Posts Tagged ‘Veterinary Care’

Age is Just a Number

April 14, 2011

When my clients make decisions on behalf of their senior dogs and cats, they routinely factor in their pet’s age.  I often hear statements such as, “I would pursue a diagnosis if only she weren’t so old.” and “I would treat him if only he were younger.”  When my clients voice such “senior objections” I gently encourage them to consider the situation a bit more objectively by considering their pet’s functional age rather than their chronological age.  For example, it might be far safer for me to anesthetize the vigorous, playful thirteen-year-old Labrador with normal liver and kidney function I evaluated on Monday compared to the debilitated eleven-year-old Labrador with impaired kidney function I examined on Tuesday. Functionally speaking, the thirteen-year-old is, by far, the younger of the two.  When making decisions, savvy medical advocates evaluate the whole package- spryness, organ function, overall comfort, joie de vivre- rather than considering age alone.  Just because a dog or cat is, by definition, a senior citizen doesn’t mean their body is functioning like that of a senior citizen.

I thoroughly enjoyed explaining this point on NPR’s popular show, Fresh Air With Terry Gross. “Terry, you and I could both be 80 year old women in need of knee replacement surgery.  You might be a terrific candidate for surgery, whereas I might be a horrible candidate!”

When making medical decisions, my clients frequently ask about their pet’s life expectancy. Life expectancies for cats and dogs of varying breeds are nothing more than averages.  This means some individuals will never reach “average” and others will far exceed it. 

Here’s the bottom line. If you have a happy, lively, interactive, and agile senior dog or cat on your hands, throw those age-related numbers and averages out the window.  Rather, I encourage you to observe your pet’s overall quality of life, share some nose-to-nose time with your best buddy, look deep into those beautiful eyes, and make important medical decisions based on what’s truly important rather than simply a number.  Have you ever needed to be a medical advocate for a senior pet?  If so, please share your story.

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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Reasonable Expectations VIII: Written Cost Estimates

January 8, 2011

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

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.  Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?  Will you be charged $300, $800,  $1,300? Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?  Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.
• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
• Written cost estimates are discussed during 14% of appointments.
• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill. 

Why is a written estimate preferable to a verbal estimate? Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.   So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!  With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

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.

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).

L.O.V.E. for Health

November 21, 2010

Amy Shojai, CABC is a certified animal behavior consultant, a consultant to the pet products industry, and the award winning author of 23 pet care books and thousands of articles and columns. She hosts Pet Peeves radio at PetLifeRadio.com, and is the behavior contributor at cats.About.com, and publishes a free Pet Peeves newsletter available from www.shojai.com. Amy lives in N. Texas with a Frisbee-loving German shepherd named Magic and a crotchety old-lady Siamese wannabe called Seren.   I’m delighted to present her guest post and to participate in her Golden Moments Senior Pet Blog Tour.

Dr. Nancy Kay

Excerpted from

COMPLETE CARE for YOUR AGING DOG

CHAPTER 3—L.O.V.E. for HEALTH           

It is important to be tuned in to your pet’s needs at any age, but vital when she becomes a senior citizen. . . .A good way to remember the special needs of your older dog is to use the acronym L.O.V.E. That stands for Listen With Your Heart; Observe For Changes; Visit the Veterinarian; and Enrich The Environment.

Visit the Veterinarian: Well-Pet Exams

            An annual checkup for your dog is a good idea whatever her age. In the past, annual vaccinations were recommended, and that was a good reminder to get a physical examination at the same time. More recent studies indicate that annual vaccines may not be necessary. However, since dogs age so much more quickly than people do, an annual physical—or “well-pet” exam—is essential to ensure that she maintains good health.

            The well-pet exam becomes even more important for aging dogs, because they have fewer reserves and can become ill literally overnight. Each year, mature dogs age the equivalent of about seven human years, so waiting 12 months between checkups leaves them at risk for major health changes. A twice-yearly visit for dogs over the age of eight makes more sense.          That’s the equivalent to a middle-aged person getting a physical about every three years, says Dr. Tranquilli, a professor of veterinary anesthesia and pain management at the University of Illinois. “It makes all the sense in the world to get more aggressive with checkups, and for the veterinarian to ask appropriate questions with regard to overall behavior changes,” he says.

            A veterinarian has a more difficult time diagnosing problems if he only sees the pet when she’s sick and has no way to compare to well-pet behavior, especially when looking for subtle disease. “I want to see the pet every year so I’ve seen him when he’s healthy,” says Steven L. Marks, DVM, a clinical associate professor of critical care at North Carolina State University. “If something changes, I want to pick it up early.”

            A complete physical should include an oral exam, says Bill Gengler, DVM, a veterinary dentist at the University of Wisconsin. “You may not be able to do an in-depth exam until the animal’s asleep, but at least you can advise the owner that yes, there’s halitosis; yes, there’s gingivitis; and there’s calculus [tartar] on the teeth so we need to get it off.”

            The veterinarian will listen to the dog’s heart and lungs, check her eyes, ears and teeth, exam her for parasites, and make a note of any behavior changes you might have noticed that could indicate a problem.

            “As these animals get older, one starts looking at their liver, their intestinal track, their kidneys, at their heart, and various body systems, looking for those organs that could be failing,” says Johnny Hoskins, DVM, an internist and specialist in aging pets. “The number one cause of death in older dogs is cancer.” Looking at the outside of the dog and listening to her breathing and heart won’t detect organ failures or cancer. Geriatric screening tests help veterinarians go beyond the hands-on exam and take a look at the dog from the inside out.  

Complete Care for Your Aging Dog is a DWAA Maxwell Award Winner, and the 2010 Amazon Kindle Edition has been revised/updated with “hot links” to the experts cited in the book. Amy Shojai, CABC is the award-winning author of 23 dog and cat care and behavior books, and can be reached at her website http://www.shojai.com

Please visit the remaining blog stops on the GOLDEN MOMENTS SENIOR PET BLOG TOUR

NOVEMBER 23rd   Aging Dog/Cat articles on pet introductions, health benefits, and more at  www.cats.About.com

NOVEMBER 27th telephone interview www.PetHobbyist.com.

_____________________________________________________

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

 

Reasonable Expectations V: Discussion of All Options Regardless of Cost

October 24, 2010

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

Veterinarians wear many different hats when they are in the exam room. It’s a given they provide medical care for their patients. But did you realize that, for their clients they often assume the role of social worker, calendar planner, grief counselor, and even mediator when there are conflicting opinions between family members (mostly spouses)? Why on earth some veterinarians wish to also become financial planners for their clients is beyond me! These are vets who pick and choose which medical and surgical options to discuss based on what they think their clients can afford.

I don’t work this way- I believe in presenting every option that is reasonable for my patient and then letting my client determine what they can and cannot afford. This means that my client will hear all the same options whether he or she arrives at my hospital driving a Mercedes Benz sports car or a jalopy. The American Animal Hospital Association agrees with my modus operandi- they conducted a study documenting that ninety percent of people want their vets to present every option regardless of cost. Please hear what this is saying: it is perfectly reasonable for you to expect discussion of all options for your precious family member regardless of cost!

Let’s consider the example of a torn cruciate ligament. The knee joint contains cruciate ligaments that are responsible for keeping the upper leg bone (femur) in alignment with the lower leg bone (tibia). Cruciate ligament tears commonly occur in large breed dogs and there are several options for treating this injury. The least expensive option is rest and anti-inflammatory medications, the cost of which might be a few hundred dollars over the course of a several months. This nonsurgical least expensive approach restores mobility and use of the leg, but predictably results in arthritis within the knee and chronic lameness. The most expensive option is one of two highly specialized surgical techniques (referred to as TPLO and TTA) performed by board certified veterinary surgical specialists. Such surgery is the very best bet for restoring complete lifelong soundness to the knee. Depending on where the dog lives (everything is more expensive in California!) the cost for this surgery is $3,000-$4,000. Tack on post-operative rehabilitation therapy (on an underwater treadmill) and add another $500-$1,000 to your bill. The “in between options” include various surgical procedures that many general practitioners perform. While they are less expensive ($1,000 to $2,000) such surgery is less likely to result in an arthritis-free knee. Treatment of cruciate ligament disease is a clear example of, “You get what you pay for.”

Now there are a number of factors to consider when determining the best treatment option for a torn cruciate ligament. Perhaps the dog is ancient and debilitated and the risk for general anesthesia and surgery is too great. Perhaps there are other medical issues that are likely to be life ending soon- in this situation it would be irresponsible to choose surgery. There are many factors to consider, and finances may be one of them. But how would you feel if discussion of medical therapy for your dog’s cruciate ligament tear was purposefully withheld because your vet assumed you could afford surgery? Likewise, what if there was no discussion of referral to a surgical specialist because your vet felt it would be too much of a financial stretch for you? Do you want your veterinarian to be your financial planner or would you prefer to hear about all the options, then decide for yourself? Let me know how you feel about this. By the way, it might be wise to let your own veterinarian know as well!

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 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.

Puppy Mill Awareness Day – September 18, 2010

September 17, 2010

Awareness Day 2010,  Saturday September 18, 2010, is focused on educating the public about the horror of  puppymills and supporting the movement to end such horrible facilities.   The two articles below were written in early 2010.   You can help by spreading word to people you know who are interested in purchasing a purebred or “designer hybrid” pup.  Educate them about the dangers of purchasing a puppy online, sight (and site) unseen.  Encourage them to avoid the impulsive pet store purchase and to support their local rescue organizations.

Puppy Mills: People and Their Puppies Pay the Ultimate Price  

By Nancy Kay, DVM

Twice during the last month, I’ve experienced feelings of anger while in the midst of euthanizing one of my patients.  Normally I feel mostly sadness, often combined with an element of relief knowing that suffering is gently and humanely coming to an end.  Anger is an unusual visitor, but this emotion is sure to surface whenever I euthanize the innocent victim of a puppy mill (puppy mills are large scale breeding operations that produce puppies for profit with little or no attention paid to breed related inherited diseases).  I feel angered when confronted with a sweet little life, cut way too short and clients left confused, bereft, and devastated by the untimely loss of their beloved puppy. Such was the case with Max and Chloe and the people who cared for them. 

Max, was an insanely sweet and adorable Boston Terrier.  Once an effervescent, bubbly Boston, this nine-month-old pup had become listless- fatigued by the exertion of breathing.  You see, Max was born with an abnormally narrowed windpipe (imagine you or me trying to breathe through a straw).  My client Ed recalled thinking that his new pup’s breathing seemed abnormally noisy when he picked him up from the airport. He was shipped to California at 10 weeks of age from a breeder in Missouri.  Ed had been looking for a Boston Terrier and fell in love with Max the moment he saw his photo online.  He did not feel the need to visit the kennel where Max was born because he was so reassured by the emails and telephone conversations he and the breeder had exchanged.  She seemed to provide all the right answers to Ed’s questions.  Max’s health was guaranteed- any problems and Max could be returned, no questions asked. 

Other than the extra noise associated with Max’s breathing (not uncommon in a smoosh-faced breed such as a Boston Terrier), Ed thought he had a normal puppy on his hands.  It was only as Max’s body grew in relation to his small windpipe that he developed labored breathing, eventually needing to utilize almost every ounce of energy struggling simply to breathe. Ed was devastated by the news that we had no way to fix this problem.  With his own heart breaking, he held his sweet little Max tightly as I injected the euthanasia solution.  

Chloe, an eleven-month-old Cocker Spaniel, was born with defective kidneys.  Joe and Cindy first laid eyes on Chloe when they happened to pass through a shopping center pet store on their way to the movie theatre.  They never made it to the movies that afternoon- they bought a puppy instead! They simply couldn’t resist the charms of the little blonde puppy with the big brown eyes.  Joe and Cindy noticed that Chloe drank lots of water, and she could never be fully housetrained. A few months later, when she began vomiting and refusing her food, kidney failure was diagnosed.  Ultrasound revealed that both of Chloe’s kidneys were small and malformed- clearly a birth defect.  The once vigorous playful puppy gradually had become profoundly weak and lethargic.  Unfortunately, we had no reasonable way of creating long-term improvement for Chloe.  Heartbroken, Joe and Cindy gently stroked and loved their little girl as I ended her life. 

Puppy mills stay in business by preying on people who are willing to buy a puppy without doing their research.  These puppy purchasers simply don’t know better or allow their emotions to override their sensibilities.  They are vulnerable to the precious face in the online photo or the adorable puppy in the pet store window (pet stores are notorious for purchasing from puppy mills).  Puppy mill breeders often “seal the deal” by guaranteeing their puppies’ health, knowing full well how emotionally traumatic and near impossible it is for most people to “return a pup” once deep attachment occurs (deep attachment typically requires less than five minutes!).   

My new year’s wish is that my veterinary colleagues and I will see far fewer victims of puppy mills in 2010.  You can help my spreading word to people you know who are interested in purchasing a purebred or “designer hybrid” pup.  Educate them about the dangers of purchasing a puppy online, sight (and site) unseen.  Encourage them to avoid the impulsive pet store purchase.  By buying online or from a pet shop, they may be risking losing their beloved new family member at much too young an age, or inadvertently committing the next 10-15 years of their lives to taking care of an inherently unhealthy product of a puppy mill.  One less purchase from puppy mills, even indirectly is one step closer to their eradication.  Please stay tuned.  In my next blog, I will teach you how to recognize the telltale signs of a conscientious breeder. 

 Puppy Mills: Part II  

By Nancy Kay, DVM

I received an abundance of feedback in response to my recent blog about puppy mills.  Thanks to all of you who took the time to share your feelings concerning this emotional topic.  Virtually all of the comments expressed agreement that puppy mills are despicable and we wish they would cease to exist.  They also included important ideas that prompted me to think, “Wow, I wish I’d included that in my blog!”  Needless to say, I can’t resist sharing these wonderful comments and stories. 

Many of you reminded me that puppy mills spawn significant behavioral issues in their “merchandise” that can be just as devastating, if not more so, than the health issues that arise: 

Debbie wrote, “The physical abnormalities in puppy mill dogs are often accompanied by behavioral problems as well, fear being a major issue for many of these dogs who receive inappropriate or inadequate socialization. Like many medical issues the damage done due to inappropriate socialization may also be irreparable.” 

Diane commented, “I wanted to point out that for me, behavioral issues are also a major concern in addition to the health problems.  Don’t get me wrong, I get my business from people who buy these puppies, but honestly, I would rather just have a class full of wonderful healthy puppies and find some other way to make money.” 

Viviane wrote, “The health problems associated with puppy mills are truly heartbreaking and your post about this brought me to tears.  As a dog trainer and dog behavior consultant, I also see the behavioral results of this sort of breeding operation all too often, and that too is heartbreaking for unsuspecting souls who fall for a sweet face only to discover profound shyness and/or reactivity.  The dog that should have given a lifetime of joy and companionship and of course received the same, now is a beloved but seriously flawed family member who requires management and training to varying degrees for a life time.” 

Vanna stated, “I think it is really important to also point out that these puppy mill dogs aren’t properly socialized early on and therefore there are often serious issues by the time they bring the dog home.  Of course there is also an issue since they aren’t breeding for temperament.” 

Some thought I was tough enough on the puppy mills, but far too soft on the people who patronize puppy mills.  

Kerri commented, “It angers me because people who are educated about these horrible operations still buy from them. You say in your post, “Puppy mills stay in business by preying on people who are willing to buy a puppy without doing their research.” When I read that, I thought it was letting the buyers off way too easy. By the late 1990s when I rescued my first Doxie and wrote an investigative piece, Disposable Pets (http://www.writeforyou.biz/Disposable-Pets.htm) it was becoming known, but I think the general public could still be excused for ignorance. Today, the puppy mill buying public would have to literally live in a bubble not to know the problem of puppy mills and the terrible conditions from which these dogs come.” 

I couldn’t resist sharing Diane’s inspirational comment with you:  “Here! Here! I go one-step further…… I do not buy ANYTHING from pet stores that sell puppies!” 

A few people reminded me that, as states are cracking down on puppy mills, the innocent victims wind up in shelters and breed rescue organizations.  The people who care for them will require extra help for these emotionally fragile dogs.  There is an instructional DVD addressing this unique situation (check out www.missiondog.com). 

Lastly, before I share Jeff’s poignant puppy mill story, please be reminded:  The purebred dog of your dreams may be awaiting you at your local shelter (yes, many purebred dogs do land there) or breed rescue association.  Please don’t forget to consider these options when you are thinking about “expanding the family.” 

Now, here is Jeff’s story:  

“Nancy: As you may perhaps recall, you sent a couple of very kind emails last year when our little Yorkie, Shelly, died suddenly after having three vaccinations in one day.  Soon after we were lucky enough to adopt two Yorkies who were saved from a raided puppy mill near New Hope, Pennsylvania.  Forty-six Yorkies were found in an abandoned house in the winter with no heat or water.  They were living in birdcages.  The Bucks County SPCA is the hero of this story.  Their director, Ann Irwin and her people responded to the police in the middle of the night.  She mobilized her whole staff and descended on the house at two in the morning and snatched up the poor little dogs.  I visited the SPCA a day later when they were giving the little tykes baths.  Most were so matted and filthy that they just shaved masses of fur rather than try to wash them.  We adopted a very small female, Molly, who they estimate is 5-6 years old.  She has numerous cesarean scars on her tummy from her various births.  When we got to the house, I took her outside to pee, but she was shocked at standing on grass; a first time experience.  After a day or so I was concerned that she wasn’t drinking water.  Then it struck me that she probably was not used to drinking from a bowl.  I bought her a tube type water dispenser like you would give to a hamster in a cage.  She practically emptied it.  I don’t think Molly will ever be completely house broken.  The extraordinary thing is how affectionate she is.  Having gone through what she did one would think she would fear humans.  She is the most loving little dog I have ever owned. The second dog is a puppy from one of the pregnant mothers who they let go to term.  We originally called her Lucy, but I renamed her Lucifer because she is so bad!  These dogs are a great joy, but I have no illusions about Molly.  I don’t think she will become an old dog due to her difficult years living in birdcages in unheated basements with poor nutrition.” 

Molly at the SPCA after being shaved and bathed
Molly at the SPCA after being shaved and bathed 
Molly in her new home
Molly in her new home 
Molly and Lucifer
Molly and Lucifer 

Thanks to everyone who shared their opinions and stories.  Let’s hope for ongoing progress in the fight against puppy mills.  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 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.

The Grapes of Wrath

November 15, 2009

What a gorgeous time of year it is where I live, in the heart of northern California’s wine country. The leaves of the grapevines are luminescent shades of orange, yellow, and magenta. The vintners are smiling because the weather has provided them with a bumper crop.  Their grapes have been harvested and the “crush” is on.

As much as I enjoy this season, the grapes always create some anxiety for me.  What most people don’t realize is that grapes (and raisins) can be terribly toxic for dogs.  Fortunately, not all dogs become sick after eating grapes or raisins, but nothing clearly predicts which ones are susceptible.  For those who are, ingestion of even a small amount (as little as 0.35 ounces of grapes per pound of the dog’s body weight and 0.05 ounces of raisins per pound of the dog’s body weight) has the potential to cause kidney failure that may be irreversible. The toxic component within grapes and raisins hasn’t been identified, but it is thought to be contained within the flesh of the grape (not within the seeds). 

In susceptible dogs, symptoms of kidney failure develop within 24 hours following ingestion of the grapes or raisins.  They include: lethargy, loss of appetite, vomiting, and diarrhea. Partially digested grapes or raisins might be seen in the bowel movement or vomited material. What should you do if you discover that your dog has eaten grapes or raisins?  Seek out veterinary care as soon as possible- the earlier treatment is started, the better the prognosis.  If it has been less than a few hours, your veterinarian will induce vomiting to try to remove the toxin before it is absorbed into your dog’s bloodstream. If several hours have lapsed, hospitalization for treatment to prevent kidney failure will be recommended.  Once kidney failure develops, the prognosis is guarded. One study documented only a 53 percent survival rate even with aggressive treatment.  

So, here is the lesson of the season- dogs and grapes (or raisins) are a potentially lethal combination. Cats are thought to be susceptible to this toxicity as well.  Fortunately, cats who fancy fruit are few and far between! Please share this information with all of your dog-loving friends and relatives and ask them to do the same.  You just might save a life in the process! 

Wishing you and your four-legged family members 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