The "Down" Side to Being a Vet

On this very dreary, rainy day (after a very dreary, rainy weekend), I suppose it's natural I gravitated to this topic, inspired by an article I just read.

Veterinary students more depressed than the rest

JULY 28, 2011

Veterinary medicine students are more likely to struggle with depression than human medicine students, undergraduate students and the general population, according to several recent collaborative studies from Kansas State University researchers.

Mac Hafen, therapist and clinical instructor in K-State’s College of Veterinary Medicine, and researchers from K-State, the University of Nebraska and East Carolina University decided to take a closer look at depression and anxiety among veterinary medical students. Although the mental health of human medicine students has been extensively studied, the same extent of study has not been performed with veterinary medicine students. Additionally, most veterinary research related to depression involves pet owners, not veterinarians or students.

“We are hoping to predict what contributes to depressionlevels so that we can intervene and make things run a little bit more smoothly for students themselves,” said Hafen, who has spent five years researching the well-being and mental health of veterinary students.

Once a semester, the researchers anonymously surveyed veterinary medicine students in various stages of academic study. The survey helped uncover a rate of depressionoccurrence and understand how it related to the amount of stress veterinary students experience during their four years of study.

During the first year of veterinary school, 32 percent of the veterinary medicine students surveyed showed symptoms of depression, compared to 23 percent of human medicine students who showed symptoms above the clinical cutoff, as evidenced by other studies.

Read More

I don't know how accurate/true across the  board this is but I do remember in veterinary school, during my first year, one of the topics in an orientation type class was about the very high rate of drug and alcohol abuse among veterinarians. 

Of course having access to some controlled drugs does play a role but I think "compassion burnout" is a huge factor. Dealing with very sick or dying patients and the families that come with them can wear you down, no matter how much of a wall you put up. I am pretty good with it most of the time - of course, I feel compassion/empathy for these people - but there are cases or days where it hits me really hard. 

There are others though. These are just some of the others in MY opinion:

1. Huge student loans coupled with low pay for the hours, knowledge base, etc - realizing it may takes years to decades to achieve certain material things and other goals because of this - exactly WHY students need to know what they are getting into before going to vet school

2. Working for other people who, unfortunately, often take advantage of new grads or just hard workers 

3. Working for unethical vets (yes, they exist) - makes you realize "hey we aren't all in this for the right reasons"

4. Long hours - and unpredictable ones too

5. Clients with plenty of attitude and no money - sometimes they are in one package but not always - many vets who have been in this profession for years have remarked about how people, in general, have gotten nastier

6. The need to be a psychologist. No, really. Many people come in to talk about all sorts of stuff NOT pet related during the pet's appointment. I have definitely come across some very lonely, sad people. I let them have their time. I figure they just need an ear. 

On a personal note, I can tell you I reached this point twice. Once was due to working for a few very unethical people back to back, the other was because I was overworked, dealing with double standards and couldn't take proper care and time with my patients! Thankfully, in both cases, I knew enough to move on (though loyalty kept me attached and ever hopeful in one case).  

Yes, I was burnt out -not to where I was doing drugs or becoming suicidal (now my martini and wine intake MAY have increased a bit during those times) but where I seriously thought about NOT being a veterinarian anymore. Of course, the reality of the student debt I still have and the years I put into achieving this goal kept me from taking any kind of huge leap. A number of great, supportive clients and friends also helped too.  I did seriously consider doing other things within  veterinary medicine but no opportunities in those areas were available at that time. 

It's all good now though - positive things on the horizon! 

The "Yogi Bears" of the Equine World!

I admit to wanting to get close to these wonderful creatures, but I let this obviously pregnant mare come to me! 

My comments are below this story:

Assateague's Wild Horses Get Too Close To Company

by DONNA MARIE OWENS

The first thing visitors notice about Assateague Island National Seashore is this: The 114 wild horses that inhabit the beachfront park along the Atlantic Ocean have full run of the place.

Summer is peak season for some 2 million tourists who visit Maryland's Assateague Island, famed for those wild horses. But increased interaction between man and beast is causing problems with the horses' diets and behaviors.

A Taste For Junk Food

It's striking just how close the stunning wild horses get to visitors, whether it's a chestnut mare chomping grass near a roadway, or a stallion and several mares trotting near a campground filled with RVs.

Ranger Allison Turner of the National Park Service monitors the herd, and says the horses are not afraid of people.

"And they can become curious about them or they may — if they smell the food — they may go investigate," she says. "They can learn that it's easy access to food."

Tammy McAdoo, visiting from Arkansas, says a horse came right up to the edge of a nearby picnic table.

"[That's] about the first time we got ... close to them," she says, but she wasn't sure if the horse was hungry. "We don't have any food out ... I guess he wanted the shade, really."

Horses are typically herbivores. But thanks to visitors who pet and feed them, park volunteer Pam Stansell says they've developed a taste for things like junk food.

"They like everything. They'll eat chips, hot dogs, raw meat, dog food," says Stansell.

Read More

Somehow this story does NOT surprise me. I was there a number of years ago and didn't witness this behavior. I also would never consider offering a wild animal "people" food either. But just like with pets, we think it's "loving" and "cute" to do so. There's always some bad side to it - whether it's aggressive behavior in wild animals, begging in our pets or health issues (obesity, pancreatitis, gastroenteritis, etc) - so it's best to just avoid this altogether!

This was as close as we got. I didn't try to touch her OR offer her any food!

Breed of the Week: British Shorthair

This is not a breed I see frequently. In fact, I don't know that I've seen more than 2 or 3 in the course of 13 years.


There are 18 colors listed for them as "acceptable" for show purposes. 


Here's a description of their temperament from Pet Finder:

If you're looking for a cat that will loot your refrigerator and swing dizzily from your chandeliers, then the British Shorthair is not for you. Brits are quiet, even-tempered, undemanding cats with a bit of typical British reserve, particularly when they're first introduced. When they get over their initial shyness, however, they become extremely faithful companions. British Shorthairs tend to show their loyalty to the entire family rather than select one person with whom to bond. British Shorthair breeders describe Brits as cats that like to keep a low profile, sweet and affectionate but not clingy 'in-your-face' type cats. They tend to be independent and if left on their own can usually adapt quite well.

As far as appearance:

Like the American Shorthair, the British Shorthair is known for its health and vigor. The breed is cobby in design, compact and powerful with a round, massive face and head. This head design sets the breed apart from other breeds developed from domestic shorthairs. A very dense, short, resilient coat is important in the show British Shorthair. The fur feels solid to the touch, like sinking your fingers into firm, warm velvet. The coat is not double-coated or woolly, which makes up-keep easier; however, regular grooming is important. Although blue is the most common, the British Shorthair comes in a variety of colors and patterns.

There are no major health issues specific to this breed. 


I have this one patient that I think is adorable and everytime he comes in, I make a huge fuss over him. He is very sweet and a pleasure to see!


Interestingly, Wikipedia lists these cats as "famous" Brits:

• Smokey in Columbia Pictures' "Stuart Little" was a British Blue. However, In the film adaptation of the novel, Smokey is a Russian Blue.
• A British Shorthair silver tabby appears on many packages and adverts of Whiskas brand cat food, and a British Blue is the face of Sheba brand cat food.
• In Terry Pratchett's Humour/Fantasy series Discworld, the Lancre Witch Nanny Ogg's cat Greebo (also known as "The Terror of the Ramtops") is often depicted in art as resembling the British Blue.^{[citation needed]}
• Winston Churchill (Church) from Pet Sematary was a British Blue.
• Happycat (arguably known as the first "lolcat"), a meme started on the Something Awful forums. The original picture of a British Shorthair came from the front page of happycat.ru, a Russian cat food company.
• Toby, a fictional cat on the ABC prime time drama Desperate Housewives, is a British Shorthair.
• Arlene, a blueish grey British shorthair, as displayed in Garfield: The Movie
• Mick, from Kamen Rider W, is a British Shorthair who can turn into the Smilodon Dopant.
• Dex-star, of the Red Lantern Corps, is suggested to be a blue British Shorthair.
• The "I Can Has Cheezburger" cat is a British Shorthair.
• Cheshire Cat in "Alice's Adventures in Wonderland" by Lewis Carroll is a British Shorthair.
• Ruby in the film adapdation of the memoir "Girl, Interrupted" by Susanna Kaysen was a British Blue.

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Fun Stuff I Get to Do OUTSIDE of Practice

"Expresso" was a very large bull - amazingly gentle though. He was at the Purdue Large Animal Hospital in this photo (nothing too serious as I recall).

I apologize for the absence of a blog yesterday as it was not my intention to "take the day off" but as it turned out, I basically did that. Oh well. I needed it. After the hectic first three days of the week, I figured it would be ok. 


Every once in a while, besides the daily grind of practice, I get to do something fun as a result of being a veterinarian. One of my favorite things is to talk to students of different ages about what it means and to really educate them on the full diversity in my profession.


Tomorrow, I'm going to be talking to some high school students about a career in veterinary medicine. I'm doing this for someone I met via my involvement in health care reform. I answered a question of his on a Facebook page when no one else wanted to respond and we began a dialogue about that. After seeing him at meetings a few times, he approached me about this program that he and his wife run in their Lehigh Valley home, once a month, called Youth Career Exploration Program. This is designed to help high school students learn more in depth about various careers - what it takes personally, what different options there are in that career, the outlook, the education required, the pros/cons, etc. It's an interactive thing. I really enjoy stuff like this - esp when the kids are old enough to ask some good questions.  


In preparing for this, I did dig up some old photos from my zoo work and vet school:
.

A paint Quarter Horse named "Question Mark" - he was for sale and I wanted him. BUT realizing I couldn't afford him long term and he'd have to live FAR away from me, I passed him up. 

"Miller" - a goat owned by a dentist who spent thousands on him - major urinary issues..blocked with stones, multiple surgeries later, he ended up with his bladder being "marsupialized" - basically he constantly dripping urine - but they loved him and he WAS their pet. He used to follow them around in the neighborhood when they went for bike rides, etc.  

Monitoring an ocelot during a dental cleaning and some routine blood work

One of my favorite things about the zoo - the lemurs. Here I am with a Red Ruffed Lemur.

The Value of Ultrasound

It's amazing what an radiograph (x-ray) will NOT show that an ultrasound will. 


Today we had a case that illustrates this point.


An 11 yr old pit bull mix had been showing signs of a urinary tract infection starting approximately 1 month ago. The signs included frequent urination and loss of house training. He had no other signs. The urinalysis run at that time showed signs of a mild infection. Another vet put him on a standard first line antibiotic. He didn't show any response to that.


 He was sent to me to do a radiograph. Anytime we have recurrent or non responsive urinary issues we need to rule out bladder (or sometimes kidney) stones. Bladder stones require surgery and antibiotics will NOT solve the problem. This dog's abdominal radiograph was essentially non-remarkable. We put him on a stronger antibiotic. After 4 or 5 days he was not only still having the same problem with NO improvement but now the owners saw swelling in his back end. 


They brought him back to me yesterday and we examined the area - which seemed to be a soft tissue swelling not associated with anything in particular. 


Since he was a neutered male, his prostate was not likely the problem of his increasingly difficult urinations but, of course, I confirmed this with a rectal exam. Neutered and un-neutered dogs can have prostatic cancers but un-neutered dogs frequently have benign prostatic enlargement that can start to clamp off the urethra and cause major problems. 

Male dog urinary anatomy

Side note: neuter your dog!


Anyhow, I also passed a urinary catheter to assess the if the patency (or opening) of the urethra through it's entire length. The catheter passed with little difficulty, however, it went in farther than usual until I got urine to start flowing and there were small blood clots in it that have never been seen in the urine samples we've seen from him.


I also palpated a mass like lesion behind where his bladder sits in his abdomen - again in un-neutered dogs this is frequently the prostate. Not in his case. I told them my primary concern was cancer - notably a bladder cancer called transitional cell carcinoma (TCC). This cancer often grows at the outlet of the bladder (called the trigone) and eventually the animal becomes obstructed. We needed to get him an ultrasound to truly know what was going on.


So today, my colleague did a complete abdominal ultrasound.


Another side note: Even though we are focused on a specific area, we always ultrasound the entire abdomen. Why? Well, you never know what else you will find. Why not? You are already there. It costs the client the same. It's not painful or invasive. I say this because in my own personal experience I received several ultrasounds that were focused on one "quadrant" of my abdomen which really - excuse me - pissed me off - since I know full well that pain in one area can be from another. NOT good medicine! That's another story though. 


What did we find on this dog? His bladder was pushed forward. There was a large mass extending from the trigone and beyond. His sub lumbar lymph nodes (under the spine) were enlarged, abnormal and pushing on his bladder. In a normal dog you don't even "see" these on ultrasound. He only had a very small portion of "normal" bladder remaining. And oh, his spleen had lesions too. It appeared he had cancer throughout his abdomen. 

This is not OUR dog but those rounded objects in the center of the screen represent TCC.

This is not surgically fixable, even temporarily. In fact, even when it's just involving the bladder it often isn't because of the location of where it typically grows. It does frequently respond to an NSAID called piroxicam. The problem is we don't know if this dog has that type of cancer, another type or even more than one. The owners will give it a try and we'll see how the dog does clinically. Ultimately though they are going to have to make a decision soon. 


A good article from DVM magazine on Transitional Cell Carcinoma. 

DOWNward Dog

This is a cute dog doing a yoga pose referred to as the downward dog - appropriate, I know. 


Today's blog is NOT about this. It's about a condition called intervertebral disk disease (IVDD) - specifically affecting the thoracolumbar spine.  The American College of Veterinary Surgeons has a more detailed web page on IVDD. 

This condition can affect the cervical spine as well but I'll leave that for another day.  


These dogs present with everything from subtle signs of pain  and lethargy to weakness in one or both hind legs to being completely paralyzed in the hind end. 


The most common breeds we see this in are the dogs with the "long" backs - dachshunds are at the top of the list (they have 10 times the risk of ALL other breeds combined!) but we also see it in corgis, beagles, shih tzus and Lhasa apsos. It CAN occur in any breed however. It VERY rarely occurs in cats. Obesity (which is a common problem in the dachshunds as well as many breeds) does add to the likelihood this will happen.


The disk between the vertebrae herniates and compresses the spinal cord, resulting in an increasing loss of neurologic function until it basically dies and is beyond saving. 

It can happen either traumatically (more common in the younger dogs) - they are hit by a car, another dog, jumping off the couch, they jumped over your deck onto the lawn, etc OR it can occur by the simple act of curling up to sleep (more common in the older dogs). As the dog ages, the disk material becomes more brittle and it takes much less to cause this material to "explode" into the space.


A complete and thorough neurologic exam helps determine whether this can be medically managed or needs immediate surgical intervention. We assess conscious proprioception (curling the dog's toes under - normally should be corrected by the dog within milliseconds!), superficial pain (pinching the skin), motor ability, reflexes and finally deep pain. If deep pain is lost the prognosis is poor even with surgery.


Interestingly, x-rays of the spine do not always show anything. In some cases we can see a narrowing of the space between the vertebrae.

In MOST cases, these dogs can be managed with cage rest, steroids and sometimes muscle relaxers and/or other pain meds (ie  Tramadol). However, it is important to note if the dog is getting worse (has increasing loss of function in the hind legs, worsening pain or difficulty with urination/defecation) because that could signal the need for surgical intervention. This downward spiral can happen quickly - even within hours. DO NOT wait! Call your vet! 


These dogs are then sent to a board-certified veterinary surgeon who will likely first want to do an MRI to get a definite diagnosis (there can be a few other things that cause similar signs - including tumors, a condition called fibrocartilaginous embolism, infections, etc) AND to get the exact location of the lesion/s. Surgery involves decompressing the spinal cord by removing the disk fragments causing the problem. 


This is NOT an inexpensive endeavor, however and if you go this route be prepared to spend $5000 or more when all is said and done (diagnostics, surgery, meds, post op care). These dogs can do great and return to completely normal function. This depends heavily on how severe the neurologic loss is at the time of presentation.


I saw a 2 yr old chihuahua last week that went to another vet approximately 2 weeks prior and was diagnosed with IVDD.  He was put on appropriate medications. The owner believed his condition was due to Lyme disease (she didn't understand the information given to her but it seemed to be due in large part to a language and education barrier). When I saw the dog, he had gotten significantly worse (confirmed after I reviewed his previous records) to the point that, now, we have to recommend euthanasia. 


A few weeks prior to that I saw an 11 yr old Pomeranian who had gone out back for a few minutes and when the owners went to check on him, he seemed paralyzed in the hind end. They didn't know what happened at all. They were not near a road, cars, etc. There were no other pets in the area. This dog had some deep pain function and because they couldn't go to the specialist, we went with trying medications. However, the next day the dog was still very painful and was not urinating on his own. I finally convinced them to go to the specialist because he was definitely declining neurologically. Unfortunately, they were unable to have the surgery due to financial constraints.

Dogs can live with hind end paralysis. They make carts for these dogs that can be fitted specifically to YOUR dog. Google  "carts for dogs"  and you will see several companies that do this. The key thing to note is that these dogs often need to have their bladders manually expressed daily AND are more prone to urinary tract infections. I have met a few that have done well with VERY dedicated and attentive owners who know when they need to be seen by a veterinarian.   

Loyalty IS Important But So Is Communication

I just want to say that good vets know who their loyal clients are and go out of their way to accommodate them - be it an appointment when there are none or an "extra" thing thrown in for no charge or even a house call for something. Yes we do still do those!


Today was an experience in loyalty and AGAIN, the importance of communication as well. 


Oh yes, communication is often cited as the number ONE reason that vets end up at the wrong end of a lawsuit. But communication is a TWO way street. As I've told you in the past, we'd MUCH prefer if you were upfront as to what you will and won't do - be it financially or for whatever other reasons. 
What is frustrating is when a client has MULTIPLE opportunities to communicate that they have financial limitations and just don't do so. I do NOT judge people for whatever financial capabilities they have. I DO expect honesty and to be paid for MY expertise, time and services.  I will always work with people who express such limitations and explain to them that while this is not the "ideal" treatment, you can try "x" but be on the lookout for "a, b and c." 


What I DO NOT like (and I know other vets share this sentiment) is after having done an exam and/or diagnostics to be told that the client 1. doesn't have a dime or 2. wasn't expecting to pay - that is just insulting. BE UPFRONT. We don't want to "eat" the costs of your pet's tests anymore than the grocery store would even consider eating the cost of that extra steak you can't pay for but you feel your family deserves.

A Really Cool Saturday

Yes, I know it's Sunday but this is about yesterday.


I work a few Saturdays a month. I don't mind them since we don't answer the phones on Saturday - this means there aren't a million things "coming right down" that people generally WAITED to call for - you know, the dog has been vomiting for weeks but 11 am on Saturday AFTER they slept in and had coffee, it's OUR problem? Oh yeah.  


Most of what I see at this practice on Saturdays is fairly routine stuff. We have a smaller staff on that day so we can't really do a lot of involved stuff but if needed, of course we would. Still, most of what I deal with are routine vaccines appointments and problems that can wait (skin issues, ear issues, some lamenesses, weight loss or gain).  


This past Saturday was similar to the others but there were two cool things:


1. The chicken, Rosa, from the other day, came in for me to recheck her. The technician that owns her works only on Saturdays so it worked out well. She was doing good - bright and even more alert. Her crop was still open and food was coming out of it at times. Still she was obviously getting some calories. She was such a sweetheart - letting me take a REALLY good look at it, debride it some more, clean it up, flush it and then suture the crop itself closed. All this without anesthesia. The skin is still open as the area is infected and needs to continue to drain. Hopefully the sutures will hold long enough for the crop to heal and then the secondary granulation that needs to take place around it will occur. We will be rechecking her Wednesday.

2. A middle age, overweight yellow Lab came in for vaccines and a few minor issues that were mentioned at the time of the visit. One of them was the dog was scooting and had been constipated. Sometimes this CAN be indicative of anal gland issues. They also mentioned seeing some blood from the area. So in cases like this we have to do a rectal exam as well and check the anal glands. They mentioned they weren't sure if she got into anything (we know Labs LOVE to eat whatever!) but they didn't "know" of anything for sure.  Interestingly, while her gland were full, I think the bigger issue was this:

Yes, this is a sewing needle with just a bit of thread attached. This was literally caught in the dog's rectal mucosa just at the end but I don't think it was going to easily come out on it's own as I had to work it out and yes, it did hurt a little. Amazingly it went through her entire GI tract without issue! (another example of the importance of listening to the owner and doing a THOROUGH exam - the best diagnostic tool!).  The owner had NO idea her dog ate this. Of course, we followed up with some radiographs of her abdomen to check for any more needles or other objects she may have eaten. Thankfully, this appears to be the only one.  Now she knows to be extra careful when sewing and put away the goods!