The Super Bowl! Time For Commercials

Here in the US one of the biggest TV and sporting events of the year is the Super Bowl, the culmination of American football for the season where the top two teams compete in a single game for the championship.  To most Americans this is a BIG DEAL.  To me?  Not so much.  You see, I'm not a sports person.  I'm a big-time geek and really could care less about the outcome of most sporting events.  I've been to a couple of football games in high school, and a few professional baseball games, but otherwise I haven't had an interest in most sports.  Honestly, I'd have to Google who is even playing in this year's Super Bowl.

But there are a few quirky, interesting things that go along with this game.  First, the NFL (National Football League) is extremely protective of the name "Super Bowl".  No other company or organization can use this in any promotions or descriptions without the risk of a lawsuit.  Only the NFL itself can officially refer to it as The Super Bowl.  Everyone else has to say "the Big Game".  I can see where the NFL wants to protect it's intellectual property, but give me a break.    Even companies advertising during the game have to say "Big Game commercials" rather than "Super Bowl commercials".  Very petty of the NFL as far as I'm concerned.

And that brings us to the other interesting thing about the Super Bowl (sorry, I refuse to bow to the overblown egos at the NFL) is that it is the biggest event of the year for commercials.  Yes, that's right.  For those outside of the US, this one game is where companies spend the most money on commercials and deliberately work to put out the most interesting and catchy advertisements.  It has become as popular to watch just for the commercials as much as for the game itself.  And there really are some great commercials out there!

Thankfully because of the internet many of these are released early and I don't have to sit through boring football to watch the fun stuff.  Here are my favorite ones so far from this year.  The first two aren't necessarily from the Super Bowl, but are fun anyway.

This one is just simply adorable and sweet.

I'm a huge fan of the Muppets, especially Animal, so of course I love this one.

And here is my absolute favorite one!  Anyone who works with animals, especially in the veterinary field, will laugh while they're glad this doesn't actually exist.

Snowmageddon In The South

I realize that some of this may be lost on my international readers, especially those not knowledgeable on US geography and culture.  So for those folks let me give a couple of brief primers.  Many parts of the US are pretty culturally different and there can be jokes and tension between regions over these stereotypes.  The biggest rivalry is between the North and the South, and it's not just a hold-over from the Civil War.  Southerners are often perceived by others as rather dimwitted and backwards, though this is certainly not true in reality.  The stereotype is especially pushed when it comes to snow in the South.  You see, we don't get much cold weather down here (I'm a Southerner born and raised, so I can speak to this point).  And when we do people tend to freak out and panic.

One of the biggest jokes is that when snow is forecast everyone rushes to the store to get bread and milk.  I get frustrated and amused at this response for a few reasons.  

1. This is the South for goodness sake.  Even if we get a true blizzard everything will be clear in a couple of days.  In my 44 years of living in this region I've only seen a couple of true snow-ins and those didn't last more than about three days.  Is everyone really going to run out of food in that time?
2. This happens just at the threat of snow!  The chance!  Most of the time nothing happens.  Yet the response from people is always the same.
3. Bread and milk?  Really?  Sorry, but if I know that I might be stuck in my house for a few days I'm going to pick up pizza, chips, and sodas.  Let's make being snowed in fun!

Another huge problem is that because of the infrequent snowy weather our governments aren't really prepared.  There are only a few snowplows or salt trucks in each metro region, unlike our Northern neighbors.  In the North when there is bad weather all of the trucks and equipment jump into action and keep the roads clear and safe.  We have such limited weather in the South that the small number of trucks is usually sufficient.  But when we DO get real snow the system is overwhelmed.

And then you get people who just don't know what to do in this weather.  With limited to no experience, most Southern drivers go too slow or too fast on slick roads.  The worst ones are the rednecks (and I say this affectionately....I have friends and family who are rednecks) with their 4-wheel drive trucks.  Sorry, but when it's snow on top of ice you're going to spin out just as easily and have four wheels with no traction rather than two.  My father is from Sweden, taught driving when he lived there, and has always been involved with cars as a mechanic or sales manager.  When I was a teenager and we would get snow a couple of times a year he would take me out in it and teach me how to be safe.  He would have me slam on the breaks and step on the gas just to see what a spin-out felt like (always in a safe area) and how to get out of one.  Because of this training I am very comfortable in winter weather without being reckless.  Most of my fellow Southerners can't say the same thing, and truthfully they are pretty stupid in this regard.

But sometimes REAL snow hits unexpectedly.

Over the last couple of days we've been hearing about the chance of snow.  As of last night it was supposed to stay south of Atlanta, hitting middle and southern Georgia.  This morning the line had moved north and we now had a 30% chance of some snow in my area (northeast Georgia).  When I went into work my staff was talking about it and I started snickering and laughing.  Over the course of the morning I continued making jokes about "Snowmageddon" and everyone rushing to the store for bread and milk.  When clients started canceling appointments I rolled my eyes.  I was only working a half day so when I walked out to my car at around 12:30pm I was startled to see snow.  Real snow!  And accumulating!  I talked to my wife and she said that the chance had gone up to 100% (no duh at that point) and was expected to keep going for several hours.

So much for accurate weather predicting.

And remember those jokes I was telling?  How I was making fun of my fellow Southerners?  Yeah, not so funny when it took me almost 2 1/2 hours to drive 24 miles home.  Unsalted Roads + Stupid Drivers = GRRRRRRR!

Now the governor is planning on declaring a state of emergency (true!), and there have been untold numbers of car accidents.  And how much snow does it take to shut down a large metropolitan area in the South, sending it into a state of emergency?

Oh, about 1-3 inches.

Yep, you heard right.  INCHES.  Not feet!  (For those on the metric system that's about 2-7cm of accumulation).  And I can actually hear the laughter from my readers in the Northern US, Canada, mountainous areas, and Scandinavia.  Here's a photo of what it looks like from one of our local friend's front door.

Impressive, right?  

Because it's dropping into the teens tonight (Fahrenheit) any melted snow will freeze, making tomorrow even more dangerous in the morning.  We may not have much if any business tomorrow, yet I'll still try to make it in.  I'm not worried about myself, but the drivers around me are a concern.  Remember....untreated or poorly treated roads plus inexperienced drivers.

Welcome to winter in the South!

Why You Should Spay

This is a very basic, simple question from a reader and one I answer almost every day at work.  But I can't remember the last time I've really addressed it in this blog and I'm trying to get through my backlog of emails, so here you go....from Heather....

I have my own (very good) vet, but in this case I would like an unbiased opinion.  

I have a 3 year old, healthy,  Saint who was originally kept by the breeder for the purpose of breeding.  However, she turned out to be infertile and does not (noticably) go into heat. 

I have always spayed/neutered all of my pets.  I am not sure if the risk outweighs the benefits in this case. She stays in the house, my other dog is neutered, and I am not sure if I should get her spayed. 

What would you recommend?

To me overpopulation and the risk of pregnancy are the least compelling reasons to spay a dog.  Surprising?  As a doctor I see far more problems with health and behavior than I do with unwanted pregnancies and a rampant unwanted pet population.  When I talk to clients about spaying the reproductive issues are the last things I discuss.

Let's take a quick look at several risks of not spaying a dog, some of them potentially fatal....

• Significantly higher risk of mammary gland (breast) cancer.  About a 25% chance compared to less than 1% if spayed before her first heat cycle.
• Risk of severe uterine infection, pyometra.  This results in a pus-filled uterus and usually requires immediate, risky, emergency surgery.  Caring for one of these cases is many times more expensive than a routine spay.
• Potential risk of ovarian cancer.
• Attracting unneutered male dogs from a surprisingly wide radius, potentially leading to aggressive interactions or the spread of diseases and parasites.
• Unwanted pregnancies from dogs outside the home.  The dogs mostly around her may be neutered, but as I mentioned above male dogs can come from far away and are often extremely persistent in getting to an in-heat female.

In Heather's specific case her dog has many years left and spaying would reduce the risks of the above problems.  Additionally, a dog who doesn't have regular heat cycles would potentially have abnormalities with her reproductive system, including hormonal imbalances, ovarian cysts, and so on.  Infertility in dogs should never be blown off, and is a strong reason to remove the reproductive organs.

I have seen all of the above scenarios and diseases, and in each situation the client was faced with a problem that would have been completely preventable by spaying.  And each of those clients faced rather large veterinary bills and regretted not having spayed earlier.  

So Heather, I would definitely recommend spaying your dog.

A Vet's Biggest Daily Problems

This interesting question comes from Alex.....

As a veterinarian, what are the biggest problems you face on a day-to-day basis?

There many, many problems we face daily.  Some of them relate to efficiency, some to staffing and training, some around client interactions, some around cases....you get the idea.  Day-to-day some of these might change.  For example, this past Sunday one of my techs had a major family crisis and couldn't come to work.  We normally have two receptionists and two techs for one doctor on a Sunday (yes, we're open every day).  It was too last-minute to call anyone in, so we had to make it work.  We don't face that situation daily.

Here's a list of some of the biggest things I can personally think of as relatively daily problems for vets, in no particular order.  I encourage my readers to add to the list!

• Having time to take lunch.  Sometimes we're so busy that I go from 9am to 7pm (or later) without a break, eating while I type medical notes.
• Explaining complicated medical cases to clients.
• Clients not having enough money to do proper diagnostics and treatment.
• Clients refusing to do simple preventative care such as heartworm prevention, even when we clearly tell them the risks of not doing so.
• Scheduling enough staff to be efficient, but not so many that we are putting too much into payroll.  This is a delicate balance, as we loose profits if we have too many people scheduled for the workload of a day, but if we have too few we can't work quickly and do quality work.
• Pets that want to bite and scratch!  People don't realize it, but vets and their staff risk bodily injury every single day.  Sometimes it's a minor scratch, but we also work with animals big and strong enough to cause severe, life-changing injuries.
• Not being able to diagnose a particular case.  Some case are extremely complicated.  We may run every test available to us and still have no answers.  Sure, we might have narrowed the possibilities but that doesn't always lead us to a correct treatment plan.  I get more frustrated by these cases than by any others, but I am more of a surgeon at heart than an internist.
• Having to deal with interpersonal conflicts between staff.  This is mostly in the hands of managers, but since I have that responsibility it comes to my mind.  Conflicts between staff can ruin the flow and morale in a hospital, as well as potentially even affect patient care.
• Lost records!  My clinic has computerized medical records but many vets still rely on hand-written files.  Having worked in these situations before, I know that sometimes a patient's medical record simply goes missing.  Computerization is the best solution to this problem, but some vets haven't made the switch.
• Clients who think that we charge way too much and somehow have the impression that I must drive a BMW and live in an estate (reality....2008 Nissan Altima and a 1500 square foot split-level house).
• Training staff to be efficient, accurate, and high quality.
• Being able to work in urgent cases that really need to be seen today when we have an already full schedule.
• Clients who have to come in RIGHT NOW because their pet has been vomiting for two weeks.
• Finding appropriate and comforting ways to help a client through the loss of a pet.

Those are the the things that come to my mind and I'm sure I've missed some obvious ones (I'm counting on readers to point them out).  Yes, a lot of it revolves around clients, something that anyone in the profession would be quick to support.  Honestly our jobs would be a lot easier if clients had less limited funds and would agree to everything we wanted to do to help their pets.  But I also can't blame all clients because many of them are in situations beyond their control.

Alex, hope that helps!

"If It Was Your Pet...."

One of the most common questions asked of a vet is "Well, what would you do of this was your own pet?"  Yes, admit it.  As a pet owner you've asked this of your vet at one point or another.  And if you're in the veterinary field you've heard it more times than you can count.  Believe it or not, this is tough to answer.

Everybody has different perspectives on pets and different life situations.  Someone who is pregnant may make different decisions than someone who just had a baby.  And both may make choices different than a grandmother.  An unemployed teacher may spend more money on their pet than a wealthy lawyer because the teacher sees the pet as her biggest joy in life and the lawyer knows he can just buy a new one.  (By the way....I'm not commenting on attitudes of teachers, lawyers, or anyone else.  It's just a random example, folks....)  There rarely is a "right" or "wrong" answer as many circumstances depend on many factors.  

Just take a look at yesterday's blog.  Pam decided to pursue a full diagnosis and then authorized chemotherapy for her cat.  She's happy with her decision and the case turned out quite well.  In a possibly similar situation I made different decisions which ended up with euthanizing my cat.  I don't regret my own actions.  Two people, two cats, different outcomes.  Neither one was "more right" than the other.  Each decision was right for that person.

That's why that question is so hard for a vet.  It's usually asked in difficult cases, especially prior to euthanasia.  Because these are hard decisions people want some guidance.  I'm happy to share my opinions, experience, and knowledge, but that's different than "Here's what I would do".  Sometimes I'd run tests that clients can't afford.  Sometimes I would stop treatment before another person would.  My own thoughts, beliefs, and history guide my decisions.  And since nobody in the entire world has my specific combination of these things, my decisions are really only applicable and appropriate for me.  My financial situations are also different than many clients, where sometimes I have more money than them and sometimes I have less.

Rarely do I give a direct answer to this question since there are so many variables and the reason why I may pick a course of action can be quite different from why a client may go in the same direction, or even the same reason may lead them to opposite actions from me.  I try to word my answer in such a way as to allow the client to make their own choice and not rely on me.  While it may not be as satisfying to some people, it would be better and easier to ask "Well, what are the benefits or problems with options A, B, and C?"  That's a question I can handle.

Why Didn't I Treat My Cat?

Okay, time to try and get through the emails I've received over the last few months.  I'll mix these in with new posts related to work and my life.  Here's one from Pam.

I was researching feline lymphoma this morning and found your blog entries about your 16 year old cat. I was curious why you did not do exploratory surgery or needle biopsies on the cat. I have an 11 year old cat who got diagnosed with small cell feline lymphoma about 1.5 years ago. He had done well with a chemo protocol. It has not been inexpensive, but since he continues to have such a good quality of life, we continue on as conservatively as possible.

Thanks for your insight and help.

I'm still tweaking my computer, re-installing software and files.  And for some reason when I pull up my blog page I can't see the search function.  The reason I mention this is because I can't search for the post to which Pam is referring.  So let me summarize.

A few years ago I had a cat who became sick.  He was vomiting, losing weight, and just not doing well.  I ran multiple blood tests, x-rays, and just about every test I had available and that made sense to run.  Everything kept coming up normal.  As he wasted away I had to weigh my options and chose euthanasia.  That was not an easy decision as he had been my friend since he was about three months old.

So on to Pam's question....It really came down to money, as well as whether or not I wanted to put him through everything.  Intestinal lymphoma was definitely on my list of possibilities but there were no obvious signs on exam or blood tests.  He never developed any masses, enlarged lymph nodes, or thickened intestines.  Any of these (especially the latter) can happen in this type of cancer and help direct the diagnosis.  It's also not uncommon to see high blood calcium levels or changes in the white blood cell count and percentages.  However, there were no abnormalities on exam or lab tests to give me a better idea.

It could still have been lymphoma.  If there is diffuse cancer in the wall of the intestine, a needle biopsy isn't going to be accurate.  Needle biopsies or aspirates are sometimes inaccurate, and you really need to make sure that the needle goes into the tumor.  Even with ultrasound guiding you, a needle into the abdomen will pass through intestines and may never actually hit a cancerous portion.  This is really a bad way to diagnose this kind of cancer.  The best way is a surgical biopsy, taking full-thickness samples from multiple locations.  However, that's an major surgery with an open abdomen, and he was in poor condition by that time.  He would have been a much higher anesthetic risk.

Let me take the time to bust a myth or two about veterinarians.  We do not get medical care for free for our pets.  Someone who owns their own practice might be able to simply not invoice out a major surgery, but they are still paying for the supplies, drugs, and salaries out of the practice's money, which in the end is their own money.  For someone like me who manages a practice rather than owning it the situation is even more different.  If I didn't charge for care of my own pets it would be essentially stealing time and products from the owner.  Yes, I do get discounts, but I still have to pay.  An abdominal surgery with intestinal biopsies may cost an average owner around $1500.  With my discounts I might pay around $1100.  Yes, a substantial reduction, but it's still a big chunk of change.  And that's where the other myth comes up....vets aren't wealthy (well, most aren't).  The average veterinary salary in the US is around $85,000 per year.  If that's a single income in the family (as in mine) it's firmly middle-class and not rich.  Considering that I'm still paying off my student loans almost 17 years after graduation, bills to pay, and two pre-teens to raise, I don't have bundles of money lying around.

Do the math in this case.  Let's say around $1000 for the surgery and we get a diagnosis of lymphoma.  It may be another couple of thousand for oncology consultation and chemotherapy, depending on how long it takes.  I don't have or use credit cards and even as a vet with personal and professional discounts I don't have $2000 to spend at the drop of a hat.

Then I had to weigh the likelihood of improvement.  He was 16, pretty old for a cat and at or beyond the life span for most feline patients I've seen in my career.  His was a good, long life without any serious hardships.  The diagnosis of lymphoma wasn't guaranteed, so I may have done surgery and biopsies and come up with nothing or something untreatable.  Pursing invasive diagnostics was a gamble and one I wasn't eager to take.  While lymphoma is often treatable and cats can live a few years past diagnosis, this isn't always the case.  At his age would I really be doing him a favor to give him another six months and then be right back at the same point?  After going through surgery and chemo?  If he was five or even 11 years old I may have made a different decision.  But 16 is far older and he may not have had much time left anyway.

I don't think there was an absolute right or wrong answer in my cat's case.  If one of my clients had wanted to do surgery and chemotherapy I would have completely supported their decision and followed through to the best of my ability.  This was a personal decision where I weighed the financial costs with the likelihood of recovery.  The scale tilted towards full recovery being less likely, so I decided to end his life peacefully.  This was my decision and even a few years later I don't regret it.

This ties in with another question vets are frequently asked...."What if it was your pet?"  But I'll talk about that tomorrow.

Where Has Dr. Bern Been?

I started this blog way back in 2008 and for the next five years I managed to consistently average at least 3 blog posts per week.  Not bad at all considering that I started it without a strong plan in mind.  And then just as I was nearing the big anniversary...

PFFFFT....

Several things contributed to the longest absence from blogging that I've had in five years.  Most of it revolved around a play that my wife directed and in which I was an actor.  It was an amazing show and I'm so proud of how she brought together a cast of over 20 people to put on a musical set in 1941.  But not only did I have the stress of being an actor, I also ended up helping with set building and decoration.  During that time my wife also started having some health concerns, and I had to rely on strength in God to be able to help her through that stressful period.  Once the play was over we had to start catching up on activities, responsibilities, and other things that had been pushed to the back burner for a few months.  Then there was a break for Christmas, during which my computer went rather glitchy with a driver that somehow locked up my computer to where even a boot in safe mode wouldn't start it.  So it's been in a local computer service store for the last nearly two weeks, finally being in working order today.  

Probably the best part of the last few months is a "good" reason why I haven't had as much time to blog.  Some days at work would be slow, giving me time to whip out a blog post from time to time.  But for several months we've had surprisingly strong business, leaving me no spare time at all.  As a manager of a veterinary practice I'm certainly all for that!  But on the other hand I wouldn't mind a breather now and then.

So now I'm back.  I've actually been contacted by a few people who have wondered if I'll do more blogs, and I certainly plan to.  Life is quickly getting back to normal and I'm finding myself with some much-needed free time, at least at home.  I feel that I still have stories to tell and advice to give, as the veterinary profession is constantly changing and evolving.

So that's what's been going on in the life of Dr. Bern for the last several months.  Time to get back to the job of letting everyone know what the life of a veterinarian is really like.