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Friday, May 22, 2015

Canine Influenza....Don't Panic!



Recently there has been a lot in the news about outbreaks of canine influenza.  So I thought I'd take the time to give my perspective on this disease, and try to caution dog owners not to freak out.

Back in 2004 there was an outbreak of canine influenza.  A vaccine was manufactured and has been available for several years.  However, it hasn't seen wide-spread use because the disease had appeared in isolated pockets and was not even seen in every state.  I live near Atlanta, Georgia, and have carried the vaccine only because a couple of local boarding facilities required it, not because we were worried about dogs contracting the disease.

Two months ago (March 2015) there was a large outbreak of canine influenza in Chicago.  The virus spread and so far has infected over 1000 dogs.  Analysis of the virus revealed an important difference.  For those who don't know, flu viruses have different strains, which is what makes the human flu vaccine less effective in some years than others.  The previously documented canine flu was a strain called H3N8.  The outbreak in Chicago was shown to be H3N2.  While the symptoms and progression are pretty much the same, tracking the and preventing the virus is different with each strain.  The H3N2 strain is believed to come from Asia, especially China and South Korea, and is not native to the US.  

Currently this is a rapidly developing situation.  Dogs have been identified in several states besides Illinois, including Indiana, Wisconsin, Iowa, Texas, and now Georgia.  This development has reached my local news outlets because it's the first time a dog has ever been confirmed to have any kind of influenza in Georgia.  And we found out two days ago (May 20th) that it's the H3N2 strain, as is the case in the other states.  It's obvious that the virus is spreading around the country.

Now I realize that sounds scary.  And if you watch TV or read the news, it is being reported as a "deadly disease", resulting in many frightened dog owners.  My clinic has been getting calls every day since the news broke last week, and I've spoken to several clients about the disorder.  Here's my simple response to people when they ask about canine flu.



One of the biggest beefs I have with the media is the constant mention of it as a "deadly" disease.  While on the surface that is true, it doesn't give the whole picture.  Of the over 1000 dogs who have been infected, only a handful have died, and the number totals to about 1% or less of those infected.  This means that 99% of dogs who develop flu will survive and be fine!  I bet you haven't seen that in the news.

So what exactly is canine flu?  Really, it's pretty much like flu in humans.  The dogs will develop respiratory signs such as coughing, will be lethargic, and will have a fever.  Since it's a virus it won't respond to antibiotics.  Tests are available but have to be sent out to a diagnostic lab and can't be confirmed in the vet's office.  Right now we are more aware of the virus and therefore are more likely to want to test for it, even though most dogs won't have it.

Do you panic about getting influenza? Most likely you don't.  We know about the vaccine in humans, but many people never receive it.  Honestly, I don't get it.  If a person gets flu, it makes us feel rotten for several days, but we are rarely hospitalized for it.  Most of the time we take antiviral medications for a couple of days, stay home, rest, and drink fluids.  It's inconvenient and makes us miserable, but in most cases it doesn't kill us.

Can influenza kill?  Absolutely!  Many millions of people have died from influenza virus over the course of human history.  Even with modern medical practices people can die.  But those who develop fatal disease are most commonly the very young, the very old, or those with a compromised immune system.  

The same is true in dogs.  Your average dog who becomes infected will indeed be very sick, but will survive.  Young, old, or weak dogs could possibly die.  But when the mortality rate is less than 10% and probably closer to less than 1%, I'd hardly consider that a "deadly disease" as the media seems to want to make it out to be.

So what about the vaccine?  That's where the strain differences come up.  The current vaccine protects pretty well against H3N8.  We honestly don't know if it gives any protection against H3N2, and from what I've read the general option among immunologists is that it probably gives no protection.  That means that even if your dog receives a flu vaccine it could still become infected with this new strain.  So I wouldn't recommend running to your vet today to demand the immunization.  It probably won't help!  I have read that researchers are rapidly working on a vaccine for the H3N2 strain, but it's not coming out any time soon.

What can you do to protect your dog?  Like with human influenza the canine version requires direct or close contact in order to be transmitted.  Dogs who board, go to dog  parks, get groomed, and are in shelters are at the highest risk.  But that's just like saying that humans who interact with the public are at a higher risk.  I certainly interact with the public every day of my job, and see around 100 people per week, not including outside of work.  In 18 years of being a vet I've had influenza once, and I've only bothered getting the vaccine a couple of times.  In general I wouldn't say that pet owners should stop taking their dogs to the groomers or the park.

The last thing to keep in mind is that this is a very quickly changing situation.  We have known about canine flu in Georgia for exactly a week.  So far it's only one case, but over the next few weeks that could rapidly change into many more.  It's also possible that we could end up seeing cases in Atlanta that equal or surpass what has been seen in Chicago.  And just because the virus has been identified in less than 10 states doesn't mean that it won't hit the other 40.

For those of you who like bullet points, here are some take-aways....
  • Canine influenza makes dogs sick but rarely leads to death.
  • It has been positively identified in only a few states.
  • In Georgia only one case has been identified so far.
  • There are two strains, H3N8 and H3N2.
  • There is a vaccine for H3N8 but not for H3N2, and the vaccine probably doesn't protect against the latter.
  • Dogs who are frequently around other dogs are at highest risk.
  • Don't listen to the media!  They're making it sound worse than it is.
If you have questions about this disease, call your vet's office.  The situation is being closely watched by the veterinary profession, so most vets should be familiar with what's going on in their local area and state, and what precautions dog owners may need to take.



***Bonus points to the geeks and sci-fi fans who recognize the image above!

Wednesday, May 20, 2015

Television Vets

Monica sent this to me, and it's something that I haven't addressed in several years (I did talk about it in relation to Dr. Pol back in 2012).  The TV landscape has changed a bit since then so I think it's a great time to revisit the topic.

I thought this would be an interesting topic to get your opinion - what do you think of the TV vet shows? Are they realistic? Unrealistic? TV vet shows such as The Incredible Dr. Pol, the Australian TV show Bondi Vet, and the recently aired series on NatGeoWild Aloha Vet are all shows I have watched. I've been watching them to learn more about the veterinary career and get more insights. I actually really like them! They're really interesting and I have learned a lot from them. My favorite one is the new show Aloha Vet following Dr. Scott Sims in Hawaii. Have you seen any of these shows or other TV vet shows? Do you think they accurately portray what a vet does and how they work? I read an article once about Dr. Pol saying that his methods are actually inhumane and that some of the procedures he did, he did them incorrectly. I thought you would give a very insightful answer to this, as I know many TV shows inaccurately portray professions and the lives of people, as most media does. I also thought it would be a question many other people would be interested in as well, as TV vet shows are becoming more popular.

I honestly don't typically watch veterinary shows at home because once I've left the clinic I don't want to think about work.  I want to focus on not being a vet, and if I watched these shows I'd be comparing them to what I do and expect.  That being said, I'm familiar with several of them based on what has been discussed in the veterinary community as a whole.

From everything that I've seen, Dr. Pol is NOT a good vet.  He's had more than one complaint and the state veterinary board has fined him and found him in violation of medical standards.  I don't know of a single vet who thinks he practices appropriately.  If he comes up in discussions with other vets it is never in a positive way.  Some of my staff have watched the show and they have been appalled at the lack of basic care and medical quality.  Yes, he seems to be a very nice, very genuine man who cares about his clients and patients.  The problem is not only his sub-standard care, but the fact that with his great popularity this are many people that see him as how all vets should be.  I can promise you that the vast majority of vets out there don't practice as he does, and for very good reasons.  Unfortunately the average viewer will walk into their own vet potentially expecting the same costs, practice, etc.  When we offer what is real medical quality, they think that we're trying to overcharge them.

So why is he still on the air?  Ratings, pure and simple.  This is the highest rated show the National Geographic Channel has ever had, and they stand behind him because he brings money to their channel.  It doesn't matter to the heads of the channel that he's had more than one state board judgement against him or that the veterinary community universally denounces how he practices.  All they care about is that they get the viewers and advertising dollars.  In my opinion, which is shared by numerous vets, the show needs to be pulled from the air immediately.  National Geographic Channel is being greedy and not caring about the impression they are giving about veterinary medicine. 

I've heard less about Aloha Vet, but what I've seen from other veterinarians is that he also doesn't practice great quality.  However, it's not as bad as Dr. Pol, and he admittedly is trying to do things in very rough conditions where his options are limited.  I believe that the appeal of his show is the tropical setting and the unique circumstances of his job.  I absolutely would not consider him an example of what vets do for a living.

The one show that I've seen that did portray our jobs accurately was Emergency Vets and its spin-off, E-Vet Interns.  The first show ran from 1998-2002 on Animal Planet, and the spin-off went from 2007-2008.  The show focused on Alameda East Veterinary Hospital in Denver, Colorado, and accurately showed a quality emergency practice.  I'm sure the show's producers picked and edited scenes and cases to be the most entertaining, but I never saw anything "bad" on the show.  One of the primary vets, Dr. Kevin Fitzgerald, is well respected in the profession and has taught at the University of Colorado, authored chapters in text books, and lectured at veternary conferences.  He is a good example of what a veterinarian can do and be.  Though the show hasn't aired in many years, I'm sure you can find full or partial epsidoes online, especially YouTube.

Everyone watching shows about ANY profession needs to remember that TV producers are typically more interested in entertainment than education.  They make their money by producing shows that will allow them to sell advertising.  All reality shows are heavily edited, and there have been many articles about how scenes are sometimes staged and rehearsed.  While some parts of the shows may be accurate, nobody should expect everyone in the profession to be the same way.  For veterinary shows, I would recommend asking your personal vet if they've seen it and what they think.  But in general take anything you see on TV with a grain of salt.

Monday, May 18, 2015

Veterinary Medicine: A Poor Return On Investment

I know I seem like a downer on my profession at times.  And it may seem like I'm discouraging people from becoming a vet.  In some ways I probably am.  But my real intent is to make sure that people are going into vet school fully aware of the challenges they face in the future.  It's one thing to say "yeah, I know I won't get paid much but I love what I do."  It's another thing to struggle to pay bills because your loan payments are so high that they eat up most of your paycheck.
 
Here's some data from a study recently published (February 2015) in the Journal of the American Veterinary Medical Association.  I apologize for the poor quality of the image, but it's pretty revealing.


Since it's a bit fuzzy, I'll summarize the findings.  These numbers are for students who entered veterinary college in 2014.  The most interesting numbers to me are the Return On Investment (ROI) and the breakeven age. 
 
For the ROI, imagine it as if you took the money you spent on vet school and invested it.  If your ROI is positive, you made money and came out better.  If it's negative, you lost money and it was a poor investment.  For all students combined it's kind of a wash (-0.4% for females, +0.45 for males).  Working in the large animal field is consistently a negative ROI, while working in industry and acedemia is consistently positive.
 
The breakeven age is the age at which you've finally paid for all of the time and investment in education and early practice, esssentially breaking even.  If you look at the numbers you can see that as a whole you're not going to break even as a vet until you are close to retirement age.
 
If you look only at the numbers, becoming a vet is a pretty poor choice.  You could make a higher salary and invest less time and money in numerous other professions.  Most vets are going to spend their entire lives and careers simply trying to keep their heads above water.
 
So why do it?  If all of this news is so bleak, why bother?
 
For some people, it may not be worth it.  You'd make more money by taking the average $150,000 debt load and invest it in the stock market.  But for many of us it goes beyond that.  We simply love animals and love the bond people have with them.  Much of our "pay" comes from the things that don't bring in more salary or generate revenue.  Puppy kisses, cat purrs, and grateful clients are a large part of our reward.  If that's enough for you and you can live with a lifetime of financial struggle, then you might consider becoming a vet.

Friday, May 15, 2015

Mental Illness In Veterinary Medicine

Being a vet is hard.  We are faced with numerous mental and psychological challenges every day.  Practice managers and owners have the stresses of the business as well as medical management of cases.  With everything we go through in our careers it probably shouldn't be a surprise that vets are more likely to have clinical depression and be suicidal than the general population.
 
This topic has been discussed more frequently in veterinary circles since the suicide of animal behaviorist Dr. Sophia Yin in September, 2014.  We as a profession are realizing that this is a serious problem and which we should all be aware.  Those of us who have suffered from some kind of psychological problems can be comforted in the fact that we're not alone, and that there are resources for help in overcoming these challenges.
 
The study was released February 13th and was conducted by the CDC in conjunction with several veterinary partners.  It surveyed 10,254 veterinarians across the US using the Kessler-6 psychological distress scale, which screens for serious mental illness.  Here are some of the key findings.
  • 6.8% of male veterinarians and 10.9% of female vets had serious psychological distress.  That compares with the US population as a whole of 3.5% males and 4.4% females.  Veterinarians are about twice as likely to have psychological illness as an average American.
  • 24.5% of male vets and 36.7% of females experienced episodes of clinical depression after graduation.  The lifetime prevalence among Americans is 15.1% for males and 22.9% for females.
  • 14.4% of males vets and 19.1% of female vets reported suicidal thoughts.  The rates in the general population are 5.1% and 7.1% respectively.
  • 1.1% of male vets and 1.4% of female vets had actually attempted suicide.  This is actually lower than the US population, but for a potentially tragic reason.  Because veterinarians have such easy access to drugs they are more likely to be successful in suicide attempts than the average person, meaning that there would be fewer people alive to respond to the survey.
  • The three primary sources of stress reported were practice management responsibilities, professional mistakes and client complaints, and the general demands of veterinary practice.
The American Veterinary Medical Association is beginning to take a serious look at mental illness in the profession, and will address it at the annual convention in July.  The Association of American Veterinary Medical Colleges will host its third Health and Wellness Summit this coming November, focusing on veterinary students and recent graduates.  In Great Britain the Rocal College of Veterinary Surgeons agreed to spend 1 million pounds (about $1.5 million) on this topic.

I am so very glad that psychological illness is being treated seriously in the veterinary profession, especially considering how much higher the rates are among us compared to the general population.  I can personally attest to the stresses of the profession, and if I had received the survey I would have been included in several of those statistics above.  Looking back I've always had a tendency for depression and mood swings, which reached a peak in veterinary school.  I've had suicidal thoughts over the years and have been on antidepressants for more than a decade.  I'm definitely a poster-child for the issues currently being discussed.  I understand these problems on a very personal level.

Thankfully my issues have rarely been severe, and I've been well managed for years through a combination of medication, prayer, and therapists/psychologists/psychiatrists.  I still have periods of becoming depressed but they are not as bad as what I've faced in the past.  And you know those three stressors mentioned in the study?  Yep, those are the reasons I still have episodes.  I get depressed over cases, especially if a client complains or the case doesn't go well.  I get depressed about the long hours and hard daily grind.  And I get depressed when business isn't meeting expecations. 

So what do we do?  I'm glad that there is a growing awareness and that veterinary organizations in several countries are working to investigate and address mental illness.  I'm eager to see what comes out of these seminars and studies, and hope that it will help many of my colleagues who may not have been as successful in managing the illness as have I.  But it really boils down to friends and family intervening with the vet, and the vet themselves being aware of the problem and seeking help.  There has often been a stigma placed on mental illness, as if we who have it are somehow "bad" or screwed up.  It took me a long time to come to terms with my own illness and be comfortable talking about it.  I'm glad that I had a lot of support from my wife and faith to help me seek the help I needed. 

If you're reading this and you are a vet or know a vet who suffers from mental illness, be encouraged.  Help is out there and you don't have to do it alone.  Many of us (heck, a whole third of the profession) have similar problems.  Here are a couple of quick resources.

Resources through the AVMA

National Suicide Prevention Lifeline:  800-273-TALK (8255)


 

Tuesday, May 12, 2015

Does Being A Vet Tech Shorten Veterinary School?

Here's a question from a reader that ties to Emily's questions from a few days ago.
 
Hello my name is Nicole and I'm currently trying to decide whether I want to go to Vet Technician school or straight into Veterinarian school. My main question is if I were to go to Veterinary Technician school would this take years off if I wanted to later on go to Veterinary School?
 
If you haven't already, go back and read my response to Emily from earlier this week, as it may help in your decision.  I've also answered similar questions over the years, so searching keywords in this blog may give you more information.
 
The simple answer is, no being a veterinary technician does not reduce the amount of time you spend in veterinary school.  At least that's true in the US, and I can assume in most other countries (I only know the US system).  One of my classmates was a technician before she entered vet school, and she did the same program as the rest of us.  The education and subjects are indeed very similar, so having gone through tech school may make vet school easier since you've learned much of it.  However, vets go into much more detail, especially on diagnosing and treating cases, so it's not a completely comparable education.  If you wanted to do both, you'd spend 2-3 years becoming a technician, then another four in vet school. 
 
Having first worked as a tech may help your chances of being accepted into vet school, as this kind of experience and training is certainly something the admissions department considers and values.  You may also find that even though the pay is less, so is the debt and the pressure.  This is often a better option for some people, and one in which they find significant personal satisfaction.
 
 

Sunday, May 10, 2015

Lacking Passion For School And Science

Here's an email from Emily.....
 
I am currently a sophmore at Western Michigan University studying Biology and am running into a rough patch during undergrad. All of my life I have loved animals and have thought I have wanted to be a Vet. I even have job shaddowed my local small animal veterinarian and loved every minute of it so I thought this will be the perfect job for me, but now I am doubting my choice.
I was always good in school during high school and got a 3.84 GPA at the end of it and I enjoyed my science classes. Then I started college, my first semester I did great! All A's and B's, then came second semester taking General Chemistry and Molecular and Cellular Biology, I studied hard and ended up getting two DC's on my transcript and retook them the next semester and got B's in both subjects. This brought my GPA down to 3.04. Anyways I am just about to finish my sophomore year of college and am starting to question my choice in pursuing a veterinary career. I love animals, but I feel like my passion for science and school work is definitley not what it used to be. I find it very interesting but I am not good at it and also adding another four years to my college career seems frightening and I have read blogs about people's live in vet school and it doesn't get any easier. I am thinking of becoming a Vet Tech, but my parents discourage me saying that I am smarter and should try to pursue my original dreams of becoming a Vet. How do you think I can decide between the two careers, Vet tech seems like the easier way out, but still rewarding, just less money. But Vets don't make that much considering the amount of money they put in for their education. I am in a pickle, I just don't know if I have the passion for school to succeed in vet school.
 
First, I'd suggest doing some keyword searches on this blog, as over the years I've talked a lot about the pros and cons of a veterinary career and whether or not it is worth it.  You'll find similar questions to yours and various answers that I've provided.
 
Simply put, if you don't have a strong passion for being a vet, don't do it.  Going through vet school was the hardest and most challenging thing I've done in my life, and that includes having studied for and received a Master's Degree just before that.  Vet school is actually more grueling than human medical school because you have to know so many different kinds of anatomy and physiology.  For four years you'll have little to no personal life and won't have time to hold down more than a part-time job.  Once you graduate you can expect long, hard hours and make a fraction of what you really should make.  Current average debt load coming out of vet school is around $160,000, yet average starting salary is around $60,000.  A recent study showed that the return on investment (ROI) for veterinary school is so bad that an average vet will be 65 years old before they break even for the amount of money and time they put into their education.
 
So with a bleak picture like that, how do we do what we do?
 
Passion.  Passion for pets, passion for medicine, and passion for the people who have pets. 
 
This is not an easy job, and it can be a struggle for newly graduated vets to make a living nowadays.  But it can still be very rewarding, which is why people continue to do so.  My rewards are not from my salary, though I'm paid decently.  I keep doing this because I get to make a difference in the lives of people and pets, I get to teach and train my staff, and I simply find medicine and surgery to be fascinating.
 
Stop and think for a few minutes.  What is it about veterinary medicine that excites you?  Are you comfortable with the idea of doing surgery every day on pets?  Do you think how a body works is really cool?  Do you want to interact with people and teach them how to be better pet owners?  Can you handle when cases don't go right or when a client refuses needed care?  Are you prepared to work you tail off to make a comparably small amount of money? 
 
There is nothing wrong with changing your mind about your career.  You have to have a huge desire and passion for science and school in order to survive a veterinary education.  No, we really don't like all of the study, but it's a necessary evil and you need to see this as a true calling rather than simply a job.  Because you have to look back on it after graduating and being in practice and ask "was it worth it?"
 
Becoming a veterinary technician is not a second choice!  It doesn't mean that you aren't smart enough to be a vet!  I have known many techs who have just as much intelligence as the veterinarian for whom they work.  Becoming a vet doesn't mean that you're "smarter" than a tech.  Many people chose to be a tech as their first choice, and are happy in that career.
 
Do some soul-searching, Emily.  If becoming a vet seems like more work and hassle than you are willing to do, then it's not going to be a career in which you are happy.  Besides....you can become a technician and still go on to vet school later if you decide that you really do want to be a doctor.
 
That actually brings up a related question by a reader, which I'll post in a few days.

Thursday, May 7, 2015

Wild Poop And Pond Water

This is a question I received from Crystal....
 
A recent question from another reader regarding horse poop is somewhat similar to my question. We have a variety of wildlife that come through our yard. Our puppy has sniffed out wild turkey and wild rabbit poop and it is in her mouth before we can get her away from it. We are trying to teach her to leave it but so far have not been succesful. We are concerned about what she might pick from eating these nasty treats.
We also have a koi pond that she likes to drink from. We are providing clean water in a dish outside for her but drinking from the pond is more fun.
Should we be concerned about either of these?
 
In either case you can have a risk of bacterial contamination, leading to digestive upset.  The koi pond may not be as much of an issue if you have good filters, but then you have to worry about any chemicals that are placed in it.  However, if it's safe for fish to live in there probably isn't a big risk for a dog.
 
A bigger concern with the wild animal feces would be parasites, especially from mammals like rabbits.  Several intestinal parasites (worms and single-celled organisms) have rodents as intermediate hosts and eating the feces could transfer those parasites to your dog.
 
Unfortunately there is little you can do to prevent your dog from eating these "treats", since it's so common around you and she is so fast.  I would recommend training her to a "leave it" command so that you can stop her with verbal orders.  Any good trainer can help you with this kind of training.  You should also make sure to have her feces checked by your vet twice annually to screen for parasites.  Keeping her on heartworm prevention should help prevent against a few intestinal parasites (especially roundworms and hookworms) but there is no preventative that will cover absolutely everything.