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Tuesday, July 31, 2012

Some Things Can't Be Unseen

You never know what you're going to encounter and see walking into an exam room.

This afternoon I had a routine exam on a dog and a rabies vaccine.  My assistant went in, talked them into a heartworm test and and prevention, then came out to update me on the case.  She warned me that the client was breast-feeding in the room, something I've encountered from time-to-time.  So I gave it a couple of minutes before going in so the woman could finish.

When I walk in the room their baby is lying on the exam table getting his diaper change while the dog is sitting on the floor.  The parents are both there and mom is doing the change while dad is helping.  Definitely not a sight I was expecting!  Especially since I could tell pretty quickly that they had a boy and he was uncircumcised.  Did I really need to know that?

Being the professional that I am, and having children of my own, I didn't make a big deal about it and for the most part ignored the dirty diaper, concentrating on talking to them about their dog.  I made a joke about the dangers of changing boys but overall went on with the visit.  Their son started to cry and be fussy so mom said that he was probably still hungry.

Remember the whole thing about breast-feeding?  Yeah.  Let me also mention that the woman was not exactly tiny and had a rather ample chest.

Sitting on the bench in the room she pulls up her shirt and bra, her left breast spilling out for all the world to see.  Unfortunately that world included me as well as her husband.  I had a rather graphic view of the entirety of her breast and all of the details.  She started to adjust herself and her baby until he was latching on.  During the rest of the conversation she continued to feed him right there in the open, periodically having to shift herself or him on her nipple.

Please understand that I am not a prude, have no problems with the human body, and find breast-feeding very natural.  However, I think there are appropriate places and times to do it.  In an vet's exam room is NOT the time or place, especially when this is your first time meeting him!  I spent a LOT of time focusing on the husband and directing my comments at him, even though neither of them seemed phased by the events.

Was I uncomfortable?  Heck, yes, and it was a very awkward situation for me. I most certainly did not want to see their baby's genitalia or the size of the mother's areola.  But I think I handled myself well and hid my discomfort.

Yes, these kinds of things really do happen to veterinarians.

Monday, July 30, 2012

Pets As Romance-Killers

I've been married for 14 years and have two children, so it should come as no surprise that my wife and I can be....intimate.  Sometimes it's just lying on the bed talking or kissing, but sometimes it turns into more.  No, this isn't a blog about my "relations" with my spouse.  Rather, it's about how pets can ruin the mood.

We have two large dogs and three cats.  All of these pets have full run of the house and will sleep on the bed.  We have a queen-sized bed, so there isn't a ton of room when both of us are lying there.  Even besides the lack of space, the pets can sometimes interfere with our plans.  A dog will jump on the bed, trying to take a nap.  Another dog will peek her head up to see what all of the fuss is about.  A noise will cause them to start whining at the closed bedroom door.  Two cats will start to growl or fight under the bead.  One cat will decide that our hips are a good resting place.  Or the kitten will think that the feet moving under the covers is the perfect object upon which to practice his pouncing.

Yes, all of these things have happened to us.  And all of them have caused distractions, forcing us to push a pet off, yell at the dog, or otherwise break the "moment".  It has gotten to the point where we'll not only make sure that the kids are out of the house or asleep, but we'll kick the pets out of the bedroom!

And I am absolutely certain that virtually every pet owner has had the same or similar things happen to them.

Pets are wonderful and I couldn't live without them, but sometimes they're not exactly the best things to have around when you're trying to be romantic.

Thursday, July 26, 2012

Veterinary Geekiness

Sometimes I can be such a geek about veterinary medicine and get excited about things that would make other people just scratch their head. 

Today I received a rodent dental pack.  Previously we had been using other instruments to file down or trim the teeth of guinea pigs, rabbits, and hamsters because we didn't see enough of them the justify $270 in specialized instruments.  You can get by with other tools, but it's so much easier with mouth gags, cheek spreaders, and rasps specifically designed for small rodents.  Business has been picking up with these cases enough that we made the investment.  When it arrived today it was like Christmas!  I opened it and was going through the instruments with a big grin on my face, telling everyone what each one was for.  I was actually dancing a bit and was quite giddy!  That may seem like something silly to be so happy about, but it's interesting for me and as cool as a new Star Wars toy.  Well, almost.

I remember several years ago when I diagnosed demodex mites on a hamster.  I had never heard of this up to that point and had to run to my text to make sure I had made the right diagnosis.  Sure enough, they could get those mites though it was uncommon.  I was so excited and telling everyone on the staff about it!  Many of us become equally excited about lancing abscesses or other things related to the field.

I'm sure everyone has things like this happen in their own professions.  Maybe a lawyer gets happy about a new legal precedent.  Perhaps a mechanic does a happy dance when a new set of tools arrives.  A computer programmer probably grins when a new type of software comes out and can't wait to dig into it.  When you're interested enough in a subject to pursue it as a career you tend to be easily impressed and amused by things that make other people simply shake their heads.

Wednesday, July 25, 2012

You're Nothing Without Client Service

When I was still in vet school I remember reading a survey that was done of existing practice-owners.  The surveyors asked what they looked for when they hired a new associate.  Absolute bottom of the list of responses was "knowledge of the profession."  Top of the list?  "Interpersonal skills."  This is a truth that has only grown more solid in my mind after 15 years in practice.

Years ago a vet in my community suddenly died.  I had heard his name but never knew him.  After his death his clients started going to other area vets, including my own practice.  I quickly started seeing major issues with this patients, as well as the fact that he never kept written records, practiced out of his garage, and many other rather scary things.  If he had been alive I would have very seriously reported him to the state veterinary board.  Despite the fact that he was breaking several practice laws and was guilty of malpractice, people loved him.  He was friendly and had great communication skills.  In fact, at one point there was serious talk of erecting a statue to him!

One of my associates is an incredible clinician with virtually encyclopedic knowledge of veterinary medicine.  I would trust her with my own pets' lives and usually wonder why she consults with me on some cases because she's generally right.  However, she is not the best communicator and doesn't always come across well to people.  Because of this some clients prefer to see me over her.

Why bring this up?  I attended a seminar today on how client experiences affect their perception of a vet's medicine, and therefore their attitude towards the practice.  All of this influences whether or not they come back to that clinic and what kind of reputation or "brand" that clinic develops.  I can't say that anything was really eye-opening, but it did help reinforce what I had personally seen over the years.  I also picked up some good techniques and hints on how to do better.

I think most people understand the need for good customer or client service.  They certainly know when they've had good or bad service, and will make decisions based on that service. Most people who receive poor service never complain, they just go somewhere else.  In today's economy, that can be disastrous, especially for a veterinarian.

I know I have many veterinary students who read this blog so take this as advice.  No client or employer is going to ask for your GPA or transcript from school.  However, they are going to pay attention to how well you communicate and interact with people.  More importantly, your clients are going to pay more attention to how you treat them than what technique you use to spay their cat.  Develop your social skills as much as you do your medical ones and you'll succeed as a vet.

Saturday, July 21, 2012

When It's Your Own

Being a vet can be interesting and rewarding, though it's hard work and not for everyone.  Often cases aren't easy and you struggle to come to a diagnosis and choose the right treatment.  But the worst cases are when it's your own pet.

Long-time readers (and newer readers who have powerful search-fu) can remember cases where I've had to diagnose and euthanize my own dog, as well as do surgical procedures on my pets.  Being a vet in these situations is a mixed bag.  On one hand I don't want to give the responsibility of care to another vet, even though I fully trust my associates.  On the other hand you don't have the objectivity with your own pets that you will with client-owned animals and in a crisis situation can be too emotionally involved.

Earlier this week I neutered my kitten, Pippin, and did a dental cleaning on my dog, Inara.  Both were routine procedures and I've become used to seeing my own pets under anesthesia.  Neither procedure was difficult for me to handle since I've seen so many of these cases over the years and have done thousands of anesthestic procedures.  I've spayed and neutered most of my own pets.  Though I know staff and veterinarians who can't even be working on a day when their own pet is having this happen, it isn't something that has ever bothered me. 

However, Pippin started vomiting yesterday and I've been worried about him.  Intense periodic vomiting, dry-heaving, and a decreased appetite.  This is something that I can't handle well.  Of course my mind runs through the various scenarios and possibilities, quickly jumping to a risk of a gastrointestinal foreign body (he gets into everything).  Money is tight and even with my discounts a major surgery would be a big burden, plus there is the risk involved (see my recent post on GI surgeries).  I spent last night and all day today fretting over him.  I examined him at home and he seemed okay, and he's been acting normal otherwise.  But I've still been tied up with worry.  Thankfully I talked to my wife earlier and he seems to be doing much better.  He does have a habit of getting into dishes in the sink more than any of our other cats, and I'm suspecting that he merely had an upset stomach.

One of the greatest skills that doctors develop is the ability to remain somewhat clinically detached.  We need to be able to approach our cases from the perspective of the best diagnostic, medical, and surgical decisions, and maintain a calm emotional state.  Though we obviously still want to feel compassion and empathy, the job is much easier and we do better if we're not as emotionally involved.  That becomes almost impossible when the patient is one of your own pets.  And I completely understand my colleagues who can't work on their own animals.

Wednesday, July 18, 2012

Lack Of Problems Doesn't Make It Right

The week before last I received an email from Paul, responding to my comments on a recent post about table food for dogs.  Here are some snippets from his letter.

I liked this post -  it spoke to me.  For 19 years I had a border collie – a wonderful healthy and active dog all his life; dying of old age coming up to his 19 birthday – missing the day by a week.  This border collie drank – a pint of milk a day – diluted with water – sometimes with osterfeed thrown in for good measure (my brother was an infant and ends of his formula feed was sometimes added to the water and milk mix that my collie loved).  Never a problem – he never was sick after drinking it and although he also had a bowl of water always he rarely drank much of it.  He ate raw marrow bones regularly – several a week.  He got scraps from the table – only what we knew was not harmful – mixed with porridge, brown  bread,  potatoes, left over meat from meals (steak, chicken, liver, mince etc), cooked vegetables (his were always taken out before salting)  – mainly turnip, cabbage and carrots – he hated peas and parsnip!! – so he didn’t get those.  He had an egg every day and either braised chicken breasts or cooked offal  all in this mix.  He also got a bonio or two every day and every week  “bob martins – vitamin supplements”.  This dog had wonderful energy, fantastic coat and was never sick..........I am not saying I disagree with you with regard to feeding a dog non commercial dog  food (quite the opposite - animals need to be fed properly - correct quantities and right kind of stuff)  but I can understand where your original poster is coming from........As I say this dog lived to be 19 years old (well missing it by one week)and died of old age.  My dogs are now fed high end commercial foods - science plan - but the oldest they have lived to have been 11 and 12 - and that was with health issues a year or two before they died. So I can really understand where your poster Liz is coming from with her question - and while I agree with you that lots of people smoke and don't die of cancer - I have not come across many dogs living long and healthy lives - with no health issues like my collie did.

This is actually a great point for discussion as it addresses a situation I commonly deal with in all aspects of medicine.  I often get clients who think and even say "Well, I've never done it that way and my dog/cat has always been healthy."  I've had clients virtually gloat when their dogs come up negative on their annual heartworm test despite not being on preventatives.  There have been similar responses from people who have only ever had their dogs get rabies and have never seen them get sick from parvo.

Unfortunately people often assume that if the do things (or don't to things) a certain way and nothing bad happens it means that they're doing the right thing.  This couldn't be farther from the truth.  A similar situation would be have someone walk across a four-lane major highway, making it to the other side without injury.  Since they performed this task and weren't run over by a car or truck, they can conclude that it's safe to walk across highways.  Right?  Obviously not.  But that's the kind of logic some people are employing in regards to their pets. Just because someone isn't killed going across a highway doesn't mean it's safe.  And just because someone's dog doesn't get heartworms when they decline prevention doesn't mean that it's the right thing to do.

Heartworms really do infect pets and kill them.  People food and table scraps really do cause pancreatitis and gastrointestinal distress.  Home-cooked food really can be an unbalanced diet.  Parvo really does kill dogs.  All of the things we veterinarians try to talk to clients about really are intended to let pets live longer and healthier.  Discard and ignore our advice at your own peril.

Tuesday, July 17, 2012

Thinking Appointments Are Optional

One of the things that annoys veterinarians the most is when people seem to think that their appointment times are optional.  Virtually every day we have people come in for their appointment early, late, or not at all.  When I'm talking about early/late, I'm not talking a few minutes.  I'm talking about an hour or more!  It gets really bad when you have an appointment show up an hour late, one show up an hour early, and the appointments scheduled for that time are also there.  Yes, this happens!

It's not like we don't try on our end.  We have set appointment times that allow us to space things out, allowing us to have time to do each appointment, drop-off patients, surgeries, and the walk-ins that inevitably show up.  Our receptionists are trained to work the schedule for the client's benefit, but also for ours.  We give them a reminder card if they make the appointment in-person, and then the day before the appointment we call to confirm the appointment time and if they are actually coming in.  Even with all of this we have clients that seem to come in or not come in at their leisure.  What is really bad is the occasional client who then complains because we don't get to them right away even though it's not technically their appointment time.

One of our clinic policies is that we will get just about anyone in the same day they call, though they may have to drop their pet off and allow us to work it in between other appointments.  But these are last-minute calls usually for sick pets that we don't want waiting.  I'm okay with these appointments and am glad to offer them.  That's different than the routine cases that I'm talking about.

No, we don't charge people for these missed appointments, though I have colleagues who do.  I don't think that the precedent is there and the economy is tough enough on vets.  But I've been tempted, as a missed appointment has taken that slot away from someone who might have actually shown up on time.  We DO charge for missed surgeries because those appointments are more limited each day.  And we'll sometimes force a client to reschedule if they come in late and we're busy with other procedures or patients.  But regardless of whether or not there is a charge, I think it often comes down to a lack of courtesy on the part of the client.  Yes, there are sometimes extenuating circumstances or the client legitimately forgets.  But most don't fall into this category.

Let me make a plea to all pet owners on behalf of all veterinarians.  Please be there on time for your appointments.  If you're going to be more than a few minutes late or have decided to not come in, please call and let us know that.  We don't mind you being early, but try not to be too early, and have patience if we make you wait until your scheduled time.  Things are much smoother for everyone involved if appointments are kept.  We schedule them for a reason.

Monday, July 16, 2012

Intestinal Surgeries: Two Outcomes

**CAUTION**  Graphic images of surgery are presented on this entry!  Viewer discretion is advised!

Though no surgery is without risk, some are certainly higher risk than others.  I had two similar cases a couple of months ago that each had very different outcomes.

The first case was a young American bulldog.  A little over a year ago he had surgery to remove a rock lodged in his small intestine.  He presented to me with similar symptoms, lethargic and vomiting.  The owner was concerned that he ate part of a cloth toy.  The first set of x-rays didn't show anything, so we did a barium series which showed a blockage in his upper GI tract or stomach.  The owner gave the go-ahead to do surgery.

First I explored the stomach because that was where the barium seemed to stop.  He was a large, deep-chested dog so I had to work in a bit of a hole.  If you've ever wondered, here's what the inside of the stomach looks like.

I spent a good bit of time emptying his stomach and both looking and feeling around.  About 30 minutes later and I had to conclude that the obstruction wasn't there.  I closed up the stomach and went looking through the rest of the GI tract.  It didn't take too long to find an obvious abnormal object in the small intestine.

It took a couple of incisions, but the object came out and I closed the intestine and the patient.  Here's what was in there.

He did well immediately post-operatively and we had the owner take him to the closest after-hours clinic for monitoring since it was such a major surgery.  Over the next few days he didn't seem to be doing well, then ended up at the emergency clinic again.  This time he apparently had peritonitis (infection within the abdomen) from a possible leakage or other infection.  Due to the costs and the prognosis, the owner elected euthanasia.

A week later I saw a cat that was acting the same way.  The owner did have ribbon around but had always been very careful with it since the cat had a tendency to chew on it.  She even cut the ribbon off her children's' balloons to keep them from the cat.  An x-ray didn't show anything but the owner was worried enough that she wanted exploratory surgery.  Once I got in there it didn't take long to find an obstruction.

Here's a better view from post-op.

Yes, that's ribbon.  And the owner couldn't remember having any ribbon of those colors, especially together.  The cat did better, recovered quickly, and looked great on the 10-day post-operative recheck.

Two intestinal surgeries, same surgeon, two very different outcomes.  Unfortunately we can't say that every surgery will do well and there will never be complications afterwards.  Even the best surgeon can only minimize risks, rather than eliminating them.  Surgery on the stomach and intestines is always very risky, but usually is better than death.  Numerous things can go wrong, even if the surgery is done properly.  Even if you're careful, an incision may leak, especially if there is a lot of movement afterwards.  The dog did vomit a little within 24 hours of recovery, which might have pulled on the stomach sutures.  If there is damage to the walls of the stomach or intestines the risk is higher, though this wasn't a problem in these cases.

Another lesson can be learned in these cases.  Be very careful about what your pet has a chance to chew on!  In the dog's case this was his second GI surgery and there was some internal scarring from the first one, which may have affected his outcome.  Both pets were known for chewing on things and the owner didn't see them actually swallow what I removed.  The other lesson is to not automatically assume the pet didn't swallow something just because you didn't find anything missing or chewed on.  The cat's owner never figured out what ribbons the cat had gotten into.  I have seen more than one case where the owner insists their pet didn't eat anything yet we find it on x-rays or in surgery.

Saturday, July 14, 2012


My son came back from 4H camp today.  When I saw him get off the bus he somehow looked older and more mature.  Our worries over him were unfounded, as he had a blast and made many new friends (which he said was one of his favorite things about camp).  My little boy is growing up before my eyes.  It also hit me when he said that he could go to camp for another two years and then if he wanted to keep going he would have to attend as a teen counselor.  I quickly did the math and realized that in three years he'll be 14.  Wow!

Unfortunately my family isn't all back together.  Yesterday my wife left for a weekend getaway with some college friends of hers and won't be back until Sunday.  So last night it was just me and my daughter.  Today and tomorrow it's me and the kids.  Then Sunday we'll be back together.

Having us split up this week reminds me of how wonderful family can be.  Sure, it can be a pain at times, and I've been frustrated with my kids and my wife.  But I also love them all very much and feel so blessed to have them in my life.  This is one of those times when the saying "absence makes the heart grow fonder" applies.  I missed my son and I miss my wife.  In two years when both kids are able to go away to camp (my daughter is dying to go) I'm not sure how we'll handle it without them for a week.  But it's all part of growing up.

So I want to take this opportunity to tell the world (since I have an international readership) how much I love my family.  I am a very blessed husband, father, and man to have these kids and this woman as part of my life.  

Now if I can just get everyone back in town at the same time....

Thursday, July 12, 2012

The Art Of Escaping A Room

I love most of my clients.  Really I do.  And there are some that I'd talk to all day.  But there are others that I just can't seem to get away from.  It has nothing to do with me not liking them, but the fact that some won't seem to shut up.

This is actually a real balancing act that us vets and our staff have to get good at. On one hand we want to be personable and open, willing to chit-chat to develop that relationship and rapport with our clients.  We also want to make sure we answer any questions they have and make sure we get a detailed history on their pet's health.  On the other hand we really don't want to hear someone's life story or about their sister's cousin-in-law's divorce.  When you see 20-30 patients in a day you can't afford to spend a half-hour or more talking to a single client.  It seems to always happen when all of the exam rooms are full and people are waiting in the lobby.  I'll get really backed up if I'm the only doctor on duty.

So how do you get out of the room with a very talkative client?  Very carefully.

First you have to make sure that they really are re-hashing things you've already covered or are just rambling.  You never want to leave a room if there are still important and relevant things to discuss.  When I want to make an exit I'll try to sum up what we're doing or state that they can go up front to check out.  If that doesn't work I'll walk to the door and put my hand on the doorknob, sometimes turning it and opening the door slightly.  Unfortunately some people don't get that hint and I end up being stuck with no real way out.

That's where it pays to have assistance.  And here's where I let you in on a little secret.  My staff is trained so that if we're getting backed up and it seems like me or another doctor is trapped in a room, they'll come in and say "Doctor, your next patient is here," or, "Doctor, we need you in the back for something."  Most of the time this allows me to politely make my escape within a minute or so, if not immediately.  If I know that a client is normally very talkative and I don't want to spend the next hour in the room, I'll tell my staff to come get me after a certain period of time (usually 10-15 minutes).

Is this unfair to the client?  I certainly don't think so.  At my clinic we really try to emphasize that relationship with each client and we give them all of the attention we can.  I stress to my clients and my staff that I never want anyone leaving with unanswered questions.  But at the same time we have to respect the next client on the schedule, or keep in mind that we have sick patients or surgeries that a doctor should attend to.  We're not going to be an effective medical team and not going to give good client service if we spend too much time with a given pet owner.  So from time to time we have to do things to allow us to move on to the next thing.

For any pet owners reading this, watch for those signals.  Hopefully your vet is friendly and addresses all of your questions.  But if they have their hand on the doorknob or an assistant comes in the room needing the doctor elsewhere, that's probably the signal that it's time to go check out.

Tuesday, July 10, 2012

Growing Up For Parents and Kids

Yesterday my son left for 4H camp.  He won't be back until Friday, keeping him away from home for a full four nights.  This is the first time in his life that he's been on any kind of overnight trip away from family other than a single night for sleepovers with friends.  Not only is he gone, but the camp rules state that he can't have a phone, computer, or any non-emergency contact with the outside world.  I have no idea how he is doing, what he's experiencing, or whether he's scared or homesick.  It's a bit strange!

I'm not worried about his safety, as this is the largest 4H camp in the country and there are around 1000 kids there and there's plenty of oversight.  He's also going with a friend from our neighborhood whose older brother is one of the camp counselors.  I'm more worried about his mental state.  He's 11 years old and a very tender-hearted boy.  We home-school but he's been to public school and knows how to get along with others.  He also interacts with other 4H kids so he's not socially isolated.  But he's generally a kind, sweet boy who isn't used to the harshness of much of life and hasn't recently had to deal with bullies or kids picking on him.  For better or for worse he's not extremely athletic and loves the comforts of home and air conditioning.  So I don't know how well he's going to do in camping huts and no video games or TV.

Though the hardest part is probably from our end.  My wife admitted that she almost cried dropping him off at the bus yesterday, and it feels very strange not to have him around.  We've decided that it wouldn't be quite as bad if we could talk to him, so the uncertainty makes it worse.  Though I think I'm handling it better than her, I have to admit a strange feeling in my gut because I can't check on him.

The longer I am a parent the more I realize what my own parents went through.  There is a growing up process not just for the kids but for the grown-ups as well.  This experience is new for all of us and we adults are having to make adjustments as much as he does.  I know we'll be as eager to have him back as he will to be back.  As long as he gets back safely and had fun, I'll be okay with the experience.  But that will open the door to more freedoms and in a short seven years he'll be graduating from high school.

My daughter is nine, so I know she's next.  She has two more years before she can go to camp like her brother, and I'm not sure how well I'm going to handle it.  Honestly it will probably be easier for me because she is more independent and social than him and I'll have gone through it once already.

As much as my wife are eager to have the kids gone and the house to ourselves again, I have to say that I'll also miss them a bit.  Of course by that time I'll probably be fed up with them as teenagers so we'll see.

Thursday, July 5, 2012

Why Setting A Plate For Your Dog Is Bad

Liz sent this in after reading one of my recent blog posts....

I was reading one of your recent blogs and a particular line caught my attention:
"They may offer ham, hot dogs, steak, hamburger, cottage cheese, rice, bread, and many other things, usually food items that we recommend never to feed."
Every item in that list (other than bread) is basically what comprises my family's dogs' diets. My parents were advised 20 some years ago by their holistic veterinarian to feed our dogs essentially the same foods we eat (with obvious exceptions such as toxic food items and things with excessive salt/sugar/fat contents). Our dogs are fed what is on your list of "no-no" foods, as well as lima beans (our bichon's favorite food!), other beans, pasta, sausage, brats, spam and cheddar cheese (these, in addition to your list, being the usual staples). And foods with a higher fat/salt contents are fed more sparingly than the others. We have always had small breed dogs (lhasa apsos, and more recently a shih tzu and bichon frise); none of them have ever had medical problems and have all lived to be 14+ years old and have died of old-age or old-age related organ failures, and none have been overweight, prone to overeating or had digestive issues. We also keep a bowl of kibble out for free-feeding when they want it, but generally they eat whatever it is we eat for dinner unless it is inappropriate- then we prepare food from the staple food list. Since my parents received this advice some time ago I was wondering what your opinion on this form of diet is? Has there been any recent research you are aware of that has proven this sort of diet to actually be harmful? Or is it just generally a frowned upon practice because it is usually not properly executed by clients? I will be starting veterinary school in the Fall and as of this point I am personally inclined to see nothing wrong with this diet if it is not abused and there is no medical need to use a special diet; but I'm obviously no expert and would love to hear your take on it! Thanks!
Let me begin by giving a little disclaimer.  You will get a big difference of opinion on multiple subjects between holistic vets and traditional vets.  I am speaking from a traditional Western medicine aspect so what I say may be at odds with someone who practices with more of a homeopathic or holistic style.
A dog's digestive system and nutritional requirements is very different than ours.  Many things that we may get great benefit from are useless to dogs because of these differences.  This is especially true of vegetable material.  They are also much more prone to digestive and pancreas issues with highly fatty foods than we are.  And there are some foods that are healthy for us but potentially toxic to dogs (grapes, raisins, chocolate, and potentially even garlic or onions).  We should never assume that just because it's good or safe for us that it also is for other animals.  That could be a deadly mistake to make.
Liz one of the things that concerns me about this diet you describe is that there are a lot of high-fat foods you're feeding and may not even realize it.  Hot dogs, brats, sausage, and Spam are all typically very fatty foods and in my opinion should never ever be a staple of a dog's diet.  Even hamburger and steak can be potentially dangerous depending on the fat content.  These things can cause upset of the pancreas which can be a serious illness. 
Dairy products give a dog little benefit because they are mildly lactose intolerant and don't absorb milk sugars and calcium very well.  Rice isn't bad and neither are beans, both having good nutritional value even for a dog.  Things like bread and cottage cheese are fine as treats or to aid in giving medications, but shouldn't be a main part of the diet.
The big question I would ask is how well balanced your own diet is.  Are you getting the right amounts of trace nutrients and minerals?  How are your own personal fat and sodium intake levels?  Is anyone in your family clinically overweight?  Have doctors told you to modify your own family's diet for various health reasons?  Of course I don't expect you to answer these questions to me, but they are worth you thinking about.  If your own diet isn't completely balanced and designed by a nutritionist, then what you're giving your dogs isn't balanced either.  I'm not pointing fingers because I fall into that category myself!
If you do have a high-quality completely balanced diet we still go back to the situation that dogs have different nutritional needs than we do and have different digestive processes.  What's great for us may not be for them, and I think it is wrong to assume that it's fine.  If you look at dogs in the wild their main source of food is the meat, organs, and bones of prey.  They typically don't eat grains or other vegetable items unless they are part of the gastrointestinal contents of their prey.
It is possible to make a nutritionally balanced and appropriate home-made diet.  However, that takes a lot of work including using vitamin and mineral supplements mixed with their food.  You need to do proper research and make sure that the source of your information is appropriate, such as a veterinary nutrition text book.  I have never heard of a veterinary nutritional specialist that has ever advocated a pet diet that is merely feeding what you feed your own family.  Yes, they may recommend certain human foods or diets, but that is part of a carefully designed nutritional plan. 
So, Liz, that's my opinion on the subject.  Just because nothing bad has happened so far doesn't mean that everything is being done right.  It's like when people who are chain-smokers make it into their 90s we can't therefore conclude that smoking is healthy.  Again, you may get different opinions on nutrition from a holistic vet.
Since you're going into vet school soon, be sure and ask your professors.  I'm sure they can give you a much more detailed response than I can!

Tuesday, July 3, 2012

Nicks & Tipples

Did you know that it's not uncommon for pet owners to misdiagnose ticks?  I see it happen relatively frequently, including just today.

A woman brought her dog in because it had ticks on its genitals and she wanted them removed.  I looked all over this dog's belly and nether-regions but didn't find a single tick or flea.  What I did find was a pigmented nipple on either side of his sheath (prepuce).  We confirmed with the owner that this was what she saw, and were able to let her know that this was absolutely normal.

Like in humans nipples are present on both sexes of dogs and cats.  Unlike humans the nipples run from the chest all the way down to the groin region, which means that male dogs will have nipples next to their penis.  A variation can occur that causes them to be pigmented, turning black.  This is normal and not a concern.

I have had people think their dogs had ticks when they actually had a pigmented nipple, mole, polyp, or scab.  I've even had people try to pull these off at home before coming to see me when it wouldn't come off and started bleeding.  Many people tend to look at a dark bump on their pet and make an assumption that it is a tick.

Here's a few hints.  Look closely at the bump and see how it's attached.  If the entire length of the bump is attached to the skin, it probably isn't a tick.  If only one end is stuck or buried, it probably is a tick.  But the biggest giveaway is the legs.  Look very closely where it attaches and you should see little tiny legs.  If not, it probably isn't a tick.  If in doubt, see your vet.

Today we started naming this phenomenon.  We threw around tick-nipple before I decided that we could combine the words.  So which do you prefer?  "Tipple"?  Or "nick"?