CRC CLIN SIGNS SML ANIM MED PDF

Introduction

You might look at this book and wonder what motivated me to do a picture atlas of small animal medicine in light of all the science that constantly embraces us in the modern veterinary literature. My answers are simple. The main reason is that there is no substitute for looking at the animal and observing its lesion or abnormal movement when it comes to making a clinical diagnosis. It is this philosophy that I was taught by my mentors at the Animal Medical Center (AMC) in New York City in the 1970s, and it is still the way I continue to teach my students up to the present day. The other important reason is that I wanted to leave a meaningful legacy to this profession and, with so many wonderful textbooks being published, I wanted the images in this book to complement the written words of my colleagues.

Western man's revision of the ancient Chinese proverb ‘A picture is worth ten thousand words' became ‘One look is worth a thousand words', as contributed by Fred R. Barnard in the advertising trade journal Printers'Ink in 1921. In 1927 Barnard republished this in an advertisement as ‘One picture is worth ten thousand words'. Regardless of the origin and subsequent modifications, the value of actually seeing the lesion is especially valuable and irreplaceable in the learning of medicine, whether it be worth one thousand or ten thousand words.

As stated above, one of the main objectives for doing this text is to provide a graphic representation of disorders that many clinicians will encounter in their practice of medicine. This desire first dawned on me during my internship at the AMC in 1970, at which time my salary was $6,500 and the unbelievably large case load made me forget that I was starving. There was no way for me to buy the camera with a ‘macro' lens that my more senior colleagues were using. So, with great frustration I had to wait for my residency in medicine, at which time I was able to borrow the cost of a new ‘Nikon Nikormat' camera with its very special macrolens, which was subsequently paid back with $35.00 taken from each paycheck. From that moment on my camera accompanied me at my patients' ‘cage side', where I recorded images that would hopefully some day enhance my real desire to teach clinical medicine.

The images selected for this book are amongst the many thousands in my collection. They have been selected because of the unique clinical situations they represent. At times the reader will find that I have presented more than one version of a particular clinical sign; this has been done in order to show that many syndromes can have several different presentations.What compelled me to show one disorder and not another was again dictated by the uniqueness of the picture and, perhaps, the rarity of certain conditions; however, the reader will find exceptions to this discretionary guideline, where some conditions might not be so rare.

I tried initially to represent most organ systems and keep the images distributed evenly amongst them. However, I soon saw that organ systems such as gastroenterology and endocrinology play a major role in an internist's image collection, so this will explain why there is a disparity amongst the various systems. At first I envisioned a book that would provide pictures of just about every topic covered in textbooks such as Ettinger and Feldman's Veterinary Internal Medicine, but the size of such a book would be just too unmanageable and probably too costly. So, perhaps the topics not illustrated will motivate me to publish a 2nd edition in the future.

The organization of this text is purely to emphasize the imagery of medicine. From the very first moment we walk into the client waiting room and the examination room, our eyes immediately fixate on the patient after first greeting the pet owner. This is the beginning of our examination and this is where ‘a picture is definitely worth a thousand or even ten thousand words'. Of course we should always be careful not to fixate on the lesion and forget about the rest of the patient. One way of avoiding this medical pitfall is to focus on the problem only after first thoroughly examining the patient.While mentioning the word ‘pitfall', this might be the best place to share with you some philosophical thoughts that I have written down over my 37 years of practicing veterinary medicine. Some might seem rather light-hearted, but others are strong warnings of potential disasters that await us all. The first list comes from my early experiences with Dr. Erwin Small at the University of Illinois, where I received my degree in veterinary medicine, and then at the AMC, where I had the great honor of being taught by men such as Drs. William J. Kay and Steven Ettinger. I assure you I was influenced by many more than just these three colleagues, but they are the ones who informed me and energized me like nothing else in this world. The title ‘Mikey's Maxims' comes from a term of endearment that was bestowed upon me in New York by one of my interns, Dr. Max Easom, and which has stuck to me for many years. So, here are ‘Mikey's Maxims':

• Treat for the treatable. 
• Assumptions lead to trouble; therefore don't assume. 
• Always interpret clinical information within the context of the patient's presentation. 
• Avoid tunnel vision. 
• Treat your patient, not just its disease. 
• Avoid overmedicating. 
• Be honest with yourself. 
• Don't postpone today's urgencies until tomorrow. 
• Think that common things occur commonly.
• Look closely at your patient; it will usually tell you what's wrong. 
• Never let your patient die without the benefit of the silver bullet.
• When you hear hoofbeats, look for horses, but don't forget about the zebras.
• Never sell the basics short – they are still the best buy in town.
• If you don't think it, you won't find it. 
• Never let a biological specimen go to waste. 
• Disaster lurks whenever a patient's problem is ‘routine'. 
• If it's not getting worse, give it a chance to get better.
• Don't stray too far from the patient – the diagnosis will appear eventually.
• Don't give your patient a disease it doesn't deserve to have. 
• Don't let technology make you decerebrate. 
• The necropsy is the clinician's trial by jury. 
• The wisdom of experience should never be ignored. 
• The diagnostician should always ask him/herself these two questions: where am I now, and where am I going? 
• If the patient isn't going where you expect it to be going, then go back to square one.
• In order to successfully to treat a cat, you must think like a cat. 
• Avoid the pitfalls of the red herring. 
• If they can't afford a Caddy, then offer them a Chevy. 
• Know thy patient. 
• Nobody wants to pay for a big bill and a dead animal. 
• You must have cognition to be a competent diagnostician 
• To prognose, you must first be able to diagnose

Funny as some of these might seem, I promise that each and every one is based on real life experiences and, by offering these to you, I hope that I can spare you a fraction of the ‘pain' that I have experienced over the years.

About 8–10 years ago I developed a lecture titled ‘Clinical Pearls'. Unlike the Maxims, which are more philosophical, the ‘Clinical Pearls' represent valuable lessons in actual practice that have helped me and others to practice better medicine. I never intended for these to be included in this image textbook, but the publisher, Mr. Michael Manson, insisted that they be included in this text. So, bowing to Mike's knowledge and experience with the written word, I have included various lists of ‘Clinical Pearls', which, again, I hope will be of great benefit to my fellow practitioners. Some are general in nature and are shown at the end of this Introduction; others are shown at the beginning of the chapter to which they relate. Some of these are written with American slang, which is essential for the maximal effect of my message. I offer my apology to those who might be overly critical of my absence of style.

There are so many people that I want to thank, without whom much of my career would not have been possible. First and foremost is my wife, M.J. (Mary Jane), who has been my faithful companion through thick and thin over the past 33 years of our marriage. Special credit is deserved because living with me under periods of extreme work pressure will never be described as a ‘cake-walk'. M.J. is actually the main person who made this book possible because she single-handedly and painstakingly scanned thousands of my slides to allow for me to enter the electronic age of teaching. I might add that she just did not scan aimlessly; instead she took each slide, cleaned it from its years of wear and tear and made it completely usable for the many years to come. Such saintly patience I could never have, or I probably would have been a brain surgeon instead of an internist! On the home front I thank my children, Andrew and Lauren, for hanging in there with their Dad even though he missed some of the special moments of their childhood, and then back to M.J., who made certain that my work must wait while the Dad was where he was supposed to be for most of those special events.

To my parents, Teddy (deceased) and Bernice, I thank you for teaching me the principles of right and wrong and for providing me with the best college education possible. To my late sister, Marsha, thank you for always sharing in my triumphs and being there when I needed a friend. You left us too suddenly. I miss you.

To my students, I leave my works hopefully for you to benefit from, because it was you who inspired me to keep on with my teaching when everything else around me seemed rather dismal. Remembering those moments of discovery during rounds still brings out the goose bumps, and those looks on your faces when you realized that you could actually practice excellent medicine – priceless.

A special thank you to my colleagues who shared in those moments of learning and who offered me their own excellent wisdom and inspiration in my search of excellence in medicine. Academic medicine is far from a relaxing environment, but at the same time it is the only place where intellectual challenges are made, egos are bruised, and, most importantly, where the art and science of medicine progresses. I only hope that we share mutually in those special moments. I also want to acknowledge my colleagues at the AMC and the University of Florida for allowing me to photograph their cases and to share them with my students, colleagues and the readers of this text.

Last and certainly not least I want to thank Mr. Michael Manson and his wonderful staff at Manson Publishing, located in London, England.What a tremendously gracious gentleman Mike is and what a wonderful intellect he has, which has made him the success that he is today. My final acknowledgment goes to Peter Beynon, who is responsible for converting my rough literary style into one that gives me more credit than I deserve. Thank you, Peter, for doing your ‘magic' to make this book the polished finished product that we now have in our hands.