We Need to Talk About Feline Injection Site Sarcomas

We need to talk about Feline Injections Site Sarcomas. I will call them FISS from now on. No one really wants to talk about this subject. It makes us uncomfortable. Our whole raison d’etre as veterinarians is to prevent and treat diseases in animals. Now we have to talk about a disease that we caused trying to prevent another disease? And it is horrible? No thank you. Some of the vaccine companies also do not want to talk about it. I am inviting you to get a bit uncomfortable and read on. I think it’s important.


Thankfully, FISS is also very rare. It depends on your source, but FISS is reported in 1 in 1000 to 1 in 10 000 cats. Most veterinarians will only see a small number of these throughout their career, which is great. We still need to talk about it.


We need to talk about vaccination protocols. As a veterinary surgical oncologist, am I the best person to talk about vaccine recommendations in cats? No I am not. Also, this is no a longer one protocol fits all situation. Here is what I do know, Rabies is a zoonotic disease that is fatal to animals and people. If you live anywhere that rabies is endemic, you have to vaccinate cats for rabies. Even if they stay indoors. Feline leukemia vaccine does not need to be given year after year. Most of these vaccines do not need to be given yearly. I highly recommend that you read the Feline Injection-Site Sarcoma ABCD Guidelines on Prevention and Management (Journal of Feline Medicine and Surgery 2015, 17, 606-613).


We need to talk about vaccine sites. The recommendations to vaccinate over a limb, rather than an interscapular site, are over 20 years old. The message has gotten through. Sort of. The whole idea behind vaccinating over the limb was that when FISS occurred at these sites, it could be treated by a simple amputation. This is less effective when vaccinating over the limb actually means vaccinating over the hip/flank area. This tends to happen when the cat is in a crouched position and also when you don’t actually vaccinate over the limb. If it happens, the resultant tumour in the hip/flank area will require a hemipelvectomy and body wall resection for treatment. This is not exactly what the feline vaccine associated sarcoma taskforce had in mind. You need to vaccinate below the elbow or the stifle. Really? Yes really. Every time? Yes, every time. You can do it! I did it for three years in general practise (1997-2000). You might need to bust out a towel, or a cat bag, or your best cat whispering skills, but it is worth it. While you are at it, you can explain to the owner why you are vaccinating their cat there and let them know what to watch for in case they develop a mass in this area. What about tail vaccines? Well I am not sure, there is only one study out on this, but to be honest, this is where I vaccinate my own cat. It is a little tricky and I recommend shaving to avoid intra-fur vaccination. Also, there is a sweet spot on the tail that is high enough that you actually have a SQ to inject into, but low enough that you can easily get 5cm margins of tail if an injection site sarcoma forms there. I live in terror that this trend will catch on, but veterinarians won’t vaccinate low enough. I can’t do a cat bum-ectomy. Please don’t ask me to.


We need to talk about what causes this disease. It is an aberrant response to chronic inflammation. There is a genetic component too, as only some cats seem to be predisposed to this and there are some reports of related cats being affected. This is hard to study because cat families don’t tend to keep in touch. Vaccines cause inflammation. Vaccines with adjuvant cause more inflammation. That is how they work. There have been case reports of other types of injections causing FISS, including cisplatin, meloxicam and a microchip. These are one-off incidents that are even less likely than the 1 in 1000 to 1 in 10 000 cats that are getting FISS from vaccines. Some vaccine companies like to focus on the fact that other injections have been reported to cause this disease. Yes, this is true, but adjuvanted vaccines is a thing that we can change and giving other injections may not be. Instead of throwing up our hands and saying, “Well any injection can cause this”  let’s focus on the thing we inject into cats more than anything else. Vaccines. We need to stay focussed on the vaccines because they are the biggest part of this equation. We can actually decide when to vaccine and where. This is where we can move the needle. It’s about the vaccines. The other side to this is that we can’t get complacent with the nonadjuvanted vaccines and start vaccinating all willy-nilly anywhere we want to because nonadjuvanted vaccines are “safe”. Stick to the distal limbs with all vaccines.


We need to talk about vaccine records. Vaccine records are not sexy, but they are so important. The type of vaccine, lot number, expiry date and vaccine site needs to be recorded. If the cat develops FISS, this needs to be reported to the vaccine company because it is an adverse event. This is a highly aggressive fibrosarcoma. It really doesn’t get any more adverse than that. As an added bonus, when you have all of this information, a lot of vaccine companies can be really great about giving some help to the owner to treat this disease. I mean dollars in their pockets to help with the cost of diagnostics and sometimes even therapy. I have had vaccine companies give between $1000-4000 to my clients to help with treatment. As my father likes to say, “it’s better than a poke in the eye with a burnt stick”. I have no idea what that means, but please report these to the vaccine companies. And, hey, giving these companies all of the information about a FISS that occurred with their vaccine might help them to understand what is going on better. Science!


We need to talk about what to do when you see a mass at an injection site. Hopefully you have an educated client who will come back if a mass develops at a vaccine site. Hopefully the mass is small and located below the elbow or the stifle. Hopefully you will recognize that this is may be an injection site sarcoma. Most of the time, a fine needle aspirate is a great test to do on a new mass. However, in the case of FISS, cytology is not your friend. It might lead you to believe that this is just inflammation. You can do an FNA to rule out other tumour types if you want, but ultimately, you are going to need histopathology. An incisional biopsy should be performed on masses that have been present for more than a month after vaccination. The goal is to get a small amount of tissue and to leave the mass intact so that it can be removed with wide or radical margins if it is a FISS. Excisional biopsies are problematic because they can make definitive resection much more difficult and, let’s face it, this is already difficult.


We need to talk about how we are removing these. Current recommendations are 5cm radial margins and two fascial planes deep. If you think about the smallest FISS that we diagnose, it is around 2cm. If you take 5cm margins, that is a 12cm diameter defect. In a cat. It is usually successful if you are lucky enough to get an early diagnosis and a location that is amenable to a radical surgery. These are two things that we have control over by educating the client, doing an excellent work up and placing the vaccine in a location where we can get 5cm margins.


I used to enjoy of the challenge of a big FISS surgery. Now I just feel sad when I treat these cases and I need to do a hemipelvectomy and/or body wall resection. This is because I know that if the vaccine had been placed low on the limb, I could have achieved the same or actually much better with a simple limb amputation. These cats are breaking my heart. I honestly can’t do any more lectures on huge cat-ectomies for this terrible disease. I can’t do another panel discussion at a conference arguing the finer points of whether we should do radiation before we remove a huge portion of cat or after we remove a huge portion of cat. I find it ridiculous. It is ridiculous. The answer is we shouldn’t be doing either of these things. We need to do better as a profession and do whatever we can to decrease the incidence of disease, diagnose it earlier, and make it easier to treat. Please let’s work together on this. I know it is only 1 in 1000 to 1 in 10 000 cats, but to cat owners going through this, this cat is one in a million.


Thanks for the talk.



Things we can change Things we can’t change
Do not over vaccinate, create protocols that are appropriate for the level of risk Some cats are predisposed to developing FISS at sites of chronic inflammation
Consider using non-adjuvanted vaccines FISS is an extremely aggressive tumour that requires aggressive resection
Vaccinate below the stifle and elbow Cats need to be vaccinated for rabies


Focus on gentle handling of cats to allow you to vaccinate low on limbs Some cats do not care for the veterinary clinic/vaccine experience
Record every vaccination and site in your medical records
Educate your clients on what to look for and what to do if a mass develops
If you see a mass at an injection site, do an incisional biopsy without delay
Report FISS as an adverse event


Wide or radical excision as the first, curative-intent surgery


The Second Amendment Right to be Afraid


Recently, I got to see first hand how the right to bear arms works out and what happens when you give a good guy an automatic rifle. I live on a massive working farm. It is hard to describe the magnitude of the place, but it is thousands of acres and around 40 people live here. It is a peaceful sanctuary and I am not sure if it is the fact that it is gated, or the fact that most people can’t find my house when they are trying to visit me, but I have always felt very safe here.


Then everything changed. I was driving home after midnight. This is unusual for me because I am old and lame and have no thyroid. I need my sleep. But we were out for a work-do. My husband and I took separate cars because he came late (Let’s face it, there is only so much work-do you can put your spouse through). I was driving home. A big truck was in front of me and the driver had punched in the gate code. I followed them in before the gates closed again. I followed them through the curvy roads on the massive farm. It was a dark night, all house lights were off and I actually drove past the house. As soon I realized it, I did a U-turn.


Then I saw another truck coming towards me. I’m thinking, “Wow, busy night on the farm”. The truck doesn’t move over to let me pass. It stops in the middle of the single lane farm road and blocks me. I see a shirtless man get out. He is fat and his hairy body is backlit by his truck brights. He has a huge automatic weapon pointed at me with his finger on the trigger. He is yelling something in vigilante-mode, like, “Freeze! Get out of the car!” I have no idea who he is or what is going on, but I am pretty sure that I am going to die right here. I don’t think that I have ever been more scared. I’m thinking, “Really? This is the last image I am going to see before I die? A fat, hairy redneck pointing a gun at me in the silhouette of an F250’s highbeams?” That is so disappointing. I always thought I would have a much more glamorous death.


Somehow my surgical training kicks in and I keep my cool. I slow things down. Hoping it is just friendly fire (because if it is not, I figure I am dead anyway), I open the window and yell out, “It’s Sarah! I live here! I live on the farm!” Then I see him pause and the weapon drops slightly. His female partner is out of the truck, holding a cell phone in one hand and a barking Jack Russel terrier in the other. They are all hysterical (the terrier slightly less so). I recognize her. They live here. She tells me that someone has followed their teenaged daughter and her friend onto the farm. I say, “No, it was just me, I was following them.” But they are not listening. They say sorry for almost shooting me and then start running for the truck again, gun/terrier/cell phone in hand. She is barking orders at her daughter into her cell phone. They are off to find the imaginary killer. I pull up to them and tell them that my husband is coming home behind me, describe his car and yell, “Please don’t shoot him!”


We head our respective ways. I pulled into my driveway and proceeded to have a breakdown. I then tried to call my husband but I had lost my ability to speak. Then I just sat down and cried. I was crying because I was scared and because when I looked at the redneck with the gun trained on me, I didn’t see hate, or anger. I just saw fear. He was afraid of me.


My husband got home without being mistaken for an intruder or threatened with deadly force. I resisted the urge to pack up all our worldly possessions (cat, dog, passports) and start driving back to Canada that night. The Redneck called my husband to apologize. I am not sure what you say here. “Doc, I am so sorry that I threatened to shoot your wife” I think that Hallmark is missing out on a niche here, a gun-violence line of greeting cards: Sorry I shot your spouse; Sorry my toddler shot your toddler; Sorry I almost killed your loved one; Sorry I accidently killed our son. He wanted to come over to apologize to me. My husband told him absolutely not and that I was far too upset for that. He came over anyway. Did not even stop back home to put a shirt on. A shirt would have been nice.


If I had not been in shock, I would have told him to leave and called the police, but Canadian politeness took over. I was also unsure of what the police would do in this situation, what with the whole Second Amendment, Stand Your Ground madness that is Florida. He was truly sorry. I cried through his apology. He explained that he thought I was “The Killer” and when he got out of the truck he was thinking that he was going to have to confront and kill “The Killer”. He said, “and then I saw your blonde hair and I realized it was you”. Suddenly “The Bad Guy” morphed into a blonde unarmed lady veterinarian in a Prius V station wagon with a Yakima roof rack. (This part amazes me. I know that he couldn’t see me, but surely he could see my car. Everyone knows that killers drive old, white windowless vans or big rusty trucks. My car is not a killer car. It does have the advantage of being a hybrid, so it is extremely quiet [ideal for sneaking up on people and killing them] and also you can drive for hours without stopping for gas after murdering people, which is very convenient. The Yakima roof rack is also perfect for transporting dead bodies without messing up the interior.)


He was also shaken up and when I looked right at him I realized that through his fear and adrenaline he had almost shot me. He became “The Killer” that he had conjured up in his mind. He told me that he was going to go to church tomorrow to pray. I wanted to ask him what he was going to pray for. For common sense? To be smarter? Was he going to thank baby Jesus that he did not shoot me? If he had shot me, would he just have prayed more? Then, feeling that he had completely smoothed over the situation with his apology and awkward attempt to touch me (I resisted), he told me that at least now I knew that there are people on the farm that are armed and ready to protect me. This is the least comforting thing that anyone has ever said to me.


It was like a Comedy of Errors, or a Three’s Company plotline, but set in rural north Florida, with rednecks and trucks and assault rifles. This is the mentality of a slice of the population in rural Florida, and possibly the United States of America. Fear drives everything. The teenaged girls in the truck saw a car behind them and assumed that there must be a mass murderer following them. They called their parents, who believed this scenario and then got themselves worked into even more of a frenzy than two narcissistic silly teenagers, which is really saying something. They grabbed their loaded guns and headed out into the night to catch “The Killer”. (There was another set of parents coming from the other side of the farm, also armed to the teeth to catch the killer/me.) Why would “killer on farm” be your first conclusion? There are so many other reasons that a car would follow you onto a farm. For example: the person in the car lives on the farm.


If I had been a true Floridian and not a Canadian, I would have had a cute bedazzled, pink couture pistol in my purse. And, legitimately feeling the threat of deadly force, I would have shot this man. Maybe we would have shot each other. This is how people die from gun violence. Fear and panic and feeling that someone is trying to kill you can get someone killed. No politician is brave enough to say it, and it will never happen here, but I think its time to take the guns away. Most humans can not handle the responsibility of deadly force and for being responsible to kill intruders. Less guns = less gun violence. The American experiment has shown that arming its citizens is an utter failure. The Second Amendment is the USA’s biggest lie. It is the right to feel terrified all the time because everyone has a gun and fear is not freedom. Americans are holding themselves hostage to fear while the rest of the world watches in horror.

Reclassified: From Thyroid Cancer to Good Cancer to Not Cancer

A recent New York Times article with the title, “It’s Not Cancer: Doctors Reclassify a Thyroid Tumor” (http://www.nytimes.com/2016/04/15/health/thyroid-tumor-cancer-reclassification.html) was a superficial discussion that sought to dumb down a recent scientific article from the Journal of the American Medical Association (JAMA) for the masses. The JAMA article has a slightly less sexy title, “Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: a Paradigm Shift to Reduce Overtreatment of Indolent Tumors.” (http://oncology.jamanetwork.com/article.aspx?articleid=2513250) The New York Times article intentionally or unintentionally succeeds to suggest that many people that were treated for thyroid cancer were over treated and they didn’t actually have cancer after all and that this is newsworthy. This is a gross exaggeration and it’s dangerous.


Let me back up a bit for some background that was not described in the Times piece. There are four types of thyroid cancer. They are Papillary, Follicular, Medullary and Anaplastic Thyroid Cancer. Papillary thyroid cancer is the most common and accounts for 70% of the cases of thyroid cancer. (I had Papillary Thyroid Cancer.) Within Papillary thyroid cancer (PTC), there are many variants. The type and variant are determined by a pathologist after the offending thyroid gland has been removed. (Warning: this part gets a bit dry. Feel free to skim one line and skip to next paragraph if you choose.) Some variants of PTC are more common than others, but the variants include: Conventional, Follicular Variant (How confusing is that?), Papillary Microcarcinoma, Tall Cell, Oncocytic (This is what I had), Columnar Cell, Diffuse Sclerosing, Solid, Clear cell, Cribriform Morular, Macrofollicular, PTC with Prominent Hobnail Features, PTC with Fasciitis-Like Stroma, Combined Papillary and Medullary Carcinoma, PTC with Dedifferentiation to Anaplastic Carcinoma.


Are you still with me? I realize that this is super boring. That is why it was not included in the sensationalized New York Times article, but it is important. When we are talking about the type of thyroid cancer that was reclassified to not-cancer, it is not all kinds of thyroid cancer. It is very specific. Another way to further classify thyroid carcinomas is whether or not they are encapsulated. Intuitively a tumor that is within a capsule is going to be better behaved than one that is not. The thyroid cancer that was reclassified is the noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma (EFVPTC). EFVPTC will henceforth be known as Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP). EFVPTC/NIFTP has been found to carry an excellent prognosis with surgery alone, so people with this diagnosis likely need a partial thyroidectomy (aka hemithyroidectomy) alone and then regular monitoring. This is really great for them because it means that they likely will have normal thyroid function and they don’t need radioactive iodine. However, here is my very unsexy headline: “A Subtype of a Variant of a Type of Thyroid Cancer has an Indolent Course”. How many people will this affect? Well, if you turn to the e-supplement section of the JAMA article, and go to table 7, you will find a list of the 5 retrospectives studies that look at the proportion of PTC cases that were classified as EFVPTC. The prevalence varies from 4.8-24.3% of the cases of PTC, with an average of 13.8%. PTC accounts for 70% of all cases of thyroid carcinoma, so this new classification will affect <10% of Thyroid Cancer patients. The other 90% still have cancer.


Here is why I think that the New York Times piece is dangerous, it gives the sense that thyroid cancer is not cancer. It gives the sense that a lot of people have been over treated for and diagnosed with thyroid cancer. It suggests that thyroid cancer survivors are not cancer survivors. The Thyroid Cancer Survivors were already a marginalized group in the Survivor community. Thyroid cancer is stigmatized for being such good cancer. I have never felt that my cancer was cancery enough to say I am a survivor. I think that a lot of thyroid cancer survivors suffer from Cancer Survivor Imposter Syndrome (CSIS). But having two surgeries to have your entire thyroid removed and radioactive iodine feels pretty cancery to me. Worrying every time that you feel an enlarged lymph node in your neck that you might have a recurrence and struggling to get your thyroid medication dose right also feels pretty real. The New York Times piece makes the Cancer Survivor Imposter Syndrome worse. It reinforces the feeling that occurs within and outside the Thyroid Cancer community that thyroid cancer is no biggie. I can’t wait for someone to tell me that my good cancer is not even cancer.


So if you are looking for credible medical information, I would suggest a peer-reviewed medical journal with a high impact factor. If you are looking for a light read to skim on your smart phone with fun health stories so that you can glean a random pseudo-fact about a disease that you don’t have and doesn’t affect you, go with a New York Times health piece.

We Need to Talk About Declaws

Some people in the general public would like to believe that declawing a cat is a friendly little procedure where those pesky nails are magically and painlessly removed and the cat is returned to them, neutralized and unable to destroy the furniture. Even the word declaw, which is distinctly nonmedical, implies that it is no big deal. I think it’s a big deal. I suspect the cat does too. This procedure involves an amputation of the last portion of every digit through the joint. Usually this is done on the front paws. In Quebec, they sometimes declaw all four paws. Mon Dieu, that is messed up.


Despite, or maybe because of my exposure to veterinary practice from a young age, I have always been horrified by this procedure. As a child, I watched the procedure and then watched the cats recover; their bandaged bleeding paws curled under them, and a look on their faces that conveyed pain, betrayal and sadness to my childhood understanding of cat-speak. I feel depressed just thinking about the way those cats looked at me. I have never been able to shake the feeling that this procedure is just wrong. I decided early on that when I became a veterinarian, I would not do declaws.


I have stuck to this promise to my feline friends. When I was an intern in 1996, the supervising surgeon tried to force me to do a declaw. She said that I had to do it because I needed to know how to do the procedure. She did not believe that as a licensed Doctor of Veterinary Medicine and adult person, that I could make this decision for myself. She lorded her power over me. A pissing match ensued. It was all unsaid, but I knew that I was facing a decision – kiss this woman’s ass like interns are supposed to (especially interns that want to be surgeons when they grow up) and declaw the cat, or refuse to do it and piss her off forever. I can remember sobbing on the phone to my dad, saying that I just couldn’t do it. (I chose the piss her off forever option and paid the price.)


During the three years I spent in general practice I continued to refuse to do this procedure. I would try my best to educate my clients. I would always start my new kitten exams by asking, “How is the training going?”. They always thought I meant litter box training and that was my awesome segue into how to train your kitten not to scratch the furniture. Then I would give them my amazing new kitten handout with tips to help them to train their kitten not to be destructive and to allow nail trims. I would explain to them what a declaw involved. The antithesis to these attempts at client education was my boss. She believed that if you are going to declaw a cat, you should do it very young, because kittens tolerate it so much better than adults. She had a point, because declawing a kitten is definitely much easier on them than it is on an adult cat. Declawing a fat old cat is a tragedy. However, the problem with this logic is that if you declaw kittens, you lose the opportunity to train them. It’s a catch 22. There have been major advances in pain control and surgical technique in the past 20 years that definitely help. Nerve blocks before the procedure, excellent new analgesics and even using a laser scalpel, have all been shown to decrease pain post operatively. That is all great, but I still think it is a rotten thing to do to a cat, and a rotten thing to ask of a professional who dedicates their life to helping animals.


Romeow helping me write this blog

When I was in general practice, I would always try to understand why the declaw was being requested. I once had clients bring in an adult cat for a declaw because Grandma was visiting for the holidays and they didn’t want the cat to rip up Grandma’s thin, crêpey skin. The cat had never been destructive or aggressive. They wanted to surgically alter their cat for Granny’s three-week visit. I talked them into letting me put some nail caps on the cat. These are little rubber caps that can be glued over the nail to prevent damage to the furniture/octogenarians. They need to be changed every 6-8 weeks but they work great. They also come in fashion colors. Grandma’s legs and the cat’s toes were spared. It was a Christmas miracle.


For some people, there is no talking to them or educating them. As soon as I tried, they would shut me down. They would say things like, “The only cat I will have in my house is a declawed cat”. Sometimes it was a husband-wife issue. “My husband won’t let me have a cat unless it is declawed.” There is so much wrong with that statement that I don’t even know where to start. And this is the dilemma that has been both thrust upon, and created by our profession. There are so many homeless cats and the ones that end up in a shelter usually are soon to be dead cats. That is the reality. They are basically a disposable pet and yes, people do dispose of them when they are not enjoying them any more. Usually the enjoyment ends around the time when the couch is getting scratched, the litter box stinks and there is cat hair everywhere. So what is a vet to do?


This is a horrible position we have been put in/we have put ourselves in. As a profession, we acquiesce and accept this procedure, with the hope that this means that these cats will have good homes and lives. (This is often true, but not always.) It’s fine to be a vet who refuses to do declaws, but every vet who refuses to do declaws knows deep down that one of their colleagues will have to take on this burden for them. Our clients demand this service and they threaten us with the promise that they will euthanize or dump their cat if it is destructive or has claws. What if we called their bluff? What if we actually told a client that if they don’t want their pet anymore, they should take them to the animal shelter. A lot of people would probably do just that. A lot of people do that anyway.


This service of declawing was obviously started by veterinarians. Now we can’t or won’t stop. It is banned or simply not practiced everywhere outside of North America (UK, Australia, New Zealand, most of Europe). And there are regions within North America where declawing is banned. So the rest of the world has to deal with alternatives. Why can’t we? Our North American society is addicted to the convenience of dropping the cat off and returning it with no claws. Instead of training, buying a scratching post, clipping nails, using nail caps, and possibly dealing with the fact that life with pets (and kids) is a bit messy.


My question is, when people start to learn exactly what the procedure is, what are they going to think of us as a profession? Are they going to turn on us? Are they going to say that they didn’t understand that a declaw is ten little amputations? Are they going to argue that this was never explained to them? Are Dr. Google or the Cyber-Bullies going to be the ones to tell them or are we? I think as a profession, we need to reconsider this procedure and have the conversation. It’s time. When a surgical procedure permanently alters an animal in an effort to protect a couch, I think it is time for some group reflection. What if we all say no to doing this procedure as a profession? What if we were to mobilize and make the procedure illegal in North America too? What would happen? I suspect that a group of cat owners would stop having cats, another group would use nail caps or train them, a group of cats would be dumped at the shelter, and shelters would continue to be over run by unwanted cats, Eventually, a new cat equilibrium would be reached.


This issue is polarizing for our profession, which is why we don’t like to talk about it. I believe that all veterinarians are trying to do the right thing for our feline patients, in doing and not doing this procedure. We just don’t all agree on what the best thing is. However, this conversation and decision should be made by professionals and not the court of the internet.

Romeow 1 cropped


Why #CeciltheLion (Still) Matters

Why can’t I let it go? It was one dentist and one lion, very far away and this incident happened almost two months ago. Jimmy Kimmel’s tears have long since dried and the news has mostly gone on to the other horrific events going on around the globe. But still, when I hear about #WalterPalmer going back to work, I feel sad-mad all over again. #WalterPalmer is the now infamous dentist and big game hunter, who allegedly paid $55 000 and with the help of his guides (who have been charged and are awaiting trial) lured Cecil off of his game preserve at night, shot him with a bow and arrow, mortally wounded him and then finished him off 40 hours later. #WalterPalmer recently emerged in a single TV interview and corrected the press that he did not eventually kill Cecil with a gun. He eventually killed Cecil with another bow and arrow. OK, you tracked him down and killed him in a much more barbaric way than a humane bullet. It’s even worse than we thought. Thanks for clarifying that for everyone.

This story is infuriating and the world has responded with internet rage. Rage at the utter heartlessness and senselessness. The entitlement. The image of a rich white American, with perfect white Chiclets, heading over to Africa to “take”, as #WalterPalmer said, a lion. With no thought of where this money will go and how this will impact the people and animals in Zimbabwe. All for the thrill of killing a beautiful animal and having his dead head stuffed and mounted. Twitter rages on. #WalterPalmer went underground. Avoiding the news and protests and cyberbullying, not to mention possible extradition to Zimbabwe to face charges for poaching. There second wave of rage came when Walter Palmer went back to work recently. Making more money to pay for more hunts and holiday properties in Florida.

Claims that he did not know this hunt was illegal are likely a lie, and even if they are true, it doesn’t matter. He should have known. If you go to another country and pay tens of thousands of dollars to kill their animals, you should know the laws of the land, that is your responsibility. Saying you didn’t know is not an excuse and should not protect you from the laws of Zimbabwe or the USA. When you are a professional with a Doctorate degree, you don’t get to play the dumb card. It does not fly. Saying you wouldn’t have “taken” this lion if you knew he had a name is also a deeply flawed argument. Cecil did not know that he had a name. We artificially gave his life meaning because of a radio collar and a human name, but he was the same lion, with or without the hashtag. It is not ok to poach, torture and kill an animal because they don’t have a name. An animal without a name does not suffer less. #WalterPalmer’s recent non-apology stated “I deeply regret that my pursuit of an activity I love and practice responsibly and legally resulted in the taking of this lion. That was never my intention.” Is the regret because of killing a named, beloved lion who was the subject of an active research project, or is it just that he regrets that taking this named lion has placed him and his family and practice in the middle of a media shitstorm that will not end? He also stands firm on the view that killing a lion with a bow and arrow is an “activity” that he “loves”. Defiant, even in his pseudo-apology.

When there is an animal cruelty case in the news or on Twitter, there is always a slight backlash that states that people should not be concerned because it is just a lion (that was tortured and killed) when there are so many people suffering all over the world. The clinic where #WalterPalmer works, River Bluff Dental’s own Twitter account stated on September 11th, and I quote: “What’s worse: #CecilTheLion or the terriorism of #September11? See, that lion isn’t a big deal after all…” Complete with a photo mashup of the victims of 9-11. This tweet is absurd and there are only two explanations for it: 1. This is a fake Twitter account or 2. #WalterPalmer is a complete idiot and/or has a terrible crisis management team.

Cruelty is cruelty, whether it is towards animals or humans. Cruelty does not need to be placed in a hierarchy with an arbitrary threshold for when it is acceptable to be upset about it. Petra Laszlo, the Hungarian camerawoman who tripped an exhausted refugee with a child in his arms and kicked another one in the stomach as they tried to flee to safety, was caught on camera in an act of cruelty. Noone died or was even badly injured, but it was an act that was exquisitely cruel. That is why it is a big deal. Cruelty and a lack of compassion are always worthy of a strong response and of fear that a human being can act this way towards another human being, or, I would argue, an animal. Contrasting one of the biggest tragedies that has ever happened in America with Cecil’s death does not turn Cecil’s death into no biggie. #WalterPalmer is not the same as Bashar al-Assad or the terrorist attacks of 9-11. Noone is saying that he is, but cruelty towards animals that goes unchecked will inevitably lead to cruelty to people. This is not my opinion. It is a fact. It’s a cruelty continuum, not a cruelty competition. If you are speaking out for compassion and kindness, you are always on the same side.

If you hear about something that moves you, you should react. Seemingly small things like gestation crates for sows, a single lion’s death and tripping a refugee carrying a child, and big things like a sarin gas attack in Syria, or millions of refugees or the unimaginable cruelty of ISIS. The smaller things might be easier to react to because they are more manageable. When the cruelty and violence drifts into the unspeakable, we don’t tweet about it or share it or attach a hashtag to it. It’s hard to squeeze all of that horror into 140 characters with a trending hashtag. For those who are more moved by acts of human cruelty towards humans, no one is stopping you from giving a voice to the issues that you are passionate about. If a beautiful lion that was illegally hunted and died a long and painful death to be a wall decoration for a rich dentist in Minnesota is not your thing, find something else to speak out about, but don’t be divisive when it comes to empathy. Trying to compare events to be empathetic about is, by definition, not empathetic.

I’m going to go out on a limb here and guess that #WalterPalmer does not have pets. I could be wrong, but how could anyone who knows what it’s like to love an animal do what he did to Cecil and countless other wild animals that he has killed without seeing his own beloved cat or dog? That is what we all see. We see their deep brown soulful eyes, not the dead glass beady eyes that #WalterPalmer has replaced them with in the faces of his trophies. We see the animals that we love and that love us back. The animals that teach us what empathy, kindness, compassion and unconditional love are, if we let them. Animals teach us lessons you can take with you no matter what man or beast you are encountering next. I will always be heartbroken about #CecilTheLion, not because it is the most important or most tragic event in the world, but because it moves me and because “taking him” means taking so much more than just one lion.

#CecilTheLion #JusticeforCecil