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Sunday, February 28, 2010

Problems Dropping Off

At times we can have a pretty busy practice.  Appointments can get booked like in any doctor's office, especially on weekends.  I don't like turning clients away as  I know what it's like to not be able to get to see a doctor when you really need to, so I try to get everyone in the same day if possible.  However, we can't put every pet into an appointment slot and still get to see the scheduled patients in a reasonable amount of time.  To get around that we will have clients drop their pets off with us and we will see them between appointments or during brief lulls.  In this way we can see the most number of pets possible and still stay on schedule.

However, some clients aren't satisfied with this plan.  In the last couple of days I've had a couple of people get upset with us at the idea of dropping off their pet.  The comment we keep getting is "I wouldn't drop off my kid at the doctor and I'm not doing that with my dog!"  Then they get upset when we tell them that all scheduled appointments are filled, and without dropping off we couldn't see them the same day.  We are trying to find a way for their pet to be seen without waiting for another day, yet they won't accept the option that we give them.

As much as I believe in pets being family members, I don't think they are the same as a human child.  Leaving a dog or a cat at a vet or boarding facility isn't abandoning them.   While I also wouldn't just leave my children alone at a doctor's office, these aren't people that we're talking about.  Pets generally do quite well in circumstances like this, and most of them don't become as stressed as their owners believe they will be.

Frankly, I know many vets who aren't as concerned about seeing every pet the same day, and would be very happy to push them until an appointment on the next day or even later.  Maybe it's presumptuous of me, but I think that clients should be grateful when a vet works hard to get them in the same day.  I've certainly been very happy when my own physician works me in on the same day I need, even if I have to wait for a long time.

Thankfully, most clients aren't like this, and are content to leave their pets with us.  It certainly helps our daily flow and ensures all pets get the care they need.

Friday, February 26, 2010

Non-Surgical Sterilization?

There are a ton of good reasons to spay or neuter your pet.  Not only do you help reduce the unwanted pet population, but you lower the risks of certain kinds of cancer and help control some kinds of behavior.  Spayed/neutered pets live longer on average than intact ones.  But what if someone is afraid of having surgery done on their pets?  What about the costs and time involved in "fixing" stray dogs and cats?

Believe it or not, there are other options.

Researchers have been investigating non-surgical options for sterilization, and some are on or close to being on the market.  Some are injections and others are implants (similar to certain kinds of human birth-control).  Here's a look at a few.

Neutersol--This came on the US market in 2003, but left the market two years later because of a split between the patent holder and the marketing company.  It involved a single injection in each testicle that would leave the dog sterile without the need for surgical castration.

EsteriSol (Mexico), Infertile (Brazil)--Like Neutersol, these are intratesticular injections that result in sterility.  Right now they are only available in the listed countries.

Gonazon--This product received approval in the European Union in 2006.  It is an implant for female dogs and cats, providing long-term birth control by hormonally preventing the estrus (heat) cycle.  There is a possibility of the same product being used to control fertility in males.

Suprelorin--Similar to Gonazon, this is a sustained-release implant that suppresses testosterone in male dogs.  It was released in Australia and New Zealand in 2004-2005, and is available in some European countries.  Though not approved for use in females, some studies have shown the potential for its effectiveness.

Currently these are the only approved products on the market (that I am aware of).  And there are several pros and cons.  The biggest benefits would be a lower cost than surgery and lower risks.  For stray dogs and cats where we only want to try and control reproduction this would be a very helpful option.  Many shelters and rescue groups could to more cost-effective "trap and release" programs.  However, the implant products only work for a year or so at the most, so repeated dosing would be needed.

The cons revolve around the fact that we spay and neuter for reasons other than reproductive control.  Removing the reproductive organs does lower the risks of several kinds of disease and cancer in both genders.  Chemical sterilization would not really help with these risks, as the organs are left intact.  Depending on the product used, there would also be some hormonal production which could lead to undesired behaviors (such as aggression or marking territory).

Other products are currently in development that would include vaccines against certain reproductive cells and receptors.  These have not been approved and have certainly not been perfected.

Personally, I think that the tried-and-true method of surgical sterilization is still the best one for pet owners, as the health risks is low and the benefits are high.  You only have to go through the surgery a single time, as opposed to potential recurrent implants and injections with most of the other methods.  Still, the idea of a good non-surgical option holds promise, and I agree that it's an area that deserves more research.

Monday, February 22, 2010

300 Posts!

When I started this blog back in September 2008 I wasn't entirely sure where it would go.  I didn't know if I'd have enough material to talk about and if I could keep the motivation up.  Now I find myself writing my 300th post, looking back at where I've come with this site.  Sure, 300 is a bit of an arbitrary number, but we humans like anniversaries, milestones, and celebrations.  And 300 seemed like a good number to mark the occasion.

At first I didn't think about tracking my readers, and didn't start that until July 2009. Since that time seven months ago I've had over 16,000 hits on the site, which honestly is more than I expected and averages out to over 2000 per month.  Wow!  For a small, growing blog I consider that a big accomplishment.

One of the most amazing things to me is that I have world-wide readership.  People in every hemisphere and six out of seven continents have accessed my blog.  Maybe in the future I'll get some Antarctic researchers who look me up and allow me that seventh continent!  People in 92 different countries have been to my site at least once (sure, some of those are likely bots, but hey, I'll take that).  I love being able to share with people in other countries, and see how many similarities we really have.

So thanks to all of my readers! I hope to continue to provide you with informative and entertaining stories about life in the veterinary field for at least another 300 posts!

Thursday, February 18, 2010

Veterinarians On TV?

A random thought occurred to me today.  There have been so many shows on television that center around the medical profession.  As I write this I'm watching House.  Another popular show is Gray's Anatomy.  When I was in vet school I was fairly addicted to ER.  Numerous soap operas involve doctors and hospitals (General Hospital anyone?).  Obviously characters and stories in these settings are interesting to people.  So why not veterinarians?

I know there have been some shows on Animal Planet about vets, but those are reality shows.  Why not a drama centered around a major specialty veterinary clinic?  What about a small-town vet as the main character in a "dramedy"?  Heck, I'd be happy with a single recurring character on some other show.

So why this lack of veterinary characters?  According to most surveys, we are one of the most trusted and well-respected professions that people know of.  The majority of Americans and others in western civilization have pets and see a vet at least once per year.  Those of us in the profession know that there is plenty of drama and humor in what we do.  There are surprises and shocks, heartbreaks and great successes.  I think it would make for a great show!

Tuesday, February 16, 2010

Changes In the Wind

Veterinary medicine is full of changes on a regular basis.  Products come and go, current medical viewpoints shift, and we have to keep up with it all.  Recently we have had changes in the type of insulin we have available for pets due to some manufacturers not making some kinds and others picking up the slack.  We sometimes have to change our medical practice because of a pharmaceutical company deciding to make or stop making a given product.

This week I found out that Bayer is going to officially sell it's line of flea and tick products over-the-counter.  Here in the US they have chosen to sell only through veterinarians.  Now, that's their official position, as I know it's easily available online and through certain pet stores.  But Bayer is going to start making Advantage and K9 Advantix easily for sale outside of veterinarians. Which means that vets will no longer be stocking these products.

Frankly, the decision doesn't completely surprise me, as I've seen the industry moving this way for years, and I know that in other countries this has already happened.  I also don't think that vets should focus on retail sales over good medical service and procedures.  However, this is going to come as a big blow to vets and is going to result in a quite sizable revenue loss for those vets who have carried the Bayer products.

But, we all have to adapt or die.  This is one more change in my career, and I'm certain it won't be the last.  As I vet I have to focus on giving excellent client service and keeping a high medical quality.  The loss or addition of any specific product may change things to some degree, but in the end I'm still a doctor and need to concentrate first and foremost on this fact.

Sunday, February 14, 2010

Let It Snow?

Here in the Southeast US we don't get much snow.  So when we do, it completely disrupts things.  It's a joke among notherners how everything shuts down for less than an inch of snow.  Earlier this year the schools closed because of the threat of snow.  When snow is expected everyone runs to the store to buy bread and milk, even though it will likely melt in a day or two and the chances of being snowed in are highly unlikely.  Even the extreme snow in the Northeast is highly unusual, being the worst in more than a generation. 

So what does all of this snow mean to a vet in this part of the country?  First, I'm grateful that I don't work on farm animals, and I don't have to go out in this stuff.  As much as I love snow and winter, I'm glad for the controlled climate of being indoors.  But for a small animal vet is can make a bit of chaos.

Friday we received several inches of snow, which shut down much of the area.  Yesterday morning when I went into work, several of my staff couldn't get out of their neighborhoods because of ice, leaving me short-handed.  However, that wasn't necessarily bad, because the morning was a wash-out as people canceled their appointments left and right.  I had expected that, but wasn't happy because it hurts business.  Then the afternoon came and a bit of craziness ensued.  People continued to cancel or not show up.  At the same time, many people came in without appointments.  So I really had no idea what to expect from moment to moment.  I often say that a vet's daily schedule can be pretty unpredictable, but it's especially true when there is bad weather.  So we saw more clients yesterday than I expected, though the day was still pretty bad from a business perspective.

If anything is good about this, it's that my kids got to see and play in the snow.  They're young enough that they don't remember seeing a real snowfall, and have been dying have some, so I was glad for them.  Unfortunately, I had to work for much of it, and it melted quickly.

Tomorrow we're supposed to get more snow and wintry weather.  Time to prepare for another odd day.

Friday, February 12, 2010

Variety In Veterinary Medicine

One of the things that amazes me the most about being in veterinary medicine is the wide variety of things you can do with the degree.  I think when most people think about being a vet they think about the typical small-animal doctor that they take their dog or cat to.  Some may think about large animal vets who work on their horses or livestock.  And truthfully, the majority of vets fall into one of these two categories.  However, veterinary medicine is far from limited to this practice.  Here are some examples:

Specialty Practice--It's possible to be specialized in one area of veterinary medicine, similar to the divisions in humans.  Certifications include dermatology, dentistry, ophthalmology, internal medicine, neurology, surgery, behavior, avian medicine, lab animal medicine, and general practice.  Some of these vets teach in colleges, but many work in private specialty practices.

Research--Someone has to make new discoveries and medications.  Anything we discover and learn has to come from researchers. 

Lab Animal--Animals are used extensively in researching medicines and procedures for humans and animals.  Veterinarians are required to maintain these laboratory animals, as well as perform surgery on them.

Zoo medicine--One of the most difficult areas of veterinary medicine is working for zoos.  Many of the species kept in zoos are rare and much may not be understood about their nutrition and physiology.  Zoos could not be maintained without highly skilled vets.

Military--Vets are needed to maintain the dogs and horses used in the military, as well as inspect meat and food supplies.

Politics--Yes, vets are involved in politics!  There are a few US congressmen who are veterinarians, and the governor of the state of Georgia is a vet.  Besides elected office, vets are needed on regulatory boards to help develop legislation for the care of animals and the practice of veterinary medicine.

Public Health--Many diseases such as rabies, swine flu, avian flu, and mad cow disease are best known by vets.  Veterinarians understand the physiology of animals and how diseases are transmitted from them to people.  Vets help to track disease patterns and warn the public of any health risks.

Food Safety--It may not be a glamorous aspect of veterinary medicine, but a very important one is food inspection.  Vets are employed by the government to make sure the food we get from animals is safe and healthy.

And you know, I'm probably leaving something out.  But you get the idea.  If anyone chooses to make their career as a veterinarian, there is virtually unlimited potential to pursue whatever kind of job they want.  Good luck to all of the future vets out there!

Wednesday, February 10, 2010

Broken Kitty's Paw

New reader Kirsten sends in this question from Italy...

I stumbled across your blog while researching how to help our cat who has the same exact fracture as the boxer puppy in your entry from June 2, 2009. We live in Italy where they still use old 1950s style radiators for heating - a favorite winter hang-out spot for our cats. 11 days ago, I hear our 6 year old cat screaming from the kitchen and ran in to find him hanging from the top of radiator by his back left paw which had somehow gotten caught in a hole on the top of the radiator.

Since it was Sunday at 10pm, I immediately called the vet, gave him a tranquilizer (Acepromazine - vet's advice) and waited until the morning to take him in. An x-ray showed that all four of his metacarpals were broken with one really displaced. The vet casted him, gave him Tramadol and scheduled surgery in 2 days. We gave him Arnica and Tramadol injections the next day, Arnica the second day and brought him to have surgery that day.

Surgery went well, two rods were placed in the middle two bones, and he had a big bandage for 5 days. He had the bandage taken off two days ago and is now wearing an Elizabethan collar. In the past 24 hours, I've noticed one of the outside metacarpals without a rod is looking really displaced, just as it was before surgery. The vet said that the middle two bones needed to be stabalized, but the other two outside bones would fall into place and heal perfectly.

My question is whether those outside two bones really are falling into place or should they also have rods placed? I'm calling the vet tomorrow morning, but I'm really interested in an American vet's opinion and to hear what you have to say considering you had another case almost identical (granted it was a dog =) ).

Thanks for anything you can tell me!

Kirsten, I'm sorry to hear about your kitty!  Your vet is going to be the best one to judge what is going on in this case since he/she can actually see the paw.  I am also hesitant to second-guess another vet when I'm not directly involved in the case.  However, I can talk about how I would handle things.

The decision of whether or not to do surgery is dependent on the individual case, taking into account the pet's size, activity, displacement of the bone, and the financial ability of the owner.  A small pet like a cat may not need surgery, and might be able to be managed with a long-term splint (4-6 weeks).  It can also be difficult to properly place pins in bones the size of a cat's metacarpals.  However, a good surgeon with the right equipment could do so, and surgical stabilization normally gives the best chance for a full recovery.

One of the keys is to maintain immobilization of the bones.  If only some of the bones are surgically fixed, then I would recommend keeping a splint of some sort on for the full six-week healing period.  Your vet may have different experience and other reasons for setting the paw differently.  There are also times when a doctor does everything appropriately, but complications still happen.  In any case, it does sound like the bones are displaced, and you should certainly take him in for a follow-up.  He may need to have further surgery or have a splint or cast placed.  A lack of stabilization was a problem with the dog case you're referring to.  The client didn't have surgery performed, didn't keep the dog calm enough, and didn't come in for appropriate rechecks, leading to some serious problems with healing.

Be sure to ask questions of your vet, and be an informed owner.  If your vet has lots of experience doing a repair this way and it typically heals well, then I would agree that this is an acceptable way to do it but you're seeing some complications.   Good luck!

Thursday, February 4, 2010

Never Too Late To Be A Vet

Karen asks this question, and I actually need some help from my readers...

I have a non medical related question. I am 34 years old and I wish to study veterinary medicine. I was unable to study directly after school due to family issues and not having science from school.

I have just completed a one year BTEC First Diploma in Equine Nursing (level 2) and I now wish to apply to vet school. Would this be sufficient for entry requirements or should I continue with the BTEC on the advanced level, which will be the BTEC National Certificate in Equine Nursing (level 3).

Or I could go back to school and complete science and re-do maths as a refresher. I really don’t know which route to take and I am now at a point in my life where I am able to take 6 years out and study.

Am I too old to want to do this? What else could I do and complete in order to better my chances at getting in? I will be applying to the University of Pretoria in South Africa and they select by academics and not work experience and the like.

Any advice?

First, I'm only familiar with the requirements in US veterinary schools, so I can't speak to any requirements in other countries.  Heck, I don't even know what a BTEC is!  However, I know I have readers on every continent except Antarctica, so I'll be surprised if someone else can't give you the answers you want about these specific issues, Karen.   Anyone who can help, please post a comment with suggestions or answers.

However, I do want to respond to the issue of age.  I believe that it's not too late to follow your dreams.  When I was in vet school there were at least 10 people in a class of 72 who were over 30 when they began.  I knew a vet who had a career in publishing (he was editor of a nursing journal) before he started vet school around 40 years old.  Now he works for a large corporate practice in the US, managing a few dozen veterinary practices in the midwest. If you have the drive and desire, 34 is not too old!  Go for it!

Wednesday, February 3, 2010

Staying Sane In Vet School

Here's a great question sent in from Jaime...

I have just been accepted for an undergraduate Veterinary Science course in Australia. I was just wondering what your advise would be to keep vet school student sane during their studies.

I have often said that it's a good thing they don't require psychological evaluations to enter vet school, as we would likely find that the majority of veterinary students are actually quite insane.  You pretty much have to be to spend that much time in school and work as hard as we do for the comparatively small salaries we make.  Now, I say all of this tongue-in-cheek, but there is probably a grain of truth to it.

My four years in veterinary school are the hardest, most stressful time in my entire life, before or after.  Nothing compares to those hardships, including work stresses, having kids, or achieving my Master's degree.  Veterinary students spend an almost impossible amount of time studying.  You're in classes and labs from around 8:00 AM until at least 4-5 PM.  Then you can expect to spend another 3-5 hours in the evening studying.  When you have a major exam, especially an anatomy practical, you may literally spend all night trying to cram the material in your head.  The amount of dedication required makes it hard to have much of a personal life and makes it pretty much impossible to have anything other than a very part-time job.  The courses are incredibly hard, and you have to learn all kinds of nuanced details about the anatomy, physiology, diseases, disorders, pharmacology, and toxicology of most non-human species.

So how do you stay sane during all of this?  It's not always easy.  Here are some suggestions.

1.  Take a little time every day to decompress.  That will differ between people, and may include talking to a friend, playing a video game, listening to music, taking a nap, and so on.  You sometimes have to force yourself to take this time, but it's well worth it.  Find something that takes you away from the rest of life and do a little of that each day.
2.  Get together with non-veterinary friends.  Spend time each week away from the studies and the field, reminding yourself that there is more to life than being a vet.  Being a vet is what you do, not who you are, and you need to keep grounded in reality.
3.  Get together with fellow students and spend time comparing notes about how horrible Dr. So-and-so is or how impossible it seems to have to learn the entire canine musculoskeletal system in a few weeks.  Sharing the misery makes you realize that you're not the only one going through all of this.
4.  Enjoy your breaks.  You'll get time off from studies throughout the year.  Do whatever you can to make the most of these times.
5.  Remember that the person with the lowest Grade Point Average in the graduating class is still called "doctor".  Once you get out of school no employer will care what your grades were like! Do the absolute best you can, but realize that after several years in practice there isn't much difference between the A students and the C students.  Practice and real life are the great equalizers.  So if you get a few bad grades, don't freak out about it (which you will likely do, as it's only the A students that can get into vet school, so it can be a hard lesson to rack up lower grades).
6. Laugh, especially when you want to cry.
7.  Remind yourself why you want to do this.  Find some sweet animal (dog, cat, horse, snake....pick your preference) and spend time just enjoying being with them.  Resist the temptation to practice your palpation and exam skills!!!!

Good luck, Jaime!

Monday, February 1, 2010

A Veterinarian's Reponsibility

Let's say that I'm presented with a very sick dog that needs extensive lab tests and hospitalization.  However, the client has just been laid off and will have difficulty affording the needed tests and treatment.  In a situation like that, do I focus on the needs of the pet, or do I try to protect the client's pocketbook?

This is a common situation that all vets are faced with.  It can create problems as the clients argue that they don't have the money and we argue that the pet really needs these services.  Since we can't force the client to do what we recommend, the pet may end up going without the care it should have.  Yes, there are subtleties in many of these situations, and you can't pigeon-hole all of them.  But in the end the dilemma is who should the veterinarian look out for most:  the pet, the client, or themselves.

Which brings up my latest poll.  I asked "What do you think is a veterinarian's primary responsibility."  Here are the results.
Look out for the best interests of the pet: 92% (53 votes)
Look out for the best interests of the client:  5% (3 votes)
Look out for their own best interests:  1% (1 vote)

Personally I would fall into the category of looking out for the pet.  Unfortunately sometimes the pet's best interests are in conflict with the client's, which causes problems when the client can't do what is really needed.  And in those situations veterinarians have to keep in mind what is really best for those pets.  This may mean that a pet needs to have certain diagnostic tests before starting treatment, even if the client doesn't want to do it.  It may mean that the best antibiotic for the pet isn't the cheapest.  It may mean that the pet needs chronic medications, or a complex surgery.

Now before someone says "well, if you're looking out for the interests of the pet, then you should just do the treatment and reduce the cost," let me remind you that veterinarians have a business to run.  They have families to support.  And they make a fraction of what most people think they do.  If vets are continually discounting or giving away services, they will go out of business, not be able to support their families, and pet owners won't have options for treatment.  Also, in the majority of the cases the vet knows better than the client what is really medically necessary (yes, again there are those out there who can bring up examples otherwise....we've already gone through that discussion and it's pretty clear that it's the minority of situations).

It's pretty clear that the vast majority of people think that a vet's responsibility is to the pet, not to the client.