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Long ER Waiting Times Are Stressful. I Feel it, Too

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It was a typical busy night in the ICU. Patients were coming in several at a time, procedures were piling up and multiple animals needed to be hospitalized for immediate treatments. As I rushed from patient to patient, filling in my technician on what needs to get done, receiving results from blood/ urine tests and reading radiographs, I ask my receptionist to put the next client in a room. I will go speak with them while I am awaiting another diagnostic to come through.

I go into the room and introduce myself with a smile. “I have been waiting for 40 minutes to be seen,” I am told by a woman who is clearly unhappy. I understand, and I have been confronted with this in the past. While the frustration is justified, unfortunately, it is often also unavoidable. Furthermore, interactions that begin like this make it challenging to establish a trusting relationship and provide the best care for a sick animal. Believe it or not, if I have kept you waiting, there was a good reason for this and I, too, am feeling the stress that I have inadvertently caused you.

As a veterinarian in a busy ER, it is common for me to be multi-tasking and seeing multiple patients at once. While my team and I have become very efficient and capable at accomplishing the many things that must be performed for each individual animal, it is still common for there to be patients who will have to wait to be seen. Long wait times lead to frustrations among awaiting clients, understandably, but what most of them don’t know is it leads to frustration for me and my staff as well.

Most people who come to the emergency room do not do this out of comfort and convenience. Most do this because they are concerned about their pet and are unable to see their local veterinarian to help with their troubles. Sometimes the animals are stable and require minimal intervention and other times the animals are very sick, critical, sometimes even dying. It is my team’s job to be able to quickly determine which animal must be given priority based on the severity of their ailment. Because, for those animals, delaying an examination may have a fatal outcome or may, at minimum, lead to a worsening in their clinical status which may make recovery more difficult. Since triaging is at the heart of ER medicine for this reason, it means that some animals and their people will at times have to wait. Unfortunately this wait can sometimes be long.

We do all that we can to limit the wait — we hire many competent staff members, we provide hours of training, we use high-quality systems that allow us to streamline our work, we have more veterinarians scheduled for weekends/ holidays and times that are expected to be busy and we use digital systems for quick information retrieval. But, despite all of this, the unforeseen will still happen and there will be a waiting period. This is a reality in the human ER just as much as it is on the veterinary side. But it is unfortunate. And when wait times get long and I feel I am unable to do more than I am doing to resolve this, it affects me, just as it does the waiting client.

So if you are one of the clients that have had the more stable pet and has had to wait, I want you to understand that this was not intentional and I am sorry for the inconvenience it has caused you. Also, I would like to say “thank you”. Thank you for understanding that other animals are less stable than your own. Thank you for understanding that our staff and I care deeply about you and your pet and are doing all that we can to expedite what we can so that we can get to you. And thank you for caring enough about your animal to bring them to the ER for 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.

ABOUT THE AUTHOR

Dr. Chivvis is a 2011 Iowa state graduate and emergency veterinarian in Roanoke, Virginia. She completed undergraduate studies in Massachusetts and moved to Iowa for veterinary school and an additional 1 year Small Animal Rotating internship. Dr. Chivvis is strictly an emergency veterinarian, who treats dogs and cats, and strives to provide her patients the highest level of care as well as communicate with, and support, their human families. 

How Responding to My Own Cat’s Code Helped Me Become a Better Nurse

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“You don’t understand.”

This is the statement given to me by anguished owners responding during their most difficult hours. My empathy sounds empty, as though I could never know or understand their pain.

I glance into the corner of room five and quickly look away from the spot I last held my beloved pet after he had already crossed the rainbow bridge away from me.

“I’m so sorry for your loss. Would you like to see him?”

Teary eyes avoid mine as she nods yes, unable to speak. I stand up and exit the room walking back to the treatment area. My eyes fall upon the wet table where I see the lifeless body of her beloved pet, our greatest attempts unable to bring him back to her. The other nurses and I prepare him the best we can; catheters removed from shaved legs, which are hidden from view under a soft, fluffy blanket.

Nothing made me understand the horror families feel as their pet disappears into the treatment area better than the day it happened to me.

I remember everything as snapshots of a blurred memory. I was standing at the base of the staircase talking with my doctor when the code blue was called. We both raced up the stairs; I remember the tan of each stair under my purple shoes. Upon reaching the ER, I saw a large black cat in my periphery as I ran to the catheter drawer. My right fist was full of catheters, and my left was halfway to the clipper blades when I hear my doctor speak.

“Is this your cat?”

I look at the wet table, really look, for the first time and see a black and white paw; a paw I knew all too well. I immediately drop the catheters and back away in shock. I step around my doctor and feel tears start to fall on my cheeks as I look down at the face of my cat.

“He has asthma. No other health conditions,” I mumble as I walk out of the ER. From there I remember only blurred scenes. I am walking down the stairs. I am hiding in the laundry room. He is an indoor cat; I don’t know what could have happened. I am crying to our surgeon as she tries to usher me into her office, but I can’t leave him.

I walk back into the ER where I see familiar faces doing familiar things to a large black cat; he doesn’t even look like mine right now. I look up as my doctor says familiar words, “I got him to fibrillate; we shocked him but he’s back in asystole.” I see a look on his face I have seen many times before; a look of doubt. He won’t come back.

“Just stop.”

I walk over as everyone backs away from the wet table. I start to notice the familiar parts of my cat as tubes disappear. I walk into room five cuddling him in my arms one final time.

The decision to stop CPR on my cat was all at once the hardest and easiest decision I have ever made. He was gone, but I did not want to say goodbye.

I blink back tears slowly as I look down on the wet table today. Images of my cat disappear as I carry my patient into the room while his mother weeps. Wordlessly, I hand him to her so she too can say her final goodbyes. 

I take a deep breath and walk back to the front; there are other patients waiting to be seen.

“Bella? I can check you in now?” I stand in the lobby with a smile as another family stands and walks down the hallway with me.

“Oh, not that room please.” The mother says to me. “That’s where we said goodbye to our other dog.”

I nod solemnly. I understand that feeling. We go into a different room.

Responding to my own cat’s code changed my perspective on the state of mind the families I help are in. The feeling of panic, helplessness, and confusion made me forget what medicine was. I use that knowledge now to help console families struggling to comprehend their own heartbreaking experience.

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.

ABOUT THE AUTHOR

Jennifer is an emergency and critical care nurse at BluePearl Veterinary Partners in Utah. She graduated from UC Davis where she gained a love of patient care. When she is not working, she is busy taking care of her four cats, and fishing with her soon-to-be husband, Paul. 

10 Ways to Love Your Dog this Valentine’s Day, Without the Calories!

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There is an epidemic going on. It’s an epidemic of high caloric proportions. Holidays are often a time where food is seen as love and the number of calories being given to our beloved dogs can skyrocket. Unfortunately, holiday calories (yes, even Valentine’s) do count for our pups – as much as we wish they didn’t.

The most recent survey conducted by the Association for the Prevention of Pet Obesity, showed over 50 percent of dogs in the U.S. are either overweight or obese. And unfortunately, based on research conducted through the University of Liverpool, most pet parents of overweight or obese dogs are unaware that their dogs are afflicted.

So why do we care? Shouldn’t our dogs be allowed to be “fat and happy”? We care so greatly because a lifetime study in dogs revealed that being just slightly overweight shortens a dog’s life by approximately TWO YEARS when compared to lean (ideal body weight) dogs. TWO YEARS! And everyone wants more good quality time with their beloved dogs.

So let’s focus on how to love our dogs this holiday season without the calories!

10. Toys, toys, toys!

Who doesn’t want to wake up to a new squeaky toy on Christmas morning? And if your pup is anything like my toy-passionate (OK toy-obsessed) Boston terrier they will get right down to making “improvements” on their toys. Okay, let’s face it, they often turn into saliva-encrusted pelts… but it’s a lot of fun!

Of course, the key is to make sure your pup is supervised while playing with any toys. The last thing anyone wants the day after the holidays is a trip to the veterinary clinic because a piece of a toy was ingested.

9. Comfy sleeping places

New bedding and blankets are a great way to keep your pup comfy during those cold winter months. My dog has more sleeping places around my home than she knows what to do with, but that way I know she can always curl up for a nap beside me (and I’m only slightly envious…). Bedding doesn’t last forever, so the holidays are a great time make some upgrades!

8. Outdoor gear for outdoor adventures

If you live in a colder climate like my pup and I, outdoor gear is a must for winter activities. I live in Ontario, Canada, so my Boston terrier requires a doggie onesie to survive the cold winter months. Yes, literally boots attached to a full body coat (aka doggie onesie). It keeps her warm and keeps the salt and sand out of her paws on our outdoor adventures.

7. Seat belts for car rides

Have a dog that loves care rides? My little Boston terrier rides shotgun (so if you ever need a ride, be prepared to sit in the back). Why not invest in a doggie seat belt to keep your pup safe and secure during car rides?

6. Grooming

No matter the breed, grooming is essential! A new brush, a new set of nail clippers, a gift certificate for a “spa day” with the local groomer, are all ways to help our pups feel their best!

Bear in mind, if your pup has any medical conditions (especially skin conditions) or becomes easily stressed during grooming, be sure to chat with your veterinarians about the best options for you and your pup.

5. Training

Want to teach an old dog new tricks? Have a new pup that is in need of a manners class? Investing in a training program that uses positive reinforcement techniques can be a great way for you and your pet to bond over the upcoming months. And remember that using your dog’s dry food during training sessions is a great way to have your pup work for their meals. And it avoids too many extra calories or an upset stomach from too many treats or people foods!

4. Food puzzles and kibble dispensing toys

One of my favorite sayings that I teach to veterinary students is, “If a dog is working for their current meal, they aren’t begging for their next meal.” Working for meals not only provides mental stimulation, it also makes the meals last longer. This is a great way to ensure the right amount of calories lasts as long as possible, especially if you have a Labrador that can eat their entire meal in 30 seconds (and then starts begging for more)!

I never feed my pup from a bowl (#BanTheBowl). Bowls are only used for water in my house. I have variety of puzzle feeders and kibble dispensing toys that I rotate through so that her three meals a day are always a source of activity. Okay, it’s not just variety, I basically have a pet store worth of different feeders at my house, but it is so much fun to watch her work and figure them out, that I invest in puzzle feeders regularly.

3. A gram scale

Believe it or not, measuring cups (even those designed for pet foods) are incredibly inaccurate. Dr. Alex German, a board-certified small animal internal medicine specialist, and colleagues, conducted a number of studies using measuring cups and published the results in 2010. Accuracy ranged from an 18% under-estimate to an 80% over-estimate in portion size! Yes, over-estimated by up to 80%!!! One more time! Over-estimated by up to 80%!!!

So what’s the solution? A gram scale (aka a digital kitchen scale) is the most accurate way to measure your pup’s food. These scales are inexpensive and can be easily purchased online. This may seem like a daunting transition at first, but it becomes so easy with a little practice. I have a good friend and her 4-year old daughter helps with all the gram scale measurements for their family dogs each morning, so it is definitely a skill that anyone can learn. The key is to measure all the food for the day in the morning and then dole it out over small meals throughout the day.

Work with your veterinary team to determine the number of calories your pup needs each day to maintain a healthy weight. This number of calories can then easily be converted to a number of grams per day. For more information on gram scales, check out my blog on #BanTheCup!

2. Pet insurance

I am a firm believer in pet insurance. As a veterinarian, I never want to have to make a decision for my beloved pup based on money. I always want to make my decisions for her health based on her quality of life. Pet insurance allows me to do just that. Investing in pet insurance or setting up a bank account for your pup for unexpected expenses are great ways ensure you can always provide the best care for your pup.

1. Quality time

Honesty the best way to show your pup just how much you love them is to spend time with them. So curl up on the couch or in front of the fireplace together. Spend a few extra minutes giving a bum scratch or a belly rub. Spending a few quite minutes with your pup could also do wonders for your holiday stress!

So be sure to love your dog this holiday season, just do it without the extra calories!

Sincerely,

The Kibble Queen

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’m Allergic to My Patients, But That’s OK

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Growing up, I was the kid who was constantly outside – running around in the grass with my dog, eating dirt, rubbing dandelions on the tip of my nose to be Rudolph the Yellow-Nosed Reindeer… and yet, by the time I left elementary school I was allergic to trees, grass, dust and cats. Once I left home, I came back from my freshman year of college to find out I had developed an allergy to my own dog.

As a pre-veterinary student with blind determination and the stubbornness of a mule, the rebukes from my own immune system didn’t stop me from speeding full-steam ahead toward veterinary school applications. I continued volunteering to assist at spay-neuter clinics and worked in a research lab exclusively with dogs. The allergy flare-ups were sporadic, mostly occurring when I would forget to take antihistamines, but when they came it was almost unbearable. I continued to insist that I would be a veterinarian because it was the main thing that set my soul on fire.

I got an allergy test my senior year of undergrad and started a weekly regimen of four separate subcutaneous immunotherapy injections in my arms. After several months, I only had to get them once every three weeks, and after two years I am still getting these injections. Do they help? I think so – they don’t cure my allergies, but I have noticed that my allergy to cats has dulled, and I don’t need to take my antihistamine medication as often.

I have thought a lot about different options in the veterinary field that would assuage my desire to work with these fluffy balls of joy and still keep my sinuses calm. I am an avid member of my school’s Veterinary Business Management Association, or VBMA, and I have learned that practice ownership or the commercial veterinary industry are two great options that could allow me to practice while also allowing for a break from constant exposure to dander.

Fighting your own immune system isn’t the only way to achieve your veterinary dreams if you have allergies. Veterinary medicine is such a large, encompassing field that it is completely possible to be a DVM and still have allergies to animals. Careers like public health, research and academia all offer options to use a veterinarian’s knowledge and skills while avoiding animal contact. Since veterinarians can practice medicine on all vertebrate species except for one (humans), there is bound to be an option for any veterinarian who happens to have an animal allergy as well.

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.

ABOUT THE AUTHOR

Catie Mullen is a third-year veterinary student at Iowa State University. She is interested in small animal nutrition and veterinary business and wants to work with companion and exotic animals once she graduates from veterinary school. She loves dogs, cats, and rats and is a converted-cat person thanks to her adopted senior cat, Minnie.
Read more from her on her Facebook page.

Why I’d Rather Do Just About Anything Than Work on My Own Pets

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I’ll tell you two secrets:

  1. I hate taking care of my own (including my family’s) pets
  2. I rarely let anyone else do it.

This isn’t an indictment of my family members, their pets, or my pets. It’s an acknowledgement of the pressure (all self-induced) I feel when I don’t have that one step of distance between myself and a client/patient. This situation is actually good for me, since it helps me have empathy for my clients and their pets. I have a very good idea of what happens when they get their pets home and actually try to follow my instructions.

Many of us in the veterinary profession are perfectionists. It hurts us when things go wrong, especially when those things involve people we’ve spent our whole lives trying to please. It hurts even more when we deeply love a pet we struggle to help.

As I write, I’m sitting with my dachshund (Frieda) whose rear legs are paralyzed. My husband is out of town, so I’m all alone with my brain running amok. I’m second guessing myself and hoping I’m not the reason she becomes paralyzed or has to be euthanized. The swirling whirlpool in my head got so bad that I did something an introvert like me almost never does – I called someone for help.

“I need a real vet,” I whined into the phone. There is never a time that I feel my absence from clinics more than when one of my pets is ill.

My good friend and fellow veterinarian laughed. “You ARE a real vet!” She gets me, though, so she knew exactly what I needed.

I laid out everything like I was going to confession. I felt lighter with each word that came out of my mouth. She confirmed that I was doing the right things and reminded me what to do to monitor Frieda for changes. After all, I haven’t treated a young dog with a disc herniation in years. Then she asked me about her cat’s breathing treatments. We both left the conversation feeling better.

So many of us feel like wimps for not being “strong enough” to handle our family pets on our own. We feel like we must be failures if we have to ask for help. Yet, we lecture our clients that they shouldn’t practice medicine on their pets themselves. That’s mostly because they don’t have the knowledge that we do. But part of it is because it’s hard to be objective and do what must be done when you’re making life and death decisions about family. We encourage and expect them to ask us for help. Why shouldn’t our rules apply to us as well?

So, phone a friend. Ask a colleague to work on your pets. One of the smartest decisions I ever made was having my friend and local vet dentist perform dentistry on my pets. It’s worth the money to not agonize over every little detail.

Do whatever you have to do to make this job just a little less stressful. And remember – the next time a client is having trouble with compliance, show some compassion. Because we’ve all been there.

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.