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Archive for the ‘For Vets’

The Pregnant Veterinarian

June 06, 2013 By: Dr. K Category: For Vets, Opinion

Babies! It seems like many veterinary practices are bursting at the seams with women traversing the 10 (Yes, 10!) difficult months of pregnancy. It’s no surprise given most of the veterinary technician workforce and 80% of all new veterinary graduates are women. During my recent pregnancy, I gained valuable insight into what it takes to practice veterinary medicine while gestating.

Anesthetic Exposure

One of the first questions I posed to my obstetrician was, “Can I still perform surgery?” Have no fear ladies, you’ll still get your chance to cut and cure! So long as your practice abides by the standards of care and has an anesthetic scavenging system (Read: The system is maintained and it doesn’t dump exhaled anesthetic on the floor), you are in the clear. Use common sense, however, and keep your face away from animals in anesthetic recovery to avoid breathing exhaled gases.

Radiation Exposure

All radiation exposure should be avoided especially in the developmentally important first trimester.

Toxoplasmosis

Toxoplasma gondii is a feline protozoal parasite transmitted by fecal-oral contamination. Avoid handling of cat feces as much as possible and practice good hygiene.  Some obstetricians will recommend having your titer checked while others don’t see the value. This one is up to you. I opted out of this test due to the low likelihood of infection and to prevent myself from unnecessary worry.

Heavy Lifting

Disclaimer: I cemented and mortared a slate patio when I was 6 months pregnant and therefore may not be the best authority in this department. If your OB says no lifting, that means NO LIFTING! Nothing is worth jeopardizing your baby.

This one is tricky. If you work at a practice with a terrific technician to vet ratio, you likely won’t have to worry about lifting that portly Puggle. For most veterinarians, some lifting is required. Sometimes heavy lifting or exertion can result in mild spotting due to the rupture of friable blood vessels on the cervix.  This will cause you to panic but is rarely a serious issue. Sometimes serious exertion can cause placental abruption, serious bleeding, or fainting.

Additionally, as your pregnancy advances your body produces the hormone relaxin that allows your tendons and ligaments to stretch to accommodate for your upcoming delivery. Add a shifting center of gravity to your gumby-legs and your balance falters.

Be deliberate, be cautious, and be reasonable. Light lifting and restraint shouldn’t pose a problem.

Performance of Duties

I worked until my 36th week of pregnancy and I know of vets who have worked right up until their due dates. Here are some things to consider when it comes to performing your regular duties:

  • Swollen ankles, shins, knees, and hands can prevent you from standing for long periods of time and affect your dexterity.
  • Your belly will get in the way of the surgical field. You’ll need to be creative to do your abdominal explore.
  • You will be exhausted in your first trimester and likely exhausted toward the end of your 3rd trimester. Avoid taking extra shifts if you can.
  • You can’t breathe. Bending over to tie your shoe becomes an olympic event so don’t think you’re going to be able to crawl on the floor upside-down to get that hard-to-reach FNA.
  • You’ll have to pee. A lot. Be prepared to zip in to the bathroom after every appointment.
  • Your sense of smell may take on superhero proportions. I never felt ill from the odors of the clinic but the smell of blood at the deli counter was enough to send me running.
  • Pregnancy brain is real. You may have a harder time remembering the details of your cases at the end of the night so try to keep up with your SOAPs as you go.
  • Pregnancy rage is real, too. Don’t tear the heads off of clients. It’s not a good practice builder.

Worry

Once you get that positive test result you quickly swing from excited to worried. What if I get a cat bite? What do I do with a Rabies suspect? I found myself suddenly concerned with having my hands in a dirty mouth, getting splashed with urine, and getting jumped on by patients.  This is normal and just starts the life time of worry that comes once your baby is born.

 

Violet Mae was born 12/26/12 weighing 6lb 5oz and measuring 19 inches. We love our little addition to the VMDiva family!

 

Handling the Winter Lull

February 17, 2013 By: Dr. K Category: For Vets, Practice Management

Winter. Short days, long underwear. The thought of winter in the Northeast conjures up the dismal gray and frigid temperatures that lull veterinary clients into a stupor. Allergic skin disease and rotten ears are distant malodorous memories. Orthopedic injuries are rare as dogs spend more time indoors. And veterinarians and staff are left twiddling their thumbs in anticipation of the next appointment. What do you do when appointments take a down turn? Follow these tips and your practice can turn the winter lull into the winter boom!

1. Update Those Reminders
Many practices have a reminder system that functions sub-optimally. Changes in protocols often require updating the client reminders, sometimes manually. Additionally, clients who have declined a vaccination or failed to bring a fecal sample to their previous appointments leave the reminders incomplete unless your staff has been meticulous in updating information. Synching annual exam dates with when vaccines are actually due, adding reminders for ancillary services like laboratory work, and reminding clients to bring in stool samples can boost the bottom line all year long. The added benefit is keeping your reception staff busy and ensuring they understand the most recent protocols and recommendations.

2. Offer Incentives

Many of the most successful practices incentivise appointments and procedures during the winter months to keep income incoming. February is National Pet Dental Health month; Offer a discount for all dental procedures scheduled in that month. January your slow month? How about $10 off an annual examination? Getting clients through the door is the name of the game.

3. Practice Your Personal Touch

During the slowest times, encourage your staff and veterinarians to take their time in their appointments to connect with clients. (I know, I know. We should always take our time and not feel rushed, but when Mrs. Pushy brings three pets to her 15 minute appointment instead of one and you have two emergencies in the wings it’s near impossible not to rush.) Connections and small talk foster trust and bolster compliance. Detailed explanations of the importance of dental hygiene, routine laboratory work, and why that Leptospirosis vaccine is really important will benefit the patient and the bottom line.

And yes, use your callback reminder system to have your staff reach out to your patients who may have fallen through the cracks. A simple phone conversation may reveal the patient you thought was thriving after discharge is not.

4. Clean

This is the easiest time of year to make your practice sparkle top to bottom. Nothing makes me cringe more than walking into a practice that smells. I’m not talking the standard smell of a hospital or a stinky Labrador who was emanating his freshly-rolled-in-poop glory. No, I’m talking the musty smell of dampness, urine, and uncleanliness that makes clients question the value and competency of the practice. There is NO excuse any time of the year.  A thorough winter cleaning keeps odors at bay and your biosecurity at its peak.

5. Educate Staff

Blocking time for a lunch and learn is a lot easier when your staff is not slammed with the spring and summer smorgasbord of cat bite wounds, limping dogs, and hot spots that all need diagnostics and treatments over the lunch period.

Educated staff equates to improved patient care leading to happier clients. It’s that simple.

Additionally, update educational material in puppy and kitten packs, handouts, and mailings.

6. Educate Clients

The stillness of winter is the perfect time to offer puppy classes, animal first-aid classes, and general pet ownership tutorials. Not only is this the perfect way to network with responsible clientele, it seats your practice as the local authority among practices in your area.

Remember: An educated client is a compliant one.

Ten Signs It’s Time To Leave Your Veterinary Practice: Part II

July 17, 2011 By: Dr. K Category: For Vets, General, Practice Management

Ten Signs It’s Time To Leave Your Veterinary Practice: Part I

I’ve listed  the first 5 signs it’s time to leave your veterinary practice in Part 1. The remaining 5 signs below are equally important. Feel free to list more signs or relate personal experiences!

6. Compromised Patient Care

Do patients sit in their filthy cages all day? Tipped over water dish never filled? If your practice fails at basic care for patients, it will never excel at advanced medical care. Practices that competently complete the basics are easy to find; Finding practices that excel at advanced care proves more challenging.

A dear friend told me about a nightmare hospital where they put on the facade of a referral hospital, even providing blood products. Of course, not one of the support staff members knew how to perform a blood transfusion. Couple that with their lack of transfusion supplies and you’ve dialed up a situation for poor patient care.

Compromised patient care, at any level, is a deal breaker. Clients entrust their beloved pets to veterinary hospitals and believe we will rightly care for them. We are obligated to peak performance. If a practice does not have its focus on patient care, refuse to compromise.

7. The Practice Is Chronically Understaffed

The formula for stress at work:

Stress = Too many tasks + Too few employees – Patient care (see #6).

If your practice is always hiring, firing, or losing employees, you can bet that turn-over rate is an indicator of severe dysfunction traceable to the leadership. Practices with high churn rates find themselves in a perpetual cycle of being understaffed. High churn also means new employees in need of training. But without staff who trains them? Too few and untrained employees results in one big problem: Poor patient care!

8. Lies, Lies, Lies

Whether it’s lying to employees or lying to clients, businesses built on lies are dangerous. Evacuate now.

9. Inability to Effect Change

The ability to effect change is integral to feeling like a contributing member of a practice. Having ideas for improvement embraced and implemented rewards free-thinking employees. Movers and shakers become frustrated when their repeated attempts at correcting problems are thwarted by ineffectual leadership.

If you’re ideas and offerings are met with cold stares, or worse, promises of compromise that never come to fruition, perhaps it’s time leave for fertile ground.

10. Life Has Changed

The fluidity of life can alter your needs so that jobs that formerly fit well then may not fit now. Marriage, children, illness, and family struggles all may change your employment needs. It’s never wrong to seek a job that fulfills your financial needs, provides better benefits, or offers the hours compatible with your life.

 

If you are in the market for a new job in the poor economy, perseverance and ingenuity are key. Make yourself more marketable by filling niches. Create job opportunities instead of just pouring over the classifieds. Thinking outside the box just may open doors for job fulfillment!

Ten Signs It’s Time To Leave Your Veterinary Practice: Part I

July 16, 2011 By: Dr. K Category: For Vets, General, Practice Management

Deciding to quit requires great consideration and, in many cases, should only occur following exhaustive attempts at improving your workplace. For tips on how to cope and avoid quitting, check out the first half of this article from US News and World Report!  If you think you are at the end of your rope, quitting your job may be the only option you have left.

Leaving your job during a down economy carries enormous weight.  Frequently the idea is abandoned because of fear of the unknown. Too often we accept mediocrity in exchange for comfort. Our griping, stress, and stagnancy linger because we don’t want to sacrifice a sure thing.

Some of the best advice I ever heard came from Mr. Vernon Hill, past-CEO of Commerce Bank. When asked what to do when management refused to budge he said pointedly, “Something’s gotta change. Either they change or you change.”

I offer you 10 signs it’s time to leave your practice. Many of the signs are interrelated, a consequence of compounded dysfunction.

Ten Signs It’s Time To Leave Your Veterinary Practice

1. Lack of Leadership

Having a definitive leader in a practice is key to maintaining balance and unity between personnel. A practice is only as strong as its leaders. The discord from lack of leadership trickles down the ranks from associates all the way to kennel staff. Leadership failures include ignoring conflict, refusing to address employee concerns, and an inability to accept feedback and criticism. If business owners and managers refuse to establish and adhere to set practices and guidelines, the practice quickly morphs into an every-man-for-himself mentality.

The strongest practice leaders seek input from their employees and strive to improve work relationships. Without that direction inconsistent policies, unresolved conflict, and disgruntled employees contribute to an even bigger problem: Poor patient and client care.

2. You No Longer Enjoy Your Job

This one seems like a no-brainer but it deserves a closer look.  Only about half of Americans report they actual enjoy their jobs. Yikes! Money, interpersonal relationships, long hours, and the job itself comprise many of the reasons for job dissatisfaction.

Burnout is one of the biggest factors affecting a veterinarian’s job satisfaction. There is a big difference between physical burnout secondary to long hours and emotional burnout secondary to chronic stress. Physical burnout can sometimes be remedied with vacations or sabbaticals. Emotionally burnt out employees may have no other choice but to leave their current position in order to reestablish balance.

We will all experience bad days, weeks, or months at work. Overall job dissatisfaction comes from chronic, systemic dysfunction resulting in more bad days than good over an extended time.

As an aside, I don’t know many veterinarians who, at one point or another, haven’t doubted their calling into the profession. The long hours, chronic stress, and interference with personal life take a toll. It leaves us second guessing. Determining whether you are unsatisfied with your job or your career is critical.

3. Work Interferes With Family Life

Veterinary professionals expect long hours and late nights. Those unfortunate enough to have the plague of  “on-call” carry a tether to the veterinary practice making maintaining your family and social life difficult.  Long hours make veterinary medicine challenging enough, throw in a chronically stressful work environment and you’ve got big trouble.

Overworked on a soft tissue rotation during my fourth year of veterinary school, the only thing I could think of on my 20-minute drive home was a hot sausage sandwich. It waited for me, an ample leftover certain to squelch my starvation. I arrived home to find my husband had eaten all of the sandwich rolls and all but three inches of coveted porky goodness. The consequences of fatigue, stress, and an 80-hr work week played into the epic at-home work-induced meltdown that ensued.

Rational thought escaped as I went on a tirade about how it was clear my husband didn’t love or respect me since he ate my long fantasized about dinner. I heated the measly morsel and continued to accost my poor husband. I stormed to the office, my husband in slow chase behind, and to my dismay my sausage rolled off of my plate and across the floor. I bawled. A lot. Work stress weaved its way into my home life and my attitude suffered for it. In retrospect, this proves another hysterical moment among many in our relationship, but a lesser man may not have been so tolerant of work-related meltdowns.

Ideals, however noble, are rarely upheld when serious long-term stress hits. Our families are the first affected by sour moods. Sometimes our work situation is so miserable no amount of positive thinking and affirmations contain the emotion of job dissatisfaction. Don’t let your family suffer.

4. Ouch! You’ve Run Into The Ceiling

Positions with little or no room for growth are frustrating. Stagnant minds rot. Stagnant paychecks are rotten.

5.  Any Other Job Is More Appealing

Find yourself thinking waiting tables looks better than your current job? Willing to take a significant pay cut just to escape? See those road workers dripping in sweat on a summer day and jealously think ‘Hey, they look so tan!’? You are not alone but it’s time to seriously rethink your current situation.

Remember the expression “The grass is always greener on the other side of the fence?” It’s true. It’s greener because it’s fertilized with bulls**t. We’ve neatly concocted scenarios in our minds as to how much better it is over there. If the only reason for leaving is  you think it’s better on the other side, think again. Perhaps you just need a vacation. But if you find yourself nodding in agreement with some other signs, this may contribute to your decision to leave.

 

Ten Signs It’s Time To Leave Your Veterinary Practice: Part II

Is it broken? Nah, it’s just fractured.

April 02, 2011 By: Dr. K Category: For Vets, General, Opinion

A colleague’s recent appointment went hysterically awry when the owner misunderstood the explanation of the dog’s illness.  Upon presenting to our clinic with a “swollen nipple”, my colleague diagnosed the dog with mastitis, a painful infection of mammary tissue.  Her owners recounted the treatment plan, consented to labwork, and waited while the diagnostics were performed. When the veterinarian and dog arrived back in the exam room, one owner said, “What’d you call that problem again? Mass tits?”

Mispronunciations and misunderstandings are a staple of veterinary medicine and I rarely fault my clients for them. Refills of subscriptions, ascriptions, and scriptions fill the prescription inbox. Eyedrops treat cadillacs. Elbows are knees, wrists are ankles, their left is my right. This list goes on and on. I usually chuckle and note I should keep a list (yes, I should definitely keep a list) but a few pet peeves still get to me.

Spaded

Every veterinarian has been there.  A client requests to have her puppy “spaded” and you fight the cringe. I’ve tried gentle coaxing with, “We can certainly set up an appointment to have your dog spayed; The receptionist can set that spay up for you.” This rarely works though I find myself trudging forward on a fruitless journey. It seems as though this term is firmly rooted in the client vernacular.

If gentle guidance doesn’t fix the misnomer, this is one better left alone. The correct term for removing the ovaries and uterus is an ovariohysterectomy. The general term for the procedure is a spay. It turns out spay is an English term derived from the French term espee, the early derivative of the sharp blade used in fencing called the épée.  A spade is a tool used to dig, cut, or remove. Maybe spayed and spaded aren’t so far apart afterall?

It’s Just Fractured, Not Broke

Somewhere in the history of medicine someone decided broken and fractured were both recognized medical terms for varying degrees of bone injuries. The idea spawned faster than mosquitoes in an abandoned tire. The misconception that fractures are minor injuries with minimal bone separation and “broken” applies to bone fragments in different counties is simply…false. Fracture is the only professional term describing the traumatic separation of contiguous bone. If it’s broken, it’s fractured. Separated bone ends are called displaced fractures. Bone fragments jutting through the skin are called compound fractures. Comminuted fractures refer to bones in multiple pieces.

This one is easy to remedy. Most clients are eager to learn about things relatable to humans. They describe the fracture in detail to friends and family and some even want copies of the radiographs to wave in people’s faces. (Much like me, many people can’t refuse the opportunity to show bruises, wounds, and other injuries in a attempt to either shock or one-up people. Some time I’ll tell you about the worst blood draw I’ve ever received. We’re talking full arm bruising. I digress.) Use this opportunity to correct wayward clients.

Lyme’s Disease

I tolerate client misinformation fairly well, but the term “Lyme’s Disease” is one I am seeing crop up on paperwork from other veterinary practices.  My skin crawls and my ears buzz when I hear a veterinary professional say “Lyme’s Disease”  further propagating misinformation and general ignorance to a highly endemic disease. If a professional can’t bother to use the correct name, how confident are you these veterinarians know the most up-to-date treatment and monitoring protocols for it?

Lyme disease is named after Lyme, Connecticut, ground zero for Lyme Disease. Perhaps I am particularly sensitive to this issue because I practice on the east coast where 9 out of 10 dogs will test positive for exposure to Lyme. Perhaps it’s because every time I turn around there is another consensus report on proper diagnostics, treatment, and follow-up on cases of Lyme disease popping up from researchers at my Alma Mater.  Or perhaps I expect the same level of attention to detail as I would give. Either way, straighten up. It’s Lyme, not Lyme’s. Read your JAVMA.

OTC Flea Preventatives: Friend or Foe?

October 06, 2010 By: Dr. K Category: For Vets, Opinion

Months ago the previously prescription-only flea preventatives Advantage and Frontline became available over-the-counter at pet stores and large chains. Veterinarians were, for obvious reasons, not happy to have to compete with discount giants like Walmart. A recent trip to Petsmart reminded me we veterinary practices are still in a competitive market when I saw our prices were comparable. Other practices that have created a cash cow out of their prescription flea preventatives are not so lucky. Finances aside, I see a prominent silver lining in the change from prescription to OTC.

I see failure after failure with home flea remedies and OTC products from Hartz and Sergeants flea products. Garlic and these products are not effective. I’m sure I’ll get a backlash from the garlic crowd, but find me scientific evidence garlic does anything for your pet other than cause anemia. I digress. With a population of folks who rarely bring pets to the veterinarian, these people can never procure quality flea and tick products. From a zoonosis and quality of life view, it is critical to have pets on flea and tick prevention no matter their veterinary-patient-client relationship. The availability of Frontline and Advantage now allows all dog and cat owners to provide their pets the best prevention.

Advice to my peers: Don’t lament the loss of your cash cow and celebrate the progress in animal and human health.

The Shortest Distance Between Two Owners Is a Straight Talk

June 09, 2010 By: Dr. K Category: For Vets, General

The diversity of my appointment schedule never ceases to amaze me. From the blissfully smooth to the guilt-inducing no-money client, I fluctuate between joy and stress throughout my day. One hair-pulling situation involves the disabled pet owner of two small fluffy dogs who routinely appoints her caregiver the task of bringing the aging beasts to me for exams. Following the visit, I then call the owner to discuss my findings, diagnosis, and plan. I’m struck with minor annoyance by having to repeat the entire appointment over the phone but can understand the owner’s absence.

The real trouble arose when I realized the owner and caregiver have a palpable distrust of each other. The caregiver revealed the owner doesn’t want her present at the exams. The owner called before an appointment to ask that I not tell the caregiver too much. The caregiver tells me the owner fails to give medications as prescribed and refuses to follow recommendations. The owner assured me she gave the medication and the dog is still no better. I’ve found myself in the middle of a owner/caregiver/dog triangle and needed to find the fastest way to the best outcome for my patients.

I’m tasked with placing the dogs’ health at the forefront while still adhering to the wishes of their owner. Now, I’m no fool and realize owners lie to me about giving medications, diets, and who knows what else on a regular basis. I rarely have foreknowledge of the impending lie. I tend to believe the caregiver’s story  because there is no rational reason for her to lie about the owner lying. The owner, with her impaired faculties, probably believes admitting to her lack of compliance will result in relinquishment of her pets. Despite this, I refused to cut some back-exam-room-deal with the caregiver to reach the treatment plan these dogs need. The owner has exclusive right to chose as long as she adheres to anti-cruelty statutes. So instead, I’ve employed my straight talker tactic.

I asked the owner pointed questions about completing courses of antibiotics and reasons she wished to pursue XYZ courses of action. We spoke candidly about quality of life and her ability to provide adequate medical care to her pets. I built trust and after we had a rapport, I reiterated the importance of all the things we discussed and planned. I cannot control whether she does them or not which is a lesson in patience and understanding only time teaches.

And I haven’t forgotten to document, document, document!

Anyone else out there find themselves in a similar situation? How did you handle it?

The Crutch: Internships vs. Employment for New Veterinary Graduates

June 02, 2010 By: Dr. K Category: For Vets, General, Opinion, Veterinary School

It’s internship season which always makes me wonder: Is life after an internship so radically different from spending your first year in private practice? I decided to forgo an internship, mostly for financial and marital reasons. Kudos to my husband who tolerated my indebtedness for four years of vet school. This year’s new veterinary graduates are faced with a decision that has educational, financial, and personal implications: Pursue an internship or full-time employment? About 40% of new veterinarians are entering internships upon graduation, leaving the remainder to *fingers-crossed* find strong mentorship at a private practice. New graduates have the base knowledge needed to develop a list of differential diagnosis but have yet to learn the the art of recognizing nuances of disease in practice, delivering bad news, and having confidence in their abilities.

In an academic setting, influences from specialists and the constant inundation of “ivory tower” medicine can easily persuade students to pursue additional training after graduation. Many of my classmates pursued an internship with knowledge they would never pursue a residency. But why? I argue many new graduates lack confidence in their knowledge and instead find themselves leaning on an internship as a crutch, that stepping stone between student and independent veterinarian. It’s not wrong to feel insecure but it warrants recognition for what it is. I’ve heard many reasons for pursuing an internship from: inexperienced, not ready, want more emergency training, not sure about specialization. Most of these reasons boil down to fear.

I felt fear and, admittedly nausea, on my first day of work as a veterinarian in private practice. I don’t regret my decision to forgo an internship. Within months I felt at home, climbed the steep learning curve, and blossomed into the veterinarian I am today. Interns earn a pittance, work double the hours of a private practitioner, and defer loan payments for one more year all the while accruing interest. I challenge new graduates to honestly explore the reason for pursuit of an internship because that path is wrought with challenges.  If the pursuit is for more education and career advancement – go for it! If it is fear of primary case responsibility and decision making – take the brave step, find a mentor in private practice, and jump!

Hope for Cats with Snots, Snuffles, and Snorks

April 14, 2010 By: Dr. K Category: For Vets, General

How do you remove dried snot from painted walls without damaging the paint? You can’t. At least that’s my experience with my chronic snotting, snuffling, sneezing, snorking cat. Winston has successfully plastered my walls with copious amounts of mucous with a holding power rivaling the largest tube of gorilla glue. If you have one of these snorkers in your house, there is hope!

I recently attended a veterinary conference lecture that focused on these cats by Cynthia Stubbs, DVM, DACVIM. We all know snot-nosed cats can prove difficult to manage for both veterinarians and pet owners. Once the appropriate diagnostics are performed to rule out some of the more easy to treat issues, many pet owners are faced with the choice of advanced and often expensive diagnostics. While I still strongly recommend performing a vast array of diagnostics to get to the heart of the disease, many times cats suffer from difficult to diagnose rhinitis and sinusitis that can be exacerbated by respiratory infections. There is a probable association between chronic snorkers and chronic infections with herpes and calicivirus. Both herpes and calicivirus attack nasal and upper airway mucosa, causing chronic inflammation that can lead to nasal discharge and destruction of the delicate nasal bones that sit inside the nasal passages. This correlation has lead Dr. Stubbs to pursue both palliative and curative treatments.

Dr. Stubbs suggested one such treatment involves giving affected cats intranasal bivalent vaccinations against herpes and calicivirus. The intranasal delivery is purported to increase local mucosal immunity and therefore decrease the inflammation in the nose. Dr. Stubbs reported some cats needed only the vaccine on an every 3-6 month basis for near complete relief. The off-label use of the vaccine does not confer any immunity to panleukopenia, so Dr. Stubbs recommended also giving the traditional subcutaneous trivalent FVRCP vaccine. In addition, Dr. Stubbs bravely uses the anti-inflammatory antibiotic doxycycline along with the NSAID piroxicam to provide additional symptomatic support. Word to the wise: Non-liquid forms of doxycycline are known to cause esophageal stricture in cats and piroxicam should not be used in cats with kidney disease.

I am planning on trialing the intranasal vaccine in my own snorker. We’ve tried multiple antibiotics – no small feat given Winston is a perceptive, neurotic, inflammatory bowel disease cat. Nothing has alleviated his six years of nasal congestion. I will certainly follow-up in future postings.

Diagnostics Performed in Nasal Discharge in Cats

  • Complete physical exam
  • Complete bloodwork, urinalysis, Felv/FIV testing, +/- coagulation testing
  • Blood pressures, particularly if nasal discharge is hemorrhagic
  • Nasal cytology, culture, and biopsy
  • Viral detection tests
  • X-rays, CT scans, Rhinoscopy
  • Nasal Flushes

Common Diagnoses In Nasal Discharge in Cats

  • Dental disease – very common
  • Rhinitis/Sinusitis – very common
  • Nasal foreign bodies
  • Cancer
  • Nasopharyngeal Polyps
  • Infection: Bacterial, Viral, Fungal, Parasites – common either as primary or secondary diseases
  • Trauma
  • Hypertension or bleeding disorders

How Many Times Do I Have To Ask?

January 20, 2010 By: Dr. K Category: For Vets

Apparently only one. At least that’s what the civil court said in a recent civil complaint against my practice. Let me give you some history.

Mrs. Notesta brought her young cats to our clinic years ago, well before I worked there. At the time, she declined Felv/FIV testing saying, in what typically amounts to a “never”, she wouldn’t test today and that she’d have to think about it. Thankfully, the veterinarian at the time noted this in the record. She declined testing the other 2 cats as well. Fast forward to eight years later when one of Mrs. Notesta’s indoor only cats, Lucky, becomes very ill. She is seen at a local referral center where, over the course of a couple of days she deteriorates and is euthanized. Lab results revealed she had Feline Leukemia Virus (Felv) and it was believed this lead to her death. Felv is not curable or even treatable, leaving cats with a compromised immune system and more likely to develop cancer. Fortunately, none of the other cats in the home were infected.

Mrs. Notesta wrote a letter to the hospital with accusations of negligence and malpractice because her cat was never tested for Felv. She contends that, because Lucky wasn’t tested, the hospital is liable for all medical bills incurred at the referral center, loss of salary for her time off, and other bills accrued during the cat’s illness. Despite having copies of the records with multiple documented refusals and repeated telephone conversations with the practice owner, she announces she will pursue a civil suit against the practice to recover her expenses.

A couple of issues come to mind with this situation:

1. Had the original veterinarian not recommended testing or failed to document her refusal, would Mrs. Notesta have a case?

  • Consider how the cat’s medical care would have evolved had veterinarians known she was Felv positive. Perhaps she would have received more aggressive antibiotic treatment when infections were evident. More aggressive treatment early on may have staved off inevitable illness a little longer.
  • Would Mrs. Notesta have pursued expensive diagnostics and treatments at the referral center had she known the cat was Felv positive and likely suffering complications of endstage Felv? Probably not. Even if the cat was not tested, testing would not have necessary affected the overall outcome. In the above scenario, is the hospital responsible for her bills if it failed to recommend testing?

I don’t know the answers to these questions but I sure look forward to hearing your opinions

2. How many times should you ask an owner about a specific diagnostic or treatment modality, especially if they say “I’ll have to think about it?”

  • The civil court judge  in this case ruled that one instance of documentation of the owner’s refusal for Felv/FIV testing 8 years ago was enough even though there were multiple documented refusals. The lawsuit was dropped, the owner paid her bill to the practice, and we haven’t heard from her again.

I think one additional inquiry about testing is warranted from a medical standpoint, if not a legal standpoint, especially if the owner left the conversation with “I need to think about it.”

3. Can clients construe repeated questioning about testing be construed as bullying?

  • Maybe. It depends on your approach and the client. If a client senses you’re uncomfortable pressing for an answer they usually become uncomfortable themselves. If a client says no, a reasonable response is “Well, if you ever change your mind and want to do that test let us know” or at an annual visit “Are we still holding off on that heartworm test like we did at your last visit? I certainly recommend the test for Fluffy.”

I am not legal expert and can rarely predict which way the court will rule, but I think veterinarians are probably “safe” recommending testing one time for diseases like heartworm and Felv/FIV provided the recommendation is recorded. Informed owners are key; It’s not enough to merely suggest a test but to explain why that test is important. I talk about heartworm disease in depth at least once, typically at a puppy’s final vaccine appointment. I still recommend testing to owners who have repeatedly declined heartworm testing for their dogs. I also discuss the long term affects of Felv/FIV with new kitten owners prior to recommending testing. I am sure to mention testing twice (if needed) and recommend the test strongly for all strays and all never-previously-seen cats.

Perhaps my approach is overkill, but I feel confident that when Mrs. Notesta writes me a letter, I have myself adequately protected.