Book review - Lucky Dog

As you may have noticed, it's been kinda slow here lately, so let's try something new. We were recently contacted by the PR people for a new book called Lucky Dog, by Dr. Sarah Boston. The nice lady who contacted us asked if we might consider reading and reviewing this book, and sent along a PDF copy for review. I agreed to read and review it, and I am so, so, so glad that I did (not that there was ever any question. I am kind of a book slut, apparently).

This book has got it going on, as the kids say. Or maybe used to say. I’m a little bit behind with respect to pop culture, I’m told. Anyway. WOW! Dr. Boston’s book resonates with me on so many levels, I cannot count them. I have always enjoyed reading stories about animals, especially stories about veterinary medicine. I would venture to say that the James Herriot novels are my favorite books of all time. This book is definitely up on the top ten list.

So, what makes this book so great? Well - Dr. Boston talks about being a veterinarian, and shares stories about her patients, in classic James Herriot style. These dogs come to life, and I feel for them and their owners on a personal and professional level. Carney with osteosarcoma, North and his nose problem, Kelly's ironic fate. Their stories ring very true, but what really stands out is the strong relationship between Dr. Boston and these dogs and their owners. I hope I am able to build such strong relationships in my own practice.

But - it's not all cancer patient stories! There's plenty of non-cancer material here. I am sure there is no companion animal veterinarian out there anywhere who won’t be able to relate to her FAQ “taken from [her] real life,” on p. 69, in particular -

“can you trim his nails and express his anal sacs while he is here?”

“Yes, as a board-certified veterinary surgeon with fellowship training in surgical oncology, I would be more than happy to perform the same duties as your dog groomer. Expressing anal sacs is a particularly enjoyable task, and I would love to do it at no extra charge.” 

See? Don’t you love this woman already?

I was also charmed by her discussion of people who overshare with their veterinarians. As she explains, when a veterinarian has succeeded in building a strong relationship with a client, this sometimes leads to a level of intimacy that can be a tiny bit uncomfortable. Apparently a classmate of hers had a client tell her “that she wouldn’t neuter her dog because she liked to play with his testicles when they sat on the couch and watched TV together.” You may not believe this but I HAD A CLIENT TELL ME ALMOST THE EXACT SAME THING! Crazy, right? But it just proves that this book is full of win - this book is like a reality show, but written down (and with better production value, and a more sophisticated tone).

She draws parallels between her own health care and the care she provides to her patients, and the compassionate efficiency of her practice’s care serves as a sharp contrast to the sluggish and apparently unfeeling Canadian system which is providing her own care. I love her descriptions of the caregivers she meets, and how they treat her. Some of them are wonderful, and some of them need a swift kick in the rear. Note also that she is not ungrateful for the care she receives in the Canadian system - her critique is very well thought out, I think.  In the end, she also experiences the American system, and I enjoyed reading her perspective on that. She shares a lot of insight into the differences and similarities between veterinary and human cancer care, not least that dogs and cats do not suffer from anticipatory worry or fear of death like people do, which is something that I always tell my own clients. Of course she spares no detail in describing her own anticipatory anxiety - the severity of which led her to take matters into her own hands, which I can also relate to. Veterinarian readers who have turned the ultrasound probe on themselves, raise your hands…. yeah, I thought so. Of course, then there’s the matter of what you do once you’ve self-diagnosed but you have to convince the doctor or doctors that you are correct… Dr. Boston has the whole story covered.

Overall, Dr. Boston’s tone is witty and her material is relevant for animal lovers, cancer patients and those who love them, people interested in comparative medicine, or anyone who has a good sense of humor. I highly highly recommend this book. Read it now!

You can buy it on Amazon, of course.

Book review - just for fun

What with all of the no-shows we've had lately here at the Greatest Animal Hospital in the World aka VBB Central, I've had time to do a little bit of light reading. I know, right? FREE TIME?? Crazy. But I, Dr. VBB, am a voracious reader, and since my good friend Dr. Grumpy had recently recommended a book to me, that's what I picked up the other day when Ms. MyTimeIsMoreValuableThanYours blew me off, leaving a 3-dog hole in my afternoon.  I continued reading when Mr. Liar McLiarson and his crew (1 dog, 2 cats) no-showed due to his allegedly being robbed at gunpoint in a shopping mall 2 miles from VBB Central just moments before his appointment (seriously, Mr. McLiarson has a history of telling big fat whoppers). Anyway. I liked the book so I thought I'd share!

It's called The Devil Wears Scrubs, by Frieda McFadden, aka Dr. Fizzy. Obviously the title gives a nod to Lauren Weisberger's The Devil Wears Prada, but this is an altogether different book. Dr. McFadden paints a vivid picture of the hellish life of the first-year medical resident. I do believe that anyone who has ever experienced life as a newbie to clinical hospital medicine will be able to fully relate to "newly minted doctor Jane McGill," as she figures out how to take care of her patients, how to find things, how to requisition things, and most importantly how to present cases and lab reports and so on to the devil in scrubs who is her boss.

As I read this book, I was reminded of a time when I had been at the hospital since 3 AM, and it was now about 7 AM, and my attending was asking me to tell him about the antibiotics that my patient was on and what was the MBC and what was the MIC and what was the mechanism of action and therefore why were these drugs chosen and all I could think of was if I never set foot in a barn again it was too soon for me, and that when I had tried to examine this patient he'd nearly killed me with a hoof to the shoulder, and boy was I tired.

Those who do not have a background in clinical (or other) medicine will still be able to relate to the human story. Basically it's the story of a woman starting her first job after finishing her training, and having the Evil Boss of Doom -- who, as it happens, may actually not be completely heartless. Throw in a McDreamy (hot hunky surgeon) & you really can't lose, can you?

My only issue with this book is, it was short - I would have loved to keep reading more of Jane's adventures.

And, I'm going to leave it there. If you're curious, you can buy the book. Oh, and by the way, I have not been paid, bribed, or otherwise profited from reviewing this book. Fizzy did publicly request that people who had read the book please review it, so, being the people-pleaser that I am, I figured I'd go ahead.

Now I gotta run - my DBB has been feeling kinda poorly lately, and I want to give her some TLC.

Rabies on the Brain

I’ve got rabies on the brain. Well, not literally, because that would mean I’d probably be dying in intensive care.

 
Last week (September 28) was World Rabies Day. It is the anniversary of the death of Louis Pasteur (more on him later).
 
Rabies is virus which causes a virtually 100% fatal neurologic disease in all mammals, including humans. According to “Rabies surveillance in the United States during 2011,” last year rabies was diagnosed in animals in 49 states (not Hawaii). Besides the “usual suspects” of bats, skunks, raccoons, foxes, dogs and cats, it was also diagnosed in cattle, horses, sheep, groundhogs, deer, beavers, otters, javelinas (shaggy piggy creatures), bison and alpaca. Bambi and Thumper could be rabid!
 
Rabies is spread by the saliva of a rabid animal. When the rabid animal bites a victim, it inoculates the virus into the tissues. Unlike most viruses and bacteria, which spread through the bloodstream, the rabies virus spreads along nerve cells. Depending on how far the bite wound is from the brain, symptoms might not develop for weeks to months to years. A person in the US died last year of rabies that was acquired from a dog in Brazil eight years previous! For eight years, the virus had been lazily moseying along, inexorably crawling up to the brain.
 
Once the virus hits the brain, bad things happen. Even in the 21st century, over 50,000 people worldwide die of rabies every year. It is a horrible death of alternating periods of lucidity and psychosis, pain, fever, convulsions, hallucinations and hydrophobia (pathologic fear of water).
 
I recently read Rabid: A Cultural History of the World’s Most Diabolical Virus, by writer Bill Wasik and veterinarian Monica Murphy. It’s a fascinating book, although I guess I might not qualify as a totally objective reviewer since I tend to get a little bit obsessed about public health and infectious diseases.
 
Wasik and Murphy weave together a history of rabies and civilization. Although many of the scary epidemic infectious diseases of humans, including Ebola, West Nile, SARS, swine flu, and hanta, are zoonotic (transmitted from animals), only rabies was known to be zoonotic before humanity ever considered the existence of bacteria and viruses. Think of bubonic plague (“The Black Death”): people didn’t realize it was caused by a bacterium spread by the bite of a rat flea. But rabies: slobbering psychotic dog bites human, human turns into slobbering psychotic animal. It was obvious even four millennia ago that rabies was transmitted by animals, particularly canines.
 
The book looks at theories, preventatives and “cures” over the millennia (the most effective preventative prior to vaccination was cauterizing the fresh bite with a red hot poker); history (St. Hubert is the healer of rabies sufferers); mythology (the slaver of Cerberus spreads both rabies and aconite); connections of rabies to werewolf and vampire legends; the handful of documented survivals of rabid humans; weird ideas that people have had to prevent rabies in dogs (one theory suggested rabies spontaneously arose in dogs due to sexual frustration and suggested prevention by creating “doggy bordellos”); rabies in various species (l’enfant du diable = the devil’s child, a skunk); history of canine mass killings in an attempt to stop epidemics; and a recent rabies epidemic on the supposedly rabies-free island of Bali.
 
The most fascinating chapter explains how Louis Pasteur developed the first rabies vaccine in the late 1800’s. In fifteen years of veterinary practice, I have never seen a case of rabies and hope I never do. Pasteur (who is also the father of pasteurization and food safety) was neither a physician nor a veterinarian, but was a really smart dude who was passionate about human and animal health.
 
You can’t grow rabies virus in a Petri dish. The only way Pasteur and his colleagues could grow rabies virus was by maintaining rabid animals in the lab, putting themselves at continual risk of gruesome death. At first they allowed a rabid animal to bite another to perpetuate the virus; then they started collecting saliva from slobbering aggressive dogs to inject into other animals. Eventually they hit on dicing up the central nervous system of a rabid rabbit and depositing it directly onto the dura mater of the recipient’s brain. By repeatedly transferring rabies directly from one rabbit’s brain to another they developed a highly virulent strain. The next step was to inactivate the virulent virus to make the vaccine strain, which they did by leaving the rabbit’s spinal cord out to air-dry for a few days. This air-dried infectious bunny brain was then injected as a vaccine: either a pre-exposure vaccine to prevent infection or a post-exposure vaccine to prevent development of symptoms after a bite.
 
The first human to receive the vaccine was a boy who had been mauled by a rabid dog. Can you imagine the agonizing wait for Pasteur to see if the boy survived or died? (He survived both the bite and the cure.)
 
We all learned in vet school that rabies is absolutely, guaranteed fatal. But some new research is showing it might not be completely 100% fatal. There was a girl in Wisconsin who survived clinical rabies after a medically-induced coma and months of rehab. And a recent paper was published in The American Journal of Tropical Medicine and Hygiene that looked at humans living in remote areas of Peru where vampire bats are a common carrier of rabies. 11% of the people had rabies neutralizing antibodies; they had not been vaccinated so those antibodies developed after infection with the real, live virus. How come they didn’t die? Has evolution favored people with a more exuberant immune system that can fight off endemic rabies?
 
However, despite this research, the odds of dying are still very, very high. Make sure your dogs, cats and ferrets are current on their rabies immunizations, and never approach an ill or strangely-behaving bat, skunk, raccoon or fox.

Book suggestion

We at VBB central may differ in opinion, specialty, race, creed, gender, orientation, etc - but we all share one thing: a wicked sense of humor. My colleagues and I have enjoyed several of this blogger's cartoons in the past, and I am overjoyed to share with you, our dear readers, that this blogger has authored a book! A collection of her cartoons is available here. They are highly, highly recommended. A couple of my personal favorites are here, here, and here.

Disclaimer: Dr. Fizzy McFizz, the esteemed aforementioned blogger, did state that she wanted nothing to do with white supremacists. Good thing we're veterinarians and not actually veteran aryans! Ha ha ha.