As I prepare for my third year at IAAHPC, the veterinary hospice conference, I’ve taken pause to reflect on this journey and how it affects the way I view veterinary medicine. Personally, I have only euthanized a personal pet in a clinic (versus at home) one time.
It was Nuke, my vet school coonhound, and he was diagnosed with hemangiosarcoma just a month after I graduated and came back home. The veterinarian was lovely and did as great a job as one can do in that situation, but so many memories still stick in my head:
-They asked me to come in at the end of the day, ostensibly to make it easier for me. It meant I had to wait all day and then sit, sobbing, in rush hour traffic. It wasn’t what I preferred, but I was too tired and sad to realize I should have asked for what I needed.
-They took him in the back to place a catheter. I get it, I did the same thing throughout my entire clinic career. It’s definitely easier for the staff. I would have preferred to be with him the whole time. After doing it by myself in people’s homes with no backup- yes, it is perfectly possible.
-After I left, they took his body and placed it in a black garbage bag in the freezer until the aftercare place arrives on their weekly rounds. I know, because we all do this. Every clinic I have worked at does it this way. It is just the way it is done.
But does it have to be?
I know that the answer is no. I know that there are options out there that so many people want, so many ways we can better respect the dignity of our patients and clients before and after death, and we owe it to you all to let you know they are possible. Veterinarians have many reasons for not offering them, and they are not invalid concerns:
They are more expensive
They take more time to organize
Most people do not want them
While many if not most clients are fine with the process the way it is, it hurts me to no end to know that so many people are still unaware of the myriad additional options out there to help your pet at end of life and to ease your pain as a family through the process. You may have to advocate for yourself, prepare, and find these options on your own- trust me, after having to advocate for my mother to get into hospice when it wasn’t offered as an option, this is kind of a universal problem.
To that end, I’d like to share with you my End of Life Bill of Rights- the things that you as an owner have a right to ask for and, after having worked with so many like minded colleagues now for several years- I can tell you that someone out there is equipped to provide you with:
The Right to Refuse Treatment. If your pet is suffering from a terminal disease, you have the right to say no to chemo, or surgery, or radiation. I believe in my heart that most veterinarians out there support clients in that, but there seems to be a lost-in-translation moment where so many owners feel pressured into heroic measures they were not prepared to take, emotionally or financially. This does not mean I am advocating to neglect an ill pet in suffering- quite the contrary, I am advocating for aggressive and patient focused comfort care.
The Right to Pursue Treatment. On the flip side, if you want to take your pet to the best of the best and do everything in the book possible to change things, it’s your call, not ours. We can offer you guidance and advice, but our job is to help you make an informed decision about realistic outcomes.
The Right to Have Your Family Involved. Unfortunately, some veterinarians still actively discourage families from having children present during euthanasia in the clinic. The emotion makes them uncomfortable and is disruptive. It is a clinic-focused way of thinking that is not focused on family needs. This is a once in a lifetime transition, and you need to do what you need to do. Many clients do not want their children present, which is fine- especially for kids under 5 who don’t understand what is happening- but it should be your choice. What your children see and hear- or don’t see- will live with them forever. If you don’t know how to approach the conversation- there are many, many professionals who do, and they have excellent resources to help.
The Right to Impeccably Respectful Aftercare. Most people don’t want to know what we do with a pet’s body afterwards. If they ask, I would tell them, and assure them we are as respectful as we can be. I believe in transparency. Nonetheless it is a disturbing image to many, myself included. If we can’t be honest without feeling like there’s a need to cushion the blow, why not change it? Especially when it’s such an easy thing to do?
More recently I have worked with a local business that doesn’t use bags or hold pets onsite; pets are wrapped in a clean white sheet and transported directly to the crematory facility, with the family knowing that the position their pet was last placed in is how they will remain. Yes, it costs more. And yes, many people are happy to pay it for that peace of mind. Some clients of mine transport their pet directly to an aftercare facility themselves, or have a trusted friend do it, because that chain of custody is important to them. These are all valid options.
The Right to Die at Home. The first time I went to a hospice conference, it changed everything for me. We can do so much better by our clients. In-home hospice and euthanasia veterinarians are changing the landscape of the profession, and providers exist all over the world. We are trained to offer not only medical support, but we are able to direct your family to the compassionate emotional support you may need, through chaplains, grief counselors, and support groups. We can offer palliative care options when medical treatment is discontinued- as in humans, we have a wide array of comfort care support that goes far beyond a pain pill here and there that can ease the discomfort of end of life.
And when the time comes, you will be at home, in a safe place, with those around you that you need. I bring blankets, candles, music- things that might not be practical in a busy clinic but, in a time of grief, provide small but vital bits of calm through all the senses. For those who experience euthanasia in a clinic, you also have the right to take the time you need, to make the environment what you need it to be for you. It matters. Your bond matters, too.
I’ve teamed up with Clorox to bring you some pet health and safety tips for the summer. Over this week and the next I’ll be sharing some info on Facebook and Instagram about household germs and infectious disease prevention. Bottom line for me is, keep it simple!
This post is sponsored by Clorox.
“Simplify the problem of life, distinguish the necessary and the real.” – Henry David Thoreau, 1848
We spend a lot of time in our lives looking for the next biggest thing that’s going to make our lives easier. What’s more efficient? Safer? Better? In doing so, we ironically end up making life ever more cluttered and complicated, piling up more things and creating increasingly complicated rituals that are anything but easy.
I work every day to help make animals healthier, but a big part of doing that means giving people recommendations they’ll actually follow through on because they are easy and effective.
I can give you a textbook on preventing the onset and spread of diseases, but do you really want that? You lead a busy life. It’s hard to follow a 15 page cleaning handbook when you have dogs, kids, and soccer practices to deal with. Let’s simplify things:
Keep your pet safe through routine veterinary care and vaccination.
Keep your environment safe with regular cleaning and disinfecting.
Dogs are messy. They get into messes and spread messes and sometimes that includes bacteria and viruses. Gross. The good news is, you don’t need a closet full of specialized Doggie Cleaning Solutions and Fido Wipes to keep the bugs at bay. All you need is ten minutes of your time and an item you probably already have in your house (just like the one in the photo, which was in my laundry room long before I started this campaign!)
There’s a reason animal shelters and humane societies across the country list bleach as one of their top wishlist items: It works, on everything from nasty bacteria like Salmonella and E.coli to the dreaded viral disease canine parvo. It’s inexpensive. It’s easy:
10 Minutes To a Safer Home
Did you know that a study by NSF International showed pet bowls and toys were in the top ten most germy items in the house– worse than toilet bowls and cutting boards? If you have pets, you can use Clorox® Regular-Bleach1 at home to sanitize their crates, pet bowls and toys.
Disinfect hard non-porous surfaces and accessories with a solution of 1/2 cup product in 1 gallon of water. For pre-wash surfaces, soak or wipe with bleach solution. Allow solution to contact surface for at least 10 minutes. Rinse well and air dry.
To sanitize pet food containers, wash bowls with detergent and rinse. Fill bowls with a solution of 2 tsp of Clorox®Regular Bleach1 per gallon of water. Let stand 2 minutes, drain and air dry.
That’s sarcasm, by the way. Cancer sucks, I hate cancer, cancer can go suck it.
When you have a dog, but especially when you have a dog who is a breed with a 50% occurrence of cancer in their lifetime, you learn to be vigilant. And by vigilant I mean you pick over your dog like a chimpanzee searching out ticks, and with good reason. So far, as you know, I’ve lost one dog to lymphoma, one to probable melanoma, and Brody’s had the following removed:
low grade melanoma on his lip (so far, so good)
medium grade mast cell tumor resulting in loss of ear
I’m a big fan of Sue Ettinger’s See Something Do Something initiative, and with good reason. Small masses are exponentially easier to deal with than large ones, for many reasons. It’s a gift to be able to catch things early.
So it was with a resigned trepidation that I noticed, buried in the vast recesses of Brody’s voluminous tail, yet another weird looking mass:
I don’t like masses. They make me scream like I’ve seen a spider over the bed.
We went and visited Highlands Ranch Animal Hospital to get it checked out yesterday, where Brody was his usual charming self. By the time we left he had the entire waiting area sitting on the floor petting him. Such a ham.
The great thing about aspirating little masses is that, while not totally diagnostic, can often give you a good feel for what you’re dealing with. In this case, no mast cells were noted. Why does this make me happy? Because he would probably have had to lose his tail and that would really really stink. The dog’s got to keep some of his parts, right?
The mass is coming off while it’s small enough to fully remove and still be able to close the skin over his tail. We are also going to send it in for pathology, which is essential for determining whether it’s something you need to follow up on. I’ll keep you posted.
I share all this in the hopes you too take a moment to go over your pet and check out the lumps and bumps while they’re teeny. It’s worth it! This is how we keep our pets around till they’re old and grey.
While a local news station was out at a park reporting on the death of a bulldog from heat stroke the day before, they came across another dog who was very close to heat exhaustion, if not stroke. This is despite the warning signs at the park entrance.
Though you’d think people would get it by now, some people really don’t. To make matters worse, the reporter spent time talking to the ranger about the dog’s condition and showing them pouring water on him while neglecting to mention the number one thing they should have been doing: calling a veterinary ER. Once the clinical signs kick in, they can be very difficult to reverse without aggressive care and time is of the essence.
Once you’ve seen a dog die of heat stroke, you get really agro about this stuff. It’s horrible. You have my permission to lecture strangers if they’re doing something dangerous like walking their pug on a desert trail in 100 degree weather with no water. It happens every day. I hereby appoint you all members of the Heat Stroke Patrol. Feel free to share the infographic as you see fit.
If I had a nickel for every time a person said, “Oh, my dog isn’t hurting, I can tell because he doesn’t cry” I would have a nice little nest egg by now. It makes me nuts, because it’s not true, and pets suffer for it.
Maybe people will take it better from this older, distinguished-looking actor in a lab coat.
Have you ever been sore, or had a headache, or tweaked your knee? Did you cry every time you moved? Probably not. Acute pain, the type you get when you stub your toe on the doorjamb or slice your finger cutting lemons, is sharp enough that you might cry out “Oh !@$@$!# that hurts!” And the people around you react with sympathy and bandaids.
But chronic pain, that dull, throbbing, always-there ache of osteoarthritis or bulging discs, doesn’t usually manifest with vocalizations. If you’ve ever spent time walking around a senior citizen center, you’ll notice two things:
they walk very slowly, probably because many of them are nursing sore bodies;
they don’t spend a lot of time screaming.
So what does pain look like?
The descriptors people most commonly give for a pet in pain are not ‘loud’ but this: tired, mopey, crabby, tired, ‘old’, cranky, fine.
Dogs with rotting teeth are in pain. They may not yelp when they eat, but they sure do eat less, or eat slowly. Most people don’t even notice this until after the problem is fixed, when all of a sudden their pet has a voracious appetite.
Cats with arthritis in their spine are in pain. They may not yelp when they walk around, but they move gingerly. When their pain is treated, they start jumping back on counters again.
pets manifest pain through behavior, not noise. Some pets don’t manifest it at all.
The rule of thumb for pain management specialists is Assume Pain, meaning, if a pet is likely to have a painful condition, go ahead and treat for it even if they aren’t obviously in pain.
If you’re a veterinary professional, stop making pain medications optional for painful procedures. That implies pain control isn’t just as vital as every other aspect of your medical management.
Dogs in pain do not act like an Excedrin commercial
The safety issue: Which is worse? Pain meds or pain itself?
Now that we are all in agreement that painful conditions are often underdiagnosed, we come to the next problem: many people are under the mistaken belief that most pain medications are so dangerous it’s better not to try them at all. Veterinary NSAIDs, the most commonly prescribed class of pain medications, are also the most indicted as a Bad Thing.
Yes, NSAIDs can have side effects. All drugs do. Some of them are severe. It is incumbent on veterinarians to ensure owners are aware of that potential and educate owners as to safe administration. They are not an appropriate choice for all pets. However, this can be mitigated:
If owners are aware of the potential side effects and discontinue the medication if any symptoms arise, the chances of long term problems are usually minimal. In my own experience, the vast majority of patients have an excellent experience with NSAIDs* when given as directed. Most of the adverse events are related to people who either wait too long to report side effects, give more than the prescribed dosage, or refuse the recommended monitoring. In other words, most are avoidable.
There are other drugs out there besides NSAIDs. Tramadol, gabapentin, Adequan, just to name a few. We can also use adjunct treatments like acupuncture, laser, and physical therapy. The more combining of medications you do across categories, the less you need of any one and the better the overall pain control. This is called multimodal pain management, and it’s the best way to deal with chronic pain.
Those cheaper, OTC remedies you read about on the internet (aspirin, Advil, Tylenol)- you know, the ‘good old days’ approach- are not only less effective, but more dangerous. The worst pain medication reactions I’ve treated have all been to OTC human meds. And a reminder: one teeny Tylenol will kill your cat.
When it comes to the pain of joint disease, the best treatment/prevention is free: keep your pet at a healthy weight.
Educated owners make good decisions. We all want that.
Pain can be managed, even in very senior and frail patients. And yes, even in cats. We just need to acknowledge that it’s there first. Don’t wait for your pet to tell you- he can’t talk, but we can see it nonetheless.
*This message has not been brought to you by a sponsored shill.
If you know and love reddit already, here’s the short short version:
Tomorrow (8/11/15) I will be on Reddit doing an AMA from 2-5 PST (5-8 EST) on /r/books. I’d love for you to join me!
If you don’t know reddit, you might need a more involved primer:
What is reddit?
Reddit is a website where people talk about, well, just about everything. Some people talk about football. Some people talk about cars. Others talk about knitting, politics, cat videos, just about anything under the sun.
As a massive catchall, it can understandably be very confusing to navigate. To help organize things, reddit is organized into topical categories, called subreddits. Some of them include:
I point this out because reddit sometimes usually is getting attention for bad things really annoying people do, and that scares some people off. Those people are on reddit as well, but if you stick to the subreddits where there are decent people talking about things you enjoy, you can avoid the purulent underbelly of gangrenous misogyny that makes some people nervous to check the site out.
What is an AMA?
One of Reddit’s claims to fame is their “Ask Me Anything” posts, where people from all walks of life go on to discuss their work, or experiences, or latest projects. Sometimes it’s an airplane pilot talking about their job. Sometimes it’s Woody Harrelson, or perhaps Elizabeth Warren. Sometimes it’s some guy who lost a leg in a tragic crocodile incident.
In the books subreddit, they limit their AMAs to authors, and this is what I’ll be doing tomorrow.
This is an opportunity for anyone to ask me about the book, the writing process, my dog’s cancer, veterinary medicine, what type of wine I prefer, my shoe size, literally anything. (That doesn’t mean I have to answer, if anyone was wondering whether I would answer what my weight is. No.)
Step Two. Come on to reddit.com/r/books between 2-6 PM PST Tuesday and find the thread (I’ll link it here too.)
Now here is how you do things on reddit. Let’s use this example of a post discussing an adorable baby bunny photo:
The post at the top is the topic everyone is discussing. Here it is a baby bunny; on Tuesday mine will be a description of the book. My username there, selected many years ago, is dogrelish. Get it? Because I relish dogs 🙂
The box underneath is where you add your comment/question. After you do that, hit “save” to submit the question. (ie Hey Dr V, do you still own the Jimmy Poos? etc)
If someone else has a comment you want to respond to, you do so by clicking “reply”
See those little up/down arrows? Reddit thrives on these. Clicking the “up” arrow means more people will see my thread. Clicking the “down” arrow buries it further down in the bowels of the internet. Use the arrows. 🙂 They help!
It’s been a while since I’ve done a Pet Doctor Barbie post. It’s past due for a new episode, yes? I think it’s time for Pet Doctor Barbie to meet one of her self-appointed arch nemeses, Pet Food Dude.
Hi Mrs. Sandford, good to see you and Muffin. It’s been a while!
I’m really glad you’re doing housecalls now. I want to get Muffin’s bump looked at again.
OK, I’ll just look at my notes here- 1 cm, top of head…mm hmmm… So where we left it one year ago was that you were going to go talk to your husband and then we were going to aspirate it.
Oh….yes. It’s grown quite a bit since then. We really need –
Yes, I wanted to talk to you about that. I’m a bit upset that you didn’t mention last time how his kibble might have caused this.
We don’t really understand why cancer occurs, Mrs. Sandford. The important thing now is to take care of this mass. I’d hate for you to blame yourself because of your food selection.
I don’t blame myself. I blame you. How much do you make from Big Pet Food anyway?
Actually nothing. But aren’t you feeding a boutique brand anyway? You told me last time you were feeding…let me check…organic grain free non-GMO preservative free all natural Wolf Chunks.
Yes, and you told me to stop and to go back to that one full of corn and despair!
Actually, no, I said Wolf Chunks were fine if that’s what you wanted. But about that mass…
I’ve been using turmeric on the advice of Pet Food Dude. Do you know Pet Food Dude? Can I borrow your computer? This guy knows all your tricks.
Sure, have at it. May I ask what tricks you are referring to?
Vaccines. Pet food. You know. Poison. They are full of free radicals that are overpowering the antioxidants and preventing cellular apoptosis no matter how many carrots I add.
Here’s his site. He knows your medicine is a lie and you’re really just after our money.
I’m going to log on and see what the forums say about your “cancer just happens” line. Oh wait….shoot. My membership is expired. Can you hand me my wallet?
Oh, I think I’ve seen his site. Is he the one who sells supplements and seminars on dog juicing?
Yes! He’s a pioneer. OK, credit card updated, I’m in.
OK, here we go: Have I at any point in the past fed kibble from Big Pet Food or gotten Muffin vaccinated? Yes, 10 years ago. So they say here that this is why he has cancer and it isn’t responding to the turmeric. They also said you would say exactly what you said about it not being their fault, and not to fall for it. What do you have to say to THAT?
Mrs. Sandford, I need to level with you here.
It really doesn’t matter to me what you’re feeding Muffin. I am glad you care about him and want to do what’s best for him. I do too! I promise! I’m having a really hard time talking to you when you’re typing at someone who is convinced I’m out to hurt you both. Right now I am just really worried about the size of this mass on his head. I think we need to get him in for a full evaluation ASAP.
*tap tap* I’ll think about it. I haven’t tried coconut oil yet.
May I ask why you even had me come out?
I just wanted this all on DropCam- see it over there? It’ll be on Pet Food Dude’s YouTube tonight. He’s doing a “Vets Revealed” bit. Well, since you didn’t do anything I’m sure you aren’t expecting payment. You can see yourself out.
As a veterinarian, I’ve seen lots of cancers: lymphoma. Melanoma. Osteosarcoma. Hemangiosarcoma. Mast cell tumors. Wait, those are just my own dogs I’m talking about. When I factor in my clients, I think I’ve seen it all.
Dogs get cancer, at very high rates: about 50% of senior dogs die of it, if the statistics are to be believed. Why? Well, if you read overly simplified, graphics-intensive websites by people who really don’t know what they’re talking about, they will tell you that they know why cancer happens: GMOs. Preservatives. Kibble. Microwaves.
I wish it were that simple. It’s not. And the reason that line of thought drives me nuts is that it has sent so many lovely people into spirals of depression when their dog dies and someone on the internet convinced them it was their fault because they, the owner, did something terrible like feed their dog kibble or use a plastic bowl. People end up in therapy because of things like this.
Cancer is not a singular diagnosis; the type and breath of neoplastic disease means there’s often little resemblance from case to case; a transmissible venereal tumor bears very little resemblance to a splenic hemangiosarcoma. If we could pinpoint cancer to one cause, we’d all be rich. And yet, with all this secret knowledge, overall cancer rates aren’t budging.
Because I love a breed known for having one of the highest rates of cancer (is it the fact that Golden Retriever owners feed worse food overall? Or is it genetics?) I watch Brody pretty closely. Knowing that 60% of Goldens get cancer in their lifetime, I spend a lot of time inspecting him for lumps. As we speak, the largest observational study of its kind is currently underway to help us better understand what’s going on. In the meantime, you do the best you can but truthfully, there’s not a whole lot of ability to predict and prevent cancer. Even for the people who home cook organic food (sorry. Do it because you want to, not because it will make your dog live forever.)
You can save money (and life expectancy) by doing some simple things:
Knowing he is an at-risk breed, I do what I can to try and keep Brody healthy. When he gained too much weight on his food, I got the weight off. Obesity is thought to be a risk factor for cancer. Just as importantly, I get his bumps evaluated and when I find one, I don’t mess around.
The dog eats like a king; I give him the good stuff because I care about quality ingredients, though not enough to condemn people who can’t afford it. But even with his high end diets, at age 6, he’s on his second cancer. The first one, a melanoma, was excised two years ago and has yet to recur- because we caught it early. And now we have this: a little teeny ear lump.
I thought it was no big deal, but I got it evaluated anyway. See? We vets do it too. A lump is a lump is a lump. Until you get it microscopically evaluated, you just don’t know. I just got the call last week: it’s a mast cell tumor.
I’m thrilled we got this diagnosis
Am I thrilled Brody has a mast cell tumor? Of course not. They stink. Despite the fact that the visible mass is only half a centimeter, this type of tumor has tons of microscopic disease and is notorious for requiring huge surgical margins for a complete excision. For that little tiny tic-tac mass on his ear, he is very likely going to need to lose his entire pinna. (I’m getting a surgical consult this week.)
However, losing an ear is minor compared to where these things end up when people wait. You can lose an ear, but you can’t lose an entire head, for example. This is small beans compared to what lots of pets need to go through later in the game when masses grow. If we get a complete excision, this should be a closed case. And guess what? It’s so much cheaper than tons of radiation and chemo and massive surgeries. Win-win for the dog and your wallet. I’m not happy he has it, but I’m happy I know now, early.
Why wait? Aspirate that shizz!!
What one thing can you do to guarantee your pet won’t get cancer? There isn’t one.
What you can do is maximize their chances of survival and recovery: Don’t mess around. Dr. Sue Ettinger, veterinary oncologist and all-around brilliant person, has an initiative called Why Wait Aspirate that is as simple as can be: when a vet tells you that a lump is ok to “just watch”, what does that mean? When do you do more than watch it? Here’s Dr. Sue’s guidelines*:
ASPIRATE OR BIOPSY IT!
Easy peasy, no pun intended. Of all the things you can do to help your pet live long and live healthy, none matters more than early detection.
*Photo Credits: Calendar by Michael Hyde, Flickr Creative Commons license; Peas by Isabel Eyre, Flickr Creative Commons License
I am becoming increasingly convinced the communication gap between veterinarians and clients is the number one problem we’ve failed to solve. We’re just not on the same page a lot of the time, it seems, and it makes me sad. I can’t read a single article online without coming across “veterinarians are money grubbing pigs that suck” (true blog title) and someone else saying “if you can’t afford x/y/z/q you shouldn’t have gotten a pet, jerk.” I feel as though this is perhaps a bit extreme, but it’s what happens when we don’t work together to identify our goals.
Common Fallacies of Bad Client Interactions
(In just as many cases, the vet on the left is an associate up to his or her ears in student debt and just trying to make it through the day without getting yelled at one more time, and the client on the right is a stressed out single parent who just spent a grand fixing her car.)
Much of this angst comes from the pervasive assumption that in all cases we will do everything we can medically, no matter what, which was fine a while back when “everything” meant “antibiotics” but as veterinary medicine has advanced, has come to mean “MRI, spinal tap, radiation.”
This assumption, of course, carries over from human medicine: if you’ve got the insurance, you’re getting the treatment. Everyone’s happy, right? Right?
Not so much. Satisfaction with a medical course of action relies on multiple factors.
Sometimes getting to “Everyone Happy” (Square B) is impossible. D’s not so bad either, but A and C are no-fly zones.
Human Medicine Satisfaction
I would argue that satisfaction with outcomes is directly correlated to the balance between the amount of treatment pursued, and its benefit.
So really, the goal here isn’t to push everyone towards the far extremes of treatment; it’s about getting to that center line of balance. In human medicine this change is slowly creaking along with things like hospice care, which moves people from C to D in low treatment benefit situations, and increased access to insurance coverage, which moves you from A to B in high benefit situations. With Mom, we were squarely in the D category, and while we’re not HAPPY, it’s a hell of a lot better than if we had treated her to death.
So how does this apply to veterinary medicine? It’s similar, except we tend to find ourselves walking a line most strongly related to finances.
Now, since we have no ability to magically divine which people are up for specialty treatment and which people are not, we always offer all the options to clients- as we should. There are people who spend thousands, lose their pet, and are still ok with the outcome- but they were also very clear on the risks and made an informed decision. Many clients, it seems, feel as if they are not.
So what do we do to improve outcomes? In my experience, the best way to move the dial from A to B is pet insurance, at least for emergency situations. There are few situations more likely to prompt a Facebook mob than a pet who died a preventable death because the owner couldn’t afford treatment and the ER vet wouldn’t do the treatment for free- nor should they. Owners need to shoulder some of the responsibility here of financial preparation, and if they refuse to take even basic steps to be prepared, maybe they really are a crappy client.
And conversely, moving the dial from C to D involves good veterinary communication, and a willingness to understand that lots of factors go into the decision about whether or not to seek treatment. If a veterinarian talks a senior on a fixed income into a kidney transplant for a 15 year old cat in renal failure, after she expressed concern about paying her rent for the month and her own upcoming surgery- maybe they really are a money grubbing vet.
But I like to give everyone the benefit of the doubt. Clients and vets both have work to do here. And I believe with all of my heart that the better we get about empowering clients to make informed decisions, the more that will carry over into human medicine- which is a wonderful thing.
I realize this is a vastly oversimplified explanation of some really complicated issues, but hey, we have to start somewhere. Whatever it is we’re doing now sure doesn’t seem to be working too well.
Perhaps you are the magnanimous sort. “Dr. V,” you say, “I ordered the book but I don’t need the free Halo or Sleepypodstuff or PetHub tag or Dog + Bone collars or Groom Genie or any of those items you are giving away, not even the awesome little activity book with coloring pages and a word search featuring ANALGLANDS and DEMODEX.” You are an ascetic. You don’t have a pet. You’re decluttering. OK, I get that.
But surely you aren’t opposed to a donation in your name, right? I have a treat for you.
Newflands is a New Zealand company, started by a veterinary nurse (don’t give me a hard time, that is what they are called in New Zealand) who was looking for an ethically sourced, sustainable brand of fish oil for her dogs. With none to be found, Fiona started her own brand, and Newflands Hoki Oil was born.
We all know that fish oil is a well-utilized and effective essential fatty acid supplement, with a high ratio of omega 3 to omega 6 fatty acids. Hoki is a fish native to the waters off the coast of New Zealand, but starting this summer it will be available in the United States through Newflands.
Newflands founder Fiona Robertson wanted to support my book campaign with a donation that would also give back to the community, so she suggested a donation of Hoki oil products to a US Charity. We selected Vets’ Pets, a program run by Angels for Animal Rights NYC helping veterans with low cost pet food, supplies, medicine, and deployment support. For every preorder Charity Treat, Newflands will donate a bottle of Hoki Oil to Vets’ Pets to support this wonderful program.
See? Win-win. A book for you, a donation for them. What could be easier?
A few weeks ago, while my publicist was asking online dog lovers if they might be interested in reviewing my book, he came back with a question:
“Do you recommend Science Diet or raw?” he asked.
“It’s really not an either/or thing,” I said. “The book doesn’t talk about nutrition at all.”
“Well, one of the people we approached said they only write about things from a raw food perspective,” he said.
“Oh, then they don’t want my book,” I said. “It’s just from a dog lover’s perspective.” And that was that. Because here’s the truth, which is going to probably cause a few people’s heads to explode: when it comes to my belief about the omnipotent power of food, I’m an agnawstic.
This belief started, as many things do, with my own experiences with food evangelism: Atkins, paleo, etc, wash, repeat. For one brief, terrifying month my husband dropped down the rabbit hole known as “extreme diets.” Now, I can’t blame him for trying- I’ve tried them too over the years, but he’s never been on board. After years of ignoring my attempts at zoodles, banana “ice cream” and other current food trends on the paleo circuit, he announced one day he was “going keto.”
“What does that mean?” I asked.
“Less that 20 net grams of carbs a day,” he said. “I heard it’s great for detoxing.”
“Did you find this on reddit?” I asked. He didn’t answer.
For the next 30 days, I learned what it is like for someone to be discovering enlightenment. He would follow the kids around the house asking them if they had any idea how much sugar was in their ketchup, pouring verboten salad dressings down the drain, and meaningfully wait until we were all in the room at the same time before turning on “Food Inc” on Netflix.
He preached fire and sugarstone, swallowing almonds with one hand while tossing pretzels in the trash with the other. He was flush with the light, or maybe just a little zany from ketotic acidosis, who knows. He says he felt great. He was online talking to people who gave up dairy, sugar, alcohol, gluten, fruit, potatoes, and on life in general and were now convinced their nuts were causing inflammation when he finally broke and had a fudgesicle. Now we are living a life of moderation together, and it is wonderful.
Now, don’t get me wrong. I think the idea of knowing what you are eating, and preparing it yourself, is a mighty fine thing. I try to avoid bread and pasta and sugar in favor of veggies, water instead of soda, but the last two months it was ALL CHOCOLATE AND CHEESE AND WINE and I didn’t feel bad about it at all. I have permission to meander in my choices. Good nutrition matters, but it isn’t the only thing that matters.
Life is balance, right? I eat well mostly and exercise a lot and don’t smoke and try to get enough sleep. Know who else did that? My mom. All my grandparents lived to 90 and she got brain cancer when she was 67 and she did everything right. It doesn’t mean I’m going to start lighting up. The CFO of Rady Children’s Hospital was killed a mile from my house during my mother’s memorial service while he was out riding his bicycle, being healthy. Sometimes shizz happens, and while diet matters, it’s no more a guard against bad luck than any of those other multitude of things in your life like genetics and a careless woman in a Range Rover.
Which brings me to what I refer to as “blog chum,” the words I always hesitate to type lest it attract a group of angry club wielding acolytes the way blood draws a Great White: Dog Food. I don’t care what you do with it. There. I said it.
You can feed a crappy kibble and your dog might live to 20 or he might look like he got run through a wood chopper.
You can feed a high quality kibble and your dog might live to 20 or he might get cancer when he’s 2.
You can feed raw poorly done and your dog might live to 20 or he might look like Casper when he’s 4 months old because he got nutritional hyperparathyroidism.
You can feed raw that someone balanced for you and your dog might live to 20 or he might get kidney failure when he’s 7.
That’s the way it works. Food is one piece of a really complicated puzzle, and anyone who tells you otherwise is selling something. (Probably dog food, magazines, or coconut oil.)
Now clearly, my education (paid for without the aid of Big Pet Food, by the by) and my experience lead me to recommend that with which I am familiar- that would be commercial dog food- but if you want to feed your dog raw and you swear it’s the most amazeballs choice ever and your dog is the healthiest dog who ever walked the face of the earth, go forth and be happy, because I really don’t have the energy to fight over any of the following:
who taught me
who bought me
who sends me places
how much I make off selling food
If you want my opinion, I’ll give it, and I think it’s an educated one. I’ll listen to what you have to say, though I may not agree. If you have decided that my views on that one topic mean my years of experience and knowledge about all things animal health related are bunk, well, we might as well enjoy a lively discussion about the upcoming primaries while we’re at it because might as well go out with a bang.
And then I will go make a healthy chicken salad and wash it down with a glass of wine, because that’s what agnawstics do.
A year ago, my husband gave me a telephone number and said his insurance company now had phone consults available. 24/7, from the privacy of my own home, I could call in and get “seen” for ear infections, get a prescription for Ambien for travel, even get marriage counseling, should I desire it. I only used it once, but I was amazed that at 10 pm I could just call and talk to some random person and 15 minutes later pick up a prescription at the 24/7 Rite-Aid. I’m not going to lie, I think it was pretty cool.
For the past five years, I have said the same thing over and over to people in the veterinary profession: telemedicine is coming. How are we going to handle it? And over and over the response has been the same: no it’s not. This is only half true: it’s not coming from inside the vet profession.
But it is coming, as this piece from dvm360 goes into. And not just Vet on Demand. I’ve been approached about 10 times in the past year to sign up to be a telemedicine/internet consultation vet, and I always say the same thing: I am bound by my state practice act’s definition of valid client-patient relationship, which says that I must examine an animal in person to establish that. Anything outside of that and I’m breaking the practice act, which is why my FAQs are so clear on the topic.
Veterinarians make excellent points as to why telemedicine for us differs so much from telemedicine for people:
Doctors get a lot more out of history than we do. People can describe symptoms they are experiencing; pets cannot say, “I have chest pain radiating down my arm”. Veterinarians rely much more heavily on physical examinations.
Human medicine is incentivized to keep people out of the clinic to keep costs down, since general practitioners are already in short demand. Vets aren’t that slammed. Come on in.
And while we are perfectly content to say “This is a terrible idea,” others are not, and are trying to reap the benefits of it. People with background in restaurateurism see a chance to make a few bucks and throw an app together, paying a vet some pittance like $5 to put their license on the line. Why not? They don’t have anything to lose. They get around it by saying things like, “oh, we’re offering general advice, not specific diagnoses,” or take the old Miss Cleo approach:
For entertainment purposes only. Riiiiight.
This is from the VetonDemand website. I dunno guys, sure sounds like diagnosing to me. (By the way, my favorite saying is a lump is a lump is a lump. No biopsy, no diagnosis, unless the lump was a tick or a piece of sticky kibble.) That’s wasted $$ right there.
To sum up: individual veterinarians are bound by their state practice acts in terms of whether or not diagnosing over the net is legal, and it’s all over the place in terms of who can do what. This is reason enough for people to fold their hands together and say, “See, it’s not going to work.” I disagree.
My husband called the human telemedicine line to ask about a cough, and they refused him antibiotics and told him to get a chest x-ray. They were clear in their limitations. I think there are opportunities for veterinarians to use telemedicine to our advantage in responsible ways:
consults for pre-existing clients
Online ER consultations in coordination with local clinics for things like post-op questions: “My pet’s incision looks puffy, can it wait or should I come in?”
With clearly defined limitations and expectations, it has its place. Truth is, most of the time the answer is, “It could be x, y, z…you should be seen,” but that’s still better than what I see happening now.
I don’t have all the answers, certainly, but I think it’s a huge mistake and a missed opportunity for the veterinary profession to not take this on proactively. It’s not a matter of if, it’s when, and if we pass up our ability to drive the bus then two restaurant entrepreneurs from Nashville are going to take the wheel instead, and we probably won’t like where they take us.
I love technology. I think we can use it, we just need to be a little creative and stop digging in our heels like those old guys who still- STILL- insist on fax over email for sending records over. Give up, man, the world is moving on.
What do you think? Would you use a service like this if you could?