Archive for August, 2010

Reasonable Expectations

August 28, 2010

Never before, during my almost 30 years as a veterinarian, have I encountered such rapid and profound changes in client expectations. We’ve entered what I like to refer to as “The Age of the Empowered Client”. I’d love to believe that this is a result of so many people reading my book, Speaking for Spot. Alas, I must give credit where credit is due- namely, the worldwide web. Discuss a symptom with my clients and I’m no longer surprised when they pull out their printed list of the diseases Dr. Google feels might be responsible. Render a diagnosis and my client can surf the net to quickly find a plethora of others who have “been there, done that” and are willing to provide advice about how best to navigate any possible medical minefield.

Do I believe these changes in client expectations are a good thing? You betcha! As I convey in Speaking for Spot, my belief is that every animal needs an empowered, adept medical advocate by its side. Of course I want veterinarians to remain essential members of the health care team, but I love it when those at the other end of the leash (or monkey-wrenching their backs schlepping cat carriers) become the team captains!

Over the next several weeks I will write about several previously uncommon client expectations that are now becoming mainstream. They are reasonable expectations in that they ultimately serve what clients and veterinarians hold as common ground- namely, the best interest of the patient. Remember, change is not for everyone- not all veterinarians necessarily “embrace” these changing expectations. Some gentle patience and persistence on your part may be needed. If you find your vet isn’t willing to budge, for your pets’ sake, I encourage you to find a new teammate.

I’m going to describe my favorite client expectation first because, once this expectation is fulfilled, satisfaction of most others will naturally follow. So here we go.  It is perfectly reasonable for you to expect “relationship centered care” from your veterinarian. This is a style of communication in which your vet holds your opinions and feelings in high regard and enough time is allowed during the office visit to hear them. He or she recognizes the unique role your pet plays in your life and is a willing source of empathy and support. Rather than telling you what to do, vets who practice relationship centered care discuss the pros and cons of all options before making a recommendation. They believe in collaborative decision making. Compare this to “paternalistic care” in which the vet maintains an emotional distance and recommends only what they believe is best without consideration of the patient’s or client’s unique situation. There are no significant opportunities for discussion or collaboration.

Relationship centered care is not for everyone- some people truly prefer to be told what to do (certainly the way I feel when my car is in need of repair!). However, if you desire relationship centered care from your vet (or for that matter your own physician), please know that this is a completely reasonable expectation. How do you find a veterinarian who employs this style of communication? At the risk of tooting my own horn, the chapter called “Finding Dr. Wonderful and Your Mutt’s Mayo Clinic” in Speaking for Spot will tell you everything you need to know to fulfill this expectation.

Do you work with a vet who provides relationship centered care? What do you like about his or her communication style?

Now, here’s wishing you and your four-legged best friend abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com  to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

A Naked Lady

August 22, 2010

It’s natural to assume that the grief associated with pet loss is a purely post-mortem event.  Not true.  For many, the grieving process begins the minute they receive a serious or scary diagnosis, even if the animal has the potential to live for another year or two.  This is why I established and continue to facilitate a Client Support Group within my community.  Not only are people who have lost their pets welcome, so too are those struggling emotionally while caring for a sick four-legged family member.  The way participants support one another is fabulous- there’s typically a healthy mixture of smiles and tears as they talk about their beloved animals. 

From time to time, someone recounts an event (I like to refer to them as little taps on the shoulder) that let them know that they’ve been “paid a visit” by their deceased pet.  Last week Stephanie told just such a story.  A few weeks after relocating from Seattle to northern California, her beloved Bear, a huge and gentle Labrador mix, became profoundly ill with symptoms referable to cancer within the pelvic canal.  With a heavy heart, Stephanie opted for euthanasia after which she fled back to Seattle to receive the emotional support she needed from family and friends.  Upon returning to her new California home a week later, a delightful surprise awaited her.  Right at the spot where Bear urinated first thing every morning appeared a two-foot tall, solitary, pink flower on a thick sturdy stalk- one we affectionately refer to in these parts as a “Naked Lady” (Amaryllis belladonna).  With a smile on her face and tears streaming down her cheeks, Stephanie described her encounter with this crazy looking pink plant, the likes of which she’d never seen before.  She knew, in her heart of hearts, that it was a sign from her beloved Bear that he was okay.  And I believe her!

Have you ever been “paid a visit” or received a “gentle nudge” from a beloved pet that has passed away?  Please, do tell.

Now, here’s wishing you and your four-legged best friend abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook    

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

What Not to Name Your Dog

August 14, 2010

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You can call me superstitious or call me crazy, but I stand firm in my belief that certain dog names should be completely avoided. Yes your new pup may be just as sweet as sugar, but call her “Sugar” and you can just about be guaranteed that she will develop sugar diabetes later in life.  Thinking of calling your dog “Lucky”?  Really? Are you kidding me?!  Every “Lucky” I’ve ever known was lucky enough to get kicked by a horse, run over by a truck, lose an eye in a dog fight, fall off a cliff, or develop every serious disease known to dog-kind. 

If you feel compelled to name your new dog after the dog you just lost, consider some serious self-introspection. When I meet Bart II, Bart III, or Bart IV (yes, I’ve met every single one of these Barts), I sense that my client never fully embraced the grieving process.

I’m a believer in freedom of speech, but name your adorable new pup “Satan”, “Killer”, or “Hitler” (yes, I’ve encountered all three) and don’t count on developing a warm and fuzzy relationship with your veterinarian.

And finally, if you happen to get two pups at the same time (generally not a good idea, but that’s a whole ‘nother blog), please avoid any of this “Bonnie and Clyde”, “Mickey and Minnie” or “Pinot and Noir” business.  Inevitably, one of your beloveds will precede the other in death and the matching name thing is only going to make the loss feel all the more painful.  It’s awfully hard for a “Batman” to stand on his own two feet (make that four feet) when “Robin” is no longer part of the dynamic duo.

Google “dog names” and you’ll come up with almost five million hits. C’mon now, no excuses!

What is your dog’s name and have you been pleased with your choice?

Now, here’s wishing you and your four-legged best friend abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook    

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Vaccinations for Your Dog: A Complex Issue

August 1, 2010

During my last year of veterinary school, I recall how scary it was when a new canine virus—parvovirus—seemed to appear out of nowhere.  Highly contagious, it spread like wildfire throughout the United States, causing severe illness and often death. It was a downright frightening time for veterinarians and the clients they served. Fortunately, an effective vaccine was rapidly developed, and this horrible new virus was downgraded from a rampant deadly infection to a preventable disease. Thank goodness for vaccines! They provide a remarkable means of preventive health care for dogs. 

As invaluable as vaccinations are for protecting canine health, determining which vaccines are appropriate and how frequently they should be administered are no longer simple decisions. In my book, vaccinations are no different than any other medical procedure.  They should not be administered without individualized discussion and consideration of the potential risks and benefits. Gone are the days of behaving like a “Stepford wife” when it comes to your dog’s vaccinations — it’s no longer necessarily in his best interest to vaccinate simply because a reminder postcard has arrived in the mailbox.

Consider the following: 

• There are currently 14 canine vaccinations to choose from! Back in the days when I was just a pup there were only five, and decision-making regarding vaccine selection for an individual dog was far less complicated.

• Over the past decade we’ve learned that, for some vaccines, the duration of protection is far longer than previously recognized.  In the past we vaccinated for the core diseases (distemper, parvovirus, and rabies) annually.  We now know that these vaccinations, when given to adult dogs, provide protection for a minimum of three years and, in some cases protection is life-long.

• The duration and degree of immune protection triggered by a vaccine is variable, not only based on manufacturer, but from dog to dog as well.

• Other than for rabies (state mandated), vaccination protocols are anything but standardized. There are no set rules veterinarians must follow when determining which vaccines to give and how often they are administered. Unfortunately, some vets continue to vaccinate for distemper and parvovirus annually even though we know that these adult vaccines provide protection for a minimum of three years.  Some vets give multiple inoculations at once, others administer just one at a time.

• Increasingly clear-cut documentation shows that vaccines have the potential to cause many side effects.  While vaccine reactions/complications are still considered to be infrequent, they can be life threatening. 

What you can do:

So, as your dog’s savvy and courageous medical advocate, what can you do to be sure that he is neither under or overvaccinated? Here are some guidelines for making wise vaccine choices for your best buddy: 

1.  Educate yourself about available canine vaccinations and the diseases they are capable of preventing (in some cases treating the disease, should it arise, might be preferable to the risks and expense associated with vaccination). Learn about duration of vaccine protection and potential side effects.  Talk with a trusted veterinarian and read the chapter called “The Vaccination Conundrum” in Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life. It provides detailed discussion about all aspects of canine vaccinations including the diseases they prevent, adverse vaccination reactions, and vaccine serology (blood testing that helps determine if your dog is truly in need of another vaccine). The American Animal Hospital Association’s “Canine Vaccine Guidelines” is also an excellent source of information.

2.  Figure out which diseases your dog has potential exposure to.  A miniature poodle who rarely leaves his Manhattan penthouse likely has no exposure to Lyme disease (spread by ticks); however a Lab that goes camping and duck hunting may have significant exposure.

3.  Alert your veterinarian to any symptoms or medical issues your dog is experiencing.  It is almost always best to avoid vaccinating a sick dog — better to let his immune system concentrate on getting rid of a current illness rather than creating a vaccine “distraction.” If your dog has a history of autoimmune (immune-mediated) disease, it may be advisable to alter his vaccine protocol or even forego ongoing vaccinations — be sure to discuss this with your vet.

4.  Let your vet know if your dog has had vaccine side effects in the past. If the reaction was quite serious, she may recommend that you forego future vaccinations, necessitating an official letter to your local government agency excusing your pup from rabies• related requirements.

5.  Consider vaccine serology for your dog.  This involves testing a blood sample from your dog to determine if adequate vaccine protection still exists (remember, vaccine protection for the core diseases lasts a minimum of three years).  While such testing isn’t perfect, in general if the blood test indicates active and adequate protection, there is no need to vaccinate. Serology may make more sense than simply vaccinating at set intervals.

6.  Ask your veterinarian about the potential side effects of proposed vaccinations, what you should be watching for, and whether or not there are any restrictions for your dog in the days immediately following vaccination. 

Vaccine Clinics

I will tell you right up front that I am not a fan of vaccine clinics –  a “factory line” approach to vaccinating dogs.  Their only redeeming quality seems to be their low cost that makes it possible for some dogs to be vaccinated that otherwise wouldn’t be.  Know that, if you choose to use a vaccination clinic you may be sacrificing quality of care for your dog in the following ways: 

• You may not receive adequate counseling about which vaccinations are appropriate for your dog based on his age and lifestyle.

• Serologic testing will not be an option.

• A thorough physical examination will not be performed prior to vaccination administration.  Abnormalities such as a fever, irregular heart rhythm, or abdominal mass will go unnoticed.  Not only might the vaccination do more harm than good in a dog that is sick, but a golden window of opportunity for early disease detection and treatment will be missed.

• Records pertaining to prior adverse vaccination reactions may not be available.

• The vaccination clinic veterinarian may not be available to tend to your dog should he experience an adverse reaction, especially one that occurs hours to days later.

Have you had difficulty figuring out which vaccines your dog really needs and how often they should be administered?  If so, please share your story with me.

Now, here’s wishing you and your four-legged best friend abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook    

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.