This month’s JAVMA features confirmation of what those of us in the profession for more than a year or two already suspected: veterinarians are a sad bunch, compared to the general population. Consider these stats from the CDC’s first-ever survey of the veterinary population:
1 in 6 have considered suicide;
25% of men and 37% of women in the profession report depressive episodes;
1.1% of men and 1.4% of women have attempted suicide;
That last stat is the only one where vets figure in below the national mean, but before you cheer consider this: it’s because more veterinarians successfully complete suicide.
This preliminary data doesn’t delve into the causes or the proposed solutions, though those are currently hotly debated. Nonetheless, it’s good to see on paper what so many who are struggling have needed to hear: You’re not alone.
After watching my Ignite talk on being a Death Fairy, a veterinarian asked me how I avoided compassion fatigue in my work. I told her I would answer that, but first I have to admit this:
For a long time, I didn’t avoid it at all. I didn’t just float out of vet school and find an amazing job and love every second and plan to be a hospice vet because I knew that was the right thing for me to be. I wish I could tell you I was that organized and thoughtful, but the truth be told I did what most people I know in this field do when they’re stressed: power through bad situations until they became untenable, taking on more responsibility every other second.
So no, I didn’t avoid compassion fatigue. In fact, I burned out and quit. But then I reincarnated, I guess you could say, with a lot more perspective and a healthy understanding of what I’m really supposed to be doing here. But not until after I got really sick, like going to specialists and talking about scary tests sick, did I decide to get my priorities in order. Once that got sorted out, life got really good!
How to be a zen vet in a Prozac profession
1. Don’t underestimate the importance of your co-workers
I think there is no greater indicator of how happy you will be at work than how well your team works together. They will prop you up when you’re down, have your back when things get nuts, and inspire you to do better every day. Unfortunately, the converse is also true. The saying “turd in the punchbowl” exists for a reason.
2. Don’t settle for a toxic environment.
Temporary Like Sadness by Dominic Alves on Flickr
Sometimes you think you’re starting in at the best place on the earth, but something happens. The office manager is stealing. Your mentor turns out to be Voldemort. You get pregnant and can’t work overnights anymore. So many people stick it out in a bad situation because 1) we’re taught not to whine and 2) we’re scared there’s nothing better out there.
There’s always something better out there, but you won’t find it if you don’t look. If you are in an office that is causing you physical symptoms of anxiety, it’s time to start looking for a new job. Living in modern day American comes with certain advantages, like the whole “no indentured servitude” thing.
3. Don’t be afraid to explore.
I had no intention of being a veterinary writer. Blogs didn’t exist when I started vet school, nor did hospice veterinarians. Sometimes you just have to strike out in a direction that looks good and see what’s out there. Because guess what? I don’t care what anyone else has told you, you’re allowed to come back and be a vet if you leave. Taking time off to explore another career, take care of family, get another degree, none of it is a one way valve- unless you want it to be.
4. Set boundaries. Mean it.
Out of every rule I laid out, this is seriously the number one important one. With the exception of the rare shining star who really does want this to be their life, most of us want a life of which veterinary medicine is only a part. This is a profession where it is very easy for it to take over your life, because there will always be more asked of you than you are able to give. Always. It is not a failing to recognize that.
Set boundaries with your clients, your co-workers, and yourself. Take vacations. Exercise. Enjoy your family. Do not let work intrude on this or else you will begin to resent it, and that is the seed of burnout. You can (and should) work your butt off, then go home and play your butt off.
Set those boundaries, and enforce them like your life depends on it.
It was an ironic realization to figure out that point of diminishing returns in terms of giving of yourself. You cannot truly understand compassion unless you’re willing to extend it to everyone, including yourself.
In the early days of the Puritan settlements, colonial Massachusetts was gripped by fear. Between the British and French warring over colonial dominance, smallpox, and potential attacks from Native American tribes, the residents of Salem Village lived in a constant state of anxiety and worry for their safety. In addition to these real concerns, an overlying and persistent worry that some people possessed supernatural powers tickled away in their psyche.
When two young girls began exhibiting strange symptoms of fits and screaming (now believed to be caused by fungal contamination of grain stores), the local doctor diagnosed ‘bewitchment’, because why not. The first to be accused were a family slave, a homeless beggar, and an elderly woman- but they weren’t to be the last.
As the hysteria spread and some of the accused confessed in an attempt to save their own skins, others took note: accusing someone you don’t like of witchcraft is an effective way to get them out of your hair while also setting yourself apart as someone virtuous enough to be worthy of bewitchment. Rivalry, desire for power, fear and suspicion, ego- pretty much everything except reality itself seemed to play a role in the accusations.
All you had to do was point your finger and yell “witch!” and out came the pitchforks.
It was quite effective- after all, how can you prove you aren’t a witch? After all was said and done, 19 people were hanged that year before everyone came to their senses.
The evidence that sent them to the gallows? Dreams and visions; and of course, some very self-assured charlatans.
Nowadays, we scratch our heads at how this could happen, how people could go so easily down the road of hysteria and gullibility. Or do we?
In 1998, a medical researcher named Andrew Wakefield published a now discredited study linking the MMR vaccine and autism. Young parents, petrified at the increasing incidence of autism in children and worrying that their own choices could play a role, began delaying or declining vaccines altogether.
In first world countries where preventable diseases were being, well, prevented, parents felt the risk of a vaccine injury was now greater than the risk of the disease itself. There’s only one problem: it wasn’t true.
As the research proved Wakefield a fraud and everyone came to their senses, the medical community assumed that people would go back to business as usual. But, people are funny creatures, and sometimes we don’t really evolve. It only took the people of Salem a year to come around, but a strange thing happened at the turn of the millennium.
The “all natural lifestyle” turned out to be a very lucrative phenomenon, tapping into all our current fears: corporate conglomerates controlling the food chain. Large pharmaceutical companies more interested in lining their pockets than curing disease. Money over health. Go back to nature, they proclaim, and the world will be a better place.
The era of social media. There was a time where in order to be heard, you had to earn a spot at the podium through having something worthwhile to say. Now, you just have to get there first and have the loudest megaphone. Also: be a babe.
On the sidelines of the ‘nature vs chemicals’ battleground, people with no stake in either the pharmaceutical industry or the coconut oil industry shook their heads. “But look!” they said, holding up science papers. “That’s not how it works! GMOs aren’t causing cancer, vaccines aren’t causing autism, and pet food doesn’t contain dead cats!
They smiled, holding their papers in front of them with their palms up, waiting for the coconut salesmen to welcome them with open arms.
The coconut salesmen, who had just celebrated their millionth Facebook fan and launched a new website selling crystals, lowered their pitchforks. They looked at the people with the papers, pointed their fingers, and in a clear, loud, voice they yelled-
And the pitchforks came out, because how can you prove you aren’t?
A word from the stake
Whenever I speak on the worrisome outcomes of the current trend of science illiteracy, people say to me, “but don’t you agree that pet food should be transparently sourced? And that companies should tell you where their food comes from?” I imagine them saying this as they hold a match to the pile of wood underneath my feet, shaking their heads sadly.
Industrialized society is a double-edged sword. There are great benefits and some pitfalls, worthy of trying to improve. But why bother with such nuanced debates? It’s much easier and faster to call someone a shill. Next!
Toxins are today’s sorcery. Shills are the modern day witch. I take pride in being put to the stake, because I know history will vindicate me. And the only reason I’m not laughing at the absurdity is because while we sit here and have these nonsensical fights, children are dying. And there’s nothing funny about that.
So, every year I attempt some form of creative teaching enterprise at the kids’ school, and some years go better than others. This year, in a school I really like, I think things went well. I was asked to do a “veterinary science station” for the annual Science Fair, and I thought back to what I was excited about when I was a kid:
Playing with guts! And I thought to myself, I bet I could create a dog version of this anatomical model. So I went to Joann’s, bought a bunch of random attachments and fabric bits, and commandeered one of my daughter’s stuffed animals to volunteer to be my surgical model.
Step one: preparing the abdominal cavity
I chose a mottled red fabric for the interior of the dog, and sewed a pouch to contain the abdominal organs. After cutting open a midline incision, I removed a bit of stuffing then sewed in a zipper. (Do this before sewing the pouch in, or you’ll end up with the zipper seam showing.) Then you can sew the top ends of the pouch to the edges of your incision and voila!
Step two: making organs
You can go kind of crazy with this stuff, but I tried to hold myself back to the main parts (no spleen, pancreas, etc). All of the organs were secured to the abdominal wall with Velcro so they would remain in the right place but they could be removed if the kids really wanted to see what was in there.
I tried to keep the organs moderately accurate, but I was limited by my own sewing experience and what I had on hand, which is how I wound up with lavender sparkly kidneys and a two-lobed liver. For the bladder we filled a white balloon with rice. The kids don’t care too much about accuracy.
The intestines were a long tube of velour that I sewed and then had to turn inside-out. I didn’t think that one through ahead of time. I debated leaving it a giant intussusception but I eventually got it figured out with actual surgical tools. Next time, forget it.
In the interest of simplicity, the loop represented both the large and small intestine. I had some nubby yarn that I really, really wanted to throw in there as omentum but I held myself back.
The stomach needed to be fairly correct as a gastrotomy was going to be one of the two surgeries the kids could do. It’s a fleecy material with the nubby side on the inside (rugae! yaay!). I ended up using ribbon “stitches” sewn into the sides of the incision, which was a smart choice once the fifth graders started yanking on them full-force.
For the uterus, I sewed two red socks together at the toe (worked like a charm!) and bought a handful of small puppy toys. The ovaries were little white yarn pom-poms.
I sewed a snap into the tip of both socks to keep the “uterus” closed. I also put in a piece of stretchy rubber ribbon on both sides of the abdomen that the uterus held to with velcro but that was overkill with these kids so I didn’t use it. Feel free to use it for the vet student in your life, though- they’ll have to get used to wrestling with that thing.
By the time everything got stuffed in there it was actually a shockingly decent approximation for the surgical experience- you look in and think, what the heck am I looking at? So I made a legend as well.
With all of that in hand, as well as a bunch of gloves and masks we didn’t end up using, we headed off to the science fair.
Step 3: The actual test
We had a lot of competition at the science fair. Computer programming, dry ice, slime, rockets, frogs. Since the kids didn’t know they were going to be doing surgery until they came up and asked what was going on, they all freaked out a little and then said, let’s do it!
I used some of the radiographs readers shared with me. The pregnancy one was a big hit!
A small cardboard tube served as a trachea and the kids intubated with a See’s candy stick.
An old pillowcase with a rectangle cutout in the middle served as a surgical drape.
For the case where the dog was vomiting, we used our legend to try and determine what we were looking for (something big and pink.)
The kids got to pull out the assortment of items our patient ingested: a ball, a sock, a rock, and to see how they would lodge in the pylorus as there was no way they’d fit into the intestines.
I could easily have had two dogs going, but as I had to re-stuff the dog after every surgery I had my assistant prepare the surgery table while the next group waited.
Unsurprisingly, the c-section was a big crowd pleaser. We had only one person run off in horror when they figured out what was going on, and it was a dad.
I wrapped the puppies in saran wrap “membranes”. For the little kids who weren’t quite up to delivering a puppy, the bigger kids could hand them a puppy to wrap in a towel, remove the membrane, and stimulate them to breathe (you see one in the lower left corner). Worked like a charm.
Even the moms learned something, as in, “dang, that’s a big uterus.” Yes, it is.
The kids were all very concerned after to make sure the dog was closed and “woken up” after surgery was completed, all except the older boys who wanted to pull all the organs out and play with them. There’s something for everyone here at the clinic.
And the best part of the night were the kids who realized there were two surgeries and came back for more. Mission Minion recruitment accomplished!
Life is weird in lots of way. Things happen for a reason, and you have to kind of be open to what life’s going to throw at you because you certainly aren’t going to expect most of it. Even the good stuff. Especially the good stuff, which is often hidden in bad stuff.
When I go to a house for a euthanasia, people invariably say one of two things:
1. This must be so hard.
2. I wish we had this for people.
The answer to both is “I agree.” The interesting part is that they co-exist.
Lots of things we deal with in life are rotten: losing an eyeball, I imagine, would be hard. Crawling through the Amazonian rainforest naked and afraid with no water. Chaperoning a group of fifth graders on an overnight field trip on a boat you can’t escape from. All of them hard, and none of them leading me to say, “gee, I wish I could replicate this experience for my family and loved ones.”
Death is hard. It can also, in certain circumstances, be good. Not always. Sometimes deaths are horrible and tragic and cruel, and when we see that we fear it, and forget that many times it can also be meaningful and loving and bittersweet. We need to cherish those experiences to give us the strength for the times it is not. We need to learn that we can talk about it and lean on each other and be there, really be there, in every way we can.
This is what I do as a hospice vet, and while it is very true that this is in my opinion the best way for a pet to experience death, I have found the ones who benefit the most from the experience are the people, not only for their pet but for their whole idea of what death is about.
Pets don’t know what death is or that it is coming. The fear they exhibit in the clinic euthanasia appointment is fear of the clinic thermometer, because when I go into a home to euthanize a pet I cannot tell you how many very ill pets look up, give me a wag and a lick, and in essence signal to their families that they are ready. It’s quite stunning to see.
When I submitted a talk for Ignite San Diego titled “I’m the Angel of Death, Now Gimme Your Kids” I think I freaked out a good 95% of the attending audience who had no idea who I was or why I wanted to steal their dumplings. By the end, though, I think they all realized that no, really- it’s a good thing to learn to move forward without fear. Pets teach us so much, from the moment they arrive to the moment they leave us. Yes, even then, if we are open to seeing it.
If you want to hear me sum it up in 5 minutes on the nose, here’s the link:
As you may or may not have heard, the internet was abuzz last week with a series of alarming headlines, such as:
PURINA IS KILLING DOGS
CLASS ACTION LAWSUIT AGAINST DOG-KILLING BENEFUL POISON
And as these things tend to do in today’s internet age, the story has taken on a life and momentum of its own, just like last year’s “Eukanuba is killing dogs” story that ended up fizzling out and the “New parvo strain is killing dogs” story that also ended up fizzling out. Remember those? No? They were huge at the time, until they realized there was no actual evidence to support the claim and WHOOSH gone, not that it seems to matter these days.
I take lawsuits with a big huge salt-lick sized grain of salt, because once you’ve seen what people do in court rooms you gain a grim view of human nature. One veterinarian I know of lost a court case alleging intentional infliction of emotional distress for a phone call that never happened, because the plaintiff was able to bring in several family members to perjure themselves and say they heard the harassing call that never took place.
The veterinarian was able to prove the call never occurred using phone records, and the case was overturned on appeal, but not before the plaintiff called in the local consumer advocate, got the clinic on TV, and had to endure months of people coming into the clinic and yelling at the staff. The damage was done.
CC by MikeMccaffrey on Flickr
Filing a lawsuit is easy. Anyone can do it. I can sue the guy across the street tomorrow if I want to. I’ve never met him or interacted with him, but I could, just because. Winning one, proving damage- that’s another story.
Here’s a hard truth: a lot of dogs die every day, and much of the time we don’t know why because people don’t have the money to spend getting a definitive diagnosis on a 15 year old dog who has been vomiting. So they look to the obvious thing: the food! and never actually learn that the dog’s had a percolating abscess in the liver, or a hemangiosarcoma that metastasized, or any one of a number of things that happen. If 1.5 billion bowls of Beneful got eaten last year, it’s a given some of those dogs will die because that happens in life not because their food killed them; but they’re the easy target.
Here are my own FAQs based on the questions I’ve been getting this past week:
1. Is it possible that Beneful has a problem?
Sure. It is possible the case has merit, but until we see the actual proof I can’t say much about it. Given the fact that the suit mentions “propylene glycol” as an antifreeze analogue (it’s not), it seems to be one more tired rehashing of the whole ‘I can’t pronounce it so it’s bad’ argument people like the Food Babe have made so popular recently. Possible? Yes. Likely? I can’t say I have seen any evidence of it. Dr. Weeth has an excellent analysis here.
Were you to believe every “this kills dogs” claim on the net in the last 10 years, you’d have to have given up the following entirely:
Febreze, Swiffer, Iams, Eukanuba, Purina, any commercial dog food, Trifexis, ice water, vaccines, corn, anything with toxins, preservatives, moldy food resulting from lack of preservatives, veterinary care, Advantage, life as we know it.
2. Don’t you believe this poor man?
I believe that the man who filed this lawsuit believes in his heart that this is what killed his dogs. My heart goes out to him for his losses, it truly does. People want accountability for sad events and that is understandable. That still doesn’t prove that the food had anything to do with it.
3. What about melamine? Is your memory so short that you think pet food companies are flawless?
Here’s the thing about the melamine incident I want everyone to remember: Do you know how that story was discovered?
-It was not one person with a Google account and a phone book opened to “law offices.”
-It was not the FDA or companies testing dog food (melamine isn’t something normally tested for.)
-It was individual veterinarians who noticed a pattern, did some digging, talked to each other, and pursued an answer. I watched it happen, and it was incredible. There are some smart vets out there.
I can list about 3 major food problems off the top of my head that veterinarians figured out, and based on their experiences I would agree that not all pet food companies are forthcoming or proactive when it comes to potential issues (none of those companies I am thinking of, by the way, is Purina or any of the other big name companies. They were boutique ‘premium’ brands.) Yes, it happens, but the answers come with careful analysis by trained scientists, not lawyers.
4. If I feed Beneful, should I change my food?
Food is kind of like religion: people get really worked up about it. Each food has its place in the market, and if you’re the type to obsess over food labels and ingredients (nothing wrong with that! I do!) you’re probably purchasing a different category of dog food anyway, right? But this food has its place too, even if it’s not in your house. For plenty of people it’s been working fine.
I say the same thing about this that I do any food: if your personal individual pet is doing fine on their food, I wouldn’t change a thing. If he isn’t? Well, let’s talk. So yes, you should always report weird symptoms to your vet and tell them what the dog is eating (it is one of many, many data points.) Most of the time it is not the food. On occasion, it is.
Any questions? Then carry on. I have to catch up on Walking Dead.
Disclaimer: This post was NOT sponsored by Purina, Nestle, Big Pharma, or Corporate Shills. In fact I’m losing money writing this because I could be working on another project I actually get paid for. Information in this blog post is for informational purposes only and should not substitute for mass hysteria generated by your regular inflammatory website.
When I was in college, I volunteered one night at a Grammys gifting suite. As a peon, I wore my one nice dress and handed bags full of ridiculously extravagant presents to celebrities and/or celebrity assistants. In return, I got….well, to say that I did it, I guess. Swag has gotten even more crazy in the ensuing years. Out of control, even.
Compared to the Grammys, the Oscars are even more insane- the “Everybody Wins at the Oscars” bag given to the non winning nominees in the top 5 categories is valued this year at $160,000. Included: glamping trips, “adult massagers”, cars, wine, jewelry, and- for real- mind control lessons. All the things a needy star could desire. Ah, Hollywood, you’re so crazy.
To balance out the scales of ridiculousness, Halo and Freekibble.com are donating something to the bag that everyone will love: 10,000 meals to the shelter of the nominee’s choice (that’s $6K in food!) So when they sort through the bottles of moisturizer and tooth care items, they will also find this:
So you don’t have to give up on humanity entirely. Some good will come of this bacchanalia.
In honor of this event, Halo is helping me out by offering something to you as well: two goody bag items, one dog and one cat. While I can’t give you guys any adult items (this is a family blog!) or 10,000 meals (though I promise if I’m ever an Academy Award bag recipient I totally will donate my prize), I can offer the following:
The dog and cat prize will each contain:
1 bag of Halo food (dog or cat depending on the prize)
1 container of Halo Liv-a-Littles treats
1 autographed copy of All Dogs Go to Kevin (to be sent after release on July 14)
At least 2 additional surprises such as a Gentle Leader, K9 Cakery kit, Yeoww! catnip cigar, Blinking Buddy cat toy, Through a Cat’s Ear CD, Groom Genie brushes, Hidey Hole cat bed!
Estimated retail value: $125
Terms: This giveaway starts NOW and ends at midnight PST Tuesday, Feb 24 2015- so enter now before you forget in your haste to watch Fashion Police on Monday! All you need to do is click here and enter your email address. One winner for each prize will be selected randomly and notified by email. US only (There’s weird laws about international food shipping, sorry.)
As for the Oscars themselves? I’m rooting for Grand Budapest Hotel, personally, but that might be because it’s the only Best Picture nominee I’ve seen. Who cares? It’s all about the dresses anyway!
I’m sure you get fan letters all the time, from people who love your art: Clerks, Dogma, Chasing Amy. I think Chasing Amy was one of the first movies I watched with my boyfriend, who is now my husband. He thinks you’re the cheese.
I think you are a great writer, and like all great writers you have an amazing willingness to share things that other people hold close. Painful things, like a humiliating experience with an airline or, in this case, the terribly personal loss of a beloved dog. I am so very sorry Mulder died. I hope it is OK I am sharing the photo you posted because the love and the bond you share in this shot is there in a way I think others would be very comforted by.
To everyone: I encourage you to read Kevin’s words about Mulder here: They are beautiful.
I’m writing you today to thank you because I don’t know if you know just how special this is- not only your bond with Mulder but the fact that you are open to sharing this with the world. As a hospice veterinarian, I see people every day who are torn to shreds to have to say goodbye to their beloved companion. All kinds of people: women, kids, men, even big burly Marines and wrinkly faced Charlton Heston types. I worry about those men the most, because they have so often been taught not to express grief and sadness that they are as worried about my own reaction as they are just letting themselves experience the moment and admit, yes, I love this creature. Of course I am grieved.
I can speak all I want and tell people that they have permission to feel this way and let themselves cry and share and ask for camaraderie in a time that often feels incredibly isolating and lonely, but until more people like you- people with influence, whose words matter to so many- do what you’ve just done, it will continue to be a struggle for many more.
The conversation you opened up on your Facebook page- that matters. That’s huge. There are so many people starved for the opportunity to reach out and know it’s OK to drop your basket over this kind of loss, it’s like a dam breaking every time. What a testament to Mulder to have so many share in kind. It doesn’t lessen the pain, but I think the sharing the burden does help cushion the blow.
He was a beautiful dog and I know your heart must be broken into bits right now. For every idiot out there who called you an ‘attention whore’ for this, there are hundreds more moved to empathetic tears by your loss. You have fans who have your back. The average person out there who doesn’t have that support needs to see that.
And in the spirit of sharing, I’ll post a picture I never planned to share for all the reasons I just mentioned: I look horrible and tear streaked. It was a private moment. It is my dog Kekoa kissing me on the day she died. I was really annoyed with my husband for pulling out the camera that day, but in retrospect, I’m glad he did. You’d be surprised- at least I was- at how many people do the same when I am there to help them say goodbye. Maybe this will help others feel more permission to do the same.
I guess now I’m attention whore too. It’s all good.
Dr. V, your newest fangirl
P.S. Will have a pint to toast Mulder’s long and storied life tonight.
Vaccines are a complicated topic, let’s start with that. It’s impossible to break down the conversation into something so simplistic as “Vaccines: yes or no”. Some are more effective than others, some prevent more severe diseases than others. There are some vaccines I did not recommend (hello, FIP) and others I was adamant about (parvo!) when I was in general practice. This is why you should have a good relationship with a vet you trust, who is willing to have a dialogue.
On the other hand, when people are wading into the quagmire of what to vaccinate for and when to boost it versus titer it, one thing stands: ALL puppies should have ALL the core vaccines: parvo, distemper, adenovirus-2, and rabies. What you do after the one year booster is between you and your vet, but basic risk/benefit is indisputably on the side of vaccinating young dogs for the above vaccines on schedule.
I think sometimes people forget how awful some of these vaccine preventable illnesses are. If you’ve ever seen a puppy dying of parvo, you would never miss that vaccine for your pet again.
Cancer. It’s scary stuff. Every day, I hear another story of an elderly dog and cat diagnosed with neoplasia, and my heart hurts for those dealing with it. Without a doubt, cancer sucks, and every new breakthrough is a gift.
There’s lots of theories and evidence pointing to different causes of cancer. Food, say some. Chemicals, say others. Vets peddling food and chemical-laden vaccines, say many. And I’m here to tell you this: They’re right.
What? Say it ain’t so!
It’s true. I’ve been giving it a lot of thought and going back through my years of work in the veterinary field, and I’m here to tell you this: In the United States, the leading causes of cancer in dogs and cats are:
Vets Lead to Cancer. There, I said it.
The epiphany came to me a couple of years ago, when I was in Granada, Nicaragua. Life is simpler there, freed of the constraints and interferences from big companies typical of our American lifestyle. The dogs down there? They are free.
Down in many of the places I’ve visited such as Granada, Iquitos, and Turks and Caicos, the dogs aren’t exposed to commercial pet foods. They eat like their ancestors, from what they can scavenge.
They don’t get injected with toxins/vaccines/anything.
And they certainly don’t have their reproductive organs rudely removed. They live and die the way God intended, without Big Corporate Interference.
And when you compare the causes of death in these areas to the causes of death here in the States, one thing is for sure:
When Vets, Pet Foods, and Medicine Stay out of the Picture, Cancer Does Too.
(Well, except for that nasty transmissible venereal tumor that is rampant in stray populations in tropical and subtropical climates and leads to a premature agonizing death, but let’s look past that all-natural death for a minute.)
Here’s the thing that has had researchers and doctors and scientists scratching their heads for years: No one can predict when cancer will strike. Sure, there are certainly things that can predispose one to tumorigenesis, such as genetics (sorry, Golden Retriever lovers), or the feline leukemia virus (sorry, 2-3% of all cats in the US with this vaccine preventable illness), but the truth is cancer is a capricious, heartless bastard.
Sometimes it strikes young people or pets who have eaten nothing but organic kale salad and free range chicken their entire lives. Sometimes it skips that old person who’s been pumping themselves full of tobacco and GMOs and grain-fed beef, or the dog who’s been swimming in toxic waste on a daily basis.
The Number One Cause of Cancer Is This
There are plenty of known risk factors for the development of cancer in certain populations, but only one that without a doubt spans all species in all countries: AGE. Age causes cancer.
If only you had died before you were thirteen, Kekoa, this bone cancer thing never would have happened. Can I ever forgive myself?
When I was in Granada, what was the main reason I saw so few dogs with cancer? Was it their diet of plastic wrappers and banana peels? (No.) Their lack of vaccines? (No.) It was because until World Vets showed up with their evil boxes of toxins and Frankenkibble and neuter packs, the average lifespan of a dog down there was four years old.
Big Pharma, Big Pet Food, and Big Vet Med directly correlate with the number one cause of cancer: living long enough to get it.
That horrible Nationwide ad from the SuperBowl has nothing on us.
Just kidding! World Vets got him set up with vaccines and dewormers. He’s one of the lucky ones.
The cocoon of health
If you want to keep your pet from dying of cancer, get suspicious bumps checked out asap, don’t let your pet pick up smoking, and cross your fingers. Or kill them off early by letting them get so fat they develop diabetes or die of heat stroke the first warm summer day you try to go for a walk. I guess that works too.
Living as we do in a comfortable place with reliable access to medical care, we’ve forgotten about the realities of all-natural living, for us and for our pets. Measles. Polio. Rabies. Organic, GMO free viruses that will kill you.
Vaccine preventable diseases suck, which is why the vaccines were developed in the first place. They are far preferable to the disease itself, and if you say otherwise (some people have), I invite you to the streets of India where rabies kills lots of children, every day. 55,000 people a year worldwide-mostly children, and 20 MILLION dogs culled in an attempt to control it.
Pet food is a reliable and affordable way to feed pets for 95% of the population here in the States. If you want to cook for your pet, more power to you, but remember this: Even the gnarliest brand you can think of is better than starving, and if you say otherwise (some people have!) I invite you to Iquitos to decide which dogs are healthy enough to save and which we have to euthanize out of kindness.
Number of people who turned down free vaccines, vet care, and food in Granada: Zero, because they were sick of seeing dead dogs in the street. Pets finally living to ten years, the age at which cancer becomes the leading cause of death, is pretty priceless.
The Four Horsemen of the Dogpocalypse
The four horsemen of the apocalypse are, if I recall correctly, Vaccines, Pet Food, Rational Debate, and Veterinarians. Oh wait, I got that backwards. It’s Pestilence, Famine, War, and Death- the stuff the first four are trying to prevent.
How easily we forget that in our armchair indignation.
It’s been entirely too long since I’ve posted, and for that I apologize. I’ve been terribly busy responding to nastygramsdepositing my checks from Big Pet Foodsneering at plebians going to a continuing education conference this past week, and what a week it was.
Like many of you, I read the Indy Star’s expose about the loose strings of pharmaceutical companies (or, in internet conspiracy parlance, Big Pharma) at continuing education conferences such as the one I was going to attend, and also like many of you, I was surprised. And excited. I had no idea this was what I had to look forward to! I thought I was just plunking down a couple grand in fees, airfare, and hotel for a measly week of polishing my science know-how, and here’s this whole seedy underbelly of riches I had no idea existed.
I arrived in Orlando for the North American Veterinary Community Conference with 16,000 of my closest friends energized, ready to be plied with jewels, cash, and cars. Kind of like The Price is Right, but with drugs.
In the past, I’ve wandered the exhibit hall for a breather in between talks, taking a peek at the new products on the market. Sometimes the companies would give us candy, or pens- enough to get us to stop by and familiarize ourselves with the product, but not enough to justify actually changing how we practice medicine. I would have done it anyway. Because becoming familiar with new products is, you know, what we’re supposed to do.
I wanted to start my day with one of the storied free food lectures, hoping to begin my morning with roasted pheasant and perhaps a fluffy souffle. Then I learned you had to get up at 6:30 and the most they could guarantee was that the food was “hot,” so I passed and had a Kind bar instead.
“All we need is cantaloupe and these vets won’t know what hit them.”
After a few am lectures about respiratory distress, where the speaker (and every other one at NAVC) carefully informed us about their financial ties- or lack thereof- to the topics of their talk, I hit the exhibit hall in search of fortune.
Somewhere past the forceps booth and to the left of the lasers, a long line started to snake through the aisles and out into the halls. Whatever they were giving away, that had to be good.
“Excuse me,” I said to the woman at the end of the line. “Is this where they’re handing out free cars?”
“No,” she said. “This line is for Build-a-Bear.”
“This huge line is for Build-a-Bear?” I asked somewhat incredulously. The three men in front of her turned around and to a one muttered something about little girls at home. It’s cool, guys. Everyone likes Build-a-Bear.
“Where’s the contest where everyone wins something?” I asked, and they directed me over to the east hall, where a bored looking woman instructed me to spin a ‘wheel of parasites.’ I won a chapstick with a picture of a tapeworm on it.
As I continued to wander, I heard some grumbling from around a corner, where four people were congregated around a woman clutching a big bag. “Where’d you get that?” they asked her, and she pointed to another long line snaking through the hall.
“Is that the jewelry line?” I asked.
“No,” they said. “This is for the stuffed Olaf.”
“Like Olaf from Frozen?” I asked.
“Yes,” a woman replied, “but you have to be careful. They’re really hard to get. You have to go through a screening process.”
“What sort of screening process?” I asked.
“No one knows,” she said. “All I know is that they keep turning people away who don’t own practices. I think they sell some sort of financial services. It might involve an application and a credit report.”
“I’ve tried three times for an Olaf,” said another woman. “They’re not very nice about it.”
“Isn’t Frozen kind of old news anyway?” I asked, but that was apparently not the right question to ask.
Dispirited, I walked into the booth of a large pharmaceutical company. “If I listen to your spiel,” I asked, “What do I get?”
“Information,” the rep said, pulling out a sheaf of papers.
“No car?” I asked, disappointed. “Or a trip somewhere?”
She dug into her pocket and pulled out some mints. “I have these,” she said, then brightened. “Or a pen! Do you want a pen?”
“I’m OK,” I said. “I think I just need something to drink.”
“They have coffee over by that pet food display,” she said. “I think the line’s down to 15 minutes.”
By this time, the line for the Build-a-Bear had disappeared, and in exchange for giving a journal my email address, I was presented with a small, naked bear.
“We’re having a contest tomorrow for some scrubs,” the booth person said.
“For me?” I asked. “Or the bear?’
“For the bear.”
After an hour or so of this, my tally of freebies was as follows:
-One naked bear
-A bedazzled lanyard
– 15 pens
-one urine container filled with yellow candy (this was actually my favorite)
“Why do you think these lines for all these freebies are so long, do you suppose?” I asked my friend Kristen. “Are we that hard up for stuff we’d wait for half an hour just for a chance to win a free ipad?”
“You’re veterinarians,” she said. “Of course you are.” Touche.
After a long day of lectures and wandering, I had worked up an appetite, so I set out in search of the free feasts. I searched every corner of the hotel, and couldn’t find a single one. I realized everyone must have gone to the free rock concert instead.
“Free concert?” I said, intrigued. Maybe there was some credence to this Indy Star thing after all! “Who’d they get? Dave Grohl? Bruno Mars?”
There was a long pause as my friend flipped through the conference brochure. “38 Special,” she said.
“38 Special?” I replied. “Are those guys still alive?”
“Apparently.” Pause. “My dad’s gonna be so jealous. He almost took a cruise with them last year.”
Hungry and alone, I went to my room at 10 pm and decided to order room service. After 15 minutes on hold, I placed an order for a Cobb salad and was told it would be an hour and a half, because shutting ourselves in our rooms alone with our papers is apparently a popular choice for veterinarians. I’m so predictable.
About one year after I graduated vet school, I took routine screening chest radiographs of my senior Golden, Mulan. I looked them over, frowning at a small, mottled spot near her sternum.
“She has cancer,” I thought. It’s not an unreasonable conclusion to come to with Golden Retrievers. Before I panicked, I asked my colleague to look at the x-ray, and she agreed it looked suspicious. I was devastated.
I took Mulan to the local specialty hospital, where an intern I knew from vet school patted me on the back while the resident internal medicine specialist pursed his lips sympathetically. He grabbed his ultrasound machine to prepare for a guided biopsy. Before starting, he asked the radiologist to stop by to give his thoughts as to what this strange radiographic feature might be.
“What are you looking at? That? That’s normal sternum,” he said, sipping his coffee with the mildest of eye rolls before strolling out of the now-silent room.
I knew just enough to be dangerous but not enough to actually come to the correct conclusion. Along the way I dragged two other very educated colleagues with me through sheer force of conviction. Mulan lived another 4 years, by the way.
Data and Interpretation
Lots of people have asked me about the controversial results from the Truth about Pet Food’s crowdsourced food safety study. I haven’t said anything, because I couldn’t think of anything to say. It’s the same response I have when people send me this picture over email and ask me what this lump is:
The correct answer is, “I need a lot more information before I can tell you that.” Which is about how I feel about the significance of this study.
As veterinary nutritionist Dr. Weeth points out in her excellent response, scientists kind of live to nitpick and poke holes in one another’s work. It’s necessary to allow criticism because there are so many ways one can go wrong with a project- from the way the study was designed, to the implementation, to the data interpretation. It was the persistent nagging of the science community that led to the eventual discrediting of Wakefield’s autism/vaccine research paper, the public health implications of which we are still dealing today, up to and including 19 people who were sickened with measles at The Happiest Place on Earth.
Without being allowed to evaluate the entire research process, we have no way of knowing how valid the results are. A pretty infographic does not science make. Nor does protesting “it’s not junk science” mean that it isn’t.
What We Know
I’m hopeful that the full set of data will be made public, including methodology. Until then, all we can do is go by what we have been told.
Dr. Gary Pusillo of INTI services, who has the misfortune of being out of the country while all of this debate is going down, was in charge of the testing process. Thixton writes that he is a board certified veterinary nutritionist, which in theory is fantastic because it means that he would have the background in both veterinary medicine and nutrition to not only perform the studies, but interpret the results. There’s only one problem: he’s not. (Nor does he in any way present himself as one, by the way.) A board certified veterinary nutritionist is a veterinarian who is also a diplomate of the American College of Veterinary Nutrition. You may think that’s irrelevant, it’s just semantics, but it’s not.
Credentials are a big deal, as I’m sure Dr. Pusillo himself would tell you were he around. I would really love for Dr. Pusillo and Dr. Purejav to have been available to answer questions while we’re all begging to know what the heck they did, and I’d love to hear more about how they determined “risk.” They may be the most qualified people in the world, but for right now, all I have is an infographic and a consumer advocate’s word that they’re the best.
Dr. Pusillo is a PhD who provides forensic science services, which actually sounds really cool and I would love to hear more about it. I have no reason to doubt that he is an excellent scientist. He probably knows tons and tons about how to test a food for specific substances. What he may or may not know is whether or not those substances matter clinically.
Data Collection vs. Interpretation
Let’s assume that the data collection was carried out perfectly. Data collection is only half of the equation- you still have to know what to do with it. You can have all the answers in front of you and still not know the question. The scientists Thixton contracted with are out of town at the moment, so who are we going to ask to help us interpret things?
Given who’s around right now, who could interpret the limited data we have through the filter of what matters?
Or a board certified veterinary nutritionist, who can tell you about nutrient analyses and why dry matter comparisons without calorie content is useless. Both of them have some big reservations about this project.
They know more than I do about such things, which is why I defer to their interpretation. Little things mean a lot- for example, when you say “bacteria are present” what do you mean? Does that mean live bacteria were cultured using sterile handling procedures to eliminate environmental contamination? Or did the test just look for bacterial RNA, which could come from dead bacteria that were killed during processing and therefore prove that production works as advertised? I don’t know, but that would sure make a difference.
When the company you contract with to run your tests asks for their name to be dissociated from any press surrounding you, there’s one of two conclusions: 1. They were not happy about how their data was manipulated in the interpretation stage and didn’t want to be associated with bad science; 2. Big Pet Food Cabal. We may never know. *shrug*
A victory for food safety
I like to look at the bright side of things, and for reasons I can’t fathom, what I’ve found to be the biggest findings of the study are barely mentioned.
What are the three most common concerns I hear about pet food safety?
pathogens of most dire human significance, specifically Salmonella and Campylobacter
pentobarbital contamination (implying euthanized rendered carcasses in pet food.)
Why were these not mentioned in the risk report?
Because they weren’t found. They did look for all of these products. All twelve tested foods were clear of the three biggest worries in recent memory to pet food safety. That’s something, don’t you think?
I’m an optimist. Let’s look at the bright side of things, what do you say!
So let’s review here: I like asking questions. I have no problem questioning consumers, colleagues, my own professional leadership. I think concerned consumers are good consumers, and I applaud anyone who is invested enough to care about what goes into their pet, be it food, drug, or plant. I have chosen not to work in the employ of companies in the field specifically so I can feel free to say what I want without worry about my job or advertisers.
That being said, I think we also have to take the Occam’s razor approach to life and assume at some point that companies are telling the truth when they tell us they aren’t actively attempting to kill our pets. There are problems, some big and some small, and those are worthy of being addressed, but if you can’t accept at the end of the day that they are generally trying to do the right thing, then we may not ever be able to come to an understanding. As part of a profession that deals with this type of distrust on a regular basis, there comes a point where you have to say, “If you’re going to insist I’m out to harm you no matter what I say then I probably should just leave now.”
So let’s end on a high note: a toast, to those who care. I think everyone’s here arguing for that reason even if the conclusions are different. Salmonella free appetizers for all.
“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “We’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “otherwise you wouldn’t have come here.”
Every time I come across a “how to choose the best veterinary hospital” article, I read it, because it’s fascinating to me to see how different authors choose to guide you in this task. The articles exist, presumably, because not all hospitals are the same, therefore some are great and some, not so much. I think we can all agree this is probably the case. It’s like dating- lots of choices, but not all are a match.
Of course, the recommendations are pretty disparate, depending on how you define “good hospital.” Are you the holistic vet, the guy who’s dedicated his career to evidence based medicine and refutes anything without a journal article to back it up, the disgruntled owner who’s displeased with one bad experience and parlayed it into a major website, or the practice owner who’s looking to attract new clients? They all have different ideas of what makes a “good clinic,” to the point that one person’s perfect place is another person’s house of quacks and vice versa.
We’ve all had those “what are you smoking?” moments.
It’s good to know what your needs are, and good to know what a clinic provides. A client/vet mismatch is unpleasant for everyone. Like that girl in college who insisted that her jerk of a boyfriend who left his dirty socks in your living room was just misunderstood and refused to believe the stories of his drunken overtures to every girl on the dorm floor, some poor souls really have a hard time believing that most people just don’t change simply because you want them to.
Yes, we all know at least one vet who had a major epiphany mid-career and did a complete 180, but most don’t. And if you know one who did, it’s probably not due to you and the article you clipped out of a dog magazine you picked up at Whole Foods. I’ll be happy to look at it- heck, I probably already read it myself, I love Whole Foods- but please don’t be disappointed that I don’t change my entire medical perspective based on our 30 minute visit.
You’re paying me to give you my opinion, but if you don’t like it, well, we have decisions to make. While I’m happy to discuss my approach and how we might adjust it to your needs, it’s unlikely I’m going to completely change my medical perspective, because, well, I’m old enough now to be at least a little set in my ways. They’ve worked out pretty well for me. And if that thing I’m not into is that important to you, rather than getting really irritated with me for not changing, it’s probably easier for everyone if you cut your losses and find someone who’s a better match.
I like to make people happy. I will do everything I reasonably can to accommodate that. But at the end of the day, sometimes you and I- we just aren’t meant to be. And that’s OK. No matter what you’re into, from crystals and aromatherapy to a $30,000 kidney transplant assisted by a human nephrologist, there’s someone who can provide what you want.
Your Compatibility Score
There’s no match.com for vets (though hey, what an idea! who wants to help me develop that?) so you’re on your own for screening your vet for a potential match. You’re going to have to figure out your top couple of priorities and go from there. Here’s some things to consider:
If you want an office open until 8 at night every day because you work, don’t go to a solo doctor office.
If you want to see the same vet every time, don’t go to a huge office with enough staff to be open every day until 8 at night.
If you harbor some deep down issue with blondes/men with mustaches/people with tattoos/some other random thing, don’t go to that vet out of some weird sense of guilt. They’d probably prefer you didn’t anyway. Life’s too short to spend it explaining to a relative stranger why you don’t like them. I can tell when someone doesn’t like me. I’ll survive.
If you want a holistic vet, go to AHVMA and find one. Acupuncture is becoming very common, and a lot of places that practice mostly western medicine offer it, but if you want homeopathy or chiropractic, you’re going to have to look a little more. Most vets offer western medicine because that’s what most vet schools teach, that’s all.
If you want a place with the best prices in town, don’t be mad when the doctor won’t answer your midnight emergency. If you want a doctor to answer your midnight emergency, don’t be mad when they don’t have the best prices in town. Same goes for fancy stuff like lasers and endoscopy.
Nobody likes to be frustrated.
If you ask me about Chinese herbs, I will tell you honestly I don’t know anything about them. You can go with what I do know, or I can help you find the guy down the street who studied them (I have one doctor in mind, and he’s great.) Forcing me to prescribe those unfamiliar drugs for you is not an option.
So here’s my one sole bit of advice for how to pick the best veterinary hospital:
Find the vet who’s already your own special brand of crazy, whatever that is.
“You are old, Father William,” the young man said, “And your hair has become very white; And yet you incessantly stand on your head— Do you think, at your age, it is right?”
“In my youth,” Father William replied to his son, “I feared it might injure the brain; But now that I’m perfectly sure I have none, Why, I do it again and again.”
After a decade trying to be all things to all clients, I have finally embraced my own brand of crazy. While I am not your doc for orthopedic surgeries, just the other day I wore a client’s bathrobe and smeared cat food on my hands to help a nervous cat feel more comfortable. If I’m not that one for you, let’s break up so you can find your One True Vet Love.
“Would you tell me, please, which way I ought to go from here?” “That depends a good deal on where you want to get to.”