Diagnostics

When a sick pet comes to see me there are a few things I can diagnose and treat based only on physical exam and the history I receive from the owner. Most illnesses, especially serious ones that appear rapidly require diagnostic testing to appropriately diagnose and treat. Even more frustrating for many pet owners are the illnesses that require more than one round of testing to reach an answer and an appropriate treatment plan. As veterinarians we sometimes become discouraged by this and fall into not pushing for the best diagnostics because we know how frustrating it can be for owners. This doesn’t do our patients any favors and in some cases it can lead us into treating the wrong diseases or it could extend the treatment of a disease costing our clients more in the long run than if we had just pushed for the more appropriate course of action in the first place.

For illustrative purposes we will pretend a dog is brought in to see us because the owner has noticed recently that the dog has lost some hair. The owner will stand quietly for a few minutes while I go over the dog and look at the skin showing through the sparse hair. As soon as I look up from the patient clients will often ask, “So what is it?” I understand the desire to know what the problem is but if it is just hair loss with no other clinical signs there are over 200 possible illnesses that can cause hair loss. Many of these are rare but the list is extensive.

If the dog is also itching at itself we can narrow our list of possible illnesses down to just under 100. So we’ve already ruled out over 100 illnesses before we do any diagnostic testing at all. Not too bad. If we add in just two more clinical signs we can narrow it down even further. Let’s say that the dog also has crusts and scabs in the areas of hair loss and that those areas have increased pigmentation. We can now narrow our list down to just over 25 illnesses. Now we’re talking! So we’ve gone from over 200 to around 25 and so far all the client has to pay for is the exam. This is going great.

It’s sort of going great. Now we have 25 different illnesses that we have to rule out before we begin treatment. This is where the job becomes challenging. I need to come up with the best diagnostic value for the client’s money. In this case we would start with scraping the skin to look for external parasites. We would also place tape on the areas of hair loss to look for fungi and bacteria. Total cost right now for the client is still pretty low. If those come back negative that means we don’t have a diagnosis or treatment plan yet but it also means we can narrow our list down even further. Now we have to think again about where we want to go next diagnostically.

My next step for this patient would be complete blood work including electrolytes and a urinalysis. Now we are spending money. We just likely doubled our bill and this still may come back as a big list of rule outs. In our line of work, however, rule outs are occasionally more important than diagnoses. If this dog has disseminated Mast Cell Tumor for example we are going to have some very difficult decisions ahead of us. It’s still entirely possible that this dog only has allergies.

Let’s say that the blood work came back with mild to moderate elevations in a few liver enzymes and a mild anemia. Well this narrows it down considerably but while it seems like it makes things easier our next step is going to be more specific. Many of our next steps will be costly and will only be ruling in or out a single disease. Here we choose to play the numbers and rely heavily on the owner’s history being very accurate. We recommend a skin biopsy. We have now increased the total cost to the client to over $600 and we still might end up with only allergies as a diagnosis.

The other road to go would be to just treat the dog for allergies and see what happens. This is leaves an uncomfortable amount of uncertainty and in some cases can end disastrously but every case is different. There have been plenty of cases where I have chosen to treat dogs for just allergies based on the history and physical exam and there have been a few cases where I have gone all the way to biopsy and then treated for allergies. There have also been cases where I considered treating for allergies, looked a little deeper and discovered diseases that might have been exacerbated by treating the dog as an allergic dermatitis. No two cases present exactly the same and some of the allergic dogs present exactly like dogs with some other more specific and serious illnesses. Unfortunately we aren’t able to attach our patients to a computer and have it spit out a diagnosis.

Please remember that we are often as frustrated as you are as we go down these diagnostic paths and sometimes maybe we take a wrong turn or two. I can say with complete certainty that I have never recommended a diagnostic test that I did not believe was necessary. That doesn’t mean I wouldn’t do a few things differently on a lot of cases if I got the opportunity. Hindsight is like that but as long as hindsight helps guide future decisions, it’s all part of the game.

Thanks for reading!

 

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Capitalizing on Nature

My intention in approaching topics like this isn’t so much to push peoples’ buttons as it is to get them thinking in a more critical manner about what they take at face value. If I told you I didn’t smirk at some of the angry comments I received however, I would be lying.

Recently, a friend of mine posted an “article” about how sodium bicarbonate or baking soda cures cancer and how drug companies don’t want us to know about it because they make so much money off chemotherapy. I could not resist pointing out that drug companies do in fact manufacture and sell sodium bicarbonate in injection form and for what hospitals pay for it on a per gram basis, they are making quite a bit more on sodium bicarbonate than the grocery store is. Hospitals of course also mark it up a bit when we give it via injection and while I couldn’t tell you off the top of my head how much the hospital I work for charges for an injection, I can tell you that if I were using it to treat cancer, I’d make more than enough to maintain my current lifestyle. And I’d also be recommending that we monitor things like blood pH and white cell counts so I’d still do alright on the monitoring end of things as well. My point being, if sodium bicarbonate was in fact a reasonable treatment for cancer – and if cancer was some sort of single disease that responded to one form of treatment – not only would drug companies recommend it and health care providers use it to the result of everyone making money on it, no new production of medical grade sodium bicarbonate would occur because drug companies already make it, health care providers already use it and they all make money on it. Just not for cancer.

In the weeks that followed I saw roughly a dozen other articles touting some natural cure that drug companies don’t want you to know about because then they couldn’t make money on them. I do not currently have any friends or acquaintances working at the executive level in any research and design department in any pharmaceutical company so I do not know that the following activity occurs but I like to think it does. An executive level research scientist for a major drug company is sitting at her desk after getting off the phone with the financial department about budgetary issues and needs to decompress before going back out into the laboratory to whip the post docs back to work. She clicks on social media for some mindless internet surfing and comes across an “article” touting celery as the anti-hypertensive secret the drug companies don’t want consumers to know about.

“This is ridiculous,” she thinks to herself as she opens a separate tab and starts combing through the scientific literature for any studies on the effect of celery on hypertension. “If there were even a reasonable amount of evidence that celery contained an effective treatment for hypertension, of course we could isolate it, purify it and make money on it. We built an entire brand around the extract of White Willow bark for goodness sake.”

And of course, she would be correct. An early form of aspirin was isolated from Willow bark in Hippocrates time and the compound was isolated in 1763. It still remains a reasonable treatment for mild pain, fever and as an anti-thrombotic in people at risk for strokes or heart attacks. And Bayer still makes money selling it. Somewhere between 1803 and 1805 a German pharmacist isolated a compound from the Poppy plant that became morphine and pain control became a lucrative and slightly dodgy industry. Still is. Later in the 19th century a plant metabolic product known as Gamma-Aminobutyric Acid was synthesized in the laboratory. Nearly 60 years later it was discovered to be part of the mammalian central nervous system and a hundred years after it was first synthesized it was found to be very useful in the treatment of nerve pain and seizure activity. Analogues of this natural product are used to treat nerve pain associated with diabetes today.

And that’s just a few pain treatments that are natural in origin. Less than 100 years ago, Alexander Fleming noticed that the Pencillium notatum mold, if grown on the right substrate would inhibit and even kill bacteria. A few years later the world was forever changed by a new ability to combat infectious disease. The fungus Acremonium eventually gave us Cephalosporin drugs and these two classes of drugs, penicillins and cephalosporins,  are still among the most commonly used antibiotics we have available to us.

But what about cancer drugs? Those are poisons. True but like a lot of other pharmaceuticals, many chemotherapy drugs have a natural origin. Vincristine is listed among the WHO’s list of essential medicines for a health care system to have access to. It is also derived from the Madagascar periwinkle, a pretty purple flower. The bacteria E. Coli gave us an enzyme called Asparaginase that is used in the treatment of lymphatic cancers as well as some Mast Cell Tumor protocols.

This is by no means an extensive list of the products that have been developed by people having recognized them in nature as effective, isolated the compound having the desired effect and found a way to make it safer and more readily available to the public. It’s just a series of examples of where a naturally occurring treatment or cure existed and people found a way to bring it to market. If lemon juice or sodium bicarbonate or Himalayan rock salt had healing properties, you can bet that someone would have or would be working on isolating what those properties were, finding a way to mass produce it and get it out into your hands.

The fact that drug companies aren’t pushing the sodium bicarbonate or any other natural product they are likely to be already manufacturing as a treatment for cancer speaks more to the lack of efficacy of any one of these products as a cancer treatment than it does as proof of some global conspiracy to hide the healing power of natural ingredients in a greedy quest for profits.

Thanks for reading.

Trust me.?!

Hope you had a fantastic Thanksgiving!

Many of the people reading this know me from my previous job in veterinary general practice. Many of them I met years ago and over time and through experience, we developed a veterinarian/client relationship and they came to trust me with the health and well being of their family pets. This is of course, a huge honor for a veterinarian and for many of us it is exactly why we went into this profession in the first place.

Presently, I am working in an emergency clinic and the dynamics are considerably different. I rarely see people more than once and they have to come into this situation trusting us from the beginning and from our side of the exam table, we have to establish that trust as quickly as possible. Their pet’s life might depend on it. Sometimes that trust comes easy, people understand the situation we are all in and they go with it, sometimes it’s less easy and sometimes it’s downright impossible.  I’d like to offer anyone reading this some advice on how to make it less scary for themselves and hopefully have a better chance at a good outcome for their pet.

There are two ways a client ends up bringing their pet to an emergency clinic. The first is the more obvious one, something happens after hours and the pet requires immediate attention. In these cases, the owner may call their veterinarian and receive instructions to contact the emergency clinic or they may find the number online. The second way a pet ends up at our facility is if he/she has an illness or issue that is going to require a level of care or monitoring that the pet’s family veterinarian cannot provide. In either situation, the owner of the pet has to bring their beloved family member to someone they have likely never met before and entrust that person with their pet’s health and well being.

This can be scary for some people. Sometimes it can be a little daunting for us as well. I have a few ideas about how we can make it a little less scary for you and ultimately better for your pet.

The first step would be that you just have to try to come into the situation with a little trust in the first place. There are few if any veterinarians or veterinary staff working in an emergency clinic who don’t really want to be there. It’s long hours, you sacrifice a lot of things we all take for granted (sleep schedules for one) and you miss that connection with clients and their pets. Don’t get me wrong, there are upsides including that the emergency clinic doesn’t support veterinarians with egos or ones who want to be dishonest. There’s too many people seeing what we do or say to clients for us to be anything but transparent and honest. That alone may not make you trust an ER veterinarian or the staff but it should help.

The other thing to remember is that if your veterinarian chose to send you to a specific emergency clinic, it’s because they trust them. Usually, if there is enough business to support an emergency clinic, two pop up to fill the need. Most veterinarians will choose the clinic that treats their clients the same way they would treat their clients. Ask your veterinarian which emergency clinic they recommend, ask them why and try to ask them before you have an emergency.

The next step after determining which emergency clinic your veterinarian recommends is to call them yourself, preferably before you have an emergency and ask all of the things you might want to know. Try to call after the morning and evening busy periods, so skip 7am to 10am and 4pm to 8pm and keep in mind, anytime can be busy for an emergency clinic. So if they seem a little brusque the first time, call back again and see if maybe you just caught them at a bad time. Once you have an idea of what the culture of the practice is like it might be a little easier for you to go into an emergency situation with a little more trust.

The final point I’d like to make when it comes to trust and the emergency clinic is that the emergency clinic has to cover all their bases, every time. What I mean by this is that we not only have to answer to you, we also have to answer to your veterinarian and to each other. Any veterinarian can only work with the information provided to them and when your veterinarian or the next shift at the emergency clinic takes over your pet’s care they will want to know why they don’t have certain pieces of information. Saying that the client and the veterinarian discussed options and decided that a specific approach fit the family’s wishes better is perfectly acceptable. Telling your colleagues the case they are taking over is lacking important information because the veterinarian failed to offer certain diagnostics is never acceptable. So while it might seem like the emergency clinic is pushing a lot of testing up front, it’s because we are but not for the reasons you might think. We have a limited window to get an answer to your problem and an obligation to offer you all of the possible options within our window. There is nothing wrong with doing the less emergent diagnostics with your veterinarian after we get your pet to a more stable state, but that has to be your decision not ours and you can’t make the decision to wait on diagnostics if they aren’t even offered in the first place.

I hope your pet never ends up in an emergency clinic. But if you do find yourself needing one, I hope that you can take some of these points and make it a less stressful and smoother event than it might have been otherwise.

Thanks for reading.

Nutrition

I talk to pet owners every single day. Even on my days off I am likely going to answer a question for a friend and I often get emails from complete strangers asking me for advice about their pets. I always take it as a compliment when someone wants my input in a decision and try to be as helpful as possible.

If nutrition isn’t the most common subject I discuss with people, it’s in the top 5. Pet owners spend a lot of time looking into what foods will be best for their pet’s needs. It makes sense, you want what’s best for your pet and nutrition is one of the easiest things to control. The problem I see people run into with their pets is the same problem I see people run into with their own diets; there are so many “experts” and so little information. Bags with claims like “human grade” “no byproducts” “grain free” “holistic” and more clog the aisles at pet food stores but don’t really have an affect on anything but the cost of the food. I usually like to start the food conversation with new people by “admitting” my dogs eat a diet with corn in it and meat is not the first ingredient on the bag. My dogs also have their health monitored pretty closely and they are lean but well muscled with the exception of our black lab who steals food from our three children, a lot. In short, my dogs are a lot healthier than the average American dog.

I wrote about this subject a while back but it was sort of more informational and less conversational at the time. I think a conversational approach to nutrition is a good idea. And I think the conversation should be centered around, what are you trying to accomplish with your pet’s nutrition?

If your goals are medically based. If you are trying to accomplish weight loss or manage a disease process like diabetes or arthritis with nutrition, then a consult with your veterinarian and ideally a veterinary nutritionist would be your best bet. They can discuss with you the advantages of using specific nutrient profiles in specific diseases and how we expect those nutrients to effect the physiology of your pet.

If your goals are athletic, your dog is sled dog or an agility dog or a dock diving dog and you want to be sure their nutrition is optimized for competition, a visit to your veterinarian is likely going to be helpful but you really want to utilize a veterinary nutritionist. Specifically one that focuses on athlete or search and rescue dogs. Veterinary nutritionists are veterinarians who have gone on and received advanced training and accomplished certification in the field of veterinary nutrition. You can find more about them here.

If your thinking about breed specific nutrition, I would recommend a consultation with your veterinarian but if your dog is a family companion and has no known medical issues, your dog will likely do just fine on any well balanced diet so long as you are paying attention to the number of calories they take in.

If you are trying to do what’s best for your pet because they are a member of your family and they are otherwise healthy, I have good news for you. Pretty much any food that meets AAFCO standards is going to be alright for your pet. Certainly, a conversation with your veterinarian won’t hurt but a healthy dog can get all of their nutritional needs met by even some of the cheaper foods that are currently on the market. I’m not saying you should necessarily reach for the cheapest food you can find but here’s a point I wish I could put on a coffee mug and give away with every puppy/kitten: If you are skipping out on preventative medical care like flea/tick prevention, oral healthcare, vaccination or annual check ups because of the cost and are feeding an expensive dog food, you are missing the point. Your attention to your pet’s well being would be far better served by focusing on preventing diseases they may encounter and ensuring appropriate oral health than by feeding them foods that aren’t providing any measurable health benefits.

If you’re trying to feed your dog a diet closer to what he/she would eat in the wild, we need to look at this realistically. There are no wild dog populations, there are feral dog populations and having visited many places that have feral dog populations the only diet I would recommend for matching the average feral dog’s is this one. That’s right, “wild” dogs eat garbage. If you are about to insist that your dog should eat like a wolf, stop. No. Your dog is not a wolf. But even if I were to humor you and agree that your dog is a wolf, you would have to concede that wolves live longer and healthier lives in captivity. Do you know what they feed wolves in captivity? Dry commercially available dog food. Don’t believe me? Here. Here. Here.

But what about cats? Feel free to substitute cat for dog above. If you have a sled or dock diving cat I would really like to meet them. And yes, feeding dry commercially available cat food is the recommended diet for small wild felids in captivity. I do prefer to see cats get at least some high quality canned food in their diets. Right now in our house, we are feeding our feline buddies Hill’s C/D stew cans, but that is subject to change based on what’s about to expire at the clinic.

So that’s my take on pet nutrition. If your pet has specific needs, please involve a veterinary nutritionist. If your really happy with your current pet food and your pet is receiving the level of preventative care that works for you, awesome! Keep it up. If you find yourself skimping on preventative care based on cost, you might benefit from switching to a less expensive commercially available dog or cat food. If you really think that your cat/dog should eat like a wild tiger/wolf, I’ll look for your angry comments below. Spelling and grammar may be enforced.

One of the best resources we have for pet nutrition is the Pet Nutrition Alliance. You can find answers to all kinds of questions and some of the reasons our recommendations are the way they are.

Thanks for reading.

Lyme Disease in Dogs

Oddly enough to those of us living in New England, Lyme disease is kind of a controversial issue in veterinary medicine. When we get onto the topic of vaccinating against Lyme disease, opinions really start to fly around and when we get to the topic of vaccinating dogs who have tested positive for Lyme disease it can get down right ugly! Which when you think about it objectively, the idea of people fighting over these kind of issues is sort of hilarious, in a sad way.

I’m not going to try to convince anyone one way or the other about whether or not Lyme vaccines are necessary or if dogs who have tested positive should be vaccinated. People can think what they want, I’ll continue to make the best decisions I can with the information available being processed by my meager mind and I expect others to do the same. If you are a veterinarian who disagrees with me or a pet owner who sees a veterinarian who disagrees with me, welcome to medicine where there is often more than one point of view. I care about what you think but more about how you got there.

My approach to preventing Lyme disease can be compared to preventing automobile deaths and for me, makes for an easier explanation of my position.

The first line of defense in preventing Lyme disease in your pet is checking for ticks every time your pet goes outside and removing them as soon as you find them. I would compare this to paying attention when you are driving as far as preventing automobile deaths is concerned. If you are looking for ticks or if you are being attentive to the environment around you while operating a motor vehicle, the chances of contracting Lyme disease or dying in a car crash are greatly reduced. Respectively of course. The best way to check for ticks is to run your hands all over your dog, going against the fur patterns on their skin. Combs and brushes may also help to remove unattached ticks or uncover attached ones. Attached ticks are best removed by grasping them down by their head and pulling straight out. I use my fingers for this. In all of the time I have been practicing veterinary medicine in tick endemic areas I have never seen a situation where leaving the head behind happened or caused any ill effects. I have never seen evidence suggesting it happens with any regularity that would elevate concerns. It would probably have similar statistical occurrence rates (though less horrible effects) to being killed in a vehicle by objects – like meteorites – falling from the sky. It happens but that’s no reason for everyone to drive an armored vehicle. So pull ticks out as soon as you find them.

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The second line of defense would be using an effective product for repelling or killing ticks when they get on your dog. You might think that I have it backwards and this should be first and checking for ticks should be second. Fine, copy and paste this into a word document, change the order around and read it that way. By having a tick preventative on your dog you are preventing the ticks from being on your dog long enough to bite and transmit Lyme. The bacteria isn’t injected into your dog immediately by the tick but if the tick is ingesting poison immediately and dying within a few minutes, transmission of Lyme is virtually impossible. Using a decent flea and tick preventative is like putting seat belts in cars and using the seat belts. Seat belts have been required in motor vehicles since 1968, as you might expect there was a lag time between requiring seat belts in cars and seeing a significant decrease in deaths per hundred thousand people in the country. The law requiring seat belts did not require everyone to buy a new car. But less than 10 years after the implementation of the law, automobile deaths had decreased by more than 20%. There are many flea and tick products on the market. I recommended a few here. I stand by those recommendations.

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Finally, Lyme vaccines are available and are effective for dogs. No vaccine is 100% effective and bacterial vaccines are particularly difficult because bacterial surface proteins are constantly evolving but studies have shown the vaccine to have an efficacy between 80 – 90%. Vaccinating against Lyme disease is like driving a car with an airbag. Airbags in vehicles were first introduced as an idea in the 1940’s but did not become prevalent n vehicles until the late 1990’s. As a result of airbag and seat belt use combined with safe driving, automobile deaths per hundred thousand citizens are the lowest they have been since 1918. Yes, that was the last time in the 20th century the Red Sox won the world series. Adding Lyme vaccines into your dog’s healthcare plan if you live in an endemic region is a very solid idea. Depending solely on the vaccine to protect your dog from Lyme disease might work but I would consider it very similar to driving a car distracted with just the airbag to prevent you. You’ll probably live through the accident but there’s also a small chance the airbag will kill you. In a similar fashion, while vaccines are typically safe and effective, there is a risk associated with stimulating the immune system and vaccine related deaths in pets do happen. So while I think every dog in endemic regions should be vaccinated for Lyme disease, I also think exactly zero pets living in non-endemic regions should be vaccinated for Lyme disease.

A side note on vaccinating, Lyme vaccines do not prevent the other diseases transmitted by ticks and this small but important fact is another reason I consider tick removal and prevention more important than vaccination.

Even with vigilant drivers who are wearing their seat belts and driving cars with airbags, there are going to be some deaths on the road every year. In a similar fashion, Lyme disease which may have been around 15 million years ago is still likely to score a few points against us despite our best efforts. But by checking for ticks every time your dog goes outside, removing them whenever you find them, using an effective flea and tick preventative and vaccinating against Lyme if you live in a Lyme endemic region, you greatly reduce your dog’s chances of being afflicted by this disease.

Thanks for reading.

Living with Each Other’s Choices

I feel like I’m sharing a well kept secret of veterinary medicine here. Except it shouldn’t be a well kept secret or a secret at all. Your pets; they belong to you. They are yours. You are the decision maker when it comes to their healthcare. Our job as veterinary professionals is to understand your problem, use our training and understanding to formulate an approach to the problem and finally, share all of that with you in the form of a recommendation.

That’s all it is. A recommendation. You are always in the driver’s seat. Sometimes, it seems like you don’t have a choice. Sometimes there are few options and sometimes decisions need to be made right away but you are always in control.

Right now I see emergencies exclusively, when I actually started this article I was doing a lot of dentistry, the parallels are very similar. When someone comes into the emergency clinic I work at right now, we often have to have difficult discussions about the problem at hand, how much it is going to cost to get a handle on the problem and the fact that we need a considerable amount of that money BEFORE we do anything with their pet. One tricky thing about quality veterinary care is that it is really expensive to provide. Our equipment, supplies and training cost just as much as the ones utilized by the health care teams who provide our own health care. The costs are essentially the same for all clinics, so if you are getting a great “deal” at your current veterinarian, I promise they’re cutting the costs somewhere. Our pets have many of the same health problems we do as their owners. And the treatments are also very similar in a lot of ways. One big difference, our patients more frequently need to be under anesthesia in order for us to do a satisfactory job. I’m not going to try to reason with a worked up house cat about, well anything really. Lacerations, porcupine quills, dentistry or even growth removals could all happen with local anesthesia in people, not so with pets. As a result, we have added costs in many areas based on the way our patients respond to care. When we are adding things like anesthesia, we are also adding risk as well, mitigating risk involves gathering additional information like blood-work, chest x rays or blood pressure measurements. This additional information also adds cost. All of it, from running blood-work to walking in the front door, is voluntary, but once we start down that path the veterinarian treating your pet has a responsibility. It is our responsibility to provide you with as thorough a plan as possible to give you the best opportunity to make an informed decision about your pet’s healthcare. What you choose to do with that plan is completely up to you.

If a person were to bring a dog having seizures to a veterinarian and task that veterinarian with figuring out why your dog is having seizures and what could be done about it, That seems like a pretty straight forward issue, make sure it’s otherwise healthy and put the dog on anti-convulsant medication and that should work, right? Maybe. I bet you would be successful most of the time with that approach. At least better than half the time, depending on the factors involved of course. If a client came to me and asked if we could just try medication, I would be willing to consider that approach so long as the client understood that we were taking a risk of missing the cause and potentially making things worse. If all I know is that you have a dog having seizures, the list of possible causes is pretty extensive; infections (viral and bacterial), parasites, toxin exposure, electrolyte abnormalities, congenital abnormalities, cancers, liver disease, kidney disease, metabolic diseases, trauma, nutritional deficiencies are just some of the causes of seizure activity in dogs. The better approach would be to fully examine the dog, discuss with them what the seizure activity looked like, how long it lasted, how often it occurred and how the dog recovered to determine first if it was truly a seizure, what kind of a seizure it was and where our diagnostic testing should start. There will be different approaches for patients in different age groups or breeds for example. Then we would present the dog’s owner with a comprehensive idea of where diagnostics should start and how we can expect things to proceed. In this situation the client can now take all of the provided information, process it and make a better informed decision. They could even take the recommendation, leave, go home, look everything up on the internet and come back with a series of questions for their veterinarian. From that conversation a diagnostic plan could be implemented and they could start down the path towards understanding their pet’s medical condition and needs but in order to get there, we need to present the owner with a complete plan.

One of my least favorite questions to answer when presenting a plan is which part of the plan is necessary. Personally, it bothers me because the idea that I would offer unnecessary testing is the same to me as asking if I’m trying to steal from you. The answer is no. Professionally, it’s a frustrating question because the only appropriate answer is, “It depends.” It depends on what you as the customer wants. Do you want to know why your dog is having seizures or do you just want to try something to see if we can reduce the number or duration of the seizures? Perhaps rather than asking how much of this is necessary, it might be better worded as, what is the minimal amount of information we need to have a reasonable chance at a positive result? Of course the answer to that is also, “It depends.” It depends on how extensive the problem is and what the solution is going to be. Sometimes, even the options available to us are incredibly limited. I still think we can have a satisfactory outcome every time just as long as we are communicating openly and understand what we are doing. Even if we chose the minimal amount of information path, if we communicated effectively,  going down a path with a lot of uncertainty surrounding our issue is alright.

Where we start to have trouble is when the communication breaks down. If we don’t have access to all of the information that makes sense for this problem then it becomes harder to come up with a treatment plan. Without a solid treatment plan we might not have the expected results, they may take longer or we may encounter complications. It’s possible everything will be completely fine but when things don’t get better or take a long time in getting better it’s also very possible that those missing pieces of information would have helped. It doesn’t mean we have to do everything recommended every time or right at the beginning. It means we have to be open and realistic about expectations. And we all have to be on the same page. And we all have to accept responsibility for our own decisions.

In no way am I typing this hoping that you start spending more money at your veterinarian’s office and I would feel awful if you took this to mean that I think you should spend more than you can afford. What I am trying to articulate is that both sides of the exam table are making decisions and as long as they are on the same page and can be frank and candid with one another, I expect every outcome to be satisfactory.

Thanks for reading.

Feeling Good About Being Bad

Recently, I’ve changed jobs and moved into a different area of practice in veterinary medicine. It has been a tough transition for me and I’ve gone from being secure in the knowledge that I was really good at what I was doing to being consumed by self doubt and second guesses. I’m struggling with handling my cases, making decisions and being sure I’m doing everything the way I should be. And that is exactly what I was looking for. I won’t go as far as to say that I’m enjoying the experience but I’m getting exactly what I wanted out of it so far.

Over the past 18 months, I found myself still learning new things but it was often on my terms and only in areas I was interested in. While a person could still improve their skill set using this approach, inevitably the subconscious is going to ignore a person’s weaknesses while developing their strengths. No one likes to focus on the things they aren’t good at. While it may be perfectly reasonable to become and stay good at what you do using this method, it is impossible to become great. Anyone performing a skilled task should be aiming to become great. Even if that means going through a period that tries your self confidence and leaves you feeling terrible about your skills.

Pick a skill in your skill set that you’re particularly proud of right now. Something you do better than almost anyone else you know. Now try to remember back to when you were just learning that skill. You were likely terrible at it, if you were immediately really good at your most prized skill you should probably rethink your skill set. Most likely however, you were terrible at it in the beginning, so terrible in fact that you might have even thought about giving up. But you stuck it out. Sometimes maybe you saw how much you would enjoy being good at something, maybe you saw glimpses of how good you might be at it or maybe you just wanted to be good that badly. So you kept your chin up, your eyes forward and your mind focused. You chipped away little by little at this skill and you got a little better every time you practiced. Eventually it became something you could brag about at dinner parties or even better, something people came to you for help with. That skill you were terrible at in the beginning became something you could use to make other’s lives a little better.

That’s the only way to get there. Hard work and keeping at it even when you and maybe even others think you’re terrible. It also means holding yourself accountable, taking in feedback that stings your ego and making the adjustments you know you need to make when you look at the situation objectively. Sometimes for me, that means looking myself in the mirror and saying out loud, “Yes, you are no good right now, but you want to get better, you know what it takes to get better and you can’t quit. Suck it up and keep at it.” A motivational speaker I am not.

Then it will happen. Whether you are trying to make yourself into a better veterinarian or a better knitter, something is going to go horribly sideways on you. Sideways so bad you can’t bring it back. And when you look at the situation objectively, you’ll see all the things you could have done better and it will hit you like a hammer. This is when your decision maker needs to be powered by optimism. It’s easy to quit after you ruin a sweater or have a patient die on you but if you’re going to be great, you’re going to have to recognize that this is the price. To change the metaphor a little bit, sometimes you’re going to find yourself in over your head and the water is going to be rough. Beat you down and hold you under rough. You’ll take on some water, sputter, cough and gag and you’ll struggle to shore. But you’ll make it through and find a way to learn from the experience and eventually the waves that once seemed insurmountable don’t even break your focus.

And that’s where you’d find me tonight. It’s Halloween night and it’s a Saturday or maybe it’s Sunday morning but I’m up, working the overnight, wondering what’s coming through the front door and wondering if I’ll be able to handle it. It’s easier tonight than it was a few weeks ago when I started but I’m still struggling, still am exposed to areas I need to improve on daily. And when that changes, when I don’t leave work feeling like it took everything out of me. When I get comfortable. It will be time to start the new chapter on this adventure. Comfortable is for retirement and retirement is still a few years away. Hopefully for you too.

Thanks for reading.

Dog and Cat Dental Disease

Roughly 80% of dogs and cats over the age of three are going to have some level of periodontal disease. It is the most common disease we face in veterinary medicine. That fact is the main reason I have devoted a huge part of my professional development towards veterinary dentistry. It is the best way to help the most pets have healthy and pain free lives. I think veterinary dentistry is incredibly important.

Veterinary dentistry is also incredibly expensive. When things are expensive in any service industry, you can be sure that it is expensive to provide as well as to purchase. Dentistry in the veterinary world is no exception. I would love to tell you that dentistry is an elective issue and not something every pet really needs. But if I told you that having a healthy mouth was an elective issue and not something every pet really needs, would that sound reasonable? No. Your dog or cat doesn’t brush his/her teeth twice a day. Think about how your mouth feels if you fall asleep without brushing for one night. Multiply that by seven and you’ve got the typical week in the life of an average dog or cat. Here is the point where we need to understand that the disease process that causes periodontal disease in dogs and cats is not significantly different than it is in humans.

I wish I could share trade secrets about how to save money on veterinary dentistry with you. Unfortunately, there are none. What I can share with you is how you can effectively do the heavy lifting so that we have to do less when your pet does need dental work. I’ll warn you however that if you consider Mike Rowe to be a bit overbearing with the work ethic shtick, you should probably just get used to writing checks for veterinary dental care.

Brushing is the absolute king of the heap when it comes to preventing periodontal disease in dogs and cats. In order to be effective brushing needs to happen a minimum of five times weekly and is really best if it can happen twice daily. I understand, all too well that this is typically a Sisyphean task. I recommend attempting to acclimate your dog or cat to daily brushing. If it works out and is an enjoyable process for both of you, great. If not then the following methods will help some.

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The kibble in dental diets have been designed to “brush” the tooth while your pet chews on the food. While these diets aren’t going to work as well as brushing does they do work very well at keeping the teeth clean. There are two different ways that you can use a dental diet:

  1. Dental diets have been formulated to meet the needs of a healthy canine with no specific dietary requirements. As a result, you can transition your pet into using the dental diet exclusively.
  2. You can add just a small amount, I usually shoot for about 1/4 of the diet coming from the dental diet. This allows your pet to continue eating the food they like while still achieving some benefit from the dental diet.

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There are several dental chews on the market that have been shown to effectively reduce plaque and tartar and promote healthy stimulation of the gingiva or gum tissue. Recently a good number of options have been added to the market, so I’m not going to list them here. I will say that anything that has approval by the Veterinary Oral Health Council (VOHC) is going to be acceptable and there are a few out there that are equally good even if they don’t have that approval.

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Finally, there are water additives that seem to help quite a bit. While there are plenty that I might be comfortable with my clients using, the only one I feel entirely comfortable recommending in writing via the internet would be Healthy Mouth it is a little bit more expensive than some of the other formulas out there but it has solid science backing it up and has agreat track record in clinical use.

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Keep in mind, that even if you were to employ all 4 of these oral heath tactics successfully, your dog or cat may still need a fair amount of dental work over the course of their lives. Just like people, some dogs were just born with difficult mouths. At least with dogs we know which breeds are going to be more at risk than others.

Thanks for reading.

Heart of Bixi

Recently, my wife and I took a weekend trip to Montreal. Sans les enfants, if you will. It was a quick two night trip to compartmentalize the stress of moving across New England, changing jobs and starting our three girls at a new preschool all at the same time. It worked. We also discovered our new second favorite business idea ever. Called Bixi, it’s a mixture of bicycle rental and taxi service. You can pay as you go or buy a pass for the day, a few days or even a season. The bicycles are available from April until November. We were only going to need them for Saturday so we opted for the $5 24 hours pass. The fun catch of the system is you only get the bicycle for 30 minutes, otherwise it starts charging more. As a result, you have to get from station to station in 30 minutes or less. With over 450 stations, this isn’t really difficult but it does lend a sort of competitive nature to the adventure.

I’m not saying bicycle is the best way to see Montreal. I’m saying that it’s probably the only way to see Montreal. You could try walking but the city is large and you’ll want to save some energy for all the stairs at Chalet du Mont-Royal or the Jardin Botanique de Montreal. Taking a car is fine but you miss so much by driving from point A to point B. The bicycle allows you to really see the area while maintaining a decent level of transportation.

Our plan for Saturday was simple enough. We wanted to see the botanical garden first. Then we were going to go down to the Promenade du Vieux-Port to see some tourist attractions. We would ride back in the afternoon and climb to the Chalet du Mont-Royal and finally shower and go out to dinner near the pavilions on or around St. Catherine.

We charted out where our Bixi adventure would start and where we would make our first bike transfer. The rule was we had to stop and wait two minutes for the system to reset before we could take our new bikes. We pedaled from the street next to where we were staying to a park with a lovely fountain system and small pond. We docked our bicycles and walked around the fountain to kill the mandatory two minutes. From there it was a straight shot to the botanical gardens. We docked our bicycles and made our way around a beautiful collection of gardens. Much of our trip around the garden was spent lamenting how little time we have to actually garden. Before getting back on our bikes to go down to the old city we had a quick snack at the restaurant in the garden.

The second leg of the trip was a longer time pedaling. it took us through the industrial area as well as some of the seedier less touristy type sections of the city. Personally, I feel like it’s important to see that side of any place you visit to remind yourself that real life happens everywhere. We cut it pretty close finding a dock at the half-way point between the garden and the promenade. This led to just a tiny amount of bickering between the Drs. McNutt but we found a station just in the nick of time. There were few bicycles there while we waited for our two minutes to elapse. We became a little nervous when a family of seven came over to rent bicycles. It turned out there was the exact number of bicycles needed for everyone to be outfitted and we all went our separate ways. The next leg of our trip was only a few minutes and we docked out bicycles and walked around the promenade scoping out what tourist attraction appealed the most to us. First we had to hydrate. The adventure to finding a convenience store led to us completely changing our plans. The restaurants and people watching in Old Montreal were too good to pass up. We spent a little over an hour exploring an indoor maze called SOS Labyrinthe before settling into a delicious meal with perfect street side seats in an outdoor restaurant that left me wondering, “What do they do when it snows?”

We cycled back to our bed and breakfast, docking our bicycles and walking the last two blocks just as the sun was setting. We decided to do the hike up to the Chalet du Mont-Royal in the morning and toyed with idea of going out for drinks and maybe dessert after a shower.

Once we were cleaned up and relaxed, however, we decided not to be too hard on ourselves for going to bed around 10pm.

We did wake up the next morning and climb the hundreds of beautifully crafted stairs that lead through the forest to the stone patio of the chalet.

An inexpensive and easy to use bicycle rental system combined with a very bicycle friendly city made our trip to Montreal one of the most memorable quick weekend trips we’ve taken in what is very close to being a decade long adventure between my wife and I.

Thanks for reading.

Optimism

I’ve written about optimism more than once. Personally, I think it is so important to keep a positive outlook that writing about it everyday wouldn’t be too much. No, I’m not going to turn this into a blog of cheesy life affirmations but I am completely serious when I type that I think an optimistic perspective is the most important thing a person can have.

I read somewhere that because we have to filter every experience through our minds in order to actually experience anything, our perspective is the key ingredient in each of our life experiences. Yes, I am saying everything you experience is in your mind. No, I’m not saying we live in a fantasy world where smiles and quotes on coffee mugs are going to ward off all the bad things that happen to people. But how you perceive and deal with these things, that’s totally up to you.

I’m not saying that keeping a positive outlook is going to make you happy. Frankly, I think that having happiness as a life goal is a great way to miss the point. To me happiness is a product of living a certain way, not a goal to be worked towards. I’ll write more about happiness later.

The key to obtaining and keeping a positive outlook is understanding that it is a skill and not something you were born with or have because you are a naturally cheery person. Like any skill, optimism can be developed, refined and improved on over the course of your life. The following are some of the ways I’ve been able to develop a flexible optimism muscle over the past decade. Hopefully you find them helpful as well.

Be able to make an “I’m awesome” list. Occasionally (several times a day) there is a little voice in the back of my head that reminds me; I often have little to no idea what I’m doing, people depend on me and that I’m far more likely to fail than I am to succeed. I shut this self doubt monster down by stopping and either mentally or physically listing 10 times I’ve surprised myself. The list might be simple things like dealing with 3 daughters throwing tantrums without losing my temper or it might contain successfully managing a penetrating chest wound in a frantic young hunting dog. The list serves as a good reminder that you are not a bumbling idiot in over your head as much as you are a skilled individual trying to stretch your comfort zone.

Set a few small goals and knock them out of the park. Make your bed in the morning, tidy up your car or desk. Little things like that can get you in the mindset that you are already being productive and that you are in fact good at doing things. This almost always gets me fired up to accomplish something else which in turn leads me to view my abilities, myself and the world in a more positive light.

Encourage others. I also call this “mining your friends.” Write, email or text a friend you have who is doing something awesome and productive or is going through something trying and difficult. I am assuming you are a decent person and want your friends to succeed and overcome their trials. Tell them how impressed you are with what they have accomplished and who they are as a person and be genuine. Don’t say stuff you don’t mean, ever. When your friend responds, save what they write, it’s almost always appreciative and kind and is helpful to remind yourself that when you put positive things out there, the world responds positively. Maybe I’m fortunate to have so many accomplished and successful friends or maybe my friends are fortunate to have someone who sees them that way. Either way, we all win.

Recognize you’re making a choice. Whether you decide to be positive or negative about an experience and how you choose to respond to an experience is entirely up to you. One of my favorite and most embarrassing attitude lessons in my recent past involved a very busy day; I had an appointment waiting, a client waiting in the lobby to speak to me, a client on hold on the telephone waiting to speak to me and a very fractious small dog with sutures near his eye that needed removing in front of me. It all became a little too much and I should have set the suture scissors down and walked away. Instead I sort of thrust the scissors onto a coworker and went to storm off, catching the pocket of my white coat on a door knob and tearing the coat. I took the coat off, threw it on the floor and walked off. I later apologized to the staff and one of my coworker’s looked at me and said, “It’s ok, I support your decision to lose your temper.” That statement is likely to stay with me for the rest of my life and serves as a good reminder that I had made a decision, and not a decision I am proud of. It also led to a Lonely Island song being played at work a lot over the next few weeks.

Raise your heart rate. Exercise is a great way to get yourself into a positive mindset. It makes you instantly feel better, accomplished and like you are taking good care of yourself. The long term results of regular exercise include better health, better self image and feeling like you can conquer lots of difficult tasks. Bonus points if you get your exercise outdoors, double bonus points if it’s through hiking, running or biking in the forest or swimming in a lake or the ocean. It’s pretty hard to be a pessimist after running through the forest or enjoying a swim in the ocean.

Cheat. When all else fails, guided meditation is a great way to let someone else do the heavy lifting. There are all kinds of guided meditations on youtube and while some of it is a little out there and cheesy, they are typically only 10 to 20 minutes long and do leave you feeling relaxed and better about the state of the world and your role in it. If you just can’t seem to shake your negative thoughts, a 20 minute break full of positive thoughts will always help. Pro-tip: listen to a guided meditation while running or walking through a natural park.

If you asked me to nail down the most important part of this list for me, it would have to be recognizing that I am making a choice in how I view and respond to the world. Each of these tricks have been very helpful to me during times when I needed to get a better perspective and maintain a positive outlook if I was going to get myself where I needed to be.

Thanks for reading.

Shadow’s Adventure

We picked Shadow up the day we moved into our house in Knoxville, he was a golden puppy of unknown breeding though he was found with a pure bred Golden Retriever that the rescue group assumed was his mother. He is the most active, energetic dog I have ever known. About three years ago, he was drinking a lot of water and peeing in the house. He would get crabby and nippy with the other dogs and his appetite would come and go. We run blood work on all of our dogs and cats at least once yearly and were not surprised but we were disappointed when we saw his liver enzymes increasing. Several procedures, visits to specialist facilities, consults with leading veterinarians in certain fields and of course thousands of dollars later we learned that Shadow has a very rare liver defect. The lining of the blood vessels within his liver never developed properly and as a result, his liver doesn’t receive an appropriate blood supply. It is very likely that this problem will be his undoing but for now, he loves life. He is also the best dog our children could have hoped for at this point in their lives. Below is one of my favorite photos of him. He does this all the time. Needless to say, we consider him a very special dog to our family.

Shadow

This was the scariest thing that ever happened to Shadow.

Brockton, Massachusetts is a small city about 30 minutes South of Boston. It has a population of just under 100,000 people and much like the rest of New England, this past Winter set some records for snowfall.

It also happens to be the home of my younger brother and his two children. We visited them on Valentine’s Day this past year to take all of the children to see Disney’s Frozen on ice. The snow on the ground was incredible and there were blizzard warnings on the Saturday night into Sunday morning. Our dogs Shadow and Angus had been fighting a bit over the Winter so we brought Shadow with us to Brockton as he tends to be the easier of the two to manage. We arrived at my brother’s home late Friday evening.

When my brother bought his house a few years ago, it was a two family. Split into an upstairs unit and a downstairs unit. If you enter from the driveway, there is a heavy wooden door that self closes. This door opens int a hallway with a set of stairs leading to the upstairs unit directly to your left. Both the upstairs and downstairs units have heavy wooden front doors that serve to separate the building into two separate homes. My brother, his daughter and his son live in the entire house.

We woke Saturday morning to get ready to go. We had breakfast and then we locked Shadow in a bed room in the upstairs portion of my brother’s home. We figured he would sleep on the bed until we returned home that afternoon. Then we began the complicated commute into the city. Normally, it would be commuter rail to the T with one line change. This time it was buses and trains and it took twice as long as usual. The snow this year was incredible. The show was great, the experience was excellent and the ride home was actually a little bit easier.

We returned home from the show around four in the afternoon. I was embarrassed and annoyed to see that Shadow had rummaged the garbage in the downstairs and had an accident on the floor. My annoyance turned to dismay when I realized that Shadow wasn’t in the house. He had opened the bedroom door, then the heavy wooden exterior door to the upstairs unit. He had gone downstairs, opened the exterior door to the downstairs unit and rummaged the trash. He then opened the exterior door to the downstairs unit a second time, opened the exterior door to the building, pushed open the storm door and ran out into the Winter Wonderland that was Brockton, Massachusetts in February, 2015.

We followed his tracks as best we could, calling and searching but got nowhere. Sun was beginning to set, the children were upset, there was a blizzard coming and we had to be back in Vermont for work on Monday morning. There was no way we could stop looking. We called every animal control in the surrounding 6 towns, checked in with every emergency veterinary facility and hit up social media. After all of that was done, we went back out in the streets looking for our dog. Within a few hours there was a huge network of people who had seen our posts on social media, they went out looking for a dog they didn’t know who belonged to people they had never met. People are awesome like that.

At 8 pm my brother and I jumped in his truck and were going to increase the radius of our search. We turned off his road and there was Shadow in the the middle of the road, dodging slow moving traffic. I hopped out of the truck and ran over towards him, calling his name but he was scared and ran off into a neighborhood. We followed his tracks, he actually ran right past my brother’s house, for a few blocks but eventually lost them due to heavy traffic.

We returned to searching the neighborhoods on foot. Hoping we could call him over, we set food out hoping to draw him back in and we opened all the doors to our family minivan hoping he would smell the familiar smell of his family and climb in to get out of the weather. And we walked and walked and walked. Then it began to snow.

We set the food in the minivan leaving all the doors open and my wife tried to go to sleep. I told myself I could sit on the couch for an hour but would have to get back up and go out looking before the snow started piling up. The couch was full so I stretched out on the floor. I fell asleep before I realized how tired I was. I woke to my brother gently kicking me. When my eyes opened and I started to rise, he told me that Shadow was back. My brother had been climbing into his bed and heard something at the front door. I went outside and closed up the minivan so it wouldn’t be full of snow in the morning. Then I went up to welcome our dog home. He was scared, cold but otherwise unscathed from his adventure. His paw pads would take some time to heal and his joints would ache for a few days but he was going to be alright.

I think we all slept well that night, even if I did sleep on the floor while Shadow slept in the bed. I took the picture below the next morning, he seemed very happy to have found his family. The one below that is from when we had our first daughter, Emily. He really is an awesome dog.

Shadow2

Shadow 3

Please Annoy Your Dogs and Cats

Please, please, please annoy your pets.

Pull their ears, play with their feet, hold them too tight and then reward them for being good. Don’t make them growl or make them scared of you but if they want to sit on the couch with you while you watch television, the payment should be that they endure you pulling at their paw pads. There are a few specific spots you want to get your dog and cat used to being handled.

Feet. Almost all dogs and cats hate having their feet touched. But feet are the among the first areas to break out during an allergy flare up. Feet get injured by hot pavement, snow and ice and even sharp rocks and sticks. And of course, nails. Nails need to be trimmed back. I like to pull at my pets feet when they are doing something I normally wouldn’t allow them to do. Sleeping with me in the bed or laying on the couch? I’m going to pull at the webbing between their toes until they pull the foot away. Then when they settle back down, I’m going to do it again. It’s such a habit of mine that I unconsciously do it to dogs waking up from anesthesia if I’m sitting with them and writing in their charts at the same time. So tug on your dog and cat’s feet, it might help us find a small issue before it becomes a big problem someday. It will at least help with nail trimming.

Ears. Ears are deep, dark places that like to hide inflammation and infection among other things. They need to be examined but they are also sensitive and very close to the pointy things. The thing is, when your dog or cat has an ear problem, I need to focus on looking down the canal and at what I’m seeing and sometimes smelling in order to get an idea of what is going to make them more comfortable. If I might suddenly have to jump out of the way of tooth or claw, it’s hard for me to focus. Playing with your dog or cat’s ears is easy. Flop them around, stick your fingers in them and scratch. Cats and pointy ear dogs look hilarious if you flip their ears inside out. Just include the ears when your scratching their heads. It goes a long way and will make a difference if your pet ever has an ear problem.

Teeth. Speaking of those pointy things. The number one disease in cats and dogs over the age of three is periodontal or dental disease. Almost 80% of them have it! That means if you have two pets over three, one of them has some level of periodontal disease. The number on reason it’s not addressed is because veterinarians don’t recommend it. The number one reason veterinarians don’t recommend it is because they don’t look for it during the exam. And the number one reason they don’t look for it during the exam is because they don’t want to be bit. Getting bit can ruin an entire career. It almost always ruins a day. Getting up in your dog or cat’s mouth can be scary. My own dogs lick at my hands, a lot. I bet your dogs do too. I like to grab their tongues, grab the lower jaw or just stick my hand in their mouth to distract them while they do this. It’s just dog saliva, it washes off I promise. Cats are a little trickier but it can be accomplished. I look at my cats’ teeth when they’re rubbing their faces against my hands waiting for treats or when they are harassing me while I read or am on the phone. Or right now, while I type this.

If you annoyed your dogs and cats in just those three areas a few times a day, they would receive better physical exams, you would pick up on things a little earlier and it might just make the difference between having a small issue and a big problem someday.

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.

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.

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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.

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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.

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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.

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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.

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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

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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…

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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?

I want to do more for my community

“A society grows great when old men plant trees whose shade they know they will never sit in.” Greek Proverb

Nearly every Thursday morning I attend a meeting of the Rutland South Rotary Club of which I have been a member since early December of 2010. It’s always a pleasant morning and I look forward to seeing the people and having the experience every week.

The motto of Rotary is “Service Above Self” and the club is involved in multiple community service projects, gives out scholarships every year and we give out dictionaries to elementary students every Autumn.

And every week someone comes in and speaks to us for a little less than half an hour about a topic of their choosing. Recently, we listened as the director of Meals on Wheels explained the logistics and importance of the program to us. They also explained their need for volunteer drivers. And it got me thinking. I always feel a little bit guilty when we have speakers talking about programs I would love to be involved with but cannot make the time commitment to. I simply don’t have the time to volunteer. Or at least not to commit to something routine. I volunteer my time when it’s possible it just doesn’t happen as often as I would like it to at this point in my life. Trying to commit to anything more than a one off time sensitive task, isn’t going to happen.

But as I was sitting there listening to the speaker explain how for some of the people receiving Meals on Wheels deliveries, those drivers are the only human contact those people will have for an entire day I got to thinking about how just informing one’s self about the needs and the people who work to meet those needs within a community changes a person’s perspective dramatically. I might not have time to volunteer right now, but if you’ve read my post about money, you won’t be surprised to read that I’d like to retire from working full time at an earlier age than you might expect. Maybe not as early as this gentleman but still earlier than expected. In fact I think the job market and entire economy would do better if we could all try to limit the length of our careers a bit more than we do. That’s a topic for another day, probably a long long time from now.

Even though this woman’s pleas for volunteer delivery drivers cannot be satisfied by me in my current place in life, I would not be surprised at all if it’s not something I do in the future. Especially if my retirement plans follow their intended path. In fact there are a lot of community minded things I would like to experience as time becomes more available. Half of the reason I would like to focus on putting my family in a position where my wife and I don’t have to work as much as we currently do is so that we can focus on the things we would like to do for and with our community

So as you are moving through life you will develop affections for issues and parts of your community. Don’t stop championing those causes and don’t stop encouraging people to take interest in them simply because you aren’t seeing the results you would like when you would like to see them. You never know what kind of an impact you’re having and you never know whose life you are reaching into with your actions or your words. For all we know, the seeds you are planting today might not bear fruit for years to come. That doesn’t mean that they aren’t worth planting now.

“Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree.” Martin Luther

Thanks for reading.

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Euthanasia Aftermath

I struggled with writing about this situation. I struggled with posting a blog about it. Please try to understand.

A few weeks ago a very good client of mine passed away unexpectedly. She had a little toy breed dog who had been battling some significant but non life-threatening medical issues for the past few years. We had developed a fairly good client-veterinarian relationship and the little dog had gone from being terrified by my presence to being quite happy to see me. I always did have a pocket full of cookies for him after all. Quickest way to a dog’s heart.

I was notified on Wednesday of the woman’s passing and the daughter set up a visit for the coming Friday to have the little guy put down. Apparently, no one in the family could take the dog and with his medical conditions the owner had left instructions to have him euthanized rather than have him surrendered to a shelter or rescue group.

I expressed some concern about the visit when it was scheduled and my employer and I discussed the dog’s history. He was 13 years old, had multiple health issues and could be aggressive when he was not feeling his best. We foolishly decided that I would have a conversation with the owner’s daughter when she brought him in for his visit.

The morning of the visit came. Not that these details are important but they play into the narrative so bear with me. My family was planning a trip to visit my wife’s family in New York. When we do that, I typically drop everyone off in the morning and then pick the kids up from daycare and then get my wife from work so we don’t have to leave a vehicle at her office over the weekend. As would be expected when you are getting five people together for a weekend away from home, I was running late that morning. Veterinary medicine is one of those professions where if things start getting a little out of hand, it snowballs quickly and getting caught up can be a challenge.

I arrived at work to a fairly busy appointment schedule. I am pretty decent at compartmentalizing my work, so there was no thinking about the four hour drive I had ahead of me until 4:30 that afternoon, but also when I’m in an exam room with a client, that’s all I think about. I didn’t plan ahead as much as I would have liked for the euthanasia visit coming in at 10:00 am.

The time came and a very distraught woman brought in a happy but slightly disoriented little dog. The woman was sobbing, able to get a few words out about her mother’s wishes and was in no place to discuss other options. We fell back on our training and guided the woman through the euthanasia process. We put the little dog to sleep and prepared his remains for cremation and because we were running behind schedule we went right into our next appointment. For some reason I feel like it’s necessary to inform you that this whole process took nearly thirty minutes and as we were preparing out back we weren’t happy about it but at the time I did not see a reasonable alternative.

I went for a walk that lunch break to process my thoughts, something was weighing on my mind. My wife called and she was in the middle of a pretty difficult situation and having one of the worst days a veterinarian can have. Little did either of us know she was about to have the worst day she has yet experienced as a veterinarian and in my opinion the worst kind of day a veterinarian can have. Not that that particular detail is important but it plays into the narrative.

I got back from the walk just in time for the first appointment of the afternoon. With appointments and callbacks I didn’t have a chance to even think about anything else until I got in my car that afternoon. When I got in the car I was on a schedule. I had to get home, pack the car for the weekend, I had a list of chores that needed doing before we left. The dogs had to be fed and they needed to do their business before we took off for a four hour drive. I packed the car and picked up the girls. We (they) talked about their day from the daycare to the practice my wife works at. Once at my wife’s practice we started discussing her day and it was such a horrible day the conversation took up a good section of the drive. It wasn’t until we were on the thruway, there is this place on the right hand side when you’re heading south that has log cabin homes on display it was there that my own thoughts started creeping into my consciousness. Like fog settling on a highway at night, they did not bring with them anything good. By then my wife was trying to get a nap in and I was left alone with the radio. I started playing back the day in my head and was overwhelmed with grief as I thought about the small dog I had euthanized that morning.

I still think about him a little bit almost every day. These are the thoughts that run through my head: I wonder if I had brought him home how long he would have really had left. I could have brought him everywhere with me and I’m sure eventually my wife would have come around. I’m just manly enough so that carrying a small white dog everywhere would have looked cool or ironic. How many times in my career is something like this particular situation really going to happen to me? This could have been a once in a lifetime opportunity to make a dog’s life a little better and I missed it. Not only did I miss it but I was the instrument that ended his life. I wish I’d had more time or had reached out to the owner’s daughter a little earlier. Maybe she would have been adamant that we follow her mother’s instruction but maybe we could have come up with a solution together. I’ll never know.

Self pity aside, this is not a situation that is all that unusual in veterinary medicine. We are often faced with the request of euthanizing a pet for reasons many people might disagree with. The idea of euthanizing a pet to meet the request of an owner after they have themselves died is also not that unusual. It happens. At one point in my career we had a patient whose owner had left him a trust fund and the remaining inheritance wasn’t to be released until the pet passed. You can imagine how the lawyer felt about those veterinary bills. But ultimately, decisions like this are always going to be a part of this profession. Some of them will be a struggle and some of them won’t. This one was and still is. I don’t think that the owner’s family did anything wrong by him, I just wish it had played out differently. Hoping there’s not a next time.

Thanks for reading.

Amazon Echo Dot

A Walk in the Woods

“I took a walk in the woods and came out taller than the trees.” Thoreau.

The above quote by Henry David Thoreau only fits this story if the reader is enamored to irony.

This was hands down one of the best experiences of my career. I learned a ton, messed up huge, looked like an idiot and still somehow came out of it all with an awesome new client who owns two awesome dogs. Names have been changed to protect the innocent.

It was an odd phone call on a Thursday afternoon. One of the clients I have been fortunate to get to know personally called with a problem. Actually, the problem belonged to a woman she had just met. I got the rundown from my client and decided to call this woman I had never met about a problem I sort of understood. Right now anyone in just about any service profession knows that this situation can only lead to hilarity.

The woman – let’s call her Becky – had adopted a dog – let’s call her Sandy – from a rescue group. To say this dog had a rough life before being placed with the rescue group would be a touch of an under statement. The poor dog did not know how to live with people and would not come inside. So they were keeping her in an outdoor pen. The problem was; she escaped the pen and had been living in the woods by their home for a few weeks. She would eat food they left out for her and she stayed near their home but she was living in the woods. Winter was coming. As was hunting season. We wanted to have her inside before the flurries and the shooting started.

I thought long and hard about how to trap a dog that was living outside and didn’t want to be trapped. I called and emailed all of the people I could think of. I looked it up online, synthesized what I found online with responses I received from a few experts in the field of wildlife medicine and finally arrived at a plan I thought had a decent chance of success. I called Becky back and we set up a day for me to come out to the house and try to sedate her and capture her.

The day was mild but overcast. A technician and I – let’s call the technician Jess – drove out on the gravel road into a thick hardwood forest with expansive pastures and the beautiful homes that can only belong to craftsmen. The type of homes that someone has to build over a lifetime rather than have thrown up in a few months as a second home near their favorite ski mountain. We pulled into the drive of Becky’s house and met her husband – let’s call him Dave – we chatted a few moments while I laced some canned dog food with the tranquilizers we were going to hopefully capture Sandy with. I made friends with their older Labrador retriever – we’ll call her Lacey – and we discussed the plan. Then we loaded ourselves into the back of an ATV and rode down a carriage path into the forest. We stopped a few hundred yards short of where she was typically fed and we found a comfortable point on the forest floor to wait. It was an old growth forest with tall and sturdy Sugar Maples making up majority of the population. The gravel road was a few hundred yards to our left and just about twenty yards to our right was a steep hill that led to a marsh pond.

The sun burned off the cloud cover while we waited patiently for the dog to eat the laced meal. The plan was simple, after she ate the food and was properly sedated, we would sneak up on her and contain her with a slip lead on a pole. This is sometimes endearingly referred to as the “rabies pole.” Once she was on the rabies pole we were going to place a muzzle on her and lift her into a large crate. There she would peacefully sleep off the tranquilizers and we would get back to the office so I could see afternoon appointments. It was a foolproof plan.

Unfortunately, I’m not a fool. I’m an idiot. And the plan was not idiot proof.

Becky sneaked quietly up to where Sandy ate and placed the laced dog food. We waited patiently and quietly out of sight while Sandy made her way over and ate the meal. It took about forty five minutes for her to become drowsy and eventually she bedded down in some tall grass and didn’t move for over ten minutes. It was time to make our move.

We quietly made our way out to the gravel road and traveled down until we were lined up with where she was laid out on a small knoll. We crept through the brush until I caught sight of her and then with the rabies pole in my hands like a spear held by a gladiator, I began my approach. She saw me coming – likely from the road – but waited until I actually thought I was going to get her on the first attempt before she decided to make a drunken run for it. I was horrified she was going to stumble down the hill and end up passing out in the pond, so I gave chase.

Sandy stumbled her way through the brush because she had been drugged. I stumbled my way through the brush because I am just under six feet tall and uncoordinated. There were a few times where I came close to her but she eventually gave me the slip all together and I made my way back to the house. A little discouraged but not defeated. I still had another dose of tranquilizer. If she wanted to make like she was the Keith Richards of dogs, I was going to indulge her. When we made it back to the house I had Jess return to the office in my car. This was taking a little longer than I expected but I was determined to have Sandy in custody before I left that day.

I mixed up another batch of drug laced canned dog food and we locked Lacey in the house. We were waiting for Dave to get back with the ATV and decided to grab a few glasses of water while we waited. I set the plate of drug laced dog food down on the porch and stepped inside for a moment to place my empty glass by the sink. I opened the door to return outside and Lacey brushed past me on her way back into the house. I went to pick up the plate and noticed something wasn’t quite right about it. In fact everything was wrong. The plate was completely clean. Licked clean. By Lacey. The old, not scared very docile dog had just received a rock star worthy dose of tranquilizers. You know that pit of your stomach feeling when something goes terribly wrong? You know that skin too tight feeling when a well thought out plan has gone completely sideways and there’s no hope for success? I had both of those feelings at the exact same time. I could have burst into tears. Thankfully, before I did that I caught sight of the bumper sticker on Becky’s car that read, “Proud Mother of a United States Marine.” I couldn’t break down and cry over a little set back like sedating the wrong dog and not being able to capture a loose dog on the first attempt in front of a woman who had raised a Marine. She probably wouldn’t have known what to do and might have had to put me down out of pity. So I swallowed hard and tried to shrink the lump in my throat before explaining to Becky what had just happened. She took it surprisingly well and I did my best to explain that Lacey was going to be just fine and would sleep off the dose she had taken while simultaneously trying to keep her from seeing my fingers crossed in hope behind my back.

We went back out in search of Sandy and while we had a few more attempts at snaring her with the rabies pole, we ultimately concluded that it would be best to return another day. We went back to the house where we found a passed out Lacey  blocking the kitchen door. I moved her to a dog bed in the living room, apologized for the outcome of the day and walked to the end of the driveway to sulk, call work and wait for a ride back to home base. I dialed my wife to hopefully get some words of encouragement and my phone beeped at me twice to remind me it needed to be fed some electricity and then powered itself off. I sat back and tried to enjoy what had become a sunny and warm Autumn day.

Jess picked me up about fifteen minutes after I called. I took over the driver seat and we drove mostly in silence the whole way back to the office. Once at the office I immediately set out to purchase a blow gun with injection darts and prepared to make a more aggressive attempt at capturing Sandy.

I received a text message a few days later that Becky had finally captured her. I am happy to report that both Sandy and Lacey are doing fine and neither dog has lost any of their faith in me. Fortunately, neither has Becky.

I still haven’t used the blow darts to restrain an animal but I practice all the time and am pretty good with it. So if you ever have a need….

Thanks for reading.

Amazon Echo Dot

First Contest!

The rules to this contest are completely subjective. You post a comment telling me what you think the reason behind the cow’s behavior is but you have to use as little anthropomorphism as possible. The comment I deem to be the best based solely on my personal opinion will win the t shirt  listed below.

So the rules are:

1. Post a comment explaining the cow behavior without applying anthropomorphism to them.

2. Lobbying for your comment, up voting someone else’s comment or adding multiple comments is strongly encouraged.

3. Any belittling or rude comments will be deleted.

4. The winner will be selected by me.

5. Contest results will be posted by midnight on June 1, 2015.

The shirt: 

It comes in other colors and of course different sizes. You can see more about it at the iheartdogs website.

Pet Cancer

With apologies to my grandmother and other more sensitive readers, the working title while I was writing this post was “f@#king cancer.” I’m not sure why I felt the need to tell you that except that it illustrates how I feel on the subject. I would open my “drafts” file every few days and see this post and start writing, scrap it and start over. This post really only applies to terminal cancers. There are a few cancers that can be cured with aggressive and sometimes even modest surgical or medical approaches.

The big casino, the “C” word. The big C. It’s one of those things that comes out as a heavy weight attached to even heavier weights. Words like surgery – not so bad – often followed by horrible words like chemotherapy, radiation or metastasis. Chemo, the other C word. When I bring up the word chemotherapy in an exam room, I know the face I’m going to see. I wish I could put myself in people’s shoes and see what they were picturing when I say the dreaded chemo-word. But I can’t forget the things I know and I can’t erase my experiences. To me chemotherapy is time, it’s a chance to set the clock back a little bit. We can take a pet who is really sick and help them get back some of that quality of life they’ve lost. For some time. It’s a chance for people to come to terms with the fact they won’t get to see their pet grow old or that their older pet is dying.

People generally have someone in their circle of loved ones who has gone through the nightmare of chemotherapy. I think they picture that experience when making the decision and to me that’s a mistake. I would never knowingly suggest putting a pet through something as horrible as what some human cancer patients endure. In our world however, we aren’t going for maximizing the total number of days nor are we hoping to strike on the cure. Our aim is to work with you to find a way to maximize the total number of tail wags (dogs) or head butts (cats) we can experience before we have to make a tough decision.

Chemotherapy is typically a series of visits, monitoring and then administration of drugs that are designed to target rapidly dividing cells, turn off the pathways that these cells use for growth and sometimes they even prepare the body to do battle with the cancer by ramping up antibody production.

Sometimes this will followed by or in rare cases replaced by radiation oncology. Radiation can also be used to control symptoms in patients who have tumors that can not be operated on or in cancers that can not be cured. It involves “firing” ionized radiation in specially shaped beams that maximize the dose of radiation at the site of the tumor while sparing the healthy tissue as much as possible. For us here in Rutland, Vermont, the closest facilities that offer this service are in Boston and Montreal.

Chemotherapy and radiation oncology sometimes follow surgery, sometimes there is no surgery and sometimes they are used to shrink a tumor enough to allow surgery. It depends. No matter what course of action is taken our goal is always to maximize the number of tail wags or head butts you and your pet share.

That doesn’t mean there won’t be bad days. There will be nausea. There will be diarrhea. There might be vomiting. There will be blood. Draws, that should have said blood draws. Holy monitoring there will be a lot of blood draws. But we can manage all of these things. And if we know they are coming we can manage them effectively before they happen. An ounce of prevention and all that.

No one wants to tell you your dog has cancer and no one wants to explain options and decisions while your head is reeling from the initial blow. I can still remember one client stopping me mid-sentence and asking me in a very concerned and serious tone, “Dogs can get cancer?” She had no idea. And why should she? She had never experienced it nor had anyone she knew. But she had a mother who went through cancer and it was terrible. She was in no shape to discuss cancer in her dog. She just found out at the same time that not only could dogs get cancer but her dog actually had cancer. So we rescheduled the conversation for a few days later and boy did she come in with some internet articles for us to peruse. I am always slightly tempted to remind people that I also have internet access, at work and at home. But she informed herself and we made some decisions for her dog and he went on to do well for an acceptable period of time.

The one take away I want you to get from this or to pass on to a friend who is going through a tough time. Please, if you can, please at least sit down with an oncologist. If you’ve gotten far enough to diagnose the cancer into a specific kind, it should be compulsory to have a conversation with an oncologist. This is not because they great sales people and will talk you into maximizing your dog’s quality of life thus justifying my means with an end. No, all of the oncologists I know are way softer and sweeter than this hard boiled, fast talking, quick blogging country vet. I want you to sit down with an oncologist because they can give you all of your options and allow you to make an informed decision. I promise they won’t push or force the issue. But it will always be worth your time to find out what can be done.

So yes, cancer is terrible. Yes it is always bad news but it is a situation where getting all of your options explained by experts is always going to be worth your time.

Thanks for reading.

Best Roomba for Pet Hair!

Fireworks and Dogs; The Scary Boom and Crash

No not the economy. Hopefully not anyway.

I’m talking about fireworks. And thunderstorms. And boats on the lake. And motorcycles on the road. And open windows letting all these noises in.

I enjoy all of these loud things but like your dog, I understand that sometimes they are just a little more than any of us want to deal with. Unlike your dog, I understand that the world is not coming to an immediate end simply because the sky is lighting up and making huge crashing noises.

An amusing anecdote about how thoughtless some dog owners can be. I once took my dog Moxie – who happens to be the most anxious dog I have ever met – with me when I went to see the fireworks over the Charles River and listen to the Boston Pops with my brother and his family. Here’s a picture of Moxie having a great time (why is there no sarcasm font?):

Moxie

As one might imagine, Moxie has zero fond memories of this trip. The stroller belonged to my nephew. We don’t walk our dog in a stroller. Not that I’m judging. We just don’t.

Sure, avoiding one of the largest fireworks shows in the United States is an easy way to help your pet through this season. But what about all the other stuff?

The first bit is the hardest to do. Don’t reward clingy behavior by going out of your way to comfort them and console them. That doesn’t mean you should give your dog the cold shoulder if they come to you afraid and seeking some affection. You are the one who is supposed to make it all better. But remain calm, speak to them in calm even tones and of course pet them. But don’t encourage them to be anxious by seeking them out and making them endure your comforting. If they are in their spot and staying calm, let them be. Instead all year, every day of their lives, reward them for being calm. Someone comes to the door and they didn’t bark? Oh that’s a cookie. A car backfires outside or a gunshot is heard during hunting season? That’s a cookie and a “good dog.” By ignoring them when they are acting anxious and rewarding them when they are calm, we are reinforcing the calm behavior. You are not reinforcing their fear by comforting them or by yelling at them to stop barking when they are startled but it does reinforce the behavior. It takes time but trust me it works. Also, be patient with yourself. This is hard work.

Then when a storm is coming or there will be fireworks or a biker parade, be around. If you are planning to get groceries but a thunderstorm is coming, put it off. The grocery store will still have food after the storm and you won’t slip on the wet floor and hurt your wrist. Be around your dog but don’t coddle them, instead play a game with them or simply go about the business of being calm, indoors and do what you normal do. When your dog calms down, give them a cookie. Reward the good behavior, ignore the anxious behavior. I know, it’s harder than it sounds.

If you can’t be around or if you are around but like to have the radio on, do so. Some quiet music can really help take a dog’s mind off the noises outside. Dogs (and cows and horses) really seem to respond to the tones and cadence of NPR. They also don’t feel guilty during the membership drive. So put on your public radio station and see if your pup relaxes a little bit. I will warn you however, I know at least a few dogs who have learned to associate the radio’s weather warning with impending thunder storms. They hear that buzzing siren sound and run and hide. So there’s that to think about.

Make sure your pup has access to somewhere to hide. Under a bed, inside a favorite crate or the kitchen table are all fine ideas. Just watch where your dog goes when there is a storm and then make sure they can always get there and most importantly, get back. If your dog feels trapped he or she might just recreate the garage scene from “Marley and Me.”

If your dog is really struggling you might think about ordering a thunder shirt. These snug fitting wraps apply a gentle calming pressure that makes your dog feel safe and apparently releases endorphins or something like that. I don’t know how they work, they seem to work and it reminds me of the squeeze chute Temple Grandin describes in her book, Animals in Translation and that’s my favorite part of the book so I have a completely illogical attachment to thunder shirts.

If that doesn’t work. Talk to your veterinarian. They may have ideas I haven’t thought of. If I’m your vet, maybe I’ll have more ideas by then. If I’ve had the appropriate amount of caffeine I might even be able look up other people’s ideas.

Thanks for reading.

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How to read pet food labels

Recently, a certain high end pet food has experienced at least one lawsuit because the marketing on the outside of their bag did not match up with what was on the inside. I am willing to wager that a lot of the higher end pet foods that cater to niche markets of consumers who wish to include ingredient x or exclude ingredient y from their pets diets are likely to have similar issues in the near future. Words on pet food labels like “human grade” or “organic” and sometimes even “grain free” have rules about when they can be used on a label but not when they can be used in advertising.

Fortunately, pets don’t need ingredients. They need nutrients and they can get those nutrients from high end “top of the line” food and they can get those nutrients from low end bargain bin food. More important than the ingredients, to me, is that the company has control over the facility the food is manufactured in and that the food, at least the basic recipe, has been put through feeding tests before it reaches your pet’s dish.

Below is a fairly comprehensive list of ingredients you might see on a pet food label and how those ingredients are defined. It is worth noting that many pet food companies will advertise “meat as the first ingredient.” Ingredients are listed per weight, it is possible to list a meat first by using chicken and then also list Brewer’s Rice, Ground Whole Brown Rice, Rice, Rice Bran and Rice Flour separately. Sure Chicken comes first but that food definitely has more rice than chicken in it. Sneaky right?

The AAFCO (Association of American Feed Control Officials) sets guidelines and definitions for animal feed, including pet foods.

  • Alfalfa Meal – the aerial portion of the alfalfa plant, reasonably free form other crop plants, weeds and mold, which has been sun cured and finely ground.
  • Animal Digest – material that results from chemical and/or enzymatic hydrolysis of clean and undecomposed animal tissue. The animal tissues used shall be exclusive of hair, horns, teeth, hooves and feathers, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed.
  • Animal Fat – is obtained from the tissues of mammals and/or poultry in the commercial processes of rendering or extracting. It consists predominantly of glyceride esters of fatty acids and contains no additions of free fatty acids. If an antioxidant is used, the common name or names must be indicated, followed by the words “used as a preservative”.
  • Barley – consists of at least 80 percent sound barley and must not contain more than 3 percent heat-damaged kernels, 6 percent foreign material, 20 percent other grains or 10 percent wild oats.
  • Barley Flour – soft, finely ground and bolted barley meal obtained from the milling of barley. It consists essentially of the starch and gluten of the endosperm.
  • Beef (meat) – is the clean flesh derived from slaughtered cattle, and is limited to that part of the striate muscle which is skeletal or that which is found in the tongue, in the diaphragm, in the heart, or in the esophagus; with or without the accompanying and overlying fat and the portions of the skin, sinew, nerve and blood vessels which normally accompany the flesh.
  • Beet Pulp (“beet pulp, dried molasses” and “beet pulp, dried, plain”) – the dried residue from sugar beets.
  • Brewer’s Rice – the dried extracted residue of rice resulting from the manufacture of wort (liquid portion of malted grain) or beer and may contain pulverized dried spent hops in an amount not to exceed 3 percent.
  • Brown Rice – unpolished rice after the kernels have been removed. Not a complete AAFCO definition.
  • Carrots – presumably carrots. No AAFCO definition.
  • Chicken – the clean combination of flesh and skin with or without accompanying bone, derived from the parts or whole carcasses of chicken or a combination thereof, exclusive of feathers, heads, feet and entrails.
  • Chicken By-Product Meal – consists of the ground, rendered, clean parts of the carcass of slaughtered chicken, such as necks, feet, undeveloped eggs and intestines, exclusive of feathers, except in such amounts as might occur unavoidable in good processing practice.
  • Chicken Liver Meal – chicken livers which have been ground or otherwise reduced in particle size.
  • Chicken Meal – chicken that has been ground or otherwise reduced in particle size.
  • Corn – unspecified corn product. Not a complete AAFCO definition.
  • Corn Bran – the outer coating of the corn kernel, with little or none of the starchy part of the germ.
  • Corn Germ Meal (Dry Milled) – ground corn germ which consists of corn germ with other parts of the corn kernel from which part of the oil has been removed and is the product obtained in the dry milling process of manufacture of corn meal, corn grits, hominy feed and other corn products.
  • Corn Gluten – that part of the commercial shelled corn that remains after the extraction of the larger portion of the starch, gluten, and germ by the processes employed in the wet milling manufacture of corn starch or syrup.
  • Corn Gluten Meal – the dried residue from corn after the removal of the larger part of the starch and germ, and the separation of the bran by the process employed in the wet milling manufacture of corn starch or syrup, or by enzymatic treatment of the endosperm.
  • Corn Syrup – concentrated juice derived from corn.
  • Cracked Pearl Barley – cracked pearl barley resulting from the manufacture of pearl barley from clean barley.
  • Dehydrated Eggs – dried whole poultry eggs freed of moisture by thermal means.
  • Digest of Beef – material from beef, which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue. The tissues used shall be exclusive of hair, horns, teeth and hooves, except in such trace amounts as might occur unavoidably in good factory practice.
  • Digest of Beef By-Products – material from beef which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue from non-rendered clean parts, other than meal, from cattle which includes, but is not limited to, lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low-temperature fatty tissue, and stomachs and intestines freed of their contents. It does not include hair, horns, teeth and hoofs.
  • Digest of Poultry By-Products – material which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue from non-rendered clean parts of carcasses of slaughtered poultry such as heads, feet, viscera, free from fecal content and foreign matter except in such trace amounts as might occur unavoidably in good factory practice.
  • Dried Animal Digest – dried material resulting from chemical and/or enzymatic hydrolysis of clean and undecomposed animal tissue. The animal tissue used shall be exclusive of hair, horns, teeth, hooves and feathers, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed. If it bears a name descriptive of its kind or flavor(s), it must correspond thereto.
  • Dried Kelp – dried seaweed of the families Laminaricae and Fu-caeae. If the product is prepared by artificial drying, it may be called “dehydrated kelp”
  • Dried Milk Protein – obtained by drying the coagulated protein residue resulting from the controlled co-precipitation of casein, lactalbumin and minor mild proteins from defatted milk.
  • Dried Reduced Lactose Whey – no AAFCO definition available.
  • Dried Whey – the product obtained by removing water from the whey. It contains not less than 11 percent protein nor less than 61 percent lactose.
  • Feeding Oatmeal – obtained in the manufacture of rolled oat groats or rolled oats and consists of broken oat groats, oat groat chips, and floury portions of the oat groats, with only such quantity of finely ground oat hulls as is unavoidable in the usual process of commercial milling. It must not contain more than 4 percent crude fiber.
  • Fish Meal – the clean, dried, ground tissue of undecomposed whole fish or fish cuttings, either or both, with or without the extraction of part of the oil Ground Corn (ground ear corn) – the entire ear of corn ground, without husks, with no greater portion of cob than occurs in the ear corn in its natural state.
  • Ground Dehulled Oats – presumably ground cleaned oats with hulls removed (ground oat groats). Not an AAFCO definition.
  • Ground Wheat – presumably a coarser grind of wheat flour. Not an AAFCO definition.
  • Ground Whole Brown Rice (Ground Brown Rice) – the entire product obtained by grinding the rice kernels after the hulls have been removed.
  • Ground Whole Wheat – ground whole kernel, presumably equivalent to AAFCO’s Wheat Mill Run, Wheat Middlings, Wheat Shorts or Wheat Red Dog, whose principal differences are in the percentage of crude fiber.
  • Ground Yellow Corn – same as ground corn, except that the corn used is yellow in color.
  • Kibbled Corn – obtained by cooking cracked corn under steam pressure and extruding from an expeller or other mechanical pressure device.
  • Lamb Bone Meal – (steamed) dried and ground product sterilized by cooking undecomposed bones with steam under pressure. Grease, gelatin and meat fiber may or may not be removed.
  • Lamb Digest – material resulting from chemical and/or enzymatic hydrolysis of clean and undecomposed lamb. The tissue used shall be exclusive of hair, horns, teeth and hooves, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed.
  • Lamb Fat – obtained from the tissues of lamb in the commercial processes of rendering or extracting. It consists predominantly of glyceride esters of fatty acids and contains no additions of free fatty acids. If an antioxidant is used, the common name or names must be indicated, followed by the words “used as a preservative”.
  • Lamb Meal – the rendered product from lamb tissues, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents except in such amounts as may occur unavoidably in good processing practices.
  • Linseed Meal – the product that remains after being mechanically extracted from ground flaxseed cake or chips after the removal of most of the oil has been removed. It must contain no more than 10 percent fiber. The words “mechanical extracted” are not required when listing as an ingredient in the manufactured food.
  • Liver – the hepatic gland (of whatever species is listed).
  • Meat and Bone Meal – the rendered product from mammal tissues, including bone, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents, except in such amounts as may occur unavoidably in good processing practices.
  • Meat By-Products – the non-rendered, clean parts, other than meat, derived from slaughtered mammals. It includes, but is not limited to, lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low-temperature fatty tissue and stomachs and intestines freed of their contents. It does not include hair, horns, teeth and hooves.
  • Meat Meal – the rendered product from mammal tissues, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents except in such amounts as may occur unavoidably in good processing practices.
  • Peas – peas.
  • Potatoes – potatoes.
  • Poultry By-Product Meal – consists of the ground, rendered, clean parts of the carcass of slaughtered poultry, such as necks, feet, undeveloped eggs, intestines, exclusive of feathers, except in such amounts as might occur unavoidably in good processing practices.
  • Poultry Digest – material that results from chemical and/or enzymatic hydrolysis of clean and undecomposed poultry tissue.
  • Poultry Fat (feed grade) – primarily obtained from the tissue of poultry in the commercial process of rendering or extracting. It shall contain only the fatty matter natural to the product produced under good manufacturing practices and shall contain no added free fatty acids or other materials obtained from fat. It must contain not less than 90 percent total fatty acids and not more than 3 percent of unsaponifiables and impurities. It shall have a minimum titer of 33 degrees Celsius. If an antioxidant is used, the common name or names must be indicated, followed by the word “preservative(s)”.
  • Powdered Cellulose – purified, mechanically disintegrated cellulose prepared by processing alpha cellulose obtained as a pulp from fibrous plant materials.
  • Rice Bran – the pericarp or bran layer and germ of the rice, with only such quantity of hull fragments, chipped, broken, or brewer’s rice, and calcium carbonate as is unavoidable in the regular milling of edible rice.
  • Rice Flour – milled rice
  • Soy Flour – milled soybeans
  • Soybean Hulls – consist primarily of the outer covering of the soybean.
  • Soybean Meal (Dehulled, solvent Extracted) – obtained by grinding the flakes remaining after removal of most of the oil from dehulled soybeans by a solvent extraction process.
  • Soybean Meal (Mechanical Extracted) – obtained by grinding the cake or chips which remain after removal of most of the oil from the soybeans by a mechanical extraction process.
  • Soybean Mill Run – composed of soybean hulls and such bean meats that adhere to the hulls and such bean meats that adhere to the hulls which results from normal milling operations in the production of dehulled soybean meal.
  • Tallow – animal fats with titer above 40 degrees Celsius.
  • Turkey – unspecified turkey. Not a complete AAFCO description.
  • Turkey Meal – the ground clean combination of flesh and skin with or without accompanying bone, derived from the parts or whole carcasses of turkey or a combination thereof, exclusive of feathers, heads, feet and entrails.
  • Wheat Bran – the coarse outer covering of the wheat kernel as separated from cleaned and scoured wheat in the usual process of commercial milling.
  • Wheat Flour – wheat flour together with fine particles of wheat bran, wheat germ and the offal from the “tail of the mill”. This product must be obtained in the usual process of commercial milling and must not contain more than 1.5 percent crude fiber.
  • Wheat Germ Meal – consists chiefly of wheat germ together with some bran and middlings or short. It must contain not less than 25 percent crude protein and 7 percent crude fat.
  • Wheat Mill Run – coarse wheat bran, fine particles of wheat bran, wheat shorts, wheat germ, wheat flour and the offal from the “tail of the mill”. This product must be obtained in the usual process of commercial milling and must contain not more than 9.5 percent crude fiber.
  • Whey – the product obtained as a fluid by separating the coagulum from milk, cream or skimmed milk and from which a portion of the milk fat may have been removed.

You now possess the power to define most of the ingredients you are likely to encounter on a pet food label.

Or you could try making your own if that’s all a bit much. Here’s a book to get you started.

Thanks for reading.

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Veterinarian Admits He Is In It For The Money

It’s true. I am. Sort of.

Being a veterinarian is my profession. Like any other professional in any other line of work, I expect to be paid for practicing my craft. I don’t think that makes me a bad person. Quite the opposite really. I took the time to think out what profession would make me the happiest and what profession I had the most to offer to and I went out and became a professional in that exact field. When you put it like that, it’s really kind of admirable. The same is true of every veterinarian you meet.

Still, somehow I hear from people that veterinarians charge too much and should do more for the love of the animals. I understand that sentiment and in a way I do actually share it. I have said it before and I meant it, I would do this job for free if I could.

But I can’t. And frankly, I don’t want to. I like money, it allows me to do stuff that makes me happy. It allows me to provide for a family, and to indulge my children once in awhile. Money pays for the gas in my car, it pays for my house and our groceries. Also electricity, health insurance, oil for the furnace and someday it will allow me to stop working and still afford all of those things.

Even if I had enough money to pay for all of those things for the rest of my life, it would still cost money to provide veterinary care. So it would still cost money to come and see me. I also expect the staff I am working with at any given time to want to earn money for the hard work they put into caring for people’s pets. So there you go.

How much should it cost? I touched on this a little bit in a post about the expense of having pets. Because this is a business and needs to earn money, in reality it costs as much as the majority of people are willing to pay. That’s sort of an underlying fundamental of economics. If there are 100 people who will pay $30 for an exam but 80 of those people will also pay $45. You charge $45. You make almost 20% more money doing 20% less work. It’s kind of silly not to. If you had 1 person out of every hundred who would pay $4,000 for an exam and you felt comfortable charging that much, you should. I couldn’t do it. But I have self esteem issues.

I know what you’re thinking. I should want to help as many pets as I possibly can. I don’t know how else to put this. I am not a superhero. No veterinarian is. The thing about trying to be all things to all people is this: when anyone does that, everyone loses. I can’t see all the pets I would like to see in a single day and still maintain the standard of service that I hold myself to. It’s much the same way veterinarians struggle to be available all hours of the day and night and provide that same level of care. No one can do it. Anyone who says they can should have been a politician instead. By limiting the number of patients I see in a single day I am able to spend more time, be more thorough and create a more personal relationship with my patients and their owners. For people who shop for veterinary service based on price, Walgreen’s will be offering that service through a company called Shot Vet.

In actuality, if I was only in it for the money, I would do something along the lines of Shot Vet. Brief exam, packaged vaccine and preventative care options and low expectations. Even at the lowest cost package; I would make the same amount of money or more by seeing patients assembly line style. That’s assuming only a slightly higher number of patients each day than I currently see.

But this is my craft, I take a lot of pride in it. So does your veterinarian. We all work to provide the best medical care we possibly can within the confines of each situation and we do our best to charge appropriately for it. I could see four times as many patients and make more money by offering less expensive but also less thorough and lower standard services, but I take pride in knowing my clients and their pets, I take pride in offering complete veterinary care that is my absolute best every single time I step into the exam room, surgery suite, or treatment area. I don’t want to be good and make lots of money. I want to be great and make an honest living. I promise you, your veterinarian feels the same way.

So yes, we are in it for the money, we expect to be able to earn an honest living, and to provide for our families. And some of us, hopefully the majority of us, will earn enough to provide a comfortable lifestyle for our families. Because when a person isn’t stressed about making ends meet, they can focus on the aspects of their profession that they love. It just makes for better veterinarians.

Thanks for reading.

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