"You're Going To Let My Dog Die?"

Today my associate saw a dog who was in pretty bad shape:  painful in the abdomen, lethargic, not able to urinate or defecate, and generally not doing well.  She found a firm mass in the abdomen and the dog had apparently eaten part of a steak bone. However, the mass was larger than the size of the bone, so she knew something else was going on.  Being a great doctor, she obviously developed a treatment plan that started with radiographs and went from there.  

As commonly happens the client said that they couldn't afford to do anything, and in fact had come to us because they couldn't afford the $100 to walk in the door at the emergency clinic.  We gave them the information for Care Credit, and they were declined.  She didn't really have many options at this point and told the client this.  The client's response?

"So, you're just going to let my dog die?"  followed by "What vet doesn't take payment plans?"

Really?  

And this isn't the first time I've run across this attitude and comment.  Plenty of clients think that it is our obligation to treat pets and do surgery, even if the client doesn't have any way to pay.  After all, if we really loved animals we'd just go ahead and do it (another comment I've heard before).  If the client can't pay and we decline to treat for free, somehow we are the ones letting the pet die, not the client.  It's our fault that we won't give away hundreds or thousands of dollars in services, but it's not the client's fault that they don't have any funds in a savings account or have such horrible credit that they can't qualify for a payment program.

I really think many people don't realize that we can't operate a veterinary practice without charging.  There are so many little things that people never think about....payroll, rent, utilities, liability insurance, worker's compensation, taxes, and many dozen other items that quickly build up and take up any revenue.  We as vets have our own personal mortgages, student loans, and other debts, as well as families to support.  And most vets aren't driving BMWs or Lexuses while living in 4000 square foot homes.  If we give away too many services, we can't pay our bills.  If we fall behind on our bills, we have to fire staff, cut services, and eventually will go out of business.  In fact, such discount practices are the number one reason veterinary practices close, and it's much more common than anyone outside of the profession realizes.

It's also not smart for most vets to set up their own in-house credit system.  I've seen this done, and more times than not clients fail to make payments appropriately.  Practice consultants routinely say that this is a bad idea for vets to do.  And if someone doesn't have good enough credit to have credit cards or Care Credit, this means that their revenue and ability to repay people is below acceptable standards.  In other words, they are very poor risks. So why should the vet take those risks?  I know that everyone says "Oh, don't worry, I'll be the one to make payments on time."  Call me cynical, but in my personal experience that is rarely the case.  Which is why most vets don't take payments, especially for first-time clients (which this dog was).

So what happens in these situations?  Unfortunately, the pet suffers.  But who is responsible for that pet's care?  It's the owner, not the vet.  The vet is the agent of treatment, but we can only advise decisions.  Ultimately the client must agree to the treatment plan, and the client is also ultimately responsible for the pet's well-being.  If the client can't pay, it's simply not the vet's fault or responsibility.  And most of us have learned not to let the client guilt us into doing it anyway.

In this case the client had enough money to afford euthanasia, which was the best decision if they couldn't do any diagnostics or treatment.  The dog didn't have to suffer for long.

It's about personal responsibility, folks. Something I think that much of American society has forgotten.  Too many people want to blame others for their failings and hard situations, when the huge majority of the time the fault is really with the person themselves.  People need to take responsibility for their own actions and for the care of the people and pets entrusted to them.

May The Bark Be With You

I don't typically share videos, links, and similar things on this blog just for entertainment purposes.  That's what Facebook is for.  However, this time I simply couldn't resist.  As a geek, Star Wars fan, veterinarian, and dog lover, I have fallen in love with this commercial.  Many of you may have seen this, as it's going viral on the internet.  Enjoy!

Febreze Me

Here in the US there have been a series of commercials by Febreze air freshener.  The set-up is that they have a very dirty, gross, nasty location, such as an unclean restaurant or musty room.  They spray the location with Febreze, then bring blindfolded people into the room and ask what they smell.  In the commercials people only smell good things.  Here's one of them to show you what I'm talking about, in case you haven't seen them.

Today we had a dog with pretty severe gastroenteritis.  She had projectile vomiting, diarrhea, and was lethargic.  We did her work-up and didn't find anything really severe (no parvo, giardia, toxicity, etc.), so she's going home on some medications to help symptomatically.  While she was in the clinic she had blow-out, severely liquid diarrhea in her kennel.  This was one of the worst odors I've ever smelled, and that's saying a lot!  I've been in this profession for almost 28 years (nearing 15 as a vet) and so I'm pretty immune to most smells of pus, infection, diarrhea, vomit, and so on.  I was having a hard time being around the kennel or in the treatment area, and my stomach actually churned!  We obviously got her out right away and began cleaning it up.  It was decided that the blanket in her kennel was a lost cause, so we just threw it away without bothering to try and clean it.  But the smell permiated the clinic!  My office manager and receptionist had to stay up front to avoid the smell.  My tech had to wear a surgical mask while cleaning it up.  And I had a client walk into one of the exam rooms and begin gagging at the smell from the back.

Once everything was cleaned up we liberally sprayed Febreze around the clinic.  Which brought the thought to my mind.  In one of their commercials they should come into a small animal veterinary practice where there are a few parvo cases or other gastroenteritis.  Leave the vomit and diarrhea, spray the Febreze, then bring people in blindfolded and ask them to smell.  Now THAT would be a real test of the product!  But somehow, I don't think that commerical will ever get produced.

Thankfully, though, I have to say that the Febreze did a really good job.

Scared Of Shadows

Stefanie emailed this question...

Just after Christmas, I adopted a blue heeler mix from a rescue group. She is approximately 4 years old. I took her to the vet and since I live in the desert - had them run a full desert blood panel on her. All results came back negative. Her white blood cell count was slightly elevated, but I was told that may be due to allergies or the tail end of a parasite she may have been fighting. She will be retested in a couple of months to see if that has improved. The only other health issue that was revealed by x-rays was hip dysplasia and she is currently on Phycox to manage that.

 

I have only had her a few weeks, so I realize that I will continue to notice new things about her as her personality unfolds. Just last night though, she became nervous and fearful of shadows on the wall. And then this morning, she saw my reflection in a window and that made her run back inside of the house. I called her outside again and she did her business and seemed ok. I just avoided walking in front of that particular window. It's hard to say what kinds of experiences she may have had in her previous home - but I was wondering if this is one of those things that will just fade away or if there is a serious neurological reason that this has started to occur? Please keep in mind, I don't coddle her when she fears something - I go about normal business and use a happy voice so I don't reinforce her fearful behavior. There haven't been any other changes as far as her house training, eating, drinking - all of those continue to be normal. She does sleep a lot - but again, she's only been with me a few weeks and I'm thinking that the walks/hikes are contributing to that and as she becomes used to the exercise - she'll be more active.

 

Some dogs are just scaredy-cats (irony intended), and it may have nothing to do with previous abuse.  One of my dogs, a very sweet young yellow lab, is like this.  A flock of birds suddenly flying from the trees can send her running back to the porch with her tail between her legs.  Just last night we came home from theater rehearsal and I deliberately hid in the darkness inside when my wife let her out, just so I would scare her a little and get her to bark.  She did bark, jumped back a little, then relaxed when she saw who it was. 

 

I share this about my dog to show how some pets can have this kind of personality.  We picked out my dog when she was less than two weeks old and took her home at around 6-7 weeks old, so I know she hasn't been abused (quite the opposite...she is very spoiled by my wife).  Stefanine, in your case we probably will never know what kind of life your dog had over the last four years, and it is possible that she was abused and now is scared of relatively simple things such as shadows and reflections.  However, it is just as likely that this is simply her personality.  Many behaviors do begin with a trigger, and something in her past may have caused her to be jumpy at indistinct shapes.  But regardless as to whether or not there is a causitive factor, you still have the current behavior to deal with.

 

I would first talk to your vet about her vision.  If there is any question whatsoever, you may consider having an ophthalmology specialist evaluate her.  Sometimes vision problems can be subtle, and if she has any deficits in her sight it can cause her to have difficulty telling what is a shadow and what is real.  Unfortunately a dog cannot tell us what they see, so it can sometimes take specialized knowledge and equipment to assess her vision in detail.

 

If everything is fine with her physically, continue to praise and reward calm behavior.  When she sees shadows but doesn't react, give her good attention and a small treat.  An adage I use frequently is "behavior that gets rewarded gets repeated", so reward the good behavior and try to ignore the bad.  If she persists or worsens, you may want to talk to your vet about various antianxiety treatments, ranging from Dog Appeasing Phereomone (D.A.P.) to Thunder Shirts (not just for storms), and even prescription medications.  Since your vet knows your dog better than I do, and can see her in the clinic, they are better positioned to help determine the cause and treatment.

Pet Obesity Hits Mainstream

Today I was looking at Fox News (yes, I'm one of those) and saw an article about pet obesity in America.  My attention was grabbed by the title (Face It, Your Dog Is Fat) and I think the article was something that will be eye-opening for many pet owners.

Obesity in our pets is a rapidly growing problem, and something that every vet talks to clients about.  However, I honestly think most of my clients don't really understand the significance or severity of the problem.  Most will acknowledge that their dog or cat may need to "loose a few pounds", but I don't think that really makes much of an impression on them.  I do my best to make them aware of the potential health problems and shortened life span, but I must not be doing a very good job because few pets come back on their next checkup having lost enough weight.  Of course, I'm not the only vet with this problem, as the number of obese pets is growing, not shrinking.

The article mentions a phenomenon that most vets and veterinary staff are aware of.  Pets who are overweight very commonly have owners who are overweight.  This situation makes the conversation more difficult, as we have to be careful to only judge the pet and not the owner.  Sometimes this can make discussions awkward.  But more importantly it indicates the root of the problem, a lack of understanding of proper health and nutrition on the part of the owners.

Keep in mind, the pets don't pick which foods or how much they are fed.  This is completely in the control of the owner.

The article additionally discusses a web site that I wasn't previously familiar with, Project Pet Slim Down.  There is a lot of good information there about how to help pets loose weight, as well as charts for dogs and cats, showing what they look at various weights and body conditions.  I would encourage every owner to really take careful assessment of their pet and do something to keep them at a normal weight.

And I'm very glad that this issue is reaching beyond the vet office and being talked about in mainstream news sources. 

Facebook Rules The World

Can anyone believe that just a few years ago nobody new what Facebook was?  Now it's pretty much impossible to get away from it and most people we know are found there.  Facebook is changing how we use the internet and how we communicate with each other.  No, this isn't an ad for Zuckerberg's creation, just a rant and some thoughts.

I started using email and computer networking back in the early '90s, when it was mainly BBS and Usenet.  I remember the great novelty of the World Wide Web when I was in vet school and how new all of that seemed.  As the Internet grew, we moved from usegroups to online forums, which really dominated social networking until Facebook came around.  And now it seems like all of this is morphing again, with older forms falling by the wayside.

A group I'm heavily involved in, Fans For Christ, started as a forum several years ago.  A couple of years ago we started a Facebook group which has really taken off through 2011.  As the traffic on Facebook has increased, the posting on the forum has significantly decreased.  We've even brought this point up in discussions, and it seems that people are just on Facebook so much that they'd rather communicate there than on the forum.  This is despite the fact that our group is so active that posts and discussions quickly get lost as new comments are made, something that isn't a concern on a forum.  In a way, Facebook is hurting our forum and it doesn't look like this is going to reverse.

I've recently made a foray into Google+, which was supposed to be Google's answer to Facebook.  Really, it doesn't seem like much is going on there, and few people are very active.  I've even talked to some of my friends and they admit they are much more active elsewhere.  And guess where that is?  Ding-ding!  Yep, Facebook.

Thankfully we still have blogs for more long-form writing, though I'm waiting for Facebook to somehow take over that area as well.  And I can't really blame anyone, because I'm on Facebook also!

Give it another five years or so and I'll be we'll see the next iteration of electronic social interaction.  Think not?  Remember MySpace?  Yep, that's what I thought.

I Think I'm A Clone Now

Any Weird Al Yankovic fans out there?  If so, you'll get the reference in this blog title.  For those who don't know much about this classic music artist, here's a YouTube link.  But he's not the reason for today's post.

Today at work we were talking about a recent news story involving a woman who traveled to South Korea to have her recently deceased dog cloned.  She spent $50,000 to have a company harvest her dog's cells, develop an embryo, and implant it in a surrogate mother.  In her case it worked, and she now has a living clone of her old dog, whom she says is identical in every way to the dog she lost.

This isn't the first time pet cloning has been in the news.  Animal cloning first went public in 1996 with the famous development of Dolly the sheep.  Since then many livestock have been cloned.  Back in 2001 a cat was cloned, and several dogs and cats have been created this way since then.  A few companies have been founded with the goal of making pet cloning a commercially viable endeavor, with prices ranging from a few thousand to tens of thousands.

I know that people dearly love their pets.  I certainly do mine, and I can think of several that had their lives cut short and would love to have back again.  It's also understandable that people become attached to a particular pet over others and never want to loose that bond.  But I also have a lot of difficulties with the idea of cloning and would never do that with my own pets.

First, there is the cost.  Approximately 3-4 million animals are euthanized in shelters every year in the US.  Yet someone will spend $50-100,000 to clone their pet?  I can think of so much more that can be done with that money that will benefit animals in a far greater way.  Still, it's their money, and I don't have much problem with people being stupid with their fiances if they came about the money honestly. 

Second, there are serious medical and ethical concerns in the cloning process.  Many embryos never become viable, and there is a high rate of birth defects in the process.  Is it fair to develop several deformed animals in order to get one good pet?  Also there is the question of the surrogates.  If you read articles about South Korea's cloning industry (such as the one linked above), many of the surrogate mothers end up on "farms" and may not be treated properly. 

Lastly, you simply don't get the same pet.  You are copying genetics, but that doesn't mean that it's going to be 100% the same.  Even with identical twins you will have differences in personality and even looks.  My wife's brothers are identical twins and do share many similarities.  But I can tell the difference between them most of the time, even in older photos, and they do have several different personality traits.  That's been the same with every set of twins that I've known.  You can have completely identical DNA, but how each gene is expressed and which ones are turned "on" and "off" can vary.  The first cat cloned, CC (short for Carbon Copy) was a calico, and though gentically identical the original and the clone have different markings.

A person or pet's behaviors are a combination of genetics and environment.  So rather than "nature versus nurture", it's about how nature is affected by nurture.  Environment is never going to be the same.  In the article above the woman got her beloved dog when she was 18 years old and the dog lived for 18 years.  The circumstances and situations that were around 18 years ago are not going to be the same now that the woman is in her late 30s.  Yes, you will have genetic tendencies for behavior, but how those tendencies are molded by experiences is going to be different now.  So no matter how similar the clone is to the original, it will never be the same.

Don't even get me started on human cloning!  It's great in science fiction, but that gets too much into the realm of souls for my taste, and I'm completely against it.

And all of this brings me to the latest poll.  If you had the money or could get it done for free, would you have your favorite pet cloned?  I'm interested to see the results.