DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Nicole Palumbo, DVM

Pet Owners, Just Let Us Do Our Job

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I recently had to use my stern voice. You know the one. It started with a “ma’am” because I feel like that sets the tone. Then I got my hand movements involved. A little bit of waving and motioning helped for maybe five seconds then I had to say a stern “ma’am” again. In the end the owner still didn’t listen and her own cat attacked her. There is the saying, don’t tell me how to do my job, and I truly believe more owners should understand that. There are several situations that endanger both the owners and our staff daily because people do not listen or care to listen to our expertise.  Here are a few situations that I implore all owners to listen to the veterinary staff and trust in our knowledge.

1. Unless you are trained in animal restraint, please do not insist on restraining your own dog or cat.

Many owners are adamant about restraining their own animal but this creates a higher risk of injury to both the owner and to the staff. Many times I’ve had owners hold their dogs head as I’m listening to the heart and as soon as I take my stethoscope off the chest they let go. The dog usually turns right towards my face and if I’m not quick enough I could get attacked. I understand you want to comfort your pet but letting our trained staff restrain takes the stress off of you and allows us to be safe.  

2. If your dog growls or lunges do not tell us that it won’t bite or that it doesn’t need a muzzle.

We have heard it all. They “like to talk” or “they have never bit anyone.”  But all it takes is a scared dog and one wrong move to turn into a terrible situation. When your dog is growling or lunging they are telling us they are scared and willing to defend themselves. A muzzle isn’t a bad thing. This creates a safe barrier to allow us to do our jobs properly and do a full exam. We know it hurts to see your pet wearing this type of restraint but remember how much more we can accomplish by using it.

3. If your cat is hissing and swatting do not try to pet it to calm it down. 

When a cat is out of their normal environment they tend to get frustrated and aggressive. They will take that aggression out on anyone, even you, their loyal lovely owner. Doctors and staff usually have protocols they use to keep everyone safe like using towels and cat muzzles if needed. Placing your hand into the mix creates uncertainty and unsafe practices. Please understand your pet won’t stop attacking because they see you and we really don’t want to see you have to go to the hospital because of your own cat biting you.

4. If your dog is protective of you please let us take them into the treatment area.

I know it’s the dreaded “take them to the back” statement. Everyone fears from many horror stories, which somehow get circulated, that we are going to abuse your pet when you aren’t around. This statement is unfortunately very wrong and couldn’t be farther from the truth. Many times the treatment room is a larger space, which makes dogs feel less crowded. We are also able to gather more help in restraining your pet and can get a better picture of what may be going on. If your pet is so worked up over trying to protect you we won’t be able to do right by them when attempting to treat the medical problem.

5. Don’t be afraid of sedation.

I’ve had owners refuse sedation to explore wounds on their pets because they were afraid of the side effects. I’ve had owners refuse sedation for aggressive pets that get more worked up when handled. In both of these situations, the pets received sub-par care because proper protocols were not allowed to transpire. The patient with the wound came back five days later with purulent debris pouring from the skin staples (the only thing they would let me do awake) and the aggressive pet that couldn’t be touched came in septic because it had ingested foreign material that perforated its intestines. If I had been allowed to do my job neither one of those situations would have happened. Sedation is a good thing and alleviates a lot of anxiety and aggression. Without it we are only doing half of our jobs for these difficult pets.

We understand that you love your pets but when that hinders us from doing our jobs it can create a mess. We don’t want to be rude but sometimes backing off makes the situation better. Let us do our jobs and we can all get along.

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.

It’s Time to Change Privacy Laws to Protect Veterinarians

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I’m sick of it. I’m very sick of the law not keeping up with current trends such as Internet reviews and harassment. I’m sick of hearing another story of “they killed my dog on purpose” with the veterinarian unable to give their account of the event. I’m sick of people getting their friends to put up fake reviews in order to drive a veterinarian out of business. We are living in an online world and unfortunately, the laws to protect businesses have not caught up. If we contact the authorities they have no real way of protecting us from online threats. If someone called the office and said, “I’m going to murder your vet for what they did to fluffy,” we can get them arrested. If they do that online the authorities don’t yet know how to respond. I am only one person but I hope that maybe we can create some change within the laws and our own privacy agreements.

Obviously changing how police respond to online threats is going to take a while. Look at all of the recent mass shooters – they were found to have discussed their plans and dislike for certain groups on a variety on online chats/websites. But right now those people hide behind a screen with no real reach of the law to catch them. No one wants big brother monitoring their computer screen but potentially with time there will be more online task forces equip to investigate these threats. So what can we do as veterinarians to help this along? Getting involved in local government, writing letters to congressmen/women, and push for a change in how we can prosecute online harassment. There are even several major court cases going on right now involving veterinarians suing for false and malicious reviews to be taken down. If even a few of us stand up to these online bullies we can set a precedent for a change in prosecution and how online reviews of businesses will need to be created.

Secondly, I believe that our own privacy laws under the practice act need to be changed. This might be a little easier to do since it would involve the smaller sector of veterinary medicine versus the entire government.  At this time the majority of states have privacy laws where the practice cannot share client/patient information without either verbal or written consent. In a lot of situations when the owners go to the press they refuse to allow the veterinarian from releasing information.  This makes the veterinarian look guilty because all they can say is “no comment.” I don’t think that the law needs to be abolished, because obviously, we want owners/patients information to stay confidential, but I feel like an addendum to the law is needed to keep up with recent online/press harassment.  In case of malicious and false accusations, the client, therefore, forfeits their right to privacy giving the veterinarian equal opportunity to discuss the case online or to the press.  How do we achieve this? We campaign- we flood our state boards and lawmakers with letters and phone calls. We get more involved and discuss the needs of the veterinarians with the AVMA in hopes to change for the better. I know there is a lot being done at the AVMA right now but veterinarians feel like it is too little too late. We need larger changes and that means changing our privacy laws.

Lastly, I believe we shouldn’t stay quiet. Right now a lot of support groups advocate to not respond or to just keep deleting the bad reviews. In my opinion, this doesn’t work very well and just riles up the other side. I also don’t believe we should harass anyone back either. Finding “dirt” on the person harassing you and posting it on websites or their Facebook does nothing but make you look like a petty person.  The best responses I have seen to Facebook stories come with genuine thoughtfulness and care of the situation. These are the amazing responses that give a clearer picture of the story without completely disregarding privacy laws. When I see a well thought out response placed on a veterinarian’s main Facebook page usually what happens is good clients respond and share it with their own amazing stories of how great you are as a veterinarian.  These responses typically start out with “ We would like to address the rumors regarding a recent event at our clinic” and go on to give basic details like “We did offer a variety of payment plans” or “We did offer relinquishment to save the pet.” Just correcting the small details can create a movement for truth and soon the good client reviews and actions outweigh the liars.

I am only one person. I am only one person trying to use my voice as a jumping point. It is now up to you to push forward with change. I will do my part in educating the public and private lawmakers but I am only one person. We need each other and we need to work together.

I have started an online petition to urge the AVMA and state VMA associations to change the privacy laws under the Practice Act. Sign the petition here.

Get in contact with your state veterinary government here.

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.

I Watched Your Dog Die Today

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I watched your dog pass away today. I did everything I could but it still succumbed to its disease. I watched your dog suffer for days as I tried to comfort it. I watched your dog continue to vomit even with the best anti-emetics. I watched your dog groan in pain even with high doses of pain medication given.

My technician cleaned up your dog for the fourth time today after it had explosive diarrhea. My technician tried to comfort your dog by giving it a hug and petting it – but your dog was still scared being in a cage all by itself.  My technician cried as your dog vomited for the tenth time. My technician watched your dog pass away today.

My staff had to call you again and tell you there has been no progress. My staff had to let you know that we are approaching your financial limit. My staff had to sit there and not respond to people telling us we are heartless because of your dog. My staff watched your dog pass away today.

I watched your dog pass away today and it could have been prevented. I watched you scramble to find enough money to try to treat your dog and it could have been prevented. I watched my staff get torn apart on social media and it could have been prevented.

I watched your dog pass away today because you did not vaccinate it. I watched your dog pass away today because you didn’t seek treatment right away. I watched your dog pass away today because you tried “cures” you read online before bringing it into the professionals. I watched your dog pass away today because you didn’t take responsibility for its life.

Parvovirus is fatal. Parvovirus is awful to watch an animal succumb to. Parvovirus is preventable. Please vaccinate your puppies.

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.

Please Stabilize Before You Transfer

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I’ve written before how amazing we are as veterinarians. We are 10 different specialties all wrapped into one spectacular person. When we decide what type of practice we are going to work for we may narrow down the spectrum of care we produce. GP clinics focus on vaccinations, nutrition, and common ailments that affect our pets daily. Specialty clinics focus on the complicated and sometimes unusual. Emergency clinics focus on trauma cases and true emergent situations. It’s great that we have all sorts of specialties in the veterinary world. The biggest obstacle is us working together for the good of the patient. Its not that we do it intentionally but I think a lot of clinics don’t have protocols set during times of emergency and this makes it harder for the referral clinic to treat. Here are a couple of basics to put on a checklist if you often refer emergency cases.

  1. Call the referral clinic- if you plan on sending a case please call the referral center and discuss the situation. The best route is to have the doctor call and give information to a technician or the referral doctor for a clearer line of communication. Having a receptionist call is not a good option because they cannot properly answer basic questions like, were radiographs taken or how stable is the pet. Many times we have been given the absolute wrong information because of the mechanics of the game telephone. When in doubt always relay the information directly to the referral doctor.
  2. Start an IV catheter- There aren’t many situations where this isn’t necessary but unfortunately, pets get transferred without catheterization and fluid stabilization all of the time. Think about it- hit by car– place a catheter and start fluids to reduce a shock state before transferring. Blocked cat- place a catheter and start fluids to stabilize. Bloated dog-place a catheter and start fluids. This is a critical step in stabilizing and many animals do not receive this before going to a referral center.
  3. Provide pain control- too many times patients are provided no pain control before being transferred. It is fairly easy to have a go-to chart for a quick buprenorphine or hydromorphine dose to relieve acute pain in unstable animals. Wait on any NSAIDS or steroids before a full workup can be done but a short course of an opioid can truly affect how a patient recovers.
  4. Send diagnostic results- If you plan on referring please send the results of the diagnostics you have performed. It does not help when you have taken radiographs but don’t email them to the referral clinic. It also is a big waste of the owners’ money if you perform blood work by sending it to an outside laboratory where results won’t be ready for 24 hours. If you don’t have in house labwork equipment and plan on referring that day its best to allow the referral center to perform it versus wasting time and money.
  5. Inform owners. Please make sure your owners know what they are getting themselves into. Too many times pets are transferred with no knowledge of the next steps towards recuperation. Several times I have seen blocked cat owners choose euthanasia after having to pay a second exam fee and blood work because they were not prepared for how expensive treatment can be.

You might not know a specific number but please warn owners that certain surgical cases can run a few thousand dollars (depending on the area) and it is a huge waste of the owners’ funds and time if they do not want to go forward with treatment.

We all want what is best for the pet and to do that we need to work together. Communication is key but also don’t forget your basic triage skills. You can truly make the difference if a patient lives and recovers well versus tragically succumbs to its crisis.

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.

How Your Attitude Affects the Outcome

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Have you ever thought about a scenario and said, “Well I would have approached that differently?” Maybe even thinking that a different approach could have created a better outcome. Even though we shouldn’t judge our colleagues on how they practice medicine we might still judge them a little on how they present their knowledge. The way we discuss a treatment plan or surgery can severely affect how far the owner may go with treatment or even their understanding of the procedure.  You may be practicing great medicine but are you truly giving your patients the best outcome?

Here is a for instance. A 10-year-old intact female dog presents with increased thirst and urination, no appetite, and extremely lethargic. She is dehydrated and her white blood cell count is at 36k. We are all thinking it… pyometra. We all know that a lot of the time these present in poor shape but can be saved with surgery. So how does one veterinarian convince a client to euthanize but another can convince them to go forward with surgery? Lets examine one sentence that can make or break this dog’s chance at treatment.

1.“Fluffy is REALLY sick and could DIE even with surgery.”

The tone of this sentence emphasizes the negative and puts doubt on the solution. Yes, we all know that even with surgery there is a chance that the patient may still pass but without it the endgame is much worse. This client will likely euthanize an animal that could have been saved.

2. “I know Fluffy is really sick and may die but if we do surgery we can potentially save her”

This tone lays out the negative but also gives hope to the solution. The client is given the facts and empathy towards the situation and is also given confidence in the outcome. Likely the client will go forward with surgery to save their dog.

3. “Fluffy is really sick and this could have been prevented. We can try surgery to save her but she might die.”

This tone places blame on the client, who already is dealing with a lot, and essentially bullies them into either euthanizing or going forward with a surgery with no confidence. This puts them in a tough spot because they feel judged and just want to help their pet.

4. “I think Fluffy may be really sick and I’m unsure if she is going to make it through a surgery like this and will probably die even if we try.”

This tone gives the client no confidence in anything you are doing. They may take a long time deciding what to do or even take the dog for a second opinion because they do not trust you. Or they will feel like it’s not worth treating if you are so negative and will euthanize an animal that could have been saved.

The great thing about veterinary medicine is that we are all different in our style and personality but we do have to remember that our attitude towards treatment severely affects our patients and our clients’ choices. Sure there are still some clients that no matter how dire the situation and outcome they will still push forward with treatment, even when we all know the pet is suffering. But for the majority of our clients we need to show confidence, empathy, and trust in how we approach treatment options. Don’t let a few bad surgeries or experiences create an attitude towards future endeavors. Don’t let your inexperience shape the way you approach a treatment. Don’t let your judgments of clients cause you to treat their pet differently. We all want to give our patients the best treatment but remember your attitude when broaching the subject can make or break even the best care.

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.

Why Age Is Not a Disease

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“They are too old for surgery!”

“My other vet said they can’t undergo anesthesia because they are over 10.”

“I’m afraid she won’t survive because she is so old.”

“He is just old – I don’t think he needs pain medication.”

I hear these words almost daily and every time I have to give owners my speech regarding this misconception. Age isn’t a disease and we need to stop treating it like one. I get it – surgery and older age diseases can be scary and complicated, but not pursuing treatment can truly be cutting your furry friends life short. This doesn’t mean that every animal should undergo surgical procedures without knowing the risks or making sure they are healthy enough to endure anesthesia or long-term medications. There are many animals that have major diseases where the risk may be higher but the benefits outweigh those risks as long as we take proper precautions.

Many veterinarians advocate for spay/neuter early in life because the risk of surgical death is significantly lower, but for one reason or another some people do not get their animals fixed at this period in their life. This tends to create a situation where I see a 12-year-old female dog with multiple mammary masses because she is intact. Now if we do not remove those masses and spay her she is likely to succumb to a pyometra (uterine infection) or those mammary masses will continue to grow, get infected, or become so large the patient cannot walk properly. This is the time I bring up surgery and many people tell me they are just too old for it or they just want to wait and see how they do. Typically this situation ends badly because they push off the surgery for so long that now the dog is a year older with necrotic masses and potentially developed other forms of disease. Now they are an anesthetic risk because they used “old age” to put off surgical intervention.

As many veterinarians will tell you, dental procedures can extend a dogs life. While I see some young dogs and cats needing dental procedures typically my patients are seniors or geriatric. The older the animal gets the more likely they will have dental disease. So many people use old age as an excuse for their pet to not undergo a dental procedure. Unfortunately dental disease can cut your pets life short and make other diseases worse. Some dogs with diabetes may have a hard time regulating if they have chronic inflammation from gingivitis.  Some cats with kidney disease can succumb to the same inflammatory response with gingivitis and resorpive lesions, which can cause significant elevations in kidney values. Not taking care of rot mouth immediately can truly make your little friends life harder and shorter.

For some reason a lot of people use old age to avoid senior diagnostics and medications as well. We see a lot of animals “slowing down” and instead of investigating the problem a lot of owners will just tell me, its just old age.  Even so that old age can be improved upon in a lot of cases. When humans get older and arthritic usually we start on anti-inflammatory medication (NSAIDS) and additional joint supplements to help us get around. So why would we not allow our older pets to relish in the advances of geriatric medicine? I hate seeing patients struggle to get up in exam rooms when they could be medicated and happy. Don’t use “they are just old” as an excuse to not treat your pets’ diseases.

Sure there are risks to anything we do when your pet gets older but that is why we take certain measures to make sure we do not cause harm when trying to help. Senior pets should have yearly blood work and urine checked to make sure they are not showing signs of kidney or liver disease. Cats tend to become hyperthyroid with age and if caught quickly they can live a much happier life.  Dogs that are arthritic and need chronic NSAIDs should have lab work tested every 6 months to make sure that the pain medication isn’t causing significant changes to internal organs. Safer alternative drugs can be arranged if we can catch diseases in the early stages. Before anesthetic procedures that same lab work can help us create a safer anesthetic protocol to lessen the risks for your pet. Our senior pets need the most care and unfortunately do not receive it because of the excuse “they are just getting old.” Be a good advocate for your pet and listen to your vets’ suggestions to make sure they age gracefully and have a good quality of life.

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.