Attack Of The Clones....or, When Everyone Picks The Same Name

Yesterday was very interesting in my clinic.  We had a busy day as is typical for a Saturday, and had many pets who dropped off for various kinds of check-ups and treatment.  As the day went on we started noticing a rather surprising pattern.  Multiple pets had the same names.  And it wasn't just a couple of them!  By the end of the day we had tallied the following: 

Two dogs named Sophie
Two named Luna
Two named Charlie
Two named Bear.....with the same last name!

That last one had us staying alert, because two dogs were in our clinic for the day, both named "Bear Miller"!  Yet neither family was related to the other.  It was just a weird coincidence that they shared a last name, gave their dogs the same name, and came in on the same day.

It really was quite funny.  But at the same time it could have been a disaster.  We had to be extremely careful to make sure that the medical notes were being entered on the correct patient (we use completely computerized record-keeping), the right vaccine or medicine was given to the right dog, and when the owners picked up that we brought the correct pet up front.  Having two black dogs with the same first and last name was especially concerning!

Thankfully all of my staff was at the top of their game and there were no mixups at all during the day.  Each pet got exactly what they needed and went home with the right family.

But believe it or not this isn't the first time something like this has happened.  It's rare to have two pets with the same last name from different homes, but it happens.  We also sometimes have more than one pet with the same name in a given day, especially with common names like Buddy, Bear, Bella, etc.  But having four sets of "clones" was pretty crazy!


In the spirit of the day, I'll leave you with this classic from Weird Al Yankovic....

Vet Vs. Client Perspectives

Recently I had an email conversation with someone seeking some advice.  During the conversation he made the following statement:

 

I wouldn't have characterized this as a mild problem, but that is me. I'm very protective about my girls, and pride myself on being in tune with their wellbeing. I can't even imagine the condition that you see some animals coming in for the first time so it's probably a matter of professional perspective.

 

He brings up an excellent point, one that I think both clients and vets sometimes forget.  A perspective is very individual and is based on personal experiences in a given area.  What a veterinarian sees on a daily basis is very different from what the average pet owner sees.  We see the best, worst, and everything in between.  Even someone who owns a dozen dogs in their lifetime doesn't compare when we'll see twice that number in a single day.

Let's look at an average case of bloody diarrhea as an example.

Mr. Sanguine sees his dog, Squirt, having diarrhea and there are streaks of blood in it.  Later that day the diarrhea is more liquid and the blood is more noticable.  He worries about the possibility of something serious being wrong, as he's never seen blood in the feces of any of his previous five dogs.  Squirt is acting normal but that blood is freaking out Mr. Sanguine, so he brings is dog to the vet.

Dr. A. Gain sees Squirt.  She collects a stool sample and sees the blood that worried Mr. Sanguine.  But the dog is wagging his tail, bouncing around the room, and has no pain or discomfort on abdominal palpation.  This is the fourth case of blood diarrhea she's seen this week and the second one of the day.When she finds out that Mr. Sanguine gave a new kind of dog treat a few days ago she stops worrying.

Each perspective is correct in its own way.  Mr. Sanguine is justifiably concerned because bloody diarreah is certainly not normal and he's never seen it before.  Dr. Gain sees several cases like this almost every week and isn't worried because of the lack of other symptoms.  Each person is looking at it from their personal experiences, one who has never seen this before and the other who has seen it every week for more than a decade.

There is nothing wrong with either point of view.  The concern of Mr. Sanguine allowed Dr. Gain to properly evaluate Squirt.  Dr. Gain's experience and expertese allowed her to assess that there was nothing seriously wrong with the dog and he could be treated conservatively.  It could easily have been a different situation, where Mr. Sanguine ignored Squirt's problem or Dr. Gain discovered something more serious like early pancreatitis.

This kind of difference in perspective can cause problems, though.  I often have to remind myself that what is normal and common for me isn't for a pet owner.  So while the owner is worrying and possibly even crying I'm shrugging my shoulders and making light of the issue.  Taking too light of a stance can make me seem uncaring or heartless to a client who is really worried.  I may be completely justified in my assessment, but that doesn't help the relationship with the client. 

In a situation like this the ball is in the doctor's court.  It is up to the vet to empathize with the client and show understanding, all while trying to assure the client that it really isn't a big deal.  We as medical professionals need to keep in mind that the client's perspective is not the same as ours because they don't see the same things we do.  It is our responsibility to not make light of this situation and to do what we can to allay their fears.  I'll often tell clients that I see a given problem multiple times per week, as that seems to help them understand that it may not be as big of a deal as they thought.

It's really about being empathetic and understanding people.  Clients should appreciate the fact that vets really do see things differently because of our daily experiences.  But vets have a bigger responsibility to try and see things from their clients' perspective and relate to their fears.

A Year Without Soda

My daughter is pretty remarkable for such a young girl.  At times she can be rather flighty and whimsical, while at other times she can be the most determined and strong-willed person I know.  A year ago she saw someone on YouTube who had done a year-long "no soda" challenge.  For some reason my daughter decided that she wanted to do that also.  So beginning on January 5th, 2015 she decided that she would not drink any soda for a whole year.

My wife and I didn't think it would last.  While our kids don't drink soda daily they do tend to have it when we eat out.  We expected her to give in at some point and decide that she wanted to have some.  It seems that we underestimated her determination.  At every point she kept to her challenge.  No matter where we went or what we did she absolutely refused to drink any soda.  This turned out to be a bit of a difficulty at times!  For example, when we would go to the movies there weren't many choices other than soda if she wanted something to drink.

But she stuck with it through thick and thin.  Everywhere we went she would have water, tea, or juice.  And earlier this month she celebrated a year without soda!  Yes, she actually did it!  Pardon the poor quality of this video, as the light was brighter than I expected.  But her initial reaction is priceless!



I'm very proud of my daughter for having the willpower and determination to succeed in this challenge.  I asked her if she wants to try for two years, but she said no.

Miniature Cameras For Your Intestine

Recently I saw an advertisement in a veterinary journal for a new product.  It is the size and shape of a large capsule or pill and contains numerous miniature cameras.  The idea is that you make the patient swallow this device and as it passes through the digestive tract it takes photographs which can be transmitted wirelessly to a recorder.  In human medicine this is called "capsule endoscopy".  I knew that such things were being developed but I honestly had no idea that they had actually come to market, especially in veterinary medicine.  The Cornell University College of Veterinary Medicine even describes it on their website as a routine diagnostic tool.

Here are some images that you can easily find on the internet.

This is so cool!  It's exciting that this kind of thing is now coming into routine use and can give us so much information with no invasiveness.  Radiology and ultrasound are great and still very important diagnostic tools that we can't do without.  But they can't let us see the inside of the GI tract with our own eyes.  Typical endoscopes are very useful, but they simply can't look at the entire digestive system because of its length.  They also require sedation in human medicine and anesthesia in veterinary medicine.  With a capsule endoscope there is no need for all of that equipment and medication.  The patient simply swallows the capsule and it transmits images wirelessly.  This is an unprecedented kind of diagnostic instrument, and opens so many new options for diagnosing and treating diseases!

Here are some examples of what can be seen.

Obviously this is pretty new and so far only found in the hands of specialists.  With time I would expect the costs to come down and start to be reasonable for general practitioners to purchase and use.  When that happens we could make so many more diagnoses than is currently possible.

I'd be interested in hearing from any clients or veterinarians who have personal experience with capsule endoscopy.  I'm certainly going to be following this imaging modality with interest.

New Influenza Vaccine

Many people are aware that in early 2015 a new strain of canine influenza hit the US and hit it hard.  I wrote a few blogs about the disease and experience (look here) as I live and practice near Atlanta and we were one of the hardest hit areas in the country.  Thankfully the outbreak passed, but it is in multiple areas of the country and definitely can crop up again in my area.  It just popped up in Montana and is causing concerns there.

 

Last year we didn't have a vaccine against this strain.  Yes, we did have an influenza vaccine, but it covered the H3N8 strain.  What we dealth with last year was the H3N2 strain and the infectious disease specialists didn't expect there to be any cross protection.  So a dog vaccinated for H3N8 was still at risk for H3N2.  Many vets gave the H3N8 vaccine because we didn't have any other options.

 

Recently provisional approval was given to two manufacturers for a H3N2 vaccine.  This is good news!  This vaccine does address the risk of this newer, more contagious strain of influenza and will hopefully help prevent outbreaks like what happened last year.

 

The vaccine is approved for dogs six weeks old or older.  They will receive a vaccination and then a booster in two to four weeks, with annual re-vaccination recommended.  It is only recommended for dogs who are potentially at risk for contracting influenza.  This includes dogs who frequent public spaces such as dog parks, are boarded frequently, groomed often, or travel frequently.  A dog who pretty much stays in their house and yard is at minimal risk for influeza exposure and so wouldn't need the vaccine.

 

Here's one caution, though.  Neither vaccine is protective against the opposite strain, so if you want to be really thorough your dog will need to receive both.  Personally (I have no evidence of this) I fully expect there to be a multi-valent canine influenza vaccine in the near future that covers both strains.  Until then you should talk to your vet about whether or not your dog needs both.  Here in northern Georgia I'm only going to recommend the H3N2 vaccine because we've never seen the other strain in this area.

 

We are just now able to order the vaccine at my practice and I was reading an article about it in a recent trade magazine, so it may not be widely available and some vets may not be aware that it has come out.  If you are interested and your dog is potentially at risk, talk to your vet.

A Prescription Of Prayer

In case you haven't picked up on it through my profile or blog posts, I'm a Christian with pretty conservative religious beliefs.  I've always been open about that and don't plan on ever hiding it.  That being said, I also don't believe in being pushy about it and don't make a big deal my faith.  It's an integral part of who I am but I'm not going to go around with a bullhorn saying "Look at me, I'm a Christian!"

 

This is true in my job as well.  All of my staff know my beliefs, that I attend church and teach Sunday School, that I've given sermons and acted as a sort of pastor.  Some of my clients know this because it comes up during casual conversation.  But many more of my clients probably have no idea what my beliefs are because I don't walk into an exam room with "Hi, I'm Dr. Bern and I know Jesus as my personal savior."  I'll have conversations if someone asks or if it comes up in the natural process and flow of the visit, but otherwise I avoid such discussions.

 

Recently I read an article by Dr. Marty Becker on the subject of prayer in the veterinary office.  For those who aren't familiar with him, he is one of the most well known American veterinarians, having appeared on TV numerous times and having written multiple books.  When he came out describing his faith and his view on prayer, it surprised me a little, as he has some very traditional Christian views.  I don't know why it surprised me, but when he was open about his faith and how that related to his profession I realized that I had never imagined this about him.  It was also a shock to see such openness in a national veterinary trade journal.  Here's a quote from the article (linked above):

I’m on-my-knees sincere when I bring God into the treatment plan. I don’t force my beliefs on anyone else, but I’ve also only had one person that I know of take offense, ridicule the practice and leave as a result of it. So we’re about 5,000 to 1.

I end every exam with the simple word “blessings.” This is not the equivalent of “thanks” or “goodbye.” I mean it when I say “blessings” and they can include: may we come up with an accurate diagnosis, prognosis and treatment plan for your pet; may we relieve your pet’s pain or even cure it; may you, the pet owner, find health, happiness or a rich spiritual connection; even just have a great week.

I just read an article in Time magazine on “How Doctors Handle Faith.” It pointed out that many people who are legally bound to make medical decisions for a critically ill friend or loved one turn to faith for guidance. But when researchers from the University of Pittsburgh and Duke University analyzed recorded chats between such surrogates and health care workers in ICUs across America, they found that spirituality rarely came up.

The study he's referring to reported that 78% of health care surrogates said that faith was important to them, but only 16% of ICU conversations about medical care touched on faith or religion.  And of those cases only 5.6% were initiated by the medical professional.

Religion is an extremely tricky subject to bring up for any professional.  I never know if my clients are Baptist, Catholic, Muslim, Hindu, atheist, or any other kind of religion.  I don't want to offend anyone by talking about something that is personal or bothers them.  Unfortunately that may go against what many clients actually want!  Every time I've ever brought up my personal faith with a client it has always been met with enthusiasm and understanding.  Are we so afraid to offend someone that we are ignoring an aspect of care that the vast majority of people actually want?  I fear that is the case in today's hyper-sensitive cultures where the emphasis is on political correctness and not saying anything even potentially offensive.  In our care to avoid these topics and phrases we may not be providing the full amount of care that we could.

In a recent post I wrote about a family that lost a dove just before Christmas and had other tragedies going on in their lives.  What I didn't write about at the time was the involvement of prayer.  When they brought their pet in for the initial follow-up the owner mentioned church at the end of the visit.  To me that was an open door to try and help them in non-medical ways.  I asked if they would mind if I could include them in my prayers.  I've done this very few times over the years, and always when it seemed very appropriate.  She responded with an emphatic "yes".  Then I felt another urge, and did something I've done only a handful of times.  I asked if I could pray over her and her son right there.  And she said yes.  So I put my hand on the son's shoulder and prayed with them. I'm sure I surprised my tech, who hasn't seen me do anything like that.  But it really seemed to help the client.

I found out how much it helped when they came back the following week to euthanize their pet.  Previously it had been the female owner and her son, but this time they also brought her daughter and husband.  Just before we were going to give the injection she asked if I would pray like I had before.  I unhesitatingly agreed and prayed with all of them in the room before we eased the passing of their beloved bird.  There was a real benefit in adding prayer to the treatment plan.

Despite me being an open Christian I have rarely brought up faith and prayer with my clients.  Should I be?  The times that it has come up have always been positive, as this latest case has shown.  Numerous studies have espoused the benefit of prayer and religion in easing minds and even reducing stress to speed healing.  Why are we so afraid to use this tool?  It seems obvious that most clients don't mind and many really appreciate it.  Are we so hesitant to bring up anything offensive that we deny this proven benefit?  Are we so shaky in our own faith that we don't trust ourselves to be spiritual advocates?  Why do so many people turn to prayer for their own spiritual beneift and well-being but don't offer it as a comfort to others?

I don't know the answers.  This is a very personal issue to the clients and to the vets.  But after my recent experience and after reading Dr. Becker's article, I certainly think I'll be more open to the option.

The Educational Benefits Of Classroom Pets

I have several clients who are school teachers, and several of them have pets in the classrooms.  Typically this will be a hamster or other small mammal, but sometimes it extends to reptiles such as bearded dragons and ball pythons.  In all of these cases I think that a classroom pet can be a great educational experience for kids and can give a broader set of experiences than you might think.

 

Last month one of my clients (a teacher) brought me her classroom pet, a ball python.  He was having some mild wheezing and she wanted to make sure he was okay, especially with Christmas break coming up.  I diagnosed him with a mild respiratory infection and prescribed him some antibiotics.  During that visit and at the follow-up a few weeks later we talked about Marvin (the snake) in relation to her classroom.  Of course she was using him as an example of animal care and biology.  But she expanded the lesson to include math and the metric system, talking to her students about how to calculate dosages, stressing the important of math in the medical profession, and reviewing the volume measurement of the medicine. She took pictures of me with Marvin (as she often does when she brings pet in) so that she could share them with her class and post on Facebook, and kept her students updated even while on break.

 

I really admire how she and other teachers find learning opportunities in even the most simple things.  A snake with a minor infection became a lesson in anatomy (snakes only have one functional lung), the responsibilities of pet care, the medical reasons for increasing temperature and humidity during an illness like this, math calucations for medications, and so much more.  Her students and friends followed Marvin's progress and he did get better.  But beyond the healing of a pet snake there were many things that the students learned.

 

Teachers like this are to be cherished and honored.  They are the ones who really take the time to teach beyond what is in the lesson plan or text book.  One of the things that always bothered me when I was a student (even though college and graduate school) was that many things really didn't seem to matter in the "real world".  I had to take two semesters of Calculus in college as a prequisite for entering vet school, and I have no idea why.  I made A's in both classes but still to this day can't tell you exactly what calculus is and when it should be used.  I definitely can say that I've never needed it in my veterinary education or career.  So why bother?  Many students feel this way about subjects like math and biology, so showing them the practical applications is important.  Much of what is taught in school really does matter, but when it comes down to book exercises and rote memorization the reasons for learning the material can get lost. 

 

That's where good teachers come into play.  Ones who take the theory and texts and apply them to every day life.  They have my admiration.

Blue Buffalo Lawsuit Update

More and more veterinarians are against Blue Buffalo due to their very deceptive marketing practices and rather mediocre foods.  In the past I reported on lawsuits between Blue Buffalo and Purina, and recently read updates.  I'm reprinting the article here completely as few consumers would have access to this kind of information.   Make of it what you will, but be informed pet owners.  The following is reprinted directly from the original article.




Purina v. Blue Buffalo court fight sprawls

New projected trial date in 2017

September 11, 2015 (published)

Edie Lau
For The VIN News Service

Under a schedule set last summer, dueling pet-food marketers Nestlé Purina PetCare Co. and The Blue Buffalo Co. Ltd. were to face off Monday before a jury in St. Louis.

That was before their battle over false advertising became a legal sprawl encompassing five more companies and four individuals, some involved in spin-off suits. The tangle of claims and counterclaims has prolonged the pretrial wrangling, pushing the projected trial date two years off.

The extensive case file in the U.S. District Court for the Eastern District of Missouri shows:

• Nestlé Purina suing Blue Buffalo
• Blue Buffalo countersuing Nestlé Purina
• Blue Buffalo suing Blue State Digital Inc. and PRCG/Haggerty LLC, an online-strategy agency and communications consultancy, respectively, for their roles in publicizing Nestlé Purina’s complaint
• Blue Buffalo suing Wilbur-Ellis Co. and Diversified Ingredients Inc., suppliers of ingredients in Blue Buffalo kibble
• Diversified Ingredients suing Wilbur-Ellis, Custom Ag Commodities LLC and four individuals at those companies, alleging fraud

The high-profile food fight started in May 2014, when Nestlé Purina took Blue Buffalo to court, claiming false advertising. Blue Buffalo sells dog and cat foods that it touts as “made with whole meats, fruits and vegetables and other high-quality natural ingredients.” Blue Buffalo calls itself the “No. 1 brand in the Wholesome Natural market.”

Nestlé Purina said it obtained an independent laboratory analysis of Blue Buffalo food that found poultry byproduct meals along with corn, other grains and artificial preservatives — ingredients Blue Buffalo disparages and associates with pet-food giants such as Nestlé Purina.

Blue Buffalo dismissed the lab analysis as “junk science.” In a countersuit, it called Nestlé Purina’s legal complaint and related publicity “a smear campaign” borne out of fear of losing business to Blue Buffalo.

Blue Buffalo later stated that it learned through legal discovery that some of its food did contain poultry byproducts, which it said were mislabeled ingredients it purchased from Wilbur-Ellis and Diversified. That revelation prompted a Blue Buffalo suit against those two companies.

Diversified, in turn, filed complaints against Wilbur-Ellis and Custom Ag Commodities LLC, a wholesaler of fresh fruits and vegetables from which Diversified purchased Wilbur-Ellis ingredients.

Diversified alleges that Wilbur-Ellis and Custom Ag engaged in a cover-up to sell adulterated ingredients for pet-food production.

“Diversified ordered high-quality chicken and turkey meal without animal byproducts and feathers from Wilbur-Ellis through Custom Ag but [they] sold Diversified cheap low-grade meal blended with beaks, feet, viscera, feathers and other byproducts and sent Diversified inflated invoices and false bills of lading …” the suit contends.

On its website, Wilbur-Ellis describes itself as a leading international marketer and distributor of agricultural products, animal feed and specialty chemicals and ingredients. Owing to Wilbur-Ellis’s size, Diversified alleges that the fraud harmed the pet food and livestock food industries as a whole.

The suit states: “The … scheme operated by the Defendants (assuming it ended in 2014) was broad and far-reaching, stretching out over at least four years and included thousands of fraudulent transactions and predicate acts. The scheme injured a wide range of victims, including Diversified, Blue Buffalo, other pet food manufacturers, the pet food buyers and in all likelihood other commodities brokers that purchased feed ingredients from Wilbur-Ellis and Custom Ag.”

In a filing responding to Blue Buffalo's claims against it, Wilbur-Ellis acknowledges that some poultry products mixed at and shipped from its plant in Rosser, Texas, were mislabeled. However, it contends, Blue Buffalo and Diversified "knew or should have known the composition and nature of the ingredients Wilbur-Ellis provided to Diversified.”

The filing states: “These ingredients were usually labeled as poultry meal ‘blends’ or specifically referred to as ‘byproduct,’ and the prices at which Wilbur-Ellis sold to Diversified Industries reflected the actual ingredients it was selling.”

Wilbur-Ellis describes itself as a “minor third-party player” that should not have been drawn into the litigation, at least not at this point.

“However, Blue Buffalo did not wait and hurled the kitchen sink at Wilbur-Ellis as an ostensible third-party defendant,” Wilbur-Ellis argues in the document. “Instead of simply making the breach of contract and warranty claims that it might have asserted once liability became known, Blue Buffalo seeks to bring a dozen claims against Wilbur-Ellis ... This scorched-earth approach unnecessarily burdens Wilbur-Ellis and Diversified, the other parties to this litigation and, unavoidably, the Court.”

In a separate filing on Diversified's suit against it, Wilbur-Ellis argues similarly that the complaint “introduces more complication and confusion."

Besides the expanded scope of litigation, progress on the collection of suits has been slowed by squabbles over what information should be held confidential during discovery. In an order issued June 16, Judge Rodney W. Sippel expressed exasperation with the fighting.

“[T]he Court has reached the limits of its considerable patience with discovery disputes in this case….” Sippel wrote. “The Court feels compelled to remind all counsel of their ethical obligations to this court, each other and this noble profession. In short, play nice.”

Update: Blue Buffalo announced on Dec. 10 that it has agreed to pay $32 million to settle a consolidated class action alleging misleading advertising claims that its pet food contains no chicken/poultry byproduct meals or corn. The company did not admit wrongdoing. The suits involving Nestlé Purina and other players in the saga are continuing.

Veterinary Medicine Jumps On The Star Wars Bandwagon

The fact that I'm a big Star Wars fan is not news to anyone who knows me.  It really has been a big part of my outlook since I was a kid.  Heck, one of my favorite sayings in human history is Yoda's "Do.  Or do not.  There is no try."  Star Wars is so ingrained into modern culture that I know everyone was getting tired of all of the marketing that tied into The Force Awakens.  

But it surprised me when one of the prominent veterinary trade publications actually used Star Wars to illustrate points in an article!

The author, Dr. Kathryn Primm, makes good use of several famous phrases from the Star Wars movies, amusingly illustrated by action figures.  She includes the above Yoda quote, as well as sayings from Qui-Gon Jinn, Darth Vader, and Lando Calrissian.  While the article isn't detailed and won't make a huge difference to most people, I think it's fun to see the geeks in our profession recognized.  I can understand these illustrations better than I could if the writer had talked about football or fishing!  

Check it out here:  Star Wars wisdom for veterinary practices

Living In Violent Times

My practice just did something that surprised me.  We discussed contigency plans in case someone violent came in and started trying to hurt people.  We utilized information from the FBI and US Department of Homeland Security to train our staff what to do in case of an intruder, terrorist, or anyone else that might want to cause serious harm.

Does that sound extreme?  Unfortunately in our current society it's something we have to consider.  The world is very different than what it was when I was growing up.  Back then I used to roam alone in the woods behind my house for hours completely unsupervised.  Sure, I had a large German shepherd with me so it was unlikely that anyone would mess with me.  However, my parents never really worried.  I can't say that I'd be so open with my kids.

In many ways violence is much better than when I was young.  Overall murder rates have been steadily decreasing for about 20 years, and are now at a rate similar to the 1950s when the rate was the lowest since data was started to be tracked around 1900.  Gun murders are at the lowest rate since 1981 and gun robberies and aggravated assaults are at the lowest rates since 2004 (source).  When it comes to mass shootings the US actually ranks 9th globally when looking at the rate versus population.  The worst mass shootings in the world were not in the US (Norway and Australia hold those records) and much of the world has seen such violence (source).  And many of the worst shootings in recent memory happened in places with high levels of gun control (the Sandy Hook massacre and the recent terrorism in California come to mind).

So overall crime, violence, and murder are down, gun control laws don't always help (29 were killed and 130 injured last year in China by knife-wielding attackers), and governments are supposed to be trying to make our lives safer.  If all of this is true, why as we enter 2016 are many businesses having to make plans like my practice?

The following is entirely my opinion, and I don't have a lot of facts to back them up.  But it makes sense to me.

We have more global organizations that want to kill anyone different than them, especially radical Muslim groups like ISIS.  Go back 30-40 years ago and the idea of a group of terrorists committing mass murders in first-world countries was unheard of.  Now we see terrorist groups making large attacks across the globe, including the UK, Spain, and several in the US.  The proliferation of such evil, murderous groups and their ability to reach outside of their homeland is worse than ever.  Sure, there have been evil people and evil organizations in the past (Stalinist Russia, Nazi Germany, and many others).  But with modern travel and technology these groups can now go places and reach people that were impossible just a few decades ago.  These groups also aren't capable of waging large-scale traditional war in order to invade and take over their enemies.  Instead, they send small groups of followers against innocent civilians rather than military or political targets.  The entire philosophy of these evil people has changed, where it's more about simply killing people to make themselves known rather than acquiring territory or capturing targets.  I don't think we've ever seen terrorism just for the sake of violence to this degree in human history.

The other "problem" is our modern idea of instantaneous news and a 24-7 news cycle.  During my childhood we would often have to wait a day or more to know that something happened.  Now we can stream the event live on our computers and smartphones.  This ready, immediate, and ubiquitous access to these events puts them in the public consciousness in unheard of ways.  Fact after fact states that violence, murders, and gun-based crime are all decreasing rapidly in Western civilization.  But I don't think that anyone really feels that way.  Why not?  Because each and every instance is now in our faces faster and more thoroughly than ever before.  When I was a kid we had three networks and one newspaper to carry the news.  Now in addition to those things we have multiple 24-hour news channels on TV and countless websites that can plaster an event everywhere we look.  Remember the hoopla over the OJ Simpson trial back in the 1990s?  Imagine the same trial happening in today's world when the internet is available to just about everyone in their hands wherever they go.

I do think that the world seems scarier and less safe than when I was young, and I grew up during the Cold War when nuclear war with Russia was a very real concern.  I blame our technology and news-obsessed culture, as well as the growth of terrorist groups that could care less about the innocence of civilians. 

So my practice now has some plans to handle a monster coming in with deadly weapons. I see the need for making such plans, but I hate that we have to do it.  

Happy 2016!

It's 2016!  Wow, where did the time go?  Shouldn't we have flying cars and hoverboards by now? 

I want to thank everyone for reading my blog in 2015, and I wish all of my readers a safe and happy 2016!