Health

The Truth About Pet Food Research

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:

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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.

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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?

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Given who’s around right now, who could interpret the limited data we have through the filter of what matters?

A microbiologist with a background in food safety would be a good start, as someone who can tell you whether or not particular pathogens are actually of concern.

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?

  1. melamine
  2. pathogens of most dire human significance, specifically Salmonella and Campylobacter
  3. 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!

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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.

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Filed: Ask Dr. V, Blog, Daily Life, Featured Posts, Health, Musings Tagged: , ,

How to find your Special Snowflake Vet

“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.”

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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.

We’ve all had those “what are you smoking?” moments.

 

Clinic Dating

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.

tinder

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.
frustration

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.”

fatherwilliam

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.” 

Filed: Blog, Featured Posts, Health, Musings Tagged: , ,

What Your Natural Health Magazine Doesn’t Want You To Know

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.

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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.

chaos

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?


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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.”

evil vet

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:

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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.

help

(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.

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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.

Filed: Blog, Cats, Dogs, Featured Posts, Health, Musings Tagged: , , ,

The Twelve Days of Clinics

I miss singing the 12 days of Christmas with you all, so I’m working through the 12 days of Clinics from a clinic perspective. Feel free to toss me ideas- we have 12 days to work through after all.

Shall we begin?

 

On the first day of Christmas, my true love gave to me:

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Tinsel never looked so sinister.

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Filed: 12 Days of Petmas, Blog, Health Tagged: ,

Rumble in the Doghouse: Evil Breeders vs Crazy Animal Rights People

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.)

Politicians Before and After Elections(1)

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)

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?

Best-In-Show-Best-In-Show-001

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.

Who’s right?

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.

Instead, I talked to someone from the American Kennel Club and the ASPCA, and guess what? They said the exact same thing:

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.

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.

judging

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.

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

The midwife at the end of life

Like many of you, I’ve been mesmerized by the bravery of Brittany Maynard, a 29 year old woman who is dying of Stage IV brain cancer. After hearing the course of the disease progression from her doctors and considering what the end of her days were likely to be like, she made the incredibly difficult decision to move to Oregon, one of a handful of states in which assisted suicide is legal, and choose the day and manner in which she will die.

brittany

 

While her story is compelling and awful, it is not so surprising a concept. For veterinarians, taking part in these sorts of heavy decisions is an everyday occurrence, and to the Maynard family I say: I am so glad you have the ability to make that choice.

As I travel to Indianapolis for the annual meeting of the International Association of Animal Hospice and Palliative Care (the mouthful acronym of IAAHPC), I find myself struck by the two most common things clients say to me when I come to their home to euthanize a sick pet:

  1. This must be so hard.
  2. I wish we had this for people.

Though we all wish for ourselves, and our pets, to die peacefully and unaware in our sleep, the truth is, that doesn’t always happen. Sometimes death is peaceful, but sometimes it is horrible and painful and agonizing and drawn-out. To say that is a fate worse than death is not a metaphor in this case. Death can be a relief. We don’t always get to choose the way in which we die, but when we know it is coming and it is going to be unpleasant, I am very grateful this is an option we have for our pets, and for some people.

I suppose in many ways veterinarians are leading the charge in normalizing people’s attitudes about this possibility, right in there with hospice workers and other professionals who deal with these realities. None of us probably gave that much thought when we signed the dotted line on vet school admission forms, but it’s there nonetheless.

There is a small but important distinction I wish more people made when talking about Brittany’s situation: they say, “She is choosing to die.”

This is not true. She wants very much to live. She has no choice in the matter. She is dying.

The accurate statement is, “She is choosing how to die,” and that is a vital distinction. I’ve seen differing views on this, people who genuinely believe that there is beauty in every moment of life, even in suffering an agonizing death with a ravaged body, and to that I simply say: I respect your view on it and your right to choose that end. I also respect those who choose as Brittany is doing, and I find beauty in that as well.

There are limits, of course. I do not show up at people’s homes and simply provide euthanasia on demand for pets who do not have a terminal disease. For my own emotional well-being I have very specific requirements and lines I do not cross. There are situations (such as a dangerously aggressive pet) where the lines about what is ethically acceptable are fuzzy, but my personal limits are not. I feel very proud and honored to be able to do what I do.

This is how I continue to do this every day: by reminding myself and the grieving owners that we are not killing a pet; the disease is killing him or her. We are simply aiding the process and making it more comfortable. I wish for the Maynards the same I do for my patients: comfort, peace, as much as can be gathered in a stressful situation.

I am the midwife at the end of life.

And I am OK with that.

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

Knuckle cracking real-time talk here.

This is not about Sophia Yin.

I feel the need to say that before launching into a discussion about suicide and depression in the animal community, because the horrible news that she took her own life and the ripples it is causing in the veterinary world is the reason I’m talking about it today. But it’s not about her or her situation, which none of us will ever really know; Dr. Yin’s legacy is the work she did during her life, and it should remain that way. This is not about one person.

Whenever a tragedy like this happens, I see the same posts over and over: “Shocking. Tragic. Hold your loved ones close and tell them you love them. If someone seems to be suffering ask if they are OK.” And so it goes for a day or two, as we hug our kids and our spouse and our dog and then go back to work and assiduously ignore the suffering of those around us. Not that we recognize it most of the time anyway, but I’ll get to that in a moment.

One of the biggest misconceptions people seem to have about stress, burnout, and depression is that it is inevitably obvious to those around the person. I blame Zoloft ads for making us think all depressed people walk around weeping with little clouds hanging over them.

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I think a lot of depressed people look like this:

positive-people

Totally fine, I’m fine, I’m fine.

You know how we always say cats walk around looking like a million bucks with BUN levels through the roof until one day, way past the point it was an issue, it’s finally too much but you never had a clue? A lot of depressed people look like that. So maybe this is a little more accurate:

flesh-wound

They do just fine at work, and out amongst friends, and then come home and realize man I am not fine. But we’ve normalized stress in our lives to the point many of us don’t even necessarily recognize the signs of depression in others, and even in ourselves. I sat on the floor of the bathroom for four hours straight one day, when I was suffering from postpartum depression, and still had no idea that sitting on the floor of the bathroom unable to muster the energy to move two feet might be a sign something was wrong (protip: it is).

I don’t like talking about that time in my life, but I will because every time we censor ourselves from discussing these things we perpetuate the stigma that drives people away from seeking treatment. We are more scared of the consequences of admitting depression than we are the consequences of not being treated, and oh my god, how awful is that? I’m pretty sure the mental health professional community has been watching us in horror for years, waiting for us as a profession to finally say yeah, we could probably use some assists here.

So while asking someone if they are ok and offering virtual hugs is lovely and kind, I really think the time has come to try and do something a little more impactful. Open dialogue is a good place to start. So let me share some things that I have discovered over time, watching us wring our hands in despair over and over while we wonder what we could have done differently:

1. You would not believe how many other people out there are going through the same thing.

People at the top of their field, with lovely families and good jobs and beautiful dogs. People who seem to have it all together. And maybe they do, if they have good treatment.

2. I wish someone had told me about these things in vet school.

I thought I was the only person plagued by worry and self-doubt in school. In retrospect, ha! That was really not the case. Nonetheless, a little peer-to-peer support or support from people already out there would have been very reassuring. I believe we need to start letting people know at the start of their career, not at the middle or end, that stress/anxiety/depression/burnout are common, but solvable problems.

3. There’s support, although it’s hard to find.

Do you know what the hardest part was for me about getting through my depression? Figuring out who to call. My OB didn’t help, the psychiatrists she gave me the numbers for didn’t take on new cases, I wasn’t actively suicidal, and by the fourth call I was too tired to deal with it any more. So I laid on the bathroom floor for a few more days until I had the lightbulb idea to call my primary care physician, who was horrified and got me in that afternoon and life got a lot better after that.

I feel like our profession is still in the same place. Help should be very visible and easy to access, a rope already floating in the water instead of a life preserver someone has to yell for when they are drowning. Want to really do something to make our profession better? Help me figure out how to make that happen.

So you think you’re depressed/ burned out/ feeling off? Take a deep breath, you are in good company. You do not stop being a successful professional and accomplished person. Life can be good and you can still rock out and kick ass and laugh till your cheeks hurt. Here’s some places to start:

1. There is active peer support, through VIN, and on Facebook. A closed group has been started on Facebook for people dealing with these issues as well as their family and friends- to request membership, click here. Peer support is fundamental, though of course it is not a substitute for-

2. Calling your primary care physician, who if they cannot handle it themselves can at least get you where you need to go. I guarantee you every mental health professional out there is going “uh, of course,” at every thing I have said because they are experienced in these things, while we are not.

3. Stop googling. Seriously, all you will do is come out blaming yourself for not juicing enough and while it is a lovely way to get vitamins, it’s probably not going to be enough. Talk to a pro, just like we tell people to stop treating their dog’s ear infections with diluted alcohol that they read about on a yahoo group and go to the vet. Right?

4. VetGirl has offered their excellent webinar about suicide awareness available for free, for everyone. It is well worth the watch not for anyone who works in the field to help increase your understanding of the issue. You can find it here.

5. VIN is offering a webinar this Sunday at 9 pm PST to honor Dr. Yin and discuss “Dealing With You and Your Colleagues’ Stress and Depression.” My understanding is that this webinar will be made available to non-VIN members as well, so stay tuned as I get more information. Both webinars, by the way, are taught by mental health professionals who know their stuff.

I will be honest and admit I hate overly sentimental statements accompanied by soft-focus ocean pictures like “fall into my arms and I will catch you” and “the world is full of hugs if you just ask for them” and all that other stuff, so I will offer you my own personal unfiltered thoughts on this:

Depression sucks, and it’s real, a physiological crap storm of neurotransmitters, and if you are reading this experiencing a dawning sense of dread with unasked-for tears rolling down your face as you desperately say nonononononono I’m fine, you might not be. So call someone who can help so you can stop feeling miserable, ok? Do it today.

hugs

OK maybe one overly sentimental picture. But just one, and only because kittens. And with that, I demand some good news so we can get back to our regularly scheduled program of fur removal device discussions and derpy dog pics.

Filed: Be The Change, Blog, Daily Life, Health, Musings, Picks of the Litter Tagged: , ,

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.

fotos-virus-ebola

 

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.

pills

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.

resistance

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.

 

myk

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.

020 0120 7141 023 0123 7173 Small is Beautiful Floor Black Still Life

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: , ,
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