Tag Archives: practice

When Winning Is Bad

Most of us would happily win a contest, lottery, or competition. I’ve never heard anyone regret a big win at a casino. Enjoying the benefits of a bit of fickle luck gives us a rush, too. That feeling you get when your chair -almost- but doesn’t quite tip over? That’s a win. The human mind loves to play the odds. Some of us are downright addicted to the gamble because of the potential payoff. Adrenaline junkies, don’t think you’re above the game. There’s a chance that parachute won’t open, isn’t there?

There are times that the odds are exactly what you want to put you on the losing end, though. When we’re talking about your chances of illness and injury, you’re hoping that you’re not that one in a thousand, ten thousand, or million. Winning a bout of the flu is one thing. Winning cancer is a whole separate kind of problem.

It’s not all that fair for me to bring up “The Big C” as an example. Yes, it does give us a clear statement of our chances. It also helps us identify risk factors so we can avoid the “win.” Cancer is so scary and close to home, though, that I think we’ll get bogged down in just the numbers instead of the big picture.

Better examples comes up when we talk about the generalities faced by pet owners every day. Should you vaccinate for a given disease? Should you use heartworm and flea/tick prevention? Should you allow your pet to go under anesthesia?

The art of practicing medicine teaches us to avoid promises and to keep to conservative estimates whenever possible. We hate to promise and under-deliver. I do, at least. It’s important to me to lay out the pros, cons, and possible consequences of our decisions. Owners need to participate in this risk assessment, but they’re at a disadvantage. More than one, really. You’ve not had the training we’ve had. You’ve not had the benefit of years of experience and thousands of cases to draw upon. We’re at a disadvantage because we simply don’t know your pet as well as you do. (Granted, I’m generalizing here against my own better judgement. Clearly we can sometimes see things that owners don’t. The reverse can also be true.)

Vets and owners usually develop rapport and can work together to help pets. We’ve got the same goals in mind, after all. There will occasionally be differences of opinion. Ultimately, all I really need is for owners to make an informed decision. I’m far more adamant when I have to advocate for a pet’s quality of life, but I can acknowledge the fact that some owners simply can’t do everything on the “Should Do” list. That’s when we optimize the “Can Do” list and move forward. Guilt, yelling, browbeating, hard sales… just not my style.

There’s a group that I need to bring into the discussion at this point: breeders. It’s a dangerous thing for me to do. I’m going to admit that I’m biased. Consider it a disclosure rather than a conflict of interest. I’ve never been a breeder. I’ve worked with many by way of my profession. Many breeders have not been vets, nor any type of veterinary professionals. What I can speak of is my own perception of the situations as I’ve encountered them.

Breeders have the benefit of having worked with their chosen breeds for a long while. They have lots of contacts in their interest group, too, which is a good thing. On the other hand, they don’t have the benefit of large, well-organized research studies to back up some of their claims.
Vets have the benefit of a lot of hard science and training. We also have the experience of working with LOTS of dogs and cats. Balancing that is the fact that we may not know a particular breed as deeply or well.

This sets the stage for a few really obnoxious contentions. Anecdotal evidence isn’t the same as data. Yes, sometimes anecdotal events are true, and research proves this. Some are not, also proven by research. The burden of proof is on the individual or group making the hypothetical statement.

For example: Breed X is more sensitive to anesthesia! Breed X will die if you give a Lepto vaccine! Breed X puppies have to be on adult dog food! Breed X can’t have pork as a food ingredient!

Often, these statements are what we are faced with in the exam room. The owner is stuck in the middle. Breeders know their own stock well. I know my products well. I don’t think that breeders are all being vindictive, here. These folks care about the animals, too. I get testy when it’s implied that I would do anything I knew was harmful, but that’s a whole other rant for another post.

Is it possible for an individual to have physiology and/or genetics that could make it more sensitive to side effects or dangers associated with vaccines, medications, anesthesia, etc.? Yes, absolutely. Could those problems run in a family line? Yes. So, if a particular breed has a fairly narrow genetic pool, then it’s technically possible for Breed X to have much higher odds of a given problem. Can that be said about ALL of the individuals in that breed? Probably not.

I’ll use one of those earlier statements to illustrate the issue. You’ve purchased a puppy of Breed X. As part of that purchase, you’ve signed a contract that says that you will not have the puppy vaccinated for distemper/hepatitis/parvo/parainfluenza (which is the “distemper vaccine”) before 14 weeks of age. You bring your happy new 9 week old puppy to me. Your kids, aged 5 and 9, have had their new puppy for 2 weeks already and are totally attached. I take a look at the vaccine records from the breeder. No vaccines given at all, but the pup has been dewormed several times. For the sake of the example, we’ll say that this puppy is normal and healthy.

I recommend starting a puppy vaccine series. You knew it was coming. The breeder warned you that I’d want to do this. Your breeder has explained to you all about how Breed X is too sensitive to vaccines when they’re young and must wait until later. My first instinct is to call BS, but for the sake of the discussion here, let’s assume that it may be true. As the owner, you now have two choices to make, each backed by an expert.

If you choose to NOT vaccinate your puppy, what are the consequences? Your pup may be unprotected. It could catch distemper, which is often fatal. It could catch parvo, which is fatal 30% of the time even if treated aggressively.

If you choose to vaccinate, some of the possible side effects include: allergic reaction that requires immediate treatment for anaphylactic shock, anemia caused by the immune system attacking the red blood cells, lethargy and mild pain at injection sites. Some of these side effects could be lethal.

As an owner, you’re stuck playing the odds. What’s more likely to happen? What are the chances of your puppy getting sick? I honestly have no idea how to advise you when you’re staring this kind of thing in the face. All I can do is give you the best information I have and hope we land on the same side of the decision.

Personally, I think that the risks for vaccines are lower than the risks of contracting one of these diseases. The benefits of protecting a dog outweigh the risks. I recommend vaccination. I’ve seen more unvaccinated dogs get sick than I have vaccinated dogs get sick due to the vaccines.

In the end, my perception is that I can do more good by ignoring most of the Breed X declarations and treating my patients as individuals. I don’t know what causes the experiences that most breeders use as support for such statements. Did they receive poor quality veterinary care? Are bad genetics being passed down in a line unknowingly? Or knowingly? Whatever the cause, it lands owners smack dab in the middle of a dispute they rarely have the information needed to sort through. That can lead to bad decisions all around, and the animals suffer for it.

My best advice is for new and prospective owners is to ask questions. When a breeder or a vet makes a statement, ask for support. What makes you say that? What specific things went wrong with your puppies/kittens that makes you say they can’t have vaccines? What kind of anesthetic complications were seen that makes you want to avoid drug Z? What will happen if my puppy or kitten does NOT get vaccines until that age and gets sick from one of those diseases? How many of your puppies/kittens have had these problems? Is my puppy/kitten from the same mother or father as that litter that had problems? What can I do to minimize risk? What happens if a complication arises?

At the very least, you’ll know the rules and have a feel for the odds.

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The future is the past?

In the midst of the major changes happening in the human medical industry, I’ve been very interested in a new business model for human physicians. It’s being called “concierge medicine” or “direct care medicine.”

Concierge medicine is set up so that patients pay a fee directly to the doctor on an annual (or monthly) basis. This fee gives the patient direct access to the doctor and medical staff. In some cases, this means that your physician is available to speak directly to you. In others, it means that you get a certain number of visits per year for preventative care. There are a ton of variations, but the primary difference between this and the common model we experience is that you get more direct and frequent access to the doctor.

Fees for concierge medicine vary from $600 to $5000 according to the figures I found with some basic searching online. Keep in mind that for some human practices, this is IN ADDITION to what you pay for insurance. In others, that fee is paid to the doctor and includes a certain amount of care, with insurance never entering the arrangement.

I have a customary arrangement with my physicians. I’ve never had the doctor call me back personally about lab results. When I call, I don’t get to speak to the doctor. If I have an emergency, they route me to the urgent care facility or the ER. If I’m feeling sick and need an appointment right away, I’m almost always routed to the urgent care facility. They also don’t ever send me reminders for when I’m due for regular services.

The advantages of the concierge plan are touted mainly because humans have more ways and opportunities to interact with their physician. Communication tools like Skype, email, and traditional phone calls can all get you in touch with your doctor. As I was reading through a couple of articles about concierge medicine, I couldn’t help but think, “Wow, they’re starting to catch up.” Veterinarians have been doing this all along!

At our hospital, I think we do a pretty good job of bucking the ‘normal’ of human practice. Doctors call clients back with blood results or other lab results. Those results are usually available the next day instead of a weeks later. We’re almost always available to speak directly to clients. We do our best to work in any sick pets the same day. (Now and then we do have to refer to the ER for extremely serious problems or major surgeries.) We also send reminders (maybe too many? 🙂 ) to let owners know when pets are due for care. The only drawback to our model is that we don’t have a doctor available outside normal business hours. It’s something I’d like to address in the future.

The best part about how most veterinary hospitals operate is that you get all of these benefits at no extra cost. It’s part of why I’m proud of our profession. We’re a great example of a lot of things that are good and right about medical practices.

What are your thoughts on how human and veterinary medicine can better serve clients and patients?

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Microcosm

Back in November, I posted about how harmony in the practice is what gets us through one-doctor Saturdays at the hospital. The staff — techs, receptionists, boarding employees — make or break those days. Without them, we’d be sunk.

Saturdays are almost always a bit crazier than usual days, but yesterday was insanely busy. From 9:01am, the phones were ringing off the hook and we had between 2 and 4 exam rooms loaded for the entire time we were there. That’s a busy day for us.

The staff working yesterday was in perfect harmony. We had a double-booked schedule for the entire shift plus a few triple-booked stretches. They did a marvelous job. “Just think about how much you will have accomplished” rang true yet again. We took care of everyone and finished the shift almost precisely on time.

Yesterday reminded me that the wide variety of things we took care of is exactly why I enjoy my profession. As a general practitioner, I have the pleasure and responsibility to see everything from nose to tail. Pets and owners with diverse backgrounds, illnesses, and challenges all need my attention. Sure, giving the umpteen thousandth rabies vaccination isn’t a challenge, so that’s where it’s important to capitalize on an opportunity.

During an appointment I have a chance to talk with an owner as I perform the physical exam. Showing them what I see or telling them what I hear helps make them a part of the process. We almost always find something to talk about during a physical. Patients that are generally healthy even present opportunities to educate owners about how to better care for them. Sick patients’ bodies “speak” to me. I translate for the owner.

Puppy and kitten visits are almost always a joy. They’ve got the market cornered on cute. We also get to work with owners that are extremely attentive. I can’t think of a time when the owner of a new pet didn’t engage in a big way. We work together to plan a pet’s start in life: medical concerns, vaccines, food, preventive products, upcoming spay/neuter. These visits are generally very positive, which helps us get to know the pets and owners better without the stress of illness or problems making things more difficult. Puppies do offer a few challenges, too, but it’s rare that they sour the appointment.

Healthy adults are also fun visits. We know these patients and owners better, so while I work I can ask about how a family is doing. I try to engage with the kids that come in, too. It seems to me like an opportunity that shouldn’t be missed. Offering to let a young child hear a pet’s heartbeat through the stethoscope is a sure way to strengthen the bond between that pet and the child. Sometimes we give tours of the hospital. Yesterday, I saw a year-old dog that was just acquired from a neglectful owner. We planned out a way to catch the dog up on health care that fit the new owner’s budget and schedule. It was time well-spent.

We had a run of sick animals to help: vomiting, diarrhea, limping, ruptured skin cyst, constipation, toxin exposure. The gamut was the gauntlet. We pulled blood to send out lab work. We took some radiographs. We ran stool checks. Medications were filled. Enemas were given. On a side note, it may seem utterly bizarre to be excited when an animal defecates. In this case, though, it meant we could send a cat home feeling MUCH better without having to anesthetize her. That’s a win-win-win!

Being able to juggle the random order of events is part of the transition that we all make as we enter the profession of vet med. In school, all of your knowledge is loaded into your head in an orderly, steady format. It’s like filing books on library shelves. Each has an assigned place. Even when you work in the university vet hospital as part of your training, your time is divided into specialty services. You’ll work in orthopedics for 3 weeks, then internal medicine, then ophthalmology, and so on. There’s not much cross-over. When you graduate, however, it’s a whole other story. You have to throw all of your brain-stored books into the air, then pluck out the pages and facts you need as patients randomly present themselves for assessment.

This randomness is daunting to a new grad. Frightening doesn’t begin to describe the situation in which one must go from puppy visit to major trauma to vomiting to euthanasia. A mind that’s not supple enough to change gears like this will snap. All of us do at some point have that little meltdown, just like I did in Hollywood when that tech told me the sun was going to come up no matter what. We learn, though, and we handle it. It has to be handled or you’re not cut out for the work.

As time goes on, I’ve learned to embrace the chaos. It’s what makes professional life interesting. It keeps me engaged. Daily challenges push me — and most all vets — to steadily increase our skills. Each experience benefits the next patient. I figure that each gray hair I get is a case I’ve learned something from. (Darned if I’m not learning a lot!) I’ve spoken often about the intricacies of working with owners. These challenges are as unique as the people who present them. I’ve learned to love that, too.

On any given day at the hospital, we see a slice of all walks of life. We see an assortment of cases and make an assortment of diagnoses. Saturdays are a microcosm within the realm of general practice. I don’t think I’d trade it for anything, even when we feel like we’re tending a three-alarm fire. The best of who we are comes through on days like that. Yesterday our staff made sure that everyone was cared for, and at the end of the day, that’s what matters most of all.

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Hindsight Planning

Far too often, vets have to deliver information to clients that comes as a complete surprise. It isn’t necessarily bad news. It’s still a surprise. Surprises don’t tend to make life easier or less complex. It can lead to frustration for clients and suboptimal care for pets.

Wait, what? TWO litterboxes for one cat? Three for 2?

Bulldogs are prone to breathing problems?

I didn’t have money to spay my dog. Now she’s pregnant…and I have to do what?

How big does this breed get? That big?!

We didn’t know that could happen…

They need how many vaccines? AND heartworm prevention?

Topics range from basic care and breed information to complex management of a difficult illness or injury. Dealing with these situations after the fact isn’t the best solution for any of us, especially the pet. Planning ahead ensures owners know what’s in store. Informed decisions allow everyone involved with the pet’s care to stay calm and clear-headed. The difficulty from our end is that we often can’t get information to owners before they show up in the exam room.

Thankfully, there are more ways than ever to educate owners and potential owners. Blogs are an obvious example. Web pages, books, visits to the vet, TV shows, and advice from friends are generally available to (potential) owners. It’s not always easy to know where to find good information, but I have a few go-to sites that I’d like to share.

The Indoor Pet Initiative
This page provides great information about creating a home environment that’s good for the mental and emotional health of your pets.

AKC Breed Information
The American Kennel Club has great profiles on breeds. You can find plenty of info to help guide your choice of a companion.

The American Association of Feline Practitioners
The AAFP is a veterinary organization that offers some excellent cat care tips.

The American Animal Hospital Association
This organization also offers a ton of good information for pet owners.

Veterinary Partner Site
Information written mainly by veterinarians on a wide range of preventive care and diagnosis-related topics is available here.

Veterinary Surgery Central
This page is written by a local surgeon. It’s got a massive amount of information about veterinary surgery. The main author, Dr. Dan Degner, is an excellent surgeon and an incredibly nice guy.
I hope that the resources above are helpful in putting information in your hands before there’s a surprise or trouble. Planning ahead is the way to go! If you have a favorite site, please feel free to offer it in a comment so others can benefit.

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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.

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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!

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Scruples

There are certainly times that I feel are appropriate to take the bull by the horns.  Last week, 20/20 did a report about unscrupulous practices among veterinarians, with the premise of protecting pets and owners from unnecessary procedures.

The show used two dogs as examples.  They were examined by a reputable, well-respected veterinarian in NYC and deemed healthy and normal.  They were then taken to other veterinary hospitals to see what the vets would recommend.  Some vets gave them the all-clear.  One recommended a dental cleaning procedure.  Another recommended vaccinations for the dogs, which were actually NOT due for vaccines.

The report available to read online implied that the dental cleaning and vaccines were unnecessary.  The undercover camera work showed the veterinarian that was recommending unnecessary vaccines — and in this case, I might agree.  Now, it’s somewhat foolish of me to comment on the full dental exam and the condition of the undercover dogs’ teeth.  In the half-second glimpse that was shown of one of the dogs, there wasn’t enough time to fully evaluate.  Interestingly enough, I saw two things that make me VERY curious about how the full exam looked.

The vet that was featured in the report was asked several leading questions by the interviewer.  He said that he was pressured by his former boss to rely upon the pet owners’ fears to push for unnecessary procedures that would profit the practice.  He also said that when he owned a practice, he did the same thing, in order to cover his overhead and costs.  (Some of that was in the written article I read online.)

So, what gives?  Is this guy really a crusader for pets?  Is he looking out for owners and animals from the pure desire to help?  I did some digging of my own.  You can indeed get a lot of information for free from Dr. Jones’ website.  You have to sign up for his email list to get most of it.  Other information you have to pay for.  He has a book now in its second edition.  The e-book version on Amazon was $47.  You can also order additional epubs from his website, for a price.

Dr. Jones says that owners need to go into veterinary hospitals because they’re a business, and businesses operate for profit.  True enough, we do.  So does everywhere else that you purchase products or services.  Even human hospitals are for-profit.

Dr. Jones and I agree about a lot of the things he’s saying.  I read through one full introductory publication from him as well as the highlights from another (about examining and healing pets at home).  Supposedly, over the next several days, I’ll be receiving more free insights into his current practice strategy of holistic, homeopathic, and free-at-home veterinary care.  He advises that owners seek veterinary care in many instances.  In others, he’s relying on his texts to teach owners to evaluate their pets at home and decide what their condition is, to help them know when to see the vet and when not to.

This all makes me pretty upset.  There are indeed unscrupulous vets out there.  There are unscrupulous people in all professions.  What I don’t like is the tone of the reporting.  It seems to operate from a “guilty until proven innocent” strategy.  Most of the vets I know are good people that are looking out for the pets first and foremost.  We’re not out there deliberately gouging pocketbooks and we sure as heck aren’t putting pets through unnecessary treatments.

Dr. Jones’ advice about how to evaluate a good hospital sets out criteria that Pet Authority meets (or exceeds!).  I’m proud of that.  I’m angry that I have to say that as a defense of our work.

Speaking personally, my clients come to trust me over time because we build the understanding that I’m looking out for them and their pets in every aspect of their veterinary health care.  I’ve talked a lot about trust during the visit with other posts, so I won’t belabor it again here.

All that I ask of my readers today is to weigh things fairly.  Weigh them and ask questions rather than assuming the worst.  For me, the pets come first.  Always have, always will.

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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.

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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!

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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.

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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.

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Filed under communication, human interest, practice

Is it important, or is it a sales pitch?

As veterinary professionals, our staff and I have a unique challenge when trying to communicate our recommendations. Everything we do has to be paid for by the owners as an out-of-pocket expense. If we’re not careful, we’ll quickly start to sound like a door to door salesman.

I’ll apologize up front to any salespeople reading the blog. I don’t mean to disrespect the profession. What I’m trying to do is make it clear that there’s an important difference when the situation includes a living being as the focus point.

That’s indeed the catch. We have a LOT of information to convey in a short period of time. Pets need a lot of care. Each pet also deserves to have their health care delivered in a customized way. Not every dog is exposed to the same environment. Cats face drastically different risks if they’re outdoors at all. Age, gender, and breed are also factors.

Clients only have a limited amount of time to spend at the hospital. It’s our 10-hour-a-day work, but for our pet owners, it can be a 1-hour ordeal. Catching a cat or loading up the dog and kids makes things complex on the best days. On a bad day…well, let’s just say that I’ve seen some owners come in looking like they desperately need a warm, sunny beach and a margarita.

In the short time we have to get an owner’s attention, we need to convey recommendations for:
General care at home — feeding, exercise, grooming, lifestyle/activities
Parasite prevention — heartworm, intestinal worms
Vaccines — only what they’re at risk for, but we have to take lifestyle into account
Labwork — additional blood testing, urine analysis, x-rays, etc.
Ongoing or New Problems — if we find something wrong, we recommend treatments

I could spend hours and hours talking about all of the things on that list. The blog is proof of that! Many of those items have their own posts. Some even have a series.

Hours are exactly what I don’t have in an exam room. I’ve got 10 minutes or so. The technicians have another 15-20, during which they make the bulk of the recommendations. (We’ve trained them to know exactly what to select as priorities for a pet.) If I spend more than a few minutes on a given topic, owners are overwhelmed with information.

In order to make the visit more pleasant for owners, we try to condense our explanations to the most critical, key points. That sounds good in theory. A few simple, meaty phrases ought to convey the idea, right? It’s more tricky than it seems. I’ll provide an example.

Distemper vaccine is something nearly every dog should have. It’s a combination vaccine with distemper virus, hepatitis virus, parainfluenza virus, and parvo virus in it. We give a series to puppies, then a booster 1 year later, then a booster every 3 years. This is a critical vaccine. These viruses cause damaging and/or fatal illness. The viruses are out there in the environment or are transmitted by other dogs. (There’s more I could go on about…)

An owner sitting there while I babble on about each of these viruses and risks will know two things. First, that I could put a classroom to sleep with no trouble at all just by continuing this lecture. Secondly, that they’ve got 50 other things to do that day and my teaching on veterinary immunology isn’t helping that list get smaller. I know both of these things, too. What’s the solution?

“Mrs. Jones, Davy needs his distemper vaccine.” Efficient, clear, and utterly, totally lacking ANY clue for an owner as to whether I’m just saying that because we always do, or if Davy really does need that vaccine to keep him safe. Add the fact that I’ve also said the same thing about the rabies vaccine, the lepto vaccine, the bordetella vaccine, heartworm and flea/tick prevention, a glucosamine supplement for Davy’s bad hips, annual heartworm test and bloodwork, and some ear medication. He also needs his teeth cleaned.

Suddenly, that distemper vaccine is in a massive group from which an owner will have trouble choosing a priority. Which are critical and which could we put off a month or two? And how much is this all going to cost? There’s the dilemma, folks, and you’ve all been in that position. You’ve been on the other side of the exam room table while I lay all that stuff out and then wait expectantly for the OK.

My hope is that the clients know without a doubt that I wouldn’t recommend something that a pet didn’t need. I just don’t do that. If you’re meeting me for the first time, though, or if the recommendation comes from one of the techs, you may not realize that everything we’ve said should be done should, in fact, be done.

Bridging the gap between the blanket list of recommendations and the mind-numbing veterinary school lectures on each little pathogen is where “sales” comes in. We have to offer enough information so that owners understand the why of our recommendations without being overwhelmed with the “because” of our recommendations. Short, pertinent bits of info are helpful. “Marketing lingo” isn’t.

“Davy is a social dog that goes to daycare and plays in the dog park on weekends. He needs to be protected from diseases that are passed by other dogs or that he might be exposed to outdoors. Kennel cough, lepto, distemper, rabies, intestinal worms, fleas and ticks are all things he could run into. All dogs need to be on heartworm prevention, which also takes care of intestinal worms. You also mentioned that after playing, he seems to have trouble getting up from the ground, so I’m recommending a joint supplement that should help.”

Is that better, or does it sound like a sales pitch? I’m undecided. The longer the list, the more it sounds like a sales pitch. I didn’t even start talking about the dental care that’s needed (which I would during a visit). There’s just no perfect answer. It may seem rude to an owner, but asking “why?” is a really good thing. It lets me know where I should spend time explaining. If we all agree that Rabies is a vaccine Davy’s getting today, but you’re undecided about lepto, we can detail that more fully.

The truth is that as time goes on, we’re better able to care for pets. We learn continuously. We do our best to offer the very best we can to care for your pet. I recommend what’s needed. I mention things that are optional. I’m crystal clear if something is critical or essential.

It all comes back to trust again, doesn’t it? I’m always more than happy to explain things at length. On those days when the dog and the kid puked in the car, you’ve got ten more errands, and money’s tight? You’re likely to want the speech short and sweet. “You need to do a, b, and c today. Please consider x. In 6 months at the next appointment, we’ll do y and talk about z again.”

We start with what’s medically best so that we have an honest start. We can then move on to the economics and talk about the most affordable way to accomplish the best care.

Thanks for reading!

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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

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Filed under neuter, practice, science, spay

Vet-A-Visit

Each year, Michigan State’s College of Veterinary Medicine hosts an event that allows the public to tour the school and hospital. It’s full of displays, demos, and all kinds of really amazing stuff. For example, you can watch a horse run on a treadmill or see how laparoscopic surgery is performed.

I HIGHLY recommend taking the family to Vet-a-Visit. It’s a great experience, and it’s free admission! Details can be found at the web page.

Vetavisitflyer

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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.

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Filed under cats, dogs, human interest, practice