DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Jennifer Shepherd, DVM

It’s Not All About Me

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Veterinary medicine can be hard. Sometimes we get cases that really challenge us. It may be the clinical signs don’t add up, the client declined diagnostics that would give us a definitive diagnosis, or the pet isn’t responding to treatment the way we expect. When I have a tough medical case, I use all my resources to try to help my patient, including discussing the case with colleagues, posting the case on the Veterinary Information Network for experts to weigh in, and recommending referral to a specialist. I feel it is important to explore these avenues and talk through cases making sure I haven’t missed something, learn from other people’s experience, or just to hear that’s exactly how they would have treated the patient.

Even though I seek the advice of other veterinarians, it has always bothered me when a client asks to have their records sent to another general practitioner for a second opinion. Doubts immediately creep into my head – What did I do wrong? Do they not trust me? They wouldn’t go to a specialist so why do they think the doctor down the road knows more than me? Don’t they see how much time and effort I have put into this case? 

It happened to me again last week. I have a case that has really challenged me. I cannot figure out what is wrong with the dog and why he refuses to eat. We have tried everything and he just isn’t responding. I consulted VIN and the consultant advised more tests, which were declined. I advised referral to a specialist, which was declined. The client and I had been communicating about her pet via email a few times a week. I hadn’t heard from her in a few days so I assumed he was doing better. But on my day off, I received a text message from one of my techs “You probably want to stop checking in on Bogsley, they had their records sent to another clinic.”  

The doubts started to creep into my head when I read this, but I decided to bury them. I had been working very closely with Bogsley’s family for a month and I knew they were frustrated that he wasn’t responding to treatment. I decided to reach out to them and I called for an update. I left a message that I hadn’t heard from them in a few days and I wanted to check in and see if Bogsley was doing better. I purposely didn’t say anything about them seeking a second opinion. When I didn’t hear back from them for a few hours, the doubts came back again. Of course, they don’t want to update me. They don’t trust me anymore to take care of their dog.  

A few hours later, I received an email from the clients.  They updated me on Bogsley’s condition and that he wasn’t doing well. “I know that we should take Bogsley to a specialist like you recommended, but we just can’t afford to take the time off of work or the money a specialist would cost. We don’t mean to offend you, but we are taking him to another clinic tomorrow for a second opinion.” 

As I read that, I realized that it wasn’t all about me. In fact, the decision to seek a second opinion had nothing to do with me. The clients needed to do all they could within their means to find out what was wrong with Bogsley. They may be desperate to help him and knew what I was doing wasn’t working. Or maybe she needed to hear from another person that Bogsley wasn’t going to get better and it was time to say goodbye. 

I realized that I needed to let my insecurities go and wish Bogsley the best. I responded “I am not offended at all. I know you want to do what is best for Bogsley and I really hope that another vet can see something that I am missing.” My email was met with the reply “Thank you, Dr. Shepherd. That means a lot!”

After all these years in practice, I am continuing to learn, especially from the most challenging cases. Bogsley’s case taught me to let my insecurities go. The clients have their own reasons when they seek a second opinion and I shouldn’t be upset or offended when they ask for their records. I offered my best care and sometimes another set of eyes is what my patient needs.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The Gift of Being a Veterinarian

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I still remember Curly and Moe’s first puppy visit all those years ago. I had just moved to the community and purchased the small animal veterinary clinic about a month before. I didn’t know many people and was under a lot of stress trying to figure out how to run a business. So, when these little black bundles of fur and energy came into the clinic for their first check up, I jumped at the chance to see them. It was puppy kisses all around from these two. They were lab/cocker spaniel crosses and so small. They came in every four weeks until they received all their puppy shots and I watched them grow.

Before I knew it, they were 80-pound balls of fluff and energy. Still every time they came in, I pictured them as little puppies and was amazed at how big they had grown. Curly and Moe had the best pet parents. They had their annual preventative visits and the family always did everything I recommended, (except weight loss, but who can resist those sad cocker spaniel eyes asking for treats). Even with the best care, Curly and Moe had their share of problems. Both were cursed with allergies. There were chronic skin infections and ear infections that we managed as best we could. There were emergency visits after one of them got cut on a fence, sick visits when they got into the garbage and developed diarrhea, surgeries to clean their teeth and remove masses that developed as they grew older.

They almost always came in together and they were always happy to see me. Until one day, almost twelve years later and Curly came in alone. Curly had a tumor on his abdomen that had been slowly growing for the past year. It had been removed once but came back and his family didn’t want to put him through another surgery. The tumor was now so large that it had broken open. Curly was feeling weak and didn’t want to eat anymore. His family knew it was time to say goodbye.

Euthanizing a patient is always hard. Even though I know I am doing what is best for my patient, it is still emotionally draining. Euthanizing Curly was especially hard. I realized that I had been part of every medical milestone in his life – his first puppy visit, his neuter, managing his allergies, helping ease his arthritis pain, removing his tumors – and now I was part of his death. I cried as I petted his curly hair, gave him treats, and finally ended his suffering.

Curly’s family came in again two weeks later. It was time for Moe’s annual exam. It was the first time in twelve years that Moe his annual exam without Curly. We talked about how Moe was doing without Curly. We reminisced what a great dog Curly was and how full of energy he was. We talked about how much he is missed. We laughed about some of his antics in his younger years.

It was at that moment that I realized what I love about being a veterinarian. I had known and treated Curly his entire life. I was there when he joined the family and I was there when he said goodbye. What other medical professions can do that? Veterinarians are a special group of people. We help our patients in so many ways throughout their entire lives. We are their pediatrician, their surgeon, their dentist, an emergency doctor, the primary care physician, and sometimes their family’s counselor. Our patient’s lives may be too short, but at least we can help them to live their lives to the fullest. And when it is time, we help end their life peacefully, with dignity and love.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The Doctor is Out

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I have two great passions: my family and veterinary medicine. With three children, ages 12, 10, seven and a small animal veterinary practice, life is a juggling act trying to balance my two greatest loves. Sometimes I slip away from the clinic for an hour or two to help at a classroom party. You may find me sitting in my car writing up records while my child is warming up for a soccer game. Trips usually revolve around a veterinary CE course at a nice hotel with things for my husband and kids to do while I am at meetings. I almost always have my cell phone with me and often find myself working even when I’m not at the clinic.

Last week, I took a few hours off to enjoy the sunshine with my kids at the pool – and received multiple texts from three different employees with questions. I took a trip to my niece’s graduation. No sooner than the plane had touched the ground, I was checking my Idexx app and texting the clinic with instructions on what to do with the test results. My family has my attention, but it’s shared with my career.

After years of practice, I think I have the balancing act down pretty well. I am there for my kids when they need me and rarely miss a big event, but I am also dedicated to my career striving to provide excellent patient care and to be there for my clients. However, once a year I drop the juggling act and focus only on my family: our annual trip to “Gramma and Grampa’s beach house”.

I grew up spending weeks of my summer at my grandparents’ cottage on Lake Winnipeg. It’s in a little community called Victoria Beach, set in the middle of the woods. There are miles of white sandy beaches along the pristine lake and the most spectacular sunsets I have ever seen. It’s not fancy, just a simple three-bedroom cottage on the lake front. Now that my grandparents have passed on, my parents have taken over the cottage and spend the summer at this little piece of heaven. Every July, my family and I pack up the car and head to Victoria Beach.

The cottage is located in Canada. Since I live in the U.S., using my cell phone at the cottage incurs a lot of international fees. The first time we went to Canada after I purchased the veterinary clinic, I looked into a cell phone plan that would allow international texts or calls. Of course, I need to keep up with my cases and what goes on at the clinic while I’m gone. I was talking to my team about the different plans when one of my techs looked at me and said “Why do you need a plan? Just turn your phone off for a week and have a real vacation!” At first I thought she was crazy, but the international plan did seem a little pricy so I decided I would take her advice and turn my phone off. I left the number to the cottage and told everyone I would check email regularly if they had any problems or questions. But guess what? They didn’t call or email me for an entire week. The clinic survived for an entire week without me.

Not only did I survive a week without work, I thrived! I was finally able to relax and truly focus on my family. I came back feeling happy and refreshed, ready to throw myself back into the balancing act. We have returned to the cottage every summer for the past five years. We stop for gas at a town about two miles from the border and I give the clinic a quick call telling them this is their last chance to talk to me before we cross the border. My call is usually met with encouragement that everything is fine, relax, and enjoy my time away. As soon as we cross into Canada, I turn my cell phone off and trust my associate and team will keep the place running with I’m gone.

I spend a week focusing only on myself and my family. We swim, build sand castles, go for walks on the beach, and have rock skipping contests. My dad and husband take the kids fishing while my mom and I enjoy a glass of wine and watch the sunset. We stay up late watching cheesy family movies and eating popcorn. I read books, lots and lots of books. I wake up early, and while the kids are still sleeping, I sneak down to the beach with my camera to photograph the pelicans in the early morning light. I do all the things I love but never have time to do. The one thing I don’t do is think about work.

I cherish every moment of this special week. I know these times won’t last forever. The kids are growing up faster than I want and soon won’t want to leave their friends or summer jobs. My parents are getting older and may not be healthy enough to spend their summers out in a cottage in the woods. But for now, I turn my cell phone off for a week and forget all about work. I focus only on myself and my family. The clinic will be there when I get back.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Yes, You Can Have It All, But…

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For as long as I can remember, I have been an overachiever. It wasn’t enough to get an ‘A’ in a class, I wasn’t happy unless I had the top grade. In high school, I did a little bit of everything: student council, band, track, National Honor Society, church youth group, I tried it all and worked hard enough that I was successful at all of it.

Naturally, I graduated from veterinary school with dreams of having it all. Having it all is different for every person. For me, my “all” included a successful career as a veterinarian, a perfect marriage, being a leader in my community and in the veterinary field, staying in shape, close friends, fancy vacations, and of course adorable, perfectly behaved children.

As I began my veterinary career, things started out well. I worked at a great clinic and was building up clientele. I was training for a marathon and taking cake decorating classes in my free time. I met my husband-to-be and we planned our dream wedding in Hawaii. Life was going just as I had hoped. But about a year after we married, we decided to have children and that is when my dream of having it all came to a screeching halt!

We had three children in five years and I was running my own small animal veterinary hospital. The combination of these two things became all consuming. There was no time for hobbies, vacation, exercise, or anything else on my list. Once all three of my children were in school and the fog of babies and toddlers was lifted, I started to look around and compare myself to people I knew. One friend had just published a book. I’ve written a few articles, why haven’t I written a book yet? Another friend qualified to run the Boston marathon. Why can’t I find time to train for a marathon?

My vet school classmates are specialists or running large five doctor practices. I’m only a general practitioner running my small 1.5 doctor practice just south of nowhere. My Facebook feed was packed with other people’s European vacations. What happened to the girl that dreamed of having it all? Suddenly I found myself chauffeuring kids to soccer practice, serving ice cream at the school open house night, and chaperoning a sleepover at the zoo with a bunch of third graders.

Just as I was feeling really disappointed in myself, I picked up one of the many veterinary magazines sitting on my cluttered desk. I came across a small article written by Dr. Lisa Radosta. Hidden in that article was a sentence that changed everything. Her friend and mentor Dr. Debra Horwitz had given her a great piece of advice “Women can have it all, but we just can’t have it all at once.”

Those words spoke deeply to me and I felt like a huge weight was lifted. As the book of Ecclesiastes says “for everything there is a season and a time for every purpose under heaven.” There will still be time to write a book, to further my career, to travel the world, and take on new hobbies. Right now, my priority is my family. I have eighteen short years with my children before I send them off into the real world. They need my love, attention, and guidance. They need me as a role model, to show them it is possible to have a successful career along with a happy marriage and family, but that there needs to be balance. My family needs to come before my career aspirations, my desire to be at the top of everything I do, and to be a leader in my field.

I will be happy with my successful but tiny veterinary practice, doing a few projects in my community, running for fun, and writing an article when I feel inspired because I will be spending the rest of my time at the ball field cheering on my son, chaperoning my daughter’s knowledge bowl team, and baking valentine cookies for the first graders. My dreams and aspirations are still there waiting in the wings until it is their time. Until then I will be content and remind myself that I can have it all, just not all at once.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Sometimes, Bad Things Happen. It’s Not Your Fault.

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It happens all the time – the receptionist takes a phone call about a patient not doing well after surgery. Maybe they aren’t eating, maybe they chewed at their incision line, maybe they need more pain medications.

Regardless of what the issue is, I always get that sinking feeling in my gut: What did I do wrong? My default is to always blame myself and I feel sick until I see the patient and know they are going to be fine.  A couple of years ago, I joined a Facebook group for veterinarians. A lot of vets posted when cases didn’t go well and I started to notice a common theme – they blamed themselves as well.

The first few times I read these posts, I felt relief –it’s normal to blame ourselves. But when I looked at the case from another perspective, I saw vets torturing themselves for things that were beyond their control. Some were facing depression or considering leaving the field. I wanted to write something to encourage them when things go wrong, to tell them that’s not their fault. To tell them to learn from what happened but realize they are still great doctors and to move on. I knew the article needed to be written, but I couldn’t find the right words.

Then it happened to me. I performed surgery on one of my best client’s dogs. Things went well initially, but over the weekend, the dog ended up at the emergency clinic with septic peritonitis and almost died. When I heard, I was devastated! I immediately blamed myself and convinced myself that I had almost killed this dog. There were multiple factors that lead to the dog’s decline, most of which were out of my control.

But I couldn’t see that. I could only see my role and what I may have done wrong. I kept replaying the case over and over in my head. The what ifs went through my head: What if I had done the surgery sooner. What if I had referred it somewhere else. What if I had flushed the abdomen one more time. What if I had done the surgery quicker. What if I would have stood up to the client and insisted she follow my post-op recommendations. What if I’m just not good enough.

In my head, I tried to convince myself I was still a good veterinarian. I thought of the times when clients have said to me things like “Thank you for saving Buddy’s life last year!” Most of the time, I don’t even remember the life-saving procedure until I read the patient’s record. It becomes routine when the patient makes a full and unremarkable recovery.  I knew that I had many cases where the clients saw me as the hero, but I couldn’t remember them. All I could think is that I was to blame for this patient and I didn’t deserve to be a veterinarian anymore.

I needed support so I turned to my online veterinary friends in a Facebook post.

I received many words of encouragement, but Dr. Ryan Llera had the right words that took me out of my negative spiral:

“You shouldn’t beat yourself up. Sometimes things go wrong and I revert to some of the rules of vet med (as taught to me by some awesome mentors 20 years ago): 1) No matter what happens or what you do, things are going to die or not do well. 2) Unless you’re God, you don’t get to change rule #1. For any of us, by feeling sadness over losing a patient, it shows that we haven’t lost our humanity. You can always question the “what ifs” but at the end, remember you’ve helped more animals than you’ve lost. You’ve given hope and happiness to more people than have become sad over losing a pet in your care. I think the good outweighs the bad and that’s the part we have to remember.”

When I read those words, it was like a huge weight had been lifted off of me. It wasn’t my fault. I did all I could for my patient. Sometimes things go wrong, despite our best effort. We are not working in a laboratory with predictable conditions. We are treating living, breathing animals who are all different. They heal at different rates. They react differently to suture and medications. Their activity and post-operative care cannot always be controlled despite our best efforts.

Even when everything seems right, sometimes things go wrong. I have heard that 1% of enterotomies fail for no obvious reason. All we can do is our best and learn from each case.

A few weeks ago, I had another case where a dog didn’t recover well from surgery and was euthanized five days post-op. To make it worse, it was my technician’s dog. It was a hard case for everyone involved and we were all heartbroken. But this time, I didn’t blame myself. I looked at the case objectively – I had done my very best for the patient and despite that, he didn’t heal. He had underlying issues that affected his recovery, issues that were not my fault and could not have been prevented.

Unfortunately, these issues lead to his death. I am sad for the loss of my patient, but I know that I am still a good veterinarian. I will continue to do all I can to improve the health and life of all the animals under my care. When the outcome is not what I want, I will learn from the case and move on, doing my best not to blame myself. I hope that all of my colleagues reading this will do the same.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The Best Gift I Gave to Myself

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It had been a bad month. There were staffing issues, including an employee with a serious dog bite injury. Our basement flooded, creating a big mess. A flu-like virus struck the whole family one at a time and I spent many nights caring for sick children so I was sleep deprived. But the hardest of the month was losing our beloved thirteen-year-old schnauzer to cancer. Through all this, I maintained a positive attitude. I dealt with each situation as it came along, searching for the silver linings.

Then Monday came. I woke up with a sore throat and feeling achy. We were too busy for me to call in sick so I took some ibuprofen and headed in to work, hoping I would feel better as the day went on. My morning was filled with appointments, including three of my most difficult clients. By noon, my positive attitude was gone. All the stress of the past month hit me and I was done. All I wanted to do was go home, curl up on the couch, watch daytime television and let myself be miserable. I sat at my desk having a pity-party of one, and glanced at the afternoon schedule, hoping I could sneak out early. But the receptionist had added another appointment. It was my favorite client Bruce and his little dog Bean.

Bruce is a special client. He is always so kind and appreciative of the care we provide his pets. He makes us all feel like heroes. But today I didn’t want to see Bruce. I was concerned something was seriously wrong with his little Bean, which would make my day even worse.

The last time I had seen Bruce, we had to euthanize one of his beloved dogs. Bruce was heartbroken. After the euthanasia, he and I talked for a while about how much joy our pets bring us. Shortly after that, I read “A Dog’s Purpose” by W. Bruce Cameron and I immediately thought of Bruce. I bought a copy of the book and planned to give it to him as a special gift. But life was busy and the book had sat on my desk for six weeks.

As I got up from my desk to see my appointment, I glanced over and saw the book. I hesitated on whether to bring it with me into the appointment. It was supposed to be a special present and the timing didn’t feel right, given my sour mood. But I didn’t want the book to sit forgotten about for another six weeks, so I reluctantly picked it up. “Maybe I should write something in it” I thought, but talked myself out of it. It was just a simple paperback book and Bruce may not even like it. He may think it’s dumb if I write in it.

I walked into the appointment and handed him the book. I quietly said “I remember our conversation when Lake died and I thought you may enjoy this book.” As I handed him the book, his face lit up. He smiled and said “What a special gift! And the author even has the same name as me!” He opened the front cover and said “You didn’t write anything. Please at least write your name so I remember it came from you.” I took the book back and said I would think of something to write, then examined little Bean. While waiting for Bean’s test results, I took the book to my desk and thought about what to write. I realized my mood lifted by seeing Bruce. His appreciation of my little gift showed in the smile on his face. I realized that Bruce has this affect every time I see him. He is such a kind person and I always feel better after talking with him.

I picked up my pen and wrote “To one of my most favorite dog lovers. I hope this book brightens your day in the same way you always brighten my day.” Then I signed my name. I gave the book back to him and told him he couldn’t read what I wrote until he was home. I also gave him the great news, that Bean’s blood tests were good, nothing serious was wrong with Bean.

As Bruce was checking out, he said he had something to tell us. He was moving to be closer to his son and would be too far away to bring his pets to us. He said “In light of this, do you want to change what you wrote in the book?” I laughed and kidded him “Well, I was going to sign it ‘from your favorite veterinarian’”. He said “Oh please do! You know you will always be my favorite veterinarian and leaving everyone at this clinic makes this move hard.” He handed me the book again and I added “(your favorite veterinarian)” below my name.

He left and I had a huge smile on my face. My pity party was over. I felt much better and more energized. I thought about why my mood had improved. Yes, Bruce’s sunny personality and his kind words helped, but what really lifted my spirits was his reaction to me giving him the book. It was a small gesture, something I initially did reluctantly and half-heartedly but it gave him joy, which in return brought me joy.  To get out of my bad mood, I needed to stop thinking about myself and focus on someone else. Doing a nice gesture for another person and expecting nothing in return was the best thing I could do for myself.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.