Archive for the ‘Internet Veterinary Information’ Category

Stem cells: A beneficial therapy or a waste of money?

May 8, 2011

 

Stem cell therapy (aka regenerative medicine) is becoming all the rage in veterinary medicine.  Initially used only to treat damaged horse parts (tendons, ligaments, and joints) the repertoire of stem cells has expanded to treating dogs, primarily for management of arthritis symptoms.  Even a few kitties are getting in on the act as regenerative medicine is investigated as a means of restoring health to their aged kidneys.

Here’s a rundown on the logistics of stem cell therapy. The process begins with the veterinarian harvesting fat or bone marrow samples from the affected individual.  These samples are then sent off to a specialized “stem cell company” for processing. Recently, one company, MediVet America, has provided the option for vets to propagate stem cells within their own hospital setting. Once harvested the stem cells are injected into the patient’s affected body part(s) and/or are administered intravenously.  Extra cells can also be “banked” for future use. And all of this for a price of $2,000 to $3,000, on average.

In theory, these stem cells have the potential to differentiate into bone, cartilage, and many soft tissue types.  Why do I emphasize, “in theory”? To date, there is no proof that the stem cells, once injected into the body, do actually become the cells we are hoping for.  Perhaps any observed benefit is a result of biochemical alterations of the cells already present rather than regeneration of new and improved cells. 

Not only is there a paucity of information about what actually happens to the cells after they are injected, there is a surprising lack of evidence-based data that supports any benefit of stem cell therapy.  In this regard, it appears that the stem cell therapy cart has pulled way ahead of the horse- unusual in the world of “western medicine” where veterinarians are typically reluctant to embrace a particular therapy without it having survived the scrutiny of evidence-based medicine.  Yet many western trained practitioners readily offer forth stem cell therapy to their clients based on anecdotal information (individual client impressions, vignettes told by other veterinarians, marketing materials from stem cell laboratories). 

According to a recent article in the Journal of the American Veterinary Medical Association (JAVMA), Dr. Robert Harman, CEO of Vet-Stem Inc reports that his company has processed stem cells from fat samples for approximately 8,000 patients.  Approximately half the patients are horses, the other half comprised of dogs and a few cats.  In the same article, Dr. Sean Owens, director of the Regenerative medicine Laboratory at the University of California- Davis School of Veterinary Medicine states, “We’ve moved forward so quickly that what we need to do now is put the science underneath.”

Dr. Brennan A. McKenzie is the president-elect of the Evidence-Based Veterinary Medicine Association. As stated in the same JAVMA article, “Dr. McKenzie thinks the use of stem cells is a promising avenue for therapy but that the evidence of efficacy and safety is inadequate to justify the expensive treatment in most cases.  He would prefer for clinics to offer stem cells as a truly experimental treatment in formal clinical trials.”

The North American Veterinary Regenerative Medicine Association has recently been organized with hopes of acting as a clearinghouse of information on the use of stem cells in veterinary medicine.  Their first official meeting will be in June with the intention of forming standing committees to address things such as clinical trials and regulatory affairs.

Given the paucity of research supporting stem cell therapy, is there any downside to opting for this form of therapy for your dog or horse?  While there is always risk associated with general anesthesia (usually required for harvesting fat or bone marrow samples as well as injecting the stem cells into the exactly appropriate spot), thusfar, there have been no reports of adverse effects caused by the stem cells themselves. If my own doggie had significant arthritis pain and nothing else in my medical arsenal (supplements, acupuncture, underwater treadmill therapy, nonsteroidal anti-inflammatory medications) made a difference, might I try stem cell therapy?  You betcha. Is there risk of expenditure of two to three grand without a return on investment?  You betcha.

Has one of your four-legged family members received stem cell therapy?  If so, I welcome your feedback.

Best wishes for good health,             

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
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, and your favorite online book seller.

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Reasonable Expectations VI: The Ability to Discuss Your Internet Research With Your Vet

December 7, 2010

This is the sixth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through five can be found at http://www.speakingforspot.com/blog.  Please take your time with this one- I realize it is a lengthy post, but there is a great deal to say about this worthwhile topic!

When your beloved pet develops a medical issue, chances are you’ll be inclined to do some Internet research and then talk with your vet about what you’ve learned.  Know that having this discussion with your vet is a perfectly reasonable expectation as long as you are careful to avoid using valuable office visit time discussing “whackadoodle” notions gleaned from cyberspace.  Here are some pointers to help you find instructive, accurate, worthwhile Internet information while avoiding “online junk food”. By the way, although I’m a veterinarian teaching people how to better care for their furry and feathered family members, please know that this information also applies to your own health care.

So, let’s begin.  How can you determine whether or not a website is dishing out information that is worthy of your time? Here are some general guidelines:

1.  Ask your veterinarian for her website recommendations.  She might wish to refer you to a specific site that will supplement or reinforce the information she has provided.

2.  Veterinary college websites invariably provide reliable information.  Search for them by entering “veterinary college” or “veterinary school” after the name of the disease or symptom you are researching.

3.  Web addresses ending in “.org,” “.edu,” and “.gov,” represent nonprofit organizations, educational institutions, and governmental agencies, respectively.  They will likely be sources of objective and accurate information.

4.  If your dog has a breed-specific disease, pay a visit to the site hosted by that specific breed’s national organization.

5.  Avoid business-sponsored websites that stand to make money when you believe and act on what they profess (especially if it involves purchasing something).

6.  Be ever so wary of anecdotal information.  It’s perfectly okay to indulge yourself with remarkable tales (how Max’s skin disease was miraculously cured by a single session of aromatherapy), but view what you are reading as fiction rather than fact. 

7.  I really love disease-specific online forums.  Check out those sponsored by Yahoo (http://groups.yahoo.com).  Not only do many of them provide a wealth of educational information, members can be a wonderful source of emotional support- always a good thing for those of us who share our homes and hearts with an animal.  If you are considering joining an online forum, I encourage you to look for a group that focuses on a specific disease (kidney failure, diabetes, etc), has lots of members, and has been around for several years.  For example, an excellent Yahoo group AddisonsDogs has 3,391 members and has been up and running for eight years.  A large group such as this typically has multiple moderators who screen participants, screen comments to keep things on topic, present more than one point of view (always a good thing), and provide greater round-the-clock availability for advice and support.  Look for presentation of cited references (clinical research that supports what is being recommended). Such groups should have a homepage that explains the focus of the group and provides the number of members and posts per month (the more the better).  They may have public archives of previous posts that can provide a wealth of information.

I happen to enjoy hearing about what my clients are learning online.  I sometimes come away with valuable new information, and I’m invariably amused by some of the extraordinary things they tell me- who knew that hip dysplasia is caused by global warming!  Surf to your heart’s content, but be forewarned, not all veterinarians feel as I do.  Some have a hard time not “rolling their eyes” or quickly interrupting the moment the conversation turns to Internet research.  What can you do to realize the expectation of discussing your online research in a way that is neither irritating to your vet nor intimidating for you?  Listed below are some secrets for success:

-I may be preaching to the choir, but I cannot overemphasize the importance of working with a vet who is happy and willing to participate in two-way, collaborative dialogue with you (please reference my earlier blog about relationship centered care- http://speakingforspot.com/blog/?p=1174). Your opinions, feelings, and questions are held in high regard and enough time is allowed during the office visit to hear them. A veterinarian who practices this “relationship centered” style of communication is far more likely to want to hear about your online research than the veterinarian who practices “paternalistic care” (far more interested in telling you what to do than hearing about your thoughts, questions, or concerns).  Remember, when it comes to veterinarian/client communication styles, you have a choice. It’s up to you to make the right choice!

-Let your vet know that you appreciate her willingness and patience in helping you understand how best to utilize what you’ve learned online.

-Wait for the appropriate time during the office visit to discuss what you’ve learned on line.  Allow your veterinarian to ask questions of you and examine your precious poopsie rather than “tackling” her with questions and discussion about your Internet research questions the moment she sets foot in the exam room.

-Be brief and “to the point” with your questions.  Remember, most office visits are scheduled for 15 to 20 minutes, max.

-Let your veterinarian know that you’ve learned how to be a discriminating surfer!  You know how to differentiate between valuable online resources and “cyber-fluff”. You ignore anecdotal vignettes and websites trying to sell their products in favor of credible information provided by veterinary college sites and forums that are hosted by well-educated moderators who provide cited research references that support their recommendations.

-When you begin conversation about your Internet research, I encourage you to choose your wording wisely. Communicate in a respectful fashion that invites conversation as opposed to “telling” your vet what you want to do.

In the Internet, we have an extraordinary tool at our fingertips. I encourage you to be selective when choosing which websites you intend to take seriously and which ones you wish to visit for a good chuckle.  Approach conversations with your vet about your Internet research thoughtfully and tactfully.  These strategies are bound to facilitate constructive conversation and create a win-win-win situation- for you, your veterinarian and your beloved best buddy! 

Have you had conversation with your vet about your Internet research?  If so, how did it go?

Now here’s wishing you and your four-legged family members abundant good health.  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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
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, and your favorite online book seller. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Gone to the Dogs for 24 Hours

November 12, 2010

When was the last time you pulled an all-nighter?  Beginning at 11:00 am PST on Saturday, November 13, 2010 eight fabulous bloggers will be blogging for 24 hours straight.  Why are they embarking upon such craziness?  They are blogging round the clock to raise money for some wonderfully worthwhile causes.  Please visit their sites and let them know that you support their efforts.   They are:

Dr. V – Pawcurious – http://www.pawcurious.com

Dr. Janet Crosby – http://aboutvetmed.com

Dr. Shawn Finch – http://rileyandjames.com/blog/

Dr. Laci Schaible – http://www.vetlive.com/blog/

Vicki Boatright – http://www.facebook.com/artistbztat

Jen Cleere – http://www.fetchingtags.net/blog/

Michelle Maskaly – http://www.mytailhurtsfromwaggingsomuch.com/

Felissa, Davinia and Indiana – http://twolittlecavaliers.blogspot.com/

Please look for my guest post within the Pawcurious blogathon.  I hope to join the ranks of the 24-hour bloggers next year!

Dr. Nancy Kay

Communicating About Communication

November 8, 2010

I’ve just returned from the International Conference on Communications in Veterinary Medicine (http://www.iccvm.com).  This was a gathering of folks from all around the world eager to share their research, report their observations, and learn more about communication in the world of veterinary medicine.  The majority of information shared at this meeting pertained directly to how veterinarians communicate with their clients.  From my perspective, this is such exciting news! As little as a decade ago, barely a trace of research existed on the topic of client communication in veterinary medicine.  Now there are a reasonable number of studies underway, many of which are geared towards figuring out the best ways to incorporate and teach client communication within veterinary school curricula.  While the Canadian veterinary colleges seem to really be leading the charge in this research, what’s clear is that more and more veterinary school faculty around the world are grasping just how important it is to teach client communication skills to their students.  Hurray!

I was asked to provide a lecture/workshop for this meeting and chose, “The Internet and the Vet: How the Worldwide Web is Changing the Way We Communicate”.  I presented the data about email communication between veterinarians and their clients that you were privy to via this blog a couple of months ago (http://speakingforspot.com/blog/?p=1363). We also discussed how to interact with clients who do Internet research pertaining to their pet’s health (These days, who doesn’t do this?). We did some role-playing to try to identify ways to make our clients feel more comfortable when discussing their Internet research.  We all agreed that most clients are a bit bashful when broaching this topic- by doing so they fear that they may be conveying mistrust in their veterinarians.

Take home points emphasized repeatedly at this meeting were the importance of empathic communication (delivered verbally and nonverbally) and relationship centered care- the communication style that emphasizes collaboration between veterinarians and their clients. The payoff for utilizing this style of communication is greater job satisfaction for the veterinarian and greater client satisfaction with the services received.  I feel wonderfully fortunate to be practicing veterinary medicine at a time when a conference about communication in veterinary medicine exists. 

Over the years have you perceived ways that communication between you and your veterinarian are changing? If so, I would love to hear from you.

Now here’s wishing you and your four-legged family members abundant good health.  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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
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, and your favorite online book seller. 

Free Christmas or Chanukah guft wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Reasonable Expectations Part IV: Communicating With Your Vet Via Email

September 27, 2010

This is the fourth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through three can be found at http://www.speakingforspot.com/blog.

Have you any interest in emailing rather than calling your vet when you have questions? This is certainly a reasonable expectation assuming that your vet is willing to communicate online. Email communication with doctors is not a new concept.  The Kaiser Permanente “My Health Manager” program with an “email my doctor” feature has been wildly successful.  Not only are more and more patients using the program (and Kaiser is promoting it in their marketing ads), a study on more than 30,000 Kaiser Permanente patients with high blood pressure and/or diabetes documented that those who communicated via email with their physicians enjoyed better health outcomes! 

I recently surveyed 120 of my northern California colleagues about email communication with clients and here is what I learned from them:

•58% of the vets who responded are communicating with their clients via email
•62% of those who use email are selective- they do not provide email access to all of their clients
•26% of those using email set “ground rules” with their clients; interestingly, many commented that they strongly feel the need to set email ground rules, but have been too “wimpy” to do so
•Receptionists communicate with clients via email in 37% of the practices polled
•Technicians (nurses) communicate with clients via email in 21% of the practices polled
•95% of the veterinarians who use email reported it to be a mostly positive experience

The veterinarians using email unanimously reported that it is great for simple, non-urgent communications (emphasis on non-urgent). Just imagine every veterinarian’s nightmare- you check your email in the evening and find a message that is eight hours old from a client describing their pet who is struggling to breathe and has blue gums!  Vets using email enjoy the convenience- for many, not only is email less time consuming than telephoning (avoids phone tag), they can respond to emails at their convenience.  I can relate to this- I sometimes don’t finish up with my patients until 8:30 or 9:00 at night at which point I’m worried that it may be too late to return client phone calls. 

Along with the fear of not receiving urgent messages in a timely fashion, here’s what the vets I surveyed told me they do not like about email:

•Clients wanting a diagnosis via email rather than via an office visit
•No simple or easy process for transferring the email communication to the patient’s medical record
•Too time consuming for vets who have remedial word processing skills or feel the need to carefully edit their “written words”
•Clients who take advantage of the system and begin emailing too much and/or too often
•Receipt of “cutesy” emails (photos or stories that are incredibly cute, but only in the mind of the sender)

I happen to be a speed demon when it comes to word processing, and I would love the flexibility of communicating with my clients in the wee hours of the morning or late into the evening.  So why have I not jumped on the email bandwagon?  If you’ve read Speaking for Spot you know that communication between veterinarians and their clients is a topic near and dear to my heart.  So much of what is perceived during communication has to do with body language and voice inflection, neither of which can be perceived via email (unless I begin Skyping with my clients, God forbid!). I worry that, by using email, I will miss out on what’s happening emotionally for my clients. Even with this concern, the results of my survey have motivated me to dip my baby toe into the email whirlpool.  I think I will invite my clients to email me with really simple questions such as, “When am I supposed to bring Lizzie back in to see you?” or “Is it okay to give Radar his heartworm preventative along with the other medications you prescribed?”  Anything more than that, however, and I’ll be jumping back onto the phone in the blink of an eye. 

Do you communicate with your vet or your physician via email?  If so, what has the experience been like for you?

Now here’s wishing you and your four-legged family members abundant good health. 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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
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, and your favorite online book seller.

You can support your favorite rescue group.  The Speaking for Spot Gives Back Program shares a portion of the sales proceeds with approved non-profit organizations when you purchase a book via the Speaking for Spot website and designate the organization at the time of purchase.

Reasonable Expectations Part III: Access to Round-the-Clock Care

September 12, 2010

This is the third part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets.Parts one and two can be found at www.speakingforspot.com/blog.

If your dog is sick enough to require hospitalization or has just undergone a major surgical procedure, how will he or she be cared for overnight and on weekends?  As much as the mere thought of this makes me cringe I must advise you that even though your dog or cat is “hospitalized”, in some veterinary clinics this will involve no supervision whatsoever from closing time at night (perhaps 6:00 PM) until early morning when the first employees arrive back at the hospital.  What if your dog manages to slip out of his Elizabethan collar and chews open his surgical incision? What if your kitty begins experiencing pain during the night?  What if your dog vomits and aspirates the material into his lungs? All these “what if’s” are what make me crazy whenever I think about a hospitalized animal left alone for 8 to 12 hours at a time.  And here’s what makes me even crazier- some people don’t think to even ask how their beloved family member will be supervised when the clinic is closed, likely because they cannot fathom the possibility that adequate supervision would not be provided.

Please know that it is perfectly reasonable for you to expect that your hospitalized family member receive round-the-clock care.  There are a few different ways this can happen.  While a 24-hour hospital staffed with a veterinarian is ideal, this simply does not exist in all communities (but if it does exist in your neck of the woods, by all means take advantage!).  Here are some other viable options:

-A veterinarian comes into the clinic multiple times during the night and on weekends to check on the hospitalized patients (some vets prefer to take their patients home with them to help make monitoring and supervision more convenient).

-A skilled veterinary nurse (technician) comes into the clinic multiple times during the night and on weekends to check on the hospitalized patients and has access to contacting the vet should the need arise.

-Your dog or cat comes home with you, but only after you receive thorough monitoring instructions along with a way to reach your vet should questions or concerns arise.  As scary as this might sound, this remains a better option than leaving your best little buddy left completely unsupervised overnight.  Just imagine how you would feel lying in a hospital bed, hooked up to intravenous fluids, and no one entering your room to check on you for twelve long hours!

How would your dog or cat be cared for overnight and on weekends should the need arise?  Please do tell.  And if you’re not sure, no time like the present to find out.

Now here’s wishing you and your four-legged family members abundant good health.

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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
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, and your favorite online book seller.

Reasonable Expectations Part II: Access to “The Back” of the Hospital

September 4, 2010

This is the second part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets.  Part one can be found at www.speakingforspot.com/blog

Care to tag along next time your pet is whisked to “the back” of the veterinary clinic for an injection, a diagnostic test, or a nail trim? Perhaps you are curious about what actually goes on “back” there. Maybe you believe that your best buddy will feel more secure if you are present.  Whatever the reason, know that  if you desire to go where your pet goes and see what your pet sees, this is a perfectly reasonable expectation in most circumstances.   Your request might be denied if: 

-Your pet is better behaved without you there (all vets have experienced aggressive patients in the exam room who become gentle as lambs when separated from their humans).

-There is something going on that is private (for example, a grieving client) or too graphic for you to see (trust your vet on this one).

-Your dog or cat will be in an area of the hospital that is off limits to humans. For example, in my hospital, in order to avoid radiation exposure, no one other than the patient is allowed in the room where X-rays are taken.  Gentle sand bags are used for restraint along with mild sedation if needed.

– The staff is aware that you have a lot to say and no one will be able to get anything done because they will be too busy responding to your questions. 

Admittedly, some vets simply don’t like having clients tag along.  If your doc falls into this camp, some patient persuading on your part may be necessary.  Provide reassurances that you will be on your best behavior and remind him or her that large animal vets do practically all of their work in front of their clients.  I happen to love when my clients wish to accompany me into the bowels of the hospital.  In fact, I find myself inviting them to follow more often than they think to ask.  I prefer they get a first hand look at what I am doing and seeing, rather than simply listening to my after-the-fact verbal description.  Admittedly, I’m proud of my facility and feel great when clients see our bustling staff, content patients in clean, comfy cages, and state of the art diagnostic and patient monitoring equipment. 

Before my clients step foot beyond the exam room, I gently coach them on the art of being unobtrusive- avoiding instructing nurses on how to restrain their pet and asking a bazillion questions while I am performing a procedure.  I always reserve the right to send clients back to the exam room if I perceive that their anxiety level is becoming contagious, and I describe in advance what they will be seeing.  This deters some, which is a good thing- nothing like a fainting or vomiting client to get the day off to an exciting start! 

Have you ever accompanied your dog or cat to “the back” of the hospital?  Was it a good experience for you?  How about for your pet?

Now, here’s wishing you and your four-legged family members 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.

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.

Breed Profiling

March 13, 2010

Racial profiling is considered taboo, and for good reason.  Breed profiling, however, is fair game for those of us in the veterinary profession! We breed profile on a daily basis particularly pertaining to health issues.  Name just about any breed of dog or cat and I can provide you with a laundry list of potentially inherited diseases.  Patty Khuly, VMD (the “VMD” means her veterinary degree is from the University of Pennsylvania) has created a wonderfully comprehensive list of canine breed related diseases (the feline list is in the works).  I encourage you to check it out at www.embracepetinsurance.com/PetHealth/default.aspx. Not only does she list the most common maladies for each dog breed, she rates the risk for disease inheritance (low, medium, or high), describes each disease, and provides the approximate (emphasis on approximate) cost to diagnose and treat each disease. Hats off to Dr. Khuly for creating such a useful tool!  And if all of this weren’t enough, Dr. Khuly also manages to find the time to pen a witty and informative daily blog (www.petmd.com/blogs/fullyvetted).    

So how might Dr. Khuly’s information about breed-specific diseases be useful for you?  Certainly, if you are thinking about adopting a purebred pup, what you learn might sway your opinion about a particular breed.  If you already have your heart set on a specific breed, the disease-specific information will empower you to ask the right questions of the breeder to learn if the litter’s dam, sire, grandparents, and aunts and uncles have been affected.  A word of warning: don’t dare rely on the proverbial, “None of my dogs have ever had that problem.”  A conscientious breeder will offer forth official paperwork rather than verbal reassurances. Finally, if you already share your heart and home with a particular breed or think you know what breeds have gone into the “making of your mutt” being informed about the diseases that may arise will allow you to better be on the lookout for early symptoms. Timely detection and intervention can favorably affect the long-term outcome.     

Official White House Photo

Now, just for kicks, let’s check Dr. Khuly’s list of inherited diseases pertaining to Bobama (the name I’ve affectionately bestowed upon the newest dog in the White House).  According to the list, Portuguese Water Dogs are at medium risk for hip dysplasia (instability of the hip joints that results in arthritis), and at high risk for Addison’s disease (a hormonal imbalance) and follicular dysplasia (a hair follicle issue resulting in abnormal hair growth).  President Obama might be interested to know that one of his predecessors in the White House had Addison’s disease- none other than the late John F. Kennedy!  I wish Bobama a lifetime of good health, not only for the sake of the first family, but for the sake of the White House veterinarian as well!   

Best wishes to you and your four-legged family members for 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
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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.

Everybody’s Gone Surfin’ (Part Two)

December 26, 2009

I happen to enjoy hearing about what my clients are learning online.  I sometimes come away with valuable new information, and I’m invariably amused by some of the extraordinary things they tell me- who knew that hip dysplasia is caused by global warming!  Surf to your heart’s content, but be forewarned, not all veterinarians feel as I do.  Some have a hard time not “rolling their eyes” or quickly interrupting the moment the conversation turns to Internet research.  Who can blame them- they’ve grown weary of spending valuable office visit or telephone time talking their clients out of crazy cyberspace notions and reining them in from online wild goose chases.  How unfortunate this is.  Nowadays, people rapidly and reflexively reach for their keyboards to learn more about their pet’s symptoms or disease diagnosis online.  It’s only natural (and in their pet’s best interest) that they will want to discuss what they’ve learned with their veterinarian.

Is there an effective way to communicate with your vet about your online research that is neither irritating to her nor intimidating for you?  I truly believe it is possible, but it involves some work and planning on your part!  Listed below are some secrets for success- things you can do to converse about your Internet research in a manner that is comfortable for you and your vet and, most importantly, beneficial for your pet’s health.

-I may be preaching to the choir, but I cannot overemphasize the importance of working with a vet who is happy and willing to participate in two-way, collaborative dialogue with you. Your opinions, feelings, and questions are held in high regard and enough time is allowed during the office visit to hear them. A veterinarian who practices this “relationship centered” style of communication is far more likely to want to hear about your online research than the veterinarian who practices “paternalistic care” (far more interested in telling you what to do than hearing about your thoughts, questions, or concerns).  Remember, when it comes to veterinarian/client communication styles, you have a choice. It’s up to you to make the right choice!

-Let your vet know that you appreciate her willingness and patience in helping you understand how best to utilize what you’ve learned online.

-Ask your veterinarian for her Web site recommendations- those that have already been “vetted”.  This is a collaborative approach that lets her know you intend to spend some time learning more, plus a respectful recognition of the fact that she is the one who has spent her career learning about your dog’s health issues. 

-Wait for the appropriate time during the office visit to discuss what you’ve learned on line.  Allow your veterinarian to ask questions of you and examine your precious poopsie rather than “tackling” her with questions and discussion about your Internet research questions the moment she sets foot in the exam room.

-Be brief and “to the point” with your questions.  Remember, most office visits are scheduled for 15 to 20 minutes, max. 

-Let your veterinarian know that you’ve learned how to be a discriminating surfer!  You know how to differentiate between valuable online resources and “cyber-fluff”. You ignore anecdotal vignettes and Web sites trying to sell their products in favor of credible information provided by veterinary college Web sites and forums that are hosted by well-educated moderators who provide cited research references that support their recommendations.  If you need a little refresher course on how to be a “selective surfer,” I encourage you to read Part One of this article (http://speakingforspot.com/blog/?p=654).

-When you begin conversation about your Internet research, I encourage you to choose your wording wisely.  Communicate in a respectful fashion that invites conversation as opposed to  “telling” your vet what you want to do. Most veterinarians don’t like being told what to do by their clients, and who can blame them?  After all, we expect veterinarians to provide a collaborative approach- it’s only fair that they expect the same from their clients.  Consider the following conversation starters about Internet research:

Approach one:  “I’m wondering what you think about mixing some canned pumpkin in with Sophie’s food.  I’ve been doing some Internet research about diarrhea and this suggestion seems to comes up frequently.”

Approach two:  “I’ve been doing some online research and learned about the benefits of canned pumpkin.  I want to begin mixing this in with Sophie’s food.”

Approach three:  “I’d like to give Sophie some canned pumpkin for her diarrhea.  A moderator from an online forum suggested I do this.”

Approach four:  “I’ve been following an online forum about canine diarrhea. One of the moderators suggested I consider adding canned pumpkin to Sophie’s diet.  How do you feel about this?”

Which of these approaches sound like invitations for discussion? Which are more likely to be a “turnoff” for your veterinarian? If you’ve selected approaches one and four as successful ways for broaching the topic of Internet research with your vet, well done!  Give your dog a hug and yourself a pat on the back!

In the Internet, we have an extraordinary tool at our fingertips. I encourage you to be critical when choosing which Web sites you intend to take seriously and which ones you wish to visit for a good chuckle.  Approach conversations with your vet about your Internet research thoughtfully and tactfully. These strategies are bound to create a win-win-win situation- for you, your veterinarian and your beloved best buddy! 

Wishing you and your four-legged family members abundant good health,

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine 

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. 

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Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross