Posts Tagged ‘medical advocate’

When the Doctor Becomes the Patient: Not Always a Pretty Picture

May 2, 2011

While in the midst of my post-surgery “down time” I’ve been chuckling a bit about what my own physicians have endured as a result of my medical background.  How commonly is a surgeon interrogated about what type of suture pattern and material he intends to use? How often does an anesthesiologist need to provide a detailed pharmacologic rundown of the anti-emetic (anti-vomiting) drugs that will be used to keep the patient with a queasy stomach from puking post-operatively? 

© Steve Horton

I remember one particular appointment with my family physician a few years back.  When we discussed the reason for the visit I began with, “I think I have cancer!”  I explained that I’d been losing weight even though I’d been eating normally.  After all, a diagnostic workup on a middle-aged dog or cat losing weight in the “midst of plenty” often results in the diagnosis of cancer.   My physician worked hard to hide a grin as he explained that, given my age, sex, and overall vigor, other diagnoses were far more likely. Thankfully, he was right, and the next time I saw him he asked for permission to share this “amusing patient story” with some medical students he was training.  

Sometimes, the medical knowledge I have can be a detriment to my own peace of mind.  As the story above illustrates, I’m always keenly aware of the worst-case scenario (tough on a person who is a natural born worrier). Would I trade being a veterinarian for any other profession?  Not in a million years.  Not only do I love what I do, I love that my medical background (along with a bit of chutzpah) allows me to be a stellar medical advocate for myself.  And if you’ve read much of what I’ve written in the past, you know that I am all about medical advocacy! 

Do you work within the medical profession?  If so, how has this been helpful or detrimental when interacting with your health care professionals (including your veterinarian)? 

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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What is a Veterinary Specialist?

March 21, 2010

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology.  The responses have been strongly disapproving, and here is the reason why:  The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing.  (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty.  This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds.  Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon!  Veterinary specialists are found in university teaching hospitals and in some private practices.  They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise.  When this is the case, you, the lucky client, end up with access to multiple specialists under one roof.  Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

  1. A second opinion is desired by you or your veterinarian.  Yes, you definitely have the right to request a second opinion.  I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.
  2. Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.
  3. Your vet doesn’t specialize in the disease your pet has or the therapy he needs.  Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist?  Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites.  Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist?  Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian?  If so, please share your experience.  I’d love to hear from you.

Diplomate, ACVIM Internal medicine (acvim.org)
Diplomate, ACVIM, Cardiology Cardiology (acvim.org)
Diplomate, ACVIM, Oncology Oncology (acvim.org)
Diplomate, ACVIM, Neurology Neurology (acvim.org)
Diplomate, ACVS Surgery  (acvs.org)
Diplomate, ACVD Dermatology (acvd.org)
Diplomate, ACVR Radiology (acvr.org)
Diplomate, ACVO Ophthalmology (acvo.org)
Diplomate, AVECC Emergency and critical care (acvecc.org)
Diplomate, ACVA Anesthesiology (acva.org)
Diplomate DACVB Behavior (dacvb.org)
Diplomate, ACVN Nutrition (acvn.org)
Diplomate, AVDC Dentistry (avdc.org)
Diplomate, ACT Theriogenology (theriogenology.org)
CVA Veterinary acupuncture (Ivas.org)
TCVM Chinese veterinary medicine (tcvm.com)
AVH Homeopathy (drpitcairn.com) or (theavh.org)
ACVA Chiropractic (animalchiropractic.org)
CCRP Canine rehabilitation (caninerehabinstitute.com)

Best wishes to you and your four-legged family members for abundant good health,

Nancy Kay, DVM
Diplomate, ACVIM
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.

An Herbal Addendum and Vital Information About Vitamins

March 1, 2010

My most recent blog focused on potential pitfalls associated with treating our pets with medicinal herbs.  As so commonly happens, I received wonderful feedback, and one comment in particular, I would like to share with you.  Dr. Susan Wynn, a much-admired veterinary colleague offered this sage advice, “I think your conclusion is appropriate – if you’re interested in herbs, talk to your vet.  I think you need to go one further, though, since most veterinarians know little about herbs – find a veterinarian who has a special interest in herbal medicine.  Not only are they more aware of interactions and toxicity, recent research and clinical experience, they also take great care to source their products from American companies, some of them organic, that employ knowledgeable formulators. About the PDR recommendation – that will not be as helpful as it is for people only.  Please see Veterinary Herbal Medicine (Elsevier, 2007).  Disclaimer – I’m the first author on it – but it was written to collect the most comprehensive available information on herbs and their use in domestic animals.  There are thousands of references, detailed information on over 100 herbs including known toxicity and interactions, species specific cautions, traditional ethnoveterinary uses and scientific support.”  

Just as many people are giving their herbs to their pets without veterinary supervision, so too are they providing them with supplemental vitamins.  I wish I could tell you that vitamins are perfectly safe to give.  Alas such is not the case and here is why.    Vitamins come in two basic varieties; they are either water soluble or fat soluble. Vitamins B and C are water soluble meaning that any excess in the body is readily eliminated from the body within the urine.  I certainly take an abundance of vitamin C when I feel a cold coming on (thanks to Linus Pauling) with no worries of an overdose.  Not true for vitamins A, D, E, and K.  These are fat soluble vitamins, meaning amounts above and beyond what the body needs cannot be readily eliminated. Rather, the excess is retained within the body’s fat stores which can result in hypervitaminosis (symptoms caused by a vitamin overdose).  For example, too much vitamin A can cause horrendous bony abnormalities and too much vitamin D can wreak havoc on normal calcium metabolism resulting in muscle tremors, gastrointestinal issues, and even kidney failure. 

What’s the bottom line?  As tempting as it is to believe that over the counter herbs and vitamins are safe for any and all living beings, take the time to discuss these products with a trusted veterinarian before you provide them to your beloved pets.

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.

Medicinal Herbs: Not to Be Taken (or Given) Lightly

February 23, 2010

As a small animal internist, the majority of my patients are referred by their family veterinarians.  By the time I first examine them, they are usually receiving a laundry list of conventional medications (antibiotics, nonsteroidal antiinflammatories, etc.) and/or complementary medications (herbs, homeopathic remedies).   I’ve always scrutinized the conventional medications on the list because their potential side effects and the ways they might impact my diagnostic and therapeutic planning.  I’ve tended to pay far less attention to the complementary medications because of my impression that these medicinals are unlikely to cause significant harm or interact unfavorably with other things I might prescribe. Well, there will be no more of this “ignorant bliss” for me! Not after reading, “A Review of the Potential Forensic Significance of Traditional Herbal Medicines” from the Journal of Forensic Science (January, 2010).  The author, Roger Byard, M.D. undertook a review of herbal medicines based on their increasing popularity (there has been a steady 10% increase in spending on botanical remedies in the United States) and the fact that access to such products is largely unrestricted- they can be purchased without prescription. Keep in mind that herbs are manufactured and sold without any FDA approval process.

Here are some of Dr. Byard’s comments and findings:

-An analysis of 251 Asian herbal products from stores in California identified arsenic in 36, mercury in 35, and lead in 24. There have been reports of lead poisoning and mercury poisoning in people caused by such contamination.
-Less expensive herbs are sometimes intentionally used to replace those that are more costly. A case is referenced in which an herb designed to promote weight loss was replaced with another. The unfortunate result for the patient was kidney failure.
-Accidental substitution can occur if plants are incorrectly identified or if the name is misinterpreted. Apparently, some traditional herbal preparations have multiple names. To make matters even more confusing, some herbal preparations that are different from one another go by the same name.
– Failure to process fresh herbs correctly can have serious consequences. Processing is designed to clean and preserve the desired material while removing or reducing any unwanted toxic components. The example provided was aconite root, a plant that must be soaked in water and boiled to reduce toxicity. Failure to do this can result in heart rhythm abnormalities and/or heart failure.
-Some herb manufacturers purposefully adulterate their products with drugs presumably to increase their efficacy. Yet no mention of this is made on the packaging. Examples of hidden products found in herbal preparations have included conventional medications to treat pain, inflammation, seizures, heart failure, and asthma.
-Herbal medicines can interact with conventional drugs and other herbs to cause undesirable side effects. For example, St. John’s Wort can decrease the blood level of some medications by impacting how they are metabolized within the liver.
-The American Society of Anesthesiologists has recommended discontinuation of herbal medicines at least two weeks prior to surgery because of their potential for causing complications. Although only eight herbs were identified as being potentially dangerous, they accounted for 50% of all single herb preparations of those sold within the United States. For example, Ginkgo has the potential to increase the risk of hemorrhage and Valerian can exacerbate the sedative effects of anesthetic agents.

Although Dr. Byard’s review is based on findings in human medicine, I have to believe that the general points he makes likely apply to veterinary medicine as well. His review has certainly served as a wake up call for me. If you use herbs, for your pets or yourself, perhaps this information will prompt you to think about things a bit differently as well. What is a practical approach for avoiding the potential pitfalls associated with herbal medications? I encourage you to consider doing the following:

  1. If you are giving herbs to your pet based on your own initiative, schedule an appointment with your vet to discuss and verify that what you are doing is reasonable and safe.
  2. Have a look at the blog I posted in July, 2009 (http://speakingforspot.com/blog/?p=407) called, “The Lowdown on Nutritional Supplements.” It will teach you how to use the ACCLAIM system to evaluate the quality of herbal products.
  3. Pick up a copy of the Physician’s Desk Reference (PDR) for Nonprescription Drugs, Dietary Supplements, and Herbs. It provides information about the indications, contraindications, and warnings for all commonly used herbs. This PDR is readily available via major online book vendors. I will certainly be using my own copy a whole lot more than ever before!

I hope I have not created fear or anxiety by presenting this information. Rather, my goal is to help you become the very best medical advocate possible. Now, like me, you know that herbal medications should not be taken (or given) lightly. If you provide herbs to your pet(s), I would love to hear from you. Please let me know which one(s) you are giving and whether you or your veterinarian initiated this treatment.

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. 

 

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