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Tuesday, September 27, 2016

The Social Media Monster

Hi guys! I am a hypocrite.

I am writing this to (mostly) complain about social media. Then, I will post it ... on social media.

It's pretty self-evident that as a service provider, social media is quite the mixed blessing for my practice. I am certain that the same can be said by any person or business in the public eye. When people share their great experiences at our practice (or we share something positive about our practice), it's really gratifying to know that we did well. It's even better to think that someone who might be looking for a veterinarian could see that post and seek us out.

I also enjoy the opportunity that social media gives us to share our celebrations (Dr. Gammon had her baby!), accomplishments (congrats to Dr. Randla on completing his "Cat-Friendly" certification), and helpful information (here's what you need to know about Canine Flu). It is also a great place to recognize special organizations and promote their needs (Partners 4 Pets needs help paying for "Arrow's" surgery), and highlight our patients ("Peanut" turned 20 today!)

But of course social media is a fickle friend. If someone is not happy with their experience here, they have a public platform on which to share how rude/incompetent/greedy etc... they perceive us to be. Fortunately, that doesn't happen often, but when it does, it is obviously very hurtful to all of us.

I will be the first to admit that we don't always get it right. Like everyone else, we sometimes make a mistake. I have always felt that the best way to judge any business is their willingness to "make right" their mistakes. We take a great deal of pride in our willingness to do that. But I admit that I miss the "old days" when people who were unhappy would call or come in to the office with their complaint. These grievances were (and still are) taken very seriously, and usually rectified, to the best of our ability, by myself or our Practice Manager.

You see, most complaints we get originate from some misunderstanding. We preach and teach communication skills to all our staff because of this. If we get a chance to hear why the client is unhappy, we can often correct the misunderstanding, apologize for our part in it, and make it right. This process cannot happen on social media. Not even close. And of course, now all of that person's "followers" have heard only one side of the story. Ugh.

As a greybeard, I have had many veterinarian friends complain to me about the social media "monster." I usually tell them that we all have to take the bad with the good. But I do wonder why, if someone truly wants a solution to some problem that we have caused, they don't pick up the phone and give me a call?

Tuesday, March 29, 2016

Antibiotic-Resistant Bugs Threaten Pets and Owners

Some of you may be familiar with the acronym "MRSA" (pronounced mer-sah). It stands for Methicillin-Resistant Staph Aureus. MRSA is a bacteria which is resistant to most antibiotics, and people who get it can die from it. However, people can carry the bacteria and have no symptoms at all; it's usually folks who are compromised in some other way (very old, pre-existing illnesses, immune-suppressive medications, etc...) who could be in trouble if they contract a MRSA infection.

Dogs and cats are not typically infected with MRSA, although they can, rarely, be carriers. In those rare cases, they usually are carrying a MRSA which they picked up from a person. So it is unlikely that you would "catch" this from your pet. And it is even less likely that a pet could get sick from a MRSA infection. Staph aureus just doesn't seem to like pets.

However, we are starting to see resistant bacterial infections more and more in our dog and cat patients. In these cases, the culprit is usually a different species of Staph, called Staph pseudintermedius. When this bug becomes resistant, it goes by the acronym "MRSP" (Methicillin-Resistant Staph Pseudintermedius). We see these infections most frequently on skin or in wounds, and they are extremely difficult to cure. Usually they require intense topical therapy (medicated baths, sprays, creams, etc...) and expensive, high-powered antibiotics, not to mention the cost of expensive culture tests. It is a nightmare for the owner, the veterinarian, and most of all, the pet. It is important to note, however, that MRSP is usually not infectious to people, just like MRSA is not infectious to pets.

Like in human medicine, veterinarians have a responsibility to do everything possible to reduce the threat of these resistant "bugs". To do that, we must recognize how they become resistant in the first place. Usually it is due to inappropriate use of antibiotics. This includes:

1. Inadequate duration of antibiotic therapy. If you don't give antibiotics long enough, you may kill most of the bacteria (enough so your pet appears cured), but the ones which are left behind are the most resistant ones. The next infection will be the offspring of these resistant bacteria, and will be much tougher to cure. So always give ALL antibiotics until they're gone, even if your pet is better after just a few doses.

2. Using "big gun" antibiotics when they're not needed. We have some really great antibiotics at our disposal, and it's tempting to use these a lot because they are likely to work. However, the more often bacteria "see" these antibiotics, the more likely they are to become resistant. When infections become resistant to our "big guns," we are in serious trouble. Veterinarians should always choose the most "narrow spectrum" antibiotic likely to work in each given situation, and leave the big guns for resistant or life-threatening infections.

3. Indiscriminate use of antibiotics.  Again, it's so tempting to give antibiotics to make clients feel better. It's also wrong. Our clients love antibiotics. However, antibiotics are sometimes not indicated, even if our clients don't understand that. In these cases, antibiotics will not do anything other than to give the bacteria which might normally be carried by the pet a chance to become resistant. Here are three very common examples: a. Viral upper respiratory infections in cats. Because they are viral, not bacterial, antibiotics will not help. b. Ear infections. These are often caused by yeast. The only way to know is by looking under a microscope at the organisms taken from the ear. If there is a yeast infection, antibiotic ear medicine is the wrong thing to use. But we get phone calls every day wanting us to prescribe an antibiotic ointment for someone's pet who doesn't want to bring the pet in. c. "Cystitis" in cats. Young cats often get a condition that looks a lot like a bladder infection. There is blood in the urine and discomfort when urinating. Without doing a culture, the condition is indistinguishable from an actual bladder infection. Cultures are expensive, and we know that statistically over 95% of cats under the age of ten with these symptoms do NOT have an infection, so I rarely prescribe antibiotics for young cats with these symptoms.

In all the cases mentioned above, the use of antibiotics can contribute to an increasingly-resistant population of bacteria, and that's bad news for all of us.