Why So Many Women?

There was a recent article describing why women choose certain professions, especially in medicine.  The study described that one of the biggest determining factors was not an inherent love of the field, but its low cost to families.  The professions that allowed the best balance of work and family are the ones that women are choosing to go into.  And yes, veterinary medicine is one of those fields.  Here's a quote from the article.

Among professions with the fastest-growing proportions of women are veterinary medicine. Because of growth in veterinary hospitals and emergency clinics, vets increasingly have been able to eliminate on-call, night and weekend hours, and to work part-time, Goldin says. The proportion of female grads in vet medicine has soared to almost 80%, from 10% in 1970. In other examples, pharmacy grads are now 60% female, up from 30% in the mid-1970s, Goldin says. And optometry is about 60% female.

The article mentions a second discussion (linked above) that gives the following quote.


Drawing from data on Harvard graduates and on University of Chicago MBA grads, Goldin contrasted MBAs to veterinarians. Fifteen years after college, among those women who have kids, 23% of MBAs weren’t working, versus 3% of MDs and 14% of lawyers. “The MBA lure for women is large; incomes are substantial even though they are lower than those of their male peers. But some women with children find the inflexibility of work insurmountable and leave or become self employed,” she said.
“If women are ‘fleeing’ the corporate and financial sectors, they have been flocking to professions in the health field, particularly veterinary medicine,” she said. “Why? The demands of professional training have not changed. But the practice setting has. Small animal clinics open from 9 a.m. to 6 p.m., six days a week, with no evening and no emergency hours have proliferated. Being a veterinarian has prestige, equivalent to that of a physician. Like some physicians there is considerable room for part-time and flexible work. The training period is less than that for doctors. Veterinarians work lower hours than MBAs and engage in more part-time work sooner in their professional lives.”

Anyone in this field knows that women now dominate the profession.  A man like myself is increasingly becoming a rare find, and this will be even more noticeable as time goes on.  Frankly I don't mind, as I've never really felt like medicine should be in the hands of one gender or another.  But as more women enter veterinary medicine it changes more than the look of a veterinary office.  As the articles mentioned, women want a better work/family balance, and this is resulting in changes in how veterinarians are employed and how practices are run.  This isn't a bad thing, just different.  And I've sometimes wondered why this gender switch is happening, so it's interesting to me to see a likely reason.

Speaking of females entering the profession, I'd like to welcome one to the blogosphere.  There is a new blog by a veterinary student (a woman, of course!) called Vogue Vet that exemplifies these differences.  You certainly will not find me discussing the fashionable accessories of a veterinarian!

Bonding With The Physician

I've come to a good understanding and bond with my own physician.  He's known what I do since I started seeing him and we'll sometimes talk about cases together.  I went to see him today and realized that veterinarians and human doctors have things in common besides our medical training.

He was running late today, and it was almost an hour from the time that I checked in until he came into the room.  Honestly, it didn't bother me.  I always bring a book or something to work on when I have a doctor's appointment, because there's usually a wait.  I'm also well aware of how your schedule can get off-kilter, so I'm very forgiving of other doctors' delays. 

When he entered he apologized for the wait.  Since we sometimes "talk shop" he explained one of the cases that delayed him.  He was seeing a man and talking to him about the health concern.  The patient's wife was also there and when the doctor was finished with her husband she said "Since I'm already here can you take a look at me too?"  I was a little floored by this, as any veterinarian can tell you that this is not uncommon in our profession.  Someone makes an appointment to bring their pet for a visit, then when they arrive they have more than just that one.  Sometimes the other pet is just there for "moral support".  But other times the client says "can you see my other pet also?"  We invariably do see them, as did my own doctor in his situation.  But since that was essentially an additional appointment it sets things behind.  Though I knew it happened to me and my colleagues, I never thought about it happening in the human field.

My doctor also talks to me differently than if I were a normal patient.  He treats me like a colleague, and discusses my cases in medical terms since I can understand on a level higher than most of the people he treats.  We talk about the symptoms and causes, and then discuss the treatment together.  However, I also realize that he knows more about human physiology and treatment than I do, so I defer to his expertise and don't presume to know as much as he does (something not all of my clients in the human medical profession seem to understand).  Really, it's kind of neat to talk to him on this level.

Basically the only difference between veterinarians and physicians is the species we treat.  And it's nice when that's recognized and those barriers come down.

 

Don't Share Your Dinner....SERIOUSLY!

My clinic received a big reminder why people should never share their meals with their pets.  Here in the US last Thursday was Thanksgiving.  To you non-Americans, this is an annual holiday in memory of one of the first colonies in the US after they survived a hard winter and gave thanks.  It's a time for getting together with family, being thankful for what we have, and eating lots of food.  Traditionally, the staple of the Thanksgiving meal is turkey, though lots of other things are also served.

Last week a client gave her seven pound yorkie a turkey leg and gravy.  Over the weekend she developed acute pancreatitis and has been in the clinic for the last couple of days.  She's stable, but is in serious condition and is very painful.  Pancreatitis is a common consequence of feeding fatty or rancid food to dogs, and is especially dangerous to small dogs because of their body size.  Most cases of pancreatitis that I have seen are due to people feeding or allowing their dog to eat food that they shouldn't.

I can't emphasize enough....don't feed human food to pets!  Yes, there are plenty of times when dogs and cats eat these foods without consequences.  I grew up feeding table scraps to our dogs (back before I knew better) and they did fine.  However, in over a dozen years in practice I've seen far too many problems after pets have had human food.

Simply put....DON'T DO IT!  Any reward you may get by sharing your meal with your doggie or kitty is not worth the risk of health problems and the subsequent often expensive veterinary visits.

And keep your fingers crossed for this little dog that we're treating.  She's doing okay but is far from being out of the woods.

Where Does Obligation End? Part 1

Recently we had a client visit one of our clinics (we're a multi-location practice) because she believed her dog had eaten some rat poison.  The doctor worked up a treatment plan and it was presented to the owner.  She said that she could not pay for the services.  She was offered Care Credit (a medical credit card here in the US), but said she wouldn't qualify.  She didn't have any other credit cards, and said that her check would bounce.  Basically she was offered every payment option we have (we don't do in-house billing and payment plans), but couldn't do any of them.  So treatment was not performed and she was referred to a local emergency clinic in hopes that they might be able to work out payment with her.  Her visit there ended up the same way, with her being unable to make any payment and the emergency clinic declining to treat without being paid.

Almost two weeks later I saw her dog for acute vomiting.  The dog was acting fine with no signs of having had any bleeding problems (the main complication of most rat poisons).  She was on a health care plan with us that allowed some blood testing at no additional cost (it doesn't cover treatments, just basic preventative care), so we ran these and everything came back normal.  Since the owner couldn't afford any other diagnostics I put the dog on some antinausea drugs and sent her home for observation.  What else could we do?

During all of this mess the client has been belligerent and confrontational.  She has accused us and the emergency clinic of "neglect and abuse" for "refusing to treat" her dog.  She has made statements that we are "killing her dog", that we "don't care about animals", and everyone is "just about the g**d*** money."  She is threatening legal action if her dog dies (it's been close to four weeks now, so the chances of that happening are slim) and has called us repeatedly with complaints and abusive language.  In her opinion we should have treated her dog regardless of her financial situation.

Personally I'm not worried in the least about this client, as I know that we and the emergency clinic offered every appropriate action and treatment.  We have documented all conversations and declined services, so she has absolutely no legal ground for a suit.  However, it does bring up an interesting question that I'm putting to a poll.  Does a veterinarian (or by extension, any doctor) have an obligation to treat a patient regardless of the ability to pay?  Every veterinarian sees pets who don't get needed treatment because the owner can't afford it.  In many cases these pets end up suffering or have chronic problems, despite the fact that have the ability to treat them.  According to this owner's comments, we should be treating them anyway.

So let's see what the poll says and then we'll revisit this topic in a little over a month.

Pain In The Neck

Back in September I saw a dog for a swelling on the neck.  Apparently the dog had fallen while running back in the Spring, and had landed on a sharp rock.  Since then she .had a bloody swelling on the left side of her neck where she hit the rock.  A previous veterinarian had thought this was a hematoma (blood swelling or clot under the skin) and various treatments hadn't helped.  So she came to me for a second opinion.

I noticed that there was a slight draining tract and some inflamed tissue that was potentially preventing it from closing.  Whatever the cause, we needed to do surgery to try and resolve the issue.  The owner agreed to the procedure, and a couple of weeks later one of my associates performed the surgery. Now keep in mind that this was about four months after the original injury and the problem was still there.

During the surgery my associate found several small slivers of wood in the wound.  She removed them and explored the area, not finding any more pieces.  The site was closed, leaving an area for excessive fluid to drain.  A couple of weeks later I looked at the incision and removed the sutures.  At that time everything looked like it was healing well.  The scab came shortly thereafter and the owner was satisfied.

Then over the last week a spot reappeared in the same location and started to ooze fluid like before.  I looked at it yesterday and felt firm swelling under the skin very similar to the first visit.  There could have been something left behind, though I know my associate is skilled and thorough.  It was also possible that there was some dead tissue that was trapped under the skin.  Whatever the cause, I knew we had to do a second surgery, and likely be more aggressive this time. 

Today I did that surgery and removed the entire tissue around the draining tract. I wanted to make sure we didn't leave anything behind, and so excised the entire area.  It was a bit tricky since I was right next to the trachea and pretty close to the region of the jugular vein.  Even so, I was able to carefully dissect down and around the area and remove the inflamed tissue.  The closure was routine and the dog recovered normally. Afterward I cut open the tissue and found another piece of wood.  This one must have been deep enough that it wasn't easily noticed on the first surgery and wend hidden until it created another tract.  This time, though, because of how much tissue I removed I'm confident that everything will be fine and we won't see another return of this problem.

The whole thing seems like a pretty crazy and freak accident.  Apparently when the dog fell and hit her neck several splinters of wood punctured the skin and were driven deep.  Because the wood wasn't obvious or sticking out, there wasn't an immediate reason to go in surgically.  So these pieces caused a reaction in the body that resulted in a draining tract, and it took six months before the final piece was removed.

Not sure that there's a great lesson here, but I thought it was an interesting case.

No Blame In Cancer

Here's a question from Stefanie...

I just recently found out that my 14 year old Queensland Heeler/Australian Shepherd dog has a squamous cell carcinoma in her throat. It is attached to her soft palate and left tonsil and is quite large. (I was shown a picture of it) To quote the biopsy results "poorly differentiated, aggressive, locally invasive". Since she is 14 - after discussing options with the vet (her recommendations were referral to an oncologist, "debulking" the tumor which would buy some time but not necessarily prevent it from growing back, or just keeping her happy and comfortable for as long as possible). I was told she has 3-6 months and the tumor will likely eventually cut off her airway. I chose option three - keeping her happy and comfortable and will put her down when the gasping for air and choking become much worse than what they are now.
 

My question is - did I do something that potentially caused this cancerous tumor in her throat? I have to tell you - she has always enjoyed chewing/eating stuffed animal parts, sticks, other debris in the yard and anything she can get a hold of in the house if I am not paying attention. Because of this - in order to help her pass these items - for the past several years - I have given her petroleum jelly (less than a tsp) once a day. My concern was always to prevent intestinal blockage - so I never even considered the possibility that it may cause her harm.
 

Any light you can shed on this would be appreciated. I love this dog dearly - she has been my constant companion since she was 10 weeks old and I hate the thought that I may have caused her harm, but on the other hand - would like to be educated so that I do not repeat the same mistake for any future dogs I may care for.

First I have to say that I'm very sorry for her medical problems.  This type of cancer usually is very aggressive and this is a difficult location to have it.  I would agree that the best thing to do at this point is to make her as comfortable as possible and enjoy the time you have left.

Let me set your mind at ease that you didn't cause this.  We don't have good data in pets regarding environmental factors leading to cancer, unlike human medicine where there are numerous factors identified that can increase or decrease cancer risks.  There are some things that can increase risks in pets, such as feline leukemia, subcutaneous injections or punctures, and certain toxins or radiation (as in humans).  But most of the time cancer is due to genetic and physiological factors that we have no control over.

In a nutshell, a tumor is a particular type of cell that grows uncontrollably.  Each cell in the body has mechanisms that tell it to stop reproducing or lead to the cell's death if there is damage.  Much of this protection is at the level of DNA, though there are external factors such as immune cells that seek out and destroy cancerous cells.  In order for a tumor to develop, all of these defenses must fail.  Truthfully, it's a wonder of nature that we don't see much more widespread cancer.  But you should be aware that in most cases of cancer in pets there is no single, preventable cause.  This means that for better or for worse, you couldn't have prevented this from happening to your dog.

To also specifically address your concern, I've never seen any link between petroleum jelly and cancer in dogs.  Also, in a dog this size a teaspoon or less probably didn't significantly help with lubrication.  But even if it didn't help, I can't think of any reason why it caused any harm.

Fourteen years is a great life span for any dog.  I lost my own dog to cancer a few months ago and she was only five.  I can certainly understand what you're going through.  It's not easy to go through this, but know that you have given her a great and long life.  Enjoy the time left with no regrets.

Pica

Pica is a medical condition veterinarians sometimes encounter in practice. Pica comes from the latin word for magpie, a bird with a reputation for eating almost anything. Pica is considered a symptom of disease (like vomiting or fever, for example), not a disease per se. Pica can be exhibited by dogs and cats suffering from a plethora of medical conditions, from gastrointestinal parasites, to anemia, to liver disease, to cancer. While most humans who exhibit pica have serious mental illness (OCD, schizophrenia, etc), dog and cats almost invariably have a physical condition, often a lack of a dietary requirement or nutrient of some kind, or any disease that results in a loss of nutrients from the body. Anemia (absolute decrease in red blood cells and hemoglobin) is a very common cause of pica. Anemia, like pica, is not a disease but a reflection of disease. Many, many diseases result in anemia: gastrointestinal parasites (especially hookworm infestations), iron-deficiency, auto-immune diseases, blood parasites, hemorrhage of any kind (especially GI ulceration), and cancer. All of these conditions, and others, can result in pica.
Patients with liver shunts (essentially, blood from the intestine doesn't go to liver but bypasses it) sometimes exhibit pica. In a nutshell, the animal is trying to make up for what cannot be produced by the liver, since the liver is not receiving nutrients from the gut.
One very recent case I saw involved a cat with true red blood cell aplasia, a rare auto-immune disorder where the immune system destroys the red blood cell precursors in the bone marrow. This cat swallowed a few shoe laces and elastic bands - you really had to see it to believe it. The objects in the poor cat's stomach were the least of his problems.
Now, can magpies suffer from pica?

X-ray from a mentally ill man with pica. The large white area on the radiograph is a collection of hundreds of coins, needles and other objects not typically eaten by healthy men. The whole story here.

 
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