One of the most important pieces of equipment during anesthesia monitoring is the electrocardiogram (ECG or sometimes EKG). With this tool we can not only keep track of the actual rate of the heart but also note electrical abnormalities in the heart, problems with rhythm, and issues with abnormal contraction patterns. Not using an ECG during general anesthesia is taking a big and unnecessary risk. Today we had an issue with our ECG machine. Remember that this is my first full week in the new location and I'm adjusting to the new staff and patterns. Though I've worked with all of them before I don't know all of the ins-and-outs of the team yet. We had induced our first procedure, a routine neuter, and had him under anesthesia. As my assistant was connecting...
Moving On
I've probably mentioned before that the practice I work for has multiple satellite locations in our area and I manage one of them. Well, the more appropriate word is "managed". Not to worry, it's not a bad thing. I'm actually just switching locations.I've been at multiple clinics over the years, and every place I've been at has been profitable and well managed. In fact, I've developed a reputation as a successful manager and strong leader. While this is a good reputation to have, it has led to some interesting experiences. A few months ago I was approached with the offer of taking a new location and trying to make it successful. The vet there is a good doctor but doesn't have the interest or ability to be a leader. In my own location there is a doctor...
Can't Heal 'Em All
Sometimes I feel so lost when I can't fix an illness. I see the patient obviously feeling bad, maybe even vomiting, and don't know what I can do to help them. So I have to sit and hope that they get better quickly.Nope, I'm not talking about my role as a doctor. I'm talking about my job as a husband and father.In the last week illness has struck my family. My daughter caught strep throat last week and still doesn't seem over it. She had to switch from amoxicillin to Augmentin. Last night my wife started feeling weak and tired and had stomach cramping and nausea. This morning my son wasn't feeling good and I ended up having to pick him up early from school. So right now I'm the only one out of the four of us that isn't sick.My knowledge as a veterinarian...
Big Bad Spays
Many people may not realize it, but not all surgeries of a given type are the same. Take spays as an example.Ask a vet which routine surgery they look forward to the least, and I bet that most of them will say adult large dog spays. I've had many of my staff say that they always figured that the big dogs would be easier because the uterus and other organs are bigger and therefore less difficult to find. Quite the contrary, actually. Yes, the diameter of the uterus usually is larger, but so are the intestines. Combine all of those organs with a much larger area to search through and it can be more difficult to find things in a larger dog. Small dog spays are usually quicker and easier.Additionally you have larger vessels, which means more that you have to...
Cons, Hair, And Droids
This weekend my family was at ConNooga, a smaller sci-fi/fantasy/anime/geek convention in Chattanooga, Tennessee. It's one of our regular events, and we have a lot of fun there. We go as part of a Christian fan group, Fans For Christ, and set up a table to talk to people as well as hold a church service.But this year was special for a few reasons. First, my wife finished her Rapunzel costume (from the recent movie Tangled) in time for the con, and it looks great! Next she's going to work on a Flynn Rider costume for me so we can go as a pair.The other big thing was that I finally was given permission to build my own droid. ...
Funny Or Fearsome?
Mary asks this question...I saw this video, and while it's funny to watch, does this dog's food aggression make him a danger to his family? http://www.funnyordie.com/videos/f8617f85fc/dog-growls-at-his-own-foot-from-that-happened?rel=player What should a family do for a dog like this?This is actually a pretty well-known video, and I believe it even won on America's Funniest Home Videos. At first glance it's funny, watching the dog attack its own foot because its worried that the foot might somehow steal its food. However, there is actually a real danger here.This dog has an obviously serious problem with food protectiveness and aggression. So much so that it doesn't even recognize its own foot as part of its body and not another animal. If a human or even another...
Best Heartworm/Flea Preventatives?
Krissy, a veterinary student at UC Davis, sent me this question last week.Thanks again for your insight on your blog, I really enjoy reading. Today we had a rep (a vet) from Bayer (the company that sells advantage) and they said there was this study and that only THEIR heart worm/flea preventative (Advantage Multi) was the only one that prevented heart worm in 8 out of 8 dogs. Very interesting, you can see the info just released this past month. http://veterinarynews.dvm360.com/dvm/Veterinary+news/Leading-parasitologist-reveals-heartworm-preventiv/ArticleStandard/Article/detail/703785?contextCategoryId=40534I understand this is a very small data sample, but of course they wanted to have to infect and kill as few dogs as possible. I also know that different products are better than...
Love Is In The Air
Those of you who are married and have kids can probably relate to my situation. My wife and I haven't been on a date in many months, and honestly can't remember when our last one was. We have lunch together a few times per month, but haven't done a real honest-to-goodness date in far too long. With this being Valentine's Day, we made a point to change that.Because I was originally scheduled to work today (I ended up taking the day off) we made our plans for last night. Rather than the typical dinner and a movie, I found a local place that had dancing and dining. It was a small nightclub with a fairly intimate setting...
Skewed Experiences
Once you're in medicine for any length of time it quickly becomes evident that there are a variety of opinions on any given topic. One joke is that if you ask 10 vets their opinion on something you'll get at least 11 answers. Why does this happen? Part of it has to do with differences among experts, which articles someone reads, which lectures they attend, how they were trained in school, and so on. But I believe that a lot of it has to do with their personal experiences.Like it or not, everyone is influenced by what they have personally seen and done. These cases and events will guide future opinions and decisions, and will sometimes result in disagreements among professionals. For example, let's take the recent discussion on GDV ("bloat") in dogs. ...
Acting Family
It looks like my family is going to be populated by actors. Not that this is a bad thing. My wife was a drama minor in college, and has always loved theater. Over the last year and a half she and I have been involved in local community theater and have really enjoyed it. In fact, if you go back in the archives of this blog you'll see some pictures of me in some of the plays. But now it's going beyond that.Last week my wife found out that she has been cast as the lead in the musical Kiss Me, Kate. Though she loves drama, musical theater is her real passion, and she's always dreamed of having the lead role in a musical. Now she gets to live that dream, and is tremendously excited. Her only fear is that she'll have to kiss her co-star, and she's...
Professional Disagreement
I'm often faced with clients transferring to our clinic from other vets, and this can be quite a challenge, especially if they're seeking a second opinion. There is the very human temptation to say that the other person is wrong and promote your own opinion. But I am very strongly of the opinion that this is the wrong thing to do for numerous reasons.Intentionally or not, clients often misrepresent what another vet says. Maybe they misunderstood, maybe the vet didn't communicate well enough, or maybe the client just didn't personally like that vet and wants to bad-mouth them. I've seen clients take a statement such as "I believe..." or "In my opinion..." and translate that as the gospel truth. So as much as it may be hard for clients to understand, many veterinarians...
Grief Counseling
One of the hardest things a vet has to do is handle grieving clients. Most of us get no training in how to handle this, as it's not emphasized in vet school. However, we're faced with this on a regular basis as we deal with critically ill patients and euthanasias. Some people are easier than others and every situation is unique. Human grief is especially hard to deal with for those vets who are very introverted and don't handle people situations very well, yet we can't really get away from it.Yesterday morning my very first case of the day was a male cat who had been straining to urinate for a day or so. As soon as I looked at him I was able to tell that his bladder was very full, tense, and painful. He was completely blocked and could not urinate. ...
Food allergies
I've blogged many times on allergies in dogs and cats. The two main categories of allergies in companion animals are atopy (environmental allergies) and adverse food reactions (food allergies).Symptoms of both can be very similar, which include chronic otitis (ear infections), itchiness of the ears, face, paws, belly, etc., non-itchy or itchy infections along the entire dorsal neck and back and other dermatological manifestations. Most (but not all) pets with food allergies are ITCHY. Some (but not all) dogs and cats with a food allergy, will have gastro-intestinal symptoms such as vomiting, diarrhea, and flatulence. In dogs, the ingredients...
Preventing Bloat
Stefanie asked a good question...What is the recommendation for feeding and exercising a dog - especially for deep-chested breeds that are prone to bloat? Is it better to walk a dog first thing in the morning and then wait and hour and feed him/her or feed first, wait an hour and then exercise? This is a condition that I have personal experience with. When I was 16 we had a German shepherd that had to be euthanized because he developed bloat. We had gotten him when I was three years old, so it was hard for me as that was my friend as I grew up. For those who aren't aware, let me describe what is commonly called "bloat" in dogs. The proper medical name is gastric dilatation and volvulus, or GDV. In this condition the stomach twists, either rotating along it's axis or...
Dealing With Burdening Loans
Evan asked this question...My sister is currently in vet school and is very worried about paying off her student loans once she is finished. The minimum payments appear to be close to $900/month, which a resident making $28,000/year would not be able to afford. Do you have any advice for young veterinarians like my sister as they try to start their careers? Evan, this is a very common and very real problem that is changing how students live and practice after graduating. Currently in the US average starting salaries for a newly graduated vet are around $55,000-60,000. The average student loan debt is around $80,000-100,000. Veterinarians have the highest debt-to-income ration of any other medical profession. That means that proportionally we go...
