For those of us learning about animal hoarding from the veterinary or animal sheltering side of the equation, I confess that there is often no understanding of the mental health challenges which result in a hoarding personality disorder, and there is often little or no sympathy for the human perpetrators.  Often, there is anger and a lot of talk about what punishment should be meted out, not much talk about how to integrate a mental health intervention into the plan. But to live in abjectly squalid, filthy conditions and to profess love and care for the animals dying and dead all around you, is pretty compelling evidence of a mental health deficit.  And those of us centered in the animal care arena of often constitutionally ill-equipped to muster sympathy for people who willingly or not, harm animals.

But punishment isn’t a great protector of animals in this case;  punishment alone will be limted to fines and prohibitions against animal ownership.  The fines are largely uncollectable (these are often destitute individuals with no attachable assets, and prohibitions against pet acquisition are easily circumvented.   Recidivism is nearly 100%, if other measures aren’t taken. Think about it–the most powerful source of comfort and identity for these troubled people is their pets (I know, I know–they’re not living up to their end of the care equation), and a judge is ruling that they may not own pets.  A more successful approach has been used by Anne Irwin of the Bucks County SPCA where they’ve negotiated a number of pets that can be reasonably well-maintained by the individual, and make sure that the pets are appropriated spayed or castrated, in a state of health that is stable and not unduly burdensome, and then maintain a connection over time with them to make sure they have access to resources that are vital (pet food, a source of ongoing veterinary support).  This approach has allowed a number of hoarding interventions to resolve with very positive outcomes, all around.

Next week, several hundred (registration is limited to 300, and we’re bumping against the 200 level right now) professionals will be learning about the problem and also exploring the intervention strategies and resources available for animal hoarding.  I am excited to know that so many are interested and might be recruited to help make the solution more effective, to have far more positive resolutions in the future.

Flashback to Florida, 2004.  An outbreak of severe Canine Infectious Respiratory Disease Complex was under investigation in a Greyhound kennel in Florida.  An influenza virus was isolated, related to equine influenza, but now established infectious agent of dogs, complete with dog-to-dog transmission.  This was the first description of influenza jumping from horses to dogs and staying to dogs.  The lead investigator,

Cynda Crawford, is in the Maddies’ Shelter Medicine program at the University of Florida.  What she found was that influenza of horses somehow got transmitted to these Greyhounds and then changed-mutated, and became a stable infectious influenza of dogs.  Since that initial description in a Florida Greyhound kennel, the virus has been confirmed in 30 states, and is considered endemic (common) in Pennsylvania, New Jersey, New York, Colorado, and Florida.

With consultative assistance from the ASPCA, canine influenza was confirmed in Philadelphia.  At the Vet School at Penn, we also saw cases coming in from the shelter, and did develop some experience in treating these patients as part of our student surgery program and from cases seen through the Ryan Hospital.

Canine Influenza Virus is highly contagious from dog to dog, and since most dogs are not vaccinated and are considered immunologically naive (no prior “street” virus exposure), most dogs are susceptible.  There is no breed, age, or sex predeliction

Michael Moyer and Cynda Crawford

, and vaccination statue (apart from influenza vaccination status) is not important.  Dogs vaccinated for Bordetella and parainfluenza are still highly susceptible to canine influenza virus.

In my mind, I always thought of respiratory flu as primarily an upper respiratory (cough, sneezing) problem, until I saw the pathology wrought by canine influenza in the lungs of affected dogs.  This is a profound lower respiratory disease, and can easily result in pneumonia. When I saw the lung pathology images, it was no surprise that these dogs cough and will not typically respond to cough suppression–huge amounts of goo and damage lung bits means lots of coughing for a long time.  With luck and support, most dogs will survive, but a very small unlucky few will decline in their breathing to a point where ventilatory support is needed.

So, is Dr. Moyer recommending vaccination across the board for all dogs?  No, but if you think that your dog’s risk for plain old Bordetella was worth the vaccination, you should probably add Canine Influenza Virus vaccination to your “To Do” list for Fido.  Dogs that kennel, go to doggie day care, high traffic dog parks in at risk communities (it isn’t in every community, but it is certainly in and around Philadelphia).  I pose some mild risk to my own dog, because I see the students’ pets at the Vet School, many of which are rescued from very high risk environments.  Please note–it is not a disease of shelters, but one that is more likely diagnosed and detected in shelters, owing to their constant intake and turnover.  But it is a disease of the community of dogs in an area, and other dogs are also at risk.

For my clients’ dogs, I recommend consideration if the dog kennels or is going to doggie day care facilities.  Some grooming facilities are requiring it, as are many boarding kennels. Oh, and I’d make sure the Bordetella and parainfluenza was updated by the intranasal spray vaccine, too.  Canine flu is new;  not every vet has experience with it yet, and the jury is still out on how widely this thing will spread.  Virologists familiar with influenza are watching this one carefully;  it isn’t behaving quite as aggressively as other flu viruses–if it changes, it may become more “successful” at infecting dogs.  Until then, though, it looks as though it has restricted itself to a handful of states, with Pennsylvania being one of those lucky few.

L to R: M. Moyer, Cynda Crawford, Julie Levy at UF CatNip, Jan 2010

I’ve been involved with feral cat issues in Pennsylvania since 2003, when (as I began ascending the Pennsylvania Veterinary Medical Association’s chairs of office) I initiated “Feral Cat Summits”. All stakeholders to that issue were invited by the PVMA to discuss, debate, and argue the merits and deficiencies of Trap Neuter Return work. For those of you unfamiliar with feral cats, now more properly dubbed “Community Cats”, there are believed to be as many free-roaming cats as there may be pet cats in the United States. That’s a lot of cats. While that sounds unlikely, bear in mind that “domestic” cats have enjoyed a rather free-roaming relationship with humans for thousands of years, and this phenomenon of strictly indoor cats is an entirely man-made construct. These cats can be owned cats, stray cats, abandoned cats, or cats that were born outside, are poorly socialized with people (“feral”), and will spend their entire lives outside.

Enter—TNR. Trap Neuter Return. Very highly motivated, dedicated volunteers Trap, temporarily house the cats until they are surgically Neuter-ed, and then Return-ed them to their original site. They are not creating outdoor cats; they are merely interrupting their reproductive cycle-permanently. They are not “dumping” cats-these cats were there to begin with, and without intervention, would be producing kittens each year. These kittens face very high mortality and a rough first year; those that survive will begin reproducing as early as August or September of the year they were born (typically February/March/April). Despite claims to the contrary, many of these outdoor cats, once past the high risk of kitten hood, can live long, stable, comfortable lives, with overall health, parasitism, and infectious disease issues comparable to indoor/outdoor pet cats.

I describe myself as a reluctant proponent of TNR. Reluctant, because it is unsatisfying to release a cat to its own devices post-operatively. Yes, it is now vaccinated, yes, she won’t reproduce, but still, it isn’t the life I’d want for my cats. The alternatives, unfortunately, are very limited. When I discuss this with my Penn Vet students, I mention the alternatives as 1) Ignore Community Cats or 2) Trap and Euthanize, which is what happens in shelters that accept Community Cats/Feral Cats but do not have a TNR program to release them. Presently, there are no effective non-surgical methods of controlling cat reproduction. So, after years of leading discussions, listening to the back and forth, seeing the TNR clinics in action, and talking with some of the best minds on this subject (Julie Levy of University of Florida, for example), I have moved over to the proponent side of the fence.

This is an incredibly complicated problem, and even the success stories of TNR (Ocean Reef Club, Merrimack River) were successes with a lot of sustained effort. I can tell you that the extermination/euthanasia approach is extraordinarily expensive, does not attract a large volunteer base to sustain it, does not attract private humane philanthropy to support it, and does not invoke warm and fuzzy public relations with members of your community (upwards of 25 to 35% of community members report themselves as feeding outside cats on some sort of basis).

I’ve provided a sampling of links; I particularly love this vague, un-helpful sentiment (in the third link):

We recommend that advocates of cat colonies seek a long-term solution to the pet overpopulation issue by redirecting their efforts toward the underlying problem of managing irresponsible pet owners.

Of the three options extant, 1) TNR, 2) Ignore, 3) Trap and Euthanize, I’ll let you decide which option they’re rooting for. For my part, I’m siding with the option that gives these cats a chance-TNR.

Operation Catnip

Merrimack River Feline Rescue Society

Natural Areas Journal – Trap/Neuter/Release Methods Ineffective in Controlling Domestic Cat “Colonies” on Public Lands

Daily Record Article – Animal groups: Could ruling lead to hunters shooting cats?

So, what great big thought have I got to share today? I had a good day in surgery with the Penn Vet students yesterday (3 dog castrations, one dog spay, two cat spays). The students are in class of 2010—just four months away from graduation, and exactly twenty years after I finished at Penn Vet.

I’m writing this from home, where it used to be impossible to conduct any sort of office work or medical text research (my veterinary library was at my practice); now, I can access journals, texts, veterinary school resources, and veterinary specific networking sites that allow exchange of current clinical information. When I graduated, if I could not find the answer to a problem, I would call a former professor in Medicine or Surgery and ask. Now, from my phone, I can find answers I would have waited days to receive. I am able to connect with specialists and colleagues not just from a practice or two away, but from a coast or a continent away. No longer is absence of information an acceptable state of affairs. We can get to information (the trick remains how to make decisions with imperfect information in a way that is rational, timely, and helpful).

We’re making some leaps in technology at Bridgewater Veterinary Hospital, a new website with exciting new functionality. We’ll be introducing email reminders, web-based medication refills, and other communications enhancements. We look forward to improved accessibility, and improved service to our clients.

You should know that surgery is sometimes a bit extemporaneous, and often quite physical.  Orthopaedics comes to mind.  In some surgeries, deft digital manipulation is the key to good outcome.  Or, sometimes, ya’ gotta’ rip it out.

Back to our mouth mass.  Having determined that our mass wanted to exit the mouth, but was temporarily unyielding to use of surgical tools, I began to stretch the attachment of the mass to the gum.  The three students watching were slightly troubled by the sound of stretching connective tissue;  my camera-wielding student was in close by my right shoulder, when the mass abruptly exited the stage, and somewhat forcibly ricocheted off the left hand of my photographer (I thought I had a better grip on it, really!).

We proceeded to the spay with our students, and at the end of the procedure, used a laser to finish the removal of the mass’s stalk.  It looks like it will be good news for the doggie, best news of all is that this sweet little pit mix has a great home.

Xylitol is a sugar substitute that appears quite safe for people, but can be dangerous or fatal to dogs. It can cause a dangerous drop in blood sugar, which can result in seizures, coma, and liver failure. This is serious, bad stuff, and yet it looks so innocent. Please, keep your purse away from your dog if you chew gums sweetened with xylitol.

What else lurks in your purse? Over-the-counter medications or prescription medications. A surprising number of calls come in each year where people were poised to take their own medication, set it up on a counter or table, and while they were getting some water or taking a phone call the dog (occasionally the cat) gets the medication. Sometimes, this is not a big deal, but some medications are potentially disastrous for your pet. Also, putting a prescription bottle on the nightstand and leaving it there with a young dog in the house seems to be the equivalent of leaving a squeaky toy there; young dogs love to chew open the vial and get into the pills (never mind that if you HAVE to pill your dog or cat, it can be a three-ringed circus of frustration).

Oh—pennies. That’s right, pennies. Since 1983, pennies are largely made of zinc instead of copper, and zinc dissolved in stomach acid to become a toxic compound in dogs. I saw a number of these while I was a surgery tech at Penn while in veterinary school and saw one as a brand new graduate in 1990 when a Yorkie ate 42 cents in change, including two pennies. Zinc toxicity produces dangerous, sudden loss of blood (the blood cells break up inside the circulatory system); luckily, said Yorkie was saved through good luck, surgical removal of the coins, and good care.

Dogs are always looking for a chance to explore things, to see if chewing and swallowing stuff is as fun as they think—keep your pet safer from the dangers of your purse, and save yourself some anxiety, too.

http://www.snopes.com/critters/crusader/xylitol.asp

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/214100.htm

My job at Penn is to teach spay and castration techniques to the students, and we do this in shelters and also at the Ryan teaching hospital.  So far, I’ve had the pleasure of working  with dozens of interns and surgeons, and over 450 vet students.  We have surgically sterilized thousands of pets, which has been a huge help to the shelters coordinating with Penn.  I also teach classes on the subject of animal sheltering, free-roaming cat issues, and diseases of particular concern to shelters and rescue groups.

The students also bring their own pets to me for veterinary care, so my clinical work has continued.  I like this clinical role, as I get to know the students and their pets just a bit better than I would in the classroom or operating room.

At the urging of several friends and associates, I have returned to clinical practice at Bridgewater, working two shifts each week.  My time in the office should allow me to do more of the things I enjoy—seeing pets and their families.  I’m re-energized to be back, and looking forward to seeing some of you in the office soon.