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Friday, July 29, 2011

World Domination Proceeding

Over the last several months to a year I have seen this blog grow, have appeared on television twice, have done several on-line interviews that have been published, and now have been published in a major US veterinary journal.  A blog post I made several months back was noticed by one of the editors at Veterinary Economics, and he thought it would make a great "Hot Button" topic for the magazine.  We went through an editing process and I just received the latest issue, which has my article on the back page, with a mention on the cover (though you can't see it in this small's just to the right of the main logo)! 

You can check out the issue online if you don't subscribe to it or are outside of the US.  Here's a direct link to the article, which regular readers will probably recognize from this entry back in May.

I'm particularly excited about this article because it's in one of the most widely read veterinary journals in the country, and will probably surprise many of my classmates and colleagues whom I haven't kept up with over the years.  Since this blog is mentioned in the bio at the end, I would also expect that I'll see a bump in traffic on this site. 

It looks like my plan for world domination is proceeding along just fine!

Wednesday, July 27, 2011

Titers Vs. Vaccines

Over the last 10-15 years veterinarians and clients have become increasingly concerned about the possibility of over-vaccinating.  This has led to changes in vaccine protocols, studies to determine longer durations for vaccines, and investigation into other methods of preventative care.  One of those potential other methods is measuring titers, something that I get asked about every now and then.

Let's first talk about titers, especially for those without a background in immunology.  When we give a vaccine we stimulate the immune system to react.  In order to help fight off an infection the body will produce antibodies specific to the invader.  These antibodies help immune cells recognize and destroy the organism.  Once the infection is defeated the body wants to be ready in order to repel a similar invasion in the future.  So antibodies against that given organism will remain in the blood stream for a period of time, allowing the body to respond quickly if it is infected again.  Each type of antibody is specific to only a single organism, though some may be similar enough that they will aid in fighting off very closely related organisms.

A titer is a measurement of antibodies in the blood stream.  It's not uncommon for us to measure titers as a diagnostic test when trying to determine whether or not a patient has a given infection.  Some people have been advocating measuring antibody titers to determine immunity before giving a vaccine.  The idea is that if the titer is high then protection is still adequate and vaccination is unnecessary; if the titer is low then immunity has waned and re-vaccination is needed. Sounds pretty simple and makes sense, right?

Unfortunately, it's not so straight-forward.  In fact, top immunologists don't recommend routine titer testing as an acceptable alternative to vaccination.  In the early 2000s the American Veterinary Medical Association published data from a Vaccine Task Force study that had been looking into vaccine protocols for several years.  More recently I read a summary article by one of my professors in vet school, Dr. Richard Ford.  There are numerous reasons why titers aren't a good idea.
1.  Antibody concentration and levels does NOT equal immunity.  A very high level usually indicates protection.  However, a low level may not indicate a lack of protection.  And in the "gray area" between the extremes there is no consensus on what level indicates adequate protection.  So just because a lab report states a given level it doesn't automatically correlate with any degree of protection.
2.  In the US there is no standardized method of measuring serum concentrations of antibodies for vaccine antigens.  Therefore the measurement reported by one lab can be very different than the measurement reported by a different lab!  You can't compare results between labs because they may not be measuring them the same way.  So if one lab gives a "high" result but another lab gives a "low" result, is the pet protected?  Honestly, there's no way to tell.
3.  There are no lab tests for most of the vaccine antigens on the market (currently only for canine distemper, canine parvo, and feline panleukopenia).  However, even if other antibody tests are developed, because the correlation between antibody levels and protection is so poor, results will be meaningless.
4. Vaccines are far cheaper than titer testing.  Most vaccines cost less than $30, yet titer testing for a single antigen may cost $80-100, sometimes even more.  For most cost-conscious clients it's better to give a vaccine rather than test for antibody levels. 

Now I know that there are those out there who are strongly against vaccines and are very in favor of titer testing.  However currently the evidence is against doing testing.  Vaccines have prevented disease for over 100 years and we are improving their quality while decreasing their reactivity.  Vaccines have saved lives and caused minimal problems.  There have been far more problems prevented than caused by immunization, and most of the concerns about them have not been proven despite studies.  So until studies show otherwise, I will continue to advocate for vaccination and against routine titer testing.

Sunday, July 24, 2011

God And Veterinary Medicine

Ready for a very long post?  Buckle in, because we're going places I haven't gone since I started this blog.

Anyone who has followed my blog over the years or has perused my profile or some of my older entries will likely know that I am a Christian.  I deliberately do not make a big deal about it as that is not the main point of this blog (for something more along those lines check out my other blog, The Christian Ninjate, which isn't updated anywhere nearly as frequent as this one).  However, I've also never hidden my faith and do believe in being openly Christian.  Today I want to talk more about my Christianity in regards to my workplace, all because of an email I received from Rachel...

I'm been interested in becoming a veterinarian since I was very little and always had a deep passion for pets.
Now that I am about to become a senior in high school and have prayed much about it, God seems to have confirmed to me that I should pursue a career path in veterinary medicine.
I came across your blog and the stories that you mention are so interesting and always make me smile :)
Plus, the fact that you are a growing Christian while having the life of a veterinarian shocked me SO much!
All of the veterinarians/pre-vet/vet tech/etcetc. seem to be so avid about animals that they push God away- many speaking against "religion" (especially those who are staunch about animal rights!)
Many people who choose to make animals a critical part of their life even treasure them above people!
I get very discouraged about this, and sometimes think that I'm not "passionate enough" about animals if I value humans and my beliefs higher.
So my questions are...

-How do you glorify God through your job?
-What pushed/motivated you through the hardship of schooling?

In answer to Rachel, let me give a little more of my background, as it's pertinent to the topic. I was raised Lutheran and in what would be considered a pretty typical suburban background.  We went to church, I went through Confirmation, but it never really meant a lot to me.  It was something that we did, not something I really felt.  By the time I was through high school and into college I had started questioning things and became a full-blown agnostic.  At one point I even looked into other religions, including Islam (which was presented in one of my college texts as a religion of peace and inclusion).  While in college I spent part of a semester in London and had an experience there that suddenly made me strongly believe that God was real.  I had no doubts at all.  However, I didn't read or really believe in the Bible, and didn't take its lessons to heart.  I went through graduate school and veterinary school living my life selfishly and in a way that God wouldn't be proud or accepting of.  I treated people horribly and did many bad things.

That turned around in 1998, when I reached the lowest point in my life.  I don't want to get into all of the particulars, but some things happened to me and I felt my life falling apart, or at least going down a track that I didn't want to see.  One evening in my apartment I felt utterly hopeless, and suddenly remembered a few things that my mother had said about being able to turn to God.  So right there I got down on my knees and asked God's forgiveness.  The next day I started looking for a church, finding one close by.  I started studying the Bible, looking at it and life in ways that I never had previously.  About a month after that I met the woman who would become my wife, who was a Christian and someone I never would have considered prior to giving my heart and life to Jesus Christ. Since then I've tried to turn myself around, have changed my attitudes, and don't think that I'm the same person I was back in the '80s and '90s.  I've also tried to listen to God's guidance and have looked for ways to serve Him.  I have been involved in helping to grow churches, have spoken in front of churches, and have become a leader in a "Christian geek" ministry, Fans For Christ, where I organize and lead church services at sci-fi/fantasy/comic/anime conventions.

So that's the short version (believe it or not) of my story as a Christian.  Now to Rachel's points and questions.

I have also seen a decidedly anti-Christian bias among many scientists, who often put science over faith.  I am a very educated person who was trained as a scientist and have published in the scientific field.  I have also taught Biology and other science-related courses, so I have a firm grasp of these fields, evolution, and so on.  I have seen too many people feel that science and religion are mutually exclusive.  I have also seen people hold onto their faith and believe in science as or even more strongly that some people hold onto their faith in God.  And I have lived on both sides of that fence, as I used to be one who valued science over religion.  I have a unique understanding of both viewpoints.

Rachel, I completely understand what you are saying about some people putting animals and humans on equal footing. I also have seen it happen, as well as people viewing their lives and profession without any religious thoughts at all.  I believe in what God teaches through the Bible, that humans are a special creation given rights and responsibilities over the plants and animals of the world.  While animals should be cherished, humans should always win out over them when a choice has to be made.  I love my pets and treat my patients with the best care I can, but I always feel that the needs of the humans in the family take priority. Don't feel like you aren't "passionate enough" if you're not like these people.  Your passion is in a different area, but that doesn't mean that you can't be a great veterinarian.  In fact, you'll probably be more compassionate and caring by following the words of Jesus.

How do I glorify God? Like on this blog I don't beat people over the head with my Bible, but also don't make a secret of it.  I've learned to believe in the old saying that I may be the only Bible that people will read.  So as I go through my day I try to conduct myself in a way that God wants to see.  I don't use curse words, I don't tell off-color jokes, I try to give my co-workers, staff, and clients respect, and I make it well-known that I'm involved in church and so won't work Sundays regularly (my clinic is open seven days a week).  If a client brings up something about God or prayer I use it as an opening to share my own faith and have even prayed with them.  Mostly I try to live by example, showing a Christ-like servant-leadership as best as I can.  Some days it's harder than others, and I'm certainly not perfect (only Jesus ever was).  I want people to see that I'm not hypocritical (most of the time) in my Christian beliefs versus my life.  I also want them to see something in me (the light in Christ that the Bible talks about) that makes them want something similar.  I pray for strength and guidance in difficult cases, and often quietly ask for God's hands to help me through tough times, surgeries, and clients.

The hardship of schooling....I wish I could say that it was my faith, but I didn't have it when I was going through college and veterinary school.  For me it was sheer stubbornness and determination, nothing more or less.  I actually think it would be easier for me now, as I have God to turn to and rely on, something I didn't have back then.  He has helped me through some equally tough times since then, and I am so glad to have Him support and love me.

Rachel, hang onto God with both hands.  Don't let others discourage you.  And believe it or not there are others out there like you.  There is an organization I've been involved with called Christian Veterinary Mission.  They have veterinarians who do mission work in various parts of the world, using their veterinary skills as a way to get involved in a community, looking for ways to share Christ with others.  They also work with veterinary students and would be a good way to fellowship with others going through the same things (look at the "Students" section on the web page linked above).  I'll pray for your success as you follow the dream that God has given you.  Always listen to Him!

Thursday, July 21, 2011

Non-Vets Doing Surgery

Sal sent this to me today....

Question:  Is it legal for someone other than a Veterinarian to perform surgery
to spay a dog?
I ask because walking out of my vet’s office, I overheard the receptionist
talking and she said that the vet would not be coming in.  However, I was had
just dropped off my dog to be spayed.  I just want to make sure she isn’t in
harm’s way.

I can't speak for outside of the US or even in every state.  However, I've been licensed in 6 states in various parts of the country and in all of those states, as well as any I've ever heard of, it is absolutely, positively NOT legal, or a good idea.  The owner of that practice could be sued for malpractice and end up with jail time for allowing it.  Also, the person who did the surgery could go to jail for practicing medicine without a license.  Even though spays are routine surgeries, they are NOT simple, and required a skilled hand.  I know experienced vets who aren't comfortable with doing spays!  It took me years of doing spays every day to get my surgery time down from about an hour to my current 20 minutes or so.

Unfortunately I have known vets who will allow their staff to do things like this, even if it's illegal.  Here in Georgia only a vet can legally give a rabies vaccine, but I recently had a client who went to a vet recommended by a local pet store and the vet's receptionist gave the rabies (without an exam!) because the vet was busy. Some vets really don't care about laws or quality medicine and that makes a bad impact on the view of the profession as a whole.

Interestingly, castrations are normally specifically excluded from the practice of veterinary medicine.  This is done because most farmers castrate their own livestock since getting a vet out to do every steer, pig, goat, etc. would really drive up the cost of animal production and therefore food and other animal products.  So technically someone who wasn't a vet could castrate their own dog or cat (or someone else's) and it wouldn't be illegal.  I still wouldn't recommend it because then you get into ethical issues of proper pain control, anesthesia, etc., but it wouldn't be "practicing medicine without a license".

Sal, I would talk to the vet about this, as it is a legitimate concern.  But I would also make sure that there wasn't some other reason for the comment, such if there were a few vets working that day and only one of them wasn't coming in, or if the receptionist was talking about the vet not coming in until later and you missed part of the conversation.  Also, maybe the normal vet wasn't coming in but they had gotten a relief vet who was going to fill in for the day.  Since you only heard part of the conversation you may have missed parts explaining what was really going on.  Give the vet a chance to explain and you may find a very reasonable answer for what you overheard.  However, if the vet does admit that a non-vet did the spay, I would immediately place a call to the state veterinary board and report that practice.

Wednesday, July 20, 2011

Reasons Regarding Regurgitation

Please excuse my alliteration in the title, but it just sounded fun.  Here's an email from Stefanie....

I have recently taken on a second foster dog. She is only about a year old and is a border collie cross. A high energy dog - which is fine - I'm learning how to channel her energy. I've noticed though that she will glurp out water as she is walking or running around. She also even glurped (my non-technical term for regurgitation) out dog food and water about 6 hours after her last meal. It's not a lot and while she has actually vomited a couple of times - it's been different objects she's chewed on around the house - it's more the regurgitation that has me puzzled.
Is regurgitation a few times a day enough to warrant a vet visit? She doesn't have any other symptoms other than what I've described - still has plenty of energy and is bright-eyed. I am fostering for a rescue so ultimately the decision to take her to the vet is at their discretion, but your advice on when to have her examined is greatly appreciated.
I would most certainly take her to the vet, and plan on having x-rays taken.  As you've indicated, regurgitation is different than vomiting.  The former is passive, with the stomach or esophageal contents spilling out because of a lack of tone in the sphincters or muscle walls.  Vomiting is active, involving contractions of the abdomen and stomach.  There are very different indications for each, so we can't treat them similarly.
The biggest concern I would have for chronic regurgitation would be megaesophagus.  This condition occurs when the esophagus is significantly dilated for some reason.  Anything swallowed can sit in this expanded area rather than passing into the stomach, and after a period of time can suddenly "glurp" back out.  In younger dogs this is most commonly caused as the result of a birth defect where a vascular arch near the heart stays around the esophagus, essentially causing a stricture and eventually dilation of the esophagus.  There are causes of megaesophagus that are more acquired than a vascular abnormality, but they are not as common.  A hiatal hernia or problem with the cardiac sphincter of the stomach (the one between the stomach or esophagus) could cause similar problems.  But I would consider megaesophagus until shown otherwise.
Megaesophagus is a big concern, as there is a high risk of food or water running backwards through the esophagus getting down the trachea and into the lungs, causing what we call aspiration pneumonia.  This kind of pneumonia can be life-threatening and the risk shouldn't be ignored, even if it hasn't happened yet.  Even if it's not megaesophagus, anything being regurgitated can be aspirated into the lungs and therefore should be checked out.
There is no cure for megaesophagus, so efforts are put to management.  I have known dogs successfully managed for many years, but it involves being very careful about feeding and drinking.  These dogs always need to have elevated bowls so they do not have their heads down while they are trying to swallow.  Essentially we are letting gravity work with us rather than against us.
So see a vet about this before something worse happens.  Good luck, Stefanie!
By the way, I love the word "glurp" and may use it myself, if you don't mind!

Tuesday, July 19, 2011

Attacked! The Good And Bad

One of the hardest things we as veterinarians have to face is the enmity of our patients.  Most people probably don't realize the real danger veterinary staff are faced with on a daily basis.  Take today for example.  I saw around 20 pets, mostly dogs, and ff those pets I had five try to bite me.  Most of them made really serious attempts to the point that we had difficulty getting muzzles on them and one we had to give an intramuscular sedative to knock her out.  Though none were likely to truly maul me, several potentially could have ended me up at the emergency room for stitches.

This isn't a rare occurrence.  In fact, it's a rare day when I don't have a pet try to bite or scratch me.  It's one of the least favorite aspects of my job, especially on days like today.  I get really tired of having pets try and take a piece out of me, but it's not like I can put a sign out saying that I'll only see nice patients (tempting though it may be).  As long as I practice I'll be faced with situations like this.

What I much prefer is how I am "attacked" when I come home in the evening.  Once I walk in the door I'm greeted by our two dogs, Inara and Yvaine. They jump all around me and seek my attention.  Then they seem to suddenly notice that I have scents all over me and before I know it I have noses running up and down my legs.  Sometimes I have a hard time moving because their faces are pressed up against me and I have two 60 pound dogs curved around me.  I don't mind this kind of attack at all and wish my patients behaved more like this.

Thursday, July 14, 2011

Identify The Critter

Here's one from Andrea that I'm hoping my readers can help with...

I'm a norwegian vet tech student currently working part of my internship at an animal clinic in Denmark. There are a lot of heart and lung worms now in the summer, so we do a lot of worm tests daily. Today I was microscoping a sample from a pug and didn't find any larvaes. But there was something else. Without the microscope I could see a lot of teeny tiny white "rice". I know they're not tape worm segments! Which seems to bee the only answer people get when they find white things in their dogs feces. I can't find anything on the internet that looks like it. I've attached a coulple of picture I took with my phone. None of our vets know what it is. There is nothing similar in our clinical parasitology book. In the microscope they look kind of like a butterfly pupa. They have spikes on their "body" and I can see a lot of, what I believe is blood vessels. They didn't move, but one of them "spit" out some grainy stuff. I'm so curious to find out what it is! Can you help me? 

I only took pictures using one of the lenses, so I don't have one where you can see the spikes.

I can't identify these, but I do agree that under the microscope they aren't tapeworms.  They look like they could be maggots of some sort, and I'm curious as to whether this sample came directly from the dog or if it was collected from the yard.  If it was the latter, then it could be environmental contamination and not a parasite.  Honestly, I can't think of any intestinal parasites that look like this, but I'm not sure if there are some in Europe that I don't know.

So, all of my international veterinary readers....any clues?

Wednesday, July 13, 2011

Are Homemade Diets Recommended?

John sent the following message to me...

My question is: Will you, as a veterinarian, ever recommend home cooked dog/cat food to dog/cat owners? If a client, like myself, insist, could you prescribe some recipes and supplements for individual dogs?

I'm a believer in homemade pet food. But most vets I spoke to recommend that I buy commercial pet food. I understand commercial foods are approved with a balanced nutritional formula. I have done some research (online and books) and I choose to cook for my 2-year-old mini dachshund and 3-months old Yorkie.

John, I'll first answer briefly:  yes and no!  It really depends on the pet and the client.

In general I have the same view as most of my colleagues that you have spoken with.  Commerically prepared pet foods are good nutrition (though some better than others), cover the pet's needs, are easy to prepare and give, and are easy to acquire.  The research on nutritional requirements has already been done for you and many decades of extensive testing has been done to figure out which are the best foods and ingredients for pets.  Veterinary nutritional specialists spend their entire careers analyzing and developing diets and the vast majority of them feed commercial pet foods to their own pets rather than making them at home.  When the experts (nutritionists, internists, cardiologists, endocrinologists, etc.) chose to buy a bag of food rather than prepare it themselves I have to believe that there is validity in their view. 

The problem with many homemade diets is that there are many trace nutrients and minerals that are important but aren't easily found in many foods we use.  We have to keep in mind that a pet's digestive tract is not the same as ours, especially the closer you get to true obligate carnivores (such as cats and ferrets).  So we can't base a dog or cat's nutrition on what would be good for us.  A proper homemade diet requires a lot of work in preparation, including using trace vitamin supplements.  Most people won't do the research or talk to experts before trying to make the food themselves.  In these cases the pets end up with nutritional deficiences.  And many of these deficiencies aren't obvious quickly, often taking long periods of time before you see a problem.  You also need to make sure that advice on homemade diets is coming from a veterinarian or ideally a veterinary nutritional specialist.  Human nutritionists don't understand the differences in physiology enough to make proper judgements for pets.

So does this mean that I never recommend homemade diets?  Nope.  I have given owners recipes in certain cases, especially if there is a medical need and the pet doesn't like a prepared food for that disorder.  But I am very careful who I give such recipes to, and I make them a copy of pages from a veterinary nutrition text book.

My question is...why would anyone want to make their pet's food?  You can get as good or better nutrition from a prepared food and do so much easier and with less mess.  You also don't run the risk of major deficiencies with good quality commercial foods. 

Nutrition has become a pet interest of mine (no pun intended) over the last few years, and I've really been doing self-education on the issue.  Knowing what I know, I have chosen to purchase commercial foods.

Tuesday, July 12, 2011

Do Cat Whiskers Regrow?

Mary asks a common question....

My friend has a couple of VERY active children and a longsuffering cat.  I was visiting this friend a few days ago when she pointed out where her son decided to give the cat a bit of a trim on her back, and drastically cut back her whiskers.  My friend told me that she's really worried about the cat now because whiskers don't grow back.  I had never heard of this before.  Is this true?  If so, what can she do to protect her cat now that she's somewhat handicapped?

Great question, Mary, and a common one.  Whiskers not regrowing is an old wives' tale that keeps being spread around.  The whiskers on any mammal are really nothing more than specially modified hair.  They tend to be thicker and stiffer than normal hairs, and at their base they are surrounded by nerve clusters.  Movement of the whiskers triggers nerve signals and are used for sensing air movement, objects close to the face, and so on.  Like any other hair whiskers grow from follicles, where they will grow to a certain length, "live" a certain length of time, and then fall out in order to be replaced by a new whisker.  They fall out and regrow in a staggered pattern, but they will indeed regrow, just like any other hair that is cut.  In fact, long-haired cats that receive close grooming routinely have their whiskers cut as part of trimming the face.  However, it can take 2-3 months for a full set of whiskers to grow out so it will not happen soon.

So reassure your friend that her cat will be fine and will have normal whiskers in a few months.  Until then the cat may feel a little strange and even be reluctant to go in certain areas as she is missing certain sensory input.  But in my experience, this is usually not noticable to the owner.

Saturday, July 9, 2011

Physician Vs. Vet

At the beginning of this past week I saw a dog for a health certificate prior to travel.  The client is moving from the US to Germany and is taking her dog with her.  She received her international health certificate  previously and just needed a more recent interstate one for flying within the US.  This was no big deal and we handled it quickly, examining the dog and issuing the certificate.  The dog was in good health so there were no issues.

Today the client calls, saying that the dog had discharge from its eyes and wondering if I had looked at the eyes.  It was a very busy day for me, so I relayed information through my staff who were talking to her on the phone. I remembered the case and said that I had indeed looked at the eyes (as I always do in my exams) and there was nothing wrong at the time.  My staff is trained that we don't issue medications without an exam, and explained this to the client.  She was not satisfied and told the receptionist "I'm a physician," which was probably supposed to open magic doors of compliance on our part.  I stood my ground and said that I still wouldn't issue medications without an exam since the problem hadn't existed a few days ago.  My office manager got on the phone and continued to explain to the client that we needed to see the pet first.  Then the question is brought to me "If you were going to prescribe something, what would it be?"  I could see right away that the client was trying to figure out what medicine she could give to her pet without being seen. Eye discharge could be the result of an infection, allergies, a corneal abrasion and several other things, all of which are treated differently.  So I couldn't give a specific medication without seeing the pet unless I was going to simply guess, and I'm not about do to something like that.  The client told my manager that she had too much to do as she was leaving the country tomorrow and couldn't take the time to bring her dog in to be seen.  She finally said "I'll just write a prescription for something" and hung up in a huff.

Sometimes the arrogance of human medical professionals astounds me.  I have never presumed to know more than my own doctor or pediatrician, and rely on their knowledge and advice.  I respect their training, position, and time.  Unfortunately I feel that some physicians and nurses feel that veterinarians aren't as smart or as well trained as they are, and see us as somehow not really doctors.  I have seen an attitude of superiority from many of these clients (though not all).  What really gets to me is that these clients should be the ones least likely to cause problems, as they should know better and understand.

For example, let's take this most recent client.  As a physician herself, what would have happened if I called her and said "I have an infection and I need you to give me some medicine.  Yes, I know you just saw me last week and I was healthy but you must have missed something and I have this problem now.  I'm a vet so I know you just need to prescribe me something."  Any responsible human doctor would say "no way" as quickly as I did.  Sending out medications for a problem that you haven't seen or diagnosed is poor quality medicine at best and potentially malpractice at worst.  Second, this client assumed that she will know as much about medical interactions with pets as she does about humans.  I can assure you that though many medicines are used between species, there are others that can be downright dangerous.  I always defer to my own doctor when it comes to human medications and don't presume to know the same things about humans as I do animals.  Thirdly, a human doctor is legally able to make diagnoses, perform treatments, and write prescriptions for only a single species:  Homo sapiens.  Though I doubt a pharmacy would really check, it is actually illegal for a human doctor to write a prescription for an animal.  Conversely I am able to write prescriptions for any animal except humans.  If I prescribed medications for myself or my family I would be breaking the law and could even loose my license.  A knowledgeable and responsible doctor would know this and wouldn't seek to circumvent the law.

Unfortunately there's not much we can do about situations like this.  Maybe some physicians, nurses, or other human professionals will see this and realize that vets are just as intelligent and highly trained as they are and give us the respect they expect be given to them.

Wednesday, July 6, 2011

Turning Off Doctor Mode

Early in my marriage my wife pointed out something I hadn't realized at the time.  When I'm talking about work-related issues I have a "doctor voice".  There are distinct volume, tonal, and speech pattern changes that I have unconsciously developed and which I only use when speaking as a veterinarian.  A psychologist could probably give more insight, but I believe that it's a way of speaking that blends compassion, authority, knowledge, and ease of description.  Since she made me aware of it, I'm usually able to tell when I slip into "doctor mode".

The strange thing is that I do it involuntarily.  When I speak to friends and relatives about their pets, I automatically tend to use this voice, often not realizing it.  There's just something that comes over me and it's like slipping on a comfortable jacket when it's cold.  My wife often finds it amusing and isn't afraid to let me know when I'm doing it.  But I don't want to do it all of the time.  Like today.

Today I brought my brother-in-law's guinea pig into the clinic with me because he wasn't eating and I couldn't see anything obvious at home.  A quick oral exam showed normal teeth, but a foul-odored liquid in the mouth that smelled like pus.  He also had sores on his tongue.  I realized quickly that we were dealing with a hidden abscess, kidney disease, or something else equally as serious.  My brother-in-law is currently out of work and his wife is in beauty school, so they really don't have money.  I was willing to do a few things for free, but couldn't do a lot of medications for free.  So to prevent his suffering, we euthanized him.

Now this is someone I've known for 13 years and have lived in the same town with him for the last 4-5 years.  We're not best friends, but we know each other well.  I also know how his family feels about this pet, especially considering that they have four children.  When I called him to tell him what I found, I realized that I had slipped into "doctor mode" and was talking to him like I would talk to any other client.  I had to work hard to change my voice and pattern into something more familiar and friendly like I normally talk to him.  Honestly I don't think he noticed, but I certainly did and I didn't want to sound that way to him.

It can be strange how your professional life and attitude infiltrates your personality and can cause a change in your behavior without you realizing it.  I often say that being a vet is what I do, not who I am.  But maybe I'm a little in denial and at least in part it has become who I am.

Tuesday, July 5, 2011


Veterinarians choose their profession carefully.  We have to put a lot of stress, sweat, tears, time, and money into getting our education, and few go into this lightly.  For most vets it's a passion as much as a career choice.  And even for those who may sometimes regret the choice and wonder "what if", there is still a strong attraction for the work.

But that doesn't mean that we love every day and feel strongly motivated at each moment.  Here's something that may be surprising to many clients and veterinary students:  sometimes doctors don't want to be at work.  Sometimes we don't want to see patients and have to struggle to get through the day, watching the clock until it's time to go home.  And sometimes we're simply bored and tired of doing the same thing over and over.  How many times in a week do I have to discuss ear infections and weight problems?

This doesn't mean that we necessarily take short-cuts in our care, or avoid patients.  But it does mean that some days we have to work harder to fake a smile or interest.  Client service is a very important aspect if veterinary medicine, and that means we have to try out best to give our best with every single person.  However, sometimes we just don't "feel" it. And some vets are better at putting on this mask than others.

Surprising to some?  It shouldn't be.  After all, being a vet is a job not dissimilar from other jobs.  And I don't think there is anyone out there who doesn't feel this way about their own jobs at times (or frequently).  It's tempting to think that people in a healing profession are always motivated and eager to do what we do.  However, we're just as human as our clients, and have the same weaknesses. 

Yeah, I'm quite unmotivated today. But life goes on, work goes on, and the clinic will open tomorrow whether or not I'm ready for it. So I'd better be ready!

Saturday, July 2, 2011

Picking A Vet School

Lauren emailed me with the following...

I currently live in Phoenix (worst place ever for a vet major since CSU is beyond difficult to get into). I have about 1.5 years left in undergrad work and was applying to schools out of state as a transfer to finish up. I am looking into schools that already have vet programs to increase my odds (I’ve done a lot of research on this and have figured out my odds of being instate for each school in the US). I have eliminated several schools based on location and difficulty as I don’t want to set myself up for failure. I have currently applied to Iowa State, Oregon State, and Louisiana State. I know I’ve already been accepted into Iowa State and am waiting to hear from the other 2. With that said, there were also 3 other schools I was looking at (Purdue, UT, and Washington State). Those applications are not even available until August 1st.  My questions are – in your opinion, is it a smart move for me to do this? I am basically putting all my eggs in one basket, but staying in AZ makes it nearly impossible. Also, if I decide to apply to the other 3 schools I won’t even hear back until mid October and I’ll be mid way through a semester at school. Should I just decide on one of the 3 I have already applied to so I can make a plan for my move for January and start looking into housing options, loans, scholarships, jobs etc now while I’m not in school and not stress about that during a very difficult semester to come? I feel a strong pull toward Iowa State. I’ve had many signs from God telling me that is where I’m needed, but I also want to be as smart about this as possible and do as much research as I can to benefit my end result. I don’t know anyone at that school so I’d be leaving everything I’ve ever know in AZ which is terrifying. I’d really love to hear from someone who has gone through this stress and decision making process to know if I am being smart and reasonable about this. I have good grades, I volunteer with a no-kill rescue, I have worked as a tech at a specialty and emergency hospital, so I feel pretty confident about those areas, just unsure of taking the final leap.

Definitely looks like you're planning ahead!  I do have a few bits of advice that may help your decision.

First of all, be VERY certain that you know what each school requires to get in-state status.  I went to the University of Tennessee for my Master's degree, and planned on going to UT for vet school since I was already there.  However, much to my dismay I learned that the admissions department still considered me an out-of-state student because I had come to Tennessee to attend school.  It didn't matter to them that I had lived in the state for two years, paid taxes, had my car and driver's license in the state, and was by all other definitions considered a Tennessee resident.  They told me that I would have to live in the state for at least nine months without attending classes before they would consider me an in-state resident for school purposes.  It is much harder to get accepted into a veterinary school as an out-of-state student, so this will need to weigh in your decision.  Additionally be aware of which credits will transfer.  You may go to a different school and discover that you have to take many classes over again because the new university doesn't accept the grades and credits from Arizona.  Before saying a final "yes" be very, very certain of how all of this will affect your credits, residency, and future chances for veterinary school.

It's never a bad idea to apply to multiple schools, as you may be declined at one and accepted at another.  But it's unrealistic to apply to a dozen or so, especially with moving costs.  It's great that you've already been accepted at Iowa!  This really helps, as you have something to fall back on if the others don't work out.  But if you have to accept Iowa's offer before you are able to apply the others or would hear back from them, I would go ahead and say yes to them so that you don't miss out on that chance.

If you're uncertain about which school to choose, especially if you are accepted at multiple ones, sit down and make a list of all of the pros and cons of each one.  Look at what you might want to do once you graduate (realizing that many people change their minds several times during vet school), and see which college might give you the best training or edge in this area.  Don't forget to list the pros and cons of non-collegiate aspects such as weather, local activities, people you know, etc.  Honestly, these "fuzzy" factors can be just as important as the actual education since you'll be living there for at least four years.

Here's another hint that might be a bit scandalous.  Don't worry about the school's national ranking!  Seriously.  When I'm looking at a new graduate I really don't care what school they've been at, and most employers are the same way.  If you've graduated and been licensed, then you're a veterinarian.  I've seen good and bad vets from most of the schools, so the college on the diploma really doesn't matter to me much.  Pick a school for reasons other than ranking.

I also wanted to address another thing that you feel that God is directing you to Iowa.  I don't often mention religion in this blog, but I'm a conservative Christian, active in church and ministries, and the will of God is very important to me.  If you feel through prayer and meditation that God wants you in Iowa, then to me that's the single most important factor.  If that's His desire and plan for you and you try to go somewhere else you will have a harder time.  God gives us intelligence and reason and we shouldn't ignore these, but He wants us to listen to Him even more.  Pray about it and listen closely to Him and you will find your answer.  "Trust in the Lord with all your heart and lean not on your own understanding.  In all your ways acknowledge Him and He will make your paths straight." (Proverbs 3:5,6)

Best of luck to you, Lauren!

Friday, July 1, 2011


My daughter is eight years old, and really loves animals.  That's not unusual for little girls, but what sets her apart is that she likes the odd animals that most girls her age run away from.  She loves our bearded dragon, thinks creepy-crawly critters are cool, and for the past year has wanted a pet rat.  Her interests are a bit of a challenge in our family, as my wife doesn't have a soft-spot for such animals, and has been reluctant to have them in our home.

Elena gets her passion for exotic pets honestly...I also love them and have encouraged her interest.  I have long known rats to be very good pets who are intelligent, generally friendly, and easy to care for.  They are my favorite rodent pet, and I find them to be far better than hamsters or gerbils.  Unfortunately many people can't get away from the stigmas of rats:  they carried the plague-ridden fleas into homes that lead to the Black Death in europe; they are found in sewers, trash dumps, and other unseemly places; they get into grain stores and contaminate them; etc.  There is also something about that long, naked tail that people find repulsive.  All of this "bad press" makes it hard for people to really look at them and see them for the great pets they can be.  Additionally, pet rats are a different species from the rats most people think of as causing disease and problems.

Finally my wife relented, and agreed to allow our daughter to have her own pet rat.  However, we required her to save her own money to buy the rat and the accessories necessary.  It took some time, but she did finally save her allowance and gift money to the point of being able to get her first rat.  A couple of weeks ago we went to the store, picked her out and brought her home.

Adara (named after the main character in the book The Ice Dragon by George R.R. Martin, which my daughter loves) is a real sweetheart.  She is everything I could want in a pet rat, being very friendly and handleable.  Elena is being a great pet owner, keeping up with food and water, handling her gently every day, and helping to clean out her tank.  She is very proud of her little rat, and understands the responsibilities that go with the fun of having a pet.

There was one thing we didn't anticipate about the new pet. One of our dogs, Inara, is very, very fascinated by Adara (yes, we like uncommon names for our pets).  We have to be careful not to leave Elena's bedroom door open because Inara will go on there and try to climb up on the desk where the rat's tank is kept.  She's not aggressive and doesn't growl, bark, or act like she wants to attack her.  She's simply very interested in our new family member.
Adara sometimes is just as interested, looking out and sniffing at Inara.  Unfortunately, I haven't been able to get a picture of that particular scene, as they move away before I can get my camera up!  It's a brief but incredibly cute interaction.

My beautiful, wonderful wife has been working on overcoming her dislike of these pets, allowing both me and our daughter to fulfill our dreams and have these non-traditional pets.  However, she refuses to have anything to do with them and set the stipulation that Adara is never to leave my daughter's bedroom.

And yes, my daughter's room is VERY pink!  Just how she likes it.