Though practiced in many countries, I believe that Halloween and trick-or-treating is biggest in America. I know that I grew up loving the holiday, and had a lot of fun. Some of my best memories of childhood are wandering through the neighborhoods begging for candy with a simple "trick or treat!" One year my parents and a few other neighbors designed a haunted woods that wound through the suburban forest behind three houses. There were elaborate spooks, decorations, and even a miniature Dr. Frankenstein's laboratory with a brief skit (I was Igor!). All of it was safe, mildly frightening, and always fun. As I grew up I realized that I still enjoyed Halloween, with all of the spooky decorations and costumes. Now I get to pass it on to my own kids.
Nowadays are different, though. With child predators and other fears, there seems to be less focus on the trick-or-treating aspect. Fewer kids go through the neighborhoods anymore, and many go around to stores in the malls. When I was young you could barely drive a car down a street because of all of the wandering children. Now the streets are pretty bare and it's much less common to have your doorbell rung. It also seems like there are fewer houses handing out candy. In the past you could go from one house to another. Now it seems like less than half the homes in a neighborhood, and maybe as few as a third, actually welcome the kids. Honestly, it makes me a little sad. There is a certain innocence of childhood that is lost in the modern world. To me Halloween is more about candy and fun costumes than it is about any real frights. And despite what some people want to make it out to be, in modern times it simply isn't about anything evil.
But all is not lost. Tonight my wife and I watched our kids have a great time. Because we're usually involved with events at our church the kids haven't been actually trick-or-treating in over three years. This year our church events were in the afternoon, so the evening was free. Lucas and Elena were running from house to house, completely enthralled by the idea of being able to get free candy merely by rining a doorbell and saying a simple phrase. Hyped up on sugar and excitement, they were practicaly non-stop. That joy was contagious, making my wife and I smile and laugh at them. It was also so nice to see the people passing out candy. These were people who wanted the kids to come by, and they were all very nice and welcoming. There was happiness, not obligation from these adults. In today's society we see so many jaded, banal people that it was refreshing to see some of that simple, neighborly happiness, harkening back to a simpler time.
Oh, and the biggest surprise came from my daughter. This is my little, cute, six year-old princess, who is nicknamed "Ladybug" by me and "Angelfish" by my wife. This little girl is obsessed with Littlest Pet Shop toys and anything that is pink. Yesterday she suddenly announced that she wanted to do something new for her Halloween costume. My little, sweet girl stated that she wanted to be......a zombie cheerleader. We have no idea where this came from! But my wife bought simple white and black makeup and she got her wish. As she went through the houses, the kids came to one where a party was going on. The people thought she was adorable. My little zombie cheerleader came running back to us laughing with pleasure because one of the people said that he was going to save some brains for her. That's my little Ladybug....
Happy Halloween, everyone!
Saturday, October 31, 2009
Friday, October 30, 2009
Brad's Guide To Veterinary Medicine
A vet I know named Brad sent me a list of 31 rules he has developed over a lifetime around veterinary medicine (his father is also a vet). Here are a few of the choicer ones. These are all tongue-in-cheek, but also give some profound truths about life as a vet.
Rule #6--The condition is never an emergency until 3 a.m.
Rule #8--The more money spent on procuring the animal, the less spent on maintaining it.
Rule #11--The more ignorant the client, the more certain they are that they know more than you do.
Rule #12--The nicer the clothing, the more nasty, disgusting, and malodorous a procedure you will be asked to perform.
Rule #17--If the client does not comply with orders and the animal gets worse or dies, it is your fault.
Rule #18--All lesions occur overnight ("Really, Doc, he was fine yesterday").
Rule #24--Any unexplained illness seen in a pet is the direct result of the spay/neuter you performed 3 years ago. ("I don't know, Doc. He was just fine until you neutered him back in '95.")
Rule #26--No matter how late you stay open, or how many days your office is open, there's always one client that will show up 5 minutes before closing with a patient that's been sick for 3 weeks, and complain that you're not open late enough.
Rule #27--Four years of veterinary school cannot possibly compare with the 15 minutes of training that the high-school drop-out got at the pet store.
Rule #28--Consciousness is a privelege; if you abuse it, it will be taken from you.
Rule #30--It is a geophysical phenomenon that all of your clients live only 5 minutes away from your hospital if it is within 30 minutes of closing.
Hope you enjoyed them as much as I did. I know that my veterinary readers will appreciate this in a special way!
Rule #6--The condition is never an emergency until 3 a.m.
Rule #8--The more money spent on procuring the animal, the less spent on maintaining it.
Rule #11--The more ignorant the client, the more certain they are that they know more than you do.
Rule #12--The nicer the clothing, the more nasty, disgusting, and malodorous a procedure you will be asked to perform.
Rule #17--If the client does not comply with orders and the animal gets worse or dies, it is your fault.
Rule #18--All lesions occur overnight ("Really, Doc, he was fine yesterday").
Rule #24--Any unexplained illness seen in a pet is the direct result of the spay/neuter you performed 3 years ago. ("I don't know, Doc. He was just fine until you neutered him back in '95.")
Rule #26--No matter how late you stay open, or how many days your office is open, there's always one client that will show up 5 minutes before closing with a patient that's been sick for 3 weeks, and complain that you're not open late enough.
Rule #27--Four years of veterinary school cannot possibly compare with the 15 minutes of training that the high-school drop-out got at the pet store.
Rule #28--Consciousness is a privelege; if you abuse it, it will be taken from you.
Rule #30--It is a geophysical phenomenon that all of your clients live only 5 minutes away from your hospital if it is within 30 minutes of closing.
Hope you enjoyed them as much as I did. I know that my veterinary readers will appreciate this in a special way!
Wednesday, October 28, 2009
Helpful Paranoia
Remember my "almost-deadly mistake" of last week? Today I did my first neuter since then, on a dog about the same size. Last week's case was running through my mind the whole time, and I was extra careful. I watched my suture placement more closely than I have since I first started doing this surgery, despite the fact that I've done thousands of these procedures. This is something that I'll probably do quite a bit in the future, not being as comfortable and complacent as I have in the past.
Honestly, this isn't necessarilly a bad thing. I realize that I'm only human and mistakes will happen (not just as a vet but in my life in general). However, I hope that I learn from my mistakes and never make the same one twice. I can clearly remember each slipped stitch, wrong drug dosage, and missed diagnosis I've made, as well as I remember certain of the highly successful cases. Everyone will make a mistake once. I try hard never to make the same mistake twice. Part of experience is learning from your past screw-ups and preventing them from happening again in the future. There are many things I am confident that I will never do a second time because I felt so bad or stupid the first time.
A little paranoid to triple-check this surgery? Probably. But I consider this a helpful kind of paranoia, as it makes me a better doctor. Sometimes the hardest lessons are the ones we learn the most from.
Honestly, this isn't necessarilly a bad thing. I realize that I'm only human and mistakes will happen (not just as a vet but in my life in general). However, I hope that I learn from my mistakes and never make the same one twice. I can clearly remember each slipped stitch, wrong drug dosage, and missed diagnosis I've made, as well as I remember certain of the highly successful cases. Everyone will make a mistake once. I try hard never to make the same mistake twice. Part of experience is learning from your past screw-ups and preventing them from happening again in the future. There are many things I am confident that I will never do a second time because I felt so bad or stupid the first time.
A little paranoid to triple-check this surgery? Probably. But I consider this a helpful kind of paranoia, as it makes me a better doctor. Sometimes the hardest lessons are the ones we learn the most from.
Monday, October 26, 2009
Private Vs. Corporate Medicine
Here in the US we have two basic business models for veterinary practices. The most common is the standard private practice. Most are owned by a single veterinarian who has a single practice location. However, it's not uncommon to have 2-3 partners owning a practice together and perhaps having a couple of locations in an area. A corporate practice is run a bit differently. There are multiple locations within a region or nationally who are run as any corporation: there is a president, board of directors, location managers, and so on. In the US the two biggest corporate practices are Banfield, The Pet Hospital and VCA, each having hundreds of locations. However, there are also smaller, regional corporate practices that may have a few dozen clinics.
What does this matter to the average pet owner? Not necessarilly much. You will have a personal relationship with your doctor and will get to know the staff at the location, regardless of who owns it. A private owner has more flexibility in what decisions they can make for your pet and your charges. With a corporate practice you have more consistency when you move around. Like with any large company (McDonald's, Sears, Payless Shoes, etc.) you know what you will get when you go to any location in the country. With our highly mobile American population, having a basic idea of what to expect from your veterinarian often will help in chosing a new vet when you relocate. But regardless of who owns or runs the practice, studies have shown that most clients make their decisions about veterinary care based on two factors: location and veterinarian. If they like the vet and the practice is conveniently located, the client will continue to take their pets there. Believe it or not, according to the surveys price is not the most important factor to clients.
What about as a veterinarian choosing where to work? The pros and cons are bigger to the vets themselves. With a private practice you have a chance of eventually "buying-in", becoming a partial or even complete owner. You also have fewer steps to go through to get approval for ordering new medications or equipment. If you're the practice owner yourself, you have complete and utter control over how the practice is run. The down side to this is that as an owner you spend a large portion of your time being a business owner and manager, not a vet. Many vets don't want this, as we don't go to business school. Historically vets are also poor business owners, with a large portion of veterinary businesses failing. To be successful you have to have an entrepreneurial mindset, something not every vet has. The big benefit to this is that a practice owner will have the potential to make more money than any other veterinarian.
A corporate practice is nice for those who never want to own their own business. You have other people handling the management, payroll, business matters and so on so you can concentrate on being just a vet. It can be nice to put 100% of your time and effort into practicing medicine. If you work for one of the larger practices you also have the opportunity to simply transfer to a different location if you move around the country, keeping your seniority and benefits, as well as being able to jump into the new location with minimal hassle. The down side is that you are limited to what the corporation decides to keep in stock for medicine and equipment, though this is not as big of a problem as many would think. You have to uphold the practice's policies and procedures, though this is true of working for a private owner as well.
Which is better medicine? Honestly you can have high quality and poor quality care with both business models. For a client I would recommend simply finding the right fit for you and don't worry about who owns it. For a vet looking for a job, check out both. If you want to be an owner, then private practice is the way to go. If you don't have that business mind-set and don't plan on ever being an owner, then a coporate practice might be a good fit.
I'm curious about whether or not both models exist in other countries. So to my veterinary readers around the world...do you have corporate practices as well?
What does this matter to the average pet owner? Not necessarilly much. You will have a personal relationship with your doctor and will get to know the staff at the location, regardless of who owns it. A private owner has more flexibility in what decisions they can make for your pet and your charges. With a corporate practice you have more consistency when you move around. Like with any large company (McDonald's, Sears, Payless Shoes, etc.) you know what you will get when you go to any location in the country. With our highly mobile American population, having a basic idea of what to expect from your veterinarian often will help in chosing a new vet when you relocate. But regardless of who owns or runs the practice, studies have shown that most clients make their decisions about veterinary care based on two factors: location and veterinarian. If they like the vet and the practice is conveniently located, the client will continue to take their pets there. Believe it or not, according to the surveys price is not the most important factor to clients.
What about as a veterinarian choosing where to work? The pros and cons are bigger to the vets themselves. With a private practice you have a chance of eventually "buying-in", becoming a partial or even complete owner. You also have fewer steps to go through to get approval for ordering new medications or equipment. If you're the practice owner yourself, you have complete and utter control over how the practice is run. The down side to this is that as an owner you spend a large portion of your time being a business owner and manager, not a vet. Many vets don't want this, as we don't go to business school. Historically vets are also poor business owners, with a large portion of veterinary businesses failing. To be successful you have to have an entrepreneurial mindset, something not every vet has. The big benefit to this is that a practice owner will have the potential to make more money than any other veterinarian.
A corporate practice is nice for those who never want to own their own business. You have other people handling the management, payroll, business matters and so on so you can concentrate on being just a vet. It can be nice to put 100% of your time and effort into practicing medicine. If you work for one of the larger practices you also have the opportunity to simply transfer to a different location if you move around the country, keeping your seniority and benefits, as well as being able to jump into the new location with minimal hassle. The down side is that you are limited to what the corporation decides to keep in stock for medicine and equipment, though this is not as big of a problem as many would think. You have to uphold the practice's policies and procedures, though this is true of working for a private owner as well.
Which is better medicine? Honestly you can have high quality and poor quality care with both business models. For a client I would recommend simply finding the right fit for you and don't worry about who owns it. For a vet looking for a job, check out both. If you want to be an owner, then private practice is the way to go. If you don't have that business mind-set and don't plan on ever being an owner, then a coporate practice might be a good fit.
I'm curious about whether or not both models exist in other countries. So to my veterinary readers around the world...do you have corporate practices as well?
Saturday, October 24, 2009
Almost-Deadly Mistake
I've mentioned this before, but it bears repeating. Veterinarians (and other doctors) are humans; therefore they can and do make mistakes. The bad thing about these mistakes is that when things go wrong it can affect the life and health of the patient. I just had a mistake that was almost very, very bad.
Yesterday I neutered a Yorkshire terrier. This isn't normally a big deal, as by my calculations I have performed over 2,000 of these surgeries. This case was slightly complicated by the fact that one of the testicles had been retained in the abdomen (a condition called "cryptorchidism"), which means we have to make a second incision and go hunting after it. Again, this isn't normally a real concern as I've done several dozen cryptorchid surgeries over the years. The pet recovered well and was sent home.
This morning the owner called, concerned about the fact that he was trying to urinate but couldn't. He also wouldn't eat or drink and seemed more painful than expected. I told her to bring him in for us to look at him. Once I examined him I could immediately tell that his bladder was extremely full as well as painful. It appeared that he had been completely blocked overnight, and was in a very serious condition. However, I couldn't figure out how that could have possibly happened. When we neuter dogs, we don't actually do anything to any part of the urinary tract. Even going into the abdomen we don't handle the bladder or any other part. So I was perplexed as to how it could have happened. But mostly I was worried. Very, very worried.
I have made mistakes in the past, but rarely have I felt this concerned. Because I genuinely care about the outcome of my cases, I take my mistakes seriously and personally. Though I know it isn't good to do, I will worry over some of my cases for days, especially if I think I might have messed up. With this puppy I was so worried about what I might have done that I started getting nauseas and light-headed. My anxiety was so high that I had to actually sit down for a while because I was afraid of passing out. I can't remember ever being that worried and anxious, but this time I was severely affected.
In cases like this we can't simply give up and tune out. The dog needed me to figure out what was wrong and fix it. I also had other patients that still needed to be seen. So with a round of prayer, I steeled myself to continue. I sedated him and passed a urinary catheter to see where the obstruction was. Surprisingly it was at the site of the standard neuter incision. I couldn't figure out what I had done, but I knew that something had blocked his lower urinary tract at the base of his penis, and the only thing that could have caused that was the suture. I knew that I had to go back in surgically and try to fix things.
I anesthetized him, opened up his incision, and removed the suture I had placed just 24 hours previously. Once I had done that I had my tech try to advance the urinary catheter. This time it passed easily into his bladder, and we were able to empty it of urine. Somehow a suture had passed around or through part of his penis, obstructing his urinary tract and keeping him from being able to urinate. I closed the surgery site again and recovered him.
He did well post-operatively and recovered quickly. I knew he was doing better when we gave him some dog biscuits and he ate them with gusto, something he hadn't done in over a day. He was much improved when we did send home. Thankfully the owners were understanding and we covered all costs of the second procedure. I was very honest with them about what had happened, as I don't believe it is right to ever lie, especially in situations like this.
Part of being a doctor is having do deal with situations like this. And I can't say that it ever gets easier. We are expected to be perfect by the law and by most people, often including ourselves. Yet it's impossible to be perfect. Impossible to never do something wrong. I'm the worst when it comes to expecting myself to do the impossible like this. This was a once-in-a-lifetime fluke that I still can't figure out. It shouldn't have happened, and I don't know how it did. But the reality is that I did make a mistake and the pet could have died because of it. Thankfully, he seems to be doing well now. And yes, I will continue to worry about this dog until I know that he does well over the next two days.
Yesterday I neutered a Yorkshire terrier. This isn't normally a big deal, as by my calculations I have performed over 2,000 of these surgeries. This case was slightly complicated by the fact that one of the testicles had been retained in the abdomen (a condition called "cryptorchidism"), which means we have to make a second incision and go hunting after it. Again, this isn't normally a real concern as I've done several dozen cryptorchid surgeries over the years. The pet recovered well and was sent home.
This morning the owner called, concerned about the fact that he was trying to urinate but couldn't. He also wouldn't eat or drink and seemed more painful than expected. I told her to bring him in for us to look at him. Once I examined him I could immediately tell that his bladder was extremely full as well as painful. It appeared that he had been completely blocked overnight, and was in a very serious condition. However, I couldn't figure out how that could have possibly happened. When we neuter dogs, we don't actually do anything to any part of the urinary tract. Even going into the abdomen we don't handle the bladder or any other part. So I was perplexed as to how it could have happened. But mostly I was worried. Very, very worried.
I have made mistakes in the past, but rarely have I felt this concerned. Because I genuinely care about the outcome of my cases, I take my mistakes seriously and personally. Though I know it isn't good to do, I will worry over some of my cases for days, especially if I think I might have messed up. With this puppy I was so worried about what I might have done that I started getting nauseas and light-headed. My anxiety was so high that I had to actually sit down for a while because I was afraid of passing out. I can't remember ever being that worried and anxious, but this time I was severely affected.
In cases like this we can't simply give up and tune out. The dog needed me to figure out what was wrong and fix it. I also had other patients that still needed to be seen. So with a round of prayer, I steeled myself to continue. I sedated him and passed a urinary catheter to see where the obstruction was. Surprisingly it was at the site of the standard neuter incision. I couldn't figure out what I had done, but I knew that something had blocked his lower urinary tract at the base of his penis, and the only thing that could have caused that was the suture. I knew that I had to go back in surgically and try to fix things.
I anesthetized him, opened up his incision, and removed the suture I had placed just 24 hours previously. Once I had done that I had my tech try to advance the urinary catheter. This time it passed easily into his bladder, and we were able to empty it of urine. Somehow a suture had passed around or through part of his penis, obstructing his urinary tract and keeping him from being able to urinate. I closed the surgery site again and recovered him.
He did well post-operatively and recovered quickly. I knew he was doing better when we gave him some dog biscuits and he ate them with gusto, something he hadn't done in over a day. He was much improved when we did send home. Thankfully the owners were understanding and we covered all costs of the second procedure. I was very honest with them about what had happened, as I don't believe it is right to ever lie, especially in situations like this.
Part of being a doctor is having do deal with situations like this. And I can't say that it ever gets easier. We are expected to be perfect by the law and by most people, often including ourselves. Yet it's impossible to be perfect. Impossible to never do something wrong. I'm the worst when it comes to expecting myself to do the impossible like this. This was a once-in-a-lifetime fluke that I still can't figure out. It shouldn't have happened, and I don't know how it did. But the reality is that I did make a mistake and the pet could have died because of it. Thankfully, he seems to be doing well now. And yes, I will continue to worry about this dog until I know that he does well over the next two days.
Thursday, October 22, 2009
Lead In Tennis Balls And Other Pet Products
A very interesting study was just released showing a potentially serious danger with some pet products. According to HealthyStuff.org, numerous pet products had noticable amounts of lead.
"Pet Products – HealthyStuff.org tested over 400 pet products, including beds, chew toys, collars and leashes. Since there are no government standards for hazardous chemicals in pet products, it is not surprising that alarming levels of toxic chemicals were found. One quarter of all pet products had detectable levels of lead, including seven percent with levels higher than 300 ppm – the current Consumer Product Safety Commission (CPSC) standard for lead in children's products."
A particularly startling finding was that almost 50% of tennis balls sold for dogs had lead in them, and that tennis balls designed for dogs had far higher lead content that "normal" tennis balls. Surprisingly, sports tennis balls had no lead at all. Considering how many people buy tennis balls for their dogs and how many dogs like them, this is a very big concern, and one that had me raising my eyebrows when I read it.
Why the concern? As most people are aware, lead toxicity is serious. It can cause anemia, gastrointestinal symptoms, and neurological problems. Because the toxicity is not always detected early, pets can become severely ill and even die. Lead also accumulates in the body, meaning that continual low-level exposure can be as bad as a single high-level exposure. The take-home point is that lead is bad, and any products that contain it should be avoided.
Frankly, as both a veterinarian and a pet owner, this has me concerned. There are no standards for lead content in pet products like there are in human products, yet the risk is the same. We rarely see true lead toxicities, but it seems that this dangerous metal is more common than previously suspected. Hopefully this data will shake some things up and have the pet product manufacturers watching more closely or face legislative action to control this health danger.
HealthyStuff.org has a pet section where you can look up the products tested and see the specific brands. Anyone who has purchased pet products recently or plans to should double-check to make sure the risk is low.
"Pet Products – HealthyStuff.org tested over 400 pet products, including beds, chew toys, collars and leashes. Since there are no government standards for hazardous chemicals in pet products, it is not surprising that alarming levels of toxic chemicals were found. One quarter of all pet products had detectable levels of lead, including seven percent with levels higher than 300 ppm – the current Consumer Product Safety Commission (CPSC) standard for lead in children's products."
A particularly startling finding was that almost 50% of tennis balls sold for dogs had lead in them, and that tennis balls designed for dogs had far higher lead content that "normal" tennis balls. Surprisingly, sports tennis balls had no lead at all. Considering how many people buy tennis balls for their dogs and how many dogs like them, this is a very big concern, and one that had me raising my eyebrows when I read it.
Why the concern? As most people are aware, lead toxicity is serious. It can cause anemia, gastrointestinal symptoms, and neurological problems. Because the toxicity is not always detected early, pets can become severely ill and even die. Lead also accumulates in the body, meaning that continual low-level exposure can be as bad as a single high-level exposure. The take-home point is that lead is bad, and any products that contain it should be avoided.
Frankly, as both a veterinarian and a pet owner, this has me concerned. There are no standards for lead content in pet products like there are in human products, yet the risk is the same. We rarely see true lead toxicities, but it seems that this dangerous metal is more common than previously suspected. Hopefully this data will shake some things up and have the pet product manufacturers watching more closely or face legislative action to control this health danger.
HealthyStuff.org has a pet section where you can look up the products tested and see the specific brands. Anyone who has purchased pet products recently or plans to should double-check to make sure the risk is low.
Wednesday, October 21, 2009
The Season For Skin?
Normally the Summer months are the worst for skin problems. Allergies are at a height, and the heat and humidity allow microorganisms to grow quickly. There are seasonal allergies in the Spring and Fall, but the worst seems to be in the Summer. Combine these conditions with a growing flea problem and you have a recipe for dermatology disaster. It's something we know about and expect. Which makes it surprising when you have a run of cases that break from the season.
Over the last week my associate and I have been bombarded with itchy dogs and cats. Most of them have come in with sudden intense itching to the point of causing severe self-trauma. The itching is bad enough that they chew themselves raw, creating large hot-spots. We expect this in dogs with flea allergies or other severe allergy disorders. But we've been seeing pets come in that don't typically have skin problems. Frankly it's been a bit perplexing since it's not a typical season for it and we're seeing 25-30% of our patients with these disorders. Our area has had a lot of rain in the last month, including a lot of flooding, which makes me consider that there may be molds releasing spores that the pets are allergic to. We do see autumn allergies, but not normally on this scale. Thankfully they're responding to therapy, but it's still a strange surge of dermatology problems.
Hopefully as the weather cools off (here in the northern hemisphere) we'll see some changes, and things will get back to normal for the season.
Over the last week my associate and I have been bombarded with itchy dogs and cats. Most of them have come in with sudden intense itching to the point of causing severe self-trauma. The itching is bad enough that they chew themselves raw, creating large hot-spots. We expect this in dogs with flea allergies or other severe allergy disorders. But we've been seeing pets come in that don't typically have skin problems. Frankly it's been a bit perplexing since it's not a typical season for it and we're seeing 25-30% of our patients with these disorders. Our area has had a lot of rain in the last month, including a lot of flooding, which makes me consider that there may be molds releasing spores that the pets are allergic to. We do see autumn allergies, but not normally on this scale. Thankfully they're responding to therapy, but it's still a strange surge of dermatology problems.
Hopefully as the weather cools off (here in the northern hemisphere) we'll see some changes, and things will get back to normal for the season.
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