VMDiva

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.

Here’s a little public grievance for my friends at Pfizer Animal Health: Stop jacking up the cost of veterinary medications on a quarterly basis and pricing my clients out of treatment!  There, I said it. Pfizer, creator of wonderful drugs like Convenia and Zeniquin, has been increasing the cost of its medications exponentially since early last year. I grimace as I prep owners for the financial shock when these medications are indicated. Don’t even get me started on the price of Rimadyl and Clavamox.

Perhaps the recession hit the drug giant hard and their financial loss is being passed along to distributors and veterinarians. This is capitalism in action and money makes the world go round, yada yada. My problem is not with profit, but the repetitive precipitous increases in cost that get passed on to my clients. It’s not that the price is rising, it’s how fast and how much the price is rising each time. In some instances, the price rises nearly $0.10/pill every quarter. That sounds like small potatoes until you take into account that’s $10/quarter and $40/year on every bottle of medication we dispense.  I recently wanted to prescribe 10 days of Zeniquin to a large German Shepherd for an ascending infection arising from a nail bed. Cost to owner would have been about $150. Yikes! Talk about seeking an alternative drug therapy!

Rising prices mean changing treatment plans to accommodate an owner who doesn’t have $150 to spend on medications. I will write a prescription for antibiotics so owners can get them for a better price at a local pharmacy. However, there are only a finite number of medications, particularly broad spectrum antibiotics, available to treat these common conditions so options are limited for a serious infection.  I lament providing the “suboptimal” treatment because, quite frankly, drug companies like Pfizer can’t put a cap on their prices for more than four months.

This one’s for the girls. Recent discussions on my friend Dr. Khuly’s blog, Dolittler, have compelled me to beg, plead, and grovel for you to please have your female cat or dog spayed. A recent discussion about a pregnancy gone awry topped with an article released from USA today about attitudes toward sterilization of pets have burdened my heart with the age old problem of pet overpopulation and unnecessary suffering. Despite advocacy to have pets spayed or neutered in a push to curb pet overpopulation, a staggering number of animals acquired last year have NOT gone under the knife! Granted, some animals were too young for surgery at the time of the survey but 24% of respondents who hadn’t altered their pets stated they “hadn’t gotten around to it” while another 14% stated they “didn’t feel it was necessary.” Irksome at best, but potentially a red flag for a bigger problem: Lack of proper communication and education between the veterinary profession and pet owners.

Top Five Reason to Spay

1. Pet overpopulation
An estimated 4 to 6 million unwanted and stray animals are euthanized in shelters every year. The world, quite honestly, doesn’t need anymore dogs and cats to add to the mix. There will always be pet overpopulation (I’m not so naive to believe the problem will ever go away) but every person can do his/her part by making sure the cycle ends with their pets. This is NOT to say responsible breeding should be outlawed or discouraged. I guesstimate responsible breeders (AKA not puppy mills, not backyard breeders, not accidental breeders) minimally affect the overall pet population.

2. Pyometra
An all too common affliction of older dogs is a condition known as pyometra, or an infected uterus. This is a life threatening condition that can lead to sepsis and death if untreated. A uterus filled with infection can rupture in the abdomen leading to peritonitis. This condition is 100% preventable with a spay. Spaying your pet as a youngster is significantly less expensive than emergency surgery years down the road, so you’ve got no room to complain about cost.

3. Mammary Cancer
Mammary cancer develops commonly in unspayed females later in life. About 45% of mammary tumors are malignant in dogs, whereas around 90% are malignant in cats, and dogs have a much higher number of complex and mixed tumors than do cats. Spaying dramatically reduces the risk of mammary cancer in both dogs and cats. In dogs the risk has been reported as 0.5% when spayed before the first heat, 8% if spayed before the second heat, and 26% if spayed after the second heat. For a listing of scientific findings check out SkeptVet.com’s summary of research regarding companion animal mammary tumors.

4. Unwanted/Unplanned/Poorly Planned Pregnancy
I’ve heard the “I just want her to have one litter” line too many times. She doesn’t need to have a litter. Period. In addition, accidental breeding can result in a size mismatch and a possible dystocia (read: stuck puppies) during labor. Raising a litter of puppies or kittens is expensive when you consider all the time, effort, or finance that goes into caring for them for 8 weeks. The bitch or queen should be examined following labor. The puppies or kittens will need to be examined, dewormed, and vaccinated prior to being sold or adopted. Lack of planning or foresight can set the unsuspecting owner back a pretty penny.

Dolittler describes a case of at best, egregious ignorance in pet owners who “married” two dogs, missed all the signs of pregnancy and labor, and allowed their poor Maltese to have a dead puppy in her uterus for 24 hours – a move that may have ultimately lead to the dog’s death. “Back yard breeders” must be discouraged. Back yard breeders are folks who decide they want to breed their dog, know little about doing it properly, and typically do it with dreams of profit. It seems as though those breeders always seem to find the sickliest, poorest-doing dog with multiple congenital and genetic problems and breed her. And don’t even dream of those dogs having been vaccinated. I actually had one couple ask if a puppy would come out of their Chihuahua’s “who who”. That’s biology 101 folks. If you don’t know where babies come from perhaps you should avoiding breeding. That applies to both dogs and people.

Proper breeders will have their dogs or cats tested for contagious diseases, examined for general health, radiographed to see the approximate number of puppies/kittens, and are prepared for whelping/queening. They will follow-up with a veterinarian and have all puppies/kittens examined, dewormed, and vaccinated prior to placing them in appropriate homes.

5. Stop that Heat Cycle
Blood, howling, nervousness, lingering males. Need I say more.

I have followed through with one of my New Year’s resolutions! And yes, I am proud of it!

You can now follow me on Twitter: @VMDiva. New blog posts will be listed on my Twitter page. Follow along for more personal updates and get to know your 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!

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!

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!

A lot happened in the veterinary community this year. Some news was widely published, like the emergence of swine flu and canine influenza, and other things seemed to slip under the radar. Reflecting on the implications of the changing veterinary world over the past year brings clarity and inspiration for 2010. The ever dynamic world of veterinary medicine affects every aspect of the world around it.  Below are some of the headlines we saw this year.

Swine Flu

If you haven’t heard of the pandemic H1N1 influenza virus you’ve been living under a rock. Swine flu emerged in April 2009 with the first cases erupting in Mexico. The first domestic cat with a confirmed case of H1N1 was reported in November 2009 followed  a month later by the first case in a domestic dog. In each of these cases, the pet contracted the influenza virus from its owner. There is no evidence of cat/dog to human transmission. Multiple swine herds were also affected in the United States.

Canine Influenza

If you missed the VMDiva article on canine influenza, read up! Canine influenza was not new in 2009, however, it gained national attention due to the ever expanding reach of the virus. By September 2009, over 30 states had reported cases of canine influenza.

Vetsulin^® No longer Available

Vetsulin^® insulin, produced by Intervet Schering-Plough, was recalled and veterinarians were advised to transition diabetic dogs and cats to alternative insulins. Vetsulin was one of the most widely used insulins in the veterinary field.

California Cities Rush to Ban Cat Declaws

Prior to legislative changes on January 1st, 2010 that would prevent cities and counties from regulating veterinary medicine practices, several California cities banned cat declaws. Included are Berkeley, Los Angeles, Santa Monica, and Beverly Hills. Both the American Veterinary Medical Association and the California Veterinary Medicine Association oppose the bans.

Court Denies Emotional Damages for Pet Loss

In a move that supports pets as property, a California court failed to award emotional damages for the death of a pet. An August 2009 ruling noted, “California law does not allow parents to recover for the loss of companionship of their children, we are constrained not to allow a pet owner to recover for loss of the companionship of a pet.”

Palladia Approved to Treat Inoperable Mast Cell Tumors in Dogs

Palladia (pdf), a new canine chemotherapeutic drug from Pfizer Animal Health, was approved by the FDA in June 2009. This drug is designed to treat mast cell tumors (MCT), a type of skin tumor that commonly metastasizes to the liver and spleen. This is the first veterinary specific chemotherapeutic for dogs on the market.

PETA Protests AVMA at Annual Conference

The annual AVMA conference was held in Seattle this year and PETA protested the aquaculture industry and the veterinary profession in response to the traditional “fish throwing” exhibition performed by the workers from Pike Place Fish Market during the conferences opening ceremonies. PETA representatives contended fish are “intelligent, sensitive animals” that should not be tossed. Author’s Note: The fish are always deceased prior to tossing and are then sold for human consumption.

Polo Horses Die From Drug Compounding Error

Twenty-one polo horses died at a Florida stable this April after they were given the incorrect dosage of a vitamin supplement. A compounding error accompanied by an illegal prescription for the drug catapulted this story into the headlines in April 2009.