Tightwads With Coach Bags

One of the things that frustrates us in the veterinary field is the life choices some pet owners make that puts their pets at risk.  I'm talking about the people who have enough money to buy luxuries but won't spend even a little money on their dog or cat.

Recently a client came in with her poodle, worried about her dog's nasal discharge and sneezing.  While the dog was in good spirits, she was running a low-grade fever and had slightly enlarged lymph nodes.  To me it was a very straightforward case....the dog had a sinus infection and needed antibiotics.  Because of the enlarged nodes and fever I wanted to treat for possible bacteria rather than just letting the case run its course.

To me this wasn't a big deal.  I ordered up the medications, which came to $18, and had my tech review the treatment.  The owner looked up at her and asked "Can I use something cheaper, like Benadryl?"

Several things bothered me about this comment.  First, antihistamines aren't going to treat an infection.  Second, $18 for antibiotics is really inexpensive.  And last, the client was carrying a Coach brand handbag.

I actually had to look up the costs of these bags, even though I knew they were expensive luxury items.  Looking on the Coach website when writing this blog, I saw that they start at around $300, and go up from there.  Some list for $1000 or more!  And the lady had one.  Sure, it's possible she got a really good deal or managed to pick one up at a yard sale for a steal.  Maybe it was a gift from someone else who had the money.  But it looks bad when you carry a brand known for its expensive price and then balk at necessary medicines that come out to less than $20.

I don't change recommendations based on a perception of the client's ability to pay.  I offer a treatment plan based on what is best for the pet, and then deal with whether or not the client can afford it.  I don't artificially inflate the price if I see a client driving a Lexus or wearing a Rolex, and I don't artificially discount the price if the come in wearing flip-flops and overalls.  What is the best treatment plan is relatively objective and whether or not a client can pay the costs doesn't change whether or not their pet needs it.

Every day I see people who want to treat their pet but can't afford to.  Many of them are sincere in their desire to help and legitimately can't come up with the funds.  But many others are tightwads are are simply looking for the cheapest way out rather than the best way.  Sure, I like a good bargain as much as the next person, but we shouldn't be dickering about the life of a pet. 

I'm sorry if this sounds harsh, but if you can't afford $20 worth of antibiotics for you pet, then you do not need to have a pet at all.  If you're that hard up for cash, put the Coach bag on eBay, make a couple of hundred dollars, and set that aside for your pet's care.

Yes, I'm ranting a bit, but it frustrates me and many others when we see clients buying costly handbags and carrying their iPhone 5 who complain about things that cost a fraction of their monthly cell phone or cable bill.  If someone is going to have a pet, then they have the responsibility to put that pet before luxuries.  Unfortunately many people have their priorities mixed up.

The Emotional Toll Of Being A Vet

A lot of people seem to think that being a veterinarian or any other sort of doctor is fun and interesting.  Don't get me wrong, because it can be.  But I think some people don't think beyond the cool cases or the cute puppies to what can happen when things go bad. 

 

This was a bad week for me emotionally.  Two days ago we had an emergency come in, a young dog who had dug under the fence, got into the neighbor's yard, and was attacked by the neighbor's dogs.  When I saw him he didn't have obvious punctures, but was breathing hard and had some air leaking under the skin.  An x-ray of the chest showed some lung bruising but no air leaking into the chest yet.  We stabilized him with IV fluids, gave pain medicine, and planned to repeat xrays in a few hours to see if there were changes.  Over the next three hours he went downhill quickly and passed away despite our attempts to intervene.  That same day I found out that one of our good clients had to euthanize her dog at the emergency clinic, and another dog that we had been treating died at home (which in that case wasn't unexpected).

 

So that day I came home pretty bummed out by all of the death I had heard and seen.  The next day was only marginally better.  One of my earliest appointments was an obese cat who was in a diabetic crisis with liver damage, and the owner had to chose euthanasia because she couldn't afford the potentially thousands of dollars to stabilize the pet, let alone the long-term care.  I also had to tell a client that their Sheltie had complete kidney failure and wouldn't make it to Christmas.  This morning another long-term client brought in their very elderly dog for lethargy.  We had been monitoring him over the year as he became more severely anemic, and the owner didn't want to pursue specific diagnostics.  His anemia was worse and his white blood cells significantly increased.  Since he was nearly 15 years old the owner decided to euthanize.

 

So over the last three days I've euthanized two pets, lost one under treatment, lost two from other causes, and had to give terminal news to another one.  Not exactly the fun parts of the job.

 

This rapid-fire set of cases wears on a person mentally and emotionally.  We do the best we can to help pets, and we are very aware that we can't save all of them.  Everyone in a medical profession has to have a certain degree of emotional resilliency in order to keep performing on a daily basis.  But some days and some cases are worse than others.

 

This emotional toll isn't always talked about.  But it's a regular part of being in a medical field.  Over the years I've learned how to cope and handle things, but that doesn't make weeks like this one any more fun.  Anyone who wants to become a vet needs to keep this particular kind of challenge in mind, as it's not typically taught in school.  These are the times when the rose-colored glasses come off and the brutal reality of death hits you in the face rather forcefully. 

 

Thankfully most weeks aren't quite so dire and depressing, otherwise I don't think I could keep doing this job.  Now I just need a few days off and some healthy puppies and kittens to see!

How To Thank A Veterinarian

Peter asked me a very interesting question, one I've never had someone ask before....

My wife and I recently had to put down our cat Jessie.  She was diagnosed with CRF at the age of 4 during blood work taken as prep for a normal dental cleaning.  (Her kidneys were the size of plump raisins... I suspect she got hit with the whole Chinese Protein fiasco, even though she never had a brand of food that was recalled.)  She lived for 7 years after that with no more than every-other-day sub-q fluids and kidney food (after starting fluids her blood values never again left the normal range by much, if at all).  Her only complications were a couple of UTI's and a stone.  In the end, it wasn't her kidneys that got her, it was lymphoma that spread throughout her intestine.

Our vet and clinic staff took great care of her over the years, and I was wondering what would be an appropriate thank you gift would be.  I was hoping for something more meaningful than a gift basket...

First, Peter, on behalf of my colleagues let me say thanks for your appreciation.  Even the best vets tend to get more complaints than compliments, or at least it can seem that way.

Believe it or not, genuine, sincere thanks doesn't come as often as you may think.  In all of my years I've probably gotten about a dozen or so thank-you cards from clients.  And I've cherished and kept every one of them.  It may not seem like much, but a short, simple card where the client expresses their thanks and feelings means more than you can imagine.  We are in this profession to help people and pets, not to get rich.  Sometimes it feels like we aren't successful as we see pets go untreated, therapy fails, or clients are unhappy.  We crave those few times that a person takes the time to single us out to let us know how much they appreciate what we do.  Such thanks often come at the times when we most need them.

If you want to do more (and believe me, a card is thanks enough!), gift cards are a great option, especially to a nice restaurant.  I've gotten a few of those over the years, and it gives me an opportunity to go out to eat with my wife, something for which we don't always have the budget.  Gift cards to coffee houses such as Starbucks are also very nice, and have sometimes allowed me to grab something caffeinated on my way to work.  Amazon.com gift cards are also nice because they allow us to splurge a little in ways we normally wouldn't.  If you want to do something more specific, make a gift basket with cookies, candy, and chips.  Nice pens are always a great gift, as we constantly lose the ones we have around the clinic.

In case you couldn't tell, those of us in the veterinary profession are very motivated by food!  We love the holidays because we will get clients bringing in cookies for the staff.  We'll often buy munchies to keep around the clinic so we can snack between patients.

I hope this gives you a little direction, Peter.  Really, the simplest thanks are more than sufficient and are greater than we usually get.  You don't have to do something extravagant in order for your appreciation to be recognized.

Fat Cats Aren't Just Fluffy

I hate seeing obese pets.  I really, really do.  It is something that in most cases is completely preventable and results from a combination of too much food and too little exercise.  Most of my clients don't seem as concerned about the health consequences as I am so it becomes frustrating to recommend weight loss and then they ignore my advice.
 

It shouldn't be a surprise that pet obesity is a rapidly growing problem in the US.  Our human population is one of the fattest in the world, so it's no shock that our pets resemble us in this way.  As with humans, there are consequences to obesity.  Cats are about six times as likely to become diabetic if they are obese, and this disease is particularly challenging to regulate in the species.  Being overweight also can lead to skin problems, liver disease, heart disease, joint issues, and increased risks of anesthesia.
 

My clinic recently saw one of the fattest cats I've personally examined.  Actually, one of my associate doctors had the case, but I got the chance to look at him too.  Here are some photos.

As you can see, the cat is morbidly obese.  When these pictures were taken he was 29 lbs (13kg), which was less than his previous visit weight of 33 lbs (15kg).  Considering that this cat should have weighed around 12 lbs (5.5kg) you can see the magnitude of the problem.  At his peak he was essentially carrying around three cats on his frame!  In human terms this is equivalent to someone who should weigh around 150 lbs (68kg) actually weighing over 360 lbs (163kg)!

This isn't cute.  This isn't fluffy.  This isn't something to ignore.  This is sad and should never have happened.  The cat is suffering because he really can't easily move around.  It requires a lot of strength and energy to move that much weight and his body isn't designed to do so.  And it puts him at a significant risk for serious disease.

Just a few days ago I saw a sick cat.  He was 13 years old and hadn't been to a vet in many years because he never acted sick.  This cat was obese, and when we ran lab tests we diagnosed severe diabetes with significant complications.  Due to the life-threatening nature of his condition and the costs involved in treating him, the client had to euthanize him.  If he wasn't obese, he may never have developed that disease.
 

The good news is that the client is taking this seriously.  It's impressive that they were able to get a 4 pound weight loss in a month or so, and they're continuing to work on further loss.  With proper treatment and diet, he has a good chance of losing the weight and becoming healthier.

Puppy Regurgitates Liquid

Today's question comes from Kathryn....

 

My 6 week old puppy regurgitates liquids, he doesn't have any problem with eating food. What should I do to begin testing to find out what his prognosis is? He is from a litter of puppies I have and has had the problem from birth, regurgitating some of his mothers milk.

I have had him to the vets, he suggested x-rays and is suspicious of Mega-esophagus, I have research this disease online but find it usually includes food reguritation.

 

First, this is definitely a case in which you should rely more on in-person vet visits than online comments and research.  I'll give my thoughts, but if you want a true second opinion find another vet to do the exam on your dog.

 

My first two concerns would be megaesophagus or some kind of hiatal hernia.  Megaesophagus in puppies is typically a birth defect where a fetal vessel around the esophagus doesn't go away, resulting in a stricture and difficulty passing food.  It builds up in the esophagus, stretching it out and leading to food regurgitation.  While Kathryn's puppy is certainly not a typical case, I wouldn't completely rule it out.  In megaesophagus cases liquids typically can pass through easier than solid foods, which is the opposite in this case.  Still, it's worth checking out.

 

A problem at the upper sphincter of the stomach (cardiac sphincter in the hiatal region) could result in the stomach opening into the esophagus more easily.  In this case liquids would be more likely to pass back out rather than solids.

 

If this was my case my first step would be x-rays and possibly and upper GI contrast study.  If this didn't give any answers and the problem persisted I would want to refer the case to a specialst to have an upper GI endoscopy procedure.

 

Kathryn, I would continue to follow your vet's advice and see if they can track down the cause of the problem.

Nutrition Mythbusting....Current Pet Food Fads

Every time I write about pet nutrition I get people commenting about how I'm full of crap and obviously don't know a thing about pet foods and what goes into them.  Time to walk that path again.

 

This post comes from a question sent to me by Sharron....

 

Hi Dr Bern: lexee is a yorkie/chihuahua 5 yrs old - my problem is i don't what to feed her - she is SO fussy when it comes to dry dog food. Of all the dry foods i have tried i always go back to Royal Canin.

But of course i have gotten raked over the coals because so many people believe it's a horrible food. Today i was asked if i'm trying to kill her by feeding her RC. I try not to get wrapped up in the holistic, organic etc trend. I think RC is fine. Lexee likes it but i still wonder if she should be on grain free - she doesn't have allergies. She also likes Hills Healthy Advantage Small Bites. Can you set me straight on these foods. Are they good foods to feed. Thankyou.

 

Before I get into the meat of my post, let me first stated that my opinions are formed by listening to and reading articles from board-ceritified nutritional specialists and internal medicine specialists.  My sources are reputable and experts in their field.  Before you disparage and dismiss those folks, remember that these are veterinarians who have studied for 5-6 years after vet school in a very specific field and then have passed rigorous exams where the pass rate is around 40%.  If you ignore their opinions, you are throwing away the views and knowledge of the people doing the reasearch that everyone else follows.

Okay, that's out of the way.  I had to throw that in there because I inevitably get people who think what I say is uninformed hogwash and my sources obviously don't know what they're doing and are shills for the food companies.

Sharron, here's the simple version....the people who are giving you advice don't really understand what they're talking about and you shouldn't listen to them.  Keep doing what you're doing.

Now the long version. 

The whole "grain-free" diet trend we've seen in the last couple of years is purely a fad without any real scientific basis.  It's perpetuated by people who have incomplete understanding of the gentics and digestive physiology of dogs, and often by pet food companies trying to sell food by playing on client fears.  So why is this such a popular trend?  From my personal experience this trend started as a result of two things, both incorrect. 

First, there is a percpetion that because dogs are descended from wolves we need to feed them something similar to the diet of their wild anscestors.  Since wolves don't eat wheat, rice, and corn, we need to be feeding grain-free diets.  The problem with this idea is that it's completely wrong.  Dogs are not wolves.  Yes, they are very similar and have a nearly identical physiology, but there are also significant differences.  Dogs have been domesticated for 10,000-15, 000 years, and in that time have been exposed to diets much higher in grains than what wolves eat.  Scientists have identified differences in several key genes in dogs related to starch digestion and glucose uptake.  This means that dogs have developed so they have a much better ability to handle grain-based diets than do wolves.  It also means that there is no benefit to feeding a grain-free diet over one with grains.

Second, there is a misconception that grains cause food allergies.  This is blatantly untrue.  It's the same as saying that a bee sting causes someone to be allergic to bees.  In any of these allergies the person/animal is already genetically predisposed to the allergy, and exposure to the allergen can trigger the reaction.  The bee didn't cause the person to be allergic; the person was already allergic and the sting simply triggered a genetic tendency.  It's the same way with food allergies.  If a dog has allergies to grains, it means that they had genes already in their body which would trigger a reaction after repeated exposure to the allergen.  Grains will absolutely not cause an allergy in a dog with no genetic predisposition, just like a bee sting wouldn't result in anaphylaxis in a person without an allergy to it.  Additionally, not every food allergy is to grains, and even if it is, it is usually to specific grains.  Wheat is indeed a common allergen, but beef and chicken are even more likely to cause a problem.  A grain-free diet is only of benefit if the dog has an already documented allergy to the grain in question.  For your average dog there is no need to limit this ingredient.

Now let's talk about Royal Canin specifically.  I think it's an excellent food, as does every nutritional specialist with whom I've ever consulted.  It is what I chose to feed my own dogs and cats, and I don't work for the company or get any financial incentives for recommending it.  I just believe in it that much.  When ever I've talked to veterinary nutritionists and asked which foods they recommend. Royal Canin is always near or at the top of the list. 

Royal Canin is a great food for a number of reasons.  They use high quality ingredients and pay particular attention to the needs and eating habits of specific breeds.  They put a lot of attention on palatability, which is why they guarantee a dog or cat will eat it.  They are highly involved with quality control on their foods.  And they are supported by the Waltham Foundation, which has been one of the premiere animal nutrition research facilities in the world for several decades.  Besides being one of the leaders in nutritional research, the Waltham Centre has always impressed me by how they take animal welfare into account when conducting research.  I would really challenge anyone to be intellecually honest and find serious fault with the research and findings of this group.

Yes, I know like I sound like I'm trying to promote Royal Canin and Waltham and that I work for them.  I assure you that I don't, and that it just comes from carefully looking into pet foods and this company in particular for over 10 years.

Sharron, I'm curious as to why some of the people you talk to think that Royal Canin is so horrible and detrimental to dogs.  I can almost guarantee it is because of some passionately held misinformed beliefs.  Personally, I think you're feeding one of the best dog foods on the market, and wouldn't recommend changing anything that you are doing.

Now I wonder how long it will be before someone starts commenting on how horrible and ignorant I am.......

Concerns About Fostering Dogs

Jennifer asks the following....

I have been thinking for a while about becoming a foster home for a bichon rescue group in my area. I am at home during the day so I would have time to be with and work with the rescue dog, and I have a fenced in yard for the dogs to run around in. I am concerned about how Sparky will react to the rescue dog. He is very friendly and energetic when other dogs come over to visit, and wants to run and play chase games. I understand that it is important for these poor little dogs to go to a home where there is a dog who is well socialized and friendly who can show them that people can be trusted. I am wondering though how do the 'home dogs' react to the very frightened and abused newcomers? Is it difficult for home dogs to adjust to a scared newcomer? I would like to be able to help abused animals in this way, however I don't want to harm my own pet in the process.

First, I want to commend you on wanting to become a foster parent for dogs.  This is truly admirable and it sounds like you have the right situation for it.

The concerns you have are valid, but there are no general answers that can be made.  Really this is very much a "it depends" situation.  If Sparky is generally friendly and gentle around new and unknown dogs, he should be a great foster brother.  If he is friendly but too energetic, he might frighten a very nervous dog with his exuberance.

On the other side it also depends on the personality and behavior of the fostered dog.  Some of them will not have been socialized well and will be nervous around any other dog, regardless of the other dog's behavior.  This can potentially result in fights from a scared or dominant dog.  It may also confuse Sparky when he wants to play and the fostered dog cowers or snaps.  Some fosters will actually like the social interaction once they get used to it, and it may be hard for you to give those up if they form a bond with Sparky.

If Sparky is as good with other dogs as you say, I would take the plunge.  It will help many otherwise homeless dogs and can be very rewarding.  But keep in mind that every dog is an invididual, and no two dogs are going to react exactly the same to the same situation.  Some of the dogs you foster simply may not be good fits in your home, and you shouldn't take that personally or think that it reflects poorly on you as a foster parent.  Have lots of love and patience with Sparky and the newcomers, and partner with an experienced foster parent who can help you though any challenges.