Signatures and Support Needed

Seems someone else in the profession feels the way many of us do and has taken it upon himself to spread the word and try to make the changes necessary to save the profession in general.  He's taking on the AVMA and asking for help on Change.org so that we can force their hand with enough signatures.

He needs our support.  Please visit the page and join him in the fight to do SOMEthing instead of sitting on our hands bitching and moaning and accomplishing nothing, as we've been doing for the last 20 years.


Save the Veterinary Profession

What are your #6WordsOnVetMed?

Our friend and colleague, Eden Myers, DVM, MS, over at JustVetData.com kicked off a page asking those in the veterinary profession and field to boil down veterinary medicine to 6 words. A handful of veterinarians and technicians have taken to the Twittersphere with #6WordsOnVetMed, others have left comments at Dr. Myers' site. Some of our favorites include:

• Patients don't care if you swear
  
• Brilliant and caring. Bad at business.
  
• No vet school for my kid!
  
• The worst part are the owners
  
• Dug a hole, created a mountain
  
• If you marry rich, it's great.
  
• Pets don't have credit cards. Bummer

There are certainly other good entries, and you can take a look for your favorites. If you haven't already tweeted your thoughts, what's stopping you? Just use the hash tag: #6WordsOnVetMed (and feel free to tag @minivbb and/or @JustavetFromSDN).

Sit In The Corner and Think About What You've Done!

As is typical for the summer time, our VBB postings become a bit less frequent. Some of us are just busy with work while others are enjoying time away with family and friends as the summer gets started.

Today I've got less of a veterinary-themed post and more of a shout-out to a blogging buddy.

A position paper was recently published in an issue of Annals of Internal Medicine entitled, "Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards." The abstract is long and wordy, as most journal-published pieces are, but the gist of it is:

Opportunities afforded by [user-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms] represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies.

What makes this paper particularly interesting to us Badly Behaving Veterinarians is that one of our human-medicine counterparts has apparently been cited as an example of un-professional behavior. That's correct, we've got a naughty doctor in the house. I draw your attention to page 622 and the paragraph that includes Reference 17.

Just as with informal in-person discussions among colleagues, the airing of frustrations and “venting” may occur in online forums. The ACP and the FSMB recommend against this practice, even among close contacts, as it may be disrespectful and undermine professionalism. We also caution against this practice in other forums, specifically blog postings or microblog sites, such as Twitter, as the material may present the physician or physician-in-training in an inappropriate or unprofessional light (17). Physicians criticizing late-arriving patients or disparaging patients for not adhering to behavior changes (such as diet and weight loss) can undermine trust in the profession.

The object of the authors' scorn here is none other than Dr. Grumpy, a medical-blogging neighbor, if you will. My initial reaction to learning of his "inclusion" in this paper was that he has now been officially acknowledged as an online medical voice worth America's attention. Or as one might say on Twitter, "#validation."

My second reaction was to the last sentence of the paragraph, which made me think, "The public being the public routinely undermines trust in the public... so what's the authors' point?"

I'll leave it to our individual readers to determine if this paper has actual merit. What do you think? Is it wrong for doctors to have an outlet to vent?

In any event, kudos to you, Dr. Grumpy, for attracting the attention of the medical busy-bodies and elitists. You've inspired us on the veterinary side to achieve similar criticism from the veterinary busy-bodies and elitists.

Another from the Mailbag

A really great entry sent in from a reader who experiences the same types of scenarios as the rest of us.  More proof that those of us at the VBB are not alone in our jaded views!



I just found myself at my desk here at VBB Animal Hospital with my formulary open, phone in my hand and six internet windows open. I was researching treatment options for a patient with allergies. I wasn’t researching drugs or treatment options - I already have those down pretty well. What I was researching was a cost effective option for clients who love their dog and want her to stop itching, but for whom money is a concern. So, there I was, still sitting at my desk an hour after closing time, calling pharmacies, googling on line compounding pharmacies and calculating dosages for multiple drugs - all to find the cheapest option for treating this itchy dog.

And you know what? This isn’t uncommon. At all. We vets hear again and again owners accusing us of only being in it for the money and charging outrageous prices for care. Who among us hasn’t heard, “If you really loved animals, you’d treat him for free.” But I had an epiphany this week when I realized how much time my staff and I dedicate to trying to make care affordable. And I don’t think I am alone here.

My staff frequently finds me staring at a shelf in the pharmacy. Fluffy needs antibiotics, or pain medications or some other expensive treatment. I usually have a few options for treating. So I stand there, appearing to be in a trance, but the cogs of my brain are turning, performing a series of calculations to determine how I can dose with half a pill at a time, or use once daily dosing, or which drugs are available as a generic, or use a liquid formulation, other mathematical manipulations to determine what the cheapest option is. And when I’m done with my calculations, there is a fair chance I’ll then refer to the Big Box Store $4 prescription list and then write a script for something cheaper than what I can offer.

Here are some other examples from just this week of what happened at my hospital. I had my staff call every referral hospital in a 100 mile radius to compare prices for a procedure I don’t perform so we could help the client find the most affordable option. We special ordered medications twice this week for clients because those drugs were going to be the cheapest treatment option for the patient. Every sick pet is provided an estimate for treatment. We always offer the best first. But when that isn’t an option, we spend as much time as it takes working with the owner to come up with a treatment plan that works with in his budget. I don’t answer the phone unless I absolutely have to, but I listen to my staff do it. And I hear them answers questions all day long. Sure, sometimes the answer is, “Let’s schedule an exam so Dr. VBB can examine Fido,” - because that is the right thing to do. But lots of times we can get you the information you need - and it’s free. If you have a question for me in the exam room, and I don’t know the answer, I’m going to find that answer for you. It might take me an hour of sifting through text books (yup, I still have some of those), consulting with other veterinarians or online veterinary groups. And then I’ll call you back and let you know what I learned. And unlike a lawyer, I won’t charge you for a minute of that time. It all gets covered in your bargain basement physical exam fee. We also treated a post dental complication this week in a cat - the owner wasn’t able to medicate her at home, so she brought her to the hospital daily for treatment, including weekends when we are not normally open. Charge for that? Free. And finally this week, I have brought into my home an obese little dog. Her owner struggles to get weight off of her. So I am converting her to a diet of actual dog food and getting her little body waddling along several times a day. I hope that if I can start a diet change and some exercise and her owner will see it is possible, he will be able to keep it up and make the dog he loves so much healthier. The charge to the client for this service? Zero.

So, I know veterinary care is expensive. I am well aware since I pay the bills for all that stuff that keeps my hospital running. But I do have your financial concerns on my mind. Always. Even when you don’t see what happens, I am working hard for you and your pet and often not charging for my time (and sometimes supplies) and often working (sometimes behind the scenes) to find the most cost effective treatment plan for your pet. I thought you should know what happens at VBB Animal Hospital - I bet you’d find it happens at your veterinarian, too.

Myrna and her Lady

Myrna first brought in Lady back in 04 when the pup was 6 months old. She had some itchy eyes from allergies or from the oppressive wind that blows its brains out every day in the summer around here, or both. That one was easy, and the drops helped. Two weeks later, I spayed the young Lady, and then I didn’t see her again until summer of 09.

Sometimes when the females have been spayed they begin leaking a bit of urine in their sleep. They tell me this happens often in the physicians’ patients, and we certainly see this in some of ours. It’s more common in the larger breeds, and it shows up more often as these girls age a bit. Lady was a German shepherd, and now she was 5 years old, so she fit the profile. We have meds that usually stop the leak, but most often this is a life long deal, so the meds go on forever. They are not resoundingly expensive, these meds, but one person’s pocket change can be another’s small fortune.

Myrna has a fortune in good spirit, but she’s not what ya might call wealthy in the traditional sense. She did find a way to pay for continuous meds, for Lady was an indoor dog, and that was just that. But it clearly wasn’t easy for her. Myrna lives alone, having been widowed some time ago. She has adult children, and some young adult grandchildren, but it is mostly a few friends who help her out. Myrna doesn’t like to talk about it, but it seems that her children and grandchildren steal from her from time to time, which is the kind of help she doesn’t need.

So a year later, when Lady began having trouble with her anus, well that’s when things got real tough.

The condition is called perianal fistulas. These are rather large holes that erupt in the tender skin around the anus. Deep under the skin a problem arises, an inflammation that becomes a pocket of yuck and this eventually burrows out to the surface, breaks open, and then you have a hole you can stick a finger in, which discharges mung and fungu and various bloody pussy stinky sticky substances. Forever.

Perianal fistulas hurt. They hurt when you poop. They hurt when you sit. They hurt when you lick yourself, if you are the dog. For the owner, they stink, they leave stuff all over everything, and they make you hurt for your dog. They often accompany chronic diarrhea, for reasons we don’t really need to consider here. They happen mostly to German shepherds. And of course it was happening to Lady.

So for the owner there is cleaning that must be done, to the dog and to the house. Cleaning of awful stuff. This presents a problem to any owner. It provided an even more difficult problem for Myrna.

Oh, did I mention that Myrna is blind? Yeah, totally blind. Myrna needed to clean Lady’s painful bloody stinky pussy shit covered anus without being able to see it. And she would smell the diarrhea, and she would go find it in her house, on her hands and knees, and she’d call to tell my just how bad it was that day after doing a digital appraisal. And no, her family was not helping.

The doctors know that perianal fistulas show up due to some crazy hiccup in a dog’s immune system, for when we are successful using the drugs that suppress the immune system, some of these dogs get better. But this condition has expensive tastes, preferring only the most costly immunosuppressive drugs. The best choice is an oral med that costs multiple hundreds of dollars a month to maintain a shepherd size dog. We also do better when we can restrict the dog’s diet, since food sensitivities also may be a trigger for the disease, and thus we need to try the expensive foods, too.

Myrna vowed to find a way to pay for all this. We shopped around for the best prices, and since I’m the boss, I cheated myself by letting Myrna buy these things from me at just about my cost. I don’t even want to know what Myrna cut out of her spartan lifestyle to support her beloved dog. Sometimes I’m a sucker that way.

Lady couldn’t tolerate the oral meds. She vomited, and even when we gave it the time you need to try before you finally give up on that med, she still threw it up.

So drug choice number two was ordered, an expensive cream made from a different but similar drug that is rubbed into the skin around the anus twice a day. This one we got through a pharmacy, so I had no way to subsidize the cost. This did work, and eventually Myrna started getting it through some Canadian pharmacy, and this brought down the cost to merely backbreaking. And Lady did much better. The sores never completely healed, but much of the stench and yuck went away, and this little blind lady was able to keep things tolerable for three years.

One morning a couple of months ago, Myrna called asking about arthritis drugs, for Lady was having trouble getting up. Myrna needed to borrow friends and cars and other people’s time to bring Lady in, so we decided to try something simple, a drug that wouldn’t conflict with the ones that were keeping Lady’s anus tolerable, and I postponed that chance to examine her. And the drug seemed to help, although at least one of the grandchildren was stealing them for his own use. Apparently, it’s easy to steal from a trusting little old blind lady if you are truly scum.

The second phone call came some weeks later. A leg was swollen and Lady couldn’t use it at all, and the big sinking feeling settled into my gut. This time we needed to take a look.

The tumor was almost softball size, tucked in behind the knee, hidden under the hair, hard to spot when you are blind and you mostly concentrated on the anus. All those parasitic offspring folks who should have seen this, never noticed.

I tried a few things to help Lady stay comfortable, but not long later Myrna and I came to the wall where we knew we had to stop. She wanted to remain with Lady when I did the last part of my job. The injection went smoothly, and Lady slipped into sleep and out of life. And since Myrna couldn’t see what was happening, I needed to tell her when this all happened. And then all that was left was the grieving.

Perhaps Myrna had more pent up inside that just the loss of her precious Lady. Certainly, from outside looking in it seemed to me she had that right. After Lady breathed her last, Myrna let some of it go, and it filled my hospital and took with it all of us here. Myrna’s heart was truly broken. There was nothing we could do save to hug her and try to convey our own sadness.

So no, I couldn’t fix that, either.

Home Made Baby Food

Mandy makes baby food for our use in VBB hospital. She buys the cheap turkeys just before Thanksgiving, putting a couple in the freezer when they are on sale. One client brings in a turkey every year just for this purpose, because his puppy began eating as it finally recovered from parvo, and what it ate was Mandy’s homemade turkey baby food. He’s been doing this for years.

We have a stove in the break room, and Mandy boils a whole turkey on that stove, all day, day after day, until it is mostly mush. The entire hospital smells of turkey when this happens. Like Thanksgiving Day at Mom’s. Then into the blender goes the remnants, and from there into ice cube trays, and then the freezer. Ice cube trays provide individual servings of Mandy’s homemade baby food, which thaw quickly in the microwave, or with hot water. We call this food magic, because puppies and kittens, old lady cats and ninety pound pitbulls will eat this before they will eat anything else in the world, and sometimes this saves their lives.

Ya see, thirty-five years ago, Mandy had a baby. The baby came a bit early, and it weighed all of 4.5 pounds, and he took a little work to get him started. Eventually he got to where he’d eat baby food, and since money was just a mite tight back then, Mandy made her own. This set a precedent.

Mandy will tell you that the homemade turkey baby food is magic, but she won’t tell you the entire truth. Sure, the baby food smells great, and it tastes great, and it slides down easy when eating is too much work, but what Mandy won’t tell you is that there is more than mushed turkey and water in those ice cube trays. Nope. That’s not all that goes into that baby food.

What Mandy won’t tell you is that she also infuses a generous serving of love into that food. And the other thing that Mandy won’t tell you is that there isn’t enough room in that baby food for all the love she has to give, so she serves up some more love on the side, every time she feeds her baby food to puppies or kittens or old lady cats, or ninety pound pitbulls. And thus we have magic.

Mandy works for me and thus I’m always giving her things to do around here. Most times she does them. But every once in a while I’ll go looking for Mandy onna counta something not getting done right away, and I’ll find her in the back, sitting next to an open kennel door. The kennel floor will be covered with one of those warm, colorful, padded kennel floor covers that Mandy sews. The water dish will be clean and full. The cat box, if needed, is clean and over there. And the puppy or kitten or old lady cat is curled up in the bed that Mandy makes for them.

Mandy talks quietly with these patients of ours, so she disturbs no one. She’ll generally have a little plastic bowl of warm homemade turkey baby food with her, maybe a spoon or small syringe, or maybe just that second finger on her right hand that delivers fingertips of baby food gently to the nose of a puppy or kitten who just might lick it off, and thus jump start a recovery.

Mandy will have already been sitting there for two hours, talking with her patient, petting or combing or cleaning softly, fussing with and touching and passing on the love she serves up with the magic of her baby food. Mandy learned that you can pass love through your fingers and your voice, and your fussing…pass it on to a tiny premature baby, or a puppy or kitten or old lady cat, or ninety pound pitbull….and that is what she does. That, and the homemade baby food.

I have tests and drugs and a scalpel, and I do what I can. Mandy follows with the homemade turkey baby food and her love, and she brings the miracles I don’t have in my box.

This morning we arrived at the hospital early. We wanted to see how Icarus was doing. This cat had come into our hospital yesterday, and he looked like shit. Sorry. He did. Mostly, he looked like flea dirt, which is flea shit, and he felt like a handful of sand when you picked him up. He had so much flea dirt all over him that the wet parts had turned red.

Icarus lay there on my exam table, limp. His right eye bulged nearly out of its socket. According to the owner, “He ain’t eatin’, and he don’t move much.” That much I had figured before Mrs. Einstein opened her mouth.

Of course she didn’t have any money. Heck, she still owed me a hundred bucks from February. Couldn’t come up with a hundred bucks in three months, although it looked as if her tattoo artist got paid. So no tests or anything useful this day. I got permission to drain the abscess, correct some of the dehydration, start the antibiotics. We’d have to hope for a miracle to do the rest.

So I turned Icarus over to Mandy. She fussed over him for three hours. When she was done, he was clean, about a hundred fleas lay dead on the battlefield, he’d been talked to, petted, touched, fussed over. His drugs were in him, his fluids delivered, and now his bed was warm. And a finger with a bit of homemade turkey baby food was touching ever so gently on his nose. He licked it off. And he rolled over to have his belly rubbed.

When we left for home Icarus could stand, and he had eaten some considerable amount of baby food, and even a bit of canned cat food. And he purred. Maybe, just maybe….

Icarus was dead in his bed this morning. He looked better dead than when he arrived, for he was clean and he died in a relaxed position. But yeah, he didn’t make it. That crying and cursing? Well, that’s what Mandy does sometimes. Especially when she is standing over one of the dead ones who shouldn’t be that way.

She hasn’t done this work as long as I have, and while I walk away muttering something about god damn f****ing stupid ass people, Mandy still screams and cries. And then later she said to me.

“You’re right, you know. You can’t love them more than their own people. You can’t or this will kill you.”

“Yeah, and good luck with that.“

She’ll be there for the next one. You watch.

Media Veterinary Medical Advice

It's a big thorn in most of our sides when we hear non-veterinarians giving inappropriate (read: wrong) veterinary advice, but in reality most of us are used to it and we usually just roll our eyes and  move on to the next problem when we hear the incredibly stupid things people say.

But, this was on the news recently, and the advice is so... how should I say it?  STUPID???  That we had to share this link and make sure that we get this incredibly important information out there for all to hear.

Don't worry about zoonotic disease or not having a clue about vaccine schedules or any silliness like that.  I mean, vets don't know anything.  We stand there talking about this stuff cause we just want that paycheck, not cause we really *know* anything about any of this stuff or because we actually care if little kids go blind from zoonotic disease or any crazy talk like that.



Veterinary Medical Advice by Non-Veterinarians


I can say a few positives, though.

1.)  At least they said that animals are expensive and you should be able to care for them.   (and saving $10 on those vaccines by doing them yourself is really gonna help when your puppy gets parvo because you were clueless about how to vaccinate and the clerk at Tractor Supply told you to give 3 vaccines 5 days apart)

2.)  They are trying to help stray animals.

3.)  Canned pumpkin is useful for SOME things.  Just not for intestinal parasites.

4.)  Molasses does taste good.  OH maybe they meant pumpkin pie?   I dunno.


But dammit, why do they get to be the heroes and those of us who DO actually "save" animals are always the bad guys?