Medicine

How My ER Visits Made Me a Better Vet

May 16, 2017 by Jessica Vogelsang DVM

In this article we are going to get a little bit personal. Not telling you the color of my underwear personal, but close. In the past month or so I have had two run-ins with the hospital (human hospitals.)

One was a scheduled elbow replacement that just took place, the other was a very unscheduled hip dislocation about a month before. The hip dislocation took me to the emergency department, while the replacement took place through a scheduled operating room intake. Don’t worry, we are past the time when you need to send me bouquets (fruit baskets accepted year round, though.)

Both of these got me thinking about the differences between human medicine and animal medicine and made me consider how I could take the positives and negatives from my experiences and make my clinic a better place for patients.

For better and worse, the two fields are very different. I have nothing but respect for human nurses, PAs, LNAs, PAs, MDs and the rest of the field. Both of my hospital experiences weren’t especially new to me, but now that I have been out in the field longer I try to look at things from the perspective of my own clinic and patients. I also tend to stay away from the ER, so this was only my second visit there ever. I look on the bright side of these hospital visits and become a better vet because of them.

The first thing that happened when I arrived at the emergency room was that I was asked what was wrong. I knew that I had dislocated my hip because I heard it, felt it and could easily evaluate that it was in the wrong place.

Our animals don’t have this advantage which is why fast, gentle and complete physical exams should always be the first thing that we do. The second thing to do in many situations is pain medication. The speed with which I get pain medication to my patients is light years faster than often happens in the human field. I want every patient that enters my clinic in pain to have the benefit of a very fast resolution. Their pain is hidden better than ours, but directly related to their fear.

I tried to imagine how I would feel if I didn’t know what had happened and couldn’t speak the same language as my nurses and doctors. I was able to reason out what was happening, but if I took only my pain and eliminated the ability to think about a plan for the future I can only imagine how scared I would have been. This is the angle that my patients are coming at me from, and it must always be the forefront of our minds as veterinarians.

Veterinary medicine is much more hands on than human medicine- and let’s be honest, you would rather put your hands on fur than a human as well. Other than vitals, often we go entire visits without our doctors touching us. We typically see physicians for each specialized field, while your veterinarian encompasses all of those fields. My orthopedic surgeon has never felt my spleen, while hardly any pet goes through my clinic without a complete abdominal exam. My surgeon can also rebuild and replace bones in a way that I could not.

It is often said that specialists have knowledge which is one inch wide and one mile deep, while general practitioners have knowledge one mile wide and one inch deep. In human medicine, each field is very specialized. Your veterinarian likely has a wider breadth of knowledge, but must refer you elsewhere for very specific problems.

Now let’s talk about hospitalization. At my ER visit I was in the hospital wearing the clothes I was going to ride my horse in. Once I got fixed up it was 1:30 am. All I wanted were PJs and to take my contacts out. I can guess that when our dogs wake up from surgery all they want is their favorite toy and a soft bed.

When I needed something, I could just hit a call button. I could tell my nurses exactly what I wanted. I could tell them my pain score, if the medicine was working, how well it was working and what needed to change. These are all things we need to try and predict for our patients since they don’t have the benefit of a call button.

Did you know that we monitor all of these things in pets too? We don’t have questions to ask them, but we watch parameters like heart rate, position in the cage, ear position, pupil appearance and breathing to monitor pain. We use the results of studies to create a generalized approach in our patients, then monitor them as individuals. We make sure that pets haven’t rolled over on a surgical area and have soft beds. We get the benefit of our patients not talking back with the downside of them not being able to tell us how they feel.

A couple of months ago while I was at a vet meeting my husband called because my dog had peed on the floor. She is very well trained and not prone to that type of thing. I questioned if she asked to go out and he said she hadn’t made a peep. I clarified that if she walks to the far end of the living room and back twice with her ears in a certain position it means she wants to go out. He justifiably told me I was crazy.

The fact is that we get very attuned to nonverbal communication from our pets. I never want crying in pain to be my first indicator that I need to intervene on behalf of a patient. It is important that I look for other silent signs to help them before they are in a high degree of pain.

Now that I am on the mend I have the benefit of stepping back and looking at the positives and negatives from my visits. While they made me less able to do intense physical labor for a while, I am hoping that they also improved my skills as a veterinarian. While I am always attuned to my patients’ needs and wants while they are in my clinic, it is helpful (though not actually very fun) to view it from the other angle.

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.

Dr. Anna Dunton-Gallagher is a 2011 graduate of Ross University School of Veterinary Medicine. She completed her clinical year at the Virginia Maryland Regional School of Veterinary Medicine and then settled back into her hometown of Rutland, VT to practice. She loves wellness pet care, pain management and her clients. When not at work she enjoys spending time with her pets, snowboarding and horseback riding..

The Biggest Lie Vets Tell Themselves

August 27, 2016 by Andy Roark DVM MS

Sometimes we tell ourselves lies to make life easier. We say things like, “I was walking in and out of exam rooms all day long. That counts as exercise,” or “There’s a ban on cellphones in the office, but everyone will understand that it doesn’t apply to me.” We kid ourselves to feel better, and it usually works.

To be fair, most of these tall tales are pretty harmless. However, some come back to bite us. There’s one particular lie that undermines the way we practice, communicate and provide patient care. It affects how we educate veterinarians and how we operate our clinics. Here’s the lie:

If we just tell average pet owners what’s best for their pets, they’ll do it.

Isn’t this a wonderful idea? The problem is that, most of the time, it’s not true. And we know it.

Don’t get me wrong—this isn’t an attack on pet owners. I’m not saying people fail to follow doctors’ orders because they’re bad people or don’t love their pets. However, the question persists. Why?

The case of the crappy car owner

Sometimes in my lectures to veterinarians, I talk about the type of car owner I am. (Spoiler alert: I’m awful.) I love my car and use it extensively. I fully understand how much I depend on it and what a bind I would be in without it. Yet I don’t take very good care of it.

When it comes to fixing problems, I head right to the shop. I’m just not so great about the regular maintenance. The auto places always give me a list of what’s best for my car. It’s just that life/work/parenthood/finances/time keep getting in the way.

One day, after I made this confession in a talk, a feline practitioner shared her candid feedback with me. She said, “You know, you shouldn’t tell that story about your car.” I asked her why not. “Because it makes you look like one of those bad cat owners. The ones who never come in on time. You don’t want people to think that’s you.”

But here’s the thing: That is me. And it’s probably you. It’s almost all of us.

How many people have cars that are due for maintenance? How many of us are past due for a physical or a dental appointment? Is anyone putting off funding a retirement account or college fund?

Listen, I’m not actually a bad cat owner. My pets receive great care not only because I’m a certifiable animal lover, but because I’m a trained veterinary professional. That’s not the case for the vast majority of our clients. They love their pets, but they also love their kids, their jobs, their hobbies, the idea of retirement and their teeth. Everyone has only so much money, time and energy, and no one thinks about pet health in their real lives as much as veterinary professionals do. Let’s face it: Most people are about as consistent at keeping up with pet care as I am with handling my car maintenance.

What we’ve gotten wrong—and how we can get it right

For years, I believed that if we just sat down and explained things to pet owners, they would do what was best for their pets. I’m sorry to say that I don’t believe this anymore. While this idea is comforting and makes it easier for us to shake it off when we make recommendations people decide not to follow, it’s simply not true. If we can come to grips with that, I think we can modify our approach in two ways to fix the problem:

1. Innovate to communicate. Often, our idea of client education is a single conversation between the pet owner and the veterinarian in the exam room. It’s an isolated interaction between a doctor and a person who may or may not be the patient’s decision maker. It’s also generally unstructured, brief and happening in front of a pet, a natural distraction. In short, it’s a frantic mess.

Educating pet owners in this fashion can yield only limited success. If we are going to successfully compel people to take specific actions, the messages we send must be clear, focused and repeated through multiple channels. We must help pet owners understand why we are making the recommendations and what they need to do. Conversation is one way to deliver these messages. Email, text messaging, videos, infographics, blog posts, interesting articles and smartphone apps are just a few ideas. Effective client communication is the single greatest opportunity for innovation in our profession today.

2. Stop abdicating our position. I have a friend who despises choosing a restaurant. In fact, it’s nearly impossible to get her to weigh in on any sort of dinner-related decision. The reason is that she doesn’t want to feel accountable if the place we visit is underwhelming. She takes comfort in always being able to say, “Well, it was your choice.” For a friend and a dinner decision, this is fine. But what if everyone approached choices this way?

Yes, we need to present pet owners with options, but we cannot relinquish our responsibility to guide their decisions. Too often, we say “Well, you could … ” and then present a multiple-choice scenario with options that may seem perfectly clear to us but are confusing to our clients. We feel good about putting the choice in their hands, but then we wonder why they so often default to the cheapest option. (The one element that’s not confusing in all of this? Price. You don’t need a medical degree to understand that part.)

Instead, what if we presented options in the context of making a strong recommendation? For example, we can use statements like, “Based on what we’ve discussed, the plan I’d recommend is … ” or simply, “To address your concerns, we need to … ” We can use these phrases and still give people options. However, they offer clear direction on how best to move forward and take advantage of our education, training and experience.

If we are acting ethically, listening to our clients and their needs and practicing a good standard of care, we should be able to give options while also making clear what path we believe will best serve the pet and owner. When we refuse to commit to any recommendation, we abdicate our position as a guide, consultant and doctor. I believe that also means we fail our clients.

Letting go of the biggest lie we tell ourselves in veterinary practice means we have to make some changes. We have to change how and what we communicate in order to increase the odds that pet owners will take the best action for their pets. In that way, we can ensure that when we tell clients what’s best, they’re hearing it and doing it. We can turn the lie into a truth.

I think I’m ready. Are you?

How Being a Vet Makes Our Own Medical Choices Better and Worse

February 10, 2016 by Dr. Andy Roark Community

My Father was a talented physician. However, he spent his career in public health research and, as such, felt far removed from clinical medical practice. Growing up I always wished he could sign off on my requisite physical exam form for sports. He never obliged and always sent me straight to the pediatrician. Any medical question I might have, he’d quip he didn’t know and tell me to ask a doctor. This always frustrated me.

However, when it came to visiting the dentist, he would assertively argue back and forth with the dentist about the necessity of dental x-rays that year. This contentious moment between he and the dentist was always slightly embarrassing, and he rarely approved taking dental x-rays.

Following in my Father’s footsteps, I also pursued a career in science and became a veterinarian. As a veterinarian I’ve taken my fair share of dental x-rays and performed a lot of extractions. When my daughter turned five, her lower adult incisors started to erupt like a shark behind her baby teeth. I was already aware that she was missing two lower incisors, so when more unusual signs developed I became alarmed. I knew that impacted teeth can cause cysts that can damage the jaw bone.

I brought this anomaly up with my dentist at my exam. I told him my daughter was missing two teeth and I wondered if those adult teeth were actually present. His comment was, “take an x-ray!” Pointing at a large panoramic x-ray machine in the corner he eagerly explained that this instrument could easily take images in younger patients that won’t tolerate clamping down on traditional bite wing films.

This made sense, so I asked him if this machine was dangerous for a 5 year old. He brushed that worry aside, so I scheduled her visit two days later when my husband could bring her in.

[tweetthis]How Being a Vet Makes Our Own Medical Choices Better and Worse[/tweetthis]

The evening following her appointment, panic set in. I had consulted Dr. Google. This informed me that panoramic x-rays (panos) in children were associated with an increased risk for brain tumors. The news sunk my heart and I was flooded with emotions of regret, anger, and fear.

If my father were alive, he would never have consented to the pano. I felt deeply disturbed that I had possibly endangered my daughter’s health. And this to answer to a question that probably did not matter right now.

I grilled my husband that night for details of the visit. “Did she wear a lead gown?” He told me that the gown was an ill-fitting adult gown and difficult to hang on her small frame. “Did she wear a neck shield?” No, she did not.

As luck would have it, my college roommate is a neuroradiologist. I called her up next and fearfully asked her if I’d made a huge mistake. She told me not to worry. Radiation risk is more about cumulative exposure. Although the pano did expose my daughter to more ionizing radiation that a traditional bite wing x-ray, it was still much less radiation than a chest x-ray.

I remembered at that moment that she had also had a chest x-ray as an infant and felt even more crushed. Over the next two days we had to have several conversations on the phone and via text to talk me off the ledge. Although I had been following the advice of medical professionals, I had done so blithely, not considering the ramifications. I myself was a medical professional.

Why had I not thought to ask more questions? Why had I not been more careful to consider my options and their ramifications? Ionizing radiation to a child can have more far reaching effects as there is more time for damage from radiation to be expressed.

When I spoke to the veterinary radiologist at my animal hospital about the pano and the adult sized lead gown she cringed. The pano I had elected for my daughter did expose her to ionizing radiation. She complained that it can be common for dental and other medical practices to be cavalier about utilizing proper protection for radiographs.

Sadly, when the formal radiology report came back, it concluded there was too much crowding of her un-erupted teeth to properly make a determination. A repeat pano was recommended for next year. I berated myself for not using a pediatric dentist who would probably have used a child sized gown and hopefully a neck shield as well for what turned out to be an un-informative test. I wondered, would a pediatric dentist also have recommended a pano?

[tweetthis]Even as a practicing veterinarian, it can be extremely challenging to navigate medical options.[/tweetthis]

Whatever the case, I can’t undo what has already occurred. I know that I won’t elect another pano for my daughter unless I’m sure the information from the test is emergently useful and necessary. Hopefully, whenever that time comes, my daughter will be ready to tolerate bite wing x-rays instead.

Even as a practicing veterinarian, it can be extremely challenging to navigate medical options. Every choice we make has ramifications, whether it be the information you’ve unearthed or a consequence of the process. I’ve learned the importance of asking more questions and keeping a critical eye regarding choices offered for care.

Nicole Cohen, DVM graduated from UC Davis School of Veterinary Medicine and completed a 1 year rotating internship in small animal medicine and surgery in northern California before moving to Washington DC. She has worked at Friendship Hospital for Animals as a primary care and emergency veterinarian for the past 10 years.

The Real Reason Your Wait at the Vet’s Office is So Long

February 3, 2016 by Lauren Smith, DVM

I recently read a Huff Post article entitled “The Real Reason Your Wait at the Doctor’s Office is So Long.” Veterinary Medicine and Human medicine vary in a lot of very meaningful ways, but we are also often the same. And in this we share a common weakness—we sometimes run behind schedule. In fact, I’d wager to say we frequently run behind schedule.

So, when I saw this article, I expected to read a well-reasoned explanation of why this is the case by someone in the know. Instead, the article read more like one woman’s angry Yelp review. Many of the comments in the article espoused similar experiences with complaints that doctors don’t value their time, overbook to cram as many appointments in as possible just to make a few bucks, and are generally greedy, no-good, shysters with big egos.

As you can imagine, myself and many other health professionals took offense to this so I am here to tell you the REAL “real reason” your wait at the doctor’s office (be that physician, dentist, veterinarian, chiropractor, etc) is so long—we care!

[tweetthis]I am here to tell you the REAL “real reason” your wait at the doctor’s office is so long[/tweetthis]

We care about you and your pet and your health, and yes, even your time. We care, and we are people pleasers who try to make everyone happy. We do our best to schedule responsibly (although sometimes there are managers and administrators who have more of a say in this than we do) but as Robert Burns said, “even the best laid plans of mice and men, often go awry.” Nowhere is this more true than in medicine.

Things are always going awry. Sometimes it’s a true medical emergency—the dog that ran into the street and got hit by a car, the cat that can’t breathe because it’s having an asthma attack, the person who goes to their doctor for heartburn but is really having a heart attack. In these cases we have to stop everything we’re doing to care for this emergency and that takes a lot of time.

Sometimes the problem is our own inability to say no. We save that appointment slot for an emergency and then someone calls up because their dog has a painful ear infection. Sure, it’s not really an “emergency” but we can’t stand the thought of that dog suffering in pain until tomorrow, so we fill the slot.

Then the next thing you know, someone calls up because their cat has vomited 6 times in the last hour and really needs to be seen. Sure, we could say we’re booked and send them to the emergency clinic, but then the client will wind up spending twice as much and they have two kids in college and can’t really afford it. So we fit them in, even though there are no open spots and taking x-rays is going to put us even more behind.

We also get behind when simple appointments turn out to be not so simple. A client schedules a wellness appointment for vaccines and then “mentions” their cat is urinating out of the litter box, and can you check this lump and his breath really smells, and oh yeah, don’t forget to cut his nails. Or the patient I saw the other day for what the client thought was an eye infection but really turned out to be lymphoma. I’m not going to rush an appointment like that just because I’m afraid of getting behind.

Yes, I feel bad that I’m making the next client wait, but I know that if something terrible ever happens to their pet, they would want me to give them as much time and attention as they need, even if there are ten people in the waiting room who are just going to have to wait a little bit longer.

And sometimes it’s not terrible news I’m delivering, but just someone who has a lot of questions. Sometimes I have to have a lengthy conversation on weight management or dental health, or the importance of heartworm prevention, that runs long.

I could easily skip over these issues especially when I’m running behind. It’s not a problem yet after all. But instead, I take the time to make sure my clients are fully educated about their pet’s health so that down the line I can hopefully avoid discussing diabetes management or the heartworm treatment protocol.

All of these things aren’t a once-in-a-while occurrence. They happen on an almost daily basis in medicine.

The truth is, maybe I could be on schedule more often. I really do value your time, but I value your pet’s health more and if being better at time management means I’m going to be worse as a doctor, then I’m not interested.

[tweetthis]I really do value your time, but I value your pet’s health more[/tweetthis]

Reprinted with permission from laurensmithdvm.com.

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 Realities of Human Error In Veterinary Surgery

December 19, 2015 by Sarah Boston, DVM, DVSC, DIPL ACVS

Helmut* was one of my cancer patients. He also had a painful, nonvisual eye. The eye ended up giving him more trouble than the tumor and the owner elected to have it removed. She had it removed by a board-certified ophthalmologist (not at the hospital I work at, I hasten to add). There was a horrible mistake made. The normal, visual eye was removed and it wasn’t until after it was over that the veterinarian realized the mistake.

The client received a phone call during surgery to ask her what she wanted to do. She said to go ahead and remove the painful eye, because it was nonvisual anyway and it was affecting his quality of life. She then tried her best to rehabilitate her newly blind dog, but he didn’t adjust. He was almost deaf as well, and the acute and complete loss of his vision was too much for him. She euthanized him several weeks later, right after Christmas last year. This was and is a nightmare for all involved, especially for Helmut.

How could this happen? And, I am sure you are thinking. Who did this? Well, to answer the second question, it doesn’t matter and to answer the first, anyone could have made this mistake. It was human error. There is a culture of shame and blame in veterinary and human surgery that prevents us from talking about medical errors. It is so much easier to assign the blame to an individual, rather than a system or institution. Wrong site and wrong side surgeries happen in both veterinary and human surgery.

[tweetthis]A culture of shame and blame in veterinary surgery prevents us from talking about medical errors. [/tweetthis]

Could this have been prevented? Absolutely. Dr. Atul Gawande has worked with a team and the World Health Organization to develop an exquisitely simple system to prevent errors like this in human surgery, a surgical checklist.

Checklists are used extensively in the airline industry to guard against human error. They are new to human and veterinary medicine, which shocks most people in the airline industry. The checklist is there to ensure that the routine things that are easy to forget or miss are systematically communicated and verified. Confirming the patient’s identity and surgical site/side, ensuring that antibiotics were given in a timely fashion, ensuring that the team has discussed potential complications or steps that are not routine preoperatively, and counting instruments and sponges.

Dr. Gawande tested the surgical safety checklist and found a significant reduction in morbidity and mortality at six different hospitals in the developed and developing world. He wrote about the surgical checklist in his book, The Checklist Manifesto. (I highly recommend this book!) I started using a checklist as soon as I finished reading Atul Gawande’s book in 2010. Now I can’t imagine doing surgery without one.

The effect of the checklist is several-fold. It focuses and empowers the team, it allows for a double-check system, it is an efficient way to go over the critical information about a case in an organized fashion, it ensures that sponges and instruments are counted in and out, and it changes the work culture for the better. The medical term “retained” surgical instrument is an indication of the bizarre blaming culture in medicine. In this case, the abdomen is blamed for actively hiding the instrument inside, rather than the surgeon forgetting it in there.

Since the surgical safety checklist came out, there has been a flurry of papers in human medicine confirming its efficacy in reducing complications in different areas of surgery. What followed is another flurry of papers on implementing the checklist and how to deal with institutional or personnel resistance to the checklist. Surgeons often resist because they are offended by the suggestion that they might make a mistake and they complain that pausing for the checklist will slow them down. The checklist is actually a faster and more efficient way to convey information once it is implemented.

I would argue that you don’t have time not to use the checklist. Further, the checklist is not there to protect incompetent people. Incompetent people will be incompetent with or without a checklist. It is there for people that are people. We all get tired, make mistakes, get distracted, rush when we shouldn’t rush, or forget to let team members know something that may improve the outcome in a case.

Most communication failures in medicine are due to either occasion or audience. Occasion, meaning that the timing of the information was suboptimal, and audience, meaning that the information was not conveyed to relevant team members. The checklist helps with this because it brings the team together at timely breaks to ensure that everyone is on the same page at the right time. The other less common communication failures include: content, meaning that the information is wrong, (checklist may not help here) and purpose, meaning that you work with a dick. (Checklist can not help you with this either.)

So, if you are not already, consider bringing a checklist system into your surgical practice. It will bring order to the chaos on your busy days. It will make your technicians happy because it will help them to do their jobs better. It will help to keep your procedures moving. It will improve the communication of your whole team. Most importantly, it may help prevent you from ever making the mistake that Helmut’s veterinarian made.

[tweetthis]You don’t have time not to use the checklist.[/tweetthis]

These veterinary horror stories rip through our profession and become legends of veterinary lore. Usually, they are accompanied with an unhealthy dose of shame and blame and they lack a concrete method to prevent these errors. That is ulcer-inducing and wholly unhelpful. Medical errors and adverse events are a part of veterinary and human medicine. Surgical checklists can help us to pick up on the preventable ones so that a wrong side surgery becomes a near miss in your practice and not a devastating surgical complication.

*Name of pet has been changed

One Question Can Save A Cat’s Life

November 29, 2015 by Dr. Andy Roark Community

What is the single most important question to ask at every feline office appointment? I imagine that you may have several, depending on the circumstances or maybe on your experiences. But I think there is one question that needs to be asked at every non-emergency (or euthanasia) appointment.

Let’s run a sad but familiar scenario. Susan comes in with her cat, Mouser. She is upset because Mouser has been urinating in the house and both she, and her partner Brian, have had enough of it. She is angry at Mouser and doesn’t understand why he is doing this. Is he is punishing them? They give him a good and loving home, he gets fed good food….Susan is frustrated and angry. She resents being put into a situation where she has to choose peace and harmony and a nice home over her cat. But, here she is, and she sees her only option as “getting rid of” Mouser.

You ask when she first noticed Mouser peeing in the house and she tells you that it was about eight or so months ago. “How often is he peeing inappropriately?” “Several times a week,” she says, “with it happening more often lately.” You find out that the problem is mostly manifested as spraying rather than horizontal voiding. “What was the final straw, the point that pushed you over the edge with this,” you ask and she replies that his spraying on her partner’s vinyl records and peeing on his sports bag last night did them in. She figures it was about the 71^st time he had sprayed.

[tweetthis]What is the single most important question to ask at every feline office appointment?[/tweetthis]

After this, you perform a physical exam, collect urine for a urinalysis and give Susan’s family a “time out” from Mouser by boarding him at the clinic while you try to ascertain if there is a physical cause before addressing stressors in the home that may be the source for Mouser’s anxiety. But sometimes, it is too late for the clients to allow the perpetrator back into the home: the bond has been broken.

Shelters work hard to find forever homes. We want to help keep these cats IN their homes, rather than have them bounce back to the shelter or be killed. The statistics for surrender to shelter for behavior problems are sobering, especially when we, as members of the cat’s healthcare team, can prevent it.

So let’s replay this scenario. When did this problem start? At least eight months ago, possibly longer given the fickleness of human memory and their lack of concern at that time. Since then, there was some level of spraying that the client was able to cope and live with. It helps to identify what that allowable frequency is, because we can’t guarantee that we can eliminate the behavior completely. We can address stressors and unmet needs (see AAFP and ISFM Feline Environmental Needs Guidelines), we can consider pharmacological and pheromonal therapy, and, with an engaged family and clinic team, there will generally be a happy ending.

[tweetthis]The statistics for surrender to shelter are sobering, especially when we can prevent it.[/tweetthis]

But did it ever have to go this far?

What if, at every visit, we asked one simple question: “Has your cat urinated or defecated somewhere in the house other than in the litter box?” If we ask this question as part of every visit, we can pick up the problem before it becomes a problem … for the clients. We can pick it up on the first or 4^th or 15^th or 70^th occasion, rather than on the 71^st when it has tipped the scale of tolerance.
Cats do not spray out of spite. There is always a reason. It may be medical (idiopathic cystitis, arthritis, diabetes, etc.), or it may be a manifestation of distress due to unmet needs that the client isn’t aware of. (See AAFP and ISFM Guidelines for Diagnosing and Solving House-Soiling Behavior in Cats)

All of this needs to be discussed and carefully evaluated, but you have a better chance of helping Mouser, before the client’s fuse has burnt out.

So let’s do it. Let’s start making this question part of every visit: “Has your cat urinated or defecated somewhere in the house other than in the litter box?” I’ll bet we can save lives and improve happiness.

[tweetthis]Cats do not spray out of spite. There is always a reason.[/tweetthis]

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.

Margie Scherk graduated from the Ontario Veterinary College in 1982. In 1986 she opened Cats Only Veterinary Clinic in Vancouver, practicing there until 2008 when she retired from regular practice. While in practice, she published several clinical trials, including the first paper on transdermal fentanyl patch in veterinary medicine. She has written many book chapters, co-edits the Journal of Feline Medicine and Surgery, has served extensively on committees with the AAFP, North American Vet Licensing, Winn Feline Foundation, WSAVA and ABVP. She is a Paw Project advocate, hoping to end declawing in Canada. She continues to assist colleagues with case management and enjoys teaching about all things feline, including improving interacting with cats, analgesia, nutrition, gastroenterology and kidney disease.

Medicine

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.

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