Thursday, February 27, 2014

A soft spot

“Open confession is good for the soul.”  ---- Old Scottish proverb

Have you ever made a mistake?

“I thought I had made a mistake once, but I was wrong.”

A comedian said that once. So have a few sociopaths. I must confess to having made mistakes. There, my soul feels better now.

Actually, during the middle of the night, that time when I cannot hide from elements that wander about my brain, I sometimes discover the list of mistakes I’ve made in a lifetime. Something reminds me of a error I’d thought I’d put away, and then the others line up obediently for my leisurely perusal. Nights are long, so there is plenty of time.

A colleague has a friend, a physician, a pediatric surgeon. Once a year, every year, on the same day, this doctor receives a letter reminding him of a child who died while under his care. This has been a regular thing, for 25 years. Best as we can tell, this doctor did nothing wrong, but a patient died while under his care. And somebody has not forgotten. From the look of things, somebody is not likely ever to forget. And they wish to assure that the doctor never forgets.

I can assure you that the doctor will never forget, and the letters have nothing to do with this. But the sender gets a wish granted, for the letters cause pain.

Years ago we used a brand name drug as part of our anesthetic combination for cats. The drug was manufactured in two strengths, one for horses and the other for ten pound cats. Since we don’t see horses, we always used the cat version. One day the drug sales rep mentioned that a generic version of the drug had become available, so we ordered it from that supplier. Used it for a short while, and frankly didn’t much like the new version. This occasionally happens with generics. Then a cat nearly died.  

The horse version of the drug had ten times the concentration as the small animal version. Guess what kind the supply company shipped to us? I didn’t catch it. I ordered one drug, received another, and used it. And a cat nearly died.

I suppose I might argue the point, but it was clearly my responsibility to catch this error. I was the one who had to tell the cat’s owner. I was the one who paid for the emergency care the cat received. I was the one who had to respond to the board complaint she filed. I am the one who relives this periodically, late in the night.

The owner tried to get my license revoked, and she swore that she would never come back, and I didn’t blame her. Two years later, when she called to schedule an appointment to euthanize another of her cats, because our fee for this was less than the practice she now utilized, I refused to see her. We like to think we keep the fees for euthanasia low as a kindness for our clients. We are not attempting to attract……

Several months later, we ordered that same drug from that same company. We specifically mandated the small animal concentration. And we told them why.

They sent the wrong one, again. We caught the error this time.

I’d be ripe fodder for the hate obsessed lady with her hate veterinarians website. I confess…I’ve made mistakes.

Twenty years ago my own dog died while under my care. The details are not relevant. Suffice it to say that Jake was another casualty of my career, another sacrifice I made in the life long obsession to try to help the animals and their people. So yeah, I know what it feels like to hate the doctor that you think killed your pet. And no, I likely will never forgive, ah….me.

People tell me I should “let it go”, but ya know how that goes. So yeah, I do sympathize with the woman who started the internet website who so hates veterinarians. Her cat died while under the care of a veterinarian, so she blames that doctor for that death.

Sure, the cat was twenty years old and it died like most every other twenty year old cat that dies, of kidney failure. Back when this happened we didn’t have dialysis for cats. Truth is we had so few things that could be done to delay the death. No doctor on earth could have kept that kitty going indefinitely. Fifteen years later this woman still hates veterinarians virulently and with enthusiasm and persistence, and she uses the internet to prosecute her vengeance.

When Dr Koshi died, a cat that she had tried to save from a lifetime of neglect in a park was instead given to the self-styled “cat rescuer” who reportedly has said she will release it back into the colony of feral cats living in that park. Despite all the evidence that feeding feral cat colonies is not only bad for the cats, but also bad for wild birds and animals, and a risk to public health…a gaggle of “cat rescuers” joined in celebration of the return of the cat to this woman. And the woman with the hate-website chimed in with her own version of hate. She of course, directed her hate at the doctor.

Don’t know if you caught any of this. But if you did…did you notice this part? Did you notice that other than the vicious veterinarian hater on the web, everyone else, those people in the street aligned against Dr. Koshi pretty much said the same thing? How wonderful that the cat was given to this person. Not a thing about any benefit or harm to the cat if it was to return to the park. Not a word of how well it had fared under Dr Koshi’s care. Nope. How wonderful for the “cat rescuer” was the theme.

This was never about the cat at all. 

Ask any veterinarians what they do, and they will tell you, “I practice veterinary medicine”. Ask any veterinarian WHO are you? And they will tell you, “a veterinarian”.

After a while in this profession, that IS who we are. And pardon the self-promotion here, but we take intense pride in caring about and for the animals and their people. That is who we are.

If the haters manage to take that away from us, and yeah…..that’s where they go because any bully knows you go for the sensitive place first, the soft spot. They attack who we are. They went after the part of Dr Koshi that was the caring, helping, sacrificing essence of who she was. Those people who attacked Dr Koshi took HER away, from her.

What was she left with?

Canine Craziness

Sometimes people just say the darnedest things.  It makes me giggle, sometimes for days.

In this case, it was my own husband.

I have one of those neurotic, crazy mixed breed little dogs that also happens to be kind of a clown.  Given his particular mix, he could easily slip into various OCD behaviors, so we try to be diligent in redirecting his attention when he seems to consider "going there."

The other day, after a particularly fun time of hauling toys around the house, pulling blankets off the bed in feeble attempts to get me to chase him with said blanket, he started jumping in the air and acting like a nut - which he does often, because he knows that doing various tricks will often end up with him getting some sort of reward.  He's really good at trying to figure what tricks will get him these rewards, in fact.   He's got me trained very well.  Being only 12 lbs, his cuteness usually wins out.

During this super surge of energy,  he started chasing his tail.  Now, we all know this isn't really a good thing to encourage, so after getting over the initial laughter, you have to really watch how you respond so you can redirect them and convince them they really don't need to be chasing their tail.

My husband, however, took a different approach.  I was cracking up watching HIM more than anything, because he'd never seen our dog do this.

His response? 


Then he looked at me and told me go "GIVE THAT DOG A PILL!"

He was joking, of course. 

I'm still laughing.

(After all of the emotions this week, and the assaults on our beloved profession, I thought I'd interject something fun here)

(In fact, I'm pretty damned proud of how all of us have rallied around this tragedy and are working together to force the changes needed to stop the cyberbullying of us all.  RIP Shirley Koshi.)

Wednesday, February 26, 2014

The "You Don't Suck" file

OK, raise your hand if you have a "you don't suck" file. You know what I'm talking about? That special file in your filing cabinet (or folder in your Evernote if that's how you roll) where you keep a copy of every nice letter or special recognition you've gotten from someone who really appreciates your work, so you can refer to it on those days when you are feeling put-upon and unloved? Well, I thought it might be nice to give us all a little example of something for someone's "you don't suck" file.

A reader-colleague has shared:

I had a refreshingly unique client experience the other day. I was doing a recheck exam on a sweet little Boston, Minnie, that had been injured when she was mushed under a closing garage door. (She's doing very well, by the way.) Her owners were just about to leave when they said to me, "When we checked out the last time we were here our bill didn't seem right." I of course instantly had the heart racing feeling that we were about to become embroiled in an angry debate about the "ridiculous" cost of pet health care. The wife continued, "When we got the total it just didn't seem like it was high enough." The husband piped up, "We wanted you to check and make sure we didn't owe you any more money. It was less than the estimate you gave us and we didn't want to leave without paying the rest." I almost fainted! I happily explained that Minnie's injuries did not end up being as severe as they might have been, so that all I had estimated had not been needed. They seemed so concerned that I had not charged them enough, and I had to repeatedly assure them that all was well and that I was glad to not have had to charge them for some procedures and treatments because it meant Minnie had not had to endure them. I have never been told the bill was not high enough before and have my doubts I'll ever hear it again! I hope they have a lot of equally sweet friends and relatives they can refer to us in the future.

Thought a story about nice folks might brighten someone's day.
Doesn't it feel good to read about clients who appreciate their veterinarians? I know it makes me feel good! I'm putting this into the virtual "you don't suck" file for all of us. 

Tuesday, February 25, 2014

Veterinary Suicide Awareness funding

We have been asked to help publicize this important message from our colleague Dr. Myers over at She is working hard to facilitate this veterinary suicide awareness webinar, and has reached out to AVMA for funding but AVMA as we know is not necessarily the fastest horse out of the gate, and she is working on a deadline!

Last month the North American Veterinary Community (NAVC) held its annual conference in Orlando Florida.  I organized a day long program called Ignite!, designed to present ideas to help us positively engage the profession's most challenging issues. Some of the issues were burnout, suicide, convenience euthanasia, mindfulness and respect.

A veterinary suicide working group formed after the presentation and breakout.  The informal working group has been offered the opportunity of putting on a free suicide awareness and prevention webinar in May courtesy of Justine Lee and VetGirlOnTheRun. The webinar spot is in May- the month in which the most suicides occur.

Each free, RACE approved webinar attracts hundreds of veterinarians, according to Justine Lee of VetGirlOnTheRun.  So in addition to presenting truly life saving information to a large number of vets at a critical time, we could ask how many vets are personally affected by this issue. We can use that info to get more money and support for dealing with suicide and depression in the veterinary profession.

We would like to pursue RACE approval for the webinar.  The group has assembled suitable content and presenters, but we need funding of $240 for the RACE accreditation fee

I've emailed AVMA for the funding at the suggestion of incoming AVMA president Ted Cohn.  Ted was kind enough to moderate part of the Ignite! session for me.  He has been personally affected by the suicide of a colleague, and is thus following the working group's progress and looking for ways to enable the AVMA to support efforts to address this issue.

But - we need to submit for RACE approval by Mar 1, and I don't know that AVMA will be able to respond in that time frame.  So, I'd like to ask people to send money so we can fund RACE approval for this webinar.  I would ask each of you to send $1. Symbolic that any one can help no matter how little you have to give, and symbolic that it takes everyone giving something to get the job done. 

Any funds over the $240 will be directed toward the working group's further efforts, which I'm happy to talk about in additional emails.  Send money using Paypal to (free to friends from your bank account or paypal balance).

We here at VBB Central are hopeful that with increased awareness and colleague-to-colleague support, we can nip this problem in the bud before it gets worse. It's all about relationships. Reach out to a colleague in need. Talk to a difficult client like you'd talk to a friend. Try to change people's perception one person at a time! And also, please, donate to help make this webinar a reality!

Depression, loneliness, and suicide

Quickie post here - we have had a number of commenters on our last post mention feeling alone, depressed, and even suicidal. Some of you we cannot figure out how to reach. Please, please, PLEASE if you are one of those people, email so we can offer some real support. Thanks!

Sunday, February 23, 2014

Murder, By Internet

I apologize in advance for the length of this, but the story is a bit involved, and I believe illustrative.

Blood ran down my arm, across the back of my hand, and dripped onto the exam table. I stood there quietly taking the verbal abuse from an outraged pet owner, my hands resting on the metal surfaced table. It's better to let them rave themselves breathless rather than trying to interrupt. Ya learn this after a while. Once they've spewed their piece, they eventually stop to take a breath. Then they are not talking. No one can listen when they are talking. It's an A/B switch kinda thing.

I'm pretty thin skinned. Don't mean by this that I'm overly-sensitive. Far from it. Nah, I'm just old. Skin gets thinner when you get old, so when the dog rakes you with those front toenails little furrows appear, followed shortly by that red stuff. And when you follow the physician's advice and take those little aspirin daily, this inhibits platelet aggregation. Oh sorry. Big words, This means you bleed with enthusiasm from little furrows.

I learn from such encounters, even after all these decades of playing this game. I listened intently to the young man, occasionally glancing over at his embarrassed wife. I wanted to learn what he thought I'd done incorrectly. She was dumbfounded by his tirade. I was a mite taken aback myself, but I too stood there taking it in.

By the time he finished, it was completely obvious that I need not try to respond. Why waste the oxygen? This guy had it all figured out, and reality had nothing to do with our little predicament. The first words out of his mouth when he had entered the exam room with his dog, “We didn't like the last vet”, would be the first words out of his mouth at the next veterinary practice. Nothing I had to say was going to change that.

I shook my head and turned away, ignoring that little bit of his spittle hanging off his lower lip. I left him puffing in the exam room. Time to bandage the arm again.

“We should have listened to your internet reviews.”

Yeah, you should have. Thought it but didn't say it. I don't read my reviews, No point in that. But someone, (the mayor of our little city) had mentioned those reviews just the week before. Apparently next to all the good ones were two rather nasty ones. I figured I knew what those were about, and when I replied the mayor simply nodded.

One was a young woman who was incensed when I excused her dog before my exam could even begin. It had something to do with not being able to touch her vicious little dog. Her boyfriend had screamed into my face that I get paid to get bit, and I took some small exception to that bit of misinformation.

The second bad review concerned another client who announced as she entered the exam room, (yep, another who didn't like her last vet) that she was dissatisfied with the dose of the pain killing drug the last doctor had prescribed for her cat, so she had raised the dose without asking if this was appropriate.
The second sentence out of her mouth was to demand from me more of the drug, long before I had the opportunity to become familiar with the animal's condition, the history and the physical exam. I didn't jump at this opportunity for a fast sale, in as much as this was a controlled substance, and prudence suggests we not simply supply these to the public .

Numerous other demands poured from this woman's mouth with each new statement she made. And then the complaints as I began my exam. I was to do it the way she required and how dare I do it my way. I smiled and continued my exam. She continued to rail against every single thing I did. I smiled again.


The mayor has been a client of mine for roughly thirty years, so I don't know why he consulted those on line reviews, but I'll get back to this thought later.

Anyway, the young couple and their dog entered my exam room. It was a busy Saturday morning and we were completely booked. We'd set aside the usual 15 minute slot for what should have been a routine visit. The chart hinted at an ear problem, and they needed a rabies vaccination. I greeted them in my usual ingratiating fashion. I'm a heck of a nice person after all. The dog was about 45 pounds of one and a half year old mix-breed.

Warning #1: “We didn't like the last vet.”

#2: Dog is wearing a harness rather than a collar. This is where self-preservation kicks in. It's kinda like how you feel when the guy walks into the convenience store wearing a ski mask. Maybe he just has bad acne, but ya still watch em closely.

#3: I get down into my squat that I use to greet every dog that comes into my exam room. This is diplomacy in the dog world. It invites the dog to come over and make friends. It often begins the process that defuses doggie anxiety in the vet's office. It makes the job easier. The friendly dogs just love it. The clients love it. And I really enjoy the dogs. This dog approaches to a four foot distance, stares at me, raises it's lip about a half inch, and then runs behind the man.

#4: “The last vet took a foxtail out of his ear.” When was this? “Last July.” OK, that's foxtail season. Seems reasonable. “But it didn't get better.” (Seemed he intimated that the other vet faked taking a foxtail out of the ear. Heard that nonsense before, too)

OK, how long has he had this ear infection? “I don't know.” Well, how old was he when you first noticed it? “He was about 7 months old.” So, about last February. And it's been infected ever since? “Yes. It didn't get better after the last vet treated it.”

Small wonder. Ears infected for a year, treated once, didn't get better. We gonna need more than 15 minutes for this.

Dog had erect ears, so from across the room I could see a bit of the inside of the ears. They were pigmented black. Bad sign. Usually takes years of neglect before the ears turn black. Turning black is scaring from chronic inflammation, and it portends other damage that is not only permanent but often requires what we call salvage surgery to keep the dog from suffering needlessly. Poor dog's owners clearly lacked the clue.

The young woman showed me the crinkled flattened tube of ear infection medicine. It contained plenty to treat the ears for the usual 10-14 day treatment. “We've been using this ever since, and he didn't get better.”


Without understanding the reasons for chronic or recurring ear infections in dogs, the poor owners who are treating these ears are unlikely to get it right. No knock on owners ( this time), but when not handled correctly such infections often turn into disasters, and even when handled correctly they are often not cured, but merely managed. The sun comes up in the east, and some dog ear infections are extremely challenging to treat. That's just how it is.

Educating pet owners is the single most important thing veterinarians do. This is how we best help the animals. It is critical. It prevents a lot of the preventable disasters. It is also the most challenging aspect of the job. (there he goes, picking on pet owners again) So I spent a half hour explaining the basics to this young couple. My receptionist stopped by to wag two fingers in my face. The next two clients were already waiting. But I was getting somewhere with these two and I didn't want to stop. They seemed to be learning.

Now you might wonder why I still hadn't examined this dog. Normally, this would precede the education part, but I like to give the fearful dogs time to become accustomed to the room and me, and it gives me time to defuse some of the anxiety or hostility residing in the owners, for they set these dogs off by how they react. So I laid on the whole lesson, going back over each concept in different ways when they didn't understand. I'm good at this. Done it for decades. Most clients thank me once they figure things out. I made my other clients wait while investing important time with this couple. It began to feel as if we might make this work.

The time arrived when I would try to examine the dog. Prospects for this hadn't improved much. The dog still would not come over to sniff me. It had sniffed the entire room, wandered out of the room when the owner didn't pull him back by the leash, but never once approached me. You don't simply reach for a dog behaving like this.

I got into my squat again, and it approached to that same 4 feet, and then headed for the other side of the room. The man holding the leash stood right beside me. His dog was over there, giving me the eye. Silly veterinarians often wonder why the owners don't simply use the leash to pull the dog to them so we can actually do our job. Rarely happens. So after a bit, I reached up and took the leash from his hand, and gently pulled the dog toward me. He stopped at that magic 4 foot distances. A bit more tug on the leash as I entreated the dog to come. Harness goes up and over head, landing limply on the floor. Dog hurries over to stand beside the woman, over there.

I held up the useless and turned to the man. “This is why you don't use a harness. They give you no control over your dog.”

Woman stands next to dog. Doesn't grab his collar. Doesn't try to bring the dog over to me. Man does nothing. Woman speaks, “Maybe I should leave the room. He gets real protective of me.”

Ah...warning #5. I shouldn't need to explain this one.

I turn to look at the man standing next to me. Why don't you go over there, take the dog by the collar, and bring him over here? A novel concept he had apparently not considered.

He squats next to me, dog cradled between his legs, biting part facing out. Perfectly wrong set up for dealing with an untrained fearful dog.

I take collar and pull dog in front of me. He lunges left, he lunges right, he lunges left again. I hold collar. He stops lunging and I turn him to face away and induce him to sit. Soft calming voice, praising him for a sit, petting and scratching his back. He settles a bit. I touch an ear.

Dog lunges left, dog lunges right. For expedience I will not repeat this part over and again. The dog did. Take my word for it. After some considerable time, I give up on examining ears. I turn to look at the man who is still squatting right next to me. No attempt whatsoever to control his own dog.

Your dog really needs a good obedience training course. Not only will it teach him to behave, but it will impart him with some badly needed confidence so he won't misbehave like this. Nothing.

OK, enough wasted time. I give the dog his rabies vaccine, and go to stand up. Dog launches one more time, spinning in a circle, which locks my hand in the collar. Not a good thing if he begins to nibble on my arm. Manage to untangle my hand without injury, but dog rears on his hind legs and rakes my arm with his claws. I know that feeling. I'm done with dog and turn him loose.

I'm washing the blood off my arm when the man launches on me. He doesn't like how I held his dog by the collar. Really? How else does one hold a dog by the collar? Silly me. Took me a bit before I realized that he didn't want the dog held at all. That thing where I always say that the use of a harness is the owner's concession that he has no desire to control the dog at all. That's this guy.

So I stood beside my exam table, bleeding, while he assailed me. And then I walked out of the room, bandaged my arm, and then put on my smile for the next client. Excuse me for trying to help. The day went on, as they have for all these decades.

Will this guy put up a bad review on line? Don't know. Don't care. I don't read reviews. I don't defend myself when a bad one shows up. Don't care. My practice has been growing for decades because satisfied clients send their friends to me, and people who don't like how I try to help their animals are welcome find someone who does it differently. Lot's of ways to skin a cat. (sorry cat lovers)

Does it hurt my feelings after all these years of dedicating my life to helping people and their pets to have someone scream at me like that. Yeah....a little. I got into this profession to help, and I've sacrificed a lot to continue doing this for a lifetime. Mostly it is rewarding. Sometimes it breaks my heart.

So why the longs story? Well, last week a few people killed a veterinarian I know.

Oh, they didn't poke her with a knife or shoot her with a gun. But they killed her.

Shirley was in practice for over thirty years, and although a bit unconventional at times, she was always compassionate, up to date, hard working. She finally got the chance to start her own little practice. On a shoestring, she opened a small place in the city of New York. As all start-ups do, it was a struggle. The economy still sucked. The weather sucked. The likely illegal collusion between landlord, banker, contractor and maybe even organized crime nearly bankrupted her. But it took crazy cat ladies to kill her.

A feeder of feral cat colonies in the city adopted a cat from a shelter and then turned it loose in a city park, in the snow and the 2014 winter, to struggle on its own. This lady thinks this is good for cats. Some friends of hers brought the sick cat to Shirley for a medical problem, but of course declined most everything necessary due to cost. So as she had done in the past, Shirley asked them to surrender their cat so she could care for it and then try to find it a nice home. Because they could not provide properly for the cat, they agreed. Later, the woman who had turned the cat loose in the park showed up to claim the cat, and Shirley refused. She didn't want to see the cat abandoned again. And she didn't at that point even know who owned the cat. For she had been duped into believing the first two people owned it.

That's when it started. Vicious evil people have the same voice on the internet as the rest. An organized assault on Shirley began on the net. An on-line blog that specializes in character assassination zeroed in on her. Protesters with signs lined the street in front of her hospital, and had to be removed from her clinic by the police. People who had no idea of the facts hopped on board with the mob because the evil rich veterinarian deserved it. They were vicious, conscienceless, and evil. But they got their wish.

Shirley killed herself the other night.

And the vermin on the blog celebrated, cheering her death in their posts. 

Ask any veterinarian out here. This hurts us. So I guess they win.

Tuesday, February 4, 2014

Deep freeze

VBB Central has seen its share of winter weather, but somehow this question was never asked by any of our clients until this very morning.

Squirts is a large-breed mutt whose owner is very fastidious in caring for her. Today, Squirts came in with a history of having vomited a lot over the weekend, and then improving and seeming completely normal on Monday, until around bedtime at which point Squirts developed raging explosive diarrhea.

Squirts' owner was up, outside in the freezing cold, with Squirts, much of the night. She brought Squirts in first thing this morning. Luckily, our exam and tests revealed no significant illness at this time, and we were able to send her home with just some supportive and dietary care.

As they were leaving, Squirts' owner said "Doctor, I just have one last question for you. There is a very very large area of my yard that is now just covered with dark brown frozen diarrhea. My street has a homeowner's association and there is a pooper-scooper bylaw. I called my snow-removal man but he won't touch it because it's diarrhea. It's not like I can pick it up and put it in a bag and I am having shoulder surgery and can't shovel. What should I do?"

They did not teach this in vet school!