Archie Update: Going to the Invitational

Archie and I have been working on our agility teamwork and handling these past few months. He is on his way to a MACH--he has 14 of the 20 double Qs required, and more than enough points. We stalled out this summer because I was pushing him too hard. I took a long break from trialing and spent the past couple of months focusing on training.

I'm not sure we will get that MACH. It will be a big accomplishment if we do. There are not many smooth fox terriers with that agility title. 

Our next big adventure is coming up in just a couple of weeks. We are off to Orlando for the AKC Agility Invitational. Going to the Invitational was definitely on my bucket list for Archie. After he advanced to the number 2 position in his breed this summer, I decided this was the year to go. Three years ago he was in the number 11 spot, and last year he was number 5. I didn't go last year but now that I'm vaccinated to the eyeballs and he's moved up so quickly in the rankings, I decided this was the year. He may qualify again in future years but I will only take him once. It's an expensive dog show and it eats up a lot of my paid leave. 

I went to the Invitational with Iz back in 2006. It was in San Diego that year. Boy, things have changed a lot in the past 15 years! For starters, there will be a lot more dogs there. As a result, there are many more rules and organizational fiddly bits that I have to keep track of. It was a big dog show back in 2006, and it's even bigger now in 2021. 

The Invitational is an interesting event. Only the top 5 dogs in each AKC recognized breed who are actively competing in AKC agility are invited. If any of those dogs decline, AKC moves down the list. To qualify for the AKC Agility Nationals, you have to be the best in your height class. Archie jumps 16" so he competes against small border collies and other fast dog breeds. Still, he's quite good and he qualified for Nationals this year (I didn't go). To qualify for the Invitational, you have to be the best in your breed. So "best" is somewhat relative. If there are only three of your breed doing AKC agility, you can be quite shitty at agility and still get an invite to the Invitational. 

As a result, the Invitational can be a mixed bag. You will see Basset Hounds, Elk Hounds, teacup Chihuahuas, Saint Bernards, and all manner of tiny mop dogs who somehow, somehow, still manage to knock down bars that are only 4 inches from the ground. You will see living examples of dogs that you've only seen before in books. And I can assure you, some of these dogs, both breed and individual, should not be doing agility in any form. But they will be there. 

One of the benefits of attending such a ginormous dog show is the vendoring. It should be magnificent! I've got some specialty items on my shopping list already. Bulk bags of freeze-dried lamb lung? Check. Real fur tugs in a thousand different permutations? Check. German steel thinning shears? Check. Hand-made leather collars? Check.

I have an "agility trial packing list" that I print out about a week before each trial we attend. I meticulously cross off each item when it is completed and/or packed into the van. Trim toenails. Take out the trash. Dog bedding for trial crates, car crates, and hotel. Bathe and groom the dog. 

The last bit may seem odd, but Archie stands out. He's got striking markings, and he's an unusual breed. Archie gets noticed. It would not reflect well on me (or his breeder) if I showed up to a trial with a scruffy, dirty terrier. As a result, he gets a bath 4 days before any trial, and is thoroughly groomed from nose to asshole 2 days before any trial. That schedule will have to be adjusted this time since we will be on the road for two days just to get to Orlando.

Lots of planning and packing. Always more training to be done. It's going to be an adventure.

It's Been A While...Time For A Recipe!

The blog post count for the past couple of years has been pretty low. But I'm not ready to toss this baby out with the bathwater, not quite yet.

So today, you get my recipe for Trailer Park Chicken and Dumplings. Or should that be Dumplin's? This is my own variation of a more complicated recipe. Tasty. Cheap. Makes a lot of food.

 

Ingredients

1.5 lb boneless chicken thighs

1 onion

bouillon (I use Better Than Bouillon Roasted Garlic Base)

flour

4-5 carrots

flour 

can of ready-to-bake biscuits (I use Trader Joe's Buttermilk Biscuits)

Instructions

1. Coarsely chop the onion and saute in olive oil until soft. Scrape the onion into a slow cooker.

2. Add 4 cups warm water and 2 Tbsp bouillon. Turn slow cooker to high setting. Sprinkle in 3 Tbsp flour. Whisk gently until smooth. 

3. In the same saucepan, brown the chicken thighs. They don't need to be cooked through, just browned on the outside. Scrape the pan into the slow cooker, including all of that delicious chicken fat. Stir gently.

4. Cook at the high setting for 1 hour.

5. Chop the carrots into rounds. Add to the slow cooker. Add thyme (dried, or fresh leaves finely chopped) and black pepper to taste. If the liquid needs a little more thickening, you can add another tablespoon of flour. Do this carefully to avoid lumps. You won't be able to whisk the lumps out now. Stir, and cook for another 20 minutes.

6. Open the can of biscuits and gently lay the biscuits on top of the liquid in the slow cooker. They will touch each other. Gently press the biscuits down with a spoon until they are submerged/covered. Make sure they aren't sticking to the sides of the slow cooker. Cook for another 20-30 minutes.

7. The canned biscuits will be cooked through and puffed up but will not brown. 

I Have Opinions About Some Books

 I haven't owned a TV since I left Saudi Arabia in 2013. I do enjoy the occasional Netflix movie or series which I watch on an iPad, but for the most part, I consume my news and entertainment by reading them, not passively viewing them.

I've always been a reader. The spiffy certificates with the gold seal sticker that they awarded for summer reading contests at the elementary school library were nice but I hardly needed any encouragement.

During vet school, I didn't read much of anything that wasn't directly related to vet med. Now that I'm free to read what I want, you'd think I'd have (virtual) stacks of books lined up, waiting to be read. (I switched to electronic books almost a decade ago.) Sadly, that's not the case. I might spend a couple of hours browsing the local library's online selection to maybe find three or four books that I might want to read. I say "might" because one of the things I've learned over the years is that I am absolutely free to stop reading a book that I don't like. I don't need a good or logical reason. My time is precious and I won't waste it reading a story when I don't care how it ends. 

An author I've avoided for years is Joyce Carol Oates. She is a prolific writer with dozens of novels and other written forms under her name and two pseudonyms. But I find her writing style by turns bloated and dry, and frankly repetitive. Her stories have never sung to me. But I recently got a copy of Blonde, which she wrote in 2000. It's not a straight up biography of Marilyn Monroe but instead an introspective exploration of known, historical events. In Blonde, JCO's prose is more bloated than usual. But that feverish, dream-like prose creates an anguished tone that is the perfect setting for those known, historical events, the tragedy that was Marilyn Monroe, the actress and the person. It's still a slog, JCO will not ever let the reader off easy, but I can't stop reading it. I won't be rushing out to pick up more of her books but I am really enjoying this one. 

In contrast, I was waiting for the release of Detransition, Baby by Torrey Peters with considerable anticipation. In fact, I put in a request that the local library acquire it, and they did. I had already read a couple of reviews of the book and heard an interview with the author and I was excited to finally get to read it for myself. And I was so disappointed when I had to stop reading it about one-third of the way through. 

The book is ... not good. It is told in chapters alternating between current events in the book, which are roughly today, and flashbacks to past events. There are two and a half main characters (yeah, that's one of the problems). One is a transwoman, another is a man who was a transwoman and the lesbian lover of the first transwoman who decided to transition back to presenting as a man but who still views himself as a transwoman inside, and the half is a ciswoman with whom the man has an affair and who gets pregnant. There, all clear, right? I actually don't have problems with this. It could be the set up to some great tragicomedy, if we are able to work through only having half a character as one of the main actors.

Prose in the chapters of the book where the the main character is relating stories from her past, about her journey to become who she is now, about her lovers, and her self-love, that prose sparkles and crackles and jumps off the page with wit and pain and love and beauty. Fabulous writing. The stuff the author added to those bits to turn them into a novel? Complete shit. The plot of the novel? Utter shit. So many huge plot holes and clumsy attempts to stitch that crap into one book instead of what this should have been, a collection of short stories. 

 I stopped reading when the half-character, the ciswoman, tells her lover, the former transwoman, that her mother (hang in there, I know it's bad) said she should communally raise the baby with the transwoman, the lover who is a man but still views himself as a transwoman, and herself because babies "need all the moms" when in fact the very backstory of the half-character ciswoman made it clear she was raised in virtual rural isolation (on a mink farm, wtf?) with a barely attentive mother. Where did all this crap about "all the moms" come from? It was so completely out of character for an already barely limned character that I just threw up my hands and said, this is fucking stupid and poorly conceived. I couldn't stand to read another word. 

The author has a lot of promise, and I hope that she gives us a collection of short stories because I would love to read more of that. This ridiculous attempt at a longer narrative? Just stop.

How'd I Do?

 The horse gut is an amazing and complex thing. They have a single stomach like us, although it's only partially glandular like ours. The real magic happens in their cecum and very long colons. They have a right ventral colon, a left dorsal colon, and a right dorsal colon, plus a regular colon called the descending colon. Their cecum is an enormous blind sac located between the small intestines and all of these colons. 

Depending on the particular pathologies involved, it can be kind of difficult to identify the various parts of the horse's gut during a necropsy. The best way is to remove the entire digestive tract from stomach down, cut all of the ligaments (thin sheets of tissue that hold it in a particular shape), and stretch it out. 

Yesterday I had a foal who died from not one but two intestinal ruptures. For accuracy in my report, I wanted to figure out exactly what parts were affected. Because everything in the foal's abdomen had been marinating in intestinal contents and bacteria for a couple of days, there was a lot of autolysis (post-mortem changes). And there was necrosis of various parts of his gut associated with ulcers and hemorrhage that preceded the two ruptures. Tissues were delicate and friable. Everything was coated in bits of partially digested feed and greenish, bloody fluid. 

We of course took pictures but those can be hard to interpret, and sometimes the techs don't get those loaded onto the server for a couple of days. After I had extricated his gut and stretched it out, I made a quick sketch, labeled some key bits, and marked the areas of the ruptures. Here's the result:

 

"Colon" is the descending colon, RDC is the right dorsal colon, PF is the pelvic flexure (a distinctive anatomical feature of the horse gut), "base cecum" is where the cecum opens into the right ventral colon, J is jejunum, D is duodenum, and "stom" is the stomach. That bit sticking off the stomach would be the esophagus. The heavy black bars are the two rupture sites.

Compare this to a diagram from one of my vet school textbooks:

 

I think I produced a real masterpiece!

Notice how I positioned the stomach to the right, descending colon to the left, the same way as in the picture. That's because we necropsy ruminants and horses from a left lateral position, meaning their left sides are down on the table. This creates the same right lateral view of the intestines as shown in the picture. I'm pretty sure I would struggle to identify things if I had to look at them from the left aspect. 

Consistency is important when doing necropsies. If we examine tissues in the same order every time, we are much less likely to miss problems.

Fun With Fungi

Rain. So much rain. Fungi with amazing colors and textures are popping up all over my property. Here's a sampling. 

Each One A Puzzle

Every necropsy case is a puzzle. To find the solutions, my colleague and I have considerable agency to select the tests that we want to apply. At one end of the spectrum is the shotgun approach: collect every type of sample (tissues, swabs, fluids) and run every test available. But where's the fun in that? Not only does this approach lack elegance and waste resources, it isn't intellectually pleasing. It's lazy diagnostics. It's more challenging by far to build a list of differentials based on signalment and history, modify that list based on gross findings from the necropsy, then thoughtfully select specific tests that will rule in or rule out your top differentials for the cause of death. 

Sometimes the necropsy itself is the only test we need. That is informally referred to as "grossing out" a case, meaning we are able to determine a definitive cause of death of an animal during the gross examination conducted during the necropsy, and the case is closed out with no further testing. Necropsies are meticulous and require a lot of careful examination, and the word "gross" in this context means we aren't using any special diagnostic tools beyond our eyes and fingers. For example, when we find heartworms in a dog who died suddenly or who had clinical signs like fainting, low energy, or coughing, and there are no other major findings such as pneumonia or masses in other organs, we gross that case out. 

While it can be satisfying to close a case based only on the necropsy, it is even more satisfying to identify a pathology during necropsy and verify it with just a handful of carefully chosen tests. Those cases give us a lot of validation. We've had several cases like this recently.

A beef cow-calf operator brought in a yearling cow. The cow was petite, quite pretty. She'd been sick for a couple of days and had not responded to his treatments. He'd lost several from his herd in the past few days, all with similar clinical signs. All of the sick or dead cows were yearlings or older--he hadn't lost any nursing calves. That was interesting. Based on my initial conversation with him, it sounded like a toxicity event and not infectious disease that was killing his cows, and he agreed. We went through the list of the usual suspects--paint cans, old batteries, sheds with old bags of fertilizer, rusting 50-gallon drums containing mystery liquids--cows are both curious and relatively indiscriminate eaters. Nothing really fit though. So into necropsy I went. 

Even if you think you know the answer, which I did not in this case, you still approach every necropsy systematically to make sure that you don't miss anything important. Heart, lungs, and spleen looked good. But the liver was moderately autolyzed. Autolysis refers to post-mortem changes that occur in tissues due to cell death and bacterial activity. The state of the liver didn't match the other tissues. I couldn't find anything wrong with the liver that would explain this, such as liver flukes or evidence of a bacterial infection in the liver. This was a symptom of something else, not the primary problem.

Next, I examined her gastrointestinal system. The rumen was filled with 20-30 L of a thin liquid slurry of finely shopped feed. Her abomasum, her glandular stomach, was red-black inside and contained a couple of liters of cloudy red-brown liquid. The rest of her intestinal tract was empty. All three of these observations were a surprise. Her rumen should have contained layers of material--a mat of feed at the bottom, a slurry on top, and a gas cap on top of that. Sure, this stratification gets a bit mixed up when animals are moved and transported after death, but the basic components can be identified at necropsy. I only saw slurry, and far too much of it. Her abomasum should have normally contained feed. It shouldn't be bloody. And she should have had digesta scattered all along her gut and feces in her colon. All of this added up to an animal that had stopped eating and had developed ileus, or a cessation of the normal peristalsis of her gut. She had continued to drink water, thus the rumen was distended with liquid. Cows can develop ileus as a result of torsion or displacement of the abomasum, heavy parasite load, blockage of the rumen by a foreign object (baling twine and plastic bags in cow rumens are common incidental findings, but they can sometimes cause problems), chronic diarrheal disease, or something called vagal indigestion related to dysfunction of the vagal nerve and rumen function. There was no evidence of any of this, so the ileus was a symptom, not the primary problem.

Next, I examined her kidneys. Kidneys are often the first tissues in a cow to autolyze, which refers to the post-mortem changes in tissues due to bacterial activity and cell death. This cow was very fresh so I didn't expect to see autolyzed kidneys. Normal cow kidneys are not quite as dark as our own but they fall well into the range of what we might call "kidney colored." Her kidneys were golden brown and covered with bloody pinpoints. The same pinpoints were visible inside in the renal cortices. These distinctive lesions are textbook examples of oak toxicity. Leptospirosis, an infection caused by bacterial spirochetes, was definitely a differential. But my other observations fit oak toxicity better. Oak toxicity is caused by tannins in leaves and acorns. It can cause hemorrhage in the glandular stomach, which was likely the precipitating cause of the ileus (the cow didn't feel good so she stopped eating), and liver necrosis, which set the liver up to autolyze faster than surrounding tissues. And it causes pinpoint hemorrhages in the kidneys.

I called the owner back and surprised him by asking about oak trees that might be in or around the pasture. Turns out that during stormy weather a couple of weeks prior, wind had knocked down several branches from an oak tree in the middle of the field. The producer had observed several of his cows eating leaves from the fallen branches. He didn't think much of it because he thought oak toxicity was only caused by buds or acorns, and we are past the time for the first and not yet into the season for the second. He gave them new forage and cleaned up the branches. I told him that young leaves and their stems are toxic too, and that unfortunately the damage had already been done. Nursing calves didn't eat any leaves so they weren't affected. And the leaf-eating had occurred long enough ago that no leaf remnants were in the rumen of this cow. I told him to expect more mortalities in the handful of cows that were still sick.

There is no bench test for oak toxicity. Diagnosis is made by gross findings and distinctive microscopic changes to the kidneys. I had to wait a couple of days for the tissues to fix in formalin, another day for trimming, and another day to cut and stain the slides. But eventually, I had the slides in my hand. Textbook case. 

My colleague recently had a similar puzzle that he quickly solved. A breeder had submitted two French bulldog puppies, only 7 days old. She had already lost most of the litter. When this kind of thing happens in pure-bred dogs or cats, breed-specific genetic or congenital abnormalities top the differential list. That list is of course rather long for French Bulldogs and other brachycephalic breeds, especially since breeders are selecting for ever more extreme deformation of the faces of these dogs. I recently did a necropsy of an adult female Bulldog whose nasal openings were positioned so far back on her head that they were over her molars, not in front of her incisors. Selecting for extreme body deformities often comes with unanticipated deformities in critical things like hearts, skeleton, and brains. Oops.

But back to the puppies. For high litter mortality, you also have to consider canine parvovirus, which can be transmitted through the placenta. Ideally, the dam should have been vaccinated for parvovirus and she would have passed antibodies to her puppies when they nursed the first time or two, but the number of people who refuse to give vaccines to their dogs is growing. She could have been infected during pregnancy, and infected her puppies in utero. Canine herpesvirus is a bit more insidious. There is no vaccine. It can also be passed to the puppies in utero and often results in abortion in those cases, but the more common route is post-natal infection. It can result in high mortality in young puppies. Dogs older than about 8-12 weeks usually only get mild disease from herpesvirus, but they shed virus in all of their body secretions. Keeping it out of a kennel is a matter of biosecurity--wash hands and shoes, quarantine new additions, segregate animals of different ages, clean surfaces. 

My colleague approached the necropsy with his usual care. Nothing significant turned up until he looked at the kidneys. The kidneys of both puppies had many small hemorrhages inside and out. Textbook example of canine herpesvirus infection. He was so excited by this finding that he called me down to necropsy to take a look. Definitive diagnosis of canine herpesvirus is available with a PCR test. It of course came back positive, and he closed the case with no further testing. We made slides of the kidneys for our own learning because they were such good examples of this disease. You could see inclusions comprised of many viral particles (far too small to see individually) in the nuclei of the cells lining the renal tubules.

Two interesting puzzles: cases of multifocal renal hemorrhage and nephritis identified at necropsy of two different species. When we combined our gross observations with signalment and history, we were able to land on diagnoses quickly. Two puzzles that we got a lot of satisfaction from solving!

Small Acts of Kindness

I got these flowers today at the lab. They were sent by a veterinarian out in the wilds of southwestern Arkansas whom I've never even met. She called the lab yesterday, almost in tears, worried that she had screwed up a case, second-guessing all of her decisions, and needing to talk to someone about necropsies. Receiving sent her to me.

I spent over 30 minutes on the phone with her. The clients were being difficult, accusing her of killing their dog. She did an in-clinic necropsy and found many dozens of heartworms in its heart and vessels of its lungs. She was worried that she did something wrong. I assured her that she did everything right. I told her that the outcome would have been the same if she had sent the dog to the lab for necropsy. I thanked her for trying to find the best answers for her patient and the owners. 

Today she sent me flowers and a short note.

It is these small acts of kindness that we give each other that get us through.

We Are All Partners In This

Despite being barely two years out of vet school, I apparently project an air of confidence and competence to my veterinary peers. I've been thinking about this ever since my conversation with Dr. M that I mentioned in my last post. It's absolutely true that I don't know everything about vet med. I've got a lot to learn. But I bring so much more to the table--years of experience with scientific writing, public speaking, and critical thinking. And my own personality contributes a lot as well--I have always had a habit of calling things like I see them.  

On Tuesday, one of the regional USDA-APHIS vets emailed me to see if I could help them out. They felt like they were not fully prepared to conduct poultry necropsies if there was an FAD event in Arkansas. 

FAD means Foreign Animal Disease. There is a very long list of FADs that are of concern to the USDA, but in the poultry world, we are mainly talking about HPAI (highly pathogenic avian influenza) and vNDV (virulent Newcastle Disease Virus). If either of those were to appear in Arkansas, it would be devastating to the poultry industry here. Containment and sampling are critical. It is far beyond the scope of my blog to talk about the training that USDA-APHIS and USDA-accredited veterinarians receive (I have Category II accreditation), but if there was a disease outbreak, USDA and other federal agencies would run the show. Their people would go into the poultry houses and conduct necropsies and collect samples which would then be sent off to the various national labs. 

So back to my vet colleagues, who reached out to me for help. The vet that emailed me asked if I could run a workshop for them, a wet lab with hands-on instruction in poultry necropsies. Sure, I said, that sounds like fun. I mean, what else would I say? I love teaching. I love working with poultry. I put in a lot of effort during vet school to gain knowledge and experience in poultry vet med. Only 2 or 3 vet schools teach about poultry, so most vets never even touch a chicken during school or during practice. 

The only problem was that I can't predict when poultry cases come into the lab. We needed birds for this workshop. Then I had an idea. We do a lot of serology testing for the big poultry companies in Arkansas. Most of them regularly send us necropsy cases too. But one of the bigger companies hasn't used us much for necropsies in the past. However, since I joined the lab, their regional rep has been sending me tough cases that really allow me to stretch my diagnostic skills. He never fills out the history on the submission form, instead preferring to call me up and chat for half an hour about what is going on at that particular farm. 

My idea? I emailed him, told him that USDA wanted a workshop, that I was happy to run it at the lab, and would he be willing to donate birds? He didn't hesitate. He immediately grasped the larger picture--if USDA vets are better prepared for a FAD event, his company would directly benefit. We are all partners in this. 

A flurry of emails ensued, and the workshop was arranged for Friday. I downloaded the training manuals that the USDA vets use so that I could see what they were being instructed to do, and I wrote a brief outline for the workshop to ensure that they would learn how to collect the samples they needed to collect.

I told them, if there is a FAD event, you will be working in some seriously adverse conditions--taped into PPE head to toe, kneeling in hot, dusty poultry houses surrounded by dead and dying birds. I told them I was going to show them tricks and efficiencies to quickly collect the samples they needed, and to make sure they were diagnostic. And then I proceeded to do just that. 

 

Me on the left. These are broiler breeder hens. They lay eggs that are hatched to become broilers, which become chicken nuggets.

It was a great workshop. I can assure you those vets know a hell of a lot more about poultry anatomy now than they did when they woke up on Friday morning. They know how to hold and use scalpel blades without cutting themselves. They know how to get blood samples my way (my way is heresy, to be sure, but it works, it's amazingly fast, and the samples are just as diagnostic as those obtained the traditional way). They know how to perform tracheal swabs on live and dead birds. All of this delivered in less than 3 hours. It was so successful that I will run another one in May for the four vets that couldn't make this one.

To be sure, this was quite a professional accomplishment for me. My USDA colleagues valued my expertise enough to ask me to share it with them. I am empowered in my own job such that I can use state resources for this kind of activity without seeking permission (although I let the upper levels know what I was up to). I really value my personal relationships with lab stakeholders, and the effort I put into them paid off nicely.

We are indeed all partners in this.

Absurdly Alice

Here are some (slightly edited) conversations I've had at work in the past few days.

Backstory: One of my favorite vets called me up to get my opinion on a recent case he submitted last week. He knows now that our reports are strictly factual--we observed this, we measured that. But on the phone or in person, he is also aware that I will share any and all theories that my colleagues and I might have about the cause of death of the animals in his cases. That's what he called me to get--the crazy theories and speculations. 

Many of his clients are cow-calf operators in the southwest part of the state. It's a long haul for those producers to bring a cow or calf into the lab so he often does field necropsies and sends us what we call "a box of parts." After a fair bit of coaching from me, he sets the bar pretty high with his submissions, generally collecting diagnostic samples for most of his cases. He sends fresh tissues and feces and rumen contents knotted up in disposable obstetric sleeves, and cuts off pieces of affected tissues and drops them into a container of formalin. Pretty much every time he sends us a BOP, the container he uses is a large bottle that used to contain 500 tablets of cephalexin, an antibiotic that can be used in food animals. Since he submits cases almost weekly, well, that's a lot of cephalexin. 

Me: So, another fabulous field submission from Dr. M. I have to know, what's up with the cephalexin bottles? 

Dr. M: Well, it's a big bottle.

Me: I know, but why do you have so many empty ones? What do you do, give them out like M&Ms?

Dr. M: Yes, exactly, everyone that comes into the clinic gets some!

Me: Like Oprah! Cephalexin for you! And cephalexin for you too! Cephalexin for everybody!

This same vet submitted the headless, legless torso that I mentioned in my previous post. That came up in today's phone call too.

Me: Um, so why did you cut the head off? Why?

Dr. M: The calf wouldn't fit in the container and...

Me (interrupting): ...hahaha!

Dr. M: ...it wouldn't fit and the courier was getting upset, needed to leave...

Me: ...so you cut off the head but you so thoughtfully left the tail! You left us a handle!

(Me and Dr. M cackling like chickens)

Backstory: I'm on a committee at the lab that handles quality management issues. We are only a committee of three. We had an event that needed to be assigned to one of us. 

Committee leader: Which one of you will take this?

MBF and I look at each other. 

Me: Rock paper scissors?

MBF: Sure. But I'm terrible at this. My wife always wins.

Me: I'm glad to hear you and your wife have a healthy process for conflict resolution.

MBF: So, on 1-2-3-go?

Me: Yes.

MBF: 1-2-3...

And on "go", I throw out paper. 

MBF: No! After I say go!

Me: Oh. Okay.

MBF: 1-2-3-go...

And I throw rock as he throws scissors.

Me: I win!

Always setting a high bar for professionalism! 

Backstory: I was approached by our local colleagues in USDA APHIS about leading a wet lab for them in poultry necropsy and diagnostics. They wanted to be better prepared in case of a disease outbreak. Sure, I said, I can do that. But we need some birds, and waiting for a regular submission is not really a workable solution. I have developed a good relationship with a high level guy in one of the broiler breeder companies in Arkansas. He submits crazy cases that keep me on my toes. I decided to ask him to donate birds for the wet lab, either spent hens scheduled for slaughter or birds from a problem farm. He'd get a full report and diagnostics at no cost.

Me: I have an unusual request. blah blah wet lab blah blah USDA blah blah warm fuzzies all around. I only need about 10 live birds.

SL: Sure! But how will we get them to the lab? 

Me: I'll bet we can get one of those USDA folks to pick them up from your folks. And I almost forgot, they wanted some deceased birds too. Can we get a few of those? 

SL: How many dead ones do you want?

Me, reading the email asking me how many dead ones I wanted: This is a strange email conversation. I want five dead ones.

SL: It's always a strange email conversation in this business. Done!

My job challenges me in many ways. I would never have expected days that leave me feeling like Alice in Wonderland.

Surprise!

I've discussed before about how we approach each necropsy case with a list of differentials for the cause of death. Before you even see the animal's remains, you can posit a decent list just on signalment (age, sex, breed) and clinical history, if one is provided. The time of year and the weather can suggest a few differentials too. And I'd say that, for most cases, our differential lists don't change much, other than to usually get a lot shorter. 

Then there are the surprises. 

Oh, a calf was sent in for necropsy? It's wrapped up and packed in a styrofoam box, and Receiving won't open it up, of course. They leave that for us in Necropsy. The box seems small but maybe it was a neonate? Surprise! We opened the box to find a single, long-ago melted ice pack and a trash bag. Inside the trash bag was a torso. A calf torso, minus the head and four legs, removed to reduce weight and thus reduce the shipping cost. They thoughtfully left the tail, however. But because the torso was shipped without enough ice, and because they had removed the head and didn't take quite enough care when removing the legs, fluids produced by rotting tissues had mixed during shipping with the diarrhea that had oozed out of the anus and blood that seeped from everywhere else to create a foul ichor, a marinade that penetrated all crevices of the torso. Except for a PCR test for mycoplasma pneumonia, the tissues were not usable for anything else. 

We see many dogs who died from heartworm infections. These cases make me angry because it was a completely preventable death. And we can often predict which cases these will be: owner-submitted, large breed, intact male dogs are vastly over-represented. Even if you are expecting to find heartworms in the heart, there are always the surprises, in which you find literally hundreds of worms packed into the heart, worms in the pulmonary arteries and even in the smaller vessels deep in the lungs. By far the worst are the dogs who died of caval syndrome in which the worms migrated upstream, back out of the heart into the caudal vena cava. Surprise! It's a plug of worms thicker than a broom handle blocking the largest vein in the dog's body. 

We handle about a dozen legal cases per year. They are always difficult since most involve animal abuse of one form or another. But we have a process that we follow, and focusing on the process helps us get through them. But there are the cases that take unexpected turns and become legal cases based on our findings at necropsy. Last year, I had a medium sized, mixed breed dog submitted for necropsy. I started by conducting a thorough physical examination. Surprise! That looks like a projectile entry wound! I ripped off my gloves and called the vet listed on the submission form and asked her, why didn't you mention that the dog had been shot? Turns out she never even saw the dog, just directed the owners to take it to the lab when it died suddenly. I took the dog over to the Crime Lab for radiographs, identified the location of the projectile, and retrieved it later during necropsy--a 9 mm slug.

And of course there are always rare congenital anomaly cases that you really just can't predict at all. The animals may have died as fetuses, or lived for a few days or even years. But they did die eventually and ended up on our necropsy table. Surprise! This Hereford calf fetus is missing most of its brain. Skull is normal, brain, not so much. Surprise! This 10-day old Angus calf doesn't have a rectum or anus! Its colon ended about 6 cm too early. Surprise! This obese 6 year old cat that died after a vet visit had two tracheas! Two tracheas all the way down, one going to the left lung lobes and the other to the right lung lobes. It also had feline cardiomyopathy, which was not a surprise. Surprise! This pure bred cat that has been genetically selected to have defects in how it makes collagen so that it will have folded back ears has malformed collagen everywhere else too, including the heart, blood vessels, skin, liver, kidneys, ligaments holding vessels in place. Nothing was normal in that cat. It was like working with a Picasso vision of a cat necropsy. A 10 month old German Shepherd pup, purchased at great expense by a breeder hoping to use him for stud work, was a "poor doer" from the start with vomiting, diarrhea, and poor growth. Surprise! The poor pup had two kidneys but they were very small. Under the microscope we could see that the usual renal structures had not formed, and the kidneys were mostly not functional. He had full thickness, bleeding ulcers in his stomach from the uremia, because the non-functional kidneys were unable to remove urea from his blood.

We approach every necropsy case with a plan, a list of differentials and tests we might want to run. We also need the flexibility and knowledge to modify that plan on the fly based on what we find, whether we expect it or not.

At Last

Yesterday, we received notice that agricultural workers and veterinarians (and their staff) could at last sign up to get the COVID19 vaccine in Arkansas. As a veterinarian who works for the Arkansas Department of Agriculture, I was in line at last.

After some quick computer work, I was set up. I somewhat randomly chose a local pharmacy about 5 or 6 minutes from the lab. Although it may have been a bit overkill, the pharmacy sent me multiple email and text confirmations and reminders. I'm okay with that. I looked at each one of them with a smile.

I got my shot today at 9:50am. The pharmacy is in a somewhat upscale strip mall on the western side of Little Rock. They set up the vaccine clinic in an empty storefront in the same strip mall, and it was a straightforward experience. The storefront didn't even have finished walls, it was just a big, empty, concrete-floored space. Plenty of room for social distancing. 

Which vaccine did I get? Does it really matter? For the record, I got the Pfizer-BioNTech vaccine. And I have a confirmed appointment for my second shot in three weeks. My colleague Xie got his shot today too, and he got the Moderna vaccine. Science for the win!

Reactions? My arm hurts. Eh. Tetanus boosters are far worse. After one of those fuckers, I can't lift my elbow higher than my waist for a couple of days. But here's the thing. Rabies and tetanus--they will kill you. As a veterinarian, I'm happy to line up for the vaccines and titer checks (my rabies titer is checked annually, at no cost to me, at the lab) and boosters. COVID19 is now just another check box on the list.

I'm quite over-committed at work right now, yet I feel like a huge weight has been lifted from me.

Solarium

 Repurposing the guest bedroom. Best seat in the house on a cold but sunny winter morning.

Digging Out and Warming Up

 By no means did central Arkansas get hit as hard as Texas by this terrible week of terrible weather. Sure, there were some power outages, some burst pipes, but these were isolated incidents. For the most part, everyone hunkered down for a week, waiting for the snow to stop, waiting for it to warm up. 

I ended up getting more than 20" of snow at my house. The daytime temps remained in the teens, nighttime temps dropped into single, even negative, digits, for almost 5 days in a row. 

I overestimated my van's ability to handle the snow and ice, and got it stuck trying to leave the subdivision on Thursday. There are only two ways out of my subdivision, and both require climbing multiple, steep hills. At least I managed to slide it parallel to the curb on a relatively flat spot of road located about 0.5 miles from my house. That night, I made two trips to the van with my cart, hauling expensive dog crates back up the hills to my house. When its wheels iced up, I dragged the cart over icy ruts.

On Friday, the sun rose in a clear sky that morning, and it was 36F by 3pm that afternoon. I visited my car twice during the day. But the icy, packed snow was too deep and the roads were still too treacherous. I whiled away the hours by shoveling my very long driveway, front walkway, and back deck. I had to use a regular shovel, which just sucked. 

I anxiously waited for sunrise on Saturday. I planned my morning to the minute and arrived at my car just as the temperature reached 34F. It was going to be a warm, sunny day (it's 45F as I write this) and large sections of the road were now covered with icy slush. 

Using another shovel that I had left in the car on Thursday, it took me almost half an hour to dig my car out so I could get it up onto the packed snow/slush on the road. I managed to white-knuckle that van up and out of the subdivision at last! I aged 10 years and acquired more grey hairs in the process, but once I hit the main road, which had been sanded and plowed, I started breathing again.

Apparently my nutritional choices diverge from a lot of other people's because although there were plenty of bare shelves at Trader Joe's, I managed to get enough food to last for another 10 days or so. I stocked up on cat litter at PetSmart, and decided that was enough of an outing for the time being. I'm back home, van parked in the driveway again, planning to spend the rest of the day cooking.

Disposition of Remains

 The lab director and I often talk about lab activities that would make good PR photos and short articles in the Department of Agriculture and State Veterinarian newsletters. The Pathology section of the lab almost never makes the cut (heh, unintentional pun there). There is no way to make a necropsy visually palatable for public consumption. There is no way to make slicing up hunks of formalin-fixed cow liver into thin sections to make microscope slides fun. And there is a very important component of our section that we can't ever discuss--the incinerator.

I didn't anticipate becoming an expert on incineration as a part of this job, but so it has come to pass. While the monthly totals vary wildly, our small lab incinerates about 25 tons of animal remains a year. Somebody has to be in charge of that, and that somebody is me.

The lab building was constructed around 1973 or 1974, and there is an incinerator built into the necropsy floor. I've been told tales of former pathologists who would perform necropsies on cows and other large animals hauled up on the hoist directly over the old incinerator. Fortunately, that generation isn't in charge anymore, because while it may be efficient, that sort of thing is fucking appallingly sloppy. By the time I arrived at the lab, the old incinerator was being decommissioned and the new one starting up.

The new incinerator is a stand-alone unit attached to a very large propane tank, located in a fenced lot across the street from the lab. It took almost six months of nearly weekly crises to get that damned thing up and running. I made significant contributions to that success, and consider it a professional achievement that I mention on my resume. 

If you were paying attention, you may have noticed that I mentioned the incinerator is across the street from the lab. So how exactly do we get those 25 tons of animal remains over there? It involves very large woven plastic sacks designed to hold many hundreds of pounds, large containers, a truck, and a forklift. It required a lot of planning and training to work out the details. We had to consider optics (can't be hauling bloody bits and leaking bags across the street) and safety while still designing a process that would work.

I know how many pounds we incinerate per time unit, how many gallons of propane we use per hour, the cost, in propane, per pound of material incinerated. Based on observations of burn efficiency, I developed a simple formula to calculate the number of hours we need to run the incinerator per 100 lbs of load. I analyze temperature logs of every incineration event. I have the cell phone number of the propane delivery driver. I arranged forklift operation and safety certification for 10 lab personnel, including myself. I have been on top of the incinerator messing around with one of the thermocouples a dozen different times. I wrote instructions on how to trouble-shoot the controller on wet days. I have chipped ice out of the tracks that the lid travels on to get the incinerator open. I have spent hours out there in all weather with various repair and maintenance guys learning how the burners work. I made worksheets for the technicians to collect the information that I need to fill out official logs related to our operating permit, and when those worksheets proved to be a bit too complicated, revised them and revised them again until everyone can use them correctly.

I expend mental and physical energy on the incinerator nearly every week. The skills I've gained seem fairly esoteric, but they are actually part of the general problem-solving aspects of my job. Incineration of animal remains is an important contribution made by the lab to general public health, but we'll never be able to "showcase" it.

Deep Freeze

 It's cold in central Arkansas. Oh, I already mentioned that, didn't I. But it's REALLY cold, 9F and snowing heavily as I write this. There is so much snow falling that the dogs have been out four times this morning, and other than some undulations of the snow drifts on the deck stairs, you can't tell they were out there at all. 

Snow is usually a fun prospect for most dogs. Not at 9F, however. Azza and Archie are all business, done in a few minutes and ready to come back in where it's warm. 

I am grateful that my house is proving to be fairly well insulated. I added insulation and weatherproofing around the doors when I moved in. I also imposed significant organization on my garage last summer so I can park my van inside. I did it mainly to be able to protect it from all of the sticky tree pollen that falls in April. Little did I know that I would also need to keep almost a foot of snow off of it.

View from my kitchen window.

 

It's going to drop below 0F tonight, and more snow is coming on Tuesday night and Wednesday. Today is a state holiday and the lab is closed anyway, but I expect it to remain closed for most of the week. Little Rock isn't really prepared for a foot of snow that doesn't melt on its own.

Super Easy Egg Bites

 It's super cold here in central Arkansas. I can't work in the yard or play outside. So what's the best way to pass the time, in between reading and napping? Cooking, of course!

I make these easy egg bites fairly often. They are full of flavor and protein, travel well, and don't need to be re-heated. This version is meat-free but not vegan.

Preheat oven to 350F. Place paper muffin cups in a standard (12) muffin pan. 

Chop half of an onion and 6 or 7 mushrooms. Saute gently with olive oil until soft. Set aside to cool.

Chop two large handfuls of fresh spinach and add to a large mixing bowl. Add 1/2 cup of grated parmesan cheese. Add 1/3 cup of milk. I usually only have half-and-half on hand, which works fine too. Break 6 or 7 large eggs into the bowl. 

Add 1/3 cup of chopped tomatoes to the mixing bowl. I use canned tomatoes, which I drain first. You can also use dried tomatoes but the egg bites are more moist if you use fresh or canned. 

Put in whatever spices make you happy. I usually only put in fresh ground black pepper, but basil, garlic, thyme, oregano, and chili powder are all nice choices. 

Add the onion and mushrooms, making sure to scrape all the lovely browned olive oil into the mixing bowl too. Gently whisk until well mixed. Spool into the muffin cups. To make clean up a little easier, wipe up any spills from the surface of the muffin pan before you put it into the oven.

Bake for 25-30 minutes. The bites will puff up a little. When they are done, a fork stuck into the middle will come out clean.

This is an extremely loose recipe--the only limit is the volume of the muffin cups. Don't like spinach? Try fresh basil. Want some animal flesh? Add chopped (cooked) bacon. Want puffier egg bites? Hand-whip some air into the mix before adding to the muffin cups. Black olives, pesto sauce, sunflower seeds or walnuts--let your imagination and contents of your pantry run free!

Head Count

 I performed 259 necropsies in 2020. This represents 63% of all necropsies that we did at the lab last year. Officially, I only do necropsies on Mondays and Tuesdays, so you'd think I'd end up with two-fifths of all the cases, certainly not more than half. But Mondays can be quite busy, and Fridays can be quite slow. And because I'm the supervisor of the Pathology section, I will sometimes take cases that come in on other days that are of interest to me.

One third of those necropsies were avians. And because this is Arkansas, by avians I mean chickens. Okay, we had a peacock, goose, and macaw, and a couple of quail cases. But by far, most of our avian cases are chickens. About half were backyard birds (single bird necropsies) and the other half were commercial chickens--broiler breeders who lay eggs from which broilers are hatched, broilers, and table egg laying hens. Commercial poultry cases generally include 10 or more birds per case. I did 57% of all the poultry necropsies. I see a lot of chicken innards.

Previous occupants of my position had necropsy case turn-around times of 20, 60, even 100 days or more. That's astonishing. There is no justifiable reason for this, even if you wanted to run every test available (and some of them did!). When I started this job, my case turn-around time was around 20 days. Within 3 months, I had dropped that to 10 days, and I maintained that throughout 2020. My colleague and I work very closely together, and since we have similar approaches to selecting diagnostic tests for each case, his turn-around time for 2020 was also 10 days. 

This is a useful metric, but it's more than just a number. Short case turn-around times mean vets and food animal producers get information about herd and flock health issues when it is still useful to them, allowing them to implement effective treatment plans. I don't treat, and I don't prescribe. My job is to diagnose. If I do that job well, it has a direct impact on animal health, food safety, and public health. No pressure or anything, though.

Let's take a look at September. There were 22 working days that month. I was on the necropsy floor for 9 days and ended up taking 16 necropsies. Here's a list of my cases from that month:

• pure-bred Highlander cat with severe cardiomyopathy which we ended up deciding was congenital
  
• puppy with parvovirus
• backyard guinea hen with no determined cause of death
• dog with heartworm
• kitten with the blood parasite Cytauxzooon, spread by ticks
• puppy that died of bacterial sepsis
• another puppy with parvovirus
• alpaca with right-sided heart disease and intestinal parasites too numerous to count
• another kitten with Cytauxzoon
• cow with an intussusception in its small intestine; this is when part of the intestine gets entrapped inside an adjacent part, like one of those finger trap toys; very bad
• calf with aspiration pneumonia; it actually died of bacterial sepsis, not the pneumonia
  
• calf with necrofibrinous pleuropneumonia; very bad
• goat that had so many blood-sucking worms in its stomach that it died of anemia and malnutrition
• kitten with bacterial pneumonia
• another kitten with Cytauxzoon
• backyard chicken with a bacterial infection in its mouth and crop, bacterial pneumonia, and coccidia in its gut
  

Some types of cases are seasonal. Ticks are more active in the summer, so we see an increase in cats that died from the Cytauxzoon felis blood parasite. Small ruminants with anemia died from infestations of the strongyle Haemonchus contortus until proven otherwise. Calves pretty much always have pneumonia until proven otherwise.

Knowing about these kinds of patterns helps us develop a list of differentials for each case. I make a short list for each case before I even change into scrubs, based on chatting with the submitting vet, the owner, or reading the history they provided on the submission form. Sometimes the signalment alone is enough to suggest some differentials (signalment to a vet usually means species, breed, age, sex, and breeding status). I modify my differential list based on gross findings during necropsy, and I select diagnostic tests that will help me rule in or rule out one or more things on the list. 

Sometimes cases can be closed using necropsy findings only. The cow with the intussusception is an example. I ran a fecal egg count as a courtesy to the producer, but her cause of death didn't represent a herd health problem. Just a case of bad luck for that cow. 

Necropsy findings in some cases can reduce the differential list down to just a couple of things. The calves with pneumonia are examples. It was obvious at necropsy that they had pneumonia, but was it viral? Bacterial? Multi-factorial? I could just order all the tests but that is lazy pathology, bad science, and a waste of money and resources. It is far more challenging to select the "right" tests for each case. 

And sometimes we just can't determine why an animal died. Or rather, we can't reduce the "why" down to one thing we can verify with testing or observation. 

In a way, I'm still in vet school. I learned something from every one of those 259 cases--technique, differentials, diagnostic tests, how disease develops and presents itself.

Whatever Dr. A. Thinks Necessary

There's a handful of vets who call me to ask for advice. Not for every case they handle, of course. They are excellent clinicians who see hundreds of cases for every one they might call me about. But they are all convinced that I can help them solve their particularly tough cases. I get calls from these vets once or twice a month, often when they are standing in a field looking at a sick cow or in their clinic with the sick pup in front of them. They've all learned that they will get far better diagnostics if they call me before they collect any samples.

I'll admit that I have found answers in some cases only by sheer luck. But the truth is, I am a careful observer, I think quickly on my feet, I am happy to toss crazy ideas back and forth, and I'm not afraid to be wrong. I also have time that these clinicians simply don't have to dive into all kinds of resources--the internet, my vet school lecture notes, textbooks, consultations with vet school classmates and teachers (I have my own advice network!), and so on. This combination means that, in fact, I am pretty good at my job.

Although it amazes me every time they ring me up to ask me what I think, I'm rather proud that I can apply my knowledge to help my colleagues out.

So I couldn't have been more pleased when one of my favorite vets, who regularly calls me up to chat about difficult cases, sent in this submission form along with the samples that I had advised her to collect, writing on the Tests Requested line, "Whatever Dr. A. thinks necessary."

That's an incredible gift of confidence and trust she gave me. After all, it's her client--she's the one who is treating the animal. But she willingly made me a partner, because in the end, she and I do in fact share the same goal--improve animal health.

Sniffing The Pole

 In AKC agility, there are several different kinds of faults. An off-course fault is somewhat obvious--the dog takes the wrong obstacle, or jumps a jump then jumps back over it. Elimination faults are more or less a failure to complete an obstacle--the dog knocks the bar off a jump, or fails to put a paw in the contact zone on one of the contact obstacles. AKC still uses the pause table in standard courses, so there are table faults too--the dog fails to stick the landing and slides off the table, or jumps on then jumps off before the 5-second count has finished.

Refusals are the most complicated fault type. There is a zone in which a refusal can be called for any obstacle that is based on distance between two obstacles, how close the dog is to the upcoming obstacle, and "refusal planes" defined by the edges of the obstacle and the angle of the dog's approach. Complicated. But some examples might help. A dog that runs up to a jump then stops will get a refusal fault. A dog that runs towards an obstacle but spins in circles instead of approaching the obstacle in a determined manner will get a refusal fault. A dog that runs around an obstacle will get a refusal. If that dog takes another obstacle before the handler can correct the refusal, the dog also gets an elimination fault. The faults can stack up fast! But a dog that runs up the Aframe, stops at the top to gaze around the arena, then continues down the other side will not get a refusal.

At the Masters level, where Archie competes, you can only qualify if you run clean, with no errors or faults. One error, no matter which type, means no Q, even if you finish the course.

At an agility trial this past weekend, I encountered a situation that I had never seen nor even heard about. Archie's run so far had been clean. We approached the weaves and in he went. His weaves are extremely solid, and he usually executes them quickly. Archie rarely makes errors in the weaves. Except that day, that day as he reached pole 8, he came to a screeching halt. Dust puffed up around his feet. He was stock still, every muscle engaged, sniffing the pole.

SNIFFING THE POLE.

I of course keep eye contact with Archie on the course so when he stopped, I screeched to a halt too. I stared at him, then started pleading, whining, c'mon, Arch, WEEEEEEEEAVE, WEEEEAVE! Arch! WEEEEEEAVE! Over and over. I tried to keep calm but I was starting to panic. ARCHIE! WEEAAVE! At the same time, my brain was endlessly looping, What is happening? What is happening! I was looking directly at Archie but the far peripheral vision of one eye was on the judge, trying to see if he raised his hand to call a refusal.

Archie just stood there, sniffing. He never moved his feet. It seemed like an eternity but it really was only about 8 or 9 seconds (actually, that is an eternity in agility). Finally he decided he had sniffed enough and finished the weaves without error. Somehow I managed to keep my plan together and we finished the course.

I ran out of the ring with Archie in my arms and people said, wow, that was incredible! I gasped, did the judge call a refusal? They said, no, he didn't!

A spirited debate ensued. Was that a refusal? Was that a failure to execute? He never left the weaves. He did all the poles correctly. We decided that although it was certainly unusual, Archie didn't incur any fault. The run was clean. Another Q.

I am so grateful for my crazy fox terrier. He never fails to amaze and amuse.

A Tired Dog Is A Good Dog

Earning all of these:

 

...resulted in this: 

The OKC-area trials tend to have a small but rather competitive 16" class. To qualify is great (yay Archie!) but to get a Q and a placement is a big deal for us. He worked hard for me all weekend, and I'm proud of those ribbons.

Let's Take A Look At Some Dog Food Labels

 I get asked quite often what I feed my dogs. I am quite willing to share that information. Purina, Hills, and Royal Canin are all good choices. I feed Archie a regular Purina diet, the cat gets a Hills prescription diet to prevent urinary blockages, and Azza thrives on Royal Canin's Ultamino hydrolyzed protein diet. The prescription diets made by these three companies are incredibly useful for a wide array of diseases. Nothing magic here, we know that diet can reduce and delay clinical signs of many types of disease for both people and animals. A managed diet can improve performance. It can help a beef cow put on more weight faster, and can help a "no antibiotics ever" broiler chicken have a healthier gut to reduce bacterial infections. 

But the important point is that all three of these companies conduct feeding trials using real dogs to determine the nutritional profiles of their foods. Other companies analyze samples of their food in a lab only, for example burning it in a crucible to determine protein content. These kinds of assays are certainly useful, but they provide no information on bioavailability of important nutrients. Only feeding a living animal the actual food can tell you if that protein can be digested and used by the animal. If a dog food label says "food is formulated to meet the nutritional levels established by AAFCO," that food has only ever seen the inside of beakers and test tubes, not the inside of a dog. Grain-free? "Human-grade" ingredients? "Natural"? All marketing. All bullshit. All to make you, the human with the credit card, feel good. 

So this windy opening sets the stage for Archie's current situation. He got a stick jammed in the roof of his mouth a month ago or so, and some pieces of it broke off and were left behind in the tissues around his left upper molars. His bad breath prompted me to take a look in there...where I found this nasty hole in the roof of his mouth surrounded by friable, brown (necrotic) tissue. It bled when I touched it. I managed to get a large piece of stick out of the hole but even after starting some antibiotics, things weren't improving as much as I would have liked.

Of course, my imagination immediately went to the worst case scenario--abscess, lysis of the bony palate, formation of a fistula (an inappropriate hole between two spaces), damage to the roots of those huge molars. All Very Bad Things. I had to get a referral to another vet to get some dental radiographs made since my vet doesn't have dental rad equipment (it's specialized). That vet flushed a couple more small pieces of stick out, and helped calm my worst fears. She added a second antibiotic to go after the anaerobic bacteria, and recommended that I feed Archie a canned diet for two weeks to give the roof of his mouth a rest. 

Archie had not shown any evidence of pain or reluctance to eat or play, but he's a pretty stoic dog in general. Two weeks of canned food seemed reasonable. Except that I haven't calibrated any canned diets. I have no idea how much canned food to feed him. 

See, I feed Archie a calculated number of calories per day, including treats. He currently eats 1 cup of Purina Pro Plan Performance 30/20 Chicken and Rice kibble per day, divided into two meals, plus two tablespoons of plain yogurt, between 20 and 40 g of frozen green beans, and 10-20 kcals of treats. I adjust this basic plan for training and trialing days when he gets lots more treats. The kibble has 484 kcal/cup, so on most days Archie consumes around 510 kcal.

Let's examine three canned food options. Rachel Ray's Nutrish dog food comes in small plastic tubs. It looks and smells like human stew. The lamb and rice stew label says to feed an adult dog 1.5 tubs per 10 pounds per day. Archie weighs about 24 pounds so according to the label, I would need to feed him THREE tubs per day. Each tub is calculated to contain 244 kcal. Let's do the math, shall we? If I gave Archie THREE tubs of this stuff a day (not sure I could get this volume of food into him, but he certainly would give it a go), he would consume 732 kcal each day. If I give him the chicken and rice stew at the recommended volume, at 290 kcal/tub, he'd be getting 870 kcal per day. That is astonishing!

I also bought some Canidae Small Breed canned food. The chicken, salmon, and pumpkin recipe, which looks and smells as gross as that sounds, contains 123 kcal/can. The label recommends 2 cans per 6 lb of weight, so if I follow those recommendations, Archie is supposed to eat EIGHT cans of this per day. EIGHT! That's 984 kcal per day. OMG, that's even worse than the Nutrish stew. That's almost TWICE the numbers of calories that Archie needs each day.

ProPlan Focus canned food is my third example. If fed as recommended, Archie would need to eat 1.5 13-ounce cans per day of the (large breed) chicken and rice formula (their "small breed" options are grain-free and I don't feed grain-free). That comes out to about 475 kcal per day, which is in line with what he actually needs. So not only is the Purina food tested on real animals, the feeding guidelines are reasonable, not grossly over the top.

Here's the bottom line. Read labels. Don't be fooled by marketing. Measure your pet's food and calculate kcal per serving (can, cup, etc.). Are they healthy now? Figure out how many calories they eat per day--including all treats. Kibble is always going to be more nutritionally dense than canned food, which is mostly water. The volume of canned food will always be more than the equivalent kilocalories of dry food. And consider feeding Purina, Hills, or Royal Canin.

The Messy Matrix of Post-Mortem Diagnostics

 I was texting with a vet school classmate last night, and mentioned that we take radiographs of some of our necropsy cases. You take post-mortem rads? She was clearly surprised. After thinking it over, I realized that it does sound odd to a GP vet that we would do that.

There are three types of necropsy cases for which radiographs can be quite helpful. The first type is gunshot suspects--we want to see if there are any metal fragments in the body and where they might be. The second type is abuse suspects--we want to look for, and document, any bone fractures. Animal rescue groups and municipal shelters and animal control usually submit these two kinds of cases, but I've had vets submit gunshot cases directly. In one memorable case, I discovered what looked like projectile entry wounds on a dog when I was examining it before starting the necropsy. But the submission form didn't mention a thing about gunshots! So I called the vet, and she admitted that she had not seen the animal herself. The neighbors had taken the dog to the vet, but it unfortunately died on the way, and the vet clinic passed the dog directly on to the lab without a thorough examination. Using the radiographs that I made, I was able to find a lead pellet lodged in the descending aorta that was the cause of the animal's death. The third type of case is a more generic legal case in which radiographs are another diagnostic tool. Racehorses sometimes fall into this category. They are usually insured to the gills, and we are asked by owners or the racetrack vet to perform a complete necropsy, even though, for example, the fractured cannon bone in a front leg is the obvious problem.

Our veterinary diagnostic lab does not have any radiographic equipment. So we rely on the generosity of the State Crime Lab which is literally next door to us. We all get gold stars for the inter-agency cooperation, but I try not to abuse the privilege. They are a busy lab. The State Crime Lab handles cases of humans who died under suspicious circumstances. Which means they have dead people there. Lots of dead people.

When I need rads for a necropsy case, I text one of the techs at the Crime Lab and set up an appointment. For small animals, we get rads before starting the necropsy. One of my techs and I will load our case, double bagged, into the back of a vet lab truck and drive next door. We back up to the dock of the Crime Lab and unload our case onto one of their gurneys. A human-sized gurney. We then follow the Crime Lab techs into a large, walk-through cooler where they store their cases. Dead people, each one enclosed in a body bag. It's super fucking creepy, and after the shock of my first trip through, I keep my eyes forward and try not to glance around. I've seen that cooler room stacked with literally dozens of bodies. Super. Fucking. Creepy. One of my techs refuses to even go to the Crime Lab, and I don't blame him for a second. 

We keep our cases bagged at all times out of respect for our Crime Lab colleagues. They don't want to see what is in our bags any more than we want to see what is in theirs. 

Their xray room is just beyond the cooler room. They have a very nice rig, all digital, quite similar to what I've seen in vet clinics, except that the table is human-sized. I bring a flash drive with me.

Taking clear, diagnostic radiographs of humans and animals is both a science and an art. There is a balance between resolution, energy of the beamed particles, and radiation damage to the patient and techs. But since neither lab is dealing with living patients, there is a lot less fiddling and more just blasting some xrays and taking a look at the result on the monitor. We don't use radiographs to FIX a problem, we use them to FIND a problem.

Horses represent a unique situation since the Crime Lab doesn't have a hoist, or any facility that could deal with such a large animal. We usually remove the part of the horse that we are interested in, most often the leg. But I did have a case in which the racetrack vet insisted that we do a more thorough examination of the caudal (neck) vertebrae. Without going into a lot of detail, my techs and I removed the neck, all seven caudal vertebrae plus the first two thoracic vertebrae, and bagged that up to carry to the Crime Lab. The rads revealed an old, poorly healed fracture in C7 and a new fracture in C2 that happened when the horse fell over as it was dying. It died from something called EIPH, exercise-induced pulmonary hemorrhage, a progressive, chronic disease. In this case, all of the horse's lungs filled up with blood very rapidly. That's a lot of lung, and a lot of blood. But that C2 fracture wasn't compatible with life either. Once we got back to the necropsy floor, we used the radiographs to precisely section the neck and photograph the fractures directly. Very interesting case that was greatly enhanced by post-mortem rads.

Working up a necropsy case requires an array of qualitative and quantitative diagnostic tools--gross examination (sight, touch, smell), bacterial culture, PCR tests, radiographs, even blood tests. The art comes in navigating the messy matrix of making a good differential list, obtaining the right samples, and selecting the right diagnostics for each case. Sure, anybody can run all the tests on every case, but what's the purpose of that? It is far more challenging, and satisfying, to find the most elegant path through the matrix.