A commenter posted this, which I felt was worthwhile answering.
I am a high school student aspiring to become a veterinarian. I'm in the process of looking at colleges and figuring out which undergraduate programs will give me the best chances of getting into a good vet school (which I know is very competitive). I was wondering what advice you might have about what's important to consider in the whole college-search process in order to reach my goal of ultimately getting a DVM.
I may be a bit controversial with my comments here, but I don't feel that there is much difference in colleges when it comes to going into veterinary school as long as you can meet the minimum requirements. Yes, some schools have higher ratings than others. But you don't need to go to a school like Yale, Harvard, or Oxford to get into vet school. I went to a small state school in western North Carolina and received a very good education. Someone involved in veterinary student selection might be able to contradict me, but I've never seen any strong evidence that the college on your diploma makes much of a difference in entering vet school
The main thing to look for in colleges is whether or not they have a pre-veterinary program. If they do, then pick a college based on your location preferences and budget. State schools will be much cheaper than private ones, and that may be a big factor in your choice. Pre-veterinary programs are designed so that they will meet the entry requirements of most veterinary colleges. It's not to say that you couldn't get into vet school going to a college without a specified pre-vet curriculum. But in those cases you will have to be much more careful in your choice and find out the requirements of the vet schools you might choose. You can request a catalog from any vet school and they will list which courses and grade average they look for in their candidates. Then you can compare these requirements against the courses offered at a college.
The important factors tend to be your grade point average, especially in the required courses, veterinary experience and recommendations (you'll need both), extracurricular activities, and sometimes an interview (depending on the school). If you have these covered you'll be in good shape. If you have poor grades or are missing experience, it won't matter which college you went to.
Keep in mind that you will likely be heavily in debt when you graduate vet school, probably well over $100,000 if current trends hold true. I would recommend an undergraduate school that is less expensive or that you can get scholarships or grants so that you lessen your debt load entering vet school. I managed to make it into vet school without any outstanding debt at all, and then racked up around $40,000 in loans in four years (and this was back in the late 1990s when costs were lower than they currently are).
Good luck in following your dream!
Sunday, March 13, 2011
Friday, March 11, 2011
Finding Motivation
This might be a shocker to those outside of the veterinary field. Sometimes vets simply don't want to go to work or don't want to see cases while they are there. Yes, I know we're supposed to love our job and according to surveys most vets do. But we're only human and no matter how much someone loves their job there are some days when you're just simply lacking motivation to perform.
This isn't a good situation in any job. A factory worker needs to be able to perform up to standards or they could be injured or produced shoddy materials. A cashier may not have many responsibilities, but they should still be careful about what they ring up and what kind of attitude they have. When a doctor is unmotivated it's a bit trickier, because they are responsible for the lives and health of their patients. If they simply don't feel like doing their job it can directly impact lives.
There are various reasons why someone might lack motivation in their job, and I think most reasons apply to any profession. They may not like their job, or at least not like their location and co-workers. They might be very tired and burned-out and therefore find it hard to motivate themselves. Or they might simply be having a lazy day and not feel like doing much (and you know we've all had those days!). A big problem with veterinarians is that it is easy to get burned out because we work so many hours and days and have a lot of emotional stress due to some of the cases.
So what do you do when you're a vet and you have to deal with normal clients, sick pets, surgery, and a full day's schedule, but you don't really want to? Like in any job you persevere and simply get to it. I find that rather than thinking about the entire day or the numerous drop-offs waiting for my attention, it's easier to just look at one case at a time, focusing on that before moving on to the next one. You might take more frequent bathroom breaks to have a bit of quite time. You also rely on your staff, letting them help direct your day, joke around with them, and maybe even playfully complain to and with them (I've had days when about 10 minutes after I arrive in the morning I ask the staff "Is it time to go home yet?" and then keep a running tally of how long until closing). If you really are burned out, then you need to make time for a vacation, even if it's staying home for a few days and sleeping late.
With as much stress as we have, there is no way for a veterinarian to be 100% motivated every single day, yet we can't let the quality of our medicine falter. So as an aid among friends and colleagues, I'd love to hear what others do to maintain motivation in their jobs on those days when they don't have it. By sharing with each other we can help one another, and help prepare students for the times ahead of them.
This isn't a good situation in any job. A factory worker needs to be able to perform up to standards or they could be injured or produced shoddy materials. A cashier may not have many responsibilities, but they should still be careful about what they ring up and what kind of attitude they have. When a doctor is unmotivated it's a bit trickier, because they are responsible for the lives and health of their patients. If they simply don't feel like doing their job it can directly impact lives.
There are various reasons why someone might lack motivation in their job, and I think most reasons apply to any profession. They may not like their job, or at least not like their location and co-workers. They might be very tired and burned-out and therefore find it hard to motivate themselves. Or they might simply be having a lazy day and not feel like doing much (and you know we've all had those days!). A big problem with veterinarians is that it is easy to get burned out because we work so many hours and days and have a lot of emotional stress due to some of the cases.
So what do you do when you're a vet and you have to deal with normal clients, sick pets, surgery, and a full day's schedule, but you don't really want to? Like in any job you persevere and simply get to it. I find that rather than thinking about the entire day or the numerous drop-offs waiting for my attention, it's easier to just look at one case at a time, focusing on that before moving on to the next one. You might take more frequent bathroom breaks to have a bit of quite time. You also rely on your staff, letting them help direct your day, joke around with them, and maybe even playfully complain to and with them (I've had days when about 10 minutes after I arrive in the morning I ask the staff "Is it time to go home yet?" and then keep a running tally of how long until closing). If you really are burned out, then you need to make time for a vacation, even if it's staying home for a few days and sleeping late.
With as much stress as we have, there is no way for a veterinarian to be 100% motivated every single day, yet we can't let the quality of our medicine falter. So as an aid among friends and colleagues, I'd love to hear what others do to maintain motivation in their jobs on those days when they don't have it. By sharing with each other we can help one another, and help prepare students for the times ahead of them.
Tuesday, March 8, 2011
Proper Communication
LeAnne emailed me with the following...
I am currently in the process of applying to veterinary school (I have an interview next week at UC Davis - wish me luck!) and I'm a full time technician at a four doctor canine and feline practice. My question stems from my experiences at work and from contemplating my own future as a veterinarian.
Part of my job is to restrain pets during exams. Because I'm pre-vet, I like to stick around after the exam to listen to the doctors go over their observations and recommendations. One of the doctors surprises me regularly by using a lot of veterinary words such as "palpation", "crepitus", "cranial abdomen", and other words that it seems to me lay people may or may not know (she says things like "I don't feel anything when I palpate the cranial abdomen"). On the other hand, she also seems to use a lot of veterinary slang as well; for example, she refers to taking an xray as "taking a picture" (I wonder if anyone ever thought she was actually taking a picture with a camera?). Once, she told someone with a puppy who was leaking urine that she wanted to ultrasound him in back to "see if he had a bladder"--meaning check to see if his bladder was full--so we could get a urine sample. The owner blinked her eyes and said, "is it possible that he might not have a bladder?" to which the doctor replied, "sure, especially if he just urinated." The owner okay'd the ultrasound and nothing more was said. I asked the doctor in back if she thought the client could have misinterpreted her and thought that the puppy may have no bladder at all. The doctor just laughed and said, "geez, I hope not!"
It got me wondering about client communications and the assumptions that doctors make about client comprehension. It seems a lot of people just nod and say okay even when they don't have the darnedest clue what the doc's going on about. What about things like the efficacy of tests--even ones that come back negative--or the fact that, depending on the nature of the ailment, the first medication or treatment tried may not always be the most effective? There are so many situations in which techs and doctors talk about things they know well or even bored to reiterate but are like greek to someone who has never heard them before.
I was wondering if you might comment about generally about how you address this issue both within yourself as a doctor and with the vets and techs that work under you. Also, how do you "dumb it down" without insulting those clients who CAN keep up with the big words and the jargon?
I am currently in the process of applying to veterinary school (I have an interview next week at UC Davis - wish me luck!) and I'm a full time technician at a four doctor canine and feline practice. My question stems from my experiences at work and from contemplating my own future as a veterinarian.
Part of my job is to restrain pets during exams. Because I'm pre-vet, I like to stick around after the exam to listen to the doctors go over their observations and recommendations. One of the doctors surprises me regularly by using a lot of veterinary words such as "palpation", "crepitus", "cranial abdomen", and other words that it seems to me lay people may or may not know (she says things like "I don't feel anything when I palpate the cranial abdomen"). On the other hand, she also seems to use a lot of veterinary slang as well; for example, she refers to taking an xray as "taking a picture" (I wonder if anyone ever thought she was actually taking a picture with a camera?). Once, she told someone with a puppy who was leaking urine that she wanted to ultrasound him in back to "see if he had a bladder"--meaning check to see if his bladder was full--so we could get a urine sample. The owner blinked her eyes and said, "is it possible that he might not have a bladder?" to which the doctor replied, "sure, especially if he just urinated." The owner okay'd the ultrasound and nothing more was said. I asked the doctor in back if she thought the client could have misinterpreted her and thought that the puppy may have no bladder at all. The doctor just laughed and said, "geez, I hope not!"
It got me wondering about client communications and the assumptions that doctors make about client comprehension. It seems a lot of people just nod and say okay even when they don't have the darnedest clue what the doc's going on about. What about things like the efficacy of tests--even ones that come back negative--or the fact that, depending on the nature of the ailment, the first medication or treatment tried may not always be the most effective? There are so many situations in which techs and doctors talk about things they know well or even bored to reiterate but are like greek to someone who has never heard them before.
I was wondering if you might comment about generally about how you address this issue both within yourself as a doctor and with the vets and techs that work under you. Also, how do you "dumb it down" without insulting those clients who CAN keep up with the big words and the jargon?
This is an excellent topic of discussion and one that's often overlooked in veterinary training. Medical terminology is very much a foreign language (quite literally considering the Greek and Latin origins of most words), and doctors spend all of their years of training learning this language. It becomes so ingrained in us that it can be easy to forget that others don't understand what we're talking about. At the same time this terminology is very specific and allows us to communicate with colleagues much more specifically than when using "ordinary" language. For example, an average person might say that there's a lump in the "upper belly". While the person might have a good idea of where this might be, it's actually very non-specific. A doctor might say that there is a mass in the "dorsal cranial abdomen" which means more to a medical professional.
I remember similar experiences to yours, LeAnne. When I was going an externship while in vet school I was at a surgical referral practice in Charleston, South Carolina. One of the doctors was trying to explain to the client about the fracture in the dog's foot. He was using terms like "distal phalanx", "comminuted fracture", and other very specific and proper medical terms. I remember looking at the client and seeing a very blank look on his face, indicating a complete lack of understanding. Yet the vet never seemed to notice or possibly didn't care. That experience really stuck with me.
One of the first lessons is that there are really three different populations of people you will be talking to as a vet. The first is the average client who has no medical background or experience. In these cases you need to avoid using medical terms, keeping it to common terms (x-rays rather than radiographs, ear flap rather than pinna, hip socket rather than acetabulum, and so on). The second group is people with human medical backgrounds who understand anatomy, physiology, and medical conditions, though not necessarily veterinary-specific situations. I generally speak to these people (nurses, MDs, paramedics) with mostly proper medical terminology, but will sometimes ask questions to make sure they're following me. The third group is the veterinary colleagues, and you can speak to them with as much terminology as you want.
You also have to avoid professions-specific slang or lingo. "Chem panel", "CBC", "rads", and other terms are not always understood by people, and yet aren't specifically appropriate medical terminology. There are ways to say these things and have people realize what you are saying, such as "organ chemistry analysis", "blood cell count", and "x-rays". Each clinic may also have certain language they use that other veterinarians may not even understand. How many vets know what a "comp" is? In Banfield Pet Hospitals (in the US) this is slang for a "Comprehensive Exam".
This is a learned skill and one that you have to actively develop. In general I avoid detailed medical terms and try to use common terms. If I absolutely have to use medical terminology or if it's just easier when describing a problem, I'll define it for the client before using it. I only slip into specific veterinary terms when I'm talking with other veterinary professionals, and then I gladly do so because it's much more specific.
LeAnne, does this veterinarian realize what she is doing? Has anyone brought up to her the possibility that clients won't understand? Since communication is a skill, it may take some training and someone to point out ways to improve.
Lastly and possibly most importantly, there is something simple that many people forget. Ask for comprehension! Before I leave a room, the last thing I always do is ask the client if they have any questions. When explaining something complicated, I'll ask them if they understand what I'm talking about. This gives people the chance to (even permission to) gain further comprehension and ask any questions they may have been afraid to at the beginning.
Great question, LeAnne. Good luck with your application.
Friday, March 4, 2011
Wait, Where's The Microphone?!?
Today I had a brand new experience. I was on TV for a local station talking about dental care in pets. And it didn't go exactly as I expected.
I've never been in a TV studio before, so I didn't know what was going to happen. I brought my dog, Inara, to use as a sort of prop to demonstrate how to brush a dog's teeth, and had arranged this ahead of time with the producer. I arrived at the appointed time, abut 15 minutes before air time, and spent some time talking to the station receptionist. At 5:30 they called me into the studio and I quietly entered as they were starting their broadcast. I had never actually met anyone from the station in person, so I wasn't completely sure who I was supposed to talk to. I discovered that the person I was told to contact was one of the anchors, and she was on air as I came in. During the breaks while they went to video and during the commercials we were able to briefly talk. I was a little surprised when she asked me what I wanted her to ask me about, as I thought she would have done some prep work ahead of time. And she was asking me this as they gave us the 1-minute warning before we went live!
We were sitting at an interview desk, and Inara is a 60 pound lab mix. When she was on the floor she couldn't be seen, so they asked if she could sit on my lap. I picked her up and she's a good enough dog that she sat there quietly even though I could tell she was a bit nervous. I discovered that the anchor was nervous also, as she looked rather uncertain about Inara being that high and close and even asked me if she was going to jump across the desk at her. I was quick to assure her that Inara was very sweet and most certainly wouldn't do that.
So they gave the signal and we started to talk. I began to go into the statistics of dental disease in pets and the link between dental problems and other health concerns. A little less than a minute into my talk the anchor said that they couldn't hear me and that my microphone must have fallen off. Keep in mind that we were on live TV! So right there I had to let Inara off my lap, quickly look on the floor to find the mike, and then put it back on my lapel. All of that used up about a minute and a half of the four minute segment! I quickly moved past that and continued my discussion of dental disease and care, using a model of a dog's mouth that I had brought.
In no time at all the interview was over and we finished up. The anchor returned to her main desk, they thanked me, and I left. Once I walked out I immediately began to think of all of the things I didn't say and should have said. I covered the basics, but also unintentionally left out such important things as "be sure to see your vet for dental cleanings", "tooth brushing won't remove established tartar," and so on. I guess hindsight is always 20-20, and whenever I've done presentations I've always had a longer period of time. This being my first time on TV I wasn't used to the quick pace and limited time. So now I'm kicking myself a little bit because of the things I left out.
Overall it was a good experience, and I'd like to think I handled myself well for my first TV interview and appearance. The anchor even said that I handled the microphone issue very calmly and did well. Hopefully I did well enough that I may get other opportunities, as I did enjoy it and really like doing public speaking. And the next time I'll do better as I have a much clearer idea of how the process works.
I've never been in a TV studio before, so I didn't know what was going to happen. I brought my dog, Inara, to use as a sort of prop to demonstrate how to brush a dog's teeth, and had arranged this ahead of time with the producer. I arrived at the appointed time, abut 15 minutes before air time, and spent some time talking to the station receptionist. At 5:30 they called me into the studio and I quietly entered as they were starting their broadcast. I had never actually met anyone from the station in person, so I wasn't completely sure who I was supposed to talk to. I discovered that the person I was told to contact was one of the anchors, and she was on air as I came in. During the breaks while they went to video and during the commercials we were able to briefly talk. I was a little surprised when she asked me what I wanted her to ask me about, as I thought she would have done some prep work ahead of time. And she was asking me this as they gave us the 1-minute warning before we went live!
We were sitting at an interview desk, and Inara is a 60 pound lab mix. When she was on the floor she couldn't be seen, so they asked if she could sit on my lap. I picked her up and she's a good enough dog that she sat there quietly even though I could tell she was a bit nervous. I discovered that the anchor was nervous also, as she looked rather uncertain about Inara being that high and close and even asked me if she was going to jump across the desk at her. I was quick to assure her that Inara was very sweet and most certainly wouldn't do that.
So they gave the signal and we started to talk. I began to go into the statistics of dental disease in pets and the link between dental problems and other health concerns. A little less than a minute into my talk the anchor said that they couldn't hear me and that my microphone must have fallen off. Keep in mind that we were on live TV! So right there I had to let Inara off my lap, quickly look on the floor to find the mike, and then put it back on my lapel. All of that used up about a minute and a half of the four minute segment! I quickly moved past that and continued my discussion of dental disease and care, using a model of a dog's mouth that I had brought.
In no time at all the interview was over and we finished up. The anchor returned to her main desk, they thanked me, and I left. Once I walked out I immediately began to think of all of the things I didn't say and should have said. I covered the basics, but also unintentionally left out such important things as "be sure to see your vet for dental cleanings", "tooth brushing won't remove established tartar," and so on. I guess hindsight is always 20-20, and whenever I've done presentations I've always had a longer period of time. This being my first time on TV I wasn't used to the quick pace and limited time. So now I'm kicking myself a little bit because of the things I left out.
Overall it was a good experience, and I'd like to think I handled myself well for my first TV interview and appearance. The anchor even said that I handled the microphone issue very calmly and did well. Hopefully I did well enough that I may get other opportunities, as I did enjoy it and really like doing public speaking. And the next time I'll do better as I have a much clearer idea of how the process works.
Thursday, March 3, 2011
Peri-Operative Care
Amanda emailed me with this...
My name is Amanda M**** and I am a student working on my Associate's Degree in Veterinary Technology. I have an assignment to prepare a presentation on the preop, peri-op, and postop procedures for a surgery. I have chosen Enucleation for my topic, but I'm having a hard time finding information specific to preop, peri-op, and postop procedures. I read your post "Bye Bye Eye" from August 4, 2010, and it was helpful--especially the pictures (which are also hard to find). I read that you welcomed questions, so I thought I'd send you a line. If you have time, could you please tell me what is needed to take care of the animal surrounding the surgical procedure? I thought you would be a perfect source of information, and I would appreciate, greatly, any information you'd be able to share with me!
That's a great question, Amanda, and one that ties in with the recent discussion and comments about the importance of technicians in anesthesia monitoring. We veterinarians couldn't do our job without our support staff, so I'm happy to help illuminate exactly what they do in cases like this.
Pre-Operatively
The veterinary technician or assistant helps perform the pre-anesthetic exam. Often they are the ones collecting the blood and should be the ones performing the diagnostic tests. They check the anesthesia equipment for proper functioning (checking oxygen levels, performing leak tests on the machine, etc.), gather the surgical instruments and suture, prepare the monitoring sheets, and otherwise make sure everything is ready for the doctor. Once it is time for surgery they may place IV catheters and set up fluid lines.
Peri-Operatively
Depending on state laws and legal certifications (when necessary) technicians may induce and intubate the patient. They hook up the monitoring equipment and begin preparing the patient and sterilizing the surgical site. During the procedure itself their primary responsibility is to keep track of the vital signs by monitoring and recording the data. They should also be examining the pet themselves (listening to the chest, feeling the pulse, checking gum color, etc.) and not just relying on the equipment. If the doctor needs more suture, new instruments, or anything else, it is their responsibility to get it since the doctor is scrubbed and sterile.
Post-Operatively
The tech normally monitors the pet during the initial recovery and extubates them once they are swallowing. Vital signs are taken again and the pet placed on a warming pad if necessary. As the pet recovers the assistant is responsible for continuing to monitor, usually administering any post-op analgesics or other medications. Depending on the nature of the surgery (routine versus uncommon) the tech will often discharge the patient, going over medications and at-home instructions.
Now these are the general instructions for just about any surgery. An enucleation really isn't that much different. Surgical shaving, scrubbing, and prep is different just because of the different location (such as versus a spay). The doctor is doing a much different surgery than an neuter or splenectomy, but that's all the responsibility of the vet and not the tech. Post-op instructions for most surgeries are going to be pretty similar, so there won't be that much difference from other surgeries.
Amanda, I hope this answers your questions!
My name is Amanda M**** and I am a student working on my Associate's Degree in Veterinary Technology. I have an assignment to prepare a presentation on the preop, peri-op, and postop procedures for a surgery. I have chosen Enucleation for my topic, but I'm having a hard time finding information specific to preop, peri-op, and postop procedures. I read your post "Bye Bye Eye" from August 4, 2010, and it was helpful--especially the pictures (which are also hard to find). I read that you welcomed questions, so I thought I'd send you a line. If you have time, could you please tell me what is needed to take care of the animal surrounding the surgical procedure? I thought you would be a perfect source of information, and I would appreciate, greatly, any information you'd be able to share with me!
That's a great question, Amanda, and one that ties in with the recent discussion and comments about the importance of technicians in anesthesia monitoring. We veterinarians couldn't do our job without our support staff, so I'm happy to help illuminate exactly what they do in cases like this.
Pre-Operatively
The veterinary technician or assistant helps perform the pre-anesthetic exam. Often they are the ones collecting the blood and should be the ones performing the diagnostic tests. They check the anesthesia equipment for proper functioning (checking oxygen levels, performing leak tests on the machine, etc.), gather the surgical instruments and suture, prepare the monitoring sheets, and otherwise make sure everything is ready for the doctor. Once it is time for surgery they may place IV catheters and set up fluid lines.
Peri-Operatively
Depending on state laws and legal certifications (when necessary) technicians may induce and intubate the patient. They hook up the monitoring equipment and begin preparing the patient and sterilizing the surgical site. During the procedure itself their primary responsibility is to keep track of the vital signs by monitoring and recording the data. They should also be examining the pet themselves (listening to the chest, feeling the pulse, checking gum color, etc.) and not just relying on the equipment. If the doctor needs more suture, new instruments, or anything else, it is their responsibility to get it since the doctor is scrubbed and sterile.
Post-Operatively
The tech normally monitors the pet during the initial recovery and extubates them once they are swallowing. Vital signs are taken again and the pet placed on a warming pad if necessary. As the pet recovers the assistant is responsible for continuing to monitor, usually administering any post-op analgesics or other medications. Depending on the nature of the surgery (routine versus uncommon) the tech will often discharge the patient, going over medications and at-home instructions.
Now these are the general instructions for just about any surgery. An enucleation really isn't that much different. Surgical shaving, scrubbing, and prep is different just because of the different location (such as versus a spay). The doctor is doing a much different surgery than an neuter or splenectomy, but that's all the responsibility of the vet and not the tech. Post-op instructions for most surgeries are going to be pretty similar, so there won't be that much difference from other surgeries.
Amanda, I hope this answers your questions!
Wednesday, March 2, 2011
The Privilege Of Pets
My latest poll was a little surprising for a couple of reasons. First, there were 152 responses, which is almost double the last poll and far higher than any previous. Second, the opinions were very strongly one-sided. How did people view pet ownership?
A right--5%
A privilege--93%
Not sure--1%
I strongly believe that nobody has a RIGHT to own a pet. You also don't have a right to drive a car, a right to buy a TV at a certain price, and so on. Dictionary.com defines "right" (in this context) as follows:
a just claim or title, whether legal, prescriptive, or moral
If pet ownership was a right, then you would be entitled to have one regardless of your ability to care for it. You would also be entitled to have a pet even if you couldn't afford to purchase one...one would have to be given to your or provided to you. As a right you could do whatever you wanted to that animal without remorse, or even ignore it, and nobody could object.
Having a pet is a privilege, and one that can be taken from you if you abuse it. Legally this is certainly the case, just as a driver's license can be taken away for repeated abuse of traffic laws. Morally it is also a privilege, as having an animal share your life is an honor and a blessing. A privilege is cherished and not taken for granted. Viewing a pet as a privilege gives them a status beyond mere property.
So since I can obviously relate more to the 142 people who view it as a privilege, I'd love to hear from the 8 who feel it is a right and why they believe that.
And the new poll is now up!
A right--5%
A privilege--93%
Not sure--1%
I strongly believe that nobody has a RIGHT to own a pet. You also don't have a right to drive a car, a right to buy a TV at a certain price, and so on. Dictionary.com defines "right" (in this context) as follows:
a just claim or title, whether legal, prescriptive, or moral
a moral, ethical, or legal principle considered as an underlying cause of truth, justice, morality, or ethics.
I don't think that owning a pet would fall under any of these definitions, or other similar ones.If pet ownership was a right, then you would be entitled to have one regardless of your ability to care for it. You would also be entitled to have a pet even if you couldn't afford to purchase one...one would have to be given to your or provided to you. As a right you could do whatever you wanted to that animal without remorse, or even ignore it, and nobody could object.
Having a pet is a privilege, and one that can be taken from you if you abuse it. Legally this is certainly the case, just as a driver's license can be taken away for repeated abuse of traffic laws. Morally it is also a privilege, as having an animal share your life is an honor and a blessing. A privilege is cherished and not taken for granted. Viewing a pet as a privilege gives them a status beyond mere property.
So since I can obviously relate more to the 142 people who view it as a privilege, I'd love to hear from the 8 who feel it is a right and why they believe that.
And the new poll is now up!
Tuesday, March 1, 2011
The Essentials
Back in December I talked about changes in anesthesia protocols, emphasizing how new research and technology allows us to evolve and adapt to make procedures safer. Yesterday I discussed one monitoring parameter, and unexpectedly started a bit of a debate on the usefulness of electrocardiograms (ECGs). Since I believe that open and honest debate is how we learn from each other, I thought that I'd clarify the things that I feel are essential to safe anesthetic events. Personally I don't think that general anesthesia should be performed without the following things, and I know that my views mirror those of anesthesia specialists.
Pre-Anesthesia Blood Tests
Just because a pet looks healthy on the outside doesn't mean that everything is normal. Low-grade anemia can be a sign of other problems and won't be obvious on a physical exam. Early liver and kidney disorders also can't be detected on an exam, but could be found with simple blood tests. If these tests aren't performed, there are many problems that can be missed and could lead to problems with the safety of anesthesia.
IV Catheter
As much as we don't want them to, things can wrong during anesthesia. If this happens, the quickest way to put corrective drugs into the system is through the veins. When a pet is "crashing", seconds matter and you don't want to have to struggle to put in a catheter. If one is already in place you can have a better chance of saving a pet if anything adverse ever happens.
Fluids
Intravenous fluids during surgery aren't about correcting dehydration. They are about maintaining blood pressure and circulation. When you anesthetize a pet it affects their cardiovascular system which can cause blood pressure to lower and can affect perfusion (how much blood ends up into tissues). When you have fluids entering the veins you can help keep pressure and circulation at appropriate levels.
ECG
Despite the debate after yesterday's entry, I feel that this is an important and essential part of monitoring. There are patterns on the ECG that can indicate problems with the function of the heart that you can't detect any other way. Simply put I feel that no anesthesia should be performed without this.
Pulse Oximeter
This piece of equipment measures the oxygen content of the blood. Obviously this is very important because even if you have adequate fluid volume and blood cells, if they aren't carrying oxygen through the body you could have a critical state. Low blood oxygen can lead to permanent tissue damage, including the brain. Honestly, though, this is the piece of equipment I would be willing to live without. I have had problems with pulse oximeters not reading properly even if the patient was otherwise normal. At the same time, if there is a documented decrease in blood oxygen, you need to intervene right away.
Blood Pressure
There are several ways to measure this and I'm not going to debate one method versus another. If blood pressure drops too much it can affect how much blood reaches tissues as well as how well the heart pumps. Conversely a case of hypertension can lead to a different set of problems, or even indicate an abnormality with the kidneys.
Trained Staff
Monitoring equipment is great and can tell us things that our eyes, ears, and hands can't detect. But they can't replace a skilled technician watching the patient. No computer or electronic device can have better judgment than someone standing there keeping track of the patient's vitals. I have my staff record information from the above monitors every five minutes. But I also train them that this doesn't take the place of listening to the heart with a stethoscope, feeling the pulse with their fingers, and looking at the color of the gums. Equipment can fail, malfunction, or misread, so as important as the are, the SINGLE MOST important part of anesthesia monitoring is an actual person watching the patient.
My colleagues who read this entry will surely have their own strong opinions. I also deliberately have avoided getting too deep into the science of anesthesia monitoring since I don't want to write a textbook on the subject and I have many readers who aren't medical professionals. I want to present this subject in a way that everyone can understand the discussion.
The important take-home message is that anesthesia is a very serious procedure with lots of potential for things going wrong and leading to death. The best way to avoid problems is to be watching the patient's vital signs in several different ways so that if an abnormality is noted something can be done quickly to correct the problem.
Pre-Anesthesia Blood Tests
Just because a pet looks healthy on the outside doesn't mean that everything is normal. Low-grade anemia can be a sign of other problems and won't be obvious on a physical exam. Early liver and kidney disorders also can't be detected on an exam, but could be found with simple blood tests. If these tests aren't performed, there are many problems that can be missed and could lead to problems with the safety of anesthesia.
IV Catheter
As much as we don't want them to, things can wrong during anesthesia. If this happens, the quickest way to put corrective drugs into the system is through the veins. When a pet is "crashing", seconds matter and you don't want to have to struggle to put in a catheter. If one is already in place you can have a better chance of saving a pet if anything adverse ever happens.
Fluids
Intravenous fluids during surgery aren't about correcting dehydration. They are about maintaining blood pressure and circulation. When you anesthetize a pet it affects their cardiovascular system which can cause blood pressure to lower and can affect perfusion (how much blood ends up into tissues). When you have fluids entering the veins you can help keep pressure and circulation at appropriate levels.
ECG
Despite the debate after yesterday's entry, I feel that this is an important and essential part of monitoring. There are patterns on the ECG that can indicate problems with the function of the heart that you can't detect any other way. Simply put I feel that no anesthesia should be performed without this.
Pulse Oximeter
This piece of equipment measures the oxygen content of the blood. Obviously this is very important because even if you have adequate fluid volume and blood cells, if they aren't carrying oxygen through the body you could have a critical state. Low blood oxygen can lead to permanent tissue damage, including the brain. Honestly, though, this is the piece of equipment I would be willing to live without. I have had problems with pulse oximeters not reading properly even if the patient was otherwise normal. At the same time, if there is a documented decrease in blood oxygen, you need to intervene right away.
Blood Pressure
There are several ways to measure this and I'm not going to debate one method versus another. If blood pressure drops too much it can affect how much blood reaches tissues as well as how well the heart pumps. Conversely a case of hypertension can lead to a different set of problems, or even indicate an abnormality with the kidneys.
Trained Staff
Monitoring equipment is great and can tell us things that our eyes, ears, and hands can't detect. But they can't replace a skilled technician watching the patient. No computer or electronic device can have better judgment than someone standing there keeping track of the patient's vitals. I have my staff record information from the above monitors every five minutes. But I also train them that this doesn't take the place of listening to the heart with a stethoscope, feeling the pulse with their fingers, and looking at the color of the gums. Equipment can fail, malfunction, or misread, so as important as the are, the SINGLE MOST important part of anesthesia monitoring is an actual person watching the patient.
My colleagues who read this entry will surely have their own strong opinions. I also deliberately have avoided getting too deep into the science of anesthesia monitoring since I don't want to write a textbook on the subject and I have many readers who aren't medical professionals. I want to present this subject in a way that everyone can understand the discussion.
The important take-home message is that anesthesia is a very serious procedure with lots of potential for things going wrong and leading to death. The best way to avoid problems is to be watching the patient's vital signs in several different ways so that if an abnormality is noted something can be done quickly to correct the problem.
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