Got an oily animal problem? Above all others, Dawn is my go-to product.
I spent the eighties and early nineties washing oil-spilled seabirds in dilute Dawn solutions. The tar glopped feet of gulls, pelicans, herons and plovers (among others) always emerged from the goo after repeated rinses in the light blue magic waters.
When cats and dogs come in covered with motor oil (reference a recent Veterinary Information Network discussion if you’re a subscriber), we always manage to get the oilies off with Dawn alone.
Then there’s the anal gland messiness and the skunk-sprayed dog to consider: Both extreme odors respond to freshly mixed baking soda mixed with hydrogen peroxide (1/3 cup to a quart, respectively), but the formula doesn’t really do it’s job without a dash of Dawn to break down the sebaceous, stick-to-the-fur components these materials are made of.
Dawn dishwashing detergent. Nothing else works half as well. And I have no idea why. Gotta say that with that endorsement, why would I use anything else in my own home?
PS: No, I have not been paid by Procter & Gamble (its manufacturers, I think). Though I would happily accept some remuneration if they cared to send it now that I’ve already waxed poetic on their product and divulged the extent of my financial ties (as all bloggers are now required to do).
Being a food animal veterinarian can offer a broader range of opportunities than the average American might think. We can shuffle papers for a big behemoth of a swine operation, sit behind a desk in Washington D.C., condemn carcasses at a CAFO, manage herds for 1,500-head dairy facilities, consult with family-run farms as they attempt to go organic or introduce chicken fanciers to the sweet mysteries of food safety.
One size does not fit all. The kind of species, size of operation and scope of duties can vary enormously. Which is a very good thing considering that I still harbor high hopes of a future career in food animal medicine...
...And yet I don’t see myself donning coveralls and a plastic sleeve as I preg check cow after cow. Nor do I fancy an avian pathology position or a regulatory post within the Federal government.
Same goes for most veterinary students. We’ve discussed the issues surrounding the dearth of food animal veterinarians here before and we concluded the following:
1-Vet students don’t tend to want to go rural (where most food animal jobs live)
Not when they grew up in suburbia (as did 95% of students these days) Even if they did want to move out to the sticks, their spouses don’t... Or rather, their spouses can’t afford to given that non-ag jobs tend to be scarcer further out.
2-Then there’s the issue of lifestyle to consider:
is a food animal career female friendly? family friendly? new grad friendly?
3-And the question of future opportunities (including future pay)
because some large animal veterinarians make a very good living but it doesn’t compare to what a board-certified neurologist makes... nor does the range of future options for a cow vet in Vermont seem so vast as for a small animal intern in New York City.
4-Finally, there’s the obvious to consider: When an estimated quarter of this year’s crop of veterinary candidates has considered going vegetarian due to animal welfare concerns, is it not obvious that conventional food animal medicine is no longer in touch with the rest of the veterinary profession?
All of which makes for a scary future when it comes to food safety, biosecurity and public health in general. The small numbers of students graduating with an interest in food animal medicine likely means non-vets will take on these roles.
It’s not an easy problem to solve. There are a whole lot of issues we have to consider when it comes to filling the shoes of the current generation of food animal practitioners. Good thing is, it looks as if veterinary medicine’s on track to start addressing them.
Places like my alma mater are working on novel animal welfare initiatives that address swine confinement issues, for example. The Pew Commission has raised eyebrows and dollars for more of the same. Students with animal welfare backgrounds are starting to see food animal medicine––rather than shelters––as a place to make their stand.
But that’s not enough, you may say. Rural life is still an obstacle. The lifestyle issue is huge. Even if food animal welfare were not a big concern, we’d be in full-blown vet shortage within a decade. And we desperately need veterinarians to remain in the food animal game if we’re to keep our food supply safe. So what’s it going to take?
In the past, I’ve despaired over this point. I’ve worried that nothing could make a difference as long as the paradigm remained the same. I’ve fretted over the potential influx of corporate lackey paraprofessionals to replace veterinarians and the pharmacy industry-style downgrading of the veterinarian’s role in the context of industrial animal agriculture. I’ve even been known to say: “Money can’t fix this problem.”
But that’s where I seem to have been wrong.
The Federal government appears to be poised to put it’s money where its mouth is. Lots of it. More of it than I ever thought possible. Enough of it to raise my hopes that food animal medicine will continue to be managed by veterinarians. Veterinarians who might’ve otherwise eschewed a cow’s backside and outright rejected a challenging career in poultry pathology.
So what’s this game-changing deal? Up to $100,000 in debt relief over a period of four years. That’s $25 K a year for vets who spend up to 50% of their working lives furthering food animal medicine. That’s what’s being discussed. And, if approved, it’ll affect graduates as soon as 2010. In fact, it’s not just for new graduates. It’s for anyone with student debt remaining on their books. As in, people like ME.
Here’s where the optimist in me does a jig. Because this kind of money for food animal medicine means a broader range of veterinarians willing to enter a world formerly reserved only for the rural in origin and those seemingly pre-destined to step into a dying breed’s shoes. With this kind of money a fundamental change in animal agriculture––though far from assured––seems far more attainable than ever before.
It’s exciting, really. Enough so that I’ve taken to contemplating the possibility of a career in food animal medicine far sooner than I expected. Though I always knew I’d be headed this way, I didn’t expect to be tempted to throw my hat in the ring so soon. But then, it’s no coverall-wearing, pickup-driving, manure-slinging food animal job I have in mind. Rather, I was hoping they’d pay off my loans for my denim-wearing, hybrid-driving, laptop-hefting brand of backyard food animal consulting.
Hey, it “furthers food animal medicine,” does it not? And God knows I could use about $25 to $50 K.
It’s a huge issue. So big it fuels a sizable niche industry created specifically to meet the needs of pets who won’t––or can’t––tolerate drugs and supplements designed to treat and/or prevent their ills.
It’s nearly every day we access our favorite compounding pharmacy’s expertise in the formulation of new versions of the same-old drugs that line our shelves. After all, pets can be picky about what we put in their mouths or mix into their meals. (You would be too if you didn’t understand why you needed to take that niacin, glucosamine or Centrum Silver on a daily basis.)
I hate taking pills. The physical act of downing the trio of tablets I take every day is an uncomfortable, abhorrent one for reasons I can’t even explain. I just don’t enjoy downing a glug of chalky solids. So why would our pets?
Some of us hide our pets’ pills in foodstuffs or treats: cream cheese, peanut butter (chunky works best, IMO), ham, chicken breast, pill pockets, filet mignon... In vet school I even spent time devising a protocol for getting fish to take their Baytril (I soaked brine shrimp in 100mg/ml solution for 3-5 minutes). As veterinarians, we do whatever it takes to get the meds into our patients. And, yes, sometimes it takes a lot of trial and error.
Others switch to liquid meds (readily available through compounding pharmacies) hoping these will make all the difference. And sometimes they do. But more than anything else, what we all want is a cure that requires no daily discomfort, wriggling, stressing, in-the-towel-burrito-ing or the potential for biting, scratching or generalized inter-species strife.
It’s for this reason we seek solutions requiring once-daily dosing (instead of two to three doses per day). It’s why Pfizer’s Convenia makes us jump for joy (one painless subcutaneous shot equals two weeks of antibiotic coverage). It’s another reason we believe radioactive iodide treatments will always best methimazole for hyperthyroidism. It’s why topical medications are so revered when they’re found to work as effectively as the oral or injectable versions. And it’s also what keeps compounding pharmacies in business.
It’s hard to quantify, but we suspect that drug non-compliance as a result of an inability to administer meds is among the biggest drivers of poor clinical outcomes in veterinary medicine (if not the biggest). Then there’s the issue of antibiotic resistance to deal with when antibiotics are started...found under the sofa...started again...spit out...repeat...
Given this setup, is it any wonder compounding pharmacies are finding veterinary medicine a lucrative place to invest their time and money?
But the take-home message here is not about building new businesses with our pet-dedicated dollars, it’s more about meeting the needs of our pets with the willingness to make medications work through any means necessary.
Trouble is, clients don’t always inform us when the meds aren’t going down the gullet. Not every pet owner is educated enough about drug choices to know they can ask us for alternatives. And, truth be told, we don’t always pointedly ask whether an unhappy outcome might be the result of poor drug compliance. (It just seems kind of rude to ask, you know?)
Now that you’ve read this, however, you know what you need to do. When your dog hides a tidy stack of tablets under the bed and your cat drools for hours after her pill, consider asking for another method. No one need suffer when so many other options are available.
Here’s another entry born of an email response to Monday’s post on how to identify quality in veterinary care. This time, it’s related to my comment on the issue of compassion in veterinary medicine––particularly with respect to high-priced, technically savvy hospitals where concern for the owner’s pocketbook takes a back seat to what’s best for the pet.
The suggestion led one emailer to ask (and I paraphrase): “Is technical prowess inversely related to compassion?” In other words, she wanted to know why the more sophisticated hospitals filled with specialists, interns and millions of dollars of equipment always seemed so rough when it came down to these issues:
Charging. Offering options. Taking pets away. Getting callbacks. Visiting hours.
And yeah, it’s generally true. A greater degree of impersonal interaction is to be expected at larger referral hospitals. These are not your regular veterinarians (and their staff) who know practically everyone who walks in their door. These are veterinarians who seldom get to see the same owner twice. And, as such, they don’t usually list "hand-holding" in their job descriptions.
Therefore, they won’t be calling you more than once a day. They won’t be allowing you to hold your animals or otherwise kowtow to your special requests. Visiting hours are limited. You will almost never be allowed to participate in even the least invasive procedures. That’s just how it goes.
Why?
Specialists and the staff of a specialty hospital are there for one good reason: You need more technically sophisticated care. And that means their organizational structure is geared towards better patient care...not better customer service.
Now, this is not always the case. There are plenty of secondary and tertiary facilities that pride themselves on their "compassionate care" towards its human customers. But that’s not the norm. And it’s absolutely secondary to their primary mission...as well it should be.
What is it they taught me in business school about “core competencies”? Stick to what you’re good at. Improve on the areas in which you offer the most value to your customers. And don’t sweat the other stuff as long as you’re really good at what your clients come to you for.
But not everyone agrees. This is especially true when it comes to the financial aspects of speciality medicine. If they can’t offer compassion in the form of a variety of financial options for advanced care, they can’t possibly achieve their mission when it comes to helping animals.
I see both sides––especially with respect to the finances. The other stuff? Phone calls, visits, bedside chatter? I can live without it. Not so much when it comes to a hospital that CAN help me find financial solutions for saving my animal’s life...but doesn’t have the bandwidth to do so. Sure, at some point the money’s just not there and euthanasia’s the only option. But when a middle ground is possible and hospitals require an all-or-none approach...that’s where I balk.
So yes, it’s true. Sometimes technical prowess does seem inversely related to compassion. But it doesn’t have to be that way. And now that the specter of competition looms larger in specialty care, we’ll see how that translates into homestyle animal hospital compassionate care. It’s another one of those things they taught me in business school: Competition is good for the soul...and for the customer, of course.
After yesterday’s post on how to spy quality in veterinary care, I received an email asking this simple question (and I paraphrase): How do I know if my veterinarian should be referring me to a specialist? What are these “complex” situations you allude to in your post and how would I know if I’m being led astray?
Excellent question! More so because there’s no clear answer. While our leading professional organizations have issued guidelines for what constitutes a specialist and when veterinarians should refer to specialists (reference the American Veterinary Medical Association and the American Animal Hospital Association, respectively), they’re loosey-goosey at best on the particular circumstances in which a veterinarian should recognize his or her limitations and offer the services of an expert.
So where does that leave pet owners who really need to know when it’s best their pet see a specialist? Kind of in limbo, I would think, considering that every veterinarian has their own personal philosophy on this issue. And because this is my blog, I’ll offer you mine.
To that end, here are the top ten problems for which I recommend specialists:
#1 Any second opinion.
Do not pass go. I will see new clients for a second opinion but I won’t usually charge them for the ensuing discussion if what they truly need is a specialist. And they usually will if they’ve got a problem their regular veterinarian was unable to solve. Here’s where it’s obvious their regular veterinarian should have already done the same rather than lose a client to another hospital.
#2 Any lack of trust (a corollary to #1).
So should you fail to trust your veterinarian when it comes to a diagnosis or treatment option, don’t see another general practitioner. Head on over to a specialist. The only caveat is that some specialists require your veterinarian’s referral. In this case you’ll have to ask your veterinarian to refer you. If this makes you uncomfortable (or should your vet refuse), well then you’ll have to come see someone like me first. Unfair, yes, but sometimes necessary––unfortunately.
#3 Any legal matter.
I will not knowingly engage in any potentially legal dispute between a veterinarian, individual or enterprise and a client without offering the services of one better suited than myself to serve as an expert on the matter in a court of law.
This is especially true for necropsies (post-mortem studies), for which I’ve determined my expertise is typically inadequate (given the degree of detail legal cases tend to require). Clients sometimes get upset at this but I’ll absolutely refuse to necropsy any legal case. Instead, I’ll happily help them ship the body to an appropriate pathologist.
#4 Any orthopedic surgery or thoracic surgery.
I’ll do ‘em if you have no other choice due to the expense involved but clients need to know they ALWAYS have better options. Orthopedic and thoracic surgeries are ALWAYS best performed by a board-certified surgeon. That’s because the literature has repeatedly shown that experience is directly proportional to outcomes in these cases. And all but the most newly minted surgeons have more experience with these cases than any generalist. After all, they do them every day.
#5 Any exploratory surgery.
I’m happy to perform exploratory surgeries as long as you understand that if I find something I can’t manage (because I don’t have the equipment or the know-how), I might be closing your pet up only to send you to the specialist anyway. btw, we call this a “peek and shriek” surgery. And nobody wants one––least of all your pet.
For example, I don’t think you want any general practitioner removing liver lobes or kidneys, reattaching intestines to the stomach or even touching the colon anywhere with a knife. And even some foreign bodies (though rarely) that I’m happy to cut might require either of the two latter procedures. That’s why I always offer a specialist––as in: “I’ve done dozens of these surgeries but you need to understand that if I find something unusual or if there’s severe infection present it would be better for you to be at the specialist’s place. It’s ALWAYS a risk.
#6 Any time it takes more than a trio of visits to solve a problem.
With few exceptions (and there are a few) any problem that requires more than two or three visits to solve gets offered a referral. This is especially true for dermatology and ophthalmology (severe allergies, non-healing corneal ulcers, etc.).
#7 When better equipment is required.
Sure, I can test for all the basics but you can’t expect me to offer every single bell and whistle in modern veterinary medicine’s arsenal. Ophthalmologists, internal medicine specialists, cardiologists, surgeons, neurologists, etc. They all have better equipment your pet might need.
#8 Any heart murmur.
I know this isn’t a popular opinion among my colleagues but ANY time I hear a heart murmur or cardiac rhythm abnormality (especially in a very young animal) I will offer the services of a cardiologist for a physical and echocardiogram. Many times I will perform the EKG and X-rays in-house and send the strip/images to the cardiologist along with the patient. While most of my clients decline this step due to cost concerns (cardiologists are not cheap), it’s always on offer.
#9 Every X-ray or ultrasound image.
Again, not a popular opinion, but it’s my take that every X-ray or ultrasound image should ideally see a radiologist or another appropriate specialist (surgeon or internist, usually, as these specialists also interpret complex images constantly).
#9 Every time critical care is required.
This goes for all my complicated diabetics (and more than half my diabetics fall into this category upon initial presentation). Complicated Addisonian’s or Cushings disease cases (again, more than 50%) or any animal that requires vigilance overnight. High fevers, respiratory problems, cardiac arrhythmias, non-routine post-operative cases: they all do best under 24 hour watch.
***
By the way, when I discuss specialists I’m ALWAYS talking about board certified specialists. Back twenty years ago it was more reasonable to refer to veterinarians who limited their practices to a specific discipline (surgery, dermatology, ophthalmology). Now that boarded specialists are readily available there is NO excuse (beyond the price factor) to see a non-boarded specialist. And in my area the prices are comparable. NO excuse.
Yes, we do indeed recognize that not all our clients will be able to afford a specialist. Nonetheless, it’s my view that to fail to offer the choice is an ethical/procedural lapse my profession needs to address with more explicit guidelines. Barring that, it’ll have to come down to the Boards and the courts should veterinarians fail in their duty to offer their clients all options.
