SALMON is KRYPTONITE

Until yesterday I did not know what Salmon was. That is not to say I don’t get my daily Omega 3’s I just didn’t realize that they could taste this amazing.It all started last night when my mom decided to get crazy in the kitchen again. You see from the minute I saw the butter, cream, and Romano and Asiago cheese come out of the fridge I knew my family was in for a real treat. We watched as she chopped asparagus, she was busy zesting and squeezing lemons all of which went into making her famous lemon Alfredo sauce. The pot was boiling and in went the linguine to cook for 9 minutes according to the timer on the stove. Then something happened – suddenly the house had a whole new smell. I watched as mom unwrapped the salmon and well let’s just say it was nirvana. The smell of the salmon was intoxicating. I paced back and forth outside of the ‘no dog zone.” Mom was stirring this and sprinkling that and I was floating on a salmon cloud. Then I noticed something out of the corner of my eye...Rome!

Rome who will not even try people food was pacing beside me keeping time with my attempt to edge closer into the no dog zone. Then he snapped and ran right up to mom and barked at her. Her response while at first startled by his bold rush into the kitchen was to say, “Excuse you!” To which he replied in dog of course “hand over the fish lady and no one gets hurt.” He was crazy spinning and barking, jumping up and laying down. I wasn’t sure but I thought perhaps he may suddenly and quite spontaneously combust. I was giving him a little extra room. Mom said to him, “Rome what has gotten into you? Get out of the kitchen.” Rome did not listen and still continued to be crazy. Mom said, “Is this what you want?” She offered him the tiniest little piece of salmon and Mr. Soft Mouth became instant Piranha – mom barely kept her fingers! She yelled for my dad. Dad came in and saw Rome had lost his mind and said “Oh no, what did you give him?” Mom said a “dime sized piece of salmon.” Dad immediately gave the piranha another little sliver and he went stark raving mad. Dinner was nearly done and mom was focused on not letting her sauce break (separate) and straining the noodles. With dinner assembled Rome was having an out of body experience as my family sat and enjoyed their meal. 

Rome paced and barked and kept going into the no dog zone for another piece of salmon. Mom is a good student and had it covered so he couldn’t get to it; I taught her well (sorry Rome). Then after dinner mom did the unthinkable she grabbed a rather large chunk of salmon and made Rome go outside. She then proceeded to make him work for it in the form of learning to roll over. That’s my mom for you, you want to be rewarded, well, you’re going to have to earn it. Rome nearly took her arm off, offering to shake instead of learning to roll over. When he realized mom was not going to give up, he relented, and was rewarded. Again he tried the new trick – another reward, and soon he was rolling over like an alligator with out even needing a command. Mom realized she was creating a monster and did not reward him for the unsolicited behaviors. Soone he was barking and shaking and giving high tens and rolling over on command like a pro. Then it happened, dad asked him to come from the other side of the yard, a simple request, and he didn’t. Mom gave dad a piece of salmon but since her hands were now the flavor de jour that was not going to happen. Mom walked over to dad and Rome followed like a puppet on a string. I sat inside the screen door howling “listen to dad you idiot” in my best French accent. Rome was deaf to my pleas for him to “pay attention you fool” I screamed in a succession of high pitch barks.

Mom took the salmon and simply fed it to me, rather then reward him for his noncompliance, and just like that the salmon adventure ended. Well almost... you see mom still smelled like salmon, the air was still dancing with the aroma of the lemon and fish and the dishes with little bits of salmon flesh still clinging to them had yet to be washed. Rome could not stand it any longer he started barking at the plates and barking at my mom and basically needed to be, in my opinion, in a straight jacket with a heavy dose of sedation. As the kitchen got cleaned and the fish put away Rome settled down and then most likely due to a synapses overload passed out. It just goes to show: we all have things that make us crazy, some call it passion, some call it obsession, some call it addiction. Apparently at our house it is called Salmon and while I must admit it was tasty it does not hold a candle to bacon. ~Ruff

Boston on my mind.

Wow what a difference an event can make. We have been crazy here at the hospital and the 15th of April was no different. Our morning started with a TTA Tibial Tuberosity knee surgery, a Regenerative Stem Cell procedure, a Perianal Hernia repair and appointments and then just like that the world gave us yet another cause for pause. An ocean and a country away people were celebrating the completion of 26. 2 miles and were stopped there, literally in their tracks, by terror. It makes me so very sad to know that our world is producing terror on such a grand scale. These events are no longer isolated. I look around at the events that plague the news and think this cannot be, this cannot be the world in which we live. Yet it is. Galileo Galilei said, “I’ve loved the stars too fondly to be fearful of the night”, and yet it is fear we feel in the darkness, tethered to sorrow and bolstered up by anger.

Today as I write, I have a dog here in our hospital with catastrophic but fixable wounds from being drug behind a truck. She does not try and bite us, she lets us simply try and help her because she knows we mean her no harm. Has she come to understand in her years or inherent nature that we truly mean only to help her. While I am sure the wounds are painful and her journey will be long and fraught with struggle and possible set backs she will heal. Fear is all consuming, it is often fear of the unknown, fear of the different or of the risk, that paralyses us. The world is changing: intolerance, indignation and misinformation are running wild like arrant children in a schoolyard. We go online and tear each other down because we can. We damage our children and shatter the innocence so we can feel better about whom we are. We are all equal, we are made of the same things and while some choose to hate, the rest of us choose to love. Think for yourselves, trust your intuition, the voice who says this does not feel right or this is the right thing to do, is the voice you should listen to. Look out for each other; we are all siblings of humanity. We cannot stand by and watch while evil and hate undo our society. We have a moral obligation to defend our children's future even if it is on our broken backs and goes against what our pervasive world broadcasts as the new normal. What these events show us is we need to come together, not tear each other apart.

"the vast majority stands against that darkness and, like white blood cells attacking a virus, they dilute and weaken and eventually wash away the evil doers and, more importantly, the damage they wreak. This is beyond religion or creed or nation. We would not be here if humanity were inherently evil. We'd have eaten ourselves alive long ago.

So when you spot violence, or bigotry, or intolerance or fear or just garden-variety misogyny, hatred or ignorance, just look it in the eye and think, "The good outnumber you, and we always will." ~ Patton Oswalt

This reminded me that sometimes we simply need to look up at the world around us and see the beauty in it. When you see a list published with names of others offering people, strangers, a places to stay, food to eat, even a shoulder to cry on should they need it, it reminds us all to remember that we are who put the human in humanity. We set the example, we guard the secret to our own happiness, insulated by our struggles and shouldered by our own fortitude that good will prevail. Change is hard and it is getting harder to make a dent in the human conscience every day. We have to keep trying to do better, to be better, not better than each other, but for each other. Dr. Head and I try and live by this rule everyday. We go to sleep each night more in love with each other than the day before because we make each other better. We cannot change the world but we can change what we choose to put out into it.

For our friends from Boston and those family and friends that live there we hope only that you do not dwell on the bad. See the goodness that people around you showed in the hours of need not the hate, not the fear; only the love and the compassion. This is easy for me to say a half a world away, but I cannot be angry, that only feeds the fire of indignation. Instead I will choose to show compassion and give hope that all is not lost, it is simply misplaced. We will find it again and be better for it. The evil of the world will try to break you, but like a fractured bone we will heal and will be stronger and better than before. We are all victims in life. We can choose to live like one or we can choose to live like a survivor. Drake said "We are all in the same game just on different levels, dealing with the same hell just with different devils." I try and remember that when life gets harder it just means we have leveled up. There is more work to be done; but we are stronger now and ready for it. This is not how my story of humanity will end. I can and will choose to be the hero of my own story and "Everything will be alright in the end. If it’s not, then it's not the end".

B.A.N.A.N.A.S

B.A.N.A.N.A.S!!! I love them in the morning. In the afternoon. I love them in the evening! Yes, oh yes, I do... ooooh! The other day the very nice men who take care of my yard chopped down one of the banana trees and left the giant bunch for my family to hang up when we got home. I knew this could only mean 2 things. First my family would peel all the bananas and freeze them. Second they would make the most wonderful smoothies ever. I waited patiently in the kitchen while my dad started to peel the ripe, firm bananas. I knew there would be imperfect pieces that were just perfect for me, and sure enough banana chunks fell from the heavens. Dad tossed me a couple odd pieces and then dropped a whole one by accident. I cleaned it up before my mom saw and dad gave me the good boy look, and I knew it was our little secret. I also knew that for mom having a peanut butter banana smoothie for dinner is one of her favorite things and that meant I got to lick the spoon. I also know that is very hard to talk with a mouth full of peanut butter. That’s ok, I can be the silent handsome type on occasion.

I don’t know about you, but for peanut butter and bananas I will do just about anything. Speaking of doing anything for the things you love... I actually have a little something to share with you. Our family, ok my nana and papa to be exact got a new dog. Yep they did, and it was love at first sight. They went to the Hawaii Island Humane Society’s “Tropical Paws” event and came home with a new family member. I heard she is a looker for sure and I also hear she can chew a mean shoe. She sounds like my kind of girl. I heard that the event was a huge success and that the food was amazing. Mom and dad seemed to have a good time and I heard my mom looked stunning. Ok, so dad is biased but that’s what he said “honey you look stunning.” My little human sister was dressed up in a beautiful magenta dress and I heard she danced the night away. It is always so fun to see everyone come home happy and excited. I think next year I should get to go since I am a HIHS success story after all. Then my parents might feel obligated to bring Rome and we all know we can’t take him anywhere.

I have some more exciting news to share as well. The hospital’s pet portal is up and running. If we have your email address we can send you out a link to log in. You can go to our website www.keauhouvet.com and log in from there as well. You can go online and see when all of your pets are due to come see my dad. There is a way to update addresses, phone numbers and even upload photos of your pets right to their file. You can request appointment times and medication requests from the comfort of your house anytime day or night. You can even have it send you an email or a text when your appointment is due. Which reminds me -- Sentinel is back and better then ever! It is also half the price of Trifexis. It does heartworm and immature stages of the flea, as well hookworms, round worms and whip worms. For those pets that can’t seem to take Trifexis and have been waiting for Sentinel’s return, your wait is over. We have a limited supply while they are rolling out the new product but you can rest assured we have enough of all sizes right now to get us through. Come in today and get your 6 packs or single doses. Remember this is an FDA regulated product and it is only available by prescription. Your pet must have a current heartworm test within the last year.

There is so much happening around here and I only have a little space to tell you it all so I guess this will have to do for now. Just one more thing before I forget, I wanted to tell my good buddy Olive congrats on her new little human sister. I heard she is a beauty. I can’t wait to meet her; my mom and dad came home raving about how sweet she is. Until then I guess I will head downstairs and sample the fresh baked bread, I know mom forgot to put away. It goes perfect with bananas and peanut butter. Now if I only knew how to work the stove I would make myself a grilled peanut butter, banana and bacon sandwich (I heard it was Elvis Presley’s favorite). Grilled peanut butter, banana, and bacon sandwich -- no wonder he got to be The King; he had great taste. There is nothing wrong with good taste right? 

~RUFF!

Annual Schmannual

Annual-schmannual

T’was, heart worm and the annual

vaccines, dewormer a fecal we suggest: 

All annuals not created equal,

 ours always offering the best.

Beware the adjuvanted vaccines my pet! 

The Sarcomas that bite, the cancers that kill!

 We use the Non-adjuvanted vaccines, and yet

 People always complain about the bill!

Dewormer prophylactically safety a concern: 

Each year a fecal we do test--
So of Internal parasites we learn.

And what of Parasites inside chest?

Of course a heartworm test each year, 

The recommendation, with fact to show, 

Coughing, gasping the signs oh dear 

That inside heartworms grow!

3 drops! 10 minutes! And then we’ll see
If your pet needs treatment quick!

A missed dose here, and worms come to be 

and then your pet is sick.

Why Senior screening, you do ask? 

Come and think, it’s in the name

 Old age, old age! 7 years to task. 

Organ decline; a blood work shame.

T’was vaccines and the annual 

The best is offered first:

 Suggestions and recommendations

 Science based on worth.

FYI

• The rhythm of this poem is loosely based on Lewis Carrolls “Jabberwocky”

• Vaccines the DHLPP is given every 3 years and contains vaccines for distemper,
  hepatitis, Leptospirosis, Parainfluenza, and Parvo virus. Leptospirosis should be
  given annually in Hawaii; humans can also get Leptospirosis.
  
• In cats, vaccinations have been linked to sarcomas, at a rate of between 1 and 10 per
  10,000 injections in adjuvanted vaccines
  
• The American Heartworm Society and AVMA (American Veterinary Medical
  Association) recommend testing for heartworm annually. As members of the AHS and AVMA this is the recommendation we follow. Heartworm is costly to treat but easy to prevent. Remember to give your pet their monthly heartworm medication the same time every month, or ask us about the injectable medication that lasts
  6 months. When we test for heartworm annually we are also testing for another illness called Ehrlichia. This is a tick-born illness that affects the pet’s red blood cells. When caught early before the pet is symptomatic it can be easily treated.
  
• We use a broad spectrum dewormer to treat your pet prophylactically for worms, like round worms, tape worms and hook worms. All of these worms think humans are delicious as well.
  
• Annual Fecal tests check for internal parasites, such as the aforementioned worms as well as whipworms, and Giardia (except heartworm remember — that’s a blood test).
  
• During your pets’ annual you should expect your veterinarian to do a full physical examination, including looking in your pets’ mouth, ears, nose eyes. They should be looking at your pets’ muscle tone and weight and giving you recommendations based on what they see. There are preset parameters for weight and body score. These things are not subjective but rather based on the guidelines from the AVMA.
  
• A Senior Screen includes blood work and a urinalysis and is recommended in
  dogs over 7 years old and cats over 8 years old. This annual screening allows your veterinarian to see what changes your pets organs have made each year. Blood work is required for any animal over the age of 1 year that is going under anesthesia for any reason. This is for the safety of your pet. 
  

Fact VS. Misconception

https://www.facebook.com/pages/Keauhou-Veterinary-Hospital/329699169653

It is a common misconception on parts of the island that there are no doctors to perform some of the more complicated surgical procedures and that people either have to take their pets to Oahu or there is really no hope. We have been told by numerous clients now that they have been referred off island or told they have to wait until the specialist comes to the island in order for their pets to have surgery. Really? Almost everyone one of these surgeries that have been described, we do here at our hospital. In fact one surgery in particular the TTA ( Tibial Tuberosity Advancement) Is done at our hospital by my dad regularly. We take referrals for this procedure and numerous others every single day. Back surgery for dogs with pinched nerves that are causing deficits in their hind limbs, yep we do it. We also do Myelograms to help diagnosis the problem so we can zero in on the exact location. PDA heart surgery you bet. Bile duct obstruction, thoracic surgeries, gall bladder surgery, difficult mass removals, leg limb deformity (some have even come to us from other islands), even oncology cases from other hospitals are all seen here regularly and with great success.

Did you know my dad was the first doctor in Hawaii to take the course and offer the TTA surgery? It's a fact. There are now 3 doctors in the state, one on Maui one on Oahu, but my dad right here in Kona was the first. Did you know my dad did an internship in small animal medicine and surgery right after vet school? He was also sent to additional training in Ohio with Synthes, for fracture and fixator courses both basic and advanced. My dad performs surgery on complicated fractures, shattered bones and corrective repairs on previously repaired fractures and surgeries daily. In addition to the surgeries we provide, we also offer advance workups in cardiology, internal medicine, VetStem, dentistry and more. This is of course in addition to the general wellness and annual care we provide.

There is a propagated misconception, that we are the most expensive practice on the island. We see everyone else's invoices and we know that is simply not true. What is true, is that we will not put your pet at risk by not doing pre-operative bloodwork or perform surgery without the benefits of monitoring devices, a catheter and IV fluids. We want your pet to have the best possible outcome. We have been told " if the doctor knows what they are doing they don't need all those safety nets". Well, as an AAHA accredited practice, we believe differently. We know that animals that are hydrated during surgery with IV fluids, do better after surgery. Animals lose blood during even routine procedures like spays and neuters and having an IV catheter in place to administer fluids can be very important to maintain proper blood pressure. You never know how an animal is going to react to anesthesia, some animals sail though and some really struggle. Having an IV catheter in place lets us give life saving drugs if we need it, when we need it. It also allows us to reverse the effects of certain medication in case of an emergency. Pre-op blood work is not a way for us to make money off you at all, we do it, because it could save your pets life. We want to know that your pet doesn't have a bleeding disorder or issues with it's kidney or liver functions prior to anethetizing them for a procedure. Your pets kidneys and liver have to process the medication we are giving during surgery, if they are not working correctly, it would be good to know before surgery not during a procedure.

Some procedures especially in animals already in crisis should NEVER even be done with out pre- op bloodwork before surgery and ECG, blood pressure monitoring, end tidal CO2, and O2 monitoring in place during surgery. These things are not options at our hospital, it is a standard of care we have chosen to provide and a commitment my dad made when he became a doctor and reinforced when we became AAHA accredited. Does it cost more, yes it does? Is it worth every penny, you bet. Pain management is another thing we take a lot of flack for. People tell us all the time "well if my pet is painful he will move around less and then I don't have to worry about him running around and getting hurt". Let me ask you, if my dad neutered you and removed your testicles or if he spayed your wife or girlfriend, removing her uterus and ovaries though an incision in her abdominal wall( assuming of course he was a human doctor and not a vet) would you want pain medication? What about if he amputated one of your limbs or plated one of your bones? What about if he extracted your teeth? Studies show that animals feel pain just like we do. They are programmed by evolution however, not to show it. I am sure you have heard of survival of the fittest right? Well we believe in pain management and not the kind that last for a few hours and then wears off. No we are talking about pain medications for days and sometimes weeks after surgery depending on the procedure. Yes even in spays and neuters.

As you can see there is a lot of misinformation out there. We believe in honesty and full disclosure. We know this may not appeal to everyone and well I guess you can't please them all. You can educated them however, by giving them all the information they need to make an informed decision. We have been providing high quality surgical and medical options and care to this island for over 5 and 1/2 years now. My dad has been practicing medicine and performing surgeries for 15 years. We send out information regularly to area veterinarians letting them know we are here and we are happy to help. In turn numerous veterinarians send us their more difficult or unique cases. Coming from emergency medicine my dad is used to seeing other doctors clients and patients and then sending them back to them for routine care. We understand that people build a relationship with their veterinarian and we respect that. This is why we want you to know that we want to help make your pet well, we are not trying to steal you away as a client. We believe in being up-front giving clients a quote for services, we know they will call around and look for whoever will beat our prices, our prices do not change based on the client or the quote they got from another veterinarian. We don't do that. It is not fair to the rest of the veterinary community and it is deceitful. As you can see it is not always an apples to apples comparison in terms of the services provided. It is always frustrating however that we can't all work together for the greater good of the patients. Veterinary medicine changes everyday, and we are committed to staying up to date on the changes. We will always try and learn more and be the best veterinary practice we can be. We know honesty is always the best policy, although it may not make you the most popular. After all your only humans.~ Ruff