DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Sarah Boston, DVM, DVSC, DIPL ACVS

How to Telemedicine

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Telemedicine has been the greatest COVID silver lining for me. (I mean, other than shaving my head and rediscovering the bidet during the great TP shortage.) Telemedicine has been the greatest professional silver lining, at least. I had been considering dipping my toes into telemedicine for more than two years before the COVID crisis hit. I had researched what platforms to use and how I would incorporate it into my practice. I just needed to figure out how to start. Then, suddenly, we shut the clients out. Remember that? One week I was trying and failing, to stop shaking hands with my clients, and the next we wouldn’t even let them in to use the bathroom. And I was all ready to go with my platform, so I just switched over all of my surgical oncology appointments to telemedicine. Was it seamless? No. Were there glitches? Of course, there were. 

But the thing is, if you are improvising and doing your best during a global pandemic, clients don’t really mind. I am not sure that they would have had the same level of patience with me if we didn’t connect perfectly during the before times. A technician asked me how I convinced the clients to do my appointments via telemedicine. “Well,” I replied, “I told them that this is how I do all of my initial consults now, so they can have a telemedicine appointment, or they can have no appointment.” Very convincing argument. 

So what is so great about telemedicine? Why was I considering this even before I was forced to? I am in specialty practise, so my cases are referrals, and sometimes my clients are driving more than two hours for their appointments, but even when the clients are close by, I think it is safe to say that all of our clients are busy. (Or, at least they were busy.) Some of them genuinely want a discussion with a veterinarian before they come in so that they can make a plan. It helps them to feel less anxious about what is going to happen. Some people want to pay us for our knowledge and time, not just for “doing veterinary stuff” and that is a gift. For years, I have had clients contact me to request a consult over the phone to help them to decide if they should bring their dog in. They have all offered to pay for my time, but we didn’t really have a mechanism for this, so we just said no. 

Here are the different types of clients that I see on a regular basis:

1. The Chatters

These people just want to meet with me to discuss the case so that they feel that they have considered all options. They have no intention of doing surgery. (Even though they are seeing a surgeon.) 

2. The Thinkers

These people will likely go forward, but they want to take the information, have a family meeting, then they will schedule, but not next week because they are going on holiday, so maybe the week after that but they aren’t sure. But as soon as they decide, they will want it to happen immediately.

3. The Same Day Peeps

These people want a CT and surgery and they want it now. Yesterday would be better. 

4. The Easy Breezy Peeps

These ones are few and far between. They do what you suggest when you suggest it. They are motivated. They have insurance. They are flexible. They are educated. More of this, please.

It is very hard to schedule procedures around The Chatters, the Same Day Peeps and The Thinkers. I have no way of knowing what type of client I am going to meet and what these clients will want, and I haven’t even gotten to their pet’s medical condition or recommendations yet. 

Here is where telemedicine comes to the rescue for me. It’s like a sorting hat (okay, that is as far as I can take this Harry Potter reference. HP just wasn’t my jam, but hopefully you know what I mean). For The Chatters, we can have a consult and they can decide not to go further without having to take time off of work, or drive 2 hours each way, or totally stress out their pet. I can schedule exactly the amount of time it takes to have the consult, answer their questions and send a summary. For the people who want everything done yesterday, I can have a discussion with them and make a plan. They can have all of their paperwork done and be ready to rock for when they drop their pet off. It is efficient and they love that because their time is valuable, which is a great point because mine is too, dammit. For the Thinkers, they can think and get back to me when they want to schedule something. Telemedicine makes it so much easier to be efficient and organized.

Do I ever find that the case is different once I bring in the pet and do the physical exam? Usually no, but sometimes yes. That is not a big deal, you just need a little disclaimer saying that once you do a physical examination, the plan might change and you will call them. Plans change all the time. Roll with it. The point is that you are going to do something and you can refine this plan once you see the pet. If you were going to XYZ, but once you examine the pet, you shift to ABC, it is not a big deal. The pet is there and fasted and ready for diagnostics or treatment. Do your thing.

Is talking on the phone just as good as a video conference? No. It’s just not. I don’t know why, but you need to look your clients in the webcam when you are talking to them. There is something about the video conference that makes it feel more like you are meeting them. You are seeing their home, their pet and, sometimes, their tears. You just don’t connect the same way over the phone. They need to see you so that they trust you with their pet. Can you imagine dropping a pet off at a vet clinic and not meeting the veterinarian? Think of how stressful that must be for our clients. We need to do what we can to help the clients to know and trust us. This is a big deal. Counterpoint to this is the telemedicine platform creates the elusive boundary that is so hard for veterinarians to master. For me, it is just the right amount of connection to have a professional relationship with clients.(Fun fact: Dementors can not suck your soul through a telemedicine platform. Also, how am I adding another Harry Potter reference when I don’t like HP at all?)

Will this work in general practise too? Yes. Of course. This technology can add value to your free advice phone calls, help you to evaluate your patients in a new way, and help you and your clients decide which patients really need to be seen and when.  It will also allow you to schedule procedures so that you aren’t trying to cram radiographs, aspirates, biopsies, blood draws, bandage changes, ear swabs and vaccines in between your appointments. It may also prevent clients bringing the other dog in the household for you to take a quick look at. It will help them focus on listening to you through your wellness discussions.

What platform should I use? You want a platform that has secure video chat capabilities. Ideally it will have a scheduling feature, the ability to collect payment, the ability for clients to schedule appointments, upload images and the ability to record the consultation. 

Do I love working from home one-day a week? Yes, I love it so much! I love having my dog and cat sit with me all day and running downstairs for a quick cup of tea between appointments. I love the quiet and the lack of distractions. I like working with people, but I also love just focussing and getting my work done so I can be done working. Does anyone have a quiet place to sit at work and bang out your paperwork? All of those little chit chats and interruptions add up and can prevent you from concentrating. (Does this sound bad? Maybe. I don’t care.)  I love sitting and looking outside the window all day. I love the flexibility. You can love all of this too. Think of the possibilities and how they will fit into your lifestyle. 

Over the past few months, I have found that we are all getting better at this. Clients are getting on board with Zoom, Facetime and new platforms. The internet speeds are getting better. It is now rare that my client is not sitting on the meeting platform on time and ready to go when I start the appointment. My clients are also starting to upload images and notes to the platform unsolicited. There are so many advantages to having a focussed consultation with the client that doesn’t involve trying to examine the pet at the same time. If I never have to listen to the inevitable uncomfortable banter and innuendo from a client as I do a rectal examination on their dog in front of them, I will be so grateful. 

If you have not embraced telemedicine yet, you are going to have to. Not just because we are not going to be crammed into an exam room with strangers breathing on us any time soon, but because it is the future. Our clients want this and, now that they have tried telemedicine, they are going to demand it. Our clients are getting younger (and/or we are getting older) and younger clients will demand the convenience and that we use technology. I promise, if you give it a try, you will want it too. If you don’t get on it during a global pandemic, then when? How do you start? You just pick a platform and get started. Just do it. Congratulations, now you do telemedicine too!

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 Life-Changing Magic of Tidying Up Your Veterinary Hospital

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Okay, I admit it, I drank the Marie Kondo Kool-Aid and, like Colbert said on her Late Show appearance, given the chance, I would probably follow Marie Kondo to her cult compound and stay with her forever. Recently, I moved into a very small home. I was already on board with a more minimalist lifestyle, but now I was forced to live it. I purged a lot of things. Let go of a lot of guilt about letting go, and I am so much happier with less. The thing is, once you start to Marie Kondo one aspect of your life, you want to Marie Kondo all aspects of your life. Everywhere I look, I see clutter and I want it to go away. I think the clutter in veterinary hospitals could use some attention.

Think about your workplace. Now, if you can, think of what it was like the day the hospital opened, or try to imagine it. Imagine it without all of the notices taped (Taped! Who does this?) to the once pristine hospital walls, the posters from drug companies and prescription dog food companies, the pictures, the memes, the thank you cards, books, the random shit that people didn’t want anymore so they bring it to work, or stuff that just got forgotten there and left to die. The KonMari method goes in order: clothes, books, paper, kimono and sentimental items. Let’s do this. I promise it will only hurt a bit.

Okay, so let’s start with clothing.

How many stained or light greyish lab coats with missing buttons or tears do you have? How many pairs of scrubs that don’t match and are faded and ill-fitting do you have there? Do they spark joy for you? Do they? Do you keep them around “just in case” you might need them one day? I promise, by the time you do, your nice scrubs will be old and you can use those ones. How many pairs of shoes are hanging out that don’t have owners? 

Next up is books.

How many textbooks do you have lying around that are over 5 years old? They need to go and you need to get new ones. Consider getting e-books if you can. Everything else that is not a current textbook needs to go. Proceedings from NAVC 2006? Bin them. Proceedings are available on VIN and, here’s an insider academic secret, proceedings are usually pretty crappy. They are written months before the speaker actually has time to work on their talk, usually under duress and after many grumpy reminder emails from the conference organizers, threatening to withhold $50 of the $250 stipend for the lecture if they don’t comply. I don’t recommend using proceedings as references. They just aren’t that good, and I’m saying this as someone who has written a lot of them. And I’m sorry.

Papers are next.

Papers are a bit like books. All the crap and papers from industry? Let them go. Industry peeps, I’m begging you, please stop with all the binders, put that shit on-line. Look at your bulletin boards. If there is a notice for a “Lunch and Learn” from 6 months ago, you can probably take that down now. The binders of manuals for equipment? Most of that is on-line too and I am guessing some of those manuals are for items that you no longer use that are in boxes being stored just in case you need them one day. So maybe have a bulletin board for current fun things and switch it up every month? If you keep the same stuff on display, no one will look at it because they get fatigued from looking at it and then you aren’t really displaying it anymore, you are just creating clutter.

Then there is Komono.

I think that is Japanese for sh#t that you don’t know what to do with. A lot of this is the swag, but it is also equipment that has ceased to be useful and had been replaced, but you didn’t get rid of the old one “just in case.” Even if it doesn’t really work. This stuff is cluttering up your hospital and it needs to go. If it is useful equipment, it may help a colleague, maybe sell it on Craig’s list or send it to a developing country. If it is not useful enough to do this, then it is not useful sitting in a box or on a shelf and cluttering up your workspace. How many times have you gone back and busted out that old equipment? I am going to guess never. Even if it is only once, it is not worth the real estate it is taking up. 

To our pharmaceutical and veterinary diet industry friends, please stop with the useless swag. Just stop. You are wasting paper, filling the world with plastic, and making our hospitals look tacky. There, I said it. If you must give us swag and gifts, please make it something useful. Here are things we need: pens and highlighters. We also like food. That’s about it. You can put your website address on the pen so we can find all of the information that you want us to have. I bet that would save your company a lot of money, too. You’re welcome. Please just stop with the stress balls (they are stressing me out), crappy T-Shirts, cell phone cases, the sticky suction things to put on our cell phone cases, the calendars, the charts that you want us to put on the wall, the binders (see above). If you must bring us things, maybe make them consumable things that will go away once your memory fades. I bet you could get nice chocolates with your logo on them. Or a cake. A cake would be great. 

Now let’s venture, if you dare, into the break room.

It is a bit like the kitchen section at a thrift store, but not nearly as nice as that. This is where all of the plastic cutlery goes to die. Mostly knives. There are a lot of plastic knives here, not so many forks. There is also the Keurig that was so popular just a few years ago that no one buys K-cups for anymore, the holder for the K-cups that sits empty on the counter collecting dust, a sandwich press, loose leaf tea (but no strainer to make it with), lots of coffee cups, lots of paper cups, paper plates and napkins from pizza lunches past, Tupperware containers that are missing their lids (so they are no longer containers, really) or lids that don’t have bottoms (also not really lids any more), maybe a crockpot, and some sort of plug-in grill. The microwave will work (sort-of), but it may be missing the spinny glass plate thing because someone broke it. The inside of the microwave will certainly be caked with splattered with food on the inside because no one heeds the angry sign that has been taped to the wall beside it saying “cover your food!.” There will be some inexplicable dirty dishes in the sink (How? Why?) There will be straws, sugar packets and a random assortment of sauces and condiments in every drawer, in no particular order.

Then there are the seasonal decorations.

I’m sure this comes as no surprise now that you are this far through this article, but I am a bit of a grinch in this area too. I like hospitals to look like hospitals, not like a craft store. That is just me. If you must put up seasonal decorations, keep it classy and minimal. Also, when the holiday is over TAKE THEM DOWN AND PUT THEM AWAY. Yes, I am yelling this part. 

Then, there are the sentimental items.

These are always hard to decide what to do with. The gifts, shared memories and pictures. Hopefully, you are now adept at deciding what you need to keep and what gifts and memories you can just keep in your heart, without the physical reminders of the time and place. One good rule of thumb is that if you would not proudly display this item in your living room, or pass it around to the different people that work at your hospital to display at home like the Stanley Cup, don’t put it up at work. What about all of the cards from clients? Well, that depends on how you feel about them. Pure KonMari would say that you take in the gratitude and the sentiment from this client taking the time to send you a card and then you let it go. However, some veterinarians really cherish these cards and like to go back to them on bad days because they spark joy. That is great. You have a few options: you can make a scrapbook of them for people to look over when they are on break, you can take pictures of them and make an electronic library of pictures and cards, or you can share them on your clinic Facebook group so that everyone gets to see them. But if you have faded cards taped (Again, taped!) to your wall that are from years ago, for pets that you don’t remember and addressed to veterinarians and staff who don’t even work there anymore, then displaying them is likely having the opposite effect than what was intended. It is just sad.

Maybe you are so busy that you don’t even notice all of the clutter, or that you don’t have time to deal with it. Maybe you think that you don’t care about the clutter. Subconsciously, I promise that you are noticing it and it is affecting you. It is making your hectic days feel more hectic because to some, clutter is like visual noise. It is affecting your mood. It is making you feel busier and less calm. Now take a deep breath and imagine what your hospital could look like without all of the clutter. Clean countertops, organized shelves, drawers with the items you need at your fingertips, and the ability to sit down and just work.

I challenge you to declutter your hospital.

Make it cleaner and more organized and easier for you and your coworkers to navigate. I challenge the industry to stop giving us swag and crap that we don’t want or need. You can do better. We can do better. Let’s do this.

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.

Do I Give it a Go or Just Say No?

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Here’s the scenario: you are in general practice and you have a patient that needs surgery. It is not a surgery that you have ever done, nor do you feel comfortable doing it. You recommend referral to a specialist. The owners don’t have the money for the referral. In fact, they have about $800 to put towards this particular problem. What do you do? Do you try? Do you feel like you have to do something? Do you feel like if you don’t take a crack at it the patient will die and it will be your fault?

What if you just say no? What if you don’t have to do anything? Not doing surgery is acceptable. Not doing surgery may be better for all concerned. If the owner has limited funds, then they are choosing a more palliative approach and that is okay. You can help them with that however you feel is appropriate.

Now before you get your knickers in a knot and fire off some choice interwebs comments below about how a specialist should not tell general practitioners what procedures they can and can’t do, that is not what I am doing here. That is a quagmire that I do not wish to wade into. (I know that someone will say this in the comments anyway, please help those peeps by referring them back up here. Thank you. Don’t @ me.) Your own experience, training and aptitude should dictate what procedures you offer to your clients. What I am saying is that the person who decides what procedures you do or don’t do should be you, not a client who is leaning on you to do them a solid on the cheap. Honestly, no good can come of that and I think it is bad for you.

This feeling of “giving it a go” comes from our roots, from back in the day. It has that retro James Herriott vibe where everyone just gives it a nudge and sometimes it works out and sometimes it doesn’t, then everyone meets up in the pub while Lassie slowly bleeds to death in the barn and isn’t that a shame. It is not that time anymore. That old school feeling has the potential to be extremely demoralizing in the present. I believe this pressure to come up with something when clients are financially strapped is a major source of compassion fatigue, burn out and imposter syndrome that is hurting our profession right now. Also, if you suddenly come up with a bonus option that is the exact amount of money the owner says that they have, it gives the impression that veterinary medicine is really more of a barter system than anything.

In my experience, this approach does not usually result in a favorable outcome for the pet. Sometimes it actually makes things worse for them. Just as importantly, if it doesn’t work out, how are you going to feel? Likely you are going to feel like you failed and you are going to blame yourself. Think of the ulcer you are going to get when you try to do a surgery you have never done, you don’t have 24-hour care for the pet, so you turn yourself upside down to try to provide the care the pet needs and it doesn’t work out. Raise your hand if you have done this and it didn’t work out and you ended up in a fetal position in bed for a while, devastated that you hurt one of your patients and exhausted because you worked so hard on the case?

What if you want to practice and get better? Is that a reason to offer a cheap surgery option? Well, that is another ethical quagmire, isn’t it? I honestly don’t know how I feel about it, but I think considering what the patient would want and how they would feel about this is an important part of answering this equation that is not always considered. They really didn’t sign up for that. I tend to think practicing and learning is best left to teaching hospitals and CE courses, where there is someone there to teach you, somewhere that you can make mistakes without consequences.

If someone only has $800, then maybe surgery is not the right choice for their family and that’s okay. It has to be okay. Every animal deserves to be treated humanely and we are obliged to prevent suffering in our patients and treat them with dignity. Not every animal can get fixed or have surgery. That is honestly very sad, but we have to be okay with it because that is reality and we have to be okay with reality or we will go mad.

I challenge you to stop giving it a go. Set yourself up for success. Set yourself up to have the best possible outcomes for your patients by doing what you trained to do to the best of your ability. Keep learning and training throughout your career. Try to have whatever is the opposite of imposter syndrome. It doesn’t have a name yet, let’s give it one. How about poster syndrome? You got this.

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.


Media’s Emotional Blackmail Is Killing Veterinarians

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A previous version of this article first appeared on Medium.com.

Emotional blackmail is the new term being used to characterize the pressure that clients put on veterinarians to care for their pets, to feel guilty about charging, and for making money. It has catapulted our profession into a crisis of burnout, compassion fatigue and suicide.

Veterinarians are currently the profession with the highest rate of suicide. There are so many factors that contribute to making this profession the hardest job you will ever love.

One new aspect is media reaction. They are killing us. Literally. There have been several high-profile stories in the press recently where a pet owner takes a sick pet, often a puppy, to the emergency hospital for treatment. The owner is given a quote and cannot afford to pay. The puppy is sick enough that, without treatment, it will die. The veterinarian, who has likely been through this heartbreaking scenario countless times, tries to offer options to save the puppy. They are likely even a bit blinded by the fact that they just can’t euthanize another puppy that could be treated and have a happy life. They will go over third-party payment plans (they exist), asking for help from family and friends, Go Fund Me campaigns, trying a less expensive treatment option that is not optimal or euthanasia. The last-resort option is to have the pet surrendered to the hospital to try to find a rescue group or owner (often someone who works at the hospital) who will assume financial and legal responsibility for the pet. Hopefully, the treatment will be successful and the pet can be rehomed. This is a monumental effort on the part of the veterinarians and staff that try to make this work, and likely costs the hospital money. Veterinarians are not looking for more homeless sick puppies to rescue. We don’t want this.

The pet is surrendered to the hospital and no good deed goes unpunished. The pet owners, justifiably heartbroken by their loss, will sometimes go to the media — particularly social media — who jump on the bandwagon to try to get their puppy back. This scenario will invariably vilify the veterinarian and staff, who have gone to great lengths to save this puppy’s life. Some of them have done far more than the previous owner was willing to do. The media are executing emotional blackmail here, and it is on a massive scale and generally brings in our friend, the Internet. The Internet will then be let loose on the veterinary hospital and staff with unrelenting trolling. When stories like these break, veterinary staff have had to endure no end of online abuse, terrible reviews and even threats to their personal safety. Some hospitals have had to close temporarily to weather the storm.

There is no effort on the part of the media to try to educate the public that veterinary care is expensive, especially the lifesaving emergency care at 24-hour hospitals. There is no effort to educate the public about the responsibilities that go along with pet ownership. There is no effort to educate the public about pet insurance, which exists. (And no, you can’t get it after your dog is sick, which is an amazingly common question and also fraud.) There is no effort to discuss why veterinary care is expensive, or the resources that go into caring for your pet in this setting. Everyone is just angry that it costs money and they direct this anger at the people who are trying to help.

There are several results of this irresponsible reporting. The obvious one is the direct damage to the veterinary hospital and staff. There is also the widespread damage it does to all veterinary professionals when they receive the message that what we do is not valuable and should not cost money, and that we are terrible people who are only in it for the money. Suggesting we are only in it for the money, or that if we cared for animals we would do this for free, is laughable to any veterinarian. We love animals more than anything. We have made caring for their health and welfare our life’s work. We have given up so much to do this. How dare anyone suggest otherwise, just because we also have to charge for our services and, at some point, make a living and pay off our huge student loans?

The unintended consequence of “news” stories like these is that many veterinary hospitals are having to change their policies so that surrender and rehoming these pets is no longer an option. This brings us back to the previously stated options, which are third-party financing or euthanasia. So, along with killing veterinarians, these stories are also killing pets. Thanks, media. I know that puppies and heart-wrenching stories like these make for great TV, but I am begging you to report on these issues more responsibly and to think about the destruction you’re leaving in your wake as you move on to the next big thing. We are still here, trying to care for animals.

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.


We Need to Talk About Feline Injection Site Sarcomas

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We need to talk about Feline Injections Site Sarcomas. I will call them FISS from now on. No one really wants to talk about this subject. It makes us uncomfortable. Our whole raison d’etre as veterinarians is to prevent and treat diseases in animals. Now we have to talk about a disease we caused trying to prevent another disease? And it is horrible. Some of the vaccine companies also do not want to talk about it. I am inviting you to get a bit uncomfortable and read on. It’s important.

Thankfully, FISS is also very rare. It depends on your source, but FISS is reported in 1 in 1000 to 1 in 10,000 cats. Most veterinarians will only see a small number of these throughout their career, which is great, but we still need to talk about it.

We need to talk about vaccination protocols.

As a veterinary surgical oncologist, am I the best person to talk about vaccine recommendations in cats? No, I am not. Also, this is no longer a one protocol fits all situation. Here is what I do know, Rabies is a zoonotic disease that is fatal to animals and people. If you live anywhere that rabies is endemic, you have to vaccinate cats for rabies. Even if they stay indoors. Feline leukemia vaccine does not need to be given year after year. Most of these vaccines do not need to be given yearly. I highly recommend that you read the Feline Injection-Site Sarcoma ABCD Guidelines on Prevention and Management (Journal of Feline Medicine and Surgery 2015, 17, 606-613).

We need to talk about vaccine sites.

The recommendations to vaccinate over a limb, rather than an interscapular site, are over 20 years old. The message has gotten through – sort of. The whole idea behind vaccinating over the limb was that when FISS occurred at these sites, it could be treated by a simple amputation. This is less effective when vaccinating over the limb actually means vaccinating over the hip/flank area. This tends to happen when the cat is in a crouched position and also when you don’t actually vaccinate over the limb. If it happens, the resultant tumour in the hip/flank area will require a hemipelvectomy and body wall resection for treatment. This is not exactly what the feline vaccine associated sarcoma taskforce had in mind. You need to vaccinate below the elbow or the stifle. Really? Yes really. Every time? Yes, every time. You can do it! I did it for three years in general practise (1997-2000). You might need to bust out a towel, or a cat bag, or your best cat whispering skills, but it is worth it. While you’re at it, you can explain to the owner why you are vaccinating their cat there and let them know what to watch for in case they develop a mass in this area. What about tail vaccines? Well I am not sure, there is only one study out on this, but to be honest, this is where I vaccinate my own cat. It is a little tricky and I recommend shaving to avoid intra-fur vaccination. Also, there is a sweet spot on the tail that is high enough that you actually have a SQ to inject into, but low enough that you can easily get 5cm margins of tail if an injection site sarcoma forms there. I live in terror that this trend will catch on, but veterinarians won’t vaccinate low enough. I can’t do a cat bum-ectomy. Please don’t ask me to.

We need to talk about what causes this disease.

It is an aberrant response to chronic inflammation. There is a genetic component too, as only some cats seem to be predisposed to this and there are some reports of related cats being affected. This is hard to study because cat families don’t tend to keep in touch.

Vaccines cause inflammation. Vaccines with adjuvant cause more inflammation. That is how they work. There have been case reports of other types of injections causing FISS, including cisplatin, meloxicam and a microchip. These are one-off incidents that are even less likely than the 1 in 1000 to 1 in 10,000 cats that are getting FISS from vaccines. Some vaccine companies like to focus on the fact that other injections have been reported to cause this disease. Yes, this is true, but adjuvanted vaccines is a thing we can change and giving other injections may not be. Instead of throwing up our hands and saying, “Well any injection can cause this” let’s focus on the thing we inject into cats more than anything else – vaccines. We need to stay focused on the vaccines because they are the biggest part of this equation. We can actually decide when to vaccinate and where. This is where we can move the needle. The other side to this is that we can’t get complacent with the nonadjuvanted vaccines and start vaccinating all willy-nilly anywhere we want to because nonadjuvanted vaccines are “safe.” Stick to the distal limbs with all vaccines.

We need to talk about vaccine records.

Vaccine records are not sexy, but they are so important. The type of vaccine, lot number, expiry date and vaccine site need to be recorded. If the cat develops FISS, this needs to be reported to the vaccine company because it is an adverse event. This is a highly aggressive fibrosarcoma. It really doesn’t get any more adverse than that. As an added bonus, when you have all of this information, a lot of vaccine companies can be really great about helping the owner to treat this disease. I mean dollars in their pockets to help with the cost of diagnostics and sometimes even therapy. I have had vaccine companies give between $1,000 to $4,000 to my clients to help with treatment. Please report these to the vaccine companies. And, hey, giving these companies all of the information about a FISS that occurred with their vaccine might help them to understand what is going on better. Science!

We need to talk about what to do when you see a mass at an injection site.

Hopefully you have an educated client who will come back if a mass develops at a vaccine site. Hopefully the mass is small and located below the elbow or the stifle. Hopefully you will recognize this may be an injection site sarcoma. Most of the time, a fine needle aspirate is a great test to do on a new mass. However, in the case of FISS, cytology is not your friend. It might lead you to believe that this is just inflammation. You can do an FNA to rule out other tumour types if you want, but ultimately, you are going to need histopathology. An incisional biopsy should be performed on masses that have been present for more than a month after vaccination. The goal is to get a small amount of tissue and to leave the mass intact so that it can be removed with wide or radical margins if it is a FISS. Excisional biopsies are problematic because they can make definitive resection much more difficult and, let’s face it, this is already difficult.

We need to talk about how we are removing these.

Current recommendations are 5cm radial margins and two fascial planes deep. If you think about the smallest FISS we diagnose, it is around 2cm. If you take 5cm margins, that is a 12cm diameter defect – in a cat. It is usually successful if you are lucky enough to get an early diagnosis and a location that is amenable to a radical surgery. These are two things that we have control over by educating the client, doing an excellent work up and placing the vaccine in a location where we can get 5cm margins.

I used to enjoy of the challenge of a big FISS surgery. Now I just feel sad when I treat these cases and I need to do a hemipelvectomy and/or body wall resection. This is because I know that if the vaccine had been placed low on the limb, I could have achieved the same or actually much better with a simple limb amputation. These cats are breaking my heart. I honestly can’t do any more lectures on huge cat-ectomies for this terrible disease. I can’t do another panel discussion at a conference arguing the finer points of whether we should do radiation before we remove a huge portion of cat or after we remove a huge portion of cat. It is ridiculous. The answer is we shouldn’t be doing either of these things. We need to do better as a profession and do whatever we can to decrease the incidence of disease, diagnose it earlier, and make it easier to treat. Please let’s work together on this. I know it is only 1 in 1,000 to 1 in 10,000 cats, but to cat owners going through this, this cat is one in a million.

Thanks for the talk.
#NoCatLeftBehind

[columns]
[column width=”one-half”]Things We Can Change
Don’t over vaccinate. Create protocols that are appropriate for the level of risk
Consider using non-adjuvanted vaccines
Vaccinate below the stifle and elbow
Focus on gentle handling of cats to allow you to vaccinate low on limbs
Record every vaccination and site in your medical records
Educate clients on what to look for and what to do if a mass develops
If you see a mass at an injection site, do an incisional biopsy without delay
Report FISS as an adverse event
Wide or radical excision as the first, curative surgery

[/column]
[column width=”one-half”]

Things We Can’t Change
Some cats are predisposed to developing FISS at sites of chronic inflammation
FISS is an extremely aggressive tumor that requires aggressive resection
Cats need to be vaccinated for rabies
Some cats do not care for the veterinary clinic/vaccine experience

[/column]
[/columns]

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 Death of a Hamster

by

I shouldn’t care about what some guy says on Twitter, but sometimes I do care. Sometimes a tweet gets under your skin for some reason. There is this guy on Twitter and sometimes I follow him and sometimes I don’t. A recent tweet by @AndyRichter read:

“In case you’re curious, the cost of euthanizing a hamster at 9:15 on a Thursday night in LA is $171”

I shouldn’t engage. I can’t help it. I engaged.

Although I think this tweet is pretty awful, I do need to pause and admire the double subtweet wrapped up in 99 characters. It’s good writing, that’s undeniable. It’s masterful a**holery. Let’s break down those two subtweets.

Subtweet #1: It is not worth $171 to pay a veterinarian to euthanize my hamster. This subtweet just makes me tired. I am so tired of defending the fees involved in veterinary medicine. Any chance you could see a physician or dentist or a lawyer or an accountant at 9:15pm on a Thursday night?

The answer is no, unless it is an ER physician and that will definitely cost more than $171. You can also see an emergency veterinarian at this time. Although the suggestion is that $171 is a lot of money for this service, it is laughable. It is so small that it should be written 171 bucks and not $171.

Although it is just a hamster (see below: hamsters), there is no veterinary degree or service that is limited to the euthanasia of a hamster. There is no hamster euthanasia drive-thru, even in LA. You need the whole package to humanely euthanize an animal, and that is a Doctor of Veterinary Medicine.

A DVM has 6-8 years of higher education and this whole operation will also require a functional emergency hospital and a technician, unless you get a house call veterinarian to help you with Hammy. Either way, the time and training required is well worth 171 bucks.

Subtweet #2: A hamster’s life and humane death is not worth 171 bucks. This subtweet then prompted a myriad of twitter responses on more economical ways to dispatch of the hamster. All of them trying to be funny. All of them cruel. I would just like to say that the hamster did not ask for this crap. None of it, starting with being born in captivity and purchased by you as some sort of animate toy for your kids.

Hamsters are not particularly social. In my opinion, they do not make great pets. (This is unlike their cousins, the guinea pig or the rat, but that is another blog.) Maybe you purchased this hamster to teach your kids about pet ownership and responsibility, but I am guessing that did not work out so well.

What you did teach your kid is that they can hold a tiny mammal captive in a cage and control every aspect of his miserable little existence, right down to whether or not he gets access to clean drinking water or food, and if he might get his stinky wood shavings changed at some point so he does not have to sleep in his own feces.

Some days, maybe he can run on his wheel or be put in a ball of terror and try to run to a freedom that he can never reach. You have not trained your kid to be a pet owner, you have trained your kid to be a psychopath. Nice work. So now that this little hamster has lived out his arguably terrible life, you are complaining about the small cost of giving him a humane death. It’s the least you can do for the little guy.

(Now that I think of it, there are three subtweets:

Subtweet #3: It is very expensive to live in LA. I don’t feel as strongly about this subtweet as I do about the veterinary profession and the plight of the common hamster, and I have never lived in LA, so I am just leaving this here. Discuss at your leisure.)

So yeah, when it’s time to say goodbye to Hammy, unless you want to commit felony animal cruelty, you are going to need to see a veterinarian, and it is going to cost around 171 bucks.

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.