Life got in the way of my writing and once I got out of the flow, I found it difficult to get back into it.

But this week, something extremely difficult has happened that hopefully this newsletter will help me to process, and which has me ready to use my voice again.

I hope you will read it through till the end, but my thoughts may be a bit messy, so please bear with me.

On grief

This past Saturday, one of my vet school professors, Dr. Julie Gard, was stabbed to death in broad daylight in the park while walking her dog.

A random act of evil and violence that I can’t even begin to comprehend.

The veterinary school in Auburn, Alabama is an extremely small and tight-knit community. With each class just over 100 students, everybody knows everybody. You see the same people all day, every day for 4 years or longer.

This sort of crime just doesn’t happen there. Or at least it didn’t — until now.

Dr. Gard was truly a special person.

She was the kind of person who was doing her soul work — and you could see that radiating out of her when she taught her students.

She LOVED cows. And she could make anybody else love them too.

Some students adoringly referred to her as Bovine Barbie, with waist-length blonde hair that sometimes picked up a bit of manure while she was palpating (but she never seemed to mind).

She was a Southern woman at heart, but she was never exclusive on the basis of that Southern-ness. She didn’t dismiss me as a Yankee. She invested in me and my education just as much as the bovine-track kids from the south.

She was so joyful in her work and she was happy to share that joy with anybody and everybody who was interested, regardless of where they were from or the level of experience they had.

She helped instill the value and importance of agriculture, farm animal medicine, welfare, and public health into me.

She was brilliant and beautiful and embodied the spirit of Auburn.

But on the day she was murdered, the Auburn Spirit was centered at Jordan-Hare Stadium for a football game, and Kiesel Park was empty.

It was there that my late professor set out for a dog walk through the park, when she was randomly attacked and murdered — her body dumped in the woods — while her dog was left to watch. The assailant then stole her Ford pickup and later abandoned it on Wire Road.

It’s a shocking and horrific story that just hits way too close to home.

I can’t even count the number of times I’ve walked with my dog alone through that park.

And Wire Road?

That’s where I used to live.

My apartment was on that road. That address still comes up every time I do a credit check. It’s the primary shipping address on my American ASOS account.

How could this happen there?

This incident comes on the back of a series of other acts of violence against women in Amsterdam this summer.

Just a few weeks ago, a girl was thrown off of her electric bike, raped and murdered here — the type of story I’ve NEVER heard in my 6+ years living in this city.

Needless to say, recent events have me a bit shook, and just feeling a little less safe in the world.

Grief isn’t something new to me.

As a veterinarian, grief rears its powerful horns through the exam rooms of my clinic every day.

But in the case of my late professor, I’m experiencing a grief that I’m not quite sure how to process.

Dr. Gard and I weren’t particularly close, and I haven’t spoken to her in years. But she was someone who had an impact on the person I am and the veterinarian I became, and I feel her loss nonetheless.

I grieve her death, but I also grieve the perceived safety of the communities in which I once lived. I grieve all the women lost to random acts of violence, which seems to be increasing lately. And I grieve the safety, security, and confidence I once had walking down the street with my dog.

On trauma

As a vet and someone who focuses on the mental health of dogs, the one image I haven’t been able to shake from my mind is the image of her dog.

On the other end of the leash while their owner was brutally murdered and then disposed of in the woods. Standing over her body, barking, pleading, for anyone to come help; defenseless against the assailant. Watching his human slip away — the one he was supposed to protect.

Can you imagine the horror this poor dog witnessed and the trauma he endured?

Thankfully, the dog has been returned to the rest of the family and still has the love, comfort, and protection of home to help him heal.

But those memories don’t leave a dog — and I’m sure he’s feeling a lot less safe in the world right now as well.

Will my late professor’s dog ever enter the park again? Will he ever be able to pass a lone man on the street without lunging at his neck in defense? Will he eat? Will he sleep? Or will nightmares of the attack leave him paddling his puppy legs, sleep-running through his fear, only to wake him every night?

You see, dogs experience trauma much in the same way that humans do.

And with a bond as strong as the one that humans and dogs share, it’s not uncommon for one species to experience trauma, PTSD, or grief in the loss of the other.

There is a case I saw at a clinic in Amsterdam several years ago that has stuck with me.

The client was a single man in his late 30’s-early 40’s that came in with a new puppy.

She was a spunky, lively, loving, 3-month-old mini golden doodle puppy in a varsity jacket.

Straight away, I could see the strong connection that the two shared.

It was instant love.

But it was a love born of grief.

1.5 years prior to adopting this sporty pup, my client had another dog that suffered a terrible accident.

He had a ground-floor art studio that he would leave the doors open to in the summer and the dog would sit at the front door and watch the world go by.

When my client was focused on some art he was creating, he didn’t notice the dog had chased something into the street.

My client heard a car racing down the road and turned his head and saw his dog standing in the middle of the street and screamed her name. Just in the moment before the car hit her, she turned her head back to look at him. And then she was gone.

He told me that he still hadn’t gotten the image out of his head.

For the entire year, he had nightmares and flashbacks, he stopped seeing friends, stopped creating.

He saw a therapist and was diagnosed with PTSD.

The interesting thing about trauma and grief is that it doesn’t stop with those directly affected. It oozes out of those present at the scene and touches everyone in their orbit.

This is why I always find it so crazy when people suggest that veterinarians don’t care, or that they’re just in it for the money, or some similar BS.

Can you not see that we carry your grief too?

My client told me the story of his dog getting hit by a car in such detail that I felt like I was there.

I carried the image of that dog’s last moment, looking back at her owner, all the way home with me that evening. And when I arrived home, I wept.

To this day it is the only new puppy appointment that I’ve wept after.

And I carry it with me STILL, as evidenced by the fact that I’m thinking about it and sharing it with you now, years later.

Stories of the grief and trauma exit through your lips and find place in our hearts.

We carry the stories of hundreds of families like this — like that of my client and my late professor — and we package them up, and hold onto them so you no longer have to.

So you can move on to the next stage in the grieving process, or focus on ushering in the joy that comes with a new puppy.

Which brings me to my final thought:

The circle of life

In the same week that my vet school professor was murdered, my best friend from vet school gave birth to her first child.

A much-welcomed beautiful little miracle of a girl, who arrived following a year+ of multiple miscarriages, scares of infertility, and the risks associated with a geriatric pregnancy.

What a strange and complex thing it is for a community to hold both of these stories simultaneously.

Similar to the feelings experienced by my client with his new puppy.

Life and death, grief and joy, love and loss. A complex swirl of emotions.

The circle of life.

But as we all come to learn, the yin and the yang exist only through each other.

You can’t have one without the other.

There is senseless evil and horror and loss in this world but there is also love. There is also joy. There is also life. There are new beginnings, and smiling babies, and puppies in varsity jackets.

And maybe the knowledge of this is how we move on.

—

For my late professor, for the dogs grieving the loss of their people, for the people grieving the loss of their dogs, and for the veterinarians out there carrying the grief of us all.

Sending love, thanks, and peace,

- Dr. Sami

A handwritten note left with flowers at the entrance to Kiesel Park read, “always an example, forever an inspiration.” And I don’t think I could have put it any better. Rest Peacefully, Dr. Gard.

For me, one of those cases occurred on a standard rainy afternoon in Amsterdam last June.

It was my last consultation of the day — a house call in the center of the city.

When I walked into the apartment, Pearl Jam was blasting through the speakers.

I called out for my client and followed his voice to the back bedroom, where he laid in bed, weak and recumbent.

He used a pulley hanging above his head to lift himself up partway and shake my hand. I knelt down by his bedside to meet him at eye level and confirm what needed to be done.

• Health checks

• Vaccines

• Parasite prevention

• Routine administration

He explained: On Monday, he would be admitted to hospice care and his cats would be transported to a cat hotel. In order for them to check into the hotel, they all needed vaccines and their passports updated.

His laptop was open beside him on his bed, and on the background display was an image of his furry companions.

All four of them together, asleep in one basket.

Before my client lived in this tiny apartment, he had a cottage on the coast. But he sold the cottage and would use the money to support his cats and ensure they could all stay together after he was gone. “Look at these cats,” he said. “You can’t separate them.”

My client grew up living on the North Sea, and it was to there he would return, he explained, his loving cats just down the street.

I commented on what a pity it was that the facility wouldn’t allow the cats to stay with him until he passed. Surely they could accommodate, if only for a short time. He told me not to worry — they would be taking up permanent residence at a fancy cat hotel, having their fur combed and their nails trimmed, staring out the window at the same ocean as he.

His daughter would visit them, and the hotel staff would send him pictures.

As I sat there envisioning this scene, it wasn’t lost on me that a dying man was the one consoling me on the fate and future of his cats.

They were a feral, rebel bunch, those four. A comedic reflection of my client in his younger years. I was down an assistant but eventually managed to wrangle them all solo.

After the whole lot was treated and paperwork completed, my work there was officially done. But it was my last appointment of the day, and I knew deep down that my work there had really only just begun.

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I returned to my client’s bedside and we split a bag of licorice.

We talked about how the world had evolved over the course of his lifetime. We talked about what it meant to be free, our favorite Rolling Stones tracks, and the timeless relevance of Pink Floyd.

I asked him how he felt to be leaving his home on Monday, and he said, “bittersweet.”

The sweet side being that his hospice facility was on the ocean, and he was looking forward to spending his last days with a sea view and the breeze on his face, in contrast to the cluttered inner-city bedroom he was presently confined to.

When I asked him what the hardest part of it all was, he said it was leaving his cats behind.

What was meant to be a 30 minute appointment quickly turned into 120. He talked and I listened, until the sun began to set and his health aid finally arrived.

Then, we bid farewell for the very last time.

I left his home that day feeling a strange combination of things. Mournful, fulfilled, exhausted, but also proud.

Proud to be a veterinarian and proud of my work that day.

On the surface, all I did was administer a few shots and fill in some passports.

But in truth, there were five patients in the room that day.

Only 4 were assigned to me, but the 5th needed care, too. And I was the only one in the room.

I couldn’t take away his pain. I couldn’t take away the cancer.

This man was going to pass away soon. And there was nothing I could do about that.

But I could listen.

And when I listened he told me that his last wish was that his loving cats would stay together.

That was something I could help him do.

And on that dreary summers day, I helped a dying man’s wish come true.

In my own small way, I made a difference.

I’ll catch you at the Rolling Stones 100th anniversary tour in the sky. Until then, I won’t forget you.

Dr. Sami

“I thought all dogs just had bad breath.”

“Yeah, their breath stinks, but their mouths are cleaner than ours!”

If I had a dollar for every time I heard that nonsense, I could’ve retired at 30.

The old fallacies that dogs don’t need any dental care and that their teeth are cleaner than ours are absolute nonsense.

To be put simply, odor = disease.

If there is a foul odor coming from your dog’s mouth, there is disease present. Period.

Dogs need daily dental care, just like humans do.

And dogs that DO receive regular dental hygiene (most importantly, in the form of daily brushing) live on average TWO YEARS LONGER than dogs that don’t.

Who wouldn’t want an extra 2 years with their dog?

Unless your dog is a complete asshole, I’m guessing the answer is: nobody.

Today is Valentine’s Day. It’s a day to celebrate love.

Show your dog you love them by brushing their teeth today.

They may hate it at first, but they’ll thank you at age 15 for their prolonged health span and hundreds of additional pain-free days by your side.

Plus, kissing them will be much more fun :)

Happy Valentines Day, and Happy Pet Dental Health Month.

Give your dog a kiss from me (but only after you brush their teeth 😉)

🦷❤️

Dr. Sami

I went into veterinary medicine for the animals, but I stayed for the people. The humans of veterinary medicine are some of the best people I know. They’re brilliant, compassionate, honest, quirky, genuine, and vulnerable. They’re the kind of people who will sleep in a cage so a hospitalized animal doesn’t feel lonely, sacrifice time with their families to stay in the lab and confirm their diagnosis for the 10th time, give up their lunch to a picky-eater patient, or drive an hour to pull a calf at 2am in the dead of winter. Veterinarians are some of the greatest people on earth.

One of those people is Dr. Eric Fish. When we first met at Auburn, he was a resident and I was a vet student, and I quickly identified him as the only other non-faculty nerd that consistently showed up to 7am onco-pathology rounds each month. Having earned both a DVM and a PhD, I like to think he’s got a brain so nice, they made him a doctor twice. Beyond the brilliant veterinarian, scientist, and educator that he is, Eric is also a gifted writer and the author of my favorite Substack, All Science Great and Small. He’s been a huge support and inspiration to me as a writer, and I’m so excited to share a bit of him and his story with you in this intimate 7 question interview. I hope you enjoy it!

-Dr. Sami

Dr. Eric Fish, a veterinary pathologist, scientist, and educator with experience ranging from academia to diagnostic laboratories to start-ups. You can read his published research here. His interests span veterinary medicine, molecular biology, and technology (especially AI), along with a passion for travel and learning about the world.

1. After you graduated from veterinary school, you went on to specialize in clinical pathology, but this wasn’t always your plan. Can you tell me about the day you decided that you no longer wished to enter clinical practice? Was there a “line in the sand” moment where you decided enough was enough?

Believe it or not, when I first entered vet school, I intended to be a mixed animal vet practicing in a rural area. My role models were the local general practitioners in Western New York who treated all types of animals at a reasonable cost, sometimes in their homes that doubled as their clinic. During summer breaks in college, I worked on dairy farms on Lake Ontario and at a one-doctor small animal hospital in Niagara Falls.

When I arrived at WesternU in California, I was exposed to so many different sectors of the profession, and everything seemed interesting! Anatomy, physiology, and pathology were endlessly fascinating. I loved the puzzle-solving element of both internal medicine and pathology. Specialization in either offered the challenge of working up the hardest cases, along with potentially higher pay, which was a growing concern as the reality of repaying my six-figure student loans sunk in.

I decided to pursue a rotating internship because it was required for an internal medicine residency and would also make me more competitive for a clinical pathology residency. Overnight emergency shifts were stressful, but in a weird way, kind of fun— there was no shortage of new things to learn, and the variety kept me from getting bored. Internal Medicine was a blast with fun procedures like endoscopy, joint taps, and bone marrow aspirates. The two most frustrating parts of IM were managing the owners of long-term patients who were never cured, and the cases where we hit a diagnostic dead-end and just prescribed guesswork treatment like steroids. On the other hand, clinical pathology offered most of the fun aspects I liked about IM without those “bad” parts.

But to be honest and vulnerable, what really made the decision for me was my time on the Community Practice rotation. Ironically for my initial goals, I was actually a pretty crummy general practice vet. I messed up vaccine schedules. I had trouble with the different preventative care recommendations. And worst of all was surgery: I was responsible for supervising DVM students on spays and neuters and had to lead them through procedures I barely felt comfortable doing myself. In one instance, I told a student something incorrect that could have resulted in a serious complication. While a faculty member above me caught the error and no harm came to the patient, they placed me on probation.

This was a huge blow to my confidence. I doubted whether I should be a practicing vet at all. The deadline for clin path residencies was fast approaching, so I took the plunge and applied. In retrospect, imposter syndrome is very common among new grads, and I probably could have overcome my weaknesses with time and practice. However, on balance I still made the right call and am happy to be a pathologist.

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2. For the pet parents out there who maybe aren’t aware of what you do — what is it like to be a veterinary clinical pathologist? What made you choose the route of clinical pathology? What have you enjoyed most about working in this specialty, and what have been some of the unique challenges that you’ve faced?

Pathologists are essentially diagnostic consultants, sometimes referred to as “the doctor’s doctor.” We spend 3+ years after vet school learning everything there is to know about autopsies, blood tests, biopsies, cultures, PCR, and more. Much of my day-to-day work involves looking at fluid and tissue samples under the microscope to tell the referring vet whether their patient has cancer, an infection, or some other disease. Sometimes we are asked to help troubleshoot lab errors or weird results, or to help the clinician select the next appropriate test.

Clinical pathology was a perfect fit because as I mentioned earlier, I love solving these medical puzzles, which is necessary for getting the right treatment to your pets (and farm, wildlife, and zoo animals!) Even though I do not have direct patient care responsibilities anymore, my time as an intern and ER vet highlighted the importance of this work. You can think of pathologists like a kicker on “special teams” in US football: even though they are only brought onto the field occasionally for specific plays, they are critical to winning games, and you hope yours is highly accurate!

3. You’ve been a part of the profession for over a decade now. What are some of the more surprising ways that veterinary medicine has evolved since you’ve become a vet? What are some of the major issues our profession is dealing with, that you’ve experienced personally?

I would group the biggest changes into three categories: (1) medical advancements, (2) technological shifts, and (3) seismic changes in veterinary education. In terms of #1, it has been incredible to watch diseases that used to be uniformly fatal become manageable in such a short time. Feline Infectious Peritonitis (FIP) is a great example that I recently wrote about: When I was a DVM student a little over a decade ago, nearly every cat with this terrible virus died. Fast forward to the early 2020s, and researchers at UC Davis, Colorado State, and other universities discovered antiviral treatments that cure virtually every patient!

For #2, technology has fundamentally altered the dynamic between clinicians and pet owners. Early in my career, we were already familiar with the problem of “Dr. Google”—clients who did their own research and came in with a list of questions (and sometimes their own suspected diagnosis or treatment demands). Today, this phenomenon has been turbocharged by social media, podcasts, newsletters, and AI systems like ChatGPT. This is a double-edged sword: It does benefit our patients to work with more engaged and informed pet owners. However, that assumes the information they are coming in with is accurate and reliable; when people go down rabbit holes filled with misinformation or conspiracy theories, it can be twice as hard to convince them to accept your medical plan. On a side note, there have been some interesting connections between #1 and #2: it was several social media groups like “FIP Warriors” on Facebook that helped import these drugs from China and pushed for regulatory approval in the US.

Finally, veterinary education is rapidly evolving. There has been a massive proliferation of new vet schools in the last 5 years; there may be as many as 30% more programs opening by the end of the 2020s. The road towards this was paved by perceived shortages during the COVID-19 pandemic, changes to vet school accreditation standards, and frankly, some financial opportunism by schools. On top of this, we’ve seen the recent push for so-called “midlevel practitioners” that can diagnose, prescribe, and do surgery with minimal oversight, culminating with voters approving the Veterinary Professional Associate position in Colorado last November (likely to be followed in other states). How these ultimately impact the profession remains to be seen. If they improve access to pet care that would certainly be a good thing. However, I think there are real questions about whether there is even a shortage of vets, and I worry about how rigorous the VPA training will be compared to the very expansive scope of practice. We’ll just have to wait and see how it shakes out…

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4. You talk a lot about the use/role of AI in veterinary medicine. What are some of the things that pet owners should know about the newfound role of AI in veterinary medicine? Is there anything we should be cautious of?

For pet owners who use AI chatbots like ChatGPT, know that they can be great tools, but the way the technology works can produce so-called “hallucinations,” aka making things up. They are also general-purpose tools that were not specifically trained for medical use. So, it is important to verify anything these systems say with an outside source. One (free) tool that is great for this is Perplexity.ai. It works like ChatGPT, and the creators tuned it to reduce the frequency of such hallucinations. What’s more, every statement you get from the system is backed by a citation with a link to a website so you can verify its claims. I have been using Perplexity for over a year and found it is generally very accurate, no major errors yet.

There are so many creative ways you can use AI! You can input text or documents from your vet or pharmacy and ask it to explain them to you in layman’s terms. You can have these systems generate questions to ask your doctor during an upcoming visit. You can even use it to see if there are any interactions between your pet’s multiple drugs or supplements, so nothing falls between the cracks.

One of the things that concerns me most about AI involves computer vision (systems that interpret photos or videos) for diagnostic imaging. This software can help radiologists and pathologists identify subtle findings and speed up their work. However, they are not perfect and can produce misdiagnoses, so it is important that a human is always overseeing such software. Many companies are pushing forward with AI-powered systems that could reduce human involvement in diagnosis, potentially eliminating it altogether. In my opinion, the technology is just not there yet. Pet owners should ask their vets if AI is being used in any of their animal’s diagnostics. If the answer is yes, they should be prepared to explain how it works and why they are confident in the results. Inability to clearly explain those points would be a big red flag.

5. Some of my most valuable experiences as a veterinarian have been those on the opposite side of the exam table—when I was actually the patient, and not the doctor. These experiences open our eyes, fuel our compassion, and teach us so much about medicine, health systems, and the patient experience. What have you learned from your experiences as ‘the patient?’ What were some of your greatest takeaways from your recent hospitalization?

Last summer I spent a week in the hospital with pneumonia. It capped a monthslong upper respiratory infection that kept progressing. I suspect stress and constant traveling for work wore me down and weakened my immune system. While I was fortunate to not need aggressive care like a ventilator, I was on a battery of IV antibiotics, and for the first few days I lay in bed miserable with an unrelenting fever, coughing constantly.

The whole experience was very humbling. As a patient, you are so vulnerable, and depend on nurses, doctors, and aides for not only your medical care but also basics of hygiene, nutrition, and comfort. I’m a Type A person and having to page staff for things like help getting to the bathroom was difficult to accept. It certainly increased my compassion for our animal patients who can’t understand what’s happening to them.

Being a patient also made me realize the preciousness of the samples I evaluate in the lab. Every day they had to stick me with needles to collect blood for various tests. By the end of the week, I was covered in bruises. They even put an endoscope down my lungs under anesthesia to collect fluid for culture. It was a good reminder that any time I complain about the quality of a sample or ask for a resubmission, it can be stressful and even painful for the patient down the hall.

Lastly, this episode demonstrated the power of the words in my biopsy reports. Part of why they scoped my lungs in the first place (not a routine procedure for a first-time pneumonia patient) were some scary-sounding sentences in the CT scan report. It turned out that was probably overly cautious and defensive on the radiologist’s part, but it was impacted by the minimal history on the submission form from the ER. It has made me more careful about listing unlikely differential diagnoses or tests just for CYA purposes.

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6. Your cat, Phoenix, was your companion through many chapters of your life—both personally and professionally. You write about him often and it’s clear through your writing how much he meant to you. How did you cope when he became ill and passed away? How did you balance being his dad with being his doctor? If you could go back in time, is there anything you would do differently in managing his case?

I think one of the hardest things about being a veterinarian is overcoming the idea that we should always be able to fix every medical problem. Vets tend to feel personally responsible for all their patients, but we can feel especially helpless or even guilty when our own pets don’t respond to treatment the way we hope. Sometimes knowing the natural course of a disease makes it worse.

Phoenix endured so many health challenges in his life, he truly had at least nine lives. One of his most significant was a multi-year struggle with Inflammatory Bowel Disease (IBD) and secondary problems like developing diabetes from the steroid treatment. In 2018, he lost a lot of weight and stopped eating. We feared it might be the end but agreed to try a feeding tube and some last-ditch changes to his medications.

Another difficult thing about being both a pet parent and a veterinarian is you can lose a sense of objectivity; it’s easy to be in denial about the severity of illness when it’s your own family. To combat this, my wife (also a veterinarian) and I set a timetable and objective metrics to determine success or failure. We were fortunate to work with several great outside vets who gave us reality checks as needed. Remarkably, the feeding tube worked and he turned a corner. Phoenix started eating on his own, gained weight, and returned to a good quality life for years.

The end came in early 2022 when he was diagnosed with an aggressive form of cancer in his liver and spleen. We knew the prognosis was poor and opted for palliative care to enjoy whatever time we had left. A few weeks after his diagnosis, I had to go out of town for a two-day work trip. Phoenix seemed stable when I left, but he precipitously declined over the next 24 hours. Over the phone that night, we agreed it was time to euthanize him when I got home.

We never had the chance. Hours before my return flight landed, Phoenix slipped into a coma and died at home surrounded by my wife and our other animals. I was able to say goodbye from the plane over FaceTime, but not being able to hold and comfort him in his final moments was devastating. That remains my greatest regret: If I could do things over again, without question I would have cancelled that trip and stayed home with him.

Grieving Phoenix took months. Just when I was beginning to feel OK again, our other cat Ezra became severely ill and had to be euthanized the day after my birthday. The loss of both cats in such a short time was almost too much to bear. I became depressed. Ultimately, what brought me out of the tailspin was a combination of the love and support of my wife and family, along with a great therapist. In addition, I started writing about the experience and found it cathartic. The saga turned into the essay “When Pathology Becomes Personal,” and inspired me to start writing on Substack full time.

7. As veterinarians, our pets are some of our most valuable teachers. What were some of the biggest lessons that Phoenix bestowed upon you? In what ways is he still with you today?

The biggest lessons I learned from Phoenix were to expect the unexpected and to be persistent. Many people would have thrown in the towel and given up years before he reached a terminal diagnosis. During his 2018 illness, he almost bled to death from a complication of a routine diagnostic procedure (collecting urine from the bladder with a needle). It turned out to be due to vitamin K deficiency from poor gut absorption. This was something that had been documented in one case report in the 90s, but even the specialists at Auburn had never personally seen it. We were able to quickly fix it with Vitamin K injections and getting his IBD under control.

Phoenix lives on in the memories of everyone who knew him. That little black cat was beloved by my friends, family, and veterinary personnel in a half-dozen states. We still tell funny stories about him, like the time he casually walked over a lit candle and singed his tail (never batting an eye), or when he stole a basting brush covered in BBQ sauce and ran around our house with it in his mouth, growling when we tried to take it back.

Finally, I got a tattoo of Phoenix on my calf to memorialize him, so he is literally with me every day. I worked with a wonderful local artist to render him as an illustrated portrait, rather than a photorealistic one. Every time I look down at him, he makes me smile.

If you loved this interview and want to hear more from Dr. Eric Fish, be sure to subscribe to his newsletter, All Science Great and Small.

In the age of chaos and misinformation, Eric is a sound and trusted voice in the veterinary, science, and technology space.

A portion of all proceeds from paid subscribers goes directly to helping animals at the Humane Society of Tampa Bay.

Luca and I have been in Mexico City for one week, and so far, we have nothing but rave reviews.

The food, the culture, superb urban design, the people, and of course: THE DOGS ❤️

It’s been the perfect place for us to start the year. And end it, too?! Who knows.

Perhaps too premature to call it, but if things continue this way, we may never leave.

Heres why you should also travel to CDMX with your dog in 2025:

Traveling from US is super easy.

• Short flight.

  Compared to other foreign countries you could visit with your dog, Mexico is super close. If you’re worried about how your dog will do on a long-haul flight, this would be a great first place to visit.

• No special treatments necessary.

  As long as your dog is healthy and has an active rabies vaccine, you won’t need any special treatments to enter Mexico.

• No health certificate needed.

  Just check in with the department of agriculture before you walk out of baggage claim, show them a clean belly, and you’ll be on your way.

Mexico City is an urban dog’s paradise.

Seemingly everyone has a dog (or two).

They all wear sweaters and walk off leash along garden enclosed corridors.

People are boxing in the square or doing yoga in the park while their dogs wrestle in the morning sun alongside. That means while you’re on your way walking to anywhere, your dog is bound to run into a friend or two.

Abundant social interactions contribute to better overall life quality and increased health-span.

Dogs are welcome in nearly every establishment.

Water bowls line the streets.

Cafes, restaurants, shops, and gymnasiums all welcome dogs and have a jar of cookies behind the counter. The other day a barista offered Luca a “perrocino.”

Like a puppacino, but make it Latin. 😂

CDMX is a very green city.

That means there’s much to sniff and never short of places to wee.

The weather is perfect.

Weather is quite temperate in the winter, and lush mature greenery provides shady relief in the summer, so it’s great for dogs that tend to be more sensitive to temperature extremes.

Dogs and people alike are both welcoming and friendly.

Given the abundance of dogs and their active lifestyle, they’re all very well socialized from a young age.

This means less anxious or aggressive interactions with other dogs.

And because people are surrounded by dogs, they all know how to interact with them appropriately, which means less scary, intrusive, or negative interactions for your dog.

Sound too good to be true?

Well, Mexico does have its downsides, too.

3 things I’m looking out for while we’re here:

1. Drinking the water.

Differences in water treatment and quality standards are a stereotypical issue one might encounter in Mexico. E.Coli, salmonella, and Giardia are all a risk. So if your dog has a sensitive belly, the abundance of water bowls lining the streets might not be for them.

2. Altitude and air quality.

One of Mexico City’s issues at the moment is air quality, which can be particularly poor on cloudy days. Dogs with respiratory issues probably wouldn’t fare as well here (although you probably shouldn’t put those dogs on a plane anyway).

3. Wounds (esp enlarging wounds).

Enlarging wounds are one of the signs for new world screw worm, cochliomyia hominovorax, a re-emerging risk in southern Mexico.

This is one of those spooky “foreign” animal diseases we learn about in vet school.

It’s rare, but it’s SERIOUS y’all. Once an animal becomes infected; they can die within days without the appropriate treatment. The US is so spooked about the re-emergence of this disease that they’ve recently invested 165 million to prevent it from crossing the US border.

If my dog develops a wound in southern Mexico, I’m going to be watching it like a hawk.

Thankfully, for now, we’re in the clear across the board.

On another note:

Interestingly, I’ve noted there are hardly any waste bins on the street. Despite this, there’s no sh*t lying around. People seem to pick it up and dispose of it… where?

I’m still figuring that out.

For now, I’m just carrying bags of sh*t around the city like a moron.

Adios for now,

Dr. Sami

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PS. If you have any recommendations for pups or people visiting Mexico City, please send them our way!

ICYMI:

10 Lessons I’ve Learned From 5 Years of International Travel With My Dog

Top 5 Mistakes to Avoid When Understanding Legal Requirements for Moving Abroad with Your Dog

12 Clever Hacks for Sneaking Exercise into Your Urban Dog’s Routine

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A few days ago Luca and I were on a flight to Mexico City, seated next to a man from LA, and discussing this very topic.

“It was the weirdest thing,” he told me. “Before the fire, there were almost no animals around.” No birds in the sky, no mammals scurrying about.

They all seemed to know, before the humans did, that trouble was on the way.

“Then out of nowhere, we saw two coyotes absolutely hightailing down the street.”

Anyone who lives on the west side of the North America knows that coyotes don’t run, they mosey. Not even a car will send them sprinting — they’ll trot off calmly, expecting you to wait. But these two animals were, quite literally, running for their lives.

And sure enough, moments later, the fire appeared— rapidly approaching.

Where do all the animals go when the world is on fire?

If they’re wildlife, you hope their intuition directs them to safety.

But what about the pets who were living in the urban and suburban areas affected?

Well, we hope they’re able to make it out of their homes with their families in time.

But the truth is, not all of them have or will.

Imagine this:

You live at home as the sole caretaker of your ailing and disabled mother. Though it’s just the two of you, you’re far from alone, because you have a house full of cats, dogs, and fish that you call family.

When the warning from CalFire arrives in the middle of the night, you look out the window and see the fire rapidly approaching.

You have just moments to leave your home, rolling the wheelchair of your elderly parent.

You can’t find the cats.

You can probably hold the dogs on leash while you wheel the chair, but you don’t have any time or a travel vessel to scoop all of the fish from the aquarium and transport them.

You start scrambling.

Can fish breathe in Tupperware?

Where the fuck is the Tupperware?!

You wish desperately to collect everyone, but if you wait another moment, you might not make it out alive.

You have no choice but to leave the fish and the cats behind.

Without even a chance to cry, you leave the front door open hoping the cats will somehow find their way, and you follow the crowd of your neighbors running for the hills.

It can be so easy to look at people who leave their animals behind in a natural disaster and say, “How could someone DO that?! I COULD NEVER!”

But as you can see, it isn’t always that simple.

Even animals that are able to evacuate with their owners may end up separated or lost amidst the chaos.

A collection of rescue organizations in LA has created a shared spreadsheet to track animals that have been lost and found in the LA fires.

I was shocked to see the animals included in this list. Puppies and piglets, ponies and kittens, a group of domestics ducks. Even a goldfish in a mason jar, y’all. I shudder to think what they’ve been through and how they survived.

Please share this Google sheet far and wide, and let’s get these animals reconnected with their families.

My heart and prayers to the state of California,

Dr. Sami

While it’s a joyous time, the holiday season poses numerous risks for our pets. From dangerous decorations to enticing poisonous plants and unknowing guests, holiday hazards are all around us.

If you also asked Santa to keep your pet healthy this season, stay vigilant about the following:

Treat Safety

Your pets will want to enjoy seasonal treats as much as you do, but frankly, it’s not always in their best interest.

1. Go slow with new dog/cat treats. If you’re like me, your dog’s stocking is stuffed fuller than yours. Be careful with how many treats you’re giving them, and if you’re giving them a rich treat they’ve never had before, give them a small piece to see how they tolerate it before allowing them to wolf down the whole thing. Dogs especially have extremely sensitive GI tracts, and one piece of a new duck jerky could give them diarrhea for days. Better not.

2. No chocolate! There’s always a lot of chocolate and candy around the holiday season. Chocolates are especially toxic to dogs, so when you empty your stockings, be sure that you don’t leave any laying around where they can get to it. Make sure your kids are aware of this risk, too.

3. Avoid table scraps. Foods high in fat can cause pancreatitis. Pancreatitis can range from mild GI signs that can be managed at home supportively to a serious and life-threatening problem requiring hospitalization. If you feel bad not sharing the table with them, you’re better off keeping a small helping of kibble or treats that are safe for your pets handy to avoid giving them food from the table.

4. Avoid common toxic human foods. I can tell you not to feed your pets human food all day long, but I know for some of you that will fall on deaf ears. If you really want to give people food to your pet, give safe foods only such as plain carrots, green beans or sweet potatoes. Make sure anything you offer them isn’t prepared with any of these common household foods that are toxic to pets.

5. Warn your guests. Let your guests know what is safe to feed your pets when they are visiting your home. If your pet has an allergy, everyone should be informed. I typically keep a magnet with a list of toxic human foods that cannot be fed to my dog on my fridge. As a general rule of thumb, it’s safest to ask everyone not to feed your pet at all.

6. Take out the trash. Be sure not to leave trash cans full of holiday food scraps after your guests leave to prevent pets from getting into it and causing GI upset.

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Decoration Safety

Christmas trees and other decorations present multiple hazards for dogs and cats. Cats especially seem to find joy in the holiday decoration mischief. Consider the following to keep them out of the ER.

1. Anchor the tree. Whether it’s tug of war or a cool new place to jump up in and hide, animals love to mess around with the tree. Consider anchoring the tree to the wall with rope or wire to prevent it from being knocked over. (PSA: I didn’t do this this year and my 15 foot tree literally came crashing down, with my dog running out from under it just in time — FEAR) You can also consider blocking off access to the tree with baby gates.

2. Do not allow pets to drink water from live trees. The water at the base of your live tree is treated with chemicals to extend the life of the tree and can serve as a breeding ground for bacteria as the tree ages. If they drink this, they can become very sick.

   Keep their bowls filled with fresh water at all times to prevent their interest in the tree water. If they’re still going for it, create a cover for the water trough and lift it only when adding water to the tree.

3. Keep ornaments out of the reach of pets. Keep the ornaments higher up in the tree where they’re out of reach for pets.

4. Avoid glass ornaments. If you have fragile glass ornaments, these are best avoided as pets will sometimes eat shards of these if they fall and break from the tree. I know that sounds crazy, but it wouldn’t be the first time I’ve seen a cat for eating glass. Glass shards also put your pet at risk for a paw pad laceration, which bleed a LOT.

5. Avoid string and tinsel. Many decorations can lead to GI obstruction if consumed, but nothing is worse than a linear foreign body, which is what occurs when a pet eats string or tinsel. Cats are especially notorious for eating string and tinsel, so it’s better to just keep that stuff out of the house entirely.

6. Careful with candles. There’s nothing better than candles to create a cozy atmosphere during the holidays, right? I love ‘em too. But candles present the risk for a burn injury or a fire hazard when knocked over by pets. Candles should be kept high enough where pets cannot access them. And if you have a cheeky cat that just can’t help himself, perhaps consider using electric candles instead.

Holiday Plant Safety

Holiday plants including poinsettias, holly, and mistletoe are toxic to pets. Although the effects of toxicity are generally mild, these should always be kept out of reach. A few points on these beautifully toxic plants:

1. Holly.

   While holly berries are an important winter food source for birds, they’re toxic to dogs, cats and humans. Several varieties include saponins, which can cause severe vomiting and diarrhea if eaten. The pointy edges of the leaves can cause mild traumatic injury to the inside of the mouth. Other symptoms include drooling, lip smacking and head shaking.

2. Mistletoe.

   Not all mistletoe is created equal, with American mistletoe being less toxic than European mistletoe. But regardless of the stain you have in the home, you should be cautious with this plant around pets. Ingested in small quantities can lead to signs of mild GI distress. In very rare cases, when ingested in large enough quantities, mistletoe toxicity can lead to a low heart rate, seizures, and even death.

3. Poinsettias.

   The milky-white sap inside the plant is irritating to your pet's mouth, stomach, and skin. Ingestion can cause drooling, oral pain, and vomiting if ingested in large enough quantities. However, the symptoms are usually mild enough that medical intervention is rarely needed.

If you suspect your pet has been exposed to any poisonous plants or other holiday toxins, contact the ASPCA Animal Poison Control Center (USA): +1 (888) 426-4435

Other poison control numbers to keep on speed dial:

• Pet Poison Helpline (USA)

• Nationaal Vergiftigingen Informatie Centrum (NL)

Ensuring the safety and well-being of your pets during this festive period is crucial.

Let’s keep the holidays memorable this year for a good reason.

🎁🎄🕍🎁🎄🕍🎁🎄🕍🎁🎄🕍🎁🎄🕍🎁🎄🕍🎁🎄🕍🎁🎄🕍

Happy holidays!

Dr. Sami

While the two Labs did their dance — sniffing, play-bowing, and jumping in circles — I asked the man how old his girl was. He beamed, ”14 months!” Just like a proud father would speak of his developing child.

Why yes, the changes happen so quickly at that age! 😂

As I laughed to myself about this exchange, he continued, “I hope she’s still hiking at 8 years old.”

Damn.

That hit me. Until then, I hadn’t really considered it, but I am lucky that Luca can still be so active with me. At 8 years old, this level of activity isn’t always guaranteed. And sometimes, I take Luca’s vitality for granted.

He still wrestles puppies to the ground and runs circles around other dogs at the park. After watching him and learning his age, the response of other dogs owners is always the same — “Wow, he plays like a puppy!”

Yeah, he does.

And that’s often how I think of him, too. But the fact is, my puppy is getting older. And to avoid that truth or to think anything otherwise is a disillusion that could ultimately put him in danger.

The perfect example of this came last summer during our stint in Montenegro.

We set out to hike Bobotov Kuk in the Dinaric Alps. Standing at 2,525 meters (8,278 feet) in elevation, Bobotov Kuk is the highest peak in Montenegro. 12+ kilometers through variable terrain, with boulder-hopping, cable passages, and scrambles included.

It was a difficult hike for a dog, no doubt.

But a younger Luca would have smashed it out of the park. This is a dog that’s hiked through the Swiss, Austrian, and German Alps. He’s done multi-day hikes in Norway and torn through the Scottish highlands. I didn’t give it a second thought.

But halfway through the hike in Montenegro, it was clear we were in a different position. Though we made it through safely, my poor boy struggled the entire way down from the summit, and we completed the hike 3 hours later than expected.

That was the first time I was truly confronted by his aging.

When I reflected back on the hike, I realized that my expectations of him were too high. We hike all the time, but the last time he had done a hike of comparable difficulty, he was only three years old — not seven-going-on-eight. It didn’t help that we took a wrong route, turning our 12 km hike into an 16 km extravaganza. That distance and elevation gain in one straight shot is way too much for a dog. And even if we had landed on the shorter route — he just can’t do things like that anymore.

At age 8, my dog is approaching his senior years.

Beyond his reduced hiking stamina, he’s starting to show his age in other ways. He’s also:

• Less heat tolerant

• Walking behind me on long walks

• Stiff in his gait after rising from a nap

• Tiring more quickly from duck-chase swims

• More reluctant to plunge into deep water and more often in need of my help to get out

• And after a long day of strenuous activity, he spends the entire next day in recovery

As he enters the next phase of his life, I find myself caught in constant deliberation over whether to include him or to leave him safely at home.

If I leave him behind, I feel guilty until I reach a difficult scramble, or the persistence of the beating sun confirms that I’ve made the right decision. If I bring him, I worry the entire way: about his water intake, energy level, sore paws, achey joints, and everything else.

On the one hand, I want him to live the richest, fullest, and most active life that he can. I selfishly always want him around and want to make as many memories with him as possible. But on the other hand, I don’t ever want to push his aging body too far, or run the risk that he could become sick or injured from our activities (especially in a remote area without access to emergency rescue services, God forbid).

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Another layer that adds to my uncertainty is the growing discordance of our physical capabilities.

As he begins to show signs of wear and tear, I feel like I’m reaching my peak physically. I’m the strongest and fittest I’ve ever been, and I’m drawn to longer and more challenging hikes. But what my dog needs is shorter, less strenuous, low-impact activity. Less intensity, higher frequency. So I have to strike the balance of challenging us both, while recognizing that just because I can do something doesn’t meant mean that he can do it.

Even if he’s been able to do everything with me in the past.

Every adventure needs to be assessed on an individual basis, with careful planning and consideration for the distance, duration, elevation gain, climate, terrain, natural resources, and more. As the limits of his physical capabilities continue to shift, so will my guidelines for when to bring him along.

Some general rules of thumb:

• Scree or gravel terrain (such as in the Dinaric Alps) is a no-go.

  • This terrain is particularly difficult for dogs. Imagine walking barefoot down a gravel driveway — ouch! The tiny rocks and pebbles also create an unsure footing, causing them to slip and slide and strain their joints. Luca’s aging mountain paws just can’t walk those paths.

• Hiking in full sun exposure for >3 hours without a lake to jump in or shady places to rest is also a no-go.

  • This is true for 21 degrees celsius (70F) and up. Spring/summer on the mountain always feels warmer. And though mountain climate is variable and unpredictable, a drop in temperature will be much better tolerated than the opposite.

• You always need more water than you think, and if your dog needs more than you can honestly carry, he just can’t come.

  • Banking on natural water sources isn’t safe or reliable. And they should never be allowed to drink from stagnant/standing water.

• If you’ve never done the hike before and you’re not sure your dog can manage it, it’s better to do it yourself first.

  • This is especially true in a foreign or unfamiliar land where you don’t know how things work or what to expect. You should assume you won’t have cell connection, access to emergency services, or access to any other resources.

I would never advise anyone to bring their dog into a dangerous or uncertain situation, but you should always be prepared for them. Better safe than sorry.

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Some other things I’m doing to improve the life of my aging dog:

• Trimming the fur between his paw pads

• Keeping his nails very short (I recently switched to the Dremel and am using that every few weeks)

• Avoiding fetch on slippy surfaces

• Switching to extra thick cushiony beds

• Giving his supplements religiously

• Keeping him at a lean body weight

• Adjusting my expectations of him

That last point is the hardest one, but next to maintaining a lean body weight, it’s also the most important.

Earlier in this article, I wrote that my dog was approaching his senior years. That was honestly difficult for me to write, but he is. While he is still very healthy, active, and energetic, he isn’t as young as the once was, and that’s just a fact.

This mental adjustment is very important to make, because it changes the lens through which I’m seeing him and making decisions on his behalf. Without it, my expectations for him are too high, and I run the risk of putting him in danger.

I’m so fortunate to have a strong and active 8-year-old dog that can still go hiking with me, but if I want to keep it that way, I need to keep him safe.

Even if that means leaving a sad pair of puppy eyes behind at the front door every once in a while.

Adventure safely,

Dr. Sami

See also:

• 3 Important Supplements I Give My Large Breed Dog Every Day (How They Work And Why I Use Them)

• What Every Pet Owner Needs to Know About Preventing Osteoarthritis

• An Arthritis Management Plan That Will Reduce Pain, Improve Mobility, And Keep Your Pet Moving Longer

🎧 Listen to the full episode on Spotify 🎧

Episode Breakdown:

Dr. Sami Morici is an American veterinarian living in the heart of Amsterdam and is the founder of The Good Boys Club in Amsterdam.

Her story of leaving everything she thought she ever wanted behind and choosing reinvention is a powerful one. Dr. Sami’s journey begins in New York. After years of veterinary training to specialize in animal oncology, Sami had a pivotal moment that led her to question the traditional career trajectory.

Despite being on the path she always dreamed of, she instead withdrew from her residency and packed her bags, and, together with her dog Luca, moved to Amsterdam to seek a different kind of life.

Navigating a new culture and language while working in an emergency veterinary clinic during the pandemic, Sami quickly adapted to the Dutch approach to life, medicine, and community, where work-life balance and quality of relationships are highly valued.

She shares her observations on how Amsterdam’s unique values, such as the importance of animal welfare and community care, have influenced her veterinary philosophy. Sami’s practice and membership community, combines house calls with telemedicine, making her an accessible part of each pet’s life. Her vision is to reimagine the veterinary experience, creating a supportive partnership for pet owners, with an emphasis on the pet’s quality of life.

Sami also shares some of the things to consider logistically when bringing or adopting pets abroad and offers valuable insights on choosing the right animal for your lifestyle. 

She also discusses the essential support network needed for international pet ownership. Her dedication to understanding pets on a deeper level and helping owners nurture their pets’ emotional well-being aligns perfectly with her practice’s mission.

Key Moments:

1. Finding Purpose and Reinvention - Sami recounts her decision to leave the veterinary oncology path, following an intuition that eventually led her to Amsterdam.

2. Pets in Amsterdam  - Sami describes how Amsterdam’s community-centered approach, emphasis on life balance, and unique values toward animals contrast with those in the U.S.

3. Starting The Good Boys Club - Sami shares how her practice combines traditional care with digital accessibility, aiming to be a consistent, supportive presence in her patients' lives.

4. International Pet Adoption Tips - Practical advice is shared on choosing pets that align with your lifestyle, particularly important for expats adjusting to new surroundings.

5. The Value of Connection in Animal Care - Sami has learned how deeply intertwined human and pet mental health can be, underscoring the impact of our well-being on our pets' lives.

🎧 Listen on Spotify 🎧

Sami the Vet is a proud member of the House of Peregrine community, a place where expats come to create and connect about living abroad with others doing the same!

For anyone out there who is looking to take the leap and leave the United States for something new, leave a comment or shoot me a message. I’d be glad to chat with you about life abroad, pets abroad, or just about anything else!

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Be brave! 💪🏽

Dr. Sami

But on this day each year, I see more cases of chocolate toxicity than I can count.

If your dog just ate chocolate, don’t panic. Not all chocolates are created equal, and chocolate ingestion doesn’t guarantee chocolate toxicity. That being said, certain chocolates can be extremely toxic, and if ingested in high enough quantities, can even be fatal. ☠️

I’m sure I’ve spooked you now, so let’s break it down quickly.

Chocolate has two different toxic elements:

1. theobromine

2. caffeine

Both of these elements are within the methylxanthine chemical class.

The more pure the chocolate is, the more methylxanthines it contains, and the more toxic it is.

In order of toxicity:

baking chocolate > dark chocolate > milk chocolate > white chocolate

Technically, white chocolate isn’t a true chocolate (containing cacao), so it doesn’t contain any methylxanthines. So, if your dog got into a bag of white chocolates, it might get an upset stomach from all of the fat and sugar, but that should be the extent of their troubles.

If your dog just ate chocolate, check their dose with the chocolate toxicity calculator*:

CHECK THE DOSE

The chocolate toxicity calculator will give you an estimation of the amount of toxins ingested, and whether or not you should pursue emergency veterinary treatment.

This is very important to do immediately, so that your dog can be brought to the vet for decontamination before they begin exhibiting any symptoms or feeling the effects of the toxicity.

*The chocolate toxicity calculator only works if you know the amount of chocolate consumed, and have an accurate bodyweight for your dog.

How to weigh your dog at home?

• Small dogs: set them on the home scale

  1. Make sure all four paws are on the scale, and they are not offloading their weight by leaning against a wall

• Large dogs: 3 steps

  1. Weigh yourself

  2. Pick your dog up and step on the scale, measuring your combined weight

  3. Subtract the difference

If you’re unable to weigh your dog at home or you’re unsure of the amount of chocolate consumed, contact a local emergency veterinarian immediately!

If you happened to find your dog sometime after the fact, these are some of the signs you should be looking out for:

At low doses (as low as 20 mg/kg) signs include:

• agitation

• hyperactivity

• gastrointestinal signs

  • lip-licking

  • drooling

  • vomiting

  • diarrhea

  • (all of which may smell sweet like chocolate)

At doses > 40 mg/kg, cardiac signs can be seen:

• tachycardia (elevated heart rate)

• hypertension (elevated blood pressure)

• arrhythmias (abnormal heart rhythm — which can be fatal!)

At doses > 60 mg/kg, neurologic signs can be seen:

• muscle tremors

• twitching

• seizures

And for doses > 200 mg/kg (approximately 100 mg/lb) —> 🪦

Often, these signs of toxicity present in order. In other words, a dog will usually have some GI signs before it develops an elevated heart rate, before toxicity progresses to seizures. But that isn’t always the case.

If your dog displays ANY of the symptoms listed above, seek veterinary care immediately.

But hopefully your pup’s Halloween won’t be so spooky.

Stay safe,

Dr. Sami

🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃🎃

The path to becoming a veterinarian is a long and challenging one. We spend over a decade in education and training, and at the end, we know far from everything. But because veterinarians are licensed to treat anything (and everything), it’s very important for a veterinarian to be aware of their limitations and to practice within their scope.

One area that general practitioners are classically undertrained in is ophthalmology. Though most vets can handle the basics, more often than not, eye problems are better off managed by an ophthalmologist. And for these cases, I’m thankful to have Dr. Hanes on speed dial.

My former college roommate and best friend of 12+ years, I’ve been fortunate to witness his entire professional journey from ramen-eating undergraduate to bleary-eyed resident, to accomplished veterinary eye specialist in New York City.

Today, he’s one of less than 500 boarded veterinary ophthalmologists in the entire United States (with other countries having far fewer). Due to the rarity of these highly-trained specialists, accessing a veterinary ophthalmologist isn’t possible for everyone. And because of this, I’m bringing him and his knowledge to you.

I hope you enjoy.

-Dr. Sami

Why is my kitten tearing constantly?

Picture this — you just brought home your new best friend, a tiny little kitten.

You spend a bunch of time and energy making sure that your living space is perfect for her. The two of you hang out constantly, but at some point between 4-10 months of age, you notice that one of her eyes is constantly tearing. She doesn’t seem very bothered by it, but it’s definitely a persistent issue.

Excessive tearing, called epiphora, is a common finding in young kittens.

There are three main categories of causes of chronic tearing in kittens:

1. irritation of the eye from abnormal eyelids, eyelashes, hairs, etc.

2. abnormalities of the tear drainage pathway, or

3. ocular surface viral disease

Though not an exhaustive list, and it’s definitely possible that your little friend’s epiphora has a separate cause entirely (for which they should be evaluated by a veterinarian), let’s discuss the major reasons epiphora occurs in kittens.

(1) Irritation from abnormal eyelids/eyelashes/hairs/etc.

There are many anatomical reasons for a cat to have chronic tearing.

Most of the time, these anatomic abnormalities also cause some degree of discomfort (this can look like: squinting or twitching of the eye, redness, etc.).

Some common anatomical sources of chronic tearing include:

o   Entropion, or inward rolling of the eyelid margin. This allows the haired skin adjacent to the eyelid margin to rub against the cornea, causing tearing and discomfort.

o   Distichia, or an eyelash that arises from an abnormal location within the eyelid, causing it to rub up against the cornea during blinking. An ectopic cilia is similar, but grows out of the conjunctiva rather than the eyelid margin.

o   Trichiasis, or haired skin rubbing against the ocular surface. This tends to be more common in brachycephalic (“short-nosed”) cats and dogs with prominent facial folds that can touch the surface of the eye

If any of these are diagnosed in your pet, they typically require surgical intervention to treat appropriately.

(2) Abnormalities of the tear drainage pathway

The nasolacrimal duct is a tubing system that connects the inner eyelid margin to the nose — it’s the reason that our nose runs when we cry.

It’s also where a major percentage of tears evacuate the ocular surface normally. If there is a reason for the nasolacrimal duct to be obstructed (at any point throughout its length), a spillover of tears and epiphora can result. Nasolacrimal duct abnormalities can include:

• Congenital (“from birth”) malformations

• Foreign bodies

• Cysts/masses/tumors

• Trauma/injury

• Etc…

In some of these cases, surgery to try to repair or re-route the duct can be considered, although the risk of permanent complications from this surgery is very high, so this is very rarely recommended.

More often, in these cases, we typically recommend tear management with regular cleaning and drying of the eyelids, instead of considering surgical treatment.

(3)  Ocular surface viral disease

Your kitten’s tearing and conjunctival redness could also be indicative of an active Feline Herpes Virus 'flare up'.

Herpesvirus is the most common cause of conjunctivitis, corneal ulcers, and upper respiratory infections in cats. This infection is caused by a virus which is specific to cats — it is not contagious to other species (including humans).

Kittens are often exposed early in life. The symptoms then localize to the eyes with squinting, tearing and possible ulceration of the cornea. One or both eyes may be affected.

Herpesvirus can become dormant and remain within the nerves around the eyes with recurrence of symptoms.

Relapses of feline herpesvirus can be triggered by stressful episodes or any change in routine. Diagnosis of feline herpesvirus can be made with various tests. Since most cats carry the virus, testing a cat is not typically necessary.

Treatment for herpes virus involves the use of antiviral medications to control clinical signs and reduce the severity and frequency of flare ups.

Some cats require medical therapy only during flare ups, while some cats require medications long term. If a cat does not respond to topical medications, oral medications can be considered. Minimizing stress for cats at home is also vital to decreasing the frequency and severity of herpes viral 'flare-ups'.

Take Away Message:

There are a number of reasons why your kitten may have epiphora, and prompt evaluation by a veterinarian is helpful to address any significant pain/discomfort, as well as to make sure that vision is preserved long-term. Some of these causes are easily addressed with surgery or medications, while others require advanced diagnostics to be able to most definitively determine an underlying cause.

Steve Hanes, VMD, MS, DACVO

Dr. Hanes is originally from northern New Jersey and works as a veterinary ophthalmologist in New York City. He completed his undergraduate degree at Cornell University, and his veterinary degree at the University of Pennsylvania. Following school, Dr. Hanes completed a small animal medicine and surgery internship at the University of Florida, and a comparative ophthalmology residency at the Virginia-Maryland College of Veterinary Medicine at Virginia Tech.

While in training, Dr. Hanes was heavily involved in clinical research, with a primary focus on cataract surgery and glaucoma development in dogs. His main clinical interests include corneal and cataract surgery, as well as management of feline ocular diseases.

In his free time, you can find Dr. Hanes exploring the abundant restaurants & breweries in New York City, traveling, and hanging out with his two cats, Shrek & Bernard.

Do you have a question about your pet’s eye? Drop a comment and let us know which topic we should cover next!

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Those residing in the greater NYC area can book an appointment with Dr. Hanes at the Veterinary Eye Center of New York City.

“What should I feed my dog?!?!”

As a vet, I can’t stand this question.

And let me tell you why. Because it’s never my clients who ask me this. Nooooo, those folks seem to have it all figured out.

Instead, the people who ask me this question most frequently are:

• Friends

• Neighbors

• A stranger I just met on the street

• Someone I went to high school with that I haven’t spoken to in 10 years but somehow tracked down my dormant Facebook account and sent me a five page message………..

I don’t blame people for seeking out advice from a trustworthy source or for trying to save a buck at the vet.

But the truth is, unless your dog is a patient of mine, it’s very difficult for me to answer that question. I don’t know anything about your dog, their health, medical history, or their lifestyle. Each dog is different with their own individual needs, and will tolerate and respond to different diets differently (just like you and I). There’s no cookie-cutter answer I can offer you.

What I can do though, is give you the information you need to empower you in making that decision yourself.

To do that, I’m going to share 5 other questions I commonly get asked about pet food and canine nutrition:

1. What are some ingredients a pet parent should look for in puppy food vs. food for senior dogs?

Puppies have a higher metabolic rate and should be fed a puppy food which is more calorically dense than adult food.

Large and giant breed puppies in particular have specific nutrient and calorie requirements to reduce their risk of developmental orthopedic diseases. Diets for large and giant breed puppies should be slightly less calorically dense, contain lower levels of calcium and phosphorous, and have a carefully balanced calcium-to-phosphorous ratio. Commercial diets that are specifically formulated for large breed puppies should take these three things into consideration.

Senior dogs have a slower metabolic rate than puppies or middle-age adults and require a food that is less energy dense to maintain a healthy bodyweight and prevent excessive weight gain.

Given the relatively long lifespan of small breed dogs, diets containing omega 3 fatty acids (EPA and DHA) may support heart, brain, and renal health, as well as provide antioxidants preventing free radical damage and inflammation, and supporting overall health long-term. Given the prevalence of arthritis in middle aged to older large breed dogs, ingredients that support joint health like omega 3 fatty acids, glucosamine and chondroitin sulfate are important.

2. Is price an important factor to consider when selecting food for your puppy? Does more expensive mean it's better?

Generally speaking, price is not an important factor to consider when selecting a food for your puppy, although very cheap foods such as those from the human grocery store or gas station are typically not the best.

Cesars, I’m looking at you. 👀

The most important factors to consider are that the diet is appropriate for the life stage of your pet (puppy vs. adult vs. pregnant vs. lactating vs. senior) and that the diet is Complete and Balanced to meet the nutrient requirements of the animal.

Pets with certain health conditions may require veterinary prescription diets, which are specially formulated to aid in the treatment of a given disease process and are generally more expensive. Fad diets such as grain-free, gluten-free, vegan, raw meat, etc. are typically not recommended for the average pet and should generally be avoided, regardless of price or popularity.

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3. How can you tell if pet food is nutritious from the label alone? Are there important factors to consider when reading a label in the pet store?

The ONLY component of the food label that guarantees the nutritive value of the product is the Nutritional Adequacy Statement.

This is typically located on the back or sides of the package and is usually in very small print. When purchasing a food product, you should always select a diet that is “Complete and Balanced” in accordance with the AAFCO requirements. “Complete” means the product contains all the nutrients that your dog’s body requires. “Balanced” means that those nutrients are present in the correct ratios. Different quantities and ratios of nutrients are necessary for different life stages, so it is important to select a diet that is appropriate for the life stage of your pet (puppies should eat puppy food, adults should eat adult food, etc.).

Any other claims about the health or nutritive value of the product (particularly on the front of the bag) are strictly marketing statements and are not regulated by AAFCO or the FDA.

By law, the first two ingredients listed on the food label must be the ingredients present in the highest quantity. If the first ingredient listed is chicken, the quantity of chicken in the food is higher than any other ingredient. If the second ingredient listed is barley, then barley is the second-highest ingredient (behind chicken). So, if corn is the first ingredient listed on the bag, better skip it.

4. How often do puppies eat?

Newborn puppies should nurse every 1-2 hours.

Puppies that have been weaned onto a commercial puppy diet (wet food or kibble) need to eat less frequently. The feeding schedule depends on the breed/size and individual needs of the animal. Small breed puppies have a much higher metabolic rate and burn through calories much quicker than large breed puppies.

Generally speaking, toy breed puppies (Teacup Yorkies, Chihuahuas, Pomeranians, etc.) should be fed a calorically-dense puppy food at least 4 times per day, whereas large breed puppies can be fed 3 times per day. As the puppy grows older and stronger, the feeding frequency can be reduced.

The appropriate quantity of food and feeding schedule should always be determined in partnership with your veterinarian.

5. How much should I feed my dog? Do large breeds need more calories per day than smaller breeds? Why?

Large breed dogs generally require more calories in total per day than smaller breeds to maintain a healthy bodyweight.

However, small breed dogs have a higher metabolic rate, requiring a higher number of calories per pound (or kg) of bodyweight when compared to large breed dogs. Nutrition is not an entirely precise science given that an individual animal’s activity level, genetics, and environment varies. Feeding directions located on the label for a complete and balanced food must specify how much of the food to give per weight of the animal.

However, these feeding directions are only guidelines and may need modification to meet a particular pet’s needs. Your veterinarian can calculate the amount of food/calories that are appropriate for your individual pet.

If you found this series helpful, please let me know!

What other food, diet, or nutrition questions should you be asking your vet?

Buon appetito,

Dr. Sami

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Let’s just say I wouldn’t have any outstanding student debt.

It seems like just about everybody wanted to become a vet when they grew up, but very few people have an understanding of what it’s like to be one. We’re a small profession. Outside of the interactions that people have with the vet they go to for services, most people don’t know a veterinarian personally.

As such, I find that very few people can relate to what I do for work, or fully understand my experience.

Here’s an inside look at what it really takes to be a veterinarian today:

It took me almost 10 years to become a veterinarian.

8 years of straight book study, followed by a 1 year clinical rotating internship. I was fortunate to be accepted into each of my programs consecutively, so I finished the requirements faster than most. At 25 years old, I was the youngest member of my graduating class. 

When I completed my clinical training, I had over $360,000 in student debt.

At that time, this debt was accruing interest at a rate of 5-7%. I was fortunate to receive a full scholarship to Cornell for my undergraduate studies, so this is the debt I had to take out to cover 4 years of professional study, alone.

By the time I hit the ground running as an autonomous veterinary professional, I was already burnt out.

I found comfort in knowing I wasn’t alone. After all, misery does love company. But still, I found that my colleagues around me were dropping at an alarming rate.

The attrition rate in veterinary medicine sits somewhere around 5%.

This means that there are more people leaving the profession than there are entering. And in a profession that’s already struggling to meet the current patient demand, that’s a jarring statistic. A portion of this attrition rate can be attributed to the efflux of the Baby Boomers, but that’s only part of the story.

The other major contributor to the loss of veterinary professionals is simply personal choice—or rather, the compassion fatigue and burnout that drives a vet to make that choice.

Earlier this year, in a paper published by the American Animal Hospital Association:

• 30% of surveyed vets said they planned on leaving their current position within the next year

• 15% said they planned to move out of clinical practice altogether within the next year

• And (of the above 15%) 9 out of 10 said that once they left, they wouldn’t go back

Sad and concerning statistics for a profession of people supposedly living out their childhood dreams.

But this isn’t what scares me most.

What’s more concerning, is not the rate at which vets choose to leave the profession, but the rate at which they choose to leave this world altogether.

Of the veterinarians who have died since 2010, 10% of them have died by suicide.

Of the vets who commit suicide, ~75% are small animal vets (like me)—those responsible for treating the dogs and cats that you call family.

As a female companion animal veterinarian with a high student debt load, I represent the group with (one of) the highest suicide rates in the country. On average, I am 3-4 times more likely than the average person to take my own life.

Read that again.

Now, maybe you’re thinking to yourself, “But you literally cuddle puppies for a living, how could life as a vet be so bad?”

I’m not saying it’s all bad.

But to help you better understand, let me run you through a typical day at the clinic:

7:45 AM: I arrive a few minutes before my first appointment so I have time to sip my coffee and review the schedule.

5 minutes later: Nurse runs to the back, our first appointment is here ahead of schedule. He can’t breathe. It’s a bulldog on a hot day, so I know what that means.

We rush him to the back and he’s gasping for air. I start directing my team:

Place an IV catheter, administer sedation, intubate!

The entrance to his airway is so swollen and deformed that we struggle to place a breathing tube. When we finally get one in, he crashes. We start performing CPR.

The client is screaming and crying that we have to save him.

After 20 minutes of CPR, we call it. Time of death: 8:20 AM.

I turn to console my client and give her a hug, but I’m not able to offer her the level of support I would like, because my assistant is waiting eagerly to speak with me.

“Your next client is here and she’s pissed. She says you’re disrespectful of her time and if you don’t see her right now she’s going to post it all over Yelp. Also, Dr. X is stuck in traffic and his appointment has also been waiting 20 minutes...”

No problem, I’ll see them both. Give me Mrs. Yelp Review and put the other one in Room 2. Thank them for their patience.

I take a deep breath to compose myself before I walk into the room.

It’s a new puppy—thank God. I quickly shift gears. I’m so sorry Mrs. Yelp Review, thank you for waiting, you have my full attention! Who is this sweet baby dog?!?!? Congratulations, he’s so beautiful! Where did you get him?!

From there, the day progresses:

In the next room, an Australian Labradoodle left to the parents following the death of a family member. Now extremely distressed, vomiting, and not eating. Owners also needed grief counseling.

Next:

Miniature Schnauzer listless and anorexic, requiring a range of tests and treatments, all declined by male owner because she’s “just a dog.” During the consultation, subtly informed of a domestic violence situation, had to alert authorities to get woman and dog out of the home.

Next:

Geriatric chihuahua referred for eye pressure measurement. Actually an unregulated diabetic needing both eyes surgically removed but too unstable for anesthesia. Young owner needed to be consoled through the unexpected euthanasia of a dog she’s had her entire life.

Next:

“Dr. Morici, we have some drop-offs here.”

Translation: My schedule was full, but these pets urgently needed care and none of the surrounding clinics had space either, so the owners dropped them off so we could see them whenever we had time between appointments. Ha, time. I jump to the back, assess that everyone is stable, jot down plans for pain meds and fluid therapy.

30 minutes behind schedule now, back to the front.

Next:

8 year old cat suddenly only eating his wet food. Diagnosed with heart disease and cancer in the abdomen. Multiple referrals needed. Older owner who couldn’t speak English and devastated by my findings, needing explanation of a complex case and consolation in my second language.

Next:

1 year old Border Collie brought in by pet sitter for suspected UTI, ultrasound revealed late-stage bladder cancer. Owner consoled remotely & advised to urgently return from holiday to say goodbye to his dog.

Next:

Cat unable to have a bowel movement, hospitalized and placed under anesthesia to have feces manually removed in-between appointments. Even though the client approved the treatment plan and associated costs, she now claims she can’t afford it. I give her a discount so she can at least afford the medications the pet needs to go home safely and comfortably, but it’s still not enough.

She begins to berate me—says I only care about money and I should be ashamed of myself.

I want to slap her, but I know she’s just lashing out and projecting her own shame, fear, and guilt. She loves her cat. So I validate her emotions and refer her to the front desk to work out a payment plan.

Back to drop-offs:

Diagnostics ordered and treatment plans completed. Call back diagnostic results, help my colleague with one of his patients, update the owners of all the pets in hospital, then I see a telemedicine appointment.

Next:

A patient that needs a blood transfusion. No blood in the freezer, blood bank can’t deliver for 2 hours, patient too unstable to transfer. I’m understaffed but I bite the bullet and send out my only assistant to pick up her dog for an urgent blood donation.

Sound like a rollercoaster? Well you’d better strap in, because it’s not even 11:00 AM.

This isn’t a bad day at a veterinary clinic. And it’s not a particularly stressful one either. This is just another day.

Being a veterinarian takes far more than just my medical training, and I spend most of my day in roles I was never trained to do.

I’m a psychotherapist, a financial advisor, a grief counselor, and a mediator. I’m a team leader and an educator, a mentor and a social worker. I’m the guardian of my community and the face of my profession.

Through years of therapy, I’ve finally granted myself the grace of imperfection, but not all pet parents have done me the same.

They expect a higher quality of medical care for their pets than they do for themselves. They expect me to respond immediately and to be available to them at all hours. They expect me to make miracles happen with virtually no budget.

And if I fall short of their expectations, they might threaten to sue.

So honestly—it comes as no surprise to me that the suicide rate is so high. I can understand how my colleagues might come home at the end of a long and difficult day and enter a dark headspace—cuffed by their student debt, with no choice but to repeat an unending cycle of compassion fatigue and burnout for the next 30 years. No escape in sight.

There’s a lot that needs to change in education and veterinary medicine, and I'm hopeful that it will.

But industry-wide change is slow, and vets can’t do it alone. We rely on the understanding, compassion, respect, and shared humanity of pet parents. We need you to do your part.

Caring for your vet looks like:

• Not shaming, blaming, or threatening your vet

• Showing up to your appointments on time, and kindly accepting a reschedule for a different day when you don’t

• Taking responsibility for your pet’s care and complying with your vet’s recommendations

• Managing your emotions

• Taking financial responsibility for your pet’s healthcare by getting insurance or starting an emergency care savings fund

• Being patient

• Keeping up with preventative care and annual exams

• Expressing gratitude, compassion, and understanding for your vet

• Educating other pet owners on what you’ve learned about the veterinary experience

• Leaving positive reviews and avoiding cyberbullying

• Recognizing their humanity

If every pet parent just did the above, the impact on the mental health of veterinarians would be profound.

More of my colleagues would remain in the profession. Pets everywhere would receive better care. And I know how much you care for your pet.

I do, too.

That’s why I became a vet in the first place.

Sending love and light to all (and to all vets more than ever), ♡

Dr. Sami

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Earlier last month I shared an abridged story on LinkedIn about a difficult case I was managing. I was overwhelmed by the outpouring of love and concern for my patient and her owner, as well as the level of support I received. Below, I share the case and my thoughts in greater detail.

This case raises a number of practical and moral questions, and has taught me a lot about life, medicine, and the power of community. If any of you out there have parallel experiences to share, I would love to hear them. I’m still learning every day.

Thank you to all ♡

I’m managing a difficult case at the moment.

Not that the medicine itself is a challenge—I know exactly which tests to run and the medications to prescribe. I’ve seen this exact constellation of signs a thousand times.

The patient, let’s call her “Annie,” is a 12 year old Jack Russell Terrier who is compliant and well-behaved. She doesn’t have any comorbidities or peculiarities complicating her case. In fact, the challenge presented here has nothing to do with Annie at all.

The greatest challenge in this case is Annie’s owner—because Annie’s owner has dementia.

She can’t recall the last time Annie ate and tells me a different story every time. She can’t keep track of the meds, and pill boxes are of no use, because although organized by time and day, she confuses which day it is. At Annie’s last appointment, she showed up 1 hour late because she mistakenly brought Annie to her physician’s office instead of to the vet.

She knew she had to go to A doctor, she simply couldn’t remember which one.

If Annie wasn’t sick, this wouldn’t be an issue.

An extra walk or a skipped meal never did anybody any harm. But Annie has a serious disease—one that she could die from if not managed properly. If she misses a few pills, she could relapse. If she receives too many pills, she could develop a severe (perhaps life-threatening) gastric ulcer, especially if she receives those pills on an empty stomach.

Because after all, is Annie eating?

Well, nobody really knows.

This isn’t something I was taught in veterinary school. Nobody tells you how you’re supposed to manage chronically ill patients when the only other member of their care team is cognitively impaired and on the decline. And as veterinarian, I’m certainly not licensed in the treatment of human dementia myself.

So, what am I supposed to do?

Many people will read this and say that the dog should be put to sleep. Or that the owner should give her to someone who is better equipped to care for her — because if managed appropriately, Annie can still go on to live a very good life. But is euthanasia or the rehoming of a 12 year old dog really what’s in the best interest of either of them?

I’m not so sure.

And yet, I’ve seen this before and I know how it goes…

When I was 15 years old, my grandfather was diagnosed with dementia. With the exception of my short and not-frequent-enough visits, the dog was the only company he had. His decline was slow at first, but when his dog passed and he no longer had anyone to care for, his decline very obviously accelerated. So, with his dog, also went his: cognition, day to day happiness and mental wellbeing, activity level, socialization, and overall life quality.

I didn’t realize it then, but it’s clear to see now that the dog was the only thing keeping him going.

Annie’s owner seems to share a similar story.

At age 80, she spends the majority of her days alone. She has no children or nearby family. All her friends have since come and gone, and Annie is the only companion that she has left.

But Annie is more than just a companion.

She gives her owner a reason to get out of bed in the morning. She gives her a routine—someone to walk, someone to feed, someone to care for. She gives her a sense of purpose.

And though she may no longer be fully equipped to provide Annie with the highest standard of care at home, is that to say that this elderly woman shouldn’t maintain the right to enjoy the numerous benefits of pet ownership?

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Studies show that dog owners who walk their dogs are 2.5 times more likely to achieve moderate physical activity than non-dog walkers. Walking a dog has also been associated with higher social interaction among older adults — a crucial element for dementia management and overall senior wellbeing.

And the benefits of pet ownership extend far beyond the physical.

Dog ownership alone has been found to be associated with a lower risk of dementia, and a study just recently published in JAMA found that pet ownership may be associated with slower cognitive decline among older adults living alone.

Without the daily routine, companionship, and sense of purpose that Annie provides, her owner would surely suffer and decline.

And Annie needs her, too.

At age 12, Annie has never known another home. She’s very attached to her owner and becomes visibly distressed when held in the arms of anyone else. The added stress of rehoming would be terrible for controlling her autoimmune disease, and is that what this dog really deserves in the last years of her life? To be ripped from the arms of her loving owner and the only home she’s ever known?

Is that what you would want for your old dog?

I don’t have the answers today.

No tips, life hacks, or pieces of advice. Only an excerpt from my experience to offer, and an understanding of the mutual need and love that these two share.

They deserve to stay together.

But as their veterinarian, and one of the very few remaining members of their community, I’m struggling to find a way to safely make that happen.

Take care of each other,

Dr. Sami

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Many of us grew up in households where love was expressed through food.

Our mothers and grandmothers showed us they cared by spreading the table with cultural dishes and family recipes, and in return, we showed them we loved them by clearing our plates. Now, as pet parents ourselves, many of us project this language of love onto our pets.

In a 2023 survey conducted by Purina, pet owners confirmed how significant food was in their relationship with their dog:

• 75% of surveyed owners agreed they feel guilty when their dogs appear hungry

• 67% agreed food is a primary source of their dog's happiness

• 67% agreed they bond with their dog by feeding him/her treats and don't want to lose that bond

• 54% agreed they feed their dog more food, table scraps, or treats when their pet begs for them

Food is a love language, but when it comes to loving our pets, food isn’t the language we should be using.

Overfeeding your pet can result in serious health consequences. Worldwide, studies estimate that upwards of 60% of all dogs and cats today are overweight or obese. This is a huge issue — because animals in excess body condition are at risk for a whole laundry list of health problems:

• Arthritis and joint pain

• Type 2 diabetes

• Heart disease

• Reduced exercise endurance and stamina

• Respiratory (breathing) problems

• Increased anesthetic and surgical risks

• Fatty liver and reduced liver function

• Bladder problems

• Cancer

• The list goes on!

Sadly, most people don’t even realize they’re overfeeding their pet.

They come to me with an overweight pet and they’re confused or concerned because their pet “doesn’t eat that much.” But in reality, they’re eating more than enough. Our pets are much smaller than we are, and if they’re not a sport or working animal, their little bodies don’t need that much energy.

At the most basic level: body weight is just Energy In - Energy Out.

If your pet is overweight, they are consuming more energy than their body needs at their current activity level.

It’s that simple.

Most commercial diets have guidelines for feeding on the back of the label, but these are just guidelines, and may not reflect the needs of your individual pet. Each animal has different energy requirements, and these requirements also change with age and lifestyle. What you fed them 5 years ago may not be what they need now (and likely isn’t). The feeding guidelines also don’t take into account any treats or supplementary feed you might be offering.

Even if you’re just offering a few treats per week, you may not realize how calorically dense those treats are.

Take this example:

A golfball-sized serving of ice cream contains ~73 calories. If you gave your 10 kg (20 pound) Beagle a ¼ cup serving of ice cream as a treat once per week, that translates to a ~0.5 kg (1 pound) increase in body weight per year. That’s the equivalent of about 9 pounds for the average adult man.

Now let’s do a similar exercise for cats:

A ¼ cup serving of whole milk contains ~38 calories. If you give your 5 kg (10 pound) cat ¼ cup of whole milk once a week for a year, that would translate to just over ½ pound per year of additional body weight. That’s the equivalent of about 7 pounds for the average adult woman.

As you can see, overloading our pets calorically is very easy to do.

But if you love your pet, you want them to live a long and healthy life. And if you want them to live a long and healthy life, offering them extra treats is the last thing you should do.

In a study published in 2002, researchers followed a group of labradors throughout the course of their lives. Half of the dogs were free-fed, and the other half were feed-restricted (fed 25% less than their full-fed siblings). The results showed that the dogs which were feed-restricted (or fed to an ideal body condition) enjoyed significantly extended healthy years (an average of 1.8 years more compared to their full-fed siblings).

This isn’t to say that you have to stop giving your pet treats altogether — but you should do so sparingly. As a general rule of thumb, treats should comprise no more than 10% of your pets total caloric intake.

Don’t default to food when your pet is looking for love and attention.

Instead:

• Play a game

• Go for a walk (cats can walk outside on harnesses too!)

• Teach them something new

• Or just be present with them! Put away your phone, talk to them, make eye contact, and have a cuddle

We need to dismantle the ideology that food is love.

In doing so, we’ll ensure that our pets live longer, happier, healthier lives.

Who wouldn’t want that?

Dr. Sami

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I always tell people that they shouldn’t give bones to their dogs. Hard chews like bones and deer antlers are dangerous for dogs, namely due to the risk of fracturing the teeth. But when a friend of mine got Luca a bone for his birthday, he was stoked — so I caved.

And within 24 hours he had two broken teeth.

At this point you might have expected me to work some of my ~vet magic~ and to have dealt with it immediately. But I didn’t — I avoided it. And before I knew it, the problem grew larger, more expensive, and more difficult to deal with.

Why would I do that? Well, maybe you can relate.

There are usually 3 reasons why people avoid dealing with their pet’s health issues:

1. They’re afraid of what the vet will find

A case of broken teeth requires a sedated oral exam and dental x-rays, at minimum. I was nervous about what I might find on those x-rays and what might need to happen next, like having to pull his tooth under general anesthesia.

2. They’re afraid of what it will cost

Veterinary care isn’t cheap, and it isn’t cheap for me either. As a vet, I save some money on labor, but I still have to pay the nurses, to run the equipment, and pay for all of the medications.

3. They’re afraid of losing their pet

If I’m being honest, this was (and still is) my deepest fear of all.

It might sound ridiculous to escalate to the idea of losing your dog over a bum tooth, but Luca has kidney disease and carries a higher anesthetic risk. If something went wrong while he was under anesthesia, he could’ve gone into kidney failure. And I couldn’t bear the thought of that.

Having fears like these is completely normal.

As you can see, I share them too.

But ignoring your pet’s symptoms or health problems won’t make them go away.

Instead, the longer you avoid the problem, the:

• larger it will become

• more expensive it will become

• less likely it is to be treatable

• more your pet will suffer

The sooner you bring them in, the sooner you’ll know what you’re dealing with, and the sooner you can get them help.

Now, if you’ve read until here, perhaps you’ve realized something…

This isn’t a post about my dog’s health issue, this is a post about mine.

Luca’s broken tooth came at a time when I was struggling with anxiety, and I let my fears dictate my decisions and (in)action.

My inability to tend to my mental health prevented me from me tending to my dog’s dental health.

And in avoiding these problems, I just made them larger for the both of us.

If you catch yourself brushing off symptoms or behavior changes in your pet — even if they’re subtle — it’s important to check in with yourself and ask why.

Is it really nothing, or do you just want it to be? Do you have limiting fears or unchecked anxiety that are standing in the way of you acting in the best interest of your pet?

(If so, I’m thinking of you ❤️)

Dr. Sami

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I was sitting in a café with Luca when an acquaintance, after watching us for some time, interjected that they had never seen a connection between a person and a dog ‘like that.’ They said, ”the bond you two share is really special.”

That warmed my heart, y’all. Our bond is special. And it’s extra special to me when someone who hardly knows us can see that, too.

The human-animal bond, or the connection we share with our pets, is one of the more beautiful things we get to experience in this life.

When you get a new dog, forging a strong connection with them will be the single most important thing you do. From there, everything flows. But if you fail to establish a strong connection with your dog, not only will you be missing out on the most beautiful aspect of pet ownership, but you may encounter a number of problems down the line.

• Poor recall

• Delayed learning

• Defiance or conditional listening

• Behavioral issues

• Poor socialization or aggression

^ just to name a few.

Similar to children and their parents, the bond your dog forms with you also serves as the blueprint for their connection with other people. Dogs that are poorly bonded to their owners may not be as trusting of other people, less likely to interact, or exhibit fear and aggression. They may also feel less confident as they interact with and explore their new world.

Unfortunately, there are several mistakes I see quite commonly among owners trying to bond with their new dog.

Where Owners Go Wrong (And What to Do Instead)

Most people don’t even realize it, but in their daily interactions with their dog, they’re making some common yet easily avoidable mistakes that weaken their bond over time. Once you understand what these missteps are, you can start taking the right actions to build a loving and lasting bond with your dog.

Here are three of the biggest mistakes holding people back:

Mistake 1: Relying on Treats

Over-reliance on treats leads to a transactional relationship.

This is the biggest mistake that people make. If you constantly reward with treats, your dog will start performing actions only for the reward rather than out of mutual respect, love, and desire for praise. You want to strengthen your dog’s connection with you, not the kibble. This can also result in defiance or conditional listening only when food is available.

Additional negative consequences:

• Poor nutrition

  • Treats are empty calories. Your dog should be getting the majority of their calories from a diet that is complete and balanced to meet their nutritional needs.

• Weight gain

  • Again, your dog should be getting the majority of its calories from a complete and balanced diet. If you cut back on food when offering treats, they won’t be getting adequate nutrition. But if you maintain their normal food portion and offer treats on top of that, they’ll become overweight.

• Risk of upset stomach

  • Dogs have very sensitive gastrointestinal systems. I can’t count the number of times that a dog ended up in the ER dehydrated with horrible diarrhea because he received a rich new treat that his belly couldn’t handle.

Rather than falling into this trap, you should:

Reward with love instead of treats.

Love is the best form of positive reinforcement — verbal praise; positive and excited facial expressions; a warm, loving, happy tone; and physical affection. And if you can’t cut them completely, balance treats with other forms of positive reinforcement like praise, petting, and play.

Food isn’t love, y’all!

Which brings me to the next mistake:

Mistake 2: Not Staying Present

Insufficient presence and attention can make your dog feel neglected.

Example: Petting your dog occasionally while distracted by your phone, scrolling while on walks, etc. Physically spending time with your dog doesn’t count if you’re not present and engaged with them.

Negative Consequences: This can lead to a dog feeling ignored, unloved, or alone. If they don’t feel loved and connected to you, they’ll be far less likely to listen to you. And if your dog doesn’t have its social and emotional needs met, they’ll also be more likely to exhibit behavioral issues.

Instead, try to be present with your dog and provide regular, undivided attention and affection.

• Show your dog they are important by being fully present during your interactions with them.

• Make eye contact.

• Talk to them.

• Dedicate specific times each day to focus solely on your dog. Leave your phone at home when you go for a walk.

• Engage in activities like cuddling and playing without distractions.

Mistake 3: Not Partaking in Shared Enjoyed Activities

No shared activities can lead to a weaker connection, boredom, and undesirable behavior.

An example of this would be only taking the dog out for quick bathroom breaks without engaging in any new, fun, or stimulating activities together. This can cause your dog to become bored, anxious, or even destructive due to lack of mental and physical stimulation.

Similar to human relationships, dog-human relationships are strengthened when you partake in shared enjoyed activities, explore new things, and learn and grow together.

A great way to strengthen your bond with your dog is to do things together that you can both enjoy.

• Hiking

• Swimming

• Camping

• Playing fetch (without your phone)

• Attending agility classes or independent training sessions (dogs love to learn!)

• Joining doggy meetups or social events

• Eating at a dog café

• Setting up doggy play dates with friends

Your Blueprint for Building a Deep Emotional Bond with Your Dog

Now that you understand the pitfalls to avoid, let's outline a proven process for building a loving and lasting bond with your dog:

Step 1: Establish a routine

• Set consistent times for feeding, walking, and playing. Dogs thrive when they know what to expect from you.

Step 2: Reward with love and praise.

• Ditch the treats and reward with praise and affection. Your dog should listen because they want to, not because they want a treat.

Step 3: Stay present, warm, and attentive

• Dedicate specific times each day to interact with your dog without distractions. Regularly show your love through physical affection like pets and cuddles. Stay attuned to their needs and know when to support them.

Step 4: Engage in shared activities

• Find and regularly partake in activities you both enjoy. If every time you leave the house you’re leaving your dog home, you’re doing something wrong.

Step 5: Set firm boundaries

• If I had to add a bonus mistake to the list above, it would be failure to set boundaries. While it is important to be warm, loving, and emotionally attuned to your dog, you also can’t let them walk all over you. You’re the boss, and they should know that.

Building a strong bond/connection with your dog is the most beautiful (and most important) thing you will do as a pet owner.

Without a strong bond, none of the training classes or practices will work. By being aware of the most common mistakes and implementing the step-by-step plan outlined above, you'll foster a stronger connection with your dog, strengthen their confidence, achieve your training goals with greater ease, and set them up for other successful relationships.

And before you know it, people will be turning to YOU in the café remarking on how wonderful your dog is.

Big hugs,

Dr. Sami

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Are you stressed out researching all the different legal regulations and nervous that you'll mess something up and your dog will get stuck?

You’re not alone.

Five years ago, I was preparing to move with my dog from NYC to Amsterdam for the first time. While I had a wealth of experience writing health certificates for my clients, I had never gone through the process of moving internationally with my dog on my own before.

As I quickly came to learn, moving abroad with your dog requires more than just a health certificate.

Each country has its own requirements, restrictions, and deadlines, and I had to make sure to comply with all of them if I wanted to land my dog safely on European soil. Because I was the vet, I was lucky to have "my vet" do the research for me. But if you're not a vet, you shouldn't expect the same. Your vet will sign the papers, but you've got to do the rest.

If this sounds like you or you're looking for key errors to avoid when understanding the legal requirements for moving your dog abroad, let me save you the headache of making the mistakes yourself, and point out the pitfalls I see most commonly among my clients who are preparing to move abroad with their dog.

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Mistake #1: Not verifying the specific requirements for your destination country

First things first, you need to look up the specific requirements for the country you're traveling to.

Just because you've traveled internationally with your pet before, doesn't mean you've met some blanket requirements for international pet travel. Each country has its own set of requirements your dog will need to meet. These requirements will also change based on where you're moving from.

Make sure you contact the health and transport officials in your destination country and that you're clear on what the specific requirements are for you to get your dog from point A to point B.

Mistake #2: Missing vaccination and health certificate deadlines

This is the single biggest mistake that pet parents make.

There are specific deadlines for vaccines, titers, and parasite treatments, and these need to be completed within a certain number of days from travel, AND within a certain number of days of the health certificate being filled out by your veterinarian. The health certificate will then need to be certified by the regulatory vet of your origin country within a certain number of days prior to your arrival at your destination country.

Get clear on the timeline, or you're going to end up repeating treatments and rebooking your flights.

Mistake #3: Overlooking quarantine regulations

Depending on travel destination, you may need to quarantine your dog on arrival, and they may need to stay in quarantine in for weeks to months.

They'll need to go straight into quarantine when they arrive, and you won't be able to visit them until the quarantine period has ended and the vet can confirm your pet is healthy and safe to officially enter the country. Again these requirements vary by country, so if you're stopping in a different country along the way to your final destination, make sure your dog doesn't get stuck behind!

Mistake #4: Failing to research local breed restrictions

These days, more and more countries are imposing restrictions on which breed of dogs they allow into the country.

Before you plan to move abroad, make sure your dog's specific breed is permitted there. The breed listed on all of their medical records and official travel documents should match and comply.

Mistake #5: Ignoring regulations for air transport

Just as every country has its own regulations, so too do the airlines.

Weight limits, carrier sizes, training requirements, and relief attestations are just a few of things you’ll have to deal with. And take it from me -- ignore one of these things, and they really won't allow your dog on board.

Moving abroad with your dog can be stressful, especially if you’ve never left the country with them before.

But if you do your research, respect timelines and a regulations, and ensure your dog is permitted in all of the places they need to go, you’ll both arrive together safely in your new land and be prepared to take on the next chapter.

Ciao for now!

Dr. Sami

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She was only two years old; I was twelve.

She was my best friend, and I was devastated.

She met her match in the middle of a busy NY highway. We didn’t find her until a week later.

As a veterinarian, I’ve seen similar cases far too often. Folks let their pets out into their backyard or garden thinking that they’re safely enjoying the outdoors. They get distracted and when they finally think to check, the dog is gone.

Accidents happen, but there are things we can do to mitigate that risk.

If you have a dog that you let out into the garden to do their business, heed these 5 tips to make sure your dog stays secure in the garden this summer.

1. Secure the gate and keep it latched

• We need a sturdy gate that latches in and isn’t made of a flexible material such that they push through at the bottom. If it’s bendy, double-latch it.

• No swinging gates or push-doors.

• Wood gates should be regularly checked for their durability and to ensure they’re not being chewed at or eroded at the bottom.

• If you have a toddler that can reach the latch, put a lock on it. And if your kid is old enough to work through that, make sure you explain to them the importance of keeping the gate securely closed, and what the consequences might be if they don’t.

2. Regularly surveil the yard perimeter and maintain its integrity

• If your fence is made of wood, chainlink, or something that tends to break down over time, make sure you’re regularly replacing it.

• If you have a solid or cement wall around your yard, make sure it’s tall enough that your dog can’t scale it. It might sound crazy, but you’d be surprised what they can do.

• Check for holes dug under the fence.

3. Spay / neuter your dog

• One of the main reasons our pets try to break out of the yard/garden is if they’re looking for a mate. Sterilizing them can help reduce their urge to leave their home environment in search of one.

4. Proactively socialize your dog from a young age

• Some dogs that are aggressive or poorly socialized will also try to hop the fence and defend the property. Socializing your dog from an early age with people and other dogs can help to reduce this risk.

5. Don’t leave your dog in the garden unattended or for long periods unmonitored

• Maybe you got the yard so you could let your dog outside without the extra effort, I get it. But just like young children, it’s always better if you keep an eye on your dog.

• And NEVER leave them alone in the yard when you’re not home.

I wish I could go back in time and give my parents this advice.

We had a defect in our gate, and one day when we left Cocoa home alone in the yard, she broke through it. She was an intact dog; maybe she was looking for a mate. Maybe she was looking for me.

I still miss her every day.

Dr. Sami

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My attending clinician shook her head as she looked down at my dying patient, and wished me luck before walking back to her computer to finish her notes.

She seemed to know something that I didn’t yet, but would come to see on my own through years of practice — how difficult it can be to say goodbye to a pet during pregnancy.

Your pet has been beside you as you reached milestone after milestone in your life, and you thought this one would be no different. You imagined the moment when you would introduce your baby to your pet for the first time, your pet sitting beside you at all hours of the night as you tried to keep up with the breastfeeding schedule, and laughed to yourself about all the trouble they would get into together down the line. But now, the picture looks a bit different.

Deciding when to let your pet go is the most difficult decision you’ll ever have to make. As if it wasn’t difficult enough, the mental, emotional, and physiological changes that take place during pregnancy make this decision ever-more complicated.

This post aims to explore some of these changes and to provide support and guidance for pregnant pet owners grappling with the decision of pet euthanasia.

Pregnancy is a period of profound hormonal and physiological changes, which can significantly impact mood, emotional stability, and decisive ability.

Some women are affected more than others, and women can be variably affected across different pregnancies.

During pregnancy, levels of estrogen and progesterone rise sharply. Because of their structure, these hormones readily cross the blood-brain barrier and can bind to receptors in different areas of the brain, enhancing brain activity.

One area of the brain that contains a particularly high concentration of these hormonal receptors is the limbic system.

The limbic system is effectively your emotional nervous system — the part of your brain responsible for your behavioral and emotional responses, especially as they pertain to the basic elements of human survival — fight or flight responses, reproduction, feeding, and caring for our young.

As levels of estrogen and progesterone continue to rise, you may experience heightened anxiety, emotional reactivity, and sensitivity, which can make decisions like euthanizing a pet feel even more overwhelming.

You trust your vet and maybe deep down you also know that it’s time, but it’s not possible to use your emotional brain and your logical brain simultaneously, and evolution has your emotional brain in overdrive.

Another hormone and neurotransmitter at play here is oxytocin.

Often dubbed the "love hormone," oxytocin levels also rise during pregnancy. While it generally promotes feelings of bonding and well-being, it can exacerbate feelings of grief and loss, especially if you have to make the decision to let go yourself.

Beyond hormonal changes, we also know that pregnancy physically alters brain structure.

These changes, while helping to prepare for motherhood, can complicate decision-making processes, alter stress responses, and cloud judgement, leading to increased anxiety and indecision, especially in emotionally charged situations like the illness or loss of a pet.

Often, I find that pregnant women facing the decision of pet euthanasia share a similar internal dialogue:

• They feel guilty because they’ve been focused on preparing for the baby’s arrival and haven’t been giving their pet the usual amount of attention.

• They feel ashamed, like they ‘should have’ noticed something was off or acted sooner.

• They fear that there must be something else they can still do, and that they’ll regret making the decision to euthanize.

These feelings are normal. But you have to give yourself some grace here. You love your fur baby and you’re doing the best you can. Everybody can see that, and your pet knows it, too.

But there comes a day when the best thing you can do for your pet is to let them go.

Be honest with yourself about how your pregnancy may be complicating your decision to euthanize your pet, and know that you’re not in this alone:

Communicate openly with your partner, other family members, and friends.

It’s extremely important that you involve your other loved ones in the process and are vulnerable in sharing your emotional experience so they know how to best support you.

Reach out to your therapist or a trusted healthcare provider to let them know that you’re dealing with end-of-life decisions for your pet.

They can offer advice on managing emotional health and stress during pregnancy, help you cope with your decision, and give you tools for managing your grief.

Take your vet’s advice to heart.

No one loves your pet more than you, but your vet is a close second. They’re always going to have your pet’s best interest in mind. They can provide clarity surrounding your pet’s condition, prognosis, and quality of life, helping to frame the decision within a clear medical context.

If you’re still unsure or don’t feel aligned, seek a second opinion. There’s nothing wrong with that. But if you’re going to get a second opinion, try to do it quickly — within the next day or so.

Chances are, if your vet recommended euthanasia, your pet is already suffering. And we want to prevent that as much as possible.

Join pet loss support groups.

Maybe you have a friend or acquaintance that was recently in your position who care share their experience and offer support. But if no one in your inner circle can relate to your experience, there are a number of counseling or support groups that can offer a space to share your feelings with others who understand the specific grief of losing a pet.

One more thing to prepare for.

Preparing for euthanasia involves both logistical and emotional preparations.

Sometimes, the time we have to prepare is very limited. But if you’re fortunate to have the time to prepare, it's helpful to know exactly what to expect during the procedure and to have a plan for a peaceful goodbye, which can help provide you with some closure and a sense of peace.

A few things to consider:

• How will you spend your last day together?

• Which vet will perform the procedure and where would your pet be most comfortable / prefer to be?

• Who would you like to be present for the procedure?

• Is there a piece of your pet you would like to hold onto? Perhaps a tuft of fur? A paw print on paper or imprinted into a piece of clay? Maybe just their collar?

• What will you do with your pet’s remains? Do you have the space for a burial or would you prefer to cremate? If you choose cremation, will you elect for a private cremation so you can hang onto the ashes or spread them in your pet’s favorite place? Make sure you have an appointment set with the crematorium in advance if you choose to euthanize your pet at home.

The grief of pet loss can be intense, and the hormonal milieu of pregnancy can only amplify these feelings.

Make sure to honor these feelings in a healthy way and to prioritize your health and healing above all else.

With a baby on the way, you have a ton on your mind and a seemingly endless list of things to get done. But the best thing you can do for your baby right now is to take care of yourself. Everything else can wait.

Here for you,

Dr. Sami

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