DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Nicole Palumbo, DVM

Don’t Forget What You Can Do

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There is a saying in veterinary medicine, “we don’t all live in the ivory tower.” Pretty much all of us know what this means. We learn the best of the best medicine in veterinary school and have access to the most diagnostic equipment, but unfortunately for 99 percent of us, that isn’t a reality when practicing. It isn’t a bad thing. Those specialty hospitals are there for us when we do need to refer complicated cases and we appreciate the time they take with our patients. But there is an alarming number of veterinarians in general practice who are referring surgeries or cases because they were taught that only board-certified surgeons can do those surgeries, or they don’t feel like GPs should be dabbling in complicated cases. This is causing some veterinarians to feel like outcasts for trying and other veterinarians to feel like tattle tails for feeling uncomfortable about their colleagues doing these procedures.

When chatting with other veterinarians I hear a lot of stories about how their boss or the prior owner used to do some incredible surgeries like hemilaminectomies, PRAAs, ventral slot procedures, mandible resections… you name it, they did it.  Those are all really complicated surgeries, but back in the day when you didn’t have a specialty hospital near you, you either learned or the animal suffered. But lately, I’ve been hearing more and more stories that go: well before I started the clinic used to do pyometra or GDVs or enterotomies, but now we just send them to the ER clinic down the street. It makes my heart hurt a little. These procedures aren’t a walk in the park, but a general practitioner should be able to do them, so why are we sending these cases away?

1. Clients are sue-happy.

We are seeing more and more clients take to Facebook or online complaint sites with half-truth stories about how a veterinarian experimented on their dog. Unfortunately, we cannot defend ourselves in these situations due to confidentiality laws. Many new veterinarians are afraid that even if it’s in the best interest of the animal to pursue a risky surgery that the consequences of it not ending well could terminate their careers.

2. Veterinary schools aren’t as hands-on as they used to be.

This goes back to the legality issue again. Veterinary schools have their hands tied when it comes to allowing students to perform or watch complicated surgeries. Many schools have taken to creating interactive laboratories, but the models are plastic and don’t always reflect real-life situations. Even when you get to see some interesting surgeries it’s usually the “zebra” cases, not the common occurrence operations.

3. In urban areas 24 -hour emergency clinics and specialty clinics are within minutes of GP practices.

A lot of the GPs have taken to using them instead of keeping the case and performing the surgeries themselves. Even those veterinarians who used to perform every surgery under the sun are now utilizing the ER clinics near them.

4. New graduates aren’t feeling adequate enough and don’t receive enough good mentorship.

If the boss sends those cases away then the new graduate will get into the habit of doing it, too. If your boss doesn’t help you gain the confidence you need to pursue those surgeries then you will feel inadequate and not want to pursue them yourself.

There may be more factors in this situation, but the main issue is we are seeing veterinary medicine become more specialized to the point that GP practices are basically glorified vaccine clinics. The general practitioner is losing out on some basic skills that we once had. The ERs are getting bombarded with cases that should have been dealt with at the regular clinic. The specialists are getting sent uncomplicated diabetics or hypothyroid cases that can easily be monitored and treated at a GP clinic. Yes, offering the highest quality of care should be a priority, but not all owners can or will chose that option. As GPs we can still provide high-quality care. If we continue to just send them away then we will continue to diminish our skills. We are surgeons, behaviorists, oncologists, urologists, pediatricians, cardiologists, dermatologists, dentists, anesthesiologists – we are veterinarians and should be proud of our amazing range of skills.

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 Rural Vets Are Dying and They Need Your Help

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Picture this. You have just graduated or are looking for a new job. There are a lot of clinics looking for veterinarians at this time, so you feel like you will have the pick of the litter. When you browse through those “veterinarian wanted” ads, you see a great clinic offering a nice salary, decent modern equipment, and full benefits. You go to apply but notice one thing… it’s in a rural area.

This scenario happens daily and 99 percent of veterinarians will choose not to apply. Corporate hospitals can offer sign-on bonuses, larger city amenities, and a flexible schedule. New veterinarians are drawn to these offers because they have a lot of school debt, and that $20k sign-on bonus seems like an amazing offer. But in ignoring those rural ads, we are essentially killing the rural veterinary clinics and hurting those communities.

I was born and raised in the south suburbs of Chicago. Restaurants, malls, shopping centers, and the city were within minutes to me. Even when I went to veterinary school the town was like a little city that had everything I needed even in the middle of the cornfields of central Illinois. Once I knew I passed my NAVLE I sent my resume to every veterinary clinic in the suburbs of Chicago – even if they weren’t hiring. I went on a lot of interviews and found out I was competing with 80 percent of my classmates for the few jobs that were open to new graduates. It was horrible. My soon-to-be husband convinced me that maybe we should expand the search. I applied to a clinic that seemed fantastic. Booked an interview and drove out to Pennsylvania. It was rural with the closest big city almost 2 hours away. But the clinic was amazing. The veterinarians were amazing. The only major downside was the clinic did on call because there really wasn’t a major emergency center close. I was a new grad and scared but also decided it might be a good challenge for me. I took the job and never regretted it.

Unfortunately, a lot of veterinarians don’t want to give these jobs a chance and these rural clinics are getting desperate and having to close. Here are a few reasons that might change your opinion on rural clinics.

  1. During my first two months, I did more surgeries than most of my colleagues that went into internships or private practices did in their first year. Because referral centers weren’t super close a lot of clients relied on us, which allowed me to take on some amazing surgeries (with help of my boss).
  2. You might have to do on-call but there are a lot of upsides to it. Learning self-sufficient skills helps you become a better doctor. Of course, make sure you are getting compensated well for your on-call and also make sure you have a good balance of life/work but honestly, you can learn some amazing triage and emergency skills doing on-call.
  3. Smaller towns = smaller cost of living. During my first few years, I was able to start a 401k, paid off my undergraduate loans, bought two new cars (my 10+ year old compact didn’t survive the PA winters), and bought a house with a ridiculously low mortgage.
  4. Smaller towns don’t always equal smaller paychecks. A lot of clinics are aware they need to up their salaries to compete. Some of these clinics may start you out at $70-90k. With the lower cost of living, you will not feel the crunch like you would in a larger city.
  5. Entertainment is an adventure. Smaller towns tend to have a lot of little events and festivals. When you want to seek out a larger city it’s like a little mini vacation.
  6. Smaller towns provide a family-like feeling. Everyone knows everyone and usually provide help and assistance to each other.  It’s a slower pace sometimes but it is probably a nice change from the hectic life of veterinary school.

I get it. I was used to a large city atmosphere. And after six years my husband and I did decide to find a middle ground again but it was one of the hardest decisions to leave the rural clinic. I’m not saying it is the best choice for everyone but honestly, it could be a great change of pace especially after the chaos of vet school. There are some amazing rural practices out there but a lot of people aren’t giving them the chance. My advice, take the opportunity and enjoy the change.

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.

A Vet’s Guide to a Better Life For Your Cat

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You have decided to adopt an adorable spawn from hell otherwise known as a cat (I kid!). Cats are amazing, but also very complicated. Many people obtain cats through friends or rescues, but may not truly know what goes into cat ownership.

As veterinarians, we often only see cats for end-of-life care. Many times we don’t get to guide owners regarding behavior, vaccinations, abnormal habits, etc. It’s tough to see an animal that could have been helped sooner, but the owners were unaware of the options. If you are thinking of adopting, know someone who is adopting, already have a cat, and are concerned about its quality of life, or just want to learn something new then this article might be for you.

Cats are not small dogs. Let’s say it again – cats are not small dogs. Once people realize this it makes it easier to acknowledge their differences and what goes into cat ownership. If treated like a dog, you might have some behavioral issues to deal with or even miss out on the subtle way cats show you they aren’t feeling well. While a dog can easily miss a meal and recover quickly, one missed meal for a cat can mean a variety of things and needs to be acknowledged in a timely manner. While dogs crave attention from their owners, cats can be more independent and need more space to do their own thing – think hiding spaces and cat trees. Dogs enjoy walks outside and sniffing new things while cats… well, sometimes they enjoy that too.

The first few months of a kitten’s life are an ideal time to bond with you and with the veterinary clinic of your choice. Many people skip this step entirely and wait until they can take their kitten to a spay/neuter clinic to have them altered and a rabies vaccine is given. Although this is a great option for people who cannot afford regular care, it doesn’t help much with socialization and fears that can become ingrained at an early age.

We typically like to see kittens for the first time at eight weeks of age to start on vaccinations, deworming, and general socialization. For the next couple of months, the kittens will come in for visits to get used to being in a carrier, being around other people, and will be monitored for health issues. This is also the perfect time for us veterinarians to discuss the lifestyle you plan on giving your new kitten – outdoor, mixed, or indoor only. Many people do not realize that even indoor cats are at high risk for fleas, mosquitoes, flies, and roaches, which can carry some nasty diseases.

If you plan on obtaining a kitten or cat, identification is a good idea. Many owners do not realize that their little bundles of joy can escape and more than 90-percent of cats in the U.S. do not have identification whether it be a collar or ID chip. Starting early it is always a good idea to get a kitten or cat used to a collar and making sure it is a safe quick-release collar is key. If your cat or kitten will not accept a collar then permanent ID chips can be done during spay/neuter. That way if they get lost it is easy to ID them. Even if you plan on keeping your cat indoors they might have other plans and go rogue so make sure there is an easy way to identify them if they get lost.

More than half of shelter-surrendered cats are surrendered because owners’ expectations do not line up with how the cat is acting. Owners think that cats are being spiteful when they urinate on their bed when in reality it might be a behavioral issue or medical problem. Many times these cats do not get spayed/neutered at the appropriate time and can start having aggression issues or urination issues. The more cats you put into a household the more it can create a hostile environment that may also start to create more issues at home.

If you have multiple cats, but only one litterbox you are setting yourself up for frustration. The usual rule is one litterbox per cat, plus an additional litterbox. If your litterboxes are in places your cats do not like going into or are guarded by the other animals in the house then your cats may start peeing or pooping in inappropriate areas. Also, think about your older cats – do they have to go down into the basement to use a litterbox? If so they might have a hard time due to arthritic issues.

I am often brought cats for euthanasia where the owners state, “she just got sick for the last month and it’s not fair for her to live anymore.” While this statement may be true and I don’t want to see animals suffer, the first part is avoidable. Half of the issue is veterinarians can sometimes blow off how important healthcare is to cat owners – it isn’t that we don’t care, but a lot of owners aren’t as receptive to it since it’s “just a cat.”

We as veterinarians need to be better at explaining how important yearly checkups are for your feline friends. But the other half is your responsibility to get your friend to the clinic when it is sick. There are many “dying” cats that could be saved if they were brought in for regular checkups. We don’t want to just see you for end-of-life care. We want to help you, and your cat, have the best life experience possible.

Cats can be complicated creatures but are overall rewarding to own. If you take the appropriate steps many abnormalities or issues can be avoided. If you have a cat or are thinking of getting one, make sure you have a veterinarian you know and trust to discuss cat ownership. Your vet can help you make sure you are providing the best care available so your little feisty devil can give you years of joy. And don’t forget, the stupidest questions are the ones that are never asked, and we always welcome educating owners on their pet care 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.

When Relinquishment Punishes Everyone

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It happened again. A family could not afford the care of their pet and the veterinarian offered relinquishment instead of having to euthanize the animal. It should be a feel-good story. It should make you say, “Wow that veterinarian is so nice to do that for that animal instead of euthanizing.” But instead, people get angry. People start harassing the veterinarian. People start spreading misinformation. And then the family gets their pet back at no charge because the public has made a spectacle of it all and forced the veterinarian to work for free.

Misinformation continues to fuel these situations.  I’ve written about this before. People get wrapped up in the title and read very little details regarding the situation and then just click that share button. And then it’s shared… and shared… and shared.  Suddenly we are dealing with a misinformation mess.  Let’s go over what really happens in these situations to try to get some facts straight before this trend continues.

In most of these stories, a pet is brought in for a major issue such as parvovirus or a surgical issue or even just a really sick dog or cat.  Typically the owners cannot afford treatment, even the bare bones estimates. The veterinarian sees this sweet animal suffering and usually has to bring up euthanasia as a treatment option but doesn’t like discussing that when the animal could be saved. So we discuss relinquishment.

Relinquishment means that we will take on the cost of the treatment but the animal now belongs to the clinic. Here is where the story always takes a turn.  The owners will always ask if they can have the animal back once it is better or sometimes will harass the clinic for updates on who is the new owner so they can guilt those people into giving the animal back. Or sometimes you see social media get involved and random people will scream at the clinic saying “If you are doing the work for free why not just give the animal back to the owner.” So let’s discuss those misconceptions.

No, the owners cannot have the animal back once the clinic has saved it unless they come up with the money to pay for treatment. Unfortunately, animal clinics are businesses and we need payment to keep afloat. If we gave back every animal that was relinquished without payment we would no longer be in service.  This also creates a vicious cycle because now those owners think any time their pet is in trouble they can get work done “for free.”

That brings up the second part. We are not doing the work for free. We still have to pay for those medications, anesthesia, and time that had been put into saving the animal.  Several animals that I have saved due to relinquishment or abandonment were charged to my account and I happily paid them since I became the new owner of said animal.  None of the work is for free. Now maybe the clinic will discount some of the services or write them off but that doesn’t mean that any random pet owner should be able to cheat the system and not have to pay.

Relinquishment doesn’t have to be a bad thing. Sometimes animals get into situations that clients cannot afford.  If a veterinarian offers relinquishment that means that they care enough to try to give the animal a chance. But if the public continues to act like veterinarians are just money-hungry people wanting to take everyone’s dogs for profit then a lot fewer veterinarians will be willing to allow relinquishment which means a lot more unnecessary euthanasia.

You don’t have to be rich to own an animal but you do need to take responsibility for that animal. Relinquishing an animal is the responsible route to take if you cannot afford treatment.  You are allowing that pet to live another day. We need to stop punishing both the owners and the veterinarians in these situations. We all want to help the suffering animal and that should be the endgame.

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 You Need to Be OK With Change

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“Change is the only constant”- Truth Potato

If you haven’t experienced the Truth Potato I highly recommend it. Sometimes we need little truth bombs placed throughout our days to realize what is most important. Change is really the only constant in life.  As part of a veterinary community we all experience change in our daily work life. Change is scary. Change is hard. Change is complicated.

At this moment I am going through a major change. I have been working for the same clinic for the past six years since graduating from veterinary school. Together the clinic and I have been through many changes like personnel changes, renovations, new technology, and new leadership. But now my husband and I have decided to make a change and move closer to a big city, which means leaving my current job.

Yes, I’m a little scared. Yes, I’m fairly nervous. But change is the only constant in our lives and in an ever-changing field we must embrace the change or get left behind.

In the veterinary field, we have all been faced with many changes.  Every couple of years a treatment plan falls out of favor only to be back in favor in another few years. Yearly we go to conferences to learn the most recent updates in medical treatments for conditions we deal with daily.

On a smaller scale as a veterinary clinic, we go through changes in technology and protocols. What once was simple and easy will eventually get replaced with something else that may not seem as simple at first. Change happens and how we respond to that change will either allow us to succeed or fail.

We all have seen it. I’ve been through a few clinics that transitioned from a written appointment book to using the computer. I even went through a transition from a DOS system to a Windows-based system.

Or maybe your clinic went from hand-dipped radiographs to an electronic system.  It’s amazing how easy or hard the transition can be depending on how you and your team approach it.  There are the people who are excited because they want to see the clinic become more efficient and make things easier. And then there are the people who complain… for years… about how great the written appointment book was or how terrible the computers are now.

These people don’t really want the clinic to fail, but their approach to change is making it harder for the clinic to succeed.  These people eventually get left behind.  I get it. Change is scary.  But as a whole, we have to realize that this change is happening with or without us on board.  And getting in the way of that change can make your life and work-life harder than it has to be.

I’m a realistic person. I’ve never really had my head in the clouds or been a super optimistic person. But when it comes to change I think we all need to take a more optimistic look at things.

We need to not get stuck in our ways- especially in this medical field. We need to stop doing things just because we have always done it that way. We need to embrace new vaccination protocols and anesthesia medications. We need to continue to improve our pain control for patients. We need to continue to improve our technology and efficiency for our clients and patients. We need to strive to be better and change.

Don’t worry- I’m still scared about the changes in my life but I’m embracing them for what they are- exciting, new, and a step forward. Don’t let yourself or your team hurt your future. Change is going to happen- it is the only constant.

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.

When Euthanasia is the Best Option

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Euthanasia… it is a touchy subject. A lot of people don’t like discussing it. It has a stigma to it. People assume that if you are euthanizing an animal you are just giving up on them or that you don’t care anymore.

These are the many reasons why veterinarians see animals for euthanasia that probably should have been put to sleep much sooner. We as humans project our emotions onto these animals and feel like we are letting them down but in return we are actually letting them suffer.

As veterinarians we don’t want animals to suffer but we also need to guide owners towards the best options.

Euthanasia is not cruel. By definition euthanasia means easy death or painless death. We are able to give this gift to suffering animals when their bodies are no longer able to function.  Euthanasia is not giving up either. It is hard to convince owners sometimes that the best option is euthanasia and it’s even harder to convince rescues that euthanasia is the best option.

On a daily or even weekly basis rescues bring in animals that were either found or surrendered to them. These rescues try hard to help every single animal they have under their care.

The hardest part is that volunteers and laypeople typically staff these rescues and when faced with decisions regarding an animal’s health, they don’t always fully comprehend the repercussions of their decisions based on their goal of helping save every animal.

While they focus all of their efforts on one animal they may be missing the bigger picture.

Here are a few examples.

1. A local rescue presents a dog with a fractured rear leg, severe arthritis, emaciated, and heartworm positive. The dog is 14 years old and is also intact. The rescue wants to do everything to save this dog. The fractured leg will need surgical repair. The dog will need to be neutered as well. Because of the heartworm disease, surgery is going to be complicated because the animal is already showing signs of heart failure.

If the dog makes it through those surgeries and heartworm treatment it now has to be on chronic NSAIDs for severe arthritis and pain. These treatments, even with discounts for the rescue, can range anywhere between 3500-6000 dollars depending on area. The rescue wants to pursue treatment because they don’t want this animal to die.

Because of the cost of treatments it bleeds the rescue fund almost dry and while this animal is getting help there are now several other animals that are denied rescue help because of lack of funds.

2. A rescue takes in an owner surrendered dog that has a history of aggression. The dog has been to several behaviorists, trainers, and households. It is currently on behavioral medications but still managed to become aggressive and attack the prior owners son and killed their cat.

The rescue doesn’t want this dog to suffer so they take it in and want to find it a “good” home. After several failed attempts they decide they are just going to have the foster family keep it as an outside dog since it seems “happy” tied to a kennel and won’t have to be euthanized.

3. A rescue brings in a litter of kittens to evaluate. The mom cat died unexpectedly and the kittens don’t seem to be doing well. The kittens are 8 weeks of age but are covered in fleas, are half the weight they should be, and all have enlarged abdomens.

On further inspection the enlarged abdomens are caused by a yellow-tinged fluid, which usually indicates FIP (a non-curable disease). The rescue wants to save these kittens even though their prognosis is grave.

As owners of pets, we are their legal guardians. We are their advocates. We want them to be happy and healthy. Yet too many times we allow them to suffer because of our misconceptions regarding euthanasia.

As veterinarians we try to guide you to make the best decision for your pet and will always offer euthanasia as a treatment plan, not a way out. Euthanasia isn’t cruel or selfish- it is an option we are able to give our best friends in their time of need.

Emotion plays such a huge role in rescues and it is hard not to get attached to everything that comes in. But in a lot of situations they need to realize that to save many you may have to make that hard decision to euthanize one.

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.