Monday, June 30, 2008

Incredible But True II

This is a little segment I like write periodically about recent experiences that seem hard to believe. Whether funny, inspirational, despicable, stupid, or miraculous, as incredible as these short stories may seem, they are oh so true. . .

Insensitive Client

A normally amicable and friendly client came in with his bulldog. My wife, who was about mid way through her pregnancy at this point, was in the exam room with us. The client asked her kindly how her pregnancy was going just as another technician entered the room, who happens to be about 55 years of age. Not having heard what the man said, but thinking that he was addressing her, the older technician asked, "What was that sir?" His reply shocked us all: "I asked how the pregnancy was going, a question clearly meant for Mrs. Welton, not you who is way too old and dried up for that."

Deadbeat Clients

4 months ago I came to the office on a Monday morning following a long weekend and inherited a case from the weekend attending veterinarian, of a very sick rottweiler. With neither myself nor the office manager present, the staff made the big mistake of allowing the doctor to begin an aggressive diagnostic work and treatment course for a patient whose owners had no previous history with our hospital, with no down payment. The canine patient, who was diagnosed with and under treatment for pancreatitis, diabetes, and hepatitis, needed several days of hospitalization to have any chance of survival. When I ordered the floor technician to enforce our policy of collecting 50% of the estimate before we go any further with treatment, the owners of course told us they had no money. When we directed them to Care Credit, they were quickly declined.

After I explained to them that they had already incurred a bill of $500 in diagnostics and treatments, and that I cannot run this up any further without any assurance of payment, they pleaded with me to continue, that they will make $200 payments every two weeks until the bill is paid off. Since the dog (who was a sweetheart of a dog) would die without treatment and my staff having already made the blunder of allowing this case to get this far without any funds from the clients, I reluctantly agreed to move forward.

What followed was a 2 week period which included several days of hospitalization, more diagnostics, and even late night telephone conversations to advise them at home. Their bill had accumulated to over $1200 after this period, and sadly the dog lost his battle with his many ailments and died. Grief stricken, the clients asked me if I would extend them just a bit more credit in order to arrange a private cremation so that they may keep his ashes. Even though they had not yet provided even a nickel toward their bill, out of compassion, I allowed this.

One week later, the owners called me excited and thrilled about the purchase of a new rottweiler puppy, bragging about how the breeder wanted $800 for the dog, but they talked him down to $600. I told them that I was glad that they were resolving their grief so well in such a short time, but that if they can afford $600 for a new puppy, then they can afford to pay the debt they owe to my hospital. To this, the clients assured me that they would square up when they come in for the ashes.

2 weeks later, the husband and wife clients came in to retrieve their dog's ashes, still not having made one single payment toward their bill. At this point, I began to feel very taken advantage of and finally put my foot down, telling them that they will not be permitted to get their ashes until their bill is settled. Once again they pleaded with me to allow them to have their ashes, that they were about to get paid on a contract next week, and their will would be settled then. This time, I did not give in, and told them that I will keep their dog's ashes safe and sound locked in my office, until such time that they pay their bill, after all, what is one more week to wait for the ashes.

Of course, next week came and went, still with no payment from these clients. Eventually, they sent their 16 year old niece to pick up the ashes, having her give us a sob story about how much it hurts her aunt an uncle to not have their dog's ashes, and begging us to release the ashes. I told her that the ashes will be released only after their bill has been settled. I also called the clients to tell them how appalled I was at their sending their young niece to manipulate us into giving the them the ashes.

Now 4 months later, the ashes are still in my office, as these people (they are no longer my clients so I refer to them as people, a term that I am not certain they even deserve) still have not made even one payment on their bill. We have long since sent them to collection and accept the situation as an expensive learning experience.

Impossible To Please Client

A client brought her cat in because he had been falling and unable to walk straight. The attending veterinarian observed the tell tale signs of acute vestibular syndrome (circling, head tilt, falling), a condition that affects the patients ability to balance due to inflammation of the brain stem. We do not know what exactly brings this on, but it tends to spontaneously resolve on its own over a period of hours to up to 14 days. During the recovery period, we treat the patients supportively with antinausea and antidizziness medication.

After the attending veterinarian explained all this to her (good news, considering that the client had thought her cat was suffering a stroke), she proclaimed that the doctor's explanation was not adequate, and she demanded better. Unable to appease the client, the doctor's only recourse was to refer her to a veterinary neurologist for another opinion, thinking that perhaps a neurologist may provide the certainty that this client was supposedly lacking.

Of course, the neurologist concurred with my doctor's assessment, reiterating the likely diagnosis. Still the client was not satisfied and demanded more concrete evidence. An MRI, a CT scan, a spinal tap, and $4000 later, the final diagnosis by exclusion due to lack of any lesions or abnormalities found on these tests, was vestibular syndrome. Still not satisfied, the client stormed out of the referral center with her cat.

As a courtesy, I telephoned the client first thing Monday morning. She explained to me that the cat had spontaneously recovered and was doing well, but was extremely unhappy that no one gave her answers. After spending 30 minutes on the telephone with her explaining the physiology of vestibular syndrome, and the fact that the cat's spontaneous recovery confirmed the diagnosis, she told me that she was not satisfied with any of the doctor's that had seen her cat, including the board certified veterinary neurologist, and demanded that we fax her the cat's records because she was going elsewhere to find another vet who would tell her what happened to her cat - this after 3 veterinarians has clearly done exactly that.

Friday, June 27, 2008

Unsung Heroes

Throughout the ongoing Middle East wars our country remains engaged in, whether citizens are supporters of the military campaigns or not, the overwhelming majority of us feel gratitude, admiration, respect, and support for our troops on the front lines of these conflicts. Along these same lines, let us not forget that in addition to these brave people of our military, there are many military working dogs (MWDs) also admirably serving our country, who are also placed in harm's way while bravely performing their invaluable tasks. Many brave and loyal MWDs pay the ultimate price for their deeds and lose their lives in service of their country. Their contributions to our war efforts and sacrifice make them deserving of our respect and acknowledgement.

Interestingly, I learned that war dogs are not a new part of the military, with the use of MWDs dating as far back as World War I. Having been more significantly incorporated in the military campaigns of World War II, MWDs have a long history of service, dedication, and sacrifice for their country. Created by former MWD military handlers inspired by the heroism displayed by their canine partners in arms, below is a website that honors MWDs by acknowledging their deeds with historical MWD information, profiles in MWDs courage, and funding for an actual brick and mortar U.S. War Dog Memorial:

Like any good soldier, a MWD deserves a peaceful, love filled retirement. For anyone wishing to perform a good deed for one who admirably served their country without hesitation, below is a website dedicated to the adoption of retired military working dogs:

While I do not expect all of my readers to necessarily run out and adopt a retired war dog (although that would be nice), I do ask that everyone consider bringing them up the next time a discussion of the war comes up or share this article and its links with friends. That way, our canine war heroes may one day be unsung no more.

Sunday, June 22, 2008

The Miracle Of Life

As a veterinarian, I deliver puppies and kittens on a regular basis, seeing on a level more primitive than ours, the miracle of new life. It never fails to touch a place in my heart when I see the little neonates experiencing the world for the first time, and I observe mommy's maternal instinct immediately kick in as she cleans, nurses, and protects her babies with her life.

As an uncle, cousin, and friend of many who have welcomed their human children into the world, I have seen, albeit as a more heightened and complex conscious experience than the animals, the hope, excitement, and joy that a new child has brought to my loved ones. However, although I have been happy for the joy of my loved ones, and always enjoyed the beauty of their infants and watched in awe as they grew, developed, and changed with time, nothing prepared me for the exhilaration that I felt personally as my son entered this world just three days ago.

The very moment he was taken out of my wife by c-section and so bravely took his first breath and made his first loud cry, I was moved to my core with a rush of love and devotion I hitherto had not felt. All thoughts of self instantly evaporated, except for thoughts of how I could better myself as a person to be the best possible example for my child to emulate, and how I could best optimize my success in order to protect and provide for my wife and baby.

On a level of faith, as a biochemist and veterinarian, having generally viewed life on a scientific level first and foremost, I still never fully abandoned some sense of spirit and divinity much greater than our physical selves. However, since the arrival of my son, spirituality is no longer just a premise that stubbornly refuses to escape my consciousness, but exists now as an active part of my human experience to embrace and enhance the lives of my fledgling family. And while do not at this time subscribe to any one religion in particular (I am currently of the belief that there is truth in all the world's major religions), a sense of the divine is very unlikely ever leave me.

Regarding my own mortality, while I had previously viewed it with trepidation and even fear, all apprehension about this reality of life instantly faded when I met my son. Having turned the page to embark on the next infinitely fulfilling chapter of my life as father, mentor, provider, and protector, I know that I will one day part this earth having done everything in my power and to my best ability to have created a meaningful and solid template for the next generation of my family to build on. My only concern is that I am blessed with the longevity to complete my task - this is only to a certain degree in my hands, so for the most part, one can only hope.

My wife and I are set to leave the hospital this afternoon and we cannot contain our excitement as we anticipate the arrival of our son to his new home, to his nursery that has been finished and waiting for him for over four months. This truly has been the most fulfilling and happiest moment of our lives.

Please join us in welcoming Austin Lee Welton to the world, born June 19, 2008, at 10:33 AM.

Monday, June 16, 2008

Finally, The Magic "Shot" Has Arrived

Some pets can be difficult and uncooperative for owners attempting to administer oral medications. On occasion, "difficult and uncooperative" is far too kind a description for the way some pets act when approached with oral medication, a problem especially prevalent with cats and small dogs. Owners of pets like this, when faced with the reality of having to administer oral antibiotics for a typical antibiotic course (10-14 days), often ask me, "isn't there just s shot you can give instead?"

Up until just last week, my answer to this question has always been that I could indeed give an antibiotic injection, but after 24 hours it will wear off, and oral antibiotics will have to begin to be administered, lessening the total course by only one day. However, all that changed when I attended a seminar presented by Pfizer, a major animal health pharmaceutical company, introducing their one time injectable antibiotic, Convenia (generically called cefovecin).

Convenia is an antibiotic that persists in canine and feline tissues for 17 days or longer according to data obtained from its extensive veterinary use in Europe, enabling bacterial fighting activity for up to 17 days or longer from just one injection. This is beneficial for the owner because they do not have to preoccupy themselves with the administration of oral medication. For owners with pets that are challenging to medicate, Convenia is especially attractive.

For veterinarians, we love Convenia because it takes out of the equation the single most common reason why antimicrobial treatment fails: owner non-compliance. Owners frequently fail to administer antibiotics in a timely fashion due to scheduling conflict, or busy lifestyles leading to forgetfulness. On other occasions, seeing significant improvement in the early stages of treatment, they decide to stop treatment to save the rest of the antibiotics for another time they suspect an infection and want to try to save on a vet visit. In fact, statistically, only less than 25% of pet owners administer medications as directed and to completion, a fact that both astounds and alarms me.

These actions lead to not only a relapse of infection, but often infections that are new and improved, because they have developed antibiotic resistance. With Convenia, veterinarians eliminate owner compliance issues, placing treatment entirely in our hands.

Of course, no drug is perfect and comes with its own set of drawbacks, and Convenia is no exception. As a cephalosporin class antibiotic, it is only going to be effective against gram positive bacteria with limited gram negative action, making it appropriate for only certain types of infections. Right now, it is only labelled for use against skin infections (most of which tend to be streptococcus or staphylococcus species bacteria), although, I suspect that it will likely be a good choice for upper respiratory infections and first or second time urinary tract infections.

The other drawback is the price of treatment, with the average injection costing the pet owner around $2 per pound of body weight. While this may be quite affordable for owners of small to medium sized dogs or cats, the price of treatment can get very high for large or giant breeds.

Still, having been using the drug for a little over a week, I find my clinic already flying through its supplies of Convenia. When used at appropriate times, Convenia has proven itself an invaluable tool to ensure owner treatment compliance, as well as create convenience and ease of treatment for clients.

P.S.: I have no affiliation with, nor do I receive any incentives from, Pfizer, As such, my critique of Convenia 100% objective, written solely for my reader's information, and not meant to be taken as an endorsement of any kind.

Wednesday, June 4, 2008

Poor Economy Affecting Animal Health Sector

"I can't afford it," is quickly becoming an all too familiar statement made by hospital clients when treatments or procedures are recommended to help their ailing pets these days. The problem is not that I am overpriced for my demographic - in fact, my hospital is known to be one of the more reasonably priced animal hospitals in the area. What's more, just 6 months ago, most of my clients had no qualms about investing in their pet's health when medications, treatments, or procedures were necessary to maintain optimal health. What has changed from 6 months ago when my hospital was still in the midst of enjoying the continued growth that begun in 2004 when I took over as owner? While I am no economist or politician, I do watch the news and pay at the pump to fill my gas tank. As such, I am inclined to opine that soaring gas prices and our depressed economy have finally begun to reek their havoc on the animal health industry.

As a veterinarian, this becomes extremely frustrating, as client inability to afford gold standard work-ups, treatments, and procedures, leads to my having to practice medicine with one hand tied behind my back. Not only am I faced with the professional disappointment that I am often precluded from practicing the best quality medicine, but I have to live with the knowledge that some of my patients fail to receive the very best modern veterinary medicine and my abilities have to offer. Finally, while some less fortunate pet owners that cannot afford quality care for their pet react to this dilemma apathetically or even callously, for many, it is an utterly heartbreaking, hopeless experience - which in turn is an utterly heartbreaking experience for the attending veterinarian.

From receptionist, admitting technician, and attending veterinarian, to pet owner and pet, all who are involved in the animal health process are deeply affected when finances get in the way of quality pet health care. While this aspect of veterinary medicine has always been and will always be a frustrating, ugly side of veterinary medicine, it seems to occur now more than ever, and increasing in prevalence with time. For sake of the family pets of our nation and for many other important reasons, we should all hope that there is light at the end of the tunnel for this struggling economy.