Fathers & Sons

For the last several days my wife has been in Ohio spending time with her grandfather, who is in rather poor health.  She took our daughter with her, leaving me and our son at home alone.  We timed it so that over the four day period I was only working one, allowing me to be at home with him and only needing to rely on my father-in-law for one day while I was working.  I very much miss my wife and am eager to have her come home this afternoon.  But I've also had a great experience with my son over the last few days.

He's 10 years old and a very good, sweet boy.  I've tried to take the opportunity to spend more time with him, as there are few distractions and I didn't have many chores around the house.  We played video games together, something that I don't always make time for.  We watched G.I. Joe: Rise of Cobra and Superman/Batman: Apocalypse.  Saturday night we went out for pizza together.  We've talked and just had fun time as father and son.

Much of this makes me think of my own father as I grew up.  We would go see movies together that my mother didn't want to see.  We would regularly get lunch at Cousin's Pizza, a local independent pizzeria in the mall.  We would talk and joke around and just enjoy time together.  I was reminded of all of that as I did similar things with my own son, and looked back on those memories with great fondness.  Even though my father and I have had our arguments and disagreements, he was (and still is) a great father who raised me well and has left me with many great memories.

Now I find myself in similar situations with my own son.  I've thought about the problems my dad and I have had and wonder if I'll go through the same things with my son. Obviously kids are always going to have disagreements with their parents and there is some inevitability there, but I also hope to learn from the lessons of the past and perhaps change a few things (likely creating new problems in the process).  I also have thought about the wonderful times I had with my father and want to be able to give my son similar memories.

And so the cycle continues.  In another 30 years I bet my son will be thinking similar things.

Advice On Becoming A Vet....Almost Ultimate Guide

It's common that I get questions related to becoming a veterinarian, and I've answered these questions several times over the last few years.  Earlier this month Maggie emailed me some questions, and it's taken me a while to get to answering them.  I actually debated about whether or not to answer since I've do so before, but decided to so that I could put most of the pertinent advice all in the same post.  So unless I get something very different, this is like the last time I'll go through this, instead referring people back to this and other posts.

Here's Maggie's email....

I come from a family with a strong medical background. My parents are both doctors, as well as extended family members, so I have always been comfortable talking about and seeing medical procedures. I love science but I am not so strong in Math. I have always loved animals and many family friends encouraged my interest of becoming a vet.  I went to the University of Virginia with the intent to be pre-health and took some pre-health courses. I did well in inorganic chemistry, but had trouble with Organic Chemistry. (I am confident I can do well with more focus than I had 2nd year of college).  I also decided that I should branch out from science, and followed an interest in marketing. Therefore, I followed this interest and got a masters in business.  Throughout all of my studies I continued to volunteer at the SPCA.  

 

I am now 25 and I work in marketing for a leading consumer products company. I enjoy what I do but do not see myself doing it long term and I am strongly considering going back to school to become a veterinarian.

 

Of course this would be a huge investment...5 more years of school, lots of student loans. I would appreciate your advice on the following!

1. I am confident that I can do well in the science courses, but I would have to do a postbac pre-health program. Do you know anything about post-bac programs for pre-vet? 

Honestly, you may not have to do any post-bac program.  Your actual major is completely irrelevant to admission into veterinary school; all that matters is that you have the required courses for entry.  I've known people with degrees in marketing, English, publishing, computers, and many other non-biology degrees who have become vets.  Also, there are no specifically pre-vet post-baccalaureate programs out there that I am aware of, because entry into vet school doesn't require it.  In fact, most pre-vet programs in colleges are simply the offices finding the required courses for vet school and organizing them into a semi-formal program.  There is no such thing as a pre-vet major or degree.  If you're missing any courses, all you have to take those classes and don't even need to get a degree.

2. Once I do a post-bac program, what applications are necessary for vet school? Will I have to take a gap year to enable the school to see my grades (like med school applications?)  

There are no real universal requirements for all vet schools, and each of them may require slightly different things.  You need to contact the admissions office of each school you are interested in to find out what they need, and then plan accordingly.  You don't necessarily need to take any time off depending on when your classes are done, as they are more interested in your required classes than your overall GPA.

3. Veterinary school is four years, just like medical school right? 

Yep.  Four of the hardest years you'll have in your life.  It's much more intensive than human medical school because you have several species of anatomy, physiology, and diseases to know.  What MDs know about humans, you will have to know about dogs, cats, horses, cows, poultry, pigs, reptiles, and many other species.  There are significant differences between even dogs and cats that human doctors never have to face.  So even though it may be the same length of time, it's harder.

4. What type of Veterinarian are you? Is it extra schooling to specialize? 

I'm a small-animal general practitioner, which is what most vets are.  If you want to specialize in a particular field (internal medicine, surgery, dermatology, oncology, etc.) you will need to do an internship which is usually a year and then a 3-5 year residency program.  

5. Now that you are a veterinarian, what is your work life balance like? This is one of the biggest challenges of being a vet, and I don't have an easy answer.  Most of us eventually learn how to balance things, but it's not easy and some never master it.  There are many articles published on how to have a work-life balance and it's a challenge to get it right.  How often do you have to work late? Are you on call? I rarely work more than 30 minutes past closing, but I'm also very fast and efficient.  I know many colleagues who regularly work late.  I also work for a practice that doesn't do any after-hours work, so we refer all of our emergencies to the local Emergency Clinic.  Many veterinary clinics require their vets to be on call, so it really depends on who you work for.  Eventually I would like to have a family - do you think being a veterinarian offers the type of work life balance to do so?  It's a real challenge, especially if you're the owner of a practice.  But it's not impossible, and with 75-80% of graduates being female it's becoming more recognized as a necessity.  It's also becoming more common to see vets working part-time in order to have a good family life.

6. What is the most rewarding aspect of your job? What are some things that you don't like about your job?  I really like when I can save a life, perform a difficult surgery successfully, and bring comfort to families.  I REALLY hate being bit and scratched.  I also dislike when clients argue over every little charge or complain about how "expensive" veterinary medicine is (it isn't when compared to human medicine).  I get tired of clients complaining over rather stupid (in my opinion) things, and I love when clients really understand how difficult the job is and appreciate our attempts.  I also wish we could actually get paid what our knowledge and skills are really worth.

7. If you could do it again, would you become a veterinarian? 

Honestly, no.  Part of that is because my interests and skills have changed over the years, as well as my tolerance for certain situations.  If I had to do it all over again and retained my current knowledge I'd become a history professor.  I know many vets who wouldn't choose to go the veterinary route again.  However, I read a survey a few years ago where somewhere around 70-80% of vets were very satisfied with their careers.  

8. I know veterinary schools are arguably even more competitive, what would you say are the most important qualities admissions committees consider? 

First, I would drop the word "arguably".  There are usually multiple medical schools in each state, yet there are only 28 veterinary schools in the US.  Each school accepts around 80-100 students per year (some a little more or less), and there are around 400-500 applicants each year.  So it's VERY competitive.  As far as the qualities, you need very good grades in the required classes, need to be a good communicator, and usually need to have some prior experience working for a vet.  I don't know of any vet school that routinely accepts people who have never been behind the scenes at a vet.  Beyond that I think things may have changed some from when I went through the process in the early '90s.  For example, I think that some vet schools have eliminated the personal interview as part of the admissions process.   Check with the schools you're interested in and find out their requirements.

9. I see you went to NCState - I am from the east coast and NCState and VATech would probably be the closest. What is your advice when it comes to considering Veterinary schools? 

Honestly, you're going to get a good education at any of the vet schools in the US, so you don't need to go to a specific one.  If you have one in your state, by all means go to that one if at all possible as it will usually be much cheaper than going out of state.   Choose the school that will cost you the least amount of money to attend.  I know this seems like a rather silly way of deciding, but the biggest crisis among newer graduates is the almost overwhelming debt burden.  It's becoming harder and harder to afford to be a vet, and you want to minimize the amount of debt you have when you graduate.  This will make life MUCH easier on you.  The days of getting a veterinary degree regardless of the financial cost are gone, as it's no longer realistic.  Once you graduate and have your license in hand, nobody is really going to care where your diploma is from.

Maggie, I hope this answers your questions!  Best of luck to you and anyone else considering veterinary medicine!

Night At The Museum, Part 2

Last year I posted about an event I was part of, Night At The Museum at the Tellus Science Museum in northern Georgia.  You can read about the basics of the event there, and see pictures of me portraying Jules Verne.  The event was successful and they had it again this year, just this past Saturday.  To keep it fresh, the museum changed things up a bit and changed the theme to emphasize where science and science-fiction meet.  Several sci-fi costuming groups participated, including the 501st Legion (Star Wars costumers), the Tennessee Who Authority (Dr. Who), some local Star Trek fans, and even a small representation from Firefly.  We mixed that with some typical scientists (Nicola Tesla, Albert Einstein, etc.), historical figures (Wright Brothers, Amelia Earhart, etc.), and sci-fi authors (Jules Verne, H.G. Wells) and their creations (Captain Nemo, Dr. Jekyll & Mr. Hyde).  And this year my wife and I were different characters.

Here's me as Tesla.  I grew a bushier mustache, shaved my beard, and darkened my hair.  It's the first time I've had only a mustache since I was in college in the early '90s, and my wife and I decided that we don't like the look.

My wife was Kaylee from Firefly.  Our friend, Alan, played Mal, the captain of Serenity.  My wife made his browncoat!

Some pictures of the entire group as well as the central area of the museum.  See how many characters and historical figures you recognize!

Here's a video that was taken at the event.  You can briefly see me in the character parade.


The event was very popular and successful, bringing in over 200 more attendees than last year.  The marketing director of the museum has already confirmed that we'll be doing it again in 2012.  And I'll be sure to post pictures again!

Human & Dog Anatomy Comparison

I get a lot of emails requesting me to post a link or guest blog from a topic on another site.  Most of these I pass on, preferring to keep to my own topics.  However from time to time something jumps out at me that I'm happy to share.  This is one of those times.

Though this is obviously intended for a younger audience, I really like how it gives side-by-side comparisons of the anatomy of dogs and humans.  So I thought I would share, including a link back to the original site for anyone to use.  Unfortunately the original image is too large to fit in my blog, so I'm giving a link to the site (click on the image below).  Enjoy!

Created by Pet365 - a UK supplier of dog collars, leads and pet accessories. Click below to see the full size version.

Never Risk Free

Last week we had a client come in to check his dog's leg.  The dog was known to have seizures, but only 3-4 per year and usually of short duration.  A few days before coming to us the dog had had a seizure lasting longer than normal.  There was a veterinary clinic close to his work and he took his dog there for immediate care.  According to his story they gave an intravenous injection of diazepam (valium), which is used to stop seizures.  Since it was an urgent situation, the vet found the cephalic vein in the left front leg and gave the injection there without first placing a catheter.  This vein is the main one in the leg that we use for blood collection, injections, and catheters, so this was pretty typical.

Once the seizure stopped they tried to collect some blood from the jugular vein, again a pretty routine procedure and a common location.  They had difficulty getting blood, and had to go back to the cephalic vein.  After that the dog started seizing again and the doctor decided to give IV phenobarbital.  They tried the right cephalic vein, but couldn't hit it and ended up going back to the left one again.  Believe it or not this isn't uncommon, as some veins can be harder to find than others and one leg may have a more prominent vein.  It can also be difficult to find a good vein in some patients, especially if there is some sort of cardiovascular problem.

The dog did fine, the seizures stopped, and everything seemed okay.  A couple of days later the owner noticed the dog licking at the leg where the injections had been given, but didn't think a lot about it.  Over the next day the skin started losing hair and becoming red and the owner became concerned.  The following day he saw that the skin had come off and was very raw.  He placed a bandage at home and brought the dog to us.  We took the bandage off and this is what we found....**WARNING*** Graphic, gross images follow!  Scroll down at your own risk!

Do you see the dark, tubular structure in the center?  That's the cephalic vein!  The skin and underlying tissues had completely died, exposing the vein and muscles.  One of the concerns was that it looked as if part of the wall of the vein had become necrotic and fallen away, leaving a blood clot exposed.  Thankfully the dog was only slightly limping and everything else in the leg and paw looked good and appeared to have a good blood supply.

So what happened?  One of the things that laypeople may not realize is that some drugs are very irritating to tissues and should only be given intravenously.  If some of the drug leaks from the vein or otherwise gets into a muscle or subcutaneous space it can cause severe damage to the tissues and blood supply, resulting in death of the tissues.  Both diazepam and phenobarbital fall into this category, leading to thrombosis or necrosis if they are given subcutaneously. Diazepam can be given intramuscularly without problems, so this may not have been the culprit.  However, phenobarbital can cause significant necrosis outside of the vein, and I believe this is what happened.  Because the vein was punctured several times while trying to stabilize the dog it likely leaked some of the drug.

As bad as this looks it can be treated, and likely without skin grafts.  Specialized bandaging methods can be used to promote healing, though it requires daily bandage changes.  As the necrotic tissue falls off and healthy tissue remains the changes can be less frequent and new tissue will close the defect.  It will likely take weeks or even a few months, but odds are in the favor of the dog just ending up with a scar.

I don't want to scare anyone unnecessarily, as this is an uncommon occurrence and a potential danger that most vets are aware of.  From what the owner told me I don't think the other vet did anything wrong and the only thing I would have done differently was to place an IV catheter once the initial seizure was stopped.  Doing so would have likely prevented this problem, but I do think the other vet was trying the best that they could.  Nothing in medicine is ever completely risk-free, though we do everything we can to minimize those risks.

This Is Why You Spay...**GRAPHIC IMAGES**

We veterinarians talk to clients all of the time about spaying pets.  It's one of the most frequent recommendations we make, and we have very good reasons for doing so.  Even though spaying helps prevent numerous serious medical problems, many people don't do it.  And that can lead to disaster.

A couple of weeks ago we had an 11 year old German shepherd come in for lethargy and vaginal discharge.  She was unspayed because the owners originally had intended to breed her.  This never happened (as is usually the case...most clients who tell me that they may breed never end up doing so), but they never had her spayed.  A few x-rays and lab tests later and we validated our suspicions...she had a pyometra.

Pyometra is the medical term for a uterine infection.  This isn't like a urinary tract infection, skin infection, or sinus problems where we can prescribe antibiotics and everything will be fine in a few weeks.  In a case with a pyometra the uterus fills with pus and is something that rarely responds effectively to antibiotics alone.  This is a life-or-death situation that requires immediate emergency surgery.  If surgery isn't performed quickly the uterus could rupture, releasing pus and bacteria throughout the abdomen and almost assuredly resulting in death.  The surgery itself cares a high degree of risk as the uterus is usually very fragile and could rupture during routine handling. Also there is a risk of pus and infection leaking from the cut areas of the uterus, resulting in contamination of the abdomen.  Serious problems!

Thankfully the owner agreed to the surgery.  When I got inside, the uterus was large and distended with pus just like I expected.  Here's what we found...WARNING...The following images are graphic photos of the surgery and are not for those offended or nauseated by such images.  Scroll down at your own risk!!!!

This uterus is many, many times larger than it should be.  A normal uterus in a dog this size and age should be somewhere between the size of a large pencil and a small marker pen, or similar in diameter to one of the instruments in the picture.  However, this is not the largest pyometra I've dealt with.  And this wasn't the only problem.

Sometimes I'll see cysts on ovaries when I'm doing a spay, especially on an older pet.  Normally there are just a couple of cysts, usually no more than 2-4.  This dog had literally around 20 on each side, and whereas cysts are normally on the ovaries, in this case they extended along the uterus itself.

Thankfully the surgery was as uneventful that we would want, the uterus didn't rupture, and the patient did spectacularly. Here's the uterus once it was removed, again many times larger than it should have been.

I just saw her a couple of days ago for her 10-day postoperative recheck, and she was in great condition, wagging her tail and acting like nothing had ever happened.  This was a very successful surgery with a great outcome.  But there was no reason why this needed to have happened.

Situations like this one are why we recommend having pets spayed.  A routine spay at our clinic runs around $350.  This client paid around $1400 for diagnostics, surgery, and medications.  That's more than four times what she would have paid if she had simply had her dog spayed!  She would have also prevented the life-threatening risk to her pet.  Thought this turned out well, it may not have and could have resulted in the dog's death.

The moral of today's story?  Have your pets spayed and neutered!!!!!

Depression In Veterinary Medicine

I recently read an article that presents some very interesting and somewhat disturbing data.  Apparently veterinary students are more prone to depression than human medical students and the general profession.  Here are some key quotes from that article (linked above). 

During the first year of veterinary school, 32 percent of the veterinary medicine students surveyed showed symptoms of depression, compared to 23 percent of human medicine students who showed symptoms above the clinical cutoff, as evidenced by other studies.

The researchers also discovered that veterinary students experience higher depression rates as early as the first semester of their first year of study. Their depression rates appear to increase even more during the second and third year of school. During the fourth year, depression rates drop down to first-year levels.

Hafen said several factors might contribute to the higher rate of depression in veterinary medicine students. Veterinarians deal with stressors that human medicine doctors do not have to experience, such as frequently discussing euthanasia with clients. Although both programs of study are intense, veterinarians must understand a variety of animal species rather than focusing on the human body. Struggles with balancing work, school and life could also lead to higher depression rates.

Honestly, I can't see that these findings surprise me. Veterinary school is incredibly hard and stressful, and I don't think people realize that vet students have to learn more than human medical students do.  I certainly remember how stressed I was and how much time I spent studying and preparing.

Unfortunately I think that it gets worse in many ways from school.  Practicing vets no longer have to worry about intense studies, but they do have more pressure on them regarding the health and well-being of their patients.  In vet school you always have a safety-net of interns, residents, and professors that can make the final decision in cases, but when you're practicing it's all up to you.  Add on stresses related to paying bills, student loans, starting families (if that hasn't been done in school), being expected to financially produce, and often running a business.  It's actually more of a wonder that we don't see most vets succumbing to depression.

Although the mental health of human medicine students has been extensively studied, the same extent of study has not been performed with veterinary medicine students. Additionally, most veterinary research related to depression involves pet owners, not veterinarians or students.

I agree that such studies need to look at the veterinary profession as much as it does the human medical profession, I think it needs to reach beyond the students and include active practitioners.  We may find that depression in veterinary medicine is more wide-spread than is thought.  At the same time, there may be a mitigating factor in the fact that we work with animals, which have been shown to lower stress.  But I'm sure the stress-lowering affect of pets doesn't include ones trying to bite you!