Health

Pet insurance- the good, the bad, the somewhere in between

I admit I am biased about pet insurance. I like it, mostly. Clients who had it were, in my experience, much more likely to approve necessary treatments. That dog with a case of happy tail who wagged it so hard and so fast he got a nasty deep infection that ended up necessitating a partial tail amputation? Insured. Hit by car? Insured. From my perspective, it allowed owners to focus on the pet’s immediate needs and get them taken care of.

I also liked it because I didn’t have to do anything to get it taken care of, other than fill out a brief form.  The owners paid me upfront, and were reimbursed by their company after the fact. If the owner and the insurer had a disagreement about what should or should not be covered, it wasn’t something I had to get involved in. It was nothing like human medicine. The summer before I started veterinary school, I actually worked the front desk in an internal medicine MD practice and good lord, those staffers spent probably 33% of the day dealing with insurance issues.

Source: Trupanion.com

Source: Trupanion.com

Just a few years ago, I could list three pet insurance companies, tops. Now there’s almost too many to count, with good policies and bad policies and fine print a mile long and exclusions even longer, especially if you have a bulldog in which case you might as well just get a second job.

Some pay a flat percentage of your bill. Others use benefit schedules, and specify exactly what amount they will pay per procedure. Most reimburse you, but I know of at least one that is rolling out a program that will pay veterinarians directly. Some cover preventive care. Some cover accidents. Some cover breed related illnesses, and others don’t. Tooth extractions? May or may not be a pre-existing condition. WHO KNOWS.

It’s gotten so confusing, even for me, that when people ask me what I think all I can say is, “Yes, go for it, but with caution.” Caveat emptor. But even then, even knowing all there is to know and asking all there is to ask, I’m hearing more and more people tell me they just spent five hours on the phone with an insurance rep trying to figure out how a newly diagnosed endocrine condition counts as “pre-existing.”

If this sounds familiar, that’s because that’s what all of us have done with our health insurers at least once, right? It’s confusing, and getting even more so the more players that enter the field. All companies are not created equal. I think most people completely understand the need for exclusions and limits, but for goodness sake let people know when they sign up what, exactly, they are signing up for.

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While lawmakers in California had hoped that pet insurance would fall under the auspice of state insurance regulators, it hasn’t happened, and people with complaints have found they were pretty much out of luck. Fortunately, a new bill that already passed the legislature and is headed for the governor’s desk should give consumers a good deal more protection.

AB 2056 will make California the first state in the nation to specifically pass regulations about the pet insurance industry, separate from its current designation as miscellaneous property and casualty. It specifies the need for clear language about co-pays, exclusions, waiting periods, and caps- all the stuff people run into issues with now.

This is good news for everyone: the excellent insurance companies out there whose reputation is being sullied by the shyster groups, veterinarians who are able to better care for pets, and most of all the clients and pets who stand to benefit from better access to care.

So let’s hear it: what’s been your experience lately? Have you been blindsided or pleased with your insurance coverage?

Filed: Blog, Daily Life, Health, Lifestyle Tagged: ,

Ebola, the real bogeyman, and you

Ever since I was 15, my sister and I have used “Ebola” as a short form derivative of every bad bug we’ve ever gotten. “Oh god, I’ve been laid up all day with Ebola,” “that taco from last night gave me Ebola,” etc, etc. We were able to say it with such offhand tone because we knew that really, Ebola wasn’t exactly a threat here in Southern California. It was simply shorthand for “really sick.”

After reading “The Hot Zone” I stopped saying the word at all. Faced with the visceral reality of what hemorrhaging out of every orifice is really like and the panic it engenders in local communities, it didn’t seem so funny a hyperbole. That stuff is scary. You should read the book if you haven’t, which will not only make you start washing your hands a little more, it will also help you appreciate the new role veterinarians are facing as the front line against emerging zoonotic diseases.

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Ebola is scary, very scary, don’t get me wrong. But we’re probably not about to be thrust into the middle of the next Zombie Apocalypse, which is what many people are expecting if my Facebook feed is any indication. If you’re in the mood to freak out, be my guest, but let me give you a better thing to be worrying about. The number of people losing their marbles over two US citizens being flown in within a self contained bubble is pretty silly when you look at all the other scary things facing us every day that, while less camera-ready than a guy in a space suit stumbling into Emory, are much more likely to truly mess up your day.

Remember: A person with a known diagnosis, held inside a containment unit, isn’t the problem here.

The guy coughing on the plane home from Heathrow who feels like garbage but doesn’t want to miss his daughter’s birthday party? That’s going to be the problem. The traveller who takes 4 Advil before hitting the thermal imaging cameras at the Shanghai airport to fool the system into thinking she doesn’t have a fever? Or the person who doesn’t even realize they’re sick until after he or she gets home? There’s the problem, at least so far as Ebola is concerned.

But Ebola isn’t the problem I’m so worried about, not really. As awful as Ebola is, there’s a much bigger tsunami lurking in the background and it’s already here.

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When the associate director of the CDC tells us, “We’re in the post antibiotic era,” THAT makes me panic. And it’s already happening.

The Real Losing Battle

We forget how recently antibiotics have developed in the annals of medical history- Alexander Fleming’s famous penicillin discovery only happened in 1928, less than a century ago. Before that, we were routinely felled by scrapes, coughs, childbirth, urinary tract infections. We’ve done a good job keeping apace of bacteria’s insanely effective evolution to defeat the antibiotic’s mechanisms of action, but we’re finally losing the battle.

It’s the result of a multitude of causalities: a slowdown in new drug development and approval. Misuse of antibiotics in both human and veterinary medicine. The ability for antibiotics to be used over the counter in food production facilities. The latter is now being removed thanks to the FDA’s Guidance 213- taking antibiotics back behind the prescription pad, where they belong.

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But it may be too little too late. The last line of defense in treating drug resistant infections, carbapenem, is now itself encountering resistant bugs. THIS scares me. It should scare you too, more than Ebola, even if Ebola makes people bleed out of their eyeballs. Bacterial infections can be gruesome too, CNN. Is that what it’s going to take?

In the meantime, I do not want to get a fever. Because if I get a fever someone is going to think I have Ebola thanks to the current media frenzy and then I’ll have to go to a hospital, where the real enemy is waiting to kill me. I’m avoiding hospitals like the plague (which is another disease that responds to antibiotics and might not in the future.) DANGIT, we just can’t win, can we?

Filed: Health Tagged: ,

Clean bill of health…

Can we talk about the fainting schnauzer video? We need to talk about it, because if there’s one thing I don’t get in this world, it’s the current trend for pets with a myriad of medical malfunctions or genetic issues becoming internet sensations.

You’ve seen the video, I imagine. A dog is surprised by the owner she hasn’t seen in a year or two, and after freaking out for a few seconds she loses consciousness briefly.

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Attempting to head off criticism, Carson Daly helpfully interjects “CLEAN BILL OF HEALTH GUYS” into the video. No problem, dog is great, everyone can go home, right?

Syncope, Part 1

Now without knowing the dog or what went down at the veterinary clinic, I can’t really tell you what happened, but I can tell you in general that fainting episodes (what we term syncope) are not normal, no matter how excited a dog is. There is a pathology there, whether it’s cardiac or seizure activity or something, but “she just got the vapors” is not a diagnosis.

Let me share with you the general arc of a visit when a patient brings a dog like this- and I’m including both seizure activity and syncopal episodes here- to me. Because the episode itself is short lived, by the time the dog shows up to the clinic he or she often looks fine. After taking a history and keeping in mind things like the age and breed of the pet, we begin the examination.

“Well, the physical examination findings are normal,” I say.

We could end things right here, and you could read that as saying “The pet has a clean bill of health!” But that’s missing the fact that while physical examinations are wonderful tools, they are limited in what they can tell us. The causes of syncope are rarely evident based on physical examination alone.

Syncope, Part 2, 3, and 4

“If we want to figure out the underlying cause of the issue,” I will say, “We should begin with some bloodwork and a urinalysis.” The client may or may not agree, mentally calculating the cost.

“If that’s normal, and it often is, we could proceed next to a cardiac workup: an EKG/cardiac echo/24 hours on the Holter monitor and have a cardiologist review the results.” Now we’ve definitely ventured into “need to think about it” territory.

“If the heart is fine, and we’re more concerned about seizure activity being what’s going on here, a neurologist is your best bet. Unfortunately, diagnosis usually involves costly procedures like CSF taps or CT scans. Epilepsy? Well, we don’t have a definitive test for that at all, so we just have to make the diagnosis based on ruling everything else out first.”

Many owners, especially after a first time episode, go as far as the bloodwork and decide to wait and see if it gets worse before moving to the next step. I don’t blame them- it’s expensive, and you have no idea if the dog will have an event a day later or a year later- but I just want to emphasize that unless they actually performed all of those diagnostics I just listed, it’s hard to definitively say the pet truly has a clean bill of health.

There’s a reason “The dog’s fine!!” is in the Today show headline and Carson makes sure to tell you “the dog’s fine! Someone said so!” and that reason is, we all intuitively know things aren’t fine. Just because you haven’t found the problem doesn’t mean it’s not there. It just means you haven’t located it yet. And I imagine somewhere in that visit, between answering calls from the Today show and counting YouTube hits, the vet did say just that.

 

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Filed: Blog, Daily Life, Dogs, Features, Health Tagged: ,

Cures what ails ya

In the olden days, people used to turn to carnival medicine men or the back pages of Look Magazine for the latest way to solve all of their problems. People don’t change, just the technology. Now we have the internet to turn to. If the web is to be believed, and it always is for some reason, there is a new cure for all the world’s ills. That cure is coconut oil.

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It’s good for your hair, your skin, your GI tract, your dog, your mental health, and your aura. It’s anti-inflammation and pro-synergy. You can rub it on your scalp, then scrape it off and use it to cook, or sit on the leather couch and make it more supple. I don’t think there is a single malady out there that someone has not suggested coconut oil can fix:

Dry skin? Coconut oil.

Dry face? Coconut oil.

Yeast infection? You guessed it.

Alzheimer’s? Eat up.

Athlete’s foot, acne, depression, hemorrhoids, anxiety, UTI, weight loss, heartburn, autism. I guess what I’m saying is you could nuke your local CVS and be just fine as long as there was a Whole Foods next door, because coconut oil’s got you covered.

I’ve done a Whole 30 challenge, which is a no-processed food crossed with a tinge of Paleo, so I’m no stranger to coconut oil. I’ve cooked brussels sprouts in it, stirred it in my coffee, used it to make paleo pancakes. They were good.

Sadly, at the end of a jar I have to say my life has not substantially changed. Everything broken in me before is still broken. Coconut oil, while delicious and no doubt healthier than, say, margarine, has not eliminated my need for my allergy inhaler. I asked my doctor if I could try shoving coconut oil up my nose instead, just for a little while. It’s way cheaper than Dymista. She didn’t think much of the idea. When I told her I was just joking, then she sighed and said, “I get that question a lot.”

While coconut oil is unsurprisingly gaining steam in veterinary medicine, we have an equivalent that already enjoys legendary status in the home remedy category: pumpkin.

pumpkin

Long treated as the pet pepto-bismol, pumpkin is the go-to far various GI maladies spanning the range from constipation to diarrhea. It’s a great thing for the colon. It’s a great source of fiber and most pets will eat it. Pumpkin is Metamucil in a more holistic package.

What pumpkin is not is everything else, like an anti-emetic or anti-inflammatory or something that will teach your dog to talk. Like, it’s no coconut oil or anything.

On a friend’s Facebook page, she recently asked if it was possible for a pet to develop an allergic reaction to a food they’ve been eating for years.

10 people chimed in (correctly) that yes, this happens. Then someone said, “Why do you ask?”

“Because my dog’s been throwing up every time he eats all of a sudden.”

As a veterinarian, my mind immediately collates a list of the differentials when I hear something like this. 3 year old pit bull, history of being a destructive chewer, clearly the problem is “pumpkin deficiency.”

Which is exactly where the comment thread went.

“OMG! You need to give your dog some pumpkin.”

“Seriously! My dog loves it.”

“Pumpkin cured my dog’s farts.”

“Pumpkin is a great source of electrolytes.” And so on and so forth.

Don’t get me wrong, I like pumpkin. As far as advice on the internet goes, it’s one of the more benign things I’ve read and unlikely to cause harm. My only concern is that people recommend this in lieu of something that might actually work, such as starting with a correct diagnosis. Fortunately this person has multiple veterinary professionals on the thread, and somewhere in between pumpkin recommendations she got some solid advice.

A couple of weeks ago, my neighbor came over with her adorable 6 month old Golden Retriever. She hopped back and forth on her toes before asking me if I had any thoughts about her dog’s diarrhea.

“How long has it been going on?” I asked.

“Two days.”

“Go to the vet.”

“We’re going tomorrow,” she said, “but in the meantime……do you have any pumpkin I can borrow?”

I did. It’s on the shelf next to the coconut oil. Hope springs eternal.

 

PS The dog improved dramatically … once the vet diagnosed Giardia and started Flagyl.

Filed: Blog, Cats, Daily Life, Dogs, Health, Musings, Picks of the Litter Tagged: , ,

Dog: World’s Worst Coach

I am training for a half marathon.

I thought about training for a full marathon, but then the reality what that was like the last time I attempted it kicked in and I remembered that oh yeah, I don’t like to run. I think you can do a full marathon once when you don’t like to run, just to say you did (Rock n Roll 2001 for me), but after than there’s really nothing to prove other than, “oh yeah, this hurts.”

A half marathon though, is doable. Still not fun, but manageable. I have decided, along with my friend from the gym who I kind of hate because she keeps inviting me to things such as “Summer Boot Camp!” and “Half marathon! It’ll be fun!” and I keep saying yes, that should we complete this without killing ourselves, maybe, just maybe, we will try and tackle a triathlon before our 40th birthdays.

Do they let people leisurely triathlon these days? All my competitiveness gets used up in my professional life so I have none left over for this.

Anyway, the point is I am doing this and it’s a grind, but I keep remembering that health is a gift and blah blah blah; I’m training with a group because it’s the only way I will drag myself out of bed at 6 am for the long Saturday runs.

Brody doesn’t come with me on those. He can manage shorter distances, but he’s made it clear he’s not yet ready for anything over 3 miles, tops, despite his summer cut. I appreciate that.

This Saturday I ran (‘ran’?) 9 miles, which sounds alternatively fantastic and psssshaw depending on where on the running spectrum you fall. To me, this is the longest distance I’ve done in a single day since I staggered off Mt Meru a few years ago, and that was because I had to since there was no oxygen up at the top.

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I’m hunched over because I couldn’t straighten up, not because I voluntarily felt like standing that way. Teri is hanging on for dear life.

So after 9 miles, at the end of which I realized my entire body was numb from the waist down, I came home and sat on the floor to stretch. Soon enough I was laying on the floor, like one of those crime scene outlines.

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020 0120 7141 023 0123 7173 Small is Beautiful Floor Black Still Life, by Steve James on Flicker

I began to appreciate why dogs do this, this splat sort of positioning. The wood was cool. Soon I melted and became one with the floor. Why don’t I do this more often? I wondered, and when my daughter asked me why I was doing that I realized it was not really possible for me to make it onto the couch at that particular moment.

Brody was excited I was in his domain, plopping down nose to nose and looking at me like, “Hey! What are you doing here?” He stared at me for a while, and then I decided I needed to stretch if I ever was to have hope of standing up again.

It went about as well as you’d expect.

Dogs don’t understand why we would come into their territory for any purposes other than play, and Brody was having none of it. He laid on my foot, licked me in downward dog, and dumped a soggy tennis ball on my stomach when I tried to stretch out my hip. It’s clear I’m not alone in this.

Dogs are awesome at many things, but sitting quietly by while you sit on the floor and bend into weird shapes is not one of them. If you’re going to goof off, they figure, might as well let me in on the fun.

Anyone else have a dog who simply won’t let you on the floor by yourself?

 

 

Filed: Blog, Daily Life, Fit Life, Goofball Antics, Health, Musings Tagged: , ,

Good health is a revelation

When I took my son in for his first routine eye exam, I had no idea he needed glasses. Neither did he. He seemed fine, wasn’t running into things, was reading fine in school, but nonetheless the optometrist suggested glasses. OK, I said, let’s give it a shot.

One week later, his glasses arrived and we went into the office to pick them up. He picked them up dubiously, slid them over the bridge of his nose, and stood there for a moment, blinking as the refracted light hit his retina in new and improved ways.

ralphie-broken-glasses

He spun, slowly, taking it all in. His lips twitched, burbling with something important. When he could no longer hold it in, he opened his mouth and shouted, “I CAN SEEEEEE!!!!”

Boy did I feel like a horrible mom as the assorted clients turned to see this blind boy get his sight back.

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Later that week I was sharing this story with a friend. As we were talking, her daughter picked up my kid’s glasses and put them on just for fun to see how weird things looked.

She came over and tugged on her mom’s sleeves. “Hey mom. Things look pretty good with these things on. I think I can’t see too well.” Then I felt less bad. It happens to us all.

We thought things were fine, my kid thought things were fine, and then someone with tools I didn’t have access to and the ability to evaluate things said, “Actually, life can be even better.” And it was.

I think of this all the time when people say, “Oh, Buster’s doing fine, he doesn’t need an exam or meds or anything.” To a client’s eye, he is fine. His gait is the same it’s always been. But I can pick up things they don’t, that slight crunchy feeling in the knee, a stiffness when I extend the leg. It took some doing, but we convinced that lab’s owner to try some Rimadyl.

Or the dachshund who came in for a routine dental. “He’s fine,” the owner reported. “He eats kind of slow but he’s been that way since we adopted him two years ago.” When we opened his mouth, the fetid odor of eight rotting teeth hit my nostrils, teeth held in by tartar more than by tissue at that point. It took some doing, but we convinced the owner to let us remove them.

In both cases, we got a call about a week later to marvel about this new dog in the house. “He’s like a puppy again! I can’t believe his energy! Who IS this dog?” Like my son spinning around in the optometrist office, they had a problem they didn’t even realize existed lifted from their shoulders, and got to experience something better for the first time.

In the year since their last eye exam, both kids seem to be perfectly fine, but I took them in dutifully anyway. Both of them need new prescriptions. This time, I don’t feel so bad. Big things we notice- small ones? Not always.

It isn’t my job to evaluate such things in my kids, or to be able to recognize the more subtle signs of something needing help. All I need to do is get them to someone who can, on a regular basis. Next stop: orthodontist. Lord help us all.

Just a little reminder to everyone that there is a reason we recommend yearly (twice yearly, for older pets) checkups at the vet. We’ll probably find things you weren’t aware of, and that’s OK. That’s what we’re here for! Every pet deserves the revelation of improved health. :)

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Filed: Blog, Health, Mother of the Year, Musings Tagged: , ,

Do we need pet care advocates?

In the depth of my despair when Apollo was dying, the medical resident at the specialty hospital made a comment I will never forget.

He was dying of a blood clot, a sequelae of hyperthyroidism and heart disease. I was in shambles, having come home from the gym to find him immobile on the couch, and rushed in straightaway, sweaty and spandex-y. I scribbled his medical history as quickly as I could, which the resident pored over with her intern as I sat in the room planning to say goodbye. I knew at that point it was coming, I was just waiting for confirmation of the diagnosis.

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I had checked ‘yes’ to allergies, in the interest of being thorough.

“What allergies?” the resident asked.

“Food allergies,” I said. “Chicken.”

She paused, and shared a knowing glance with the intern. “And how do you know this?”

I blinked. “I’m sorry?”

“How do you know he has food allergies? Did you just assume, or did you actually test him?”

“I….I did an elimination diet, 10 weeks…not the full 12…. but it was obvious by that point,” I stammered, though what I really wanted to say is “WHAT THE HECK (ok maybe another word) DOES THAT HAVE TO DO WITH THE PROBLEM AT HAND?? WHO CARES HOW HE WAS DIAGNOSED WITH AN UNRELATED MANAGED CHRONIC CONDITION A DECADE AGO??”

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But you know, I just sat there because what are you going to do.

OK sure, let's talk more about Hills z/d and then can you please get this cat some morphine?

OK sure, let’s talk more about Hills z/d and then can you please get this cat some morphine?

Now, I understand that a teaching hospital is going to teach, but from the patient perspective I suppose I would appreciate the teaching being limited to the issue at hand instead of using an emergency cardiac event to make a point on dermatology. I don’t know if it was that, or the way she asked the question as if she were sure I was going to give the wrong answer, that rubbed me the wrong way. I also had to tell her not once but twice that I didn’t want to hospitalize him on the off chance his clot might dissolve enough to give us another month at home. We didn’t hit it off.

Fortunately I didn’t see her after that and was turned over to the lovely cardiologist who looked and talked like Oberyn Martell and understood when I said, “Please confirm my suspicion so I can give him a peaceful goodbye at home”, but it really reminded me, from the other side of the table, how hard it is to be a patient advocate for our pets. I knew what I was doing and I still had to push a little. It was a lonely experience.

It’s even worse in human medicine, as this ER physician who was hit by a car will attest to. Without someone who knows what’s going on to oversee the process and keep the focus on the overall wellbeing of the patient, things fall through the cracks. Flustered and underinformed family members get confused. Specialists focus on this problem or that problem and not the patient. How can we do better?

Um, no, actually.

Um, no, actually.

In human medicine, many hospitals now have designated patient advocates who serve as an invaluable liaison between a family and a healthcare provider. In veterinary medicine, it’s not something I’ve ever heard of, so we’re stuck with ourselves, the vet clinic, or the internet to help us make sense of complicated issues, to understand why the vet wants to do this or that and to empower clients to make informed decisions, including “No.” It’s not the ideal system, clearly.

I wonder if people would benefit from a neutral third party patient advocate group in veterinary medicine. I think things are only going to get more complicated from here on out, and as both a patient and a vet I think that sort of thing could only help. Food for thought.

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Have you ever felt confused and not sure how to proceed with your pet? Would it have been helpful to have a pet care advocate to serve as a liaison?

 

Filed: Blog, Daily Life, Euthanasia/Hospice, Health, Musings, Picks of the Litter Tagged: ,

One Twenty Over Eighty

A few years ago I ran away from my job.

At least, that’s what I called it at the time, that is how I framed it in my head. I couldn’t hack it, I was a failure as a vet. My mind was wrecked, my physical health was wrecked, and my stomach curled up into knots every time I pulled into the parking lot. It wasn’t only me who suffered; I knew my heart was not where it needed to be for my patients. They deserved for me to want to be there. It was a bad place to be in.

With the gift of perspective, I know now I was dealing with some pretty significant burnout. I didn’t know that was what it was at the time; after all, don’t you have to be in it at least a couple of decades for that to kick in? Or be a practice owner? This is how it works, I was told. No one really talked about it, or it was code for ‘bad vet’, not for a defined type of stress reaction. Old Doc Johnson who treats everything with pen G and steroids needs to get put out to pasture, he’s old and burned out.

No matter the reason, I knew I needed to leave and take a breather. I am very fortunate that my husband was supportive of the decision, even without knowing how it would play out, or when I would be back. Although I saw it as a failure on my part at the time it was the best thing that could have happened to me.

I have learned to let go of a lot of destructive ideas in the past few years:

  • that taking care of yourself is an indulgence;
  • that saying ‘no, I can’t’ means you are a slacker;
  • that being a veterinarian means you put your work above all other things.

I had to practice those sentences a couple years before I really truly believed them, but I do now. I listened to a wonderful VetGirl webinar today on the topic of veterinarians, depression and suicide and was kind of taken by surprise when our wonderful presenter said, “self care is an ethical obligation- to yourself and to your clients.” She’s right.

If you recall, one week ago today this happened in my neck of the woods:

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A few days after the smoke had cleared, I had a girls’ weekend getaway that we had been planning for almost half a year. Girls weekends aren’t really something I’ve done much of- too busy, other priorities- but we randomly decided at a Christmas party that we should plan one. I didn’t know how much I would be needing it at the time, but man, I’m so glad it happened the way it did.

I flew far, far away from my blackened streets and up to the land of one of the world’s finest philosophers: Santa Rosa, home of Charles Schulz.

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We ate, all weekend. Really, really good food.

2011-onetwenty-over-eight_webWe tasted some wine. Really, really good wine. Our personal favorite was a wine by Ehlers Estate, which was founded by a man with a deep philanthropic interest and is now owned by a trust that funnels all its profits into cardiovascular research. (I tell you this not to try and sell their wine, though if you ever get a chance you should absolutely try it, but because it ties into the rest of this story.)

The wine we sampled is called “One Twenty Over Eighty,” in honor of an ideal blood pressure. We liked it, so we bought a bottle to share that evening.

We all came on this journey with our own piles of stresses and stuff going on, and one of those things involved a friend taking a spot check blood pressure monitor, just to kind of keep an eye on things.

“I feel really relaxed,” she said later in the afternoon. “I’m going to check my blood pressure, just to see how it went today.”

She took it, looked at the numbers, shook her arm a little, and held up the monitor.

“One Twenty…Over Eighty.”  OK, maybe closer to 125/82, but nonetheless, it was pretty darn good. Magic, almost.

ehlers

On the last morning before we left, we bumped into Kenny G in a bistro. All I have for proof is a surreptitiously snapped picture of the back of his gloriously curled head, but it was confirmed that yes, we lunched with the G himself. Seriously, if ever you were waiting for a sign from the universe that you needed to kind of chill out for a few, there are few signs more blatant than running into the king of smooth jazz. This may top the time I ran into Weird Al at Disneyland (story for another time).

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Good friends, laughter that makes you snort in the most unfeminine of ways, and maybe a sip of an exceptional wine if that’s your thing. It may not replace all the medicines in life you might need, but a little self care now and then does wonders, it really does.

Here’s to your One Twenty Over Eighty, whatever that might be. Cheers.

Filed: Adventures, Blog, Daily Life, Health, Musings Tagged: , , , ,

A place of passing

“I’m never going back,” I have heard more than one pet owner say. They are talking about the office of their veterinarian, a person with whom they have built a relationship for years, someone they like and trust. But their pet died there, and the painful memories are too strong. So strong for some people that they go and find a new vet, even if they liked their old one just fine.

It’s one of the reasons I like having the option that I offer, of performing in-home euthanasia and pet hospice with Paws into Grace. Because I know more than anyone that as much as the client hated the office that one time, many pets hated it every time. That can be pretty upsetting for some families.

Which leads to the next concern, one I hadn’t thought of until a client voiced it to me. “I don’t want to go to the vet office, but I can’t euthanize my pet at home,” she said. “I can’t have that memory associated with my house.” So sometimes those clients end up decamping to a third party location, a park or a beach. And I respect that decision, though I would encourage those who feel that way to think on it a little while before making up their minds. Here’s why:

1. The precedent has been set in human hospice for staying at home.

The gold standard in human hospice, for those who have adequate support systems in place, is for people to pass at home whenever possible. That is by far the most comfortable place for a patient, in familiar surroundings. I was with my grandfather when he quietly died on a rented hospital bed in the living room he called his own for 40 years. He hated hospitals and I’m pretty sure had we put him in one, he would have haunted us all.

2. Moving an ill pet can be a challenge.

Pets who are very ill can be nauseated, painful, disoriented, and uncomfortable. This goes for people, too. How many times have we been down with the flu and known that we should probably go to the doctor but we feel too rotten to move? Same goes for pets. Add in mobility issues and it is just one more stress for owners, especially with very large pets or very upset cats- no matter the destination.

3. Your home is deafeningly, loudly, overwhelmingly a place of comfort.

This is the place Kekoa died:

home1

But unlike a vet office where I might only have a handful of memories, I see this place every day and I don’t look at it as the place my dog died. I look at it as my living room, the place we opened Christmas presents, the place Brody plops down while I’m writing. It also happens to be the place Kekoa chose to settle down and leave this earth, because she knew as well that this is a happy place.

And you know what? It still is. I am glad she chose our sun dappled living room. At home, when I administer a pet’s sedation, they choose where they want to be: outside, in the kitchen, in mom’s lap. People find comfort knowing their pet selected the place they are most at home.

home euthanasia pet hospice

I’ve only been in this house a year and it’s had more than its share of sadness. I am looking at the floor where Kekoa died while sitting on the couch where Apollo died. I actually drove him home from the specialty hospital as quickly as I could- after he got lots of pain meds, so he could curl up on my lap after everyone got a chance to say goodbye.

But right now, it’s the place my dog is chewing up a toy and my son is doing his homework. This is our home, where life happens. And I feel good about that.

Want more info or to know if anyone in your area provides this?

Not all veterinarians even know this service exists, and information can be hard to come by. Here are two national databases of veterinarians that offer this service:

The International Association of Animal Hospice and Palliative Care

Association for Pet Loss and Bereavement

Here in America’s Finest City of San Diego, you can of course reach me or my wonderful colleagues through Paws into Grace.

Filed: Blog, Cancer sucks, Daily Life, Euthanasia/Hospice, Health, Musings, Picks of the Litter Tagged: , , ,

Awesome App Alert: Pet First Aid

You’re on a walk with your dog. He looks tired. You don’t know if he’s just tired from the walk or if he’s showing early signs of hyperthermia. What do you look for?

Unless you have a lot of experience with dogs or happen to have an emergency medicine textbook on you, you might not know. But thanks to increasingly cooler and better apps, you can get some immediate reassurance from your smartphone.

The latest must-have app for dog and cat owners just came out, and at $0.99 there’s no reason not to download it right now. The Pet First Aid app from the American Red Cross was developed in conjunction with the vets at Penn, and offers concise, easy to navigate info that you can access in seconds. It’s worth the price just for the 18 second CPR videos covering three sizes of dog and a separate one for cats. (There have been some awful CPR videos out there on YouTube, just sayin’.)

app

I just bought it and put it on all the smart apps in the house. The pictures (dog with bee sting!) and videos (bulldog in respiratory distress!) are ones you can use to educate yourself, or for the vets out there serves as a quick and easy resource to show clients in the exam room. And it has quizzes (thank goodness I passed all the ones I took, that would have been embarrassing.)

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Thanks Red Cross for another great- and affordable- resource!

Pet First Aid at itunes

Pet First Aid at Google Play

Filed: Blog, Cats, Daily Life, Dogs, Health Tagged: , , ,

The Secrets to Saving Money at the Vet

Hoo boy, that 20/20 piece sure stirred up some emotions, didn’t it? And it’s Thanksgiving, a week of gratitude, so I’m going to take a step back and say thank you to all the wonderful readers and colleagues who make writing this worthwhile. In honor of that, I’m going to take a moment and also share with you some of my own veterinary secrets. For the low low price of nothing, I want to explain to you what I believe, based on over a decade now in the field, is the best way to save money at the vet. No sarcasm here.

The best way to save money at the vet is….are you ready?

To spend more time at the vet. No, really.

Preventive Care is where it’s At

If one wants to know some of the best ways to save money on medical care, we need look no further than the group that has gotten the cost/benefit analysis down to an exact science: the human medical profession. It’s taken a long time for the field to come away from the model of medical firefighting: wait until something gets bad- CANCER! KILL IT WITH RADIATION! and more towards preventive care: MAMMOGRAM ALL THE LADIES! Firefight when you have to, but how much better is it to catch things early? For us, of course, it’s lives on the line, but guess what? It’s better for the bottom line too. Win-win.

Interestingly, the three situations described in the 20/20 bit as potential money grabs by the veterinary profession are perfect illustrations of why preventive care is so very important. Had we seen the extent of Marty Becker’s 90 minute interview for the piece in context, this would have all been part of the piece, by the by.

1. Cancer

50% of dogs over the age of 10 will develop cancer. I see it every day. It stinks, and once it’s diagnosed  in advanced stages the treatment options are difficult and expensive. When your veterinarian finds a lump on a dog during a routine exam, for the love of everything, check it out! Trust me, I would make more money resecting it in a messy surgery a year from now when it’s huge as opposed to doing a little biopsy or fine needle aspirate here and now, but I don’t recommend that because I don’t want that to happen to your pet.

meme

Here’s just a few examples of things I have diagnosed on a check of a lump the owner was on the fence about doing anything about:

-melanoma

-lymphoma

-sarcoma

-mast cell tumor

K32C4002

Kekoa had a sarcoma hiding under a lump of fatty tissue that, to my fingers, felt like a lipoma (benign fatty tumor.) It wasn’t.

Early detection saves lives.

2. Vaccines

People often go to those weekend vaccine clinics to save money instead of getting it done in the office. Then what happens? They hand you a pamphlet and you have to decipher which package, A, B, or C you want like it’s ordering your kid’s school photographs. It’s confusing. Often, you overbuy. It’s a lot of work to try and stay on top of these things, and I certainly don’t expect pet owners to be reading up on current best practices for vaccines each and every time the dog’s getting boarded and you need a Bordetella vaccine.

I take vaccines very seriously. I keep up on the latest AAHA guidelines- based on research, science, and the best our field has to offer in terms of what constitutes duration of immunity and core versus non-core vaccines. I use that to tailor a vaccination protocol for each pet who comes through the door. I can’t tell you what I recommend across the board because there is no such thing as ‘one size fits all’. I’ve done the full complement, I’ve done titers, I’ve written letters asking the county to exempt an elderly pet with a history of vaccine reactions from a rabies vaccine. This is what we do. If your veterinarian isn’t open to that conversation, I agree 100% that you may want to find someone else.

That being said, the majority of my patients do stay on schedule with vaccines, because once you’ve seen dogs dying of parvo while a little child weeps, you kind of get invested in doing all you can to prevent that.

Bottom line: It’s worth it to find a veterinarian you trust. We’re not unicorns, at least in my experience; we usually can be found hanging around.

Vaccines save lives.

3. Dentistry

Here’s the one that caused the most discussion. Our profession is in the middle of some real change in terms of recognizing the importance of dental care. Since I am not a boarded veterinary dentist, I defer to their vast reservoirs of knowledge and the evidence is clear: 85% of pets have periodontal disease by the age of 4. Most of it is invisible to the naked eye. Can you imagine if we waited until our teeth looked brown and grungy with recessed red gums before going to the dentist? There is real, actual value in getting professional care even if a mouth “looks” OK.

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The *best* way to keep your pets’ teeth healthy at home is incidentally also the cheapest: brush their teeth daily. The other best thing is to get regular, anesthetized dental cleanings to prevent disease from developing/worsening. If you choose not to anesthetize a healthy pet at 3 years old for routine maintenance, the end result is often a 12 year old with impaired organ function and a mouth full of horrifically painful teeth that need to be removed, at great expense. I can address the anesthesia component in another post, because it’s worth a discussion all its own, but suffice to say, anesthesia performed to excellent standards of care- that’s the key- while not risk-free, is actually very safe in healthy pets.

The three issues presented above are life-savers for pets. I am not saying this hyperbolically. Done early and with forethought, they are also money-savers, because they stave off much more significant, and expensive, disease down the road. There’s a reason my own insurance has a $0 co-pay for preventive care: it works. Same goes for our pets.

And happy Thanksgiving, everyone.

Filed: Blog, Daily Life, Health, Musings Tagged: , , , ,

Some Veterinarians Sell Unnecessary Online Memberships By Throwing Colleagues Under the Bus

Some Veterinarians Sell Unnecessary Shots, Tests to Make Extra Money, Says Former Vet

 

Did you see this bit on 20/20 this weekend? Ah, media. Titled “Veterinary Confessions,” the piece follows a couple of dogs through a series of veterinary visits where different vets offer different services based on their clinical experience, interspersed with the contrite admonitions of a former veterinarian who says that he was, before he relinquished his license (more on that later), the medical equivalent of a used car salesman.

Look, I’m not going to tell you that every vet in the world is equal and that everyone follows the same recommendations every time, but if you think that was the real point of this piece, you’ve been duped. Citizens of Oz, let me show you the Wizard.

“The vast majority of vets are ethical” and don’t recommend what’s not needed, says Dr. Andrew Jones, who then goes on to admit he regularly practiced the most unethical practice of recommending what wasn’t needed, just to make more money, hence confessing that he personally was worse than the vast majority of vets. Sounds like a legit guy to speak on behalf of the profession.

Why is he a former vet, you may ask? Well, the excellent blog SkeptVet profiled him a couple of years ago, if you’re interested. Rather than stop his continued practice of talking smack about, well, pretty much any vet except for himself- he was great, you see, unlike the rest of us slobs- he voluntarily gave up his license to practice in Canada.

And what is the good Dr. Jones doing now? Championing the cause of the poor and underserved, fighting the good fight to educate consumers about the latest AAHA vaccination recommendations or raising money for all those people getting soaked by the rest of us unethical greedy vets?

Um, not quite. He has a website. On it, he offers a

 “Free DVD”

which sounds nice and altruistic. Oh look, he’s pre-prepared for the website traffic he’ll get tomorrow:

Pet Health And Pet Care With Dr. Andrew Jones_ The Online Vet_s Pet Health DVD

 

So, if you continue to scroll down for 5 or 600 feet, you’ll see that yes! it’s FREE!

(save the $6 shipping and handling)

Hey man, sign me up! Only $6 for all this info! I’m going to CLICK!

Pet Health And Pet Care With Dr. Andrew Jones_ The Online Vet_s Pet Health DVD-1

Wait, what? In order to get the free $6 DVD I have to also sign up for the $10 monthly service in perpetuity? Isn’t that the Naughty Video Site approach?

So, in return for tossing me, and my friends, and the vet you hopefully like and trust, under the bus, the good doctor is already planning for the side bennie of all those new subscriptions (note the date on the website, and the date I’m posting this.) All in the name of altruism, you see. Behold the Wizard.

You know me, I don’t normally get this upset, but MAN, my hide’s a little chapped right now. Greedy vets? When’s the last time I’ve asked you for a credit card in order to peruse my website?

I will leave you with one last thought. In this piece, Dr. Jones called dental cleanings the “would you like fries with that” of veterinary medicine, a very often unnecessary bit of work. To illustrate the point, he used a little pit bull who was seen by several vets who said she was fine and didn’t need any dental work. Anesthetized dental cleanings, by the way, often allow you to do a closer examination than you can do on an awake pet and might let you discover something like

pibble

Yes, that’s the same dog.

But by all means, continue to compare me to a kid at McDonald’s. In the meantime, may want to get that looked at.

 

Filed: Blog, Features, Health, Musings, Picks of the Litter, Tails from the Vet Clinic Tagged: , , ,
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