried them. Case 2: A 3-year-old male intact French Bull Dog presented to a referral practice with the inability to urinate This 3-yo Frenchie presented for an inability to urinate. Any patient that cannot urinate is considered an emergency. We see a lot more blocked cats than blocked canines. But, it does happen! The first thing to do is pass a urinary catheter to relieve the obstruction. If they are still urinating, then getting an x-ray may be the first thing you do, but in this case, since our little patient couldn't urinate, in went a catheter. A little tip for when passing a catheter in a male dog. You can have an assistant use digital rectal pressure to guide the catheter around the pelvic brim, so when you are passing the catheter around this sharp angle of the urethra, it will be guided more easily. Treatment for our little Frenchie was placing him on IV fluids and a urinary catheter placement for the night with some pain medication and prepare him for a cystotomy and castration procedure the next morning. Case 3: A 20 month-old male intact South African Boerboel My patient had been experiencing intermittent hematuria (blood in the urine) for the last year. Six months prior to presentation to my hospital he had a visit with his regular veterinary clinic and x-rays had not shown any uroliths. His urinalysis showed bacteriuria and pyuria with no crystals. He was put on antibiotics. While on antibiotics, the blood would resolve, but then a few weeks later it would happen again. On presentation to me, there appeared to be no straining, but blood at the end of urination. I took one look at him, not familiar with the exact breed, but saw a very large mastiff-type dog, and because I had done a lot of research on our previous intact mastiff, the alarm bells went ding ding! I told the owner he has a cystine stone until proven otherwise. It turns out the South African Boerboel's are predisposed to cystine stones. Again, not all uroliths will show up on x-rays. Even when a stone is radio-opaque, sometimes they can be difficult to see. Since nothing showed up on x-rays at the previous clinic, I offered a fast ultrasound of the bladder. In the ultrasound image below, my patient is laying in right lateral recumbency, and I am sending the ultrasound beam from his left side towards the right side. On the far side or gravity dependent side of the bladder you can see a hyperechoic (bright white) round structure that is casting a dark shadow, within the anechoic (fluid filled or black) bladder. Using the measurement tool on the ultrasound machine, the stone measures approximately 1.2 cm in diameter. If your patient is stressed and will not lay down, that's ok! You can image from ventral to dorsal, panning the ultrasound probe back and forth looking for artifact shadows. In this image, you can see that the stone is on the gravity dependent side of the bladder - which is the ventral aspect - after you do your mental gymnastic while imaging. I had a discussion with the owner about castration and cystotomy, versus trying low purine diet since he was presenting for blood in the urine and not yet obstructed. The owner was warned that if he did get obstructed he should get a cystotomy. Within two weeks he was in due to the inability to urinate. He went in for a cystotomy with my colleague and below are the stones that they pulled out. Those stones went out for calculus analysis which I told the doctor where going to be cystine based on the breed. They had put him on the urinary s/o diet after surgery. Well, we just got the results back from: 100% Cystine. Guess who is getting another diet change. Case 4: A 3-year-old intact male pitbull mix presenting for straining to urinate About a month after case 3 presented, I had another intact male dog straining to urinate put on my schedule. A new graduate was hanging about and I said, intact male, straining to urinate - it's bladder stones. How do I know? When it is an intact male that is straining to urinate, it's a bladder stone until proven otherwise. The patient was sweet, but leaking urine and urinating on everywhere! On the floor, on us. I just had to laugh as I'm trying to do my exam and he's peeing on my shoe! I threw a dipstick on the urine and it was high with leukocytes and had moderate blood. I told the owner we should do an x-ray to check for bladder stones. This owner had no plans to breed his pup and I discussed that castration during the same anesthetic procedure is the most cost effective means of treatment and prevention. Fortunately for this pup the owner was up for my recommendation! As you can see, a urinary catheter was placed for overnight care and he went for surgery the next morning. Management and Prevention #1 castration. Maybe it's just me, but I have seen a growing trend to not castrate male dogs. Part of it will stem from male owners feeling bad about castration, because they put themselves in their pup's paws. The female owners don't really care too much, except when they have a breeder contract that says they need to keep their male intact for 18 months, or something like that. The other hesitation to castration is that some breeds are predisposed to orthopedic issues, which is thought to be related to castration prior to the growth plates being closed. Larger breed dogs take longer to mature, while smaller breed dogs are ready for breeding at 6 months of age. Castration tends to prolong the time to closure of these growth plates and is thought to cause issues like cranial cruciate ligament tear and hip dysplasia. However, hip dysplasia has a genetic predisposition, and also a dietary component. Additionally, large breed dogs are not being fed like large breed dogs (see my previous post on what you should feed your dog). What we do typically see is that neutered animals tend to gain excessive body weight. Excessive body weight worsens CCL tear and hip dysplasia. So, sadly, you cannot have a cause-effect relationship with castration alone. The bigger question is: If your male dog has a bladder stone that is there because he is intact, and he is not a breeding male, do you want to anesthetize him every few years to have a stone removed? I didn't think so. #2 breed predisposition. Breeders should be aware if their line of males is predisposed, since there are types of cystine stones that are genetically passed on to offspring. If you're a breeder, please educate your purchasers on the condition in your breed of dogs. There are three known types of Cystine stones. Type I: a recessive gene found in Newfoundland dogs, Landseers, Labrador retrievers and their mixes Labradoodles. Type II: a dominant gene found in Australian cattle dogs and possibly min-pins. Type III: the genetic abnormality is not yet determined, but found in the mastiff types (including the South African Boerboel discussed above), English bulldogs and French Bulldogs and only occurs in intact male dogs. Do your research before you purchase, and if you're breeding your male, be sure to see #3 below! #3 is diet. The cystine and urate crystals in the urine are formed when there is a high purine level in the diet. When we start talking purines and pyrimidines, I am sure everyone has a glazed look in their eyes. Ok, maybe not everyone, because there are some people that love biochemistry. Not me. I had a panic attack after my undergrad biochem midterm *shudder* So, what do we need to know about purines? Purines are the nitrogenous bases adenine (A) and guanine (G) that make up DNA, in somewhat simplistic terms. A low purine diet is essentially a lower protein diet. Because of the way that base pairs work, you always get a pyrimidine (T or C in DNA) that matches up with a purine (A or G). Anyway, there are two prescription diets for dogs that are low in purines (again, I do not benefit from these recommendations!). If you can afford the canned diets, this would be ideal to help dilute the solids that make crystals form. Hill's u/d and Royal Canin Urinary UC. As you may know from my previous post on diets, I will give my clients the option to balance a homemade diet. You can balance a low purine diet through BalanceIT.com, but similar to other prescription diets, you will need your veterinarian's approval. I also always encourage pet owners to read the reviews on the product website for all diets. For those of you with intact male dogs, if you feel like having your dog on antibiotics several times a year has not gotten rid of that pesky blood in the urine, please consider an x-ray of the bladder and/or a bladder ultrasound! Also, consider castration. It's ok to wait until they are fully grown at a year old, but you do not need to wait until they are 3 years to neuter them after they develop a bladder stone. I can guarantee that undergoing an elective surgery for castration with adequate pain management is much less painful than trying to pee out a 1.2 cm stone!
Here is another PSA! All indoor/outdoor cats need regular deworming. Roundworms Those long spaghetti-like worms are a type of roundworm. Most likely Toxocara cati, since it was found in the vomit of a cat. But we didn't look for the species as it does not change the treatment outcome. The even more fun part about roundworms is that they are zoonotic! What is zoonotic you say? It means that these fun little critters can cause illness in people. Children and immunocompromised people are at higher risk. There was a report of a child becoming blind due to larval migration. Educate yourself and your family. As one of our parasitologists in school used to say, itchy bum, sucky thumb! That just means it can be passed on from the feces of an infected animal to the oral cavity of a person. Or pinworms in people, but we can discuss that another day. Treatment and prevention of Toxocara cati depends on a few factors. The age of the cat - is it a kitten and still nursing or is it weaned; the lifestyle of the cat - is it an indoor only kitty, or barn cat that is hunting; the cleanliest of its environment - is it apt to reinfecting itself with grooming or grooming another cat? Since I have moved to a more rural area, I am seeing a lot more internal parasites and a lot more intact female cats. Educating pet owners is key to prevention. Life Cycle: The life cycle of the parasites is always the tough part. I am so glad I do not have to study this, I can just look it up! How does your cat get Toxocara roundworms? Your cat can consume the L3 larvae in the tissue of a paratenic host (in this diagram the duck or the rabbit, but mice and rats are also paratenic hosts). The L3 larvae migrates through the liver and lungs, and manages to be coughed up by the cat and swallowed into the stomach - very strange, but it needs to do this in order to become an adult worm. The adult worms lay eggs, and the eggs get pooped out. Eggs are then consumed by the paratenic host (or reinfection when the cat grooms itself or eats some infected grass in the environment). If your cat is pregnant, then there is vertical transmission to the kittens. At birth, the kittens are not infected, but when they drink their mother's milk, it goes through a transmammary route. That is a whole new level of breast is best - but I digress! Larvae are found in kittens from days 15 to 22 after birth, when they are nursing from an infected mother. What to do for prevention? Well, you need to break up the life cycle somewhere in there. Preventing your cat from consuming paratenic hosts, preventing your cat from chewing infected materials that are contaminated by feces, cleaning up the feces to prevent contamination of the environment, and regular deworming. The period of time in which the pet is infected and the time where the parasite is susceptible to medications will be important in the treatment regimen. Every 2 to 3 weeks for kittens and once a month for adults seems to be sufficient when using selamectin, moxidectin or milbemycin. Deworming medication There are a few products out there, some I use for treatment and some I use for prevention. Definitely discuss the cat's prevention with your veterinarian! Below are just some of the options we use in Canada, by drug name, not brand name, but you can look up what you are using easily. Fenbendazole: It's a fairly safe medication as it preferentially binds to nematode tubulin (the proteins that are required for mobility). However, it's not the most efficacious medication, so it needs to be given in multiple doses once daily for 3 to 14 days, depending on if the worms have some resistance to the medication. It does come in a liquid oral suspension though, which can be mixed with wet food, making it easier than pilling your cat. It also comes in granules, but those I find more difficult to dose. Milbemycin: One of the many macrocyclic lactones available. It is more efficacious than Fenbendazole, only needing a single dose, but for outdoor cats, repeating the dose monthly is recommended. It can also come in a product combined with Praziquantel. The down side... very few cats will willingly chew a tablet, so its down the hatch! Pyrantel: It is a nicotinic building medication - causing the worms to contract and then be paralyzed. Again, this can come in a liquid oral suspension. It is also labeled to be given to kittens as young as 2 weeks. As mentioned above, kittens can get Toxocara from their mother through the transmammary route. There is a tablet form that comes in combination with Praziquantel as well, but most people with kittens will stick with the liquid. Selamectin: Instead of pilling your cat, you can apply a topical product once monthly. This is a macrocyclic lactone, working by paralyzing the worms. But your kitten has to be 6 weeks for labeled use of the topical medication. This medication gets the added protection from fleas and ear mites. Moxidectin: Another macrocyclic lactone also coming in a topical formulation for cats, similar to selamectin. However, it is not labeled for kittens under 9 weeks of age, or smaller than 2 lbs. Emodepside: Comes in a topical with Praziquantel and is labeled for use in your queen (mother cat) to prevent the kittens from becoming infected through the transmammary route. The transmission from queen to kitten is decreased by greater than 98%. I know I said Praziquantel a few times up there. So let's take a look at tapeworms. Tapeworms Echinococcus multilocularis Why am I starting with this one? Because it is zoonotic. So for the protection of your family, your dogs and cats need prevention. I already wrote about this tapeworm species, but here's how it works with your cat. Cats are rarely infected or show clinical disease from this Echinococcus species, but they can get it from eating one of the intermediate hosts, mice or voles. Cats can act as the definitive host by shedding the eggs of the tapeworm. Humans are a incidental host - but can get infected by consuming a tapeworm egg, getting the hydatid cystic form of the disease. See my previous article for more info. Disease or infection in your pets can be prevented with monthly Praziquantel products (topical or oral as discussed above). Taenia taeniaeformis This is likely the species of tapeworm in our lovely video. They are the flat and wide worms that look like a piece of tape. Fortunately not pathogenic to humans, but gross none-the-less. Taenia taeniaeformis are passed from a mouse host, surprise, surprise, on to your cat. In cats with really high infestations, you might see intestinal impaction from too many worms. Prevention is keeping your cat indoors or on monthly deworming medication. Dipylidium caninum This is the third genus of tapeworms we will discuss. This one is not passed on through a mouse host! This one is passed on through fleas or lice. The flea larvae consume the eggs of the worms. Then when the cat or dog has a flea on it, and it eats the flea when they are grooming themselves, then they become infected with the tapeworm. Flea prevention will prevent infection, however, you can also use monthly praziquantel for this tapeworm as well. On the rare occasion, your child may ingest an infected flea and become mildly ill. There are other species of tapeworms, so depending on the area of the world you live in, be sure to discuss with your veterinarian if you or your pet could be at risk.
Have I told you lately that I am really enjoying my new job? For real! Every day has new challenges, but the anxiety that I had at my previous job didn't seem to follow me. I don't know if it's because of the larger space, and having more people around. It's not like there are more people to help me, there are actually fewer people to help me directly, because we have a lot of in hospital patients. Patients in recovery from surgery. Patients waiting for procedures or imaging. So, our staff is really pulled from one area to another. So what is it that I am loving about my new job? 1) Having a consistent schedule. I have a better work-life balance. Yes, it's COVID and I can't actually do anything outside of work, but I do enjoy my time off. My work schedule is truncated into 4 work days, and three days off in a row. So I actually feel refreshed after my weekend. I do spend an hour or three finishing up my medical records on one of those days, but it doesn't seem to drag on. I have a consistent schedule. I think that is huge. Every day I start at the same time. I may not leave at the same time every day, but I don't have to get up really early to get to work for 8 am. If you can manage to get a consistent schedule, ask for it! I work the late shift every work day, but it works for me. 2) Clients are less demanding. What was it at the previous clinic that I struggled with? We had very demanding clients. The folks in the current geographical area seem to be more laidback. I used to get anxious running late, and being slammed with work. I would hardly ever get time for my medical records. I don't think I am seeing fewer cases, at least production-wise I seem to be doing more. I even feel like the clients here listen more. Is that weird? They seem to want to take my advice instead of pushing back. 3) Having a great team. There isn't anyone in my current team that I have butt heads with. All of our RVTs are skillful and I can rely on them without having to watch over them. No one is putting down anyone else. There does not seem to be a clique or any cattiness. Or maybe I am not seeing it. I think people are so busy with their work that they don't have time for arguments, or perhaps it's their personalities. Either way, I am enjoying working with this staff. 4) No dentistry. I spend two years out not doing much with dentistry. Then got thrown into it with minimal training on my three year out. After breaking root tips and having to go hunt for them, I will gladly leave it up to the other doctors to perform dentistries! 5) Exotic pets. Despite the fact that I am green with the exotic pets, I seem to remember a lot of what was taught in our exotics class. It could be the fact that I volunteered on my weekends throughout vet school assisting the ZEW service (zoo, exotic, wildlife) with whatever came to them. I am still very much learning, and have had a few hiccups along the way. But I think that if I had been a new graduate seeing the same cases, I would have cowered and told the reception team not to send any more my way. My medical director says that sometimes folks are just happy that you will see their exotic pet. 6) Ultrasound. Even though the ultrasound machine that I have now is partially broken, the imaging it way better than what I was working with before!
Ah, you know how FaceBook reminds you of your past life? Five years ago we could freely travel without worrying about this pandemic. In the summer of 2015, I travelled to Cincinnati for a veterinary externship in zoological medicine. The biggest reason I wanted to go to the Cincinnati Zoo was due to the CREW facility, the Center for Conservation and Research of Endangered Wildlife. In case you cannot recall, I was pursuing my Master of Science specifically in reproduction, and ultrasonography was my interest. During my externship I stayed in the zookeeper intern house. Facebook had reminded be that we made giant s’mores. This was also one of the most fun veterinary rotations that I took. For those of you interested in wildlife, zoo or exotic veterinary medicine, I arranged my zoo externships while I was in second year. The administration at my school told me not to think so far ahead, but I had one mentor who coached me and told me, if you want to do an externship in a zoo, you need to arrange it early. How to arrange an externship If you are looking for a highly competitive externship, you should start arranging something while you are in your second or early third year. If you wait until you have your start dates for your clinical year or draft day, it may actually be too late and you will have missed that opportunity. I am talking mainly about zoo externships. You can find a few opportunities listed on the AAZV's website. For opportunities in the U.S.A. head here. For outside the U.S. you can try here. Given COVID-19, you may have restrictions on travel, so ensure you are checking to see what each state or province has for restrictions. If you're Canadian, on the AAZV you have two contacts, one for Granby Zoo and one for Toronto Zoo, but that does not mean that there aren't others available. For me, as I said above, I was looking for something that would overlap with my Master's work, which allowed me to see how we apply reproductive techniques to wildlife. I was able to shadow CREW when they were training their female polar bear to accept an ultrasound scan, seeing an ultrasound performed on a pregnant aardvark, and monitor anesthesia for one of the ocelot laparoscopic inseminations. Be sure to check with your college to ensure that you aren't stepping on anyone's toes. If they have a built in externship in their draft, they do not want you going around to the back door to try to skip this - giving all of the students equal opportunity. Other facilities will not be listed in the draft because they would like to interview or select individuals for their externship spots. It is risky, however, to leave it up to the day of the draft, because you may really want a particular rotation as one of your electives, and not get it, leaving you feeling bummed. So either be prepared in advance and choose an externship outside of the list, or be prepared for some level of disappointment. Cincinnati Zoo Veterinary Externship Here are a couple YouTube links of the animals I got to see and help treat for wellness, prevention or illness. Harapan (Sumatran Rhino): Zookeepers Preparing for Shipment and Saying Goodbye to the Sumatran Rhino program with CREW Ali (Aardvark): Needed a dental (I'm in this video!) Dale (Baby Takin): Dale was reared in the nursery and needed his blood checked for iron levels, so I got the opportunity to take blood samples. Faru (the male Black Rhino): He was in quarantine while I was there. The introduction would have happened after I left. Red Panda Cubs: This was their first exam. I helped with their vaccinations. I watched the zookeepers handle their venomous snakes, and took blood from one of the non-venomous constrictors. I assisted with hoof trimming and teeth floating for a zebra. Assisted for wellness examination for the Aye-Aye. Watched a technician-in-training take blood from the dorsal coccygeal vein in a penguin. Darted a polar bear for its vaccination. I honestly cannot tell you what the most memorable moment was for me, but I would do it all over again in a heartbeat! I do have photos from 'behind the scenes' but we're not supposed to share those ones! #zooexternship #veterinaryexternship
I'm writing this in advance of the one year anniversary since starting this blog. My goal for this blog was to create a space to dump my thoughts. I had found solace in writing my thoughts on the proverbial paper of the electronic world. This space then evolved into an educational platform. A place where I felt like case studies from the perspective of a still fresh and green veterinary practitioner could be archived, and newly graduated veterinarians, or veterinarians-in-training could go for information, so that they did not feel alone. A branch of this blog went towards my winding journey towards veterinary school. I had spent seven application cycles trying to achieve this goal of just being accepted. Once I was in veterinary school, I spent a good portion of my first year with imposter syndrome - did I really belong there? My first year out of veterinary school is not unlike other veterinarians. Naïve to the ups and downs, and eager to make a difference in the lives of others and their pets. To be broken down within days of starting out as a small animal practitioner and having to weave my way to the place where I am now - feeling much more fulfilled in my practice. But how do you get there? I started blogging before COVID-19 hit North America. I started blogging within the first month of being diagnosed with anxiety and depression, and starting treatment for this. My blog posts went through the unknown of whether COVID-19 was going to be passed from pets to humans, or vice versa. I also started blogging before I was diagnosed with low ovarian reserve, even lower than expected for my age. Before undergoing fertility treatments during a time when you could not book a face-to-face appointment with your medical doctor. I started blogging before I turned 40. Before my sister and her family moved away, back home to BC. Before my husband and I drove across the country to start a new life in my home province. Today, I can honestly say, I am happier. My new job that I started last month feels a lot better. When my husband and I started 2020 hopeful with sooooo many things to look forward to, the COVID-19 pandemic took everyone for a ride through the ringer. This is going to be a blog post of reflection of the significant changes that have occurred this past year. Let's see. We went to L.A. in March. This was before SARS-CoV2 hit Canada, and there was one case off the coast of the U.S.A. The reason we went to L.A. was because hubby works in the animation industry. He is a storyboard artist with dreams of becoming a director one day. L.A. is where major studios live. Disney, Pixar, Netflix and Skydance are just some of those studios that you may have heard of. I even joined the VCA family in 2019 in order to set ourselves up for an easier transition for me to transfer to a veterinary hospital through VCA. We loved L.A. March was also six months after we had started trying to conceive. Trying to build a family proved harder than I was hoping for. I was always erring on the side of pessimism, which some people will say it's part of the reason we didn't have a successful pregnancy. But I had an inherent premonition for lack of success. Why would anything come easy for me, given my history of struggling to get to where I am with my career? And well, life in general?? My hubby and I are torn from the same ragged cloth of immaturity, being late bloomers, we both took years to get started with our careers, and to get married, and to settle into life. I don't believe in curses, but sometimes, I wish I did. When we got back from L.A., I got my blood taken and I was diagnosed with low ovarian reserve, having a low AMH even for my 39th year around the sun. I recall that all ultrasonography was put on hold, because Canada was entering a state of emergency, lock down was approaching. When the country locked down. So did my hubby. His dream of going to L.A. and starting a career as a full storyboard artist was punctured. There was no travel across the border, unless of essential services. I had to be the one to tell him that his work was not considered an essential service. He actually had developed a cough while we were in L.A. He was one of the first in Toronto to receive a COVID-19 screening test. He went to a walk-in clinic and then panicked and sent him to the hospital where folks in HAZMAT suits jabbed a giant q-tip through his nose towards his brain. The test came back negative, but our life has not been the same since. Let us reflect on the good that came from this. He worked from home for some time, and since he has been applying for jobs in L.A. he actually landed a gig working for a studio based in L.A. If COVID-19 restrictions weren't in place, he wouldn't have gotten that job. He also wouldn't have been signed on for the four other jobs that he has gotten since then. For someone with social anxiety, working from home is perfect! In May, we started at a fertility clinic in Toronto. The initial phone consult was very hopeful. I really liked the doctor that we were referred to. The clinic had put in all sorts of restrictions and screening, so that they were able to perform services for fertility, despite not being considered an essential service. I was able to get baseline Day 3 blood work and an ultrasound performed. My AFC really wasn't that bad, all things considered. By then, we were getting winter over with and being on my medications my stress and anxiety was a bit more manageable. I had started listening to a reproductive specialist on her podcast last spring. One of the things she mentioned was to evaluate your goals. I had modified it slightly since that blog post and now that I think about it, people always say to break down those larger goals into smaller more easily attainable goals. From the professional perspective, I still want to specialize. Being part of the VCA family I'm hoping will help with that goal. It isn't something that I expect to start on right away, especially since there are more pressing goals - like start a family - that will go ahead of the career goals that I have. However, this does not stop me from educating myself and to pass on some of this information to others through this blog. It may not be formal teaching and educating, but sharing knowledge here and on my Instagram is part of that goal. May was also when my sister and her family moved away. That was a new low in my life. It was even harder because we weren't allowed to have any social gathering or contact. My husband drove out with me to say goodbye, because I couldn't drive with tears welled in my eyes. The personal goals of travelling and training more BJJ would need to occur in a post-COVID world. Like many folks, I struggled to stay motivated to work out at home. I had joined an online community, then strained my neck, so that put a damper on that. In the summer, once Toronto BJJ was set up for training in small groups, I had a few training sessions with some of the ladies. It was extremely well needed. But then, the cases of COVID-19 started going up again. We were put on the funded list for IVF treatment, and I really couldn't take the risk of exposing myself to COVID and having to have my cycle cancelled because of that. So my workout activities halted, and I started to prepare myself for IVF injections. Fall came and we passed through the season doing fertility medications for what seemed like ages of waiting and then quickly resulted in a cancelled cycle, a conversion to IUI, that was also cancelled. Then an unsuccessful timed intercourse that cost way more for medications than was necessary. As soon as they cancelled my IUI, we were planning out drive across the country. We had already planned to move. It was in my head the moment my sister entered B.C. and my poor hubby who has never lived outside of the GTA had to mentally prepare himself for a huge move. But I am now closer to my family. When we build our family, this will be a lot more important! I started this blog for me. Then, I started sharing it with the cyber world. Like every new blogger or social media influencer, you have to get through the haters, and put hope into helping others. If my blog posts help one individual feel like they are not alone in this dark profession, then I will keep posting! Fortunately, the haters were few, and the support from the community thus far has been great. I don't want to put it out into the world to bring too much hope to myself, but after blogging for this past year I decided I was going to add a new endeavor to this - I will be starting a podcast! As soon as we can get our new home set up, and whatever equipment needed for that, I will let you know when that gets started. Let me reflect more from this past year, when I said 2020 was our year, when it ended, I can't be disappointed about not achieving all that we had set out to do. Everyone is in that boat of little achievement and a lot of weight gain! We didn't make a family, but that doesn't mean we can't make it happen. Now that my work life is feeling more balanced, I feel like the stress of work is one less thing that will be affecting my fertility. My work schedule is consistent, so my sleep pattern will be a lot more consistent. I met with a new naturopath, so I have new ideas to improve my egg quality and I received a referral to the local fertility clinic here in B.C. So what is your goal? One of the goals with blogging was to get words out of my head, and on to paper so that I could sleep better. With better sleep, I would have reduced stress. It was a step towards happiness. I also produced an average of one blog post every 2 days. Some months were more productive than others. I found that when I was really busy with work, I either had a lot to say, or no time to say it. I even had a dozen or so posts that were started and never published. I don't want to make a goal of posting more, but a goal to continue posting when I have something cool to add to the community. I will still post my journey of trying to conceive. I still have more to discuss with mental health struggles. There will always be interesting cases to learn about and discuss here. There will always be new goals. Thanks for reading over the past year. The support means a lot to me!
It's interesting that the two most popular posts on my Instagram feed are videos of ear mites. Too funny! Kitten Ear Mites Ear mites in kittens are not uncommon. You can diagnose by swabbing the kitten's ear canal and putting it on a microscope slide. Not all dark brown debris that comes from kitten ears will have ear mites, despite what some owners may think. However, if the kitten has not had treatment for fleas/ticks/mites, then I will do one course of treatment, and attempt to clean the ears. My go-to treatment is a single dose of selamectin. There are other treatments for kittens, so definitely go with what you are comfortable with. If there is a severe infection, with a lot of eggs, then you may require a repeat dose in 4 weeks. You may also have the kitten on monthly doses if they are indoor/outdoor kitties. If you are lucky to have a kitten that will sit still for an otoscopic examination, then you can use a standard otoscope and see the mites crawling around inside the ear canal. Pretty cool huh? If you are studying for the NAVLE, the ear mite for a cat is Otodectes cynotis which apparently you can find in ferrets' ears as well, if they live with an infected cat. Random ferret fact! Bunny Ear Mites I haven't done much exotic pet medicine in the past few years. In fact, now that I think about it, I have seen more exotic pets in the past few weeks than in the entire 3 previous years of my veterinary career! There are some standard things that I remember, and one of those happens to be the rabbit ear mite, Psoroptes cuniculi. I vaguely remember that the difference between the two ear mites was that Psoroptes had longer little trumpets on the ends of their legs. The good thing is that you can treat both types of ear mites using the same medication, kitten products extra-label to treat rabbit ear mites. Similarly, you can use the otoscope with its magnifying glass and see the ear mites crawling around in the rabbit's ears, or you take some of those crusts and put a little bit of mineral oil on your slide to hold them on there and voilà! I am so sorry I didn't get a before cleaning photo! So, here's what it could look like before treatment and ear cleaning. Here is a Day 1 of our patient and 3 weeks after a single treatment with selamectin. I did end up giving her a dose of meloxicam as well, because this is really painful for our patient. The plan was to have our bunny patient come back at the 4 week mark for a second dose of selamectin, however, the owner wasn't keen on cleaning the bun's ears at home, so we did the ear cleaning a few times. I was quite pleased to see our bunny at the 3 week mark, looking much less crusty! Needless to say, our patient responded well to the treatment, and I hope they continue to do so!
My husband has a running joke going with his mom. We are living in a small town in B.C. where there are two radio stations that we can pick up on the FM dial. His joke is that, one is country and one is rockin' country. The other day, I had a backyard chicken as a patient. I snapped a photo of this patient and sent it to hubby and he says, "We really are in the country!" For a guy who grew up in the suburbs of the GTA, he had a different idea of what B.C. life would be. I can tell you after a month of working at the hospital that I'm at now that people here are much more laid back. I rarely have that anxious feeling in the pit of my stomach, wondering what a pet owner might say or really, what they may choose to argue with me. I feel a genuine openness and gratitude for the education that I can offer the clients here. I may say, do you mind if I email you some information on X condition and how we can prevent it for Luna? There is so much more willingness to engage and receive here. Right now, my commute is over half an hour. Going in isn't too bad. I've usually slept enough and driving on the highway along Kalamalka Lake is a beauty. But the radio. It really does suck. I had been listening to a few podcasts back in TO, but now I'm listening every day. I have to download them on to my phone because I lose data coverage on the drive to and from work, but it's made my drive a lot more pleasant. Lately, I have been listening to every podcast interview with Dr. Gabor Mate. I had introduced you to this gentleman a few blog posts back when I talked about fear and anxiety. Most behaviourists know that fear and anxiety in a puppy's life is a reflection of that puppy's early childhood - between the ages of 8 to 16 weeks, give or take. Dr. Mate can see the trauma on people when he watches them. We as veterinarians need to look within ourselves to reflect on our own trauma and how we project this outward to our clients and our family. I was also listening to my fave podcaster, Dr. Natalie Crawford, MD on 'Just Say No' in episode 78. This one she talks about how burn out is the consequence of saying 'Yes' to every thing. Why are you letting it be for fear of causing conflict??? You don't want to say no, so you just carry on. I can understand for new graduates it is hard to say no. You have imposter syndrome. You wonder if you are supposed to be there. You feel like a burden to the associates around you. You feel stuck. When I went to add this blog post, and I jumped on my search engine and typed in my web address SerenaVet2016. The first search item in the list was my Twitter account - despite the fact that I rarely post on there. Next was my Instagram. Thirdly my actual page! But surprisingly, I also missed that Dr. Ivan Zak had posted on his blog his Top 13 picks for Veterinary Blogs - including this one. Seriously, so honoured to be on this list! One of the things that I keep mentioning throughout, either directly, or in the undertones of my writing, is that veterinarians suffer the most when it comes to burnout. Dr. Zak had put out a survey that showed the younger generation is more likely to suffer. I contemplate and suspect that these folks are more likely to admit that they suffer!! The older generation of veterinarians are predominately men, but I do not feel like they suffered less. However, the older generation of female veterinarians are in the 'carry on' culture. If you cannot work like a man in your career as a veterinarian, then you don't deserve to be there, or really, you just get looked down on for standing up for your own personal goals - that is to have a life. To have a life outside of work. Is that really too much to ask?? We are already soooooo consumed with our careers, spending countless hours away from our families, or in some cases, spending sooooo much time consumed with our work that we forget we had goals outside of work - like building a family. It's easier for men. Yes, I said it. It is easier for you guys. For a veterinarian who has carried a living being inside of her, birthed them and then aimed to provide them with the best quality nourishment through breast feeding their child post-partum - whether it was by going back to work and pumping during breaks, or just being the food truck on demand while on maternity leave - it's harder. For those old school, female cattle veterinarians, if I wore a hat, it would be tipped to you. But do not expect this generation of female veterinarians to do the same. We need to stand united for the good of our profession. Stop glorifying being a workaholic! Working like this is an addiction. The addiction to work is to make yourself feel worthy. People need to have a purpose to live. But why? Why can't we just live??
How can you not feel like a failure? Well, to be honest, I actually feel like I was failed by my medical team. It is also soooo hard to feel supported when the people around you just don't get it. (Un)fortunately, I have a good friend how gets it. Yes, we are 1 in 6, but we are also not alone. We understand that no one else understands. To try to be hopeful for each other is to be hopeful for ourselves. Every body is different. Again, I was on FB today. There were some ladies who were asking about estrogen priming. Well, estrogen priming didn't work for me, it over-suppressed me. I had an AFC of 8 on my baseline scanning, and after Estrace priming for 3 and a half weeks, it was 2. So, that was part of the failure - I got the wrong protocol to start with for my body. Failure number 2 was when the nurse told me to cancel everything. To have someone in your medical team put you down like that was just as devastating as seeing the #2 on the piece of paper. After discussing with my doctor, we agreed to try IUI. I was hopeful that my RE understood that I was tired of waiting. Six months of waiting and tests, and more waiting, and more blood tests. Failure number 3 came when the Sunday ultrasound technician failed to see my follicles that were larger than 10 mm in diameter. Failure number 4 came when my estrogen was noted to be high, but I was not given an antagonist to prevent ovulation prior to my IUI. Failure number 5 was when the nurse told me that likely my timed intercourse wasn't going to work. That it would be pointless to use progesterone during the early stages of 'pregnancy' because I wasn't going to get pregnant. You know how the say 3 strikes and you're out? Well, I'm not out but that medical team is!