All The World's A Stage

My wife is a big drama nut. She loves performing, and minored in drama in college. Maybe I'm partial, but I think she's quite good. We've been in this area for about three years, but she hasn't gotten involved with the local community theater. That is, until now. Earlier this week she auditioned for Shakespeare's Much Ado About Nothing. The crazy thing is that she somehow managed to talk me into auditioning as well.

When I was a senior in high school I was a co-star in two plays. At the time I thought I was pretty decent and auditioned for a part in a play when I started college. That's when I discovered just how outclassed I really was. Since then I've had parts in various church plays, but have never tried out for anything in local theater. Mostly that's because of a lack of real interest. I kind of like acting, but it's not in my blood like it is in my wife's. She is passionate about all aspects of theater and talks about the thrill of the smell of greasepaint. Me? Not so much. I actually like acting, but I hate memorization. And unfortunately that's kind of an important part of theater. Really, I agreed to audition because my wife wanted me to, and I really can't resist when she bats those beautiful brown eyes and gives me "that look". I melted and caved in.

The audition went well, and we were both offered parts. I'm playing Borachio and she's playing Margaret. Both are supporting roles, but it gets her foot in the door with the theater company. And I have to say that I'm actually kind of looking forward to it. I've been a big fan of Shakespeare for years, though I completely disagree with studying it as literature. Shakespeare wrote plays, not books. His works are meant to be performed and seen, not read. This play is a comedy, and looks to be a lot of fun.

To anyone considering a career as a veterinarian, remember that your job is not your life. You really need to have interests and pursuits away from work or you'll go insane. Now we just have to figure out a way to juggle work, kids, church, and play rehearsals!

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A Vet's Life, Part 3

And here's the last of Lani's questions on what life as a veterinarian is like.

What are some of the negative aspects of it?
Well, it's pretty rough to have the skills and ability to help a pet, but the clients can't afford it or won't do the treatment. There are lots of clients who willingly don't give their pets the care that they really need, and spend money on grooming rather than heartworm prevention. It's not fun to have to deal with aggressive pets. There is a lot of mental stress because your skills and knowledge are often the difference between life and death for a pet. Managing a business can be difficult, since you have to handle finances rather than medicine, something you don't really get training in.

What are the type of animals you typically see other than cats and dogs?
Most small animal practitioners see only dogs and cats, and it's uncommon to find many vets who do a lot of work on other species. However, I have an interest in them, so I've gotten to see many kinds. Here's a quick list: macaws, cockatoos, parakeets, cockatiels, finches, several species of turtles, several kinds of snakes, geckos, bearded dragons, uromastyx, water dragons, iguanas, anoles, guinea pigs, hamsters, rats, gerbils, and sugar gliders. I may have missed a few in there, but that pretty much covers it. The main lesson is that pretty much the only species you can't treat is humans. Every other kind of animal is a potential patient if you would like it.

Lani, I hope this gives you a better idea of what it's like to be a vet and helps you make your decision. Good luck, and thanks for the questions.

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A Vet's Life, Part 2

Here are more of Lani's questions...

Do you get the freedom in your job (ie. do you get to be your own boss?)
Like the situation with hours, it depends on where you work. If you are working for someone, your freedom is limited, as you have someone else making the decisions as to what you are going to stock, what you are going to charge, and how the practice is going to be run. A good practice owner will listen to your suggestions and may implement them if they are reasonable, but in the end it's their decision, not yours. Owning your own practice definitely gives you complete freedom, but is more business responsibility than most people want. Running your own business is a huge responsibility and just as much of a headache. But for the person with the right skills and personality, it can be extremely rewarding. There is an middle ground, which is what I'm doing. I manage a hospital for a multi-location practice. I have a lot of freedom to manage via my style, but I still have to stay within the practice's guidelines and still have people I answer to.

Do you ever get tired of working with animals?
For the most part, no. I love animals, or I wouldn't be in this field in the first place. There's something in me that craves being around animals (which is why we have two dogs and three cats). However, I get very, very tired of having to deal with aggressive animals, which happens at least once or twice every day. It's part of the job, but I don't like risking a serious bite or scratch. There are many days when I'd be happy dealing only with my own pets.

Do you get a lot of time for your family?
Nowhere near as much time as I would like, and it's a problem sometimes. Truthfully, though, it's no different than any other job. I leave for work around 8:15 most days and get home around 7:30. That gives me about an hour with my kids each day, and about 3-4 hours with my wife. I do get two days off per week, and when the kids are in school my wife will meet me for lunch about once per week. I also get enough vacation time that I get to have time off with the family. So I can't say that it's really much worse than most other jobs. If you do your own emergency calls it can be tougher on family time, as you may not even get those few hours per night with your family. If you own your own practice, it's even worse, as you often have a hard time leaving the place in the hands of other people. As a business owner, your entire existence is tied up in the practice, making it hard to get away.

Tomorrow...the last of Lani's questions.

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A Vet's Life, Part 1

Lani sends this increasingly common scenario, wanting to more about life as a veterinarian.

I came upon your blog a few days ago, and have been reading up on your posts. I am currently in law school, and I have one year left. After going through it, and after having experienced a legal career over the summers, I am no longer sure I want to be a lawyer.

There is no freedom in your schedule, it is a very cut and dry atmosphere (there isn't a whole lot of joking around), and most attorneys hate their jobs. I am currently 23, about to be 24, and I am thinking about making a major career change and go to vet school. I have already researched it, and I would have to go back to undergrad for a year to get my second bachelor's degree in science. And then I would have 4 years to get my DVM. I think I will be 30 once I actually start working.

Can you tell me more about your life as a vet?

I've answered questions like this in the past, but Lani has some interesting and new inquiries that I'll be addressing over the next couple of days.

What are the hours?
Depends on the practices, really. Most new practitioners can expect to work 40-45 hours per week, though the daily hours will vary. Some practices keep a standard 9-6 schedule, but more and more are opening earlier and closing later. Many practices do their own emergency work, meaning that you'll have to be on call from time to time. However, this is not the rule, and many don't do any after-hours work at all. Because this is so variable, you'll want to ask around a lot when you're looking for a position.

Was all the schooling worth it?
Whew, there's a pretty weighted question. Most vets would say that it is definitely worth it. I'm maybe not so certain about that, but this is just me. Financially I would have to say that it isn't worth it. The debt-to-income ratio for vets continues to worsen. I was reading an article in a journal last week that discussed this issue, and it stated that student debt was growing at an unsustainable rate. Within the next 5 years a new graduate needs to make a starting salary of over $100,000 per year simply to be able to afford to pay back their loans. This is about double what the current starting salary is, and is also more than most existing practitioners make. Now, you would get many who would say that the joys of the profession outweigh the financial issues. However, you still have to pay your bills, and that's hard to do when 50% of your monthly salary goes to loan repayments. You'll want to spend some time working with a local vet to see if you think it's really worth it. To be perfectly honest, I don't know if I would make the same decision again, knowing then what I know now. But studies have shown that 80% of vets surveyed are very happy with their choice of profession.

More of Lani's questions tomorrow!

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It's A Small World After All

One of the things I love about the Internet is how it can bring together people from various nations and cultures in ways previously unheard of. I have met people from literally every continent except Antarctica without ever leaving my home. There is really no way that I would ever have a chance to meet these people other than through the wonders of computers. My father is originally from Sweden, so I have an interest in learning about other nations and cultures, finding the differences and the similarities curiously fascinating. In this very blog I have interacted with people in numerous countries, and found commonalities that we may have never expected.

I bring this up because I added a few gadgets to my sidebar. Scroll down to the bottom of the bar on the right, and you'll see a counter and a map. First, I was surprised to find that in the last 48 hours I have had approximately 100 unique visits to this site. That's far more than I expected. I know that have more readers than make comments, but I figured maybe a couple of dozen, not far more than that. The map is also interesting, as it tracks where the IP addresses originate. I knew that I had readers in England and New Zealand, but some of the other countries surprised me: India, Malaysia or Indonesia (hard to tell on the map), and far northern Canada. I expected readers across the US, but didn't realize that they would be so wide-spread.

So my humble little blog has generated literally world-wide interest!!!! Wow, that sounds pretty crazy to say. Makes it seem bigger than it is. But it's fun to think of the people that are hopefully finding my entries interesting, educational, thoughtful, and fun.

So keep watching to see how all of this grows. I certainly will!

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Little Land Sharks

Today I read an article in one of my journals that might be surprising to laypeople, but wouldn't be a surprise to anyone in the veterinary field. The title caught my interest.

"Study: Chihuahuas bite vets most; Lhaso Apsos inflict worst injuries"

A study performed in Colorado studied bite statistics and learned some interesting facts. The tendencies of certain breeds to bite was one of the most telling items. Labrador Retrievers were the most likely to bite at 13% of the total. This was followed by Pit Bulls (8.4%), German Shepherds (7.8%), Rottweilers (3.9%), and Chow-Chows (3.5%). Among children the data was similar: Labs (15.6%), Pitt Bulls (7.5%), German Shepherds (6.8%), Chihuahuas (4.2%), and Rottweilers (4.1%). However, just because a dog was likely to bite didn't mean that the bite was severe. The most severe injuries were made by American Bulldogs, Dalmations, Dachshunds, English Bulldogs, and Lhasa Apsos.

The study was not without possible flaws, as it is estimated that only 6.2% of bites are actually reported to animal control. And in the study, only 0.28% of the dogs estimated in the area were responsible for bites. It is also likely that bites from large breeds are reported more often than bites from small breeds, making large breeds overrepresented and small breeds underrepresented. About 40% of all bites are by mixed-breed dogs.

I often tell me that I'm much more likely to be bit by a chihuahua than a pit bull. However, if the chihuahua bites me it will be annoying and at worst may need a stitch or two. If the pit bites me, I'll be lucky to not need major surgery. My experience has showed me that chihuahuas are one of the breeds most likely to try and take a piece of me, and I'm very cautious around them. Pit bulls are some of the friendliest that I generally work with, at least towards people. I'm cautious around many terriers and shih-tzus, as well as chows, German shepherds, and Rottweilers. But I've seen friendly and aggressive dogs in just about every breed.

The risk of being bitten is one of the major daily hazards of the profession. Most of us get good at reading body language and learning how to avoid bites. But every once-in-a-while we misjudge a pet and manage to receive a wound. Thankfully, none of the bites I've personally received have been very serious. But I still have decades of career left to get a bad one.

So watch out for those small dogs! You may not think about it, but they're the ones you have to be careful with.

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A Kitty's Mysterious Wrists

Here's one of the most interesting cases I've seen, sent in by Denise. This is the set-up and history.

My daughter's kitten, Skeeter who wax 6 pounds the other day at the vet, is 10 mos old, female, not spayed yet. She is from a litter of 8, she was #7. Her and her itsy bitsy sister #8 [both were super tiny] survived with our help and have done very well, very healthy, gorgeous fur, happy and very playful. No problems at all - till now. As for nutrition, free food with Diamond Natural's Kitten food till about two months ago when I switched them to Purina One. About a week-1/2 ago Skeeter started walking with a slight gimp on the front, very slightly but I noticed it and kept an eye on her. Then I noticed that she was starting to walk leaning to her wrists, sloping if that makes sense. Both her front legs look very much looks like a dog with carpal hyperextension. We took her to the vet today, they took xrays, and were not sure what to tell us. They told us: Possibly genetic, possibly due to her being so tiny at birth, possibly an injury to both front wrists from jumping off the counter like felines tend to do. They mentioned they could have been broken, I just don't see that and would not know when that could have happened. Our cats are like our kids and loved, and spoiled rotten. No answers from the vet though, they seemed a bit perplexed and that is not comforting because we do not know what route to take now. We are getting a little desperate, because she is pretty uncomfortable and the way it showed up. So fast. She favors the left more and being just 10 mos old that is so sad. We do not want her to suffer. The slope seems to gradually increase, even in just a week. She is not as active now, sleeps more and I can only think it's due to the uncomfortable-ness(?) of the wrist joints.
If it's surgery to fuse a bone to both wrists, to correct this like in hyperextension, is this normally successful for a long happy life, in cats? I read it is for dogs, but can't find anything about cats. And - by the xrays, if you see the problem, how long do you think we have, to raise the money for surgery, before she suffers immensely from this.

Denise, congratulations. You have now stumped four vets, one of them a board-certified internal medicine specialist. This was an odd case, so I ran it by a few other vets I know to make sure we were covering the right bases. The general consensus is that this is an extremely odd case, one that everyone is having a hard time figuring out.

First, I don't see evidence of a fracture in any of the x-rays (to the other readers, she provided several). The case also looks like carpal hyperextension (like you mentioned), which doesn't have to be related to a fracture. This doesn't rule out trauma, just not likely a fracture. Many of the other possibilities are very unlikely due to Skeeter's age and other health status. For example, diabetes can lead to neurological problems that can cause a similar stance in the hind legs. However, it really doesn't normally affect the front limbs, and a kitten her age simply shouldn't have diabetes. I was able to come up with several possibilities.

1. As your vet mentioned, jumping from a high location could cause trauma. This can affect the tendons and ligaments, not just the bones. A situation like this can get progressively worse as more and more damage is done every time she walks. Even though it is not in the bone, a situation like this may require surgery, including fusion of the wrists. A young cat can learn to walk well with fused wrists and can indeed live a long, normal life. It's a bit tougher for a cat since they're normally so flexible, but the can adjust.

2. Nutritional or metabolic diseases can lead to deficiencies in certain minerals or electrolytes that can lead to damage like this. It would be a very rare occurence, but this is already a strange case. I would recommend having your vet run a full blood panel including electrolytes to see if there are any noticable abnormalities.

3. Neurological disorders can manifest like this, but it would be very strange to affect such a specific location and evenly in both limbs. The internal medicine specialist asked several questions about this, including whether or not she was tested for feline leukemia, as it can lead to neurological issues. If your vet hasn't done this recently, have it done or repeated. Even if the test was previously run and was negative, run it again. Sometimes this virus can take some time to develop to the point of being detected. This is a small possibility, but one that can be tested for in your vet's office in a matter of a few minutes.

4. A developmental abnormality is definitely a possibility. However, by 10 months old most of the bone and soft tissue growth is completed. If this was a genetic disorder leading to improper growth, we would expect to see it sooner. However, since this is an usual case, there are instance where the soft tissues will grow at a different rate than the bones, potentially leading to situations like Skeeter. If this is the case, she should grow out of this within the next month or two.

In the end, this is a very tough and unusual case. If this was seen in my office, I would recommend having a consultation at a specialty referral practice or veterinary school that has several specialists. That way you can have both an internal medicine specialist and an orthopedic specialist evaluate the case. But prior to that have your vet run the blood tests. This doesn't appear to be serious or life-threatening, but I would pursue this as quickly as possible because of her discomfort.

Denise, I really wish you the best with this, and wish I could give you a more definitive answer. Please let me know how Skeeter turns out, as I'm very curious. And since I have readers who are vets, I would be appreciative if any of you could add any differing viewpoints or opinions.

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Advice To Wannabe Vets, Part 6

#8: Remember that veterinary medicine is what you do, not who you are.
Life balance is one of the biggest issues facing many people, and vets are no exception. We go into this profession knowing that we will work long hours and make a fraction of the salary as our colleagues in the human field. This is our choice, and one driven by compassion and dedication. However, the emotions that push us into the field of animal medicine over human medicine can also lead us to focus more on our job than our lives. Finding that balance is tough, and something that I'm still working on 12 years after graduation. But it's very important, even more so as my kids grow older. If you focus only on your work to the detriment of your private life, you will find yourself burned out and lonely. Go to work and work hard. But when you leave, truly try to leave it behind. You don't have to live, breathe, and eat veterinary medicine 24/7. It's okay to have a life outside of work, and even *gasp* put that life AHEAD of work.

So that's my last bit of advice (for now) for those wanting to or about to enter the world as veterinarians. I hope this has been a bit of an insight for the laypeople reading this into the mind of a vet, and useful for those who have yet to receive their degree.

Tomorrow I have a very interesting and unusual case submitted by a reader.

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Advice To Wannabe Vets, Part 5

#5: Study allergies closely.
Another issue that comes up on a daily basis is that of allergies. This can be a complicated topic, and rarely has a straight-forward diagnosis or treatment. It's also very frustrating for a vet and a client to deal with, since the goal is treatment, not cure. I have seen way too many vets who rely on steroids as the only treatment, or who ignore allergies as a cause of chronic skin and ear problems. If you can remember how to handle an atopic dog or cat, you will be a better vet and will provide your clients with much better treatment.

#6: Remember that any mistakes you make have already been made by someone else.
It's hard to consider, but doctors aren't perfect. At some point in their career every single doctor has misdiagnosed something, completely missed a finding, chose the wrong medication, or slipped during a surgery. Hopefully this happens only rarely, but it will definitely happen. Your career will go on, and you will be okay. Whatever stupid mistake you make, someone has done it before you and gone on to be just fine. That's not to say that it's okay to make mistakes. Just realize that it's going to happen, and learn how to move past it. And never make the same mistake twice.

#7: There is more than one way to do the same thing correctly.
As a student and then a new doctor you will have many people telling you that a certain thing is the way that you should do something. Don't ignore that, but also be open to learning other things. I know of at least a half-dozen different ways to tape in a catheter, and all of them work just fine. Learn all of the methods that you can, then figure out which one works best for you. The best method is the one that you do best. There are very few things in medicine that MUST be done only one certain way.

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My apologies....

... for not having posted for quite some time. Suffice it to say that I have been going through a very difficult personal period and that it has been extremely difficult to find the strength to do some of the things I enjoy most, like blogging and painting.
I will overcome this. This post is not to garner pity from anyone, but rather to express that, as all of us have experienced at some point, I am trying to overcome an unexpected curve ball that has recently been pitched at me.

This difficult period has been exacerbated by the recent euthanasia of my wonderful cat, Isaac, seen in the photo at the top of this page. I had been treating him for diabetes for about two years, and following a relatively recent additional diagnosis of acromegaly, it was evident his diabetes became uncontrolled. While he was not overtly suffering, his consumption of water had increased significantly and his voracious appetite, while I had previously written about it in my blog somewhat humorously, was really the only thing that was defining this cat. He lived to eat, would rarely leave his empty food bowl, and beg for food like a starving roadside village waif. His urine and stool were foul, reeking the house to a point where guests could not come over unless the house were fully aired out. The decision to euthanize him was based not only on condition, but on our suffering. Callous it may sound, but this is fact. While I could not predict exactly when, I knew that at some point he would start showing overt signs of suffering: he would develop ketoacidosis from uncontrolled diabetes, as well as the likelihood of starting to manifest neurological symptoms like behavioural changes and seizures secondary to acromegaly (caused by a pituitary tumor, which was spilling excessive growth hormone into his bloodstream). I was resolved it was his time, our time.
It was performed by me, peaceably, lovingly, painlessly, while he purred away in his owners' arms, knowing that they loved him as much as a human being can love anything.
Isaac was buried in a quiet corner of the backyard, with a large flagstone covering the earth over his grave, in which his body now lies still, while his spirit is meowing, hunting, and craving pizza somewhere above us.

Isaac, the cat: RIP 1995-2009

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Advice To Wannabe Vets, Part 4

#4: Learn how to do dentistry.
I'm not sure how training is in other countries, but here in the US vets really don't receive enough training in dentistry. When I was in school we had a single lesson in dental cleanings, no real lessons in extractions, and a couple of lessons in dental structure at all. I mentor a lot of new graduates and students, and it seems like it hasn't really changed since I graduated. This is a major oversight in veterinary education. In private practice we educate virtually every client on dental care and the consequences of dental disease. We do dental cleanings almost every day, and often multiple times in a day. Extractions are common, and they're not easy to do if you don't know certain methods. I'll readily admit that I hate dental work, and would never do it again if I had the option. However, I really don't have that option. Dentistry is an essential part of private small animal practice and something that every vet needs to be proficient in. Now, I'm not talking about going into specialty dentistry (yes, there is a board certification in dentistry, and these vets can do caps, crowns, root canals, braces, etc.), just learning how to be good at the basics. As much as you may hate it, you're going to do it every day. Probably 95% of what I learned was after graduation through attending continuing education lectures and reading journal articles. When you go through vet school and after you graduate, take it upon yourself to learn as much as you can about dental care and extraction procedures. It will make you a better vet and actually make your job easier.

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Tough Decisions & Lucky Breaks

Yesterday I saw a young boxer named Rocky. He came in for very vague signs of acting lethargic, not eating, and not drinking. When I examined him, he was overall in good condition, but obviously didn't feel well. Mysterious malaise usually necessitates running a battery of tests to try and figure out what the problem may or may not be. Unfortunately in this case the owner was a young man with extremely limited funds. The lab tests were $155, and that's with giving him a free office visit as a courtesy. He had an upper limit of $150, and that was with his father chipping in $50 and him not really eating for the rest of the week. So not only could he not afford the recommended tests, but if we did find something wrong he couldn't afford any treatment.

That left us with tough decisions. We couldn't completely waive his fees, but we had to work within his budget. We needed to run a full series of tests (chemistry panel, blood cell count and differential, electrolytes, and urinalysis), but he couldn't afford it. And we couldn't just randomly pick a medication and try it, because we had no idea what was wrong. We struggled to decide which tests to run, trying to do it piece-meal. The problem with doing it this way is that the test you leave out may be the one that gives you your diagnosis; you don't know that until you run them all.

After going around the issue a few times, I decided to run some blood tests, as it would at least rule out serious issues like kidney failure, pancreatic issues, or liver disease. We usually collect blood from the jugular vein in the neck because it's an easy and large vein to access. When we lifted his neck to get to the vein, he whined in pain. That surprised me, and totally changed the picture. Instead of drawing blood, I began to manipulate his neck. It became quickly obvious that he was reluctant to move it, and would cry in pain when we tried to move it too much.

Severe neck pain was the likely cause of all of his symptoms. It was also a very specific sign that we could consider a limited list of possible problems. When we talked to the owner, we discovered that Rocky lived with and played with a lab that was literally twice his size. My suspicion was that they played to rough and the other dog accidentally injured his neck. There was a strong likelihood that it was simply a bad muscle sprain or twist, though there was also a possibility of a slipped disc in the neck.

Our whole game plan changed. X-rays were the next step, but they would have been far above the owner's budget. However, now we had an identifiable problem that we could direct treatment at. I sent him home with some medicine for pain and inflammation, with instructions to strictly restrict activity and exercise, use a harness rather than a collar, and not let the other dogs play. The owner gets paid next Friday, and if the problem persists, he is going to come back for radiographs. However, we may have already put him on the right treatment, and were able to get him out for about $30.

If we hadn't decided to run blood tests, we wouldn't have moved his neck significantly enough to cause pain. And then we wouldn't have isolated the problem to neck pain. We got a lucky break yesterday. And the owner was left with enough money for gas and food.

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Advice To Wannabe Vets, Part 3

#3: Never forget the importance of customer service.
Veterinary medicine is a service industry, whether or not everyone realizes it. And in a service industry we have to remember how to treat our clients well. If they like you, they will continue to come back and see you. Liking you isn't all about your medical and surgical skills, though this is important. Clients will like you if you're nice to them, compassionate, and treat them well. The question is "how". I tell people to think about times they have gotten great client service. Here are a few of mine.

I was at a Tiger Direct Outlet Store in Raleigh doing some minor shopping for computer equipment. As I was leaving, my son asked for some candy from the candy machines at front. I told him that I was sorry, but didn't have any change. The manager walked over, put a quarter in the machine, and turned the knob. I was surprised, and told him he didn't need to do that. He said it wasn't a problem, and he had a son of his own so he understood. That twenty-five cents made me a customer for life, and I have told many people about the excellent client service I received. For a small personal investment and a minor gesture, he received my business as long as I lived in that area.

One time I ate at a Logan's Roadhouse restaurant, the first time at that location. They messed up my order, which is never a good thing. But both the waiter and the manager were exceptional in how they handled it. They didn't charge me for the meal, which is typical in such situations. However, they were appropriately apologetic and went out of their way to talk to me and make sure that everything went well. Despite the mistake, we continued to go to that restaurant because of how great they were.

Client service isn't hard. It's a matter of small gestures, honest treatment, and true caring for the client's desires. No, the client isn't always right, but there are ways to handle even the difficult people. Someone who can give great service will be very successful.

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A Problem With Royal Pains

Yes, I know I already blogged for today, but I really need to get this off my chest. So forgive the rant.

Tonight I watched an episode of the new USA Network series, Royal Pains (it comes on right after Burn Notice which is my current favorite show). In the episode the main character, a doctor named Hank, is dealing with a mysterious respiratory infection causing pneumonia among members of a household and then party. As he's working on one patient, he picks up her dog and notices that the dog is warm. He then touches the dog's chest and notes a "dull spot". His immediate conclusion is that the dog is the source of the infection, especially once the owner says that her vet has had him on medications for kennel cough. My interest (and skepticism) perked up at that, and I paid closer attention. Unfortunately, the episode became completely unrealistic from that point on. Let me point out the problems that are driving me crazy and would be missed by the average public.

1. Hank barely touched the dog and noticed that he was warm. A dog's normal temperature is 101-102F, several degrees warmer than a human. Unless he had extensive experience with pets, how would he notice an even warmer temperature?

2. Hank noted a "dull spot" when he touched the dog's chest. The writers probably intended this to be evidence of him doing percussion on the dog. However, percussion involves listening to the chest while you're "thumping" it. He didn't use his stethoscope, so he couldn't have been certain of a dull spot, especially with simply touching it. And that's assuming that he even knew what a dog's chest normally felt or sounded like!

3. Hank looked at the dog's medicine, which included antibiotics and antivirals. The vet had prescribed the medicine because of kennel cough. First, we really don't routinely use any kind of antiviral drugs in dogs, as there haven't been much testing or approval. Second, kennel cough is a bacterial disorder, not viral. I don't know any vet who would prescribe antivirals if they suspected a bacterial infection.

4. Hank then proceeded to do minor surgery on the dog. It was never stated what kind of anesthetic he used, and I can't imagine what he would have had in his truck or bag. I also can't imagine that he would have known what dosage to use, as medicines are dosed very differently in human and veterinary medicine. Physiologies are also different, so the doses are rarely the same. He could have easily killed the dog by using the wrong drug or dose.

5. Hank intubated the dog while it was upside down using his laryngoscope. This is how it is done in human medicine, but not in veterinary medicine. In fact, it would be very difficult to do it this way, not the quick, easy procedure that he performed.

6. The entire scenario with him anesthetizing the dog and performing surgery on it was illegal!!! As a veterinary doctor, I am legally only allowed to practice on non-human patients. Human doctors are only allowed to practice on human patients. Hank practiced veterinary medicine without a license, which is very illegal. This is just as bad as if I decided to do surgery on one of my friends. He also did it without proper knowledge of animal anatomy and physiology, which could bring him up on malpractice charges as well. My knowledge of veterinary medicine does not give me equivalent knowledge of humans. In fact, I wouldn't have the faintest idea what dosages of any medicine to use in humans, and certainly would never feel comfortable trying to anesthetize and intubate one.

7. He drained pus from the dog's chest, and then proceeded to fashion a home-made microcsope out of a jeweler's loupe and a lens from what looked like a telescope. He looked at the pus and immediately was able to identify methicillin-resistant staphylococcus. This is ridiculous for several reasons. First, you need 1000x maginfication to really get a good look at bacterial shape and structure. You can't get that maginfication from a loupe and telescope. Second, you really need to stain bacteria in order to identify them properly, which he didn't do. Third, even if he had that magnification, you need a focused light source and immersion oil on the lens to be able to see clearly. His "microscope" was illuminated by a flashlight held at an angle and the end of the scope never touched the "slide" with the pus. Too little light and too far away to tell what he's looking at.

8. Let's assume that he did actually did have a microscope and could clearly see the bacteria. All he would have seen was cocci-shaped bacteria (round dots). Staphyloccoccal species aren't the only ones shaped like this, and there would be no way to tell that they were methicillin resistant based on appearance. To get a proper diagnosis he would have needed a culture of the sample, which can take 5-7 days.

9. And finally, staph infections like this aren't really considered transmittable between dogs and humans, especially as casually as was implied in the show.

So this whole episode was totally bogus. I would be extremely surprised if they bothered consulting a veterinarian with this, as there are a ridiculous number of problems and mistakes.

Okay, that was theraputic. I think I have it out of my system now.

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Advice To Wannabe Vets, Part 2

#2: Hone your interpersonal skills and communication abilities.
My father told me many times that "it's not what you say, it's how you say it." As much as I might have rolled my eyes at his cliches (hi, Dad. I know you're reading this), there was great wisdom in this. I have learned the hard way that you can say the same thing in different ways and have people take it well in one case and poorly in another. The ability to communicate with people effectively is probably the most important skill a vet can have. Yes, even beyond their medical and surgical abilities. When I was in vet school I remember reading a survey of existing practitioners and what they looked for when they hired a new associate. Dead last was "knowledge of the profession". Top of the list? Interpersonal skills.

Recently I have seen this issue with a relief vet that works with us and with one of our supervisors towards my current associate. I didn't disagree with what these doctors said to my staff or associate. I understood their points, and found merit in them. However, how these points were communicated was less than desirable. When I talked to the staff and explained things differently, they understood and accepted. If you don't know how to talk to people properly and frame things correctly, you can upset or offend someone. Take the same message and communicate it better, and those same people will agree with you and appreciate what you said. Even if it's a form of disciplinary action, you can phrase things in such a way that people understand that you're not attacking them.

Similar principles apply with clients. You need to find ways to talk to them in such a way that they understand what you're saying, but you're not talking down to them. I remember when I was in vet school and did an externship at a surgical specialist. There was one time he was explaining an orthopedic injury to the clients and how to repair it. He continually looked at the radiographs and used all of the proper medical terms. I glanced over at the clients and saw that they had a glazed look on their face and obviously didn't understand what he was describing. Yet he never seemed to notice or care. A vet needs to be able to communicate diseases and treatment to clients in a way that they understand and can make educated decisions. Vets also need to be able to compassionately discuss tough issues such as euthanasia.

Anyone who wants to go into veterinary medicine because they don't like dealing with people is in for a very rude surprise! Your ability to handle people (clients and staff) is one of the biggest keys to success as a vet.

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Advice To Wannabe Vets, Part 1

Over the years I have mentored several new graduates and veterinary students. My experiences with them has shown me that there are many common issues that people wanting to be veterinarians have to contend with. This week I want to go over a few of these topics and hopefully pass along some useful information to those planning on entering the veterinary profession.

#1: Learn business skills.
Personally, I think that a basic business course should be required in veterinary school. Some schools have a lesson or two, but it's really not enough. Why is this necessary? Many, if not most veterinarians will end up managing or owning a business. Having skills in and understanding of how economics work and how businesses are run is a great advantage. Recent graduates rarely know how pay scales work, how to make enough production to pay for themselves, how to charge appropriately, why you can't afford to discount services, and why you can't let every client make payments. Even if you don't end up being an entrepreneur, you will have a greater understanding of why your boss or manager makes the decisions they do. I really can't stress enough how a thorough understanding of these processes will make you a better vet. Whether or not anyone likes it, veterinary medicine is a business. In order for us to practice effectively, we need to know this side of the profession.

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Like Cats And Dogs

We all know the stereotype...fighting like cats and dogs. The idea behind it is that somehow canines and felines are natural mortal enemies. In nature, wild dogs (or wolves) and wild cats rarely come into contact with each other. Both are the top of the food chain, predators with no natural enemies. With our domesticated animals, I believe that the animosity was seen because housecats are about the size of a good prey item and run away nicely, invoking a dog's instinct to chase a moving object. All of that has developed into the current, almost cartoonish hatred that has completely captured society's (and Hollywood's) attention.

However, reality is often different, and most of us know that cats and dogs can get along just fine. In my own family, both of our dogs have grown up around cats. Two of our three cats have always had a dog around. Our third, and oldest, cat has never really liked the idea of the canines living in his house; he tries to avoid them as much as possible. The other cats and dogs do great together, and have really bonded. In fact, it's pretty amazing to see how well they get along sometimes. Now if we can just find ways for people to get along as well!

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Secondary Pet Caretakers

We live in a busy society, and many people work when the can and as much as they can to make ends meet. Or maybe some people just find it hard to work their pet into their hectic schedule. In any case, it's not uncommon for someone other than the primary caretaker to bring a pet in for a veterinary visit. This might be spouse, child, grandparent, friend, or anyone else besides the person who normally cares for that pet. All of that is understandable, because at least the pet is coming in. The problem is that this secondary caretaker often doesn't really know what's going on with the pet.

With well pets we will generally ask people if they have enough heartworm prevention or flea and tick prevention. We may also ask about any health problems, what kind of food is being fed, and so on. If the primary caretaker isn't there the answer is often "I'm not sure" or "My wife normally keeps track of that".

The situation is worse if the secondary caretaker is bringing the pet in for health problems. Unfortunately, they often don't know the details of the history at the level that would be very helpful. This usually results in cell phone calls that will hopefully reach the other person. But it can be frustrating to try and diagnose a problem when we don't have all of the information. It's like trying to figure out a mystery image on a jigsaw puzzle without having all of the pieces.

So I would ask anyone taking a pet in to get all of the details. Even if it's not your pet or someone else in the family normally does most of the care, your vet will want to know what's going on. Do yourself, your vet, and your pet a favor and try to get all of the information before going in.

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You Can Only Do So Much

Last month I showed an x-ray of a puppy with a badly broken paw. Unfortunately, we're having difficulties with the client, and it's a tough situation. Here's another view behind the scenes of running a veterinary business.

When we first did the services, the bill was over $500. They didn't have that right away, so we worked out with them that they would pay half that day and the remaining half a week later. If they didn't pay the remaining balance they would be sent to our collections department. When the time came they didn't pay, even though we gave them several extra days. Another few weeks later the puppy came in for a recheck and the paw was swollen, the splint was broken, and the whole thing had slipped down a little. We needed to replace the splint, but she didn't have the money for it. I was going to remove the splint but send her home without anything else because she couldn't pay for it. She said that she would check and see if she could borrow the money from her mother, and would let us know. We kept the puppy, heard back from her a few hours later, and she said to go ahead and do it. Then when she picked up, she didn't have the money to pay for it. So she got sent to collections a second time! And she was informed that from that point forward she would not be able to receive any services unless she paid for them in advance. Most recently she called me on Wednesday saying that the paw was swollen. I again discussed repeating x-rays, removing the splint, and checking the foot; I also repeated that she would need to pay for any services in advance.

Today I had to stay home from work and have another doctor cover for me because my daughter was running a fever and my wife was out of town helping with a church youth camp. This same person came in today, expecting to see me, and was upset when I wasn't there even though my receptionist explained why I was out. The office called me about this, and wanted to double-check with what I had told her about payment. The foot was very swollen and the dog needed treatment for it. Honestly, this dog needed surgery about a month ago. I'm not sure what ended up happening, but I'll find out tomorrow.

Situations like this are pretty tough. I want to be able to help this dog, but I can't do full treatment for free. The client has already defaulted on almost $500 worth of services that she had agreed to, and on one occasion deliberately deceived me. I know that she is trying to help her dog, but she's going about it the wrong way by lying to us and basically performing fraud. The splint isn't helping him, he needs surgery, and he won't get better because he's not getting proper care. I know the owner can't afford it, and that's not really her fault (though it illustrates a point I've often made about setting aside money for your pets). But as a businessperson, I can't do such extensive and expensive services for free. And the fact that she has knowingly reneged on her agreements makes us less like to want to help.

In the end, the pet is the one who suffers. And really I can only do so much. I feel bad for the puppy, but I don't feel guilty. The owner is ultimately responsible for what happens and any decisions.

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Do It Yourself

Today I neutered my kitten, Tristan. To me it wasn't a big deal, and was a procedure that took only a minute or two. However, one of my staff questioned whether I would do it myself. That's not the first time someone asked me a question like that. I've neutered most of the cats I've had, and spayed my dog, Guinevere. I would have spayed Inara, but the shelter had done this before I adopted her.

This is strange to many people I've worked with over the years, and I can kind of understand it. Seeing your own pet that you know and love under anesthesia can be very strange. This animal that normally plays with or cuddles with you is lying there in a very unconscious state with monitors flashing and beeping. Then you take a scalpel and cut into that beloved companion, removing organs of some sort. And no matter how good you are, there is still that slight risk that something could go wrong. Those thoughts can be there no matter who the pet is. But when you have that personal attachment and connection, it can be a bit strange.

However, for doctors there is also the thought that you don't want to entrust it to anyone else. Even if I trust my associates and know they do a great job, this is my own pet's life and health, and I want to be personally responsible for it. The special connection with a pet works on several levels. And even though I would readily let a specialist do what was needed on my pets, for routine procedures I would prefer to do it myself.

So to any who ask, no I don't find it strange to do surgery on my own pets, and even prefer to do it. By the way, Tristan is doing great, and was purring just a few hours after surgery.

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Spay? Spade? What The Heck?

I sometimes get random, strange thoughts, and today one occurred to me. I have been in veterinary medicine for about 25 years, and have always know that a spay is when you remove the reproductive organs from a female. I've always accepted that and never really thought about it. But today for some reason it suddenly dawned on me that the word didn't make sense.

The proper term for the surgery is ovariohysterectomy. Where do you get "spay" out of that word? A castration is called a neuter, and is used only for males. I can understand neuter, as you're kind of changing a male into a neutral. But what about the word spay? Word origins often interest me, so I tried looking it up. The problem is that it still doesn't make sense!

Here's what an online etymology dictionary has for "spay":
c.1410, "stab with a sword, kill," also "remove the ovaries of," from Anglo-Fr. espeier "cut with a sword," from M.Fr. espeer, from O.Fr. espee "sword" (Fr. épée), from L. spatha "broad, flat weapon or tool," from Gk. spathe "broad blade" (see spade (1)).

So basically the word "spay" refers to cutting someone. How this ended up being specific to removing a female animal's reproductive tract, I still don't know. And if anyone else knows, I'd love to hear from you!

Believe it or not, strange and random thoughts like this are not uncommon for me!

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