Tuesday, September 28, 2021

What If There Were No Veterinarians?

At SEVA GRREAT, we take the health and well-being of our dogs very seriously, and our relationships with our veterinary partners is a crucial part of our work. We are incredibly fortunate to have access to amazing expertise, coupled with boundless compassion in our veterinarians and in all the members of the veterinary teams with whom we work. This skill and talent ranges from the front desk staff all the way to the veterinary techs, assistants, and kennel attendants. We could not be more grateful for what they do for our dogs and for the humans who care about them.

My title for this entry may seem a bit apocalyptic. But in just the last few weeks, I have read or personally experienced multiple public announcements or other communication from veterinary practices about the extreme stress they are experiencing and pleas for people to be understanding and respectful. This is showing up in the veterinary literature I follow as well, and it makes me wonder if my title really is that far-fetched. We are all experiencing longer delays for appointments, reduced access to urgent care, and much busier veterinary settings overall.  Emergency rooms are turning away cases that might have been seen just a few years ago. Veterinary hospitals and emergency facilities are having to make some difficult decisions to prioritize care to make sure those in greatest need are seen quickly. That means some others will have to wait longer than what has been the case previously.

No doubt some of the challenges are due to the changes that practices had to make to keep open and to ensure the safety of all the people and animals they encounter. Maintaining the high standard of care that our veterinarians provide is taking a little longer these days, and the demand for care has skyrocketed. As the stress and demands on these professionals have increased, some practices are making changes just to maintain the ability of the staff to keep functioning at such a high level.  Some clinics have reduced hours or have a time of shutdown during the day to enable everyone at the clinic to catch up on work. Some have days during which they close completely. Several of the emergency clinics we rely on have reduced hours or had complete shutdowns for a brief time, reducing access to care and obviously shifting the load to other facilities that are already operating at capacity.  Staff turnover has been high in a field that already had challenges hiring well prepared personnel, and it is not uncommon at some clinics to encounter many new personnel on the administrative side and often with the animal care side as well.  Add to the challenges the context of longstanding and under-recognized comparatively high rate of suicide among veterinarians.  (See link to Not One More Vet at the end of this entry.) I am hearing repeatedly, from a number of sources, that the stress and emotional demand on veterinary staff that has always been there is getting much worse.

What makes me most heartsick about this scenario, however, is the veterinary staff who report being routinely subjected to rude, hostile, demeaning, and sometimes threatening behavior by the people with whom they interact. Perhaps it is only a small percentage of people who behave that way. But it cuts deeply, and it leaves a lasting impression. As more than one clinic staff has reported, it may be just a few, but those are the ones you remember until you just don’t want to do it any longer. 

Big deal. We’re all stressed, you might think. We’re all struggling so what is the problem? Veterinarians surely are used to the stress and demands of the work. Many come to their positions through a long history of animal care, often starting as veterinary assistants in a practice. (One of the articles linked at the end of this post does an excellent job capturing some of the common themes in the life of a veterinarian.) But they are not used to the level of hostility and rude behavior they now encounter on such a frequent basis. No one should have to become used to that.  I have heard stories of people being threatened, arguments over costs and a client being willing to pay only a portion because that’s “all the service is worth.” There are stories of name calling and insults I won’t print here. It has gotten so bad that some have had to shut down practices for a time or, at minimum, adjust work hours in order to take care of themselves.  Research consistently has shown that when people are stressed and overloaded, performance suffers and mistakes can be made. Add hostility and name calling to the regular stress of the work and who can blame them for some of the changes they are instituting to protect themselves and the quality of the care they provide. Thank goodness it is likely only a few people who behave this way, but even that is too many.

But that can leave us feeling frustrated that we do not have the access to which we are accustomed, and it is frightening to think about what you would do if there were a true emergency and your nearest animal hospital is closed for a week because they had to restructure to keep working in this challenging environment. Even dealing with doggie diarrhea for an extra few days while you wait for an appointment can be distressing for you and your dog. So what are we supposed to do?

We can do a lot! We are facing a compelling, perhaps necessary, occasion to rethink our relationships and our expectations of our vets and also to improve our own ability to manage the health of our pets. While we might resent how things are, I prefer to see it as an opportunity for transformation that can improve the care of our dogs and our roles as their human caregivers. I asked a number of veterinary personnel for their suggestions given how things are these days and want to share those here, along with some other ideas that I think constitute best practice if you have an animal in your care.

1.  Number one, they told me: Be nice. This was the priority I heard from the veterinary staff with whom I spoke.  Your veterinary staff are doing everything they can, they really do care deeply about your animal, they are experiencing unprecedented demand, and they are working hard to provide the best care possible for everyone who needs them. You’ve probably heard the saying “If you can be anything, be kind.” If you’re a country music fan, feel free to substitute “always be humble and kind.” Either will work, and will be a welcomed interaction with your veterinary professionals. It doesn’t cost anything, it is sure to help, and there is no down side. In the world of medicine, it doesn’t get any better than that. If you are always nice, you say, then that’s terrific! Maybe do a little extra because I am hearing that there are plenty of people who aren’t being so respectful and kind.

2.  Adjust expectations.  It takes longer to get an appointment or a question answered or a refill. It just does. That isn’t such a big deal if we plan ahead. You know your dog needs a medication. Don’t wait till the last minute for a refill. Anticipate there may be shortages in some areas so prepare for that as well. Get extra food or other essentials if your dog has specific needs. Be aware also that veterinary medicine is using remote or telemedicine approaches just as human medicine is. Most state laws require that veterinarians examine an animal in person in order to write prescriptions. However, a telemedicine visit can be very helpful in narrowing down what is going on and how urgent the situation is and how to handle it until you can see your own vet. Our expectations need to adjust to incorporate some unique ways of getting care just as we are doing with our own medical care. 

3. Keep a focus on prevention and being proactive. Some of the main reasons dogs need ER visits stem from things that are easy to prevent. Your dog eats everything? Then make sure  there isn’t anything in reach that is harmful. Take 60 seconds outside every morning to pull up those mushrooms and scout the yard for other hazards. You can save yourself, and your dog, a serious and expensive health problem. Consider play dates with dogs you know and owners you trust rather than the dog park.  Choose appropriate toys and chews; the harder and more long lasting the chew, the greater the potential for a broken tooth. That is one painful and expensive outcome for you and your dog. Keep on schedule with regular exams at the vet. By all means, keep up the heartworm preventives and get refills well ahead of when you need them. Do everything you can for the health of your dog (hopefully this isn’t a change for anyone). Be proactive so problems are detected early and there is more time available to make an appointment. If your dog has a history of ear infections, allergies, or hot spots, to name a few common examples, check regularly so you catch a recurrence early. Talk with the vet about what you can do to minimize recurrence or at the first signs of trouble. Work with the vet to get to the cause of the problem so you may not even have to worry about recurrence so much! This can take some trial and error, but a dog with intractable ear infections or frequent bouts of diarrhea that finally are resolved after a thorough test of different diets is well worth the effort (every golden in my life would agree).

4. Along with the above, it is helpful to learn all you can about your dog. Get your info from good sources.  The American Veterinary Medical Association has a good page with resources for owners, linked below. Look for professional organizations or veterinary schools, veterinary offices, or the ASPCA as other useful sources. Learn what is normal for your dog and what might be an early sign of trouble. A daily lump, bump, ear, eye, teeth, and skin check takes less than two minutes depending on how thorough you are and how often you pause to throw in a few loving glances and “What a good boy!” praise. Not wanting to weaken my reputation as a “poop expert,” I firmly believe that every dog owner should see, fairly close up, at least one poop each day. That way you know that the dog pooped, whether there was any difficulty pooping, and whether it looked normal for your dog or not. Checking on urination is good, too. You might not see the output, but you will know the dog was able to go without difficulty and how often. Looking at one poop a day is a small sacrifice to make to avoid a much worse case of diarrhea and will buy you some time until your vet can see your dog if a visit even becomes necessary. 

5. Know how to handle the unexpected. Keep an emergency kit for your dog including hydrogen peroxide if directed to use it for accidental ingestion (check with animal poison control before using it, though, as it could be harmful if used incorrectly). While we’re on the subject, did you know the American Red Cross offers Pet First Aid Courses? They actually are quite good and cover Heimlich maneuvers and CPR for animals, along with basic first aid.  Your dog means the world to you and you would do anything at all to make sure it is well cared for? Well, there’s something you can do. The class currently is offered online and costs $25. If you feel helpless in case of injury, shock, bleeding, etc., completing such a class can be very empowering. Be aware that emergency facilities may only be able to see cases with true emergencies, the situations that threaten life, such as problems with breathing, bleeding, toxic exposure, foreign body ingestion, GI obstruction or bloat, heatstroke, and snakebite. Know where your local facilities are, know where there are urgent care options, call before going. If you know what to do in the interim, it just might save your dog’s life.  Can’t stand the thought of having to do some emergency care for your dog? Well, there’s that prevention thing described above.

6. Plan for the expenses.  This can help with your own stress around the care of your dog. It costs a lot to own a dog and provide it with proper food and medical care. Skipping routine care to save money may lead to bigger problems down the road, especially as the dog ages. I can’t think of a single situation in terms of human or animal health that is not improved by catching it early. One veterinary professional strongly suggested that people get insurance for their animals. There are numerous options available now and some workplaces even include a pet insurance option as a benefit, recognizing how important our animals are to our lives.   Those of us who know and love golden retrievers realize the particular challenges that come with that breed and the various scenarios we may encounter with them as they age. We hope many of those won’t come true, but need to be prepared for the expenses nonetheless.  The value of what we receive with stellar veterinary care and the advanced diagnostics and treatments available for our animals cannot be beat.

         Veterinary practices are experiencing tremendous stress and high demand at present. Some of the changes we are seeing may be around for a long time. But we have a wonderful opportunity to change our vision of the care of our animals. We must become better informed, more proactive, and more involved as we develop a quality relationship with our veterinary teams. Plan ahead, adjust expectations, and develop your own knowledge and commitment to your dog’s health.  Not only will this enhance the health and well-being of your dog, but it will make the best use of the professionals available. Follow the directions your veterinarian provides. Don’t skimp on all those “good boy (or girl)” interludes with your dog while doing those lump and bump checks. I know our veterinary professionals appreciate the same expressions of kindness and gratitude as well.   I don't want to think about what life would be like without them.



Alarming suicide rates reflective of stresses felt by veterinarians.  https://www.wisfarmer.com/story/news/2021/05/26/alarming-suicide-rates-reflective-stresses-felt-veterinarians/7361193002/

Not One More Vet.  http://nomv.org

American Red Cross, Cat and Dog First Aid training.    https://www.redcross.org/take-a-class/first-aid/cat-dog-first-aid

American Veterinary Medical Association, resources for pet owners: https://www.avma.org/resources-tools/pet-owners

American Veterinary Medical Association.  Veterinary telehealth: The basics.  https://www.avma.org/resources-tools/practice-management/telehealth-telemedicine-veterinary-practice/veterinary-telehealth-basics

Telemedicine and how it works (VCA handout). https://vcahospitals.com/know-your-pet/telemedicine-and-how-it-works



Saturday, May 22, 2021

Don't Shave That Golden!

The temperatures are soaring, and we humans are running for pools, iced drinks, or whatever else brings us relief from the heat. Surely your fluffball golden must be miserable under all that fur! Time for the “summer cut” and let’s get rid of that extra hair so the poor thing can cool off, right? 

WRONG!! No, never, don’t even think about it, and no way. Big no-no as a matter of routine to shave your dog for summer. You mean leave all that fur on? Absolutely! 

We often refer to the dog’s fur as a “coat,” but that contributes to a misunderstanding of how the dog’s fur really works. Of course wearing a coat in summer the poor thing must be dreadfully warm! So let’s dispense with the word coat for this discussion. Instead, let’s think of the fur in terms of what it does, and that involves its functions for insulation and protection.  As you know with a house,  insulation is important to keep temperatures stable. You set a desired temperature on your thermostat, and the heat and air conditioning systems work to create and maintain that temperature. The insulation helps to separate the inside of your house from the outside so it is easier to get the temperature to stay where you set the thermostat.  Take away the insulation, and your mechanical systems are going to have a heck of a time keeping your house at the temperature you desire. The inside will always want to match the outside if there is a poor barrier between the two. 

The insulation function of a dog’s fur works in the same way.  Dogs have a core body temperature that they must maintain for the organs to function well. Generally this is in the vicinity of 100 to 102 degrees or so, give or take. The fur is what protects them from external stimuli that can cause that temperature to be harder to maintain. Without the fur as insulation, the heat gets in more easily and the body has to work that much harder to keep things stable.

Imagine shaving your head and being outside in the summer. Would it be cooler without that hair? Quite the contrary. You not only will feel the sun’s rays more intensely but you will be more subject to injury. OK, so you’re not shaving the dog down to the skin, so that isn’t a fair comparison, you might say.  The physics are still the same. The sun and the heat can more easily affect the dog because the fur is not there as insulation to protect the dog from the external environment. Even if the temperature outside is lower than the dog’s body temperature, the sun and all the other environmental characteristics are now acting more directly on the dog because there isn’t that important layer of fur to insulate the skin. Dogs can get sunburned, and you may recall a time when you were outside in 90 degree weather, feeling the sun on your skin and thinking it felt a lot warmer than 90 degrees! Add to that experience the heat of pavement or a patio which are well over the ambient air temperature, and things can become dangerous quickly without some insulation or protection. A  temperature of 90 degrees is barely suitable for a warm bath. But the sun hitting your skin with a 90 degree air temperature, or maybe more if you are near reflective or heat-absorbing surfaces? You will feel that! So will your dog, and it can be dangerous, especially for a dog without it’s normal protective layer of fur.     

Dogs like our goldens are designed well for maintaining a healthy body temperature. As double-coated animals, they lose their undercoat as the seasons change to warmer months. This loss of undercoat adjusts the insulation for them automatically. In the winter, they grow that back to provide more protection against the cold. You may have noticed how it can be snowing or sleeting like crazy and in spite of that 100 degree body temperature, the snow does not melt when it lands on your dog’s fur. That fur is doing a great job keeping that body heat regulated.  Mess with their fur by shaving them and you have disrupted that crucial thermoregulatory mechanism, which is a fancy way of saying the dog’s ability to maintain the temperature essential for life. Thermoregulation. It comes built in to the dog and includes their fur as a crucial component. So do not shave your dog.

Fur also serves another purpose, and that is protection from physical elements. Fur provides an additional layer of protection against injury to the skin such as might occur from a good roll in the grass. The topcoat, which is what you see when you first look at your dog, also helps to repel dirt and debris and sheds water to some extent. Check that out the next time your dog is out in the rain for a short time. The top layer of fur will be wet, but the skin can still be fairly dry (depending on how long they are out and how hard it is raining. Some of my goldens didn’t know, or want, to come in from the rain so your mileage may vary). 

Good care for a golden includes recognition that both the fur and the skin are important to your dog’s health. There is a need to be vigilant year round about good skin and fur care. Summer provides its own reasons and challenges in that regard. You and your dog may be outside more, playing in the grass, perhaps swimming or whatever summer fun you have in store together. Attention to cleanliness to remove contaminants (like all that wonderful pollen we have in Virginia) is important to keep the fur and skin healthy. Regular brushing and removal of mats will increase the effectiveness of the fur and the comfort of your dog. Keep the skin dry to help fight off hot spots. While tending to the fur, it is a great time to check for parasites like ticks and fleas; dangerous debris such as foxtails; and also lumps, bumps, or injuries to the skin. One of the best things you can do for your dog is catch a skin problem or a lump or growth early. To help your dog through the hot summer months, provide plenty of shade and water and monitor their activity and their behavior. Goldens do not always know when to quit when they are having fun. 

Help your dog keep that system of skin and fur working well through good grooming and examinations to catch problems early. Shaving and removing that fur just because it seems like a good idea in the summer heat does not help your dog. Good grooming and assessment will. Besides, you’ll have some nice bonding time as you groom your dog, and your dog will be gorgeous with a gleaming and healthy thermoregulatory system.