veterinarian

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A follow-up to New Graduate Problems, which I published in Nov ‘13. Which means I’ve been doing this crazy job full-time now for an entire year.

People often comment and say, ‘it must be hard being a vet, having to put down all those animals’, and it certainly is. But, after having a particularly harrowing week, I thought I’d highlight a few of the other day-to-day difficulties faced by the vet crew that you might not have thought about.

Please, be kind to your vets and vet nurses. :)

Veterinarians aren’t greedy; they make less than most pharmacists, almost all human physicians and almost all dentists. Their hourly rate is lower than your plumber’s. They went to school for half their adult life not because they want to be rich, but because they care about your pets.
— 

Liane Ehrich, Vet Tech, for the examiner.com.

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Single most important thing for a veterinarian to remember about the species they are treating

As vets we have to retain an awful lot of knowledge about a bunch of different species in our brain, but I could only impart one factoid onto a new vet for each species, these would be it.

Dog: Everything that can go wrong will go wrong, in a German Shepherd

Cat: Species most likely to send you to the hospital.

Horse: Species most likely to send you to the morgue.

Cattle:  Hygiene and lube.

Sheep: Not little cows!

Goats: Not funny sheep!

Deer: Don’t. Just shoot them.

Birds: No diaphragm, if you squeeze them they will die.

Raptors(eg eagles) : Much easier to handle with a sock over their head.

Chickens: If it’s egg bound there is no such thing as too much lube.

Water birds: Projectile feces. Aim with care.

Rabbits:  Drug sensitivities

Guinea Pigs: Lethal penicillin

Rats & Mice: It’s going to be a tumor.

Snakes: Don’t leave them in a cage. They get out.

Lizards: 90% of the time it’s a husbandry problem

Aussie mammals: Don’t wrestle wombats, you can’t win.

Fish: You can MacGuyver an anesthetic rig from two buckets, some tubing, a straw, a clean cat litter tray and some alfaxan. Do not use electro-cautery on a wet fish.

Ferrets: Most of their problems are from the same area; the kidneys, adrenals and ovaries seem to be part of a club to cause havoc for this species.

Pigs: Wear ear muffs, because they scream like you wouldn’t believe, and remember that they’re bred for meat, which is muscle and they know how to use it.

This is not an attempt to condense veterinary medicine into a few dozen sentences. But if you can only remember one thing, make it a useful one.

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Veterinarians Read Bad Pet Advice.

Traps for new vets

There are certain pearls of wisdom that you really want to hear before you have a chance to make these mistakes yourself. Note: This list is by no means exhaustive.

  • When expressing anal glands, do not stand directly behind the animal and do not talk. Keep your mouth shut, do not talk.
  • Always check the animal’s sex before calling them into the exam room. Some people like to give their male pets strongly feminine names and enjoy getting upset when you assume ‘Susan’ is a girl.
  • Never say “At least he doesn’t have a tumor” until you have finished your physical exam.
  • Goats and valium do mix.
  • Book double consultation times for clients that may not be to comfortable with English. Best case scenario is they bring a friend or relative to translate for them, requiring the whole conversation to happen twice. Worst case scenario is that you end up communicating via charades.
  • Mast Cell Tumors look like everything, and anything. It might not be a lipoma.
  • Cats will heal just about anything if you put their pieces close enough together. (If they don’t, look for FIV or FeLV). To think of it another way: Cat’s are nature’s jigsaw puzzles.
  • All dogs bite. That’s how they eat. The breeds most likely to send veterinary staff to hospital for serious dog bites are actually Labradors and Golden Retrievers, simply because you don’t expect them.
  • Don’t use the smallest possible catheter when trying to hit a vein. They’re flimsy and they suck. You can place a 22g in a kitten. You really can.
  • If you’re not sure, and need time to think in front of a client, either put your stethoscope on, listen to the heart/abdomen and shut your eyes or if dealing with cattle, put on a rectal glove, get in there and look as though you’re concentrating hard. Nobody likes to interrupt.
  • If you think a client is using a euphemism for genitals, ask them to show you what they mean and henceforth use correct anatomical terms.
  • You can always use your first principles
  • Don’t say “I don’t know” unless you follow up with “But I have a plan to figure it out.”

One day, there will be a part 2 to this post.

To anyone considering declawing their cat and those who find to problem with declawing,

Please watch the Paw Project. Declawing is extremely harmful to cats. Declawing does not simply remove the nail, it removes the last segment of the cat’s toes. In an attempt to regrow the nail, declawed cats’ toes often have small nail particles growing in their toes and as you can imagine, it is extremely painful to the cat. Additionally, while one may think that declawing will make a cat more “friendly” (because it cannot scratch), cats will often resort to biting. 

Anyways, the Paw Project can articulate all of this and more better than I can so please head over to netflix and watch it now!

#HeforShe for Vets

View blog on WordPress; image credit: Liv @ why-i-am-a-vet-student

If you have been on the internet in the last few days then you’ve seen Emma Watson’s inspiring and poignant speech in her new role as a goodwill ambassador for UN women. In her speech she calls out for men to take up their end of the bargain in the fight for female equality and empowerment. It’s an inspiring speech and if you haven’t seen it yet, you can watch it [here]. After signing up to the #heforshe pledge I started thinking to myself what role sexism played in my life and I kept coming back to my place as a future veterinarian.

 Anybody in vet school across the world can attest to the fact that more females are entering the profession than ever before. In my class alone, 85% of the students are female, and this is universal across western countries with a similar trend across the world. This is in stark contrast to the male-dominated profession that has been the norm historically. There are a whole assortment of theories as to why this is the case, and these range from increased academic commitment of females to more males pursuing high-income professions. In the end though the ‘why’ isn’t the important part, it’s how it’s approached which is the issue.

 I remember that in my first years of vet school, on visits to clinics in regional Australia, that I was treated differently to the female student I conducted the visits with. It wasn’t every clinic, and it certainly wasn’t every vet, but it was enough to be noticed. Comments like ‘Geez it’s great to see some male vet students coming through’ were fine – we are definitely few and far between! It was comments like ‘you had better pull this calf instead’ (when my partner had grown up on a dairy farm and was definitely far better at pulling calves than I was -and still is) that really stuck out. When it REALLY got uncomfortable was when I heard numerous theories about the failure of the profession due to there being too many women unable to run businesses. As a young student I listened to these comments come from good vets, employers, pillars of their communities, and I found it more perplexing

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This was an insane case that took everyone in the clinic on a roller coaster ride!

"Sunny" was a 5 year old female spayed Beagle. The owners called, concerned, a few hours before close because the dog was straining to urinate and didn’t seem to be producing anything for the past day. They lived over 100 miles away but promised they could be there before we closed. We asked if they wouldn’t rather take her to a clinic in their rural town but they said they trusted us and would rather she come see us.

They made the three hour drive and arrived 45 minutes before close. I was hoping that she would just have a UTI, since complete urinary blockages are very rare in females. But she sat there on the exam table wagging her tail and then trying and trying to urinate, and not producing a single drop.

I took the first x-ray and groaned. Her bladder is HUGE. There are also a cluster of stones in the bladder, which at first distracted me from the real problem — the stone in her urethra, visible behind the pelvic bone. It was huge as well.

With a sinking heart I told the owners that she had a complete obstruction. The owners looked to each other in tears. They had significant financial constraints. I told them that a surgery tonight to remove the blockage would likely be $2000-$3000 at an emergency hospital. They could also try to have her catheterized so that the stone could possibly be pushed back into the bladder (where it would be unlikely to fall into the urethra again), but with anesthesia and hospitalization that would still cost $1000 and might not work anyway, it’s very difficult to catheterize female dogs.

The owners wanted me to try calling a few e-clinics to see if anyone thought they would be up to catheterization. I tried the two local clinics but no one there felt confident in their female dog catheter skills. I called one further away and they thought they could do it, but the $1000 price tag was still the owner’s whole paycheck.

The owners were crying as they told me they would have to put her to sleep, since they couldn’t afford either procedure and knew they did not want her to die at home from an obstructed bladder, which is a terrible death; toxins fill the bloodstream and the bladder begins to die or can even burst. I told them we would have the tech go over the estimate, and gave the dog a huge handful of treats, which she ate with joy, wagging her tail.

Agonizing I went into the back, wiping the tears from my eyes. It was horrible! She was only 5! What bad luck it was to get blocked as a female dog (whose short wide urethras usually protect them). I felt sick but at the same time knew that I did not want her to just die at home. I knew I couldn’t catheterize her (I couldn’t even do it in a cadaver at school, let alone in a life or death situation) and was just feeling awful about my inability to help. Death seemed so wrong and yet was better here than slowly dying at home.

While the technician was going over the estimate for euthanasia I suddenly heard a call for me. “Doctor!!!” I hurried down the hall and there was a most beautiful sight — the Beagle wagging her tail, standing proudly next to a huge puddle of urine and the HUGE stone in the picture. SHE DID IT! SHE PASSED THE STONE!

We snapped one more x-ray and voila! The small stones are still there, but the bladder was tiny! One owner ran at me with her arms wide in a huge hug when I showed her the x-ray. Every tech and receptionist was sooooo relieved, we all left with the hugest smile on our faces when we sent them home with food to dissolve struvite stones and antibiotics. YAY.

If there had been any less delay in any of those scenarios — they hadn’t made the drive, they hadn’t had me call around — we could have had them sign those papers sooner and she wouldn’t be here. It really felt like a veterinary miracle!!!

Want to be rich and famous? Don’t become a veterinarian. Want to have a career where you can wear designer clothes that stay pressed and clean all day? Don’t become a veterinarian. Want to eat a big fat slice of humble pie on a regular basis? THIS IS THE CAREER FOR YOU!!

Seriously…the veterinary profession tends to keep you humble. You’ll make a tricky diagnosis and start strutting around like you are the next Dr. House one day, and then miss a case of ear mites the next. You’ll be a kick ass surgeon and rework a cat’s intestinal tract on Monday, and then on Wednesday you’ll puncture a bladder while performing a routine spay. One week you will be the golden child, the one that clients absolutely love and adore, and the next week you’ll be getting nastygrams, or letters from the Better Business Bureau.

Make no mistake…this career will humble you. When I graduated from vet school, I was on top of the world. I was going to be the best veterinarian ever…clients would adore me, animals would calm in my magnificent presence. They would write books one day about my awesomeness.

(In reality, I was fairly terrified my first year out and oftentimes had no idea what I was doing. Of course, I couldn’t let clients or my technicians see that, so I learned to fake it pretty well. I was sort of like the little weeny Chihuahua that barks really loud at a passing Rottweiler…I sounded tough but often felt like running away with my tail between my legs)

A few months out of school, a 5 month old pit bull presented to the clinic with a two day history of vomiting and not wanting to eat. It did not have diarrhea. Those of you that are experienced vets probably know already what the diagnosis is. I had no clue.

I did take a history and performed a physical exam. The owner assured me that the dog was “totally vaccinated.” The dog was dehydrated, lethargic and actually vomited during the exam. I was certain it was a foreign body or some kind of toxicity. I recommended taking x-rays of the abdomen.

As I was confidently walking the dog back to the x-ray room, one of my technicians asked me why I wasn’t testing the dog for Parvovirus. I glared at her a bit, puffed myself up and told her that it couldn’tpossibly be parvo, because the dog didn’t have diarrhea! DUH. Also, the owner said it was fully vaccinated. DOUBLE DUH. The technician stated that a lot of times Parvo dogs came in initially vomiting. I rolled my eyes and told her to get the x-rays.

As they were x-raying the dog, it puked a few more times. As they were developing the x-rays it sprayed bloody diarrhea over every surface of the x-ray room. I would later find some on the ceiling.

Well, as it turns out the x-rays were normal other than showing very angry looking small intestines. I muttered under my breath that there was NO WAY it was Parvo, but reluctantly allowed the technician to run a Parvo test. Low and behold, it most definitely was Parvo. I had just paraded a dog with a VERY contagious disease all around the hospital. The dog had sprayed Parvo infested diarrhea all over the imaging room.

I learned from that episode to A) Never trust an owner when they say their dog is “vaccinated.” B) Parvo dogs can present initially with just vomiting. C) Listen to your technicians.

Another time my head got pretty swollen because a client actually requested me to change her dog’s splint. It was a little Chihuahua with a broken radius that my boss had been treating by splinting. The splints he put on kept falling off, which annoyed the client. I happened to put on a splint that stayed, and she was singing my praises in the lobby.

I took the dog to the back, hemmed and hawed to my staff about my vastly superior bandaging technique, and even managed to put two little red hearts made out of vet wrap on the splint. The client loved it! I was awesome! I walked on water! As she was bowing down to my immense greatness the Chihuahua shook its leg a little bit and the splint came flying off. Oops. The client didn’t really care so much about the vet wrap hearts at that point.

I have tried to spay a neutered male cat. I’ve accidentally cut into a bladder during a spay. I’ve raved to clients about how AWESOME they are doing with weight loss on their fat cat only to find out that the cat is a diabetic. I once did a physical exam on a newly adopted Boxer, and told the owners it was in great health and there were no abnormalities. They called the next day, pretty upset because overnight their “normal” dog gave birth to 12 puppies.

On a more somber note, I’ve made mistakes that have resulted in the death of my patients. A little Labrador puppy was bitten pretty badly by a neighbor dog. I saw some deep puncture wounds, but not much else. I cleaned her wounds and put her on antibiotics. I missed the hole that had been torn in her intestines, and she died a few days later of a raging abdominal infection. I misdiagnosed a cat with asthma, when it had heart failure. That night when the owner attempted to give him medication for the asthma, the cat died of heart failure, most likely secondary to the stress of medication. I missed that a dog I put on Rimadyl was also on steroids, and ended up causing the dog to suffer a perforated stomach ulcer.

I even had a cat die after I neutered it. I still to this day am not sure what happened, but I know that he was very little, and I was “fairly” sure I was cutting a testicle. Whatever it was that I cut wouldn’t stop bleeding and he died a few days later. A cat neuter is considered to be one of the simplest surgeries we do as veterinarians.

Now, I know you are all thinking that after knowing all this there is no way in heck you would use me as a veterinarian. Here’s the thing though….we all have messed up. We have all missed diagnoses, screwed up a surgery, given a wrong medication. My grandma always says that is why they call it the “Practice” of medicine.

As horrible as some of the mistakes I’ve made have been, I have learned from every single one. Today, I would not miss that Parvo diagnosis. I treat dog bite wounds very seriously and always look for deeper injuries. I am careful to try and differentiate a cat with asthma and a cat with heart disease. Every time I neuter a cat I think of my neuter that went horribly wrong, and I remind myself to not treat it lightly even though it is such a straight forward surgery.

I also don’t let myself get too cocky or confident. I’ll smile when I make a tricky diagnosis or do a tough surgery, but I don’t strut. I know that probably within a day or so I’m going to do something that will knock me back down to earth. When I hear of mistakes other veterinarians have made, instead of feeling superior, I nod with sympathy and think back on the mess ups I have had.

Phyllis Theroux, in Night Lights states that “Mistakes are the usual bridge between inexperience and wisdom.” If you are a new veterinarian or technician, give up on the idea that you are going to be perfect. You will make mistakes. You will harm a patient because of those mistakes. Learn from your mistakes. Don’t blame others, or incessantly beat up on yourself. Take a deep breath, file it away in your memory, and keep carrying on.