The Right To Yell?

Yesterday my office manager was speaking to one of our regular clients who have four pets we see.  One of them apparently had a ruptured anal sac and the client was wanting to get in right away to have it seen.  I was off yesterday and they prefer to see me, but we were completely booked up today so there wasn't an easy time for her to come in.  Knowing they were good clients my office manager was trying to work things out, but was explaing about our busy schedule.  That's when the client started yelling at her.

Being a professional, my manager calmly asked her not to yell and maintained her own cool.  The client said "I have a right to yell!"

Excuse me????

Since when is yelling at someone a "right"?  There is nothing in the US constitution about "freedom to yell", and I doubt any other countries state this.  I know of nowhere in the Bible explaining how God gives people an innate right to loud verbal exclamation.  In fact, the Bible speaks against such behavior.  So how can someone truly believe that they have a "right" to yell at someone else?

This kind of interaction happens more frequently than most people realize.  Clients can be unreasonable and have very hot tempers, sometimes taking it out on the veterinary staff.  I try to teach my employees to not respond back with similar behavior, and understand that the client may be upset, have had some other tragedy recently, or otherwise be unintentionally lashing out.  At the same time I tolerate such behavior from clients for only a short period of time.  If they become verbally abusive or simply unreasonably loud I will ask them to not yell, then warn that if they continue this behavior I will hang up on them.  Usually that calms them down and we can have a reasonable discussion.  But I have hung up on people that simply insist on yelling, cursing, and threatening.

There is no excuse for acting this way.  There is no excuse for yelling at someone who is trying to help.  And there most certainly is no "right to yell".

My office manager was actually on the verge of hanging up when the client calmed down enough that she could talk to the owner and arrange to have the pet squeezed in during this morning's appointments.  Thankfully the husband is much nicer than his wife and the appointment went well with quick treatment of the problem.  And no yelling from anyone.

The Costs Of Not Preventing

I have always preferred the idea of preventing disease to treating it.  It makes sense that it costs more to deal with a problem than to keep it from happening.  Ben Franklin said it best when he wrote "An ounce of prevention is worth a pound of cure."  This very topic was the focus of one of my earliest blog posts back in 2008.  But while most people seem to understand this theoretically, it can be hard to bring it home to their wallets.

Veterinary Pet Insurance (VPI) recently released costs associated with various common dog and cat health concerns that could be prevented.  Based on their data they showed what the average cost is to treat each condition compared to what it costs to prevent it.  The results are pretty revealing.

Dental Diseases (tooth infections, periodontal disease, etc.)

Treatment:  $531.71

Prevention:  $171.82

Internal Parasites (roundworms, tapeworms, giardia, etc.)

Treatment:  $179.93

Prevention:  $29.51

External Parasites (heartworms, lyme disease, flea allergy dermatitis, etc.)

Treatment:  $180.67

Prevention:  $84.89

Infectious Disease (parvo virus, feline leukemia, etc.)

Treatment:  $678.24

Prevention:  $73.52 for cats, $85.14 for dogs

Reproductive Organ Diseases (pyometra, prostate disorders, ovarian cancer, etc.)

Treatment:  $531.98

Prevention:  $269.69

Personally I disagree with the classification of heartworm disease as "external", even though it is transmitted by mosquito.  And I know that treatment for that costs anywhere from $600-1000.

Even if these are only average costs and not exact, it really emphasizes how much money people save by making sure that their pets' preventative care stays up to date.  By not giving vaccines, heartworm prevention, flea prevention and so on clients are not only risking their pets' health and lives, they are also potentially costing themselves much more money.

So why do people avoid such care?  Understandably they may not have the money.  But if that is a long-term issue they should probably consider giving up their pet to someone who can give it the proper care.  People also often don't understand the true risks and costs.  I've had many clients who didn't think their pet could get parvo or heartworms and then ended up with hundreds of dollars in bills to treat these diseases.

If you own a pet, please, please, please keep up with preventative care.  And make sure you pass that nugget of wisdom along to all of your pet-owning friends.

A Citizen Of Ladonia

There are some quirky things in this world, and I enjoy learning about most of them.  Recently I developed a passing interest in "micronations".  These are small countries or principalities not formally recognized by other nations.  For example, there is the Principality of Sealand, established on a tower platform off the coast of England.  And the Republic of Molossia, consisting of a house and yard in Nevada.  Some of these are created on a whim or as a joke, some exist for the purpose of parody or to prove a political point, and some are legitimate aspirants to nationhood.  Some of these micronations issue stamps, currency, and passports, though these are not recognized anywhere outside of that "country".  If you do a little research you'll be surprised at how many you'll find.

In researching the topic I came across the micronation of Ladonia.  One of the first things that intrigued me was that it was set in a nature preserve on the coast of Sweden, my father's home country.  Ladonia originated after a dispute between an artist, Lars Vilks, and the local council who objected to him erecting some driftwood sculptures in the preserve.  After they told him to dismantle them he created Ladonia in 1996 in protest.  For a complete timeline of important events see Ladonia's official website.

Ladonia has a Queen as well as an elected president and vice-president.  In fact, elections are soon to be held, something common in other constitutional monarchies.  There is a national anthem and an official flag:  a green Nordic cross on a green background.

An interesting thing about Ladonia is that you can request citizenship and even pay to be nobility.  Not wanting to invest money but curious, I applied for and was granted citizenship.  State Secretary Vilks is in charge of such things and was able to process the request.  So now I have dual citizenship in the United States of America and Ladonia!

So the question is probably being asked...why????  You can't live there (it even says so on the Ladonian web site) and it's not an official nation, so why bother?

Why not?

There is an interesting point being made about art versus municipal rules, which is what started the whole nation.  It has now spread to over 16,000 people in over 100 countries who claim Ladonian citizenship.  But more importantly (to me, at least) it's simply fun.  There may be a focus on the sculptures Vilks made and the freedom to be an artist, but to me that's not as important.  I get to be a part of a sort of social experiment, something that 30 years ago wouldn't have been possible.  I am able to interact with other Ladonians around the world through the nation's Facebook group, and even participate in elections.  There is a sort of odd joy in the fantasy of a new country populated from every part of the globe.  Yes, it's a bit silly (the current elected president is an old pair of shoes living in Sweden and the national anthem is the sound of a stone being thrown into water), but without a little fun in life things get rather boring.

So here's to Ladonia! 

An Anal Gland Facial

Vets sometimes have to deal with some pretty gross things.  But it's worse when you get it all over yourself.

Today I was dealing with a sick cat and not having much luck finding what was wrong.  All of the lab tests were coming up normal yet the cat was acting abnormal at home.  Finally I decided to put it on an appetite stimulant and send it for ultrasound tomorrow.  As my techs were giving it some fluids one of them noticed that the rectal area seemed a bit puffy.  She felt back there and thought that the anal sacs were full.

For those not in the know, anal sacs are normal structures on dogs and cats.  There are two of them, one on either side of the rectum in about the 4:00 and 8:00 positions.  The secretions are used for scent marking and when the animal has a bowel movement the feces moving through the rectum pushes against the sacs, expressing them onto the stool.  At least, that's what normally should happen.

Owners of small breed dogs know that the glands often get full or impacted, resulting in the dog "scooting" on their bottom.  Groomers and vets can easily express the glands manually and it's a common occurrence.  However, cats rarely get impacted anal sacs.  In fact, I may see 1-2 anal gland expressions per year in cats.  

Anyone who has been around an anal gland expression knows that it's very stinky.  Few things can turn the stomach of even an experienced veterinary worker than anal gland secretions.  It's a sort of "fishy" smell and will quickly fill the air in a room.  Definitely not something you want to get on yourself or your clothing.

So I slipped my glove on, liberally applied lubricant, and stuck my finger into the cat's rectum.  Much to my surprise the sacs were extremely full.  And as I tried to express them I discovered that the secretions were much thicker than normal and impacted.  I began gently but firmly squeezing, knowing that I had to get the material out.  The first sac was difficult but I finally accomplished it.  I switched to the other side and began working.  That sac was particularly full and I had to squeeze harder.

Can you see where this is going?  I learned long ago to put a paper towel over my hand so everything goes onto my glove or the towel, keeping mess to a minimum.  In this case I wanted to watch for problems since it was so tough, so I left it partially uncovered.

Big mistake.

There I was squeezing and all of a sudden everything released.  The very thick, malodorous material flew out, spattering along the entire length of my arm.  As soon as I noticed this I felt a wet splat on my face.  And it was not an insubstantial splat.

Keep in mind that I have facial hair.

There I was with thick anal gland secretions along my arm and a large amount on my face.  Yet the sac wasn't completely empty and my finger was still up the cat's bum.  I had to finish what I was doing while the goo sat there on my cheek.

One of my assistants looked up and saw it.  Apparently it was a sizable amount extending from the edge of my mustache nearly to my chin.  She started gagging, holding back a vomit reflex.  And this is someone who has been working in the veterinary field for about 10 years!

Once I was done with the cat I started to wipe the mess off.  That ended up smearing it into my mustache which caused my assistant to gag again.  I went over to the sink and started washing my face so thoroughly that I could taste the soap.  But eventually I got cleaned up.

I know other vets and staff who have had similar experiences.  This was the first time it's happened to me.  And it's not an experience I'm anxious to repeat.

Ain't being a vet grand?

The Great Veterinary Food Conspiracy?

Over the last week I've been discussing topics on pet foods, something that is often a polarizing issue.  Most veterinarians have a pretty good consensus on what we look for and consider "quality".  Some very passionate owners will strongly contradict this consensus with heated opinions of their own.  It can become difficult for vets and these owners to communicate effectively as both sides have contradictory opinions on what is best for their pet.

What irks me and many other vets is that many of these pet owners seem to get the feeling that there is a great conspiracy in veterinary medicine where food companies completely dominate education on nutrition and gleefully influence the weak-willed veterinary community into blindly recommending their diets, which everyone knows aren't really that good.  For those who don't read all of the comments, here are some quotes after my blog on corn in pet food....

of COURSE Hill's would push for dogs to eat a "balanced diet" chock full of corn and other grains, because they have one of the highest corn contents on the market!

I find it remarkably coincidental that so many veterinarians out there sing the tune of this post, while at the same time Hills throws large amounts of money at vet schools and clinics...

I feel that most veterinarians are against raw diets because either A) they don't know enough about it or B) they see clients who don't know enough about it

What about comments from several years ago when I talked about what I felt are the best pet foods?

So the 'top nutrition specialists' feed their dogs food full of corn, by-products, fillers, unnatural preservatives, etc.? Great to know that these are the people 'educating' us on pet nutrition.
I think you should do some more research. It doesn't sound like these 'veterinary nutritionists' were taught anything more than what little the regular vets are taught. It's all still heavily influenced by the very companies they are recommending. After all, Science Diet and the likes are the ones who sponsor/teach those pet nutrition courses. Coincidence? I think not.

The nutritionists you speak of may have done their own 'research', but it looks like they stuck close to what they were 'taught' and based it all off of that.

I'm content in the fact that there are indeed /some/ vets that have gone beyond what they were 'taught' by those companies and truly done their own research. I'm hoping more vets will begin to do so.

And then there's my orignial discussion on raw food diets...

Your comments are what I call typical vet responses that I usually get from vets that have only been educated from one perspective. (That being from classes taught by the dry food manufacturers.)

The amount of research and money spent by manufacturers making heat processed food has convinced the public that because of that they must be safe and adequate to feed.

As for your "scientific data", who paid for those studies? Well, each and every one has been paid for by pet food companies. Think logically for just one second. Do you think a pet food company would pay for a study to be done on BARF? Certainly not! They already know what the results will be, so they avoid it all together.

I'll tell you one thing you'll see in BARF dogs, that's a lower risk of cancer. Yep, I said it. Do you remember in vet school what they taught you about cancer? ...or maybe they didn't. Well, here goes. Cancer feeds off sugars. What do carbohydrates get broken down to?

The problem I have with the Veterinarian profession is that their education centres around commercial food companies and little in the way of real nutrition is taught, much as with human medical instruction.

I think every veterinarian is familiar with these discussions and comments.  The words may vary but the sentiment is the same:  "Pet food companies teach the nutrition classes and sponsor the research, therefore what vets learn about animal nutrition is wrong."  That's the essence of this "conspiracy" about manufactured pet foods.  Unfortunately for the detractors of common foods, there is no validity to any of these claims.

Let's start with the classes.  Pet food companies absolutely do NOT teach the nutrition classes in vet school.  Veterinary colleges utilize professors that are specialists in their field and are independent of any for-profit company.  Various vendors and companies have given lunchtime lectures at schools, but that is not related to classes and are always voluntary.  The curriculum is also determined by academics to meet standards of education and testing in the field.  These companies have absolutely no influence whatsoever over the content of these classes.  I challenge anyone who feels differently to find an official for-credit veterinary nutrition course taught by someone working for a food company.

What about the "nutritional specialists"?  There is a specialty in this area just as there are veterinary specialties in pathology, radiology, oncology, cardiology, dermatology, and so on.  In order to become a board-certified specialist you must attend 3-5 years after vet school of intense training in that particular field, then take a qualification test.  Depending on the specialty, this test will have a pass rate of somewhere around 20-40%.  So someone who is a specialist and an official member of the speciality organization has had more rigorous training and a greater amount of knowledge in their field than anyone else in the profession, and certainly anyone outside of veterinary medicine.  These doctors are the ones who have done and are doing the research that lets us know how foods are absorbed, how they are utilized by the body, and how they are manufactured.  We wouldn't have any true understanding of animal nutrition and its influence on physiology without these specialists and researchers.  It takes an incredible amount of hubris and blindness to believe that the large majority of veterinary nutritionists are merely lock-step with the food companies.  The food companies listen to them, not the other way around!  Pet foods are manufactured based on the research that has been done, not just because they want to throw some ingredients in.

Then there is the research.  Yes, much of it is paid for by various food companies.  But this is true in pretty much any industry.  There is certainly the risk of bias, but that risk is well known by the researchers and is carefuly watched for.  Government and private grants are often few and far between, so research necessarilly has to be funded by pharmaceutical companies, food companies, etc.  Research costs money and can't be done without sponsorship.  While I agree that we should look very closely at the results from a company's sponsored research, such sponsorship doesn't automatically invalidate the study.  Also, there are many studies that have show a particular chemical or drug to be ineffective, including studies sponsored by the companies making that product.

One of the main things we are taught in vet school is how to think critically and how to follow diagnostics and scientific research.  There is absolutely no way that any doctor can memorize the entirety of medical knowledge, so we are taught how to think through a problem.  Veterinarians are also by nature very independent, strong-willed people.  It's just the nature of the kind of people who can make it into and through such intense training.  These kind of people aren't easily fooled and normally don't simply take the word of anyone they talk to.  Saying that vets are merely blindly repeating what the food companies say without having investigated it is doing a great disservice to the intelligence of vets. 

Here's the gist of the argument from people like those whom I've quoted above:  Many thousands of veterinary specialists, researchers, instructors, and general practitoners are merely dupes of the food companies and have no ability to think for themselves or really investigate the issues.  Only the small handful of vets who are against these foods really know the "truth" and are the only enlightened ones.  And of course all of the breeders, pet owners, and people on forums know more about animal physiology and diets than the huge majority of the veterinary profession.  Also, all of the pet food companies could care less about our pets, don't really have an interest in quality nutrition, and are merely trying to market crappy food as cheaply as possible to the ignorant masses.

If this were true it would require an incredible conspiracy between food companies and veterinarians, as well as incredible stupidity among veterinarians.  Does this really seem likely?  Doesn't it make more sense that the nutritionists and research is valid and these foods aren't really bad?

Many of you may be familiar with Occam's razor.  To quote Wikipedia....Occam's razor (also written as Ockham's razor from William of Ockham, and in Latin lex parsimoniae) is a principle of parsimony, economy, or succinctness used in logic and problem-solving. It states that among competing hypotheses, the one that makes the fewest assumptions should be selected.  This principle is used throughout philosophy, science, and medicine and has applications to real life.  Essentially it is saying that the simplest explanation is most often the right one, and is certainly the one that should be investigated before going to more complicated ones.  Apply it in our current discussion.  Which fits Occam's razor best?  That the majority of veterinarians and researchers are right and are making good recommendations, or that the majority are deluded and wrong?

There is no great food conspiracy in veterinary medicine.

The Tricky Fine Print On Pet Food

Continuing with our theme of how to read and analyze pet foods....

There is a lot of wording and fine print that most pet owners don't pay attention to, and even if they did it probably wouldn't make much sense.  For example, some foods are essentially puppy or kitten foods, even if the packaging says its for adults.  How can that be?!?  Look near the ingredient list and content analysis and you will see an AAFCO (Association of American Feed Control Officials....obviously only in the US) statement along the lines of the following:  "[dog food] is formulated to meet the nutritional levels by the AAFCO Dog Food Nutrient profiles for maintenance."  Pay close attention to those last words.  If you see "maintenance", "maintenance of adult cats", or similar words, this has been designed as an adult or senior food.  Statements like "growth" or "growing puppies and gestating or lactating females" means that the food is for kittens or puppies, or the mothers until the babies are weaned.  That makes sense so far, right?  On some foods you will see "all life stages".  That means that the food must meet the most stringent nutritional requirements of the different stages of life.  And the toughest stage is puppy/kittenhood.  So essentially a food "for all life stages" is a puppy/kitten food!  In an adult or senior pet the increased calories and nutrients are unnecessary and can lead to the pet becoming overweight.

Let's look at another part of the AAFCO statement.  Besides the life stage you will see either "formulated" or "animal feeding tests".  This part of the statement indicates how the food was analyzed.  A formulated diet is calculated by an ingredient formula before feeding, and the food is analyzed based on this formula meeting certain standards.  While not necessarily a bad way to analyze food, it isn't the most accurate.  Just because an ingredient is included in the formula doesn't mean that it is easily digested and absorbed.  Analysis through animal feeding tests indicate that the food was analyzed prior to feeding, then the feces analyzed afterward, with a comparison of the two determining how much of the food was actually utilized by the pet.  While feeding tests are the most accurate way of determining food absorption, most pet foods use the formulated method, even the good brands.  Still, it's one more thing to consider in the analysis.

Most of the information a pet owner needs in order to tell what's in a food is there on the label.  But it's not easy to understand what all of it means.

The First Ingredient....It May Not Be The Most!

I'm sure many of you have looked at the ingredient list on a pet food container.  And you probably believe that they are listed from most to least.  Well, that's mostly true.  However, it's not as clear-cut as most think.

Yes, the ingredients are listed in decreasing amounts, from greatest to smallest.  However, these are listed by pre-cooked weight, not by percentage.  Why is this an important difference?  Because one ingredient may weigh more than another, but have fewer nutrients.

Let's look at chicken as an example.  If you see "chicken" on the ingredient list, this is chicken meat (muscle) with some remnants of skin and possibly pieces of bone, but excluding organs.  For the most part this would be the same kind of meat you and I would eat.  If you see "chicken meal", this is the same tissue but dehydrated and ground into smaller pieces.  Look at a chicken breast at home and weigh it.  Then imagine that same breast that has had all of the water removed.  Muscle tissue is going to be about 70-80% water so when you dehydrate it the ingredient is going to weigh less.  What is the main reason for using meat?  The protein, though there are other nutrients we also consider.

Following so far?  Good.  Because now we're going to do math.

Let's assume that a chicken breast weighs 500 grams and the non-water portion is 100% protein (not true, but we're wanting easy math here).  If we remove water content of 75% we're left with 125g of protein in that breast.  If we grind it up, we now have chicken meal which gives us 125g of protein.  If we have three dehydrated breasts we now have 375g of protein.  That's three times the protein of a single breast.  Simple, right?  Well, because the meal weighs less than the breast (375g versus 500g) it will be placed lower on the ingredient list, even though it contains more protein!  So if you see "chicken" as the first ingredient on one bag of food and "chicken meal" as the third ingredient on a different brand, you might initially think that food #1 is better.  But food #2 may actually have more chicken protein!

Confused yet?

Reading the ingredient list is certainly a good thing.  But it absolutely does NOT give you all of the information about what is in a food, or even exactly how much of each nutrient is present.  Analyzing the nutritional content of pet foods can be very confusing, even for veterinarians. 

Next time we'll talk about a statement in the fine-print on a pet food label that most people have never read, yet is quite important.