Many of you may be aware of a National Geographic television show featuring a charismatic individual who helps dog owners.I recently came across this video on the website and I urge you to watch it (preferably without the sound so as not to be distracted by his talking) and keep your eye on the dog.Here is what you will see:
Within the first 5 seconds, the handler kicks the dog in the abdomen.When the dog turns toward him he is jerked off his feet.A struggle ensues where the handler gets bitten several times and the dog is seen to be struggling for air. Finally he gets the dog onto the ground and the dogs tongue is blue and the dog is gasping for breath.When he finally gets the dog up it appears that there might be urine on the ground and that the dog voided his bladder in distress.
What you have witnessed is not dog training but abuse.Not only does the dog suffer, but clients are at risk if they attempt these interventions themselves.These are not appropriate measures and compromise the welfare of the dog and the safety of people.His explanations are false and not based on science as we know it. We as veterinarians must make our voices heard and let National Geographic and most importantly our clients know that these types of interventions are wrong and not in the best interest of dogs or people.
As a veterinary behaviorist I have dealt with behavior problems in companion animals for over 25 years and would never confront a dog this way.Not only would it be dangerous for me and the family, it would be harmful for the dog. My goal is diagnose the problem, and design humane treatment plans that help the family change the behavior of their dog so that they can safely live together. I hope all veterinarians can agree that this is the best approach.
I would love to hear your thoughts. Most importantly, go to the link and scroll down the page to “contact us” and click on that. Let National Geographic know what you think.
I was disappointed to read the “Hot Button” column in the November issue of Veterinary Economics. Despite a number of concerns facing the veterinary industry today, VE elected to print the second submission in seven months by the same author, and, more or less, about the same topic.
In devaluing low-cost spay and neuter (LCSN) clinics, Dr. Craig Woloshyn (who is credited as a member of the VE Advisory Board) has even used some of the same language that was printed in his April 2010 article.I responded then, and feel compelled to do so again.
To be certain, I am not a spay/neuter activist – I manage a multi-doctor mixed practice in rural Oregon.We have worked extensively for years with our local shelter and other providers of LCSN programs and continue to run one specific program of our own.Our practice grosses seven figures; our Doctors and staff, as well as myself, are all paid well above the nationwide average salary for our positions – all with a fee schedule that continues to be a bargain by some standards.
My problem is two-fold.First of all, Dr. Woloshyn is wrong…..LCSN programs can be a productive component of fighting pet overpopulation.I don’t have to be a DVM to understand that, with respect to social problems, failing to act has an exponentially negative effect, even if taking action falls short of our desired outcome.Unless he is suggesting that cats and dogs would reach a “nature imposed” population ceiling if allowed to breed freely, then the case can be made that the problem would be much worse if not for our industry’s efforts.
So if we can agree that altering pets improves, even if slightly, the forecast for population, the subject of low cost programs is still left to debate.In the past, our practice typically performed a total of 300 feline spay/neuter procedures per year, and that number was the same from year to year despite economical changes and our practice growth.After expanding our cooperation with local humane organizations and creating our own in-house low-cost cat neuter program, that number rose to nearly 1,000 procedures per year.For anyone doing the math, that’s 700 cats per year that are no longer procreating, and while that may not dent Dr. Woloshyn’s 40% unaltered statistic, it’s certainly a move in the right direction.
Though pet overpopulation pales on the list of other social problems that we face in this world, it’s a relief to know that the same approach is not being applied to decisions about other issues such as famine, illiteracy, or disaster relief. What kind of world would it be if we only applied our resources where total success could be achieved?
My second problem is the decision to print what is essentially a retread of old ideas.All I seem to read lately is ‘101 ways’ for consultants to say the same thing…..Veterinarians should charge more and stop worrying about it.Continuing to focus on this one issue (which we all decide on our own anyway) is shortchanging the need to hear about real problems.For every veterinarian who under charges, there is one who overcharges (that is a blasphemous statement, no doubt), and who’s business is that but their own?
Lower cost practices can’t damage the industry…have you ever seen an association of fine dining establishments lobby to eliminate McDonalds?Instead, they understand the concept of target marketing, and creating (selling) the “experience” of a customer visit, not to mention great food.Here’s an interesting exercise for managers – ask your clients to rank their priorities for a visit to your practice (I have). It’s a truth most would rather not hear, but many clients put the resolution of their pet’s medical problems way down the list - often behind customer service, thorough explanations, wait time, convenience of hours, cost of services, etc.
The veterinary industry faces many serious issues - the evolving role of the certified technician; the lack of business preparation in new graduates; how to bridge the mentor role from one generation to the next; the role of staff in “training” new graduates; and the inconsistency of state’s practice acts, to name just a few.Isn’t it time to break some new ground and get outside of the box?I admit, 15 years ago, I was fascinated by the cutting edge advice from veterinary management experts, but that excitement has been replaced by the feeling that today’s consultants are still singing a few really old songs.
A friend forwarded this essay to me; I felt it was important to share. Whatever choice you make in November, please do it with care.
Eve Ensler, the American playwright, performer, feminist and activist best known for 'The Vagina Monologues', wrote the following about Sarah Palin.
Drill, Drill, Drill
I am having Sarah Palin nightmares. I dreamt last night that she was a member of a club where they rode snowmobiles and wore the claws of drowned and starved polar bears around their necks. I have a particular thing for Polar Bears. Maybe it's their snowy whiteness or their bigness or the fact that they live in the arctic or that I have never seen one in person or touched one. Maybe it is the fact that they live so comfortably on ice. Whatever it is, I need the polar bears.
I don't like raging at women. I am a Feminist and have spent my life trying to build community, help empower women and stop violence against them. It is hard to write about Sarah Palin. This is why the Sarah Palin choice was all the more insidious and cynical. The people who made this choice count on the goodness and solidarity of Feminists.
But everything Sarah Palin believes in and practices is antithetical to Feminism which for me is part of one story -- connected to saving the earth, ending racism, empowering women, giving young girls options, opening our minds, deepening tolerance, and ending violence and war.
I believe that the McCain/Palin ticket is one of the most dangerous choices of my lifetime, and should this country choose those candidates the fall-out may be so great, the destruction so vast in so many areas that America may never recover. But what is equally disturbing is the impact that duo would have on the rest of the world. Unfortunately, this is not a joke. In my lifetime I have seen the clownish, the inept, the bizarre be elected to the presidency with regularity.
Sarah Palin does not believe in evolution. I take this as a metaphor. In her world and the world of Fundamentalists nothing changes or gets better or evolves. She does not believe in global warming. The melting of the arctic, the storms that are destroying our cities, the pollution and rise of cancers, are all part of God's plan. She is fighting to take the polar bears off the endangered species list. The earth, in Palin's view, is here to be taken and plundered. The wolves and the bears are here to be shot and plundered. The oil is here to be taken and plundered. Iraq is here to be taken and plundered. As she said herself of the Iraqi war, 'It was a task from God.'
Sarah Palin does not believe in abortion. She does not believe women who are raped and incested and ripped open against their will should have a right to determine whether they have their rapist's baby or not.
She obviously does not believe in sex education or birth control. I imagine her daughter was practicing abstinence and we know how many babies that makes.
Sarah Palin does not much believe in thinking. From what I gather she has tried to ban books from the library, has a tendency to dispense with people who think independently. She cannot tolerate an environment of ambiguity and difference. This is a woman who could and might very well be the next president of the United States . She would govern one of the most diverse populations on the earth.
Sarah believes in guns. She has her own custom Austrian hunting rifle. She has been known to kill 40 caribou at a clip. She has shot hundreds of wolves from the air.
Sarah believes in God. That is of course her right, her private right. But when God and Guns come together in the public sector, when war is declared in God's name, when the rights of women are denied in his name, that is the end of separation of church and state and the undoing of everything America has ever tried to be.
I write to my sisters. I write because I believe we hold this election in our hands. This vote is a vote that will determine the future not just of the U.S. , but of the planet. It will determine whether we create policies to save the earth or make it forever uninhabitable for humans. It will determine whether we move towards dialogue and diplomacy in the world or whether we escalate violence through invasion, undermining and attack. It will determine whether we go for oil, strip mining, coal burning or invest our money in alternatives that will free us from dependency and destruction. It will determine if money gets spent on education and healthcare or whether we build more and more methods of killing. It will determine whether America is a free open tolerant society or a closed place of fear, fundamentalism and aggression.
If the Polar Bears don't move you to go and do everything in your power to get Obama elected then consider the chant that filled the hall after Palin spoke at the RNC, 'Drill Drill Drill.' I think of teeth when I think of drills. I think of rape. I think of destruction. I think of domination. I think of military exercises that force mindless repetition, emptying the brain of analysis, doubt, ambiguity or dissent. I think of pain.
Do we want a future of drilling? More holes in the ozone, in the floor of the sea, more holes in our thinking, in the trust between nations and peoples, more holes in the fabric of this precious thing we call life?
Recently, some negative statements have appeared on various blogs concerning Purina’s Beneful brand dog food. These allegations and misleading statements indicate that the product may cause specific problems, ranging from basic vomiting and diarrhea to death. These statements are not backed by any scientific studies, and the conditions described in the postings are amongst the most common conditions seen in everyday veterinary practice.
When a pet is sick, pet owners often look first to the pet’s food as the cause. However, it is rare that their food is responsible for the illness.
I’ve read through many of the current comments regarding Beneful and believe they do not provide any evidenced-based rationale for making such claims.Some of the comments mention illness resulting from a “one time feeding,” which in itself could be the cause of the gastro-intestinal symptoms described. A pet’s food should not be changed abruptly. Instead, whenever a new food is introduced, it should be mixed with the previous food on a gradual basis, over a period of a week to 10 days, to help prevent such symptoms from occurring.Other claims are that the dog suffered from chronic weight loss, or even death, but from these internet descriptions, it seems possible that these animals were ill to begin with and thus the diet (Beneful or otherwise) likely had nothing to do with the illness.
I have been a practicing veterinarian for over 40 years, specializing in small animal internal medicine and cardiology. During this period I also have participated in numerous pharmaceutical and food trials as well as writing scientific papers on the results of these clinical studies.I edit and am a contributing author of the Textbook of Veterinary Internal Medicine, a book used throughout the world by veterinary students and clinicians for up-to-date, timely and peer-reviewed information on veterinary medicine, including nutritional aspects of medicine.
While in practice, I have trained externs (preveterinary school graduates), interns (first year veterinary graduates) and residents (graduates pursuing a specialty). One of the hallmarks of the training (and that at accredited veterinary institutions) is the need to look for empirical evidence regarding statements made about diseases, drug therapies, surgical techniques and nutritional requirements. To lay blame on one particular product without substantial studies as proof of claim is inappropriate and misguided.
As someone who has worked in the industry for years, including work with Purina, I have been impressed with Purina’s quality and safety standards. Purina pet food products are made under rigorous quality supervision. Prior to making accusations that may be unfounded, it is first necessary to investigate the actual cause of a dog’s illness.Veterinary scientists can help to identify causes of illness and death and should be consulted for their expertise before making broad statements that have not been shown to have a scientific basis.
I do agree that ANY abnormalities noted by pet owners should be brought to the attention of their veterinarian, and any concerns with a particular product should immediately be brought to the attention of the manufacturer so that information can be collected and products appropriately monitored. The veterinarian and the pet owner then can decide whether to contact the FDA, as well. To date there has been no evidence that Beneful has caused any problems when fed to dogs. Poison control groups have not expressed any concerns, nor has the FDA.
As a final remark, I might mention that my own dog, Katie, a happy, healthy 8-year-old Newfoundland has been fed Beneful virtually all of her life. I feed her Beneful because she is a very fussy eater and has refused every other dry food we have tried. Neither cost, nor for that matter, contents are the reason for her getting this food, but rather her own preference. Until I am aware of there being a real reason to discontinue any pet food product made under such rigorous standards and controls, I will continue to feed her the product she chooses to eat.
Dr. Stephen Ettinger is a world-renowned veterinarian with more than 40 years of experience in the veterinary care industry. His areas of expertise include small animal veterinary internal medicine, small animal cardiology, hospital management and professional veterinary development. He continues to practice small animal medicine and works with a number of animal health companies, including serving as the Nestlé Purina Fellow in Veterinary Medicine and as a spokesperson for Purina Care pet insurance.
Writing and blogging, when I finally tried it a few years back, came easily to me.Facebook and Skype did as well.Twitter was difficult.I gave up a few times.I am so glad I did not give up entirely, as I would have missed out on so many special friendships and links to great information, in the veterinary community and world at large.In case it is as strange to you as it was for me, here are a few starting points.Try it.Then try it again.I hope you find the twitter forum as rewarding as I have!
Start with a personal account.Most of the veterinarians on twitter with whom I engage speak for themselves, not their practice.This gives more freedom to say random, un-veterinary things.If you want to say, “prevent heartworm disease in your pets” in one tweet, then “my dog just did the cutest thing!” then “I got some great sweet corn at the Farmer’s Market today!” no one will say, “Well that’s a weird train of thought for a veterinary professional!”And you do not need to worry that you are representing your business.
But remember that you ARE representing your business.People DO know that you are a vet, and in a few clicks of the mouse, they can find out where you practice, if you have not bragged about it endlessly in your tweets and profile already (which I think you should, by the way.)So…
Keep it clean.
Be kind.I suppose “be kind” is also self-explanatory.Still, twitter is much more fun if everyone is kind.If you have a gripe about a company, send it to them in a DM (direct message).Then when they respond, you can tweet that- “You would not believe how quickly @GreatCompany resolved an issue for me! Thank you @GreatCompany :)”
Be twitter-kind.Twitter has its own quirks that you would not automatically know.Not shouting (THIS IS SHOUTING) is kind.“Retweeting” (Repeating another’s tweet and giving them credit) is kind.Following someone who follows you is kind.Talking directly to others using @ followed by their twitter name is kind.
Be as good at patient confidentiality as you are in Real Life.Do not share patient and client information without the permission of your client and your veterinary hospital leadership.Even with blessings all around, do not share specific medical information about a specific case.
Yes: (with permission of boss and client and photographer) “How cute is my patient?? http://twitpic.com/mjpib”
Even better: (less permission-getting needed) “How gorgeous is my cat?? http://twitpic.com/sh0of”
Follow people you would enjoy getting to know.When I started twitter, I followed family members and friends, veterinarians and other pet lovers and people in Omaha.In hindsight, that was one thing I got right from the beginning.
Keep tweeting till it makes sense.My brother Dave convinced me to start twitter, because he knew I could reach a larger audience with pet preventative care information.For several months I would open twitter, watch the time line of the people I had followed, close twitter, and sigh, “I just don’t get it.It’s like facebook without the fun pictures.”Dave would smile and say “Don’t give up” and I would repeat the process: open twitter-check timeline-close twitter-sigh-gripe.Till one day, I did get it.“Hi how’s it going?” someone tweeted.“Great” I tweeted back.Hey, this was fun!It was like waving to a neighbor, only it was ok if she was three states away…or around the world!
Start a hospital twitter account.Oo, I have not done that yet…maybe that is my next great adventure… :)
The door from the garage at the base of stairs creaks open. Take a deep sniff, and check the downstairs cat box. Poop’s in the box.
Take the stairs slowly, looking for vomit next to the front door. Clear. The living room, steam cleaned again and again by my wife and I, is still free.
A few more stairs, wide-eyed watching in the twilight darkness for a wet mess, and then I’m in the kitchen. We’ve had a few pee problems in the corner, but it looks clear.
Now down the hallway to the cat room (everything’s in the litter, where it should be), the 1-year-old’s room (no mess in front of the dresser like before), and then our bedroom. There’s never been poop in our bedroom, but, y’know, who can tell?
Some might see this as a horrific situation, and it sucks. One cat has a bad day and craps on the carpet, and over the course of the day a perfectly normal spot on the carpet turns into a litter-less toilet.
Me, I try to be positive about it. I think these cats are teaching my wife and I to be better people.
We once had two cats and one cat box. Now we’ve followed advice and have five litter boxes (four cats plus one).
We once cleaned the cat box once every 36 hours or so. Now it’s twice a day like clockwork.
We once figured the cats were upset at us for something we did when we found pee or poop. Now we figure they’re a) sick, b) freaked out about the cat box for some reason, or c) being inscrutable. But we try not to take it personally.
And I look to the future for consolation today in my fight against occasional vomit and piles of diarrhea in the house: When the 1-year-old’s moving from diapers to toilet, there’ll be a mess or two—far bigger than the cats’.
These cats? They’re like gardeners, tending the better fruits of my mental garden: patience, understanding, sympathy.
Thank you, cats, for all your fluids. Your messes have made me a better man.
Not long ago, a good friend of mine took his girlfriend to a local pet store to look at puppies. They fell in love with a little Yorkie, and posted pictures online of themselves playing with the dog. She was a cutie, for sure, but this particular store doesn’t have the best reputation in the dog community. I was tempted to call my friend and beg him not to buy the puppy. I wanted to tell him about the horrible rumors I’d heard about where pet stores buy their dogs and the terrible things some of these puppies are subjected to.
But then again, who am I to judge? Ultimately it was their decision, and I had no place intervening. I certainly wasn’t going to become the type of person who judges someone based on where they get their dog. Still, I was quite relieved when they eventually decided not to purchase the dog.
Today, I’m experiencing my own internal struggle. My wife and I are ready to add a new canine member to our family, but can’t decide where to look. Do we buy a puppy or adopt a shelter dog? It’s a question I’ve been trying unsuccessfully to answer for months now.
As I wrote about recently, our first attempt at adopting a dog didn’t go so well. Thankfully, Tyson is doing great in his new home and loves his new family. But the whole ordeal left a bad taste in my mouth. How can I trust that another rescue dog’s behavior won’t change completely once we get him home?
I’m well aware that there are thousands of amazing shelter dogs looking for homes. Most of them have no aggression issues and will fit right in if given a chance. But after the Tyson ordeal, I can’t afford to make a mistake. Giving him up was one of the hardest things I’ve ever done, and I don’t want to go through that again.
After working at a dog daycare and boarding facility through college, I’m pretty knowledgeable about dog breeds and personality. The problem is that I like too many of them. I like English bulldogs, vizslas, golden retrievers, and Weimaraners, I like German shorthaired pointers, boxers, Great Danes, and Boston terriers. And of course, I like mutts.
I search for dogs nearly every day. I look in the local paper’s classifieds for puppies from breeders. I scour through rescue groups’ websites. I search comprehensive adoption sites. I browse through city shelters’ listings. I can’t decide exactly what I’m looking for, but I hope it will become clear once I see the perfect listing.
As much as I’d love to “do the right thing” and adopt a dog, I can’t help but be scared of how he might turn out. What if he’s been abused and harbors aggression toward people? What if the shelter is unaware of the fact that he bit a child in the past? I’m more than willing to be patient and work with a dog to curb behavior issues, but I won’t put my family in danger.
So where do I go from here? It seems everyone has an opinion on the matter, but when it comes down to it, my wife and I will have to decide what’s best for us. In all honesty, I’m not as concerned with where the dog comes from as I am with finding one that fits with our lifestyle and will become a loyal, loving family member. I guess all that’s left is to find the perfect one.
Today, I'm taking the first step toward getting organized here at work. There's something about the start of the New Year that really inspired me this time (probably for the first time in my life). Here's the deal: I've stared down the same unruly, unorganized file cabinet drawer for three years. For some reason it has never bugged me until, oh, last week. It used to be a drawer I never had to venture into very often, but as my job duties have evolved, I find myself filing and retrieving more items out of the drawer. I've become the Keeper of Things on the Veterinary Economics team.
Anyway, here's a peek into my drawer. Now quickly look away before it burns your retinas!
The tri-cut file folders are overlapping, making it hard to thumb through and find what I need. There's no real system in place for how the stuff is filed. Labels have whiteout all over them. And then there's my terrible handwriting in several different colors. The tabs are worn—and that boring manila color ... ugh!
Time to take action. I just ordered a label maker after coveting the one that belongs to my editor, Kristi Reimer. You wouldn't believe the way that label maker transformed her file drawer. It's going to be agony waiting the 3-5 days for shipping!
So stay tuned. I know you're all breathlessly awaiting the "after" photos. That is, if your retinas are still functioning.
[Update 1/19/09: Here's a link a photo of the final results]
Last spring I gave a presentation on dog first aid for a group of people involved with therapy animals. While discussing the first aid of dog fight wounds I mentioned that most dogs will bite each other on the back of the neck and shoulders, but that pit bulls tend to go for the throat. I received a nasty email after the presentation; some of the attendants had pet pit bulls and objected to my statement, accusing me of perpetuating unjust beliefs about pits. Yes, I made a generalization, but I think it’s a fair assessment.
One argument that people make is that “there’s no such breed as a pit bull.” It’s true that there is no AKC-registered breed called a Pit Bull (there are American Staffordshire Terrier and Staffordshire Bull Terrier), but just do a quick search for pit bull puppies on craigslist and you’ll see that it’s a real breed. I use “pit” as a somewhat generic term for stocky, smooth-haired dogs with block heads and huge, powerful jaws. They’re a dime a dozen in Salt Lake. And, yes, they are used in pit fighting rings.
Pits are usually very sweet, stoic patients, even when seriously injured. I’ve seen pits stabbed, shot, and dragged behind trucks, and they sat placidly for veterinary care. It’s very rare that we have to muzzle one to handle it (unlike, for example, Chow-Chows, Shar-Peis and Rottweilers, of which the great majority are muzzled). My understanding is that fighting pits who attack humans are summarily killed, thus selecting fairly immediately for dogs who are gentle to humans. At least that’s the case around here. However, I know a vet who lives in Florida and she reports that the pits there are frequently involved in attacks on humans, often fatal. In June, an elderly man was working in his yard when he was attacked by two neighbor pit bulls. They severed one of his arms, and he later died in the hospital.
The pits in this area, while usually gentle with humans, are hell on other animals. I’ve seen a German shepherd with its trachea ripped; a Shih-Tzu with a lacerated spleen from being dragged under a fence; a Chihuahua with its intestines dangling out of an abdominal laceration; and numerous DOA pets—all from pit bull attacks. Pits have enormous jaw strength and when they clamp down they don’t let go. One of my favorite patients, a little mix who looks like Bolt from the Disney movie, nearly became a Scooby Snack for a pit. His mom was walking him on leash at the park when a pit burst out of its house across the street and made a beeline for him. His mom yanked him up by his leash and collar and shielded him with her body. Luckily for her, the pit wasn’t human-aggressive.
There is a good resource called the KC Dog Blog: Unofficial Watchdog on Animal Welfare Issues. The blog owner posts about a variety of issues, including dog attacks, and seems to be objective in the presentation of facts. Various dog breeds are involved in human fatalities, from shepherds and Labs to huskies and pits. The blog owner states that “it is impossible to judge the actions of dogs without judging the actions of the people that surrounded the dogs.” And that’s certainly true. For example, in the case of the little old man with the severed arm, the two dogs had been involved in previous incidents of human-directed aggression. Neither the local authorities nor the dogs’ owner acted to prevent further attacks. Those dogs should have been euthanized long ago.
There’s an ongoing debate about dangerous dog legislation and breed-specific legislation, with arguments pro and con. My personal feeling is that there are some breeds which are inherently dangerous, but where do you draw the line? Who makes the call on an individual dog’s breed composition? What about mixed breeds? Which breeds should be banned? One of my own dogs is a German shepherd mix and I would trust her with a preschool full of children, but other shepherds have fatally attacked people.
There are exactly three Rottweilers that I trust in my practice—every other Rott gets a muzzle, no questions asked. I would rather offend an owner by muzzling his precious than risk my face and livelihood. Other breeds that generally scare the crap out of me are Cane Corso, Dogo Argentino, Fila Brasileiro, and Presa Canario. Those breeds are all big and aggressive, and I wouldn’t let one within thirty feet of my kids. Some were bred to hunt down and kill escaped slaves. Great, huh? Do you want a breed that was bred to be a companion or one that was bred to be a man-killer? I recently had a client, with small child in tow, bring in her new dog who was supposedly a Cane Corso. She asked if I thought it was; my answer was, “She’s much too small and her face is wrong. I doubt she’s a Cane Corso, and honestly if I thought she was I would tell you to get rid of the dog before it kills your kid.” That opened her eyes.
Probably more effective than breed-specific legislation are laws which address aggressive dogs on an individual basis. Many dogs involved in fatal cases have documented prior attacks on animals or people, but are allowed to continue unchecked. After the first attack the dog should be required to be confined and/or muzzled at all times. If a second attack occurs there should be euthanasia for the dog and jail time for its owner.
And for the pit-lovers who objected to my comments, I would point this out: A pregnant California woman who was killed last month by her own pit bull “was an avid pit bull lover and supporter of Bay Area Dog lovers Responsible About Pit Bulls, or Bad Rap, a group that tries to change negative attitudes toward pit bulls.”
I was in a discussion today about piercing and tattoos and if professionals should avoid them. Here are my thoughts on this. I think people should be able to do what makes them happy and comfortable. I also try my best to always judge people by their actions and not their appearance. On the other hand I certainly do know that extreme individuality makes people judge you differently and act differently and I bet it even holds people back from being successful. I meet lots of people and see lots of speakers and and everyone is very "normal" appearing but I would hope that if I went to a conference and there was a management topic I wanted to hear being delivered by a fully tattoo'd woman with an eye brow ring that I would still attend and not be distracted. I would hope that I would admire her individuality and right to do what she wanted that made her feel comfortable. On the other hand...would I hire her? Well based on my policy manual I couldn't but that would be the extreme. I have 2 staff with tiny nose studs and I myself am thinking of getting one. I find them very feminine and beautiful. I have staff with tattoos but most of them can't be seen. I too, have 2 tattoos but they only show in a bathing suit. I am trying to break in to the veterinary world as both a consultant and a speaker. I love my profession and am passionate about what I do and believe in. I have worked hard to earn my Associate and Bachelor Degree as well as my CVPM certification. would a nose stud make me less knowledgeable? I would hope not. So the debate rages on I guess. I may get the nose stud....and hope that I am not judged. I will see the speaker covered in tattoos but probably wouldn't be able to hire her as my receptionist. Not because I don't want to but because my policy manual for the practice I don't own states that I cannot. I would also feel that the extreme might be distracting and make clients uncomfortable. On the other hand a small nose stud or even a small tattoo on the back of her neck (I have staff with both of these) wouldn't bother me and I don't think would bother my clients. Why the difference? Small is not distracting and extreme is?? Not sure. What about piercings that are part of a culture? Is that more acceptable? I guess this is a debate that will live on. I hope the day comes when we are all judge solely on how we treat people and what our skills are. I wonder if that will ever happen?
Myth: Dr Robin Downing’s client who can’t afford $5,000 for GDV surgery would have been able to, if they only had pet health insurance.
Truth: The insurance that Dr Downing promotes on her website has a basic plan for a 3 year old German Shepherd with an annual premium of $305, a $100 deductible and a $2,500 per incident limit. So for a $5,000 GDV surgery your out of pocket expense is $2,805. Deal or No Deal?
And if one thousand of your clients buy a $305 annual policy, they’ll spend $305,000 on pet insurance. At $100 per incident for the average annual visit cost those clients spend an additional $100,000. But wait, the basic plan doesn’t cover wellness exams, that’s an add on option. So your thousand insured clients just gave the insurance company $405,000, and you and they got NOTHING for it.
I know, I know. The ONE client who had the $5,000 surgery bill thinks it’s great. They at least recovered half their bill. But the way the insurance industry works, they have to collect more in premiums than they pay out in benefits...a lot more. So should you be RECOMMENDING insurance?
To maximize the use of the coverage your client would have to see you for a single visit where you charge no more than $3,225. The client will pay the $100 deductible and $625 (20% copay). The insurance will reimburse the client for the balance of $2,500. Keep in mind that one client has now received more benefits than they paid into the insurance plan. The insurance company has to sign up 9 more clients just to cover that bill.
What if you charge $481.25 for a visit? The client pays $100 deductible plus $76.25 copay. They receive $305 reimbursement. They’ve just been “paid back” for the annual premium. If the number of client visits per year that have a visit total more the $481.25 is low, then it probably is good for YOU to sign your patients up. Is it really good for them?
Myth: Pet insurance is like car insurance.
Truth: Well, yes and no. Pet insurance and car insurance are indemnity insurance. But car insurance is required by law, in case you hit someone else. Pet insurance doesn’t cover if your dog bites the neighbor’s kid, which might be a reasonable risk to cover. Car insurance is valuable because most people take out a loan to buy a car. If the car is totaled in an accident and you don’t have insurance, you’d be stuck paying off the loan, for a car than no longer works. And cars cost $10K to $80K; a much larger financial burden to replace. In addition, most people are dependent on transportation for survival. If the car doesn’t work, they don’t either.
Myth: The extra paperwork is minimal, and should just be part of providing great service. Heck you can even store the claim forms for each of the insurance providers and print out the one your client needs at the conclusion of each visit!
Truth: That was written by an insurance industry hack. Veterinarians already undercharge for their time and expertise. So now, you also should, for no additional compensation help a client fill out a form and comply with any complicated set of rules in order to be reimbursed.
We can learn from our friends in the chiropractic profession who bought all those same arguments. They also were initially happy that if chiropractic care were “covered” they were finally legitimized as a medical provider and more patients would seek care because it was covered. And obviously, to provide great customer service, we’ll start accepting payment from the clients for only the deductible, then bill the insurance for the balance and wait to get paid. Within ten years, the small, single doctor chiropractic office had to hire a full-time employee just to process the paperwork: rejections because the form wasn’t filled out corectly; the denials because the specific code wasn’t covered; the returns because the insured’s information didn’t match exactly what was on file.
Myth: Sure occasional clients will blame you when things go wrong, but that’s true with any service or company you might recommend, so you can just roll with the punches.
Truth: The insurance company has carefully made any payment delays YOUR FAULT. If the vet would only provide a copy of the medical records (which you already have, for the third time) they would be able to pay the reimbursement. If only the vet’s invoice used the proper diagnostic terms, we’d be able to pay. If your vet had just used a different diagnosis, it would have been covered. Maybe your vet can ALTER THE RECORD and use a different diagnosis so you can get paid. (Clients have actually asked me to do this, on the “implied” advice of the insurance provider). Dr Downing’s own blog actually suggests it is easy to alter what you name your services in order meet the demands of the insurance limitations
And if you decide the insurance companies AREN’T out to serve your clients, you can stop recommending them. BUT the client is still on an annual contract, so you’ll have to live with the negative repercussions of your recommendation for the balance of their contract. Frankly, clients understand that recommending a pet-sitting service is someone you have reason to recommend and your recommendations may change over time. But recommend an insurance company and you’re perceived to be part of the problems when they occur.
Myth: Providing pet insurance as an employment benefit to your employees is a great way to help your staff afford great pet care.
Truth: Many years ago a pet food company worked a deal with veterinary universities. They provided pet food at cost to students. After four years of buying their food, upon entering practice, many veterinarians naturally used, recommended and referred that pet food for their patients.
The same tactic will build the word-of-mouth for pet insurance. If your employees have the insurance provided as a benefit, they will only pay the deductibles and the copay. Hey, it’s great! But their unbalanced view of the insurance will lead them to proselytize for the insurance company. And employees are more likely to be high users of pet medical care.
Just as with human health insurance, the worst path for veterinarians is to see pet insurance become an employee benefit that our clients do not pay for out of pocket. When that happens you will see the insurance industry gain more control over what you can charge (by referring their policy holders to veterinarians who have agreed to a “fee schedule”). And you will most certainly have the added costs of additional staff time spent helping clients process forms, respond to insurance company requests for documentation, and the financing or “float” of your fees until the insurance company pays.
Insurance is great for the insurance company. But the insurance company only stays in business if they collect more premiums than they pay out in benefits. Now that you have a clear picture of how it works, consider this: clients would be much better off putting aside the $300 - $400 a year in an interest bearing savings account to pay for future unanticipated “large” pet medical bills. And the beauty is that if they don’t have the large medical expenses, the money is still theirs.
I organized our first Helping Hearts Free Veterinary Clinic. I first got the idea from a veterinarian on VIN who hosted a Pets In Need Clinic. Hers was a bit more extravagent then what I wanted to tackle so I designed this to fit the needs of my practice. She was kind enough to share her forms and I just had to edit them....great help. The date for the clinic was Saturday, May 16, 2009 and I have to tell you it was a great success. After I laid out a plan I contacted media to get the story out. We appeared on our local Fox, NBC and ABC stations to discuss this clinic. Wonderful warm and fuzzy marketing as well. I decided that it would be too time consuming to try to hold this based on income. I didn't know what a good income level requirement would be. Next, I thought about offering it to those who were on unemployment but that included some of my staff and though they definately had to make some life stlye changes they weren't to the point of needing free veterinary care. My solution? I had an application and requested they had a referral letter from a clergy member, case worker or social worker. We took applications for about a month. I contacted my vendors and suppliers and most of them were so kind and willing to help. We offered free physical exams, vaccines, FLVT and HWT, intestinal parasite screens along with sending home food, shampoo, flea/tick and heartworm prevention and more! I was freaking out Friday night when I counted 57 pets that we would see in the 4 hours. I had 100% of my staff donate their time and even some spouses who don't work with me. Each room had a DVM/ 2 tech team. We had 2 CST, 3 lab techs, kennel staff, floaters and even someone to man the brochure table and hand out food. We had a wonderful turn out and everyone was so thankful. We ended up seeing just over 60 pets that day! The feeling to be able to help was amazing!
A cold wind had stopped blowing in last night around 7:30pm or so. The temperature had dropped outside our house by 20 degrees. The heater was doing its work.
My wife, in bed, turned to me. "Is there a cat outside?" she asked. I hadn't heard anything. Did one of our four felines, all indoor cats, get locked out accidentally? I walked down the hallway and was greeted with blood-curdling shrieks from our new 6-year-old adopted cat. I saw her on the other side of the dining room desperately trying to drag her two suddenly limp hind legs behind her along the floor. She was meowing and howling, again and again. My wife appeared in the hallway, and, down from my sitting on the floor, I told her Cassie couldn't move her back legs. "Can you get the magnet off the fridge and call VSEC right now?" I asked. VSEC is a pet emergency clinic just 10 minutes away from us. My wife wasn't sure I was being serious. I kid around too much, I guess.
The woman on the other end of the line heard Terri describe the fact that Cassie couldn't move her back legs. She told Terri to come in immediately. Terri and I took turns getting dressed and keeping Cassie relatively immobile on the carpet.
Five minutes later, a desperately panting, pained, screaming Cassie was in a carrier, and Terri and I were driving as calmly as possible down the dark streets. We turned into the parking lot and carried Cassie in to an empty lobby. Two serious-faced receptionists greeted us, and a veterinarian showed up seconds later and said she'd start an IV immediately.
Less than five minutes, as Terri finished the paperwork, a veterinarian ushered us into an exam room.
Cassie likely had some level of heart disease, and a blood clot had clogged blood flow to Cassie's back legs. Her rear legs were limp and cold. She was in an oxygen chamber to try to improve her breathing, but it wasn't helping much. There were no options other than euthanasia. He could perform more tests, he told us, but it would likely just confirm. We consented.
We signed forms and paid at the desk. A few minutes later, the doctor came back. He couldn't get Cassie to calm down enough to justify moving her out of the oxygen chamber. We could see her in the back.
A technician was holding Cassie by the scruff of her neck, her eyes looked like they were bulging with the necessary force. The doctor explained she was trying to chew out her IV, and they had to hold her to keep her stationary. Her tongue rippled, her howls echoed through the half-empty, shared emergency treatment room. My wife started crying hysterically. She couldn't touch Cassie, it was too terrible to watch her in pain.
The veterinarian administered a clear dose through the syringe into the IV drip. Cassie suddenly and unnaturally calmed, drool oozing from her mouth. Her eyes hung, half-open, half-closed. My wife couldn't bear to touch her, but I petted her head and neck as she lied there.
I thought, "All this pain will be gone for you really, really soon." I stay calm and rational in intense situations. I knew damn well what was happening when the doctor pushed the pink liquid into the IV. My cat was going to be dead in seconds.
I kept petting her. The technician looked sad and resigned. The doctor was apologetic. He wished we could have given us more time with her, but he explained it was best to end her suffering as soon as possible. Throughout this short visit of less than 30 minutes, he had explained to us at different times, in at least three different ways, that she was in pain and the best thing was euthanasia. He remained calm, sympathetic, and informative. He handled an intense situation of great sadness on the part of my wife and I with grace, authority, and sympathy. Did I already say sympathy? It's hard to write this. I'm repeating myself.
Anyway, last night my wife heard our black-and-white domestic short-hair cat Cassie cry out from the dining room 30 minutes before the doctor euthanized her. Cassie was the one we inherited fat, the one who would sleep between my legs despite my movement, the one who liked to open up petting sessions with a friendly head-butt on the hand. She was with us for only four months. My wife found her at a garage sale. She was a pretty cat and friendly. Cassie, a previously indoor cat, had been in the woman's garage for 18 months because a grandson was allergic.
When Cassie came to our house, she used to be friendly but also bit my wife on the hand a few times when she was being unpredictable: Did she wanted to be petted or didn't she? Cassie wound up loving my wife a lot, and my wife loved her.
Cassie spent her last four months of life sleeping indoors comfortably, receiving lots of affection from people, and some modicum of comfortable living with the other four cats.
I'm an editor, but I can't bear to edit this right now.
Cassie was a good cat, and it was a privilege and a gift to get to spend time with her.
The movie Beverly Hills Chihuahua opens today, amid some concerns that the movie may lead to rash Chihuahua adoptions, which would likely lead to an increase in abandoned Chihuahuas. I really can’t add anything to this argument except to say that, as we all know, not all pets are right for all people. Whenever possible, we should try to help owners make smart choices and steer them away from pets that don’t match with their lives. (Veterinary Medicine published an article on this in the October 2007 issue.) I know that I won’t be seeing the movie, not as a boycott but just because it doesn’t look very good to me. I am not enough of an animal lover to watch a movie simply because it has an animal in it.
Anyway, all of this is to say that seeing the advertisements for Beverly Hills Chihuahua got me thinking about animal movies that I really like. My top six animal movies in no particular order:
• March of the Penguins • Best in Show • Prancer • Charlotte’s Web (the older, animated version—I have not seen the new one) • My dog Skip • Babe
So do you agree with my choices? What are your favorites? I know I’m missing some obvious movies, such as Seabiscuit, Beethoven, and Benji. In some cases, that’s because I haven’t seen them, so make your case for why I should give these movies a watch—or another watch as the case may be.
Today’s post is one that has been on my mind for a while, and quite honestly, I have been a bit scared to write it. It is a conversation I have had with so many colleagues who feel the same way. Anyone who knows me can tell you that I am pretty optimistic (probably to a fault,) but I cannot keep denying what is right in front of me anymore.
I want to know what in the world is going on in our profession. Why in the world are veterinary students coming out of school with a mountain of debt and dicey job prospects at best? Beyond corporate practices, which are open 7 days a week, I do not know of a single animal hospital that is hiring a veterinarian. Now mind you, I do live in an area close to a veterinary school, but I also serve over 50 animal hospitals, and do you know how many of them are looking to hire a full-time veterinarian? NONE!
I know there are people who graduated from veterinary school 7 months ago and are struggling to find a full time job. I ran into one of them just last week, and thankfully, he does finally have a full time job prospect. Unfortunately, this problem is bigger than just veterinary students and is starting to affect veterinarians coming out of specialty training programs as well.
Meanwhile, what do we hear from the veterinary schools? Oh yes, they are all deciding to increase their class sizes or have already done it. Are you kidding me? Are US veterinary schools that out of touch with reality that they can’t see that the light at the end of the tunnel is actually an oncoming train? What will it take for them to see that we have a very serious problem developing in veterinary medicine?
Nothing personal against my alma mater, NC State, but I was visiting a friend who works there the other day, and we went into the junior surgery lab. It looks very different than it did when I was a student.
Now each surgical bay has a large screen monitor (like 42 inches) on the wall and a laptop. I asked my friend, “Why do they have all this in a junior surgery lab?” She said, “Well, you know we must keep up with all the other veterinary schools.” My thought was, “well we know whose back that is on”-the poor veterinary students. I am all for improved learning and technology, but really, when is someone going to stand up and say ENOUGH ALREADY!
I was talking to a college student this morning, and she was contemplating veterinary school. I told her as much as I love being a veterinarian, I am not sure I would recommend that she go to veterinary school. The amount of debt these young veterinarians must endure on top of limited job prospects and probably decreasing salaries is going to create a perfect storm of not good!
I believe a lot of people in positions of influence either have their heads in the sand on this issue or don’t want to speak up, but I think we can no longer deny what is happening before our eyes.
So what is your take on this perfect storm that is brewing, and what should we do to solve this daunting problem in our profession?
Knowing that I have an interest in investigating the evidence behind claims for veterinary healthcare products, clients and colleagues sometimes pass along materials concerning veterinary supplements, herbal remedies, and other similar products and ask my opinion. Since there are hundreds, if not thousands of products marketed to pet owners to preserve or restore their pets’ health, I can only look into a few. However, the more of these I investigate, the more clearly I see the patterns of disregard for science and manipulation of the consumer that they have in common.
The latest in this category is a collection of products from a company called Nzymes.com. The website and pamphlet for this company exhibits nearly all of the warning signs of quackery. The company systematically tries to frighten the consumer by suggesting that pets cannot be healthy without their product and that the food and healthcare they are currently getting is inadequate.
Give Your Pet a Fighting Chance
If you are feeding your pet one of today’s popular processed pet foods, then chances are, your pet’s body is depleted of the primary enzyme precursors nature provides abundantly in all living foods.
The fact that we continue to feed our pets such enzyme-less food over an entire lifetime may contribute to the growing list of animal health problems we witness today including; osteoarthritis, inflammation, joint pain, hip dysplasia, pano, OCD, HOD, shedding, hair loss, dry skin, itchy skin, digestive disorders, gastritis, pet food allergies, epilepsy, fatigue, hot spots, and many other stress related symptoms contributed to by a weakened immune system.
The whole “living enzyme” argument is complete nonsense, and there is no evidence for the suggestion that commercial diets are nutritionally deficient or responsible for this long, redundant list of random symptoms and disorders. Some of these problems may be related to nutrition, but that has nothing to do with the claim made here, which is baseless.
But the pseudoscientific nonsense doesn’t stop there. The web site also blames pet food, vaccines, and medications for a variety of ailments, again without paying any attention to the real, and complicated, risks and benefits of these interventions. Classic quack nonsense like claims about the Pottenger cat “study,” about boosting the immune system, about mysterious “toxins” as a cause of unrelated diseases, and about Candida yeast infections as a common cause of many health problems are all over the company web site.
So, what are they selling with all this fear? Apparently, miraculous panaceas with uncounted benefits and absolutely no risks! Since they aren’t allowed to claim they can actually prevent or treat any disease without having evidence to support it (though they effectively do, despite the Quack Miranda Warning here and there), they promise to “support”
I like how they throw in “Healthy Organ Function” and “General Overall Wellbeing” just to cover any possible body part they might not have thought of. So if you’re afraid the imaginary causes of illness they mention have caused your pets’ problem, or might cause something bad someday, you can take comfort from knowing they this product can treat or prevent absolutely everything (except when it can’t, in which case it’s because of the food, the water, the medications, or anything else except the lack of benefit of their product).
What, exactly, are the miracle elixirs offered by Nzymes.com?
Ox-E drops This consists of 5% sodium chlorite, a chemical related to bleach. Properly diluted, this chemical is a safe disinfectant, killing infectious organisms through oxidation. With a pH of 13, if not diluted the chemical can cause burns, especially to the eyes and mucous membranes. Accidental overdose can be fatal.
The company advertises this as helping in “the removal of potentially dangerous free radicals and toxins,” and claims that is boosts the immune system, supports digestion, and enhances “performance.” Impressive claims for a potentially toxic disinfectant that is actually an oxidant rather than an anti-oxidant.
As the accompanying quack Miranda warning attests, and a simple literature search confirms, there is absolutely no evidence for any of these claims. Plenty of testimonials are offered, of course, which is always the evidence of choice for products that are based on pseudoscience and have never been tested in any reliable way.
Antioxidant Treats The antioxidant hype is a common marketing ploy for supplements because it’s vague, and there is enough suggestive preclinical research to suggest the general idea is plausible. Unfortunately, there are few clinical trials which show significant real benefits from particular anti-oxidants in particular conditions, and the evidence is growing that some such agents, such as Vitamin E, can actually increase the risk of disease.
The specific ingredients include Vitamin A, Vitamin C, Vitamin E, and a proprietary freeze-dried sprouted soybean meal claimed to contain:
These amounts are probably not high enough to cause harm, but given that most pets are fed diets already supplemented with more than enough of each, the amounts in this product are unnecessary as nutrients. The use of excess amounts of these vitamins as medicines to prevent or treat disease, is not proven, and has often turned out to do more harm than good when tried in humans.
As for the sprouted soybean meal, there is no scientific evidence to suggest health benefits from this either. The company sites a variety of epidemiological studies in humans indicating an association between eating tofu or other soybean food products and lower cholesterol levels, rates of some cancers, and a few other health problems. (They do not, of course, refer to any of the research in humans showing lack of benefit or potential risks from soy supplement products). All of this, unfortunately, is entirely irrelevant to whether or not this particular soy-based product has any benefits for dogs and cats.
The amino acids, vitamins, and minerals listed are all provided in adequate amounts in good quality commercial pet foods. The enzymes are of no benefit, particularly when taken orally since they themselves are destroyed by normal digestion. And none of the phytochemicals have yet been demonstrated to have any health benefits in dogs and cats. So while it is unlikely to be harmful, to is an expensive way to get a few nutrients your pet probably already has enough of and some chemicals that may or may not have any health effects, positive or negative.
Black Leaf Tincture This is an herbal product containing black walnut extract, olive leaf extract, and cayenne in 75% alcohol(!). The usual vague and unscientific claims are offered about supporting the immune system, the circulatory system, the digestive system, and so on.
Black Walnut- There is insufficient evidence to support any of the claimed health benefits despite traditional use for a wide range of unrelated problems. There is some concern about possible toxicity, from the walnut itself and from possible fungal contaminates.
Olive Leaf- The evidence in humans suggests some possible beneficial effects on blood pressure and cholesterol levels, but it is weak and not conclusive. There is no eveidence on the possible effects in dogs and cats.
Cayenne- There is a fairly large amount of preclinical research suggesting possible benefits in humans, but little in the way of clinical trial evidence, and nothing in dogs and cats.
Probiotic I’ve written extensively about probiotics, and this is an area in which I think some real benefits are possible. Unfortunately, we have yet to develop an adequate understanding of the normal gut ecology to be able to influence it in significant ways, and the evidence for real clinical benefits from specific products varies from weak to non-existent. Nzymes.com does nothing to change this. Their product contains a variety of typical probiotic bugs, and there have been no clinical trials to show that the specific combination has any value. The product was tested, however, in a study looking at quality and label accuracy for veterinary probiotics. It was found to contain only 2.7% of the number of bacteria claimed on the label, suggesting even the ingredient claims made for this product may be questionable, much less the claims of health benefits.
“A Veterinary Study” The company does claim to have one rather large veterinary clinical study from 1989 showing that dogs with musculoskeletal pain benefit from its sprouted soybean product. The study was never apparently published, and the information provided on the web site does not make it possible to evaluate it extensively. Six unnamed veterinarians apparently diagnosed dogs with “musculoskeletal inflammation” based on their own exams and the opinions of owners. They gave the supplement to 387 dogs, and 340 of them were reported as improved in one of more of these measures: energy, alertness, stamina, appetite, and accelerated healing. Most cases improved within the first week.
This is almost a cartoon caricature of what a scientific study shouldn’t be. No randomization, no placebo control group, no standardized diagnostic evaluation, no objective diagnostic evaluation (all subjective), no clearly defined diagnosis, no blinding, no record of other conditions or treatments used, and no predetermined or even halfway consistent criteria for response. Any high school science class ought to be able to put together a better “study.” If this is the best the company has been able to do in over 20 years, there is absolutely no reason to believe they have any interest in the scientific validity of their marketing claims.
Bottom Line These products are being marketed with an impressive number of the myths and warning signs of snake oil and pseudoscience. The theories offered for why these remedies should help your pet range from complete nonsense to vague unproven hypotheses. There is no scientific evidence to indicate any specific benefit from any of these products for any particular condition in dogs and cats. All the testimonials in the world can’t prove any of the company’s claims to be true, nor can they guarantee that the products cannot hurt your pets. Just as there is little evidence regarding the claimed benefits of these products, there is little to demonstrate that they are safe.
As a Practice Manager, I only have four really big pet peeves – the annual process of quoting health insurance rates; salespeople who want to talk to me about my credit card processing rates; discussions about different types of suture (boring!), and…….yellow page ads.This week, I began the process of saying goodbye to the ads!
I’m sure we’re not the first practice to decide that this money is better spent elsewhere, but that doesn’t dampen my absolute joy in doing so.Our community sits at the convergence of geographical areas that are covered (of course) by multiple yellow page books – six to be exact- and once you’ve made the commitment to be in one or more, it’s hard to know which one you can live without. After years of debating with the practice owner, we’re going to try living without any of them.
I’ve endured an ongoing circle of yellow page ad discussions with my boss – “why do we need them?” as he’s signing all of the checks, and “why don’t we have a bigger ad?” when a client has mentioned their difficulty finding us.Over the years, we’ve reduced our ad size (though with the “discount” they were giving you before, the smaller ad is almost the same price), and done the “blind phone number” ad to track calls and revenue generated.It’s not that we don’t get something from the ads; it’s just no longer enough.
Here’s why we’re dumping them:
1.Our staff and families are a varied mix of the community – older, younger, professionals, kids in school, etc., and no one can remember the last time they personally opened a book…..it’s all internet now.
2.Even if someone out there does still use them, who’s to say that they diligently replace the old with the new, which means we’re still in many of their books from years past.
3.$7,692.00 per year can buy a lot of other types of advertising – my favorite being the way our practice financially supports a zillion community organizations.Now we can support a zillion and then some, and get a more positive response than we ever got in these books.
4.After a few months, I will never, ever, have to deal with another yellow page salesperson!The annual parade of these people who think they know our business better than I do, and want to “counsel” me on how to generate new clients, makes me want to stick my head under water.
So far, I’ve had the pleasure of delivering the news to a couple of reps…… both asked me to “take a few minutes and discuss how I would be otherwise spending our advertising money,” as if they could turn me around with a few magical words of wisdom.When I explained that such information was irrelevant to them, one even argued that it certainly was relevant, as they could show me how it would be a big mistake to leave their book. When that failed, she took the approach that we couldn’t have an internet listing if we didn’t have an ad in the book – apparently, she’s not aware that such information is NEVER removed from the internet (especially if you want it to be), so as long as we don’t change our phone number, we’ll always be there.Case in point – you can still find our number on the web under corresponding associate veterinarians who have been long gone from our clinic.
Two down, four to go…..it feels great to scratch one pet peeve off of my list, AND save several thousand dollars in the process!
“I brought you into the world, and I’ll see you out at the end.” These words have inspired me for over a decade and are the essence of why I became and vet and why I still love being one twelve years later.
They were spoken by a man I never met, but came to respect greatly - because his clients loved him so much. The man was Charlie Johnson, a Scotsman who started Parkvets in the charming little town of Chislehurst, Kent, back in 1979.
I took over the branch surgery where Charlie had spent his last few years prior to retirement looking after his old clientele. At times the going was difficult me, a fresh faced new graduate, because everyone clearly loved “Old Charlie”, the never-ending tales of his charismatic approach to vet medicine were a real throw back to the days of James Herriot. But at the same time they were nearly enough to give anyone a complex! I remember thinking that if I could get these clients to care just a fraction as passionately about my way of doing things as they did about Charlie’s I’d be delighted.
Then one day a dear client told me a story that touched me deeply. The tale was about her first dog ‘Bounder’ whom Charlie had delivered by Caesarian section. She went on to tell me how eighteen years later with many, many happy memories (and quite few visits to the vet under her belt), she had found herself back in the same consult room where it all began.
Charlie was there, as always, but by now Bounder was now struggling to live up to his name, so severe was his arthritis. It was clear to all that the time had come to ease his suffering.
As Charlie administered the final injection and Bounder slipped off into peaceful sleep, he quietly spoke the words that I have held in such esteem since, “I brought you into the world, and I’ll see you out at the end.”
So soft, so poignant, so caring.
It makes the hairs on my neck stand up just telling you about it. Those words really cut to the heart of why I personally chose to become a veterinary surgeon. For me it was a choice to be a meaningful part of a community I cared about and wanted to be a part of. But they also spoke volumes of the level of customer service and respect afforded to his patients. Charlie, who sadly died a few years ago, was from a bygone era where relationships mattered more than money.
Times have changed and I doubt that many of today’s graduates will ever look after one patient for as long a period. Now is the time of the more scientifically trained vet, the rise of the scalable corporate practice and who ever heard of staying in job for more than couple of years?
Society, to some degree, has changed as well. Now things seem more focussed on the individual over others. In other words, in little under a decade things have swung round to be the very opposite of everything Charlie stood for.
Today we are more aware of the need for a veterinary practice to generate profit (and rightly so). But the clinic that seeks to chase profit first without the client-focused approach of Charlie Johnson is surely doomed to failure. Could this lack of empathy and caring be one of the reasons why at a time when the pet-owner bond is at its highest, the number of client visits is falling alarmingly?
In a recession-bitten economy the time and effort you put into developing strong client relationships is what will see you through. It’s perhaps the best competitive advantage you’ll ever have because first and foremost I believe we are a service industry – not a scientific one.
Old Charlie’s clients respected and loved him because he respected them first. In fact he always put them first (often ahead of his business) and there is no doubt that even today, over a decade since he retired, Charlie Johnson’s name is still the stuff of local legend. A true local brand that was cherished by the community.
Yes things have moved on, and in many ways for the better. But in order to bring clients on the journey with us, we must not forget the skills and charisma of yesterday’s generation. If we can combine modern medicine and the generation of profits, with the charisma of Charlie and his peers, then we might just be onto something special.
This blog is dedicated to Charlie Johnson, Sam Duff and all those fabulous old vets who were and continue to be an inspiration to us all.
In the January issue of Vet Economics Vol. 52, No 1, Dave Nicol offers the recommendation to utilize more "persuasive language" and minimize options for pet owners. (Editor: Click here to read Dr. Nicol's column.) While I agree with some of the comments especially about what our client's hear, the tenor of his article suggests that we be more paternalistic in the way that we, veterinarians, speak to our clients. This recommendation is the exact opposite of what 30 years of evidenced based research points out in human medicine and which is being duplicated in veterinary research. I would offer up the 2nd edition of "Teaching and Learning Communication Skills in Medicine" 2nd Edition by Kurtz, Silverman and Draper. As a practicing veterinarian for 35 years as well as a communication's coach I would suggest that veterinarians seek to master the art of shared decision making which allows for a thorough back and forth communication with our clients so that they truly understand the options that they have as well as the risks and benefits associated with them. Money must be discussed within the realm of decision making, but too oftern we as veterinarians x-ray the client's pocketbook and make the misdiagnosis as to what they can and are willing to spend. Clearly, we all know that there are some clients who strictly work by the numbers but opening a dialogue, giving the pet owner a good opportunity to explain what they are looking for and then discussing the appropriate options will get much greater results and improved outcomes, than being overly persuasive to your personal beliefs.
I was a pre-med in college and had every intention of going to medical school. In fact, as a high school senior I was accepted into a program which guaranteed me admission into medical school as long as I maintained an acceptable GPA throughout my undergraduate career. It wasn’t until my senior year as an undergrad that I decided to apply to vet school instead of med school.
There were two factors which affected this decision. First, I was taking a couple of fascinating classes relating to animals. One was called Human-Animal Relationships and explored the ethical, biological, evolutionary and economic facets of our relationships with animals, whether companion, farm, wildlife, research, or zoo. The other was Comparative Anatomy, in which we followed the anatomical and physiologic constancies across species, from shark to frog to cat to human.
The second factor was my pre-med classmates. The majority wanted to be doctors because their fathers were doctors, or because they craved the prestige and wealth. Most of them didn’t want to be doctors to help people, to cure the ill or heal the injured. I had already spent four years in classes with that bunch of jerks and couldn’t face another four. So I went to vet school instead. Veterinarians as a rule are overworked and underpaid, so we’re all in this to help animals and people, not to get rich and famous.
The Fourth of July confirmed to me that I made the right decision back in college. One patient I saw was a leopard gecko named Athena. Although I don’t technically treat exotics like birds or reptiles, they occasionally find me anyway. Athena had tried to eat a decorative plastic cactus from her cage, but her eyes were bigger than her gullet and the faux cactus was stuck in her throat. I held her mouth open and my technician gently pulled out the plastic. Athena was fine and her humans were appreciative.
Later in the morning a middle-aged male cat named Al was brought in by his concerned people. They said he had been straining in his litter box but was only able to produce a few drops of blood-tinged urine. I ran blood work and x-rays on Al, and found that he had bladder stones, several of which had migrated down into his urethra preventing him from urinating. So I anesthetized Al, flushed the stones up into his bladder, and surgically removed them from the bladder. When he woke up he was able to pee comfortably and looked content, enjoying his pain medications.
All day I was working sick, and by the afternoon I was coughing and wheezing and was pretty sure I had bronchitis, so I left early to go to InstaCare. There I was seen by a forty-something white male physician. I was wearing scrubs with a doggy-and-kitty print, so it was fairly obvious where I’d come from. He asked where I worked; I told him the clinic name and added, “I’m a vet.”
“What do you do there on a holiday like today?” he asked.
“Well, I did a cystotomy on a cat today.”
“Really?” He smiled and I thought he was impressed. But then he added, “Do you have a vet there or is he on call?”
“Umm, I am the vet,” I said. What I wanted to say was, “He? Were you not listening when you asked me three minutes ago where I work? Why do you assume a vet must be a man? I know for damn sure there are plenty of women physicians in this very hospital. And do you really think so little of veterinary medicine that you assume that a random lay person could do a feline cystotomy?”
What a jerk. I saved lives while he insulted his patient. I treat any species and do everything—from internal medicine to surgery to dentistry. I’m not rich but my patients and their families benefit from my skills.
Blog Posts With the Most Comments
dog training gone bad dog training gone bad
http://channel.nationalgeographic.com/series/dog-whisperer/3252/Overview#tab-Videos/05198_00
Many of you may be aware of a National Geographic television show featuring a charismatic individual who helps dog owners. I recently came across this video on the website and I urge you to watch it (preferably without the sound so as not to be distracted by his talking) and keep your eye on the dog. Here is what you will see:
Within the first 5 seconds, the handler kicks the dog in the abdomen. When the dog turns toward him he is jerked off his feet. A struggle ensues where the handler gets bitten several times and the dog is seen to be struggling for air. Finally he gets the dog onto the ground and the dogs tongue is blue and the dog is gasping for breath. When he finally gets the dog up it appears that there might be urine on the ground and that the dog voided his bladder in distress.
What you have witnessed is not dog training but abuse. Not only does the dog suffer, but clients are at risk if they attempt these interventions themselves. These are not appropriate measures and compromise the welfare of the dog and the safety of people. His explanations are false and not based on science as we know it. We as veterinarians must make our voices heard and let National Geographic and most importantly our clients know that these types of interventions are wrong and not in the best interest of dogs or people.
As a veterinary behaviorist I have dealt with behavior problems in companion animals for over 25 years and would never confront a dog this way. Not only would it be dangerous for me and the family, it would be harmful for the dog. My goal is diagnose the problem, and design humane treatment plans that help the family change the behavior of their dog so that they can safely live together. I hope all veterinarians can agree that this is the best approach.
I would love to hear your thoughts. Most importantly, go to the link and scroll down the page to “contact us” and click on that. Let National Geographic know what you think.
Thank you for your time
Debra F. Horwitz, DVM, DACVB
Defense of Spay Neuter Clinics Defense of Spay Neuter Clinics 2.0
I was disappointed to read the “Hot Button” column in the November issue of Veterinary Economics. Despite a number of concerns facing the veterinary industry today, VE elected to print the second submission in seven months by the same author, and, more or less, about the same topic.
In devaluing low-cost spay and neuter (LCSN) clinics, Dr. Craig Woloshyn (who is credited as a member of the VE Advisory Board) has even used some of the same language that was printed in his April 2010 article. I responded then, and feel compelled to do so again.
To be certain, I am not a spay/neuter activist – I manage a multi-doctor mixed practice in rural Oregon. We have worked extensively for years with our local shelter and other providers of LCSN programs and continue to run one specific program of our own. Our practice grosses seven figures; our Doctors and staff, as well as myself, are all paid well above the nationwide average salary for our positions – all with a fee schedule that continues to be a bargain by some standards.
My problem is two-fold. First of all, Dr. Woloshyn is wrong…..LCSN programs can be a productive component of fighting pet overpopulation. I don’t have to be a DVM to understand that, with respect to social problems, failing to act has an exponentially negative effect, even if taking action falls short of our desired outcome. Unless he is suggesting that cats and dogs would reach a “nature imposed” population ceiling if allowed to breed freely, then the case can be made that the problem would be much worse if not for our industry’s efforts.
So if we can agree that altering pets improves, even if slightly, the forecast for population, the subject of low cost programs is still left to debate. In the past, our practice typically performed a total of 300 feline spay/neuter procedures per year, and that number was the same from year to year despite economical changes and our practice growth. After expanding our cooperation with local humane organizations and creating our own in-house low-cost cat neuter program, that number rose to nearly 1,000 procedures per year. For anyone doing the math, that’s 700 cats per year that are no longer procreating, and while that may not dent Dr. Woloshyn’s 40% unaltered statistic, it’s certainly a move in the right direction.
Though pet overpopulation pales on the list of other social problems that we face in this world, it’s a relief to know that the same approach is not being applied to decisions about other issues such as famine, illiteracy, or disaster relief. What kind of world would it be if we only applied our resources where total success could be achieved?
My second problem is the decision to print what is essentially a retread of old ideas. All I seem to read lately is ‘101 ways’ for consultants to say the same thing…..Veterinarians should charge more and stop worrying about it. Continuing to focus on this one issue (which we all decide on our own anyway) is shortchanging the need to hear about real problems. For every veterinarian who under charges, there is one who overcharges (that is a blasphemous statement, no doubt), and who’s business is that but their own?
Lower cost practices can’t damage the industry…have you ever seen an association of fine dining establishments lobby to eliminate McDonalds? Instead, they understand the concept of target marketing, and creating (selling) the “experience” of a customer visit, not to mention great food. Here’s an interesting exercise for managers – ask your clients to rank their priorities for a visit to your practice (I have). It’s a truth most would rather not hear, but many clients put the resolution of their pet’s medical problems way down the list - often behind customer service, thorough explanations, wait time, convenience of hours, cost of services, etc.
The veterinary industry faces many serious issues - the evolving role of the certified technician; the lack of business preparation in new graduates; how to bridge the mentor role from one generation to the next; the role of staff in “training” new graduates; and the inconsistency of state’s practice acts, to name just a few. Isn’t it time to break some new ground and get outside of the box? I admit, 15 years ago, I was fascinated by the cutting edge advice from veterinary management experts, but that excitement has been replaced by the feeling that today’s consultants are still singing a few really old songs.
critical thinking critical thinking
A friend forwarded this essay to me; I felt it was important to share. Whatever choice you make in November, please do it with care.
Eve Ensler, the American playwright, performer, feminist and activist best known for 'The Vagina Monologues', wrote the following about Sarah Palin.
Drill, Drill, Drill
I am having Sarah Palin nightmares. I dreamt last night that she was a member of a club where they rode snowmobiles and wore the claws of drowned and starved polar bears around their necks. I have a particular thing for Polar Bears. Maybe it's their snowy whiteness or their bigness or the fact that they live in the arctic or that I have never seen one in person or touched one. Maybe it is the fact that they live so comfortably on ice. Whatever it is, I need the polar bears.
I don't like raging at women. I am a Feminist and have spent my life trying to build community, help empower women and stop violence against them. It is hard to write about Sarah Palin. This is why the Sarah Palin choice was all the more insidious and cynical. The people who made this choice count on the goodness and solidarity of Feminists.
But everything Sarah Palin believes in and practices is antithetical to Feminism which for me is part of one story -- connected to saving the earth, ending racism, empowering women, giving young girls options, opening our minds, deepening tolerance, and ending violence and war.
I believe that the McCain/Palin ticket is one of the most dangerous choices of my lifetime, and should this country choose those candidates the fall-out may be so great, the destruction so vast in so many areas that America may never recover. But what is equally disturbing is the impact that duo would have on the rest of the world. Unfortunately, this is not a joke. In my lifetime I have seen the clownish, the inept, the bizarre be elected to the presidency with regularity.
Sarah Palin does not believe in evolution. I take this as a metaphor. In her world and the world of Fundamentalists nothing changes or gets better or evolves. She does not believe in global warming. The melting of the arctic, the storms that are destroying our cities, the pollution and rise of cancers, are all part of God's plan. She is fighting to take the polar bears off the endangered species list. The earth, in Palin's view, is here to be taken and plundered. The wolves and the bears are here to be shot and plundered. The oil is here to be taken and plundered. Iraq is here to be taken and plundered. As she said herself of the Iraqi war, 'It was a task from God.'
Sarah Palin does not believe in abortion. She does not believe women who are raped and incested and ripped open against their will should have a right to determine whether they have their rapist's baby or not.
She obviously does not believe in sex education or birth control. I imagine her daughter was practicing abstinence and we know how many babies that makes.
Sarah Palin does not much believe in thinking. From what I gather she has tried to ban books from the library, has a tendency to dispense with people who think independently. She cannot tolerate an environment of ambiguity and difference. This is a woman who could and might very well be the next president of the United States . She would govern one of the most diverse populations on the earth.
Sarah believes in guns. She has her own custom Austrian hunting rifle. She has been known to kill 40 caribou at a clip. She has shot hundreds of wolves from the air.
Sarah believes in God. That is of course her right, her private right. But when God and Guns come together in the public sector, when war is declared in God's name, when the rights of women are denied in his name, that is the end of separation of church and state and the undoing of everything America has ever tried to be.
I write to my sisters. I write because I believe we hold this election in our hands. This vote is a vote that will determine the future not just of the U.S. , but of the planet. It will determine whether we create policies to save the earth or make it forever uninhabitable for humans. It will determine whether we move towards dialogue and diplomacy in the world or whether we escalate violence through invasion, undermining and attack. It will determine whether we go for oil, strip mining, coal burning or invest our money in alternatives that will free us from dependency and destruction. It will determine if money gets spent on education and healthcare or whether we build more and more methods of killing. It will determine whether America is a free open tolerant society or a closed place of fear, fundamentalism and aggression.
If the Polar Bears don't move you to go and do everything in your power to get Obama elected then consider the chant that filled the hall after Palin spoke at the RNC, 'Drill Drill Drill.' I think of teeth when I think of drills. I think of rape. I think of destruction. I think of domination. I think of military exercises that force mindless repetition, emptying the brain of analysis, doubt, ambiguity or dissent. I think of pain.
Do we want a future of drilling? More holes in the ozone, in the floor of the sea, more holes in our thinking, in the trust between nations and peoples, more holes in the fabric of this precious thing we call life?
Eve Ensler
September 5, 2008
Help Clients Put Internet Misi Help Clients Put Internet Misinformation in Perspective
Recently, some negative statements have appeared on various blogs concerning Purina’s Beneful brand dog food. These allegations and misleading statements indicate that the product may cause specific problems, ranging from basic vomiting and diarrhea to death. These statements are not backed by any scientific studies, and the conditions described in the postings are amongst the most common conditions seen in everyday veterinary practice.
When a pet is sick, pet owners often look first to the pet’s food as the cause. However, it is rare that their food is responsible for the illness.
I’ve read through many of the current comments regarding Beneful and believe they do not provide any evidenced-based rationale for making such claims. Some of the comments mention illness resulting from a “one time feeding,” which in itself could be the cause of the gastro-intestinal symptoms described. A pet’s food should not be changed abruptly. Instead, whenever a new food is introduced, it should be mixed with the previous food on a gradual basis, over a period of a week to 10 days, to help prevent such symptoms from occurring. Other claims are that the dog suffered from chronic weight loss, or even death, but from these internet descriptions, it seems possible that these animals were ill to begin with and thus the diet (Beneful or otherwise) likely had nothing to do with the illness.
I have been a practicing veterinarian for over 40 years, specializing in small animal internal medicine and cardiology. During this period I also have participated in numerous pharmaceutical and food trials as well as writing scientific papers on the results of these clinical studies. I edit and am a contributing author of the Textbook of Veterinary Internal Medicine, a book used throughout the world by veterinary students and clinicians for up-to-date, timely and peer-reviewed information on veterinary medicine, including nutritional aspects of medicine.
While in practice, I have trained externs (preveterinary school graduates), interns (first year veterinary graduates) and residents (graduates pursuing a specialty). One of the hallmarks of the training (and that at accredited veterinary institutions) is the need to look for empirical evidence regarding statements made about diseases, drug therapies, surgical techniques and nutritional requirements. To lay blame on one particular product without substantial studies as proof of claim is inappropriate and misguided.
As someone who has worked in the industry for years, including work with Purina, I have been impressed with Purina’s quality and safety standards. Purina pet food products are made under rigorous quality supervision. Prior to making accusations that may be unfounded, it is first necessary to investigate the actual cause of a dog’s illness. Veterinary scientists can help to identify causes of illness and death and should be consulted for their expertise before making broad statements that have not been shown to have a scientific basis.
I do agree that ANY abnormalities noted by pet owners should be brought to the attention of their veterinarian, and any concerns with a particular product should immediately be brought to the attention of the manufacturer so that information can be collected and products appropriately monitored. The veterinarian and the pet owner then can decide whether to contact the FDA, as well. To date there has been no evidence that Beneful has caused any problems when fed to dogs. Poison control groups have not expressed any concerns, nor has the FDA.
As a final remark, I might mention that my own dog, Katie, a happy, healthy 8-year-old Newfoundland has been fed Beneful virtually all of her life. I feed her Beneful because she is a very fussy eater and has refused every other dry food we have tried. Neither cost, nor for that matter, contents are the reason for her getting this food, but rather her own preference. Until I am aware of there being a real reason to discontinue any pet food product made under such rigorous standards and controls, I will continue to feed her the product she chooses to eat.
Dr. Stephen Ettinger is a world-renowned veterinarian with more than 40 years of experience in the veterinary care industry. His areas of expertise include small animal veterinary internal medicine, small animal cardiology, hospital management and professional veterinary development. He continues to practice small animal medicine and works with a number of animal health companies, including serving as the Nestlé Purina Fellow in Veterinary Medicine and as a spokesperson for Purina Care pet insurance.
Twitter Twitter
Writing and blogging, when I finally tried it a few years back, came easily to me. Facebook and Skype did as well. Twitter was difficult. I gave up a few times. I am so glad I did not give up entirely, as I would have missed out on so many special friendships and links to great information, in the veterinary community and world at large. In case it is as strange to you as it was for me, here are a few starting points. Try it. Then try it again. I hope you find the twitter forum as rewarding as I have!
Start with a personal account. Most of the veterinarians on twitter with whom I engage speak for themselves, not their practice. This gives more freedom to say random, un-veterinary things. If you want to say, “prevent heartworm disease in your pets” in one tweet, then “my dog just did the cutest thing!” then “I got some great sweet corn at the Farmer’s Market today!” no one will say, “Well that’s a weird train of thought for a veterinary professional!” And you do not need to worry that you are representing your business.
But remember that you ARE representing your business. People DO know that you are a vet, and in a few clicks of the mouse, they can find out where you practice, if you have not bragged about it endlessly in your tweets and profile already (which I think you should, by the way.) So…
Keep it clean.
Be kind. I suppose “be kind” is also self-explanatory. Still, twitter is much more fun if everyone is kind. If you have a gripe about a company, send it to them in a DM (direct message). Then when they respond, you can tweet that - “You would not believe how quickly @GreatCompany resolved an issue for me! Thank you @GreatCompany :)”
Be twitter-kind. Twitter has its own quirks that you would not automatically know. Not shouting (THIS IS SHOUTING) is kind. “Retweeting” (Repeating another’s tweet and giving them credit) is kind. Following someone who follows you is kind. Talking directly to others using @ followed by their twitter name is kind.
Be as good at patient confidentiality as you are in Real Life. Do not share patient and client information without the permission of your client and your veterinary hospital leadership. Even with blessings all around, do not share specific medical information about a specific case.
Yes: (with permission of boss and client and photographer) “How cute is my patient?? http://twitpic.com/mjpib”
Even better: (less permission-getting needed) “How gorgeous is my cat?? http://twitpic.com/sh0of”
Follow people you would enjoy getting to know. When I started twitter, I followed family members and friends, veterinarians and other pet lovers and people in Omaha. In hindsight, that was one thing I got right from the beginning.
Keep tweeting till it makes sense. My brother Dave convinced me to start twitter, because he knew I could reach a larger audience with pet preventative care information. For several months I would open twitter, watch the time line of the people I had followed, close twitter, and sigh, “I just don’t get it. It’s like facebook without the fun pictures.” Dave would smile and say “Don’t give up” and I would repeat the process: open twitter-check timeline-close twitter-sigh-gripe. Till one day, I did get it. “Hi how’s it going?” someone tweeted. “Great” I tweeted back. Hey, this was fun! It was like waving to a neighbor, only it was ok if she was three states away…or around the world!
Start a hospital twitter account. Oo, I have not done that yet…maybe that is my next great adventure… :)
Poop = Self-improvement Poop = Self-improvement
The door from the garage at the base of stairs creaks open. Take a deep sniff, and check the downstairs cat box. Poop’s in the box.
Take the stairs slowly, looking for vomit next to the front door. Clear. The living room, steam cleaned again and again by my wife and I, is still free.
A few more stairs, wide-eyed watching in the twilight darkness for a wet mess, and then I’m in the kitchen. We’ve had a few pee problems in the corner, but it looks clear.
Now down the hallway to the cat room (everything’s in the litter, where it should be), the 1-year-old’s room (no mess in front of the dresser like before), and then our bedroom. There’s never been poop in our bedroom, but, y’know, who can tell?
Some might see this as a horrific situation, and it sucks. One cat has a bad day and craps on the carpet, and over the course of the day a perfectly normal spot on the carpet turns into a litter-less toilet.
Me, I try to be positive about it. I think these cats are teaching my wife and I to be better people.
We once had two cats and one cat box. Now we’ve followed advice and have five litter boxes (four cats plus one).
We once cleaned the cat box once every 36 hours or so. Now it’s twice a day like clockwork.
We once figured the cats were upset at us for something we did when we found pee or poop. Now we figure they’re a) sick, b) freaked out about the cat box for some reason, or c) being inscrutable. But we try not to take it personally.
And I look to the future for consolation today in my fight against occasional vomit and piles of diarrhea in the house: When the 1-year-old’s moving from diapers to toilet, there’ll be a mess or two—far bigger than the cats’.
These cats? They’re like gardeners, tending the better fruits of my mental garden: patience, understanding, sympathy.
Thank you, cats, for all your fluids. Your messes have made me a better man.
Should I buy or adopt? Should I buy or adopt?
Not long ago, a good friend of mine took his girlfriend to a local pet store to look at puppies. They fell in love with a little Yorkie, and posted pictures online of themselves playing with the dog. She was a cutie, for sure, but this particular store doesn’t have the best reputation in the dog community. I was tempted to call my friend and beg him not to buy the puppy. I wanted to tell him about the horrible rumors I’d heard about where pet stores buy their dogs and the terrible things some of these puppies are subjected to.
But then again, who am I to judge? Ultimately it was their decision, and I had no place intervening. I certainly wasn’t going to become the type of person who judges someone based on where they get their dog. Still, I was quite relieved when they eventually decided not to purchase the dog.
Today, I’m experiencing my own internal struggle. My wife and I are ready to add a new canine member to our family, but can’t decide where to look. Do we buy a puppy or adopt a shelter dog? It’s a question I’ve been trying unsuccessfully to answer for months now.
As I wrote about recently, our first attempt at adopting a dog didn’t go so well. Thankfully, Tyson is doing great in his new home and loves his new family. But the whole ordeal left a bad taste in my mouth. How can I trust that another rescue dog’s behavior won’t change completely once we get him home?
I’m well aware that there are thousands of amazing shelter dogs looking for homes. Most of them have no aggression issues and will fit right in if given a chance. But after the Tyson ordeal, I can’t afford to make a mistake. Giving him up was one of the hardest things I’ve ever done, and I don’t want to go through that again.
After working at a dog daycare and boarding facility through college, I’m pretty knowledgeable about dog breeds and personality. The problem is that I like too many of them. I like English bulldogs, vizslas, golden retrievers, and Weimaraners, I like German shorthaired pointers, boxers, Great Danes, and Boston terriers. And of course, I like mutts.
I search for dogs nearly every day. I look in the local paper’s classifieds for puppies from breeders. I scour through rescue groups’ websites. I search comprehensive adoption sites. I browse through city shelters’ listings. I can’t decide exactly what I’m looking for, but I hope it will become clear once I see the perfect listing.
As much as I’d love to “do the right thing” and adopt a dog, I can’t help but be scared of how he might turn out. What if he’s been abused and harbors aggression toward people? What if the shelter is unaware of the fact that he bit a child in the past? I’m more than willing to be patient and work with a dog to curb behavior issues, but I won’t put my family in danger.
So where do I go from here? It seems everyone has an opinion on the matter, but when it comes down to it, my wife and I will have to decide what’s best for us. In all honesty, I’m not as concerned with where the dog comes from as I am with finding one that fits with our lifestyle and will become a loyal, loving family member. I guess all that’s left is to find the perfect one.
Let's get organized! Who's wit Let's get organized! Who's with me?
Today, I'm taking the first step toward getting organized here at work. There's something about the start of the New Year that really inspired me this time (probably for the first time in my life). Here's the deal: I've stared down the same unruly, unorganized file cabinet drawer for three years. For some reason it has never bugged me until, oh, last week. It used to be a drawer I never had to venture into very often, but as my job duties have evolved, I find myself filing and retrieving more items out of the drawer. I've become the Keeper of Things on the Veterinary Economics team.
Anyway, here's a peek into my drawer. Now quickly look away before it burns your retinas!
The tri-cut file folders are overlapping, making it hard to thumb through and find what I need. There's no real system in place for how the stuff is filed. Labels have whiteout all over them. And then there's my terrible handwriting in several different colors. The tabs are worn—and that boring manila color ... ugh!
Time to take action. I just ordered a label maker after coveting the one that belongs to my editor, Kristi Reimer. You wouldn't believe the way that label maker transformed her file drawer. It's going to be agony waiting the 3-5 days for shipping!
So stay tuned. I know you're all breathlessly awaiting the "after" photos. That is, if your retinas are still functioning.
[Update 1/19/09: Here's a link a photo of the final results]
Pit Bulls and Dangerous Dogs Pit Bulls and Dangerous Dogs
Last spring I gave a presentation on dog first aid for a group of people involved with therapy animals. While discussing the first aid of dog fight wounds I mentioned that most dogs will bite each other on the back of the neck and shoulders, but that pit bulls tend to go for the throat. I received a nasty email after the presentation; some of the attendants had pet pit bulls and objected to my statement, accusing me of perpetuating unjust beliefs about pits. Yes, I made a generalization, but I think it’s a fair assessment.
One argument that people make is that “there’s no such breed as a pit bull.” It’s true that there is no AKC-registered breed called a Pit Bull (there are American Staffordshire Terrier and Staffordshire Bull Terrier), but just do a quick search for pit bull puppies on craigslist and you’ll see that it’s a real breed. I use “pit” as a somewhat generic term for stocky, smooth-haired dogs with block heads and huge, powerful jaws. They’re a dime a dozen in Salt Lake. And, yes, they are used in pit fighting rings.
Pits are usually very sweet, stoic patients, even when seriously injured. I’ve seen pits stabbed, shot, and dragged behind trucks, and they sat placidly for veterinary care. It’s very rare that we have to muzzle one to handle it (unlike, for example, Chow-Chows, Shar-Peis and Rottweilers, of which the great majority are muzzled). My understanding is that fighting pits who attack humans are summarily killed, thus selecting fairly immediately for dogs who are gentle to humans. At least that’s the case around here. However, I know a vet who lives in Florida and she reports that the pits there are frequently involved in attacks on humans, often fatal. In June, an elderly man was working in his yard when he was attacked by two neighbor pit bulls. They severed one of his arms, and he later died in the hospital.
The pits in this area, while usually gentle with humans, are hell on other animals. I’ve seen a German shepherd with its trachea ripped; a Shih-Tzu with a lacerated spleen from being dragged under a fence; a Chihuahua with its intestines dangling out of an abdominal laceration; and numerous DOA pets—all from pit bull attacks. Pits have enormous jaw strength and when they clamp down they don’t let go. One of my favorite patients, a little mix who looks like Bolt from the Disney movie, nearly became a Scooby Snack for a pit. His mom was walking him on leash at the park when a pit burst out of its house across the street and made a beeline for him. His mom yanked him up by his leash and collar and shielded him with her body. Luckily for her, the pit wasn’t human-aggressive.
This past week in Salt Lake, a service dog for a blind man was attacked and critically injured by two pit bulls. The pits were running loose, and three people were bitten trying to remove them from the service dog.
There is a good resource called the KC Dog Blog: Unofficial Watchdog on Animal Welfare Issues. The blog owner posts about a variety of issues, including dog attacks, and seems to be objective in the presentation of facts. Various dog breeds are involved in human fatalities, from shepherds and Labs to huskies and pits. The blog owner states that “it is impossible to judge the actions of dogs without judging the actions of the people that surrounded the dogs.” And that’s certainly true. For example, in the case of the little old man with the severed arm, the two dogs had been involved in previous incidents of human-directed aggression. Neither the local authorities nor the dogs’ owner acted to prevent further attacks. Those dogs should have been euthanized long ago.
There’s an ongoing debate about dangerous dog legislation and breed-specific legislation, with arguments pro and con. My personal feeling is that there are some breeds which are inherently dangerous, but where do you draw the line? Who makes the call on an individual dog’s breed composition? What about mixed breeds? Which breeds should be banned? One of my own dogs is a German shepherd mix and I would trust her with a preschool full of children, but other shepherds have fatally attacked people.
There are exactly three Rottweilers that I trust in my practice—every other Rott gets a muzzle, no questions asked. I would rather offend an owner by muzzling his precious than risk my face and livelihood. Other breeds that generally scare the crap out of me are Cane Corso, Dogo Argentino, Fila Brasileiro, and Presa Canario. Those breeds are all big and aggressive, and I wouldn’t let one within thirty feet of my kids. Some were bred to hunt down and kill escaped slaves. Great, huh? Do you want a breed that was bred to be a companion or one that was bred to be a man-killer? I recently had a client, with small child in tow, bring in her new dog who was supposedly a Cane Corso. She asked if I thought it was; my answer was, “She’s much too small and her face is wrong. I doubt she’s a Cane Corso, and honestly if I thought she was I would tell you to get rid of the dog before it kills your kid.” That opened her eyes.
Probably more effective than breed-specific legislation are laws which address aggressive dogs on an individual basis. Many dogs involved in fatal cases have documented prior attacks on animals or people, but are allowed to continue unchecked. After the first attack the dog should be required to be confined and/or muzzled at all times. If a second attack occurs there should be euthanasia for the dog and jail time for its owner.
And for the pit-lovers who objected to my comments, I would point this out: A pregnant California woman who was killed last month by her own pit bull “was an avid pit bull lover and supporter of Bay Area Dog lovers Responsible About Pit Bulls, or Bad Rap, a group that tries to change negative attitudes toward pit bulls.”
Tattoos and Piercings Tattoos and Piercings
I was in a discussion today about piercing and tattoos and if professionals should avoid them. Here are my thoughts on this. I think people should be able to do what makes them happy and comfortable. I also try my best to always judge people by their actions and not their appearance. On the other hand I certainly do know that extreme individuality makes people judge you differently and act differently and I bet it even holds people back from being successful. I meet lots of people and see lots of speakers and and everyone is very "normal" appearing but I would hope that if I went to a conference and there was a management topic I wanted to hear being delivered by a fully tattoo'd woman with an eye brow ring that I would still attend and not be distracted. I would hope that I would admire her individuality and right to do what she wanted that made her feel comfortable. On the other hand...would I hire her? Well based on my policy manual I couldn't but that would be the extreme. I have 2 staff with tiny nose studs and I myself am thinking of getting one. I find them very feminine and beautiful. I have staff with tattoos but most of them can't be seen. I too, have 2 tattoos but they only show in a bathing suit. I am trying to break in to the veterinary world as both a consultant and a speaker. I love my profession and am passionate about what I do and believe in. I have worked hard to earn my Associate and Bachelor Degree as well as my CVPM certification. would a nose stud make me less knowledgeable? I would hope not. So the debate rages on I guess. I may get the nose stud....and hope that I am not judged. I will see the speaker covered in tattoos but probably wouldn't be able to hire her as my receptionist. Not because I don't want to but because my policy manual for the practice I don't own states that I cannot. I would also feel that the extreme might be distracting and make clients uncomfortable. On the other hand a small nose stud or even a small tattoo on the back of her neck (I have staff with both of these) wouldn't bother me and I don't think would bother my clients. Why the difference? Small is not distracting and extreme is?? Not sure. What about piercings that are part of a culture? Is that more acceptable? I guess this is a debate that will live on. I hope the day comes when we are all judge solely on how we treat people and what our skills are. I wonder if that will ever happen?
Response to Pet Insurance Myth Response to Pet Insurance Myths
Myth: Dr Robin Downing’s client who can’t afford $5,000 for GDV surgery would have been able to, if they only had pet health insurance.
Truth: The insurance that Dr Downing promotes on her website has a basic plan for a 3 year old German Shepherd with an annual premium of $305, a $100 deductible and a $2,500 per incident limit. So for a $5,000 GDV surgery your out of pocket expense is $2,805. Deal or No Deal?
And if one thousand of your clients buy a $305 annual policy, they’ll spend $305,000 on pet insurance. At $100 per incident for the average annual visit cost those clients spend an additional $100,000. But wait, the basic plan doesn’t cover wellness exams, that’s an add on option. So your thousand insured clients just gave the insurance company $405,000, and you and they got NOTHING for it.
I know, I know. The ONE client who had the $5,000 surgery bill thinks it’s great. They at least recovered half their bill. But the way the insurance industry works, they have to collect more in premiums than they pay out in benefits...a lot more. So should you be RECOMMENDING insurance?
To maximize the use of the coverage your client would have to see you for a single visit where you charge no more than $3,225. The client will pay the $100 deductible and $625 (20% copay). The insurance will reimburse the client for the balance of $2,500. Keep in mind that one client has now received more benefits than they paid into the insurance plan. The insurance company has to sign up 9 more clients just to cover that bill.
What if you charge $481.25 for a visit? The client pays $100 deductible plus $76.25 copay. They receive $305 reimbursement. They’ve just been “paid back” for the annual premium. If the number of client visits per year that have a visit total more the $481.25 is low, then it probably is good for YOU to sign your patients up. Is it really good for them?
Myth: Pet insurance is like car insurance.
Truth: Well, yes and no. Pet insurance and car insurance are indemnity insurance. But car insurance is required by law, in case you hit someone else. Pet insurance doesn’t cover if your dog bites the neighbor’s kid, which might be a reasonable risk to cover. Car insurance is valuable because most people take out a loan to buy a car. If the car is totaled in an accident and you don’t have insurance, you’d be stuck paying off the loan, for a car than no longer works. And cars cost $10K to $80K; a much larger financial burden to replace. In addition, most people are dependent on transportation for survival. If the car doesn’t work, they don’t either.
Myth: The extra paperwork is minimal, and should just be part of providing great service. Heck you can even store the claim forms for each of the insurance providers and print out the one your client needs at the conclusion of each visit!
Truth: That was written by an insurance industry hack. Veterinarians already undercharge for their time and expertise. So now, you also should, for no additional compensation help a client fill out a form and comply with any complicated set of rules in order to be reimbursed.
We can learn from our friends in the chiropractic profession who bought all those same arguments. They also were initially happy that if chiropractic care were “covered” they were finally legitimized as a medical provider and more patients would seek care because it was covered. And obviously, to provide great customer service, we’ll start accepting payment from the clients for only the deductible, then bill the insurance for the balance and wait to get paid. Within ten years, the small, single doctor chiropractic office had to hire a full-time employee just to process the paperwork: rejections because the form wasn’t filled out corectly; the denials because the specific code wasn’t covered; the returns because the insured’s information didn’t match exactly what was on file.
Myth: Sure occasional clients will blame you when things go wrong, but that’s true with any service or company you might recommend, so you can just roll with the punches.
Truth: The insurance company has carefully made any payment delays YOUR FAULT. If the vet would only provide a copy of the medical records (which you already have, for the third time) they would be able to pay the reimbursement. If only the vet’s invoice used the proper diagnostic terms, we’d be able to pay. If your vet had just used a different diagnosis, it would have been covered. Maybe your vet can ALTER THE RECORD and use a different diagnosis so you can get paid. (Clients have actually asked me to do this, on the “implied” advice of the insurance provider). Dr Downing’s own blog actually suggests it is easy to alter what you name your services in order meet the demands of the insurance limitations
And if you decide the insurance companies AREN’T out to serve your clients, you can stop recommending them. BUT the client is still on an annual contract, so you’ll have to live with the negative repercussions of your recommendation for the balance of their contract. Frankly, clients understand that recommending a pet-sitting service is someone you have reason to recommend and your recommendations may change over time. But recommend an insurance company and you’re perceived to be part of the problems when they occur.
Myth: Providing pet insurance as an employment benefit to your employees is a great way to help your staff afford great pet care.
Truth: Many years ago a pet food company worked a deal with veterinary universities. They provided pet food at cost to students. After four years of buying their food, upon entering practice, many veterinarians naturally used, recommended and referred that pet food for their patients.
The same tactic will build the word-of-mouth for pet insurance. If your employees have the insurance provided as a benefit, they will only pay the deductibles and the copay. Hey, it’s great! But their unbalanced view of the insurance will lead them to proselytize for the insurance company. And employees are more likely to be high users of pet medical care.
Just as with human health insurance, the worst path for veterinarians is to see pet insurance become an employee benefit that our clients do not pay for out of pocket. When that happens you will see the insurance industry gain more control over what you can charge (by referring their policy holders to veterinarians who have agreed to a “fee schedule”). And you will most certainly have the added costs of additional staff time spent helping clients process forms, respond to insurance company requests for documentation, and the financing or “float” of your fees until the insurance company pays.
Insurance is great for the insurance company. But the insurance company only stays in business if they collect more premiums than they pay out in benefits. Now that you have a clear picture of how it works, consider this: clients would be much better off putting aside the $300 - $400 a year in an interest bearing savings account to pay for future unanticipated “large” pet medical bills. And the beauty is that if they don’t have the large medical expenses, the money is still theirs.
My first free veterinary clini My first free veterinary clinic held this past Saturday!
I organized our first Helping Hearts Free Veterinary Clinic. I first got the idea from a veterinarian on VIN who hosted a Pets In Need Clinic. Hers was a bit more extravagent then what I wanted to tackle so I designed this to fit the needs of my practice. She was kind enough to share her forms and I just had to edit them....great help. The date for the clinic was Saturday, May 16, 2009 and I have to tell you it was a great success. After I laid out a plan I contacted media to get the story out. We appeared on our local Fox, NBC and ABC stations to discuss this clinic. Wonderful warm and fuzzy marketing as well. I decided that it would be too time consuming to try to hold this based on income. I didn't know what a good income level requirement would be. Next, I thought about offering it to those who were on unemployment but that included some of my staff and though they definately had to make some life stlye changes they weren't to the point of needing free veterinary care. My solution? I had an application and requested they had a referral letter from a clergy member, case worker or social worker. We took applications for about a month. I contacted my vendors and suppliers and most of them were so kind and willing to help. We offered free physical exams, vaccines, FLVT and HWT, intestinal parasite screens along with sending home food, shampoo, flea/tick and heartworm prevention and more! I was freaking out Friday night when I counted 57 pets that we would see in the 4 hours. I had 100% of my staff donate their time and even some spouses who don't work with me. Each room had a DVM/ 2 tech team. We had 2 CST, 3 lab techs, kennel staff, floaters and even someone to man the brochure table and hand out food. We had a wonderful turn out and everyone was so thankful. We ended up seeing just over 60 pets that day! The feeling to be able to help was amazing!
Donna
Last night was not a good nigh Last night was not a good night
A cold wind had stopped blowing in last night around 7:30pm or so. The temperature had dropped outside our house by 20 degrees. The heater was doing its work.
My wife, in bed, turned to me. "Is there a cat outside?" she asked. I hadn't heard anything. Did one of our four felines, all indoor cats, get locked out accidentally? I walked down the hallway and was greeted with blood-curdling shrieks from our new 6-year-old adopted cat. I saw her on the other side of the dining room desperately trying to drag her two suddenly limp hind legs behind her along the floor. She was meowing and howling, again and again. My wife appeared in the hallway, and, down from my sitting on the floor, I told her Cassie couldn't move her back legs. "Can you get the magnet off the fridge and call VSEC right now?" I asked. VSEC is a pet emergency clinic just 10 minutes away from us. My wife wasn't sure I was being serious. I kid around too much, I guess.
The woman on the other end of the line heard Terri describe the fact that Cassie couldn't move her back legs. She told Terri to come in immediately. Terri and I took turns getting dressed and keeping Cassie relatively immobile on the carpet.
Five minutes later, a desperately panting, pained, screaming Cassie was in a carrier, and Terri and I were driving as calmly as possible down the dark streets. We turned into the parking lot and carried Cassie in to an empty lobby. Two serious-faced receptionists greeted us, and a veterinarian showed up seconds later and said she'd start an IV immediately.
Less than five minutes, as Terri finished the paperwork, a veterinarian ushered us into an exam room.
Cassie likely had some level of heart disease, and a blood clot had clogged blood flow to Cassie's back legs. Her rear legs were limp and cold. She was in an oxygen chamber to try to improve her breathing, but it wasn't helping much. There were no options other than euthanasia. He could perform more tests, he told us, but it would likely just confirm. We consented.
We signed forms and paid at the desk. A few minutes later, the doctor came back. He couldn't get Cassie to calm down enough to justify moving her out of the oxygen chamber. We could see her in the back.
A technician was holding Cassie by the scruff of her neck, her eyes looked like they were bulging with the necessary force. The doctor explained she was trying to chew out her IV, and they had to hold her to keep her stationary. Her tongue rippled, her howls echoed through the half-empty, shared emergency treatment room. My wife started crying hysterically. She couldn't touch Cassie, it was too terrible to watch her in pain.
The veterinarian administered a clear dose through the syringe into the IV drip. Cassie suddenly and unnaturally calmed, drool oozing from her mouth. Her eyes hung, half-open, half-closed. My wife couldn't bear to touch her, but I petted her head and neck as she lied there.
I thought, "All this pain will be gone for you really, really soon." I stay calm and rational in intense situations. I knew damn well what was happening when the doctor pushed the pink liquid into the IV. My cat was going to be dead in seconds.
I kept petting her. The technician looked sad and resigned. The doctor was apologetic. He wished we could have given us more time with her, but he explained it was best to end her suffering as soon as possible. Throughout this short visit of less than 30 minutes, he had explained to us at different times, in at least three different ways, that she was in pain and the best thing was euthanasia. He remained calm, sympathetic, and informative. He handled an intense situation of great sadness on the part of my wife and I with grace, authority, and sympathy. Did I already say sympathy? It's hard to write this. I'm repeating myself.
Anyway, last night my wife heard our black-and-white domestic short-hair cat Cassie cry out from the dining room 30 minutes before the doctor euthanized her. Cassie was the one we inherited fat, the one who would sleep between my legs despite my movement, the one who liked to open up petting sessions with a friendly head-butt on the hand. She was with us for only four months. My wife found her at a garage sale. She was a pretty cat and friendly. Cassie, a previously indoor cat, had been in the woman's garage for 18 months because a grandson was allergic.
When Cassie came to our house, she used to be friendly but also bit my wife on the hand a few times when she was being unpredictable: Did she wanted to be petted or didn't she? Cassie wound up loving my wife a lot, and my wife loved her.
Cassie spent her last four months of life sleeping indoors comfortably, receiving lots of affection from people, and some modicum of comfortable living with the other four cats.
I'm an editor, but I can't bear to edit this right now.
Cassie was a good cat, and it was a privilege and a gift to get to spend time with her.
Goodbye, Cassie.
Get your popcorn and take a se Get your popcorn and take a seat
The movie Beverly Hills Chihuahua opens today, amid some concerns that the movie may lead to rash Chihuahua adoptions, which would likely lead to an increase in abandoned Chihuahuas. I really can’t add anything to this argument except to say that, as we all know, not all pets are right for all people. Whenever possible, we should try to help owners make smart choices and steer them away from pets that don’t match with their lives. (Veterinary Medicine published an article on this in the October 2007 issue.) I know that I won’t be seeing the movie, not as a boycott but just because it doesn’t look very good to me. I am not enough of an animal lover to watch a movie simply because it has an animal in it.
Anyway, all of this is to say that seeing the advertisements for Beverly Hills Chihuahua got me thinking about animal movies that I really like. My top six animal movies in no particular order:
• March of the Penguins
• Best in Show
• Prancer
• Charlotte’s Web (the older, animated version—I have not seen the new one)
• My dog Skip
• Babe
White Fang is also up there but didn’t make my top six. It, along with Prancer and Charlotte’s Web, is a movie that I loved as a child and still really enjoy. Although not in my list, Turner & Hooch is also a good dog movie and has a Veterinary Medicine connection.
So do you agree with my choices? What are your favorites? I know I’m missing some obvious movies, such as Seabiscuit, Beethoven, and Benji. In some cases, that’s because I haven’t seen them, so make your case for why I should give these movies a watch—or another watch as the case may be.
What is Happening to Our Profe What is Happening to Our Profession?
Today’s post is one that has been on my mind for a while, and quite honestly, I have been a bit scared to write it. It is a conversation I have had with so many colleagues who feel the same way. Anyone who knows me can tell you that I am pretty optimistic (probably to a fault,) but I cannot keep denying what is right in front of me anymore.
I want to know what in the world is going on in our profession. Why in the world are veterinary students coming out of school with a mountain of debt and dicey job prospects at best? Beyond corporate practices, which are open 7 days a week, I do not know of a single animal hospital that is hiring a veterinarian. Now mind you, I do live in an area close to a veterinary school, but I also serve over 50 animal hospitals, and do you know how many of them are looking to hire a full-time veterinarian? NONE!
I know there are people who graduated from veterinary school 7 months ago and are struggling to find a full time job. I ran into one of them just last week, and thankfully, he does finally have a full time job prospect. Unfortunately, this problem is bigger than just veterinary students and is starting to affect veterinarians coming out of specialty training programs as well.
Meanwhile, what do we hear from the veterinary schools? Oh yes, they are all deciding to increase their class sizes or have already done it. Are you kidding me? Are US veterinary schools that out of touch with reality that they can’t see that the light at the end of the tunnel is actually an oncoming train? What will it take for them to see that we have a very serious problem developing in veterinary medicine?
Nothing personal against my alma mater, NC State, but I was visiting a friend who works there the other day, and we went into the junior surgery lab. It looks very different than it did when I was a student.
Now each surgical bay has a large screen monitor (like 42 inches) on the wall and a laptop. I asked my friend, “Why do they have all this in a junior surgery lab?” She said, “Well, you know we must keep up with all the other veterinary schools.” My thought was, “well we know whose back that is on”-the poor veterinary students. I am all for improved learning and technology, but really, when is someone going to stand up and say ENOUGH ALREADY!
I was talking to a college student this morning, and she was contemplating veterinary school. I told her as much as I love being a veterinarian, I am not sure I would recommend that she go to veterinary school. The amount of debt these young veterinarians must endure on top of limited job prospects and probably decreasing salaries is going to create a perfect storm of not good!
I believe a lot of people in positions of influence either have their heads in the sand on this issue or don’t want to speak up, but I think we can no longer deny what is happening before our eyes.
So what is your take on this perfect storm that is brewing, and what should we do to solve this daunting problem in our profession?
Nzymes.Com: Same Snake Oil, Di Nzymes.Com: Same Snake Oil, Different Day
Knowing that I have an interest in investigating the evidence behind claims for veterinary healthcare products, clients and colleagues sometimes pass along materials concerning veterinary supplements, herbal remedies, and other similar products and ask my opinion. Since there are hundreds, if not thousands of products marketed to pet owners to preserve or restore their pets’ health, I can only look into a few. However, the more of these I investigate, the more clearly I see the patterns of disregard for science and manipulation of the consumer that they have in common.
The latest in this category is a collection of products from a company called Nzymes.com. The website and pamphlet for this company exhibits nearly all of the warning signs of quackery. The company systematically tries to frighten the consumer by suggesting that pets cannot be healthy without their product and that the food and healthcare they are currently getting is inadequate.
The whole “living enzyme” argument is complete nonsense, and there is no evidence for the suggestion that commercial diets are nutritionally deficient or responsible for this long, redundant list of random symptoms and disorders. Some of these problems may be related to nutrition, but that has nothing to do with the claim made here, which is baseless.
But the pseudoscientific nonsense doesn’t stop there. The web site also blames pet food, vaccines, and medications for a variety of ailments, again without paying any attention to the real, and complicated, risks and benefits of these interventions. Classic quack nonsense like claims about the Pottenger cat “study,” about boosting the immune system, about mysterious “toxins” as a cause of unrelated diseases, and about Candida yeast infections as a common cause of many health problems are all over the company web site.
So, what are they selling with all this fear? Apparently, miraculous panaceas with uncounted benefits and absolutely no risks! Since they aren’t allowed to claim they can actually prevent or treat any disease without having evidence to support it (though they effectively do, despite the Quack Miranda Warning here and there), they promise to “support”
I like how they throw in “Healthy Organ Function” and “General Overall Wellbeing” just to cover any possible body part they might not have thought of. So if you’re afraid the imaginary causes of illness they mention have caused your pets’ problem, or might cause something bad someday, you can take comfort from knowing they this product can treat or prevent absolutely everything (except when it can’t, in which case it’s because of the food, the water, the medications, or anything else except the lack of benefit of their product).
What, exactly, are the miracle elixirs offered by Nzymes.com?
Ox-E drops
This consists of 5% sodium chlorite, a chemical related to bleach. Properly diluted, this chemical is a safe disinfectant, killing infectious organisms through oxidation. With a pH of 13, if not diluted the chemical can cause burns, especially to the eyes and mucous membranes. Accidental overdose can be fatal.
The company advertises this as helping in “the removal of potentially dangerous free radicals and toxins,” and claims that is boosts the immune system, supports digestion, and enhances “performance.” Impressive claims for a potentially toxic disinfectant that is actually an oxidant rather than an anti-oxidant.
As the accompanying quack Miranda warning attests, and a simple literature search confirms, there is absolutely no evidence for any of these claims. Plenty of testimonials are offered, of course, which is always the evidence of choice for products that are based on pseudoscience and have never been tested in any reliable way.
Antioxidant Treats
The antioxidant hype is a common marketing ploy for supplements because it’s vague, and there is enough suggestive preclinical research to suggest the general idea is plausible. Unfortunately, there are few clinical trials which show significant real benefits from particular anti-oxidants in particular conditions, and the evidence is growing that some such agents, such as Vitamin E, can actually increase the risk of disease.
The specific ingredients include Vitamin A, Vitamin C, Vitamin E, and a proprietary freeze-dried sprouted soybean meal claimed to contain:
The amount of the vitamins in the supplement are far in excess of what is recommended to prevent deficiency.
Vitamin A- 1000IU (recommended daily dose 50IU/kg, safe upper limit 2,099IU)
Vitamin C- 30mg (recommended daily dose 0, dogs and cats make their own)
Vitamin E- 5IU (recommended daily dose 1mg/kg)
These amounts are probably not high enough to cause harm, but given that most pets are fed diets already supplemented with more than enough of each, the amounts in this product are unnecessary as nutrients. The use of excess amounts of these vitamins as medicines to prevent or treat disease, is not proven, and has often turned out to do more harm than good when tried in humans.
As for the sprouted soybean meal, there is no scientific evidence to suggest health benefits from this either. The company sites a variety of epidemiological studies in humans indicating an association between eating tofu or other soybean food products and lower cholesterol levels, rates of some cancers, and a few other health problems. (They do not, of course, refer to any of the research in humans showing lack of benefit or potential risks from soy supplement products). All of this, unfortunately, is entirely irrelevant to whether or not this particular soy-based product has any benefits for dogs and cats.
The amino acids, vitamins, and minerals listed are all provided in adequate amounts in good quality commercial pet foods. The enzymes are of no benefit, particularly when taken orally since they themselves are destroyed by normal digestion. And none of the phytochemicals have yet been demonstrated to have any health benefits in dogs and cats. So while it is unlikely to be harmful, to is an expensive way to get a few nutrients your pet probably already has enough of and some chemicals that may or may not have any health effects, positive or negative.
Black Leaf Tincture
This is an herbal product containing black walnut extract, olive leaf extract, and cayenne in 75% alcohol(!). The usual vague and unscientific claims are offered about supporting the immune system, the circulatory system, the digestive system, and so on.
Black Walnut- There is insufficient evidence to support any of the claimed health benefits despite traditional use for a wide range of unrelated problems. There is some concern about possible toxicity, from the walnut itself and from possible fungal contaminates.
Olive Leaf- The evidence in humans suggests some possible beneficial effects on blood pressure and cholesterol levels, but it is weak and not conclusive. There is no eveidence on the possible effects in dogs and cats.
Cayenne- There is a fairly large amount of preclinical research suggesting possible benefits in humans, but little in the way of clinical trial evidence, and nothing in dogs and cats.
Probiotic
I’ve written extensively about probiotics, and this is an area in which I think some real benefits are possible. Unfortunately, we have yet to develop an adequate understanding of the normal gut ecology to be able to influence it in significant ways, and the evidence for real clinical benefits from specific products varies from weak to non-existent. Nzymes.com does nothing to change this. Their product contains a variety of typical probiotic bugs, and there have been no clinical trials to show that the specific combination has any value. The product was tested, however, in a study looking at quality and label accuracy for veterinary probiotics. It was found to contain only 2.7% of the number of bacteria claimed on the label, suggesting even the ingredient claims made for this product may be questionable, much less the claims of health benefits.
“A Veterinary Study”
The company does claim to have one rather large veterinary clinical study from 1989 showing that dogs with musculoskeletal pain benefit from its sprouted soybean product. The study was never apparently published, and the information provided on the web site does not make it possible to evaluate it extensively. Six unnamed veterinarians apparently diagnosed dogs with “musculoskeletal inflammation” based on their own exams and the opinions of owners. They gave the supplement to 387 dogs, and 340 of them were reported as improved in one of more of these measures: energy, alertness, stamina, appetite, and accelerated healing. Most cases improved within the first week.
This is almost a cartoon caricature of what a scientific study shouldn’t be. No randomization, no placebo control group, no standardized diagnostic evaluation, no objective diagnostic evaluation (all subjective), no clearly defined diagnosis, no blinding, no record of other conditions or treatments used, and no predetermined or even halfway consistent criteria for response. Any high school science class ought to be able to put together a better “study.” If this is the best the company has been able to do in over 20 years, there is absolutely no reason to believe they have any interest in the scientific validity of their marketing claims.
Bottom Line
These products are being marketed with an impressive number of the myths and warning signs of snake oil and pseudoscience. The theories offered for why these remedies should help your pet range from complete nonsense to vague unproven hypotheses. There is no scientific evidence to indicate any specific benefit from any of these products for any particular condition in dogs and cats. All the testimonials in the world can’t prove any of the company’s claims to be true, nor can they guarantee that the products cannot hurt your pets. Just as there is little evidence regarding the claimed benefits of these products, there is little to demonstrate that they are safe.
Goodbye Yellow Pages! Goodbye Yellow Pages!
As a Practice Manager, I only have four really big pet peeves – the annual process of quoting health insurance rates; salespeople who want to talk to me about my credit card processing rates; discussions about different types of suture (boring!), and…….yellow page ads. This week, I began the process of saying goodbye to the ads!
I’m sure we’re not the first practice to decide that this money is better spent elsewhere, but that doesn’t dampen my absolute joy in doing so. Our community sits at the convergence of geographical areas that are covered (of course) by multiple yellow page books – six to be exact- and once you’ve made the commitment to be in one or more, it’s hard to know which one you can live without. After years of debating with the practice owner, we’re going to try living without any of them.
I’ve endured an ongoing circle of yellow page ad discussions with my boss – “why do we need them?” as he’s signing all of the checks, and “why don’t we have a bigger ad?” when a client has mentioned their difficulty finding us. Over the years, we’ve reduced our ad size (though with the “discount” they were giving you before, the smaller ad is almost the same price), and done the “blind phone number” ad to track calls and revenue generated. It’s not that we don’t get something from the ads; it’s just no longer enough.
Here’s why we’re dumping them:
1. Our staff and families are a varied mix of the community – older, younger, professionals, kids in school, etc., and no one can remember the last time they personally opened a book…..it’s all internet now.
2. Even if someone out there does still use them, who’s to say that they diligently replace the old with the new, which means we’re still in many of their books from years past.
3. $7,692.00 per year can buy a lot of other types of advertising – my favorite being the way our practice financially supports a zillion community organizations. Now we can support a zillion and then some, and get a more positive response than we ever got in these books.
4. After a few months, I will never, ever, have to deal with another yellow page salesperson! The annual parade of these people who think they know our business better than I do, and want to “counsel” me on how to generate new clients, makes me want to stick my head under water.
So far, I’ve had the pleasure of delivering the news to a couple of reps…… both asked me to “take a few minutes and discuss how I would be otherwise spending our advertising money,” as if they could turn me around with a few magical words of wisdom. When I explained that such information was irrelevant to them, one even argued that it certainly was relevant, as they could show me how it would be a big mistake to leave their book. When that failed, she took the approach that we couldn’t have an internet listing if we didn’t have an ad in the book – apparently, she’s not aware that such information is NEVER removed from the internet (especially if you want it to be), so as long as we don’t change our phone number, we’ll always be there. Case in point – you can still find our number on the web under corresponding associate veterinarians who have been long gone from our clinic.
Two down, four to go…..it feels great to scratch one pet peeve off of my list, AND save several thousand dollars in the process!
A Special Place Where Charisma A Special Place Where Charisma Meets Medicine
They were spoken by a man I never met, but came to respect greatly - because his clients loved him so much. The man was Charlie Johnson, a Scotsman who started Parkvets in the charming little town of Chislehurst, Kent, back in 1979.
I took over the branch surgery where Charlie had spent his last few years prior to retirement looking after his old clientele. At times the going was difficult me, a fresh faced new graduate, because everyone clearly loved “Old Charlie”, the never-ending tales of his charismatic approach to vet medicine were a real throw back to the days of James Herriot. But at the same time they were nearly enough to give anyone a complex! I remember thinking that if I could get these clients to care just a fraction as passionately about my way of doing things as they did about Charlie’s I’d be delighted.
Then one day a dear client told me a story that touched me deeply. The tale was about her first dog ‘Bounder’ whom Charlie had delivered by Caesarian section. She went on to tell me how eighteen years later with many, many happy memories (and quite few visits to the vet under her belt), she had found herself back in the same consult room where it all began.
Charlie was there, as always, but by now Bounder was now struggling to live up to his name, so severe was his arthritis. It was clear to all that the time had come to ease his suffering.
As Charlie administered the final injection and Bounder slipped off into peaceful sleep, he quietly spoke the words that I have held in such esteem since, “I brought you into the world, and I’ll see you out at the end.”
So soft, so poignant, so caring.
It makes the hairs on my neck stand up just telling you about it. Those words really cut to the heart of why I personally chose to become a veterinary surgeon. For me it was a choice to be a meaningful part of a community I cared about and wanted to be a part of. But they also spoke volumes of the level of customer service and respect afforded to his patients. Charlie, who sadly died a few years ago, was from a bygone era where relationships mattered more than money.
Times have changed and I doubt that many of today’s graduates will ever look after one patient for as long a period. Now is the time of the more scientifically trained vet, the rise of the scalable corporate practice and who ever heard of staying in job for more than couple of years?
Society, to some degree, has changed as well. Now things seem more focussed on the individual over others. In other words, in little under a decade things have swung round to be the very opposite of everything Charlie stood for.
Today we are more aware of the need for a veterinary practice to generate profit (and rightly so). But the clinic that seeks to chase profit first without the client-focused approach of Charlie Johnson is surely doomed to failure. Could this lack of empathy and caring be one of the reasons why at a time when the pet-owner bond is at its highest, the number of client visits is falling alarmingly?
In a recession-bitten economy the time and effort you put into developing strong client relationships is what will see you through. It’s perhaps the best competitive advantage you’ll ever have because first and foremost I believe we are a service industry – not a scientific one.
Old Charlie’s clients respected and loved him because he respected them first. In fact he always put them first (often ahead of his business) and there is no doubt that even today, over a decade since he retired, Charlie Johnson’s name is still the stuff of local legend. A true local brand that was cherished by the community.
Yes things have moved on, and in many ways for the better. But in order to bring clients on the journey with us, we must not forget the skills and charisma of yesterday’s generation. If we can combine modern medicine and the generation of profits, with the charisma of Charlie and his peers, then we might just be onto something special.
This blog is dedicated to Charlie Johnson, Sam Duff and all those fabulous old vets who were and continue to be an inspiration to us all.
Nicol on Communication Nicol on Communication
In the January issue of Vet Economics Vol. 52, No 1, Dave Nicol offers the recommendation to utilize more "persuasive language" and minimize options for pet owners. (Editor: Click here to read Dr. Nicol's column.) While I agree with some of the comments especially about what our client's hear, the tenor of his article suggests that we be more paternalistic in the way that we, veterinarians, speak to our clients. This recommendation is the exact opposite of what 30 years of evidenced based research points out in human medicine and which is being duplicated in veterinary research. I would offer up the 2nd edition of "Teaching and Learning Communication Skills in Medicine" 2nd Edition by Kurtz, Silverman and Draper. As a practicing veterinarian for 35 years as well as a communication's coach I would suggest that veterinarians seek to master the art of shared decision making which allows for a thorough back and forth communication with our clients so that they truly understand the options that they have as well as the risks and benefits associated with them. Money must be discussed within the realm of decision making, but too oftern we as veterinarians x-ray the client's pocketbook and make the misdiagnosis as to what they can and are willing to spend. Clearly, we all know that there are some clients who strictly work by the numbers but opening a dialogue, giving the pet owner a good opportunity to explain what they are looking for and then discussing the appropriate options will get much greater results and improved outcomes, than being overly persuasive to your personal beliefs.
MD's vs. DVM's MD's vs. DVM's
I was a pre-med in college and had every intention of going to medical school. In fact, as a high school senior I was accepted into a program which guaranteed me admission into medical school as long as I maintained an acceptable GPA throughout my undergraduate career. It wasn’t until my senior year as an undergrad that I decided to apply to vet school instead of med school.
There were two factors which affected this decision. First, I was taking a couple of fascinating classes relating to animals. One was called Human-Animal Relationships and explored the ethical, biological, evolutionary and economic facets of our relationships with animals, whether companion, farm, wildlife, research, or zoo. The other was Comparative Anatomy, in which we followed the anatomical and physiologic constancies across species, from shark to frog to cat to human.
The second factor was my pre-med classmates. The majority wanted to be doctors because their fathers were doctors, or because they craved the prestige and wealth. Most of them didn’t want to be doctors to help people, to cure the ill or heal the injured. I had already spent four years in classes with that bunch of jerks and couldn’t face another four. So I went to vet school instead. Veterinarians as a rule are overworked and underpaid, so we’re all in this to help animals and people, not to get rich and famous.
The Fourth of July confirmed to me that I made the right decision back in college. One patient I saw was a leopard gecko named Athena. Although I don’t technically treat exotics like birds or reptiles, they occasionally find me anyway. Athena had tried to eat a decorative plastic cactus from her cage, but her eyes were bigger than her gullet and the faux cactus was stuck in her throat. I held her mouth open and my technician gently pulled out the plastic. Athena was fine and her humans were appreciative.
Later in the morning a middle-aged male cat named Al was brought in by his concerned people. They said he had been straining in his litter box but was only able to produce a few drops of blood-tinged urine. I ran blood work and x-rays on Al, and found that he had bladder stones, several of which had migrated down into his urethra preventing him from urinating. So I anesthetized Al, flushed the stones up into his bladder, and surgically removed them from the bladder. When he woke up he was able to pee comfortably and looked content, enjoying his pain medications.
All day I was working sick, and by the afternoon I was coughing and wheezing and was pretty sure I had bronchitis, so I left early to go to InstaCare. There I was seen by a forty-something white male physician. I was wearing scrubs with a doggy-and-kitty print, so it was fairly obvious where I’d come from. He asked where I worked; I told him the clinic name and added, “I’m a vet.”
“What do you do there on a holiday like today?” he asked.
“Well, I did a cystotomy on a cat today.”
“Really?” He smiled and I thought he was impressed. But then he added, “Do you have a vet there or is he on call?”
“Umm, I am the vet,” I said. What I wanted to say was, “He? Were you not listening when you asked me three minutes ago where I work? Why do you assume a vet must be a man? I know for damn sure there are plenty of women physicians in this very hospital. And do you really think so little of veterinary medicine that you assume that a random lay person could do a feline cystotomy?”
What a jerk. I saved lives while he insulted his patient. I treat any species and do everything—from internal medicine to surgery to dentistry. I’m not rich but my patients and their families benefit from my skills.