A Vet’s Guide To Life

Regular reader Mary sends in another question.

I recently saw a person who means very much to me. This person has two cats. In all the time that I have known this family, they have always taken very good care of their pets, but since they have had children, their cats have been banished to the basement where they are fed from a giant trough. (Before this time, their cats were a reasonable weight.) While I was visiting this person, I got to see the cats. It had been a while since I had seen the animals, but they have become ENORMOUS! I am concerned, because I’m pretty sure these cats have got to be pushing 30 pounds. I don’t know how to talk to this person about the unhealthy condition of their pets, or how to urge them to put their cats on a diet. I know they have lots on their plates (pardon the expression), I know I haven’t always been the best pet owner, but I feel really terrible for their poor cats. It’s probably easier for a vet to express concern about the condition of someone’s pets.  It’s part of the job, and you have a certain authority that we lay people don’t have (besides, you can probably be more frank about it and get away with it, you are a doctor after all). Are there any suggestions you can give me about how to handle this situation?

This is a tough situation, as you want to help out their cats, but you also don’t want to upset a friend.  I think how you handle this depends on which you feel is more important.  But in the end, I always think that honesty is the best policy, and it sounds like these cats are in a serious health condition.

Obesity in cats is a serious health condition.  They are much more prone to diabetes and liver disease, as well as causing stress on their joints.  Most cats should weigh about 9-11 pounds, with certain breeds (Maine Coons and Norwegian Forest cats) weighing 15-20 pounds.  Your average cat weighing 30 pounds is like a person who should weigh 150 pounds actually weighing over 400.   People can usually understand this kind of analogy better than simply saying that their pet is overweight.

Here’s how I would recommend approaching them.  The next time you’re over look at the cats and say something like “Wow, those are pretty big cats.  I’m not sure I’ve ever seen cats that big.  What did your vet say about their size?”  Then let them answer the question.  If they say “Yeah, she said they needed to loose weight,” you can then talk about it a little more.  “Yeah, I’ve heard that obesity is a really serious problem in cats and can cause a lot of health problems.  So I guess you’re working on that, right?”  Then see where the conversation leads.

Now, if the discussion takes a different turn, such as them replying “No, we haven’t taken them to a vet in years”, or “Yeah, the vet said they were a little fluffy but I really don’t believe it”, then you’ll have more difficulty.  Depending on how comfortable you are with them, you can just jump into “You know, I heard that overweight cats can die of diabetes or liver disease.  Aren’t you worried about that?”

Now, if you still don’t feel comfortable with that, I have another, maybe easier option for you.  “You know, I’ve been reading this really cool blog written by a vet.  It’s has funny stories and free veterinary advice.  Oh, and you can ask him questions for free!  Oh, I know, why don’t you ask him about health problems in cats and talk about your own cats.”  I’ll be very happy to be the meanie and tell them how they’re basically killing their cats.

Good luck!

Here’s a consequence of being in veterinary medicine that nobody seems aware of.  When you’re around animals on a daily basis you WILL get “stuff” on you.  There is literally not a bodily excretion or fluid that I haven’t had on me at one time or another.  Most of the time you just get used to it since it all washes off.  To someone in this profession, it’s really not a big deal to get blood, pus, urine, feces, etc. on you.  If that kind of thing really bothered you or disgusted you, you simply wouldn’t last long.

Some days, however, are worse than others.  Like today.  The very first pet I handled was a dog that had been dropped off to be neutered.  And apparently he wasn’t too happy about it as he tried to bite my tech.  I managed to get ahold of him so that she could put a muzzle on, but this was not easy.  He was fighting me and flailing and really putting up a struggle.  A 30 pound dog really isn’t too hard for me to manage, and I was able to keep him relatively still.  However, when a pet is really scared and stressed, they will often release their bowels and bladder.  And he did so.  In abundance.  By the time we got him muzzled the floor and my legs were covered in feces and urine.  He had managed to defecate right on my shoe, leaving a really big turd right in the middle.  His struggles had also managed to get feces up and down both of my legs and one of my socks.

Many people reading this are probably completely disgusted and would have even thrown up if they had been that covered in poop.  But not a vet.  Oh, I was really ticked off, but it was because of the inconvenience.  A little poop can be washed off, but this was too much to easily clean, and I couldn’t exactly spend the day seeing clients with feces-covered pants.  So I had to reschedule my appointments for an hour or so, drive home, change clothing, and drive back to work.  So I was more ticked that I had to change clothes and interrupt my schedule than I was about what exactly I had gotten on me.  And that’s the mindset of a vet.  Yeah, we’re not exactly normal.

Oh, and I got my revenge.  He still got neutered.

It surprises me how many people consider diarrhea a dire emergency.  A pet can be coughing for weeks and I never see them, but they have diarrhea on the owner’s floor one time and they’re right in.  Most of the time these are cases that would resolve on their own, and there isn’t really a need to see the vet.  However, there are some guidelines to follow, as diarrhea can also indicate some health problems that should be addressed.

If your pet has diarrhea for 1-2 days but is otherwise acting normal and eating, it probably doesn’t need to be seen.  If there is vomiting at the same time and the pet isn’t eating, I would definitely recommend a vet visit.  If the diarrhea continues for 3 days or more, you should see the vet, even if it turns out to be minor.

Most people are highly concerned about dehydration when their pet is vomiting or having diarrhea.  Honestly, dehydration doesn’t happen that quickly in most cases.  Unless the symptoms are severe, a pet isn’t going to easily dehydrate from a little diarrhea.

Another concern is if there is blood in the stool.  This really freaks people out, even though it’s usually minor.  Most commonly this is small drops or streaks of blood in the feces or some small clots of blood.  Even though the sight of blood panics people it’s not always a cause for concern.  When the colon is irritated, the lining might bleed a little bit.  This is merely a sign of irritation (colitis) and usually not a serious problem.  However, if the blood is profuse or if there is any bleeding from anywhere else, it can indicated more serious problems.

So keep this in mind the next time your pet has a little loose stool.  You may be okay to wait it out for a few days rather than rushing right to the vet.

Something I always try to tell my clients is that vaccines can cause soreness and lethargy.  Unfortunately, some people seem to get very upset if this happens.  I occasionally have clients who bring their dogs back to me the day after being given vaccines because their pet is just laying around and not eating.  In probably better than 99% of the cases, there is nothing to worry about, and they never needed to come back in the first place.  So I thought I would spend a little time telling everyone about this so maybe you won’t worry about your own pets and won’t bug your vets.

When we give a vaccine we are stimulating the immune system.  The goal is to create antibodies so that if the pet (or person) is exposed to that disease, their body will be prepared to fight it off.  Vaccines stimulate the immune system in a controlled way that should cause antibody formation without causing the actual disease.  However, being infected with a disease will also stimulate the immune system.  When it becomes active, more happens than just antibody production.  The cells that produce antibodies also release biochemicals that cause a cascade of events throughout the body.  Some of these chemicals can cause inflammation (locally or systemically), raise the body temperature, and similar effects.  Know how you feel sore and drowsy and just “blah” when you have a cold?  That’s the effect of these biochemicals.  The same ones can be released by vaccines, and all it means is that the immune system is working properly.

Each individual’s immune system reacts differently with illnesses and vaccines.  When getting a tetanus or flu shot some people will be just a little sore at the injection site.  Some people will be really sore in their whole arm.  And some will run a low-grade fever and feel achy.  The same thing happens with dogs and cats.  Many have no side-effects whatsoever.  But some can feel various degrees of lethargy and soreness for 24-48 hours.

This is not a vaccine “reaction”.  Instead, it is a vaccine “response”, and is normal.  True adverse reactions usually cause excessive vomiting, facial swelling, or hives along the body.  In a true anaphylactic reaction, the pet (or person) will suffer a very quick reaction and will generally collapse as the blood pressure drops.  In 12 years of practice, I have seen this happen 3-4 times out of the thousands and thousands of pets I’ve vaccinated.

So if your pet is sore or lethargic for a day or two after vaccines, don’t worry.  This is nothing to be concerned about, and if you just wait another day or so, everything should be back to normal.  But if you have any doubts or questions, please contact your vet.

I was looking back over my archives, and realized that the last time I talked about some of my pet peeves was way back in November.  Well, today I came across a couple more.  Both have to do with cheap clients.

Number 5:  Clients who come in for exams but already know they can’t do anything.  This really gets me.  A client will come in with a sick or injured pet, yet they have absolutely no money to do any diagnostics or treatment.  Today I had someone who brought a small dog that had been completely lame on a hind leg for two weeks after being bit by another dog.  There was something wrong with the knee and I needed to take x-rays.  They couldn’t afford to to that, but also didn’t want to get any pain medication.  All I ended up doing is telling them that their dog had a problem with his left knee, which they kind of already knew.  Last week we had someone who wanted us to do a free exam on their sick pet because they couldn’t afford the office visit fee.  I refused because I knew that if they couldn’t afford the office visit, they certainly couldn’t afford any tests or medication.  The client became very upset because we refused to see her pet.  No, we would be happy to see the pet, just not for free.  I can understand not having money to do extensive tests or treatment.  But if you know going into the appointment that you don’t have any money beyond the office visit, what is the point?  It’s very uncommon for us to see a pet and not need to do anything at all.  Usually we need to do at least some testing and treatment.  What do these people expect of us?  I usually forget to bring my crystal ball and magic wand to work, so I’m not much help in these cases.  I really wish people would realize that the exam is simply the beginning, and there almost always will be more.

Number 6:  People who refuse services when you know darn well they can afford it.  Today we saw a client who refused to do more than a rabies vaccine on her pet.  She didn’t want heartworm testing or prevention, or a distemper-parvo vaccine.  She complained about it being too much money.  Yet my tech had seen her pull up in a 2009 BMW that still had a temporary tag.  Lady, if you can afford a brand new Beamer, you can certainly afford to take care of you pet!  I know some people can’t afford to do much (which is another pet peeve that I’ve already talked about).  But don’t come in with expensive cars, clothing, and jewelry and tell me that you don’t have the money to do the simple things.

Sometimes you just have a hard day, and nothing seems to help you feel better. This afternoon I had two appointments and two walk-in clients in the last hour, all with sick or injured pets. That’s always a bit of a stress, as I hate leaving work late. I’m very much a home-body, and really want to get home on time to have at least some time with my kids before they go to bed. Having last-minute clients often delays me, and that makes me frustrated. Then when I came home, I had to take pictures of our pets for a school project of my daughter’s. If anyone has ever tried to get pets to pose exactly as you want them, you know how hard this can be. So that made me more frustrated. As I was getting over this, I lost some things I was trying to work on, and couldn’t find them anywhere. So by the time I finally sat down to relax, I had gotten myself pretty worked up and was trying to keep my temper in check.

Then I put Tristan on my chest, and he started to purr. Wow, that was a great feeling, and very relaxing. As I stroked him and looked down at the little guy, my stress seemed to melt away, and for the first time in several hours I smiled. As I type this he is trying to play with my hands, and is watching my typing very intently.

This is why we have pets. They can be frustrating and a headache at times. But they give us so much love, amusement, and pleasure. They love unconditionally. And it’s so great to have one of them cuddle next to you, lick you, or otherwise show their affection. It melts your heart, and suddenly all of the frustration seems worth it. The picture below shows Tristan in one of his favorite places, on my shoulders or behind my neck. He fell asleep in this position and my wife grabbed the camera.

So here’s to therapeutic kitty purrs! Better than any prescription medication!

It’s pretty crazy how our society has changed in the last 10 years.  I remember a time with dial phones, no answering machines or voice mail, no cell phones, and no call waiting.  If you called someone and they weren’t home, you tried calling back at another time.  But that’s not the way it works anymore.  Many people don’t have traditional land lines anymore, opting strictly for cell phones (including myself and my wife).  Nowadays if you can’t get ahold of someone at home, you call their cell phone.  If you can’t get ahold of them there, you might freak out a little (like happens with members of my wife’s family).  I couldn’t imagine not having my cell phone, yet I also see how it has changed how we act towards each other and how we interact with society.

One of the areas that I see it is in my work.  I’ll walk into a room and the client will be talking on their phone.  I sometimes have to wait for a while for them to finish before I can talk to them.  Or similarly they will answer their phone while I’m trying to talk to them about their pet.  It’s really rude and annoying to have to fight the cell phone for their attention.

Yet on the flip side it’s been very helpful.  It’s common that the person who brings the pet in may not be the one who actually knows all of the details about a situation.  When that client can call home to their family members, it really helps me try to make decisions on how best to care for their pet.

Whether or not we love them or hate them, cell phones aren’t going away.  In fact, I think it’s gotten to be difficult to fully function in a 21st century Western society without one.  Yes, it may annoy me at times when clients can’t leave it alone, and I try to avoid being the same kind of person when I’m with a doctor or in a professional situation.  But it’s something we all have to learn to live with, and I just hope that everyone learns proper etiquette and politeness when using your phone.

Here’s the last of Jessica’s questions (read the last two days).  I wanted to post this one separately because it’s a great topic of discussion.

And finally, I consider myself a mix between introvert and extrovert… but I really value having free time alone and stuff. Does this job take up a lot of your time, so that you don’t have any time to NOT think about your job?

I’m not sure how much of an issue this is in other professions, but it’s a big one for most vets that I’ve know, myself included.  Historically it was common for veterinarians to work 60 hour weeks as a rule, and many older practitioners see nothing wrong with this kind of schedule.  However, most people getting into the profession in the last 5-10 years actually want a life outside of work, and so it’s more common to emphasize a typical 40 hour work week, or even part time (as we discussed before).  Nowadays this is more the rule than the exception.

Depending on the practice, you may also have to do your own after-hours calls.  More and more vets are referring cases to local emergency clinics rather than doing them themselves.  People are realizing that there has to be a balance between life and work, and doing your own emergencies makes this difficult.  Other vets feel such a strong loyalty to their clients that they don’t want to send them to anywhere else.  Be aware of the practices stance on emergencies before choosing a job, and make sure that you’re okay with this.  I’ve been on call before, and am glad that I now work at a place where I never have to go in after closing.

The problem is being able to leave work at work.  Most of us go into veterinary medicine because we have a lot of compassion, and that means that we care a lot.  When we care this much we worry a lot about cases.  I’ve had numerous times when I have worried about a pet for days.  Sometimes it’s a difficult surgery that I worry about the complications and recovery.  Sometimes it’s a medical case that isn’t turning out right.  In most situations it’s not because I did anything wrong, but because I second-guess myself a lot.

So really the fact of whether or not you can NOT think about work is more about you than it is about the job.  It’s all a matter of how well you individually can handle the stresses and worries inherent to this job.  Some people have no problem with it while other struggle a lot.  I’ve been mostly in the latter category, and it has taken a toll on my wife.  After 12 years of practice I’m better at it and don’t do it as often, but it still happens.  I wish I could give you a great tip on how to cope, but I’m still learning myself.  But this is one of the things that you’ll have to figure out about yourself and take into account as you choose your career path.

Great questions, Jessica!  Everyone else, feel free to ask your own.

Remember yesterday?  Here’s the next part of Jessica’s question.

I was also wondering if it’s possible to be a part time veterinarian. Only because if I ever get married and have children in the future, it might be hard to be a full time veterinarian at first.

Women are now in the majority of veterinarians, and this is changing the business of veterinary medicine.  Part of these changes are directly related to Jessica’s question.  More and more women want to have a family AND a career.  Instead of having a full-time job and putting the kids in daycare all of the time, they want to work part-time.  So this is definitely not an unreasonable thought.

I know many people who are veterinarians and only work part-time.  Most of them work 3-4 days per week.  This kind of work pattern is in the minority (and likely always will be), but is becoming more common.  The trick is to find somewhere that will allow this.  Since more prospective employees are looking for this kind of schedule, more employers are willing to accommodate it.  When it comes time to look for a job, you may have to do more looking around to find someone willing to hire you with this stipulation.  It may be more work, and may mean it will be longer to find a job, but if it’s what you really want it will be worth it.

Tomorrow…the last of Jessica’s questions on being a vet.

Here’s the first of several questions from a reader, Jessica.  She has some good ones that merit discussion so I’ll split them up and answer each in turn over the next couple of days.

Hi! My name’s Jessica and right now I’m eighteen years old, trying to decide my future and all that… haha.
 
I’ve been considering going into some sort of medicine for some time now, and I think veterinary school would be a good option for me. I’ve always grown up with animals and loved animals, and I would like to make a difference in animals’ lives and in the lives of their owners. So, I’ve been thinking a lot about being a veterinarian. But I was wondering if you could answer a couple of my questions on it.
 
First… do you think it’s easy to find a job and a practice to join right out of veterinary college (assuming I don’t take an internship or residency?). Also, my mom is wary on this path because she thinks with the economy, it would be hard to find a job, since “people won’t be as willing to take their dogs to the vet” etc. Do you think that’s true?

Actually, it’s very easy to find a job as a vet, especially if you have some flexibility about where you live and practice.  There is a lot of talk about shortages of veterinarians in various parts of the US (I can’t say about other countries), so depending on where you want to go, you could get something quickly.  If you have any interest in large animal medicine or public health, these are the areas where there is the most need.  I’ve never known a veterinarian to be unemployed because of lack of opportunities.

The aspect of the economy is actually an interesting one, and something that’s being discussed a lot here in the US.  Interestingly, people tend to take their pets to a vet MORE in economic hard times.  They may not have a lot to spend, but their pets are a source of great comfort, and they want to take care of them.  Yes, many vets have seen reductions in their client numbers, but it’s not everyone.  My own practice has been open about 2 1/2 years.  In 2008 we saw a 59% increase in our business compared to 2007.  So far in 2009 we are averaging about an 80% growth over the same period in 2008!  You definitely can’t look at my location and tell that there is a recession anywhere nearby.  I’m practicing north of Atlanta, in an area on the border between suburban and rural, so I’m not in a high income area.  My situation may not be the rule, but it’s also not the exception.

I feel that there is no concern about going into veterinary medicine because of economy situations.  In fact, a veterinary degree is a great thing to have, as it’s extremely versatile.  You can do everything from private practice (large and small animal) to research, specialty to general practice, working for a government (federal or state), teaching, and just about anything else.  There are always opportunities for a vet with the right skills and interests.

Here’s a suggestion I have about looking for a job.  First, find an area that you want to practice.  Then find the address of every single veterinary practice in the area you are considering.  Send all of them a resume and letter of introduction.  Follow that up with a call to the hiring manager or practice owner.  You’ll be surprised at what might happen!  I did this before I graduated and sent out about 40 letters, calling each of them.  I ended up with about a dozen face-to-face interviews.  That led to offers from three different practices, and I got to pick the one I liked best.  What is most interesting is that the one I eventually chose (and worked at for almost 2 years) had never advertised for a new vet!

Jessica, also keep in mind that you won’t be graduating from veterinary school for at least 7-8 years assuming everything goes well and you get in on your first attempt (something not everyone does).  A lot can change with the economy during that time, and we may be having a completely different conversation in 2017.

More of Jessica’s questions tomorrow!