In other news, despite the two year old with congenital kidney disease and the extremely complicated diabetic, one patient politely insists on living.

She’s a 21 year old purebred cat, who has apparently been on death’s door for five years.

And every time I see her, something’s wrong. We discuss euthanasia, and despite myself I always offer ‘just one last chance’ to respond to a treatment or therapy.

And wouldn’t you know it, it works every damn time.

Last time I put her on metacam for arthritis. The owner knows that metacam might shorten her life if she has any kidney compromise, but in their words, “Shorten it from what! She’s already 21!”

Now the cat is climbing the back of the couch and jumping up into places she hasn’t been in years, and putting on muscle.

She now seems most likely to die from falling off the top of the curtains.

One of these decades.

Blood, sweat and tears

You can’t choose which patients live.

It doesn’t matter how much you try, how much medical knowledge and care you provide, some things are beyond your control and there’s not a single thing that you as a clinician can do to turn them around.

I had a patient that was spectacularly trying to die: diabetic ketoacidosis with intravascular haemolysis from secondary hypophosphatemia and a marked hypokalemia on top of all that.

For the less medical in the audience, this is the simple version: diabetic dog doesn’t get enough insulin for a prolonged period, so blood is full of glucose. That excessive glucose gets turned into ketones, which acidify the blood. Acidic blood denatures the body’s proteins, sort of like the change you see when you marinate meat in lemon juice, and can kill the dog.
So you give insulin to transport that glucose into the cell where it can be used. Next problem is that the glucose takes potassium with it when it crosses the cell membrane, so all that glucose entering cells drags potassium with it. As the blood potassium is used up, the heart slows down, and will try to stop. This is as bad as you expect it to be,
AND THEN the glucose, finally inside the cell, gets turned into energy. On a molecular level, that’s turning molecules called ADP (with two phosphate molecules) into ATP (with three phosphate molecules) where does the cell get all that extra phosphate? From the blood. What happens when the blood phosphate levels drop too low?
All the red blood cells decide to explode and become useless. Hello severe anaemia. So there are multiple ways the patient is trying to die.
Oh, and it was pancreatitis in the first place that triggered the whole catastrophe. (I’m not kidding when I say don’t feed them bacon,)

And here I am, sweating over this patient, desperately trying to find a source of intravenous phosphate that I can have RIGHT NOW, because our supplier wont have any for two days, by which time the patient would be nicely frozen in our cadaver storage.

A whole week I spend micromanaging this patient, trying to control all these factors and trying to get the patient back into any kind of balance. That included two nights in ICU at the 24 hour clinic, and one of me checking him at the clinic during the night. Mate, was this patient a lot of work. I was dreaming of his supplement calculations.

He even received a blood transfusion from my parent’s dog when his phosphate dropped to 10% of its normal level.

Until two days after his transfusion, when I was finally starting to hope, he crashed. He was put to sleep.

He had the blood, sweat, and now the tears.

“How should we market these scalpel blades?”
“You can’t go wrong with a giant floating, glowing blade of doom.”
“True. How’s this look?”
“Fantastic. But people need to know they’re for veterinarians. These ain’t no human blades.”
“So we’d better put animals on the box, too.”
“Should they be screaming? I really think they should be screaming.”
“Of course. Perfect.”

Marijuana Toxicity in Pets.

This shouldn’t be a contentious issue, but in my newbie days blogging as a vet student, I once plainly stated that marijuana is considered toxic to dogs, and you shouldn’t give it to your pets. 

Surprisingly, I was promptly inundated with comments and messages from various cannabis enthusiasts calling me all sorts of things along a conservative right wing agenda (ha!) for daring to say that nobody should be deliberately trying to get their dog or cat stoned. These people also accused me of having a bias against cannabis for calling it ‘toxic’. Though it is the dose that makes the poison, marijuana is considered toxic to dogs and cats. So is chocolate, and panadol (acetaminophen) is highly toxic to cats, but nobody accused me of being politically opposed to those substances. 

Marijuana is toxic to dogs and cats. The veterinarian treating your pet, however, doesn’t give a damn how the animal became exposed to it, and only wants to treat your pet. That includes inducing vomiting if the drug was eaten. Yes, despite marijuana’s touted anti-nausea effects we can still make intoxicated pets vomit, it only renders apomorphine less effective. We have other ways. 

We’re also very interested in whether the pet ingested any chocolate to go along with that mull. As a profession with have no interest in your personal liberties, only the welfare and treatment of that pet. It may be that whatever your pet has eaten alongside or subsequent to the marijuana toxicity could be a bigger problem than the marijuana itself, because frankly they will eat lots of stupid things. Don’t lie to your vets. 

Animals progressing to tremors and seizures from marijuana will require hospitalization and sedation. This is potentially as serious as chocolate toxicity. 

“But wait!” you may cry. “Isn’t cannabis good for seizures?”

Well, that’s complicated. Marijuana is what pharmacologists may refer to as a ‘dirty drug’. That means it contains lots of different compounds which all do different things. Cannabidiol compounds appear to be responsible for the anti-seizure effect, and there are more than a hundred variants of those. The combination of cannabidiols and THC in the particular strain that the pet accidentally got into will vary, because there’s no labeling or really any quality control. It varies from plant to plant, from strain to strain, and even the conditions the plant was grown in. This makes marijuana plants currently useless in veterinary medicine, as we can’t prescribe accurate doses, and it’s still firmly on the toxic list, next to chocolate. 

Affected animals, in addition to tremors, seizures, urinary incontinence and vomiting, often display behavior changes which could be attributed to paranoia, anxiety or possibly even hallucination. 

Herein we find my primary problem with people that deliberately try to get their pets stoned. Some do it because it’s funny. Some do it because they think the pet ‘likes it’ when really the pet probably just likes being near people. Animals do not have a concept of ‘future’ like we do, and they attribute consequences to only very recent actions. It takes a fair amount of thinking to realize that what you’ve just eaten, or inhaled, it causing all these strange sensations in your brain. Pets don’t understand this, and become distressed. They also can’t consent to this. 

Think of dogs and cats as having approximately the same mental capacity as a 2 year old child. You wouldn’t deliberately attempt to get the child stoned, nor should you inflict it upon a pet. If for no other reason, you simply cannot explain to the pet what’s going on, or why you’ve done it to them. 

There is no good reason to give your pets marijuana. Whether you think it’s funny, whether you think the pet wants it, or whether you read on some forum that it’s good for treating ‘X’, the effects are to unpredictable. The side effects are too risky, and the distress you can cause your pet who doesn’t understand what’s going on is simply going to be cruel. 

There are a whole bunch of things in this world that are fine for humans, but not our pets: alcohol, chocolate, coffee, onions and certain medications. Add marijuana to that list. 


Why you should never use flea and tick medication for #dogs on #cats #poisoning #veterinarian #vetmed #vettech #vetschool #veterinary. When in doubt, please call @aspca_apcc for life saving advice! #repost @doctor.sagen

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Single most important thing for a veterinarian to remember about the species they are treating

As vets we have to retain an awful lot of knowledge about a bunch of different species in our brain, but I could only impart one factoid onto a new vet for each species, these would be it.

Dog: Everything that can go wrong will go wrong, in a German Shepherd

Cat: Species most likely to send you to the hospital.

Horse: Species most likely to send you to the morgue.

Cattle:  Hygiene and lube.

Sheep: Not little cows!

Goats: Not funny sheep!

Deer: Don’t. Just shoot them.

Birds: No diaphragm, if you squeeze them they will die.

Raptors(eg eagles) : Much easier to handle with a sock over their head.

Chickens: If it’s egg bound there is no such thing as too much lube.

Water birds: Projectile feces. Aim with care.

Rabbits:  Drug sensitivities

Guinea Pigs: Lethal penicillin

Rats & Mice: It’s going to be a tumor.

Snakes: Don’t leave them in a cage. They get out.

Lizards: 90% of the time it’s a husbandry problem

Aussie mammals: Don’t wrestle wombats, you can’t win.

Fish: You can MacGuyver an anesthetic rig from two buckets, some tubing, a straw, a clean cat litter tray and some alfaxan. Do not use electro-cautery on a wet fish.

Ferrets: Most of their problems are from the same area; the kidneys, adrenals and ovaries seem to be part of a club to cause havoc for this species.

Pigs: Wear ear muffs, because they scream like you wouldn’t believe, and remember that they’re bred for meat, which is muscle and they know how to use it.

This is not an attempt to condense veterinary medicine into a few dozen sentences. But if you can only remember one thing, make it a useful one.

Online Vet Student Resources

Here are some great resources I have used throughout vet school: 


Clinical Pathology:

  • eClinPath: by Cornell, wonderful site that has explanations for findings on ClinPath results, lists differentials, as well as describes that pathophysiology basis of some processes. 
  • Serum Chemistry: You will need VIN access to open this, but another great Clin Path resource to refresh your memory on what each profile tests for and various differentials for the fluxes. 


  • CAPC Vet: Great site that list parasites, life cycles, prevalence, emerging patterns, diagnosis, treatment, prevention, and public health concerns. 


  • AMRLS: A wonderful website that provides information on antimicrobial pharmacology and provides information on resistance patterns.


  • VetBact: provides basic information on veterinary important bacteria. List current bacteria name changes, microbial tests, hosts, and a basic description of the clinical disease. 

Veterinary Search Engine: 

  • VETNEXT: Essentially a search engine like that on VIN. You can search by species or clinical sign. Provides decent information about diseases. 
  • WikiVet: Another decent search engine, I believe you will need to be a student to use this site (like VIN), I don’t use it often because it is extremely slow, but there is a lot of information on there. 
Veterinarians aren’t greedy; they make less than most pharmacists, almost all human physicians and almost all dentists. Their hourly rate is lower than your plumber’s. They went to school for half their adult life not because they want to be rich, but because they care about your pets.

Liane Ehrich, Vet Tech, for the


You can take your 'Natural' Flea Remedies...

… And shove them somewhere dark and anatomical.

You sit comfortably behind your computer screen, far from suffering, possibly never even seeing a flea, either because you never looked or because they were never there in the first place, and proudly tell people that vets are just in it for the money, so you should treat fleas with olive oil / garlic / diatomaceous earth / apple cider vinegar / wishful thinking instead.

You’re not here in the real world trying to comfort an old, desperate woman who took your advice and is paying the price.

Her old cat is being put to sleep because of massive flea burden causing an iron deficiency anaemia, with a PCV of 11% (lost 70% of her blood cells to these parasites). She could have afforded real flea treatments that work, but she certainly can’t afford the blood transfusion, oxygen therapy and intensive care her cat requires.

You’re not here as I put her cat to sleep, resting on her tear soaked chest, coat greasy with olive oil, stinking of garlic and lavender.

You don’t see the consequences of these unchecked parasites, which you probably only ever thought of as a dirty annoyance.

But I am here.

I am here comforting this woman while bad internet advice killed her cat with a completely preventable condition.

So to those promoting ‘natural’ parasite control, whether it’s because you like to feel clever, or always wanted to be a vet but didn’t get to be one, I’d just like you to know one more thing.

Death by parasite is completely 'natural’ too.

Cow mandible with honeycomb network of abcesses from actinomycosis infection. Actinomyces bovis is a gram-positive bacteria that leads to granulomatous abcessing of infected areas of the head and neck in cattle which can destroy bone. A rel…ated bacterium A. israelii causes a simillar but more rare condition in humans. In cattle the condition is referred to as “lumpy jaw.” Untreated, the infection will produce copious amounts of pus whichs discharges from the skin. Actinomyces were one thought to be a fungus because of their branching filamentous structures.