Never Too Late To Be A Vet

Karen asks this question, and I actually need some help from my readers...

I have a non medical related question. I am 34 years old and I wish to study veterinary medicine. I was unable to study directly after school due to family issues and not having science from school.

I have just completed a one year BTEC First Diploma in Equine Nursing (level 2) and I now wish to apply to vet school. Would this be sufficient for entry requirements or should I continue with the BTEC on the advanced level, which will be the BTEC National Certificate in Equine Nursing (level 3).

Or I could go back to school and complete science and re-do maths as a refresher. I really don’t know which route to take and I am now at a point in my life where I am able to take 6 years out and study.

Am I too old to want to do this? What else could I do and complete in order to better my chances at getting in? I will be applying to the University of Pretoria in South Africa and they select by academics and not work experience and the like.

Any advice?

First, I'm only familiar with the requirements in US veterinary schools, so I can't speak to any requirements in other countries.  Heck, I don't even know what a BTEC is!  However, I know I have readers on every continent except Antarctica, so I'll be surprised if someone else can't give you the answers you want about these specific issues, Karen.   Anyone who can help, please post a comment with suggestions or answers.

However, I do want to respond to the issue of age.  I believe that it's not too late to follow your dreams.  When I was in vet school there were at least 10 people in a class of 72 who were over 30 when they began.  I knew a vet who had a career in publishing (he was editor of a nursing journal) before he started vet school around 40 years old.  Now he works for a large corporate practice in the US, managing a few dozen veterinary practices in the midwest. If you have the drive and desire, 34 is not too old!  Go for it!

Staying Sane In Vet School

Here's a great question sent in from Jaime...


I have just been accepted for an undergraduate Veterinary Science course in Australia. I was just wondering what your advise would be to keep vet school student sane during their studies.


I have often said that it's a good thing they don't require psychological evaluations to enter vet school, as we would likely find that the majority of veterinary students are actually quite insane.  You pretty much have to be to spend that much time in school and work as hard as we do for the comparatively small salaries we make.  Now, I say all of this tongue-in-cheek, but there is probably a grain of truth to it.

My four years in veterinary school are the hardest, most stressful time in my entire life, before or after.  Nothing compares to those hardships, including work stresses, having kids, or achieving my Master's degree.  Veterinary students spend an almost impossible amount of time studying.  You're in classes and labs from around 8:00 AM until at least 4-5 PM.  Then you can expect to spend another 3-5 hours in the evening studying.  When you have a major exam, especially an anatomy practical, you may literally spend all night trying to cram the material in your head.  The amount of dedication required makes it hard to have much of a personal life and makes it pretty much impossible to have anything other than a very part-time job.  The courses are incredibly hard, and you have to learn all kinds of nuanced details about the anatomy, physiology, diseases, disorders, pharmacology, and toxicology of most non-human species.

So how do you stay sane during all of this?  It's not always easy.  Here are some suggestions.

1.  Take a little time every day to decompress.  That will differ between people, and may include talking to a friend, playing a video game, listening to music, taking a nap, and so on.  You sometimes have to force yourself to take this time, but it's well worth it.  Find something that takes you away from the rest of life and do a little of that each day.
2.  Get together with non-veterinary friends.  Spend time each week away from the studies and the field, reminding yourself that there is more to life than being a vet.  Being a vet is what you do, not who you are, and you need to keep grounded in reality.
3.  Get together with fellow students and spend time comparing notes about how horrible Dr. So-and-so is or how impossible it seems to have to learn the entire canine musculoskeletal system in a few weeks.  Sharing the misery makes you realize that you're not the only one going through all of this.
4.  Enjoy your breaks.  You'll get time off from studies throughout the year.  Do whatever you can to make the most of these times.
5.  Remember that the person with the lowest Grade Point Average in the graduating class is still called "doctor".  Once you get out of school no employer will care what your grades were like! Do the absolute best you can, but realize that after several years in practice there isn't much difference between the A students and the C students.  Practice and real life are the great equalizers.  So if you get a few bad grades, don't freak out about it (which you will likely do, as it's only the A students that can get into vet school, so it can be a hard lesson to rack up lower grades).
6. Laugh, especially when you want to cry.
7.  Remind yourself why you want to do this.  Find some sweet animal (dog, cat, horse, snake....pick your preference) and spend time just enjoying being with them.  Resist the temptation to practice your palpation and exam skills!!!!

Good luck, Jaime!

A Veterinarian's Reponsibility

Let's say that I'm presented with a very sick dog that needs extensive lab tests and hospitalization.  However, the client has just been laid off and will have difficulty affording the needed tests and treatment.  In a situation like that, do I focus on the needs of the pet, or do I try to protect the client's pocketbook?

This is a common situation that all vets are faced with.  It can create problems as the clients argue that they don't have the money and we argue that the pet really needs these services.  Since we can't force the client to do what we recommend, the pet may end up going without the care it should have.  Yes, there are subtleties in many of these situations, and you can't pigeon-hole all of them.  But in the end the dilemma is who should the veterinarian look out for most:  the pet, the client, or themselves.

Which brings up my latest poll.  I asked "What do you think is a veterinarian's primary responsibility."  Here are the results.
Look out for the best interests of the pet: 92% (53 votes)
Look out for the best interests of the client:  5% (3 votes)
Look out for their own best interests:  1% (1 vote)

Personally I would fall into the category of looking out for the pet.  Unfortunately sometimes the pet's best interests are in conflict with the client's, which causes problems when the client can't do what is really needed.  And in those situations veterinarians have to keep in mind what is really best for those pets.  This may mean that a pet needs to have certain diagnostic tests before starting treatment, even if the client doesn't want to do it.  It may mean that the best antibiotic for the pet isn't the cheapest.  It may mean that the pet needs chronic medications, or a complex surgery.

Now before someone says "well, if you're looking out for the interests of the pet, then you should just do the treatment and reduce the cost," let me remind you that veterinarians have a business to run.  They have families to support.  And they make a fraction of what most people think they do.  If vets are continually discounting or giving away services, they will go out of business, not be able to support their families, and pet owners won't have options for treatment.  Also, in the majority of the cases the vet knows better than the client what is really medically necessary (yes, again there are those out there who can bring up examples otherwise....we've already gone through that discussion and it's pretty clear that it's the minority of situations).

It's pretty clear that the vast majority of people think that a vet's responsibility is to the pet, not to the client.

Bob Beats The Odds

Last year I started seeing a hamster named Bob.  He presented to me with several abscesses under the skin, some pretty large.  I talked to the owner and he agreed to let me try and surgically remove them.  Now, this is a little hamster, about 37g, so any surgical procedure carries more than an average risk.  But this little guy (the nicest hamster I've ever seen) did great.  Unfortunately, some of the abscesses were very deep and had spread between some of the muscles and bones.  I told the owner that I couldn't remove all of them and he had a guarded long-term prognosis.  We started antibiotics post-operatively and hoped for the best, though I warned the owner that we might have to euthanize him soon if he didn't improve.

That was almost a year ago.  Bob has been back to see me several times, each time for a return of his abscesses.  We haven't done more surgery, but I drain them as best as I can, put him on antibiotics, and caution the owner that his prognosis is guarded.  Today he came in again for a new, large abscess, and we went through the same procedure.  Throughout it all, Bob has been a little trooper, handling the procedures well and continuing to be extremely well behaved.  And despite my continued warnings, he is still doing pretty good.

Bob has taught me a couple of things.  First, it reinforced my belief that a pet's monetary value has little to do with the emotional bond people have.  This owner has spent close to $400 in the last year for various visits, medications, and procedures; buying a new hamster would cost less than $10.  His owner loves him very much.  The second lesson is that we doctors don't have all of the answers (not that I needed too much reminding of that), and some pets simply defy the odds. 

Bob is now 1 1/2 years old, which is geriatric for a hamster (most live to be around 2).  I'm not sure how much longer he has, especially with a new abscess that I couldn't completely drain.  But I'm not giving up on him, and continue to be amazed by this little guy.

A Client's Bad Decision

Today I had a client who really frustrated me.  And this was a situation that I really haven't been faced with before, making it even more difficult to handle.

The client has a deaf boxer a little over a year old who has separation anxiety issues.  A few days ago he noticed the dog drooling, looked in his mouth, and saw that he had broken a tooth.  Today he brought him in for evaluation.  The dog was in overall good condition, but had broken off the tip of his upper right canine tooth.  The fracture was fairly close to the gum line and the pulp was obviously exposed.  So I began to work up an estimate for him.  A healthy canine tooth has a long, curved, thick root and is pretty hard to remove.  Generally the best way is to use dental drills to remove part of the bone away from the outside of the tooth, allowing it to be loosened and removed more easily.  Such a procedure also requires lifting part of the gum away from the bone and then suturing it back over the whole.  All of this requires general anesthesia since it is painful and can take quite a while to do.

I gave the estimate to the client.  He declined, but not for the reason I expected.  Instead, he said that his sister was a dentist (for humans), had removed broken teeth from his Rottweiler, and he was going to have her fly in to remove this dog's tooth.

WHAT????

This was wrong on several levels.  First of all, a human dentist is no more qualified to work on a dog's teeth than I am to work on my wife or children's teeth.  Just because you know about one species doesn't mean that you know about others.  There are certain similarities between teeth of various species, but the structure is certainly different.  Also, and most importantly, a human doctor is absolutely unqualified to perform anesthesia on an animal.  Drugs, dosages, and complications are all different.  What might be safe for one species doesn't mean that it's safe for all.  And dosages can be VERY different.  As an example (a non-lethal one), a human adult's correct dose of diphenhydramine (Benadryl) is 50mg.  In dogs we dose it at around 1mg per pound (2mg/kg).  That means that an adult human's dosage would only be enough for a medium-sized dog!  I would have no clue how to dose anethesia safely in a human.  So why would a human doctor feel that they can properly dose anesthesia in a dog?

The second issue is a very legal one.  Medical professionals are very specific in the species that they are legally allowed to see.  Human doctors are legally only allowed to work on humans.  Veterinarians are legally allowed to work on every species except humans.  So if I try to do a medical procedure on one of my kids, I can be arrested for practicing medicine without a license.  Similarly, when a human doctor works on an animal (say by, oh....doing a dental extraction on a dog) they are just as guilty of practicing medicine without a license.  If this dentist was ever confronted, she could potentially see jail time and lose her medical license.

I have no problems with a client wanting to save money.  But doing it in this way is putting the dog at a high risk of complications.  There is a right way and a wrong way to lower costs...and this is most certainly the WRONG way.  Also, I have no respect for the owner's sister at this point if she actually does this.  She is acting recklessly and extremely unprofessionally and should really know better.

When a client makes a poor decision, it's not them who suffers.  It's their pet.

Whose Fault?

From Robbie...

I recently adopted a lardge bloodhound from the pound. He was too awesome a dog to get put down, and besides, my other bloodhound needed a playmate.Being from the pound, I was required to have him neutered. The procedure went well, but something did go wrong. His scrotum had swollen immensely, and so two days later they did an emergency surgery to remove it. Afterwards, the vet explained that the problem was one vein he had tied off wasn't tied tight enough and had filled the scrotum with blood. I know very well that mistakes happen, and I'm just glad the problem was resolved. However, this surgery drove the total cost up quite a bit. Times are tough and frankly, I can't afford it, but the vet is charging me full for both surgeries. I don't really see this as fair because the second surgery resulted from his mistake during the first. Do I have any options? Thank you. 

About 12 years ago my father collapsed in his bathroom and my mother called the paramedics. When he got to the hospital the doctors worried that he was having a heart attack and placed a catheter into his artery.  While doing so they accidentally tore a coronary vessel, causing him to bleed around his heart.  This required emergency open-chest surgery.  Thankfully, they fixed the problem and he's doing fine today.  And yes, the hospital charged a the full price for all procedures, including the surgery to correct their "mistake".  After he recovered, my mother was asked if she was planning on suing the hospital.  After all, it was their fault that he bled and almost died.  There was actually a good chance that she would win the suit.  However, my mother replied "Why should I sue?  They saved his life."

I really respected my mother for this decision.  I believe that far too many people sue in our society, and that people are simply not allowed to ever make mistakes.  My mother looked at the larger picture of the fact that the doctors had done everything they could and succeeded in saving my father.

Now back to Robbie's situation (yes, there was a point to my little story).  I have had dogs that I neutered develop a scrotal hematoma, similar to what Robbie describes.  All of them developed a swollen, bruised scrotum, though they did not require surgery.  Most cases like this will eventually reabsorb and resolve without further surgery, though the dog may be more uncomfortable than normally happens post-op.  In all of these cases I performed the surgery within acceptable standards and to the best of my ability.  If a suture wasn't tight enough or had slipped off, it wasn't due to neglect or inability on my part.  So even though this complication happened after I performed the surgery, I don't know that it was due to my "mistake".  Unfortunately, nobody can be perfect, even doctors.  There will be times that a doctor does everything correctly, but something still goes wrong.

Robbie, the vet does have a right to charge for both procedures.  They also have a right to waive any fees.  When I made my mistake (which you responded to) I chose to avoid charging for the second surgery, though I did not refund any fees for the first one. However, in that particular case I had accidentally created a life-threatening condition, though it was a once in a career situation.  Your case has happened to almost every vet out there, and is not life-threatening.  Was a second surgery even necessary?  I can't say, as I didn't see your pet, and I can see justification for and against a second procedure.

There are a couple of ways you can choose to act.  Because there is a chance that the vet did not perform the surgery adequately, you could consider a lawsuit.  However, I think it would be a tough case to win, as you would have to prove malpractice or neglect.  A slipped suture causing a non-life-threatening condition is a potential risk of a surgery.  However, I'm not a lawyer so I can't say for certain if it's a valid suit.  Or, you could take an attitude like my mother did and realize that the vet did help your dog, and had to use his time, equipment, and materials and it is fair for him to be reimbursed.  In the end, the decision has to be yours.

Top 10 Poisonous Human Medications

There was a recent article by a vet with the Pet Poison Helpline describing the top 10 human medications that poison pets, and I thought it was worth repeating here.  Credit for this information goes to Ahna Brutlag, DVM.


1. NSAIDs (e.g., ibuprofen, naproxen)—Topping our list are the common household medications called non-steroidal anti-inflammatories (NSAIDs), which include common names such as ibuprofen (e.g., Advil and some types of Motrin) and naproxen (e.g., Aleve). While these medications are safe for people, even one or two pills can cause serious harm to a pet. Dogs, cats, birds and other small mammals including ferrets, gerbils, and hamsters may develop serious stomach and intestinal ulcers as well as kidney failure.
2. Acetaminophen—When it comes to pain medications, acetaminophen (e.g., Tylenol) is popular. Even though this drug is safe for children, it is not safe for pets—especially cats. One regular strength tablet of acetaminophen may cause damage to a cat’s red blood cells, limiting their ability to carry oxygen. In dogs, acetaminophen leads to liver failure and, in large doses, red blood cell damage.
3. Antidepressants (e.g., Effexor, Cymbalta, Prozac, Lexapro)—While these and other antidepressant drugs are occasionally used in pets, overdoses can lead to serious neurological problems such as sedation, incoordination, tremors and seizures. Some antidepressants also have a stimulant effect leading to a dangerously elevated heart rate, blood pressure, and body temperature. Pets, especially cats, seem to enjoy the taste of Effexor and often eat the entire pill. Unfortunately, just one pill can cause serious poisoning.
4. ADD and ADHD medications (e.g., Concerta, Adderall, Ritalin)—Medications used to treat Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder contain potent stimulants such as amphetamines and methylphenidate. Even minimal ingestions of these medications by pets can cause life-threatening tremors, seizures, elevated body temperatures, and heart problems.
5. Benzodiazepines and sleep aids (e.g., Xanax, Klonopin, Ambien, Lunesta)—These medications are designed to reduce anxiety and help people sleep better. However, in pets, they may have the opposite effect. About half of dogs that ingest sleep aids become agitated instead of sedate. In addition, these drugs may cause severe lethargy, incoordination (including walking “drunk”), and slowed breathing in pets. In cats, some forms of benzodiazepines can cause liver failure when ingested.
6. Birth control (e.g., estrogen, estradiol, progesterone)—Birth control pills often come in packages that dogs find irresistible. Thankfully, small ingestions of these medications typically do not cause trouble. However, large ingestions of estrogen and estradiol can cause bone marrow suppression, particularly in birds. Additionally, intact female pets are at an increased risk of side effects from estrogen poisoning.
7. ACE Inhibitors (e.g., Zestril, Altace)—Angiotensin-converting enzyme (ACE) inhibitors are commonly used to treat high blood pressure in people and, occasionally, pets. Though overdoses can cause low blood pressure, dizziness, and weakness, this category of medication is typically safe. Pets ingesting small amounts of this medication can potentially be monitored at home, unless they have kidney failure or heart disease.
8. Beta-blockers (e.g., Tenormin, Toprol, Coreg)—Beta-blockers are also used to treat high blood pressure but, unlike with ACE inhibitors, small ingestions of these drugs may cause serious poisoning in pets. Overdoses can cause life-threatening decreases in blood pressure and a very slow heart rate.
9. Thyroid hormones (e.g., Armour desiccated thyroid, Synthroid)—Pets—especially dogs—get underactive thyroids too. Interestingly, the dose of thyroid hormone needed to treat dogs is much higher than a person’s dose. Therefore, if dogs accidentally get into thyroid hormones at home, it rarely results in problems. However, large acute overdoses in cats and dogs can cause muscle tremors, nervousness, panting, a rapid heart rate, and aggression.
10. Cholesterol lowering agents (e.g., Lipitor, Zocor, Crestor)—These popular medications, often called statins, are commonly used in the United States. While pets do not typically get high cholesterol, they may still get into the pill bottle. Thankfully, most statin ingestions only cause mild vomiting or diarrhea. Serious side effects from these drugs come with long-term use, not one-time ingestions.

So be aware of the risks of these medications you may have around your house!  If you think that your pet may have swallowed anything listed here, talk to your vet right away.