Yesterday I received a very aggressive and deliberately hateful comment on my most recent blog entry. The comment also included strong profanity. Because of its aggressive tone and use of inappropriate language I have deleted it, as I will not tolerate such things on this blog as I do not tolerate them in my offline life. This is actually the first time in the three years I've been blogging that I have deleted a non-spam comment. I am very open to differing opinions and hard comments about my own views and actions. Just go back through some of the comments on big topics over the years and you'll see that I'm very tolerant of contrary comments and do not believe in censorship. But I will not accept profanity (and do not use it in my own life) and will not accept a comment that is nothing but hate-filled rhetoric with nothing constructive to add.
Over the years I've been very open with this blog and have allowed open commenting, including as an anonymous poster. At times I've thought that this made it too easy for people to speak strongly since there was no way to tell who had commented so they didn't have to worry about it getting back to them. People tend to be bolder, especially on the internet, when nobody knows who they really are. It has also made it a little confusing at times when several people would comment on an entry as "Anonymous". The hateful poster yesterday commented in this way, not identifying themselves, and this has helped make a decision that I was considering anyway.
I have changed the commenting section so that you must be a registered Google or OpenID user in order to post a comment. From this point on there will no longer be any anonymous commenting. I hope that this does not discourage people from commenting (most people doing so are already registered anyway), and that some of my regular Anonymous posters (yes, I've gotten to know some of the writing styles) will consider registering (since it's free) and commenting more openly.
Sunday, August 28, 2011
Thursday, August 25, 2011
Freak Accidents Unfortunately Happen
This afternoon one of our clients brought their dog in for a simple nail trim. He is a 13 year-old German shepherd mix (probably with husky) and not in the best of health. He also is a bit of a biter. One of my assistants brought him to the back to have the nail trim done, and a new doctor we just hired was holding the dog. As they were doing this the dog's hind legs suddenly slipped on the smooth tile flooring and he went sprawling with his hind legs splaying in a "frog-leg" position.
When they tried to get him up they found that he couldn't stand and was painful. They brought the owner back and got me to look at him. I noticed that he was very painful in his left hip and couldn't put that leg down. I was also having difficulty trying to extend the hip backwards. We put him in a kennel to rest for about 30 minutes and then got him out for another exam; we found the same problem. The next step was x-rays. We told the client that we needed to sedate him and do this, and wouldn't charge her for it. Once we put up the films we noted quickly that the left hip had dislocated. Ouch! For many reasons.
This is a very old dog who wasn't in the best of health. When we ran routine blood tests in May we noted increases in his liver values. He also had severe muscle wasting in his hind legs and hips, though he was walking pretty normally. In fact, I think the lack of good muscle mass was the reason for the dislocation. Many people don't realize it but good muscle tone and development is just as important for hip support and strength as tendons and ligaments. I've seen many dogs slip or lay like he did, but I've never seen a hip dislocation. It was also strange because normally when a hip dislocates the femur moves craniodorsal ("up" and "forward"). This hip slipped ventrally ("down"), opposite the normal direction. I think that the muscle atrophy allowed the hip to move abnormally; a normal amount of muscle likely would have prevented the injury.
Unfortunately we found other problems on the x-rays. The 3rd through 7th lumbar vertebrae had bone bridging that was fusing the vertebrae together (called spondylosis, and not an uncommon finding in older dogs). We also saw stones in both kidneys. These findings were incidental but weren't good to see.
So let's recap. We had a geriatric dog with underlying liver problems, atrophied muscles, spondylosis and kidney stones slip on the floor and dislocate his hip. Not a good situation by any analysis. While he was sedated and relaxed I tried to put the hip back in socket, but no luck. It's hard enough to replace a dislocated hip, but this hip was out in a way that I was never trained to fix.
This was a completely freak accident that I have never heard of before. Unfortunately it happened at our facility, so we feel responsible even though we didn't do anything wrong, and there is some potential liability since it happened under our care. We sent the dog home with analgesics and didn't charge for anything we did. We're also sending him to an orthopedic surgeon tomorrow to have the case reviewed. I'm hoping that the surgeon may know some tricks to non-surgically put the hip back in joint because this dog is a pretty poor surgical candidate. We're also going to cover the costs of any treatment, even if it comes to surgery. We're not technically to blame, but we don't want the owner to feel that way and also do feel bad about the situation.
No, it's not easy being a vet.
When they tried to get him up they found that he couldn't stand and was painful. They brought the owner back and got me to look at him. I noticed that he was very painful in his left hip and couldn't put that leg down. I was also having difficulty trying to extend the hip backwards. We put him in a kennel to rest for about 30 minutes and then got him out for another exam; we found the same problem. The next step was x-rays. We told the client that we needed to sedate him and do this, and wouldn't charge her for it. Once we put up the films we noted quickly that the left hip had dislocated. Ouch! For many reasons.
This is a very old dog who wasn't in the best of health. When we ran routine blood tests in May we noted increases in his liver values. He also had severe muscle wasting in his hind legs and hips, though he was walking pretty normally. In fact, I think the lack of good muscle mass was the reason for the dislocation. Many people don't realize it but good muscle tone and development is just as important for hip support and strength as tendons and ligaments. I've seen many dogs slip or lay like he did, but I've never seen a hip dislocation. It was also strange because normally when a hip dislocates the femur moves craniodorsal ("up" and "forward"). This hip slipped ventrally ("down"), opposite the normal direction. I think that the muscle atrophy allowed the hip to move abnormally; a normal amount of muscle likely would have prevented the injury.
Unfortunately we found other problems on the x-rays. The 3rd through 7th lumbar vertebrae had bone bridging that was fusing the vertebrae together (called spondylosis, and not an uncommon finding in older dogs). We also saw stones in both kidneys. These findings were incidental but weren't good to see.
So let's recap. We had a geriatric dog with underlying liver problems, atrophied muscles, spondylosis and kidney stones slip on the floor and dislocate his hip. Not a good situation by any analysis. While he was sedated and relaxed I tried to put the hip back in socket, but no luck. It's hard enough to replace a dislocated hip, but this hip was out in a way that I was never trained to fix.
This was a completely freak accident that I have never heard of before. Unfortunately it happened at our facility, so we feel responsible even though we didn't do anything wrong, and there is some potential liability since it happened under our care. We sent the dog home with analgesics and didn't charge for anything we did. We're also sending him to an orthopedic surgeon tomorrow to have the case reviewed. I'm hoping that the surgeon may know some tricks to non-surgically put the hip back in joint because this dog is a pretty poor surgical candidate. We're also going to cover the costs of any treatment, even if it comes to surgery. We're not technically to blame, but we don't want the owner to feel that way and also do feel bad about the situation.
No, it's not easy being a vet.
Wednesday, August 24, 2011
Give Up The Dream?
I received this email from Laura...
I recently came across your page and have to say I found it very enjoyable to read. I always wanted to be a vet however I was a few points short of getting into vet school and so settled for my second option: nutrition and dietetics. Five years later here I am, qualified but still desperately wanting to work with animals. My parents keep telling me that once I work as a dietitian I can volunteer with animals in my spare time and I know they are right but I want it to be a bigger part of my life than that. I know that going into vet school as a grad is not only hard to from the point of view of gaining a place but its also incredibly expensive and I would need to take out a huge loan to afford it. I have been offered a masters in public health here at home, employment within the health system is poor at the moment and so there are no jobs, my only options are a return to college or emigrate. The problem with emigration is the registration and expense of trying to become eligible to practice in another country with no guarantee of a job.
I feel I have to take the offer of the masters in public health however I feel I am once again turning my back on the one thing I have ever wanted to do- work with animals. You mention a few detours on your way to becoming a vet and I was wondering what your advise would be?
This is certainly a tough decision, Laura. I want people to follow their dreams and find what will really make them happy, but it can also be a financial burden to acquire a veterinary degree and it's becoming harder to pay off that debt. So it may not be the right decision for you.
I would start by figuring out exactly what it is about animals that you like. Yes, you want to work with them, but WHY? Looking inward and discovering the "why" of the desire may help guide you into something. Do you like just watching them? Maybe a job at a pet store or zoo. Do you want to help them out? Maybe a job as a veterinary assistant or volunteering for a shelter or rescue group. Do you like the animal-human bond? Maybe work for a group that uses dogs, cats, and horses as therapy animals for the elderly, special needs, and hospitalized.
But also consider your training and education. If you have a background in nutrition, could you get education at a university that would be applicable to animal diets? Perhaps look into getting a job with one of the food companies. I know that Royal Canin has a research center where the animals are housed and treated as pets, not just put in cages. (And no, I don't work for them). If you're in an affluent area then perhaps you could get training and set yourself up in business as a pet dietician. I'm certain that many wealthy people would pay for such a service. With a Masters in Public Health you could concentrate on diseases transmittable between humans and animals; you wouldn't get direct animal contact most of the time, but it would still be in that field.
In the end you're looking at only a few possibilities. Most of the jobs working hands-on with animals will require you to switch careers and likely take a substantial pay cut. Getting a good paying job in the animal or veterinary fields will require money spent in further education. If you can't spend the money or have a pay cut, then you may have to settle for being a volunteer, which is always needed. Heck, you could start your own private shelter or rescue group!
My readers may have other suggestions. Best of luck, Laura.
I recently came across your page and have to say I found it very enjoyable to read. I always wanted to be a vet however I was a few points short of getting into vet school and so settled for my second option: nutrition and dietetics. Five years later here I am, qualified but still desperately wanting to work with animals. My parents keep telling me that once I work as a dietitian I can volunteer with animals in my spare time and I know they are right but I want it to be a bigger part of my life than that. I know that going into vet school as a grad is not only hard to from the point of view of gaining a place but its also incredibly expensive and I would need to take out a huge loan to afford it. I have been offered a masters in public health here at home, employment within the health system is poor at the moment and so there are no jobs, my only options are a return to college or emigrate. The problem with emigration is the registration and expense of trying to become eligible to practice in another country with no guarantee of a job.
I feel I have to take the offer of the masters in public health however I feel I am once again turning my back on the one thing I have ever wanted to do- work with animals. You mention a few detours on your way to becoming a vet and I was wondering what your advise would be?
This is certainly a tough decision, Laura. I want people to follow their dreams and find what will really make them happy, but it can also be a financial burden to acquire a veterinary degree and it's becoming harder to pay off that debt. So it may not be the right decision for you.
I would start by figuring out exactly what it is about animals that you like. Yes, you want to work with them, but WHY? Looking inward and discovering the "why" of the desire may help guide you into something. Do you like just watching them? Maybe a job at a pet store or zoo. Do you want to help them out? Maybe a job as a veterinary assistant or volunteering for a shelter or rescue group. Do you like the animal-human bond? Maybe work for a group that uses dogs, cats, and horses as therapy animals for the elderly, special needs, and hospitalized.
But also consider your training and education. If you have a background in nutrition, could you get education at a university that would be applicable to animal diets? Perhaps look into getting a job with one of the food companies. I know that Royal Canin has a research center where the animals are housed and treated as pets, not just put in cages. (And no, I don't work for them). If you're in an affluent area then perhaps you could get training and set yourself up in business as a pet dietician. I'm certain that many wealthy people would pay for such a service. With a Masters in Public Health you could concentrate on diseases transmittable between humans and animals; you wouldn't get direct animal contact most of the time, but it would still be in that field.
In the end you're looking at only a few possibilities. Most of the jobs working hands-on with animals will require you to switch careers and likely take a substantial pay cut. Getting a good paying job in the animal or veterinary fields will require money spent in further education. If you can't spend the money or have a pay cut, then you may have to settle for being a volunteer, which is always needed. Heck, you could start your own private shelter or rescue group!
My readers may have other suggestions. Best of luck, Laura.
Tuesday, August 23, 2011
Important Figures In Veterinary History
If you've followed my blog for a while you may have come across me mentioning an interest in history. So when I received an email mentioning an article on a site that was entitled Veterinary Hall of Fame:10 Veterinarians Who Made History, I was intrigued. I went there and found a few interesting things that I hadn't known, especially regarding Bernhard Bang (discovered brucellosis), Louis Camuti (the first feline-only practitioner), and Elmo Shropshire (wrote "Grandma Got Run Over By A Reindeer").
However, on this list of ten historically important vets, I noticed some glaring omissions.
James Herriot (James Alfred Wright): British veterinarian who wrote of his experiences and has been a huge influence on many of us in practice. How can you have a list of influential vets without him?
Sonny Purdue: A former veterinarian who went into politics and became governor of Georgia.
Scott Campbell: Whatever you think of corporate practices, he was certainly influential by creating and developing what is now known as Banfield Pet Hospital. This is the largest veterinary practice in the world, with almost 800 locations across the US.
Marty Becker: The list above includes several TV personalities in various countries, but doesn't include Dr. Becker? He has written numerous books and has been on national TV and radio.
Peter Ostrum: You may not know the name, but you know who he is. Dr. Ostrum was Charlie in the original Willy Wonka and the Chocolate Factory (the Gene Wilder one). He left entertainment and went on to be a currently practicing large animal vet.
Martin Fettman: Again, not a well-known name, even among vets, but an important accomplishment. He was the first veterinarian to participate in a mission on the space shuttle.
And these are just people I thought of off the top of my head (okay, I did have to Google Dr. Fettman, but I knew of veterinarian astronauts). I'm sure others can think of other equally important people in veterinary medicine.
And yes, I did respond back to the site, suggesting the above additions.
However, on this list of ten historically important vets, I noticed some glaring omissions.
James Herriot (James Alfred Wright): British veterinarian who wrote of his experiences and has been a huge influence on many of us in practice. How can you have a list of influential vets without him?
Sonny Purdue: A former veterinarian who went into politics and became governor of Georgia.
Scott Campbell: Whatever you think of corporate practices, he was certainly influential by creating and developing what is now known as Banfield Pet Hospital. This is the largest veterinary practice in the world, with almost 800 locations across the US.
Marty Becker: The list above includes several TV personalities in various countries, but doesn't include Dr. Becker? He has written numerous books and has been on national TV and radio.
Peter Ostrum: You may not know the name, but you know who he is. Dr. Ostrum was Charlie in the original Willy Wonka and the Chocolate Factory (the Gene Wilder one). He left entertainment and went on to be a currently practicing large animal vet.
Martin Fettman: Again, not a well-known name, even among vets, but an important accomplishment. He was the first veterinarian to participate in a mission on the space shuttle.
And these are just people I thought of off the top of my head (okay, I did have to Google Dr. Fettman, but I knew of veterinarian astronauts). I'm sure others can think of other equally important people in veterinary medicine.
And yes, I did respond back to the site, suggesting the above additions.
Saturday, August 20, 2011
Difficult Decision
A few days ago I saw a 10 year old husky for a routine check-up and vaccines. She is unspayed and has been overall healthy for most of her life. During the exam I noticed a firm, irregular mass in her mammary chain, and with a second look I found a smaller mass nearby. I called and talked to the owners, and they had not noticed these swellings, and were surprised when I pointed them out. We had also seen this dog in May for unrelated issues and had not noticed the masses then either. So in a 2-3 month period these lumps had developed.
In an older female dog who had never been spayed the most likely possibility is mammary gland cancer. This form of cancer can potentially be as bad and as malignant as breast cancer in humans. We took some chest x-rays to make sure there were no obvious metastases in the lungs, and when those were clear I talked to the owners about a partial mastectomy. In cases like this it's important to move quickly, removing the masses as soon as possible to minimize the likelihood of them spreading. Leave them too long and you're almost assured of metastasis. There are sometimes benign masses as well as other types of cancer, but there is no way to tell for certainty without removing them and sending them for a pathologist review.
Today she came in to have the surgery done. We did our normal preanesthetic evaluation, blood tests, and so on, and considered her generally healthy. We placed her catheter, induced her, and began doing the surgical shave and prep of the site. As we were shaving we noticed another small mass under the skin on the same site but several centimeters away from the largest mass. Further shaving showed an fourth mass close to the newest one but on the other side of the abdomen, so in a completely different mammary chain. This concerned me greatly, as we had masses developing in very separate locations from the largest lesion. I had checked all of the mammary regions earlier in the week, so it surprised me to find more masses, even if they were small. Did I miss them because they were small and she has thick fur? Did they start to grow in a few days time? Unfortunately I couldn't say for sure.
I called the owner before we went to surgery and presented them with the new information. I discussed the options, neither of which were good. The primary reason for doing the surgery was to remove the masses before there was further spread. We didn't know how quickly it was spreading, as the lumps I found could have started growing two months ago or in the last couple of weeks. Since there were new lumps in different locations, there was already spread. However, we could proceed with the surgery and do a more radical procedure, basically a double mastectomy. This is a radical, extensive, and painful surgery, and one not to be undertaken lightly. The odds were good that spread in the bloodstream was already happening, but there was no way to tell for certain. So should we do a more complicated surgery and roll the dice, hoping for the best? Or should we realize that metastasis may already be happening, it was too late to prevent it, and save her a painful and potentially long recovery?
This was a very difficult decision for the owner. Honestly, I was on the fence myself, though leaning towards not doing the surgery as I was worried that it wouldn't help her in the long run. But my job is to give the client enough information for them to make an informed decision. I can never make the decision for them. And if it was my own dog I would have had an equally hard time making up my mind.
In the end the owner decided to forgo the surgery and observe her, giving her the best quality of life they can. I can't say that this was the wrong decision. Sometimes in medicine there is not a straightforward choice, only difficult ones.
In an older female dog who had never been spayed the most likely possibility is mammary gland cancer. This form of cancer can potentially be as bad and as malignant as breast cancer in humans. We took some chest x-rays to make sure there were no obvious metastases in the lungs, and when those were clear I talked to the owners about a partial mastectomy. In cases like this it's important to move quickly, removing the masses as soon as possible to minimize the likelihood of them spreading. Leave them too long and you're almost assured of metastasis. There are sometimes benign masses as well as other types of cancer, but there is no way to tell for certainty without removing them and sending them for a pathologist review.
Today she came in to have the surgery done. We did our normal preanesthetic evaluation, blood tests, and so on, and considered her generally healthy. We placed her catheter, induced her, and began doing the surgical shave and prep of the site. As we were shaving we noticed another small mass under the skin on the same site but several centimeters away from the largest mass. Further shaving showed an fourth mass close to the newest one but on the other side of the abdomen, so in a completely different mammary chain. This concerned me greatly, as we had masses developing in very separate locations from the largest lesion. I had checked all of the mammary regions earlier in the week, so it surprised me to find more masses, even if they were small. Did I miss them because they were small and she has thick fur? Did they start to grow in a few days time? Unfortunately I couldn't say for sure.
I called the owner before we went to surgery and presented them with the new information. I discussed the options, neither of which were good. The primary reason for doing the surgery was to remove the masses before there was further spread. We didn't know how quickly it was spreading, as the lumps I found could have started growing two months ago or in the last couple of weeks. Since there were new lumps in different locations, there was already spread. However, we could proceed with the surgery and do a more radical procedure, basically a double mastectomy. This is a radical, extensive, and painful surgery, and one not to be undertaken lightly. The odds were good that spread in the bloodstream was already happening, but there was no way to tell for certain. So should we do a more complicated surgery and roll the dice, hoping for the best? Or should we realize that metastasis may already be happening, it was too late to prevent it, and save her a painful and potentially long recovery?
This was a very difficult decision for the owner. Honestly, I was on the fence myself, though leaning towards not doing the surgery as I was worried that it wouldn't help her in the long run. But my job is to give the client enough information for them to make an informed decision. I can never make the decision for them. And if it was my own dog I would have had an equally hard time making up my mind.
In the end the owner decided to forgo the surgery and observe her, giving her the best quality of life they can. I can't say that this was the wrong decision. Sometimes in medicine there is not a straightforward choice, only difficult ones.
Thursday, August 18, 2011
Never Satisfied
I've come to the conclusion that in my work I can't seem to be satisfied with the work load. Not that this would be a surprise to my wife.
This time of year we see a slight dip in business as kids go back to school and parents concentrate on that for a few weeks. It will pick up again in early September, but is slower right now. When I get to work in the morning one of the first things I do is look at the day's schedule. When I leave at night one of the last things I do is look at the next day's schedule. And this week the schedule has looked pretty sparse.
This leaves me in a mixed mood. To be truthful, I'm basically a lazy person. I have a very strong work ethic and really do work hard. But I'd rather not have to, and don't mind being a bit relaxed and slow some days at work. This means that a slow schedule may suit me just fine. On the other hand I have a responsibility to manage and grow the business, maintaining a good profit margin. And we can't make good profits if we don't have appointments.
So some days I wrestle with myself. I want to be lazy and get upset when we have a full schedule where I don't get much of a break or rest during the day. Then when we're slow enough for me to prop my feet up I'm fretting because we're not bringing in enough revenue. So I'm frustrated on both slow days and on busy days, each for different reasons. Basically it sometimes seems that I can't be satisfied at work.
Anyone else feel this at least some of the time? Thankfully I'm stubborn enough and have a strong sense of responsibility so I don't let the business suffer (after all, my salary is tied to the clinic's profits).
This time of year we see a slight dip in business as kids go back to school and parents concentrate on that for a few weeks. It will pick up again in early September, but is slower right now. When I get to work in the morning one of the first things I do is look at the day's schedule. When I leave at night one of the last things I do is look at the next day's schedule. And this week the schedule has looked pretty sparse.
This leaves me in a mixed mood. To be truthful, I'm basically a lazy person. I have a very strong work ethic and really do work hard. But I'd rather not have to, and don't mind being a bit relaxed and slow some days at work. This means that a slow schedule may suit me just fine. On the other hand I have a responsibility to manage and grow the business, maintaining a good profit margin. And we can't make good profits if we don't have appointments.
So some days I wrestle with myself. I want to be lazy and get upset when we have a full schedule where I don't get much of a break or rest during the day. Then when we're slow enough for me to prop my feet up I'm fretting because we're not bringing in enough revenue. So I'm frustrated on both slow days and on busy days, each for different reasons. Basically it sometimes seems that I can't be satisfied at work.
Anyone else feel this at least some of the time? Thankfully I'm stubborn enough and have a strong sense of responsibility so I don't let the business suffer (after all, my salary is tied to the clinic's profits).
Tuesday, August 16, 2011
Heartworm Treatment Crisis
When we treat heartworm disease there is really only one medication that most vets reach for, called Immiticide (melarsomine). It first came out in the mid-1990s, replacing the previous drug of choice, Caparsolate. The latter drug isn't used by most vets anymore because it runs a higher risk of side-effects and can cause significant tissue damage if it gets outside of the vein. Immiticide is much safer and less irritating, making it the gold standard for around 15 years.
For the last two years Immiticide has been in short supply because of ingredient shortages and other manufacturing problems. Currently it is only manufactured by one pharmaceutical company, Merial, and they have limited sources of the ingredient. For the last two years when we wanted to treat a pet we had to directly contact the company, discuss the case, and get them to ship it directly rather than ordering it through typical distributing systems. This method allowed Merial to keep the supply going to pets that really needed it rather than sitting unused on vets' shelves. It was a real hassle to us vets, but I never ran into a problem getting it when I needed it.
That is changing. A couple of weeks ago Merial announced further problems to the point of them not being able to produce any more Immiticide for the foreseeable future. The only product left is what is sitting on shelves in offices and warehouses, and that will quickly be depleted. Merial is hoping to have more available within seven months, but there is no promise this is the case. So treatment is now being withheld from mild cases without symptoms and being reserved only for severe cases.
This is extremely frustrating, and keeps us from providing the best care for pets. I also think it's crazy that we are so dependent on one single source for such an important medication, leading to situations like we currently have. Honestly I don't know all of the details behind Merial's problems, but with a shortage being known for about two years I would have hoped that someone would have come up with alternative sources by now.
This means that many people who have their dogs diagnosed with heartworms will have to go without proper treatment, instead relying on symptomatic control and other secondary treatments that aren't as fast or effective. However, keep in mind that this is a completely preventable disease! There is no reason for dogs NOT to be on heartworm prevention. So a solution is pretty simple from one aspect...use prevention and your dog's won't get the disease!
And let's hope that this shortage ends soon.
For the last two years Immiticide has been in short supply because of ingredient shortages and other manufacturing problems. Currently it is only manufactured by one pharmaceutical company, Merial, and they have limited sources of the ingredient. For the last two years when we wanted to treat a pet we had to directly contact the company, discuss the case, and get them to ship it directly rather than ordering it through typical distributing systems. This method allowed Merial to keep the supply going to pets that really needed it rather than sitting unused on vets' shelves. It was a real hassle to us vets, but I never ran into a problem getting it when I needed it.
That is changing. A couple of weeks ago Merial announced further problems to the point of them not being able to produce any more Immiticide for the foreseeable future. The only product left is what is sitting on shelves in offices and warehouses, and that will quickly be depleted. Merial is hoping to have more available within seven months, but there is no promise this is the case. So treatment is now being withheld from mild cases without symptoms and being reserved only for severe cases.
This is extremely frustrating, and keeps us from providing the best care for pets. I also think it's crazy that we are so dependent on one single source for such an important medication, leading to situations like we currently have. Honestly I don't know all of the details behind Merial's problems, but with a shortage being known for about two years I would have hoped that someone would have come up with alternative sources by now.
This means that many people who have their dogs diagnosed with heartworms will have to go without proper treatment, instead relying on symptomatic control and other secondary treatments that aren't as fast or effective. However, keep in mind that this is a completely preventable disease! There is no reason for dogs NOT to be on heartworm prevention. So a solution is pretty simple from one aspect...use prevention and your dog's won't get the disease!
And let's hope that this shortage ends soon.
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