Two Resolutions for the New Year

1) Discuss training and behavior
I am reluctant to discuss little Phoebe's misbehavior, as she lunges like a snapping turtle toward my face, for fear the owner will take offence. Many owners excuse their dog's behavior ("She's protecting me"," He's scared", or my favorite - "He's never bit anyone BEFORE!").  However, I haven't been doing dogs any favors, as studies indicate 10-17 % of dogs euthanized at animal shelters are due to severe behavioral problems (usually biting).  There are many excellent training aids, and great positive, reward based, HUMANE, training centers.  We are all busy people, and I have heard every excuse (and made them myself).  But, seriously, when someone chooses to own a dog, they have the responsibility to train it. Some resources:
 http://drsophiayin.com/philosophy
http://www.dogstardaily.com/

Local trainers:
http://www.theclevercaninenw.com/
http://www.tails-a-wagging.com/
 http://thinkingdog-lauraberger.com/

2) Discuss insurance with new pet owners.

oblique mid diaphyseal fracture of tibia and fibula distal to TPLO repair

       In the past, I  have been hesitant to discuss insurance, because I don't want to endorse one company over another or come across as a saleswoman. In addition,  the discussion can be time consuming- limiting how much health  and behavioral information that can be covered in an already tight schedule. However, I have seen too many owners struggle with being able to afford medically indicated treatments that would have been covered (in part) by insurance. As an example, the cost of surgically
repairing a  torn cruciate ligament (knee injury)  via tibial plateau leveling (TPLO) is approximately 2000 $. This cost of repairing the  fractured tibia that occurred after this dog (imaged above) slipped at home doubled the original cost.
 Here is a website with comparison information: http://www.petinsurancereview.com/dog.asp

Holiday Hazards to avoid

I mentioned a few weeks ago some of the dangers that Thanksgiving poses for your pet. In that same vein I thought I'd outline some holiday hazards for the month of December.  As an aside, I am not using "holidays" as a politically correct term here- don't sick Fox News on me! I am being inclusive as there are many faiths with celebrations in the month of December- all of which have hazards for our pets.

Prevention is the key  to protecting your pets, and avoiding  an emergency trip to the veterinary clinic.

Some plants found this time of year are toxic. Lilies are found in flower arrangements are are deadly to cats. Make sure your floral decorations don't contain Tiger, Asian, Japanese Show, East, Stargazer, or Casa Blanca lilies, as even a small amount ingested by your cat can lead to kidney failure.  The Ilex genus of holly has 29 species; the best known is  traditional English holly (Ilex aquifolium).

Generally self limiting symptoms are all that is seen with ingestion (vomiting/ decreased appetite, and diarrhea). Best to keep this plant out of reach.   




American mistletoe can cause stomach upset as well, however  European mistletoe is much more toxic.  Fortunately, American mistletoe is the commonly used mistletoe

in holiday decorations.  European mistletoe can cause a drop in blood pressure and decrease the hearts contractions, which would be seen clinically as decreased energy, or even collapse and death.  Be on the safe side and don't let your pets near it.  A plant that is not as toxic as most people think is Poinsettia. However, it can cause mild oral irritation and perhaps some vomiting.

There are a number of hazards around your Christmas tree. Starting at the bottom and working up, the water your tree sits in can harbor bacteria and fertilizers. Ingestion of the water, usually by a thirsty or inquisitive dog, can lead to vomiting or diarrhea. Try to cover the water stand.  Electric cords lighting up your tree can electrocute your pet if they chew through the cord. Cover your cords, and unplug your lights if your pet is left unsupervised in the house.  

Kelso demonstrating his interest in ribbon!

Ribbons and tinsel are attractive not just to us, but to our cats and dogs as well. If eaten, these can cause serious intestinal obstruction, which may require surgery to alleviate.  Don't wrap bows around your pets neck, as this poses strangulation risk. 


The last Christmas tree hazard are the glass and breakable ornaments, as sharp pieces can lacerate the delicate mucous membranes of the mouth and intestines if they are eaten by a dog or cat. Place delicate ornaments and ribbons/ tinsel high up on the tree, out of reach of your pet.  Lastly, you pet should not be left unsupervised with access to the tree or decorations. 

Wishing you and your four legged family a happy and safe holiday season!

My brother, forever young

Today is my brothers birthday, Ian would be 52. But he is frozen in time, as a spirited 23 year old. He died August 3rd, 1986, in an unusual summer avalanche on Mt Baker. There is a saying, "Don't speak ill of the dead", that holds us back from discussing the very human nature of the deceased. His death was a tragedy for his friends and our family,  I miss him daily, but he wasn't an easy older brother to grow up with.

As the youngest of four, I remember trying  to keep up with my older siblings ( Caroline, Ian, Brett- in birth order). My siblings are close in age, and I the afterthought 4 years later.   I took up all things boy: I shot arrows, helped build a fort in the yard, climbed trees, and hiked with enthusiasm. On hikes my brothers would play a game of prisoner, holding me back, then I would run as fast as I could until they inevitably caught me.  We then hid in the ferns waiting to scare our parents.

 My brother was many things, but easygoing was not one of them. He taunted me at an early age to toughen up- using his superior strength to make his point. Using climbing gear, he  hoisted me to a  ceiling beam at age 7, and left me there for over 30 minutes. A few months later he tied me up and put me in a toy chest, but let me out quicker. He could also be generous, helping me with homework or encouraging my skiing.

He grew out of bullying his two younger siblings in high school.  His last letter (when I was a freshman at UC Davis) complimented me on how well I was doing in school. I learned of his death when I was at an ecology field camp in Montana; an early morning phone call breaking the news. All these years later,  as appalling comprehension took hold of me, that moment stands as the the divide in my life, the before and after. Before, death was abstract; after, an ever present reality. He was larger than life to me, vibrant and fearless (he climbed Liberty Ridge , Mt Rainer,  among many other feats). He couldn't be dead... I saw him out of the corner of my eye for weeks, found myself expecting him to walk into the room at any moment.

He was authentic, ornery, enthusiastic, and I  hold his memory dear.

Imperfect medicine

December 1st, 2014

I enjoy puzzles, mysteries, and riddles, which is  one reason veterinary medicine appealed to me. Additionally, all processes of life fascinate me. How is it possible for a polar bear to survive the arctic winter, a hummingbird to fly 500 miles,  your own dog to recognize your voice?

What I did not factor into the decision of becoming a veterinarian is how difficult it would be to treat my own pets.  Recently my dog Kiwi vomited a few times. Not a big deal, I would counsel owners. Dogs eat things they shouldn't (she was a 9 pound Papillion and had a penchant for cat poop among other doggy delights). I took a radiograph (X ray) which was normal. However, as she was an older small breed dog, and she did need to have her teeth cleaned  (an annual occurrence). Her pre-anesthetic blood work demonstrated some problems- and an ultrasound (performed by me) revealed a tumor.

 When our pets are ill, it is suddenly difficult to be the logical veterinarian. Everything we know, all the hours of education, have a way of disappearing.  I knew I was in over my head. Small dogs live forever... at least into their teens- I reminded myself.  My amazing colleague Kim Barron (DVM, owner Northshore Veterinary Hospital) biopsied her pyloric tumor (stomach).  Results indicated a tumor that is locally aggressive, but with complete removal , can be cured (leiomyosarcoma).  I called a surgical specialist, Mark Davis, DVM, DACVS. He performed a delicate surgery to remove 1/3 of her stomach. However , as the pancreas is adjacent to the stomach, she developed severe pancreatitis, and her surgery never healed. I had to let her go 5 days after surgery.

I have asked myself a number of times- what did I miss? Why didn't I notice something earlier? The answer is unknowable. I miss her dearly.

Dr. Timothy Kraabel: Family Medicine

Reposted from Dr Tim Kraabel, DVM, DABVP

Monday, December 1, 2014

Family Medicine

     The blog I re-posted last week was by Dr. Brita Kiffney.  Brita is veterinarian in Bellingham and is my cousin.  I have always been very proud that we are both veterinarians.  In all the interactions we had as kids I don't ever remember talking about both of us wanting to be veterinarians. We just looked up when we were in college and saw we were following the same path.  I graduated from vet school in 1989 and Brita in 1995. We had this happen again a few years ago when we realized we were both pursuing board certification with the American Board of Veterinary Practitioners (ABVP). We are now both Diplomates of the American Board of Veterinary Practitioners, specialty Canine and Feline Practice, and certified just a year apart.

   
Brita's dad, Paul, is my dad's little brother.  Their dad, Don, was a physician as was his brother, Austin.  Don and Austin practiced together in the Kraabel Clinic near Woodland Park Zoo.   Grandpa and his brother were in practice when penicillin was discovered.  My Uncle Paul tells stories about how magical his Dad's little black bag that he carried on house calls seemed.  He learned later that mostly he could only dispense hope.  Grandpa used to talk about the advent of penicillin ushering in the era where doctors could finally do something.  Our Uncle Al is also a physician and orthopedic surgeon, though he hasn't practiced since the early 90's.
   
Brita and I grew up with our family taking care of us.  I remember going to the Kraabel Clinic. There was a messy doctors' office with shag carpeting and dark paneling and a spot in reception where lollipops were kept.  Helen, the great nurse who seemed larger than life, would always let me have as many as I wanted. My memories are sketchy since I was young when they both stopped practicing and they were both gone by the time I was in middle school.  Our Uncle Al was a great role model.  I spent a lot of time at his office with various orthopedic/sports injuries over the years.
   
Brita and I took the medical legacy in our family into veterinary medicine.  I have always felt medicine was in my blood, even if I didn't chose to direct that towards human patients.   Early in my career, I would see the occasional client that had been a patient of my grandpa or Uncle Austin.  It always made me feel connected across decades to a set of brothers that I only really knew for a short time.  I recognize their contribution to my life in veterinary medicine.

Life has interfered many times and Brita and I have had times we haven't kept in great contact.  But between social media and ABVP that has changed.  We initially reconnected over the ABVP certification process and have stayed in better contact since.  We just got back from the annual ABVP continuing education conference.  It was great to spend time with Brita and our extended group of friends in the organization.
 
Significantly, Dr. Fritzler and I are proud that the family legacy may move into the next generation.  I wrote in a blog before that our sons both want to be veterinarians.  We just found out this week that our oldest son Geoffrey got through the initial application process to vet school and has an interview in January for a spot in the WSU College of Veterinary Medicine Class of 2019.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Thanksgiving stress and how to avoid having to go to the veterinarian the day after!

We all know spending time with family during the holidays can be stressful. Arguments break out over the smallest things. Fights erupt over deep-seated issues. It's hard to remember the topics not to discuss; there are the obvious ones like religion and politics, but don't forget your aunt just divorced, (maybe best not to speak of men?) or your step sister hates her new haircut...

It is easy to spoil your pets in response to all this stress- hey, they don't argue about politics or care about the tattoos your son has acquired!
Just remembers that some treats can lead to injury or illness for our pets. The following are some tips for a happy holiday with you pet.

1. Fatty Foods:  Foods high in fat can give your pet pancreatitis or gastroentertitis. Avoid feeding your dog or cat turkey drippings, turkey skin, bacon, or other high fat foods
2.  Alcohol: Cats and dogs are very susceptible to alcohol toxicity- they don't just get drunk , they can die from alcohol ingestion. All poisoning problems boil down to the amount (dosage) of alcohol ingested compared to weight. Most of our pets are much smaller than a typical adult human. Within 30 minutes of a pet drinking alcohol, symptoms can appear: staggering , depression, and stumbling.  Keep alcoholic beverages and medications out of your pets reach during the holidays.
3. Bones:  Bones can lacerate or obstruct your pets' insides. Save the bones for soup - not your dog.
4. Onions:  Onions and onion powder can cause destroy your dog or cat's red blood cells, which can lead to anemia.
5. Grapes and Raisins:  Grapes and raisins  can cause kidney damage to both dogs and cats.
6. Chocolate:  Death by chocolate- it can actually happen to  your dog or cat; so keep the sweets  out of reach.
7. Fresh Water:  When there are a large number of people in the house, there's a good chance to bump into the water bowl leaving your pet dry.
8. Quiet Time:  Cats and dogs need to have a place to escape from all the holiday festivities. Make sure there is a quiet room, crate or other location they can escape the curious grandchildren, or drunken adults!
9. Garbage:  The garbage is sure tempting to your pet during thanksgiving. Its full of food wrappers (that can cause a gastrointestinal blockage if eaten) , high fat foods like grease, corn on the cob (can cause obstructions) and spoiled items. All of which could lead to vomiting, diarrhea and a trip to your veterinarians office.
10. Bread dough:  Some dogs will  ingest raw bread dough. The yeast added to bread dough converts the carbohydrates to alcohol and in the process, carbon dioxide is released which makes the dough rise. This same reaction occurs in the stomach once the bread dough is swallowed. Not only can this result in alcohol overload (see above) but the stomach distension can cause serious breathing and heart problems