Vet Wisdom® Café

In the Vet Clinic and Behind the Scenes

Our friend and colleague Dana Durrance used to drive back and forth from Colorado Springs to Fort Collins three days a week for work.  That's over 200 miles a day!

Dana wanted to work at CSU's veterinary teaching hospital as a veterinary grief counselor, but her husband owned a veterinary practice in the Springs.  There was nothing else to do, but get on I-25 going north in the early morning and back on it going south at night.

But, even though the commute was grueling, Dana says she never had regrets.  She was doing something she loved and that made the effort worth it.

For the past several years, Dana hasn't had to commute.  She's worked with us online, providing us with a peek behind the scenes of veterinary medicine.  She's written about the medical marijuana business that moved in next door to their clinic and the mess they had to clean up when several pipes burst near their surgery room.  She has educated us about compassion fatigue and described all the ways veterinarian-client communication can go wrong.  She's made us laugh.  And, she has shared her grief, like when her sweet dog Pfeiffer died or the giant tree in her backyard was felled by a storm.

Now, the regrets are ours as Dana will no longer be writing for the VetWisdomCafé.  She has plans to write another book for AAHA, this one about compassion fatigue in veterinary medicine, and she will continue her consulting and teaching work.  We hope she'll still make comments once in awhile and perhaps pen a guest blog now and then.

If you want to wish Dana well or let her know about a blog you particularly enjoyed, here's your chance!

Thank you, Dana.  We'll miss you!

--Laurel

Exam Room Flubs Part 2

So, we've already covered some of the most awkward exam room mishaps. But would you like to hear more? If you do, please join me in talking about some of the weirdest client requests ever: (see the full stories at DVM360)

1. A client who showed up for an appointment and assumed that the veterinarian would babysit her children while she ran errands around town.

2. A client who wanted a taxidermist so that his deceased dog who always sat next to him by the fireplace could continue to do so indefinitely.

3. A client who wanted the veterinarian to give his pig a sedative so that he could butcher it later in the day.

4. A client who actually asked for her dog's anal gland to be "sucked out."(There's not enough money in the world to cover this one!)

5. A client who wanted his dog's testicles returned after the dog was neutered (add a little formalin and you've got quite a keepsake there)!

How about you all? What are some of the weirdest things you've ever asked your veterinarian to do?

--Dana

 

Exam Room Flubs

Every year, DVM 360 publishes an article about some of the most interesting "exam room flubs" that have occurred over the year. They're all quite interesting and conjure up some vivid images but I thought I'd share with you some of the highlights:

1. "Oops Moment:" An italian greyhound ends up breaking his leg during emergency treatment from a hit-by-car. (You can watch the vet tech tell her story about this one in a video with the full story.)

2. "Anatomy 101:" A hysterectomy is performed on a female kitten and after an hour of searching, the veterinarian discovers that there are no ovaries anywhere in the kitten's body.

3. "Wardrobe Malfunction:" A very nervous pet owner brings in a very nervous dog for an exam. In the middle of the appointment, the dogs tries to crawl into the woman's bra for safety and ends up popping off all the buttons on her shirt.

4. "Identity Crisis:" A very stressed out woman brings her cat into the hospital for an exam. As the appointment progresses, the client suddenly turns to the veterinarian and asks, "is this my cat?" 

5. "The Ick Factor:" A veterinarian is expressing a dog's anal glands when the dog unexpectedly bolts. During the struggle to keep the dog on the exam table, the anal gland fluid goes flying across the room and directly into the client's face and mouth. 

6. "A Revealing Appointment:" A woman brings in a rescue cat that is having skin problems. The veterinarian diagnoses it as ringworm. The client then asks the veterinarian if the lesions on her own body might also be ringworm and proceeds to take off her clothes to show him. 

 Yes indeed...it's a mad, mad world out there folks!

--Dana

Mis-diagnosis: Whose "Fault" is It?

Today, I have more questions than answers for you...

I've had several emails and phone calls the past couple of weeks about pets who were terminally ill, but weren't accurately diagnosed by their veterinarians.  In all of these cases, the pets had been taken to their vets and treated for "suspected" problems.  Yet, in all of these cases, the pets continued to get sicker and eventually died from terminal disease.

In one case, the veterinarian suggested more in-depth diagnostic tests, but the pet parent declined them.  In another case, the veterinarian didn't even suggest further testing and didn't seem to consider that a more serious disease might be the root of the problem.

What's the right answer here?  And who is to "blame" when an undiagnosed or misdiagnosed pet dies?

Does it all come down to the further testing?

It seems that, if veterinarians suggest too many diagnostic tests, many pet parents feel they are being "taken for a ride" financially.  Yet, without these tests, vets simply can't make an accurate diagnosis.

On the other hand, it seems that, if vets don't suggest further testing, perhaps with the goal of trying to make veterinary care as affordable as possible for their clients, they often "miss" a serious problem and ultimately lose their patients---and their clients!

If we, as pet parents, decline further tests for our pets, is it fair to come back at the veterinarian later for not "catching" the disease?

How do we pet parents know when further testing is truly necessary?  What can veterinarians say or do that will help us understand WHY spending money on diagnostic tests makes sense.  What can vets say or do that will help us trust them and the wisdom of their recommendations?

I'd really like to know how you handle this!

--Laurel

Related articles that may be helpful:

8 Tips for Making Decisions for Your Pet

Fighting Like Cats and Dogs

And now directly from the odd but true category. We all know the old saying about "fighting like cats and dogs." Yet, as thousands of pet owners will tell you, there are countless cats and dogs out there that get along just fine. In fact, we have clients who swear that their dogs and cats believe that they're just one big happy family. Such is the case of one of our clients, a physician in Colorado Springs. The other day he came in with both his cat and his dog for exams and heart worm tests. Now these two "pals" are reportedly, the best of friends. They always get along and often find each other to snuggle or play. In fact, they get along so well no one ever worries when they're together. Well, I guess even the best of friends can have their off days.

Let me describe the next few events as best as I can....cat hears loud noise outside in waiting room and jumps off the exam room table to go hide underneath the bench. Dog is curious as to why cat jumped and decides to investigate why cat is hiding underneath bench. Dog pokes his nose under the table and cat responds with hissing, demonic guttural sounds that only a terrified kitty can make. Upon hearing this hissing, dog comes completely unglued and loses his mind turning into a wild, growling, and snarling beast trying to bite whatever he can get near.

Now right before this charming encounter, Steve and the client were happily chatting away about the upcoming football season. It wasn't until they saw a flash of teeth, fur, and claws did they realize that they had a little problem on their hands. Curious as to what happened next? Owner pulls dog off of the cat while veterinarian scoops up cat and takes him to another room. After both are checked throughly for injuries, dog and cat are then reunited in the front lobby of the hospital. Upon seeing each other, dog walks over to cat, wags his tail, and starts licking the cat in the face. Cat responds by rubbing his face against the dogs and starts to purr loudly. Go figure.

For all of you who have both dogs and cats, what have been your experiences? Do you think that dogs and cats just instinctually "dislike" each other or is it more about socialization? I'd like to hear your stories! (photo from Dreamstime.com)

--Dana

 

Heartbreaking

Heartbreaking...it's a term used quite frequently maybe even more that it should be. However, there are situations where this word is spot-on. Unfortunately, we had one of those at our pet hospital. A good client of ours found that one of her cats had accidentally been exposed to a bat with rabies. Appropriately, she brought the cat in and sure enough, the bat tested positive for rabies. As you all know, there is no cure for rabies.

Fortunately, the cat who had played with the bat was up-to-date on her rabies vaccinations. Therefore, she's only needing to be under quarantine for 14 days. Unfortunately, this client has several other cats (2 of which were also exposed to rabies but have never been vaccinated for it). Now I'm not sure about other states but in Colorado, the quarantine process for animals exposed to rabies who have not been vaccinated is so arduous and complicated, it becomes literally impossible to do. Some instances can require the animal to be in quarantine for over a year with the pet owner incurring the expenses of boarding for the entire duration. Our client simply could not afford the cost of keeping these 2 cats in quarantine for such a long time. So in the end, she had to euthanize both of them. It was heartbreaking for us, for our staff, and most importantly of all...for her.

I can't imagine the pain this client is going through. My heart hurts for her and it's so hard to know that a  simple vaccine could have prevented all this. This situation is a loud wake-up call to all pet owners about the importance of  regular vaccinations for their pets. All pet owners (even the most caring and competent ones) cannot always predict or control the potential dangers to their pets. It's a horrible feeling to be part of a situation in which there are no acceptable options.

I'm sure that many of you have your pets vaccinated on a regular basis. What do you think veterinarians can do to educate people better about these dangers and to make this process easier? At our hospital, we don't require the pet to see a doctor for routine vaccinations (unless of course, there's a compelling medical reason to not do this). With a veterinary nurse giving the vaccinations, we can keep the costs at a minimum and many of our clients prefer this. What are your thoughts?

--Dana

P.S. I ask you to join me in keeping this pet owner and her two cats in our thoughts and prayers. Thank you.

Pain...It's No Game

The August 2010 edition of Veterinary Practice News contains an article advising veterinarians to use multi-modal approaches to pain relief. This is a hot button issue and just like in human medicine, pain management has become a new and progressive specialty that many practitioners refer to. At our hospital, good pain management is and always has, been the law of the land.

When Steve was in veterinary school at CSU, he was fortunate to be taught by one of the nation's premiere pain management specialists, Dr. James Gaynor (who now has a pain management specialty hospital here in Colorado Springs). Dr. Gaynor would always tell his students that there are 4 Laws or Principles of Pain Relief: (these are posted in our back treatment area right next to the controlled substances cabinet)

1. Use a multi-modal approach to pain management

2. Use pre-operative, intra-operative, and post-operative pain relief (before, during, and after)

3. NEVER make your patients prove to you that they need pain relief.

4. Good pain relief is good medicine and good business.

As a pet owner, what expectations do you have for your veterinarian about your pet's pain? Do you think veterinary medicine as a whole does a good job of addressing this issue? How do they compare with human medicine? Your thoughts?

--Dana

Where Are all the Einsteins?

The August 16th issue of Time magazine contains a story about the intelligence of animals. It's titled, "What Animals Think" and discusses the brains and thought processes of animals as varied as gorillas, crows, orangutans, elephants, chimpanzees, and lions. The interesting part of this article is this...if animals can reason (even if its in a crude way), the unavoidable questions must follow, "can they feel? Do they experience compassion and empathy? Can they experience the emotions of love, hope, or grief and what are the implications with how we treat them?"

Science has been toiling over this topic for generations now. Although many people have never reached a full consensus, it seems that science can't help itself...we seem to have an instinctual need to understand the other animals we share this planet with.

At our pet hospital, we will often get the typical "smart" questions about our pets..."what is the smartest dog breed?' "How do you know if your dog or cat is intelligent?" "Can you teach your pet to think?" These are tough questions with even tougher answers.

What do you all think? What are your feelings about these types of questions and what should the veterinary professional  say in response? Do you have ideas about this continuously emerging scientific field? (full story and photo here.)

--Dana

Something Little Packs a Punch

Do you ever have days when you're in a bad mood and then all of a sudden, something little happens and changes your whole attitude? It's a nice little treat, isn't it? This week has been the start of school so we've had some increased stress in our household. Today, after school ended, I walked up to meet my son feeling cranky and grouching about the afternoon heat.

But on the walk home, a little boy approached me just bubbling over with excitement about how his dog's behavior problems are "all fixed." I knew this boy immediately (his family and their pets come regularly to the pet hospital). This particular family is so conscientious they could be a walking poster child for what an ideal and responsible pet owner should be.  Unfortunately, they have had some very serious behavior issues with one of their dogs...so much so, that they've even had to consider relinquishing this dog (which was agonizing, devastating and horribly painful for them to even consider).

Hearing this good news about the dog lightened my mood almost instantly (I had spoken to the mother a few months ago and had recommended her to Bark Busters--the well-known dog training program). I was thrilled to hear that the referral worked and the happy sparkle in this little boy's face just completely made my day (and week).

Behavior problems are a huge issue for pet owners and many clients at our hospital will ask for advice and guidance. We do the very best that we can, but I always end up wondering how the "story" ended. Have any of your pets had serious behavior problems? How did it affect your life, family, and your mood? What role do you think the veterinary profession should play in all of this?

--Dana

Guilty As Charged

There's been a whole lot of stress at the Iams pet food company these past few weeks (as well as at scores of veterinary hospitals all over the country). As many of you know, on August 4th, Iams had to recall some 22 of its veterinary diets resulting from a concern over Salmonella. It was the necessary and ethical thing to do but boy did it cause a whole lot of worry to thousands of pet owners. (See the Iams site for a list of the recalled foods.)

At our own pet hospital, the phone was ringing off the hook for almost an entire day. It can be very difficult to reassure someone who is feeling anxious, worried, and even angry all at the same time. Though the problem originated at the Iams company, it's probably hard for the average pet owner to make a distinction between Iams and the veterinary profession (after all, it is usually a veterinarian who ends up prescribing these special diets in the first place). It becomes a case of guilt by association. How do you think veterinarians should have handled this situation and what would you want to hear from your own veterinarian?

--Dana

Kids Will Be Kids

As any parent knows...kids will be kids. A bit of childish mischief and larceny is expected. But what about our other "kids?" Yesterday, a friend asked me what types of problems are most commonly see at our hospital during the summer months. Snake bites and ticks, of course. Heart worm, ringworm, and other parasites...you know it. Heat exhaustion, dehydration, and "sport injuries"...that too. But what do you think about  squabbles with your friends at summer camp? 

Like most summers, we've been seeing pets with injuries caused by fights with other animals (usually at a boarding facility, doggy camp, or some other "day care" center). This makes sense because the summer months are when most of us take family vacations. However, I've noticed something odd about this summer...so far we've seen almost DOUBLE the number of pets (mostly dogs) injured from fights than what we saw last year. I don't have an explanation. We've always provided emergency medical care for several "day care" facilities in our community but it seems like we've seen an explosion of fights these past few weeks.

The reasons...there's likely a bunch. Maybe dogs and cats get cranky on really hot days like we've been having. Maybe more and more facilities are allowing animals interact with each other but lack the proper training or knowledge to keep fights at a minimum. It would be interesting to know if other veterinary hospitals in town or other places have seen this same trend.

What do you think? Are there any other reasons you can think of to explain this increase? What kind of experiences have you had with your own pets at "day care" or a boarding facility? What do you look for with pet sitters? Would any of your own pets possibly cause a bit of mischief (or have they)? Let's talk about these naughty kids! (photo from bigstockphoto.com)

--Dana

13 Black Cats Underneath a Ladder

A mirror shattered into tiny bits, a black cat crossing your path, and stepping on cracks in the sidewalk...what about these sound familiar? Is someone out there trying to get my attention?

I've never put much stock into certain superstitions (although I find them fascinating). However, today I have cause to reconsider. At our pet hospital, we had the triple threat...a client accidentally broke a mirror in one of our exam rooms...the sidewalk leading up to our entrance is cracking, and yes...we most definitely have a black cat (in fact we have FOUR in our cat boarding this week)! Okay, so three bad omens...what now? Do we carry on boldly or visit the nearest exorcist? I'll let you make the call.

Please allow me to summarize a few of today's events:

1. We should have known something was up when the power went out this morning and the alarm clock didn't wake us up. Oh and yes...I burned the toast and spilled orange juice on the floor but it's okay since we didn't have time to read the newspaper because it was thrown on top of our roof by the mail carrier.

2. At the pet hospital, a brand new employee failed to show up for her early morning shift. After attempting to contact her, we found a tattered piece of scratch paper informing us that she is quitting and won't be coming back (this of course, after extensive interviews and discussions about her commitment and weeks of training hours). The news doesn't all have to be bad though, you see she still has a key to the hospital front door and we can't get ahold of her to get it back. That means we'll get to see our friendly neighborhood locksmith to change the locks!

3. I'm just guessing here, but I'm pretty sure that when you turn on your sprinkler system, there shouldn't be a geyser of water the size of Mt. Vesuvius shooting everywhere. However, the good news is that the man who does our lawn care and sprinkler system maintenance is out of town and won't be back for 10 days. This means we can entertain the neighborhood!

4. Our newly purchased FAX machine decided to take a sick day. The upside? We've only got 15 blood panel results to track down instead of 16. Thank goodness for those small favors.

So, what's your call? Should I have just stayed in bed until tomorrow morning? Was someone trying to warn us or do we chalk it all up to "coincidence?" I'm sure that all of you have had very bad days in your lives or work. Did you have any sense it was coming? Have you ever gotten a warning before a bad event? Your ideas interest me and I need to find something else to do besides smashing the sprinkler system with a broken FAX machine and alarm clock. I'm off to get a four leaf clover, a rabbit's foot and a cup of salt to toss over my shoulder (the rabbit's foot is fake of course). Please let me know if you seen any leprechauns.

--Dana

Bring Out The Cheesy Gold Watch

This week is a tough one. I feel a jumble of wildly conflicting emotions and amidst all the jumble, I'm starting to get a little sea sick. I guess I should explain...

We have an employee who's been with us for over 8 years. Now in the world of veterinary medicine, this is a REALLY LONG time. In fact, it's probably worthy of a cheesy gold watch given out at the retirement party. Veterinary hospitals and clinics tend to have a fairly high level of turnover compared to many other professions (however, I should mention that this can vary a great deal from hospital to hospital). For our hospital, 8 years is an impressive time. She knows our hospital and "the routine" like the back of her hand. She's liked by all of the employees and she's liked and respected by our clients. She's great at animal restraint (even though she's not a technician), and she's got a wonderfully wicked sense of humor. Sounds all good right? Unfortunately though, she is also leaving this week and moving to another city.

For her, this move is a good one. It means better opportunities and a better quality of life for her and her children. Moreover, she's truly happy about it. You can just see it in her eyes and that's a wonderful thing to see. The un wonderful part is that we're really going to miss her.

Question...can you genuinely be happy for someone who's moving on while also feeling sad and upset about them doing it? I'm sure that in every profession out there, this is a common conundrum. How do you support someone who's leaving when you really don't want them to go? I certainly don't have all the answers. The best that I've been able to come up with is telling her the truth. I'm thrilled for her personally, yet I'm really sad that she's leaving.

How do all of you deal with the emotions related to staff turnover? What is it like from a supervisor's point of view and what's it like from an employee's point of view? Any pearls of wisdom for us?

--Dana

Sick And Tired

A recent study from the United Kingdom reveals some troubling news. They have found that the suicide rate of veterinarians is four times higher than that of the general public and double that of other health professions (Veterinary Practice News, May 2010). While conducted in another country, these findings are disturbing and many feel that these numbers also apply to veterinarians in the United Sates (as well as in other countries).

Why? Why is the suicide rate so high? What contributes to this problem and what can we do about it? I could spend an entire year studying this and still not have all the answers. Since I don't want this blog the same length as War and Peace, I will try to condense the explanation down to two important factors... veterinarians are TIRED AND UNDER PAID.

Compassion fatigue and burnout are very real threats to the veterinary profession (and always have been). Study after study will tell you that compassion fatigue is on the rise (or at least more people are admitting to having it). It's not really a shocker. Veterinarians have almost all the same stresses that human physicians have and on top of that, they also witness death 5 times more frequently that their human medicine colleagues. In fact, they actually have to facilitate the death of beloved patients. They must provide stellar service to pet owners who believe that their pets are family members, but they should do this with the same salary veterinarians were making in the 1960's. In many ways, veterinary medicine parallels human medicine. Advanced medical treatments using the latest technology, amazing client service, and fabulous patient care are now the expected norm. Yet, these expectations come without little thought as to the true value of these services.

We've talked about this financial disparity before here at the Café. Pet owners proudly profess that their pets are true family members but when it comes down to spending money on them, many sing (and dance) a very different tune (although there are a lot of exceptions). Somehow, the mindset seems to say, "it's a veterinarian, not a human physician, so naturally the salary should be dramatically less. This is how it's always been and should always be." There are scores of factors that play into this, but it's still a head scratcher for me. Now please don't misunderstand me...I'm not yelling at any pet owners or accusing them of being hypocrites. With the lack of insurance in Vet med and the depressed economy factored in, I can see why this disparity exists. The real world is sometimes harsh but knowing this doesn't make it any less difficult.

This study from the UK also reveals that many veterinarians suffering from compassion fatigue, substance/alcohol abuse, anxiety, and clinical depression are completely under-supported. Like the military, professional and social stigma prevents many people from seeking help and support. And even if they do seek out support, the amount of quality services for veterinarians are so few that it is a tiny drop in the proverbial bucket.

For time reasons, I won't present all the factors and many variables that contribute to this problem (but you can explore this topic further from Veterinary Practice News, May 2010). I'd like to know your thoughts out there. Do you agree with this? Do you think veterinarians are under supported and under paid for their work? Why is this and what can we do about it as a society? Should we do anything about it? Please send ideas!

--Dana

Luv 4 My Bff's

R U there? It's gr8 to C U. I'm tryin to write the way my tween girl does 2 her BFF's (LOL). How R U my gf's and bf's? I want U 2 think I'm kool, so please don't call me a BLT (which is NOT a bacon, lettuce, and tomatoe sandwich). Wow, I feel 25 years younger already!

It's a new age we live in. PDA's, Blackberries, IPods, and IPads abound. You can now twitter and tweet your way through life in the fastest, most immediate, and most convenient way ever. But if I were to go back to my real age, I would wonder about how all this new technology is changing the way we all talk to each other. Veterinary medicine is embracing high tech just as everyone else. You can know tweet your veterinarian, log on to see your pet, and receive regular e-mails about your pet's status. You can do this without ever having to talk to one single human being. Is that better? It certainly is convenient.

What do U think? N D. tech is 4 those who are fab but what is the cost to our BFF's in vet med? C M L,

--Dana

Parvo Virus and Eggs...Sunny Side Up

Picture this for breakfast...bacon, pancakes, hash browns, and Parvo virus eggs...yummy!!! That's what many veterinary professionals sign up for to fulfill  continuing education requirements. Licensed veterinarians and technicians are required to complete a certain number of continuing education (CE) hours in a two year period. When there's no time or money to go to one of the major conferences, you end up with Parvo virus along side your morning coffee.

CE is essential for staying current on the latest treatments, advances, and technologies (like many other professions). Unfortunately, some people have little time or money to do this so they have to be creative. An early morning breakfast lecture or a saturday dinner symposium with a taco bar is the perfect solution. It's just what the doctor ordered. There are no lost work hours, no huge travel expenses, and on top of everything else, you get to eat!! 

Steve and I have attended our fair share of breakfasts, lunches, dinners, afternoon snacks, cookies and milk, etc. I've even taught some courses to provide CE for others. One of the things that I've always liked about CE is that it gives you a chance to get together with your peers and share your stories, struggles, whatever. While convenient and still of high quality, some of these quick courses end up feeling very rushed. You race to get there and then spend the rest of your time worrying that you can't absorb everything fast enough (along with the occasional indigestion). 

What other professions can you think of that require CE to maintain their licenses? What are your thoughts about CE courses being rushed? How would you feel if you paid your vet for an office visit only to find out later that there's a new and better treatment for parasites? Please share your thoughts!

--Dana

Woody Woodpecker's Ghost

We have an unwelcome animal guest at our pet hospital. He's charming, kind of cute, but immensely annoying. He's a woodpecker who refuses to accept the fact that the roof over our front lobby is NOT a good summer home. Scaring this little fella hasn't worked, but I must give him kudos...he's one determined bird on a mission (maybe it's his vacation house).

There are scores of stories out there about home owners having problems with wildlife. My dog Chance would tell you that all squirrels are a plague on this earth and deserve to be systematically eliminated (he's probably not the only dog who feels this way). What are your stories? How did you fix the problem? It's time to learn some new tricks!

--Dana

Summertime Safety Part 2

We've talked about it before...the lazy days of summer. What a wonderful time for us and our pets. Yet, with increased activity and more time outdoors, our pets are also more vulnerable to harm. Last time, I gave you a list of potential toxins commonly found in "summer" products. Today, we're going to cover physical injuries often seen during the summer months. So away we go:

• Cuts, lacerations, and severed tendons on the paws caused by lawn edging
• Torn knee, leg, and joint ligaments from excessive jumping, running, or hiking 
• Broken bones from falls or accidents
• Rattlesnake bites and other venomous snakes and insects
• Other unfortunate encounters with wildlife such as porcupines, skunks, and predatory animals (particularly with small pets)
• Eye, nose, and ear injuries sustained from poking the head into bushes or holes
• Dehydration and heat stroke during very hot weather
• Health problems from parasites such as mosquitoes, heart worm, tics, and fleas (while these are not injuries, they still pose significant threats during the summer months)

So how do you keep your pet safe while still enjoying your summer? Let's go with what every mom in the universe has done for her own human children:

• Create a first aid kit: items such as ointments, gauze pads, styptic powder (stops bleeding from cut toenails), saline, isoprophyl alcohol, iodine, hydrogen peroxide (to induce vomiting), towels, tweezers, scissors, and muzzle

• Make a list of pet emergency contacts: these can include your own veterinarian, overnight emergency hospitals, the ASPCA Poison Control Center, and the local humane society in your area
  
• Make a list of pet emergency contacts: these can include your own veterinarian, overnight emergency care, the ASPCA Poison Control Center, and the local humane society in your area
  
• Signed authorization to permit emergency medical treatment at boarding facilities, pet sitters, and pet daycare "camps" 

Have I overlooked anything else? Just like before, I welcome any of your ideas and suggestions. Now let's all go out and have a wonderful summer with our pets. (photo from istockphoto.com)

--Dana

Summertime Safety

Summer is nearly upon us and that's good news for our companion animals. It means longer days, camping trips, hikes, playing  ball in the backyard, and generally enjoying the relaxing "dog days" of summer. However, summertime can also mean increased dangers to our pets. These dangers can include poisoning from toxic plants/flowers/insecticides, and poisoning from household products/foods.

Imagine this...I'm having a barbecue party with friends in my back yard. We're grilling burgers, playing croquet, and soaking up the summer weather. While I'm distracted with serving potato salad, I don't see one of my dogs munching on grapes that my kids accidentally dropped on our deck. "Uh Houston...we have a problem" (grapes are highly toxic and even a few can cause significant kidney damage).

Luckily, the ASPCA has made a list of the top 10 poisons dangerous to our pets: (www.aspca.org/pet-care/poison-control)

1.Human medications. Last year, over 45,000 calls were received by the ASPCA poison control center involving a pet accidentally ingesting a human medication (acetaminophen and cats for example...NOT a good scene).

2. Insecticides

3. "People" food such as grapes, raisins, avocados, baker's chocolate (or any food containing methylxanthines), and any food with the sugar substitute xylitol

4. Plants such as Rhododendrons, Azaleas, and Lilies

5. Misuse of veterinary medications

6. Rodenticides

7. Household cleaners including bleaches, detergents, and disinfectants

8. Heavy metals like lead, zinc, and mercury found in paint, linoleum, and lead dust

9 Garden products such as fertilizers and products that accelerate and enhance flower growth

10. Chemical hazards such as ethylene glycol (found in engine antifreeze/coolant), paint thinners, pool/spa chemicals, and drain cleaners. 

Can anyone think of some other possible toxins for our pets? I welcome your ideas and suggestions!

P.S. Hey folks, a few days after writing this post, I realized that the  list of "people food" hazards was incomplete. I also need to include:

• Leeks, onion, garlic, and chives (large amounts can cause red blood cell destruction
• Caffeine (it affects the animal's metabolism in damaging ways)
• Yeast  or any type of dough with yeast in it (the yeast grows in the stomach causing it to distend and sometimes twist...this is known as "GDV-" gastric dilitation and volvulas and can be fatal)
• Fatty foods like butter, meat scraps, and grease (can cause severe pancreatitis)
• Alcohol (animals have trouble metabolizing it)

Glad we got those in there...let's protect our pets!

(photo from Dreamstime.com)

--Dana

More Than Coffee Mugs And Pens

We just recently switched heartworm medications we use for our clients. This new product is slightly more superior, but that's not the primary reason we switched it. In fact, The reason has absolutely nothing to do with medicine and everything to do with communication (I know....Dana's favorite topic). In this day of high tech and the internet, why is the personal touch still so important?

The previous medicine we used worked wonderfully and there were very few problems with it. However, the drug rep for that company left much to be desired and was truly the invisible man. We never heard from him... ever. No visits, no calls, no offers to do some staff training, no pamphlets about the product... nothing. It had been so long since any of us has seen this man that we didn't even recognize his name when he sent us a fax assuming we would be making a summer order.

What about the other drug company you ask? This representative has visited our hospital 5 times in two weeks, provided product samples, product coupons, educational material,  has offered to teach staff on the latest parasite treatments, and has even brought the staff lunch (and cookies... twice)! He's also offered to share the cost of mailing cards to all our clients about heart worm.  Call it a bribe if you want, but all things being equal, I'm going to go with the one who visits me, helps me develop my business, offers assistance, keeps my employees educated, and keeps my staff happy (never underestimate the power of  cookies)!

I know that there's a lot of controversy about drug companies working with human medicine. Understandably, people want to know that their doctor is prescribing a particular drug because it's medical necessary, not because the company hands out attractive coffee mugs and pens. However, if we're talking about the same exact drug from one company to another, the choice seems obvious.

What do you all think about drug companies and their representatives visiting your vet's office (or even your own doctor's office)? Do you think it's ethical and how should the doctors (in both professions) respond? Is there a difference between accepting a free lunch and accepting a free vacation to Bermuda? Your thoughts please!

--Dana

Clients first

This is a topic that either Laurel or Dana usually writes about, but I came across this interesting article and wanted to share!

There is a veterinary hospital in Arizona that is doing things a bit differently. The Animal Specialty Group in Scottsdale, Arizona is making their hospital with a focus on client communication and needs. The owner says, "I didn't want it to look like a typical veterinary practice. I wanted something comfortable, a place people could come and feel at ease. When clients are referred to us, it's because they have big problems, serious problems."

The owner, veterinarian Ross Lirtzman has taken every single aspect of designing his new hospital to be sure it offers up comfort and communication to his clients. The seating, the exam rooms, even the lighting are different than you might find in a "typical" practice. The exam rooms have small couches in them for more comfortable waiting. The whole place has a HEPA air filtration system to keep the air fresh at all times.

Another interesting and unique feature is that pet parents can actually watch live surgery of their pets via the web. If they don't watch, they can call in and receive updates during the surgery or a team member will call them with progress updates.

Lirtzman says, "It's a business about taking care of people who own pets." Sounds familiar! Our mission at World by the Tail is quite similar - "caring for people who care for pets"!

I really like the idea of this new hospital. I think it's a very smart way to run a practice. The focus is usually on the pet, which is as it should be for the pet's health, but the client is sometimes left in the dust! More and more veterinarians seem to be realizing this and working hard on the client communication aspect of their field!

What do  you think? Would you like a hospital where you could watch your pet's surgery? Or wait in a very comfortable exam room? Would you expect to pay more if the hospital was designed like this new one, and would you be willing?

--Tammy

"It's Okay To Cry...You Want To Know Why?"

I'd like to tell you about a sweet and burley yellow labrador with the personality of a hero and the heart of a locomotive. He gave so much in his 12 years of life on this planet and I feel that it's important to honor him.

We have had a client for over 10 years now that has a neurological disease. He's a fantastic guy who's intelligence and humor sometimes gets obscured by his illness. He has an amazing spirit and grace about him but he would tell you that a lot of his accomplishments are due to one single furry friend...his assistance dog. This amazing dog made his life easier, more accessible, and always broke the ice when making new friends. He not only provided physical assistance, but he provided the emotional support needed to negotiate life with a devastating disease.

Sadly, this beloved companion developed cancer and stopped responding to treatment. He was euthanized last week and afterwards, the client started to cry and apologized for it. In a respectful way, Steve reassured him that it was okay to cry and express his grief...in fact that it was NECESSARY to cry and release those emotions. The minute that Steve gave permission for emotions, it was like the floodgates opening unabated. This man's grief was profound and Steve and I take comfort in knowing that he was able to let out some of this intense pain.

We had just recently heard from this client (he has a new assistance dog). He thanked us for allowing him to express his sadness without us getting uncomfortable or "weird" around him. This situation reminded me of how important it is for veterinary professionals to develop a comfort level with loss and grief. By doing that, they can allow the clients the freedom to experience all of their emotions, even the really intense ones.

How about you? Have any of you known a veterinarian or pet hospital that does a really good job supporting emotions? What kinds of things would you look for in finding someone like this? I'm curious as to your thoughts.

--Dana

P.S. Please join me in taking a moment to honor a dog that gave absolutely everything he had...he was truly, a special soul.

AWAREness Is The Key

As many of you know, I write frequently about on-line pharmacies and the potential dangers they pose to the health of our pets if they are unsupervised or mismanaged. Well, I'm happy to tell you that the U.S. FDA has now created a brochure for pet owners outlining the safe and appropriate use of online pharmacies.

This brochure contains excellent suggestions for pet owners wanting to purchase medications online (and I'm sure will help veterinary practice owners sleep better at night). They encourage the following guidelines using the acronym A W A R E:

Ask your veterinarian what he/she thinks about a particular on-line pharmacy before buying medications there. While it's true that purchasing some medications online can save you time and money, your pet's health should always be the number one priority. If you work together with your veterinarian, your pet will benefit. Be careful with pharmacy sites that do not require a prescription or will continue to refill medications even when the prescribing veterinarian has declined the refill. For certain medications, there's an important medical reason to decline the refill (the pet's health status must be evaluated periodically by physical exams or blood panels). Most veterinarians will allow refills for up to  6 months (although there are exceptions for many drugs). Also, beware of sites that have no physical address or are not located in the U.S.

Watch for red flags. Things to look for include: pharmacies that send unusual looking, broken, or previously opened bottles; medications with a different name than the one prescribed; and any other things that seem unusual.

Ask about the pharmacy's accreditation. Before purchasing, check to see if the pharmacy follows the guidelines for accreditation. They must be accredited by Vet Vipps (Veterinary Verified Internet Pharmacy Practice Sites).

Report any problems with a medication and any suspicious behavior to the FDA. Accredited online pharmacies are required to follow certain protocols and this includes monitoring a medicine's side effects or other problems.

Educate yourself about online pharmacies. The good news is that by reading this blog, you've already done just that! Do any of you have other ideas or things to look for? I'm curious.

Obviously, following these guidelines won't eliminate all potential dangers completely but it's certainly a giant step in the right direction. Isn't it great when you can let go of some of your stress and worry (even a small amount)? Whew!.... I feel better already!

--Dana

Please Pass the Aspirin

Well I can't say that life at the pet hospital is boring these days...as many of you know, we've had our share of unexpected "events". One of these involved a cracked water line that ended up flooding the hospital and creating one massive headache.

It's now time to reach for that second dose of aspirin. We are now having the hospital "re mediated" (which is a fancy way of saying that they're going tear open all our walls in order to remove any mold that has developed). So for the next few days, we will be working amidst hammers, loud machines, and distracting surroundings (fortunately, the company doing this is willing to do work on week-ends).I guess the silver lining is that we know ahead of time about this so we can plan accordingly. Who knew that a small split in a dental instrument could cause so much trouble?

We always say that a clean, uncluttered hospital is essential in making a good impression. How do you feel when a company or place you frequent is doing renovations and the physical appearance is less than desirable? 

--Dana

Too Much Information?

A few weeks ago, we had a new client come to our hospital to talk about her pet's health. This client was respectful, very nice, and was easy to communicate with. During the the conversation however, she stopped talking about her pet and started talking about contraceptive devices instead (specifically, a device she found at her house that wasn't hers).

Can anyone say awkward?....or "TMI" as my daughter would text it. Every once and awhile, we see clients that want to share maybe too much about their personal and family life. It can be difficult to respond to this while still avoiding the communication minefields that follow.

We all have a need to connect with our fellow human beings. It's simply in our nature. I think that many people trust their veterinarians so they occasionally end up discussing things that have little to do with medicine or even pets. I believe that it's a way for the client to connect with us on a basic human level. We always want to acknowledge and support our clients, but what should we do/say when the sharing of information goes overboard? How can we respect and support our client's feelings but keep the boundaries between us at a healthy level? From someone who occasionally shares TMI, I'm interested in your thoughts!

--Dana

The Power of Pee

Is anyone out there in the mood to talk about pee with me? I know....it's probably not a topic you discuss on a daily basis (unless you're 3 years old). However, pee is really important when it comes to our pet's health. By analyzing a dog or cat's urine, the veterinarian can learn all sorts of important information. It can be a vital part of good preventative medicine and helps the doctors keep your pet healthy as long as possible. The tricky part comes when we need to convey this and educate our pet owners about pee (we call it the "Pee Talk").

Here is one time when thinking about one's own medical care helps us to educate pet owners. We use the medical model because most of us have had their urine tested at some point in our life (for all sorts of things) so we understand the importance and we can all relate.

A recent AAHA newsbrief contains a terrific description of the value of urine and the many different ways to collect it. If we can educate an owner about the power of pee, we are much more likely to catch a medical problem early on which always makes the prognosis that much better. If you're interested, you can visit the following link. Feeling hesitant? You can do it...simply remind yourself that testing pee is good veterinary medicine. I'm curious, what do all of you out there think about this "pee stuff?"

--Dana

CSI Veterinarians

CSI (Crime Scene Investigation)...it's been one of the most popular television shows in the country for over 8 years (and CSI Miami, as well as CSI New York). I'm sure that many of you have seen at least one episode of them over the years. So what would you think about a show called, "CSI Veterinarians?"

There is a new and emerging field in the veterinary world known as "Veterinary Forensic Medicine." Yep.... it's precisely what you think it is. Veterinarians use remains of animals to understand and piece together the details of an animal's death. Dr. Melinda Merk, the senior director of veterinary forensics for the ASPCA, believes that this field will continue to gain popularity over the next few years which is good news for our furry friends.

When authorities were trying to prosecute Michael Vick for his illegal dog fighting ring, Dr. Merk was one of the star witnesses for offering proof of his crimes. After excavating the graves of of many of the pit- bulls and analyzing their remains, she was able to piece together the horrific details of their deaths (some had been hanged, some tortured then beaten to death, while others were shot). Her expertise was the primary reason why Michael Vick finally admitted his guilt and was sent to prison as a result.

Merk says that her career got started because she wanted to help suffering animals and bring those who hurt them to justice. Back in 2000, the state of Georgia passed a state law making animal cruelty a felony. Merck had been running a veterinary hospital in Roswell, GA at the time. She knew that this state law would be no good unless people understood how to enforce it. She started out by first working with human forensic experts  to learn  how to collect evidence, handle various fluids, and how to interpret bullet trajectories. She also learned how to examine claw marks which can indicate an animal's struggle with a perpetrator. Today, Dr. Merk is one of the most sought after experts in veterinary medicine. (for more details you can visit www.VeterinaryPracticeNews.com).

Next spring, the University of Florida will begin a certificate program as part of its on-line master's degree in forensic science. Dr. Merk is helping to develop this program which will teach veterinarians how to recognize crimes against animals and give them tools to do something about it.

What are your thoughts about this? (I think it's fantastic and long, long overdue), Would any of you ever consider working in a field like this? Wouldn't it be wonderful to finally be able to punish those who abuse and torture animals? Let's hear your opinions!

--Dana

Website Surfing

I was out taking a casual stroll the other day through my MSN browser. I came across a story that made me angry and I'd like to get your opinion on it http://www.msnbc.msn.com/id/35286379/ns/health- heal petpet_healthpet_health/petpet_healthpet_health/ 
Since the title contained the words"pet health" I was naturally curious. What I found was an interesting diatribe and protracted criticism of veterinarians as a profession (and how as a group they are so unwilling to acknowledge their mistakes or even apologize.)

The article contained several, detailed stories of mistakes made by veterinary hospitals and encouraged pet owners to sue these doctors for malpractice. They provided another link http://www.vetsfromhell.com and encourage people to visit it. While I agree that veterinarians are human beings capable of making mistakes, it doesn't appear to me that as a profession, veterinary medicine is shirking its responsibilities to the public. 

If you have time, visit one of these links. I'm curious to hear you opinions and your thoughts about how the stories could have been more even-sided.

--Dana

Water, Water Everywhere...But Not a Drop To Drink

Have you ever worked at a job where you couldn't use the bathroom the whole day?  Sound a little uncomfortable and stressful? Well, for one day last week, there was a whole lot of uncomfortable stress going around our pet hospital.

At first the day was humming along quite nicely...we had two dental cleanings happening simultaneously, several minor procedures were underway, and there was plenty of staff to help. We were all feeling positive about how the day's schedule was right on track. Was is it that they say about never commenting on how well a day is going?  We're living proof that the minute you do, something bad follows immediately.  Right as Steve started to extract some infected teeth, the entire water supply to the hospital simply vanished. As it turned out, a major water main had broken down the street and in order to repair it, the utility company needed to shut off all water to the surrounding area for the entire day.

I guess that no one felt the need to inform all the local businesses about this, but then again, maybe we just expect too much. With no water, the dental procedures came to a screeching halt and we were forced to bring these patients out of anesthesia before completing the work. But this wasn't the only fun tidbit that day. No one could use the bathroom (clients or employees); we couldn't wash any bedding; and it was basically impossible to accomplish one single thing (from medical treatments to just about anything else).

Small business owners know that on any given day, something unexpected can always happen. Well it seems to me that we've had more than our fair share of "happenings" lately. I'm always up for some excitement now and then, but why does it have to be something that shuts down business for the entire day? It's not very fun telling clients that they will need to bring their pets back in, put them under anesthesia yet again, and take another entire day to complete work that should have been completed today. If you were one of these clients, how would you feel and how would you want your veterinary hospital handle it? I'm interested in your thoughts.

Thanks for listening and FYI, that whole "stop thinking about needing to pee thing"....it doesn't work so well.

--Dana

Some Good Old Fashioned Communication?

Good communication...it's a simple thing and it can really make a difference in someone's life. A short while ago, I told you about the new medical marijuana dispensary that set up shop right next door to our pet hospital. At the time, I was very concerned given the nature of the"item" being dispensed. Many of you provided much needed reassurance but I was still concerned with all the controlled substances we have at our hospital. It seems my fears are justified, but there is a bit of good news as well. Since the dispensary opened (less than 3 weeks ago), there have been several calls to the police from nearby home owners about excessive noise and disruptive behavior (what a shocker). And then last week, two people broke into the dispensary overnight hoping to steal any of the marijuana they could find. Fortunately, the police were notified by the alarm service and both of these individuals were caught.

Good news you ask? A few days later, there was an article in our local newspaper about the situation. The owner of the dispensary was interviewed and he informed everyone that this dispensary isn't really a dispensary at all....it is simply a place where people can meet with a doctor in order to obtain a medical marijuana card! There are no products or drugs on site, it is simply a small doctor's office. That was music to our ears so please feel free to share!

My question is this...why didn't the dispensary owner share that information with us (and the other surrounding businesses) earlier? I already have enough gray hair thank you very much. So much stress could have been avoided with just one simple phone call. What do all of you think?

--Dana

The Wow Factor

Yes, it's true...American Idol has started it's new season. That's good news at our household as we always enjoy "family time" when we watch the show. As always, the first few weeks of the show highlight the auditions (where you can also observe a cornucopia of mental illnesses). For those with actual talent, I would imagine that the audition process is intimidating and quite overwhelming.

These contestants have a mere 5 minutes or so to make a positive impression on the judges. How do you "wow" someone in 5 minutes? You've got to have a good voice of course, but what else can you do to get noticed or be remembered (other than walking around naked)? It suddenly dawned on me that we also must "wow" clients coming to our hospital in a very short time span. Studies show that first impressions are powerful. If the first encounter is rough, it's very hard to get a second one. So...how do you make the most of those first few minutes?

There are the obvious things...a clean, uncluttered lobby, a warm environment, and friendly people, but I wonder what else pet owners look for in choosing a veterinarian? Most of the time, a client's first impression of us occurs before they even meet the doctor. Those precious few minutes are important (especially in our city where veterinary hospitals are practically tripping over each other).

My question to you is: how do you impress a pet owner in just a few minutes? What kinds of things should be done to stand out? I welcome your ideas (now is your chance to be Simon Cowell)!

--Dana

Education Station

Every year, veterinary hospitals all over the country celebrate February as the official "Dental Health Awareness Month." The goal is to educate pet owners about the importance of keeping their pet's teeth clean and show how regular cleanings can add years on to their pet's life.

At Mountain Shadows, we promote dental health the entire year but in February, we usually offer a 15% discount on all dental cleanings in order to boost participation. So far, it looks like this discount may help generate some new business in this depressed economy. Our hope is that once the client and patient come in, our entire staff can answer their questions or concerns about dental issues.

What are your opinions about veterinarians becoming "educators?" I  talk about that frequently but I've always wondered what separates the good ones from the rude ones. How should a veterinarian go about educating his/her clients without sounding judgmental or critical? I welcome your ideas.

--Dana

Maui Waui And Your Veterinarian?

Never in my wildest dreams did I ever think I'd say the following words, "we've got potential pot problems at our pet  hospital." As everyone probably knows, it is now legal to dispense marijuana for medical purposes here in Colorado. I never really paid much attention to the hoop-la surrounding it  until I saw that a new marijuana dispensary has opened up right next door to our pet hospital (yes, the universe just keeps handing us these little goodies). We were stunned to see the sign outside (apparently there are few to no zoning restrictions for these dispensaries so surrounding businesses do not need to be notified when they've moved in).

Now I'm not going to get involved in all the political and philosophical controversies regarding marijuana usage. As a cancer survivor myself, I understand and agree with the need to help patients with their pain and side effects of chemotherapy. However, I am concerned about how this may impact our business. We are located smack dab in the middle of a residential area (the local elementary school is just up the road). We advertise ourselves as a family practice rooted in the community, but I wonder how the community feels about getting Fido's vaccinations while college students are getting their ganja right next door?

Let's face it, there will be people who buy the marijuana for something other than medical purposes. Ever since marijuana has been legalized, dispensaries are popping up all over the city like weeds (pun intended). As it stands right now, it seems fairly easy to obtain a medical marijuana card (most dispensaries can set same day appointments to see a "medical marijuana doctor" and from what I've heard, hardly anyone is refused). In fact, one can even apply for a marijuana card online (I found this out from reading hot tips from the "Pot Doc").

So here's my question...how much do you think this will impact our business? What, if anything, can we do to address this problem? Should we work to get this dispensary to move to a location farther away from residential areas and schools? Will we lose clients because of concerns over personal safety? I have no clear answers, but I can tell you that it makes me very nervous when I think about the many controlled substances we have on site at our facility. So I appeal to all of you out there.....help please!!!!!!!

--Dana

Let The Goo Keep On Rolling

As any small business owner will tell you...bad things tend to happen in bunches so that when the goo hits the fan, there's a huge mess everywhere. Recently, we have found that owning a pet hospital can be a royal pain when the gooey mess comes calling.

Our goo started before the holidays when one of the water lines from our dental equipment cracked and ended up flooding our treatment area and surgery suite with several inches of water. But hey, after a $15,000-20,000 dollar repair and professional "restoration," things should be back to normal (if this was to be a holiday gift we would have gone with the rotten eggnog and stale fruitcake thank you very much).

Next came the groomer who has been theoretically renting space from us at our hospital. I say in theory because she owes us several thousand dollars in back rent. A few days ago, she dropped off the face of the earth after removing all her belongings in the dark of night. We've not heard from her since and I doubt we will.

But hey that's okay because the veterinary nurse we hired a few weeks ago just didn't show up for work one day. Not even the police know what happened to her but lucky for us she has a key to the pet hospital and we now must spend several hundred dollars changing all the locks and keys to the building.

Many of you have worked in or owned small businesses so these situations may sound familiar to you. My question to you is how do you get through it all until the bunches of goo stop coming?

--Dana

Eye Contact Or Computer Screens?

One of the newest rages in Vet Medicine are EVMR's (electronic veterinary medical records). Just as in human medicine, many veterinarians are using this technology in caring for patients. EVMR's offer the general practitioner a wealth of easy accessible information. There's no flipping through charts, or trying to read an illegible note or lab report. Digital images also allow for better and more precise x-rays.

The downside of all this? It's easy to get lost in the new technology and forget about the most important thing of all...the client and the patient. I've heard about many pet hospitals who struggle with keeping their services "personal" while implementing more advanced record keeping. For example, EVMR takes some of the doctor's eye contact away (to look at the laptop computer). In fact, a study done in human medicine found that 62% of respondents mentioned loss of eye contact as a concern and a barrier to use. (Banfield, Vol. 5, number 6).

For me, I embrace new technology and all the bells and whistles that accompany AS LONG AS the interpersonal communication remains the same! Making a connection with a client is critical for developing trust whether or not there is advanced technology. Things like open body language, eye contact, and interpersonal warmth must always exist in good working relationships.

Have any of you experienced some problems with your veterinarian after implementing new technology? I'm curious as to your thoughts and ideas.

--Dana

Sick As A Dog

Well, we knew it would happen eventually... my morning newspaper (The Colorado Springs Gazette) says that a 13 year-old mixed breed dog is the first confirmed case of a dog with the H1N1 Flu. This dog in White Plains, New York is recovering well but apparently caught the virus from his owner. Dr. Anne Schuchat of the federal Centers for Disease Control and Prevention confirms that dogs can carry and spread viruses, but such cases are extremely rare and should not make people afraid of their pets (just as they said with cats and ferrets).

The dog... suffering from breathing problems, was taken to the Katonah Bedford Veterinary Center in Bedford Hills, New York on Dec. 13th. The dog was tested for H1N1 because it's owner previously had the virus. They expect the dog to make a complete recovery and be "back to his old self" very soon.

Have any of you heard about any other dogs with H1N1? If we become ill with H1N1 ourselves...I'm wondering how we can prevent giving this virus to our pets? Your thoughts?

--Dana

Pet Health Insurance...A Good Idea?

According to the December, 2009 edition of Veterinary Practice News, more than nine out of 10 (94%) pet owners know that pet insurance exists but are likely to avoid buying plans because of cost concerns. An online survey conducted by the marketing firm LePoideven Rickinger Group, polled 800 veterinary professionals and 4,600 pet owners to determine their awareness of pet insurance.

One of the most significant findings was the relatively high number of veterinarians who had no opinion (or a low opinion) of the facts of pet insurance (40% of veterinarians surveyed do not recommend pet health insurance). Pet health insurance has gained popularity over the last few years, but it's still fairly uncommon and somewhat controversial.

Those who endorse pet insurance see it as a way to help save a pet's life by allowing the owner to avoid decisions based solely on "economic euthanasia." This sounds appealing, but there are also people who worry that the proliferation of pet health insurance would change veterinary medicine (and NOT for the better). Many  worry that health insurance would make veterinary costs sky-high and become out of control (just as in human medicine). Also, veterinarians worry about these insurance companies dictating for them what treatments they can provide for their patients.

I can see both sides of the pet health insurance debate. What about you? Do any of you have pet health insurance and if so, what are your opinions and experiences? Would you recommend it to other pet owners? What do you think?

--Dana

Doctors In Dangerous Waters

In October, I presented six lectures at the Wild West Veterinary Conference in Reno, Nevada (WWVC).   I was more than a bit tired after coming home but that conference has made me realize that the field of veterinary medicine faces a very real threat. As usual, I presented material to help veterinary professionals communicate more effectively with their clients in order to promotes client loyalty. The audiences were terrific and quite enthusiastic but I was stunned to see how many veterinary professionals wanted help with taking care of themselves as well as their clients.

My lecture covered the topic of compassion fatigue (a deep physical, emotional, and spiritual exhaustion accompanied by acute emotional pain). Compassion fatigue was originally thought to be a condition that afflicts disaster relief workers, fire fighters, paramedics, etc). In the past 10 years, more and more people are realizing that this type of professional burn-out can affect anyone who works in a "helping" profession. In the medical field, human doctors were the first ones identified as vulnerable but in the past few years, consultants, counselors and managers are addressing compassion fatigue in veterinary medicine as well.

The veterinary profession is a highly stressful. There's a a great deal of animal sickness, injuries, and heartbreaking stories. Workers in veterinary medicine witness death death five times more frequently that their counterparts in human medicine. That's a whole bunch of death and stress. Additionally, since euthanasia is acceptable and practiced routinely in vet medicine, these professionals are the ones who actually facilitate their own patients' deaths (obviously done to prevent needless suffering). Ultimately, no matter what the intent is behind it, it's still the purposeful act of taking a life. Doing this and also supporting grieving pet owners can take it's toll over time.

Ways to prevent and deal with compassion fatigue in medicine are still being developed so many professionals out there are in quite a bit of distress. I worry about these folks and hope that they can learn new self-care skills to make their stress a bit easier to bear. I'm curious as to what you all think (pet owners and veterinary professional alike). Do you see this problem in your own lives or in others in the "helping" professions? If so, what do you think should be done to help deal with it? (photo from Dreamstime.com)

--Dana

Breathing Easier

I've certainly had cats on my mind lately and I've got some great news! I just finished reading an article about a possible cure for feline asthma in one of the latest online veterinary journals (AAHA NewStat 10/28/09). Apparently, 1%-5% of all cats suffer from feline asthma (that translates into 4.1 million cats!) This can be a very serious disease and is potentially fatal so it's good to hear about the progress they're making.

The funding for this research comes from the Morris Animal Foundation. They provide essential funding to veterinary schools all over the country for the advancement of animal medicine. This latest study conducted by Carol Reinero, DVM, DACVM, PhD looks to be quite promising.

Have any of you had cats afflicted with feline asthma? If so, how did it affect your relationships with them and their quality of life? Once again, I ask you cat lovers to send us your thoughts!

--Dana

Lost and Found

If you were to look at the nightstand by my bed, you'd see a messy pile of magazines, books, newspapers, other articles, and chocolate bar wrappers (my kids affectionately refer to it as "Mom's Mess'). Well...I was skimming through "Mom's Mess" the other day and found an article about advances in returning lost animals to their owners using microchip technology.

The November edition of the Journal of the American Veterinary Medical Association (JAVMA) gives details about how the American Animal Hospital Association (AAHA) is launching a startup company that will help reunite lost animals with their families. Many of us are already familiar with the process of micro chipping and the companies which provide these services (American Kennel Club's Companion Animal Recovery, Intervet/Schering-Plough's HomeAgain, Bayer's resQ, and Datamars' PetLink.)

Although this micro chipping process has certainly helped reunite many lost pets with their owners, the system is far from perfect. Data bases can be incomplete, and many of them are not updated on a regular basis. Currently, microchip providers in the U.S. offer about half a dozen major registries in which pet owners can enter information. What AAHA wants to do is establish one single source for recovering information from microchip registries. The hope is that this will create many more happy endings for reuniting pets and their families.

What are your thoughts about using microchips for our pets? Do many of you have your animals micro-chipped and do you think it gives people a false sense of security? I'm interested in your thoughts.

--Dana

*If you're interested in learning more about this issue, you can visit AAHA's website: www.petmicrochiplookup.org. You can also learn more by visiting www.checkthechip.com.  

Close Encounters of The Cat Kind

This past week-end in Denver I lectured to a group of feline practitioners at their annual society meeting (AAFP). It was a fun time, a bit unusual, and a valuable learning experience. It was also the first time that I had ever lectured to veterinarians who work exclusively with cats.

The AAFP is committed to improving the lives of all domestic cats. They support cat advocacy programs and provide advanced medical continuing education for feline doctors. There are those in veterinary medicine who feel that cats are a bit under served when compared to dogs. While it's true that more people own dogs than cats, it's still very important for cat owners to have access to quality medical care.

As I spent time with this group, I started to realize that cat owners deal with some unique emotional issues. As we all know, cats and dogs are quite different as are some of their medical needs. Cats in general, tend to be more stoic than dogs. I've blogged about this stoicism before... but it bears repeating because many cat owners have a hard time knowing when their cat is in any pain. If owners  cannot know for sure, there's always the potential for them to miss a serious illness or problem. This can translate into an immense amount of guilt when their cat dies.

Cats also also tend to have longer life spans that dogs (some live well past 15-16 years and a select few can live into their 20's!)" These longer life spans can create tremendously strong bonds as a person can literally "grow-up" with their cat. When people have relationships with their cats dating all the way back to  childhood, their grief can feel quite overwhelming (they are not only grieving the cat's death, but they are grieving the end of an era as well).

What are some other emotions experienced by cat owners? Do you feel that any of these are quite different than for dog owners? I want to hear from all our cat lovers out there! (photo is of Tammy's cat Henry)

--Dana

A New Type Of Crash Cart?

An article in the October 2009 edition of Veterinary Practice News explores the problems associated with veterinary hospitals that are unprepared for medical emergencies. The thought is that developing and keeping a well-stocked and organized crash cart would create less chaos and make a difference in saving a life. To quote the article, "when emergency medicine isn't a daily routine readiness can lag. In the moment of need, technicians rush to find the appropriate drugs and equipment instead of reaching for it in it's designed space. This reduces the likelihood of a successful recovery."

It occurred to me that veterinary hospitals could also benefit from having an "emotional crash cart." These would be protocols, materials, and other procedures in place to help support the emotional needs of clients during these critical times. Obviously, medical intervention is paramount, but it is also important for the staff to know how to effectively support clients in these unexpected times

I would imagine that many emergency hospitals already have something like this since they see medical crises on a daily basis. How about your average general practitioner? It seems to be an excellent idea to me. I think I'll start developing a formal emotional crash cart for our hospital...what kinds of things should I include to help a pet owner in crisis? I welcome your ideas!

--Dana

A Good Dose Of Job Security

In today's economic climate, almost every business in the country is experiencing difficult times. I was happy then to read about an economic study conducted by "Packaged Facts: a unit of Market Research Group in New York.* According to this study, the overall US market for pet care services will grow annually by about 9 percent and exceed 34 billion by 2013.

That growth is faster than the annual 7 percent rate in the past five years during which the market grew from 17.1 billion in 2004 to 22.7 billion in 2008. The study also says that veterinary services account for 75 percent of the overall pet care services market and is expected to lead growth in the overall market.

This seems logical since veterinary care is the most essential type of service compared to services such as grooming, training, and boarding. I wonder though if the improvement of emotional support in veterinary care is also a reason for this good news? When money is tight, people are probably willing to pay for a service as long as they believe that service is of good quality medically and emotionally.

What kinds of things do you predict for the field of veterinary medicine economically and otherwise? Do you think good communication makes or breaks a business in a slow economy? Let's hear from you!

--Dana

*Source (Veterinary Practice News, September 2009, Page 5).

Let's Hear It For The Nurse!

The September/October issue of Trends Magazine has an interesting article about veterinary as technicians (at our hospital we call them nurses) and how they are under-utilized. Overall, it seems that they are not doing many of the tasks that certified nurses are specifically trained to do. However, with the emergence of larger veterinary hospitals, things are changing. The nurses are no longer limited to just holding patients, drawing blood, and filling prescriptions. In fact, they are starting to take on similar roles much like nurses in human hospitals. This means that they can monitor a patient's condition, summarize intake findings, and carry out treatment protocols that the doctor prescribes.

When nurses take on more tasks and responsibilities, the hospital benefits by saving money (the nurses are doing tasks that are often done by higher-paid veterinarians and the doctors have more time to do things that only a doctor can do ( such as diagnosing a medical problem or performing surgery.) To quote certified nurse, Elise Atkinson at Alameda East Animal Hospital..."we want responsibility , and above all, we want doctors to have faith in us."

At our hospital, we try very hard to utilize our nurses effectively. We even have what we call "nurse-only appointments" (they involve things like vaccinations, wound checks, and removal of stitches). By utilizing our nurses more effectively, they also seems to have more job satisfaction because they are being challenged more. It's a win-win situation across the board.

As pet parents, what do you all think? How do you view the veterinary nurses who work with your veterinarian? What kind of experiences have you had and do you think they are under-utilized? All you nurses out there...please feel free to chime in! (photo from bigstockphoto.com)

--Dana

All in the Family

I recently saw an article in the newspaper that predicted in 20-30 years, small veterinary practices will be a thing of the past (presumably swallowed up by the big companies like Veterinary Centers of America). Obviously, as co-owner of a small practice, this prediction is worrisome. However, even if you take the monetary issues out of the eequation, I wonder if these massive veterinary hospitals can offer the same type of personal touch a local veterinarian does.

With human medical care, the notion of a "family doctor" already seems to be dying out in today's world of specialists and insurance requirements. Some people welcome the change, but I wonder how losing your neighborhood veterinarian would affect pet owners and their pets? We always talk about how relationships are the key to a successful businesses, but it can be pretty hard to develop a personal relationship with a practice that has 50 doctors on staff.

How do you think human medical care has changed now that family doctors are few and far between? You can certainly make the argument that the larger, more specialized hospitals can provide the most advanced services, but can't the family doctor provide this too? What about the benefit gained from the doctor knowing his/her patient's medical/life history? It's an interesting question. Does successful medical care require a good relationship with the doctor? I'm curious to know your thoughts.

--Dana

A Skunk In The House

Many veterinarians will tell you that one of the best parts about their job is that they get to see a variety of animals. Over the last 10 years since we've owned our veterinary practice, we've made of list of the most unusual patients we have seen (our list includes snakes, lizards, various types of rodents, and even a squirrel)!

Well, we can now add skunk to the list! I know that this is not earth shattering news...there are quite a few people out there who own skunks...we've just never seen one at our hospital. If you can take away the odor problem and the potential for rabies, it sounds like skunks can make very nice pets but I have some doubts I think it's wonderful when people have connections with animals, but I'm not quite sure how to draw the line with wild animals.

I'm curious about your thoughts...what is an acceptable pet and what isn't? Is there such a thing? Is the size of the animal the determining factor? Over the years, I've known people who have owned bears, wolves, chinchillas, and wild cats (tigers and lions). Should people own these types of animals and what issues are created? Let's hear you. (Photo from metro.co.uk)

--Dana

Should Vet Technicians Be Able to Euthanize Pets?

I had an interesting conversation the other day with a veterinary technician...one who is educated, licensed, dedicated to her field, and takes advantage of continuing education opportunities to deepen her training in all aspects of her field.  The conversation was about the movement to allow technicians greater freedoms and responsibilities in practice.  This would require practice owners to pay them more and may require the techs themselves to carry more liability insurance.

The tech I spoke with explained that, at present, she can't administer controlled substances without supervision, etc.  "This means I can't be the one to euthanize a client's pet, even if they prefer to have me do it."  In her practice, she gets very close to people and forms real relationships with them.  When it comes time to euthanize the pet that she and her clients have cared for together for so long, some are disappointed that she can't complete the care she has always provided.

If your clinic allowed veterinary technicians to have this kind of responsibility, would you prefer to have a staff member conduct your pet's euthanasia or do you feel this is a role only a veterinarian should play?  I have mixed feelings about it.  I've certainly known many, many vet techs who would have been totally capable (and most likely even more emotionally supportive) of putting my pet down, yet, philosophically, I guess I believe this is a job for the veterinarian.  And, I think the techs should be in attendance, providing emotional support for the grieving owners.

I've been at hundreds of euthanasias and it's important for the vet to remain medically focused.  Occasionally, things do go wrong and, when they do, someone has to know what to do RIGHT NOW and someone else has to be able to focus on the pet owners to calm them and help them understand what is happening.  I think euthanasia is at least a two-person endeavor.  If techs are able to perform this service on their own, I'm afraid they may be over-burdened with it, with many vets (who are uncomfortable with the emotions and client time associated with it) all-too-often passing the task on to them, especially if the tech is a female.

Which would you prefer?  I can see lots of "people" issues arising from this change...what would they be for you?

--Laurel

"Dr." Groomer

Let me start out right now telling you that groomers as a whole, are terrific people and work hard at what they do. They care about their clients and their pets. However, we occasionally have difficult days when a groomer has "diagnosed" a problem with a pet and the owner comes in telling us what treatment must be done.

Groomers, animal behaviorists, trainers, and animal care specialists certainly have experience working with animals and have knowledge that exceeds the average person. They can alert an owner about a change in their animal's coat or other problems. But...it is a bad situation when a client comes to us saying that the groomer has decided her dog has cardiac problems (this happened just last week). ???? How would the groomer come by that conclusion? That's a pretty bold statement and seems out of bounds to me. What's worse is that the client often believes the groomer even to the point where they argue with the veterinarian about the diagnosis. I'm sorry, but this makes about enough sense as it does for me to consult my hairstylist about my cancer treatment. It just seems weird but it happens more frequently than you think.

Because owners are loyal to their groomers, it can be very difficult to convince clients that their groomer is incorrect about advice they've given (especially with dermatological problems). It's also frustrating because the pet is the one who suffers the most. It would be so much easier and save a lot of time and heartache if groomers refrained from diagnosing medical problems all together.

Opinions everyone...what are your thoughts about this? If there are any professional groomers or animal care specialists out there to lend us your opinions? I welcome your ideas and feedback! (photo from bigstockphoto.com)

--Dana

Finding The Safety Net

Most veterinarians who own a practice have experienced it before...it's the stressful and regrettable job of having to "fire" a client. This happens so rarely (thank goodness), but it is an amazingly stressful experience for the entire hospital staff.

Last week, we had to face this stress and ask a client to never come back to our hospital. There's no doubt that we did the right thing (he made several overt threats to our staff members; and he mentioned bringing a gun each time). He started coming to us because another veterinary hospital had fired him the week before. It feels so wrong to turn away a sick animal, but we simply had no other choice. We're lucky because this other hospital warned us when this client requested his records to be sent to us. They helped us to be prepared and it was nice to know that competitor or not, we're all in this together.  

At our staff meeting, we discussed our frustrations about the situation. It's always so hard to see an innocent animal suffer at the hands of a disturbed person but this situation allowed us to talk with our employees about safety policies. You never want to think about those things, but it's necessary and we took this time to debrief. Everyone on staff told us that this debriefing was quite helpful.

I'm curious about your thoughts. At what point is it necessary for a veterinarian to "fire" a client? How should the veterinarian determine these things? I'd like to hear from you!

--Dana

"Soft Skills" Deluxe

Here at the café we often talk about the importance of effective communication in the veterinary profession. In the past 20 years, there's been an impressive "communication movement" that has allowed many more veterinary schools to improve their training and many veterinary organizations are offering more continuing education about these issues. While many veterinary schools and professional organizations are addressing this need, there is still much work to be done.

The September 8, 2009 on-line issue of Exceptional Veterinary Team magazine (myEVT) contains an article discussing this very problem. In the article: "Veterinary School: What They Don't Teach;" Dr. D. shares her frustration about having limited training in this area and how she felt unprepared to deal with her clients emotions in her first job out of school. The author states, "although I was confident in my medical skills, the way the client's tear-filled eyes locked onto mine as I explained the effects of snake bites made me more than a bit nervous...after all, veterinary school taught me how to treat an injury but not how to deal with distraught pet owners."

It's true that many more veterinary schools today are changing and adapting their curriculum to help students learn communication skills. It's also true, however, that there are some schools that still provide no training at all. The financial pressures Universities face in today's economy are just as intense as the pressures in many other institutions and businesses. It can be hard for them to find adequate resources to provide training with Dr. D. calls the "soft skills." When push comes to shove, they feel that the medical information has to take priority.

What do you all think about this issue? How do you go about ranking the importance of topics in veterinary curriculum? Should there be a formula, and what should be done when no money is available to teach communication skills? I'd like to hear your thoughts! (photo from istockphoto.com)

--Dana