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Tuesday, March 29, 2016

Veterinary Behind-The-Scenes

Recently I came across an article on Mental Floss entitled "12 Behind-the-Scenes Secrets of Veterinarians."  I'm always skeptical of such things, but as I was reading it I was nodding my head in agreement.  Part of my purpose in blogging has always been to give people a glimpse behind the curtain of veterinary life to see what we face daily.  The Mental Floss article did a good job so I want to share it here.  

Sunday, March 27, 2016

Happy Easter

If there is no resurrection of the dead, then not even Christ has been raised. And if Christ has not been raised, our preaching is useless and so is your faith.  More than that, we are then found to be false witnesses about God, for we have testified about God that he raised Christ from the dead. But he did not raise him if in fact the dead are not raised. For if the dead are not raised, then Christ has not been raised either. And if Christ has not been raised, your faith is futile; you are still in your sins.  Then those also who have fallen asleep in Christ are lost. If only for this life we have hope in Christ, we are of all people most to be pitied.               1 Corinthians 15:13-19

Saturday, March 26, 2016

Every Pet Has A Story.....Why We're In This Field

Recently I attended a leadership conference.  As part of that conference we focused on the story that every pet and every pet owner has. And it had a big impact on me.

We started by watching the following video.  Some of you may have already seen it.  If you haven't, have some tissues handy.

Many of my clients have bonds with their pets similar to that between Ben and Denali.  Every vet has those clients.  And we need to keep that in mind whenever we're talking to the pet owner and handling that pet.

That video was pretty powerful, but what really got to me was in a session where we had to write a letter to a pet that had made an impact on our lives.  It could have been a personal pet or one we saw as a patient.  I ended up writing to my cat, Galahad.  He was the first cat I ever owned, and the first pet I owned by myself when I left home.  For our first two years together it was just him and me in a one bedroom apartment, and we had the most incredible bond.  I lost him to stomach cancer when he was 11 years old, and that was around 15 years ago.  Yet I still miss him incredibly and wish I had him around.  

I'm not ashamed to say that I had a hard time writing that letter and tears were running down my face.  I wasn't the only one crying.  In fact, there were few people, men or women, who weren't teary-eyed during this exercise.

Why do all of this?  Why remember pets like that or watch Denali's video?

Sometimes we need reminders about why we got into this field.  The day-to-day grind can make us burned-out and cynical.  Compassion fatigue is a very real thing in any medical profession as it gets hard putting our emotions into our work 20 to 30 times per day, five days per week.  I've been at that point many times in my career.  So we need to be reminded about the stories that every pet and every pet owner have.  We need to remember that one pet that impacted our lives, and keep in mind that the next pet we see may have that same kind of impact on someone else.  We need to realize that Ben and Denali are not only ourselves, but are our clients.

You have to have some objectivity to be a doctor and can't get too emotionally involved with every patient.  However, you also can't become cold and unfeeling and still be able to recognize the emotional needs that clients have for their pets.

Friday, March 18, 2016

Me In 20 Years? Crazy Clients Are International

Once again I have to share a post from one of my favorite websites,  This situation happened in Argentina and really goes to show how veterinary clients are pretty similar no matter where in the world they may be.  I've had conversations very similar to the one below.

(I am at a pet shop that has as a veterinary clinic in the back, looking for a kennel for my dog. A lady is at the counter complaining to the only employee there, so he can’t come help me, but I’m no hurry, so I wait.)
Lady: “But my dog won’t eat this food. Don’t you have [Brand #1]?”
Employee: “Sorry, ma’am, we only have this [Brand #2].”
Lady: “But he won’t eat it! Is there any way to make him eat it?”
Employee: “He might need time to get used to it.”
Lady: “But even if I give it to him, he won’t eat it!”
(This goes on for about five minutes, with the employee telling her there’s nothing to be done if the dog doesn’t want that food and the lady complaining because they don’t have the brand she always takes and asking if there’s a way to get her dog to eat the food. Finally, the lady changes tactic.)
Lady: “I want to speak with [Vet]. Maybe she’ll know a way to make him eat it.”
Employee: “Sorry, she isn’t here now, but the other doctor is in.”
(The other doctor is a tall, sixty-year-old man with a grey beard who clearly doesn’t appreciate being called from the back to attend to this issue, but he speaks to the lady nonetheless.)
Vet: “What seems to be the problem?”
Lady: “Well, you don’t have [Brand #1], but my dog doesn’t like [Brand #2] and he won’t eat it…”
(Meanwhile, the employee comes to show me the kennels and I pick one. All the time the lady keeps arguing with the vet about ways to make her dog eat the food.)
Vet: *visibly tired of her insistence* “Look, the only way to make him eat it is if you starve him until he has no more choice than to eat it.”
Lady: *she doesn’t seem very happy with this reply, but she takes the dog food to the counter to pay for it* “Are you sure you are a vet? I have never seen you here before.”
Vet: “Yes, ma’am, I have been for forty years. I just stay in the back most of the time.”
Lady: “Why?”
Vet: “Because I’m too old for this s***.”

Will that be me in another 20 or so years?  Quite possibly!

Saturday, March 12, 2016

What Kind Of Legacy?

Last week my wife's grandfather passed away at the age of 83.  We went to Ohio for the funeral and to be with family.  As is typical for such things, the service included stories, memories, and what kind of an impact he had on people.  He had lived in the same small country town for the majority of his life and had many locals come to pay their respects.  At one point the line stretched out of the church and into the parking lot with people waiting almost an hour to get a chance to say goodbye to him and give their condolences to the family.
As I was sitting in the service and listening to the words I started thinking about the legacy he was leaving.  People talked about what a man of God he was and how he loved to talk to people about his faith in Christ.  This was very impactful because he had been an alcoholic and shunned churches until he found a relationship with God.  His son-in-law (my father-in-law) talked about being part of his family for over 40 years.  His son told stories about coon hunting and what a good father he was.  I believe that once it was mentioned that he had been a carpenter and worked at a lumber yard, but otherwise everything that was said about him related to his family, his faith, and his relations with the people around him.
It often happens at times like this that you start becoming very introspective, which I certainly did.  I started thinking about my own father (who is 84) and what I will say about him at his funeral.  Like with my wife's grandfather I can think of numerous stories about the fun things we did, how much he loved my mother, the hard but good lessons he taught me, and what a great family he made.  Everything I will say about him will revolve around what a good father and husband he was, and I'm sure neighbors and friends will share their own stories about how good he was to them.  I honestly can't think of anyone bringing up how good he was at his job.  You see, he started off as a car mechanic and worked his way up to becoming a regional sales manager for Volvo, managing sales at dealerships in a multi-state region.  Sure, I've heard plenty of stories involving his job and have been on business trips with him.  But how good he was at his job isn't something that anyone will remember.  Even his co-workers would tell personal stories of how they related to him.
Trickle all of that down to me.  After thinking about my father I started wondering what kind of legacy I will leave.  What will people say about me?  What do I want them to say?  For what kinds of things will they remember me?  What stories will they tell?  I can promise you that little to none of that will reflect on me as a veterinarian.  And I'm fine with that!  In fact, I could care less about being remembered as a good doctor.  Sure, I have plenty of clients who think I'm great and will readily tell people about how I saved their pet's life.  But once I leave the clinic those stories aren't that important.  I see most of my clients a couple of times per year, and as much as they may like me I'm not really having a drastic impact on their lives.  However they may think of me I know they could find another doctor just as skilled.
So how do I want to be remembered?  First, as a man who was truly in love with his wife for his entire life.  Second, as a father who loved his kids and gave them everything they needed (not wanted), especially lessons about life.  I want to be thought of as a good friend, someone who truly cares about those I would let into my small inner circle.  And I want to be remembered as a strong man of God, someone who follows Christ and the Bible, and in whom you can see that daily.  I wouldn't mind being remembered for how I shared God with people rather than how well I healed pets.  I want people to think of me fondly for the positive impact I made on them personally, especially my family and my God.
I still have a ways to go before that legacy is set, especially with regards to my faith.  I madly love my wife and I am a good father most of the time, but I can do better.  I fail God in so many ways and know that I can do better...should do better.  Hopefully I still have time to correct all of this.  I certainly pray that I do.
It's funny how much emphasis we place on our careers.  We push ourselves and are pushed by others to do more, get better accolades, rise in the ranks, and otherwise go higher and farther with our chosen profession.  We spend so much of our time and effort on making an impact in our job.  Yet at the end of our life few people are going to remember how well we climbed the corporate ladder or how much money we made.  When we take our last breath we will be remembered for how we treated people and how we made them feel personally. 
Maybe we're putting the emphasis in the wrong part of our lives.
Food for thought, folks.

Friday, March 4, 2016

Flint, Michigan Water Crisis And Pets

My international readers may not be aware of current crisis in one American city, even though it is bad enough to have made national news and even the cover of Time magazine.  So here's a quick summary.
Flint, Michigan had been purchasing water from Detroit until 2014, when it switched to using treated water from the Flint River as part of cost-saving measures.  The river water was corrosive to the old pipes in the city and caused lead to leach into the water supply.  This has lead to an incredible health crisis in this very poor city (nearly half of the residents live in poverty), especially among children where the rates of high blood lead levels have doubled.  There has been a lot of finger-pointing between various government agencies, Flint's mayor, Michigan's governor, and has turned into quite the snafu.  The political fallout is nothing compared to the real health crisis among the citizens, especially now that all water in the city has been found unsafe, and the population has been left to drink, cook with, and bathe in bottled water or water trucked in from outside the area.  Because of the lead contamination even boiling it won't fix the issue. 
All of that is horrible and seems to show significant issues with how various government officials have handled the problem.  This crisis will affect an entire generation of Flint's citizens and will take years to sort out.  But until recently I hadn't considered the other victims....the pets.
Recently DVM 360 magazine published an article on the Flint crisis threatening pets.  They illuminated the fact that contaminated water not only threatens humans, but the dogs, cats, and livestock that drink water from the same supply as do their owners. 
In the article they interview the Michigan state veterinarian, Dr. James Averill.  So far there have only been two confirmed cases of lead toxicity in pets in Flint, but there are factors that may be artificially lowering this number.  Because so many people live below the poverty line they may not take their pets to a vet regularly and may not  have the funds to do much testing even if they did.  The small amounts of lead end up developing into more of a chronic issue rather than acute symptoms, so the problem may go undiagnosed for a long time.  And chronic lead toxicity has very nonspecific symptoms, such as vomiting, diarrhea, and changes in behavior.   The actual number of cases is likely much higher than what has been officially reported, and will probably continue to rise.

When there is a major crisis it is easy to see the impact to humans.  But it can be difficult to see the animals in those situations for those of us not close to it.  Toxic water, wildfires, tornados, earthquakes, and any other large-scale disaster can affect the pets just as much as the people.  Thankfully there are people who try to help our furry, feathered, and scaled companions.  For example, I know of many vets and veterinary staff who went to New Orleans after Hurricane Katrina to help take care of the displaced and injured animals.

Let's hope that the government quickly fixes the problem in Flint so that the people and animals can get back to the basic necessity of safe water.

Tuesday, March 1, 2016

Heartworm Vs. Flea Prevention: Weighing Costs In Tough Financial Times

Recently I received an email from a reader, and it's a rather timely one.  People often have to make financial decisions about the health of their pets, giving things up because they simply don't have the funds.  So this situation is one that many pet owners can understand.

I recently fell down a flight of stairs & did horrible damage - breaking my hip, smashing tailbone & disks.  I am in a horrible place financially now.

I had my 4 yr 100 lb black lab on Triflexis.  We live outside Houston & have bad flea issues.  I can't afford the Triflexis anymore.  What cost effective combo would you recommend for heartworm & flee control?  What about ticks?  Do I need to worry about missing treatment for that?

I've spent hours reading blogs- including yours - and I just need some definitive advice.  Every penny counts right now & I'm desperate to find a solution.  We - my two kiddos & I - love our crazy lab & I want him to be as healthy as he can for his life - but I'm really in a bad spot financially.  My vet doesn't seem to understand that - and thinks Triflexis is the only way to go.

Any help would be greatly appreciated.

First, I'm so sorry that you hurt yourself that badly!  I sincerely hope that you are being treated and are on the road to recovery.

I do think that Trifexis is an excellent product, and we carry it in my practice.  I'm very aware of how expensive it is, but I think that given what it covers this is not an unreasonable cost for a product like this.  It is a unique product, and currently is the only oral product that will prevent heartworms, kill fleas, and protect against three intestinal parasites.  I don't doubt that other companies are trying to develop similarly all-inclusive products, but they haven't released them yet.

In a situation like this my first recommendation is to cover the heartworms.  Yes, the fleas are very visible and in Texas are a real problem.  However, they are mostly a great nuisance and rarely carry anything fatal to the pet.  Heartworms, on the other hand, are a "hidden" and potentially fatal disease.  Only a blood test can detect a dog with heartworms in the early stages, so by the time you see clinical signs of heartworms your dog is in a more advanced state of the disease.  Treatment is possible, but can cost $800-1000 in an uncomplicated case.  If it goes untreated it will lead to congestive heart failure and eventually a slow, lingering death.  Obviously, you don't want this!  If you have to make tough financial choices, pick an inexpensive heartworm prevention.  There are several on the market in the US that are equivalent to Heartgard and can cost around $50 or even less for a six month supply for a dog the size of yours.  Many of these are available online with a veterinarian's prescription (which all vets are legally required to provide you if you ask).

But what about combination products?  Trifexis is probably the most expensive of thembut none are going to be cheap.  Sentinel has the same heartworm preventative found in Trifexis, but it doesn't kill fleas, only prevents the eggs from hatching.  Advantage Multi and Revolution are topical preventatives that will prevent heartworms and kill fleas, but they aren't inexpensive.  You can shop around and see what the price of each might be for your dog.

That brings us to flea prevention.  Obviously you want to use some in your area!  Many good flea preventatives are now over-the-counter.  Frontline and its generic equivalents can be found in almost any store that carries pet supplies.  While I don't think it's the best product, I think it's better than just about any of the cheaper ones.  Personally I like the Advantage products (found over-the-counter), Vectra (sold through vets), or Seresto collars (found through pet supply stores).  I think each of these is very effective, though they aren't inexpensive.  Some flea prevention is better than none, so you may have to sacrifice in this area and risk having fleas.  Though treating an existing flea problem is much harder and more expensive than preventing one.

You should compare the costs of separate heartworm and flea preventatives to the combination products and see which is going to fit in your budget the best.  If you simply can't afford both, then I would absolutely focus on the heartworm prevention, as this is a much more severe disease. 

What about ticks?  I think it depends on the risks in your area, and that's something that a local vet can answer better than I can.  It also depends on your dog's lifestyle.  Even in an area with ticks, if your dog is only in your house and fenced yard there will be a much lower risk than if that same dog was running through woods or fields.  Not every flea preventative will also cover ticks, and there is nothing currently on the market that gets fleas, ticks, and heartworms.  Products will cover fleas and heartworms or fleas and ticks, but not all three.  If your dog is going to be at very low risk for ticks based on location and lifestyle, I would pick something without tick prevention to help costs down.

I really do hope that this helps at least a little!