I always assumed my experience as a veterinarian would serve me at some point when I needed to navigate the human healthcare system. The similarities between veterinary training and medical training, after all, lend themselves to a good number of similarities: how to read scientific articles critically. How to read an MRI. When to call the office and say, this prescription doesn’t seem quite right, is this what you wanted?
The similarities are all well and good, but I never understood, in the marrow of my bones, until recently that what would serve me best was our differences.
We MDs and DVMs are both given an ethical mandate to ‘do no harm’, which we as communities hold dear. Our duties to our patients are guided by this overarching principle; we look to it for direction in complicated cases, fall back on it when we feel conflicted about a request, and hold it like a flashlight when we shine a light into the cave of an uncertain future, looking for direction.
But oh, do those lights shine in very different spectrums.
As a veterinarian, I agree. We veterinarians occupy a strange place in the medical field in that most of us view it as not only an option but often a moral imperative to ease the pain of a traumatic death process through pharmacologic means. We are precise in our process, with the goal of minimizing stress and pain. We view it not as causing death, but as easing an uncurable pain. In this, we view our fulfillment to do no harm.
But in the human medical field, the prevailing attitude is by and large that hastening death is, indeed, harm, and anything we do to prolong a life is conversely fulfilling their requirement to do no harm, no matter what it does to a person or family in the process.
Even if it is multiple craniotomies.
Months of chemotherapy.
Daily radiation therapy with a bevy of ill effects. And you have to get screwed down to the table wearing one of these while they shoot brain shrivelling radiation beams at your head:
Not to cure a disease, but to make a patient breathe one more day, for better or for worse. It is the second most common utterance to me in my hospice work: we do better with our pets than we do our people when it comes to end-of-life decisions, and truly, friends, we really do.
I was recently-by invitation- listening to a doctor outline just such a series of events and possibilities to a patient who didn’t want to partake in them, who has been looking- without success- for someone to say, it’s ok to say no to months of hospital visits and yes to fewer days filled with this:
Plenty of people do want everything we have to throw at disease, and more power to them all. Thank God for modern medicine. But when did it become not only an unthinkable mistake, but an outright affront to the medical community to say, “thanks but no thanks”?
Searching for information on hospice and palliative care has been as challenging as getting bootleg rum during prohibition, furtive conversations in hallways and whispered hints at such necessary things as family support and respite care, secondary concerns far down the to-do list after scheduling yet another CT. I never knew how much of an afterthought the emotional wellbeing of the patient truly is in many medical decision making processes.
“So what if they don’t want to do this?” I asked.
“Well, this is the standard of care,” the resident responded.
“And if they choose not to do this?” I asked again.
“Why wouldn’t you?” he said, dumbfounded. He never did give me an answer.
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.
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:
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.
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.”
After the fifth time someone forwarded me “The Shocking Truth Your Vet Is Hiding” type articles in the past week, I had to take a stop from my scheduled 12 Days of Clinics to address it. I debated on a few clickbait titles for this post:
alt: “Why Magazines are Getting Away With Murder”
alt: “The Shocking Truth These Publishers Are Hiding”
It doesn’t really matter what the title is or if it related to the content anyway, but I imagine you already know that. But let’s step back a moment, and go back for a breath to 2011.
The most singularly amazing experience of my life took place in a forest in Tanzania. I had waited my whole life to visit the chimpanzees of Mahale, an experience I had anticipated with baited breath. Good, gentle, kind chimps.
And this is what I actually learned: chimps can be asses. Petty, sneaky, grumpy asses. Most everyone kind of knew that, though, right? They’re allowed bad days just like everyone else.
But I learned something else, which was also an eye opener not only for me but for the rest of the people there, for researchers who have spent their whole careers in the M community (by convention these communities are all lettered). Chimps, under pressure, can be vindictive.
The events I witnessed in my time, a Machiavellian soap opera of alliance forming, led to the never before witnessed assassination of the alpha chimp by his own community, an event so unexpected and rare it was written up in multiple journals. Pimu was a jerk, no doubt about it. He ruled with an iron fist. But no one expected the other males in his own community to kill him.
I was there. I saw it. I saw the way the pot-stirring chimp, third in line from the top, systematically groomed all the other males in the group, waiting for just the right moment to take advantage of their fears and frustrations with Pimu. Then- triggered by some small infraction that in other circumstances would have passed without comment, he lit off the powderkeg that resulted in an alpha getting his head smashed in by a rock.
The instigator didn’t even have to get his hands dirty. He was the Petyr Baelish of Mahale, climbing the ladder of the chaos he sowed.
The argument can be made that we are hard-wired for a black and white view of the world, to see people as friend or foe, with us or against us. Once someone’s a foe, there is nothing valuable, worthy, or meaningful in anything they say or do, ever, marinating in their evil fortress of pain or whatever it is enemies do.
It takes work to suppress that natural inclination and try to genuinely understand the actual truth of things- that most people, even those on the other side of the fence, usually have good intentions and may actually have a point about some things. But you can’t start a conversation when the guns are firing.
There’s always one person who benefits when two factions are fighting, and it’s rarely the ones out there actually getting bloodied.
Skull Smashing in Modern Veterinary Medicine
I am part of the V community of pet lovers: the veterinarians. This informs how I view the world and my place in it: as a pet lover, trusted advisor, someone who cares enough about the health of our companions that I chose this as my life’s work. I believe in the value of our work and our research and use that to make recommendations for my clients.
I am also part of the larger O community of pet lovers: the owners. I understand knowledge evolves. I attend hundreds of hours of continuing education, became certified in acupuncture, and I’m not afraid to change my advice based on evolving knowledge. I came out the gates of vet school ready to challenge old assumptions about vaccines, pain management, and nutrition, and over the last decade we have changed the way we practice medicine as a community.
I kind of assumed it was ok to be on both teams. So do you understand why it drives so many of us crazy to see this sort of thing?
These are Dogs Naturally Magazine’s most popular articles. Half the time the articles don’t even really correlate with the tone of the headline, but the damage is done. Clickbait is the equivalent of the pot stirring chimp sticking a rock in your hand and then shrugging and saying, “What? I didn’t tell you to hit anyone with it.”
I promise I never once looked a dog straight in the face with maniacal glee as I prime a syringe in front of their face, imagining the piles of money I get to roll in after work after wiping the blood of a thousand sickened pets of the floor with the research showing all these medications I recommend are actually totally unnecessary.
I’m not holding the V community blameless here. I understand there are vets who dig in their heels and refuse to admit that you have a valid interest in researching things and asking questions. There are those who look at everyone with a concern about DOI studies like this:
And they really wish you would just stop looking things up and just do what they tell you, no questions asked.
But that’s not most of us. If these types of publications (I’m picking on Dogs Naturally but that’s only because they’ve published about 10 pieces like this in the last month) really cared about the overall wellbeing of pets, they would be advocating for better ways to communicate with your veterinarian instead of just telling you we all want to kill your dog with Drano injections, euthanized horsemeat kibble and drugs we are prescribing solely because we were given a free pen, so you should just stay home and feed them coconut oil and canned pumpkin and whatever else their advertisers are selling you.
(I aced “Making Little Kids Cry in Terror”, which I took the same semester as “Why Sick Pets are Better for Business than Healthy Ones so Make Sure To Keep them Sick Through Recommended Shots and Foods.”)
So yes I’m irritated, not because the content in articles like “Why Vets Are Getting Away With Murder” has no merit despite the misleading headline, but because those clickbait pieces really just serve themselves. Information is good. Using it to sow discontent instead of discourse? Not so much.
Communication, not Coconut Oil: The True Key to Health
Concerns about vaccinations, sarcomas, immune system function, and nutrition are all perfectly valid. This should be able to be part of a discussion with a good veterinarian without bloodshed or Yelp. You are all smart people. A nice, polite, rational approach to collaboration may not sell magazines, but it does create better outcomes. I will talk to you about anything, even coconut oil, delayed neutering, titers, and raw food.
I understand the difference between your pet and the community as a whole, and if you ask why we have the recommendations we do, I’d be happy to go into all the boring public health theory and discussion of cell mediated immunity and why titers don’t prove definitive immunity and all those other things a drug rep with a burrito did not teach me in a one week course. This is communication, and it’s what two people who don’t want to kill each other do.
The Truth I Don’t Want You To Know
Is there one? I don’t know, maybe this:
the times I went home crying because I couldn’t save a pet.
The times I vomited in the parking lot because of the stress of the day or the person who threatened my receptionist with a gun.
The fact that on some days, I said to myself had I known the physical and emotional cost of this job, I might have chosen a different path. Especially on the days people tell me I’m only doing it for the money, or the glory, or the free pens.
I understand there are crummy vets out there. There are crummy whatever it is you do for a living, too. Just try not to be one of them.
You know what I’d really be doing if I was in this for the money? Looking for a pet with a genetic problem to exploit for fame and fortune. Alas.
I find it ironic that people are willing to believe, without question, the word of a person selling magazines, conference tickets and, I assume, advertising, and that this is done solely out of their benevolent desire to tell you the truth about the crapfest that is my profession and nothing else. There’s no room for nuanced discussion and benefit of the doubt when you’re trying to grow a brand in a world that thrives on conflict. I’d have a much larger site if I were willing to throw a few thousand colleagues under the bus for fun and clicks, but sadly, I’m plum out of rocks today.
You and I want the same thing, long and happy life for your pet. Bananas for everyone.
As you probably know, I have a bit of a complicated relationship with the PTA moms. Not moms in general, mind you, just the small subset of Pinterest loving, glue-gun wielding domestic lifestyle experts whose expectations I can never, despite my best efforts, seem to live up to. It doesn’t matter what school we’re at, it happens every time. First it was the art project/pooper scooper incident in kindergarten. Then it was the Have a Very Agro Valentine’s Day episode. And now it’s crudite, crudite that torments the soul.
It started simply enough: an email asking for volunteers to bring in food items for the teachers this conference week. I looked on the sign up sheet and put my name next to crudite: veggies and dip. Easy, I thought, a quick run to the grocery store for some carrot sticks and dip and done.
I forgot where I was.
(Not two weeks ago, I found myself in the midst of a malestrom for the fifth grade Halloween party when all the room moms got together and asked the parents to bring in food. I asked my class parents to bring in pretzels and fruit. The other moms showed up with cookies shaped like rotting fingers with almond nails and jelly blood, and eyeball eggs with veins hand-painted on with food dye. My pretzels were shoved under the table.)
So now, a few minutes after signing up for the veggie tray, I received an email instructing me to be creative! which is always concerning. To illustrate her point, the organizer included this helpful photo:
As to what our vegetables should aspire to be.
Now at this point a normal person would laugh and say, “OK, lady,” and bring in a tray from Costco, but unfortunately I still have the sin of pride to contend with on a regular basis, so I instead spent the afternoon standing in line at the grocery store watching YouTube videos of Martha Stewart blanching asparagus. Three hours of cursing later, with piles of peeled burnt chestnuts and carrot shavings dripping out of my hair like Jackson Pollock on a bender, I came up with this:
This is the dogged tenacity that makes people like me get through vet school even when all indicators point to the “why?” factor. We can’t explain it. We just have to.
I shared this with my friends, and they all got a good laugh out of how silly it was, and then later in the day my friend in Ohio sent me a link and said, “See? You’re not alone.” It was a photo of some artfully arranged food items a group of mothers had arranged for their teachers.
It was, upon further inspection, a photo from my very school from earlier in the day. It had already made the Pinterest rounds and ended up in Ohio, where my friend saw it and sent it to me as an example of Moms Gone Styled. I scrolled through it, looking for my contribution.
Notably lacking? The crudite. They were apparently so lackluster as to have not even rated a Facebook photo, and when I returned to pick up the dish I found they had been shoved in the corner in order to make way for some gluten free turkey wraps with hand-whisked dressings in, of course, Mason jars.
At this point, even a not quite normal person would just give up, which is theoretically what I should do, but it’s become clear to me I live in a parallel universe where I am destined to almost-quite get it, over and over and over, but not get it entirely. This is why I am a veterinarian, the almost-quites of the medical field.
So you know what? I’m embracing it. This afternoon I decided to go on a Pinterest binge and make a little Pinterest and dog-friendly crudite platter my way. Hope you enjoy it.
A bright autumn day, full of promise and gently whispered secrets amongst best of friends, calls for sustenance.
Lovingly hand-extruded kibble, with ingredients sourced from local artisans in an organic human-grade facility in Portland by men with bushy beards. In a Mason jar.
We end our afternoon in the garden of delights (it’s water friendly succulents! We’re eco friendly here in drought-parched SoCal) with hand-cut carrot bones from the local CSA, mint from the garden, words of wisdom from the dog sketched in canine-friendly peanut butter hand ground at Whole Foods. And of course, no pet garden of delights would be complete without the coup de grace:
nitrate free ham roses.
You saw it first here, folks. I’m waiting on sponsors for a YouTube tutorial but I think a ham bouquet is a lovely thing.
There was a time, back in a pre-internet era known as the Good Old Days, when two people who had different opinions on a topic could talk about it and, even if they did not come to an understanding, could at least part ways with a better grasp of the other person’s point of view. People with different opinions were still, at the end of the day, people.
I’m not entirely sure that is the case anymore.
Lest anyone doubt me, proof enough should be the fact that we’ve just come off an election cycle. I live in an area with one of the most hotly contested Congressional races in the country, better known to us locals subjected to the campaign ads as “Mouthbreathing Carbuncle-Having Satan Worshipping Slimeball” versus “Luciferous Mucusbucket Festering Wound.” (Definitions supplied by opposing parties.)
It was a close race. I think most of us voted for one or the other not based on deep unabiding adoration so much as we held our noses and selected the one we found less odiferous. Nonetheless, after the Slimeball defeated the Festering Wound by the narrowest of margins, the loser went on the air and graciously wished his opponent “all the best”, which is a strange thing to wish someone you truly thought was the Antichrist. If you truly thought he was the path to death and destruction, you think one would continue to rage against the injustice of it all and exhort people to do something to undo this miscarriage of justice.
But politicians know the truth that a lot us seem to have forgotten. All that bluster is just that, bluster. And at the end of the day they actually have a lot more in common than not:
both middle aged men of the same demographic savvy enough to be successful in local politics
Neither advocates overthrowing Congress and disbanding the Constitution
both against selling tanks to minors
Both for free sunlight
Both generally want to work for the constituents in order for people to live well in our beautiful city, though their ideas of how to get there might vary.
And now they will retreat to their corners to do whatever it is they do until they are again required by the tenor of American culture to again start yelling about how much the other person stinks.
Rumble In the Doghouse
We all know this about politics, we all roll our eyes with the silliness of it all, but don’t be mistaken- this “live and die by the sword”, “you’re with us or you’re worthy of a messy death” attitude has permeated many corners of our lives, and it’s not pretty.
The first time I met someone at a breeder’s event, I started talking to a person very involved with the dog fancy world. When she learned what I did, she looked at me a little sideways and said, “So you’re an animal rights person.”
PETA, protesting that abhorrent group of animal haters known as the American Veterinary Medical Association (true story).
“Not animal rights. Animal welfare,” I corrected her, as the person who introduced us (you know who you are, you rotten troublemaker) rubbed his palms together and waited in glee for us to start ripping each others’ hair out.
“What’s the difference?” she asked. So I called her a puppy mill, because all breeders are the same, right?
We looked at each other, hesitated a moment, then burst into laughter as she said, “Point taken.” We’ve been friends ever since.
I suppose in another world, maybe hidden behind an anonymous screen and keyboard, we could have become mortal enemies, but we’d spent too much time face to face to be able to call the other person demon spawn. We both knew we had too much in common, including:
a love of good wine
writing long and probably way too involved stories
thinking dogs are the absolute bee’s knees. We both totally adore and spend most of our free time thinking about, canines.
This friend recently began a Kickstarter campaign to create a website commemorating National Purebred Dog Day. Now, I’m not trying to convince anyone to go and support the campaign if it’s not your thing, no more than I would try and convince someone to donate to a political candidate they did not agree with. But the simple fact that she waited a long time to even begin the campaign because she was nervous about people targeting her for being an Evil Dog Person is honestly, pretty sad. I feel the same way about that as I do people who target pittie advocates trying to end BSL: why would you do that? We are not each other’s enemies here.
A few weeks ago I wrote a piece for Vetstreet about purebreds versus mutts. I wonder if perhaps the editor was wanting me to go for the easy kill, the one that would bring 5000 shares and bloodshed in the comments section: quote people talking about how wrong the other side was, how misguided. But I didn’t want to do that.
We want people to find the right dog for their family so they keep them forever.
They had different ideas about the best way to do that, but they’re both perfectly valid approaches, really, and people have been using both successfully for some time. Let me repeat: at the end of the day we all want the same thing. The rest is just window dressing.
Can you tell which dog is more worthy, loved, or better for my family? I can’t.
Who’s the real enemy here? Apathy. Ignorance. Greed. Say what you want about either the dog fancy or the rescue community (and indeed, the large numbers who belong to both): they are not apathetic people. They care, and they want what’s best. Instead of shaking your fingers at the other side’s perceived shortcomings, listen. There is much to be learned, on both sides. I know this from experience.
It’s very easy to continue to point and shoot at the easy target. Keep on doing it if it makes you happy. It certainly makes life easier for the people at CheapPuppyMillDog.com; whenever someone gets turned off by the antics they encounter at either end of the spectrum, guess who’s waiting with open arms?
We are not each other’s enemy. If you want someone to hate on who really deserves it, I suggest these idiots. Seriously, no redeeming qualities whatsoever.