Balancing the scales in medicine

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.

Make sense?

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.

The Veterinary Experience

There’s a whole lot of people in square C these days, who spent more than they really had on treatments they weren’t sure they wanted, because they felt like they had to, and when things go downhill as they often do with very ill pets, people can end up really, really disillusioned with the profession.

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.

The calm before the storm

Oh my goodness. One week from tomorrow and it’s going to be one of the most important days of my life: right up there with graduating, getting married, having my kids.

I will be an official published author. Aieeee!

I dreamed of this long before I thought about going to veterinary school, back when I was seven and I pulled every book off my shelf and artfully arranged them around the house playing bookstore ( Or was it library?)

When I sat under the kitchen counter reading National Geographic.

When I perched at the bus stop reading Piers Anthony, hoping today was the day the other kids at the bus stop would forget to throw spitwads at me.

To me, writing is transcendent: a waystation to another place or time where your life ceases to be front and center, if only for a moment. If you are fortunate and have chosen your book well, you return slightly better than when you left. If you are seeking respite when your choices are limited, books are a way to travel, to find camaraderie, to escape. Reading and writing are two sides of the same coin.

When I started writing, it was almost a compulsion, banging away at my dad’s IBM 5150 about unicorns or Weird Al or whatever it is that interests 10 year olds. It might have even been a story about Weird Al riding a unicorn, I don’t know. I printed the stories out on the dot matrix printer and presented them proudly to no one but my mother, who always said they were excellent even when they weren’t.

I thought we were tres sophisticated, since we didn’t use typewriters. After that, we progressed to Macs, which were even more amazing save one little blip:

These were the computers I used in high school when I was editor of the school paper, a job which taught me two things:

1. Writing can be tremendously powerful
2. I enjoy poking the badger (still do)

As the years have passed, the computers have gotten better but two things never changed: my desire to write and my mom’s support.

Authors are my heroes, and to be allowed into even the peripheral orbit is an honor I can’t describe. Well, I could, I guess, but you know what I mean. When I got the very first draft of my book, bound in blue construction paper and full of typos, my mother was frothing to read it and I said no, you have to wait until July 14th like everyone else.

Fortunately, I changed my mind.

She read it in a day and called to tell me all the things she thought about it, which were beautiful and joyful and redeeming. I am so glad my first review was from her. She told me once a few years back that she always wanted to write a book.

“About what?” I asked.

“Hobos,” she replied.

“Hobos?” I asked, completely confused.

“Yes, hobos, you know, the guys who rode the rails?” she asked.

“Any particular reason why?” I asked, since as far as I knew she had little experience with rail riding vagabonds from the Great Depression Era, though my Uncle Steve does come close.

“Nope,” she said.

And here I always thought I got my weirdness from Dad.

Nonetheless, it is her love of the word, the countless hours on her lap being read to and carted back and forth from the library, that comes to fruition next week. Obviously, I want the book to be successful because that’s the only way you get to write other books, and I already know what the titles will be because I am always dreaming and wishing and writing things in my head as I walk around.

I want it to do well, because I’m proud of it and I want others to enjoy it too. But even if that never happens, if this is as good as it gets on that front, I will never be prouder than I was the moment Mom teared up and told me how much she loved my book. And that, all by itself, is enough.

Charity Treat: Newflands Hoki Oil and AFARNYC

Perhaps you are the magnanimous sort. “Dr. V,” you say, “I ordered the book but I don’t need the free Halo or Sleepypod stuff 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?

How to Claim a Charity Treat 

1. Preorder 2 copies of All Dogs Go to Kevin (if you want them signed, get them from Warwicks)

2. Head over to the Treats Page and select “Shiny Happy Charity Treat”

3. Follow the instructions, including proof of purchase for 2 books

4. We’ll follow up in the coming weeks to confirm the order!

Bites for Books: Halo Pet Treat to Eat!

We are almost to the end of our treat selections and they are going fast! All you need to do is order 2 copies of the book and you get a treat- it’s like free goodies from heaven!

Today’s treat comes to you courtesy of Halo Pet Food, a long-time friend of the blog. They are ingredient-focused, with an emphasis on no chicken meal, by-product meal, or rendered meat.

You may be familiar with the brand as a highly philanthropic company, with their freekibble.com site donating hundreds of thousands of meals to pets in shelters. These things make me very happy.

As a thank you for those who preorder All Dogs Go to Kevin and choose the Treat to Eat, you will get a coupon for a free bag of Halo dog food up to $18 in value! One present for a friend and one present for your dog or cat. What beats that? (Sorry, couldn’t get a meet and greet with Ellen, but that would probably beat this. Barely. )

How to Claim a Treat to Eat 

1. Preorder 2 copies of All Dogs Go to Kevin (if you want them signed, get them from Warwicks)

2. Head over to the Treats Page and select “Treats to Eat”

3. Follow the instructions, including proof of purchase for 2 books

4. We’ll follow up in the coming weeks to confirm the order!

Grungy Dogs rejoice: Neat Treat Groom Genie and Paw Sponge are here!

When you live with a Golden, you get very accustomed to fur tumbleweeds skittering across the floor, wet footprints marking the tile, and a standing order for lint rollers. It just comes with the territory.

I’ve also become somewhat of a connoisseur of brushes; brushes for removing undercoats, for dematting, for general purpose grooming. So when I was sent an unassuming Groom Genie to test out, I figured, “here we go, another one for the grooming bin.” Then I tried it.

I don’t know what wizardry went into its construction, but this little brush is the bomb. Its handleless shape is meant to mimic you stroking your dog or cat, adding to its calming properties, but the real genius is in its bristles. Its bristles are different heights and have enough give so that it works by detangling without pulling. Brody leans into it and does that happy “hrrrmmm mmmmm hmmmm” groan when we pull it through his fur, even the long feathers that tend to get tangled.

My initial response was to run it through my daughter’s tangly hair, but before I could do that they also sent me a Knot Genie (the human version) to try out. My sister and I took turns grooming each other like ecstatic chimpanzees before declaring both of them the bees knees. It was the only brush that could detangle my mom’s hair without hurting her after 10 days of being unable to touch it due to her surgery, and for that alone I say, THIS ROCKS.

The Groom Genie is part one of the Neat Treat Package.

The Neat Treat is a Duo

The Paw Sponge is part two. Do you ever do that thing during rainy season where you have to cordon off the back door and tackle the dog, trying your best to wipe all the mud from between his toes with a dishtowel before he goes prancing over the carpet? Or those little wipes that only slick the mud around?

The Paw Sponge is an elegant solution: a mitten-like sponge that slips over the paw. Squeeze, twist, clean. I’ve also started recommending them for dogs with pododermatitis who need regular cleanings with diluted chlorhexidine or other medicated shampoos. This is one of those “Why didn’t anyone think of this sooner?” dog devices.

Between the Groom Genie and the Paw Sponge, the Neat Treat package will keep your pup looking his finest for all those summer parties. Yours FREE for all those generous All Dogs Go to Kevin preorders. 

The Neat Treats are limited quantity, and only available until July 14th- so if you want one, grab one fast!

How to Claim a Neat Treat

1. Preorder 2 copies of All Dogs Go to Kevin (if you want them signed, get them from Warwicks)

2. Head over to the Treats Page and select “Neat Treat”

3. Follow the instructions, including proof of purchase for 2 books

4. We’ll follow up in the coming weeks to confirm the order!

Abandoned Dog Fights for her Life

A desperate fight is on at an animal hospital in Fayetteville, North Carolina.  Dr. David Barkman at the Highland Animal Hospital has improved her status to “hopeful,” but she is no where near out of the woods just yet.

Someone apparently had left the dog, now dubbed Precious, for dead.  She had been found a few days ago by a couple passing by.  They said the dog had been locked in the crawlspace of an abandoned home.

She weighs less than 23 pounds.  Way under weight for a dog of her breed.

Dr. Barkman said, “We are hoping that we make it through, but we have got intestinal parasites, hookworms, heartworms, and positive for Lyme disease.  She has got a long way to go, but we are pulling for her.”

The next few days are critical for Precious, and even though the general prognosis seems grim at the moment, with some love and care, she can be brought back to her former self.  Hopefully then, a good forever home can be found for her.

As for now, a local rescue group are picking up the medical bills.  The final cost of care still isn’t fully known.  If you’d like to find out more, you can click here and go to the Highland Animal Hospital’s website.  If you’d like to see their Facebook page, click here.

How to Manage Seasonal Anxiety for your Dogs

Photo from barkbusters.com

Summer time can be a stressful time of the year for dogs.  Increased thunderstorms and fireworks can make for a rough time for your pet’s, especially with all the loud noises associated with both.  Thanks to Barkbusters, there are some things you can do to help.

Richard and Vicki Horowitz are the force behind Barkbusters.  They are all too familiar with how difficult it can be to keep a dog under control under these circumstances.  Dogs can exhibit behaviors like running and hiding, panicking and barking, and becoming destructive.

They attribute this seasonal fear with two things.  First, your dog can sense the change in the weather.  They pick up on the drop in barometric pressure, and often will detect a huge storm before it actually hits where you are.  This early warning system usually drives the animals affected by it to find shelter, but that’s something your dog already has.  For some reason, this is a big time stressor for most dogs.

The second thing it has to do with is sound.  Dogs and many other animals have an acute sense of hearing.  Sometimes, so much so that something like a clap of thunder, or an exploding firework becomes nothing short of terrifying.

So, what can be done to help your dog?  Well, here are a few suggestions the Horowitz’s have to help with storms:

• “Always keep proper identification securely fastened to your dog’s collar in case your dog gets out. Be sure to keep it up to date.”
• “Give your dog a safe place to stay during storms. Create a quiet den-like area where your dog can feel secure. A crate or kennel can be a calming refuge.”
• “If your dog lives outside, cover his doghouse or dog run with a blanket to shield him from the bursts of lightning.”
• “Dogs can pick up fear or discomfort with storms from their owners.  Let your dog stay close and try to distract him with activities like play or brushing. Do not try to reassure him in a sympathetic voice—this will sound like praise and may increase his nervousness and anxiety.”
• “Some dogs become destructive when frightened. A crate or confined area is always the best way to keep your dog safe and minimize any destructive behavior.”
• “During a storm, keep windows and curtains closed to reduce noise and bright flashes. Turn on a TV or radio playing soft music at normal volume to distract your dog and help him to relax.”
• “Keep your dog away from doors that lead outside. This will minimize the chance of your dog getting out should he look to escape.”
• “If your dog is very anxious, it may become incontinent. Be prepared and don’t react in a negative manner.”
• “Dogs that are fearful of thunderstorms may have to be reconditioned by creating an artificial storm using YouTube videos or storm sounds.”
• “In the most extreme cases, speak with your veterinarian about possible medication treatments to help your dog cope with his fear of storms.”

When it comes to the 4th of July and fireworks:

• “Many of the same suggestions we discussed for thunderstorms are also relevant when it comes to fireworks.  But there are some additional considerations.”
• “If you are going to the fireworks, leave your dog at home.  This is where he will be the safest and most comfortable.”
• “Never leave your dog in the car. A partially opened window does not supply sufficient fresh air for him to breathe, and it creates an opportunity for your pet to be stolen.”
• “If possible, stay with your pet during the majority of the fireworks. A dog often reacts more intensely to loud sounds and flashes of lights when you are not with him.”
• “Consider hiring a pet sitter to stay with your dog while you are away from home.”

Using these suggestions should make it much easier for your dog when faced with these very scary things.  Consistent practice will help foster your dog’s behavior, and provide good coping mechanisms that dogs can do without human intervention.  For more information, or to find out more about Barkbusters, you can click here.  There are a variety of topics covered, and great tips on helping you and your dog become even better friends!

Stock photo from barkbusters.com