Finishing up the lit search stuff

 

More pics from last Wednesday's ride just because - do you notice the difference between the mane shown here and the pics in the last post which are post-shaving? Long manes are beautiful, but they can make the horse look so bedraggled if they are muddy and tangled. I must admit I sort of miss her beautiful mane, but this is so much more functional.

Continung on our literature discussion:

3. Look at the figure next. This was a tip I picked up during an onco journal club last block. Look at the figures, decipher what they are saying and what they mean and decide what your conclusions would be based on the figures. You may need to refer to the method and results section to find out what the different definitions are that are represented in the graph.

4. Methods and Results section. And then the conclusions. Are their conclusions supported by their results? You may (like me) have your eyes glaze over in these sections, but if you've got in your head straight what they are trying to prove (from the abstract), what kind of study they are running and what their figures say, then you should be able to muddle through the jargon enough to figure out whether the research really is promising, or if someone's grant money was running out and they really needed another publication.

5. At some point browse the intro and conclusions. It's also useful to use these sections as references if you aren't sure what they are talking about or are using vocab that isn't familiar - however, remember that no matter how interesting and enteratining these sections are, they aren't the meat of the paper. They are telling you what other people found, and then telling you what they are going to prove.

Shall we apply this? Absolutely! Here's an annoucement that showed up in my inbox a couple of days ago "Golden retriever study suggests neutering affects dog health".

I haven't reviewed this yet, so we will go through this together. Here's the link: news.ucdavis.edu/search/news_detail.lasso?id=10498

1. This is a news release based on a study. Let's see what I can get from the news article first.

• Study examined health records of 759 golden retrievers.
• A single hospital database was used.
• Point of the study was to examine effects of neutering on the risks of several diseases (2 joint disorders and 3 cancers) in the same breed, distinguish between males and females and between early/late/non-neutering.
• Early/late neutering break point was 12 months.
• Dog ages in study ranged from 1-8 years
• Results: doubling of hip dysplasia among male dogs neutered before one year of age, increases in all five diseases significantly higher in both males and females that were neutered early or late when compared to not altered animals.

Besides confirming all the results/study design from the actual study, here are my inital thoughts/questions based on the news release: Could there be a bias because of a single database: a tertiary referral hospital who may see disproportionately higher numbers difficult cases, or unaltered "quality non-pet quality" animals because they are considered valuable and thus owners bring them to the university hospital? How have the authors controlled for this?

Some biases that I am aware of that I have going into this study are:

1. I believe that in most cases, assuming responsible ownership, dogs shouldn't be altered before they hit puberty and their growth plates close.

2. I believe in most cases, unless planning on breeding, adult dogs should be altered.

3. I believe that hormones are important and the lack of them, or presence of them, can be a signicant factor in disease formation. Nothing is done without consequence in biology, including removing hormones from the system. Growth is a critical time for hormones, thus I like to see altering wait until after the growth period, but I am open to the fact that removing hormones may influence other disease processes, while keeping in mind that hormone presence can exacerabe/increae the risk of other diseases........

Going on to the actual research!!!!!!

1. Read the abstract: Objective was to examine the variables of gender and age at time of neutering (versus leaving dogs in intact) on all disease occuring with sufficient frequency that they could be statistically evaluated. The abstract confirmed the information in the news release such as the sample size, breed and age range chosen etc. Hip (HD), cranial cruciate ligament tear (CCL), lymphosarcoma (LSA), hemangiosarcoma (HSA) and mast cell tumor (HCT) were the diseases that were chosen.

Results according to abstract:

Hip dysplasia and lymphosarcoma is more common in early neutered males as compared to intact males. (My bias from previous research, knowledge, and personal experience tells me to believe the hip dysplasia component of this. I know that hormones affect bone growth and those males neutered before 12 months would have had the hormones removed during their growth period. However, I also wonder whether those early neutered males were pet quality with perhaps contracts from the breeding requiring neutering and thus a higher number of poorer quality dogs are represented in the neutered group. Knowing the dog isn't breeding quality may have motivated advice by the breeder and the vet to neuter the dog early, which would skew the results. This argument could also be applied to the lymphosarcoma cases - If more lower quality animals are part of the early neutered category, and if lymphosarcoma has a genetic component associated with these types of backyard breeding programs - as compared to the guide dog organization for example - than it's possible that the trend has more to do with genetics than the neutering status).

There were cases of CCL in early neutered males and females, but none in the unaltered animals. (see my comments for hip dysplasia.)

Late neutered females: Had 4 times more HSA cases than the intact or early-neutered females. No MCT cases in intact females, but an occurance of nearly 6% in the late-neutered females. (This is interesting and I have no prior knowledge or experience that tells me whether there might be a confounding factor like in the early neutered male dog/lymphosarcoma link. Late spayed females covers a wide range of dogs - from those dogs like Tess that were neutered after their first heat at 14 months, to those retired breeding bitches who were neutered at 5 years of age after many heat cycles and/or pregnancies, because of the risk of pyometria etc. in an unbred intact bitch. Thus, I don't think that there is an inherent bias in dog quality in the late neutered females, like the early neutered dogs. I'm not sure what the mechanism would be for the increase in neoplasia, but I'm willing to consider this link as I know that hormones are powerful stuff and according to my experence so far, I don't see any obvious confounding factors with this link).

So what did I get out of the abstract? I'm still concerned about an inherent bias in the early neutered groups. The hip dysplasia/CCL link has been fairly well documented even though there's the confounding factor of dog quality, I think that previous research does a good job of linking hormones with bone development. I'm curious about the increased neoplasia in the late-neutered females and what the authors have to say about a potential mechanism, or if there's been other research that talks about this potential link.

 

2. Type of study and other general info......

The type of study is a retrospective review of records from a referral hospital at a vet school. As far as I can tell how the dogs were screened and chosen, it is in line with what is said in the news release and the abstract. I do wish that this study had taken related puppies/littermates and done a cohort study with them --> randomly neutering some early and late and leaving some intact. I feel that it would have been more valid. There is the argument that all golden retrievers are incredibly related thus genetics aren't a big deal and has actually been controlled for in this study by picking a single breed.....however being this is a referral hospital, I know they see quite a few very well bred Golden retrievers (out of the guide dog programs) that may or may not be altered, and I think it's unfair to compare them against golden retrievers that are almost a completely different breed - that of the backyard golden retriever (I have one, I know the difference!). Cohort studies are costly and take time, thus a retrospective is a viable alternative. I think another thing that would have made me more comfortable with the results in the expand the databases used - screen hospitals not considered referrals for the same breed/age range/diseases and add them to the results.

3. The figures!

Very nice graphs!!!!! that are actually self explanatory. Would have liked to see the confidence intervals/error bars so that it was more apparent what was statistically significant.

No CCL cases among intact males (and CCL cases occur in both early and late neutered males). Mean age of CCL onset in early neutered males is 3.6 years (the single late-neutered dog was diagnosed at 7.4 years). There is aboslutely no cases of lymphosarcoma in late neutered males (yet cases among both early neutered and intact males) - which is weird because if it's hormonally dependent I would have expected the late neutered dog to have some cases. According to the text in the actual paper, the age of onset for LSA in intact males and early neutered males is nearly identical (5.3 versus 5.8 years).

Bottom line: while the CCL condition seems to have some correlaton with neutering status for males, I'm not seeing it for LSA

In the female graph, there doesn't appear to be any difference between the 3 categories of dogs and hip dysplasia - why would presence/absence of gonadal hormones matter in the male but not the female? Weight is one factor thorugh to contribute to joint disease, and according to the text the BCS in the male dogs (ie how fat they were) was compared to the results and no difference was found between early-neutered dogs with and without HD when compared to their BCS scores (even though the early-neutered dogs were slighly fatter). Since female dogs tend to be smaller than their male counterparts, weight was one theory I had why HD would be significant in the male category and not here, but for there not to be a correlation between weight and HD among the males, makes me doubt that female dogs being smaller is the entire explanation.......something else is going on.

Another point in the female graph: Like in the intact male group NO cases of CCL in the unaltered group. However, there is also no CCL cases in the female neutered late group. Thus in terms of CCL, the late neutered female behaves like a unaltered female. Similarly in LSA the late neutered female is similar to the unaltered.

Bottom line for me: Assuming there is a link between the muscularskeletal system and neutering, it's a male problem and mostly related to early neutering, not late. LSA is much higher in early neutered dogs, but considering that there are ZERO cases in late neutered dogs (there are cases in intact dogs) I think it is valid to question whether this is a neutering related problem, or a genetic problem. There seems to be a stronger link between late female neutering and specific types of neoplasia (with the exception of LSA which seems to be relateded to early neutering, similar to the males). Neutering females late seems to eliminate any CCL risk related to neutering.

If I have a male dog.........wait to neuter until after 12 months to reduce hip dysplasia, while also reducing risk for CCL and LSA. Neutering late as opposed to not neutering at all seems to reduce the chances of LSA.

If I have a female dog......wait until after 12 months to reduce CCL risk (and LSA). Realize that by neutering late, there may be an creased risk of HSA and MCT as opposed to doing it early or keeping the bitch intact.

4. Methods section:

1. Besides the structure of the study already mentioned, another important point is that the neutering of animals occured PRIOR to the diagnosis of the condition. For example, there's a difference between a dog neutered at 8 months of age, then diagnosed with hip dysplasia at 18 months, and a dog that was diagnosed with hip dsyplasia at 18 months and then neutered at 20 months because he wasn't breeding quality due to the development of hip dysplasia. In the first case, an argument could be made that the neutering could affect the development of hip dysplasia, but in the second case, hip dysplasia was the cause of the neutering!

2. Only diseases with at least 15 cases found in the record database when screening based on the breed and age range were considered.

Bottom line: Overall seems sound. I think the inherent problem of there being a bias of lower quality animals in the early neutering group exists.

5. browsing other sections

In the second paragraph of the discussion section I run across this sentence: "for all five diseases analyzed in the present study, the disease rates in males and/or females were significantly increased when neutering was performed early and/or late. " Whoa whoa whoa!!!! Say what?

-- In male, the late neutered hip dysplasia rate was the same/less than the intact males. No difference in the females.

-- LSA risk is highest in early male neutered dogs, but there were NO cases in the late-neutered group, while there were a significant number of cases in the unaltered group.

--CCL numbers in female late neutered and unaltered females is the SAME. Same for LSA.

Thus I vementantly DISAGREE with that statement and do NOT believe that the authors have results that support that statement. If someone reads this and sees something I don't, please enlighten me

Reasons/mechanisms given for the musculoskeletal diseases described didn't introduce anything new. The authors give several suggestions for why the neoplasia numbers look like they do - mostly having to do with hormones sensitizing various cells, etc., all of which seem like valid working theories for future research.

How do I use this research?

I think that there is clear evidence for waiting to neuter males and females in regards to musculoskeletal conditions, keeping in mind that genetics may play a large factor is whether the animal actually develops the disease. However, I do NOT think that this study gave me a good reason to not neuter after 12 months and keep an animal intact as a way of avoiding disease, including neoplasia. A cohort study, or a retrospective that controlled for genetic pools of animals, and/or records pulled from a larger sampling of hospitals is needed for me to change my mind regarding not neutering for the health of an animal beyond 12 months of age.

Bottom line: Interesting, but I need to see further research before I start making animal health decisions based on this paper, especially in regards to the development of neoplasia. Definitely not a paper I would wave around as justification for not neutering my dog at any point.

As you can see, going through this process is a lot of work. It obviously is a lot more work and time to put it down on paper, and you aren't going to have to go through every point listed here for every paper. I do like this approach because it forces me to focus on the meat of the study and what they did or didn't do - not how well their introduction is written etc. By focusing on the claims, the method, and the figures/results, you can decide how far to take the reserach.

 

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Farley's mane

Yesterday (BTW - keep in mind that these posts are often scheduled, so "yesterday" is relative! thus, Farley go her vaccines on Sunday, not yesterday as the scheduled 6 am post this morning suggested) Farley got over her indignation long enough to take her front half out of the shadows so I could get a decent picture.

Farley says: I'm watching you.

Here's a view from the saddle.

We went on a 7 mile trail ride yesterday. We did it in under an hour, and Tess did more like 10 miles through brush and brumble and over hills and through ditches......Longest trail ride and certaintly the fastest for Tess and she was an ANGEL. She actually napped in my lap that night while I watched a movie. Endurance conditioning = best job EVER for a brittany! Tess and Farley are settling in well together on the trail. Farley has accepted the fact that the white bouncy dog streaks from behind at top speed and is a bit clueless about horses and Tess is now pretty sure that it's still me on that thing, even if I'm wearing a helmet and look weird.

 

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Vaccination

Yesterday I popped Farley with 2 vaccines.

I considered long and hard what I wanted to do with the vaccinations this year. Last year I wasn't pleased with the slight hoof sensitivity that occurred after vaccination that lasted about 3 months - where she was once sound at a canter/gallop on gravel, she now only wanted to trot.

AAEP publishes vaccination guidelines/recommendation and if you aren't familiar what is in your 4 or 5 way, or other vaccines, it might be helpful to take a moment to review.

WEE and EEE:

These are zoonotic diseases that are transmitted by the mosquito vector. They cause severe enchephalitis in horses and humans (humans have low levels of the virus in their blood if they are infected and do not transmit the disease to mosquitos). The eastern form can be found on the west coast and vice versa. The disease can be fatal and can pass to humans. These are considered "core" vaccines by the AAEP and is in most of your standard combo vaccines. Because of vaccination, WEE and EEE epidemics no longer regularly occur in the US (reference: CDC website). Here is the link to a summary of cases/distribution of cases over the last couple of years: http://www.aphis.usda.gov/vs/nahss/equine/ee/

Did I vaccinate for this yesterday? No. My risk is low where I live, and during some years of competition, I was vaccinating for these 2 diseases as often as every 4 months based on AAEP recommendations for a performance horse. Because this is a core set of vaccinations that are given often, chances are if a vaccination was causing some increased inflammation/sensitivity, this is my prime suspect.

Tetanus toxid

I think everyone knows about tetanus. Horses are particularly sensitive. Tetanus vaccine is available by itself or in conjunction with lots of different combo vaccines.

Did I vaccinate for this yesterday? You betcha. Especially with that old wire injury that may or may not allow crud up in there and was causing problems....yep, she got popped with a tetanus toxoid vaccine in the right thigh.

 

West Nile

I spoke on this in an earlier post. Mosquito vector, zoonotic (but not passed between humans and horses). According to Aphis (http://www.aphis.usda.gov/vs/nahss/equine/wnv/index.htm) there were cases very very near me last year, AND Farley boards on a river bank. AND mosquitos have already started showing up. 3 types of vaccine available. AAEP recommends 6-12 month vaccination.

Did I vaccinate for this yesterday? Yep. I consider "before the vector season" to be the end of February in this area (the fruit trees are already coming into bloom....) and that will give me good protection through September, the peak time for WNV infections.

 

Influenza? Rhino? Strangles?

She didn't get any of these yesterday. There's a couple of reasons. Strangles I don't give for a variety of reasons. Influenza, Rhino, EHV are all a concern, but I'll evaluate once I know my competition season. I'll vaccinate no less than 1 month within a competition date to give the inflammation time to die down if it is going to affect her feet, and she'll have protection during the time she needs it most - at competition where she's sharing water troughs and around lots of strange horses. These are more examples of vaccines that were in the combo that I gave up to every 4 months so another good candidate for already having increased titers.

Splitting up some of my vaccines based on vector season and others based on competitions is a way to spread the vaccinations out over time. I like doing this especially if I suspect there was a problem last time. WNV and tetanus are diseases I'm worried about NOW, these others I worry about more when I'm competing, this they will come around in a couple months.

A note on spreading vaccines out: I talked to a vet with a vaccine company and he suggested that if I spread vaccines out to do it over a MONTH, not a week or so - introducing another vaccine 1-2 weeks post vaccination means introducing that vaccine at the height of the vaccine response (and inflammation) from the previous vaccination. If you are going to spread them out, make sure to wait at least a month.

Also on the suggestion of the same vet, I gave everything in the thigh instead of the neck. The neck is easy, but residual soreness in the neck can be harder to pinpoint and attribute to transient hoof sensivity.

What about NSAIDs? I decided that at least for tetanus and WNV NOT to give banamine or bute. Reducing the inflammation can potentially decreased the vaccine response, and because I'm giving those 2 only and not the combo, I elected to give them without any additional medications and see what her response is.

There's one more vaccine that I didn't mention above that I do keep Farley current on: Rabies. I don't have my license so I can't give it. Rabies occurs in wild populations of animlas, and according to the state I live in, bats testing positive for rabies were found in both the county that Farley boards in and surrounding counties. The chance for interaction between Farely and a bat, oppossum, or skunk is fairly high and thus, I chose to keep that vaccine current. One thing to remember about rabies. There is NO test that can be done on a living animal in order to determine whether it has been infected with rabies. ONLY a post-mortem (after death) brain sample can be definitively tested for rabies. I was told in class that we aren't even allowed to test for rabies antibodies in a suspected animal - they need to be euthanized and the brain sample submitted.

I write this from a horse owner perspective, not as a vet or future vet. As a vet I would absolutely tell you to vaccinate with all the core vaccines (barring any issues such as past reaction etc. - this is a THEORTICAL CONVERSATION). Perhaps spacing them out at least a month for clients with my worries, and administering a concurrent NSAID with the vaccines for the older horse who has a strong vaccination history for certain diseases not necessarily edemic in the area the horse lives or travels in.

I absolutely believe in the efficacy of power of vaccines and believe they do more good than harm. However, I look back at the volume of vaccination I did based on recommendations and wonder whether for an older, well vaccinated horse if some of the core are really necessary, especially for the horse, which seems to be more prone to issues associated with inflammation. On the dog side, the most current recommendation is that the core (distemper, hepatitis, parvo etc.) be given every 3 years. Horses are a different species and thus we cannot extrapolate from dog core recommendations to horses, but I do wonder what the titers look like long term for an older horse with a strong vaccination history.

One last note about vaccines - Dr. Bigbie, the vet who spoke about west nile a couple of days ago at the lunch talk (see previous notes on west nile) told me that years ago he wrote an article about rhino/influenza/EHV called "A snotty horse is hard to love" and even though he's done a ton of WNV stuff etc over the years, that's the first thing that will pop up on a google search of his name. Sure enough, I found the article: http://www.horses-and-horse-information.com/articles/0496rhino.shtml.

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A new hair do

Farley: what are those in your hand?

Me: Clippers.

Farley: ummmm.........

Me: it's either your hair or mine and you have the better bone structure to pull off the whole chopped look.

Farley: I'm pretty sure it's fine. See? you barely even notice the knots from here. No need to feel guilty that they represent you ignoring me during the whole "vet school thing".

Me: Hair grows back

Farley: No it doesn't - have you seen the horses around here? I'm pretty sure it's an outbreak (Farley is boarded at a polo barn).

Me: Think about how much cooler you will be! And no more braiding! Or me tugging at your mane!

Farley: OK. Fine.

Me: Oops.

Farley: WHAT??!?!!!

Me: I forgot to leave a handle next to your wither. Oh well, I'll just put it here.

Farley: I told you this was a HORRIBLE idea.

Me: I can totally fix this. Don't worry.

Farley: No. Stop. Just Stop.

Me: You know what would fix this? Clipping your jaw line. Then you won't look like a goat!!!!

Farley: Goat isn't bad

Me: Ummmm......you are fourteen years not days and thus "goat" looks a little bit more like this:

Farley: Mmmm....you have a point.

Me: Brrrrrr..............

Farley: Are you done yet?

Me: just a little more.....

Farley: I think it's time to stop. This is now way out of control and I will point out that you are no where near my mane anymore.

Me: just a little more.......

Farley: I'm done. I'm really really done.

Me: Fine. Ready to see yourself?

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Farley: NOOOOOOOO!!!!!!!!!! What have you done!!!!!!!!!!!!!

I'm standing over here until you FIX THIS!!!!!!! Immediately!!!!!!!!!

Here's what Farley actually looked like once I was done. I left her forelock for the summer flies. My clippers are old and didn't like the thick thick thick mane, so it wasn't totally roached down to the skin.

She has little fluffy hairs that emminate from the opposite side that the mane lays, so you can't even see the change from the left side! Especially with my handle flopped over.

Regarding the clipped jaw line - No whiskers where harmed during the making of the jaw line - just extra fuzzies from underneath. Not even clipped to the skin.

 

Farley prefers to stand in the shade will hopefully no one notices the travesty that just occurred.

 

 

 

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Vetmed subject: West nile

Zoetis talk at the vet school today - presenters Rocky Bigbie and Jeff Hall, both DVMs.

Below I'm going to summarize my notes from the talk, and insert some other learning points from my classes. Call it AERC convention practice.....

West Nile

Single stranded enveloped RNA virus (Flaviviridae, arbovirus). What does that mean? Typically enveloped viruses are not as hardy in the environment - viruses known as being especially persistent in the environment (polio, parvo) typically don't have an envelope......so just from this information, I know that WNV probably is a reservoir in a host somewhere NOT in the environment.

Transmitted primarily by mosquitos belonging to Culex sp. (this is important - sometimes the only reason there isn't a certain disease in a certain country is because the vector isn't present. )

First isolated in Uganda (West nile district) in 1937. Noted in Egypt and france in early 1960s. Entered the western hemisphere in 1999. First discovered at the Bronx zoo - lots of birds were dying. Public health and CDC officials running all over.......thought it was japenese encephalitis and the zoo vet is the one that confirmed west nile!!!!!!!! (that's because vets are the coolest... :))

Life cycle: mosquito to birds to mosquitos to birds. 99% of the virus on the planet is in the blood of birds --> There can be so much virus in the blood of birds that it can actually be like sludge.

Horses and humans are incidental infections and dead-end hosts - virus levels stay low enough that it cannot be passed on, even to pasturemates. Dogs and cats DO get west nile - however usually the disease is of no-consequence unless the animal is already sick.

WNV mutated when it came to north america. The new mutant has a shorter incubation period (by 2 to 4 days) in mosquitoes compared to the original strain - this allowed for more efficient transmission within the mosquito population and selection pressure for the newer strain. HOWEVER, unlike the influenza mutations you might be familiar with, this mutation did not affect the immunity any of us (or our vaccinated horses) have, even if we were infected with the "old strain" (because of where the mutation is in the virus). - The mutation affected how it amplified in mosquitos and is the reason why WNV spread so much faster than the experts initially predicted.

Clinical signs in horses - (BTW - mules/donkeys get WNV just like horses - the rumor that they didn't has turned out to be false)

1. muscle fasciculations (60%). A very unique feature of this disease - looks like nothing else.
2. Recumbency (35%)
3. Depression (51%)
4. Mortality rate (30-38% overall, 70% for those that become recumbent).
5. Weakness (100%)
6. Ataxia (100%)
7. Fever
*****Major rule out (alternative diagnosis) is EPM (which I'm also learning about in school, and that is a sucky disease too...)

*Remember that some horses won't present for any signs at all, get bit, get the virus, get over it and have titers and you won't even know they've had it. A bunch of us have west nile titers too --> got bit by a mosquito, got a headache, took care of it.

Treatment: nursing care, symptomatic. KEEP THEM UP, keep them hydrated, anti-inflammatory. Average cost over $1,000/day if recumbent. (about $2,200 per horse in one survey - $350-8,500 range)

Prevention: eliminate standing water - tires are the worst offenders. In a single tire, 10,000 mosquito larvae can be harvested. Get rid of the tire piles. This is probably NOT a good fencing alternative if you are concerned about west nile....

****4 days required for mosquito breeding!

Add fish to any tanks or ornamental pools.

Aerial spraying may be of limited value (even though the adults die there are TON of larvae and egg stages that aren't affected).

Topical insect control on the horse

Stalling horses from dusk to dawn with a fan is an excellent preventative.

Vaccinate: Disease kills, vaccine works, adverse reactions are rare (keeping in mind that this presentation was by a vaccine company). Case control study showed almost 97% vaccine efficacy. Vaccinated horse are 31x less likely to get the disease.

What about bird control? no vaccine labeled for use in birds (however there have been people who have given 1000's of doses to birds). Zoos are experimenting with using WNV vaccines in birds - response is species dependent and it's important individually test the efficacy in each species. Adverse reactions almost non-existant. (FYI - the California condors have been vaccinated.......I think the paper is on science direct if you want to google and read it).


Other random facts of interest

FYI September is the WORST month for west nile infections (for us horse owners that are vaccinating --> best to do so prior to the vector season and make sure that September is included if you are using a 6 month protocol.

2012 worst year for West Nile (human infections)--> just not talking about it anymore in the nightly news......The horses aren't falling over dead because the vaccination protocols have largely worked.

Important to remember that even though we don't get nightly updates from the news on the Risk from the virus is still out there!

Compared west nile to another disease - Parvo. Once epidemic, now endemic. Was shown some data that when states stopped vaccinating because the thought was the prevalence was low and perhaps it wasn't necessary to vaccinate any more, the disease rates shot up.

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Why yes, I DID ride this morning.

During my ride this morning Farley was a little perturbed.

"THAT is the dog you have chosen to go with us?"

Me: yes.

Farley: But it doesn't even ACT like a dog. Are you sure it isn't a rabbit?

Me: it's white, has a fluffy tail and bounces. It could be a rabbit. Pretend you are Alice.

Farley: (spooking) GEEZ!!!!!!!!! I didn't know dogs could MOVE and JUMP like that.

Me: It's called being athletic.

Farley: No, being athletic means completing Tevis and numerous other 100s. If I acted like that you would call me stupid and sell me.

Me: Probably.

 

I'm feeding for the next couple of days for my barn owner so made sure to get there early enough to go for a spin around the orchard.

I took Tess with me. This deserves a post all to its self, but because I have accepted the fact that if I wait to write important posts, they don't get written, this landmark gets squished into this post (although the trend is I *think* I'll be able to write about more than one thing, and I end up having to end early so I can do something like actually pass my classes!).

One of my reasons I chose a Brittany is to have a dog athletic enough to go on conditioning rides with me. Taking a dog along is good for my mind and my horse's mind. A year ago Tess went on her first trail ride. She was attached to a long leash and it went well, although she got stepped on and was generally completely clueless about horses, even after being boweled over by Farley. It was a promising outing and I've continued to work on Tess on being off leash, and the concept that the whole world isn't full of fuzzy loving things that adore white bouncy puppies.

Since then she's gone on daily off leash walks with me while I introduced the moving commands we would do from horseback, to endurance rides and horsey walks where she got time to really think the huge creature that walked beside me, and a better understanding of the world that not everything is puppy-safe.

Today, 2 weeks shy of her two year birthday the time was right. It was early enough that there shouldn't be a lot of people out and about in the fields, Farley had been out 2 days ago so shouldn't be entirely wild, and during our daily lunch walks we were no longer having to work on training.

I was happy to see she was keeping her distance from Farley, and instead of seeing her as a big dog, was giving her a healthy dose of space and respect. I mounted up.

Tess was really confused. Where was Melinda? The voice was coming from somewhere above the snorty thing but no where did she see the creature that she associated with ME. Apparently wearing a coat and helmet and sitting on a creature presents a slightly different picture. She conceded to come with me, but kept looking behind her at the ranch as if wondering whether she was making the right decision to go with this weird beast. She actually stopped a couple of times and when I called to her started to run back to the ranch, being VERY confused about where I actually was.

I knew she's a smart dog and it wouldn't take her long to figure out that the four legged, 2 headed creature was her person, so I was patient, talked to her and sure enough, 10 minutes later she was out and about like a normal walk.

Farley's pace and Tess's pace is PERFECT for eachother.

Tess lasted approximately 25 minutes before she lost her puppy mind all over the trail. At 2 years old she acts reasonable and adult like a majority of the time. The joy of racing through the river bottoms without interference from me (because I could keep up with her and see her!) was too much to handle and I had zoomy puppy with empty dumb eyes that required a 3 minute sit stay so that the pieces of her brain could sift back through her ears and into her skull near the end of the ride.

Once the glazed over look faded, I released her and we finished our ride.

Success!!!!!!! Tess is now perfect. She has fulfilled every wish I had when I was picking out a dog. I wanted a companion that could go on the trail with me off leash, who came when called, who was independent in a healthy way (no separation anxiety), and who was friendly towards strangers (both the people and dog kind). I didn't know that it was going to take 2 years --> but after understanding growth, maturity, and dog development better, it makes sense and I realize how unrealistic my expectation was to have an "adult" dog at 1 year, no matter what the size of dog.

Moving on to other thoughts

I swear I'm getting dumber. The smarter I get in school the dumber I am in real life. The whole absent minded professor thing is TOTALLY true. The more I know about medicine and animals and differentials that less easy it is for me to remember where I put my keys, or what day of the week it is, or what years I rode Tevis. I go around 90% of the time not knowing the date or calendar day.

I'm actually contemplating giving both me and Farley a "vet school" do and going super short on both of us. Her mane is a mess and mine isn't much better.


I am officially registered for the convention and have reserved my hotel room. Tess will most likely be going with me, so if you see a weird looking white Brittany, you have probably found me! Come over and say hi.

Gear recommendation: Looking for a GREAT jacket to ride in and do some barn stuff? Look for a snowboarding jacket on sale NOW and you won't be dissapointment. In a lapse of judgement I agree to learn out to snowboard with Matt as a "couples" activity. LOL --> we have both agreed that at 30 we are both too old and fat to learn to snow board, but both of us persevere on and have yet to actually break anything. Matt is heavily subsidizing this broke college student for the snowboarding experiencing but there has been a couple of pieces of gear that I am responsible for --> one of which was buying a jacket that didn't result with snow down my pants. (I know I know I know --> stop falling down and I probably won't have snow in my underwear....). I found one online that I bought based on price and when it came it was OK, but not "WOW". I was contemplating sending it back, but then I happened to ride in it on Wednesday and it has become a WOW.

1. 2 way zipper on front means that I can have it zipped it all the up to my chin, But have it unzipped from the bottom for ventilation or movement.

2. Generous cut sleeves and cuffs work well for gloves or non-gloved hands. I undo the cuffs and the sleeves cover my hands on the reins. Or the cuffs can be tightened to keep the weather out.

3. No fuzzy anywhere! I fed Wednesday evening after my ride and NO HAY STUCK TO IT!!!!!!!

4. Ventilation zippers. Strategically placed under the armpits, in the saddle I was super comfortable at all times because I could ventilate it many different ways beyond just the front zipper. Snowboard jackets are meant for an athletic event which is why they are better for riding than some of the other cold weather jackets I've tried.

5. Generous long cut. That doesn't bug me while I ride because of the 2 way zipper.

I'm bringing it to the convention if anyone wants to check it out.

Picking a vet - I'm finishing up my second year communication courses (most notably end of life and euthanasia scenerios) and it's been really interesting. I think it's important to realize that people who wear the vet "coat" are as varied and different as the rest of the general population and there are differences of opinion between vets that may or may not impact the experience you get at the vet office. I am of the opinion that when looking for a new vet, after getting recommendations from people you trust, you should interview the vet and talk about things that matter to you, and see how the vet stands compared to you. Don't know where to start? Go to the AVMA website and read some of their policies. Like or don't like some of them? There's your starting point for your "interview" with the new vet to see where they stand compared to you.

Call up, make an appointment, pay the exam fee, take or don't take an animal, and have a conversation with the vet.

Here's an example of where it might make a difference. When is the right time to put down an animal? Some vets might say as long as they are eating and drinking there is a quality of life present that euthanasia is not warrented. Some might say that is just the price of admission and that they should be able to get up on their own and defecate/urinate. There is a variety of opinions and you probably even have your own.

If I was moving to another area and needed to find a vet I would want to talk about quality of life and euthanasia, what they use for pain management (is it a one size fits all or do they have lots of animals and will individually assess animals?), how much face to face time does the vet/client get in a routine appointment, if I have to leave my animals overnight, where will they go to the bathroom and what precautions are taken to make sure my animal doesn't escape (double leashed? fenced property? runs?), what recent CE (continuing education) have the vets participated in, what are the special areas of interests of the vets, and what types of cases are typically referred and which ones are handled in house. Do they have electronic records? Or hand written?

I feel this information is well worth the exam fee I would pay to be able to sit in a room and talk with the vet without my animal in order to make a decision of where I am going to spend my vet dollars. I've had excellent luck finding quality care for Farley based on recommendations from horse people I trust, but finding a small animal vet that I like has proved to be a different story. My biggest pet peeve? Not giving my animal a complete physical exam, yet charging me $50+ dollars for doing so. The physical exam is extremely valuable --> and I think that how the physical exam is performed it indicative of the overall care I can expect from that hospital.

 

 

 

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Happy new years to me! First trail ride of 2013

Let's start with a Farley update.


I haven't ridden Farley on the trail since she bucked me off in October. October!!!!!!! It really has been that long. We've done some free lunging and turn out, and 2 rides in the arena at walk trot (dressage) since that time. Some of it was me --> illness, school, etc. Some of it was her --> lameness (that old wire injury aka "abscess" and some was neither --> an unfortunately wet Christmas break.

She's looked super super absolutely sound in the arena during turnout and lunging so a couple days ago (Monday) I jumped on for a couple of minutes and confirmed that she's really really perfectly sound in the saddle at a trot, even when asked to do some on the haunches, tight dressage moves. Time to take it out on the trail.

Yesterday was PERFECT weather if a bit windy. I joked with the high schooler as I mounted up that it was the first time that we had been out in 3 months and (hahahahaha......) she had bucked me off last time.

I kinda of regretted it when I saw the look of concern on his face and realized that it would be highly embarrassing to be "rescued" from my stupid fat short pony just because we were out a bit longer than usual because we were having fun.

Truthfully I wasn't worried.

Farley really is a good girl, even with time off. She's not mean or malicious or deliberately unkind. I wouldn't have kept her through vet school if I couldn't ride her sporadically. During out October "adventure" it was 100% my fault for coming off and was an example of pure stupidity on my part.

Which I made a pact with myself to avoid such mistakes on this ride.

1. I was in my saddle with seatbelts (ie the aussie).

2. I had no intention of cantering. In fact, I wasn't sure we would make it to a trot. She hadn't necessarily been BAD during those 2 arena sessions....BUT she also didn't give me ANY comfort level that she wasn't willing to do some airs above ground if given the right opportunity. I didn't plan on giving her that opportunity.

3. It may have been mostly flat, but since we ARE conditioning, I was planning on making her little butt WORK - ie travel correctly, stepping underneath of herself and plumping that hind end back up. Giving a smart talented horse something to think about as you ride along (be rounder, push harder, go lower) is a GOOD THING.

The picture at the top of this post was taken a few steps off the barn property and after attempting to sign up for a GPS tracking thing on my smart phone, and realizing that "signing up for a new program on the smart phone with one hand and not looking where I was going" went solidly into that "being stupid" category, I decided I didn't NEED to know how far and how fast and put the phone away.

40 minutes later it was safe enough to take the picture below -->; 40 minutes of some really nice trotting on a beautiful day, on a horse that was being "good enough". Who could ask for me?

Farley, apparently wanted more.

45 minutes into the ride we encountered the best footing so far. It was beautiful. I was riding on the edge of orchard land that had recently had the trees pulled out and the ground totally and beautifully disced and prepared for the next orchard crop to go in. It was better than any dressage footing I've ever been in --> neither too deep or too hard, even, flat and instead of sand the most perfect dirt you can imagine.

Farley wanted to canter.

The last time I conceded to her cantering wishes I got bucked off. And I'm miles from home. 

Uhhh....absolutely no way.

Farley promises to be good. She gives me a beautiful dressage trot with her head low, her back up, and with very little tension.

I relent. The next mile is some of the nicest 3 beat, balanced, non-fussy canter I have EVER had on this horse.

What a gift.

I'm more sore than I want to admit after that ride yesterday, but that's OK. Nearing home I reflected on the time off that we both had, unplanned as it was, and I decided that we both needed those 3 months. I thought we were ready to go back to work after our LD last fall, but now I truly believe that for some reason, a little more rest was needed. I'm not sure why, and I might never know --> but yesterday I realized that now, 2 years post injury (Farley, not me) I don't feel like I'm on the edge of doing too much.

I was talking with a fellow endurance rider and I joked that Farley and I were on the "vet school" training program, which looks a lot like the training plan that one of my very first endurance friend uses to get to Tevis each year --> lots of rest, rides when possible, and honest evaluation of the horse's readiness using just a few key rides during the year.

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I haven't dropped off the face of the earth. 

I'm having some health issues --> nothing extremely serious but enough to keep me barely functional in school and it's unfathomable for me to even think about trying to do anything like blogging.  Dizzy, nauseous, +/- vertigo. 

I managed to free lunge Farley at the beginning of the week, but since then have been put squarely into the category of invalid as I drag my sorry butt from class to class and whine my way through the day. 

Health is so important and I keep being reminded of this fact.

Mel's Literature cheat sheet

We are continuing on the topic of how to evaluate a study --> the scenario is this: you have an issue, you have sought the best advice you can from friends, mentors, and vets, and you want to see what the most current literature has to say on a particular subject. How do evaluate studies? Chances are you will find lots of conflicting information and it can be confusing with all those statistics and "45 dollar" words........which brings me to my first point.


1. Read the Abstract - but don't make a decision yay or nay for a particular topic until you've read the actual paper. An abstract can be so clearly written and make so much sense. Sometimes it's the only thing that is available to read online for free. HOWEVER, I can't tell you the number of times that I've been burned by just reading the abstract - think of the abstract as a series of claims by the author. Without seeing their evidence, even if their hypothesis makes logical sense, it's no better than asking yahoo answers what to do and then taking the advice of a random stranger. The abstract is a STARTING point that helps you decide whether the article is related to your topic of interest enough to put in the time to actually evaluate the rest of the paper. It's perfectly fine to tell someone you saw a study on a particular subject, and it looked interesting and the authors made such and such a claim......BUT you cannot claim the study as fact until you have examined whether the authors conclusions were supported by their data (and more papers than you would think have serious enough flaws that I would be hesitant to say that anything was proven or even strongly correlated!).

When I'm reading a paper I like to start with the abstract and write down in sentence form what I think the authors are claiming before I read the rest of the paper, so I can keep straight in my mind what the point was suppose to me.

2. Background information - here I try to decide what kind of study it is. Retrospective? Case control? Cohort? Each study has it's own strengths and drawbacks. Each study type is suited to something different and the data collected can be used to calculate things like risk, relative risk etc. It's important to know what KIND of study it is so you can determine whether the conclusion of the paper is VALID. Some types of studies can tell you risk, and some CAN'T - but it's amazing how many papers I've read in school journal clubs that we get to the results section and are all like "WTF? you can't use that stat with this kind of data?!!!?????"

Disclaimer. I'm not a statistician. This is a brief summary of what I've learned in class and how I've tried to remember and applied it! I welcome corrections :).

Retrospective - Often looking back at records, or using surveys that rely on people's memory - these can be useful for gathering information about a certain condition/treatment etc over a long period of time.

Cohort

Often start with a "healthy" cohort, meaning that it's a population of critters that are all basically the same and no one has been "exposed". You then expose some of your cohort with a risk factor and you see who in what group develops some specific condition. For example, you take a group of endurance riders. You put salmonella in the ride meeting potluck potato salad of half of them, and you give unadulterated potato salad to the other half. You then measure the number of Salmonella cases from each group - the exposed group and the non-exposed group.

You can use Cohort studies to calculate "relative risk". Relative risk is a the risk of developing the condition/disease RELATIVE TO BEING EXPOSED. This is different than absolute risk. Absolute risk would be your risk of getting salmonella if you eat the salad. You can see that this is a stupid and ridiculous conclusion to try and make from our cohort study. The ride meeting cohort study isn't measuring your risk of getting salmonella from eating ride meeting potato salad - it's measuring your risk of getting salmonella if you eat infected potato salad, and your risk of getting sick if you eat the "normal" salad. Thus its measuring your relative risk of developing a condition having been exposed (or not) to the risk factor.

It would be WRONG to publish a paper on the risk of developing salmonella at a ride meeting from our cohort study and conclude that the risk of getting sick from the potato salad is X%. It would be CORRECT to say that your relative risk of getting salmonella from a ride meeting salmonella-contaminated salad is X%.

Releative risk can be given as a ratio that expresses the relationship of condition developing in the non-exposed and exposed groups. A ratio of 1.0 means that the relative risk of developing the condition is the same in both exposure groups.

Limitations of Cohort studies: less useful for rare diseases. it might not develop at all if it's rare enough, even in your "exposed group".

Case Control

You have cases (endurance riders with salmonella) and you have controls(endurance riders at the same ride without salmonella). You then try to decide what the exposure factors are. You are basically working in reverse of a cohort study! Case control studies are much more useful for rare events/diseases/conditions etc.

For our salmonella stricken riders, you must first try to find the exposure factor. Perhaps you chose the chicken as your "exposure".

Perhaps you calculate chicken exposure for your salmonella verus non-salmonella riders and find that your salmonella riders ate more chicken than your non-salmonella riders. Great! Riders who ate the chicken were more at risk for the Salmonella infection!!!! Yeah!

But wait.......the salmonella was in the potato salad. Oops.

See - that's what can happen with a case control study - you can pick the wrong exposure factor to study. However, with rare diseases it allows you to study a group of individuals with a disease instead of hoping that the disease develops in your healthy cohort as you fling exposures onto them.

While looking at what kind of study it is, try to decide whether you agree with the authors - are the controls really controls? Are they measuring the correct thing? Are they using the appropriate type of study?

This subject will continue in a future post!!!! This infectious disease block is sucking the time out of my life to do anything but study, so it's off to antibiotic therapies for now.

 

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An open letter to my classmates

...And whoever else who is tempted to immediately complain that something in education isn't working and there needs to be immediate changes so that it is an effective learning experience for them as an individual. 

We are in a class of over 130 people.  There is a subset of those 130 people that do really well with power points, minutae, a diadactic learning style where we are talked to for hours on end and told what is need-to-know for the test.

I am not one of those people.

Did you know that I'm at the bottom of the class rankings?

A lot of my classmates are surprised to hear this - after all I can have a conversation about the material with them and can intelligently discuss mechanisms and I have a very good understanding of the material being presented.  Read through this blog and I think you would be surprised at some of the topic depth that I chose to share with the general public and my readers because I am confident enough that my explanation will make things CLEARER for them which will ultimately help the vet profession and our patients.

Did you know that I fail tests on a regular basis?  Even if I love the subject?  That there has been more than one block that I've barely squeeked by in by a percentage point or less?  Did you know that I've been told by Doctors I respect that I'm going to make an excellent vet or graduate student? 

Did you know that power points and long multiple choice tests that attempt to trick me by wordings do not accurately test my understanding of the material even if they do yours?

How often do I stand up in class and announce that power points do not work, and case studies bore me the tears and thus there needs to be a change?  Never.

Instead I take psychiatric medicines in an attempt be able to focus and care about class (even though I love medicine and vetmed), force my brain to focus for 50 minutes at a time, and pray that what the teacher decides to ask test happens to be comprehensive enough that I pass. 

In this current block, infectious disease, I am currently getting an A.  I'm not having problems completing my assignments, reading, or other expected self learning materials.  I'm engaged in class, taking notes, and the tests are actually reflective of what I know.

Amazing!

While people around me grumble and complain about the lack of specifics in Dr. F's lectures and his casual style, and berate Dr. B for the structure of her team based learning experiences, I couldn't be happier.  I'm learning the material, I LOVE school again.

And folks - I sick of hearing you bitch about the structure of this block and every other block that isn't didactic based. 

-Do you realize that different learning styles exist in this class and by constantly catering to one set of you, it leaves me and my type completely in the dark, struggling and feeling like our voices are never heard and our learning style is never addressed - even though that was exactly the point of this new curriculum? 

-Do you realize that when you speak up in class and offer criticism about the block structure that you are not speaking for everyone in the class?  That you are speaking for YOURSELF and to assume that you are even in the majority is a bit presumptuous?  At least for myself - I'm so used to shutting up and dealing whatever is thrown at me even though it DOES NOT WORK FOR ME TO LEARN THE MATERIAL, that truthfully, you may not even know that I exist - so you can be forgiven in thinking that everyone is fine with powerpoints and being talked at.

-Did you know that it is OK to make mistakes?  That in the real world you get to take "tests" that you never studied for, and thus only figure out what you need to go learn after the fact?  And that this is OK?  Failure is part of the learning experience.  It's effective and it's completely normal - and to be so afraid of failure that you refuse to let it enter into your learning experience is to completely shut out one of the most effective learning tools.  The real world rarely comes with manuals and powerpoints and that's what is wonderful about it.  It isn't about regurgitating the minutiae - it's about using your networks, critically thinking skills, and taking risks because the risk outweighs the benefit.

-I am told by many of you that there simply isn't enough hours in the day to finish everything that you need to finish for the block to prepare.  When I feel that way, it's often because I'm approaching the material in the wrong way.  I rarely blame the material, the block, the instructors and instead put the blame/accountability where it belongs - on me.  I am accountable for my learning experience.  There seems to be a perception among some people that since we are paying a ton of money for them to teach us how to be vets, that the instructors are responsible for giving us the information we need as we sit there and listen, and then go home to figure out how to memorize it for the test.  *I* am paying a ton of money for these precious few years not to thrown factoid after factoid that I could learn out of a book - I am paying money so that I can be immersed into the subject of MEDICINE and veterinary SCIENCE.  So that I can learn the stories and the people behind it.  So that I can gain that feel for immensity of the subject that can't be experienced by reading a book.  Vet medicine is more than giving medicine B to treat condition A.  It's the culture, and the experience and to cut it down to bullet points on the slide and miss the passion and excitement of the professors that are willing to emphasize the stories and wonders of biology is to sell our wonderful profession short. 

The intention of this post was not to point to a specific person or learning style and to say "you are wrong" - it was to perhaps introduce you to a view point that you did not know existed among your class mates.  Although I suspect that the people I wanted to read this the most probably got pissed off in the first paragraph or two and didn't bother reading it through.  Veterinary medicine is diverse and so are your classmates.  Not all of us are going to be clinicians, not all of us want power points, not all of this are getting into this primarily because we love animals, and not all of us think that tests are the most important part of vet school.

Let's go have a beer after class one day and get to know each other better.  Tell me why you went to vet school and why you are excited about your career.  Let's help each other through these blocks as one plays to the strengths of some, and then another block to the strengths of others.  Let's build some lasting relationships that remain long after the test grade.