Archive for the ‘Veterinary Office Visits’ Category

A Truly Hands-On Physical Examination

March 24, 2011

Have you ever gone to the doctor and realized after the visit that those healing hands never actually touched your body? C’mon now, that’s not okay!  Nor is it okay for your veterinarian to skimp when it comes to examining your pet.  In veterinary school, we are taught to perform a thorough physical examination on each and every patient.  It would be a travesty to miss a new heart murmur or enlarged lymph node on a patient that presented for limping.  The sooner abnormalities are detected the more likely we are to gain an upper hand.

 

Listed below are the elements of a thorough physical examination for your dog or cat.  Bear in mind, it takes no more than a minute or two for a seasoned vet to competently complete the following (by the way, it helps if you are not talking when the stethoscope is being used!):

  • Assessment of overall alertness and appearance
  • Evaluation of gait
  • Evaluation of the skin and haircoat
  • Measurement of body weight, temperature, heart rate, respiratory rate, and capillary refill time (the time it takes for the gum line to become pink after it has been blanched by finger pressure)
  • Examination of the eyes, ears, nose, and oral cavity
  • Palpation of lymph nodes
  • Palpation of the thyroid gland (specific for cats)
  • Auscultation of the heart and lungs (listening with a stethoscope) on both sides of the chest
  • Palpation of the abdomen
  • Rectal examination (specific for dogs that are middle aged and older)

Vets perform physical exams differently in terms of order of events.  No matter in the least as long as everything is included. And please remember, such thorough exams are not to be reserved for only the annual office visit. If your kitty is vomiting or your dog has an ear infection, you should expect the whole shebang (although your dog or cat would probably prefer a mini-exam).

Is your veterinarian “hands-on” and doing one heck of a thorough job when it comes to the physical exam?  Please share your experiences.

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, 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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Wacky Tales of Whacking Tails

February 24, 2011

How on earth could a wagging tail be a problem?  Have you ever been around a large, muscular, happy dog who upends flower vases and knocks over beverages on coffee tables with his long vigorously wagging tail?  People living with such dogs literally have to “tail-proof” their homes! Ever been repeatedly slapped across the thighs by one of these wagging whips, and the more you react to the pain the more the dog wags?  Ouch! 

Such vigorous tail wagging can also be problematic for the dog.  By repeatedly whacking his tail against a firm surface such as wall or a table, an open bleeding sore can develop on the tail tip.   The dog’s response is to lick and chew at the site resulting in more inflammation and bleeding. This tail tip trauma isn’t typically terribly painful for the dog so, of course the tail keeps right on wagging.  Only now it’s a live paintbrush spattering speckles of red at the walls, furniture, kitchen appliances, and even nearby humans!  The result is as graphic as a CSI crime scene. 

One might imagine this would be a simple problem to fix.  The fact of the matter is, a bleeding tail tip poses a significant medical challenge. In order to heal, the tail must be immobilized, but how in the heck can you make a dog quit wagging his tail?  You can’t.  And it’s almost impossible to keep a bandage secured on the tail tip.  Most dogs are happy to chew off (and ingest) their tail bandages, and there are no Elizabethan collars large enough to prevent the tongue from reaching the tail tip. I’ve seen other things tried such as temporarily bandaging the tail to the dog’s hind leg so he can’t wag, or 24-hour supervision until the tip heals (a certain way to create a tired and pissed off client).   Besides, even if the tail tip does heal, the dog is going to re-whack it and the bleeding will start all over again. 

So, what’s the solution?  Partial amputation of the tail is the treatment of choice.  The tail revision need not need be as short as a Rottweiler look. Rather, the length should resemble an Airedale or Vizsla tail; still some tail, but short enough to prevent the wagging tip from coming into contact with hard surfaces. As with any surgery, there are potential complications and it is important to discuss them with your veterinarian.  Yes, the look of the dog is forever changed, but the wag will continue as vigorously as ever without altering the color of your wallpaper. 

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, 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.

Videotaping for Your Vet

February 1, 2011

Rarely am I bothered by client misbehavior, but when a client answers their cell phone while we are in the midst of discussion, I admit to feeling a bit peeved. So why in the world would I invite my clients to whip out their cell phones during the course of an office visit? Because I want to see video of my patients’ symptoms! Unless you are like me- still using a cell phone that my daughter considers prehistoric- your cell phone allows you to have instant access to shooting video. And if I can watch videotape of your pet’s confusing symptom or odd behavior, I’m more likely to figure out the underlying issue, more so than with just your verbal description (no offense intended). And when I have a better sense of the underlying issue, I can more expediently, and often less expensively, guide you towards rational diagnostics and/or therapy.

Unless the odd behavior or new symptom is occurring round the clock, the likelihood of it happening in my exam room is slim to none. You’d be surprised what symptoms fully resolve when animals are under the influence of adrenaline. So, if your dog or cat is doing something bizarre that you think will be difficult to accurately describe to your vet, I encourage you to grab your cell phone and shoot a video (feel free to include some Jacques Cousteau narration if you like). By all means, nix the video if you sense you are observing something that is life threatening, and get to the nearest veterinary hospital ASAP.

Here’s a classic example of how videotaping a medical problem can be wonderfully helpful. A common symptom in dogs is referred to as “reverse sneezing.” It occurs when a dog feels a tickling sensation in the back of their throat. It is somewhat equivalent to a person clearing their throat. However, when dogs reverse sneeze, the symptoms appear ridiculously overly dramatic. They assume a stiff posture with head and neck rigidly extended forward. This is accompanied by forceful, noisy inhalation and exhalation that can last for several seconds, even minutes. Check out the example of reverse sneezing in the video below.

For the uninitiated, reverse sneezing is a scary thing to watch- clients commonly report that they think their dog is having an “asthma attack.” Show your vet a video of reverse sneezing and he or she will be able to recommend what to do about it as well as provide plenty of reassurance that, no matter how dramatic the symptoms appear, they are not causing any oxygen deprivation. As much as video is helpful in this situation, I must admit I will miss watching my clients trying to imitate reverse sneezing (oops- I just revealed one of this veterinarian’s dirty little secrets)!

Here are some examples of other behaviors/symptoms that should prompt you to grab your cell phone and shoot some video (if you can think of others, please let me know):

1. Weakness
2. Trembling
3. Incoordination
4. Falling down/collapse
5. Episodes of pain
6. Symptoms associated with passing urine or stool
7. Making odd noises (in this situation audio taping is a must along with video)
8. Coughing (again, adding audio is great)
9. Labored breathing
10. Limping/lameness
11. Odd behavior

Have you ever shared video with your vet? If so, did it prove to be beneficial in making decisions about how to proceed?

Best wishes,

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.

Price Shopping: To Be Avoided at All Costs

December 13, 2010

I recently exchanged emails with a woman who was feeling frustrated while searching for a new veterinarian.  Her search included some “fee shopping” and she was disgruntled to find that some vets had the nerve to mark up lab fees more than others.  She wrote to me to find out how she might gain access to the fees charged by commercial veterinary laboratories so she could figure out how much mark up each veterinarian applied. She mentioned that she’d found one vet she really liked, but she was “out of the running” because her office charged double the lab fees (exact same test) as two others she’d investigated.

Here’s how I responded.  I encouraged my email buddy to consider reasons why fees are not uniform from hospital to hospital. In some cases, laboratory testing is run “in house” requiring on site technician time and costs involved in maintaining equipment.  Certainly charges to the client for this should be higher. The expertise a veterinary specialist brings to interpreting laboratory test results may be greater than that of a general practitioner.  Shouldn’t a client pay more for this? Additionally, every clinic must pay its overhead to continue to provide good service, and the more “bells and whistles” the hospital has, the higher that overhead will be.  For example, if the hospital employs sophisticated equipment to monitor anesthesia, that’s a really good thing, right?  Chances are, the fees for surgery there will be higher in order to cover the costs of this advanced level of care.

I went on to explain that I truly discourage people from price shopping when it comes to veterinary care unless it is an absolutely necessity.  A sweet six-month-old Labrador is currently being treated at my hospital because she sustained a horrific thermal burn all along her back from a faulty heating pad used during her surgery at a low cost spay/neuter clinic. This has necessitated major reconstructive surgery over her back- a tremendous price to pay both in terms of money and what this poor dog is going through. By the end of our email thread my correspondent seemed convinced- she told me that she’d decided to use the vet she really liked in spite of more expensive lab tests. Hurray!

Now, I’m not completely naïve when it comes to how our current economy is influencing delivery of veterinary health care.  I realize that for many folks, price shopping has become a financial necessity.  When this is the case, I encourage the following:

-Do your best to avoid sacrificing quality of medical care.  The old cliché, “You get what you pay for,” is often true.  Be thorough in your investigation: don’t make up your mind based on brief over-the-telephone price quotes.  Visit the clinic, tour the facility, and meet the staff to feel confident this is a place you and your pet will feel comfortable.

-Watch for “hidden” fees.  Some clinics may offer an extremely reasonable quote for a surgical procedure, but then charge additional fees for the initial office visit or for post-surgical necessities like removing stitches.

-Keep in mind the potential for complications.  If a significant complication occurs due to substandard care (such as occurred with the Labrador mentioned above) you will end up spending a great deal more money treating it, not to mention associated emotional energy, than you would have spent at the better more expensive clinic to begin with.

When you chose your veterinarian, how did fees enter into your decision-making?  If so, how did things turn out? I’d love to hear about your experience.

Now here’s wishing you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

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).

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).

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.

Dogs, Chocolate, and Smart Phones

May 31, 2010

Here’s a little ditty I couldn’t resist sharing.  I’m such a sucker for upbeat stories that involve kids or animals, and this one happens to involve both. An ingenious seventh grader named Parker Stevens was featured in a recent issue of DOGliving, a wonderful magazine out of North Carolina.  This young man created an iPhone application called ChocoTox that determines whether or not the amount of chocolate ingested by a dog is toxic. The iPhone user plugs in the dog’s body weight, amount of chocolate ingested, and “strength” of the chocolate (i.e., dark chocolate contains more of the toxic principle called theobromine than milk chocolate).  The smart phone then determines if veterinary intervention is indicated (I don’t think it mentions the need for impending carpet cleaning).

 

Kudos to Parker for his clever App aptitude! I sense this kid will be accomplishing great things in the world of technogeekdom!  Keep in mind, there are a few chocolaty circumstances that definitely favor consultation with your vet rather than your iPhone:

-More than one dog was involved in the chocolate fest and it is impossible to know which dog ate how much.
-The container that contained the chocolate was also ingested and is now residing somewhere in the dog’s gastrointestinal tract.
-The ingested chocolate happened to contain other toxic substances- a leafy green substance seems to be a common ingredient in brownies baked by some of our hospital clients.

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
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.