Category Archives: Veterinary Life

Perspective Shift

Perspective Shift

IMG_1038Working in veterinary medicine for any amount of time will affect your perspective, in ways you won’t always be able to predict.

The first thing that goes is the feeling that anything is ‘too gross’ to talk about, even while eating. Things that were formerly far too repulsive to even contemplate will become part of your daily life, and you’ll forget you ever thought they were that bad. New, much more disgusting things will take their place. The bar will be forever raised. I think of this as a good thing, particularly if you have kids.

As a side effect of not being grossed out by much, you’ll find that watching surgery can make you hungry (spays remind me of Italian food). It also gives you a totally new perspective on cutting up meats in your kitchen. You’ll start to notice the vessels and identify the bones in your chicken, and feel faintly bad about cutting into muscle.

It’ll change you in ways you aren’t aware of being changed. For example: in my kitchen, I have a sponge to wash dishes with (much to my dishcloth-using family’s disgust). For years, my sponge of choice has been the wavy pink one that is ubiquitous at grocery stores and Targets.

Probably the most important part of my job is monitoring patients under anesthesia. I have stared at innumerable dogs and cats, assessing color, feeling pulse quality, watching breathing, looking at eye position, jaw tone, and several pieces of monitoring equipment. Although every patient is slightly different, I know what anesthesia should look like, and am trained to notice if things don’t look quite right, or if things change.

A friend once stopped in while I was working, saw a cat under anesthesia and remarked, “That cat looks dead!” It was a revelation to me. The cat was  pink, breathing well, monitors all showing good vitals—to me, that cat was manifestly alive! It’s a shift. But I digress.

So, back to my kitchen. One day, I decided to be spontaneous and crazy, but most of all eco-friendly, and buy one of those weird recycled hemp style sponges you see that are 95% something awesome that will save the planet. I’m all for planet saving. When my last pink sponge became hopelessly clogged with cheese (you sponge users/cheese fanatics out there will know what I’m talking about—when you have to pry your sponge off the counter because all the cheese acts as glue), I tossed it, and proudly placed my new Eco Savior sponge on the counter.

Now, if you’ve seen these sponges, you know that they are that brown paper bag color that signals to all and sundry that you are quite the eco-minded individual. Doing something great for the planet! They are, in a word, beige.

So the next morning, having forgotten all about my new sponge and mission to save the planet, I get up and stagger to my kitchen for my morning coffee. I glance sinkward and gasp!—my sponge is dead! Or at least, that’s the first thought that my shocked brain can formulate. My sponge was pink, healthy, and now its color is terrible—it must be dead.

About a nanosecond later, all the other neurons in my brain were laughing and pointing at the one poor guy who sent out the alarm signal. But, I realized, that’s what I’m trained to do. I ultimately had to divest myself of the beige sponges and go back to pink. I want to save the world, but I need a healthy sponge. Besides, it turns out that those sponges don’t clean very well and fall apart really quickly.

Some shifts are more predictable: you’ll start to have opinions on how your family and friends take care of their pets. I should warn you about this: learn to keep your mouth shut early. If someone asks you for advice, by all means give it. But you’ll have to learn how to say things as general guidelines, without drawing specific attention to the ways they are failing their pets, in your eyes. I’ve seen this divide families, and cause lasting rancor.

Another thing to change, profoundly, is your reaction when you hear about animals in hoarding situations, or abuse or neglect cases. These make everyone sad, and angry. They’ll make you physically ill. Once you have seen an animal or two from a situation like that, doing the mental multiplication will punch you in the gut.

These are just a few examples of the ways your perspective will be altered. The veterinary world will make you a different person, but you will join a huge fellowship of people who feel just the way you do, and together, you will make a difference for many animals and their people.

Veterinary Pet Peeves

Veterinary Pet Peeves

drt_sxWant to know what drives veterinarians and their staff nuts? Here are some common pet peeves (well, people peeves, actually).

Veterinarians are “real doctors.” They go through just as many years of difficult study as any human doctor. Please, treat your vet with respect! If you wouldn’t dream of walking into your doctor’s office without an appointment, remember that your vet is probably just as busy. Also, it is so thoughtful to call us if you can’t make your pet’s appointment. Not only does it show respect for the vet’s time, someone may be waiting for that cancellation.

Keeping us apprised of changes in your pet’s behavior or health can often help identify problems early on and intervene more quickly. This can save your pet discomfort, and save you some money in the long run, if we can keep the issue from becoming more serious. Early detection and treatment isn’t just a good idea for humans!

So do call us to ask questions about your pet’s health, but understand that the person answering the phone may not know the answer, and that the doctor is busy and cannot usually take calls during work hours. Don’t be offended if we ask to check with the doctor and call you back. And remember, your veterinarian does not possess a crystal ball, or the ability to diagnose over the phone. We can’t tell “how long this bout of diarrhea will last,” or “if it will go away on its own.” If we get back to you to let you know the doctor wants to see your pet, there’s a good reason, and it’s not about being “in it for the money.” If you knew how little even the veterinarians actually make compared to what they owe in loans, you’d understand how absurd this statement really is.

On a related note, one thing you can say that is guaranteed to elicit an internal, “so what?” is to tell us, “I’ve spent [insert $$$] at your clinic!” We aren’t keeping track. That’s the thing about medical problems. They occur with zero regard for how many issues you have already treated. Life isn’t fair! I recommend pet insurance.*

Many veterinary clinics are not equipped to deal with emergency situations requiring a lot of time and staff, especially if it occurs at the end of our working day. If we refer you to another clinic or animal hospital, it’s because your pet needs more immediate or intensive care than we can provide, not because we don’t want to treat your pet. Also, realize that we cannot cancel all other appointments to accommodate your emergency. Always keep the address and phone number of a local emergency clinic handy in case you have a situation we simply cannot handle right away.

And again, if you have a very sick or injured animal and no money, please don’t tell us we are uncaring people because we won’t work for free. Would you tell your auto mechanic that he should do your transmission repair for free, because he loves cars? Do you think our supplies and equipment and utilities and staff are free?

Finding out that an owner stopped giving necessary medications or treatments is frustrating for us. It’s usually accompanied by a frantic phone call and unscheduled visit that disrupts the other appointments, and can be life-threatening for the pet. If you are having trouble giving medications, please ask your clinic for advice as soon as possible. We’re all pet owners too, and I guarantee we have all faced similar challenges! Just because we are veterinary staff does not in any way mean that our pets all open wide for their medications. We wish.

Just as in humans, the aftermath of a pet’s surgery can be painful. Please make sure that you take home any pain meds your pet may need—and give them as instructed. The old wives’ tale that animals don’t feel pain “in the same way” as humans do is utter nonsense. If you want to test this theory, step on your pet’s tail or paw. Pet screech = feeling it. The notion that they feel these stimuli as painful but not, say, surgical removal of a uterus, seems nuts to me. Animals have biological reasons to try to hide pain. So the safe assumption, in my opinion, is if would hurt you, it hurts them.

Ultimately, the best way to save money and keep your pet healthy is through preventative measures. Schedule a check-up once a year, keep your pet’s vaccinations current, and report any changes in behavior or health immediately. Remember, if you can’t afford the costs of regular veterinary visits, vaccinations, medicines, and nutritious food with a reserve for emergencies, don’t get a pet! As your best friend and your dependent, your pet is entitled to the best care you can find.

If you recognize yourself in any of these scenarios, I hope that you will take this advice to heart. If you do, you will be saving time, money, and possibly your pet’s life.


*Do your research though. Not all plans are created equal. And if you can, sign up for it when your pet is young.

Euthanasia, Part 1: Why?

Euthanasia, Part 1: Why?

Homeless puppaEuthanasia has been on my mind a lot lately. This year we have said goodbye to so many of our most beloved patients, it seems like the end of an era. I am at the point where I am saying goodbye to dogs I have known as puppies. One of the hardest things for all the members of our staff is seeing our clients try to ‘keep it together’ in our office while they undergo this most emotional of experiences. The phrase we most frequently hear in this moment is, “I was hoping she would just die a natural death.”

Many times, we hear this when the patient in front of us is laterally recumbent, panting, pale, and skeletal. Owners know that their pets look and probably feel awful. One thing I have told unknown numbers of clients over the years in this situation: we almost never see pets for an appointment like this too early. Here’s the deal, as I see it:

Our pet animals do not lead a natural life.

We have selectively bred dogs for a variety of unnatural qualities, like short, twisted tails, squat, compact bodies, muzzles that barely protrude from the skull, bulging eyes, flopping ears. We have bred dogs the size of teacups and dogs the size of small horses. Dogs turn out to have very plastic genes. Cats maybe not so much, but witness Persians, Scottish Folds, Devon Rex, Munchkins, Siamese—there is plenty of variation, if not as much in size.

We have domesticated them, and provide them with food and shelter not always available in the wild. We give them medical care to address common (and fatal) diseases, treat them when they are sick, brush their teeth (well, some of us do) or allow their veterinarian to perform dentistry procedures to remove excessive bacterial deposits in the mouth or abscessed teeth, we give them joint supplements and medicated shampoos. Some of us even provide acupuncture and therapeutic laser treatments. Consequently, our pets live far beyond an age that could be reasonably expected in the wild (I like to imagine packs of wild Shih Tzus when I say this).

One question this begs is: what do we mean when we talk about a natural death? Are we thinking of dying from the effects of disease, or starvation, or exposure, or being killed in a territorial fight with another animal? This is a common collection of natural deaths. No, in our minds, a natural death means curling up quietly on a pillow, drifting off to sleep, and never waking up. And once in a great while, this is what happens. Most of the time though, the story is quite different.

We diagnose many geriatric pets with diseases, in some cases metabolic diseases, such as diabetes, Cushing’s disease, hypo- or hyperthyroidism, and in other cases, cancerous or benign tumors. If you live long enough, chances are, you’ll have one or more of these types of diagnoses yourself. Few people die peacefully in their sleep at home of ‘old age.’ Why do we assume it will be different for our companion animals?

In my experience, many people are blissfully ignorant of the realities of the final stages of terminal disease processes. I consider this a perk of living as we do in a first-world country, where we have access to wonderful health care and where disease and dying are largely hidden from us. Unless you have watched a family member suffer through a terminal disease, or have had a previous pet with the same issue, you are unlikely to truly understand what those last days are going to look like.

For many animals, the end stages of several types of organ failure and cancers look very similar. It isn’t pretty. The pet is not eating, mentally foggy, and possibly in pain. Muscle wasting takes place, and moving around becomes difficult, even if it is not actively painful (although many older pets have arthritis as well). These pets can be nauseated, an unpleasant way to live. Congestive heart failure causes pets to be drowning in the fluid that builds up in the lungs, or unable to take a breath due to fluid in the chest.

At this point, many of our clients are hoping that their pets will ‘let go’ and pass quietly in their sleep at night. But the actual process of dying can take a long time. At some point, it becomes too hard to watch, or the pet simply stops getting up, or becomes agitated. We receive a number of faxes every week from the emergency clinics around town, letting us know that such-and-such patient presented at 3 a.m. laterally recumbent, taking agonal (dying) breaths, and was euthanized.

This is why we consider it a loving act to be able to spare our animal companions suffering. Death is a natural part of life, but that doesn’t mean that the natural way of death is in any way preferable to humane euthanasia. I personally hope that by the time I am diagnosed with some terminal disease, I will have the option to be euthanized at the time of my choosing!

I have made this pact with my own kitty, who at this time is pushing 16 years old, and starting down the well-trodden path toward renal failure. I have looked into her eyes and told her that I will not let her suffer. I will not let her become a cat skeleton covered in fur who can’t move and is too nauseated to eat, and has to receive so many mLs of fluids a day just to hang onto that tenuous thread of life. I know she doesn’t understand my words, but she knows I love her, and that I will take care of her.

This brings up the other objection many people have to the idea of euthanasia. We hear a lot about how the client isn’t comfortable “playing God” by deciding when Fluffy or Shadow will die. The truth that’s missed here is that you have effectively played God for the entire rest of your pet’s life, by feeding, sheltering, immunizing, and treating for illnesses. Why get right to the point of true suffering, and then stand back and say, it’s in God’s hands now?

For my part, I can’t imagine a God so narrow-minded that he would object to your selfless act of mercy on behalf of your faithful companion. If you want to be biblical about it, we as humans have been granted “dominion over the beasts of the field,” and regardless of how you interpret the ancient Hebrew ‘dominion,’ the responsibility for your pet’s well-being is yours.

‘Natural’ is a loaded word. I think that in this context, we have to take a hard look at what is truly natural, and what isn’t. Truly natural is not always better, despite how we have been conditioned.

Euthanasia, Part 2: When?

Euthanasia, Part 2: When?

Savannah's CakeA frequent question surrounding the issue of euthanasia is, how will I know when it’s time? How can I tell if my pet is suffering?

The short answer is, you won’t. That is, you may never be completely sure, and your pet may hide signs of suffering from you. Unless you wait until the point where your pet is actively dying, you will have doubts. And that’s okay. It means you have a conscience, and that you are concerned about doing the right thing for your pet.

Despite thousands of years of domestication, most animals still retain their instinct to hide injury, illness or suffering. In the wild, animals that are weak, injured or ill will starve or be killed. So there is a very powerful evolutionary drive to mask  any outward signs of problems.

Another contributing factor here is that unlike you, your pet isn’t worrying about tomorrow. Your animal buddy lives exclusively in the moment, whatever that moment may be like. Your pets will continue to try to go about their canine or feline business, until they simply can’t, anymore.

So my advice is this: you know your pet best. You will be the best judge of when his or her quality of life has decreased to the point that you should be thinking about euthanasia.

Quality of life can be assessed in a couple of ways. You can start a journal, and log good days and bad days. When the bad days far outnumber the good, it’s time to start thinking about your pet’s quality of life. This is a tough method for some people, because one good day in a month of bad days can give false hope.

Or, you can take a mental inventory of the things your dog has always loved to do. Does she love long walks? Playing with a favorite toy? Investigating every bush in the back yard? Following you around to see what you’re up to? Whatever the list, be aware when favorite pastimes drop off the daily schedule. Older animals do sleep more, but when your dog spends all but one hour a day sleeping, you have to wonder about his quality of life.

You have to be realistic. Your 17-year-old Labrador who can barely walk with arthritis is not going to miraculously get a lot better next month. How much can you take? Your lab will keep going until she gives out. Do you wait until she’s down and can’t get up? Many people do, because that’s what it takes to see that she is suffering.

One thing I find a lot of people have a very difficult time assessing is their pet’s daily level of pain. There is an anthropomorphic assumption many people make that their pet would cry or whine if he or she were in pain. Sure, we would, but human beings are wimpy, particularly compared to dogs and cats. If it takes your dog a minute and a half to reach a standing position from lying or sitting down, he’s painful. If your cat can’t jump up on the couch, she’s painful. If movement is restricted to to and from the food dish, or in and out to pee or poop, he’s painful. Unless you startle a dog or cat with a painful stimulus, you probably aren’t going to get the crying you expect from pain. I have seen dogs and cats with broken bones, who only vocalize when the break is palpated.

There are more subtle indicators also. A dog that breathes heavily and pants when he hasn’t been exercising or hot, is probably a painful dog. A cat that sleeps 23 out of 24 hours in a day is probably painful. You simply can’t assume that because he never complains, pain is not a constant presence in your pet’s life.

I wish that I never saw patients whose quality of life had so deteriorated that they were essentially already gone. I wish everyone was on the same page as far as preventing suffering and that no animal would have to suffer before the decision could be made to humanely euthanize. But the reality is that everyone is different. Everyone brings their own emotions and experiences to this decision. And many times, suffering has to occur before a person can feel like euthanasia is the right thing to do.

It’s about love. It’s about loving your pet enough to let go, and make the transition from life to death smoother and more comfortable for your faithful animal companion. What we do when we euthanize is to create the death everyone wants for their pet, snuggled in the owner’s arms, falling asleep. If you have ever been anesthetized, you know what it’s like. You are there, and then you are not there. It’s as peaceful as we can possibly make it. I believe that it’s our responsibility as pet guardians to provide this act of love if it’s needed.

What it’s like

What it’s like

IMG_1066 Yesterday, I got diarrhea in my mouth. And in my eye, on my face, my arms, my scrubs. It was everywhere. On the fluid lines, in the kennel, on about twenty towels and blankets, and (somehow) on two separate rubber mats. It was sticky and chunky and bloody and smelled absolutely horrible.

This is not a profession for the squeamish, or the faint of heart. Poor Jackson, the dog responsible for the epic blow-out poop episode, is being euthanized today. He is a fourteen-year-old Lab, and his health has steadily declined in the last few weeks. Now he is in renal failure. We have known Jackson for years. We have coaxed him into eating cookies, poked him with a million needles, apologized to him a million times for poking him with a million needles, petted him, restrained him, collected blood, stool, and urine samples from him, prescribed a million medications for him, treated his arthritic joints with acupuncture and lasers. He is part of our family, and he is dying. Every patient’s death is a sad occasion, but some are sadder than others. If you stay in this job long enough, every patient you grow to love, dies.

Yesterday, we met Otis. Otis is an eight-week-old Basset Hound puppy. His owners found him through a series of coincidences they found too powerful to ignore. They were still grieving the loss of their beloved Gus. That’s Gus, top left, immortalized in cookie form. Those are bespoke cookies from a specialty bakery in California. In his decade or so on earth, Gus survived a GDV, a splenectomy, anal gland ablation, and one form of cancer, before succumbing to a second form. Gus’ owners could almost certainly have bought a second house with the money they spent on Gus’ care and treatments. But he was more important to them. They never said, He’s just a dog. He was their baby. He became our baby, too. The day we euthanized Gus, there was not a dry eye anywhere in an area of 5,000 square feet. But now we have met Otis, whose ears are so long, he steps on them as he walks. Will he grow into those ears? We can’t wait to watch him grow up.

Yesterday, I laughed with some of our patients’ owners, called with advice on how to best battle home flea infestations, took histories on their pets’ recent health, explained surgical procedures and the safety measures we take, listened to their concerns over anesthesia, assuaged their fears as best I could without guarantees, discussed the costs of surgical procedures, and scheduled everything from nail trims to dentistries and mass removals.

This is not a profession for people who don’t like people, and think working with animals will be easier. The animals, sadly, can’t drive, can’t tell you what’s wrong, and can’t pay for their own care. “Must love dogs” is a good qualifier, but to make veterinary medicine the right choice for you, you must love humans. And that can be pretty difficult. Sometimes your love for animals has to sustain you after owners have yelled at you, insulted you, been condescending, or just plain rude. You will be in situations where the owner who drives a Mercedes SUV and wears a rock the size of a grapefruit will be appalled by the $285 dentistry estimate. You will also see situations where the owner who has been out of work for a year and a half will go pawn their only valuable possession to make sure his pet gets medications it needs. You will see the owner who doesn’t sleep because she is giving medications around the clock. You will see the best and the worst of human nature. The good news is that you will find that there is a lot more of the good than the bad. You learn as much about human psychology as you do about animal psychology.

Yesterday, I learned how to get a bowl in and out of an aggressive bird’s cage without getting bitten. I have been learning about cats and dogs for twelve years now, and now we have started seeing birds at our practice. There is always, always, ALWAYS something new to learn. If you love to learn new things, and you don’t mind the ‘feeling stupid’ part of the learning curve, and most of all, if you can easily say the words, “I don’t know,” you will love this job. The more you know, the more you will realize is out there to know. It can be overwhelming. It’s also a lot of fun.

Yesterday, two doctors and four technicians got enough of a lunch break to go eat sushi together. We talked about everything under the sun and stuffed ourselves with sushi and everybody picked off of everyone else’s plate. We are a family. There is something about everything we go through together that builds a family. Stabilizing an emergency, trying to see all of our appointments when three people have called in sick, catching a renegade aggressive cat that has stuffed itself under the recovery cage, crying together over a euthanasia, getting through a four-hour surgical procedure, rejoicing when a pet who has been close to death is back to running around like a puppy. And even though we are an admittedly dysfunctional family, we have each others’ backs. We have to. Or someone gets bit.

Yesterday was a pretty ordinary day.

But if you want to know what it’s like, this is it.