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Friday, May 28, 2010

You Named Him WHAT????

I love seeing pets with unique and original names, and have tried to keep my own pets from having common names.  There's nothing wrong with frequently used names such as Buddy, Max, Bear, Precious, and so on, and I bet most pet owners don't realize how common some names are.  But those of us in the veterinary field see certain names happen again and again.  So it stands out to us when people pick uncommon names.  However, sometimes people go too far.

Recently I've been having a discussion with some colleagues about some of the very inappropriate names people give their pets, none of which I can fully repeat here since I try to keep this blog family-friendly.  But we're talking about names like Dam**t, Sh**head, Nig**r, B*tch, Dumba**, and so on.  People sometimes use curse words, derogatory racial names, crude slang for genitalia, and so on.  Frankly, it makes no sense to me, and usually indicates someone who is rude, crass, inconsiderate, and insensitive.  And these people appear to be highly amused by their own perceived cleverness.  "Hey, come here, Dam**t!" [snicker, snicker]  "Did you kids feed Sh**head yet?" [goofy grin] 

I think it's very sad that these people don't seem to realize how offensive these names are.  And I can't imagine their kids growing up in such a household where language and attitudes like this are normal and accepted.  Is it any wonder that our society is becoming increasingly morally degenerate?  It boggles the mind that there are people who find these things completely appropriate in public situations.  Over the years I've seen a few clients who have named their pets like this, and I can tell you that they're not people I would want to spend time with.  And I've also refused to call these pets by their names since I don't use language like that myself.

Thursday, May 27, 2010

They Grow Up Fast

Summer is here and my kids are out of school.  This year they've discovered that there are other kids in the neighborhood that are about their age, and have started playing with them.  Since the other children live down the road and a neighboring street, it means that my kids are starting to spread their wings and explore on their own more.  This has been an adjustment for me and my wife as we learn how to let go and give them freedom, yet balance this with the knowledge that child predators exist and we don't want our kids harmed.

Looking back I can't remember all of my milestones.  I know that I learned how to ride a bike at six, but I don't know when I was allowed to go around the neighborhood on my own.  I know that my parents looked out for me, but I also remember having pretty wide range of where I roamed.  I'm trying to find that balance with my own children, realizing that the world isn't the same as it was 30 years ago.

It's also hard to see my kids learning and growing without us.  A month or so ago we discovered that my daughter learned how to ride a bike on her own.  That was a huge surprise, as a few months before that I had tried to show her and she couldn't do it.  Then I walk out one day and she's riding her friend's bike without any problems.  When did that happen?

At the same time, the kids are becoming more self-sufficient and responsible, which is nice.  My son can easily make his own lunch and both kids put their own laundry away.  So there are some pluses to them growing up.  I'm looking forward to when he can mow the yard!

Wednesday, May 26, 2010

Trying One's Patience

I'm a huge proponent of client service and really try to get everyone on my team to go the extra mile in little ways to show our clients how much we appreciate them.  But there are limits to this.  And I hate to break it to anyone who has illusions, but your physicians and vets don't like every client they see.

I have a particular client whom we'll call Ms. Howlett (not her real name).  She can be a real trial to deal with in several ways.  She can be demanding of my time and insists on always seeing me.  She is reluctant to spend money and has legitimately limited funds, but also wants problems with her cats fixed.  She doesn't seem to understand relatively simple things I tell her and I have to repeat myself several times whenever I talk to her.  She gets copies of her medical notes and nit-picks every little thing I have in there and every slightly abnormal lab value.

One of her cats was diagnosed with diabetes last week and she came back in today for me to go over with her how to administer insulin.  That took many tries of demonstrating the injection, having her try it with some saline, and going over the instructions several times.  What should have taken me 10 minutes with an average person took me about three times that long.  Another of her cats has had chronic diarrhea and we're trying to work through a possibility of inflammatory bowel disease.  This has necessitated several rounds of testing and may including having to do intestinal biopsies.  But it has also involved lots of discussions on diet and other therapy, which of course leads to repeating information unnecessarily.

This afternoon she was at our hospital for over two and a half hours, in what for an average person would have been less than an hour, even waiting for lab tests.  At the end she wanted us to fax her insurance forms in, a total of 15 pages.  We were already about 10 minutes past closing, so we declined to do so, which upset her a bit and caused her to spend even more time trying to convince us to do this.  If it was just a page or two I wouldn't have minded, but this was her responsibility and I thought it was rude for her to insist on us doing it for her.

Now based on what I've put here there are probably many reading who wonder what the big deal is.  Those of you who do veterinary work can certainly identify your own Ms. Howletts and know exactly what I'm talking about.  We can't like everyone, and sometimes a certain personality rubs us the wrong way.  However, we still have to treat them with respect, and this really isn't a business for professionals with poor people skills.

Tuesday, May 25, 2010

A Tragic Double-Whammy

The two c-sections in the last week where all puppies lived were great experiences, and very happy. Unfortunately, not all cases can end on such a high note.

Today we saw a pair of puppies that had been adopted from a shelter last Thursday. As soon as the client took them home, they started coughing.  A few days later she took them to a vet who diagnosed kennel cough, and put them on antibiotics but was worried about the fact that one of them had a poor appetite.  Two days later she was at the emergency clinic with that puppy who was diagnosed with pneumonia and a consolidated lung lobe.  They switched antibiotics and hoped for the best.

When the two pups (black lab mixes about 3 months old) came in today there hadn't been any improvement.  The most severely affected one was also having diarrhea and her sister had just started having diarrhea and a loss in appetite.  Though not clinically very severe, both were lethargic and had coughs.  After talking to the owner and examining them, there was something nagging at the back of my mind.  These pups had been dewormed a few weeks previously, and had had two prior negative parvo tests.  But the symptoms other than the cough were consistent with parvo virus or some intestinal parasite.  Even though this was the third test for parvo, I convinced the owner to test for it.  And I'm glad we did.

The test rapidly became strongly positive for parvo.  So not only did both have kennel cough, but they also had a parvo infection and one had pneumonia.  Any one of these diagnoses was potentially severe enough and parvo by itself is life-threatening.  Having two diseases at the same time was a severe double blow to their chances of survival. 

Under ideal circumstances with unlimited money, these puppies probably would have had a 50/50 chance of survival at best, and realistically probably much less than that, especially with pneumonia.  They would have required intense hospitalization, easily totaling $1000 or more per puppy with no promise of survival.  Because of the money and the chances, the client elected to euthanize both puppies.  It was a very sad bookend to the successes of the two c-sections.

This case also reinforced a few lessons for me.  First, experienced doctors should follow their instincts.  Something abut this case made me suspicious of parvo, and though it wasn't my top likelihood I did consider it.  Second, there is a big benefit to diagnostic testing rather than guessing.  We could have assumed that the diarrhea was due to the liquid diet the owner was feeding and the inappetance was due to the respiratory disease and not ended up finding the real problem.  Third, a previous negative test doesn't mean that you can't be positive in the future, so it's often worth repeating diagnostics.

Oh, and make sure your pets are vaccinated!  In this case it wasn't the client's fault, but it's still important to remember.

Monday, May 24, 2010

Special on C-Sections

Cesarean sections are not a common occurrence in an average veterinary practice, especially emergency ones.  I'll average one every year or two.  Some breeds such as English bulldogs give birth through planned c-sections, but even those aren't common.  This is why I was surprised today with a second emergency c-section.

This dog was a Maltese who started active labor around 10:15 and had part of the amniotic sac coming out of her.  The owner called us about three hours later, worried because no puppies had come out yet.  We told her to come in immediately, and once she arrive I was able to quickly see the intact sac protruding from her vagina.  She was dilated enough that I could gently put my finger up her birth canal and feel a puppy likely in breech position.  It only took an instant to tell that she need to get to surgery right away.

Within a couple of hours we had six new puppies and a recovering mother.  These pups were harder to recover and it was touch-and-go for a while.  But we did manage to save all six, including the one I found in breech.  The surgery itself was a bit easier than the one last week because this was a much smaller dog.  And like last time, mom and puppies left to head home and heal.

It's pretty strange to have two emergency c-sections in five days.  Thankfully, everyone is doing well so far, and it looks like they will make complete recoveries.  One of the biggest lessons to learn here is to HAVE YOUR DOGS SPAYED AND NEUTERED!  With "fixed" dogs, neither client would have had to spend the money or have their pets at risk.

Saturday, May 22, 2010

No Veterinary Hand Models

Today I was on the losing side of a run-in with a particularly evil cat.  I ended up with numerous scratches over both hands and arms, though thankfully managed to avoid being bitten.  Though not the worst I've ever had, it was the most scratches I've received in a few years.  They're more annoying than really deep or dangerous but they're a reminder of what can happen in the business.

Injuries from animals are a known hazard of being in veterinary medicine.  I've known large animal vets who have had limbs or backs broken by a kick from a horse or cow.  I've personally been bitten by dogs, cats, snakes, lizards, birds, hamsters, rats, guinea pigs and just about every species I've ever worked with.  Thankfully most of my injuries have been minor, but I've been to the emergency room in the past to have deep bites treated.  My first battle wounds happened when I was only 14 years old and had been working for a vet for just a few months.  When we're in this field, we are aware of the risks.  Most of our patients aren't going to be a problem, but there is a reason for muzzles, cat bags, and bite-resistant gloves.  We also learn to read behavior and body language and most of the time are able to tell when to push and when to back off.

Those of us who have been doing this for long enough have the marks to prove our profession.  I can still see the small scars from my first cat bite 26 years ago.  I've often said that there will never be any hand models among veterinary staff because of the wounds that we get.  At any moment you can find someone on my staff that has welts, bruises, or scratches from some of the rougher patients. 

In a way, I think we get jaded to the whole experience.  When I was getting scratched today I didn't freak out or panic, instead concentrating on trying to handle the patient with minimal further trauma to me or the cat.  After we decided that we couldn't do anything without sedation, I worked on cleaning and treating my wounds, followed by bandaging my arm.  Within a few minutes I was making jokes and seeing my next patient.  When you're in veterinary medicine you don't have time to be sidelined by a little thing like cat scratches.

Yes, more excitement in a day in the life of a vet.

Wednesday, May 19, 2010

A Half-Dozen New Puppies

Today I had a very, very pregnant dog come in.  We have been seeing her for a while, and had been watching her pregnancy for the last couple of weeks.  The timing of the pregnancy was weird, as she either was bred a full month after she should have been fertile or she was over a month delayed in giving birth.  Somewhere the timing didn't match, so we couldn't be sure how far along she was.  However, it was obvious that she was near term simply by looking at her.  Radiographs showed about a half-dozen puppies, so we knew it wasn't just fat.  She was getting more and more uncomfortable, and today seemed in particularly bad shape.  Yesterday she seemed to show behaviors consistent with nesting prior to labor, but was showing no signs of labor itself.  After weighing the risks, we decided to do a c-section.

This kind of surgery always carries a fair degree of risk.  When we anesthetize the mother, we're also anesthetizing the puppies, so we have to work quickly.  It's not normally done with epidurals and local blocks like in human surgeries.  It's also more complicated because we're delivering multiple babies at once rather than one or a few.  The goal is to get into the abdomen as quickly as possible, remove the puppies individually, then pass them over to a technician who proceeds to stimulate the puppy, clear mucus and fluid from their mouth and nose, and generally make sure they start breathing.  Getting the puppies out is very messy, as amniotic fluid and blood come out copiously and you have to try and prevent that from getting into the open abdomen.  If the plan is to breed, you have to be careful not to damage the uterus and then close it up.  It's much easier to simply spay the female and remove the parts normally.  After all that you have a very large incision to close. 

This dog had a total of six puppies that I removed, and then spayed her.  We were lucky that all of the puppies responded and survived, and once the mother woke up from surgery they started to nurse.  The mom left this evening in apparent good shape, though obviously tired and sedated (I gave her lots of pain medications).  Even so, she walked out on her own.  She's not out of the woods yet, but if she does good for the next few days should be perfectly fine.

There is something incredibly rewarding about bringing new life into the world.  This is especially true when you're the one who pulls the babies from the womb and welcomes them into the realm of the living.  My entire team was so excited and proud, especially with the puppies all doing well (five females and one male).  Everyone had their phones out taking pictures and videos.  And I was guilty of the same thing, wanting my daughter to see the new pups.

It will be exciting to see these puppies grow up and know how they first began.

Tuesday, May 18, 2010

An Ever Changing Job

One of the hardest things to do in veterinary medicine is keep up with all of the changes.  It can be quite confusing at time, and require constant learning.  My practice is currently in the midst of revising our vaccine protocols, which we did just one year ago.  New data on immunizations and recommendations from specialists has changed our thinking on which vaccines to give, which ones to recommend to specific pets, and which to not give.  In my 13 years in practice, I have seen numerous discussions and opinions on vaccines, and with new technology and research the viewpoints change.

This is really true of every aspect of medicine.  I have seen the names of microorganisms change from what I learned in school.  New technologies have become much more common, such as ultrasound and digital radiography.  Manufacturers stop making certain common drugs and medications, while new ones are released.  Treatments are modified as more is understood about disease processes and physiology.  Whatever the aspect of the profession, there are constant changes.

These frequent changes are why we read so many journals (I'm subscribed to four) and are required to attend continuing education every year.  And it certainly keeps the job from getting boring.

Friday, May 14, 2010

The Importance Of Mentors

When I was growing up I had a great mentor in veterinary medicine, Dr. John Strasser.  He took a chance and hired me as a 14 year-old slightly bratty kid. I'm not sure what he saw in me, but he was a good judge of character and knew there was potential in me.  I worked for him off and on for 13 years, until I finished vet school.  Many of the best lessons I learned about being a vet came from him, even though I haven't worked for him in 14 years and haven't seen him in about 5 years.  Though not the sole factor, he was a large part of developing me into the veterinarian I am today.

That kind of mentorship is very important to newly graduated veterinarians, and something we don't always get.  Though my first employer as a doctor was a great guy and gave me great opportunities, he wasn't the best in training and developing my medical or business skills.  A few weeks after I started working as a newly graduated vet, he took a week's vacation and left me alone in the clinic.  I did fine, but that could have easily been a bad situation for many young doctors.

To me one of the most important things an experienced vet can do is to help develop new colleagues.  There are many things we know and have learned that can really help out newer graduates.  Sharing our mistakes can help keep others from making the same ones.  We also can help build confidence and show them all of the little tricks and tips we pick up over the years.  Frankly, I feel that mentoring is an important responsibility that too many vets don't understand.  Admittedly, not everyone is cut out to be a mentor.  But those who are should embrace the opportunity.

I would also encourage any new vets or anyone approaching graduation seek a job with a practice that has an active mentorship program.  Smaller practices may not have formalized this much, but at least one doctor in the clinic needs to be willing to take the new graduate under their wing and not just throw them into the fray.  Larger practices may have a more developed program with specific goals, timetables, and so on that help to gradually ease the new doctor into their role and skills.

Carefully developing new veterinarians takes a lot of time, effort and resources, but is well worth it.  A good mentor can positively affect someone for a lifetime.

Wednesday, May 12, 2010

Final Step Into The 21st Century

I've enjoyed computers and electronics as far back as I can remember. When I was young I had an Atari 2600 video game system with around 40 or more games.  I had an email account as far back as the early '90s, and was regularly posting on newsgroups on the old Usenet before the current Internet really got going.  I've had laptops for several years, and as a family we have a total of four computers (two aren't really working, so I don't know if they really count).  I've had a blog for over a year, and know my way around computers and the web.  Thought I don't own every little thing (not going for an iPhone or iPad, thank you very much), I consider myself fairly tech savvy.  But there was one little thing that for whatever reason I never transitioned music.

Sure, I've downloaded songs onto my computer, but generally with the purpose of burning them to a CD.  I never really saw the need to have an MP3 player.  Then someone at my clinic brought in an iPod dock and several people began bringing their iPods.  Suddenly I realized that digital music was pretty cool, and a heck of a lot more portable than lugging CDs around.  Before long, I was pricing MP3 players and talking about wanting one.

A couple of days ago I finally did it.  I bought my first MP3 player.  Not an iPod, though I don't have anything against Apple.  After a lot of research I went with a Sansa SanDisk, getting it for about half the price of an iPod, and having all of the same basic functions.  I'm still trying to learn how to use it, but am looking forward to trying it out.  However, first I have to load it with my music.

That has been quite the ordeal, as I have many dozens of CDs.  For the last several days I've been working hard to rip my music onto my laptop in preparation for copying the songs to the MP3 player. That has been a lot of work!  But as of this afternoon, I finally finished, and am currently transferring everything over.  Tomorrow I get to really try it out as I mow the lawn.

I kind of feel silly, as I'm one of the few people I know who is this late in moving into the digital music realm.  But better late than never!

Saturday, May 8, 2010

Starting Them Young

As a veterinarian and a pet lover, it has been very important for me to raise my kids to be responsible pet owners.  I have worked hard to teach them to treat animals gently and with patience and care.  I have also made sure they understand the work involved in keeping a pet. When we got Inara last year, we did so with the understanding that the kids would take care of her, feed her, clean up her messes, and so on.  And for the most part, they have done so.  Feeding all of the pets is part of their daily chores, and my daughter is learning about the proper care of bearded dragons.

Now, this is easy for me with my own children since I get to see them and interact with them every day. It's harder to do this with other children.  Some of the children of my clients seem off to a good start, and their parents are obviously trying to show them the right way to have a pet.  Others, however, will grab their new puppy or kitten without regard for their own strength or the potential to harm the pet.  I know it's hard to manage the kids and pets at the same time, but I also wish some people would do a better job raising their children into good pet owners.

My kids came across an interesting new web site, Foo Pets.  This site has virtual dogs and cats and requires the kids to interact with, feed, water, and groom the pets daily.  If they don't work on proper care, the pet will suffer.  It was apparently started by a veterinarian to help develop these skills in children, and it's an interesting concept.  Truthfully, I'm not sure how well it might work, since there are no real consequences if the child completely abandons the virtual pet and let's it "die".  However, I think it's a good start, and an potentially good learning tool when supervised by an adult.  If the child can't properly take care of a virtual puppy or kitten, they certainly aren't ready for the responsibility of a real one.

Children need to be involved in proper pet care from an early age, and are never too young to learn how to take care of the animals in their lives.

Wednesday, May 5, 2010

Celebrity Clients?

Isn't it funny sometimes how certain names become associated with specific people?  I feel sorry for people with a similar or same name.  Just today I saw a client named Pamela Andersen.  Yes, slightly different than the actress/model Pamela Anderson.  But the name made me look a few times to make sure I saw it correctly.  I also went to school with a Steven King (as opposed to the author, Stephen King).

Now sometimes you do get real celebrities in private practice.  I once had a local morning radio DJ for a client, as well as a woman who had a minor part in a new TV show.  A friend of mine had the singer Bobby Brown as a client (yes, the real one!).  I think this is an interesting part of veterinary practice, because you get to see a completely different side of people, and realize that they are just pet owners.

So what about my colleagues out there?  Has anyone treated the pets of legitimate celebrities?  Anyone else know people with names similar to public figures?

Tuesday, May 4, 2010

Do Grades Matter?

Haleigh has this question....

I am a freshman in college and have had a little bit of a shaky first year. my first semester i got all A's and B's with one D that i am making up this summer to exchange grades. my second semester was very difficult for me and may not have very outstanding grades.will vet schools judge me harshly on my first year of college or do they take into account for the transition period of incoming freshman? i appreciate your time and energy

First of all, each veterinary school has different entry requirements.  Yes, all of them share some common factors, but you really should look at what you need for each one.  I would recommend getting catalogs from any schools you may apply for and see what their criteria are.  You can also talk to someone in registration at the school and see what they look for in their selection process.  Be careful, as the catalog may say that there is a certain minimum GPA needed, but this is only a minimum.  Realistically you'll need much higher because of competition with other prospective students.

Each school looks at grades differently.  Some will weigh experience, recommendations, or interviews just as high.  Grades are only one factor that schools use to select students.  However, grades are certainly an important part of that decision.  Those grades are usually looked at in a couple of ways.  First is your overall GPA when you apply (which may be before final graduation).  Some schools will also look at your grades in the required classes.  For example, a D in Art History will affect your overall grades, but isn't as important to your entry into vet school as your grade in Organic Chemistry or Biology (a D in these is a pretty bad thing). 

My recommendation is to really work hard to bring up your grades.  To even have a chance to be competitive you'll need at least a 3.0 GPA (using American standards), but realistically you'll need a 3.2 or better.  As perspective, I graduated Cum Laude with a 3.495 from undergraduate, but then went on to get a Master's degree before entering vet school.  I feel that the graduate degree probably helped me compete against those who had a Bachelor's but a higher GPA.  I'm not recommending going for advanced degrees prior to veterinary school, just showing an example of how other factors can affect our chances.

Work hard, Haleigh, and good luck!

Monday, May 3, 2010


Nope, I haven't fallen off the Internet.  Between doing two plays and all of the rest of normal life, I haven't been on the computer very much and haven't had much time to blog.  But I'm back!  And some big changes at work.

I work for a practice that has normal operating hours seven days per week, as well as evening hours.  The idea is to be there when clients need us rather than keep to traditional doctor's hours.  It can be a bit tough on family life, as I normally don't get home until 7:30-8:00 at night, but the trade-off is that we don't have to do any after-hours emergency work.  It's definitely not "traditional" veterinary hours. 

Also, I manage the location for a multi-location practice and don't own it.  For the past two years it's been me and one other doctor at this location.  Business has grown enough that some changes are being made.

The first change is that we're adding a third doctor.  Bringing a new doctor into a practice is always a big change, as it alters the interpersonal dynamics.  You also have to walk a fine line by bringing the doctor in just before you fully have the business for it, allowing them to grow into the role and build a clientele.  I really like this new doctor and I think she meshes very well with the staff.

The other change is that we're extending our operating hours until 8:00.  This will make us open from 9:00 AM until 8:00 PM Monday through Saturday, and 10-5 on Sunday.  Yes, this will make for longer days, but it also allows us to get our weekly hours in fewer days.  I will actually have three days off per week rather than two, which is a nice trade.  Though I'll get home after my kids go to bed two days per week, I'll have a full extra day to do things around the house and spend time with them after school.

Changes are always a bit challenging.  I think that we're ready to expand, as business has been doing well.  However, there is always that part that worries if it's the right decision.  We'll find out pretty quickly!