Today I saw the most pets I have ever seen in one day...47! Considering that an average doctor should see 20-25 pets per day that's a pretty crazy number. Probably 40 of those I saw between 2:00 and 7:00, which averages 7-8 pets per hour. Again, that's a crazy amount to see. My practice has a policy that we will see any pet that needs to be seen. We simply don't turn people away. For the most part I agree with this, as it keeps pets from having any delay in diagnosis and treatment when they need it. However, at some point I think that pet care potentially suffers.It's a question of quality versus quantity. And it really makes me wonder which people want. When I'm seeing almost 8 pets per hour, that averages to spending less than 10 minutes per pet. For a routine puppy booster vaccine...
What Is Quality?
For the past week I have been in meetings to help improve the quality of service, medicine, and performance of my clinic. Having managed veterinary hospitals for the last 9 years, there wasn't anything earth-shattering that I learned. Definitely a few confirmations of what I believed, as well as some new hints and tweaks to my methods, and for that I am pleased. But another thought began to occur to me. How do we define quality veterinary medicine?In reality, quality is pretty subjective. What might be good quality to one person may not be the same to another. "Quality" is a word that we think we all can understand, but really we need to define it. Is someone a high-quality doctor because they use all of the latest and best equipment? Does a vet give you quality service because they...
The veterinary consultation starts here:
While veterinary consultations typically involve physical ailments and diseases, normal mental or psychological health is just as important in our canine companions. These things can and should be addressed by the veterinarian as soon as the client is greeted in the waiting or consultation room.I feel this involves greeting the client and taking a brief period of time taking a history, while virtually ignoring the dog. The vet should deliberate approach the dog, while still ignoring it. This allows the dog to not feel like the focus of attention, reducing its anxiety and allowing it to remain calm. Should the dog cower behind the owner or stand...
Do People Still Fall For It?
Anyone reading this blog has at least a basic knowledge of the internet, email, and everything that entails. Which means you are also likely aware of the various email scams out there. Most of them come from someone overseas that needs help moving money, and promises you several million dollars (pounds, etc.) if you will help them. I receive those emails virtually daily on all of my email accounts (I have three). The one I use for my blogs isn't used for any other communications, yet I still get 10-15 per week.Knowledge that these are scams is very common, and has been reported on the internet, TV, radio, and print media. There shouldn't be anyone using computers that doesn't know that these are bogus and are used to bilk people out of considerable money. Yet they are still ubiquitous...
Are You Ready For The Hair?
We're in shedding season, if you haven't figured that out by now. That makes me think about the type of fur pets have, and what people have to deal with. Personally, I would never have a long-haired pet because of the high maintenance. I have seen too many people come in with heavily matted dogs and cats, or have to get them groomed every month or two to keep the coat manageable. It's a lot of work! It's also important since a matted coat can trap dirt, cause skin irritation, and can be painful as the hair pulls the skin.Thick coats can be as bad as long ones. Dogs like Siberian huskies and German shepherds have dense undercoats that will come out in clumps during the warm months. These coats require regular brushing to keep them from being a problem. Honestly, these dogs don't need...
Long days... and loving it.
After nearly three weeks at my new full-time position, I continue to look forward to going in to work, to working long days, to a fantastic, talented, and industrious group of employees, to a friendly and down-to-earth clientele, to a plethora of challenging cases, to learning, to sharing my knowledge, and to invest in this position. Though my hours are long, my schedule allows for plenty of days off during the week, allowing me to enjoy all of my personal activities.Malassezia (yeast) infections: something extremely common in cats and dogs, especially during allergy season. These little buggers can cause nasty ear infections, and if you look...
"That Flea Medicine Isn't Working!"
This time of the year it's a daily occurrence to talk to my clients about flea control. Here in the southeast US we have a lot of fleas, especially during the warm weather, so flea prevention is a necessity. Without using it, you're just asking for flea problems. However, many clients apply one dose, a week later see fleas, and complain that it isn't working. Last year I wrote an entry about flea control, which I wanted to remind everyone about (right here). But here's a quick review...*A single dose of flea prevention will NOT get rid of your flea problem.*Fleas have to jump on the pet in order to be affected by the topical preventions.*You have to treat the house and yard in order to completely control the problem.*Every pet in the house must be treated.*You can't bathe your pet too...
Can You Hear Me Now?
A stetheocope is a very important piece of diagnostic equipment that every physician and veterinarian uses. High quality ones can cost $200-300, so this is not simply a rubber tube, ear plugs, and a head. With a good stethoscope you can hear very subtle changes in the heart and lungs, aiding in the diagnosis of cardiac and pulmonary disorders. Very small differences and alterations can be difficult to hear with a lot of ambient noise, so we try to listen in quiet areas. To aid in hearing these faint sounds, the ear buds fit very snugly in the ear canals, keeping sounds from overwhelming what you are trying to hear.Why am I describing this? Because I want you to understand that when we put the stethoscope in our ears, we are deliberately trying to filter out and elminate all sounds except...
Good News....It's Normal!
Making a diagnosis and implementing a treatment plan is not something that happens instantly, but is a process. When we as doctors see a set of symptoms in a patient, we have a list of possible diseases or disorders in our mind. We then need to try and figure out which of those possibilities is the likely correct one. With many patients we can't determine which problem is the right one merely on symptoms alone. For example, let's say that a patient comes in for excessive drinking and urinating. Possible causes include diabetes, kidney disease, a urinary tract infection, or Cushings disease. Each of these are radically different disorders with equally different treatments. We can't simply try a treatment and hope it works. If we put a patient on antibiotics for an infection, we could...
"Do I Have To Pay Again?"
How many of you have gone to your doctor for a problem, had a tentative diagnosis made, and a treatment plan prescribed? Then if the treatment doesn't work, you go back again. Would you demand free treatment then? Would you demand a refund on your money for the medicine that didn't fix you?What about a mechanical problem on your car? You take it to the garage and they replace a part they suspect is the problem. Well, the problem doesn't go away. Would you demand that they fix it for free since you already paid once?In situations like this I bet that most people realize that not all problems can be fixed quickly, and that it's often a process that can take some time or trial and error. Why does it seem like people don't consider vets in this equation?It's not uncommon for me to have...
Feeding Pregnant Dogs
I think you all know by now how much we vets talk about how important it is to feed pets the proper pet food, and not to feed people food. Believe me, we're not in the pocket of the pet food companies, and are just trying to help you take care of your pets. Here's another reason why.Mattie was a little dachshund, about 2 years old. I saw her last week for sudden weakness, incoordination, and overall just acting strange. She had given birth to a litter of 5 about three weeks previously. As I did my exam I noticed a dazed look to her eyes and muscle trembling, even though she was alert and could walk around. My immediate thought was a low calcium level, and lab tests confirmed this. I spoke to the owner, and he said that his wife kept insisting on feeding the dogs hamburger and hot dogs,...
Escaping The Modern World
Sometimes I think it's easy to forget that doctors are just people. We have interests and hobbies outside of medicine. Our lives aren't filled with diseases, injuries, diagnostics, and surgeries 24/7. We aren't constantly thinking about medicine. And sometimes our other interests are far removed from our jobs. In my case one of these departures is Renaissance Faires.I have always had an interest in Medieval and Renaissance time periods. The ideas of knights, damsels, intrigue, and swashbuckling have always drawn me to them. When I was in college and was required to take Physical Education courses, I deliberately chose classes in this vein:...
Antibiotics do not suppress the immune system
If somebody asks me one more time, "Aren't antibiotics bad for the immune system?", I'm going to blow a gasket.As a veterinarian trained in the West, I've been trained to use antibiotics for bacterial infections, not homeopathic remedies, nothing freshly grown and picked from the earth.I believe I am diligent about the prescription of antibiotics... a pill-pusher I am not, unless of course pills need to be pushed.If a dog, cat, or human being, has a bacterial infection (pneumonia, for example), the infection itself stimulates the body's immune system (because the bacteria are antigens - unrecognized by the body's immune system), while the stress...
X-Ray Week: Knee Problem
This dog came to me because of fluid draining from his knee. Over a few years he had undergone two surgeries for a torn anterior cruciate ligament (ACL). I could feel the suture material in the knee, and was concerned that the fluid had been caused by the surgery. Over time the suture had caused inflammation and irritation in the joint, which had begun draining through the skin. To see there was any problem with deterioration of the bone, I took some x-rays. There are two things that stand out on these x-rays. First, the suture material had broken, likely leading to significant irritation. Second, the suture isn't placed correctly. One...
X-Ray Week: Esophageal Disorder #2
This case is from a middle-aged dog that my associate saw. He had been vomiting frequently, so she took some radiographs of his stomach and chest. The ones from the chest were the most interesting. See if you can notice the problem here....The vets reading this probably can see the issue. We have lots of training and experience in seeing subtle problems. For the laypeople, take a look at the parallel white lines through the chest. Here is the same image with some highlights to emphasize this.See it now? This is a pretty big abnormality, and indicates an extremely abnormally large esophagus. Megaesophagus is most commonly diagnosed in...
X-Ray Week: Esophageal Disorder #1
Here's a bit of a strange case for those vets reading this blog. And some cool images for everyone else.This dog came to us about 3 weeks ago for vomiting. Blood tests showed nothing abnormal, so my associate started her on anti-nausea medication and some easily digestible food. The dog was acting good overall, and is a 2 year-old spayed female terrier mix. The problem didn't seem to get any better, so the client brought her back. This time we did x-rays. When we start this kind of diagnostic we do what we call a "plain film", which is a basic x-ray. This is what we found.See the problem? Yeah, neither did I. So I made the dog swallow...
Cats don't normally....
... consume much carbohydrate. Felis catus, like the larger Felidae, are strict carnivores. The only carbs the large cats consume come from the gut contents of their prey (herbivores). Felines typically don't eat bread, grains, seeds, pasta, rice, couscous... you get the point. Not to say that they won't eat these things, right? Cats, though much more discriminate than dogs, also enjoy food!So I came home to find my cat chowing down on a zucchini-carrot muffin, which he stole from the bottom of my gym bag. Especially for a diabetic cat, muffins are really not the way to go!He's voracious all right. Things he'd eat in a second. How 'bout...
Air France crash
Apparently, a member of a royal Brazilian family, a dancer from the famed "Riverdance" group, and a couple of CEOs from some big company, were amongst the 228 killed in the Air France crash. Everyone on that plane was someone's "royal," someone's dancer, someone's boss or employee, someone's love. They were all human and every death caused as much devastation to a family as the next. Who cares what the ---- they did for a living or how popular they were in society... all mattered equally to somebody.My thoughts are with the grieving famili...
X-Ray Week: Broken Paw
Here's an interesting set of images that I thought many of you would find interesting. This dog is a boxer puppy, about 5 months old. He was playing with a neighbor's dogs when one of those dogs bit him hard on the foot. Normally this would cause some wounds, but not necessarily anything serious. Not so in this case. There really weren't any deep wounds, but there was some obvious damage to the foot. When he came in I could tell that the paw was at a slightly odd angle, and the x-rays confirmed it.All four metacarpal bones are broken, and a couple of them are pretty displaced. In a human these are the bones in the hand between the wrist...
Humane Society Woes
Many years ago, soon after I moved to Toronto, I visited the Toronto Humane Society. I told them that I recently graduated as a vet, and management took me on a personal tour of the facilities, which had impressed me greatly at the time. Granted, there were exponentially less cats there at that time than today, but the wards were spotless, the dogs appeared clean and friendly, their runs were well-kept, and the cats lazily purred away while their owners-to-be agonized over which ones to choose. Upon questioning the manager about the THS's long and altruistic history, she reached for her bookcase and provided me with a copy of the THS Calendar,...
