VMDiva

This time of year reminds me of the nerve wracking process of job interviews and trying to find my place in the veterinary world after graduation. Most new vet graduates, the 60% or so who choose to become general practitioners immediately following vet school, are knocking on doors in search of the ultimate vet practice. The strained economy makes openings at the best practices hard to come by but a little bit of knowledge can go a long way in guiding a new vet toward a good practice. Of course, the list of things to look for in a practice are also the same things pet owners should look for in a hospital. Pet owners don’t necessarily get the “inside scoop” but simple observations can help them make a decision.

For Vets

Standard procedure for the interview process involves a tour of the practice, a meet and greet with all veterinarians, head technicians, and business managers at the practice, an interview, and lunch/dinner. The last one is actually pretty important. Practices unwilling to “court” their prospective associates are either cheap, too informal, too understaffed, or just lacking in business etiquette.

Know your values and personal standard of care. Have a problem with unsupervised overnight hospitalization? Want to refer complicated cases? Oppose declaws, ear crops, tail docking? You’d better ask what the practice policy is and if you are expected to perform any of these duties.

Do vets share cases or will you need to figure it out on your own? Is there continuity of care? Is your boss willing to mentor you? I remember my very first interview where the owner told me, in more explicit terms, that he hated seeing the term “mentorship” in a cover letter. Red flag. New graduates need a support network.

For Vets and Pet Owners

Looks matter. Are the buildings and grounds well kept? Does an odor smack you in the face when you open the door? Well maintained practices indicate a higher level of dedication and pride in the practice which can translate to quality of medicine practiced. This doesn’t mean the practice needs to have marble countertops and fireplaces. An old home that is well cared for can provide the physical foundation for an excellent practice. People make the practice, not the building.

Keep highly attuned to how you are treated from the second you walk in the door. Do the receptionists make eye contact or welcome you as you come in? Are they friendly? From a vet’s perspective, the receptionist’s are on the front line of the practice. Aside from the veterinarian, they are the face and personality clients will engage with most. Rude or inefficient receptionists can indicate a systemic problem.

Employee churn is a red flag. The constant turnover of employees, both support staff and veterinarians, can indicate a management issue. In my experience, churn happens for a few reasons. First, employees who feel undervalued or under respected are likely to leave. Next, employees making minimum wage need benefits because most cannot afford insurance or routine medical care. Practices that don’t provide benefits will lose employees as their life events dictate. Veterinarians tend to leave positions when the hours stink, the boss is inflexible, and promised changes never come to fruition. Personality conflicts are inevitable and expected. Most times, employees can work through them to get the job done.

For Pet Owners

Remember small mistakes will happen and cut the staff a little slack. If your medication isn’t refilled on time or a phone call isn’t returned in a timely manner, remember it isn’t personal. However, repeated errors, confusion, and inaccurate charges are a sign the practice is inefficient.

Basic observation skills and a little probbing can ensure both veterinarian and pet owner find a practice suited to their needs.

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.

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.

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.

An appalling case of animal abuse occurred near my alma mater this week and it sickens me. The local news reported a 33 year old Philadelphia father, surrounded by his small children, decided to teach his young pit bull a lesson after the puppy nipped at him. His solution involved dousing the animal in alcohol and setting him on fire. The man’s children reported the incident to school officials. The dog has apparently survived but has a tenuous recovery from severe burns to his face and neck.

This type of cruelty stirs a nauseating anger that grows the more I think about it. Pennsylvania Animal Cruelty laws state “It is a Misdemeanor in the first degree if a person: “Kills, maims, mutilates, tortures or disfigures any dog or cat, whether belonging to himself or otherwise; or administers poison to or exposes any poisonous substance with the intent to administer such poison to any dog or cat, whether belonging to himself or otherwise”  This is punishable by a fine of not less than $1,000 and/or imprisonment for up to 2 years.” This particular suspect is facing many other charges such as child endangerment and arson.

Remove children from the situation and this guy (or a similar perpetrator) could get a slap on the wrist. A $1000 fine is insufficient for this type of malicious disregard for life. Imprisonment up to 2 years is reasonable, but very rarely do the courts drop the hammer on animal abusers. This confuses me given the known ties between animal cruelty and domestic violence. It has long been understood that animal abusers often graduate to domestic violence. Regardless of personal beliefs about treatment of animals, it would be prudent of the courts to look at “gateway abuses” critically. I wonder how this man responds to his small children when they misbehave.

We need to seriously consider the way we handle perpetrators of heinous acts of animal cruelty. Anger management, domestic violence classes, and compulsory prison sentences should be mandated. Psychological evaluations could help prevent future abuses and should be incorporated. Perhaps the courts should even  require community service in an animal shelter. A small fine for first time offenders equates to a slap on the wrist and does nothing to prevent further abuses of both animals and people. Drop the hammer. Please.

A recent article in the Wall Street Journal made me evaluate how my own pets affect my relationships. The article highlights how distorted priorities can lead to marital problems and dysfunction in the family. My husband knew what he was getting into when he married a vet, so I almost get a free pass when it comes to me lavishing my pets and treating them like the infallible monsters they are. With my own pet-to-husband balance in check (I admit to the occasional argument on who cleans the litter), I mulled on the ways my pets affect everyday life.

I just recently realized how disruptive the cats are to our sleep during their recent month of confinement. Both have been banished to the basement due to Winston’s inappropriate elimination (before you think I’m mean, it’s a finished basement with all the kitty amenities). With the cats safely locked away, there was no more waking up in the middle of the night to ax-like paws digging into my sternum. No more 3am howling in triumph after killing the toy mouse for the 1000th time. No early morning meowing alarm clock nervous we’d forget to feed him breakfast. I must say, I’ve been sleeping quite well.

In addition, the cats definitely affect the relationship with my in-laws. My father-in-law is dreadfully allergic to cats and despite my cleaning, vacuuming, dusting, and sterilization of the house, his visits can only comfortably last about 2 hours despite allergy medications. Summer visits lend themselves to sitting outside but winter visits result in trips to the movies or going out for dinner. I have no plans on ridding the house of cats in the future so I guess I have agreed to awkward visits.

I’m wondering how your own pets affect your day to day and extended relationships?

I’ve gotten a number of questions about Angels’ Eyes, the oral product that proclaims to rid little white dogs of their unsightly red-brown tear stains. Small breed dogs and brachycephalic cats commonly experience epiphora, or excessive tearing. Products like Angels’ Eyes promise to rid a pet of its tear stains with a daily oral supplement. I typically consider such claims nothing more than another gimmick. However, it seems as though this product might actually work for little Fluffy. I researched the miracle product and was surprised to find the secret ingredient is Tylosin.

Tylosin is a macrolide antibiotic commonly used in food animals but can also be used to treat campylobacter and mycoplasma spp infections among others in dogs and cats. It is also used as an anti-inflammatory to treat colitis, much like metronidazole. It is in the same drug family as erythromycin and azithromycin (Z-Pak). The company claims the product kills yeast, which they mistakenly call a bacterial infection, that are responsible for producing red pigment. Tylosin actually kills the bacteria that, when interacting with the yeast, cause the formation of pigment and subsequent stain.

I have some major issues with this product:

Tylosin tartrate is labeled by the FDA for OTC use in food animals. When it comes to use in dogs and cats, the FDA notes federal law restricts this drug to use by or on the order of a licensed veterinarian. This drug should not be sold OTC for pets. Period. Loopholes in the supplement labeling system allow companies like the manufacturers of Angels’ Eyes to sneak around FDA regulations with the disclaimer: These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. This disclaimer does not make the act of dispensing this drug legal, it merely allows the manufacturer to make the product without going through the expensive and arduous process of FDA approval. Because the FDA typically has bigger fish to fry, companies like this cruise under the radar.

Antibiotic resistance is a problem that affects all facets of medicine. Many common antibiotics have dual use in both veterinary and human medicine. While tylosin is a veterinary only drug, drug resistance to one drug can potentially result in resistance to an entire class of antibiotic.  I am concerned there are voices on the web who say that, because tylosin is a narrow-spectrum antibiotic, resistance is not a worry. Say what? First of all, tylosin has broad spectrum coverage against gram positive bacteria. Second, if an antibiotic has activity against ANY bacteria that bacteria can become resistant. Those same voices also claim tear staining leads to eye infections. Sorry, wrong again. Staining leads to unhappy owners; Improper tear production and tear flow coupled with shallow orbits, bulging globes, and underlying pathology leads to infection.

I also have serious concerns for any use of an antibiotic to treat a cosmetic issue. This is bad medicine no matter which way you slice it. Angels’ Eyes gets my stamp of disapproval.

I was recently unpleasantly surprised with the diagnosis of a bone tumor in a young golden retriever I was convinced had a cruciate ligament tear. The ensuing conversation blindsided the pet owners and I was reminded of the importance of delivering bad news properly. I’m not the most articulate person but as I travel along in my veterinary career I have learned invaluable lessons in the delicate art of breaking bad news. Below is a short list of insights that may help an unsuspecting new veterinarian.

Be honest and forthright.

I am not a fan of the question “What would you do if he was your pet?” While I offer my opinion when solicited, I always note that I have a bias. That bias is what makes me a veterinarian. My job is to cure and treat disease, alleviate pain, and want to find the diagnosis. If you think an animal is suffering, kindly say so. Veterinarians sometimes better recognize the signs of pain, discomfort, and failing quality of life.

Get to the point. Repeat.

When delivering bad news to an owner, like the diagnosis of a tumor, it is tempting to talk about normal results and how the animal arrived at this point before giving the diagnosis. It just doesn’t work. Most people are perceptive enough to sense something is dramatically wrong and their minds begin racing as soon as you don’t say everything is okay. I find the most effective way to deliver the blow is with a soft voice, caring personal tone, and preface the entire conversation with “I’m afraid I have some very bad news for you, it appears as though Fluffy has a tumor in his abdomen that looks as though it has spread to his chest. I know this is a lot to handle but I’d like to discuss it with you.”

Further discussion at that time is completely dependent on the owner. Some owners want to discuss all options then and there. Others need time to digest the information and will need to call or visit later. Determining what the owner needs is a skill a vet develops over time. Too many times I have tried to plow through a discussion of what we do next only to realize the owner hasn’t moved beyond the word “cancer”. Once you deliver the news, summarize the findings again. In a state of shock, owners may remember only a fraction of what you tell them.

Don’t Use Euphemisms

It may be tempting to sugar coat findings to try to spare emotions but you will do a disservice to your patient if you fail to adequately explain the dire situation to its owner. A gentle apologetic tone prevents you from sounding too calloused. For suddenly deceased pets, using terms like “moved on”, “passed on”, and “no longer with us” are not definitive for a reeling mind. Use the terms “death” and “died” at least once in conversation and supplement the conversation with the other terms.  For the terminal diagnosis, terms like “life-ending”, “end-stage”, and “not recoverable” are warranted. In addition, “uncomfortable” does not mean the same thing as “suffering” to most owners so choose your descriptors wisely.

Offer Follow-Up

Once you’ve delivered the news, acknowledge there will be more questions. Suggest owners write them down, sleep on it, and call you the next day with questions. Make yourself available for a consulation appointment as some owners prefer speaking in person.

Be Compassionate

You’ve just rocked someone’s world. Remember what it is like to be confused and stunned. Don’t be afraid to reach out and hug a client in need.