Pain Control as an Option? Really?

I'm going to share an "industry" secret with you. We price-shop our competition. All veterinary hospitals/clinics do this as a way to make sure our prices are in line. We have to do this by calling other veterinary clinics and pretending to be a price-shopping client. Anti-trust laws prevent us from having honest discussions with our competition about what they/we charge, so we all have to be clandestine.

Anyway, as we were calling around last week to get price quotes for dental and surgical procedures, we discovered something that disturbs me very much. A small number of veterinarians consider pain medication and/or IV fluids optional. The absence of pain-controlling medication for an invasive surgical or dental procedure is, in my opinion, barbaric. Would anybody out there be willing to experience a hysterectomy, castration, or tooth extraction and wake up with nothing to help the pain? Really? If you were the patient, would you want your surgeon to make that an optional thing?

When I was in veterinary school in the '80s, pain control was not a point of major emphasis. We were taught that animals don't experience pain in the same way as humans, and that some degree of pain was helpful in preventing our patients from "over-doing" it after surgery. We now know that animals in pain are adept at hiding it, but they are hurting/suffering just as much as we would be under similar circumstances. We also know that effective pain control actually speeds healing. So there is a comfort benefit and a medical benefit.

Without going into a boring physiological description, I would like to briefly describe the purpose of IV fluids in an anesthesized patient. First of all, it gives the surgeon/anesthesist quick venous access in case of an anesthetic emergency, or even if the patient needs additional pain control under anesthesia. Secondly, it allows much greater regulation of blood pressure in these patients. We now know that most anesthesized patients experience a significant drop in blood pressure, which could result in organ damage that may not show up for weeks or months. Even though these patients may "wake up" from their procedure just fine, damage HAS been done. Only IV fluids and blood pressure monitoring can minimize this risk for the patient under general anesthesia.

For a veterinarian to skip, or make optional, these services, in order to offer a cheaper spay (or whatever), is unforgiveably irresponsible.

I Bet You Don't Take Your Cat To The Vet

Admit it. You have a cat that I, your veterinarian, don't even know about. I have been taking care of your dogs for many years now, so we know each other pretty well. But you never mention that cat. I know what you're thinking. "Why should we talk about the cat? He seems healthy enough, never goes outside, and besides, he HATES car rides and new situations."

You are in good company. The overwhelming majority of American cat-owners do not take their cats for routine check-ups and vaccines. They all think like you do (we have survey results). It's understandable, but dead-wrong to not give your feline friend the same medical care as dogs get. I blame myself (and my colleagues) for your misinformation. Veterinarians do not do a good job of educating the public about why cats NEED regular veterinary care. So here I am, trying to help correct this oversight.

I'm going to start with the most important reason to take your cat to the vet every year. Cats are amazing at hiding signs of illness. I mean really gifted. More often than not, when we see a sick cat, we see a cat who is in real danger of dying from their disease. And the owners of these dying felines usually tell us that their cat has only been sick for a few days (and doesn't even seem too sick). Meanwhile, the weight loss, pale mucous membranes, heart murmur, jaundiced eyes, or disastrous lab results tell a different story. The owners simply never noticed the signs because the cat was too clever to give himself away.

You see, cats are not small dogs. If one of your cats lost 2 pounds (20-25% weight loss) over a 6-month period, would you notice? Or if one of your cats was drinking more or urinating more? What if one of your cats (assuming, like many cat owners, you have three or more) stopped eating, and was hiding more? How long before you notice? Well, you can bet that most cats are sick long before they start even showing these signs that you won't notice.

I can tell you with total confidence, that cats who get regular check-ups will have their diseases noticed much sooner, with less medication needed, and most-importantly, a better prognosis.

What about the fact that, unlike your dogs, your cats never go outside? This makes them less at-risk, right? Hmmm.... maybe so, but not much. Parasites, and disease carrying vectors will find their way into every home. Did you know that most commercial potting soil is contaminated with roundworm eggs? Also, indoor-only cats are actually at an increased risk (compared with indoor-outdoor cats) for certain diseases such as interstitial cystitis. The most important thing to think about here, though is this: staying inside will not protect your cats from diabetes, hyperthyroidism, chronic liver and kidney disease, asthma, etc....

Now, I know your cat hates to ride in the car, and hates new situations. My cats do too. However, we do have a special cat-friendly exam room just for him. We like cats here. We will be gentle. He will still get stressed out, but in all honesty, didn't your kids get stressed out at the doctor when they were little? But you still took them, because the alternative was very frightening. Your cat is in the same situation. I know you love him and want the best for him. You didn't know! Now you do. I will see you both soon.   :-)

Pets Aren't Fruitcakes

With the holiday season fast approaching, this is a good time to write about something that bothers every veterinarian I know, which is the concept of giving a pets as presents. If you stop to think about it, you can easily figure out how this might not be a good idea, but in case you can't, I will explain.

A pet (and I'm talking mostly dogs and cats here) is an ongoing expense, and a LOT of work. When you give someone a pet, you are giving them a tremendous amount of responsibilty that they may not have asked for. Those of us who love our pets (and consider them family members) are willing to deal with the accidents on the rug, the chewed-up furniture, the need to skip happy hour so we can let the dog out, the smelly litter box, the humongous vet bills, and all of that...because WE agreed to these things when we got our pet(s).

However, if you aquire a pet involuntarily, all of these issues become yours for the next 10-15 years. Merry Christmas. As a veterinarian, and especially in my position of County Veterinarian, I have witnessed what can happen when someone gets a pet they didn't ask for. Usually it's the pet that suffers the most. These innocent animals are neglected, resented, and occasionally abandoned or abused. That's a tragic thing for a creature who mostly wants love and companionship. Sometimes, the owner tries valliantly to do right by their unwanted pet. But this can be sad too. I've had several nice folks bring their "gifts" to me for regular check-ups and illnesses, but with every visit they say, "You know, he's a nice dog - I just didn't ever want him. I feel guilty saying this but...I'll be glad when he's gone."

We animal-lovers know how special and wonderful it can be to have the companionship of a beloved pet (or pets in most cases!) But there has to be just as much commitment and devotion from the owner as there is from the animal. The decision to become a pet-owner, and what type of pet to get, is one that should take a lot of thought, and should never ever be made for someone else.

Can't decide on what to give someone? Give them a fruitcake. At least no one is hurt if that gets neglected or discarded.

You Think Your Dog Is Safe, But...

One of the large veterinary pharmaceutical companies recently conducted a survey of clients leaving veterinary clinics who had declined heartworm preventative medication for their dogs. When questioned why they had chose not to protect their dogs from heartworms, the most common responses were: 1.They didn't think it was very likely that their pet could get heartworms 2.They figured it would be cheaper to just treat the dog if it got heartworms than to pay for preventative medication. This blog is to address these misconceptions.

First off, heartworms are much more common than people believe. At our practice, the majority of our dog-owning clients give their pets at least some heartworm preventative. Unfotunately, many of these folks skip or "miss" a few months every year (even though they tell us otherwise, the data doesn't lie). Of the dogs who get no heartworm prevention or intermittant heartworm prevention, we see more than sixty new cases of heartworm infections per year at our practice alone! Here's what their hearts will look like:

Because heartworms are spread by mosquitos, ALL dogs in the midwest are at risk without prevention. The travesty of this is how easily (and relatively inexpensively) heartworm infection can be prevented. We sell heartworm prevention pills which cost from $5 a month for small dogs to $7.50 a month for large dogs. There is even a twice-yearly shot for those who hate pills! In contrast, it typically costs $500-$1,000 to safely treat a heartworm-infected dog. Plus, you don't have to subject the dog to what is shown in the photo above.

I had to tell a long-standing client this week that her 9-year old dog had heartworms. She had always purchased preventative from us, but admitted that she did occasionally skip a month when she wouldn't get around to picking up more pills. She is now racked with guilt (she cried when I gave her the news), and faces the expensive prospect of heartworm therapy. She's one of those who always thought "It can't happen to my dog."

The take-home message? Get your dog tested every year, and buy a year's worth of preventative when you do. The medication is much cheaper when purchased as a full year's supply, and you are less likely to subject your best friend to what is shown in the photo above.

Ten Rules For Getting A Pet

Ten Rules For Getting a Pet:

 

1.       Be sure a pet fits your present and future lifestyle before you buy one (or accept a free one).  That cute little puppy is going to grow.  That kitten may use your furniture as a scratching post if not provided with a suitable substitute.  Are you planning on moving in the near future and are uncertain whether you could take animals with you?  This is no excuse to kill a pet or turn the responsibility over to someone else.  Did you know that veterinarians are asked to euthanize more pets for behavioral reasons than for medical reasons?  This reflects a failure on the part of owners, not of pets.  Pets are demanding of your time and deserve that time when you make the conscious decision to bring one into your home. Be honest with yourself – don’t “give it a try” and see what happens.  What happens over 1800 times every hour of every day in the United States alone is that these animals are eventually killed.

2.       Be sure you can be a responsible pet owner.  Although everyone considers themselves to be responsible, the facts say otherwise.  Do you believe cats should always be able to roam outdoors?  Wrong!  Do you think it is a pity not to have at least one litter from your current pet before it is neutered?  Wrong!  Is it all right to let your dog out without a leash because it always listens to you?  Wrong!  Pets need our attention, our protection, and our concern.  They are not disposable items when they misbehave, get older, or outlive their entertainment value.

3.       Be sure you can afford a pet before you get one.  Pets have needs and it is short-sighted to think that the purchase price is the last expense other than food.  Pets need routine health care, vaccinations, spay/neutering, dentistry, training and licensing.  Most would agree however that a pet gives much more than it could ever cost.  Should economic constraints arise, there are many public service organizations that will see that you can have your pet neutered at low or no cost.  Failure to take advantage of these programs is a reflection of irresponsibility, not poverty.

4.       Never buy a pet on impulse.  Most puppy/kitten “mills” thrive on this behavior.  Do you want to rescue that poor puppy from that enclosure?  Can’t stand to see those kittens kept in that unclean cage?  Your intentions may be honorable, but you are directly contributing to more of these animals being produced and sold that way.  If you want to break the chain of events that makes this happen, don’t buy a pet from these outlets and caution others against it too.

5.       If you do not need a pet for show purposes, consider adopting an animal that needs a home.  Breed rescue organizations do their best to place animals in good homes and they will be familiar with the breed and be able to tell if they have a suitable pet for you.  If you don’t want a purebred, visit the local shelters.  Not all shelters are created equal.  Only deal with ones that have the best interests of the animals at he4art.  Responsible shelters will want to make sure that the animals are going to an appropriate home, that you understand about vaccinations and health care and that you agree to have the animal neutered if it has not yet been done.

6.       If you do want a show-quality pet or think you may want to breed it someday, deal only with a reputable breeder.  Reputable breeders will undoubtedly be affiliated with the appropriate breed clubs, have health care information available for several generations of their animals, and if applicable, have had these animals screened for genetic problems.  Call the breed clubs and ask for information and a list of breeders they might recommend in your area.  Many good breeders spend more time scrutinizing you before they trust you with one of their animals than you’ll spend assessing them.  A good rule is not to buy any purebred where you can’t see at least one of the parents and have access to the medical history and performance record of both.

7.       If you intend to buy a purebred animal, check with your veterinarian as to the potential hereditary problems in that breed and ask if they can be determined before purchase.  Breeders that are truly interested in the breed will be happy to discuss these concerns with you, and, if possible, will provide proof of being “clear” or can give a guarantee.  The same cannot be said of indiscriminate breeders and many pet shops.  What is their policy if your new pet does have a hereditary defect?  An exchange-only policy is common for pet-sale outlets but they know that once an animal has been welcomed into a family, most people can’t return it.  These problems can also happen to reputable breeders occasionally and how they are handled is a mark of just how responsible they are.  Always enquire before you buy.  Caveat emptor – Let the buyer beware!

8.       Be reasonable when it comes to purchase price.  You can buy a pet with “papers” for $25 or $2500.  Either could be disasters.  Ask yourself what your money is paying for.  Has there been excellent prenatal care for the mother and proper health care for the puppies/kittens or are you paying for freight and cage space for an animal shipped in from a distant location?  Were the parents champions (documented), did they hold titles in obedience, and are the “clear” of heritable disorders?  Are the animals kept in clean hygienic quarters and have they been well-socialized?  Is the breeder/seller accredited in responsible health care (e.g. Project TEACH)?  These are much more important questions than does it have papers, or how much does it cost?  Support those breeders that care enough to do the job right and expect to pay more.

9.       Immediately after acquiring a new pet, make an appointment with your veterinarian and bring along all information you have about its previous health care.  It is also wise to bring a stool sample since parasites such as worms are not unusual but will require proper diagnosis and treatment.  Puppies and kittens need a series of vaccinations when young and then regular boosters annually.  And, make sure you have your new pet neutered or spayed as soon as your veterinarian recommends.  Do not wait for the first “heat” or for a first litter.  Did you know that you can significantly diminish the risk of mammary tumors in bitches by spaying them before their first heat?  Neutered males are also at reduced risk of experiencing prostate problems later in life.

10.   If you’re truly interested in pets and their welfare, take time to understand the issues and why so many pets are destroyed each year.  Give a home to a pet in need.  Don’t accept a pet that doesn’t fit your lifestyle.  Don’t buy a pet as a whim.  Don’t support irresponsible pet sales.  Don’t become a backyard breeder or buy a pet from one.  Make sure that your pets have been neutered.   And, if you know somebody who doesn’t know better, tell them, or give them a copy of this.

Pet Rescue Groups - Heros To Me

I was invited to speak last night to the Metro-East Petlover Coalition (MEPC) meeting. The MEPC is  a gathering of personnel from area humane groups and animal control departments.  I'm embarrased to say that prior to my invitation, I was unaware of this group's existence, but it was thrilling to know that these folks have such a desire to improve animal rescue and welfare that they gather once a month to listen to speakers and exchange ideas about how to improve their effectiveness. It got me thinking about the people who do animal rescue, and how highly I regard them. So I wanted to share some of that with you.

In my career as a veterinarian in private practice, as well as my job at Rabies Control, I have worked with or volunteered for several dozen humane organizations. In most of these organizations, the "workforce" is composed primarily of volunteers and minimally-compensated employees. A lot of these workers have regular jobs, just like the rest of us. They have bills to pay, and mouths to feed at home. In spite of that, they spend many hours every week, using the family vehicle to transport dogs and cats from animal control facilities (or just about anywhere where they have been abandoned) to rescue shelters, adoption events, vet clinics, and/or foster homes. Trust me, the animals are often dirty, stinky, agitated, and VOCAL. These folks are volunteering to clean cages, litter boxes, kennels, floors, and walls. They volunteer to spend their weekends at adoption events and fundraisers. They are usually doing the most un-glamorous jobs you can imagine.

But amazingly, these folks will tell you that the best part of their week is when they're doing these dirty jobs for the pets they've pledged to rescue. As an animal-lover, I can tell you that these people are heros to me, and the community in general. They promote responsible pet ownership, help reduce euthanasia rates, and campaign for better treatment of animals. Yes, there are some nutjobs in the ranks, but even they usually have good intentions and are dedicated to the animals. They're sometimes just a little self-righteous, or just simply misguided.

I am honored to be able to work with these heros. I've said it before, but I truly believe that the privilege I have of practicing veterinary medicine is accompanied by a responsibility to help homeless pets in the community. My role is easy when compared to the efforts of my many friends in animal rescue and relief. God bless you.

When The End Comes

Unfortunately, one of the most critically-important things veterinary teams do is end the lives of suffering pets. I guess it goes without saying that we all hate that part of our jobs. Ironically, it often creates a lasting bond between us and the family who is losing their pet. I think this is because there is sincere grief and empathy on our part for the passing of one of God's valued creatures. People appreciate that we are grieving right along with them, and this helps to affirm that losing a pet can be incredibly painful. Our society is much more accepting of the bond between pets and people than it used to be. Still, some of us are ashamed to let others know just how much we love our furry family members. I have had people tell me that their human family members ridicule them for the love and attention they give and get from their dogs or cats. The decision to euthanize one's pet is often surrounded by guilt. We can feel like we're "killing" a family member. Most people want their veterinarian to tell them how to know when "it's time." Unfortunately, there is no black-and-white criteria for making this decision, and this makes the decision even more difficult. Most of us hope in vain that our pet will simply pass in their sleep. I usually tell people that "it's time" when the pet has suffering that can't be relieved, or the pet is causing significant quality of life issues for the owner which can't be alleviated. The pet's suffering is usually in the form of pain (old dogs with end-stage arthritis, cancer, or back disease), but can also be caused by a variety of medical symptoms (dimentia, wasting, seizures, respiratory compromise, etc...) The client may have significantly-compromised quality of life if a pet can no longer control their bladder or bowels, or a large pet that can't move without assistance, or a serious medical condition which is beyond the financial means of the owner. The knowledge that euthanasia is truly painless gives me comfort. As far as the pet is concerned, it is just another trip to the vet - they do not have the same anticipation (and anxiety) as the owner, who knows what's going to happen. So the mental anguish that we feel is blessedly absent for the patient, which along with the painlessness of the procedure makes it much better for the pet than the owner. When we built our new facility, we made a room especially for euthanasias. It has a comfortable couch, a rug, soft lighting, and window treatments. The fact is, these things are mostly for the benefit of the family. As a veterinarian, I envy the fact that we can painlessly end the suffering of patients who are beyond medical hope. Animals give us their best for the duration of their lives. They ask very little in return. Like all of us, they reach a point where quality of life is irreversibly compromised. Why should they continue to suffer when we can offer them something better?