The unnecessary death of the Ebola dog

Ebola virus hysteria is taking hold of the northern hemisphere. The latest victim was a cross-bred dog called Excalibur, who was euthanased by the Spanish authorities even though he showed no signs of being infected with the virus, and despite the fact that there is no evidence that dogs can transmit Ebola to humans.

The twelve year old rescued dog had the misfortune to belong to a Spanish nurse who became the first person to become infected with Ebola in Europe after nursing a Spanish missionary priest who had been repatriated from Sierra Leone to Madrid for intensive treatment. The priest died of the virus on September 25th,, and the nurse is thought to have picked up the virus after touching her face with a contaminated glove as she removed her protective suit after finishing her shift.

Excalibur was a much loved pet in perfect health, and after Madrid’s regional government obtained a court order to euthanase him, the nurse’s husband put out a call for his life to be saved. An online  petition rapidly gathered over 400000 signatures, and crowds of angry animal-loving protestors had to be restrained by police outside the apartment where the dog lived. Despite the protests, Excalibur was euthanased. The deed has been done. But was it really necessary? Did the animal present a risk, or was he just a scapegoat sacrificed to give the authorities a sense that they were doing something?

There is scanty evidence to support killing a dog in a situation like this. Bats are thought to be the natural reservoir for the Ebola virus in central Africa, carrying the virus without showing signs of illness. Monkeys and apes become infected and fall seriously ill, like humans. But despite extensive research, there’s been almost no evidence of other animals becoming infected or carrying the virus.

There is one study that casts a cloud over the innocence of dogs: researchers investigating the 2001-2002 outbreak of Ebola in Gabon found low levels of antibodies in blood samples from dogs in areas where there had been cases of Ebola in humans and apes. This confirmed that the dogs had been infected with the virus, but it was impossible to know the source of their contact: from bats, apes, or from humans? It was also not possible to determine whether the dogs could have been infectious to humans at some point. In theory, the fact that they had been infected with the virus implies that at some point they may have shed the virus in their secretions, in the same way as infected humans pass on the infection.

Some researchers believe that it would have been wiser to have kept Excalibur alive, not for sentimental reasons, but to learn more about the spread of the disease. If he had been kept in quarantine, serial blood samples could have been taken, monitoring his immune status. The question of whether or not dogs need to be included in Ebola virus control schemes could have been definitively answered in a safe environment. And if he had been clear of any sign of the virus after several months, he could have been released from quarantine to resume a normal happy doggy life.

Sorry, Excalibur: the precautionary principle and the political need for action seized the initiative: we still don’t know much about Ebola in dogs, and you’ll never enjoy another happy walk with your owners.…

Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled “Debunking myths about “rip off” veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice.

My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it’s different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it’s an unavoidable part of our job description.

One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it’d be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn’t leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs.

We took all the usual precautions to ensure Sam’s safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end.

Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn’t feel that I could go ahead with this without permission.

While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn’t working. What should I do now?

If I went ahead, I’d be carrying out unauthorised work on someone’s pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay?

The safest legal approach would be to make a note of what needed to be done, and then to inform Sam’s owner that he needed a follow up anaesthetic in a few weeks, during which we’d tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam’s dental issues would probably not be treated, and he would suffer as a consequence.

I made an “on the hoof” decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner’s response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn’t afford more than the estimate that I had given her?

I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it.

But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated.

What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?

 …

Debunking myths about “rip off veterinary fees”

“Rip-off veterinary fees” were the subject of a recent poll on a vets-only website.
In answer to the question “How often does your practice receive complaints about the prices it charges?“, the results were:

  • All the time – 16%
  • Fairly often – 53%
  • Hardly ever – 30%
  • Never – 1%

So around 69% of vet clinics get regular complaints about their fees, and given that many people may feel irritated about fees without vocalising their concern to the vet, the true level of discontent is likely to be even higher. This is clearly an aspect of veterinary care that pet owners feel strongly about.

I always find this a difficult topic to discuss: as a vet, I can’t help feeling defensive, and it’s all too easy to write a self-justifying commentary. Sceptical readers may then brush off any of my explanations: “well, he would say that, wouldn’t he?”….

Information overload? – Trusting online pet advice

From the minute you bring a new pet home, as well as the companionship, fun and general entertainment there will always be a lot of questions and there will always be plenty of people more than happy to give you their advice and opinions. From your mother (always!) to the lady down the road that’s owned dogs for years, to the man in the pet shop, to your vet (listen to them!) and, of course, the internet. However, sometimes views vary wildly and it can be difficult to know who to trust.

With any health related issue a vet should always be your first port of call; either by booking an appointment or ringing for advice. A good clinic will always be happy to chat on the phone but in many cases will want to see your pet before giving you a definitive answer. This can sometimes put people off but if you are concerned enough to ring, very often your suspicions are correct and there is a problem. However, there are many simple queries that can be handled over the phone, so do pick it up! Even at night and weekends, with a single call you should be able to speak to a vet or nurse, as in the UK all practices are required by law to provide a 24 hour service.

Sometimes though, you might have questions that are more mundane or trivial or want the answer right now and that is when you will fire up Google! However, this is when things can get tricky. There are loads of brilliant sites out there giving excellent quality advice but there is also an awful lot of old wives tails, self-important pontificators and downright bonkers information as well! How do you decide which is which and what to believe?…

Banning no-stun slaughter in the UK: a step forwards for animal welfare or a populist anti-religious minority measure?

Killing is by definition an unpleasant business, with physical trauma to a living creature and spilling of blood. For some individuals, animal slaughter is so abhorrent, that vegetarianism is the only answer (7 – 11% of the UK population is vegetarian, with twice as many women as men). But for the majority of citizens in the United Kingdom, meat is a desirable part of the diet, and slaughtering animals is seen as a necessary part of society. Legislation has been put into place to ensure that animals suffer as little as possible during the process, and this is enough to satisfy most people.

To ensure that animals do not suffer as they die, the law insists that the animal is first stunned e.g. with a captive bolt applied to the brain, or via a strong electric shock to the head. This pre-stunning means that the animal is completely unaware when its throat is cut a few minutes later: there is no sensation of the knife passing through the flesh, nor the blood draining away.

Sensationalist reporting of TB in cats is not helpful: does the media want a cat cull?

Let’s start with the facts about the cats with TB, as reported in the Vet Record: perhaps surprisingly, these have not been published in full in any of the mass media outlets in the past two days:
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BETWEEN December 2012 and March 2013, a veterinary practice in Newbury (west Berkshire) diagnosed nine cases of Mycobacterium bovis infection in domestic cats. In seven of those cases the diagnosis was confirmed by bacteriological culture. The nine affected cats belonged to different households and six of them resided within a 250 metre radius. The animals presented with mycobacterial disease of variable severity including anorexia, non-healing or discharging infected wounds, evidence of pneumonia and different degrees of lymphadenopathy. The latest information is that six of the cats have been euthanased or have died. The three surviving animals are undergoing treatment and are reported to be responding. At the time of writing, no new cases had been detected in local cats since March 2013.
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The newspapers have missed this aspect of the story, and focussed entirely on the fact that the disease, for the first time, seems to have been passed on to two humans who had been in contact with one of the cats. The humans have responded well to treatment……..

Is Paul O’Grady mad to spend so much money on his terminally ill dog?

Paul O’Grady, the comedian-turned-dog-advocate, hit the news this week when he talked about spending over £8000 in vets’ fees to treat his nine year old Cairn Terrier Olga for cancer of the kidney. The Daily Mail reports that Paul has ignored advice to have her put down, and instead he’s paying for intensive chemotherapy and surgery to keep her alive. The story has ignited a debate about veterinary fees and pet insurance: Judith Woods, a feature writer for the Daily Telegraph, has added her own tale of spending £3600 when her Manchester Terrier, Daisy, developed a rare form of kidney disease. She had her pet insured, so her feature extols the benefits of pet insurance for these unexpected occasions.
Paul and Judith are clear in their opinions, with no doubt that they have made the right decision for their own pets. It’s the online comments on the stories that are interesting, with members of the public sounding off with their own thoughts on expensive treatments for pets, and the pros and cons of pet insurance.

The Daily Mail readers’ comments to Paul’s story are mostly short and positive: “It’s lovely that he’s done this for his beloved dog”, “Good on you, Paul, you are a true dog lover” and “If I was as rich as him, I’d do the same”.
Telegraph readers have responded in a predictably more loquacious way to Judith’s feature.
First, of course, there are many “dog lovers” who are supportive of giving pets all reasonable treatment that can be afforded, accepting that high quality veterinary care can be costly, and agreeing that pet insurance can be a sensible way of budgeting for unexpected health crises. When completing a survey of attitudes to dogs on a recent trip to a slum in Delhi, I found that around 60% of the local population “liked dogs”, with 40% disliking them: I now find myself wondering if a similar proportion of attitudes exists in the UK population. For the 60% who care for their pet dogs, it’s hard to consider withholding treatment.

There are plenty of comments from the opposite side of the spectrum – perhaps the 40% who aren’t so fond of dogs. Some of these “anti-treatment” comments are worth discussing in more detail:
“All pet insurance does is persuade owners to consent to prolonged and possibly invasive treatment of their pet. Unless they own a valuable breeding animal they would be kinder and more sensible if they had a really sick pet put to sleep.”

A vet in Delhi – day 6: a selection of photos

I’ve been busy this evening working through my survey results so that I can give a presentation to ASHA about them tomorrow, so I have not had time to write a blog. But to give a sense of the past day here, I’ve put together a selection of photos. The captions should be enough to tell their stories….

A vet visits a Delhi slum day 5 – asking about dogs in the world’s biggest motor workshop

When I return to the slum each morning, I’m repeatedly reminded of a type of hell: there is mud, grime, and two other aspects that are difficult to convey via a blog – a strong “workshop” smell (oil, fumes, solvents etc), and most of all, NOISE. Maypuri is known as the biggest motor workshop in the world, and wherever you go, there are deafening sounds of metal beating against metal, metal drilling through metal and engines roaring. Unemployment here is not the highest in the world, at 20%: there is work, but it’s tough, noisy, dirty work. Beat-up vehicles litter the streets, where they are picked at by people with spanners, screwdrivers and sledge hammers. I saw a dumper truck being reduced from a slightly bashed but otherwise perfect vehicle to absolutely nothing at all after being picked at all day by a small army of hard working labourers.

Nothing is wasted. People collect 5cm lengths of wire, random nuts and bolts, springs and anything at all. Children as young as five are sent by their parents to search for bits of metal, using wooden sticks with big magnets on the end. The oily grime on their skin is permanent: hot showers or baths don’t exist here.

I have found myself questioning my priorities as I walk through them holding a questionnaire to ask about the stray dogs. Many of them seem bemused: nobody has ever asked them about dogs before. Why dogs, when people are clearly suffering?…

A vet visits a Delhi slum day 4: getting down and dirty with the questionnaire

We are staying in the YWCA close to Delhi city centre, so every morning we are collected by a minibus and dropped at the slum. I was faced with the first shock of the day as soon as I stepped out of the minibus. Most street dogs lift their heads to look at you as you walk past: this young one didn’t, so I stopped to get a better look. I called to him, then I gently touched him but he didn’t move. I picked up his hind foot, aware that I could be bitten if he was frightened, but he remained motionless. He was still breathing, but he was unconscious: he was dying.

I couldn’t do anything to help him. I called back an hour later, and as I ‘d expected, he was dead. At the end of the day, I looked again, and his body was gone. This type of incident must be a daily occurrence out here, but for a newcomer like myself, it’s hard to get used to….

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