VMDiva

I began formal training today for the 10-mile Broad Street Run (Philadelphia) with my new found Team in Training friends at The Leukemia & Lymphoma Society. I ran 2 miles today in horizontal snow working up to my May 2nd 10-miler. I’m not going to lie, it was miserable to have snot dripping from my nose and my lungs scorched from the cold. And did I mention I hate running? But I did it. Let me tell you why.

Over a year ago I met a vibrant sassy 27 year old named Shanna when she began working at my hospital. She was diagnosed with uterine cancer at 16 and underwent chemotherapy. I learned she unexpectedly became pregnant at age 21. She went into preterm labor at six months gestation from complications from her cancer. Six months later, despite the NICU’s best efforts, he died.  She then had a hysterectomy and partial ovariectomy. As if that was not enough grief for one person to bear, flash forward six years and she found herself afflicted with malignant tumors in her remaining ovary. Another surgery and series of body scans cleared her of cancer. She was doing well until about 4 months ago, when she found a painful lump in her breast. Multiple visits to doctors and multiple breast surgeries revealed severe mastitis secondary to Stage 3 Lymphoma in both axillas. This is a crushing blow to everyone who knows her as we anticipate more chemotherapy and surgeries.

Shanna brings join, humor, and life to people around her. In her 4th battle with cancer, she has remained positive and hopeful. She’s still working as she rapidly approaches her surgery date for a single mastectomy and lymph node removal. She’s the reason I committed to running and raising money for The Leukemia and Lymphoma Society. If Shanna can come to work every day with a smile on her face, I can certainly run 10 miles and raise money for this great foundation.

I need your help on multiple levels. First, I need fundraising ideas! If any of you have a practical idea for fundraising, please let me know! I have boxes of candy bars and sweet treats to sell at the office. I am thinking about selling homemade dog biscuits. What else?

More important is the focus on raising funds to benefit cancer patients, for research, and to provide a network of understanding and support for people with blood cancers. If any of you know of a blood cancer victim and feel compelled to donate to LLS, please visit My LLS Site to make a donation! My personal goal is $1000 by race day but I would be proud to surpass that!

Discussions on a colleague’s blog stoked my agitation about rude exam room etiquette.  If you’re a cell phone user, screamer, or lousy parent, this blog post is for you. Most people understand how to behave in any professional appointment. When I go to the doctor’s office, I sit quietly in the waiting room and then in the exam room,  stay courteous, and express my health concerns. I wouldn’t even think about wandering the hallways or yakking on my cell phone. Here are some examples of how not to behave at the vet’s office:

Don’t Arrive Late and Then Act Angry When You’re Bumped to the End of the Line

Most veterinary practices operate on 15, 20, or 30 minute appointment schedules. Your 10-15 minute tardiness can drastically affect the flow of appointments when the schedule is full. Try to arrive early. If you know you’re running late, call the hospital. If you arrive late, be prepared to wait. It’s not fair for clients who arrived on time to wait past their appointment time due to your tardiness.

Stay Off the Cell Phone

Cell phone etiquette is generally terrible every where we go. I enter a public arena and often hear a loud one-sided conversation. That doesn’t belong in an exam room. If you are caught on your cell as the veterinarian walks into the room, promptly end the call. If you don’t, your veterinarian may just walk out on you. I’ve done it.

Don’t Take Your Pet For a Walk During the Appointment

This seems like common sense. If you are in an exam room waiting for the vet, don’t leave. On numerous occasions I have walked into an empty room. I would rather have Fluffy urinate or defecate on my floor (what, you think that’s the first time it’s ever happened?) than walk into an empty exam room. See scheduling crunch listed above.

Your Appointment is Not the Time to Start Disciplining Your Pet

Most pets, when confronted with the unfamiliar and sometimes terrifying prospect of their veterinary visit, will act uncharacteristically anxious, fearful, or aggressive. Vets expect this. I dread owners, who I sense haven’t invested much time in training the pet, that resort to screaming and correcting the dog in a volume loud enough the dogs in the waiting room obey the commands. On the other hand, I also loathe the owner who finds the pet’s biting, scratching, and fearful behavior hilarious. Don’t laugh and think it’s cute when your pet bites at my staff. Bites and scratches are serious threats to well-being.

Your Appointment is the Time to Start Disciplining Your Children

Children should never handle instruments in the exam room. They are expensive and not designed for little hands to bang and drop on the floor. It’s happened to me. Don’t allow your children to pinch, poke, or otherwise agitate the veterinarian. That’s happened to me as well. And it’s always a good idea to keep your kids away from Fido’s face during the exam and vaccinations. You cannot always anticipate fearful behavior and bites may ensue.

I hate on-call. I loathe, detest, and lament on-call. Every time I have that ringing beast in my possession my stomach churns when it sings it melodic tune. Most small animal general practitioners would agree on-call just plain stinks. Calls during dinner, holidays, and the middle of the night coupled with the constant threat of changing plans and interruptions give on-call its much deserved bad reputation. No one likes a leash. Shifting trends in veterinary medicine are making on-call obsolete, though its archaic status is not uniform across the veterinary world yet.

Many new practitioners look for positions with limited or no on-call. It’s very difficult to balance home and work when works comes home and calls you in the middle of the night. The new generation of veterinary medicine recognizes the need to better balance work and life which has culminated in less hours, more vacation, and flexible schedules. Requirements to see patients on emergency add long and irregular hours to an already stressful, tiring job.

A majority of the push to eliminate or limit on-call is probably traceable to the changing demographic and ideals of the newly female-dominated workforce. Women must exercise caution when meeting a client alone in the middle of the night for an emergency. Ketamine, among other drugs, has increasing street value and veterinary hospital robberies are not uncommon. Additionally, phone calls and travel throughout the night do not provide a family friendly schedule and mothers of young children may find it impossible. Employers have noticed and many have begun advertising positions with no on-call in the banner.

On-call is more than an inconvenience for veterinarians forced to hastily jump from bed.  If not executed properly, the on-call vet can find herself providing sub-par care overnight or on the weekend. On-call compensates for a closed office and closed offices rarely provide 24-hr care. While leaving an unsupervised but stable animal in the hospital overnight may be okay in some circumstances, sick and unstable animals typically require more extensive monitoring, medications, and treatments. I am in the camp of “If it’s sick enough for you to call me at 3am, it’s sick enough to warrant 24-hr care.”

If a veterinarian offers to see a pet at an owner’s regular hospital on an emergency basis, it’s important the owner know what types of services the vet can provide. Without support staff, usually simple tasks like drawing blood or taking an x-ray can prove challenging. Having owners help retrain their pets is dangerous and a potential legal nightmare.  Will the vet or a technician stay at the hospital that night to observe the animal? Most times the answer is no. Many pet owners may find more comprehensive care at an emergency hospital, and given the rising cost of GP’s emergency fees, the price difference probably won’t amount to much.

Many stalwart veterinarians insist they are providing a service to their clients. In rural areas where the nearest emergency center is miles away, I can see that point. But the majority of people live in or around cities where overnight and 24-hr hospitals abound. Those hospitals are equipped with multiple technicians, multiple veterinarians, and the ability to care for a sick pet quickly and efficiently. I challenge those stalwarts to examine if they are looking out for the animal’s best interest or their bottom line.

I like to think I can separate my personal life from my professional life, but let’s admit it, we’re all guilty of letting emotions roll over from home to work and vice versa. When personal life drama spills into work everyone is affected. From patient care to interpersonal relationships, the entire practice feels the impact.  Everyone has a personal struggle that affects work occasionally, but what do we do when that person’s problem becomes the practice’s problem?

Gossip Solutions: Veterinary hospital staff is predominantly made up of women. My various experiences with large groups of women leads me to believe that, no matter where you are or what the mix of personalities, conflict will arise. A wise businessman I know adopted a no gossip policy at work: first offense received a warning, second offense resulted in termination. The policy worked very well at stopping the behind-the-back sniping (at least in the office).  Additionally, veterinarians and higher-ups must lead by example. It’s pretty difficult to correct a toxic environment if those in control are polluting it.

Relationship/Family Drama Solutions: Break-ups and divorce have no place at work. A person can talk with coworkers, however, personal relationship problems should be kept under wraps. In addition, parents with small children should be prepared for a child’s illness. They should have open communication with the employer regarding missed work days. Employers can and should allow use of sick days, vacation time, and/or unpaid time off for parents to care for sick children. However, at-will employees who repeatedly fail to show up at work are at risk for termination. Businesses require reliable help to operate properly.

Illness: Employees dealing with extended illness require us to explore our options. Nobody asks for cancer. Most reasonable small business owners will bend over backwards to accommodate ill employees as they seek treatment. There can come a time when an employer considers termination. Terminating an employee simply due to a diagnosis of cancer or disability is unethical but may not be illegal depending on employment agreements. At-will contracts allow employers to dismiss employees for any reason, extended illness and inability to perform duties included. Many employer contracts allow for legal termination if the employee cannot work for a period longer than two months.

The biggest problems arise when the illness prevents the employee from performing his/her normal duties. These employees can be reassigned different tasks in most cases. A bigger issue comes when the use of medications, fatigue, or lack of mental clarity directly affect performance. Small mistakes are forgivable. Bigger mistakes affecting client and patient care directly affect the quality of care and economics of the practice. These situations warrant medical leave and need delicate handling. Employers, though simply looking out for the best interest of the practice, can appear calloused and uncaring if they don’t make it apparent this is a professional issue and not a personal one.

Termination is a final option. Unfair? Probably. Legal? Most likely. Necessary? Maybe. Difficult? Absolutely.

I received a call the other night from a distraught pet owner who sheepishly approached our conversation about his 5lb puppy. “I did something really stupid.” Uh-oh. I have heard a lot of crazy things so I was prepared for just about anything he was going to tell me. His voice cracked as he slowly said, “I can’t believe I thought this was a good idea.” I started to squirm then he admitted he gave his puppy “a few tablespoons of wine” and now realized it was an idiotic decision. Lethargy, and probably a drunken stupor, hit the puppy hard.

I decided the puppy, who was then walking around as the effects of the alcohol wore off, seemed stable. We spoke about what to expect and what clinical signs required emergency care. I’ve never heard back from him. After I hung up and realized I didn’t even ask him why he did it. Truthfully, I don’t think he even knew. I gave this guy the benefit of the doubt. We’ve all made stupid, thoughtless decisions which weigh heavily in our stomachs as we mull the horrible decision and try to rectify it. He clearly didn’t think. Any rational person would know not to feed any animal, let alone a small puppy, alcohol. He at least redeemed himself by calling my office to find out what he should do. Perhaps I was too lax, but I trust this man will never make this mistake again.

I like tangents and this case got me thinking about how I could measure a blood alcohol content (BAC) in a domestic pet. Breathalyzer is out. A quick search on Google failed to yield any available bedside blood alcohol tests. Laboratory tests exist but shipment of blood for a BAC would take too much time. Any veterinarian should provide decontamination and supportive care to any alcohol poisoning suspect pending any bloodwork. The animal would most likely have either recovered or died while waiting for BAC lab results.

I then tried to calculate the puppy’s BAC using The Original Blood Calculator. A full 5 oz glass of wine would have given Fido a fatal BAC of 0.813%. Two tablespoons equal 1 oz of wine, so Fido’s BAC may have been closer to 0.16%. While it is clinically interesting to speculate, this value may or may not be close to accurate given varying metabolisms between humans and dogs.

Animals entrust us with their care. Be smart and don’t abuse it by giving them alcohol. For more information on alcohol poisoning in domestic pets, check out this article on VIN!

Admittedly, I stopped reading books for pleasure during college and had a long dry spell until I resolved to pick up the slack several years ago. My attention span is embarrassingly limited so a book really needs to peak my interest for me to even pick it up. I’m a sucker for stories narrated by emotive animals (can anyone say anthropomorphism) but I’m particularly vulnerable for insightful ones. Such was the case with The Art of Racing in the Rain.

Enzo, a lovable aging dog, tells the story of his owner’s balancing act between his desire to race cars and his commitment to his struggling family. His comedic and painfully accurate assessments of human personalities keep you laughing and cringing at the same time. He also offers a poignant perspective on his own impending death.

Laughter, anger, love, hope, introspection: It all made me fall in love with Enzo.  This book will leave you wondering what your own dog is thinking.

Highly recommended.

Faced with a leg amputation to treat bone cancer, dog owners can experience trepidation over their pooch’s outcome. This scenario is playing out for one couple at my practice who’s six year old golden retriever, named Goldie Hawn, has been diagnosed with bone cancer in her left femur.  Given their amazing ability to walk on three legs, amputation is the treatment of choice. Amputation will at least provide palliative treatment of her tumor and at best a cure. Amputation is permanent which makes the stakes even higher. Goldie’s owners have that knot-in-their-stomach nervousness but a little education can alleviate some fears.

From a veterinarian’s perspective, it’s easy to discuss the surgery, recovery time, and varying anticipated outcomes following a leg amputation. What we aren’t always ready for are those questions regarding specific parts of the dog’s quality of life. I smiled as Goldie’s owner asked how she would be able to “squat to pee” and if she would “have a stump”. I walked them through preoperative and postoperative care, glancing over the surgery itself when they told me they couldn’t handle the details. I recommended they watch videos on youtube.com of three-legged dogs to get an idea of what to expect. Knowledge is power.

Dogs never cease to amaze me with their ability to cope. Many dogs swiftly adapt to their tripod status. It seems hind leg amputees ambulate better than fore leg amputees but both still motor along with the best of them. Check out these videos!

Fore Leg Amputee Playing Frisbee

Hind Leg Amputee Competing in FlyBall

It disheartens me to see my alma mater struggle during the recession, especially when a portion of its economic strife is not under the school’s control. The Commonwealth of Pennsylvania has slashed its funding to the veterinary school so severely the school has been forced to eliminate numerous faculty positions as well as entire departments. It is evident these cuts affect the public and veterinary students as the repercussions funnel down to them. I have great concern for the future of Penn Veterinary Medicine, especially when the future is partly controlled by bureaucratic decisions.

Veterinary student debt is a common topic and I certainly don’t want to harp on something most veterinarians know about. With budgetary issues at the forefront, it only flows that student tuition will continue to rise.  At Penn Vet, the current cost of tuition for PA residents is $32,902. The current tuition for non-residents is $40,058. That doesn’t even cover cost of living during those four years. With debt soaring, students shouldn’t have to deal with another tuition hike. They shouldn’t be sitting on top of one another in class either. Class sizes are always increasing but have significantly risen in the past few years.

The public will ultimately be hurt by these cutbacks.  The Matthew J. Ryan Veterinary Hospital has eliminated its neurology and special species departments and rumors swirl about the elimination of more departments. Pet owners will need to go elsewhere for some types of specialized care, sometimes miles away from home.

Perhaps most concerning is the elimination of the Center for Infectious Disease Research, highlighted in the CNBC article. “Established to study diseases with the potential to move from animals to people (or vice versa), the center’s loss is “stunningly myopic” in the era of swine flu, [Dean] Hendricks said.” Veterinarians do not merely care for sick pets. They play a critical role in protecting public health by researching and preventing zoonotic disease and inspecting the US food supply though the USDA.  A slash to infectious disease control measures will put the public at greater risk for zoonotic disease and could affect our food supply.

I am generally not a fan of home-cooked diets for pets because, too often, I have seen pet owners fail to provide a balanced diet. Now, I’m not talking about the folks who do their research, provide a variety of nutrients, and add supplements. I am talking about the owners who report their precious Fluffy just won’t eat anything but roast chicken and green beans. Merely adding a veterinary or human multivitamin to a diet does not make it balanced as those products are labeled for use in addition to an already balanced diet.

The dangers of an unbalanced diet are multiple. Nutrient deficiencies can result in anemia, skin issues, gastrointestinal issues, nerve conduction problems, and immunosuppression among many other medical conditions. It is crucial that pet owners who want to make food for Fluffy do it well. Many of the home-cooked diet recipes that came out from companies like Hill’s Pet Nutrition about 10 years ago have since been deemed unbalanced and are no longer recommended although you can still find recipes circulating the web. A Google search yields pages and pages of scientific, non-scientific, and opinionated recommendations on what to feed pets. With all this information, it can be difficult for pet owners to know which recommendations to follow.

As a general practitioner, formulating a diet is something I could do with the guide of a nutrition book and many calculations but is beyond my comfort zone. When faced with folks who have questions on how to provide a diet for their pets, I state the easiest way to achieve a balanced diet is to feed a balanced commercial food. If the owner finds this undesirable, I talk about the other two options: Consult a veterinary nutritionist or use a veterinary nutritional website to find a diet that fits the pet’s needs.

Owners can search the American College of Veterinary Nutrition to find a veterinary nutritionist. If that seems like too much work then they should check out these two websites below. I like both of these sites because they personalize diets on an individual pet basis.

PetDIETS.com was developed by a veterinary nutritionist and can provide specific diets for healthy and sick pets. These nutritionists can recommend a home-made diet, a commercial diet, or both depending on the pet’s nutritional needs.

BalanceIT.com allows pet owners to choose the protein and carbohydrate sources they wish to feed their pets and creates a supplement based on a recipes the owner purchases. This is great for folks with pets with GI sensitivities or skin issues who have already been feeding an unbalanced diet. It allows them to continue feeding their current diet while adding supplements to make it balanced. I really love this one.