Friday, May 17, 2019

WHEN JOHN BOLTON SAID IT IS OK TO LIE ABOUT WAR!

Journalist Whitney Webb recently tweeted a 2010 video clip I’d never seen before featuring US National Security Advisor John Bolton defending the use of deception in advancing military agendas, which highlights something we should all be paying attention to as Trump administration foreign policy becomes increasingly Boltonized.
On a December 2010 episode of Fox News’ Freedom Watch, Bolton and the show’s host Andrew Napolitano were debating about recent WikiLeaks publications, and naturally the subject of government secrecy came up.
“Now I want to make the case for secrecy in government when it comes to the conduct of national security affairs, and possibly for deception where that’s appropriate,” Bolton said. “You know Winston Churchill said during World War Two that in wartime truth is so important it should be surrounded by a bodyguard of lies.”
“Do you really believe that?” asked an incredulous Napolitano.
“Absolutely,” Bolton replied.
“You would lie in order to preserve the truth?”
“If I had to say something I knew was false to protect American national security, I would do it,” Bolton answered.
The video is here:

“I don’t think we’re often faced with that difficulty, but would I lie about where the D-Day invasion was going to take place to deceive the Germans, you’d better believe it,” Bolton continued.
“Why do people in the government think that the laws of society or the rules don’t apply to them?” Napolitano asked.
“Because they are not dealing in the civil society we live in under the Constitution,” Bolton replied. “They are dealing in the anarchic environment internationally where different rules apply.”
“But you took an oath to uphold the Constitution, and the Constitution mandates certain openness and certain fairness,” Napolitano protested. “You’re willing to do away with that in order to attain a temporary military goal?”
“I think as Justice Jackson said in a famous decision, the Constitution is not a suicide pact,” Bolton said. “And I think defending the United States from foreign threats does require actions that in a normal business environment in the United States we would find unprofessional. I don’t make any apology for it.”
So that’s a thing. And it’s important for us to know it’s a thing because of the way things are heating up in Iran right now, since Bolton’s fingerprints are all over it.
Bolton has long been calling for war with Iran and in a paid speech in July 2017 told his pro-regime change MEK terror cult audience that they would be celebrating the successful overthrow of the Iranian government together before 2019. Now we’re seeing threat alarms being elevated and fearmongering about Iranian missiles being circulated, with reports being leaked to the press of possible plans to send 120,000 US troops to the region.
This is an environment that is ripe for deceptions of all sorts, and, given what Bolton said on live television nearly a decade ago, we would all do very well to remain very, very skeptical of any and all news we hear about Iran going forward. If for example you hear that within this environment of escalated tensions and military posturing Iran or one of its “proxies” has attacked the United States in some way, your immediate response should be one of intense skepticism about what the mass media talking heads are telling you to believe.
Back in 2012 at a forum for the Washington Institute Of Near East Policy think tank, the group’s Director of Research Patrick Clawson openly talked about the possibility of using a false flag to provoke a war with Iran, citing the various ways the US has done exactly that with its previous wars.

This chilling video is here:


“I frankly think that crisis initiation is really tough, and it’s very hard for me to see how the United States president can get us to war with Iran,” Clawson began.
(Can I just pause here to note what a bizarre series of words that is? “Get us to war with Iran?” Get us to the thing that every sane human being wants to avoid with every fiber of their being? You want to “get us to” there? This is not the kind of thing normal humans say. You only hear this kind of insanity in the DC swamp where creatures like John Bolton have their roots.)

“Which leads me to conclude that if in fact compromise is not coming, that the traditional way that America gets to war is what would be best for US interests,” Clawson added. “Some people might think that Mr. Roosevelt wanted to get us into the war… you may recall we had to wait for Pearl Harbor. Some people might think that Mr. Wilson wanted to get us into World War One; you may recall we had to wait for the Lusitania episode. Some people might think that Mr. Johnson wanted to get us into Vietnam; you may recall we had to wait for the Gulf of Tonkin episode. We didn’t go to war with Spain until the USS Maine exploded. And may I point out that Mr. Lincoln did not feel that he could call out the Army until Fort Sumter was attacked, which is why he ordered the commander at Fort Sumter to do exactly that thing which the South Carolinians said would cause an attack.”
“So if, in fact, the Iranians aren’t going to compromise, it would be best if somebody else started the war,” Clawson continued. “One can combine other means of pressure with sanctions. I mentioned that explosion on August 17th. We could step up the pressure. I mean look people, Iranian submarines periodically go down. Some day, one of them might not come up. Who would know why? We can do a variety of things, if we wish to increase the pressure (I’m not advocating that) but I’m just suggesting that this is not an either/or proposition – just sanctions have to succeed or other things. We are in the game of using covert means against the Iranians. We could get nastier at that.”
So these are ideas that have been in circulation for many years. That gun is loaded and ready to fire.
Bolton trussed up his 2010 confession using an example that most people would agree with: that it was reasonable for the Allied forces to deliberately deceive the Nazis about the nature of the D-Day invasion. But we know John Bolton better than that by now. This PNAC director and architect of the Iraq war once threatened to murder a foreign official’s children because his successful diplomatic efforts were putting a damper on the manufacturing of consent for the Iraq invasion. He wasn’t defending the use of deception in crucial military options used to halt tyrants trying to take over the world, he was defending the use of deception in the senseless wars of aggression that he has built his political career on advancing.
Take everything you hear about Iran with a planet-sized grain of salt, dear reader, and everything you hear about Venezuela too while we’re on the subject. There are skillful manipulators who are hell bent on toppling the governments of those nations, and they have absolutely no problem whatsoever with deceiving you in order to facilitate that. And they don’t believe the rules apply to them.

Tuesday, October 30, 2018

PAT ROBERTSON – THE CHRISTIAN FROM HELL!

Evangelical Christian and CBN CEO appeared on national TV this week calling for Americans to “cool the rhetoric” on Saudi Arabia over the apparent brutal killing of U.S. resident and journalist Jamal Khashoggii at the hands of the Saudis because the Middle Eastern nation is an “ally” and has a lucrative arms deal with the United States. Trump's administration is going crazy trying to salvage this bloody mess with all the usual political excuses and lies. Yet, many companies have been backing away from doing business with Saudi Arabia citing the alleged murder and subsequent investigation.
On national broadcast Pat Robertson stated:
“We’ve got an arms deal that everybody wanted a piece of… it’ll be a lot of jobs, a lot of money come to our coffers. It’s not something you want to blow up willy-nilly”.
It is clear from his statement that Pat Robertson could care less if those weapons will be used to murder innocent, defenseless civilians and children in neighboring Yemen, or will be used against innocent Palestinian, Syrians and Iranians, so long it is done in the name of preserving and alliance and more than $100 billion worth of arms sales – this despite of the fact that the Saudis – NOT IRANIANS OR SYRIANS – were behind the 9/11 events.
Pat Robertson is an idol, highly respected by the Evangelical community. He is notoriously known for his blabbering in favour of Israel and the Saudis, and hatred-filled saber-rattling against Iran, Palestinians and Syrians... yet, he forgets that Saudi Arabia scores much worse in human rights and religious freedom than any other Muslim country in the Middle East. Ignorance is conveniently blissful.
This is another tragic evidence of the state of putrefaction of Christianity in the US. With immoral spiritual leaders like Pat Robertson, it is not difficult to understand how Christians in America have been easily seduced, polluted and invested in the military; it hasn’t taken much convincing for Christians to become "patriotised Christian Jihadists", fooled, corrupted, and turned into ignorant, violent, warmongering, satanic, bigotry-filled religio-Zionist-statists.
And here's to you, “Pat Robertson” , ♬ Jesus loves you more than you will know -Wo wo wo...♫
God bless you, please, ♪♫ “Pat Robertson”, ♪♫♬ Heaven holds a place for those who pray - Hey hey hey, hey hey hey! ♪♫♬
As for me… I will never watch CBN again…
And finally, a very important question remains: Will the United States Congress finally speak up against the genocide of innocent Yemenis at the hands of Saudis, or the Petrodollars filling their pockets will continue to silence them? 

Friday, March 30, 2018

THE PETRODOLLAR SYSTEM AND WORLD WAR III

OK. I haven't written for  long time. My wife and I decided to move back to Alaska. Pictures of our adventures here will come soon! But before it happens, let me get a bit political.

If you follow my blog from over the world and are an intelligent person, you must be asking yourself - "why are the US and her vassal states (the UK, Canada, France, Belgium, Germany, etc.) aggressively attacking and demonizing Russia, China, North Korea, Iran? Are these nations really nasty thugs, or is there something else behind this whole propaganda that we do not know?

The reality is - any country that objects to the US satanic desire for geopolitical dominance in the world will be targeted as evil and attacked (who is the real thug, uh?). The US buried herself on a huge shit pile of debt and she can't pay it back. Consequently, America desperately relies on the international demand for dollars (Petrodollars) to keep her mega debt-based economy afloat; if oil-producing countries decide to sell petroleum using any currency other than the Dollar - the US  economy is toast. Therefore, the US had to come up with a big lie to sell to the public - the so called "war on terror" to protect "freedom". The real underlying goal is not to spread democracy of freedom in the Middle East. Rather it is to change the geopolitical landscape in order to establish more puppet governments there - governments that won't dare to move away from the Petrodollar Ponzi Scheme.

It is not working... and more powerful players are standing up to Uncle Sam's wicked plans. Now Uncle Sam is deranged, desperate and rabid. To save his ass, the US and her coward vassal states are launching a savage, unfair propaganda against Russia, Iran, China and N. Korea. The United States no longer has any morals. It is ruled by psychopaths who could care less if they have to start nuclear WWIII - even if the entire world (including children) are destroyed. 

Worth watching: 

https://www.youtube.com/watch?v=TC3tINgWfQE&t=107s

Monday, January 18, 2016

The Coming Recession in Veterinary Medicine

AVMA economist Michael Dicks reported to the House of Delegates that a growing number of seats in veterinary academia means more new graduates are entering the job market. At the same time, he said, older veterinarians appear reluctant to retire. "We have a lot more people after 65 still hanging in the workforce. ... As density of veterinarians increases, average income falls," Dicks noted. A recession is looming, not just for veterinarians but for the entire U.S. economy.

The forecast came from American Veterinary Medical Association economist Dr. Michael Dicks, who addressed the House of Delegates on Saturday in Chicago. He told veterinarians that while the economy should remain healthy for the next eight to 20 months, they can anticipate a downturn that will impact all corners of the profession, from private practice to academia. Without articulating reasons for the anticipated downturn, he stated: "I have bet my finances on a recession happening in early 2017."

Dicks' prediction comes on the heels of a paper he published last month addressing growth in veterinary academia — new schools and increased class sizes — not seen since the 1970s, and the impact it's having on the profession. Athough Dicks doesn't mention them by name in his paper, plans to create new programs are emerging at Texas Tech in Amarillo and in Miami-Dade County through a partnership with Florida International University. They follow the creation of three other veterinary medical programs in three years: Lincoln Memorial University in Harrogate, Tennessee; Midwestern University in Glendale, Arizona; and the University of Arizona in Tucson, which has not yet opened but is under review by the AVMA's accrediting body, the Council on Education.

Meanwhile, some already-established programs have increased their class sizes to accept more students, a move that some believe is a tactic to help replace funding once provided by state legislatures. School officials say the expansion of their programs make seats available to qualified candidates who otherwise might be locked out of the nation's 30 accredited veterinary medical programs.

During the past 30 years, the number of first-year seats in veterinary schools traditionally have outnumbered the number of applicants by more than 2-to-1, making it easy for programs to select the most qualified candidates. Dicks observed that the pendulum, however, is swinging in the other direction. With the current applicant-to-seat ratio at 1.6-to-1 — the lowest it's been since at least 1980 — he forecasts that the applicant pool is likely to continue to shrink. 

The general message from Dicks: Veterinary academia (i.e., number of schools) is growing at a time when veterinary medicine as a career prospect may have lost some of its luster. Even so, he said, there are bright spots. As a whole, U.S. veterinary students accumulate $750 million in educational debt each year to pay $650 million in tuition, leading Dicks to believe that students aren't borrowing wildly beyond their tuition costs. Mean starting salaries were in the range of $70,000 a year in 2015, reflecting a $3,000 increase over the previous year, Dicks said. (When asked to expand on those figures, he noted that the 2015 salary findings are not yet published but will be explored in upcoming AVMA reports on the veterinary education market.) The debt-to-income ratio, Dicks added, is 2-to-1 and stabilizing.

Still, a debt-to-income ratio of 1.4-to-1 "would be much more palatable," Dicks said. Six-figure tuition and low salaries could deter would-be applicants. "We believe that applicant knowledge about debt and cost (of education) is improving and might lead to a change," he told delegates. "The ability of schools to fill non-discounted seats will continue to be more difficult." That trend, Dicks said in his paper, will negatively impact the profession's applicant-to-seat ratio through the next decade.

"As the cost of education continues to climb, and as college students become increasingly knowledgeable of the financial hardships associated with the profession's high debt-to-income ratio, this applicant-to-seat ratio is forecast to decline even with a constant number of available seats through 2025," Dicks wrote. "However, if the rate of increase in the number of seats at existing schools continues the long-term trend and two new schools are added, then the combination of new seats and declining applicants will bring the applicant-to-seat ratio to an estimated 1.04-to-1 by 2025."

That’s a single applicant for every seat — an unprecedented low. In 1998, there were nearly three applicants for every available veterinary education seat. Ten years later, the ratio was 2.4-to-1, and it has steadily declined since then. Between 2002 and 2013, the numbers of applicants climbed 52 percent, from 4,440 to 6,769, according to figures from the AAVMC's Veterinary Medical College Application Service.

The idea that there’s a great unmet demand for veterinary education clearly has contributed to growth in new schools and elevated class sizes. In his paper, Dicks begins by noting the importance of asking three questions before starting any business: Is it physically possible? Can it make money? If so, can it survive long-term competition? The final question, he said, is the most difficult to answer.

"The continued push to expand the number of veterinary schools (and thereby the number of seats available to veterinary students) certainly has me wondering whether all of these basic prerequisites are being considered in the planning process and before commitments are made to pursue the necessary approvals and begin the accreditation process," he wrote. "...The market for veterinary education faces a competitive demand for seats from applicants, as well as a competitive market for veterinarians that is derived from the competitive market for veterinary services. Thus, the new veterinary college must consider both forces, now and in the future, in determining the sustainability of its business."

Landscape of education
Between 2012 and 2015, U.S. veterinary academia added more than 500 first-year seats, the AAVMC reports. According to the group's data, 3,586 first-year students were admitted to U.S. veterinary medical programs in 2015, up from 2,570 a decade earlier. Those totals do not include American students earning their veterinary degrees abroad. AAVMC reported that in 2015, 619 Americans graduated from institutions outside the United States, many coming from Ross University, St. Matthews University and St. George’s University in the Caribbean. Another 2,977 students graduated domestically in 2015, bringing the total number of graduates to 3,596.

Within the next three years, the number of new graduates is expected to increase another 7.3 percent, totaling 3,870 Americans graduating from veterinary medical programs on U.S. soil and overseas. About that time, demand for veterinary education will keep pace with the growing number of seats, with the possibility that some could go empty. "Worst-case scenario," Dicks said, is that the survival of some veterinary colleges soon might be in question.

In his paper, Dicks characterized the relationship between veterinary programs as "extremely competitive." Reports of friction between programs already is on display at Texas Tech and Texas A&M University, the latter of which has run the state's only veterinary college for nearly a century.
"...Veterinary schools will in the near term have to compete for students," Dicks wrote. "With the addition of even more seats, the market for veterinary education would become a buyer’s market, meaning that each applicant (the buyers in this case) would face less competition for seats at veterinary colleges (the sellers in this case) ...

"Based on our modeling," he added, "there is a threshold value for tuition costs that the average student is willing to pay; above that threshold, the number of applicants decreases, and recent analysis has shown that this threshold may be declining."

Translation: In the near future, the number of students willing to pay between $77,055 and $232,528 for in-state tuition and up to $261,308 for out-of-state tuition, will dwindle. Dicks did not specify the break point. His report, however, makes it clear that some programs are in line to struggle, especially those schools with tuition in the top 20th percentile.

"The bottom line here is that unless a new school can provide a veterinary education at a cost to students at or below the threshold in this increasingly competitive market, a veterinary degree program will not likely be sustainable," he said. Considering the weight that six-figure student loan debt bears on new graduates, Dicks added that the survival of new schools eventually will depend on their ability to either educate graduates for less or train them to attract more demand for their services.

Step forward for AVMA?
To some veterinarians, Dicks’ forecast and analysis reads like a no-brainer, echoing what many in the profession have been saying for years. Others find the statements, coming from AVMA, refreshing considering that until a few years ago, the organization professed a shortage of U.S. veterinarians. Challenged by practitioners feeling squeezed by a tightening job market, that outlook eventually was recanted, though the AVMA said there wasn't enough data to draw workforce conclusions. The issue couldn't be discussed without violating antitrust laws, AVMA legal counsel warned in 2011.

Discontent among veterinarians and criticism of the AVMA has since followed, along with accusations that the organization has sugarcoated a veterinary surplus and failed to tighten the reins on accrediting new programs.

Considering the AVMA's stance on workforce topics, Dicks' paper is a "huge step forward," said Dr. Paul Pion, president and co-founder of the Veterinary Information Network, an online community for the profession and parent of the VIN News Service. Dicks' findings reflect the "observation and logic" long-expressed by AVMA members, Pion wrote in a VIN discussion.

"... AVMA is late to the party — we should all welcome them," he said.  

Others are more cynical about Dicks' perspective.

Dr. Frank Marchell in Kittery, Maine, believes the profession is worse off than Dicks asserts. "Economists love graphs, trends, simplifying assumptions, concise if/then scenarios to tell their ‘story,’ he wrote on VIN. "The total picture is messier."

Dr. Bill Folger, a board-certified feline practitioner in Houston, said it’s the prospect of struggling veterinary programs that led the AVMA to release a somewhat negative perspective on the growth of new schools — not the plight of members.

In his paper, Dicks did not explore concerns that the increased number of seats have led to a growing supply of veterinarians in the United States, a condition about which practitioners across the country have long lamented.

"At this time, we do not have a model for the effect on unemployment," Dicks wrote. (By email, he explained that modeling is underway, but there is not yet enough data to draw conclusions.) Dicks predicted that starting salaries likely will be adversely impacted by an increased number of graduates entering the job market.

"This decline in income would exacerbate the existing disparity between growth rates in income and debt, causing the debt-to-income ratio to rise," Dicks wrote. "The rising debt-to-income ratio will likely accelerate the reduction in applicants, perpetuating the potentially negative effects on the market for veterinary education."

Dr. Tony Bartels, a VIN employee with expertise in student debt, noted that the veterinary education market and reality of private practice are "highly disconnected." He added that there’s no real incentive for veterinary colleges to lower tuition when the federal student loan system does not limit how much students can borrow for their education.

"I guess I'm just not that excited by this revelation," he said of Dicks’ report. "Sure, it actually shows some data that looks negative in terms of a new school opening up … but is that really (worthy of) applause? Maybe a sarcastic golf clap, if you will.

"And they certainly didn't say it was a bad idea to open a new school."

Sunday, December 6, 2015

BREEDING BITCHES: WHAT ARE WE TO DO WITH THE C-SECTION FAD?



By Claudio Lagoa, DVM, MS

"How do you make a million dollars breeding dogs? Start with 2 million dollars" – the saying goes. Breeding dogs is not cheap…monetarily, emotionally, or with the amount of time invested. Precious lives are involved. Lamentably, few people breed dogs responsibly.

I have always passionately loved dogs. But sometimes, the interaction with some clients and breeders can become a source of major frustration - an experience shared by many of my colleagues. And while some clients and breeders are to be praised for their avid interest in searching for medical information to improve the health & care of their beloved pets, one thing needs to be very clear: neither Dr. Google nor books from your local library will ever be able help you attain the same level of expertise of a DVM for a very simple reason: veterinarians spend thousands of hours learning complex concepts in physics, chemistry (general, organic and inorganic); genetics (basic and advanced); basic and applied physiology; pathology; microbiology; medicine, surgery, etc. -- these are only a few disciplines that we must tackle during our many years in vet school. Then, add to that the complexity of combining theory & practice to become a seasoned vet – something that may take years to achieve. Veterinary medicine (like human medicine) is an ever-evolving science, requiring constant dedication to keep us abreast of new advances. To make things even more ghastly, some vets will go on to pursue advanced training – be it in research (masters or a PhD) or a clinical residency program and sometimes all of the above. Every year vets must comply with state board regulations and complete a certain number of credits in continuing education, or else, lose the license. As you can see, learning is never-ending. Every day I still find myself returning from work only to get immersed in veterinary books and scientific articles – all of this to assure that I am doing what is best for my patients. But all of the above may not be enough for veterinarians to convince "all-knowing clients" to do what is best for their pets. Many will contend that they know more than their vets. And while the digital era has made the dissemination of information easily available and contributed to great strides in some areas such as preventive medicine and welfare, in some areas, this has not been for the better. One of these areas has to do with the fad of cesarean section (C-section) in bitches.

Cesarean section has been part of human culture since ancient times and there are tales in both Western and non-Western cultures of this procedure resulting in live mothers and offspring. According to Greek mythology Apollo removed Asclepius, founder of the famous cult of religious medicine, from his mother's abdomen. Numerous references to cesarean section appear in ancient Hindu, Egyptian, Grecian, Roman, and other European folklore. Yet, the early history of cesarean section remains shrouded in myth and is of dubious accuracy. Even the origin of "cesarean" has apparently been distorted over time. It is commonly believed to be derived from the surgical birth of Julius Caesar; however, this seems unlikely since his mother Aurelia is reputed to have lived to hear of her son's invasion of Britain. At that time the procedure was performed only when the mother was dead or dying, as an attempt to save the child for a state wishing to increase its population. Roman law under Caesar decreed that all women who were so fated by childbirth must be cut open; hence, cesarean. Other possible Latin origins include the verb "caedare," meaning to cut, and the term "caesones" that was applied to infants born by postmortem operations. Ultimately, though, we cannot be sure of where or when the term cesarean was derived. Until the sixteenth and seventeenth centuries the procedure was known as cesarean operation. This began to change following the publication in 1598 of Jacques Guillimeau's book on midwifery in which he introduced the term "section." Increasingly thereafter "section" replaced "operation".

In the bitch, C-sections are done with the intention of saving the life of the bitch and as many puppies as possible. Most often, dystocia (complicated/obstructed delivery) necessitates an emergency C-section. By this time, one or more of the fetuses may be dead or compromised and the mother weak or debilitated. In some – but not all cases - planning a Cesarean section can prevent fetal or maternal loss and can eliminate midnight emergency calls to the veterinarian.

In human medicine, the culture of giving birth has changed drastically since 1970. The caesarean section, once known as a life-saving medical procedure to be used under extraordinary circumstances, is now perceived by the medical profession and their female patients as a safe, painless, modern, and ideal form of birth for any pregnant woman. Certainly, this cultural phenomenon has now extended beyond the medical arena to affect veterinarians and their clients as well.

In human medicine doctors have appropriated cultural values regarding the female body and sexuality and reinforced a blind fascination with technology and medicalized women's fear of labour to justify their preference for surgical births. By narrowing ethical concerns to the doctor-patient relationship and drawing on the notion of the patient's best interest, physicians defend their practice of C-sections as appropriate -- and even desirable. Likewise, the widespread use of C-sections in bitches follows similar trends. On one hand, veterinarians have appropriated breeders’ perceptions regarding the subjective value of a bitch or sire (particularly in the context of dog shows) to justify that they are acting in their client’s best interest while capitalizing on the number of procedures performed. On the other hand, breeders lured by advances in veterinary technology have easily accepted C-sections as a safe procedure, and routinely turn to them for two main reasons: first for convenience; understandably, breeders dread the late night or weekend delivery. And as the noun implies, "labour" involves really hard work: whelping a bitch requires many hours of preparation, attention and stress as the owner has to monitor and assist the bitch (and puppies) during and after delivery. It is not uncommon for dedicated owners to be up for 12-24hrs when a bitch is in labour. Secondly, breeders elect C-sections in hopes of maximizing their financial gain; many na├»vely believe that C-Sections can miraculously deliver them more viable puppies (regardless of the risks involved for the dam and litter) and will often pressure veterinarians into performing the procedure. Sadly, in our fast-paced, digitalized, touch-screen, theme park, multi-level, homogenize-the-world mochaccino-era, the commitment to vaginal whelping is dwindling among breeders.

In human medicine, most U.S. experts—whether high-risk obstetricians or home-birth midwives—agree that the U.S. C-section rate is higher than medically necessary and acknowledge that many women are undergoing major surgery for unnecessary reasons. Jeffrey Ecker, MD. ’88, professor of obstetrics, gynecology, and reproductive biology, is a high-risk obstetrician at Massachusetts General Hospital and director of his department’s quality and safety program. A few years ago, working with the Massachusetts Department of Public Health, he compared C-section rates among the commonwealth’s hospitals. The study, like similar ones in other states, found great disparities: Massachusetts hospitals showed as much as a threefold variation in frequency of cesareans. These disparate rates, Ecker says, "can’t all be optimal," and, he adds, it’s "certainly very difficult to demonstrate that higher cesarean rates are associated with better outcomes."

Undoubtedly, some dog breeds need higher caesarean section rates compared to others. In a research published in the Journal of Small Animal Practice (2008), Dr. Evans KM demonstrated that the breeds with the highest caesarean rates were the Boston terrier, bulldog, French bulldog, mastiff, miniature bull terrier, German wirehaired pointer, Clumber spaniel, Pekingese and Dandie Dinmont terrier. In the Boston terrier, bulldog and French bulldog, the rate was > 80%. A higher incidence of dystocia in brachycephalic breeds (breeds with shortened heads/faces such as Bulldogs and Boston Terriers) is a non-intuitive, expected finding. Why the incidence of C-sections is increasing in all breeds demands a reasonable scientific justification - one I presume does not exist.

The majority of clients who come to the ER to get a C-section are in panic mode. They do not know when the litter is due because they often breed their dogs without veterinary assistance. Accurate prediction of the due date relies on hormonal evaluation of the bitch BEFORE BREEDING. Common sense calls for the routine assessment of any dog(s) for breeding purposes by a licensed veterinarian. Why so many clients decline a simple physical exam, vaginal cytology and blood work for less than $250 is mind-boggling. The proper coordination of breeding with vaginal cytology, serum luteinizing hormone (LH) and serial progesterone measurements often allow a more accurate prediction of whelping date. Measuring blood levels of progesterone can also give an idea of whether whelping is imminent because the levels fall when puppies are ready to come out. Usually, levels of 2-3ng/ml are considered low enough to raise suspicion and demand close observation for imminent labor. However, it is not uncommon for bitches to maintain progesterone levels around 2-4ng/ml for a few days before whelping, which can throw some confusion in regards to "readiness" for birth.

Clients must recognize that a C-section should be used only for high-risk pregnancies (brachycephalic dogs, for instance) or for emergency situations, as C-sections can disrupt many important physiological processes that can be detrimental to both dam and newborn puppies. Above all, it is important for clients to understand that it is FETAL MATURATION - NOT THE MOTHER that sets the time for delivery. In late pregnancy, fetal cortisol secretion stimulates lung surfactant production, activates hepatic, and gastric enzymes, and promotes overall final fetal maturation. Subjecting the infant to the expulsive/mechanical forces of vaginal birth is also critical for proper perinatal pulmonary (lung) adaptation. For instance, studies have shown that the absence of a compressive force in the fetal chest while passing through the birth canal reduces the breathing reflex in neonates delivered by C-section. Babies born by C-sections lack the rapid clearance of fetal lung fluid promoted by the normal physiological hormonal environment present in spontaneous labor. Additionally, surfactant synthesis – an essential molecule for proper post-natal lung function/respiration -- is only produced when babies are fully developed and ready for life outside the uterus. If puppies are delivered prematurely, the absence, deficiency or inactivation of surfactant can lead to severe respiratory dysfunction (neonatal respiratory distress syndrome), which is one of the most common of neonatal complications in premature infants. A study recently published in the Journal of Veterinary and Emergency & Critical Care demonstrated that puppies born by elective C-section PRIOR to the onset of expulsive uterine contractions had significantly lower mature amniotic surfactant concentration compared to those delivered by vaginal birth, which indicates incomplete pulmonary maturation. Finally, C-sections require general anesthesia, which further contributes to respiratory depression in puppies. Consequently, babies delivered by C-section may inevitably experience respiratory distress due to ineffective fluid absorption by the lungs, due to lack of adequate amounts of mature surfactant and depression of breathing efforts by anesthetics. Controlled studies in human medicine have demonstrated that babies born via C-section have higher incidence of obesity and asthma later in life. Women subjected to C-section face greater likelihood of future complications in pregnancy, including uterine rupture or conditions in which the placenta covers the opening to the cervix (placenta previa), adheres abnormally to the uterine wall (placenta accreta), or separates from it (placenta abruption). These women are also less likely to breast-feed, and may be at greater risk for depression and post-traumatic stress. Likewise, bitches can experience hurdles as well. They are subject to complications such as intra and post-operative hemorrhage, placental retention, infection, blood clots, uterine scars, bladder damage and possible bowel obstruction. Insufficient mothering instinct or rejection of newborns in dogs is likely to be more prevalent in C-sections and may result from inappropriate hormone balance and/or post-operative pain.

Even if clients insist on having puppies surgically delivered, the dam should be allowed to progress as far as is practical and possible into labor. She needs time to concentrate on licking her nipples and vulva (and everything else within reach) and with your good vet standing by, it is safe. The pre-delivery licking coincides with the release of endorphins and hormones which lay an important foundation for the bonding behavior between mother and whelp. The first time dam who is trotted off to surgery without benefit of the nesting, licking and cleaning behavior is one who will most likely never develop good mothering skills. She is more apt to reject or be frightened by those odd squirmy little things she awakens to find in her bed. Conversely, the dam you allowed to become serious about licking, digging, and arranging her bed can be taken straight into surgery and home as soon as possible.  That way, she will take up where she left off as soon as she's regained her wits.

In conclusion, since there is no safe, effective way to induce canine labor, the practice of elective caesarian has grown by leaps and bounds. While doing a C-section can save the bitch and/or puppies in an emergency, it should never be done as a matter of convenience. In the broadest sense, attaining an optimal C-section rate in bitches may be a matter of finding a middle ground between two approaches to birth and risk—between vigilance toward the "disaster waiting to happen" and support for the "physiologically sound process." That way, surgery happens when necessary, but is avoided in the many cases when it’s not.

Tuesday, November 24, 2015

Vector Borne Diseases



The prevalence of tick-borne diseases in the East Coast (Pennsylvania in particular) is very high. Diseases transmitted by ticks are very serious! I regularly find ticks and fleas on my patients. Unfortunately, a significant number of clients do not treat their dogs and cats regularly with anti-flea and anti-tick products. Many stop applying these products in the winter, mistakenly believing that ticks and fleas are not around in the cold winter months. Many also use "home-made products" that are completely ineffective to rid dogs and cats of fleas and ticks. Talk to your vet to learn how to EFFECTIVELY prevent tick and flea infestation of your pets. It can save your pet's life!