Category Archives: practice

Shortage vs Planning

Back in 2011, the company that manufactures the drug we use to treat a heartworm infection in dogs stopped making the product.  The factory was old and couldn’t meet quality standards, so the FDA stepped in and recommended shutdown.  I found out from an interesting article that the factory is owned by a different pharmaceutical company than the one that owns the rights to the drug.

The resulting shortage led to a situation where veterinarians have to call the company that markets the drug (Merial) if we diagnose a dog with heartworm disease.  They determine if that patient is eligible for treatment with the medication.  A very small supply of the drug is being imported from Europe with FDA consent.  Yes, you read that properly.  Our federal regulatory agency is allowing a small amount of the drug to be imported by the company for sale here in the US so that we can treat the dogs that come up positive for heartworm.

A few reasonably obvious questions come up when we consider this situation.
Why are so many companies failing to produce the medications we need?
Why are many of these drugs produced in only ONE facility in the whole country?
Why is the FDA apparently cracking down on these factories?
Why can’t we import more of the drug?
What alternatives do we have?

Truth be told, I’m not certain of the FDA’s grounds for cracking down on these companies.  I’d think it was with the intent of keeping the safety and efficacy of our drugs intact.  That’s a good thing.  It’s also scary.  How long has substandard production been going on?  I can only suppose the reasons for one facility being the sole production site.

This whole situation is a real bear.  We’ve struggled at Pet Authority to keep stock of some of our most important drugs so we can treat our patients.  I can think of four drugs in addition to the heartworm treatment medication that have simply been unavailable at some point in the last 2 years.  It’s maddening.  There’s nothing we can do about it.

Well, that may not be entirely true.  There’s one drug shortage that wouldn’t affect our clients and patients much at all.  How much need would there be for the medication used to treat a full heartworm infection if pets were protected by monthly prevention?  Almost none.

Year-round prevention is the best way to keep your pet from ever needing to be treated for heartworm disease.  There are enough products out there with nearly 100% efficacy that even if one or more becomes unavailable, there are alternatives that will get you through.

Stated more simply:  heartworm disease is preventable.

I’ve lectured and guilt-tripped and begged and advised, but still, owners simply choose to stop giving prevention.  I see at least one dog every day that I practice that has not been given prevention monthly.  Often, missed doses are during the height of the summertime mosquitos; the highest risk.  I just don’t get it.

The mystery of drug shortages is an opportunity to look at how our behavior influences the lives of our pets.  The choices we make are a much more direct way to influence wellness.

Prevention over cure.

1 Comment

Filed under practice, preventive care

Chemical Castration : The Future?

I’m going to tackle the article sent in my by one of my regular readers. It’s an interesting article. In case you missed the link last Thursday, here it is again:

New Strides in Spaying and Neutering

The short version of the story here is that there is a company relaunching a product and method to “neuter” a dog by giving an injection in the testicles. It prevents reproduction but does not fully eliminate testosterone production.

There’s some history here. The original company that produced this formula (Neutersol) launched their product in 2003. There were issues with ownership and production that led to the discontinuation of the product. Another company, Ark Sciences, bought the rights and is relaunching the same product under the name Zeuterin.

Simply put, a dog is given an injection of a zinc-containing compound in the testicle. It causes inflammation that destroys the sperm-producing cells, which causes the dog to be sterile. In comparison to a regular castration, the testicles are NOT removed after injection. They do sometimes decrease in size, but it’s my understanding that that effect varies.

I have not yet been through the training that Ark Sciences is requiring to use Zeuterin. It’s my understanding that with the prior company/product, the dogs didn’t require much in the way of sedation, and they generally didn’t require full anesthesia. If I recall correctly, the post-injection care was pretty minimal. Some dogs were quite painful after the injections. That should be something fairly easy to address, however. Sometimes the testicles swell after injection, which is to be expected. This, too, causes pain; again, it shouldn’t be hard to address. As far as I know, there don’t seem to be any longterm problems with this method of sterilization.

So, why the fuss? Why is this news fit for a headline? Lots and lots of reasons. Neutering is a long-running debate with decades of vehement support on both sides. The US is a country in which neutering dogs at a young age (less than 1 year) is most commonly recommended. In other parts of the world, neutering is NOT recommended at all. There are pros and cons as well as many unfounded fears circulating on the internet. Inaccuracy and belief-over-evidence runs rampant, too.

Here’s what I know for sure about surgical castration:

  • Castration reduces the risk of perianal tumors (usually benign tumors around the anus of intact male dogs).
  • Castration eliminates the risk of testicular cancer.
  • Castration eliminates the risk of benign prostate enlargement.
  • Castration reduces roaming behavior and dog-dog aggression in most male dogs.
  • Castration addresses overpopulation of stray/feral/ dogs.
  • Castration of very young male dogs can alter their physical appearance slightly; the medical significance of this is less certain.

There are valid questions out there about the risks of castration, particularly early in life. Early neuter may well cause increased risk of some medical problems, including cancer, abnormal bone growth, and possibly an association with mental decline later in life. A higher rate of fearful behaviors has also been noticed in neutered dogs. Many of these questions require more study. It is, however, a very real possibility that neutering (and spaying) can cause some diseases to occur more frequently. What remains uncertain is whether the studies already published are as good as the results seem to imply. Interpreting historical data is much more complex and difficult than it seems.

I encounter a lot of fear on the part of clients about neutering. Many owners believe it will make their male dogs fat and lazy. They worry about the risks of anesthesia. They worry about the cost of the procedure. Sometimes, cultural beliefs make castration extremely unappealing as an option.

In many cases, these fears are easy to dispel. In my experience, neutered dogs are NOT less active or driven than their intact counterparts. Neutered animals don’t need as many calories as an intact male, so they will probably need less food. Overfeeding makes dogs fat, in my opinion, and is a much more potent factor than the presence of testosterone. (I’m not saying there’s zero influence of sex hormones on physique and body condition score. I’m saying most of my clients overfeed their pets.) Anesthesia performed properly is NOT high-risk. Yes, the procedure is costly compared to general well-health veterinary care. Discussing that will require a whole separate post, but I’m open to doing so in the future.

So what are we going to do with all of this information? I try to be practical about it. Honest, too, as there are some issues we need to confront head-on.

How many of these “benefits of neutering” can be replaced with deeply responsible pet ownership? Lots of them. Roaming behavior, inter-dog aggression, pet overpopulation… owners that were more hands-on with their dogs and willing to curb these kind of issues would take these problems off the surgical table and put them on the end of the leash. I’m not trying to be condescending or elitist. The flat truth is that if your dog is intact and you let him out in the backyard without a fence and with no supervision, you’re contributing to the problems. Pet overpopulation is a very real, very serious problem in this country. Not because roving packs of wild dogs are stealing children away, but because MILLIONS of stray dogs and cats are killed every year. Three to four million, in fact. Irresponsible ownership is a big part of that death toll.

Speaking from my personal standpoint, if an owner is responsible, I don’t see a problem with not neutering. Part of that responsibility is shared between the owner and the vet. I’m responsible for informing that owner of the risks and benefits of neutering. I’m responsible for answering honest questions with honest answers. Some of those answers may be, “We don’t know” or “Yes, there are specific diseases for which neutering raises the risk.” Together, owner and vet will have to weigh those pros and cons and select an outcome that works best for that situation.

In my experience, neutering is still the best case scenario for most male dogs and their owners. Our hospital still officially recommends neutering at 6 months of age.

This brings us neatly around to the actual topic of the original article. Can chemical castration replace surgical castration? I don’t think so. Not broadly, anyway. Chemical castration leaves some testosterone intact, and that hormone is the balance point for behavior and medical risk.

If a given owner is responsible and simply wants to eliminate the risk of unwanted puppies, then chemical castration is a very viable option. Remember that the presence of testosterone may also protect dogs from some of the diseases we mentioned above that occur more frequently in neutered dogs.

If the testosterone-driven behavior of a male dog will increase his risk of trauma, or increase risk to the family, other pets, other families, etc., then chemical castration won’t change that behavior. Surgical is the only way to go, as that’s the only way to eliminate the production of testosterone.

In summary, chemical castration isn’t a miracle cure for all of the controversy of neutering. I think it has a place in the discussion, as well as a place in the set of tools we use to keep pets healthy and safe. I would caution my clients and readers against thinking that chemical castration is “better” than surgical methods. It’s simply a different path to take as we navigate health care for our pets.

This is a broad topic. It was also a really long post. If you’ve made it this far, I thank you. If you’re hungry for more, check out this blog post: The SkeptVet

I’m happy to tackle questions, too. Comments welcome!

2 Comments

Filed under medicine, practice

Harmony

harmony [ˈhɑːmənɪ]
1. agreement in action, opinion, feeling, etc.; accord
2. order or congruity of parts to their whole or to one another

Pet Authority is open on Saturdays. That’s not likely a surprise to any of you, nor would it be to most clients out there. Very few vet hospitals aren’t open on Saturday. It’s an important day for many people to have available for appointments. We understand that you have jobs that coincide with most of our regular hours. Not everyone can take a half day or a day off, nor even leave early, nor come in late. (Some of you can do those things, which is great! We’d be pretty bored Mon-Fri otherwise. 🙂 ) Additionally, a pet getting sick rarely happens according to a convenient schedule.

Saturday isn’t a “normal” day for us for a few reasons. First, there’s only one doctor on duty. Normally, we have two. With only one doctor, we have fewer support staff as well: two receptionists, three techs, and one or two boarding employees. Most of the time, this is plenty of people to keep the hospital running smoothly.

From my perspective, Saturdays are a great work environment. I get to be the captain of the ship. I’m responsible for all of the patients. I have a staff on hand that knows how I like to get things done, so they’re able to anticipate my needs. I can give directions to them to carry out with the confidence that they’ll do exactly as I’ve asked. I also tend to see more of “my” clients — the people that regularly choose me to care for their pets.

Once in a while, we have an insane Saturday. There’s more work to be done than we properly have time for. My attention is pulled in too many directions at once: phone calls, emergencies, urgent-care-level sickness, regular health care, phone calls with questions, medication refills, pharmacy refills, pharmacy call-ins, lab work interpretation. It’s way too much to handle on my own.

I’d be completely sunk if I didn’t have a staff I could trust. There’s literally no way for me to be in more than one place at a time. Sure, I can work in 2-3 rooms at once by juggling. I still can’t defy the laws of physics and reality. There’s no cutting of corners, either. I can’t decide to do a crappy job with anyone’s pet, nor to limit a client to a certain number of questions. Each pet deserves my full attention. It’s also critical to me on a personal level to retain good bedside manner.

That’s where harmony comes into play. I mentioned already that the staff knows what I need and how I like to work. The situation goes well beyond that. The reception staff begins prioritizing files for me so I know what to attend to immediately and what can wait for a small free moment. The technicians will often get things started for another appointment that they are certain I will want done. Our boarding staff offers to help with whatever needs doing. Everyone comes together to accomplish the necessary tasks in the proper way. That’s harmony.

When I was an intern in Hollywood, Florida, I had one particularly horrible night. From about 10pm to 4am, I had eight rooms going at one time. Yes, eight. From vomiting to a broken leg, as soon as I had one patient squared away, anther would arrive to take its place in the exam room. At that time, I was still pretty green. I didn’t have the experience I do now, so handling this level of stress was not easy for me. I was slower, needed to look things up more often, and wasn’t sure how to direct an extremely capable staff to get things done. One of the techs at that time responded to my grumbling by saying, “Just think about how much you will have accomplished by the time the sun comes up.” I was livid at that particular moment and snapped, “That’s three hours away. What am I supposed to do until then?” She calmly replied, “Just keep working.”

Her wisdom was that with harmony, you can make it through. By the time the sun had come up, I had everything settled. The patients were stable. Reports had been written. Orders had been created for the techs. The incoming receiving doctor took the cases from me and sent me home to sleep. All of that was according to plan. As much as I wanted the sun not to set again, which would waive my responsibility for another night, it did so. I went back to work with a better understanding of how to view a day’s work. I was able to pass that wisdom on to the incoming crop of new interns.

You may start at a given time. You may have the goal of finishing at a certain time. In between, you will work as hard as you must work to get done what you must get done. Your staff is there to help you. Empower them to do so. Your clients need your best regardless of the simplicity of the vaccine or the complexity of the trauma case. You do not have time to worry about you. You must worry about your patients instead. The sun will rise and set independent of your wishes, so let it do only what it does: mark the passage of time. Today may be horrible. Tomorrow is a new opportunity.

We had a rough Saturday yesterday. Last night, the sun set. This morning, it … lit up the rain, more or less. Thanks to my staff, we completed what needed to be done. I worked hard. The staff worked harder, without complaint, and supported me by performing admirably well with each case.

Saturdays: a lesson in harmony.

Comments Off on Harmony

Filed under human interest, practice

Wow!

Dr. Wright and I both have over 10 years of experience being vets.  We’ve both worked in emergency hospitals, and we’ve both seen our fair share of crazy things.  It takes quite a bit to rile us up.  Usually, when a receptionist or technician lets us know that there’s an emergency coming in, we’ve dealt with the problem before.  Sometimes, what’s coming in is a new experience or a big twist on an old theme.  In the past 2 weeks, we’ve had that happen twice.

The first case was a dog with a fishhook.  That’s nothing special — happens all the time.   The hook usually ends up in the lip or the tongue, which is easy to deal with.  A quick pop of anesthesia, push the hook through, cut it off, and you’re done.

This one?  Not so easy!  We had a bit of line coming out of the dog’s mouth with no hook in sight.  I decided it must be partway down the throat, which is still reasonably easy to retrieve.  We took an x-ray to confirm.  I was wrong.  The hook and swivel attachment were in the stomach.

After discussing the possibility for using an endoscope to retrieve the hook, the owner opted to have us retrieve it from the stomach surgically.  As it turns out, this was the right way to go.  Though I didn’t know it at the time we started surgery, this dog had swallowed the hook, then tried to run on the dock.  The line and fishing pole were enough weight to set the hook in the stomach.  What should have been a simple hook retrieval turned into quite an ordeal.  Definitely not one of the simpler surgeries that I’ve completed.

We did all right, though!  The dog has made a good recovery and shouldn’t be any worse for the wear.  Moral of the story:  keep your dog away from fishing tackle.

The second case is quite a bit more shocking.  We’re all familiar with the usual risks for small dogs.  They have problems with dental disease, heart disease, back injuries, and higher risk for injuries from jumps and so on.  What doesn’t always occur to us is the risk of a dog becoming prey for a larger wild species.  Hawks are a prime example of this kind of risk.

A very small dog was outside in the yard with the owner.  He heard a scream and turned to see a large hawk standing on his dog.  He managed to scare the hawk away, scooped up his dog and raced to the hospital.

Dr. Wright was able to stabilize the poor little dog.  He didn’t have any immediately life-threatening injuries, but one eye had been badly damaged by a claw or beak.  We sent him to the emergency hospital for overnight monitoring and aggressive pain control.  Even if the eye can’t be saved, this little dog should recover fully.  Moral of the story:  Keep a -close- watch on your small dogs when you’re out in the yard.  Even in the suburbs, there are potentially dangerous predators nearby.

See you in two weeks!

3 Comments

Filed under case report, emergency, practice

Pharmacy Choices

Last week, we ran into a problem at the hospital. It brought right to the forefront a complicated, potentially upsetting dilemma faced by veterinarians and pet owners. I’ve carefully avoided preachy blog posts about the costs involved with pet medications. It’s a topic I can’t cover from an entirely fair position and I’ll admit that up front. I’ll do my best to stay objective.

Online pet pharmacies sell pet medications. They are usually cheaper than at the local vet hospital. Veterinary hospitals can’t purchase medications in enough quantity to be able to offer the prices that online pharmacies do. Some companies offer prices that, if we matched them, would cause the hospital to lose money on the sale. We simply can’t do this and stay in business.

Large retailers are now offering, and heavily advertising, pet medications as well. These prices are also lower than at most veterinary hospitals. Prices, again, may be due to buying in high volume, or a strategy to serve as a loss leader. We simply don’t know.

Lastly, some medications are human meds that we use in veterinary patients. Those are also sold by any human pharmacy. Sometimes those prices are lower than what we can offer. The reasons are the same as above.

At this point, it certainly seems like veterinarians and vet hospitals are crying over a loss of revenue. To some degree, that’s true. We’re having to find new ways to serve our clients fairly and well with the loss of revenue from some medications. I think that everyone understands our need to pay and educate our staff well, to have good equipment and supplies, and so on. All professions, all private businesses, all corporations, set out to make a living from their work.

So what’s the catch? There are several. I’m going to use heartworm prevention as an example. The manufacturers of heartworm prevention products generally sell their products directly to vets or through a licensed/approved distributor. The manufacturers tell us that they only sell this way, and that they don’t sell to online pharmacies or retail outlets. Somehow, the products end up at other retailers, though. There are only two plausible reasons: vets buy tons of product and sell it to other retailers, or the manufacturers are selling to retail outlets.

If the products are purchased by vets and sold to other retailers, that’s called diversion, or “gray market” sales. The manufacturer’s can’t safely say that their products were handled properly, stored in the proper conditions, or are free from tampering. As a result, the manufacturers won’t guarantee those products. You’ll have to deal with the retail outlet. And, of course, I’d hope that your veterinarian can help out. The trouble is, if your heartworm prevention doesn’t work the way it’s supposed to, your pet could be the one that suffers. Nobody wants that, not the vet, not the retail outlet, not the owner.

The situation that prompted this post occurred with one of our clients. They requested a written prescription for heartworm prevention for their cat. They took it to a local human pharmacy that was offering pet medications. The store didn’t have what we’d scripted in stock, and told the owner to see if the dog version would work just as well. Thankfully, the owner called and asked rather than just taking the medication home. It wouldn’t have harmed the cat, but the medication was different from the cat version — including an additional ingredient not in the cat product.

As far as I’m aware, human pharmacists and pharmacy staff do not often have any official training on veterinary medications. I’m hopeful that the retail chains offering pet medications will provide education and training for the staff there. If they haven’t, or they don’t, it’s far from an ideal situation. I’m not trying to say that pharmacists are bad people or that they don’t care. They’re probably just as uncomfortable with the situation as we are.

So what’s our take on the situation? We feel that the health and safety of your pet should be in the hands of properly trained professionals. Vets, vet techs, and even our reception staff have been trained to know which medications are the appropriate choices. They’re familiar with the products we carry. The manufacturers guarantee their products’ safety and effectiveness when you purchase through a vet hospital.

While I firmly believe that everyone involved in the practice of vet med and pharmacy has a desire to help keep pets healthy, the simple fact remains that your vet hospital is the best educated advocate for your pet’s well-being. I want all of our clients — and all pet owners — to make an informed choice.

2 Comments

Filed under ethics, medication, medicine, practice, safety, training

Say what, now?

I was chatting with the boss yesterday about communication. She’d mentioned that recently she’d seen a talk show on TV with Alan Alda as a guest. Alda was talking about how he’s been working with human med school students about how to speak to people so they understand what’s being said. The boss and I disagree a little about how technical we can be without overwhelming a client, but she made an important point: sometimes we forget how alien medical terminology can be.

Interestingly, the site I host the blog with (WordPress), gives me a lot of data from search engines that people use to find the blog and/or the topics of my posts. I can see what some of the common search terms were that led people to the blog. This ties in because the posts that have gotten the most hits are the posts in which I explain more about particular diseases or detail out terms or concepts.

The short list below is a selection of things that came right to mind as being confusing items. I hope it’ll help get you thinking about other things that just don’t click for you. Ask away!j

•A heartworm test is done with a blood sample.

•A fecal exam / stool check / parasite check is done with a poop sample and looks for intestinal worms. (Hookworm, roundworm, whipworm.)

•A Distemper shot doesn’t have anything to do with a dog’s temperament. It’s also referred to as a DHPP or DA2P vaccine. The abbreviated letters indicate which diseases are in the vaccine. Distemper, Hepatitis (Adenovirus type 2), Parainfluenza, and Parvovirus.

•The kennel cough vaccine comes in 2 forms: injection and a liquid squirted into the nose. The full name for the vaccine is Bordetella. (Bore-duh-tell-uh) We often hear “bordello” vaccine, which is … a term we wouldn’t cover on a family blog. 😉

•Heartworm prevention products all cover pets for heartworm prevention, AND some of the intestinal worms that they can get. The different products cover a different selection of intestinal parasites. We decide which product is best by looking at a pet’s lifestyle and activities.

•When we find a lump/bump on a dog, we’re likely to call it a tumor or a mass. These words do NOT indicate that that we know whether it’s cancerous or not. A lump or mass is an easier way to say “neoplasia,” which means “new growth.” In order to know whether a mass is cancerous, we need to take a needle sample or a piece to send to a pathologist.

•With those tumors, a sample that we take with a needle is called a “Fine Needle Aspirate.” We poke a needle and syringe into the tumor and suck out some cells. We squirt the cells onto a glass microscope slide and then examine it under the microscope. We can sometimes tell what a tumor is based on how the cells look. When we surgically take a chunk of the mass and send that off to the pathologist, that’s a biopsy.

•When we remove the ovaries and uterus of a female dog or cat, that’s a spay. The full name is ovariohysterectomy. The past tense version would be spayed, which sounds like ‘spade,’ but a spade is a shovel. We will often abbreviate the surgery as OHE or OVH.

•When we remove the testicles from a male dog or cat, that’s called a neuter, or orchiectomy. That surgery is often abbreviated as an OE.

I think that’s a pretty good start. What has your vet said that just wasn’t that clear? We can work on making it more understandable.

7 Comments

Filed under communication, human interest, practice

Old Science

Old Science

From Wikipedia: The scientific method (or simply scientific method) is a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed scientific, a method of inquiry must be based on empirical and measurable evidence subject to specific principles of reasoning. The Oxford English Dictionary defines the scientific method as: “a method or procedure that has characterized natural science since the 17th century, consisting in systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses.”

In short, in order to have good, solid knowledge — the truth, if you will — we have to follow a specific and highly detailed process to collect and analyze data. If we are not very careful, we can come to the wrong conclusions, leading us to something that isn’t the exact truth. Until someone comes around to test what we’ve decided is true, we will operate under the information we have at hand. The system relies heavily on the integrity of the people doing the research. It’s a very murky area that’s honestly well beyond what I want to talk about this week.

The take-home message here is that scientists (and therefore the rest of us) have a duty to carefully collect, analyze, and interpret information on a particular topic so that we have a better understanding of the world around us. Anything from the way the sun produces heat and light to the way the tiniest viruses can make us sick is investigated with the scientific method. This information is what veterinarians rely upon to do our work. (We’re certainly not alone in that respect!)

What happens, though, when technology advances, or knowledge advances, and we have new data that doesn’t fit the original conclusions? What happens when there is a shift in our social and cultural morals? What happens when something completely new and original shows up that we’ve never seen before? If we’re ethical and honest, we’ll admit exactly this: we don’t know. We don’t know what, why, how, when, or where. We don’t know quite how this will change our understanding of the topic. What we DO know is that we must begin again with a new hypothesis, test again, collect and analyze data, and draw new conclusions. I have a two specific examples in mind to illustrate what I mean.

Dogs and cats don’t need pain medication after spay or neuter surgery.
Yes, horrifyingly, many veterinarians long ago believed that animals didn’t need pain control post-operatively. The truth was that we simply didn’t recognize the signs of pain as animals display them. You’d think common sense would prevail — cutting the body hurts! — but it didn’t. Some veterinarians used pain as a justification for keeping an animal from being too active after surgery, too, which is equally horrible. Thankfully, good, careful research has led us to not only know that animals feel pain, but also to a wide variety of excellent and useful pain medications for animals. I have never had an owner refuse pain medication when we’ve recommended it.

Pain control seems like a no-brainer. Looking back at a time when pain meds weren’t used frequently feels much like the dark ages. It’s an embarrassing part of our history as vets and pet owners. What about a more complex issue, such as early spay and neuter? That gets a lot tougher to pick apart.

Early Spay and Neuter is the Best Decision for Longterm Health
This one has been a contentious issue for a long, long time. Dogma said that pet owners weren’t responsible enough to control their pets’ reproductive activity, so we needed to spay and neuter to reduce pet overpopulation. We performed these surgeries as early as possible (especially at shelters or rescues) so that pets wouldn’t have a chance to reach sexual maturity and reproduce. Veterinarians also justified early spay and neuter as a way to reduce the incidence of certain diseases. Ovarian, uterine, mammary (breast) and testicular cancer were at the top of the list. Uterine infections are also essentially eliminated after a spay. Behaviors such as urine-marking, roaming away from home, and aggression were also used to push the idea of early spay and neuter.

I’ll point out before I explain that in the vast majority of Europe, spay and neuter are NOT performed unless there is a medical reason to do so. Did we get it wrong here in the US? Maybe. Partially.

There are two studies that have offered evidence that we didn’t discover the whole truth with our initial recommendations. It appears that in some breeds, early spay and neuter can increase the risk for a specific type of bone cancer. We have also observed physical differences in appearance between early- and late-neutered male dogs. There is speculation that bone and joint diseases may also be affected by a pet’s sex status (for the worse).

Notice that I said “the whole truth.” It’s not an attempt to shed blame or escape the admission that we got some things wrong. It’s an honest look at the fact that we didn’t have a complete set of data, nor did we have all of the effects of one decision observed yet. As time goes on, we learn more and more. We’re able to see the effects of a certain decision on individual pets and the population as a whole. These are complex biological systems — living things — that are affected by their genetics, environment, and medical care.

It’s truly a complex process to get down to ONE variable for a study. Can we prove that it was ONLY the spay that increased risk of bone tumors in this one breed? We thought at one time that certain types of vaccine were causing tumors in cats. As it turns out, the cats themselves have a genetic factor that increases their risk of developing that type of tumor. We have to design a study that is big enough and careful enough that we can draw conclusions for the whole worldwide population of animals in that species. Unfortunately, time politics and money end up contributing to the limits of a given study or researcher. If we acknowledge those limits, the data and conclusions may still be very useful.

So, what do we do now that there’s new data to suggest we might have been wrong before? We study some more. We try to repeat the experiments in the study that raised the question to see if the same conclusions can be drawn in other places. We reinvestigate, and reinvestigate, and reinvestigate again. New data, new tools to measure things, new technology to make the investigations go faster, and techniques that are more accurate are all part of the scientific process.

In the long run, our goal is to provide the right answer for as many pets and owners as possible. Pets and owners directly benefit from our most rigorous efforts to seek the scientific truth. It’s a strength to be able to incorporate new information and improve how we do things.

I invite you to be bold by asking me to dig into a topic that you feel cold use explanation or re-examination. What do you think we need to know more about?

For Science cat

3 Comments

Filed under neuter, practice, science, spay

Microchips

While I was away and deliberately lost last week, it crossed my mind that I hadn’t ever talked about pet microchips. There’s a lot of misinformation out there about what the chips can do and how they can be used. I’ll spend some time today talking about statistics and the truth about the utility of microchipping pets.

The concept of microchipping is simple: each pet receives a non-removable identification tag with a unique number implanted under the skin. That unique ID number is kept in one of several lists maintained by the microchip manufacturers. If a pet is lost (or for any reason the ID is needed), a handheld scanner can be used to read the ID number in the chip.

Each little microchip is a small bit of circuitry enclosed in a glass capsule. The chips are actually passive RFID tags. The scanners send a radio signal to the chip, which uses the energy in that signal to send back the chip’s number. Without the scanner, the chip does not do anything on its own. It just sits there.

Microchip

There are several companies out there that make microchips. While most are utilizing a universal format that allows all of the scanners to read all of the chips, not all do so. Incidentally, we use one of the universal chips and scanners. Veterinarians, rescue groups, animal shelters, etc. purchase chips from the manufacturer. The manufacturer keeps track of the chip ID numbers so that from the moment the chips leave the distributor, there is a paper trail for a chip.

Pet owners have the chip implanted with a simple injection under the skin. It’s a larger needle than for vaccines, but most pets tolerate it very well. Once the chip is implanted, the owner provides contact information. This information is registered in the manufacturer’s database. Once the information is registered in the database, the company will not delete it.

If the chip is scanned, the number will guide the return of the pet to the rightful owner. There are several ways to look up the number, but the owner’s privacy is respected throughout.

It’s that simple! Unfortunately, I hear a LOT of concern about chipping pets. In my usual blunt manner, I’d like to provide some solid information. The statistics were provided by the manufacturer that we use for microchips.

•One in 3 pets will get lost in its lifetime. About 90% of pets that are lost don’t ever make it home.
•Animal shelters euthanize at least 4 million pets a year.
•Microchips are NOT a GPS tracking system. The chips can not send a signal unless they receive a signal from the scanner.
•Microchips do NOT cause harm to the patient. They are enclosed in glass that does not cause inflammation or problems at the injection site.

There’s really no downside to chipping a pet. Even indoor pets can benefit from the protection a microchip provides. If your pet isn’t chipped, or is chipped and isn’t registered, please contact us to get that sorted out!

You can read about the HomeAgain microchip at their web page. This is the company we chose to work with. They’ve reunited over 1 million pets with their owners, which is no small feat.

9 Comments

Filed under cats, dogs, human interest, practice

Trust in the Veterinary Practice

Just a quick note before my exposition for this week. I probably won’t be posting on Thursday January 17th. I’m positive I won’t be posting on Sunday, January 20th. I have another commitment that is going to keep me away from the computer on those days. I’ll be back on January 24th!

Nurses, doctors, and veterinarians consistently rank highly in polls that ask people which professions are the most trusted. It makes sense for the most part. Those of us trained to help and heal are the sort of personalities, in general, that engender trust. We have to work with people to overcome problems centered on health and well-being. It’s difficult to get more personal than that, and that level of intimacy creates trust.

I’m extremely grateful for the trust extended to me by clients (and pets!). We’re allowed to make recommendations for the care of an important family member. We often have to take a pet away from the owner’s immediate presence to draw blood or perform surgery. While it’s clear that some owners are uncomfortable with this, they still allow it. Make no mistake, I understand just how much weight this trust carries. I don’t take it for granted.

Mistakes happen, complications arise, misunderstandings occur. We’re left having to work out very difficult circumstances in the midst of intense emotions. Most of the time, the trust we’ve built allows an honest, open discussion about what has happened and what can/should/must be done to move forward.

I will state clearly that there are unscrupulous, dishonest people in every profession, including my own. There’s a question of degrees when we compare dishonesty in advertising or sales to dishonesty in medical practice. In medicine, lives can be at stake. The violations of trust are far more damaging when a person discovers that his/her medical professional is acting unethically. This is rightfully so.

This leaves us in a position in which we all admit that there are jerks out there that you have to watch out for. It also leaves us with the encouraging statistics that most vets have properly earned and maintained a trusting relationship with their clients. With that trust, we can accomplish more as a team caring for a particular pet. Everybody wins! How often do you hear that phrase? Not as much as you’d like, I bet.

The frustration arises when that trust hasn’t been established. Clients are wary. I understand that in most cases. We may be seeing a pet for the first time, or personalities may not mesh well, or new staff members may be helping a client. There are times when a preferred vet or staff member isn’t available. There may be an emergency that requires immediate action and decisions. A receptionist may take a call for an important or urgent question. All of these circumstances happen frequently. It’s the unfortunate nature of medical practice most often. New circumstances require new trust-building. I acknowledge that.

Here are the sticking points, though. Some clients refuse to get to know new staff members. They refuse to tell a receptionist what their concerns are. They refuse to see anyone but their preferred vet. They refuse treatment recommendations because they “just don’t believe that’s necessary.”

I’ll be frank in expressing my side of the story. This kind of behavior can do two things. It can endanger a pet, which in my opinion is unforgivable. Our personal issues shouldn’t get in the way of helping an animal that can’t speak for itself. Secondly, refusing to accept what a vet has relayed through a receptionist or a tech feels, from my side of things, that an owner thinks vets are employing dishonest, unreliable or improperly trained staff.

Not trusting staff hurts me on a personal level, especially when it’s one of our technicians. I’m responsible for their training at the practice. We push them -hard- and they’re required to know a LOT more than at most other practices I’ve seen/heard/worked. I trust them with my own pet.

Okay, deep breath here. Again, I deeply appreciate clients that are dedicated to a particular vet or staff member. It’s a vote of confidence that we’re grateful for. I also understand that when clients aren’t familiar with how things work at a given practice, it’s harder to have faith in the system.

I’m still firm in stating that when I delegate instructions or decisions to our highly trained staff, the client is getting information from the veterinarian. The buck stops with us, always. I also think it’s a very good idea to get to know more than one of the vets at the practice, just in case someone’s unavailable on a given day.

The vets at Pet Authority do their absolute best to be available for clients at all times. We certainly don’t prefer to hide out and not have direct contact. I’m pretty proud of the fact that most times, we -can- directly interact. For those occasions that we can’t get right to a call or a concern, I’ll summarize with what I see as a way to bridge the trust gap.

I’d like clients to feel that they can express their concerns about speaking with or meeting someone they’re not familiar with. (If it’s done politely.) They should also be willing to work with someone new. After all, the only way to gain trust is to work with someone and get to know her. Please understand that our staff does not act on their own without first verifying instructions from the doctors.

Our staff will acknowledge concerns and provide a way to build trust. The staff will tell an owner that they’ve spoken with the doctor, or have had an available doctor review the case to provide an answer. (Which is exactly what they already do. 🙂 ) They offer to follow up later to make sure things are getting better and that all concerns have been addressed. When something comes up that a staff member feels uncomfortable with, the doctors are notified and will speak with a client.

This is truthfully the coolest part about working where I do. We’ve got a great group dedicated to the best outcomes for our patients. They have my trust. I’m honored to have clients’ trust. We’re all working toward a common goal: healthy pets.

2 Comments

Filed under ethics, human interest, practice

Teaching Veterinarian

I enjoy the daily work that being a veterinarian includes. Sure, there are challenges. I have bad days once in a while. More often than not, I have great days. It’s fun to see clients and their families. I’ve been at the practice long enough now that I’ve got relationships with clients that go beyond the job at hand. My first year out of school helped me decide that private practice was where I wanted to build my career. It was the right decision then. It’s the right decision now.

After ten years of practice (eight at Pet Authority), I’ve got the routine down pat. This is good and bad. The good part is that I can save my stress for the really challenging cases instead of the day to day “little things.” The bad part is that now and then I realize that I’m giving my umpteenth rabies vaccination. I’m not trying to say I’m bored with the routine stuff, nor that I’m suffering from burnout. What I’m poking at is that everyone enjoys new challenges in a professional capacity. Humans are creatures of routine and pattern recognition, but we’re also inquisitive. An analytical mind likes new puzzles to work out.

A few years back, I was asked to give a tour of the hospital to a Brownie troupe. I believe I had a Boy Scout troupe in for the same thing not long before that. I was also asked to talk to a middle school class about my career. Initially, I was very nervous about these public speaking engagements. I tend to take on responsibilities with extreme seriousness. It’s a frank need to do a great job, so I’ll spend many hours preparing. My biggest challenge was learning to adapt my material for various age groups.

The presentations went over well. I found that I had enjoyed speaking as much as I enjoy practice. It was a bit of a surprise, to be honest, as I usually prefer to keep a low profile. What I realized is that I can convey my love for my career and profession by sharing things with others. This blog is another perfect example of me taking an opportunity to explore lots of things that I take for granted or even consider routine.

I’ve learned a great deal about others this way, too. I’ve found that nearly everyone has a reverence for their pets that goes well beyond the most simple basic needs of animal husbandry. There’s a whole culture to explore. I’ve also had the opportunity to meet and talk with lots of people that have different outlooks. Friendly debates are an excellent way to learn if you keep an open mind. As I’ve become more comfortable as a veterinarian, I’ve become more comfortable with understanding different people and pets. I’m continually amazed at the myriad dedications people show for animals.

Teaching has become an important aspect of my professional life. I’m able to contribute to the community this way, which I think is a very important civic duty. It allows me to encourage young people aspiring to be veterinary professionals. It also helps prepare them for some of the harsh realities of the profession. At the very least, it will help demystify what happens at our hospital. In turn, that encourages the building of trust between a client and a veterinarian. More trust means a cooperative approach to health care for the pet. Everybody wins.

We currently have students from the local colleges’ Veterinary Technology program doing internships with us at Pet Authority. We’ve had students come in to observe. I’ve spoken in classrooms, business expos, and our own open house events. I’m happy to come speak to classes or set up observation days at the hospital. Please don’t hesitate to leave a comment here or to contact me at the hospital.

At the deepest heart of everything is a desire to ensure that pets and other animals are cared for as they deserve to be cared for. These outreach efforts are just as important as giving that next Rabies vaccine.

MarySurgery  16 copy

4 Comments

Filed under communication, fun, human interest, practice

Lifestyle Evaluation

Flying Dog

We’ve talked pretty extensively about vaccinations and other preventive healthcare recommendations. For both dogs and cats, the list of things available to help care for them on a daily basis is huge. Not every pet needs everything we have to offer, however, so many of these recommendations are based on an evaluation of a pet’s lifestyle. We try to determine exactly what risks each pet faces based on how they live their lives with their owners. From there, we’re able to select the essential parts of that pet’s care plan. This way, we’re addressing the actual risks for that pet without giving things that aren’t needed. Medications and vaccines are two very specific things that we don’t want to overdo. I’d like to take some time today to talk about the risk factors that we evaluate for each pet.

Indoor or Outdoor Living

Almost all dogs go outside. The cats we see are generally indoor-only, though we do see indoor-outdoor or outdoor-only cats once in a while. The outdoors is a high-risk place for many reasons. Parasites (hookworm, roundworm, fleas, ticks, toxins, heartworm), physical dangers (cars, sharp objects, bodies of water, predators, wild animals), and environmental risks (heat, cold) are all found outside the house. Infectious diseases like distemper, parvo, rabies, leukemia, feline respiratory disease, and FIV are all out there lurking in the environment. Depending on a pet’s time spent outside, we will determine which vaccines and parasite prevention products are needed. Sometimes, outdoor living indicates a need for additional blood testing. This is primarily for cats as we test for Feline Leukemia and FIV.

As a reminder: ALL pets, dogs and cats, indoor or outdoor, are at risk for heartworm disease and should be on monthly prevention.

Social Activity

Pets that have social contact with other pets are at risk for sharing infectious diseases and parasites. There is also the risk of fights. Wild animals are another risk for pets that are out and about, especially at night. Going to the groomer, boarding, obedience or recreational classes, dog parks, or nose to nose contact at a fence or window screen are all ‘social’ activities that bring along the risk of disease transmission. Additional vaccines such as Bordetella and Feline Leukemia are indicated for pets that have social activity.

Travel

Owners that take pets along with them on vacations have a unique set of challenges to overcome. Pets may get carsick. Traveling to other countries requires very, very specific procedures for having the Rabies vaccine up to date. Certain areas of the country put pets at risk for contacting diseases or dangers not found here in Michigan. Rattlesnakes, poisonous toads, plants, tick-carried diseases, toxic plants, and exposure to extremes of heat/cold all come into play when pets travel. Even going “Up North” here in Michigan presents additional risks (ticks and wildlife, primarily). Pets traveling to the ocean can become very sick if they drink too much saltwater.

Diet

It’s important for us to know what a pet is eating. This means that owners need to be honest and fully disclose all of the things a pet is eating. Often, owners are embarrassed to tell us that a pet eats people food or gets a lot of treats. They don’t want to be “in trouble” with the vet. It’s far more important to speak up so that we can come to a plan together that will fit that pet’s life. Treats aren’t all bad, and not all people food is bad. We do have to be very careful about things like onions, garlic, grapes, and raisins. Cats have special dietary requirements, too. Both dogs and cats can benefit from an individualized nutritional plan, so it’s in their best interest to have open and honest owners!

Exercise

This is another topic with a heavy guilt attachment. Most of us should be more active for our own health. The same goes for our pets. We’ve got a little sign in our break room that says, “If your dog is too fat you’re not getting enough exercise!” As we learned with the recent news post on exercise regimens, it’s important to ease pets into more activity.

Other Illnesses & Age

Not every pet is in perfect health. Just as in people with chronic problems, pets that have diabetes, abnormal thyroid function, cancer, digestive problems, allergies, and so on all need to have those problems taken into account as we choose a preventive health care plan for them. Pets with cancer should be vaccinated less or not at all. Pets with diabetes have to have a very specific diet. Environmental allergies are aggravated by being outside more. Arthritis can be a bigger problem for pets that are active. Aging pets need to have more testing of their organ health.

As you can see, there are many factors that are evaluated to help us choose a preventive care plan. The questions may seem tedious and overly long for owners when they come in, but the truth is that without that information, we can’t offer our best possible care. The more we know, the better we can serve the unique needs of your pet.

Leave a comment

Filed under practice, preventive care

Communication Tightrope

800px Tightrope walking
I’ve talked before about how “medicine is the easy part” of being a veterinarian. The challenges come when working to bridge the gap between the perfect world of ideal medical care and the reality that most people live in. We have budgets, mortgages, groceries to buy, school supplies to purchase, and far more. It can be difficult to juggle finances. It’s just as difficult (if not more so) to educate clients about what we feel is the best possible care available.

It’s not unlike a high wire tightrope, stretched between my veterinary oath and a client’s home. I have to walk that line with the proper caution to make sure I safely get to the other side. In some cases, the directions I give help the client cross my way.

Ultimately, both the owner and the veterinarian want what’s best for the pet. We’re usually able to find a happy medium. I’d like to share some examples of the situations I’ve worked through. How would you respond?

First case: A 3-year-old cat comes into the hospital for a checkup because the owner saw some little worm things stuck to his backside. The cat goes outside, has never had shots, and sometimes gets in fights with other cats in the neighborhood. The owner says he only has enough money to cover the exam, a stool check, and a dewormer. What would you do as the veterinarian? Let me add a few pieces to the puzzle. This cat should have a feline leukemia and feline immunodeficiency test, distemper and rabies vaccinations, a leukemia vaccination, heartworm prevention, and flea control. He also has really nasty teeth that should be cleaned. Now what do you do as the veterinarian?

Next scenario: An owner comes in with a new puppy. She’s brought her other adult dog in only twice in the last 4 years. That dog isn’t on heartworm prevention regularly, is overdue for some vaccines, and hasn’t had a stool check in 3 years. The new puppy will need 3 visits for her puppy vaccine series, stool checks, heartworm and flea prevention, and spay surgery. The owner has a brand new leash, collar, t-shirt, and purse for carrying the dog around in. She also has “lots of chew toys at home.” Let’s make this one a little easier by saying the client has no financial constraints, so money isn’t the reason she’s behind on caring for the adult dog. As the veterinarian, how would you advise that client about caring for two dogs when the first dog didn’t even get what we would consider the bare minimum for care?

Last one: An owner that comes in once a year with his dog and keeps up on heartworm prevention and vaccines is here for the annual visit. The veterinarian identifies a small lump under the skin and really bad dental disease. The dog is otherwise healthy. The owner gets the heartworm test and prevention, allows us to update the dog’s vaccines, and purchases some flea control for the summer. However, when the veterinarian discusses a dental cleaning and mass removal, the owner refuses to plan to have these services done. “It’s too much money and he still eats, so I don’t think he’s in pain and his teeth are fine.” What would you do as the veterinarian? Would that answer change if I added more information? That tumor could be cancer, cured if we remove it now, or fatal if it’s left in for months and months. This dog could develop a heart condition, kidney damage, or liver damage because of the bad teeth. Those consequences could take up to 2 years off the dog’s lifespan.

I firmly believe that the vast majority of clients love their pets dearly. I believe that they want to do as much as they can for their pet. I believe in trying to find a happy medium whenever I can. However, I also have a responsibility to advocate for the pet’s best interests. I have to discuss the consequences of not taking action. It requires extremely careful language to tell a client that their decisions are going to kill their pet without being offensive. I’m really not trying to blow my own horn, here. There have been times when the approach I thought would be good turned out to be horrible. People communicate in different ways. They have different values, different goals, different circumstances.

I would love to hear some feedback! All comments are screened, so if you don’t want your comment posted on the blog, just type that into the comment. I won’t publish any comment that you wish to remain confidential. If you’re willing to share, let me and the other readers know what your approach would be if you were the veterinarian working those cases. I learn things from clients every day, so I’m always eager to hear what you think.

Thanks for reading!

2 Comments

Filed under communication, practice

Quality of Life

Last week, I talked about pain in our veterinary patients. I’m going to expand on that topic today by discussing how we evaluate “Quality of Life.”

Whenever we see a patient for an appointment (for any reason, well or sick), we perform a physical examination. We also ask for an extensive history about food intake, weight gain/loss, activity level, general attitude, and any concerns the owner may have. An assessment of a pet’s level of pain is also included in the examination and history.

Once we have all of our information organized, we have a good idea about whether a pet is healthy and doing well, or not. For the pets that are doing well, there’s not much that we need to do beyond routine preventive care with vaccination, parasite prevention, bloodwork and stool checks. However, many of our patients will have a problem that needs to be addressed. We spend time talking with the owner about what’s wrong and what can be done about it. We put a plan into action to help the pet, then re-evaluate at some point in the future to reassess the situation.

Some conditions can’t be cured, only managed. They become an ongoing part of our evaluations and plans. As patients age, we see problems begin to arise that are simply consequences of being older. Arthritis, loss of sight, lumps bumps and tumors, dental disease, mental decline… these are just a few of the chronic issues we deal with on a daily basis with our older pets.

It rapidly becomes very important to look at the big picture. We understand that older pets or certain illnesses are going to mean that a pet isn’t “100% healthy and problem-free.” Bearing that in mind, we ned a way to evaluate whether a patient is living a good life. We need to know if the treatment we’re providing is good enough that we aren’t being unfair to our pets by asking them to suffer. These are difficult subjective questions to talk over with owners. Each pet requires an assessment based on a smaller number of very specific guidelines which help us decide if a patient is doing well enough or needs more intervention.

One of the least specific questions we ask is, “Are there more good days or bad days?” This one’s tough for the veterinary team but great for owners. You know your pets better than anyone, so you’ll know if they’re having a bad day. You’ll recognize subtle changes in personality, activity level, enjoyment of toys/treats/activities, and sleeping patterns. Many older pets do have some days that are worse than others, and we have to be lenient about that. Things aren’t going to be perfect. That being said, a pet that’s having more bad days than good ones needs help to get back to more good days than bad.

Back in 1993, the United Kingdom’s Farm Animal Welfare Council developed a way to evaluate living conditions for farm animals. They’re quite easy to adapt to companion animals, too. They utilized a concept called “The Five Freedoms.”

1. Freedom from Hunger and Thirst
2. Freedom from Discomfort
3. Freedom from Pain, Injury, and Disease
4. Freedom from Fear and Distress
5. Freedom to Express Normal Behavior

These five criteria touch on the most basic parts of a life that we could consider ‘good.’ The most basic things — eating, for example — MUST be present for that animal’s life to be considered good. Without those, we’re doing any animal a disservice by continuing without changes to improve the animal’s status.

A veterinarian named Dr. Villalobos created a Quality of Life Scale that can be used to evaluate domestic pets. Each of the following criteria is evaluated on a 0-10 scale, with 0 being worst and 10 being best. It’s useful for both the veterinary team and the owner to fill this out for patients who need evaluation. We each have unique insights that, when combined, provide the most accurate assessment of quality.

HURT – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?

HUNGER – Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?

HYDRATION – Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.

HYGIENE – The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.

HAPPINESS – Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?

MOBILITY – Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)

MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.

A score over 35 is considered an “acceptable” quality of life. Download a nice PDF of the assessment sheet here.

This is always a touchy area with owners. I believe the most owners know in their hearts when quality of life isn’t good enough. However, acknowledging that means that we have to accept the fact that a pet is in trouble and needs help, or will need to be put to sleep. If the condition that is causing life to be poor is easily addressed, the pet gains tremendous benefit and can have quality go way up. Sometimes, though, the harsh reality is that there will be a limit to what can be done. We have to be fair, we have to be selfless, and we have to be realistic. Letting go is insanely difficult, a fact that -any- pet owner understands. From my side of the table, I have seen clients make poor decisions about quality of life that they ultimately regret. I don’t say this to be judgmental or to preach. Seeing the truth is difficult at best, not to mention emotionally painful in many ways.

The Quality of Life assessments, when started -early- and used often, can help us identify small problems before we’re trying to push a boulder up a hill. All too often, I see pets that have had declining quality of life that the owner overlooked until it’s so bad that the pet is in horrible shape. In some cases, the owners elect to euthanize. In others, they ask, “What can we do to save him?” That second question is guaranteed to bring about an extremely difficult answer. Whether it’s the high financial cost to try to get a pet with lots of problems back on its feet, or a disease we simply can’t do anything about at that point, the pet is the one who has suffered its way to that point in time.

We can do so much better than that. Every single one of the quality criteria in that list can be worked on and improved. “Pawspice” care can be a wonderful way to ease pets through their golden years, but only if we have the courage and dedication to acknowledge that it’s needed.

1 Comment

Filed under behavior, medicine, practice, preventive care

A Little Drop of Poison

The majority of the time that we spend talking about toxicities, we’re assuming that a patient has ingested a large amount of something bad. While that’s the more common way for things to happen, we’ve had to deal with a fair number of low-quantity toxicities. Some medications/toxins are dangerous at small doses, infrequent doses, or a single dose.

By far, the most frequent issue we deal with is an NSAID. NSAIDs are “non-steroidal anti-inflammatory drugs.” This class includes aspirin, ibuprofen, naproxen, ketoprofen, and many others. Many of these medications are available over the counter for humans to use. They’re indicated for pain most commonly. A quick peek at Wikipedia cites a source with this frightening information: NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits. Clearly, these medications are not to be taken lightly.

800px Ibuprofen 8330

We do use NSAIDs in veterinary practice. Thankfully, we have a variety of options that have been specifically developed for pets. While all NSAIDS (veterinary and human both) have potentially dangerous side effects, when they are given properly they’re considered safe. Monitoring is necessary to ensure that side effects are not occurring.

The crux of the post today is that human NSAIDS can be extremely toxic to pets. I’ve seen cases where a single Aleve (naproxen) or just 2 doses of ibuprofen have seriously and permanently damaged a dog’s kidneys. I’ve seen stomach ulcers caused by aspirin.

In many of these cases, owners were giving the medication with the best of intentions, to help their pets not be in pain. I can understand the desire to ease pain. What I can’t understand very well at all is the assumption that if it’s OK for people it must be OK for pets. This simply isn’t true!! Dogs and cats have some unique aspects to their physiology that make medications behave differently than they do in the human body. Sometimes this means we have to give more of a certain medication; others, far less nor none at all. Supplements are considered medications as far as I’m concerned. Anything holistic, naturopathic, herbal, traditional medicine, etc. should be considered with the same weight as a “drug.”

I wholeheartedly believe that we can, and should, consider our pets as family members. They’re children, albeit shaggier than their human siblings. What we can not and should not do is treat them as if they’re tiny humans. If we are going to adhere to the idea that we will do what’s best for our pets, giving them any medications/supplements/treatments at all without consulting a qualified veterinary professional is a bad idea. It may be a fatal mistake.

Very few things are as crushing to an owner as finding out that something that was done with the best of intentions is responsible for the death or severe illness of their pet.

I strongly encourage you to call us (or your regular vet!) if you are considering ANY product for your pet. I realize that resources are sometimes limited, so you may not always be able to come in for a consultation or appointment, but at the very least we can help you avoid a terrible mistake. It’s always best to call BEFORE starting a medication or supplement. There may not be much I can do if someone calls and says, “I’ve been giving Product X for the last week and Fluffy isn’t eating, now…”

My last comment from the soapbox today is to mention that even products “made for pets” can be dangerous. I’ve seen flea and tick prevention for dogs and cats cause serious toxicities even when used as directed. I’ve cruised the aisles at pet supply stores and seen huge bottles of aspirin for dogs on the shelf. I’ve seen supplements that contain things that I don’t think are beneficial at best (and dangerous at worst). The point here is that finding something in a pet store doesn’t mean it’s the right choice for your pet!
Mr yuk563
Thanks for reading! Up next on Thursday is a guest column written by one of our techs. She volunteered to do a post on “Whoops, my dog’s pregnant. Now what?” (Bonus points if you recognize the little face. A flashback from when I was far younger…)

1 Comment

Filed under medication, practice, toxicology

Communication

389px Sir Joshua Reynolds Self Portrait as a Deaf Man Google Art ProjectOne of the biggest challenges we face in practice is conveying important health information so that owners understand it. It’s not that owners are stupid or incapable — quite the opposite, in fact! — but more that owners haven’t been through four intense years of veterinary college.

The actual words we choose need to be words that educate and create understanding. We also have to deliver potentially stressful information in a way that doesn’t cause the owner to become closed to communication.

It’s a very delicate balancing act in some cases. Each person that we work with has different goals, ethics, beliefs, and resources. I have just a small window of opportunity to reach the sweet spot in which these goals are met:

•The owner understands my diagnosis, my recommendations, and the treatment options
•The owner understands the consequences of following or not following various treatment plans
•The owner hasn’t been made to feel angry, stressed, or guilty
•The pet is being cared for in the best manner possible

I’ve had the full range of reactions from owners. When I first started practice, I got a lot of glazed-eye expressions. I needed about a year to get my explanations revised to the point that clients didn’t feel like they were sitting through a vet school lecture. (Believe me, I wouldn’t wish that on anyone! :)) I’ve had clients scream at me, walk out, tell me I’m a bad vet, tell me I’m just in it for the money, and threaten to sue. I consider myself a reasonably good communicator. These negative experiences point out one critical thing: If a vet can’t adapt how he or she conveys information to a client so the client’s needs are met, the communication will fail.
640px Drill instructor at the Officer Candidate School

Effective communication requires a ton of effort. The photo above is an example of the wrong sort of effort! I could go on for pages and pages, citing resources on how to handle conversations and conflict, but I think the underlying message is far more simple. If we (the owner and the veterinarian) are going to do what’s best for the pet, we are going to have to work together.

It’s my responsibility to examine, test, diagnose, and offer treatment for the pets. I need to explain what’s happening (good or bad), and I need to be able to tell you what I recommend in a way that is understandable to you. I need to be able to advise you about prognosis, possible outcomes, and cost in a way that’s neither too pushy nor too cold. I need you to understand how serious a given finding is and what it will mean longterm if it isn’t handled properly.

I believe it’s the owner’s responsibility to answer our questions about housing, food and treats, activity level, appetite, previous medical history (even if treated by another hospital), medications, supplements, observations about bowel movements and urination, and a basic summary of the problem. Without this information, the veterinarian is already behind.

I need you to be forthcoming with all kinds of details, even if it means admitting you missed a heartworm prevention or medication dose. I need you to listen attentively when I do explain things or show you something. It will help me tremendously if you let me know what your goals are for the visit, what you want to do longterm for your pet, what you can afford, and what you are willing to do at home for treatment.

Honesty from me and with me will help your pet far more than you telling me what you think I want to hear. I’m not pulling punches when I explain that untreated dental disease will take 2 years off a pet’s life, for example. I need you to be brave enough to tell me that you’re concerned about the anesthesia, or that you don’t think you can give your cat a pill. The staff and I can make a tremendous contribution to giving you the training and tools you need to do what your pet needs you to do.

If we’re able to work together, your pet will benefit from the full weight of our knowledge and your commitment to good care. That is, after all, why we’re here!
320px 2008 12 01 White GSD at the vet

I’d love to have some comments from your perspective about visits to the hospital or other customer-service experiences. What does it take to make you feel like you’ve been treated well? What sorts of things have happened to give you negative customer service experiences? What advice could you offer to help us communicate better?

As always, thanks for reading!

1 Comment

Filed under practice