JCOC—Day One
It is approaching 7 AM on Sunday, September 11. I am aboard a C-17 Cargo plane headed for Guantanamo Bay in Cuba. We are told that this will be a 3 hr. flight.
Our JCOC experience began yesterday on September 11th. We were bused first to the Marine Barracks where we were briefed on the mission of the marines stationed there. This detachment is largely ceremonial and includes the Marine Band (The President’s Own), the Marine Drum and Bugle Corps (The Commandant’s Own), and the Marine Precision Marching Team. The tour included the Commandant’s residence, a structure built in 1804 and the only surviving building of the war of 1812. Fortunately, the British claimed this historic structure as their own headquarters which resulted in it being spared.
Our buses then transported us to the Pentagon where our vehicles were first checked for explosives and then allowed to enter a secure parking area. We were greeted on the steps of the Pentagon by our military escorts and then led inside to a large conference room where we were briefed about our afternoon activities and served lunch.
Our group of 50 individuals has been broken down into 5 smaller groups and each have been assigned a young officer from on of the 5 branches of the military, the Army, Marines, Air Force, Navy, and Coast Guard. Our group leader is Lt. Jenn Wombley who is relatively fresh out of Annapolis. Because we are “Navy”, our Pentagon tour guide is a 3-year enlisted sailor whose brother was killed in the Twin Towers on 9/11. Needless to say, having him as our guide provided extra meaning to our tour experience. The Pentagon itself was pretty much as expected. Huge, complicated, a maze of corridors, and city within itself with restaurants, drug stores, dry cleaning establishments, gift shops, etc.
As expected, the most meaningful part of the tour was the portion of the building destroyed on 9/11. 184 people died at that location and to see the enormity of the area affected was staggering. But even more amazing was the re-construction process. Originally estimated to take 2 years to complete, the construction crews worked overtime, weekends, and holidays and finished the project in 8.5 months. When Congress authorized the millions of dollars to pay for the extra hours and work to finish the project ahead of schedule, every construction worker declined the extra pay declaring that the effort was their gift to their country.
Returning to our Pentagon conference room, our group of 50 was gathered on risers for a group picture. As we were being arranged for the picture, we were told that we would be joined by a VIP and we were all pleasantly surprised as Secretary of Defense Robert Gates entered the room, joined the group for pictures, and then proceeded to answer questions for about 50 minutes.
Gates was asked some very tough questions by some of my fellow JCOC team members. He responded to each question quickly, confidently, and without hesitation. This is an individual who served as the President of Texas A&M University and who also has worked for eight different presidents. As the Secretary of Defense under the most recent Republican administration, he is the only cabinet member to be re-appointed to the same position as a result of a change of political parties. At a time when our country is fighting two wars while facing great instability in many parts of the world, Secretary Gates appears to “have what it takes” to manage our defense. I found him to be very comforting.
Following Secretary Gates question and answer event, we were escorted out of the Pentagon where we boarded our buses and were taken to Fort Myer and the George Patton Officer’s Club. There we were joined by various members of the military, enjoyed a fine dinner, and heard a detailed presentation by a General Frazer (4 Stars) who heads the Southern Command. You will remember that the Southern Command (one of ten Commands) consists of everything south of Mexico to the tip of South American and the two oceans on either side. General Frazer also provided about 30 minutes for questions and again, we left being very impressed.
But our evening was not finished. We were bused back to the Pentagon where were able to view the 9/11 memorial at night. Briefly, the memorial consists of a cantilevered bench for each person killed in the attack. Under each bench is a pool of water which appears to be a miniature flowing stream. There are hidden lights in the pool and those lights are the only source of light at the memorial at night. The benches are positioned to be pointing either to the Pentagon or to the sky which identifies where the attack victim was at the time of impact. The emotional impact of this memorial cannot be described. The fact that the memorial was funded entirely by corporate and private donations further speaks to the spirit and determination of the citizens of our great country. Thank God the planning, funding, and construction of this project was not the responsibility of Congress!
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.
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]
Two years ago, our practice had a firsthand experience with a canine “hero.” Our staff begins to show up for work just before 7:30am, and on the day in question, the first two were greeted by a loose dog in front of the building. Their first thought was that the poor dog had been dumped by someone who no longer wanted him. We’ve shown up in the morning to find dogs tied to our door, cats in carriers, and newborn litters in cardboard boxes. However, it should have occurred immediately that no dog would ever stay at a veterinary clinic by choice.
After our two staff members got a good look at him, they recognized him as “Boomer,” a mixed breed dog that belonged to an older woman who lived next door. Mrs. Brown was probably in her 80’s, and frequently visited the practice to leave letters to be mailed in our outgoing box, to chat with our staff, or from time to time, for Boomer’s veterinary care. One of our managers accompanied an assistant next door to return Boomer and neither of them were prepared for what they found.
Mrs. Brown’s house sat in the middle of a large lot and was surrounded by a fair amount of trees and brush. Partway to the house, our staff members spotted Mrs. Brown lying motionless on the ground. They shouted her name, but she didn’t move. Fearing the worst, they approached her and found that she was quite alive, though hard of hearing. She was injured (we found out later she had broken her hip and was immobile), and had been there all night. It was fall and the temperature had dipped into the low 40’s overnight.
While our staff waited with Mrs. Brown for emergency responders, she mentioned that after Boomer had found her, he stayed with her providing body heat all night, before leaving in the morning. Though she wasn’t sure where he went, she hoped he would be found, and that she would be too. There was no question that Boomer was a hero – both for keeping Mrs. Brown warm, and in seeking help for her. She went to the hospital, and Boomer stayed with us – at least until he was adopted by a local family (Mrs. Brown was in poor health, was not expected to return to an unassisted living situation, and had no local family). We haven’t seen Boomer since, and rumor was that Mrs. Brown passed away in late 2009.
You can imagine my surprise when I ran into Mrs. Brown in the waiting area of my dentist two weeks ago. She was in a wheelchair, but entered the dentist office unattended. She was always kind of an odd lady, and for about 10 minutes she proceeded to carry on a conversation, though it was clear there was nobody listening. Finally, she noticed me and saw the practice logo on my coat. Surprisingly, she remembered me, and we spent a few minutes catching up. Near the end of our conversation, I brought up Boomer and what he had done for her.
What she had to say was unexpected……..she didn’t miss Boomer at all – in fact, she said the only reason she fell and broke her hip was because “that darned dog” tripped her. Trying to stay positive, I reminded her that he did stay by her side all night, at least. She quickly shot back that he had no choice – she had a firm hand on his leash and only let him go when she heard cars arrive at our clinic.
It’s hard to say what really happened that night – our initial information came from her, but somehow, over time, she’d changed her mind. The story had been reported in the local newspaper when it happened, and she gave the same account to the reporter. What I do know is that broken hip or not, Mrs. Brown was too frail to hold onto Boomer’s leash all night…. he wasn’t wearing a leash when we found him….and she couldn’t hear a car if it was sitting next to her, much less 100 yards away. I’m going to stick with the idea that Boomer was a hero that night – after all, there’s still no plausible explanation for a dog voluntarily coming to the vet.
Every wild canid has a long muzzle, relatively long legs, and erect ears. Look at wolves, coyotes, dingos, and the wild dogs of Africa.
We veterinarians did not create pugs, basset hounds, dachshunds, bulldogs, and so on. But we have to deal with them. Their prolapsed eyeballs, the intervertebral disc disease, the respiratory distress, and the other problems man-made artificial selection has created.
Look at old-time paintings of the English bulldog. We have, in a century or two, exaggerated the anatomy of the bulldog so as to cause physical problems that, in nature, would lead to extinction.
We humans have a tendency to exaggerate physical traits in our domestic animals that originally served a purpose. Then, eventually, because of fashion, or style, or because dog show judges prefer the extreme anomalies, the distortions become preferred.
Editors' Links:
Dr. Miller's Mind Over Miller Articles from Veterinary Medicine
Dr. Miller's Cartoons
Here I am, a week into my seven-week, 29-day coast-to-coast tour, and honestly, as big an endeavor as this is, I'm actually a little surprised things have gone so well. The glitches have all been pretty minimal, and have been addressed and correctly on the fly. Talks have been rewritten, media events added and deleted, and even one event (the VIP hour in Miami) canceled after it became apparent that I wasn't going to out-draw the Royal Wedding.
Our tour manager, Jimmy Searlesl assures me things happen on the tour, and he even warned us all that the first couple of days would be rocky, which they were. But he said that if you have a good team things would gel quickly, and we have.
Personally, I think it's working because I'm passionate about the message that healthy pets visit vets, and that while you can find information on the Internet, the place to find the information that's right for an individual pet is in the veterinary exam room. People need to understand that even though they can visit WebMD, Mayo Clinic and other human health sites, they're capable of advocating for their own health. Their pets? They suffer in silence. They need a veterinarian, and we need to help people realize it.
The "hook" this all hangs on is my new book, "Your Pet: The Owner's Manual." But the fact is that I don't need to wrap a 45-foot bus previously used by Lady Gaga and Dog The Bounty Hunter to sell books. I've had New York Times best-sellers before, and I never had to ride a bus to get them. The reason I'm doing so this time is because what I'm "selling" is bigger than my book, bigger than my own "brand" and is at the heart of everything I believe and stand for.
I believe in the importance of the human-animal bond. And I believe in veterinary medicine.
Now that I have the first week behind me, I'll start blogging regularly. Last week, I was working out all the issues that comes with a massive endeavor like this one. And for keeping my colleagues in the loop, I had the help of the wonderful Mindy Valcarcel, whose reports you've read here on DVM360.com.
But now, it's up to me to keep you up to date on the tour. In the days and weeks to come, I'll be offering my take on how things are going as well as an insider's view of what the tour is like for those of us on it.
Stay tuned.
From the road to Raleigh ...
Wolves are pack animals. They have a strictly structured relationship in the pack from the alpha (number one) male down to the most timid female. They are also possibly the most curious of animals. These two factors probably allowed them to be the first domesticated species and the most molded in behavior.
Beagles are a good example of man’s ability to transform a breed to fit his needs and wishes. They come in two sizes, thirteen or seventeen inches, their approximate height at the shoulder. They are bred to help hunting rabbits. They have a braying bark (rather annoying in a pet) much like that of the coonhound. Coonhounds are chosen to bray loudly to be heard for a long distance when the raccoon they are chasing has fled up a tree. The hunter then runs to dispatch the quarry. (Where did you think Daniel Boone got those coonskin hats?) The beagle brays loudly when chasing a rabbit to frighten it and will drive the bunny in a circle back to the waiting hunter’s gun.
They are usually very pretty, small brown and white dogs which is probably the main reason they are kept as pets, certainly not for their intelligence.
Mrs. Tralmer Haug bought her son Doug a female beagle as a pet when he was in junior high school. She then named the pretty little dog “Penelope.” As usually happens, time transpired and Doug went off to college. His mother of course was charged with caring for the “intact” bitch.
She brought Penelope in to my office one fine October day with the complaint “She is getting so fat.” After palpating her rotund little belly, I turned to Mrs. Haug and proffered my diagnosis. “She is getting so fat because she is so pregnant.” “Why, how can that be?” She asked incredulously. “Didn’t she run away one day about two months ago?” I asked, “Oh yes, but just overnight ------ ?” What more could it take?
That explained things and the now convinced Mrs. Hogg said, “Of course you will come attend won’t you?” I almost chuckled as I said “Certainly.” Before seven o’clock in the morning about two weeks later a very excited matron called to report the dog pen was as she said, “full of puppies!!” Indeed that is what I found after arriving at her house. There were seven puppies some brown, some brown and white, a black and white one, straight or curly haired and I can’t remember what else. “What do you think the father was like?” said the rather shocked lady. “I believe there were multiple fathers” was of course my reply.
“Oh no, My Penelope would not be that indiscreet!!” she firmly retorted.
An excerpt from Doc S’s Tales
If you liked this story look up The Love of a Dog posted 5 weeks ago
Some years ago I was watching a hummingbird 8,000 feet above sea level in the Colorado Rockies. It was summertime. And then I suddenly wondered, “where does this tiny delicate creature go in the wintertime?” Surely it can’t migrate!
When I got home I looked it up. That miniscule buzzing bird migrates all the way to Mexico. How was it possible? This is as great as any of nature’s wonders. It flies thousands of miles to a tropical winter.
During migration, the heart of the hummingbird beats up to 1,200 times per minute. Its tiny wings flap as many as 80 times per second. Imagine the calorie intake necessary to sustain life. No wonder they continuously sip nectar — which, of course, facilitates pollination.
The next time you see a hummingbird, watch it for a while and reflect upon its extraordinary powers of flight, in all directions; it’s marvelous physiology; and the splendor of the life force that created it.
Editors' Links:
Dr. Miller's Mind Over Miller Articles from Veterinary Medicine
Dr. Miller's Cartoons
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
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.
At 2:30 am it finally hits me why my left thumb is so sore. Nine and a half hours earlier, I failed to revive a dog with emergency treatment and CPR. I also failed to save him with aggressive surgical, medical and supportive care during the preceeding several days. The chest compressions of my final attempt to save Dog must have hyperextended my thumb. My only two comforts are that Dog no longer hurts and my thumb does. I fall into a troubled sleep.Very recently, I had given two talks, one to grade schoolers and one to middle schoolers about how great it is to be a vet. At the time, I had just started Dog’s treatment, his prognosis still had a sliver of hope in it, and if I had read about his case in a journal article, it really would have made a great story. I feel like a big liar, and to children no less. Right now, I hate my career.
I wake up wondering how Dog’s family is doing.
I stay awake a second night going over and over every detail of Dog’s case, deciding at every remembered step that I would not have made different decisions on Dog’s behalf. I would not have wanted the family to make different decisions. We needed to give Dog every possible chance. Every time my husband asks why I am crying/scowling/staring off (and at one point freaking out when I am in the sun, not the shade, at an outdoor concert), I say “I need to have been able to save him.” I am pretty sure that is not even a valid sentence structure.
Sometimes, being a vet sucks.
It is not as if I have a choice. I could have no easier chosen a different career than I could have chosen to be right handed. I mean, I could have forced myself, but I hear that messes people up pretty badly.
And really, even now, I do not want to be anywhere else than in the middle of grief for a dog I just met and who is technically a “patient” but is really a friend I fell for hard and fought for hard, and a family that is technically a “client” but really a team of fellow pet lovers who also loved Dog – but as a family member, and for years and years, not days. If this week is rough for me, it sucks many times over for them and will for a long time.
I don’t know why this has stuck with me for all this time, but another veterinarian once told me that unless I could rein in my “personality weakness” of letting sad cases hit me so hard,
“You will never be a successful veterinarian.”
It was a great little pep talk (ha!) but honestly, I believe the opposite is true. I can no more let go of my empathy than I could have chosen a different career. If I did not feel such rage and despair and hopelessness at not being able to save a Dog I really, really, really wanted to save, THEN I would concede his point, and truly, I would not be a successful veterinarian.
As it is, my career is a part of me I cannot separate from myself. Good or bad, I cannot care less than I do, or give myself a “healthy emotional distance,” even if I did want to, which I do not. This week sucks, and I do not know when I will be able to say I love being a vet again, but I will. And if I did not hate it now, that would be a serious red flag to me, and I would do everything I could to reconnect emotionally.
There are wonderful veterinarians who are much more emotionally even keeled than I. It is not a requirement of the profession to be a big cry baby sap. In fact, I do need to check myself when families need my support; they do not need me pushing them out of the way for the Kleenex box. It is just that empathy is such a big part of MY veterinary career, that if losing patients were to “get easier” as some older veterinarians promise, trying to be comforting, I would know that I had lost a part of myself, and would hang up my jacket and stethoscope.
I have normal range of motion in my thumb and just a small, persistent ache. I really hope next week is better than this week – how could it not be? I hope the hearts of Dog’s family members heal over time. I know that though it will be a long road, their hearts will heal, almost completely. I really hope that my thumb does not heal, but it is already feeling better. Dang it.
also published on Life With Dogs, reprinted with permission from Neil.
Formaldehyde is considered to be a dangerous chemical. In low doses it irritates the eyes and respiratory system. It can cause ataxia, nausea, fatigue, and dermatitis. Chronic exposure can result in memory loss, abdominal pain, weakness, and otitis. It is a toxin and it may be carcinogenic. Its use in vaccines is currently very controversial. It is officially recognized as “bad stuff.”
So, I have a question: How come every anatomy professor I know of has lived to such an old age? I have lectured at all but three of the veterinary schools in the United States, and nearly all the anatomy professors are old. Even the younger ones look old, but that may be the result of the stress induced by a classroom full of freshman veterinary students.
Is it possible that the preservative qualities of formalin exceed its toxic properties?
Editors' Links:
Dr. Miller's Mind Over Miller Articles from Veterinary Medicine
Dr. Miller's Cartoons
I read with interest several of the comments on the message boards about pet insurance and what it will not do, and I am amazed by what can only be described as misinformation... or perhaps bad luck... For the record, I DO NOT now, nor have I ever had a financial relationship with ANY pet insurance company. I have never been sponsored in any of my public speaking or teaching by ANY pet insurance company. That said, I feel I must address misconceptions. For instance:
"No pet insurance covers cruciate surgery." This is blatantly false! Once a dog has been insured for 12 months with no evidence of cruciate disease, on pet insurance company in particular will not only cover the surgery, but also the post-operative rehabilitation/physiotherapy at an 80/20 ratio—that is, the client pays 20% after the deductible is met. How do I know this is true? Because I am treating several patients who fit this description! And one of my patients has just had her SECOND ACL surgery, and it was covered as well.
"Pet insurance companies are nearly as bad as human ones." Some companies (in EVERY industry) recognize an opportunity to turn a quick dollar, and will market that they are something they are not. Happens in the pet food industry all the time, so why is anyone surprised? Part of our obligation to our patients is to assist our clients in making good decisions. Would you refer your client to a quack veterinarian? Probably not. So why not help your client get their facts straight about choosing a reputable pet insurance provider?
"For this client we had to completely restructure our billing to include a 'sick exam' so that the insurance would reimburse him." This comment is especially puzzling to me. Every single veterinary software that is currently on the market allows the practice to change the description of the services that we provide as they show up on the invoice. That means that removing the word "wellness" from that line on the invoice would have cost the receptionist no more than 3 seconds in order to assist that client.
"We don't want the responsibility of researching policies and taking care of claims for clients." Then don't do it. If you live in an area unaffected by the economic maelstrom and have no need to "go the extra mile" for your clients, then don't. In our practice culture, we choose to assist our clients by educating them about the pet insurance vehicle that provides for them true indemnity insurance, and a straightforward 80/20 split. Perhaps it is made easier for our team by the fact that their pets are insured by our practice as a part of their benefit package. One pet for every year they work for the practice. That way, two things happen:
1. I charge my employees full-fee (and their pets get "full-fee" care) when their pets have a medical problem. They are responsible for their 20%, the practice is paid appropriately for the care rendered, and no one is tempted to "cut corners" because we are working on an employee's dog/cat that will not be charged as a "paying" client.
2. If my employee's pet needs and deserves to see a specialist for a procedure that we are not qualified to provide, I do not worry about anyone who works for me having to perform "economic euthanasia" because their pet was not insured and they couldn't afford care. BTW, my OWN pets are also insured, for the simple reason that I am happy to leverage OPM ("other people's money") and I KNOW that pets get sick—I want my own pets to receive the care they need and deserve without worrying about cutting corners.
"The insurance company never received the claim." Sometimes bad things happen. When a good relationship with the client includes open communication, when the unexpected happens, clients are willing to give you the benefit of the doubt.
"We're not sales people. I'd rather my staff spend the time educating clients about heartworm disease." Interesting comment in light of the fact that we ARE sales people. What we do every single day in veterinary medicine is sell—ourselves, our recommendations, peace of mind. The list goes on. As for educating clients, I find that educating them about how best to AFFORD care is JUST as important as educating them about what care their pet needs. Veterinary medicine will NEVER return to the "good old days"—whatever they were—when care for our pet patients was not very sophisticated. Medicine is VERY sophisticated, will continue to become MORE sophisticated, and our clients are more and more knowledgeable about what is available to them and their animal family members. How horrifying to have to perform economic euthanasia as one of my clients did a few months ago...
Their older GSD developed GDV, they caught it early, and he had successful surgery. He experienced some age-related complications, and their bill was quite hefty. They willingly tapped their reserves to save his life. Unfortunately, their younger GSD developed GDV just 8 weeks later. They had chosen to ignore our recommendations to insure their dogs. They made the difficult decision to euthanize their younger dog—also caught early, which means her GDV was fixable—because the first surgery had exhausted their financial resources. The irony is that had both dogs been insured, the client obligation would have been 20% of the bill after a $75 dollar deductible, and both dogs TOGETHER would have ultimately only cost them about 40% of the first dog's procedure. What a senseless tragedy!
"Is managed care next?" Not if our profession gets over itself and places appropriate demands on providers, and assists our clients to do the same thing.
The bottom line is that in countries where pet insurance is the norm (e.g. the UK), the sky has not fallen. Clients are compliant with veterinary recommendations, and pet owners seek care in a timely fashion. In our practice, our insured patients receive care for their "accidents and illnesses" (indemnity issues) promptly because our clients seek care early in the course of an illness, often allowing us to avoid what might otherwise be a more complicated (and costly) treatment.
In my pain management referral practice, we also provide oncology care. Pain and cancer are two illness categories that carry with them significant investment by the client. How rewarding it is to work with clients who took the time and made the commitment to their pets early on, had those pets insured, and now have the ability to pay for complex, comprehensive, and sophisticated care.
We DO have to be educated about some of the garbage that's out there masquerading as pet insurance. We DO need to be sure not to accept a move to managed care (BTW, not a single expert believes that's a reasonable fear for the veterinary profession/industry...). But it's not that difficult or time-consuming to find a reasonable insurance instrument and then make simple, straightforward recommendation. We predict that the number of our patients who are insured will rise significantly in this next year as clients better appreciate the need to leverage their out-of-pocket to its greatest potential.
To go back to the message board about pet insurance and share your thoughts, click here.
—Robin Downing, DVM, CVA, CCRP, CPE, DAAPM
Hospital Director The Downing Center for Animal Pain Management
LLC Windsor Veterinary Clinic, PC
At our practice, one of the questions our Doctors, and especially our staff, try to avoid is the dreaded “what would you do?” We’ve always believed that our role ends with thorough education and the presentation of options……the decision always rests with the family.
A week ago, however, a very good friend of mine asked the question. Her 13 year old Golden Retriever was in for dental work, and intraoral radiographs indicated many teeth that were on the borderline of unacceptable bone loss. Her upper canine teeth were very slightly mobile, though no teeth were deeply diseased. Unfortunately, during the oral exam we discovered a mass. In house cytology pointed strongly toward cancer.
The client and I go way back – I coached her son for many years, and during that time I always told her the truth…..no small achievement in the world of youth sports. She trusted me enough to ask the question, and after making sure she had all the information and options from the Doctor, I answered it.
Veterinary professionals seem to fall into two categories – those who will let medicine take them down every possible road in treatment of their own pet, and those who have seen some of the limitations of medicine and spend a lot of time contemplating what “quality of life” means, and to whom it refers. I’ve been in the latter category ever since I experienced the loss of a pet for the first time a few years ago.
I had worked for our practice for over 10 years at the time, assisting in more euthanasia procedures than I could remember. In response to my participation, I’d felt sadness, discomfort, relief, loss, and disgust, depending on the particular situation. What I had never felt, however, was the weight of responsibility that comes with the decision making process.
Our family at the time included two Saint Bernards, McDuff and Olivia (my wife Julie, who also works at our practice, and I have always been Shakespeare fans). They were known in our community due to their presence in a number of parades, from our walks through town, and, in Duffy’s case, from his position as my educational partner (a position now held by Puddy, our Jack Russell Terrier). Both were part of our clinic family, helping many new technicians and assistants learn to collect a blood sample or place a catheter. Duffy had donated blood many times, contributing directly to the recovery of several patients. They were inseparable.
Once afternoon, I noticed that Olivia was breathing very loudly, and it seemed, with difficulty. Julie and I brought her to the clinic and after a radiograph of her lungs, she was diagnosed with pneumonia……after a cytological examination of her swollen lymph node aspirate, she was diagnosed with cancer. We were stunned – we expected to lose Duffy at any time due to his age, but she was younger. Together, we made a difficult decision to try chemotherapy, which would be administered in our clinic.
We knew that her outlook was for six months at best, but her symptoms had developed so quickly that we weren’t ready to give up. Though Julie was by then part of our management team, she was still an accomplished technician and did most of Olivia’s treatment herself, setting every catheter and reading every CBC. Olivia’s condition improved initially, and it was clear to everyone that she enjoyed the extra attention and time with Julie.
Unfortunately, Olivia never again left our clinic. She lived almost six months to the day, and when we finally made the decision to stop her treatment, it was only after days and weeks of guessing and second-guessing. Was today the day, or could tomorrow be better? While there is no doubt Olivia was very happy lying next to Julie’s desk every day, I’ve felt ever since that our decision to keep her alive was more for our sake than hers. It’s a lesson that I think about often during the course of a day, and it immediately came to mind when my friend asked what I would do.
After Olivia was gone, I worried a lot about being faced again with the decision to go through extensive treatment or elect euthanasia. Two months later, I found Duffy in the morning, curled up and in the spot he normally slept. His food dish was empty and there was no sign that he had been in distress……he was just gone. Since that day, it’s the end of life I hope comes for every family and every patient, whenever their time may be.
Dr. Marty Becker’s Big Bus Tour kicked off a little early yesterday in Houston, Texas. Although the 30-city, 45-day "Healthy Pets Visit Vets" tour didn't officially begin until today, yesterday he headed over to KTRH NewsRadio in Houston for a live segment on the weekly Sunday evening show "Your Pet's Health" hosted by Brian Beale, DVM, DACVS, a surgeon at Gulf Coast Veterinary Specialists in Houston. 
Dr. Becker (pictured during the show, right) gave listeners a peek at the hundreds of tips featured in his book Your Dog: The Owner's Manual--including the fact that we can prevent common poisonings in dogs by being more aware and preventing accessibility (i.e. keeping human prescriptions, the most common poisoning in dogs, off kitchen or bathroom counters; restricting access to our purses, which often feature sugar-free gum that contains xylitol, the second most common poisoning).
Dr. Becker even helped Dr. Beale (pictured below) with his most pressing pet problem--dog hair all over the house. Dr. Becker's advice for these "hairy hand grenades" is to bathe and brush them weekly with an appropriate tool, or even prevent heavy shedding problems in the first place by getting a small, long-haired dog. Why? Smaller dogs have less hair to shed; long-haired dogs shed less often, and you can trim their hair to further alleviate the shedding situation.
The tip to bathe dogs once a week surprised me. I had always been told that this frequent of bathing would cut down on the natural, necessary oils on a dog's skin. But Dr. Becker countered exactly this old advice, saying that dermatologists he's talked to now recommend weekly bathing to eliminate environmental allergens on your dog, which have been attributed to causing, among other things, 80% of ear problems in dogs as well as anal gland problems. One of my dogs has frequent bouts of both, so he may start getting weekly scrubbing sessions when I get home. He'll love me for it.
Speaking of bathing, did you know that to stop a dog from shaking right after a bath in an inopportune place, you just have to hold the dog's nose and, voila, instant shake cessation. Then just move the dog to a more appropriate area and allow it to shake away. Dr. Becker says this simple secret has astonished and delighted even seasoned veterinarians and veterinary staff he has met.
On tap today, a VIP breakfast and presentation, a community event at Petco, a TV appearance on KTKR in Houston, and then a long drive to New Orleans where we may get a chance to eat at one of Emeril Lagasse's restaurants by special invite of Dr. Becker's good friend, none other than Emeril himself.
Details on these events and more from the road to come...
And to read all about the 30-city, 45-day tour, go to dvm360.com/beckerbustour.
Wednesday was mostly a travel day for the Dr. Marty Becker and his tour crew. They spent Tuesday night in Tallahassee, Fla., and got up to drive to Tampa, Fla., to tape an episode of "The Animal House," a weekly program on NPR. He also did a live radio Q&A with pet owners on the Allan Handelman Show on WZTK in North Carolina. During the show, he helped a pet owner deal with fighting dogs within a household, discussed the amazing stories of cancer-sniffing dogs, and much more. Callers were waiting for over an hour to get their questions in. But the official tour events—the VIP luncheon and meet and greet at Petco—won't happen until Thursday in Tampa. So Wednesday was a chance for the crew to catch their respective breaths and take stock of how things are going so far.
So just who is this crew?
Gina Spadafori, Dr. Becker's writing partner, is handling the tour's PR, including blogging and Tweeting at almost every moment to keep Dr. Becker's many followers up-to-date on the goings-on. She has known Dr. Becker for two decades, and together they've written more than a dozen books, including Your Dog: The Owner’s Manual. She is also the author of the best-selling Dogs for Dummies and Cats for Dummies, among many others. She started her career as a reporter for The Sacramento Bee. Spadafori's and Dr. Becker's working partnership is a match made in heaven. "We are the perfect combination of an expert on knowing people and communicating and a trained reporter and editor," said Spadafori. "Our skills just dovetail so wonderfully. The most important thing is that we're very adaptable and nimble. We have to stay on top of the curve." She equates this flexibility with how all veterinarians must adapt to the new reality of vets vs. the net, the theme of Dr. Becker's presentation to VIP veterinarians (see Becker Bus Tour: Everything's bigger in Texas).
Jimmy Searl, the tour manager, has arranged the tours of countless performers including Whitney Houston, Stevie Wonder, and many more. Searl is always ready to relate fabulous tales of his adventures on tour and off in his eloquent speaking style. Searl is usually found on his laptop or phone making sure all goes smoothly, from hotel bookings to the logistics of getting Dr. Becker where he needs to be every day—basically being responsible for everything. And anything may be thrown at him at any time. His unflappable and down-to-earth nature quickly smooths any wrinkles that come along. He's enjoying the Big Bus Tour and working with Dr. Becker. "Even though it's only been a short time, it's very easy to see why Dr. Becker is as noted as he is—as well-covered as he is in the media," said Searl. "More than anything, Dr. Becker's personality allows him to relay his expertise in a way that makes you want to listen. He's just a cool guy."
Chris Binnall (as in "Been all over the place," as he says) the assistant tour manager, is the man to get things done. Whether chauffeuring Dr. Becker to media events while arguing with Laura, as he has named the voice of the GPS device that barks at him from the dashboard, or carrying out any other of a whole slew of essential tasks, Binnall uses his easy charm and gentlemanly manner to make everything come out just right. Dr. Becker brought Binnall on board himself after meeting him in Dr. Becker's home town of Bonners Ferry, Idaho, where Binnall is a building contractor. And he's having a great time so far. "Lovin' it!" Binnall said enthusiastically. "These are all great people."
Phil Stewart, the tour bus driver, has driven tons of stars in his past 16 years as a driver, including David Copperfield, Eminem, Hootie and the Blowfish, Lady Gaga, the Rolling Stones—the list goes on and on. With his sly grin and quick laugh, he makes fast friends with all who enter his bus doors, resulting in repeat business (he has driven David Copperfield for 13 years). So how does the Big Bus Tour compare with previous tours? "It's like a vacation tour," said Stewart. "I don’t have to deal with groupies. It's a lot less stressful." And Stewart has obtained a few groupies of his own since, while driving Dog The Bounty Hunter around on a book-signing tour about six months ago, he ended up appearing frequently in the show, resulting in people recognizing him and asking for his autograph. But Stewart shuns such attention and takes it all in stride. In fact, Dog's wife, Beth, started calling him "Mr. Cool Breeze." To see a clip of Mr. Cool Breeze in action, click here.
Last, and most important, is McKenzie, the official tour dog. Convinced that the tour is truly all about her, and not Dr. Becker, McKenzie is a flat-coated retriever that belongs to Spadafori. She steps in when demonstrations such as tooth brushing are needed for media events. Otherwise, she can be found napping on her tour bus, making sure to get enough beauty sleep. She must be ready for her closeup!
The Becker traveling team also has Christie Keith and David Greene, associate editors at petconnection.com—the online home of Dr. Becker—keeping them grounded. Keith and Greene have been helping with research not easily conducted while rolling around on four wheels as well as with posting online and arranging media events. They have been lifesavers more than once.
Thursday, a more typical tour day commences quite early once again for an appearance on a Tampa, Fla., morning show. Stay tuned!
In veterinary medicine, much of our business is based on word of mouth. I love that. I love my clients and their pets. So many of them are family and friends and friends of family and family of friends. And the “strangers” are people who love pets, and so I love them too.
I do not think everything we have been taught about word of mouth business is true. See if you agree. See if this applies to your veterinary practice as well.
A satisfied client tells four people. A dissatisfied client tells ten people. Or so they say.
So don’t torque them off. Or so they say.
Let’s think through this.
I believe that this model falls apart a bit if your veterinary team is doing a consistently excellent job, if pets are well cared for as are their people, if medicine is being practiced honestly and well.
Consider these possible situations:
1) A patient receives routine (albeit awesome and amazing) wellness care. Is your client really going to call four friends and say “You would not believe the care Max received today! He had his wellness exam and…well, that’s my whole story”? Probably not. But if a friend or family member asks if they know a good vet hospital in town, they will probably say how much they trust their vet.
2) A patient receives excellent non-routine care. Now they are calling friends. They have an exciting story of life-saving and compassion in which you are the hero.
3) A client leaves less than satisfied. Being a great team, you follow up and discover and fix the issue. If they tell others, you are still the good guy.
In my mind, if you are truly an excellent veterinary team providing consistently excellent care and discovering and fixing issues as they arise, that is the end of the story.
That may be shocking to hear after hearing for years and years that you should be scared to screw up because ten people will tell ten people and soon the whole world will hate you. So, no, don’t screw up, and if you do, own up and fix it, but do it because you are awesome, not because you are scared someone may say you are unawesome.
Which brings us to our final situation:
4) A dissatisfied client tells ten people.
Who do we have left? You have provided excellent routine and non-routine care. When you have not or the client has perceived that you have not, you have followed up and fixed the issue and restored a good relationship. What we have left are the clients you do not want.
In my professional life, I have personally only “fired” two clients, both for extreme, unrepentant rudeness to my teammates. I like and can work with almost anyone. When I call clients out on poor behavior (also very rare – maybe five times in my career), we can almost always come back around to a healthy working relationship.
One of the two clients I fired used a racial slur to address the person at the front desk. The other was very mean (not crabby – I love crabby, not rude – I can do rude, but MEAN) to another person at the front desk. I gave both a chance to apologize, and when they would not, asked them to find another veterinary team with which to work. Both situations were resolved well, I thought, as did they, I assume, as I did not hear from either of them again.
But what if these dissatisfied clients HAD decided to tell ten friends? What if Ms. Racial Slur or Mr. Meany Pants told ten friends with equally inappropriate habits not to come to our veterinary hospital and their friends told ten friends? Do you know what I think would happen? Eventually, everyone who enjoyed yelling racial slurs or other mean things at people who were trying to help them would know that they were NOT a good match for our hospital, nor us for them.
And then, everyone wins. Even Mr. Meany Pants.
This was also published 1/9/12 as my weekly article for Life with Dogs. The comment section has very thoughtful perspectives from people in industries other than veterinary medicine as well at thoughts from the veterinary client perspective.
An excellent response article addressing how the internet affects word of mouth reviews, Word of Mouth Advertising, Social Media and Dissatisfied Clients, was published by Lorie A. Huston, DVM on her website Social Media Savvy Pets 1/9/12.
Yesterday was a busy day. :)
Oh! And about the hat...
Reassociating Super Cute Green Hats with Only Happy Things
on Riley and James
OK, that is all.
I figure comedian Don Friesen is a pretty typical pet owner. Although funnier than most. In this clip he talks about veterinary fees and gets lots of laughs. But the issues he brings up are real. That's why they're funny, of course.
In my book, this is one of the best possible illustrations about the need for pet insurance. And at the same time, it's clear that it's hard to get pets insured. Why?
1. You have to change pet owners' expectations. There's nice data out there about the total costs over a pet's lifetime. How can each of us get the word out better? When I see this video I laugh — and then I think I need to tweet pet costs once a week, maybe. All so it's not such a shock that the "free" kitten is going to cost something to keep healthy.
2. You have to change pet owners' expectations. Yes, I know I said that. But this time I'm all about comparing the costs of pet health care to the costs of equivalent human health care. Talk about changing perspectives! (And there's that whole upside for you that pet insurance has absolutely no relation to the managed care approach on the human side. Huge sigh of relief!)
3. You have to get pets on insurance programs before they're sick. See point one. Pet owners don't know they have a problem. They're not trying to solve it. They don't think they need insurance.
4. Puppy and kitten visits are probably one of your best opportunities to talk about insurance, and you have too many other critically important things to discuss. Nutrition. Flea control. The importance of spaying and neutering pets. How to master house training. It's hard to fit it all in.
5. I've heard many of you say, "I didn't get into this to sell insurance. I'm a healthcare provider, not a salesperson." I get it. I've also heard that if a veterinarian recommends pet insurance a pet owner is four times more likely to buy that insurance. And I know you'd like to present a recommendation five years from now and hear the pet owner say, "sure."
Anyway, watch the video. Maybe you'll laugh...
What an ecological disaster. This time it's polluting our shores; it's killing our birds, sea mammals and fishing industries. And it took the lives of 11 people.
I distinctly remember BP's discovery of this huge cache of oil in the Gulf of Mexico. It was major news. One discovery that would help reduce our reliance on foreign oil. Maybe it will someday. Maybe it will spur good old American ingenuity to make drilling safer and find cleaner alternatives. But BP and the government have to plug this hole.
The ecological damage happening today will take decades to repair. I almost couldn't believe the statistic I heard last night on the news. There is enough oil in this reserve to spew on like this for the rest of our lives. And we will likely never truly understand the impact of this catastrophe. And even more grim, this slick keeps growing.
Everyone is arguing about the estimates, but thousands of barrels of this stuff is flowing into this body of water each day. And it's been going on for 37 days.
Take a look at your kid's lava lamp and remember that 42 gallons equal one barrel of oil. BP estimates that more than 200,000 gallons have been leaking into the waterways every day, others think they have been low-balling the estimates.
To date, the Unified Area Command, the government agency charged with monitoring the disaster's clean-up, estimates there are something like 1,220 ships working the spill, and more than 2.8 million feet of containment and sorbent boom have been deployed. After a month, they have recovered 11 million gallons of oily water.
And now it's making its way onto the shores of Louisiana. In fact, 30 miles of coastline are believed to be fouled. And the U.S. Fish and Wildlife Service reports that 32 national refuges remain at risk. In addition, the National Wildlife Federation reports that 154 sea turtles, 12 dolphins and more than 20 migratory birds have been found dead or dying on Gulf beaches. The group is forming a cadre of volunteers to look for oiled wildlife along the coastline. More casualties are coming. It's inevitable. But many other animals are being rescued and treated.
I also found out they have set up 17 staging areas to protect sensitive shorelines in:
Dauphin Island, Ala.
Orange Beach, Ala.
Theodore, Ala.
Panama City, Fla.
Pensacola, Fla.
Port St. Joe, Fla.
St. Marks, Fla.
Amelia, La.
Cocodrie, La.
Grand Isle, La.
Shell Beach, La.
Slidell, La.
St. Mary, La.
Venice, La.
Biloxi, Miss.
Pascagoula, Miss.
Pass Christian, Miss.
And you can bet, that at every port or area threatened by oil, there are veterinarians ready to help care for oiled wlldlife.
Stay tuned to dvm360.com. DVM Newsmagazine editors are actively pursuing this story and are planning reports including an update from Dr. Michael Ziccardi, a University of California-Davis veterinarian and director of the Oiled Wildlife Care Network.
The economy is on the mend. And we can’t have that – what will all the journalists and bloggers like me have to write about? So it’s time to do your bit and push the world back towards financial oblivion.
Since credit has largely dried up you can’t possibly get into more personal debt. And since the government has largely removed any responsibility from the big boys, it’s time for us small and medium enterprises to enter the fray. It’s time to ensure that your practice contributes absolutely nothing to GDP this year.
Be strong people. Do your bit and follow these tips on how to run your practice so badly that it won’t ever make a penny, cent or peso ever again.
Step 1 – Don’t make any attempts to get customers through the door.
Don’t advertise. Don’t train your staff on phone techniques. Don’t maintain your buildings or appearance. And under no circumstances engage in any ‘high-falutin’ social media marketing activity. Dangerous stuff that.
Step 2 – Try not to find any problems with pets.
Don’t employ the best vets – go for the cheapest. New grads all the way! Do not waste money on continuing education courses for staff. Actively discourage using new skills or individual development in your practice.
When your vets are using vaccine consults as ‘catch-ups’ take no action. After all the pet’s teeth will still be bad next year and that niggling lameness will probably get better on it’s own. Found a lump? Probably just a lipoma – no need for a time consuming aspirate.
Step 3 – Stop selling them solutions.
If your vets (pesky lot) absolutely insist on looking for medical problems, all is not lost. Since most of them haven’t a clue how to effectively persuade a client to take the right action this doesn’t represent a big issue. To keep it this way, do not try to teach them communication skills or sales techniques. That would be disastrous in your efforts at avoiding profit.
Step 4 – Sinks yourself with pricing.
Ah-ha! Double opportunity to fail here. Firstly, make sure your prices are so low that there is no way you could ever make a profit. Secondly, don’t tell your staff what’s expected of them when it comes to billing. They’ll make it up as they go along and almost certainly lose you a fortune. Good job!
Step 5 – Try not to collect money.
OK, healthy cash flow is not the same as profit but it does mean your business keeps trading. This in itself means you are a risk to economic meltdown. Therefore, try not to worry too much about asking clients for cash. It only makes the vets feel awkward and annoys clients. Everyone will be happier if you just ignore this bit and let clients wander out the door before paying.
Step 6 – Don’t pay bills.
Now you wouldn’t be doing your bit unless you helped pass the pain up the supply chain. So, to make sure no-one else has any money to pay bills or encourage growth keep all of your bills in a pot on the shelf, wait until they are all final demands, then (and only then) select one randomly and pay it.
And while you’re at it, make sure you’re paying top whack for all of your stock, can’t have the margins creeping up now.
Dave’s Tuppence-worth
If you follow these tips folks then within a few months you’ll be guaranteed to be lining up….at the job centre, claiming back some of that money you gave the government in last year’s tax bill. Now, job done…doesn’t that feel better?
Or there is another way…. 
Join Us on The Hamster Wheel.
