Sunday, May 15, 2011

Humane Movement + Veterinarians = Success

This past week I returned home from my much-anticipated yearly vacation event, i.e. gambling and gallivanting in Monaco. Yes, of course I’m kidding. I was actually down in Orlando, Florida at my fourth Animal Care Expo. The Humane Society of the United States holds this conference annually, not just for animal shelter personnel but also for anyone working to further the cause of animal protection in this country or abroad.

This year, there was a talk I was happy to attend called “Veterinarians and the Humane Movement: Past, Present, and Future.” The majority of people who love animals but are neither veterinarians nor workers in the humane movement seem bewildered when they learn that cooperation between these two camps is not automatic. Actually, there has always been some degree of animosity between them.

The person giving this talk, a PhD historian, gave a factual presentation on how both the humane movement and the veterinary profession developed. (Facts are important to vets, since we are programmed to reject "fluff" and subjectivity.) Speaking of "fluff":

I think there's a rabbit under there.

Anyway, the historian explained how the American veterinary profession emerged in the 1800’s primarily to uphold and ensure the nation’s transportation infrastructure and economy (i.e. the horse). Imagine if airplanes and cars today were subject to decimation by a disease epidemic (like the equine flu epidemic of 1872) and there were no mechanics. In other words, veterinarians were essential to maintaining the economy and making sure the horses were “working.”

The humane movement, on the other hand, came into existence around the same time because horses were also, not surprisingly, being overworked, whipped, abused and objectified.  If you don’t know the story of Henry Bergh, he was outraged when he witnessed a man beating a horse that was unable to pull a load beyond its physical capacity. This inspired Mr. Bergh to found the ASPCA, one of our largest animal protection agencies, which is still advocating for animals almost 150 years later.

Some other historical facts presented: the AVMA opposed the Lab Animal Welfare Act in 1966, and veterinarians throughout the 1950’s-1970’s tried to prevent veterinarians in animal shelters and SPCA’s from conducting spay/neuters, despite the serious overpopulation of animals. In more recent years, only 6 of 28 veterinary schools surveyed viewed animal welfare as worthy of inclusion in a veterinary curriculum, and 3 actually labeled it a threat.

Why is this the case? Because it is deep-rooted in the veterinary tradition, culture and purpose to preserve “animal resources”, a term still present in our veterinary oath. And, as we know, huge portions of our economy benefit when animal welfare is downplayed. (The myth that animal health and productivity are synonymous with animal welfare has been debunked more times than needed.)

However, the good news is that as society evolves, so does veterinary support for the humane movement; it has been increasing steadily over time, and will surely continue to do so. The time has arrived when animals are regarded as family members, and our economy is relying less and less on animal labor and products in order to function. There are plenty of dynamic, intelligent and dedicated people showing a new road, including veterinarians.

One of the purposes of this talk I attended was to reaffirm the century-old invitation for veterinarians to get on board with the humane movement. At the end of the talk, I was happy to meet several other veterinarians who are making great efforts to help the veterinary profession and humane movement join forces.  One such amazing person I met is Dr. Lynne Swanson (Cornell '86) who, in her retirement, runs her own nonprofit animal rescue and rehab center, complete with its own mobile spay/neuter clinic. She is a gem! (In my retirement, I'm going to be gambling and gallivanting in Monaco. Right.)

A great place to find other vets interested in combining animal welfare and veterinary medicine is the Humane Society Veterinary Medical Association. They are the force behind HSVMA Field Services/Rural Area Veterinary Services, and overall they’re providing an amazing service to animals, veterinary students and their veterinarian members. Check them out! Maybe I’ll see you at a future HSVMA gathering or Animal Care Expo...please find me and say hello!

Sunday, April 17, 2011

Harlem Vaccine Clinic Superlatives

Here we go! These are just a few obligatory superlatives from yesterday's ASPCA vaccination and microchip clinic in Harlem, NYC, where our little mobile van of hard workers served 119 animals. I gave about 200 vaccinations, implanted approximately 100 microchips and left with only 1 band-aid on my hand. Kudos to NYC for being well-behaved...among the 217 total animals I've now seen there, only one could  truly be considered "fractious." No, it wasn't a human animal. It was one of those feline animals who was spitting and striking at the carrier before it was even approached...even my cat whispering can't fix that under those circumstances.


Best Dressed:  New York City residents insist on dog couture. I've been told New York City dogs (and only New York City dogs) will freeze and die without dog couture. All right. In any case, this dog was pretty hot!

Best Smile: Does any other type of dog ever win this superlative? Impossible! And he had an ultra-fast wagging, thumping pittie tail to go along with his bully smile.

Most Spirited: This little guy reminded me of my own "spirited" pup (i.e. the EthVet mascot). He came for vaccines and a microchip but had his own plans in mind - he spontaneously leapt off the table and decided to go hang out in the paperwork area of the van instead. Jacks... you know how they are!

Luckiest: This little cutie and its equally cute sibling were scooped up by the pictured kind gentleman, who stood on line for over an hour to get them their first vaccines.

Best Ride: This little guy arrived in a denim tote bag. He was cool with it, as long as his little paws were allowed to hang out.

This event also had daylong spay/neuter services onsite and was a great educational opportunity. As always, I'd like to underscore my strong belief that veterinarians have a professional obligation to educate clients and the public about the importance of spay/neuter. Aside from prepared spiels about it reducing mammary cancer, uterine cancer, pyometras and testicular cancer, I feel it is the veterinarian's responsibility to emphasize that there are 4-6 million animals put down in shelters every year because there are already too many dogs and cats out there.

Thanks to the folks at the A for all they do, both locally and nationally.

Some noteworthy ASPCA services: 
Operation Pit:  free spay/neuter surgery and vaccination for pits/pit mixes in NYC, by appointment only
Free or Low-Cost Mobile Spay/Neuter Clinic: visits all 5 buroughs
Adoption Center: placed over 3,540 animals into adoptive homes last year

P.S. Special thanks also to Strictly Roots all-vegan soulfood restaurant in Harlem, simply for existing, and only a block away from the vaccination clinic. I was starving by the end of the day. (If you haven't been to an all-vegan restaurant, take your animal advocacy to the next level while treating yourself...there are more than 45 outstanding vegetarian/vegan restaurants in New York City alone!)

Tuesday, March 29, 2011

We Provide Genuine Care and Compassion (While Deliberately Running Up Your Bill?)

This is going to be kind of a Part 2 for anyone who read my post last month on overvaccination in companion animals. I want to point out that I write these sorts of posts not to indiscriminately criticize my own profession. On the contrary, I think highly of my occupation and therefore believe it should conduct itself to be above the occupation of highway robbery.

Please, allow me to illustrate.

Recently, a relative of mine who lives in another state contacted me to ask whether her dog's vet visit seemed "odd" to me. She had taken her 6 year old (Katrina rescue!) dog in for a routine physical exam and vaccines, and left shortly thereafter with an $800+ bill. Naturally my first thought was, "Was there a medical problem detected? A disease diagnosis? A mass biopsied? Radiographs? A minor surgery?" Nope, apparently the dog had a minor ear infection, and was otherwise perfectly normal. Based on my own experiences, I didn't believe this bill was possible for a practically uneventful check-up, until my relative sent me the itemized invoice.

Here are just a few of the things that I indeed found "odd":

1.) $38 for a coronavirus vaccine. Two additional, separate charges of $28 and $26 were listed for parvovirus and DHLP, respectively. The fact that a combination vaccine containing all of these can be purchased from the distributor for approximately $5 cost to the vet is not even the oddest thing (although $5 to $92 is quite the mark-up in my opinion). The oddest thing is that coronavirus is known to cause illness only in puppies under 6 weeks of age, and even then only mild signs, i.e. there is no medical reason to give this vaccine to an adult dog. Even if it was given as part of a DHLPPC combo shot, why would one charge a separate fee for it, let alone one that is higher than that for the "functional" vaccine components?

2.) $89 for subcutaneous fluids. (Again, quite the mark-up considering even an entire liter only costs about $3 to the veterinarian). And now you're of course asking, why fluids??? Because her dog had been "taken to the back" for its vaccines, she wasn't even aware these fluids had been given until the dog returned. When she asked why they'd been given, a veterinary staffer told her it was to "dilute out" the effects of having so many vaccines at once. I cannot speculate (and have yet to find another vet who can speculate) as to how this bizarre protocol could be medically feasible. Please contact me if you have an idea!

3.) $38 for each ear when they did the ear cytology. The dog was then prescribed both oral and topical medications for the minor ear infection. Based on the recurring motif of superfluity, I have a feeling the topical alone would have sufficed...

4.) The 6 year old dog with no clinical signs then had full bloodwork performed. Perhaps they're going to do another senior screen next year when she turns 7?

5.) Special prescription diet. Even though there were no other clinical or bloodwork abnormalities, she was told the dog needed this because cholesterol was mildly elevated on bloodwork. It is normal that cholesterol can be elevated in a dog's blood for up to 10 hours post-prandial and dogs are not at risk for the cardiac problems/atherosclerosis strongly associated with high cholesterol in people. In the absence of other bloodwork or clinical abnormalities, high cholesterol in dogs is not considered a concerning or relevant finding.

Clients should know that, unlike human doctors, many veterinarians are paid based on their production. A veterinarian interviewing for a job at an animal hospital might be asked, "What is your average invoice at your current job?" Actually, this was directly asked of me in an interview. And although that particular veterinary business was sure to ask about invoices and the like, throughout their whole extensive interview process, they never once asked for character references or references from a previous job. Go figure. What is your average invoice? I would have been less put off by some over-the-top, pretentious quiz of useless knowledge, like "How many glycosylation sites are present on a molecule of Antithrombin III?" (The answer is 4, by the way.)

The following questions should help bring to light the difference between medicine and business:
Do you go to a human physician for vaccines every year of your life? Do people who vomit a couple times or have a bout of diarrhea head to the hospital and have mutliple diagnostic tests performed to determine the exact specific cause? Do apparently healthy children have bloodwork performed on them every year? Do you take a regular prophylactic for diseases that are not endemic to your geographic area?

The moral of the story (how annoying is it that I always have a moral?) is that more expensive vet care does not necessarily mean better care. In fact, some of the "extras" may instead put your pet at greater risk. My advice is this: if you ever feel suspicious that a veterinary hospital is exposing your animal to unnecessary vaccines, medications or stressors for the sake of "production" or because it's part of a hospital routine, I would encourage you to ask them for an in-depth medical justification, as it pertains to your animal.  "We're doing this to prevent____" shouldn't cut it.

If a veterinarian ever becomes defensive in the face of such questions, just ask them how many glycosylation sites are present on a molecule of Antithrombin III. They'll probably wonder if you're someone with medical discernment ability...and your bill might go down regardless!

Remember...productive veterinary business, despite all its bravado for being thorough and leaving no stone unturned, is not interchangeable with good veterinary medicine. Make sure you're paying for time with an honest, intelligent, compassionate professional and not paying predominantly for the hospital's fancy lobby skylights or a state-of-the-art treatment room, where your animal might be manhandled while you wait in the exam room. Believe me, it happens.

A wish for your tomorrow.

Tuesday, March 1, 2011

Spay Day Superlatives!

On Feb. 19, I was happy to participate in the I Love NYC Pets Month Spay Day event in New York City's Lower East Side, sponsored by the ASPCA, Humane Society of the United States and the Mayor's Alliance for New York City's Animals. If you're a vet or tech, I'd encourage you to help out your community through this kind of spay/neuter or vaccine clinic. After all, performing microchipping and vaccinations all day can be like a vacation compared to a typical day in private practice.

For the I Love NYC Pets event, there was a great turnout despite wind and cold; there were early arrival campouts followed by a continuously long line. The only things distinguishing this scene from a rock concert scene were dogs, cats, and the absence of a pervasive marijuana smell.

Close to 100 animals were vaccinated and microchipped, and another 100 were spayed or neutered. Here are the obligatory superlatives from my vaccination/microchipping recipients:

Best Dressed:

I think his ultra-short Dachshund legs prevented him from pawing off that baseball cap like any other dog would have. By the way, don't rag on him for being a Yankees fan...again, this was New York City.

Best dressed human and overall best dressed runner-up was HSUS's Adam G., who spent the day as a Schnauzer. What a good sport...or perhaps just smart, since he was probably the only one out there there not freezing his tail off.


Everyone's favorite (or maybe just mine) of those coveted pit bullies with donkey ears. I tried to steal him away from his people, but unfortunately they refused to leave without him.

Funniest AND boldest:

....because not everyone is fearless enough to wear their pumpkin suit when they visit the doctor in the middle of February!

Thank you to the ASPCA vet assistants who diligently flipped every single animal around to face left so I could attain my preferred microchipping angle. Here is the hard-working crew:

If you're a veterinary student, tech or vet interested in spay/neuter or vaccination experiences near or far from home, read about the Humane Society Veterinary Medical Association's Field Services program (formerly known as RAVS/Rural Area Veterinary Services).

Also, with all my sincerity, I'd like to thank you for reading this blog. You're one cool cat for doing so. A lot of people are too busy playing Farmville or texting to bother reading at all, ya know?

Monday, February 7, 2011

Overvaccination: Is This Really Happening?

Sorry, vaccinarians, I just have to write about this.

Do know that sash of bullets that Rambo wore? I always imagine a vaccinarian should have a similar sash, except it would be lined with vaccines instead of bullets. One day when I’m hosting Saturday Night Live, I promise to have a skit about it.

Anyway, I recently saw two back-to-back appointments that were oddly linked to each other. The first was an annual exam for a 10 year old, indoor-only cat, who was "due" for the gamut of vaccines - FVRCP, rabies and feline leukemia. This particular senior cat had never had bloodwork, a urinalysis or screens performed on it. However like many other clients, the cat's person was concerned that the most important reason for her cat’s vet visit was its vaccines. The next appointment I saw was another indoor only cat, 4 years old, with a nasty, festering, baseball-sized malignant fibrosarcoma on its left hindlimb, a finding that is almost always associated with the feline leukemia vaccination.

Obviously, most cats vaccinated with the rabies and feline leukemia vaccines never develop these tumors, but it is estimated that as many as 1 in 1000 do. Ever since vaccine-associated sarcomas were first elucidated in the early 1990’s, practitioner associations and task forces have recommended limiting the feline leukemia vaccine to high-risk cats only – as in, those who roam outdoors and are likely to contact or fight with other cats. In determining risk, it’s also important to remember that susceptibility to the virus declines considerably with age. In other words, it is a practical impossibility for an indoor-only, 10 year old cat to contract feline leukemia virus.

In short, lifelong vaccine-centric medicine is not good medicine. In all honesty, only a fraction of vaccines given to your pet in its lifetime are, in general, crucial to its health. For dogs, this includes the first DAP (distemper, adenovirus-2, parvovirus) “puppy series” and rabies vaccine. If you saw the movie Old Yeller as a kid and/or need to comply with state laws, your dog needs to also have repeat rabies vaccines every 3 years of its life after the 1 year booster. For cats, it is important to complete a FVRCP “kitten series.” Feline rabies vaccine mandates vary from state to state; I seldom gave them to indoor cats in California, but NY requires it.

Do not assume that because vaccines can occasionally cause adverse reactions that your puppy or kitten should not have its puppy/kitten series. This is a big mistake. Parvovirus is everywhere, I see it all the time, and it is hell on Earth for a baby dog to spend time during its first few months of life flat-out, depressed and dehydrated in a pool of bloody diarrhea and vomit. Not to mention that even with expensive, aggressive, often week-long hospital stays, they don’t always survive the disease.

After your puppy or kitten has its series, booster him or her a year later, but after that, repeat DAP or rabies vaccines need not be given more often than every three years. Ideally, a distemper-parvo antibody titer can be performed periodically to ensure persistent immunity. In New York, if you lapse on the rabies vaccine (i.e. return for a booster after the due date) vets are required by law to give another 1 year vaccine instead of a 3 year. So if you're giving your pet a rabies vaccine and your state has an equivalent law, get it in to the vet on time so no one sticks you in a corner.

Annual distemper or rabies vaccines on current, previously vaccinated dogs are not medically functional and confer no "extra" immunity. Antibodies from these vaccines have been repeatedly demonstrated to last much longer than 3 years, and often last the life of the animal.

There are a couple of other vaccines that may be of benefit in certain situations (i.e. Lyme Disease, leptopirosis), depending on your location and possible exposure to wildlife. Vaccine manufacturers market these vaccines zealously in an attempt to bring them up to the same perceived level of necessity as, say, puppy DAP vaccines, but I disagree with how commonly these vaccines are administered. To avoid being altogether contentious, I will simply state that I live in a hotbed of Lyme disease, ticks, deer and rodents, and I still choose not give my dogs either of these vaccines.

In general, here is a short list of vaccines that I definitely do not recommend giving to your animal, either because they target minor, easily treatable illnesses, or because their efficacy has not been sufficiently demonstrated.
Canine porphyromonas
Canine coronavirus
Feline leukemia (unless outdoor cat, and even then consider discontinuing after 5 years of age)
Canine rattlesnake vaccine
FIV (feline immunodeficiency virus)
FIP (feline infectious peritonitis)

I tend to be in agreement with the UC Davis vaccine protocols, which are available for your perusal hereFor your information and/or entertainment, here is a letter written nearly a decade ago by a Texas veterinarian; he filed a complaint against vaccinating veterinarians in the state for: "fraud by misrepresentation, fraud by silence, theft by deception, and undue influence."

Unrelated, but also for your entertainment, is this anecdote: A client recently told me, "When I die, I want to donate my body to Purina, so they can make a cat food out of me." And then, in a justifying, explanatory aside, she said, "I just really love cats." (?!)

 Until next time....please continue to be the supervet that you are:

Tuesday, January 11, 2011

Business as Usual: State Veterinarian Defends Animal Abuse

Imagine this. Imagine you always wanted to be a pediatrician. Not for prestige, not for money, not because your parents were pediatricians, but because you adored kids and wanted to help them. You had a knack for interacting with children in a way that made them comfortable and non-threatened, even when they were sick or injured. Imagine you understood children's needs and fears intuitively. Imagine you cared deeply about their well-being, and resolved to become the best pediatrician on Earth.

Now imagine that in medical school, the professors and the profession were trying to teach you that in general, children deserve the same level of care, the same high-quality medicine, the same bedside manner, and the same regard for their feelings. Except a certain large population of children. These children, you're told, will never come to your doctor's office or a hospital. That's because they've been selected to live their whole lives, from birth to death, locked in cages, in a sweat shop. 

Society wants you to go to them, inspect them, and ensure they look healthy enough to keep working and eventually reproducing (new child workers must be created to replace the worn-out child workers, who are killed). But the children are never let out of their cages, and it is not uncommon for them to rock back and forth incessantly, as though they're insane. They're bored, they're frustrated, they often lie in their own waste, they're taken away from their mothers as babies, and the whole building that crowds them reeks of their waste. The children are viewed as product-making machines rather sentient and emotional. For that reason, it is all too easy for their overseers to physically abuse them. But even if the overseers don't inflict outright abuse, the sweat shop environment and restriction on the children's natural interests is so obviously violating that the forced existence in itself is abuse.

Next imagine that social workers who recognize and confront the horror of the situation begin saying that the child sweat shop system is deranged, and that we as a society are morally wrong to be exploiting the innocent, let alone for the unnecessary products the children are making. Imagine that the medical profession, despite its longstanding awareness of child sweat shops, refused to condemn the concept on ethical grounds. The medical profession never recommends the sweat shop system be abolished, because it is being paid quite nicely for its inspections and on-site medicating of the children. Also, most of the doctors buy the products made by the children and believe their lives would be deprived without them.

The social workers are outraged, while the doctors claim the social workers have no business being involved because they have no medical training. Eventually the social workers begin secretly recording and video-documenting various sweat shops and exposing them to the public, hoping that someone will care. It happens over and over and over again. The sweat shop owners claim every single instance of outright abuse caught on tape is an anomaly. Most significantly, they claim the forced existence of the children is approved by the medical community. This is their easy out, because the medical profession is highly respected for taking such good care of all the "other" children - the ones who live in homes with their families and visit the doctor regularly. The majority of people who respect the medical profession have no idea what goes on in child sweat shops, even though they buy the children's products and thereby fund the sweat shops.

Eventually, with enough videos, newspaper articles and campaigns by the social workers, people start gradually losing respect for the medical profession and wondering why it condones something so unethical. After one particular sweat shop video, where a sick child is stunned and then thrown alive into a trash bin, the sweat shop owner in question disposes of that child, cleans up the facility a bit, and invites the state doctor to inspect it. After watching the video where the child is beaten and thrown alive into a trash can, after viewing a child with blood dripping from its mouth and several others with open, festering skin sores, the doctor states,

"But if the personnel are trained according to the requirements of the company and behave according to the way they are trained, it will significantly reduce what is a relatively minor problem as far as I can tell at this point."
This all happened, of course, exactly as stated, except that the children are pigs, the sweat shops are factory farms, the medical profession is the veterinary profession, and the horrified pediatrician is me. Click here  to read the pigs' story.

The state veterinarian defended the indefensible. He said, "I don't think there's a perfect way to do this. In anything that is under scrutiny, whether you're talking about a barbershop or an animal farm, what you observe the day you're there may not be typical." 

Next time you enter a barbershop or salon, expect to see an employee throwing a living thing into a dumpster. Expect to see massive suffering and exploitation of the defenseless. Then expect that an inspector and the authorities will refer to this as a "minor problem."


Tuesday, January 4, 2011

*It Happened in the Hospital* Part 2

What better way to start the New Year than to learn a few things you didn't already know?!

*I recently saw a Pug for its annual exam. It that had the worst generalized Malassezia dermatitis, probably in the history of the world. It was a walking, snorting little train wreck, rubbing and scratching its greasy, yeasty skin all over everything. Puggy emanated yeast vapors. On last year's record, I had diagnosed it with, wouldn't you know it, "the worst generalized Malassezia dermatitis, probably in the history of the world." I didn't actually write that. It would have been unprofessional. However, the condition had been noted and was still raging a year later. I once again begged the little old lady client and her little old man husband to bathe this creature regularly with antifungal shampoo, which she already had at home from last year. I told her the dog's condition was like having Athlete's Foot - on your feet, your ears, your face, your stomach and a whole lot of other places that aren't feet. To this she replied, "I don't want to bathe him because my daughter's dog recently passed away from having too many baths."  
What you've learned: Oral ketoconazole, despite being a heavy-duty drug that can damage the liver, is actually safer than baths.*

*I told a client that the long-term prognosis for his dog with liver disease was guarded, and that the dog could die from it. At that moment the client said he had a very important question for me. He then asked, "How much would you guys charge to stuff him?" Virology, pathology, taxidermy - I'm pretty sure we took all those classes in vet school, didn't we?  
What you've learned: Crematoriums are not necessarily sufficient, particularly if you practice in rural America.*

*A few days before Christmas, I was in the middle of telling a client that her dog had dental tartar and gingivitis. Her daughter, who was about 8 years old, interjected in a very adult-ish tone, "What should we be doing to help her with her gingerbread-itis?"  
What you've learned: Holiday foods can contribute to canine dental disease.*

*Two months after an itchy dog was treated with steroids and antibiotics, the client called to ask for a refill. Seeing in the record that a food trial had been strongly recommended, the receptionist asked him if he'd switched foods yet. To this, he replied, "I'm in the process of thinking about it."
What you've learned: a handy response to use next time your car is 4000 miles overdue for an oil change and you still don't feel like getting it changed. Mechanic: "Would you like us to change your oil?" You: "Not today, actually. I'm in the process of thinking about it."*

Until next time...please keep doing your best to discourage irresponsible dog breeders from drilling more holes in the side of the boat.