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Wednesday, August 31, 2011

Unsung Heroes

I was talking to one of my staff today (Hi, Brooke!) and she said "why don't you blog about your wonderful techs?"  Y'know, I think it's about time that I did.

I started in veterinary medicine at the bottom kennels and walking dogs.  Over the years I worked my way up to assisting doctors, working the reception desk, doing minor groomings, and eventually becoming a veterinarian.  In my lifetime I have held pretty much every position you can at a small animal practice, and feel that I'm better because of it.  These experiences helped guide me as a vet, especially showing the importance of a good support staff.  And my time as a doctor has only strengthened this view.

You cannot have a veterinary clinic at all without a vet, so it is very arguable that the vet is the single most important part of the veterinary staff.  There are fewer vets than paraprofessionals and a veterinary education is long, difficult, and expensive.  However, I feel strongly that a vet's ultimate success is made or broken by his or her team.  Good vets rely heavily on well-trained and efficient staff to perform daily duties well.  Without a good team, the vet is left doing everything except practicing medicine and surgery, and can't see as many patients.  I would be lost without my team, and let them do as much as they are legally allowed.  Not having to read fecal samples, place IV catheters, collect blood samples and so on frees me to concentrate more on the things that only a vet can do, which in turn allows me to see more pets and still get home on time.

One of my "best" days ever as a vet involved me seeing 40 pets by myself.  To give you perspective, my practice wants a vet to see 18-22 pets per day.  More than that and you may end up compromising quality of medicine or client service because you're moving so fast from one patient to another.  However, some days are simply slammed, and you have to roll with it.  On this day about 6 years ago we were that busy.  Yet even seeing double the normal pets I still got to take a full hour lunch and left exactly at closing time.  The ONLY reason I was able to do that was because my team was very highly trained and skilled, and they handled everything for me.  If I didn't have a great team, I never would have been successful that day.

So here's to all of the kennel workers, assistants, technicians, receptionists, office managers, groomers, and anyone else besides the doctor on the veterinary team.  From the bottom of my heart, thank you for the great work you do.  We literally couldn't do it without you.

Sunday, August 28, 2011

Changes To Commenting

Yesterday I received a very aggressive and deliberately hateful comment on my most recent blog entry.  The comment also included strong profanity.  Because of its aggressive tone and use of inappropriate language I have deleted it, as I will not tolerate such things on this blog as I do not tolerate them in my offline life.  This is actually the first time in the three years I've been blogging that I have deleted a non-spam comment.  I am very open to differing opinions and hard comments about my own views and actions.  Just go back through some of the comments on big topics over the years and you'll see that I'm very tolerant of contrary comments and do not believe in censorship.  But I will not accept profanity (and do not use it in my own life) and will not accept a comment that is nothing but hate-filled rhetoric with nothing constructive to add.

Over the years I've been very open with this blog and have allowed open commenting, including as an anonymous poster.  At times I've thought that this made it too easy for people to speak strongly since there was no way to tell who had commented so they didn't have to worry about it getting back to them.  People tend to be bolder, especially on the internet, when nobody knows who they really are.  It has also made it a little confusing at times when several people would comment on an entry as "Anonymous".  The hateful poster yesterday commented in this way, not identifying themselves, and this has helped make a decision that I was considering anyway.

I have changed the commenting section so that you must be a registered Google or OpenID user in order to post a comment.  From this point on there will no longer be any anonymous commenting.  I hope that this does not discourage people from commenting (most people doing so are already registered anyway), and that some of my regular Anonymous posters (yes, I've gotten to know some of the writing styles) will consider registering (since it's free) and commenting more openly. 

Thursday, August 25, 2011

Freak Accidents Unfortunately Happen

This afternoon one of our clients brought their dog in for a simple nail trim.  He is a 13 year-old German shepherd mix (probably with husky) and not in the best of health.  He also is a bit of a biter.  One of my assistants brought him to the back to have the nail trim done, and a new doctor we just hired was holding the dog.  As they were doing this the dog's hind legs suddenly slipped on the smooth tile flooring and he went sprawling with his hind legs splaying in a "frog-leg" position. 

When they tried to get him up they found that he couldn't stand and was painful.  They brought the owner back and got me to look at him.  I noticed that he was very painful in his left hip and couldn't put that leg down.  I was also having difficulty trying to extend the hip backwards.  We put him in a kennel to rest for about 30 minutes and then got him out for another exam; we found the same problem.  The next step was x-rays.  We told the client that we needed to sedate him and do this, and wouldn't charge her for it.  Once we put up the films we noted quickly that the left hip had dislocated.  Ouch!  For many reasons.

This is a very old dog who wasn't in the best of health.  When we ran routine blood tests in May we noted increases in his liver values.  He also had severe muscle wasting in his hind legs and hips, though he was walking pretty normally.  In fact, I think the lack of good muscle mass was the reason for the dislocation.  Many people don't realize it but good muscle tone and development is just as important for hip support and strength as tendons and ligaments.  I've seen many dogs slip or lay like he did, but I've never seen a hip dislocation.  It was also strange because normally when a hip dislocates the femur moves craniodorsal ("up" and "forward").  This hip slipped ventrally ("down"), opposite the normal direction.  I think that the muscle atrophy allowed the hip to move abnormally; a normal amount of muscle likely would have prevented the injury.

Unfortunately we found other problems on the x-rays.  The 3rd through 7th lumbar vertebrae had bone bridging that was fusing the vertebrae together (called spondylosis, and not an uncommon finding in older dogs).  We also saw stones in both kidneys.  These findings were incidental but weren't good to see.

So let's recap. We had a geriatric dog with underlying liver problems, atrophied muscles, spondylosis and kidney stones slip on the floor and dislocate his hip.  Not a good situation by any analysis.  While he was sedated and relaxed I tried to put the hip back in socket, but no luck.  It's hard enough to replace a dislocated hip, but this hip was out in a way that I was never trained to fix. 

This was a completely freak accident that I have never heard of before.  Unfortunately it happened at our facility, so we feel responsible even though we didn't do anything wrong, and there is some potential liability since it happened under our care.  We sent the dog home with analgesics and didn't charge for anything we did.  We're also sending him to an orthopedic surgeon tomorrow to have the case reviewed.  I'm hoping that the surgeon may know some tricks to non-surgically put the hip back in joint because this dog is a pretty poor surgical candidate.  We're also going to cover the costs of any treatment, even if it comes to surgery.  We're not technically to blame, but we don't want the owner to feel that way and also do feel bad about the situation.

No, it's not easy being a vet.

Wednesday, August 24, 2011

Give Up The Dream?

I received this email from Laura...

I recently came across your page and have to say I found it very enjoyable to read. I always wanted to be a vet however I was a few points short of getting into vet school and so settled for my second option: nutrition and dietetics. Five years later here I am, qualified but still desperately wanting to work with animals. My parents keep telling me that once I work as a dietitian I can volunteer with animals in my spare time and I know they are right but I want it to be a bigger part of my life than that. I know that going into vet school as a grad is not only hard to from the point of view of gaining a place but its also incredibly expensive and I would need to take out a huge loan to afford it. I have been offered a masters in public health here at home, employment within the health system is poor at the moment and so there are no jobs, my only options are a return to college or emigrate. The problem with emigration is the registration and expense of trying to become eligible to practice in another country with no guarantee of a job.
I feel I have to take the offer of the masters in public health however I feel I am once again turning my back on the one thing I have ever wanted to do- work with animals. You mention a few detours on your way to becoming a vet and I was wondering what your advise would be?
This is certainly a tough decision, Laura.  I want people to follow their dreams and find what will really make them happy, but it can also be a financial burden to acquire a veterinary degree and it's becoming harder to pay off that debt.  So it may not be the right decision for you.
I would start by figuring out exactly what it is about animals that you like.  Yes, you want to work with them, but WHY?  Looking inward and discovering the "why" of the desire may help guide you into something.  Do you like just watching them?  Maybe a job at a pet store or zoo.  Do you want to help them out?  Maybe a job as a veterinary assistant or volunteering for a shelter or rescue group.  Do you like the animal-human bond?  Maybe work for a group that uses dogs, cats, and horses as therapy animals for the elderly, special needs, and hospitalized.
But also consider your training and education.  If you have a background in nutrition, could you get education at a university that would be applicable to animal diets?  Perhaps look into getting a job with one of the food companies.  I know that Royal Canin has a research center where the animals are housed and treated as pets, not just put in cages. (And no, I don't work for them).  If you're in an affluent area then perhaps you could get training and set yourself up in business as a pet dietician.  I'm certain that many wealthy people would pay for such a service.  With a Masters in Public Health you could concentrate on diseases transmittable between humans and animals; you wouldn't get direct animal contact most of the time, but it would still be in that field.
In the end you're looking at only a few possibilities.  Most of the jobs working hands-on with animals will require you to switch careers and likely take a substantial pay cut.  Getting a good paying job in the animal or veterinary fields will require money spent in further education.  If you can't spend the money or have a pay cut, then you may have to settle for being a volunteer, which is always needed.  Heck, you could start your own private shelter or rescue group!
My readers may have other suggestions.  Best of luck, Laura.

Tuesday, August 23, 2011

Important Figures In Veterinary History

If you've followed my blog for a while you may have come across me mentioning an interest in history.  So when I received an email mentioning an article on a site that was entitled Veterinary Hall of Fame:10 Veterinarians Who Made History, I was intrigued.  I went there and found a few interesting things that I hadn't known, especially regarding Bernhard Bang (discovered brucellosis), Louis Camuti (the first feline-only practitioner), and Elmo Shropshire (wrote "Grandma Got Run Over By A Reindeer").

However, on this list of ten historically important vets, I noticed some glaring omissions.

James Herriot (James Alfred Wright):  British veterinarian who wrote of his experiences and has been a huge influence on many of us in practice.  How can you have a list of influential vets without him?
Sonny Purdue:  A former veterinarian who went into politics and became governor of Georgia.
Scott Campbell:  Whatever you think of corporate practices, he was certainly influential by creating and developing what is now known as Banfield Pet Hospital.  This is the largest veterinary practice in the world, with almost 800 locations across the US.
Marty Becker:  The list above includes several TV personalities in various countries, but doesn't include Dr. Becker?  He has written numerous books and has been on national TV and radio.
Peter Ostrum:  You may not know the name, but you know who he is.  Dr. Ostrum was Charlie in the original Willy Wonka and the Chocolate Factory (the Gene Wilder one).  He left entertainment and went on to be a currently practicing large animal vet.
Martin Fettman:  Again, not a well-known name, even among vets, but an important accomplishment.  He was the first veterinarian to participate in a mission on the space shuttle.

And these are just people I thought of off the top of my head (okay, I did have to Google Dr. Fettman, but I knew of veterinarian astronauts).  I'm sure others can think of other equally important people in veterinary medicine.

And yes, I did respond back to the site, suggesting the above additions.

Saturday, August 20, 2011

Difficult Decision

A few days ago I saw a 10 year old husky for a routine check-up and vaccines.  She is unspayed and has been overall healthy for most of her life.  During the exam I noticed a firm, irregular mass in her mammary chain, and with a second look I found a smaller mass nearby.  I called and talked to the owners, and they had not noticed these swellings, and were surprised when I pointed them out.  We had also seen this dog in May for unrelated issues and had not noticed the masses then either.  So in a 2-3 month period these lumps had developed.

In an older female dog who had never been spayed the most likely possibility is mammary gland cancer.  This form of cancer can potentially be as bad and as malignant as breast cancer in humans.  We took some chest x-rays to make sure there were no obvious metastases in the lungs, and when those were clear I talked to the owners about a partial mastectomy.  In cases like this it's important to move quickly, removing the masses as soon as possible to minimize the likelihood of them spreading.  Leave them too long and you're almost assured of metastasis.  There are sometimes benign masses as well as other types of cancer, but there is no way to tell for certainty without removing them and sending them for a pathologist review.

Today she came in to have the surgery done.  We did our normal preanesthetic evaluation, blood tests, and so on, and considered her generally healthy.  We placed her catheter, induced her, and began doing the surgical shave and prep of the site.  As we were shaving we noticed another small mass under the skin on the same site but several centimeters away from the largest mass.  Further shaving showed an fourth mass close to the newest one but on the other side of the abdomen, so in a completely different mammary chain.  This concerned me greatly, as we had masses developing in very separate locations from the largest lesion.  I had checked all of the mammary regions earlier in the week, so it surprised me to find more masses, even if they were small.  Did I miss them because they were small and she has thick fur?  Did they start to grow in a few days time?  Unfortunately I couldn't say for sure.

I called the owner before we went to surgery and presented them with the new information.  I discussed the options, neither of which were good.  The primary reason for doing the surgery was to remove the masses before there was further spread.  We didn't know how quickly it was spreading, as the lumps I found could have started growing two months ago or in the last couple of weeks.  Since there were new lumps in different locations, there was already spread.  However, we could proceed with the surgery and do a more radical procedure, basically a double mastectomy.  This is a radical, extensive, and painful surgery, and one not to be undertaken lightly.  The odds were good that spread in the bloodstream was already happening, but there was no way to tell for certain.  So should we do a more complicated surgery and roll the dice, hoping for the best?  Or should we realize that metastasis may already be happening, it was too late to prevent it, and save her a painful and potentially long recovery?

This was a very difficult decision for the owner.  Honestly, I was on the fence myself, though leaning towards not doing the surgery as I was worried that it wouldn't help her in the long run.  But my job is to give the client enough information for them to make an informed decision.  I can never make the decision for them.  And if it was my own dog I would have had an equally hard time making up my mind.

In the end the owner decided to forgo the surgery and observe her, giving her the best quality of life they can.  I can't say that this was the wrong decision.  Sometimes in medicine there is not a straightforward choice, only difficult ones.

Thursday, August 18, 2011

Never Satisfied

I've come to the conclusion that in my work I can't seem to be satisfied with the work load.  Not that this would be a surprise to my wife.

This time of year we see a slight dip in business as kids go back to school and parents concentrate on that for a few weeks.  It will pick up again in early September, but is slower right now.  When I get to work in the morning one of the first things I do is look at the day's schedule.  When I leave at night one of the last things I do is look at the next day's schedule.  And this week the schedule has looked pretty sparse.

This leaves me in a mixed mood.  To be truthful, I'm basically a lazy person.  I have a very strong work ethic and really do work hard.  But I'd rather not have to, and don't mind being a bit relaxed and slow some days at work.  This means that a slow schedule may suit me just fine.  On the other hand I have a responsibility to manage and grow the business, maintaining a good profit margin.  And we can't make good profits if we don't have appointments. 

So some days I wrestle with myself. I want to be lazy and get upset when we have a full schedule where I don't get much of a break or rest during the day.  Then when we're slow enough for me to prop my feet up I'm fretting because we're not bringing in enough revenue.  So I'm frustrated on both slow days and on busy days, each for different reasons.  Basically it sometimes seems that I can't be satisfied at work.

Anyone else feel this at least some of the time?  Thankfully I'm stubborn enough and have a strong sense of responsibility so I don't let the business suffer (after all, my salary is tied to the clinic's profits).

Tuesday, August 16, 2011

Heartworm Treatment Crisis

When we treat heartworm disease there is really only one medication that most vets reach for, called Immiticide (melarsomine).  It first came out in the mid-1990s, replacing the previous drug of choice, Caparsolate.  The latter drug isn't used by most vets anymore because it runs a higher risk of side-effects and can cause significant tissue damage if it gets outside of the vein.  Immiticide is much safer and less irritating, making it the gold standard for around 15 years.

For the last two years Immiticide has been in short supply because of ingredient shortages and other manufacturing problems.  Currently it is only manufactured by one pharmaceutical company, Merial, and they have limited sources of the ingredient.  For the last two years when we wanted to treat a pet we had to directly contact the company, discuss the case, and get them to ship it directly rather than ordering it through typical distributing systems.  This method allowed Merial to keep the supply going to pets that really needed it rather than sitting unused on vets' shelves.  It was a real hassle to us vets, but I never ran into a problem getting it when I needed it.

That is changing.  A couple of weeks ago Merial announced further problems to the point of them not being able to produce any more Immiticide for the foreseeable future. The only product left is what is sitting on shelves in offices and warehouses, and that will quickly be depleted.  Merial is hoping to have more available within seven months, but there is no promise this is the case.  So treatment is now being withheld from mild cases without symptoms and being reserved only for severe cases.

This is extremely frustrating, and keeps us from providing the best care for pets.  I also think it's crazy that we are so dependent on one single source for such an important medication, leading to situations like we currently have.  Honestly I don't know all of the details behind Merial's problems, but with a shortage being known for about two years I would have hoped that someone would have come up with alternative sources by now.

This means that many people who have their dogs diagnosed with heartworms will have to go without proper treatment, instead relying on symptomatic control and other secondary treatments that aren't as fast or effective.  However, keep in mind that this is a completely preventable disease!  There is no reason for dogs NOT to be on heartworm prevention.  So a solution is pretty simple from one aspect...use prevention and your dog's won't get the disease!

And let's hope that this shortage ends soon.

Monday, August 15, 2011

Fathers & Sons

For the last several days my wife has been in Ohio spending time with her grandfather, who is in rather poor health.  She took our daughter with her, leaving me and our son at home alone.  We timed it so that over the four day period I was only working one, allowing me to be at home with him and only needing to rely on my father-in-law for one day while I was working.  I very much miss my wife and am eager to have her come home this afternoon.  But I've also had a great experience with my son over the last few days.

He's 10 years old and a very good, sweet boy.  I've tried to take the opportunity to spend more time with him, as there are few distractions and I didn't have many chores around the house.  We played video games together, something that I don't always make time for.  We watched G.I. Joe: Rise of Cobra and Superman/Batman: Apocalypse.  Saturday night we went out for pizza together.  We've talked and just had fun time as father and son.

Much of this makes me think of my own father as I grew up.  We would go see movies together that my mother didn't want to see.  We would regularly get lunch at Cousin's Pizza, a local independent pizzeria in the mall.  We would talk and joke around and just enjoy time together.  I was reminded of all of that as I did similar things with my own son, and looked back on those memories with great fondness.  Even though my father and I have had our arguments and disagreements, he was (and still is) a great father who raised me well and has left me with many great memories.

Now I find myself in similar situations with my own son.  I've thought about the problems my dad and I have had and wonder if I'll go through the same things with my son. Obviously kids are always going to have disagreements with their parents and there is some inevitability there, but I also hope to learn from the lessons of the past and perhaps change a few things (likely creating new problems in the process).  I also have thought about the wonderful times I had with my father and want to be able to give my son similar memories.

And so the cycle continues.  In another 30 years I bet my son will be thinking similar things.

Saturday, August 13, 2011

Advice On Becoming A Vet....Almost Ultimate Guide

It's common that I get questions related to becoming a veterinarian, and I've answered these questions several times over the last few years.  Earlier this month Maggie emailed me some questions, and it's taken me a while to get to answering them.  I actually debated about whether or not to answer since I've do so before, but decided to so that I could put most of the pertinent advice all in the same post.  So unless I get something very different, this is like the last time I'll go through this, instead referring people back to this and other posts.

Here's Maggie's email....

I come from a family with a strong medical background. My parents are both doctors, as well as extended family members, so I have always been comfortable talking about and seeing medical procedures. I love science but I am not so strong in Math. I have always loved animals and many family friends encouraged my interest of becoming a vet.  I went to the University of Virginia with the intent to be pre-health and took some pre-health courses. I did well in inorganic chemistry, but had trouble with Organic Chemistry. (I am confident I can do well with more focus than I had 2nd year of college).  I also decided that I should branch out from science, and followed an interest in marketing. Therefore, I followed this interest and got a masters in business.  Throughout all of my studies I continued to volunteer at the SPCA.  
I am now 25 and I work in marketing for a leading consumer products company. I enjoy what I do but do not see myself doing it long term and I am strongly considering going back to school to become a veterinarian.
Of course this would be a huge investment...5 more years of school, lots of student loans. I would appreciate your advice on the following!
1. I am confident that I can do well in the science courses, but I would have to do a postbac pre-health program. Do you know anything about post-bac programs for pre-vet? 
Honestly, you may not have to do any post-bac program.  Your actual major is completely irrelevant to admission into veterinary school; all that matters is that you have the required courses for entry.  I've known people with degrees in marketing, English, publishing, computers, and many other non-biology degrees who have become vets.  Also, there are no specifically pre-vet post-baccalaureate programs out there that I am aware of, because entry into vet school doesn't require it.  In fact, most pre-vet programs in colleges are simply the offices finding the required courses for vet school and organizing them into a semi-formal program.  There is no such thing as a pre-vet major or degree.  If you're missing any courses, all you have to take those classes and don't even need to get a degree.

2. Once I do a post-bac program, what applications are necessary for vet school? Will I have to take a gap year to enable the school to see my grades (like med school applications?)  
There are no real universal requirements for all vet schools, and each of them may require slightly different things.  You need to contact the admissions office of each school you are interested in to find out what they need, and then plan accordingly.  You don't necessarily need to take any time off depending on when your classes are done, as they are more interested in your required classes than your overall GPA.

3. Veterinary school is four years, just like medical school right? 
Yep.  Four of the hardest years you'll have in your life.  It's much more intensive than human medical school because you have several species of anatomy, physiology, and diseases to know.  What MDs know about humans, you will have to know about dogs, cats, horses, cows, poultry, pigs, reptiles, and many other species.  There are significant differences between even dogs and cats that human doctors never have to face.  So even though it may be the same length of time, it's harder.

4. What type of Veterinarian are you? Is it extra schooling to specialize? 
I'm a small-animal general practitioner, which is what most vets are.  If you want to specialize in a particular field (internal medicine, surgery, dermatology, oncology, etc.) you will need to do an internship which is usually a year and then a 3-5 year residency program.  

5. Now that you are a veterinarian, what is your work life balance like? This is one of the biggest challenges of being a vet, and I don't have an easy answer.  Most of us eventually learn how to balance things, but it's not easy and some never master it.  There are many articles published on how to have a work-life balance and it's a challenge to get it right.  How often do you have to work late? Are you on call? I rarely work more than 30 minutes past closing, but I'm also very fast and efficient.  I know many colleagues who regularly work late.  I also work for a practice that doesn't do any after-hours work, so we refer all of our emergencies to the local Emergency Clinic.  Many veterinary clinics require their vets to be on call, so it really depends on who you work for.  Eventually I would like to have a family - do you think being a veterinarian offers the type of work life balance to do so?  It's a real challenge, especially if you're the owner of a practice.  But it's not impossible, and with 75-80% of graduates being female it's becoming more recognized as a necessity.  It's also becoming more common to see vets working part-time in order to have a good family life.

6. What is the most rewarding aspect of your job? What are some things that you don't like about your job?  I really like when I can save a life, perform a difficult surgery successfully, and bring comfort to families.  I REALLY hate being bit and scratched.  I also dislike when clients argue over every little charge or complain about how "expensive" veterinary medicine is (it isn't when compared to human medicine).  I get tired of clients complaining over rather stupid (in my opinion) things, and I love when clients really understand how difficult the job is and appreciate our attempts.  I also wish we could actually get paid what our knowledge and skills are really worth.

7. If you could do it again, would you become a veterinarian? 
Honestly, no.  Part of that is because my interests and skills have changed over the years, as well as my tolerance for certain situations.  If I had to do it all over again and retained my current knowledge I'd become a history professor.  I know many vets who wouldn't choose to go the veterinary route again.  However, I read a survey a few years ago where somewhere around 70-80% of vets were very satisfied with their careers.  

8. I know veterinary schools are arguably even more competitive, what would you say are the most important qualities admissions committees consider? 
First, I would drop the word "arguably".  There are usually multiple medical schools in each state, yet there are only 28 veterinary schools in the US.  Each school accepts around 80-100 students per year (some a little more or less), and there are around 400-500 applicants each year.  So it's VERY competitive.  As far as the qualities, you need very good grades in the required classes, need to be a good communicator, and usually need to have some prior experience working for a vet.  I don't know of any vet school that routinely accepts people who have never been behind the scenes at a vet.  Beyond that I think things may have changed some from when I went through the process in the early '90s.  For example, I think that some vet schools have eliminated the personal interview as part of the admissions process.   Check with the schools you're interested in and find out their requirements.

9. I see you went to NCState - I am from the east coast and NCState and VATech would probably be the closest. What is your advice when it comes to considering Veterinary schools? 
Honestly, you're going to get a good education at any of the vet schools in the US, so you don't need to go to a specific one.  If you have one in your state, by all means go to that one if at all possible as it will usually be much cheaper than going out of state.   Choose the school that will cost you the least amount of money to attend.  I know this seems like a rather silly way of deciding, but the biggest crisis among newer graduates is the almost overwhelming debt burden.  It's becoming harder and harder to afford to be a vet, and you want to minimize the amount of debt you have when you graduate.  This will make life MUCH easier on you.  The days of getting a veterinary degree regardless of the financial cost are gone, as it's no longer realistic.  Once you graduate and have your license in hand, nobody is really going to care where your diploma is from.

Maggie, I hope this answers your questions!  Best of luck to you and anyone else considering veterinary medicine!

Wednesday, August 10, 2011

Night At The Museum, Part 2

Last year I posted about an event I was part of, Night At The Museum at the Tellus Science Museum in northern Georgia.  You can read about the basics of the event there, and see pictures of me portraying Jules Verne.  The event was successful and they had it again this year, just this past Saturday.  To keep it fresh, the museum changed things up a bit and changed the theme to emphasize where science and science-fiction meet.  Several sci-fi costuming groups participated, including the 501st Legion (Star Wars costumers), the Tennessee Who Authority (Dr. Who), some local Star Trek fans, and even a small representation from Firefly.  We mixed that with some typical scientists (Nicola Tesla, Albert Einstein, etc.), historical figures (Wright Brothers, Amelia Earhart, etc.), and sci-fi authors (Jules Verne, H.G. Wells) and their creations (Captain Nemo, Dr. Jekyll & Mr. Hyde).  And this year my wife and I were different characters.

Here's me as Tesla.  I grew a bushier mustache, shaved my beard, and darkened my hair.  It's the first time I've had only a mustache since I was in college in the early '90s, and my wife and I decided that we don't like the look.

My wife was Kaylee from Firefly.  Our friend, Alan, played Mal, the captain of Serenity.  My wife made his browncoat!

Some pictures of the entire group as well as the central area of the museum.  See how many characters and historical figures you recognize!

Here's a video that was taken at the event.  You can briefly see me in the character parade.

The event was very popular and successful, bringing in over 200 more attendees than last year.  The marketing director of the museum has already confirmed that we'll be doing it again in 2012.  And I'll be sure to post pictures again!

Monday, August 8, 2011

Human & Dog Anatomy Comparison

I get a lot of emails requesting me to post a link or guest blog from a topic on another site.  Most of these I pass on, preferring to keep to my own topics.  However from time to time something jumps out at me that I'm happy to share.  This is one of those times.

Though this is obviously intended for a younger audience, I really like how it gives side-by-side comparisons of the anatomy of dogs and humans.  So I thought I would share, including a link back to the original site for anyone to use.  Unfortunately the original image is too large to fit in my blog, so I'm giving a link to the site (click on the image below).  Enjoy!

Created by Pet365 - a UK supplier of dog collars, leads and pet accessories. Click below to see the full size version.
Dog Anatomy Infographic

Sunday, August 7, 2011

Never Risk Free

Last week we had a client come in to check his dog's leg.  The dog was known to have seizures, but only 3-4 per year and usually of short duration.  A few days before coming to us the dog had had a seizure lasting longer than normal.  There was a veterinary clinic close to his work and he took his dog there for immediate care.  According to his story they gave an intravenous injection of diazepam (valium), which is used to stop seizures.  Since it was an urgent situation, the vet found the cephalic vein in the left front leg and gave the injection there without first placing a catheter.  This vein is the main one in the leg that we use for blood collection, injections, and catheters, so this was pretty typical.

Once the seizure stopped they tried to collect some blood from the jugular vein, again a pretty routine procedure and a common location.  They had difficulty getting blood, and had to go back to the cephalic vein.  After that the dog started seizing again and the doctor decided to give IV phenobarbital.  They tried the right cephalic vein, but couldn't hit it and ended up going back to the left one again.  Believe it or not this isn't uncommon, as some veins can be harder to find than others and one leg may have a more prominent vein.  It can also be difficult to find a good vein in some patients, especially if there is some sort of cardiovascular problem.

The dog did fine, the seizures stopped, and everything seemed okay.  A couple of days later the owner noticed the dog licking at the leg where the injections had been given, but didn't think a lot about it.  Over the next day the skin started losing hair and becoming red and the owner became concerned.  The following day he saw that the skin had come off and was very raw.  He placed a bandage at home and brought the dog to us.  We took the bandage off and this is what we found....**WARNING*** Graphic, gross images follow!  Scroll down at your own risk!

Do you see the dark, tubular structure in the center?  That's the cephalic vein!  The skin and underlying tissues had completely died, exposing the vein and muscles.  One of the concerns was that it looked as if part of the wall of the vein had become necrotic and fallen away, leaving a blood clot exposed.  Thankfully the dog was only slightly limping and everything else in the leg and paw looked good and appeared to have a good blood supply.

So what happened?  One of the things that laypeople may not realize is that some drugs are very irritating to tissues and should only be given intravenously.  If some of the drug leaks from the vein or otherwise gets into a muscle or subcutaneous space it can cause severe damage to the tissues and blood supply, resulting in death of the tissues.  Both diazepam and phenobarbital fall into this category, leading to thrombosis or necrosis if they are given subcutaneously. Diazepam can be given intramuscularly without problems, so this may not have been the culprit.  However, phenobarbital can cause significant necrosis outside of the vein, and I believe this is what happened.  Because the vein was punctured several times while trying to stabilize the dog it likely leaked some of the drug.

As bad as this looks it can be treated, and likely without skin grafts.  Specialized bandaging methods can be used to promote healing, though it requires daily bandage changes.  As the necrotic tissue falls off and healthy tissue remains the changes can be less frequent and new tissue will close the defect.  It will likely take weeks or even a few months, but odds are in the favor of the dog just ending up with a scar.

I don't want to scare anyone unnecessarily, as this is an uncommon occurrence and a potential danger that most vets are aware of.  From what the owner told me I don't think the other vet did anything wrong and the only thing I would have done differently was to place an IV catheter once the initial seizure was stopped.  Doing so would have likely prevented this problem, but I do think the other vet was trying the best that they could.  Nothing in medicine is ever completely risk-free, though we do everything we can to minimize those risks.

Thursday, August 4, 2011

This Is Why You Spay...**GRAPHIC IMAGES**

We veterinarians talk to clients all of the time about spaying pets.  It's one of the most frequent recommendations we make, and we have very good reasons for doing so.  Even though spaying helps prevent numerous serious medical problems, many people don't do it.  And that can lead to disaster.

A couple of weeks ago we had an 11 year old German shepherd come in for lethargy and vaginal discharge.  She was unspayed because the owners originally had intended to breed her.  This never happened (as is usually the case...most clients who tell me that they may breed never end up doing so), but they never had her spayed.  A few x-rays and lab tests later and we validated our suspicions...she had a pyometra.

Pyometra is the medical term for a uterine infection.  This isn't like a urinary tract infection, skin infection, or sinus problems where we can prescribe antibiotics and everything will be fine in a few weeks.  In a case with a pyometra the uterus fills with pus and is something that rarely responds effectively to antibiotics alone.  This is a life-or-death situation that requires immediate emergency surgery.  If surgery isn't performed quickly the uterus could rupture, releasing pus and bacteria throughout the abdomen and almost assuredly resulting in death.  The surgery itself cares a high degree of risk as the uterus is usually very fragile and could rupture during routine handling. Also there is a risk of pus and infection leaking from the cut areas of the uterus, resulting in contamination of the abdomen.  Serious problems!

Thankfully the owner agreed to the surgery.  When I got inside, the uterus was large and distended with pus just like I expected.  Here's what we found...WARNING...The following images are graphic photos of the surgery and are not for those offended or nauseated by such images.  Scroll down at your own risk!!!!

This uterus is many, many times larger than it should be.  A normal uterus in a dog this size and age should be somewhere between the size of a large pencil and a small marker pen, or similar in diameter to one of the instruments in the picture.  However, this is not the largest pyometra I've dealt with.  And this wasn't the only problem.

Sometimes I'll see cysts on ovaries when I'm doing a spay, especially on an older pet.  Normally there are just a couple of cysts, usually no more than 2-4.  This dog had literally around 20 on each side, and whereas cysts are normally on the ovaries, in this case they extended along the uterus itself.

Thankfully the surgery was as uneventful that we would want, the uterus didn't rupture, and the patient did spectacularly. Here's the uterus once it was removed, again many times larger than it should have been.

I just saw her a couple of days ago for her 10-day postoperative recheck, and she was in great condition, wagging her tail and acting like nothing had ever happened.  This was a very successful surgery with a great outcome.  But there was no reason why this needed to have happened.

Situations like this one are why we recommend having pets spayed.  A routine spay at our clinic runs around $350.  This client paid around $1400 for diagnostics, surgery, and medications.  That's more than four times what she would have paid if she had simply had her dog spayed!  She would have also prevented the life-threatening risk to her pet.  Thought this turned out well, it may not have and could have resulted in the dog's death.

The moral of today's story?  Have your pets spayed and neutered!!!!!

Tuesday, August 2, 2011

Depression In Veterinary Medicine

I recently read an article that presents some very interesting and somewhat disturbing data.  Apparently veterinary students are more prone to depression than human medical students and the general profession.  Here are some key quotes from that article (linked above). 

During the first year of veterinary school, 32 percent of the veterinary medicine students surveyed showed symptoms of depression, compared to 23 percent of human medicine students who showed symptoms above the clinical cutoff, as evidenced by other studies.

The researchers also discovered that veterinary students experience higher depression rates as early as the first semester of their first year of study. Their depression rates appear to increase even more during the second and third year of school. During the fourth year, depression rates drop down to first-year levels.

Hafen said several factors might contribute to the higher rate of depression in veterinary medicine students. Veterinarians deal with stressors that human medicine doctors do not have to experience, such as frequently discussing euthanasia with clients. Although both programs of study are intense, veterinarians must understand a variety of animal species rather than focusing on the human body. Struggles with balancing work, school and life could also lead to higher depression rates.

Honestly, I can't see that these findings surprise me. Veterinary school is incredibly hard and stressful, and I don't think people realize that vet students have to learn more than human medical students do.  I certainly remember how stressed I was and how much time I spent studying and preparing.

Unfortunately I think that it gets worse in many ways from school.  Practicing vets no longer have to worry about intense studies, but they do have more pressure on them regarding the health and well-being of their patients.  In vet school you always have a safety-net of interns, residents, and professors that can make the final decision in cases, but when you're practicing it's all up to you.  Add on stresses related to paying bills, student loans, starting families (if that hasn't been done in school), being expected to financially produce, and often running a business.  It's actually more of a wonder that we don't see most vets succumbing to depression.

Although the mental health of human medicine students has been extensively studied, the same extent of study has not been performed with veterinary medicine students. Additionally, most veterinary research related to depression involves pet owners, not veterinarians or students.

I agree that such studies need to look at the veterinary profession as much as it does the human medical profession, I think it needs to reach beyond the students and include active practitioners.  We may find that depression in veterinary medicine is more wide-spread than is thought.  At the same time, there may be a mitigating factor in the fact that we work with animals, which have been shown to lower stress.  But I'm sure the stress-lowering affect of pets doesn't include ones trying to bite you!