Dad Challenge

This is not a blog post about being a veterinarian. If you are looking for veterinary blog posts click here. If you don’t understand why I am posting non-veterinary blog posts click here. If you just want to read today’s post then get on with it already.

I am the best dad in the whole world. It’s true. Don’t believe me? I don’t care. I am hands down the best dad in the whole world. Think you’re a better dad than me? Fine. But you’re not. If you want to prove it, go right ahead. Here’s the challenge; you raise your children to the best of your abilities, put in as much time as possible and be as involved in their lives as possible while still giving them a chance to grow on their own. The game doesn’t actually end until you and I are both dead but maybe our children can tally the score. You know who will win? Everyone involved. Directly or otherwise. So get to it.

To help you along, I’ve compiled some parenting advice. The best dad in the world doesn’t give parenting advice you’d expect and that’s what makes it the best parenting advice you’ll ever get. Grab a pen. You’re going to want to take some notes.

1. Put your children in danger. You don’t have to toss them into the bear cage at the zoo but let your kids put themselves in precarious situations and then let them figure out their own way through the situation. Be there to keep them safe but try to intervene as little as possible. You won’t always be there to catch them when they fall physically or figuratively but you’ll always be there to comfort them after the fact. Give them the tools they need to recognize danger and take appropriate measures to minimize risk. Also teach them that a little danger is an important ingredient for a well rounded and satisfying life.

2. Get in trouble. Whether it’s getting pulled over by a police officer while driving or reprimanded for climbing up on the shelving units at your favorite home improvement store, let your kids see you get in trouble. Let them experience you being respectful and attentive to an authority figure. Show them how to apologize when you’ve done something wrong or made a mistake and then make sure you change your behavior for a few days. Forever would be better but let’s set realistic goals here. Let them see that it’s alright for them to mess up or break the rules every now and then so long as they are respectful and learn from the situation.

3. Fight with your spouse. I know, everyone tells you never to fight in front of the children. That’s because most people fight like spoiled children in a “who can be the biggest jerk” contest. Don’t be that guy but don’t shy away from sharing your feelings with your life partner in front of your children either. They need to see that two people can have disagreements, major disagreements, and still not only respect each other and work together on building a life together but can stay madly in love with one another even after they’ve worn the polish off the relationship. Fight honestly, respectfully and in a way that will set an example for your children. Teach them to expect that from and to provide it to their life partners then sit back and watch them have really fulfilling relationships.

4. Bully them. Your children aren’t going to be as coddled by the world as they are by you. In fact, no one on Earth is going to be as good to them as you are. You’re spoiling them but you can fix that. Tease them, pick on them and make sure you don’t stop until they are good and upset. This works best with young children. If you get tears, you’re winning. Then remind them that you love them and are trying to make them into the best person you possibly can. The lesson is; the way a person acts towards you is not a reflection on who you are as a person but how you choose to respond to them is. Teach them that when someone acts like a fool and is really mean to them, the best thing to do is brush it off, feel bad for them and love them anyway. This is the most important part; never ever stop doing it and don’t let them forget the lesson. Then when they are bullied in school or in life you can remind them that even you bullied them and look how much you care about them. Who knows, maybe they’ll make some of their best friends out of the people who initially bullied them. Or maybe they’ll drive a few jerks nuts with their incessant kindness in the face of terrible behavior. Either way it’s a win.

5. Give them nothing. Instead teach them how much more they appreciate things that they have truly earned. If you’re really going to take a shot at my best dad in the world title, you’re going to have to really push the limit with this one. Don’t give your children an allowance, make them earn every penny. Don’t buy them a car, tell them to get a job within bicycle riding distance and them help them learn how to manage their money well enough to buy a car for themselves. If you hit the college years and they are looking at going to schools they can afford to pay for, you’re doing pretty well. Teaching your children that hard work is the only way to get what they want will teach them to either work harder or want less. Either way that’s a pretty important lesson.

There you go. Five simple tips about parenting from the best dad in the world.

In all of this, don’t forget to set an example. If you’re teaching them to not lose their cool when people bully them and then you freak out when someone insults you in traffic, you’re losing. If you fight with your spouse and start calling them names or putting them down, you’re losing. If you get pulled over and start yelling at the police officer, I hope you get pepper sprayed. In front of your kids.

Thanks for reading.

Advertisements

7 things being a veterinarian has taught me about life.

Every occupation or experience has life lessons to offer if you’re the type of person who looks for lessons in everything you do. I happen to be a person who sees lessons in my work and in many other aspects of my life. While there are probably dozens if not hundreds of life lessons being a veterinarian has taught me, these are my seven favorite.

1. Being friendly makes everything better. Dogs and cats who are friendly and let me handle them in the exam room always receive a more thorough examination. Always. Is that fair? Nope. But that’s how it goes. With a friendly animal I can pull on the legs, evaluate the gums, look into the eyes, feel for every lymph node and look in between the toes. I can even smell their breath which is a very important diagnostic tool believe it or not. With some of my grumpier patients, I can’t even take a temperature. Right now, if you’re a pet lover like me you’ll be thinking, “Come on Heath, that’s not the dog or cat’s fault.” And of course, you’re right. I’m not passing judgement but the truth of the matter is, friendly and outgoing pets will get more thorough exams every single time. More thorough exams mean we catch things faster, sometimes before they are actual problems. And in the rare case that an animal needs to be hospitalized, the friendly ones can receive much more intensive care. This leads to better outcomes. Think about that the next time you’re trying to get a table at a restaurant or reroute a flight after weather or mechanical problems interrupt your travel plans. The worst thing being friendly in tough situations can do is make it a little more pleasant for everyone involved. Who knows? It might just get you a better outcome as well.

2. Be comfortable with you. Dogs are gross. Cats, while more fastidious are also gross in their own way. Nothing is so happy to see you and as ready to snuggle as a muddy dog. Some of the presents your cat leaves you can make you want to wretch. But they make no apologies for how they are or who they are. I’m not advocating cutting back on the hygiene or wearing outfits that might land you on the people of Walmart blog but we could all stand to be a little less insecure and a little happier with how we’ve turned out so far.

3. Don’t hold grudges. Occasionally, I hold your dogs like the photo below to trim their nails. Sometimes we have to place a cat on their side and poke them with needles. These are super unpleasant experiences. When we let them go, how often do you think they turn around and try to bite or scratch at us? If you said almost never, you are correct. When you release a dog after having to pin them down, the worst thing that might happen is they try to get away from you. Cats will sometimes take a swing but for the most part, they too are just happy to not be held down. Applying it to your own life, the next time you’re out driving and someone pulls out unexpectedly or turns without using their signal and you have to hit the brakes but everything turns out ok, channel your inner dog/cat and let it go. Same goes for gossipy co-workers or meddling managers, the damage they cause is so temporary and insignificant, if you broke down our lifetime into the span of a dog’s life, the time rumors or managers spend hurting us is probably no longer than a nail trim.

20150616_211820

4. Always make an effort. Watching dogs and cats wake up from anesthesia is one of my favorite things to do. Not just because it means that another anesthesia event is coming to a successful conclusion but also because the mentality of dogs and cats coming out of anesthesia amazes me. They always have someplace they need to get to. Sure, some of them seem a little frightened but for the most part they look like they just need to keep moving. You can typically stop, sit with them and pet them and they will calm down a little bit but they really have somewhere else they need to be. I like to imagine they wake up and think, “I haven’t checked on my human in awhile, I should get on that.” That level of persistence and determination in the face of an insurmountable obstacle such as anesthesia always makes me smile. I think about that persistence when I’m out for a run and hit that point where I want to walk and catch my breath. A dog recovering from anesthesia wouldn’t stop there. Why should I?

5. Don’t sweat the small stuff. Or the big stuff. Or anything really. Some of the pets who come to see me are really sick. I mean like hammering away at death’s door like a maniacal girl scout sick. Here’s the thing, sometimes you can’t even tell. I’ve had dog’s that were actively bleeding into their abdomens from ruptured splenic tumors wagging their tails and taking cookies out of my hand. The dog that is in the picture at the top of the page came in with porcupine quills everywhere and was still wagging her tail and loving on all of us. She didn’t seem to understand why we would only pet certain parts of her. Dogs and cats don’t seem to think about the future much, this frees them from worry and leaves them blissfully unaware when they are suffering from terminal illnesses. While not planning for the future could leave you and I in a pretty poor predicament a few months or years, not worrying about it has few if any side effects. If you think worrying and planning are the same thing, I would encourage you to read Sacrifice vs. Value for an idea of how much perspective can affect outcomes.

6. Face your fears. At least a few times a week I will step into our feline exam room with a significant amount of apprehension. There are 12 pound cats out there who make my heart freeze when I see their names on my appointment scheduler. And I am actually pretty good at handling cats, despite the opinions of at least two of my previous clients. I admire the tenacity and fearlessness that these cats display in the exam room. If there was something 10 times my size – large male Grizzly Bears can weigh this much – coming at me for any reason, my first reaction wouldn’t be to pick a fight. Even if I lived with Grizzly Bears and those bears fed me and took care of me and loved on me, if one I didn’t live with went to examine me my first reaction wouldn’t be to fight it. You have to admire that level of pluck. I often channel my inner fearless feline when I have to deal with uncomfortable situations. Dinner party where you know no one? Client angry about service you provided? Need to dispute a bill? Hey, at least you don’t have to fight off a Grizzly Bear in a white coat with a thermometer.

7. Live here, now. Dogs and cats are present, in the moment. They are never dwelling on the past or pining for the future, they are experiencing life as it comes. Even in our end of life visits they are in that moment, it never ceases to amaze me, dogs will sit there and happily munch on treats while we prepare to end their lives. They are blissfully oblivious because they are here now. (And of course they don’t really understand or appreciate the reality of the situation) We could all take a page from that playbook. Things aren’t always going to go your way. In fact, by the end of it all, nothing goes our way. If we’re lucky, we will grow old, people we love will pass on before us and eventually our bodies and minds will deteriorate until we finally  join our loved ones. Way to end on a high note McNutt! Seriously though, bad things are coming for you and they’re coming faster than you realize. It’s enough to drive a person insane. You will never get to complete all of the things you want to complete or experience all of the things you want to experience. And that’s ok. This moment – as you read these words – this is your life. Enjoy it now. Be that Golden Retriever with its head out the window on the way back from the lake as often as you can be.

There are more than likely, hundreds of lessons my career and the pets and people who make it possible have shared with me over the past few years. Hopefully, there is a lifetime of life lessons ahead of me. My only hope for myself and for you is that we never get tired of learning from them.

Thanks for reading.

//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=heathmcnutt-20&marketplace=amazon&region=US&placement=B01N9KSITZ&asins=B01N9KSITZ&linkId=ae66c45676a99dede6b65361b5d2af10&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff

How to finance your pet’s healthcare.

The standard of healthcare we are able to offer our pets in the developed world rivals the standard of healthcare we ourselves have access to. Options such as MRI, organ transplants, chemotherapy and even root canal therapy are utilized many times a day for pets in our world. The problem with having really high healthcare standards is that those standards are accompanied by really high price tags. All too often, my colleagues and I see pets that have issues that go untreated, preventative care that is incomplete or even pets that have to be put to sleep all because of poor finances. We hate that but we’re also not in the position to loan the money to our clients ourselves. Sometimes we do, in the form of letting a client make payments but our financial threshold for payment plans is really quite low. How then, are pet owners supposed to meet those expenses? The following is a list of ideas and recommendations I’ve developed through experience and stressed out brainstorming about trying to accommodate pet owner’s financial situations.

The best time to think about paying for your pet’s heath care is before you have a pet. I understand that we mere mortals don’t ever do this. In the off chance that one of the financial superheroes who will soon be our economic overlords might be reading this, allow me to offer them this piece of advice in the hopes they will look upon me with favor some day. If you are thinking about getting a pet, especially if you are planning on buying a purebred dog or cat from a breeder, try to put away three to four times the initial cost of the pet in a high yield savings account or even an online investment account like Vanguard or Betterment. After the initial account is set up, find out how much health insurance would cost for your new pet and transfer that amount of money into the account monthly. You’ll draw the money out of your account once yearly in good years and it will be there if you have an emergency or illness. If you never have to deal with an illness or an emergency, the money will have been well invested and you will get it back when you no longer need it. The same can not be said of insurance. Of course, if you have the money available to take this route you probably don’t need financial advice from a broke veterinarian.

For the rest of us there is pet health insurance. A quick internet search for pet insurance will yield dozens of viable options. The thing about pet insurance is that if things go well, it is not going to save you money on your pet’s healthcare. If your pet ends up with a few emergencies and a couple of sick visits over the course of a life time, you still aren’t likely to save money. Only when you get into the scary and stressful stuff that comes with taking care of our furry, feathered or scaly family members does the insurance start to pay off. By then, you’re not really thinking about the money. Trust me, I see it everyday. Insurance is great if you’ve been through a really bad illness with a previous pet and want the peace of mind that comes with insurance for your new pet or if you have a breed that is predisposed to health issues, even if it’s just allergies. That stuff gets expensive quickly.

Both of the options above require some planning. For many of us, the health care part of the equation comes into play long after we are smitten by puppy breath, kitten antics and the like. Most of our clients haven’t planned at all for an emergency situation or an illness and many haven’t even checked into the costs of routine preventative care before they bring a new pet into their family. And there is nothing wrong with that! Bringing a new pet into your life isn’t really a financial decision, if it was we would never do it. It’s a lifestyle decision and like many lifestyle decisions, cost is never the biggest factor. Still, things happen and we want to do our best for our pets when they aren’t feeling well or have an accident. Here are a few ideas about what to do if you’re already facing a medical expense with your pet.

Third party payment options are the number one way we typically deal with the expense issue. Right now the most common ones are third party lenders who will cover your bill today and you will pay them back over the next few months. Many of these plans offer interest free payments over a set period of time. Beware however, as the interest rate outside of this time period is often astronomical. I’ve seen an APR as high as 30%! That’s crazy! Still, it makes a huge difference when we can sort of put the money aside for a little bit and focus on what is medically best for your pet.

Recently a new model of the third party payment option has been offered to pet owners and veterinary clinics. Starting in 2013, a service called vetbilling.com began a third party payment plan for veterinary patients that doesn’t have the high interest rates. Instead you as the pet owner, pay an enrollment fee and a small administrative fee is attached to each payment. You pay the company and they make a payment to your veterinarian. It takes a lot of the pressure off the veterinarian’s office. I don’t expect veterinarians to offer this to every client, we can’t afford to have revenue trickling in, but for those unforeseen emergencies it will be a real life saver. Sometimes literally.

Why can’t my veterinarian just offer me a payment plan? It’s simple and complicated at the same time. The easy answer is; we can’t afford to. Current industry averages in veterinary medicine put our payroll expenses at roughly 40% of gross revenue and inventory/supply expenses at about 30% of gross revenue. That means that 7 out of every 10 dollars we earn goes right back into providing services for our clients and their pets. We can’t make payments on our staff salaries and most medical supply companies do not finance. Especially when we’re ordering from them biweekly in many cases. So if we offered payment plans and they were utilized by even a quarter of our clients with a short repayment period of three months, we wouldn’t have the cash flow necessary to make payroll or order supplies within the first month. We’d either have to borrow money to stay in business, go out of business or stop offering payment plans.

Finally, when facing larger than you can afford medical expenses for a pet you can always compromise. Your veterinarian’s job is to offer you the best care that they can possibly provide. Every single time you come to them with a problem. It is up to you to determine whether or not that level of care is worth it to you. The best way to do that is to have an open and honest conversation about the situation and how you feel about it. Simply saying the words, “I can’t afford to do it like that” will go a long way at opening the door to other options. Just keep in mind that when we start to cut down a plan to save money, we are also affecting the outcome to a certain degree. That’s not necessarily a bad thing. For example, I recently had a conversation with my doctor about an outpatient procedure I’m planning for this Summer. My insurance has a ridiculously high deductible and it actually ends up being cheaper for me to pay cash for most things because of the discount and save the insurance for big scary stuff. I asked my doctor if paying cash changed things at all. Turns out it does. Now I don’t have to go to the hospital, see an anesthesiologist and deal with recovery. Instead, we’ll do it in his office under a local anesthetic. There are many situations in veterinary medicine that are also like that but we can’t just assume you want the cheapest or bare bones method. You have to tell us and we have to warn you about the consequences. For example, if I have an anaphylactic reaction to local anesthesia during the procedure this Summer, I would be far less likely to die in the hospital than I will in the doctor’s office. Your veterinarian will be the best one to let you know in each specific case how making changes to a plan will affect the expected outcome.

Having pets in your life is always rewarding. It enriches your day and even helps with your mental and physical well being. There are going to be times where pet ownership is stressful and even downright scary. Don’t let money be the scariest part of the equation and don’t let it come between you and your pet.

Thanks for reading.

//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=heathmcnutt-20&marketplace=amazon&region=US&placement=B01N9KSITZ&asins=B01N9KSITZ&linkId=ae66c45676a99dede6b65361b5d2af10&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff

Optimism and Stretch

Life is funny. Except it’s not. Life is difficult and many of the lessons you will encounter arrive as stressful and sometimes painful experiences. Here’s the thing about that. It’s important to stay optimistic and it’s even important to embrace things that you don’t feel like you can accomplish. Embrace them with optimism. No matter how it turns out, you probably ought to be facing it anyway and you’re going to learn something important.

Don’t be afraid to stretch yourself. Yes, it’s important to know where your line is. But it’s also important to flirt with that line every now and again to improve yourself as an individual and a professional. Most of the experiences I think back on when I think about how I’ve developed over the past few years and decades were experiences I was not ready for and not really equipped to handle.

Below are three stories from my first few years in practice that stretched my abilities and stressed me out but ultimately taught me a lot about patient care, client communication and personal development.

1. The dog was an epileptic. We knew that. When he had seizures he usually had them in clusters. We had him fairly well managed for the most part up until that night. He came in actively seizing and wouldn’t come out of it. We call that status epilepticus. He didn’t respond to several doses of anti-convulsant medication but we finally put him under anesthesia with a drug called propofol, you might have heard if it. Thanks a lot MJ.

As soon as the propofol wore off he went directly into seizing again. Propofol is a short acting drug, it can be formulated into a constant rate infusion but it also has a narrow margin of safety and if given too quickly patients stop breathing and if no one is there to respond they might not start again.

The concern with constant seizures is that they cause damage and lead to more seizures. Dogs can end up blind or worse. I had recently read a paper that described using a drug called ketamine as a constant rate infusion to control status epilepticus in a dog. The tricky business there is that ketamine at certain doses can cause seizures and at lower doses it won’t stop the seizures, only make the patient more restless and disoriented. But still, there are some significant neuroprotective benefits to using ketamine in patients undergoing seizure activity, especially extreme seizure activity.

I had a conversation with the owner and explained that I had never done this before but there were some benefits that would fit their dog’s condition perfectly and that it would be better than using propofol. They understood and agreed with me and we set it up. I stayed and watched over him for a few hours, ignoring my wife’s text messages until she finally just went to bed. The overnight technician finally convinced me to go home.

There was no seizure activity over night. The next morning we turned the infusion off, the dog was groggy but slowly regained his ability to walk and move around. He stayed seizure free and went home that afternoon. I have since used ketamine to control status epilepticus in a number of dogs and have very good results with it.

2. The owner had called and said he was pretty sure the stick was in her lungs. A 10 month old German Shorthaired Pointer had been playing rough outside and had impaled herself on a stick according to the owner. He was already on his way. The owner arrived carrying a dog carrier/ He placed it on the table and a visibly frightened puppy stepped out of the front. She had her head hung and looked weak. Then she took a breath. A spray of blood and foam came out of the three inch hole in her shoulder. I clamped a hand over the wound and tried not to show my panic. I’m sure it was pretty clear. This dog had a penetrating chest wound and there was nowhere to send her. I used a few clothespins to hold the wound closed while I sorted out what we were going to do next.

We placed an IV line, took some preliminary x rays and got her into surgery right away. Once we had an endotracheal tube in place, someone could manually breathe for her and the waves of panic reached their high water mark and started to ebb back into something that resembled calm. We opened up the wound to about twice its original size so that we could surgically explore the site. We removed as much stick material as we could find. As we closed the surgery site that had once been a wound, one staff member held the lungs inflated while I placed the sutures as quickly as my hands would move. This would help to be sure there wasn’t much air in around the lungs while they did their job.

Once the wound was closed, we placed a tube into her chest to draw off any excess air. It would stay in place until no more air could be drawn off. The overnight technician stayed with her and her evening was uneventful.

The dog went on to make a full recovery. I have gone on to place more chest tubes than I can remember right now.

3. I looked in the box at the cat, she was bright yellow with jaundice. The cat barely lifted her head to look back at me. As a general rule, jaundiced cats don’t typically survive. The cat had been bit by a dog in the groin area and the fat around that area had become necrotic. Necrotic fat sort of liquefies and spreads out under the skin. It’s a disgusting mess. The cat was septic, meaning an infection had entered her blood stream. She looked pretty bad off.

The trick to dealing with sepsis is lots and lots of fluids. You sort of over-hydrate them to dilute and flush out the endotoxin chemicals produced by the bacteria and the inflammatory mediators produced by the body. The other thing about dealing with jaundice in cats is that they need to receive nourishment. Need to as if their lives depend on it, because they do. Any jaundiced cat without a feeding tube is courting the idea of being dead. A jaundiced tube with a feeding tube can still die but one without a feeding tube is way more likely to. So our kitty had an IV line placed for fluids and then a feeding tube for nourishment. Then she was started on a regimen of antibiotics, feeding and pain management.

Eventually all of the skin along her underside sloughed off leaving bare muscles and connective tissue exposed. Several procedures later we were able to limit the exposed tissue to just her abdomen. Still feeding and giving fluids aggressively. Eventually, she started to turn the corner. We were able to assist her skin growth by packing the wounds with sugar and eventually the yellow color faded from her eyes, skin and gums. When she started eating on her own and we were able to remove the feeding tube, we knew she was going to be alright.

After several more days of sugar bandages and eventually leaving the wound open to the air, we were able to send her home. She went on to completely recover from her ordeal.

Any one of those situations might have gone differently had our team not kept a positive outlook or had we retreated back from the problem and said, “We can’t handle this.” In truth, not a single one of those situations was handled perfectly. There were shortcomings in every single one of them. But we recognized them, learned from them and are better for having the experience. Most importantly, our patients were well cared for and received the best care we had available to offer them.

I hope that life continues to throw challenges at me that will stretch my abilities and I hope that I embrace them with the same optimism that has allowed me to get so much out of these experiences so far. I hope the same for you.

Thanks for reading.

//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=heathmcnutt-20&marketplace=amazon&region=US&placement=B01N9KSITZ&asins=B01N9KSITZ&linkId=ae66c45676a99dede6b65361b5d2af10&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff

How to catch a cat in a HavAHart trap

My employer shared the letter with me not because there was really anything I could change or that could be done about what had happened. It was more to let me know that she had received it and because it was too good not to share.

A few weeks previously, a couple had brought us one of their adopted feral cats for a bite wound on its back end. They had warned us about how the cat was and told us to be careful with her. We had listened and had found the small gray tabby to be a wonderfully easy patient. She snuggled up on us during her exam and we loaded her in to her carrier without incident when her owners came to pick her up. I find this to be true of many adopted feral cats. They turn into big loves so long as you let them set the terms.

We did the recheck in our Ludlow office. The owner was present for the recheck, she had not been present for the initial visit. I took the feral cat out of her carrier, she was nervous but after some chin scratching she rubbed up against my hand. When I went to lift her up to examine her abdomen the owner tried to intervene. The cat did not approve of the intervention, my response to the intervention or both. She exploded around the room, knocked the blinds off the windows and then hid behind the sink. I retrieved her and finished the recheck. The issue had resolved and would not require any further attention. The feral cat and her owner returned home.

The letter arrived the following week. I don’t remember the details anymore, I had saved it for a few years but must have discarded it recently. The basic premise was that I was an inept veterinarian who didn’t know how to handle feral cats and shouldn’t be allowed near animals. I do remember that the word “idiot” was used eleven times in the one page letter. It was directed at me every single time. Needless to say I was not this client’s favorite veterinarian.

Fast forward one month, exactly one month from the day of that fateful recheck exam. The same owners bring in another feral cat, this cat had just been captured by these feline rescuers and was still mean as could be. It likely goes without saying that they did not want any of the veterinary services to be performed by me. Completely understandable.

Then the cat got loose in the cat ward. Bear with me while I paint the cat ward into your mind. It’s a rectangular room, eight feet wide by sixteen feet long. There is a single door at one end of a sixteen foot wall and two large windows along the other. At the 8 foot wall nearest the door is a treatment table and scale for weighing cats and a cat kennel bay on the other end of the room. All in there are 10 feline kennels in that room. The cat ward also serves as the location for the server and data lines for the hospital so there is a shelf in one corner and a hole in the ceiling for all of the data lines to go throughout the practice.

We attempted to capture the cat but he wedged himself behind the kennels against the far wall in the cat ward and would hiss and strike at us as we tried to get him out. Fortunately, the kennels are on wheels so I wheeled the kennel away from the wall and climbed on top of the kennel to get at the feral cat. The plan was to corner the cat on one side of the space behind the kennel by advancing a broom towards him. Once he was in a position he could not bolt from I was going to jump down, throw a thick towel over him, scoop him up and return him to his carrier. Seemed easy enough.

Instead of being cornered, the cat decided that it was fighting time, he attacked the broom that I was advancing towards him without any semblance of fear. My plan had been to use the broom to guide him gently out from behind the kennels, his plan had been different. Once he latched onto the broom and realized it was good for climbing, it took less than a second for him to be crouched next to where I was laying on top of the kennels. We locked eyes. I sat still watching him as he glared at me, waiting for him to attack me. Instead he hissed once in my face, turned and jumped up through the hole in the ceiling and was gone. I sat for a long moment in silence. All I could think to say after that moment had passed was, “I can’t believe that actually happened.”

I got down from my perch and went to the hatch that led to the crawl space attic above the cat ward, stood on a stool and shined a flashlight inside. Two glowing green eyes peered back at me and after looking around the small crawl space, I decided he didn’t have much room to hide and I could probably capture him with the net. So I climbed up into the crawl space with a four foot long loop net and planned to capture the escaped feral cat. I was of course, wrong. The crawl space had roughly one million tiny places for a feline to fit that a human might not even see let alone climb into. And it was approximately 1000 degrees Fahrenheit in there. After a few minutes up there, I retreated to the safety and comfort of the treatment area and thought about what to do next.

We decided to set a catch and release trap with some cat food in the attic and wait until morning. My boss told me she would call the owners of the feral cat when she arrived at our Ludlow office for afternoon appointments and explain everything to them. That seemed fair, I hadn’t even lost the cat. I was just trying to be helpful. What we didn’t take into account was that we were at the tail end of road construction season here in Vermont and the commute took her considerably longer than usual. As a result, appointments started a little late in Ludlow and she struggled to keep up. In Rutland, the owners of the feral cat stopped by to pick up their cat.

I must have rehearsed what I was going to say to these people fifty times in my head before I stepped into the cat exam room. I was going to explain to them that I (the veterinarian they called an idiot in the letter they wrote to my employer) lost their feral cat in the ceiling of our practice. Then I was going to get out of the room. As soon as I closed the door behind me, my mind went completely blank. I stood there for what felt like an hour before I decided that I had to just go for it.

I do not remember a word that I said to them or a single word they said to me but I do remember that they didn’t smile. Not once. They left and we set a HavAHart trap with some canned cat food up in the attic.

You can get your own here: HavAHart

The next morning the cat was in the trap. We called the owners, they picked up the cat and we never saw those cats or their owners again. I saved the letter for years but apparently discarded it recently. I suppose I am ready to move on.

Thanks for reading.

Best Roomba for Pet Hair!

Never Hear Wolf

Being a veterinarian here in Vermont is pretty awesome all of the time. There are two seasons that are especially awesome to be a vet here; Winter and Summer. Both seasons bring in tourists and both seasons are a little bit slower for our regular clientele so we can focus on catering to our out of state clients without feeling like we are ignoring our regular folk. It’s a really fun situation. Also, I like skiing and swimming. Not at the same time of course.

I am using three out of stater stories to illustrate the importance of taking to heart the complaint a client calls in with.

1. It was the first July I was in practice. It was hot and my wife and I had only recently found out we were expecting our first child (we didn’t know it was a girl until she was born.) My in-laws were visiting and we were living in East Dorset at the time. There was a great little pick your own berry farm just down the road from us. The afternoon plan was, we were going to pick some berries then head down to Emerald Lake State Park for a quick swim before grilling some dinner on the deck. It was going to be a pretty sweet New England summer afternoon and night.

But I was on call and of course my phone rang as we were headed into the berry farm. I took down the client’s information and called while I was finding a parking spot. It was legal to use a hand held device while driving at this point. I might be the reason it’s not anymore. The client was visiting from Connecticut and their Labrador Retriever puppy had been spayed the day before. There was a problem with the incision. I called and the woman owner – a pleasant but slightly frantic pet owner – answered. She informed me that her dogs spay incision was open and she was pretty sure that she could see intestines.

I was fresh out of school, young and at least as excited about veterinary medicine as I am today. I told her I would meet her at the hospital right away. I told my wife what was happening and she – infected by my enthusiasm – agreed to walk the mile back to our house. In the heat. Pregnant. I left in a hurry and made the drive from East Dorset to Rutland in 19 minutes. Google map that. This story will be here when you get back. I have a client who is on a police force in Southern Vermont and lives in one of the towns I drove through way too fast. I am sorry. I am glad no one got hurt.

I pulled into the driveway and was kind of excited that I beat the client there. I got out of the car, grabbed my keys and went to unlock the door. Then I caught a glimpse of myself in the reflection in the window. I had on board shorts, an athletic shirt and flip flops. (Relax OSHA I have Crocs in the clinic (relax fashion police I’m a veterinarian I’m supposed to look terrible)) I wondered how anyone was going to take me seriously. I threw on a pair of scrubs and my Crocs.

The client arrived and I led them into the exam room. I carefully asked the dog to lay down and had a look at her incision. I’m not sure what I was expecting but I did my best to hold in a laugh, told the woman that the incision edges were just a little swollen and there was a small strand of subcutaneous fat that was poking through the edge of the incision. To ameliorate her concerns, I applied a bandage and told her she could remove the bandage in 24 hours and could apply an antibiotic ointment twice daily until the incision was healed.

2. The second incision emergency was in a Labrador Retriever visiting the Ludlow area from New Jersey one Winter. The owner carried her in as I was finishing appointments one evening. I remember it being already dark so here in Vermont it might have been just a little past noon on a Winter day. The dog had been spayed a few days previously and her owner was adamant that the incision had opened up while they were out snowshoeing that morning. A brief six mile snowshoe adventure in some fairly deep and fresh snow. He also mentioned that he was taking the dog cross country skiing tomorrow and that the dog’s intestines were poking through. In the same sentence. Both of those statements can not be true.

I took a look and he was half way correct, the incision was open a small amount at the very top of the incision. The intestines? No that turned out to just be an extra long suture tag from the closure. I trimmed the suture back a bit and encouraged the owner to apply a small amount of antibiotic ointment to the open part of the incision until it healed. And to try to tone down the exercise for a week or so.

3. Ah the rule of three. Also known as the comic triple. The third call came in the Winter as well. A young couple from Massachusetts had brought their recently spayed Labrador Retriever – a recurring theme in incision issues all around – with them on a ski vacation. One of their friends had come along with them and was watching the dog while they were enjoying a sunny and warm ski day. We got the call on a very busy Saturday morning. Labrador. Visiting from out of state. Spay incision is open. Something was sticking out. I told the receptionist to have them come right in. I remember turning and looking right at the two technicians we had working that morning and making a joke about it needing a good application of antibiotic ointment. I remember having a brief conversation about telling them to wait until they got home to their vet in Massachusetts because we were so busy. We decided to play it safe and that it would be quick and easy. I would probably just step out in the lobby, look, tell them it would be fine and would send them on their way.

All of our smiles and laughter disappeared when a trembling, nervous black lab was led into our treatment area. I could tell from where I was standing that something was wrong. Yes, I’m pretty good at recognizing problems but also she had something that should have been in her abdomen trailing behind her on the floor. So it wasn’t too hard. I could not tell if the dangling bit of innards contained intestines but it was large and starting to smell a little putrid so at that point, anything was possible. I was pretty worried about this little puppy. On top of that she was justifiably upset and nervous. We couldn’t get her to hold still for much more than a physical exam and even then getting a temperature was an exercise in futility. I desperately wanted to sedate this dog and determine how bad the issue was and what needed to be done as soon as possible. But the owners were still skiing and not answering their phones. Megan, one of our technicians sat with the puppy and tried to keep her calm until we got in touch with the owners. I carried on with appointments, putting the distressed little puppy out of my mind as much as I could while I examined other pets and addressed other concerns. Finally about an hour after the initial phone call, the owners called and gave me permission to sedate their dog. They were coming right down from Killington which is about a half hour drive from our practice on River Street in Rutland.

We sedated the dog and examined the incision and the abdominal contents coming out of the incision. A small amount of the omentum which is a lacy blanket of fat that covers and protects the abdominal organs was hanging from a very small hole in the abdominal incision. Fortunately, there were no intestines and just a few blood vessels associated with the omentum protruding from a two inch long section of open incision. By the time the owners showed up, I had the problem figured out and a solution worked up. We went over the plan, the costs and the expected recovery. We agreed on everything and we took the dog into surgery immediately.

The technician working with me in surgery, Alex, would feel like I was leaving a little bit out if I didn’t inform you that the surgery was not straightforward. During the removal of all of the omentum that had been outside the body a large artery was inadvertently transected with the needle attached to our suture material. The resulting bleeding was fairly remarkable and it took some time to get the bleeding stopped, clean away all the blood and be certain that the bleeding was not going to come back. We had allotted an hour for surgery and all in the procedure took us a little over two hours.

We had a few appointments we had to reschedule due to taking the surgery into overtime. So on top of a stressful and exhausting surgery, I had to make a bunch of apologetic phone calls while waiting for the lab to recover from anesthesia. The puppy recovered and we ended up sending her home later that evening. The puppy went on to make a full recovery.

I’m glad I had the puppy come right in. I’m glad I didn’t give in to the pressure of a busy day and the past experience of false alarms. Asking them to wait until Monday would have been a disaster. Hopefully they wouldn’t have followed that recommendation but more importantly, I’m glad I didn’t make it.

I hope that life will continue to throw enough of these experiences at me so I don’t get complacent or comfortable enough to start taking my clients concerns less seriously than they do. At least not until I confirm that the exposed intestines are actually just suture material.

Thanks for reading.

//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=heathmcnutt-20&marketplace=amazon&region=US&placement=B01N9KSITZ&asins=B01N9KSITZ&linkId=ae66c45676a99dede6b65361b5d2af10&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff

How to pull porcupine quills out of your dog.

They are about the size of a large cat, near sighted and they don’t run. Instead they sort of dreamily lumber around in the dark making odd grunting noises and barely acknowledging you if you follow them around with a flashlight. I like to think of them as beavers who joined a punk band, got burned out on tour and are returning back to their roots.

Unfortunately, your dog likes to think of them as giant chew toys. To be fair, it probably does seem like a lot of fun, a waddling big rodent that rustles when you get too close. To a dog that probably seems irresistible. I imagine that the thought process in a dog encountering a porcupine goes something like this, “Oh man, this is going to be awesome, it’s wiggling at me this is going to be so much fun!” Smack “Oh man, this is pretty terrible, I’m not having any fun.” But there are always repeat customers. We had one dog come in four times in the same Spring for quills one year. Depending on the client, I will often relate it to tequila and college students. It’s one of those things that seems like a great idea and a really good time and then suddenly, it’s no fun anymore. But they often go back another day for more.

Dogs almost never get into porcupines first thing in the morning. It’s usually evening, you’re letting them go out for one last pee before bedtime, you’re half asleep while you stand at the door after you let the dog out and he or she comes back with a face full of quills. Well great. Now what?

The following instructions are only intended for people who are within an hour drive of the developed world. If you find yourself a day’s hike out in the wilderness and then your dog gets quills there you can skip the steps and go to the bottom. If you’re that far out in the wilderness and don’t have a hemostat. Shame on you. Be more prepared next time.

Steps to removing quills from your dog:

1. Call your veterinarian. Darn it. You thought I was going to tell you how to do this at home. Did you forget I’m all about the money I can make from clients? Seriously though, porcupine quills are no joke. Here’s an article explaining their shape and why pulling them out awake might be a terrible idea. It’s at least worth a phone call to speak to a veterinarian and explain the situation. Calling the vet should always be free.

2. Follow your veterinarian’s instructions. For one or two quills, I might have you try to pull them at home. Sometimes even one or two quills requires some form of restraint and professional attention. If there are quills in the mouth or quills around the eye or especially, quills near the shoulder area I will always recommend we remove them for you. Always. These evil little buggers are composed to move in a single direction. Usually they migrate out to the surface but not always. Scroll to the second to last paragraph of this article to see what I mean.

3. Be ready for this to take more than one episode. If your dog does a good enough job on the porcupine there may be quills that we can not reach on the first go round. As these move toward the surface, sometimes a separate procedure is necessary to get everything out.

If your veterinarian told you to try to pull them at home or you are out in the wilderness please open this photo in a separate window. See the tool this person is using to remove them? You need a tool like that, pliers might work but hemostats are better. “But Heath, I don’t have hemostats.” Here’s a pair for less than $15. Hemostats

If you’re spending time in the woods these would come in handy in multiple situations. If you fish, even more so. Look back at the photo. Grab the quill down in the dark section and pull straight back to remove it. One quick motion, no twisting and no bending. If your dog bites you during this, that’s on you. Sorry. That’s one reason why we sedate them.

If you’re unlucky enough to find your dog with quills, give your veterinarian or local veterinary emergency clinic a call. And if they do it once, chances are they will do it again.

Thanks for reading.

Amazon Echo Dot

In U.S., More Say Animals Should Have Same Rights as People

I love all animals and consider them intelligent and unique beings but giving them the same rights as humans and then trying to keep our current healthcare system will do more harm than good. Just imagine all the pet owners we would have to report to authorities for neglect just because they ignored their dog or cat’s teeth. And then what happens with these animals with human rights? We can’t just keep them in cages after we remove them from neglectful guardians. Seems like a situation I’d rather not be involved in. Not right now anyway.

The Paw Report

A third of Americans want animals to have same rights as people……What do you think? More of the story below….

http://www.gallup.com/poll/183275/say-animals-rights-people.aspx

View original post

Barking Characterizes Dogs as Voice Characterizes Peopleb

A very interesting and easy to read post about dog voices.

Scott Reed DVM

A research group of Computational Intelligence Group (CIG) collaborated with a veterinary student from Universidad Politécnica de Madrid (UPM) to conduct research on canine behavior showing that gender, age, context and individual recognition can be identified with a high confidence level through computational methods of pattern recognition applied to the dog’s barking!

Canine communication has been a research topic over the past decade. Most of the research has been focused on how dogs can understand different forms of human communication such as hand gestures or human voice recognition. The joint research conducted by CIG and UPM focused on understanding the acoustic signals obtained from dog barking when in certain situations. They used a computational system based on statistic modeling to recognize diverse characteristics of the dog such as gender, age and more.

They experiments were conducted in Budapest with eight dogs, three males and five females. Each dog was aged…

View original post 209 more words

How to communicate perfectly.

You can’t. That doesn’t mean you shouldn’t bother trying to.

I don’t know how to communicate perfectly but over the past few years and especially over the past few months I am starting to understand the keys and the benefits to effective communication. While I approach it from a veterinary/client point of view I imagine these points can be applied to nearly every relationship you have. Heck, I apply them to conversations with my three and four year olds as well. In the spirit of being a cliched blog fit for social media sharing, I am going to share my top five points on effective communication.

Be Honest. I mean honest when it hurts the most. When you just want to tweak the details a touch or leave out one piece of the story. Everyone feels like they are an honest person and I’m sure you are but there are those times where you might “spin” an issue or withhold a small but possibly critical piece of information in the hopes that whatever you are trying to communicate isn’t bogged down with concerns from the receiving party. In my world and practice it often goes like this, Fluffy is having problems a, b and c. To get close to an answer and formulate a treatment plan she needs testing x, y and z done. Then once we have that information we will be doing something. What I often find myself guilty of glossing over is the money part. If you’ve read my posts on this subject here or here you might understand that I am starting to get more comfortable with the fact that my services cost money. If you ever read my previous blog you might see how far I’ve come. By not fully preparing one of my clients for the costs associated with our services, I am not being one hundred percent up front with them. If someone is surprised by their bill at the end of a visit, I haven’t communicated effectively. It still happens to me but I’m getting better. The other area I think honesty can get a little cloudy is when people ask questions we don’t know the answer to. I remember telling someone I didn’t know what was wrong with their dog once early in my career, they went elsewhere. You can imagine how I felt about telling another client I didn’t know what was going on with their pet. Somewhere along the way I figured it’s just less stressful for me to be honest than to seem like I know everything. And then something amazing happened. I somehow found a way to explain things clearly enough so that people understand, it’s not that I don’t know what’s going on, it’s that what is going on is more complicated than it seems. Pets are really complex little systems and a lot of things can go wrong and cause very similar issues. By telling them I don’t know right now, it went from them thinking I had no idea what I was doing to them being able to appreciate how unique their pet’s problem was. It made communication easier and kept the lines open which always allows us to at least reach a point where everyone is satisfied with what we can or can’t accomplish.

Listen. It’s the most important and often the most overlooked part of effective communication. How can you convey the information the other person needs if you don’t listen for the parts the other person doesn’t understand? I try to spend less time talking in the exam room than the client. With some clients that is really easy, with others it can be like pulling teeth. It’s even worse on the phone. But when you stop and listen to what people are saying you find you are much better at providing them with excellent service because you actually understand what they want. It’s worth a lot to know what people want from you and when you can deliver it and see the results, it will really reinforce the benefit of you shutting up a little more often and listening to what people have to say. When I first got out of school and started practicing, there was so much information to convey, how was I going to get it all out and in a way people would understand? I needed to teach them how to take care of their pets. Wait, what? No, I had it all wrong. Yes, often people come to me with issues they want my expert advice and assistance with, that’s my job. But most of the time, people want me to provide the services they would like for their pets. And in order to know what those services are and to provide them effectively, I have to listen.

Slow down. If you’re talking so fast that someone can’t understand you or can’t get a word in edge wise, you are not communicating effectively. Think about an evening out with friends, everyone has a few adult beverages and starts telling stories. You have a great story that fits right into the conversation but by the time there is a space in the chatter the topic has moved off so much that your story seems out of place and kind of silly. A simple and amusing part of a night spent with friends, not so amusing when trying to communicate with your veterinarian about your pet’s health. Tied in to the problem I had early on with listening was in trying to get all of the super important information I needed to share with my new clients I would just blurt it all out whether they were listening or not. I would rattle stuff off so fast people were probably thinking that I was auctioning their pet off like livestock. Looking back I’m surprised no one ever made a bid. While I don’t currently speak with the same number of pregnant pauses as President Obama, I do try to stop talking for a few seconds every time I am changing the subject or about to make a recommendation. People deserve a chance to disagree or interrupt you and let you know what they are thinking. Also, you are going to be way more effective if people understand you. So slow down, catch your breath. Give the other person a chance to talk and tell you what they want. Especially on the phone. Stop making every phone call a race to hang up. Take the time to have the conversation. You’ll be amazed at how much better your service or outcome is.

Less filler speak. On of my least favorite things to hear when trying to communicate with anyone is a barrage of filler speak. Works such as; like, you know, basically or the uhs and ums of communication get in the way of allowing open communication and road block the other person from having a say. The author, debater and contrarian Christopher Hitchens put it nicely in his article for Vanity Fair, The Other L-word,  “People who can’t get along without “um” or “er” or “basically” (or, in England, “actually”) or “et cetera et cetera” are of two types: the chronically modest and inarticulate and the mildly authoritarian who want to make themselves un-interruptible.” Try to replace your filler speak with silence and you’ll be amazed at what people would like to say if only you’d give them the opportunity. I haven’t really ever been guilty of a lot of fillers in my conversation but it’s similar to talking too fast or omission. There have been times, I am afraid to admit, where I knew something needed to be done for someone’s pet but if I gave them a chance to start digging at my recommendations I might have given them the chance to talk themselves out of following through with them. So I talked too fast, didn’t include all the details and got the job done. Foreign body surgeries used to be like this for me. I see filler words used in much the same manner, they fill in the gaps that should otherwise be replaced with details or with a pause to give an opportunity for rebuttal. So again, shut up a little bit. Stop steam rolling the people you are trying to communicate with with ridiculous non-words and see how much better your communication skills get.

Let the other person end the conversation. If you are the one making a recommendation, providing a service or trying to convey information, the other person is the customer. They chose you out of all of the other options to help with their problem and they are working with you and letting you do your job. They get to decide when the conversation is over. And they will, trust me. No one wants to be on the phone longer than they have to, no one enjoys being stuck in your windowless exam room. You’re not that entertaining. But giving them the chance to say everything they wanted to say leaves them satisfied and if you need me to help you understand the importance of a satisfied client or why having people enjoy communicating with you should matter to you, this blog isn’t for you.

Most importantly, communication is a skill. Like any skill, you will have good days and you will have bad days but as you work towards your goal your skill set will improve. Over time. Don’t try to rush these things. Take the time to master the fundamentals and then work on the implementation and make it your own. Remember, “slow is smooth and smooth is fast.” Baby steps. You’ll get there and you’ll like the results.

Thanks for reading.

The Best Roomba for Pet Hair!

And the winner is…

Two days late but I selected this post as the winner for our first contest;

“These cows have been specially trained by their handlers to perform for the camera in an effort to usurp cat videos on youtube and demonstrate to the world that cows are also cute. Because they are!”

It was submitted by Carin of Buckinghamshire, UK. You can see her blog here: https://carinrambles.wordpress.com/

Thanks everyone for playing. I’m not sure I’ll do it again but who knows?