VMDiva

Recent comments on my posts have touched on one of the most pervasive yet least talked about subjects in veterinary medicine: Burnout. There were no courses in vet school on how to deal with this topic. I suppose we are expected to suck it up and deal with it. That doesn’t sit well with me as I see excellent veterinarians bail on their careers, families, or worse, lives, in response to the stress this profession brings.

Burnout has many causes. Veterinarians typically work long hours. Very long hours. Those hours are changing, fortunately, for small animal veterinarians and a small subset of large animal veterinarians. Long hours alone can lead to mental fatigue but then take into consideration emergency care. The long hours topped off with calls in the middle of the night lead to physical fatigue. Yawn. For the practice owner, life is even more harried. Owners are balancing veterinary medicine with business decisions. In their “down time” they are making financial decisions for the practice, handling upset clients, and managing personnel. It can easily consume all of an owner’s waking hours. Maintaining a proper work to life balance is critical in keeping your sanity.

Next is the issue of stress. Every veterinarian has different stressors. For some it is dealing with difficult clientele who demand so much of your time you fall behind schedule or sit on the phone for what seems like hours waiting to leave at the end of the night. For others it is dealing with compassion fatigue. As acclimated to pain, suffering, and death vets become, we are never quite comfortable with it. The mental toll this takes is not always apparent until you find yourself lying awake at night thinking about a case. I still have patients who break my heart and I admit to tearing up over them. Compassion fatigue alone can be enough to lead a veterinarian to burnout. This phenomenon is common in all medical professions. And for other vets, stress comes from balancing the desire to provide optimal care with an owner’s financial considerations. Rare is the vet who hasn’t heard, “I can’t afford any of that. You’re going to let my pet die. If you cared you’d give it to me for free.” These difficult situations are only magnified by the aforementioned physical and mental fatigue.

Any job can cause burnout if the work environment is toxic. Viral personalities, unyielding bosses, unreasonable hours all lead to discontentment. As stress and angst grow at work, small issues become magnified and soon become large issues. In these cases, if the practice is stagnant and unwilling to change, you’ve got to make the change yourself. Quitting your job is no flippant recommendation. It should always be considered carefully as the grass is always greener.

So what do we do about it? More vacation, less hours? That will certainly help. Do we leave our jobs? For some that’s feasible, for others it’s not. But what are some creative ways to lessen the daily stress that tends to accumulate over time?

• Don’t sweat the small stuff. Seriously. All those little things truly add up.
• Remember there are always clients who won’t like you, won’t agree with you, and won’t listen to you no matter what you do. It’s not always easy to swallow criticism and personal attacks, but you are one in a long line of veterinarians who has been on the receiving end of a negative client.
• Focus on your favorite clients. The one’s who bring you food, remember you during the holidays, and always thank you for your time.
• Eat healthy, exercise, don’t smoke, get enough sleep. Everyone knows these recommendations. Now actually follow them.
• Stop micromanaging. Micromanagement creates more work. If the job isn’t getting done, it could be a personnel issue.
• Use your vacation time.
• Make your CE time count (especially if you can’t take vacation): If you can swing it, take one of those exotic continuing education courses to the Caribbean or Central America.
• Say no. Believe it or not, you can refuse to pick up that extra day, run a bake sale for the kids, or cover another weekend.
• Don’t be afraid to work part-time. There is no shame is cutting your hours to maintain a healthy family balance.
• Find a hobby that gets you out of the house. Fresh air does wonders for the soul.
• See your doctor. If you are experiencing severe fatigue, make sure nothing else is going on!

Our feline friend from A Complicated Matter: Locating a Rogue Testicle had exploratory surgery today. He was not amendable to a thorough physical exam prior to surgery but once he was under anesthesia, the usual locations for a rogue testicle were inspected before making an abdominal incision. The likelihood the testicle had arrived in the scrotum was slim to none and, as expected, the scrotal sac was empty. However, another common location called the inguinal ring yielded a full-sized testicle!

When the testicle descends during development, it travels from the caudal pole of the kidney, down a ligamentous pathway called the gubernaculum, through a pelvic and muscular channel called the inguinal canal or ring, and into the scrotum. In our friend, the cryptorchid testicle was most likely trapped in the canal and could not be palpated externally or internally during the original abdominal explore. With time, growth, and a little luck, the testicle emerged from the canal and could be removed via a relatively non-invasive skin incision.

The story doesn’t end with surgery. Tackling the inappropriate elimination issue is key! I’m looking forward to a happy ending.

Last night I may have gotten a taste of what it’s like to be a mother who has to let her baby cry himself to sleep. But let’s start two weeks ago, when my cat Winston decided to urinate outside the litterbox. It was not urinary “accident”. Oh no, it was a protest. He protested the delay in breakfast and, in true attention seeking fashion, urinated on the carpet at the entrance to my bedroom. I cleaned the stain, chalked it up to a one time event, and went along my way. About a week later I noticed the undeniable odor of cat urine wafting down the hallway. A nose to the carpet revealed the pungent odor of urine along the wall outside my bedroom. Despite all my veterinary behavior knowledge, I was ticked but decided to fight the urinary demon full force.

This wasn’t the first time we’ve had urinary accidents in the house. In 2006, when my new husband moved into our new home, Winston began urinating in the dining room and bedroom. After performing a medical work-up to rule out some of the common causes of inappropriate elimination (see below), I determined the stress of the move and a new family member shook his world. We scrubbed carpet, added another litterbox (actually, an underbed sterilite container filled with litter), removed lids from the other 2 boxes, and changed to unscented litter. We purchased a cat tree, toys, Feliway diffuser, and locked him out of the bedroom. And when that wasn’t enough, he even received a six month stint of Prozac. He finally began using the litterbox again, was taken off of Prozac, and the carpet in the dining room was removed. All was well until two weeks ago.

Back to last night when I decided to lock the two cats in the basement in an attempt to curb the inappropriate urination. The crying, howling, and gnashing of teeth began in protest of their new imprisonment. It killed me to hear them pawing at the door and meowing their melancholic sorrow. Alas, it had to be done. I am hoping a couple of weeks of confinement will yield a mental reprogramming of sorts. My husband’s office is in the basement so I have eyes watching Winston use the litterbox, which I am proud to report he has been doing.

Tips for Dealing with Feline Inappropriate Elimination

• Talk to your veterinarian. Many urinary accidents have underlying medical causes therefore it is important to rule them out before proceeding with behavior modification. Diseases like urinary tract infection, feline lower urinary tract disease (FLUTD), bladder stones, kidney disease, diabetes, and hyperthyroidism among others can cause cats to urinate outside the box. A behavioral issue cannot be diagnosed until all medical issues have been ruled out.
• Never punish your cat for urinary missteps. It won’t work as cats are immune to guilt.
• Have your cat spayed or neutered.
• Increase your number of  litter boxes to one more than the number of cats in your home (n+1). Uncover litter boxes as the covers trap odors and can scare skiddish cats. Place boxes in areas of accidents.
• Give your cat a smorgasbord of different litter box styles and litter types. Underbed Sterilite containers work well.
• Change litter often and clean sides of pan. Use unscented litter.
• Be sure to clean soiled carpet with an enzymatic cleaner like Anti-Icky-Poo.
• Confine your cat to a small space equipped with litterbox, food, water, and bed. Cats are unlikely to urinate where they eat and sleep.
• Enrich your cat’s environment with toys and things to climb. Cat trees work well but so does shelving. Make sure you optimize play time.
• Reward your cat for proper litterbox use. Treats work best.
• Try a feline “happy, calm” pheromone such as Feliway.
• Prevent your cat from seeing other cats outside.

I will be sure to keep you posted!

I was recently awarded the opportunity to diagnose and correct a gastric foreign body. I had a phone call from a concerned owner who reported her young Samoyed, who I’ll call Hoover, was caught with a spool of thread in her mouth. According to the owner, Hoover had a propensity to consume anything and everything in sight. The owner was concerned with a threaded needle that was missing. I recommended monitoring Hoover’s feces in the coming days for any evidence of a needle and thread. Five days later, no needle. The dog remained asymptomatic.

The dog was admitted for radiographs which revealed a needle in the cranial midline abdomen. Discussion with the owner touched on the risk of needle migration within the abdomen or even though the diaphragm and into the chest. We also agreed about the unlikelihood the needle would pass through the GI tract given how much time had passed. We decided to take Hoover to surgery for an abdominal exploratory. We were prepared to find the needle in the stomach, intestines, liver, or free floating in the abdomen.

The abdominal explore began by observing the liver and abdominal cavity for evidence of a threaded needle. Then the stomach was exteriorized and I palpated significant amounts of firm material and digesta. The length of intestines were examined. Once I determined no foreign material was present elsewhere in the GI tract, a gastrotomy was performed. Two stay sutures were placed in the oral and aboral portions of the fundus. An incision was made near the greater curvature of the stomach. Initial digital exam revealed large amounts of foreign material in both the pyloric and esophageal regions. Two large pieces of soft plastic material, resembling snack cake wrappers, were removed from the fundic and esophageal regions. A large firm glom of material was palpable in the pyloric region. Steady traction yielded a large baseball-sized orb of chewed pieces of white plastic, undiscernible foreign material, and, in the dead center, a needle with dark thread wrapped around the entire mass.

The prognoses for the dog’s recovery and future repeat offenses are both excellent. Hoover will most likely return to my care for a foreign body in years to come.

The name Michael Vick tends to incite inflammatory conversations about the man’s widely publicized exploits in dog fighting rings. Pet owners nationwide were largely aghast that the Philadelphia Eagles would extend a contract to a man who was convicted of brutalizing pit bulls in 2009. Now, I don’t believe Michael Vick is any different from Baltimore Ravens infamous bad boy Ray Lewis, who’s rap sheet could circle the equator, just because his crime is against animals. They are both criminals who don’t deserve NFL contracts. I don’t believe either one of these men should be given the privilege of million dollar contracts, public notoriety, and a position as a role model for children. But that’s another conversation.

What I find more disturbing is that the Philadelphia Eagles awarded Vick the Ed Block Courage Award.  Are you serious, Philadelphia!? The Ed Block Courage Award is “given annually to a player who exemplifies commitment to the principles of sportsmanship and courage.” Vick is anything but courageous. Courage implies choice to persevere despite adversity. The only choice Vick made in this situation was to abuse and mutilate dogs. The law caught up with him and placed him behind bars for 18 months. There is nothing respectable nor courageous about serving your prison term.

“I’ve had to overcome a lot, more than probably one single individual can bear,” Vick said. “Take a look at what I’ve been through. You ask certain people to walk in my shoes, they probably couldn’t do it — probably 95 percent of the people in this world. Because nobody had to endure what I’ve been through — situations I’ve been put in, situations I’ve placed myself in, decisions that I’ve made — whether they were good or bad. There are always consequences behind certain things and there are repercussions behind them, too. Then you have to wake up every day and face the world, whether they perceive you in the right perspective or it’s a totally different outlook on you.”

Michael, you’re missing the point here entirely. People would not walk in your shoes let alone try them on! They would not beat, electrocute, and mutilate dogs for entertainment. I couldn’t walk in your shoes, not because I couldn’t endure prison, but because I could never have exhibited such blatant disrespect for life! And Michael, you don’t deserve to have a “right” public perception. I perceive you as a heartless, money hungry athlete who was willing to brutally sacrifice animals for cash and amusement.

And where does personal accountability come into play? He shows a glint of personal accountability but loses any credibility when he bookends his speech with his sob story about the challenge of living the life of a convicted felon. He wouldn’t have had nearly as much to overcome had he not continually recommitted himself to his dog fighting ring. Vick should never have gotten another opportunity to play professional sports, let alone an award for pulling himself out of the hole he dug with his own hands.

Philadelphia Eagles, you look like a bunch of Dodos.

I spent months dreaming up the names for my cats. No ordinary names would do. In the end, I kept the name Fox for my sneaky, pointy-nosed, red male. I did, however, rename my other chubby male from Winston, a regal deviation from his shelter name Cedar.

Many people name their pets using descriptive, cute names. These names, because of their mass appeal, result in names that are hackneyed.  For example, I can’t come close to counting the number of Chocolate Labs I see in my practice named Hershey or Cocoa. Then you have the calico named Callie, the Jack Russell Terrier named Jack, and the ever clever Deeogee (sound it out).  Over the years names like Max, Buddy, Fluffy, and Shadow have reigned supreme. While there will always be a place for those names, they have yielded to trendy names that sound more like a child’s name than a pet’s.

Perhaps the changing tide in pet names revolves around the changing perception of pet’s as family members. I’d never name a child based on his skin and hair color, but Pasty Toehead Koehl does have a ring to it.  Perhaps popular pet names merely lag behind popular people names. As Chloe, Zoe, Molly, and Maggie’s pet name popularity rises, their prominence as new baby names wanes. Or perhaps, we just can’t resist a cute little tabby named Daisy and a lumbering Golden Retriever named Charlie.

Check out the list of names below!

Petfinder.com Top Pet Names for 2009

For the third year in a row, the No. 1 and No. 2 names for dogs are “Buddy” and “Max.” “Lucy” took the No. 1 spot for cats, and “Smokey” came in as the second most popular feline-forename.  For the first-time in recent history, “Bella” made the list for both cats and dogs. After all, all pets are beautiful, right? (Check out 2008′s most popular pet name list.) Here’s the rest:

2009 Top 10 Most Popular Dog Names
1.  Buddy
2.  Max
3.  Daisy
4.  Lucy
5.  Charlie
6.  Bella
7.  Molly
8.  Jack
9.  Sadie
10. Lady

2009 Top 10 Most Popular Cat Names
1.  Lucy
2.  Smokey
3.  Midnight
4.  Bella
5.  Molly
6.  Daisy
7.  Oreo
8.  Shadow
9.  Charlie
10. Angel

Have a cute and original pet name? Leave it below!

Everyone knows if you are going to keep a New Year’s resolution you’re more likely to do it if others know of your plans.  I’d prefer to approach them as New Year’s goals…the places you want to take yourself in the coming year. I have high hopes for VMDiva.com in 2010!

2010 New Year’s Goals

• Write posts in more routine fashion, accelerating to daily postings
• Develop VMDiva Twitter account AND actually use it
• Apply for American Animal Hospital Association’s blogger position
• Develop and publish PDF technician lesson files
• Write and publish at least one news article

Cheers to a productive and prosperous 2010!