There I Said It

For as much as we as veterinary professionals speak so highly about the desire to support one another, in my experience, that support often comes with conditions. We support those who do what we do, but can be downright hostile to those who do something we are not familiar with.

When I first started working as a vet assistant in high school, I had this awkward feeling about my job. I enjoyed my job immensely, and I even had a fantastic work environment, but I never quite felt that loved my job. At the time, I assumed this would change once I moved forward and was given more responsibility and taught new skills – it didn’t.

My sophomore year of undergrad, I was working in a rural mixed animal practice. I thought maybe the tone shift would be exactly what I needed to finally love what I was doing. After all, before I had only had experience in suburban small animal practices, and my new place of employment could not have been more different. Perhaps this was where I would find my calling.

I quit after two months.

After the failure of that job I felt broken. I didn’t understand why even though I had always felt my place was in vet med, I couldn’t connect with, I couldn’t love, any job I had had so far. I decided to stop applying to work in veterinary practices. I just knew, no matter how much I wanted to love it, it was not for me.

I was still a college student in need for a job, so I applied to other animal related jobs around my campus. The first one I was offered was simply titled “Animal Caretaker”. It turned out to be a job as an animal husbandry technician for the university’s research department, and the pay was excellent. I took the job, expecting to at least not be broke for the rest of my undergrad and then go back to contemplating what I was going to do with my life.

I loved this job.

Something about this job just immediately clicked with me. I enjoyed every second I was at work, and for once in my life I was actually excited to get up and go to a job. Working in animal research, this was my calling, I could feel it.

I was elated by my new discovery – until I decided to tell people about it.

All the support and comradery I had felt from other veterinary professionals has suddenly vanished. People asked me why I would want to do something so evil with my life. Why would I want to hurt animals for a living? What kind of person would want work in animal research? They always said those words like they were a derogatory expletive. I felt shame.

I didn’t understand. I was a good person, I drove an hour and half to adopt a dog from a high-kill shelter while I was still in college. I loved animals. I didn’t see my job as evil. Without research, we wouldn’t have all of the products and technology we use in our profession, but no one else seemed to see this.

After that, I stopped talking about my job to other veterinary professionals I met. I would either say nothing or lie about what I did. In fact, after talking to my coworkers, they even recommend not being honest with other people about what we did, unless you wanted to risk backlash.

I still love working in research with all my heart. I’m working towards my next certification and I don’t plan on leaving anytime soon. But I just wish I had the freedom to talk about what I do just like everyone else can.

I shouldn’t feel ashamed for working in research, and we still have a long way to come as a profession if we truly want to make each other all feel supported, and not just the ones who do exactly what we do.

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

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In three years of residency, I’ve lost two friends to suicide; one former coworker, and one classmate. I wasn’t permitted to go to either funeral due to clinical obligations. The experiences prompted me to write the following:

Stop pretending that a normal work schedule is five consecutive 12 hr work days, not counting on-call responsibilities. Stop pretending that a scheduled work day only involves what you do for that day’s patients, ignoring the preparatory work that must be completed for the next work day’s patients.

Stop pretending that the only work that’s done is daily clinical, ignoring the supplemental work associated with the program and what necessary for the career and preparation for the specialty board exam – which is kind of the point after all. Stop pretending that unhappiness at being taken advantage of is unreasonable. How dare we say anything?  Stop ignoring the underlying situation prompting the observations and comments. Stop setting us up to fail.

Want us to not burn out? We don’t try to. We don’t go out of our way to pretend that we do what we do because we want to have compassion fatigue, neuroses, and untreated, unrecognized, denied mental health issues. The system dictates our priorities. We’re accustomed to succeeding. We recognize what’s necessary to succeed, regardless of how self-destructive it is. The penalty for pointing out systemic deficiencies is having our future threatened. Rather than acknowledging the validity of our feelings and reactions to our situation, we’re set up to fail.

Four day work weeks. Quarterly mental health check ups with independent professionals who can refer us for further therapy if indicated, without professional penalty. Relief from routine clinical duties if on call work exceeds a certain threshold time. Nothing earth shattering, but ideas that may keep us alive.

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

We live in the internet age, where a friend posting a story about something that happened to them can lead to a frenzy of conjecture about how “insert business or big corporation here” is taking advantage of the consumer and should never be trusted.

Veterinarians are not immune to this perception, and there is always going to be a subset of our clientele that thinks that we are only in it for the money and that we are using and prescribing toxic pharmaceuticals to line our pocketbooks with no regard for the health of our patients.

During 17 years of clinical practice, I did know a few unethical veterinarians, and I don’t think it is in our best interest as a profession to deny that those individuals exist.  However, we know that the vast majority of our colleagues are profoundly ethical and generally incapable of putting financial considerations above the health of our patients.

So, how can we defend ourselves when a client comes in with the latest issue of a magazine that says otherwise?  After all, it is right there in print that traditional veterinary practice is harming their baby.

Part One – Setting the Stage

The first step is to understand that this is a good pet owner because they are truly concerned about what is best for their pet.  Then, recognize that they don’t have the training that we do to evaluate whether what has been written is good information.
That is where it can be useful to have a few pseudoscience articles in the hospital that can be dissected to help the client understand why the information is not generally reliable.

For example, a recent well-circulated article implying that parvo isn’t that big of a deal is a veritable gold mine when you need to explain the difference between science and pseudoscience.

Using this article as a reference, I would suggest the following:

• ACKNOWLEDGE that some complementary and alternative medicine is still good science. Many of the current drugs used in modern medicine are derived from or modeled on natural substances such as penicillin from mold or Comfortis from spinosad.  Just because an herb hasn’t been patented doesn’t mean it can’t have therapeutic uses.

• ACKNOWLEDGE that just because we don’t know how a certain medication works does not mean it is not effective, so it is conceivable that some holistic alternatives are safe and effective. It is always comforting to understand the mechanism for how a treatment benefits the patient, but it is not actually necessary as long as rigorous studies have shown efficacy and safety. We know now WHY handwashing prevents illness, but the mechanism lagged behind the observation for quite a long time.

• ACKNOWLEDGE their fear.  With stories such as “Rabies Vaccinations and Aggression in Dogs” reporting that giving the vaccine will endanger your children, emotions begin to run high.

• DO NOT make disparaging remarks about veterinarians who have a different viewpoint. As noted above, the vast majority of veterinarians are PROFOUNDLY ethical.  Misconceptions can easily occur without the benefit of advanced training.  It is much safer to assume that these articles written by lay people (in this case a banker) have taken the veterinarian’s views and data out of context than it is to assume that they are deliberately putting pets at risk with questionable information.

I’m sure I am not the only veterinarian to have a client tell me that I am so much better than the vet from last week and that they are going to follow my recommendations instead – only to discover that I WAS the veterinarian from the previous week and the recommendations are the same.  We all know better than to automatically believe what a client says about the vet clinic down the road.

Debunking Pseudoscience Part Two: Digging In

Then use the article itself. In this case, we’re discussing a widely shared piece called “Why Parvovirus Isn’t as Scary As You Think”. (You can Google it if you’d like to follow along.) We can’t possibly address all the bad science without a much longer article, but here are some gems:

A quick call to the practice reporting the statistics on vaccinated dogs getting parvo confirms that they do not give the vaccine, so we are left to wonder how they verify whether a standard protocol is used or even if the dogs had received more than one vaccine.  There is a big difference between a dog breaking with parvo within a few days or week of the first vaccine because it was too soon for the vaccine to protect, and a dog breaking with parvo a full 7-10 days after the last dose in an AAHA recommended protocol.

1. This study, even if valid, is localized. Perhaps there is a local strain of parvo for which the vaccine is not effective. Further study could be warranted, but broad sweeping conclusions would not be valid.
2. There is no statistical analysis that tells us whether or not these results could happen just by chance, and so even if these numbers are true reports, it doesn’t prove anything. There are also no references that would help us understand how this information relates to other scientific work in this area.
3. The magazine reports that the Wellness Program uses nosodes rather than vaccines. Then reports the data that 12/175 puppies on the wellness program got a preventable disease and 17% of those died – not exactly a glowing report.
4. Correlation does not equal causation. If two events occur together, it’s natural for one to think they are related. Without proof, some will make wild assumptions without testing whether those are true. For example, someone could claim that a solar eclipse is a bad omen and anything bad that happens afterward was caused by the eclipse. Many Ancients believed this. However, with science, we can test that belief and learn that natural disasters or other tragedies are no more likely after an eclipse than at any other time.

Pseudoscience says if two events occur together they HAVE to be related. Real science says they may be related. They have to be studied and tested to see if they are.

In the context of this article, we can examine the difference:

1. The article states that the mortality rate with aggressive treatment is only 5-10%, so the 17% mortality rate in the nosode group in the first study and 43% mortality rate in the non-nosode group could seem awfully high.
2. Pseudoscience could say that since the mortality rate is higher at this hospital, it is caused by the hospital.
3. Science says that there are other variables such as the number of clients who opted for aggressive treatment that need to be considered to make a fair assessment of the hospital’s performance.
4. In the same line of reasoning, pseudoscience can say that the mortality rate in vaccinated puppies is higher because of the vaccine because they occur together. Science would examine any other differences between the nosode and vaccine group such as the relative percentages of each who received aggressive treatment.
5. As noted in a table in the article – in the nosode group, 50% survived and 0% died. 50% are either missing or zombies. Even clients with very little formal education can understand that this means that anything else reported is suspect.
6. Magazine employees earn their living from advertising revenue. The more shocking the headline and article are the more clicks and magazine purchases and the higher their income. This particular magazine is also launching a fee-based subscription service for more information.  It is fair to question if they are in it for the income, not for the outcome.

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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ABOUT THE AUTHOR

Kristin Tondra True graduated from the U of MN College of Veterinary Medicine in 1998 and went on to finish an MS in population medicine. Her early career involved a combination of mixed animal practice and food safety work, and was followed by 16 years of small animal practice. She currently lives in SW Minnesota with her husband Mike and their feline overlords Emma and Xavier.

Welcome to There, I Said It- a column where we give you, the reader, a chance to get something off your chest in an anonymous fashion. Be it embarrassing, frustrating, or just something you don’t want to admit out loud, it still might make someone else having a bad day feel just a bit better. If you have a story of your own, unburden yourself at editor@drandyroark.com.

By Anonymous

I sat on my living room couch, phone in hand, staring at the number I had queued up. My thumb just a half inch from the dial symbol, but I was frozen there. I couldn’t seem to make my thumb press the button. The number on the screen was that of my university’s student counseling services.  I was two weeks from the end of my second year of vet school. I was navigating the curriculum well enough, but my nose was barely above water. I was stressed, anxious, and feared I had a mental illness. I needed help, but I was terrified to ask for it.

All I had to do was hit that call button, make an appointment, and show up. I could have help with confidentiality, and the service was free of charge. However, my mind was flooding with a hundred different thoughts of why I should put down the phone, ignore the problem, and just keep treading water. What if my family found out I had a problem? What if people in my class found out? What if clinicians or professors found out? Would that hold me back in my profession? Did I really even have a problem, or was I just too weak to handle vet school? Maybe I am not as strong as I thought; maybe I am not cut out to be a veterinarian.

I spent the next hour alternating between sitting on the couch staring at my phone screen and pacing the living room, trying to dig deep enough to find the courage to make that call. “Just make the call, you can do this,” I told myself. “No, this is silly, you don’t need help.” Eventually I made the call; I scheduled an appointment. Against all of my fear, anxiousness, and trembling hands, I went to that first appointment, and I kept going back nearly every week. Showing up to each session got a little bit easier. I was slightly less nervous and embarrassed about having a problem and needing help.

There is still a long battle ahead, but I am fighting, and I will be a veterinarian.

I have obsessive compulsive disorder. I am not overly neat or organized, and I do not wash my hands every thirty seconds. I am fixated on patterns. Whether it be a physical or mental motion, I repeat the same acts over and over and over, then usually over again like a broken record. I have done this for almost as long as I can remember. When I was younger it was just an annoyance, something I felt I had to do, but I still led a relatively normal life. Once I entered college and began the treacherous pre-vet curriculum, the struggle became more obvious. Now it wasn’t just an annoyance, it was a malicious distraction that demanded the majority of my time and attention. I dredged my way through undergrad, but in vet school the obsessions and compulsions were further amplified as the stress accumulated.

I spent a large portion of my life not knowing that these obsessions and compulsions were symptoms of a mental illness. As a child I didn’t realize just how abnormal they were, and in college I assumed everyone struggled this much. During my first year of vet school, I heard a radio interview piece on NPR; the interviewee suffered from OCD. As he described his symptoms I began to have a realization: there is someone else out there who understands this! I might not be alone! There could be an explanation for the turmoil that has afflicted my mind for so many years.

I am fortunate enough to attend a college of veterinary medicine that values mental health. We have a representative from student counseling services that dedicates a portion of their schedule to service the vet school exclusively. If this opportunity were not so readily available, I may have never sought help. I would still be fighting a battle alone, silently, without the confidence that I could persevere.

I am a male third year veterinary student, less than twenty one months from entering practice. One of my main goals as a practicing veterinarian will be to change the stigma surrounding mental health of the veterinary profession. In an occupation where we are so dedicated to caring for and saving the lives of others, we often forget the importance of caring for ourselves. We may perform superhero like acts, but we are not superheroes. We are human beings, we are imperfect, we may struggle with mental illness, and sometimes the bravest thing we can do is to admit that. It is the responsibility of our profession to make sure that when one of our members makes that admission there is a compassionate community to turn to for the service and support they desperately need.

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Welcome to There, I Said It- a column where we give you, the reader, a chance to get something off your chest in an anonymous fashion. Be it embarrassing, frustrating, or just something you didn’t want to admit out loud, it still might make someone else having a bad day feel just a bit better. If you have a story of your own, unburden yourself at TISI@drandyroark.com.

By Anonymous

I’m not just a veterinarian.

I’m a young woman, a daughter, a sister, a friend, a niece, an aunty, a granddaughter, a girlfriend. I’m an avid reader and a keen equestrian. I love camping and sitting by a fire under the stars. I have a whole life outside of work, just like you. I need to spend time with my friends and family, just like you. I need time away from work, again, just like you. Because I’m not just a veterinarian.

If you want to talk to me about your pets, that’s ok. If you want to ask me for advice, that’s ok too. It’s not ok if that’s all you ask me about. It’s not ok for you to be annoyed with me if my advice is ‘take your pet to the vet.’ It’s not ok for you to repeatedly message me if I’m not replying to you immediately. And here’s why:

I’ve only been doing this for less than a year. I’m still making a lot of mistakes. There’s a lot I haven’t seen yet. There are so many times where I do a full examination of a patient and all kinds of tests and still I’m not sure what’s going on! And so sometimes I make recommendations that don’t work, even with all of that information at my disposal. Of course when you send me a grainy photo or an unfocussed video or a detailed description of your pet asking me what’s going on and what to do about it I’m going to say take it to the vet.

I’m not so arrogant that I think that at eight months of out university I can make an accurate diagnosis off a photo or description. (This attitude is unlikely to change even when I’m eight years out of university, or 10, or 20.) And secondly, can you imagine how we’d both feel if I took a guess, got it wrong and your pet got worse? Or if I said it’ll be ok until tomorrow and you woke up tomorrow but your little friend didn’t?

I work between five and seven days a week. I work after hours. When I finish work and I’m not on call and I’m not checking on patients through the night, I’m doing things I enjoy doing. And I need to do that, to not be just a veterinarian, to unwind from what can be an extremely stressful job. Heard of compassion fatigue? Google it. Google the suicide statistics for those in my profession while you’re at it. I don’t mention this as a kind of sick bragging right, I mention it because it’s a very real problem among vets and at eight months out I’m starting to see why.

I love my job, I really do. But I need time away from it, just like you. If I’m not answering your questions about your pet immediately, I’m probably spending some time with my family, my friends, my own pets. MAYBE I’m out celebrating someone’s birthday, or anniversary, or spending time with close ones during a difficult time. Hell, I could even be at the movies. Because I’m not just a veterinarian. Or I might actually BE at work. Sundays aren’t always a day off for vets. When I AM being a vet and I’m on call, I’m glued to my phone, waiting to respond to the next animal emergency and that’s quite stressful. Please don’t expect me to do the same on a weekend off. I relish not having to answer my phone immediately on those weekends I don’t have to. Wouldn’t you?

Either way, I will answer you when I do get a chance to check my phone or my Facebook. Because I do care about your pet. What I don’t care about is who you are. It doesn’t matter if you’re my housemate, my best friend, related to me by blood or marriage or someone I just met at a party, my advice will be the same. Take your pet to the vet. Where they can do a full examination, an x-ray, a blood test and make a much more informed diagnosis. You know what else they can do there? Give your pet the treatment it needs. There’s no way I can do that over the phone, is there? I might be many things as well as a veterinarian, but able to work magic isn’t one of them.

So feel free to keep asking questions, feel free to tell me about your pet’s problems and the concerns you have. Just understand why I answer the way I do when you ask me what to do. And understand that if that’s all you talk to me about I will remove you from my life. Particularly if you’re married to a guy I once worked with years ago and message me out of the blue from another country for advice.

I’m so much more than just a veterinarian. Let me be more.

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Welcome to There, I Said It- a column where we give you, the reader, a chance to get something off your chest in an anonymous fashion. Be it embarrassing, frustrating, or just something you didn’t want to admit out loud, it still might make someone else having a bad day feel just a bit better. If you have a story of your own, unburden yourself at TISI@drandyroark.com.

By Anonymous

Hold on to me, ’cause I’m a little unsteady… A little unsteady… If you love me don’t let go… The radio played in the background. Almost perfect. Except for the ‘don’t’ part, I thought.

I euthanized my neurologic dog tonight.

Three years ago, we adopted her as a senior from a breed rescue. We were only supposed to foster her but she stole our hearts before she even jumped into the car.

Seven days ago, she looked a little stiff so I started her on pain meds.

Six days ago, she looked a little worse.

Five days ago, in a matter of hours, she lost the use of her hind legs.

Four days ago, an MRI showed a large tumor pressing against her spine.

Three days ago, I took my other dogs to daycare so they wouldn’t jump all over her all day.

Two days ago, I bought her a bigger kennel and zip-tied foam to the sides so she couldn’t fall and hurt herself.

One day ago, my husband ordered a special harness to help support her paraplegic little body.

Today, we found out that she has aggressive spinal cancer. Which kind of explains why the steroids didn’t make her better, didn’t help her walk again like we’d hoped.

“I’m sorry. I don’t know what we’re going to do, but we can’t leave her like this.”

Surgery wouldn’t remove the whole tumor and might make her worse. If it did work, it’d only buy us two months. Her specialists were hesitant to irradiate. And chemo may or may not help, but eventually we’d be back to where we were today–with a proud little dog who couldn’t stand up on her own and who cried when she urinated in her kennel. With a pitiful little dog who was visibly exhausted but couldn’t get any rest.

On my way home from work, I stopped at Wendy’s to get a bacon cheeseburger and fries. Then I stopped at Chik-Fil-A, because milkshakes are better than Frostys. She always tried to drink out of our milk glasses.

When I got home, she was cuddling on the couch with my husband. The one place that allowed her to forget she couldn’t walk. I cut the burger into pieces and watched her inhale every crumb. We watched her drink her milkshake. And once she was finished, with a full tummy and an empty bladder, we stroked her and kissed her, trying to memorize every idiosyncrasy, until she relaxed. She’s the rare dog who enjoyed hugs and PDA.

I didn’t want to wait too long for fear of GI upset. I couldn’t do it too soon for fear of rushing my husband. I couldn’t let tears fill my eyes as I was executing this most important mission. And as her body relaxed and her eyes closed with long-overdue sleep, I slipped my syringe of propofol into her IV catheter. Not too fast, not too slow….

She yawned and exhaled. Then I snuck in the euthanasia solution. And when I was done, she looked perfectly asleep.

I’m not a particularly religious person, but I silently thanked God for allowing her to have a good death. And allowing me to give her a good death.

I know nothing will fill the empty space in my heart. Instead, I’ll do my best to stopper the hole. I’ll remember how she could raise anyone’s self-esteem by making them think they were the BEST DOG-PETTER EVER. I’ll remember how she would tap her tail and stare in annoyance if you stopped scratching her chest. I’ll remember chasing her away from eating the other dogs’ poo in the backyard. And I’ll remember the soft curves of that kissable little head, the head full of experiences I will never know, which turned her into my perfect little once-in-a-lifetime dog.

I don’t think there’s such a thing as a perfect euthanasia, a happy ending. Because nobody wants to lose their best friend. But tonight, I feel lucky that I came close.

 

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.