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Wednesday, March 4, 2015

Veterinarian, Breeder, Store Clerk....Who Do You Trust Most?

I make recommendations to clients with every visit.  It may be about vaccines, the kind of heartworm prevention they should use, which foods to feed, and so on.  My opinions are based on four years of medical school, 18 years of practice, over 300 hours of continuing education over the years, and countless journal articles.  I'm not perfect and I don't know everything, but I'd like to think that my knowledge base is pretty comprehensive.  This is why it still surprises me when someone believes a breeder or pet store clerk over their veterinarian.
I've run into many situations where a breeder tells a client "whatever you do, don't let your vet do XYZ!"  Some of these breeders are quite vehement about their opinion, frightening the client into compliance.  "Your vet will tell you to do this, but don't do it!  I've been breeding for 30 years and I know dogs!  This is very harmful and your vet is just trying to make money and doesn't care about the risks!"  Yes, I've heard these very words, and even seen similar ones written on papers given to a client when they purchase a puppy.  I have to sigh and shake my head, wondering at the influence that the breeder really has.  And they do have considerable influence, because I've had clients disregard my words and recommendations based on what the breeder told them.
Similar things happen with pet store clerks.  I'll talk about food choices, and make some strong recommendations based on what nutritional specialists have said to me.  The client then goes to the pet store and pick something else because the clerk said that what I suggested was bad. 
Let me be clear.  Not every vet is right, and not every breeder or clerk is wrong.  But stop and think about this situation for a minute.  On one hand we have someone with a medical degree and years of experience, plus mandated continuing education every year and with subscriptions to multiple scientific journals.  On the other hand we have a breeder who "knows dogs" and visits internet forums.  Or we have a clerk that's worked in the pet store for a few years but hasn't had any formal training in the subject.  Who does it make sense to believe?  The person who studies immunology at a cellular level, or the person who reads a lot from like-minded people online?  The person who has learned the microscopic structure of the intestinal lining and how nutrient absorption works, or the person who has attended an at-work seminar? 
If you're doubting your vet because a non-vet told you something, stop and ask yourself why.  What training or experience does the non-vet have that trumps the training and experience of vet?  I can bet that most vets can run rings around the non-vet with actual data and studies, rather than just relying on "years" of breeding/working/experience.  Feel free to question your vet (in fact, I encourage it), but in the end stop and realize who really has the best background to make recommendations for your pet.

Saturday, February 28, 2015

A New Way Of Veterinary Education

In one of my recent journals I was intrigued by an article entitled "Urgently rethinking the way we teach veterinary medicine".  The premise behind the article is that our current method of developing new veterinarians needs an overhaul and isn't the best way it can be in the 21st century.  I have to say that I agree with many of the points made, and I want to discuss them.  I'll present a quote from the article, then my own thoughts.
"Students are still taught predominantly using centuries-old methods that make them passive recipients rather than active seekers of knowledge—the most common format is a professor standing in front of a group of students and talking...........Colleges are beginning to address the situation by converting lectures to seminars and workshops—the so-called “flipped” classroom in which students assume active leadership roles and faculty serve as coaches. This way, students also learn communication and negotiation skills. This is an exemplary model for training future professionals."
This is one of the points where I'm a bit skeptical, but it's probably my own personal bias.  I think I learn better by attending a lecture and then learning how to apply it.  I think I'd get a bit lost if there was a lack of structure in the classroom.  However, I know that many people with extensive training in teaching methods do advocate this particular way of learning.  I don't think that attending a lecture means that someone isn't an "active seeker of knowledge", so I do take exception with that comment.  Perhaps more of a blended method would bring the best of both styles into the educational system.
"A strong prior academic record is a good indicator of success in the veterinary curriculum, but it is not necessarily an accurate predictor of career success. To effectively assess students’ life-skills, admission interviews need to be mandatory and include comprehensive evaluation of communication skills, interpersonal behavior, creativity and leadership potential. Merit should be given to applicants with a broad range of experiences, both academic and extramural, and formulated prerequisites should be minimal."
I really agree with this point.  When I was applying for vet school I had to go through an interview, and I have to say that I completely nailed it.  I know that many schools have gotten away from this particular admission requirement, probably because it takes time and is more subjective.  But many people who get into and through vet school have the personality of a wet paper bag and virtually no social skills.  It's a bit harsh to phrase it that way, but I can think of many examples in my own class at vet school.  One in particular was a straight-A student, but nobody liked her and she just didn't seem to know how to handle herself in social situations.  I absolutely agree that veterinary students need to be screened for personality and communication skills, not just academic performance.  No matter how smart someone is, if they don't have good interpersonal skills they won't be very successful in their career.
"There is no reason why six-year, European-style veterinary education could not be successful in North America. One approach would be to admit students to a four-year veterinary program after two years of appropriate undergraduate education....Students benefit from reduced tuition and out-of-pocket costs, smaller debt loads, and opportunities to earn income two years earlier."
I'm a big believer in job training, no matter what the job someone wants.  As much as I value my education, I think there has become too much emphasis on a college degree as a measure of competency, when it really doesn't say much about a person's chances for career success.  I've seen too many academics in veterinary medicine insist on the importance of scientific training and development of students, seemingly over basic job performance skills.  Medicine absolutely involves science, and any doctor needs to be able to understand the scientific process, critically analyze studies, and be aware of advancements in the field.  But understanding all of this is different than being a scientist.  Let's be perfectly honest.  Some veterinary students will go into academia and research, but the vast majority just want to work as a doctor.  Most vet students want career training, not scientific training.  They want to be good at practical medicine, not learn how to conduct the latest research.  Personally I see nothing wrong with that!  By de-emphasizing the need for a 3-4 year degree before even getting into vet school we go to a more streamlined system that will help significantly decrease the debt load of new vets.  Considering that this debt is one of the single biggest crises in the veterinary field today, this could be a good solution to the problem.  It works well in many European schools, and I see no reason why it wouldn't work in the US.  The only people I see opposing this are those entrenched in the academic "ivory towers", most of whom have no idea what the real world of veterinary medicine is like.
"Biomedical faculty’s job is to help create competent future veterinarians, not biomedical scientists......Some medical schools have introduced a “clinical immersion” approach, which teaches basic medical science through the solving of clinical problems—for example, one learns practical anatomy and physiology from a patient, not a book."
The first sentence goes back to what I was talking about above.  We need to be turning out great vets, not necessarilly great scientists.  There is a big difference between the two.  Practical teaching is a great way to make book learning stick.  Now, we already do this to a degree during school.  When I was in first year anatomy class we would have cadavers from which we learned anatomy, as well as examining live greyhounds and livestock to make the jump from book to reality.  An extension of this idea is becoming more popular in vet schools, especially the newest ones.  These schools are trading typical classrooms for more clinical, hands-on learning.  There is some merit to this direction, though again I don't think a lecture setting should be completely eliminated.
"Perhaps the biggest effect of technology on the veterinary curriculum may be the growth of online coursework. “Education without borders”—any place, any time—is an apt metaphor for 21st-century learning. In medical education, so-called blended learning (which integrates online and onsite teaching) will become more common as it combines the advantages of both. Veterinary students will increasingly enroll online in courses outside their home campus, which will provide education in areas where the college has limited expertise and expand their options for focused electives."
Education is changing because of technology.  Veterinary medicine needs to follow it.  In the early 21st century online teaching is much more commonplace, and can allow interaction with specialists and educators that are far from the college campus.  This broadens and enhance the educational process. However, none of this takes the place of face-to-face interaction with instructors.  I've taught at the college level, both in the classroom as well as online.  My online students had more struggles and there was less ability for me to help them one-on-one.  I don't think we should ever get rid of that teacher-student interaction, as it's best for both parties.  However, integrating technology as a way to enhance the process is a great idea.
"Training for clinical competency without imparting a keen understanding of the economic ramifications of that training is weak at best and disastrous at worst. Veterinary students are often the victims of their emotional expectations of a career in veterinary medicine, and this fiscally impaired vision can make them easy prey to financial institutions eager to lend them money. The enormous debt load carried by growing numbers of students is the principal factor keeping them from a satisfactory lifestyle, home ownership and practice ownership."
I've been encouraged to see more veterinary colleges providing financial training and advising to the students.  This is something that wasn't emphasized when I was in school in the late '90s, and I think that has contributed to the financial challenges many vets face.  Too many vets graduate without really understanding their financial situation, and fewer still have the training to manage or own a small business.  Fiscal training is essential to the success of new vets.
Overall I found the points made by the authors to be interesting and refreshing.  But my cynical side doesn't see too many changes happening in the near future.  The problem is we have many entrenched academics who learned the process in the late 20th century, before even the Internet was widespread.  I see many (but not all) of these people being resistant to change.  But if we're going to give the best education and changes to new veterinarians, we need to make some changes in the process.

Wednesday, February 25, 2015

Drop Off One Dog, Pick Up Two

Last week something rather surprising happened at my clinic.  A client had dropped off her dog for routine vaccinations, lab tests, and checkup and had planned on picking her up in the afternoon.  All of that went fine and I called her to let her know that the dog was ready to go home and had no health concerns.  Let's call her Mrs. Saint and her dog Sophie.
The owner came in after work, around 5:00 pm.  At the same time a new client brought in a four month old puppy that they were going to have to get rid of.  They were planning on only doing an exam before trying to find her a new home.  This dog was emaciated!  Her ribs and spine were prominent and she was just skin and bones, so let's call her Twig.  They had had her for two months, and I couldn't believe how skinny she was.
Mrs. Saint was there to pick up Sophie and was standing at the front desk when the skinny dog was being checked in.  Overhearing that they needed a new home and seeing her condition, she immediately offered to take the dog.  The other people jumped at the chance, and right then and there Twig changed families.
We examined Twig, gave her a dewormer and vaccines, and determined that other than being extremely skinny she wasn't in bad health.   She was shy and rather reserved, but she was just going through a complete lifestyle change and didn't even know that she would be spending that night in a new home.
As Mrs. Saint was checking out with Twig we brought Sophie out.  This was the first meeting of the dogs and Sophie took it in stride.  However, I don't think she knew exactly what was going on and probably thought it was just another dog in our lobby.  I wonder what was going through her mind as she got into the car with this strange dog!
I've had clients adopt strays, but I've never had it happen right there in my lobby.  I was extremely impressed and awed by Mrs. Saint, and told her so.  She had my admiration for taking a new dog who was obviously malnourished, all without calling her husband or giving it much thought.  Twig was in a bad situation and needed a new home.  Mrs. Saint just couldn't let that go and will be giving Twig a spectacular home.  She started the morning with one dog and ended the day with two.
Faith in humanity restored!

Sunday, February 22, 2015

Employment Prospects For Veterinarians

In this blog I've often discussed the current rather bleak job outlook for recent veterinary graduates.  Each year new vets are accumulating more debt while the starting salaries have been stagnant or even decreasing.  What hasn't been discussed as much is the employment and underemployment status of the profession.  Prior to recent data I had only seen one study that showed the unemployment rate gradually going up.  But a 2014 study by the American Veterinary Medical Association (AVMA) shows some differences.
The study sent surveys to over 8000 veterinarians and received just under 2000 responses.  The good news is that the current unemployment rate in the profession sits at around 3.4%.  This is far lower than the national unemployment rate (no matter how you measure it), and is encouraging.  This means that finding a job as a vet is much easier than the general populace and comparing to other professions.
However, this one number doesn't tell the entire story.  And this is where it gets a little more complicated.  Of the vets surveyed, 14.5% are "underemployed", indicating that they want to work more hours per week for increased compensation.  Where it gets tricky is that 20% of the respondents say that they want to work fewer hours.  The underemployed group wants to work an average of 12.2 more hours per week, while the other group wants to work 12.7 hours less.  There is also a clear gender bias, with females overwhelmingly wanting to work the lighter schedule and males (especially more recent graduates) wanting to work more.  While the study didn't look at the reasons for the data, I would suspect that women want to eventually have families and balance children with work, which often necessitates less work hours per week.  Since men don't tend to be the primary child caregivers at home, they don't need to work less.
According ot the study here's the other good news...the number of vets who want to work less exceeds those who want to work more.  This means that about 2,000 new veterinarians could be employed to balance the difference.  Good news for those seeking jobs!
All of these statistics are encouraging and show that most vets who want jobs will get one.  But that's a rather broad statement.  It still doesn't do anything about the huge debt load that goes into getting the degree, or the relatively low starting salaries.  It also doesn't guarantee that you'll get the exact job you want.  So even though I think the news from the study is overall very positive, I wouldn't recommend ignoring the debt-to-income ratio and would still be very aware of these issues when considering becoming a vet.

Thursday, February 19, 2015

Rabies Testing--A Gruesome Job

Rabies is a serious, scary disease.  We have done a great job of significantly reducing the number of cases in the US through extensive, legally mandated vaccination programs, but we haven't eliminated it.  Nowadays most vets and virtually every American will go their entire lives without seeing a case or being exposed to it.  That rarity has the potential to breed complacency about the disease and risks.
A couple of weeks ago a young puppy was rushed in for odd neurological signs that had started the night before.  We had just seen him two days prior to that for a routine checkup and vaccinations, and he had been fine at the time.  His history was a bit "sketchy".  The owners had gotten him from someone through a Craig's List add, and the mother had died (the new owner didn't know how or why).  So there were some questions about his background and environment that couldn't be answered.
When he came in it was quickly obvious that he was having some kind of seizure activity.  It wouldn't resolve without IV medications, and even then he had one break-through seizure.  He was salivating heavily, wouldn't swallow, and was having some kind of severe neurological disorder.  The owner said that there was no toxin or medication exposure, so the origin of the seizures was mysterious, especially given the severity.  Due to the costs in stabilizing and treating, as well as the strong possibility of something that might not be treatable, the owner elected euthanasia.
When we're in vet school we are told to treat every neurological case as possible rabies until proven otherwise.  The vast majority of those cases will not be rabies, but we take appropriate precautions just to be safe.  Rabies is an incurable disease that causes severe, permanent brain damage.  Any animal or person who contracts it will in all likelihood die, and if they somehow live they will probably be in a vegetative state.  It is transmitted through bodily fluids, primarilly saliva, and can pentrate through any wound, abrasion, or mucous membrane.  Because of the severity and incurable nature we are very careful about human exposure.  This is also why the vaccine is legally mandated in every state, and why most countries are so careful about importing animals.
The chances of this puppy having rabies were very low, but not impossible.  The symptoms certainly could fit, and the questionable background wouldn't allow us to rule out prior exposure.  Due to the fact that there was human exposure and the owner had children, I made the decision to be absolutely certain and have the puppy tested for rabies.
Unforunately there is only one way to definitively test for it.  Brain tissue needs to be examined for the virus.  So there is no way to confirm or rule out rabies in a living animal.  We have to get to the brain.
This is one of the worst jobs I've had to do, and I've had to do it several times over my career.  Laboratories won't accept an entire corpse, so we have to submit only the head.  This means that we have to cut off the head.  Putting it bluntly, we have to decapitate the animal.  I can't think of a more gruesome procedure, and when I've had to do it I'm typically more subdued than normal.  I can perform a necropsy without problem and while still cracking jokes, finding the appearance of the internal organs interesting as I search for causes of disease and death.  But there is something psychologically different about having to separare the head from the body, and I try not to look at the animal's face or think too much about what I'm doing.  It's absolutely necessary to do, as part of our oath as veterinarians is to protect the public health, so I can't ignore the risks of disease transmission to families, my staff, or myself.
Thankfully the test came back negative.  We still don't know what caused the problems, but we do know that it wasn't something as serious as rabies.

Monday, February 16, 2015

Would You Eat Dog Or Cat?

My staff and I engaged in an interesting discussion recently.  Would one of us eat dog or cat meat?  Most people said no.  I said yes.
This may seem very surprising to many people.  How could I as a small animal veterinarian bring myself to eat the very patients that I treat?  Isn't that unethical and inhumane?  Let me take some time to explain my thoughts on this matter.
I'm not a vegetarian.  Not even close.  I've often joked that I'm a strict carnivore.  To be truthful, I don't eat as many veggies and fruits as I should.  I really do love the taste of most meats, and think they're perfectly fine to eat.  I simply couldn't survive as a vegetarian because I don't like the taste of most vegetables.  Yes, I know there are numerous health benefits to eating more of these foods and I'm not on a balanced diet without them.  But I've learned to live with this and make the best and healthiest choices I can given my taste preferences.
What meats someone eats and doesn't eat is completely cultural.  I don't think there is anything inherently immoral about eating any kind of animal meat, no matter what the species (other than humans, of course).  The shock or revulsion only comes when it goes against cultural norms, and that differs greatly from one culture to another.  What is repugnant to one culture is normal to another. 
There are numerous examples we can use.  Pig meat is not allowed by Jews and Muslims, yet ham, pork chops, and bacon are well received by most of western society.  Many Americans have tried to outlaw export of horses if they are used as meat sources, yet horse is considered a delicacy in Europe.  Hindus would never eat cattle, yet hamburgers and steaks are incredibly common in America, where you can find just about any fast food joint serving some kind of beef.  In much of South America guinea pigs are routinely eaten and there are even festivals around this practice, yet they are considered pets in America.  I know someone who raises rabbits as a family meat source, yet that doesn't bother me as someone with four pet rabbits.  Even within a country there are differences, such as pickled pigs' feet being eaten in the southern states of the US, while much of the rest of the country would whole-heartedly reject this food.  In my life I have eaten chicken, turkey, duck, beef, pork, lamb, ostrich, bison, snail, squid, rattlesnake, frog, aligator, shrimp, lobster, clam, and several kinds of fish.  If I took that list around the world I'd easily find countries where at least one of the ingredients was against the local culture and custom.
So that brings us back to dog and cat.  No, I could never cook up and eat one of my patients or one of my own pets.  There is an emotional bond in these cases and it would be like eating a family member.  But that bond isn't unique to what we in Western culture consider pets.  I've seen people have the same kind of attachment to pigs, cows, horses, chickens, ducks, and just about every other animal.  If an animal was someone's pet and I knew that, I don't think I could eat it under normal circumstances (other than during a zombie apocalypse, and then all bets are off).
That then begs the question "What is the difference between a 'pet' and an 'animal'?"  To me, a pet is an animal that someone keeps for purely emotional reasons and with whom they have an emotional bond to that particular individual (as opposed to the species).  So all pets are animals, but not all animals are pets.  And as far as I'm concerned, any non-pet animal is fair game for the food table.
Also, being a vet really doesn't play into the situation.  All animals used in food production are supervised at some point by a veterinarian.  In fact, some vets spend their entire careers working with poultry, swine, beef cattle, and so on.  Those vets don't have an issue with eating a sausage biscuit before going to the hog pens or coming home from work to some fresh fried chicken.  We know that these animals are being used purely for food, and that they exist for no other purpose.  Our job is to make sure they are healthy and treated as humanely as possible until they are killed and turned into food products.  It's really easy for most of us to realize that this is a living creature that one day will sit in someone's stomach.  I know that may sound very harsh, but I'm practical and a realist.  This should only come as a surprise to anyone who really hasn't thought through how meat ends up in the grocery stores.
If I was in a foreign country and my host offered a dish of dog or cat meat, I would consider eating it.  I'd think about it a lot more than if it was a meat I had eaten in the past, but I wouldn't inherently turn my nose up at it.

Friday, February 13, 2015

Don't Let Them Urinate!

Here's a big pet peeve that vets have.  A dog is scheduled for an appointment for abnormal urinating.  When the client brings the dog in they let them urinate in the parking area before bringing the pet inside for its appoitnment.  Then when we try to collect a sample for analysis the dog is empty and can't provide one.
To me it seems like common sense that if your pet is having difficulties urinating or the urine looks abnormal that the vet will want to perform a urinalysis to see if there is an infection, bladder stones, or other problems.  If your dog is allowed to urinate just before being seen, then there isn't any urine to analyze.  Maybe that's just me and it's not so obvious to most people. 
Many things can cause a change in frequency of urinating, urine apperance, and other abnormal bathroom habits.  While we may have some suspicions based on an exam, there is no way to tell for certain without performing tests on the urine.  We can identify infections, suspect diabetes, analyze part of kidney functions, and get a hint about bladder stones with a simple urinalysis.  In fact, we're usually hesitant to prescribe antibiotics for frequent urinating because we've all see cases where it's due to something other than an infection.
And if we can't get urine, we can't run these tests.  This may mean keeping the dog in the clinic for several hours to allow them to build up more urine, or even getting it in the next day.  Sometimes the only option is to have the owner collect a fresh urine sample and drop it off.  In any of these cases it can be frustrating to the owner because we can't make an immediate diagnosis and start treatment.
If you're a pet owner and your dog or cat is scheduled to see the vet for urinary problems, please do yourself and the doctor a favor.  Do everything you can to keep your pet from urinating for at least several hours before the appointment.