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Monday, December 29, 2008

Things They Don't Teach You

It's pretty much a "given" that veterinarians are well trained in medicine and surgery. We spend four years or more receiving incredibly intense and specific training in recognizing disease, interpreting lab results, understanding medications and their effects, and performing surgery. Once we graduate, we have a very good understanding about how to be a doctor. We hone those skills over years of practice, until most of us become very good at our jobs. Our clients also generally understand that we are skilled physicians and surgeons, and realize that we had a lot of training to become this way. Vets are required to attending regular continuing education seminars to maintain our license, so the learning doesn't stop at graduation. However, there are many non-medical things they never teach us, but we still have to deal with.

One of them is personnel issues. My lead tech was recently promoted to that position this past Summer, and was doing a good job. However, over the past couple of months her performance has gotten worse, and she is not good at being able to handle the rest of the staff. She criticizes bad things, but doesn't complement the good things. Our weekly supply orders have been getting messed up so that we will often run out of things before our next order arrives. And she has a very negative attitude about things that she is asked or told to do if it doesn't exactly fit with her own ideas. I was called today (on my day off) by the other doctor I work with to discuss some of these issues. This isn't the first time in my career that I've had to try and intervene with poor attitudes or performance, and will likely not be the last. At other times I have had staff that constantly bickered at each other, staff that angered clients, staff that wouldn't do their jobs properly even with considerable and repeated coaching, and just about ever other issue you could commonly think of.

Did we get any training in how to handle this in vet school? Noooooope. Sure didn't. Yet most of us have to deal with handling the staff in situations like this. I don't think any vet went to school because they dreamed of being a personnel manager or business leader. We get no training in these areas either before or during school. Once we're in our careers, we end up falling into these positions, and quickly sink or swim. I've been lucky that I have had good opportunities for training, but I've also made many mistakes. It's much harder for us to handle a situation like my head tech is causing, than it is for us to remove a spleen or cure skin mites. We also usually don't like this kind of interaction, otherwise we would have gone to school to get a career in Human Resources.

As much as I can't stand this aspect of my job, and as much as it causes me great stress, it's also one that I can't ignore. I think that veterinary schools need to be more proactive in recognizing the situations their graduates are going to be placed in, and give at least one course in managing people and businesses.

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Saturday, December 27, 2008

Furry Christmas Presents

It is not uncommon for people to give puppies, kittens, and other animals as Christmas presents, especially to children. Though it's a great idea and intention, this isn't the best time of year to try and deal with a new pet. There is a lot of chaos and confusion with people off work, family over for the holidays, and lots of new presents to distract people or pets. However, it's inevitable, and at this point has already happened to many. With that in mind, keep in mind some basic tips and hints.

New puppies and kittens need visits to the vet right away. Regardless of where you get them, it's important to have a vet check them over. Bring your records from the breeder or shelter so the vet can review the preventative care history up to this point. Despite great intentions, breeders don't always have the correct knowledge and practices. A vet can make sure that your new pet gets off to the right start. Parasites such as intestinal worms are common in puppies and kittens, and aren't immediately obvious. Your vet can check for these things and give appropriate treatment. You should also talk about flea and heartworm prevention as well as proper nutrition.

Just yesterday I saw two rabbits who had just been given as presents. The owner wasn't completely sure of the genders, and one had just given birth that morning. Even hamsters, gerbils, guinea pigs, lizards, birds, and other "exotic" pets need to have a veterinary visit after coming to a new home. You want to make sure you know how to care for them properly and screen for any obvious health problems.

During this time of year it's easy to get caught up in how busy things are, and in the enjoyment of a new pet. With everything else going on, the kitten or puppy (or other) can get unintentionally neglected, at least as far as health care. Nothing can be more important than a veterinary visit. I've seen many new pets in the last week, and everyone has questions about how to properly care for them. I know there are some people who haven't brought their new pets in for a visit, and hopefully they will soon. If that's one of you readers, make an appointment with your vet this week.

Friday, December 26, 2008

Little Lost Doggie

My neighborhood has several dogs that kind of wander around unleashed. Because I keep my dog inside or under supervision in the yard, this really annoys me. As a vet, my mind immediately starts to go through the injuries that the dogs can get and the diseases that the could spread. On Christmas day I found a new little dog to worry about.

I was outside bringing some tables and chairs out of my wife's van to set up in preparation for dinner at our house (eight adults and eight kids). I let my lab, Guinevere, outside with me to play in the yard while I got things in. I made a few trips in and out and then looked to see her in the yard across the street. She is trained to stay in the yard, so I had to look and see why she had wandered. There were two dogs that she had gone over to say hi to. Guinevere is a very friendly dog that likes being around others of her kind. I called her back and she ran over to our yard, followed by the two dogs. One of the dogs was a beagle/basset hound cross that my wife had seen in the neighborhood previously. The other was a little mixed-breed of uncertain origin that looked awfully tiny to be wandering on its own.

I decided to take a quick look at them, and discovered both to be very friendly. At a glance I estimated the beagle mix to be about 10 months old, and was not neutered. The other was a little girl, probably about 10 weeks old (give or take). After making sure they were okay, I wandered back to the house. The dogs followed me. I went back to the neighbor's yard, and they tagged along. I tried to leave them there, but they came back with me to my house. The puppy actually tried to go inside with me when I went in. Once I was inside, she stood up to look through the window, obviously wanting in. I did everything I could to get them back to their own yard, but I wasn't even sure who they belonged to. She had a collar, but no ID tag, and he didn't have anything on. After several tries, I just came back inside, hoping they would eventually tire of trying and go away. After some scratching at the door, barking, and whining, they finally did.

Any of you readers who have dogs that wander freely, please consider their safety and health. It wasn't good for either one to be out there, but especially for a puppy less than three months old it was a big risk. Dogs in these circumstances may not be able to find their way home, and especially with the young puppy may not have known how far they had wondered. There are dangers from other dogs being protective of their territories, as well as being hit by a car. Dogs who wander are also more likely to be exposed to parvo virus and ground contaminated with intestinal parasites. And all of these concerns ignore that many cities have leash laws, making freely roaming dogs illegal.

Be a responsible pet owner and keep your dog confined to your yard or home.

Thursday, December 25, 2008

What Christmas Is About

Our son woke up bright an early today, before 7:00. He kept opening his bedroom door and looking out to see if anyone is awake, and finally about 7:15 we gave in and got up. The kids ran downstairs to see what Santa had brought, and have been playing with their new toys all morning. But that's not what Christmas is all about.

Now before I continue, let me be clear that I'm aware of all of the origins of Christmas. I know of the Roman holiday of Saturnalia. I know that evergreens with lights (Christmas trees) had their roots in the pagan Winter Solstice celebrations. I know that Jesus was likely born in the Spring, and not December. I know that the wise men didn't visit Jesus as His birth, but a few years later. I enjoy the secular aspects of Christmas, such as Rudolph the red-nosed reindeer, Santa Claus, and selves. I enjoy giving and receiving gifts, and get excited about decorating the house. But none of this contradicts what the Bible says or what the true meaning of Christmas is.

Regardless of when He was actually born, this day is a celebration of the birth of Jesus Christ. Among Christians only Easter has a similar significance. This is the day that God took human form, and came to earth in the most humble of bodies and settings. He came to walk among us and share out lives, so that He could eventually take on our sins as a human. We have chosen today to celebration His birth, and that should never get lost in the other aspects of the holiday. A tiny baby was born and placed in a feeding trough among stabled animals, and He would one day change the world and humanity more than any other single human before or since.

Today enjoy your family and friends, and have fun with the new trinkets and toys. But take time to remember the best Christmas present, Jesus. Treat each other like He would want you to treat them, love each other, and let there be peace among all men and women of this world. This is the celebration of Jesus' birth, and so we should give a gift to Him. That gift is ourselves and our hearts. Give to Him fully, and let Him know that you love and appreciate Him. Be filled with the true meaning and spirit of Christmas!

Wednesday, December 24, 2008

Christmas Traditions

Christmas is pretty much the biggest holiday in western societies. Though it has become very secularized, it is still very important to many people. This is my wife's favorite time of year, and we start decorating on Thanksgiving. One of the things I find very fascinating about the holiday is the variety of traditions people have around the world. I work with a Russian woman, and did some relief work at a clinic with a German woman. It was interesting to discuss their traditions versus the ones we normally see in our own country.

One of the reasons for my fascination is my own heritage. My father is from Sweden, and growing up we incorporated many Swedish traditions into the American ones my mother grew up with. Now that I have a family of my own, we have continued this theme and are teaching our kids about Sweden. In America, Santa Claus comes after everyone goes to sleep on Christmas Eve, with presents waiting on Christmas Morning for everyone to open. This is also when families exchange presents with each other. However, in Sweden Yul Tomte comes on Christmas Eve, and actually enters the home when everyone is awake. He gives presents to the good kids and sticks to the bad ones. Families also give each other their presents on Christmas Eve. We have blended these two traditions by exchanging our family presents on Christmas Eve, and having Yul Tomte leave gifts for them outside before they go to bed. Then Santa comes later in the night, and in the morning the kids get their presents from him.

We also use a traditional Swedish advent candle holder, lighting one candle every Sunday during december. We have several Swedish Christmas decorations, such as a straw goat (called the Julbock), and a small figurine of Santa Lucia (a Christian saint who is celebrated on December 13th in Sweden). However, we also leave out cookies for Santa, have a traditional Christmas tree, garland, lights, and so on. We also have new tradtitions that we've started for our own family. On Christmas Eve we read the story of Christ's birth from the Bible. We wrap the baby Jesus from our nativity set that night, and open it as the first present on Christmas morning. On Christmas Day my wife and the kids make a birthday cake for Jesus.

Christmas is most important for it's religious origins (and which I'll talk about tomorrow), but it is also a fun time for families to gather and share special moments and gifts. The kids mostly love getting the gifts, but it's a wonderful time of sharing and giving for us adults as well. This is a very special time of year, one that is truly magical.

Here are a few links of interest....

Christmas in Sweden
Swedish Christmas Traditions
Santa Lucia
Santa's Origins

Now here's your turn. I would love to hear of your own unique Christmas traditions, whether it's due to cultural differences or new ideas you've come up with for your own family. Post your own country's or family's spin on Christmas in the comments section!

Tuesday, December 23, 2008

Go Vols!

This story requires a little background set-up, especially for my international readers. Unlike many or even most men, I could really care less about sports. I have nothing against them, I've just never been very interested. I've been to some baseball and hockey games, but have found football (American football, not what we call soccer) uninteresting. Whether it's college or professional teams, I've never gotten caught up in all of the hoopla surrounding these games.

One of the major college teams in the southeastern US is the University of Tennessee Volunteers (or "Vols" for short). I received my Master's Degree there, but still never considered myself a big supporter. I don't hate them, I'm just rather ambivalent. However, there are many people who fairly obsess over them, including one of my techs. The other vet I work with is also from Tennessee and went to vet school at UT. So we have some Tennessee fans there. Until today, I didn't realize that at least one of my patients shares the same sentiment. And yes, I mean "patient", not "client".

Today I saw a basset hound named Copper for his routine annual vaccinations. He was wearing a Tennessee Volunteers collar and leash, which had already stirred some excitement with the rest of the staff. When I went into to see him, I commented to the owners that we had several UT fans here. "However, I'll admit that I'm not exactly a fan," I said conversationally. As soon as I finished the sentence there was a great big "woof" from Copper. The timing was extraordinary, as it completely seemed as if he was taking offense to my comment. We all shared a laugh at the coincidental timing, and I proceeded with my exam.

Once I was done and had put him back on the floor, I spoke to the clients some more. When it came time for him to leave, I crouched down and gave him a little more attention. He was a very sweet boy, and other than the one bark earlier, he had been quiet and well behaved. I gave him another rub behind the ears, gave him a thumbs-up sign, and said "Go Vols!" Immediately he gave a hearty "Woof, woof, woof!"

I swear, it seemed like he had been trained, or somehow comprehended what I was saying. The timing of both barks was uncanny. Apparently the owners weren't the Tennessee fans...Copper was!

Saturday, December 20, 2008

The Doctor Is Right?

One of the biggest problems that a veterinarian (and really any doctor) faces is with compliance. There have been several studies published recently that show that our clients don't follow our recommendations anywhere nearly as much as we think they do. This is an incredibly frustrating problem, as we don't make recommendations lightly, and always with the goal of helping the patient. Refusing the doctor's instructions can lead to persistent problems or failure to improve.

I had been in practice for about a year when I saw a kitty with an eye problem. It had some drainage and was squinting one eye. An exam and stain quickly revealed that the eye had a moderately sized but superficial ulcer. These can happen from scratches or something else abrading the cornea, and most of the time respond well to therapy. We prescribe antibiotic drops or ointment, and the problem usually gets better quickly. However, because this doesn't always happen, we do follow-up visits. When I saw the kitty the following week, the ulcer hadn't gone away. The owner was using the medications appropriately, and it wasn't any worse, so we gave it another week to heal.

The next week she brought the kitty back, and it was still the same. I started asking more questions, and learned that the cat was rubbing it's eye frequently. Thinking this might be causing the problem to persist, I recommended an e-collar. For those not familiar with the terminology, this is one of those lampshade collars pets wear for certain injuries. The do a great job of keeping the pet from getting to its face, or from licking its body. Unfortunately, pets hate these things, and usually try to get them off. It also makes eating and drinking difficult. It's a difficult treatment aid, but one that this cat really needed.

A week went by, and the cat came in for its recheck. The ulcer was still the same size. I asked the owner if she had been using the e-collar, and she admitted that she kept it off him most of the time. He just hated having it on, and she hated seeing him act that way. I strongly emphasized that he really needed this, since he was still rubbing the injured eye. She said that she would use it this time, though I was beginning to loose hope.

The week after that (for those keeping score, we're in our 4th week of treating something that usually resolves in 1), the cat came to us to be boarded. The corneal ulcer hadn't improved at all, and I knew the owner hadn't been keeping the e-collar on enough. Since he was going to spend three days with us, I knew we could give him some relief. Over the weekend, the e-collar was on continuously. However, when I checked with the kennel worker on Monday, he had apparently gotten the directions confused and had been putting the medicine in the kitty's other eye! With a bit of frustration, I repeated the stain to see how bad the ulcer was. To my surprise, the ulcer had almost completely healed! In three days, the problem had just about gone away, even without medication. All because we kept the e-collar on at all times. If the owner had done that to begin with, the cat would have been saved weeks of pain and hassle.

Doctors make therapeutic recommendations because it's what they feel is best to help their patient get better. If you don't follow their instructions, don't be surprised if the problem doesn't go away.

Friday, December 19, 2008

A Matter of Perception

When my wife and I were dating, she would sometimes come on emergency calls with me. I was working for a practice where we handled our own emergencies, sometimes having to go out in the middle of the night. Luckily, this wasn't too often, as I never liked cutting into my private life to traipse off in the wee hours. There were several times that my wife (well, not my wife at the time) would accompany me.

Though my wife loves animals, she never had to worry about the illnesses and injuries they sometimes get. She also doesn't have a strong stomach, and can't easily handle "gross" things. This little quirk made it interesting on some of these emergency calls. Keep in mind that after-hours calls were never something simple or routine. They were usually poisonings, injuries, or sudden and serious illnesses.

One of these calls was because a basset hound suffered a bad laceration. The wound was long, deep, and bloody. It needed to be cleaned and sutured, which would require sedating the dog. The owner agreed to the treatment, and I started getting things ready and gave the dog its sedative. Once the dog was unconscious, I started to clean the wound and explore it more. It was a pretty ugly laceration, but one that would respond well and heal with proper treatment.

The owner had a little girl with her that was about six years old. My wife-to-be had taken one look at the bloody dog and quickly turned away. She decided to occupy the girl's attention while I handled suturing the dog. At first that was working well, but then the girl became curious about what I was doing to her dog. She wandered over to where I had cleaned up the wound and was beginning to sew it up. My darling future wife looked in horror at the gaping wound and the needle passing through the torn skin, and tried to guide the girl away. But the little girl was having none of it, and moved closer in obvious fascination. She spent the next several minutes watching with close interest as I fixed her dog, while my girlfriend avoided looking anywhere near the treatment table.

After 10 years being married to a vet and after two children, my wife has a bit more tolerance for things like this, and doesn't immediately run away if she comes to visit me while I'm doing surgery (though she still doesn't want to watch). However, I'll always remember that little girl, and how she had a higher tolerance for blood than an adult woman. It was the same thing being viewed, but each perceived it in a different way.

Thursday, December 18, 2008

Let's Talk About Sex, Bay-bee

There are many questions and confusion about the reproductive cycles of dogs and cats, so I thought I'd give a quick lesson in canine and feline sex issues.

Dogs and cats reach sexual maturity at around 7-9 months old. At this time the sexual organs are fully formed and producing full amounts of hormones. Once this happens, they start to exhibit behaviors related to the gender and become fertile. Females are only fertile and receptive a few times per year, unlike humans.

The heat cycle in both species begins similarly. Initially there is a period lasting 7-10 days where the ovaries begin producing hormones and prepare to ovulate. In dogs, this is accompanied by vaginal bleeding similar to what happens in a human woman's menstrual cycle. Cats do not have noticeable bleeding, but begin to exhibit strange behaviors such as increased affection, presenting their tails and hind end, and strange vocalizations (what I often term "demon-possessed"). Cats are also what are called induced ovulators, meaning that even though they are reproductively "ready", they won't actually release their eggs until they have intercourse with a male.

A dog's fertile period begins once the bleeding stops. For the next 7-10 days they are ovulating and can become pregnant. An interesting tidbit is that because ovulation takes place over several days, dogs and cats can mate multiple times, with the potential for different males fertilizing the animal. It is therefore possible for siblings in a litter to have different fathers.

If the animal doesn't become pregnant, they will begin their reproductive cycle again. Dogs will cycle every 6-9 months, so usually a couple of times per year. Because cats are induced ovulators, once they start going into heat they will continuously cycle in and out until they mate. This can go on for months without end and can be very annoying to the cat's owners.

Pregnancy in dogs and cats lasts about 2 months, an average of 61-63 days. The size of the litter varies based on the species, breed, and size. Smaller dogs usually have smaller litters than larger ones, and first pregnancies tend to produce smaller litters than later ones. Most of the time delivery is routine and uncomplicated, with the animal cleaning the babies and stimulating them to breathe and move.

On the male side of the equation, here are a few interesting trivia facts that you probably never wanted to know. Dogs have tissue at the base of the penis called the blubous glandus. When the male becomes excited, this structure swells, forming a "knot". During intercourse with a female, this part of the penis is inside her vagina, causing them to "lock" together. This same structure can also become enlarged when the dog is extremely happy, and to some people can look like testicles, making them wonder if the dog was actually neutered. When the male and female are locked, the male will turn around to face away from the female, remaining inserted in her. This puts them back-to-back until he finishes inseminating her. And yes, his penis can bend that way to point directly behind him.

Intact male cats have barbs on the end of their penis that causes strong stimulation when he has intercourse with a female, causing her to ovulate. These barbs are dependent on testosterone, and when the male is neutered the barbs disppear.

Now it's up to you to figure out exactly when to use your new knowledge at cocktail parties.

Wednesday, December 17, 2008

Common Misconceptions, Part 1

There are many things that people believe to be true, but actually aren't. This is definitely true about pet care and veterinary medicine. So, inspired by this list on Wikipedia, I'm going to do occasional themes based on common misconceptions about pets and vets.

Neutering will calm down my dog/cat.
Spaying and neutering only affects behaviors related to gender-based behaviors. This can include territoriality, aggression, sexual desire, and so on. However, it does not include activity levels. A pet that is excited and hyperactive before neutering will be the same after surgery. Being sexually intact is irrelevant to such behaviors.

Neutering will make my male dog/cat lazy.
As with the first misconception, spaying and neutering has no affect on most pet behaviors. Removing the gonads (sexual organs producing hormones) has nothing to do with a pet's energy levels or overall behavior and attitudes.

If I come home and discover my dog urinated/defecated on the floor, rubbing his nose in it will teach him not to do it again.
Studies have shown that unless a punishment or reward is given within 20 seconds of the behavior, the dog will not associate the reinforcement (positive or negative) with the behavior they performed. This means that punishing a pet more than a few seconds after the behavior has no effect at all, other than making them scared of you.

When my dog does something bad, he knows it and acts guilty.
Have you ever come home to a knocked-over trash can, and your dog runs and hides with their head down and tail tucked? We perceive that as guilt, and they know that they did something wrong. Well, that's not how canine behavior works. Remember, punishment must be given with few seconds to be effective. Try the following some time...when your dog isn't in the room, turn over the trash can, then walk away. Wait until your dog goes into the room and sees the mess, then see how they act. Their behavior will be the same as if they had gotten into the trash themselves. In a dog's mind, they associate there being a mess on the floor with getting punishment from their owner. They don't make the connection that you're mad that they made the mess. They make the connection between the presence of a mess and your reaction.

I'll post more as they come to mind!Bold

Tuesday, December 16, 2008

"House" Calls

Apparently one of the most popular shows currently on TV is House. I've heard of its multiple awards, and know many people who follow it very closely. Frankly, I never really felt much interest in it, and the teasers for it on TV struck me as annoying rather than appealing. Hugh Laurie's character seemed too harsh and cynical to me, and I didn't really understand why people were so drawn to the program.

Until now.

I happened to have the TV on last week when the show came on. I didn't feel like changing the channel, and ended up watching it. And I have to say that I became hooked, to the point that it annoys my wife. Besides the good drama, what appeals to me is the medical detective work. As a doctor (albeit for different species), I deal with diagnostic challenges daily. They aren't anywhere near as hard as those treated by Dr. House and his team, but the sometimes really challenge me. I enjoy watching the thought processes of the doctors, and how they work through their lists of possibilities to reach the conclusion. Other doctor dramas haven't captured my interest as much, since they seem to focus mostly on the interactions between the doctors and patients, or among the medical staff. House is different on several levels, and that uniqueness is what appeals to me.

So yes, I've finally joined the rest of America and seek out episodes of House. Now what I'd really like to see is a similar show based on a veterinarian!

Sunday, December 14, 2008

Holiday Hazards

We're less than two weeks away from Christmas, which makes it an appropriate time to talk about the potentially harmful things that pets can be exposed to during this season. Though most people don't willingly set out to harm their dogs and cats, there are some dangers to be aware of and to try to avoid.

Tinsel--Cats are at the biggest risk with this traditional Christmas decoration. If they swallow a strand, there is a risk of it becoming entangled inside the small intestine. It can bunch up and draw together like the string in a curtain, and eventually begin to saw through the intestine. Obviously, this is a life-threatening problem, requiring emergency surgery. I recommend that anyone with cats in their home simply avoid using tinsel.

Chocolate--Holiday candies are often made of this ingredient, and it can be potentially toxic. The main ingredient of concern is theobromine, which is related to caffeine. Toxicity is entirely dependent on the type of chocolate and the size of the pet. Baker's unsweetened chocolate is the worst, and milk chocolate isn't as bad as dark. Small pets require less chocolate to cause problems than larger ones. A lab could eat a whole Hershey's bar and likely not even have much diarrhea, while a chihuahua would be in a very serious situation. Be careful with your treats and Christmas cookies.

Poinsettia--I've included this common holiday plant because there is a wide-spread belief that it's very poisonous. However, this is mostly untrue. The sap of the plant can be irritating, causing discomfort in the mouth and vomiting if enough is eaten. However, it is not truly dangerous, and usually doesn't require any treatment.

Holly--Holly berries, on the other hand, can cause severe vomiting and diarrhea, sometimes leading to dehydration and electrolyte imbalances. Though not deadly, they can cause some serious gastrointestinal upset.

Home Cooking--Family usually comes over for the holidays, bringing food or joining meals. Pets sometimes are given scraps and leftovers, especially bones from the ham or turkeys. I've already blogged on the dangers of people-food, so I'll just remind everyone that these things are bad for your pets. Bones can cause GI obstruction and irritation. Scraps, even in small amounts, can cause vomiting, diarrhea, and pancreatitis. Simply avoid the temptation of giving these to your dogs and cats.

Electrical Cords--Both dogs and cats like to chew on things, and electrical cords are a favorite choice. With all of the extra lights we hang up around Christmas, this means extra cords. Watch them for tooth marks to warn you if your pets are chewing on them. Getting to the wires can cause severe electrical burns and damage.

Christmas Trees--Watch your cats for climbing in them, and watch all pets for knocking ornaments off. Trees can fall over, so make sure they are stable and well secured to prevent damage and injuries. Pieces of ornaments can cause damage or obstructions if ingested, and broken ornaments (especially glass ones) can be dangerous to step on.

With a few precaution, your pets can have a safe and fun holiday just like the rest of the family.

Friday, December 12, 2008

Winter Prevention?

Here's a question from Randar...

Hey, I got a dog question. Is it necessary to keep my dogs on heart worm and flea stuff during the winter or do they just say that to keep up sales.

The short answer is "it depends". And since I've discovered that my readership is international, let me forewarn that my answer is mainly based on northern hemisphere, especially North American, pattern.

Fleas require warm, humid environments in order to thrive. The lower the temperature and the dryer the environment, the worse the conditions for them. This means that in desert climates or areas that have strong winters there isn't as much of a flea problem. In the American southeast, flea prevention is needed pretty much year-round. The further north or west you go, the less the concern. For example, in the winter in the Daktoas, fleas definitely won't survive. However, you need to keep in mind that this is mainly talking about fleas surviving outside. We keep our homes very climate controlled, with temperatures in the upper 60s to low 70s (Fahrenheit), and often humidity control. Under these conditions fleas can survive year-round. Even in the US southeast, I have never seen a month go by, even in Winter, that I haven't seen at least a few clients with fleas on their pets. Take these guidelines and make the decision about whether or not to use flea prevention during the winter. Or better yet, ask your vet about local flea prevelance.

Heartworm prevention is a different issue. It is transmitted by mosquitoes, so conditions in which these insects would survive will increase the risk of heartwom disease. If the conditions are too cold or dry (since mosquitoes need water to lay their eggs), they the mosquitoes won't live and therefore heartworm risks are lower. However, the disease you are risking is much greater. Fleas can cause allergy problems, skin disorders, tapeworms, and even anemia in small pets. However, heartworm disease can cause death. Currently only about 50% of American dogs are given heartworm prevention regularly. Since the potential disease is so severe, it is recommended to keep dogs on prevention year-round.

The recommendations of veterinarians are based on the best health care for your pets. Yes, we would like to be profitable and support our familes. But most of us don't try to deliberately make recommendations or manipulate clients in order to make money. We really are trying to look out for our patients.

Wednesday, December 10, 2008

Say Cheese!

Last weekend I took some pictures of our family in front of the Christmas tree. We do this to add a recent photo when we send out Christmas cards. So my wife and kids started to get into position as I set the camera up and got the timer ready. While we were getting set up, our dog, Guinevere, walked over and sat down next to everyone. It honestly seemed like she knew we were doing a picture as a family, and didn't want to be left out! Now, I realize that I'm anthropomorphizing a bit, but that was the first thought that came into our minds. She even turned towards the camera like she was posing.

One of the things that I love so much about pets is how they become family. I definitely don't subscribe to the idea that "it's just a dog" or something similar. We worry about our dog and cats almost as much as we do about our kids. We make sure they're well cared for and always try to plan around them as much as we do the rest of the family. Now, I don't think that animals have the same inherent "value" as a human, but I do think they are very important. Guinevere is laying on the foot of the bed as a type this, and will sleep there all night (usually crowding my wife and myself).

Many of my clients share the same sentiment, and I love seeing that bond. To many people, their pet is another child, and they do everything for their dog or cat that they would do for a person. These sentiments towards pets aren't limited to their owners. Just today we received a flyer at my clinic for a "Pet Play Place" that offers day-care and boarding. Only, instead of calling it boarding, they use the term "sleepover". They have couches for the dogs to sleep on, provide TV and radios, and even have swimming pools. I'm going to have to go check this place out myself sometime soon. And yes, I thought of our dog as possibly staying there at some point if I like it in person.

Pets add so much to our lives that I think they deserve to be treated special. Many studies have showed that pet ownership helps improve health, reduce stress, and lengthen human lifespans. They provide a special emotional bond and outlet that many people wouldn't have otherwise. They definitely deserve to be treated as more than "just a cat".

Oh, and we couldn't ignore Guinevere's obvious desire to be included in the picture. After all, it was going to be a family photo, and she's part of our family.

Tuesday, December 9, 2008

The Changing Face Of Veterinary Medicine

One of this blog's readers works in veterinary medicine in New Zealand, and recently posted on her own blog about the gender changes in the profession (check it out here). What I find interesting is that this is a world-wide phenomenon. Though she's posting about conditions on the opposite side of the world, it holds equally true here in the US.

Historically medicine was a male-oriented field, with women being mostly in supporting roles. As gender equality has become more prevalent in society, and women have become accepted working full-time outside of the home, this has shifted considerably. In the hall of my veterinary college (North Carolina State University College of Veterinary Medicine), there are pictures of every graduating class, with portraits of each student. The first class graduated in 1985, and I did in 1997. It was interesting to me to look at the framed class pictures, walk down the hall, and slowly see the increase in the number of women while the number of men decreased.

The trend has been growing rapidly. A few years ago the Minnesota vet school accepted their first 100% female class. About the same time it was reported that the population of practicing veterinarians was 50% female. My own veterinary class was 75% female. So I am quickly becoming a minority in my own field! Since the support staff is still almost entirely female, I have grown used to being the single male in just about every place I've worked. There is pretty much no topic about a woman's life, relationship, or bodily functions that I haven't heard!

Besides the simple fact of there being more X-chromosomes when you walk into your local vet's office, there are some other substantial changes that this gender shift are causing. Many female veterinarians want to have children and families. Once this happens, many don't want to work full time, preferring to split their time between children and practice. They also want time for maternity leave, fewer hard hours, and overall a better quality of life. Though there are many women businesspeople and practice owners, fewer are wanting this option than men. Historically women are also less likely to bargain aggressively for salary and benefits than men, which in part has led to women's pay falling behind men's. All of these factors are leading to more veterinarians working part-time for lower salaries and fewer being practice owners. And before you think I'm being sexist or biased, these are all facts that have been reported in veterinary journals in the last couple of years and are based on several surveys.

Most of this is really just affecting the business of veterinary medicine rather than the practice of it. Most clients will see few or no changes in the care their pets receive. Only those of us behind the scenes in the profession will reallly see how far-reaching these changes will be. But just like the rest of society, veterinary medicine is constantly changing and evolving. It will be interesting to look back on all of this in 20 years and see how far things really have come.

Saturday, December 6, 2008

The Solution To Chronic Ear Infections

If the title of this post suddenly grabbed your attention, then you are very aware of the problems some dogs face with ear infections. Most dogs never have any problems with their ears. But others have life-long issues that can lead to permanent damage. If you have struggled with recurring infections in your dog, then this article is for you.

If your dog has more than two ear infections in a year, then this is very abnormal. In these cases, the ear infections are not the problem. The infections are indeed a concern, but they are a symptom of a larger problem. Infections do not happen on their own. There must be some underlying reason for it. And you will never get it fully under control until you discover and treat that primary cause.

Breed has a lot to do with these problems. Certain breeds have long, heavy ears that hang close to the ear canal, preventing good air flow. This allows moisture to be trapped in the canal, creating a warm, moist environment that is a great breeding ground for bacteria and yeast. Cocker spaniels are one of the worst breeds in large part because of this ear structure. Some breeds, such as Labrador retrievers, produce more cerumen (wax) than other dogs, which can trap microorganisms. Small, fuzzy dogs, such as shih tzus and poodles, often have hair growing from deep inside the ear canal, which can clog the canal like hair blocks a sink drain. All of these physical factors contribute to enhance conditions for microorganism growth. However, they may not be enough to make a bad problem.

Low thyroid levels are one of the most common metabolic disorders in dogs. One of the issues hypothyroidism causes is to make the patient more susceptible to infections, especially of the skin and ears. Chronic ear infections can be a result.

However, one of the primary causes of chronic infections is related to allergies. I'll likely talk about allergies in detail later, but for now realize that we're not talking about the sniffles and sneezes that people get with hayfever. With pets, allergies can be to food, fleas, grass, pollens, dust mites, and many other things. Itchy skin and ears is the result, as well as infections. Veterinary dermatologists have shown that sometimes the only sign of a food-related allergy is chronic ear infections!

If your dog is having more than two ear infections a year, you need to do more than simply putting more medicine in the ears. This doesn't really treat the problem, and can lead to more serious problems down the road. If this describes your dog, here's what you need to talk to your vet about. First, have the thyroid level checked. This is inexpensive, and many vets can do it in their hospital. If they have to send it out, the results usually come back the next day. If the thyroid level is normal, then start talking about allergies. A food trial is usually the first step, feeding a special hypoallergenic diet for 2-3 months. If that doesn't work, medication such as prednisone or cyclosporine may be needed to reduce the body's reaction to allergies. If these don't control the problem, your vet may recommend sending you to a veterinary dermatology specialist.

Treating ear infections should always involve trying to cure the current outbreak with appropriate medications. But if it keeps coming back, you and your vet should try to figure out why, and treat that main problem. Doing so will save you money and your pet discomfort.

Friday, December 5, 2008

The Cost of Becoming a Vet

I frequently speak with people that thought of being a vet at one point or another. They love animals, and thought it would be great to have a job helping them. For whatever reason, they never followed up on that desire, their lives taking them down a different path. I'm not sure if they or many other people really understand just what it takes to be a vet.

Here in the US there are only 27 veterinary colleges. Out of 300 million people and 50 states, we don't have even one vet school per state. Each school accepts around 80-100 students per year, but receives 400-500 applications. That means you have around 5 people competing for each available slot. Pretty stiff competition! Good grades are a must, as well as some experience in the veterinary field.

Medical school of any kind is extremely difficult, with many long hours of study. When I attended vet school, I already had my Bachelor's and Master's degrees, and had published an article in a scientific journal. I had graduated high school with a 4.0 average (out of 4.0), and graduated college Cum Laude. All very high accomplishements. However, vet school royally kicked my tail, and was the hardest thing I had done before or have done since. I simply cannot describe the amount of blood, sweat, tears, and frustration it took to make it through those four years.

Besides the mental stress, there is a lot of financial investment. Costs of achieving a veterinary degree have been going up faster than just about any other type of education. Recent data from the American Veterinary Medical Association showed that the average debt load for newly graduated veterinarians is $80,000. There are houses you can buy for that price! Yet the average starting salary is currently $55,000-60,000. Remember that these are averages, so some have more debt load, and som start with a lower salary. Once you graduate as a vet, the large majority of your salary goes to repaying debt. This is actually a major problem in the US, with new vets finding it harder than ever to make ends meet, and not having the financial ability to start or buy into a practice. We have the highest debt-to-income ratio of any medical profession in the US! That means that we acquire the most debt in relation to our salaries of any other doctor, including physicians, dentists, and ophthalmologists. These low salaries compared to the amount of debt we repay makes it hard to survive for a new graduate.

Why do we go through so much time, trouble, and money when we get paid about 1/3 of a MD's salary? Well, it's sure not because we like working long, hard hours for much less than our education would suggest. And it's not because we expect to drive around in BMWs or Lexus sedans. We all know what we're getting into when we start vet school. We do it because we love animals and medicine. We have dreams to help animals and their families. And to most of us, that emotional and intellectual reward is greater than any financial one.

Still...I don't think any of us would mind a bit of a raise.

Thursday, December 4, 2008

Veterinary Medicine Is Expensive???

Over the years I have heard people complain about the cost of health care for their pets. Yet veterinary care remains one of the cheapest forms of medical care anywhere. Let me give you a few examples of equivalent procedures on a pet versus a human (all in US dollars).

Spaying a dog--$150-300
Hysterectomy in a human--$7,000-15,000

Office visit for a vet--$35-50
Office visit for a physician--$155 (average, 2004 data)

Hip replacement in a dog--$2700-3500
Hip replacement in a human--$20,000-50,000 (2001 data)

Pick almost any procedure, and cost comparisons would be similar. Veterinarians receive as rigorous training as human doctors, however, we have to learn the anatomies and physiologies of multiple species. A veterinary general practitioner must be able to perform often complicated surgeries that human GPs would quickly refer to a specialist. We have costs of equipment and staff, as well as our own families to support. We have our own student loans to pay back, and default on them far less than our colleagues in human medicine. We also make far less than human doctors (which is why I drive a 13 year-old car with a dented bumper and hood). Yet somehow we have to get by with charging far less.

Human doctors have a large benefit in that insurance is wide-spread, and will pick up most of the costs so the patients are rarely out of pocket. Veterinary doctors do not have this aid, and often have to convice clients to pay for basic, routine services. So when someone has a $20 co-pay to their own doctor, they don't realize that well over $100 is paid by their insurance company. This low co-pay suddenly makes a $40 veterinary visit seem incredibly expensive.

Veterinarians have every right to make a profit. Profitability allows us to invest in newer and better equipment and medications, thus allowing us to serve our patients better and safer. The huge majority of us do not try to over-charge and gouge our clients. There are a lot of costs involved in making a business successful, and a lot of investments that need to be repaid. If we can't charge a fair price, we quickly go out of business. And who has really benefited in that case?

The next time you visit your vet and think the charges are too high, just think about how cheap you are really getting these services for.

Wednesday, December 3, 2008

The Slow Season

Did you know that veterinary medicine is a seasonal business? Well, at least here in the US it is. I've never completely understood why, even though I know some of the factors.

Summer is the busy time for us. We see more frequent skin and ear infections, flea problems, and allergy issues. These are complaints that happen more frequently in warm weather than in other times of the year. However, we also see more pets for routine preventative care. The increased number of clients is likely because of several influences besides medical need. Many parents have summers with more free time because they are home with the kids and don't have to worry about school schedules. People need to have their pets ready for boarding, getting them up to date on vaccines in preparation for taking them to kennels while the human family goes on vacation. There also seems to be more discretionary income available.

By contrast, the winter months are very slow for us. Extra money is spent on Christmas rather than the pets, and people tend to get into a greater financial crunch around this time of year. Cold, dry air isn't good for fleas, and is more forgiving to skin problems, so these issues tend to go away for the most part (depending on the part of the country). And since we are now in December, yes, we're becoming much slower and I am getting caught up on some reading that I didn't have time to do in the Summer.

We as a profession have learned how to deal with this seasonality. While many businesses hire seasonal help during November and December as the Christmas shopping season happens, we hire Summer workers to aid in the extra business. Sometimes we'll plan building or cleaning projects for January or February when we know there won't be many clients around. We hate having to reduce employees' hours as the holidays approach, but it's also necessary in order to stay in business.

Apparently, seasonal variations happen in other non-retail businesses. I spoke to my kids' pediatrician once, and she said that because of colds and flu their client flow is seasonal also, but with the height during the winter months. I'm curious as to whether non-American veterinary practices see a similar pattern.

Just another view behind the scenes of a veterinary practice!

Tuesday, December 2, 2008

A Doctor's Stress

I'm not sure whether or not people really understand how stressful a doctor's job is and how much pressure we feel in making the right decisions for our cases. We know that our skills and knowledge will determine a pet's health and life. If we're good enough, the pet gets better and does well. If we misjudge something, make a mistake, or do the wrong thing the pet doesn't get better, and perhaps even suffers or dies. That's a big responsibility, and sometimes weighs heavy on us. Frankly, I don't know how human doctors and paramedics handle it. It's hard enough when I loose a patient, but I couldn't imagine if it was someone's parent or child.

Today the doctor I work with had to re-do a surgery. She had spayed the dog earlier this year, but it had been a difficult surgery with some complications (not related to the doctor) and she had to complete the surgery quickly. The client was well informed of this, and knew that there was a possibility that one of the ovaries wasn't fully removed. This indeed happened, the dog went into heat, and my associate had to go back in today and find the remaining ovary. I scrubbed in and helped her, which was necessary since the ovary was pretty tricky to find and remove. During the surgery she was enlarging the initial incision and cut through a blood vessel in the abdominal muscle. This is common, and usually not a big deal. There was a quick spray of blood, and then she clamped it off for the remainder of the surgery. By the time the surgery was over and she was closing the abdomen, the bleeding had stopped. At that point it seemed like a pretty routine recovery.

The dog was fine all afternoon. Now keep in mind that this is a dog that is very difficult to handle, has to be muzzled, and one of the reasons for difficulties in the original surgery was due to her extreme excitement and need to be excessively sedated to be handled. When it was time to discharge her, the dog became excited to see her owner, and jumped around a little. Suddenly her incision started to bleed. This really freaked out her owner, and understandably so. My associate had to bring her to the back and try to stop the bleeding. However, the dog was struggling against us (I was trying to help), which made the bleeding worse. We needed to place a pressure wrap around her belly, but she was making it harder for us, and that made her bleed more. After quite a bit of work, we finally got the wrap placed.

Here's what we believe happened. That vessel that was cut had clotted, but when she became excited the clot broke, causing the bleeding. There were no signs of internal bleeding or that anything had gone wrong with the surgery. We see this happen rarely, but it does happen, and usually is not very concerning, just messy. However, even knowing all of that, my associate is likely worrying tonight and will loose sleep. I know, because the exact same thing has happened to me, and I worry and fret far too much. No matter how much we might know that some things are beyond our control or ability as doctors, we still realize that we're responsible. And if something very bad does happen to this dog, this doctor will have to answer questions about it. Even though she did everything appropriate and I was also there, she will wonder if there was anything she could have done differently. And though there really wasn't, she'll still blame herself. Again, I've been there, and will likely be there again in the future.

Doctors have very hard jobs, and the good ones take a lot of personal responsibility for their patients. This can make it very hard on them mentally and emotionally, and they often carry these concerns home to their families (just ask my wife). Please realize that your doctors are human, and really do care. When something goes wrong, they worry as much as you do. Say a prayer for your vet and physician.

Hard To Find Gift

My son is seven, and in the last 4-5 months has developed a great interest in Bakugan. For those of you without a young boy, this is the latest craze. It's a kids' anime (Japanese animation) show on Cartoon Network (here in the States), and has a game to go along with it. The game involves plastic marble-like spheres and cards with metal inserts. You set the cards up in a pattern and each player rolls the Bakugan of their choice onto the cards. A magnet in the sphere is triggered by the metal in the card and the sphere springs open to reveal a particular character. Depending on the point value of the character combined with bonuses from the card, one person will win. And that's what my son is very heavily into right now.

In the past he has been a little bit behind the popular "thing", so getting gifts hasn't been difficult. Unfortunately, now he's managed to get on the curve of the most popular thing out there for boys his age. And as I'm sure you know, Christmas is only a little over three weeks away. What does he want for Christmas? Bakguan! So for the past week, my wife and I have been panicking because we couldn't find what he wanted anywhere. The shelves in the stores have been bare, many online retailers are out of them, and people online that do have them are selling them for 2-3 times the retail price.

Why is this important? Think back to when you were kids and how much you wanted a certain gift. Remember how disappointing it was not to get it? Or when your parents got you something they thought you would like but it wasn't exactly what you wanted? I have strong memories of a couple of times like that. My parents were great, and loved me very much. They were very generous, though I don't think I was spoiled. They really wanted to make me happy and get something that I had asked for, especially from Santa. Most of the time they did great. But a few times I was disappointed because they got me something other than what I had asked for. I'm not sure if it was because they didn't really understand, or because (like in my own current situation) they couldn't find it. But I remember those times over 25 years later. I don't want to do that to my own kids, so I go on the hunt.

Luck was with us today. Target (a competitor to Wal-Mart for those of you outside of the US) had just put out a brand new shipment of Bakugan sets today. And on a risk I called the closest Toys'R'Us and they had the last of another Bakugan toy he wanted. So we were able to get exactly what he asked for. The other things he wants are much easier to find (such as Star Wars Legos), so I think we have his Christmas set. Thankfully, my daughter isn't as picky. This year, that is.....

To all of the parents out have my sympathies. I'm discovering how hard it is to make your kids happy with gifts, and how important it is for the parents to get what their kids ask for. It makes me appreciate my own parents a bit more, and what they had to do to meet my own demands when I was young.