Too many clients think that we (the doctors ) just don’t understand what they ( the clients ) go through when they have to make decisions concerning their pets lives.  Somehow we have an unlimited amount of money, resources, time, luck or whatever and we always have our animals live until they die in their sleep of old age.  Oh, if it were only so.

Two out of three dogs sleep in bed with us, and usually there is a cat thrown in the mix as well.  I usually don’t have room on the sofa because of the dogs sitting next to my husband.  If I go to sit in the chair or go back to bed, I’ll have a cat or two on me. My dog Abby is my shadow and is usually following me around no matter what I am doing; this can be a bit annoying when I am trying to mop the floor.  Oh, and Abby was an abuse case; it took us over a year to get her housetrained.  We have furniture with chewed ends; it was good furniture until it became a dog’s teething post.  And when we lose a pet, we grieve and mourn and second guess the decision…did we wait too long?  Did we do it too soon? 

Obi one of our hospital cats came to us as a hit by car when he was only a year and a half old, shortly after we bought the hospital.  He had a broken leg and a crushed pelvis and the owners couldn’t afford to fix him up so they signed him over to us so we could fix him.  We had a doctor working for us that liked orthopedics so we let him work on Obie.  There was not much that could be done with the pelvis except to let it heal but the broken leg had to be pinned and put back together so it could heal.  It did heal but there was some nerve damage and Obie would be weak in the damaged leg for the rest of his life.  He quickly made himself at home in the hospital and instead of trying to find him a home, we decided to keep him as a hospital cat. 

As time went on he found my husband’s lap comfortable and would lay there while my husband worked on the computer.  Obie learned his boundaries and found out that lunch times were relatively quiet and that’s when he would venture out to the reception area to greet the clients (without their dogs).  We also found out that he liked to be stretched so at least once a day the girls would pick him up under his front armpits and stretch the legs behind his head.  You could just see his body tense up and his toes splay out at the wonderful feeling of being stretched. 

All was going well till he started to have problems with his bowel movements.  We took an X-ray and found that he had a huge colon (the last part of the intestines).  That crushed pelvis was coming back to haunt us.  Apparently the pelvis had healed in such a fashion that it restricted the outlet from the colon.  We brought in an orthopedic surgeon who said that she could remove the portion of the crushed pelvis that was blocking the colon but his colon may have been damaged and may also need to be removed.  We could do it all in one surgery or split it up.  We decided to just remove the crushed pelvis and wait to see if the colon got better – Well it didn’t so we had her go back in and remove the colon. 

The colon is that part of the intestine that absorbs water and firms up the stool.  So to prevent major bouts of diarrhea Obie had to be on a special diet.  We experimented with a number of foods, talked to the food manufactures and finally found a food that seemed to work well for him.  Unfortunately, he didn.t like to be restricted to only one food and would sneak to the back of the hospital where we store the prescription foods for sale.  We always knew when he had gotten into the food in the back because he would have blowout diarrhea.  We then had to search the foods to see what he had gotten into and pull it from the shelves so we didn’t sell someone a ripped open bag.

One day his former owner stopped by and wanted to see him.  We were fearful that she had wanted him back but agreed to let her see him.  She was amazed to see how big he had gotten and said that her neighbors told her that we had probably just put him to sleep and didn’t try to fix him like we told her we were going to do when she signed him over to us.  She was very happy that we proved her neighbors wrong. 

Years had gone by and all was fine until he started getting sores on his skin.  We couldn’t figure out what was going on so we biopsied the sores and sent them in for analysis.  The report said it looked like burns.  We told the pathologist that there was no way the cat was getting burned and asked them to look at the sample again.  Upon closer scrutiny, the pathologist said that it looked like he was throwing micro-clots which would reach the skin and shut off blood flow to that area.  This was a weird finding and the only thing we could think of that would cause this was the pin in his leg.  On a long shot we had the pin removed by an orthopedic surgeon in Stuart.  That was the last of the sores.

Several years later he started to have these mild seizures.  We checked his bloodwork and everything was fine but he kept having the seizures.  We could only assume that something not good was going on in his brain.  The only way to diagnose it would be to have an MRI done but even if it showed something, we couldn’t do anything about it.  So we could only wait and watch to see if it progressed.  As time went on, the seizures didn’t really get much worse but there were periods when they were more frequent and he would not act normal for a couple of days.  Another one of Obie’s lives used up.

But now Obie, our beloved hospital cat, is losing his life because we are out of options to make him feel good.  We think he has some kind of esophageal cancer.  He is in pain.  He is not eating.  He is getting weak.  He is a hospital cat but whenever I would go in on the weekends he would be my partner in doing whatever it was that I was doing.  He would sit and watch, sometimes get involved, sometimes just want to be brushed and petted.  He is a hospital cat only because he does not like dogs.  I would have taken him home at some point otherwise.  We have spent money on him.  We have taken him to specialists.  But now Obie is on his last life and we are out of luck.  I cannot watch him slowly wither away.  So we are at the point of making that final decision.  So tell me again, how we doctors just don’t understand what it is like to spend money and make tough decisions regarding our pet’s lives!

Tonight Obie is very weak, he has labored breathing and just doesn’t look good at all.  We wanted to wait till tomorrow when all the staff was there but I think that would be selfish.  His time is now.  We put him to sleep tonight. 

Death and destruction.  Not many people think about that when they go to work.  Firemen, police officers, people in the armed services.  And a lot of doctors, including most veterinarians.  A good day in my mind is a day without death or destruction.  I started thinking in terms of death and destruction a long time ago when I realized that diagnosing diseases frequently meant talks about euthanasia.  And while rare, doing surgery meant the possibility of death.

Over twenty plus years, I have anesthetized thousands of animals.  I have lost about a dozen patients either in surgery or immediately after.  Those are pretty good odds…unless you are one of the owners of the pets that died.  I still remember every pet I lost this way.  Early in my career I was told about the bone chain that grows throughout our career.  We carry it with us for the rest of our lives.  For those of you that are not familiar the bone chain, it is the veterinarian version of Jacob Marley’s chains from the story “A Christmas Carol” (Scrooges dead partner).  Marley’s chains were brought on by his greed, selfishness and ill deeds.  My bone chains are of those pets that have died during and after surgery.  It is a short chain but one that weighs heavily on my soul.

The reason I bring this up is because on Thursday I had a sweet kitten die post-op.  The first surgical death I have had in years.  On Friday I euthanized someone’s beloved dog.  And then on Saturday I euthanized two more beloved pets and found out that a dog that I have known for 14 years went to the emergency clinic and was euthanized there.  Death and destruction.  Three bad days in a row and more bones on my bone chain.  I needed today off just to be with my own guys and give them plenty of hugs and kisses.

However, as doctors we can’t let these negative emotions overtake us.  The reason we became doctors is to treat and cure.  Over the years I have saved or reduced the pain in probably tens of thousands of pets and this is what I have to focus on.  If we dwell on the negative we can’t do a good job with the positives.  This is true not only with veterinary medicine but is probably good advice for any walk of life. 

If you didn’t know it, Winter/Spring is the busiest time of year for the businesses in Port St. Lucie.  Just look at all the different states on the license plates that you see while driving around town during this time of the year.  This is also true for our veterinary business but for us business really starts to pick up after January 1st and goes through the middle of the year so many of you may have noticed that we are fairly busy right now. 

Not only is this the busiest time of year but as you also probably know by now, we are short one doctor.  As a consequence we have had to change things up a little.  We just don’t have enough doctor hours available to keep our sanities and keep having Thursday evening appointments, so we have done away with our Thursday late nights – for now.  And because we have fewer doctor hours available, we may not be able to get you in as quickly as we used to.  We try to spread out the routine stuff and to fit in the stuff that can’t wait.  On Thursdays we only have one doctor, so you may have to call several days ahead if you require an appointment on a Thursday.

The good news is that this is only temporary.  We have been searching for a new doctor and we believe we have found someone who will fit in quite well and will also bring something extra to our practice.  Her name is Sarah Zucker and she is a new graduate from Michigan State.  She has an interest in surgery and will be certified in canine rehabilitation- Joints, Arthritis, hips etc.  But we will give you more information on her in the future.  The bad news is that she will not be able to start till sometime in July.  But needless to say, we are very excited to have her come on board and we feel that her interests will be a great fit to our practice. 

Finally, on behalf of Dr. Amanda, me and especially the staff, we would like to thank you for your patience during this transition period.

January 20, 2011, 1:22 pm
How the Doctor Almost Killed Her Dog

By RANDI HUTTER EPSTEIN, M.D.

The week before Christmas, I nearly killed my German shepherd.

His name is Dexter, and he’s 11 years old. It all began on a Saturday morning in Central Park, when he ran in playful pursuit after a young Labrador retriever. Afterward he limped home.

Yet again his arthritic leg was acting up — he also tore a ligament a few years ago — and in an effort to save money and a trip to the veterinarian, I gave him some high-dose ibuprofen. It was in the medicine cabinet, left over from my son’s root canal.

I am a doctor — a people one — so I know quite a bit about medicine. Little did I know how little I knew about veterinary medicine.

Over the course of about a day and half, I had given Dexter three 600-milligram pills. He stopped limping, but also stopped eating, and for the first time in his life, he wet himself during the night. He then flooded the hallway with urine as he ran for the door in the morning.

That’s when I called the veterinarian’s office. It was Sunday, and I left a message saying that it wasn’t an emergency, but perhaps Dexter should be seen on Monday.

The phone rang immediately. It was my veterinarian. She told me to get Dexter to an animal hospital. Right away.

That’s when I learned that ibuprofen, the key ingredient in Motrin, poisons dogs. After a seven-day stay in the intensive care unit, ultrasound exams and a big bottle of take-home medicine, I brought Dexter home, along with a $3,000 vet bill.

My kids could not believe that I had given the family dog medicine made for humans. My 14-year-old son had the gall to make fun of me in front of his friends. “My dog was in the hospital. My mom almost killed him. Can you believe she gave him people medicine?”

But my dogs have had a long — and happier — history of human-drug therapy, all veterinarian-approved. Dexter also takes glucosamine, a supplement for arthritic joints that my mother swears by. He takes levothyroid for his slow-acting thyroid gland, precisely the same thing people take. And when he has digestive issues, which is fairly frequently, I reach for the Pepcid and Imodium, an over-the-counter antidiarrheal medicine.

When my previous dog, a golden retriever, had lymphoma years ago, he was treated with the same chemotherapy regime given to human cancer patients.

And to be honest, I had never worried too much, because I thought so many of the pet dangers we hear about are exaggerated. Take chocolate: They say it kills dogs, but my dogs have always scarfed down the chocolate crumbs my kids have dropped without consequences.

Dr. Safdar Khan, senior director of toxicology research at the A.S.P.C.A. Animal Poison Control Center, which runs a 24-hour hot line for pet owners (1-888-426-4435; fees apply), urged pet owners, “You must, must check with your vet” before giving pets human medicines. Imodium, for example, can mask underlying causes of diarrhea, like parasites. And drugs like Pepto Bismol contain aspirin, he said, which can irritate a dog’s digestive tract and cause severe damage to cats.

But ibuprofen “is a double whammy,” said Dr. Amy Attas, my vet and founder of City Pets, a veterinary house call service. It can cause ulcers and bleeding in the intestinal tract and damage the kidneys. High doses can cause fatal renal failure.

There are many other canine poisons in the medicine cabinet as well. Acetaminophen, the key ingredient in Tylenol, is toxic to dogs and cats because the liver enzyme responsible for its breakdown works differently in cats and dogs than it does in people. One dose can kill a cat.

And as for chocolate, a few chocolate bits or a chocolate chip cookie is not going to kill your dog, Dr. Attas said. But lots of dark chocolate, the kind often used in baking, can be deadly. It has a caffeinelike ingredient that damages the canine central nervous system.

Other foods to avoid: grapes and raisins can lead to kidney failure. A lot of onions — say, if a dog gets into the garbage and eats the onion-covered chicken — can prompt anemia, which can be fatal. And macadamia nuts can cause muscle tremors, weakness, vomiting and dangerously high body temperatures.

The worst, Dr. Attas said, are artificial sweeteners. Xylitol, the ingredient in most sugar-free gums, causes sugar levels to plummet in dogs, and may damage their livers too. In a paper in the Journal of the Veterinary Medical Association, researchers reported the death of four of eight dogs that had eaten xylitol-laden desserts.

Dr. Attas also warned that Easter lilies are poisonous to cats.

So what do you give a dog when joint pain flares up?

Your veterinarian may recommend a medicine called Rimadyl, a nonsteroidal anti-inflammatoy drug that works in dogs but, wouldn’t you know, is toxic for people.

As for Dexter, it’s been about a month and he’s on the mend. He’s still on antibiotics twice a day and needs to be walked about every three hours.

The bottom line is that while your domesticated pets may act like small children and your children may, at times, act like wild animals, when it comes to health care, they should always be considered different species.

In other words, don’t do what I did. Call your vet before you experiment with your pets. You could spare yourself a medical crisis – and a hefty bill.

This is another one of the stories that you can read on our website.  I hope you enjoy it.

In the old days when Dr. Coy was my associate it seemed that we had more emergencies than we do today but this may just be what time does to your memories.

We had a veterinary surgeon named Dr. Robin Holtsinger that came up from Lauderdale when we scheduled her for orthopedic surgeries.  She had been doing that for us for about 4 years and the drive was taking it’s toll so she called one day telling me that she had another surgeon that just moved to the Stuart area that she really wanted me to meet and hopefully start using instead of her.  I told her anytime they wanted to come was fine...no time was less crazy than any other.

It was a typical afternoon where both doctors were full with appointments.  One of the early appointments was a “second opinion” for Dr. Coy.  It was a little mini schnauzer that supposedly had a urinary tract infection about a month earlier.  It went to another vet in the area and just wasn’t getting any better.  The owner brought the records from the previous vet visit.  No urine sample was analyzed and the only thing that was being done was a combination steroid and penicillin injection.  And the owner was told that it would fix the dog.  No worries

Well the owner was worried and rightfully so.  Over the past few weeks, little “Fritzie” had become more and more lethargic.  She wasn’t eating well anymore.  And today she had started to stumble when she walked.  When Dr. Coy examined her, he realized that the little dog was in dire straights.  Her breath smelled very uremic, an indication that the kidneys were not working well.  Her temperature was actually below normal as was her heart rate.  She was actually very close to going into shock.  He did bloodwork, which indicated that her kidneys were having problems excreting the toxins that build up in the body.  Her urine was full of white blood cells (pus) and there were casts of white blood cells which indicates a kindney infection and not just a bladder infection.  On the radiograph, one kidney was much larger than the other one.  He suspected severe pyelonephritis or a kidney infection where the kidney just becomes a bag of pus putting toxins into the body instead of flushing them out of the body.

We discussed what to do next and I recommended Lance do an IVP which is a special x-ray that tells us if the kidney is working.  If both kidneys were not working then there wasn’t much we could do.  If it was just the big kidney that was bad and infected then we could remove that kidney and “Fritzie” could potentially go on to live happily ever after.  Meanwhile through it all, the owners of Fritzie sat in the exam room absorbing one test result after the other and telling us to keep going to try and figure out what to do to help her.  And since this was taking so long I was taking care of both my appointments and Dr. Coy’s appointments.  And into this melee entered Dr. Robin Holtsinger with her future replacement surgeon, Dr. Kathy Wander.

It was quite busy and I told them that it would be awhile (maybe never) till I got a chance to talk with them.  Robin asked what was going on and I told her to check in on Lance while I went to see another appointment.  When I next checked in on them they were talking surgery.  The normal sized kidney really was normal and the damaged toxic kidney could be removed with no future harm but the dog was in such a critical, shocky condition that Lance didn’t think she would survive.  Robin and Kathy were arguing that she definitely would die if he did nothing.  The owners were willing to take the risk knowing that “Fritzie” had a 100% chance of dying if nothing was done.  I told Lance that I was handling the appointments so if he wanted to do the surgery, go for it.  Lance had only been out of veterinary school a couple of years and although he liked surgery I think he was nervous about doing the surgery on such a critical dog.  Robin and Kathy said that we were their last stop for the day so they would be glad to stay and help.  Lance didn’t have much of a choice at that point, the surgery was thrust upon him.  Not only was he going to have to do surgery on a very critical dog, he was going to have two board certified surgeons standing over and watching him. 

Imagine cooking a meal that you’ve never prepared before with Julia Child and Emeril Lagasse “assisting” you.  Now imagine, also, that if you made a mistake, whoever ate your meal would die.  That was the position Lance was in.  He had never removed a kidney before.  He was at one end of a 15 pound seriously ill dog while 3 feet away two board certified surgeons who were acting as his anesthetists and assistants. 

As I walked from one exam room to another, seeing both Lances appointments and mine, I would peek my head in on occasion to see three heads over a very small dog covered in a very large surgical drape.  Lance was very sweaty and the two surgeons were very quiet as they continuously worked to keep Fritzie alive. 

I found out later that a number of times during the procedure, her heart rate would slow down and Lance would get nervous about continuing but Robin and Kathy would just tell him to keep going and they would handle the anesthesia.  She almost died once but the experience of Robin and Kathy kept her going until Lance finished removing the bag of pus that once was her kidney. 

Fritzie survived the surgery and gradually recovered to be a happy normal schnauzer again.  If she were a person, I have no doubt that she would have told her near death story to anyone who would have listened.  Her owners do that for her.