No title today.

One of the quiet- but important- parts of what I consider to be my mission in this life is to not stand idly by while seeing the truth others "have spoken twisted by naves to make a trap for fools." As a result I often find myself responding to some article or loose expertise on subjects like health care, science and the like. I try to be diplomatic and informative, but honestly, there is a fair amount of anger and disdain involved. Probably, this is due to my understanding the limits of the system being criticized, as well as my repulsion to the idea that something with even less evidence than we already have could be considered of equal value or that something should be pushed onto the public based on a limited amount of actual science. This happens on all sides of a number of issues and it leaves me tired at night and frustrated a lot during the day.

My most recent tirade was this morning in regards to vaccination. My response to the idea that vaccines cause more harm than good is as follows: Smallpox. Diphtheria. Polio. Tetanus. Yellow Fever. Measles. Rinderpest. Rabies. Rubella. Brucellosis. Parvovirus. Distemper Virus. Panleukopenia Virus. Pertussis. These are all diseases that we in the developed world don't have to think about as much in our human or animal populations due in large part to successful vaccination programs. It's not without problems (you can apply that statement to the whole world, every program ever run and our own lives). Over-vaccination definitely occurs; it is rampant in my world. Vaccine reactions or adverse effects do occur: I've seen eight that required intervention in the roughly 15,000 vaccines I've administered. I've seen at least a dozen cases of vaccine-induced sarcomas as well. Vaccines aren't perfect but to remove one of the most valuable tools that human and animal health have experienced based on a few poor outcomes is to miss the point of medicine. Prevention is always the mission and to do that, we have to take a holistic approach and that has to include vaccines, it has to include filaricidal therapy in drinking water for river blindness and dracunculiasis , it has to include education about clean water and hygiene and it has to include access to a safe and healthy food supply.

I understand the concern: it is serious and it is personal when it happens to you or someone you love. I would never say that the system is perfect and that we don't need further investigation and robust criticism combined with regulation. However, I bristle at the notion that science isn't the best way to work out what we do and don't understand about the Universe and the best way to apply that understanding, however limited it may be. I am repulsed by the idea that- given everything we don't understand- someone would consider it appropriate to apply ideas, models or even treatments without putting them through the same rigorous (although admittedly not perfect) gauntlet that all of the other ideas, models and treatments must endure.

Most likely, this is the same way a quarterback feels on Monday morning watching the sports networks or our men and women in uniform feel when they listen to talking heads go one way or another about military intervention. I think Theodore Roosevelt put it best in his speech Citizenship in a Republic: "It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

My ultimate response is to encourage anyone willing to put themselves to task, earn the credentials to give yourself the opportunity to approach these issues with some credibility. Then choose to stand with or against me but until you've earned that right my response is the same, "Thanks for the input but I've got to get back to work."

Meatloaf, papaya and money.

I'm constantly trying to increase the number of people I reach with this blog and some of my other activities. If you enjoy reading A Vet's View please follow me on facebook where I'm posting much more often and I am often not as wordy!

The three title items are the only things I can say I don't like on a regular basis. I'm sure there are others but when ever people ask me to list things I don't like this is what comes to mind. I've written about this topic before but it is such a constant issue for me and my thoughts and position are constantly evolving so I am writing about it again. This is one of those mildly opinionated pieces so it's mostly in the first person because I can only really speak for myself.

It's not that I don't actually like money. I am an American after all: I love money, to a point. What I don't like is when money comes between me and a patient. Actually, that's not entirely true either. I don't like it when money comes between me and my client. A common misconception about veterinary medicine for the public and veterinarians alike is that veterinary medicine is about pets and not people. This is a service we provide to people for their pets. This is a people profession and I love people. I care about your pet, a lot. If you and I have been through an illness, injury or difficult visit chances are you already understand that. I care about your small furry family member and I am one hundred percent invested in what I do. I believe every veterinarian I've ever met feels the same way.

What I might fail to impress on people sometimes is how much I care about them. I love caring for your pets; I spend hours of my time gettting better at it and sharing as much of my time and knowledge as I can. As much as I care about your pet, I care about you more. The relationships we develop with people tend to last longer than most pets live, we are forging relationships with people that may carry through several pet lifetimes. While in some ways that is sad and a difficult thing to put into writing, in many more ways it is my favorite part of the job. I love people. I love being a part of your life. And that is why the money issue is such a frustration to me. When you are standing in my exam room with a pet for a wellness exam or with a sick pet who needs care, there are a lot of things that can and should be done and all of them will cost money. While I understand that for a few of us the finances don't matter, for the vast majority of us every dollar counts. That is true for my family as well. I live in the same world you live in.

I also understand that we will all look at the same thing from different angles. Many of us will put different values on the same service, product or experience. If I had an extra $200,000 I think a tourist trip to space would be well worth the experience; many people think that's stupid. We might both be right. I even have opinions about the value of certain procedures or products offered in veterinary medicine that differ from some of my colleagues. Again, we might all be right.

Here's where I think I lose people quite frequently with the money stuff. We all have predetermined ideas about what things are worth the expense and what things are not. My job is to offer you all of the options that are relevant to your pet's health to give you the best opportunity to make an informed decision. If I think to myself that you won't want to spend money on a treatment or test, and then choose not to offer it to you because I am afraid you'll say no or that you will get the impression that I am only after your money, then I have effectively removed your ability to make an informed decision. What seems even worse to me is that I have made a judgement about you in one way or another. If I decide that you would not be willing or able to spend money on a particular service I am making judgements, whether consciously or not, about your finances, your level of concern for your pet and how you value veterinary medicine. I would effectively be saying, "While some clients can or would afford this level of veterinary medicine for their pet, this client won't or can't." That's not fair. So my job is to offer the best medical advice I can to each and every client I see regardless of my personal beliefs or ideas.

The other important thing to remember is that I offer my professional opinion and medical advice. That's what you pay for and that's what you get, an opinion and advice. Another vet may read your situation completely differently and you might get a different opinion or different advice or both. Remember please that as a profession we veterinarians do care about the relationship we have with you the client; we are always willing to work with you to improve that relationship and the services we offer to you. Just please also remember that while it is our job to offer you every option we have, just because we offer something doesn't mean you have to take it. We make a recommendation and then do our best to work with you to find the best plan that fits your expectations, personal beliefs and lifestyle. The worst thing we could do for you is not let you make the choice by not giving you all of the options.

The Heavy Stuff

My job is inherently emotional. It goes without saying that when you are treating sick pets, things can (and often do) get intense in one direction or another. Sometimes the emotions run hot and we catch the blunt end of the anger stage of grieving. Sometimes emotions run in the sunny direction, often surprisingly. It will never cease to amaze me how frequently we get thank you cards and gifts from clients after their pet does not survive a serious illness or accident. Not that I expect them to be unhappy with us; we show up everyday- sometimes at night- and give one hundred percent of ourselves for one hundred percent of the time we are servicing our clients and their pets. This often includes stepping from one appointment with a seriously ill patient into a vaccine appointment with a new client and their puppy or kitten. That is the topic of this week's A Vet's View.

Actors practice their art by tranforming themselves into different characters to tell a story on stage or screen. It is an art form that involves controlling and expressing human emotion in a believable and realistic manner. The daily life of a veterinarian is not unlike that of an actor. Allow me to tell you about a day I had recently. It wasn't a whole day; in fact, just a few hours of one day. 

Seeing appointments is a juggling act; not only because you see multiple different kinds of appointments in the same day, but also because you will often come across things in appointments that cannot wait to be treated. Wounds can be especially like this; not that they can't be stabilized and wait but if we are going to treat them and get them home in a timely fashion we will often work wound treatment into our day. This is a very perfectly balanced game of beat the clock. Depending on the wounds, I will sometimes tell people their pet absolutely has to spend the night. More often than not, it will be treated and return home that afternoon. On the particular day in question we saw a pet with a fairly extensive (but not terribly difficult to treat) wound on its side. It would be a straight forward task to explore the wound, remove and dead or infected tissue, flush the wound and then close it. And it went exactly like that: the pet's wound was extensive and had a large amount of infected tissue associated with it but everything was going great. We were able to clean the entire wound out, flush it and were getting ready to close the wound. We wouldn't even be running late for the next appointment. Then the pet died. Out of the blue. No changes noted on our monitoring equipment before hand, good strong heart beats and good deep regular breaths and then nothing. Silence. We fall back on our training in moments like this: commence resuscitation, get the client on the phone, explain the situation, continue resuscitation. In this case we were unable to bring the pet back. We lost. Anyone who has ever experienced this will tell you that if you were to offer them the choice of this situation and the feeling that comes with it or being sucker punched in the gut as hard as possible, they would ask you what the difference would be. The only real difference is you don't replay a sucker punch a thousand times wondering how you could have dealt with it differently. A sucker punch doesn't make you want to quit. A sucker punch just hurts for a little while.

I had to walk away from that situation and into an appointment that did end up having to wait for me because I was now running about forty-five minutes behind schedule. Of course the waiting client wasn't happy about waiting and while they might have understood if I had explained everything to them, they didn't need to have that heavy material laid on them at that moment. As it was, their pet wasn't feeling well and they wanted to be reassured that it was going to be alright. It was going to be fine but it was going to have to go see a specialist for its problem. While I was working that out over the phone, the owners of the first pet arrived. I spoke with them and answered as many questions as I could, and then went into my next appointment- a recheck appointment and suture removal for a wound treatment I had performed a little over a week previously. This pet had healed wonderfully and was doing very well. As I was talking to them at the check out desk about scheduling a grooming appointment for their pet now that the sutures were out, a very large dog with a very large wound came through the front door leaving a very large trail of blood behind it.

On a typical day, we deal with and experience a complete range of emotions. We knew what we were getting into before we stood in that hall and took the veterinary oath. That doesn't mean that some days don't absolutely devastate us. But we look forward to each and every day we get to go through these experiences with you and your pet. Thank you for giving us the opportunity.