Beware of Practitioners of Negativity

As in any profession, there are as many different approaches to the practice of veterinary medicine as there are veterinarians. No one method is wrong, however some may be better than others. I am a big believer in education of the client, walking them down the path of understanding the condition that is affecting their pet and explaining the best plan and the potential outcomes. It may seem intuitively obvious to you that this is the way any medical consultation should be handled, but it is not everyones approach. There are practitioners that do not take the time to create a complete plan and provide a picture of the reasonable expectations for the patient. They tend to take short cuts and, if they are not careful, they can become practitioners of negativity.

As my parents have aged, I have become increasingly aware of certain doctors making treatment choices based on their age and seemingly lowering their expectations for their patients.  How often have you heard of a veterinarian saying that the pet was too old, or the condition too ‘bad’ to treat?

“It’s too serious” or “ poor prognosis” with out an explanation or a discussion of options is quite frankly a cop out. I do not mean to imply that every disease can be cured. Unfortunately, ultimately, some disease does eventually lead to the demise of every organism. The issue at hand is how do we fend off disease and how well will the patient fair during that treatment process and how acceptable is the plan to it’s owners . I like to refer to it as our philosophical approach to the patients illness.  With each patient, each set of clients, and each disease process  a philosophy for the management of the illness has to be developed. This is even more important in veterinary medicine where the cost of the services, the amount of at home care the patient will need, and the cost of medications all play a roll in developing that ‘philosophy’. 

It takes a considerable amount of effort, continuing education, experience and time to be able to allow owners an idea of what is wrong with their pet, why it is an issue, what can be done and how their pet will recover. I recently had this discussion with an emergency doctor. I had  noticed that a number of her cases where given a grave prognosis and the owners had elected either euthanasia or ‘hospice-type’ care. There was a common thread among these patients, they all were older and they each had a hemoabdomen (free blood in the abdomen). We discussed these cases and what I appreciated was that her scope of understanding regarding possible causes and outcomes was limited. She needed to go beyond recognizing the condition was serious and realize what options were available. Now she is realizing that there are diagnostics that can define just how serious the condition is and identify the cause. Once this is understood the owners can be educated about the choices they have and potential outcomes. Some of these patients can go on to live normal lives, just because it ‘looks bad’ on initial presentation.

I have a friend that had an geriatric cat that had a number of illnesses. I tried to help her as best as I could long distance. She visited with specialists that appeared to be unenthused about managing a geriatric with multiple health problems. They provided palliative treatments. Here is where they really failed my friend, they did not explain that by following this conservative approach a certain outcome was to be expected. They also did not provide an over view of the potential benefits and risks of a more aggressive approach. My friend quickly became disenchanted with this practitioner. Later, when the pet was failing even more, she visited another veterinarian who played the ‘it’s bad’ card and recommended euthanasia. Again, that may have been a very appropriate choice under the circumstances, but it is a choice. A choice made by the owner with information and options, that is what a good practitioner owes their clients. 

Over my career I have managed patients that other clinicians had declared to have a poor prognosis or a serious condition. These owners wanted more choices, and we together crafted the plan that met their expectations and their pets needs. Many of these pets lived on, very happily, to far exceed their previously poor prognosis. 

Painting an inappropriately rosy picture is wrong, but educating and providing options is definitely the name of the game. Even with the benefit of information some clients are going to choose conservative plans, and that is alright. The important thing is they made educated decisions. 

Read more...

A Tribute To The Cats

Clinic Cats

Every animal that comes through our doors has a special story and touches the lives of each doctor and technician they meet. We deeply value these experiences. We also care deeply for the animals that we ‘live’ with within the hospital. They are the ‘clinic cats’. They entertain fussy children and fidgety adults, chase the wayward field mouse and sit quietly with clients that are stressed and sad. Clinic cats have a sixth sense about people that are allergic to cats and they gravitate to them! They know what dogs are friendly and what dogs to give a wide birth. Some of them pick favorite emergency doctors and make sure they snuggle with them when they are resting at night. They can be crazy, running through the hospital halls, or quiet, curled in front of a sunny window. Clinic cats donate blood for the sick cat and compassion to the people that need it.

Read more...

Community Sharing's Pet Pantry Is In Desperate Need!!!!!

Our Task must be to free ourselves....by widening our circle of compassion to
embrace all living creatures and the whole of nature and its beauty.
Albert Einstein

Community Sharing continues to have new families coming to their doors for help. Each day they are open they add 5-8 new families to their already long list of people in need. Along with providing food and other services to the two footed members of the family, The Pet Pantry at Community Sharing is providing food to the four footed family members. This is a desperately important service to families, children, elderly persons that rely on their pets for solace during difficult times. The food provided to these pets is an important humanitarian outreach that prevents the pain and suffering of all living creatures.

The Pet Pantry's shelves are empty ! We need your help. Please bring donations to Apollo Center or to VCS and the food will be greatly appreciated.

We are all very fortunate to live in this great community. Thank you in advance for your help.

Read more...

Our Little Duckling Is All Grown Up!!!!

A week ago Saturday we released our little duckling that we had raised over the summer. My children named her, Rex (it is very difficult to tell a female from a male duckling), because she looked like a T-rex with her short little 'arms'. When she first came to us she was yellow and fuzzy. Over the summer, through the help of my kids and all the staff at the hospital, we were able to raise her to become a fine young Mallard hen.

Friends of ours, that have a beautiful place on a quiet lake, allowed us to release her there. It was a cool and blustery day. My family and Joe and Linda all walked down to the beach. My son set down the carrier on the beach, opened the door and without hesitation Rexy walked out of the carrier. She calmly evaluated the situation and then flew. Simple as that. It was breath taking. We were all a little surprised it happened so fast. She had never flown before, but she immediately new what to do and what a beautiful job! We were pleased that she did not try to stick next to us or act scared. We had done our job well. She was a WILD duck.

Afterward, we stayed and visited, hoping to catch a glimpse of her before we left. Linda was concerned that she had not seen any Mallards in the area for at least 2 weeks. But, before we left we spotted her with two other Mallards! Since then Linda reports that they are sticking in the general area, but Rex has never returned looking for her carrier.

Read more...

What Makes VCS Pets First Special? Learn About Our 5 Core Values

VCS Pets First was developed after Veterinary Care Specialists, a 24 hour emergency, critical care and referral hospital, had been in existence for over 12 years. Over those years we had developed a facility that provides the most current equipment, experienced doctors and skilled support staff. Veterinary Care Specialists cares for critically ill and injured animals 24/7. Now we are taking our commitment to our community to a new level. As Veterinary Care Specialists and now VCS Pets First we have developed five, fundamental core values that serve as the foundation of our exceptional facility

 Compassion
 Honesty
 Education
 Expertise
 Community

Read more about VCS Pets First Core Values…
Every veterinary clinic says they care about animals and they respect your pet as a family member, we do too! But you want more from a hospital. You want it to provide, consistently, the highest quality medical and surgical care, regardless of the hour. So why consider VCS Pets First for your pet’s veterinary hospital?
Consider our five core values:

 Compassion
o Each patient that visits our hospital, whether on a well visit or if they are hospitalized, is treated with the respect and care that they are entitled. We spend time with our patients and their owners, we are attentive to both of your needs. Most office calls are 30 minutes in length, making sure that we listen to your observations as well as giving your pet a thorough evaluation. Each pet is cared for, whether it is a spay or a complicated orthopedic surgery, in our intensive care area, where we can spend time with them, monitoring and interacting with them. Regardless of the severity of your pet’s health concern, they will be supervised and treated in a compassionate manner 24 hours daily, 7 days a week.

 Honesty.
o Treatment plans will be based on thorough history taking and complete examination. You will receive the optimal treatment plan every time. We will take the time to go through the plan, offer you options and explain the pros and cons of each choice. Other facilities may make choices for you, but at VCS Pets First you will receive an honest and thorough assessment. Then YOU will be given the tools to make choices for your pet. Also, our choices regarding medication and treatments will not be influenced by potential profit for the hospital, but on what we feel is best for your pet. Being sure we do the right by your pet and your family may take extra time, but we feel that is time well spent.

 Education.
o We believe that by educating you we will create a situation where we will be able to work together most effectively in devising a plan for your pets care. Whether it is flea control or exploratory surgery, we will spend the time to answer your questions and be sure you understand the choices you make.
o We will be sure to share with you the most current information regarding your pets care. New vaccines, vaccine protocols, new medications and alternative forms of therapy are just a few examples of areas on which all our doctors remain current.
o All of our doctors receive continuing education yearly, allowing, them to provide your pet with the most current veterinary care possible. Our technical staff also receives continued training. VCS was one of the first veterinary hospitals in the country to have a veterinary technician accredited in Emergency and Critical Care.

 Expertise.
o Patients at VCS Pets First have the benefit of the specialists and specialized care available at Veterinary Care Specialists. All of our doctors have access to veterinarians that are either specializing in certain areas of veterinary medicine or have received additional training beyond their DVM degree. Along with continuing education we also have access to additional specialists within other institutions that we can either consult with or provide you with a referral. Ultimately, our goal is to always be sure that your pet gets the very best veterinary care and we will use all the resources available to achieve this goal.

 Community.
VCS Pets First is locally owned. We actively support many local organizations, like the Pet Food Pantry at Community Sharing. We are also active members of the Highland Business Association, the Lakes Area Chamber of Commerce, the Huron Valley Chamber of Commerce, the Milford Rotary Club, the Huron Valley Optimists Club, the Livingston County Veterinary Medical Association, and the Michigan Veterinary Medical Association. We believe strongly in the value of our local community and all of its members. In order for us to succeed, our towns need to be successful as well. We plan on continuing to be active participants and contribute to the growth and prosperity of our community.

Your family and pets are part of our community as well and are members of the VCS Pets First family. When you visit our office you all are treated like a member of our family. Customer service is a major focus for our doctors and staff, we want you to feel comfortable and well cared for.

Read more...

Yes, Cats Really Do Get Heartworm. The Story of Fergus

Until I met Fergus, I must admit that despite the fact that I knew feline heartworm existed I had little first -hand experience with the disease. Fergus presented one spring morning on the emergency service. The owners had woken to find him recumbent, now he was inches from dying. The staff and doctors that day jumped into action and over the next 24 hours he gradually stabilized. The owners reported that they had adopted him a few months ago from a rescue organization. He had been tested for the feline viral diseases and vaccinated. He was neutered and just beginning to adjust to his new home. Fergus was not allowed outdoors, outdoor cats are more likely than indoor cats to meet with various inexplicable catastrophic events, and until that morning he appeared to be doing very well.

Whenever a cat is presented in such critical condition, with multiple organ systems affected, it is common for us to check their viral status along with serum chemistries and a CBC. Feline viral diseases can be stealthy, but devastating, and cats that test negative 4 weeks earlier can be positive the next month. We tested Fergus’s blood for FELV(Feline Leukemia) and FIV(Feline Immunodeficiency Virus) and also for heartworm antigen. He tested positive for one, heartworm disease.

Feline Heartworm Disease is diagnosed less often in cats since the parasite does not survive as successfully in the cat as it does in the dog. Cats are also less likely to have circulating microfilaria which means that they are less likely to spread the disease. At this time we are unsure why this is the case. Feline heartworm disease can also be challenging to diagnose and can present in many different ways. Because the parasite does not thrive in the cat as it does in the dog, some cats may remain unaffected by a heartworm infection and never demonstrate any clinical signs.
However, when a cat does become ill, the infection can be devastating, even fatal, affecting their heart, lungs, liver and kidneys. Some cats may be mildly affected, demonstrating respiratory signs. Any cat that has evidence of lung disease (like Feline Asthma), coughing or other respiratory signs, should be tested for heartworm. Of course, heart murmurs and cardiac dysfunction, and liver failure can also occur as a results of the adult worms damaging the heart and occluding vessels. Also, gastrointestinal upsets and vomiting can be signs associated with the disease.

Unfortunately for Fergus , he basically had every conceivable clinical sign. He had vomiting, diarrhea, kidney dysfunction, anemia and eventually a heart murmur and heart failure along with an allergic pneumonitis (an inflammation of the lungs), all developing within 24 hours time. His infection had been present for months, but now he was experiencing the devastating consequences of a successful infection. It took Fergus almost a week of intensive care to recover. At one point some of the adult worms moved (we were actually able to see and document this on cardiac ultrasound, an echocardiogram) and lodged across his tricuspid valve, a heart valve between the atrium and ventricle on the right side of the heart. This led to cardiac dysfunction and failure. At that point things looked grim, Fergus was placed on cardiac medications and just when we thought the battle was lost the worm moved (again we documented this on ultrasound). Fergus began feeling better and eventually returned home.

Feline heartworm and its associated illnesses have not been a commonly diagnosed condition in veterinary medicine, so there is sparse data regarding survival rates and successful treatment plans. Published reports at this time usually include as few as 5 to 50 patients from which to draw conclusions. Small study groups may lead to poorly representative information regarding a disease. One study did find that cats like Fergus, if they survive the first 24 hours of their illness, have approximately a 60% chance of surviving that crisis and returning home. A study looking at 50 cats with heartworm disease, the median survival times as 4 years post diagnosis.

Over the next year Fergus will need to be closely monitored to continue to manage his disease as best as we possibly can. Unlike dogs, there is no treatment that has proven successful in eradicating an adult heartworm infection in the cat. Heartworm infected canine patients can be treated with medications that kill the adult worms. In most cases the medication, although strong, can be well tolerated. In the cat there is a high mortality associated with adulticide therapy and there appears to be little benefit from being treated. Surgery can be utilized to remove the adult worms, but again the risks and the mortality (death) rate is very high vs little apparent benefit. When cats have heartworm infections we have to carefully treat the consequences of the infection and place them on a monthly heartworm preventative. The adult heartworms will not live as long in the cats as they do in dogs and will eventually die off.
Feline heartworm preventative is available in pills, chewable tablets and topical solutions for your cat. Particularly if you cat goes outside, contact your veterinarian to discuss what product would be best suited for your cat.

Read more about feline and canine heartworm disease at www.heartwormsociety.org

Read more...

Unraveling the Mystery Of Flea and Tick Control

Michigan is my home state. However, half my family hailed from a small town in western Arkansas just on the edge of the Ozark Mountains. Every summer we visited. It was a wild place, a kids dream. Thick woods, horses, goats, cows, snakes and wily farm dogs that roamed freely as there were no neighbors for at least a mile in all directions. It was a wonderful place to play and explore. The only hitch to outdoor exploration was the preparation. The bug spray, long pants and long sleeve shirts my mother, a native of Michigan, insisted we wear. In her estimation, Arkansas was a tropical parasite and insect laden, poisonous spider and snake infested waste land.

The perimeter of the farm house yard was treated with chemicals to prevent the encroachment of these pests and dogs were regularly doused with flea powder. But there were still ‘bugs’. The parasites and other threats were very egalitarian dog, cat, kid it did not matter. I recall a few episodes of chigger infestation that led to itchy, sleepless nights.

Back in Michigan no one knew what a tick or chigger was and fleas were an infrequent bother. As time has passed, we travel more and we take our pets with us more often, and our winters have become warmer, and the pests that were isolated down south have crossed our borders. Recently, the whole of the Journal of Veterinary Emergency and Critical Care was devoted to emerging infectious diseases. I was struck by how many, of these increasingly more common diseases, were spread by flea and tick infestation. Many of these diseases are zoonotic diseases, that means that they are diseases that can infect people as well as their pets.

Over the past two summers, as we have been developing our general medicine and surgical service, VCS Pets First, I have struggled with counseling people about flea and tick control. I advocate the judicious use of all medications, including flea and tick medications and trying to achieve a balance between chemical use and adequate protection is a challenge. Our office recommends separating flea and tick medications from the heartworm prevention since there is no need for a flea control product, in most cases, from December to May. So, initially we offered a product that killed fleas and ticks for the spring and summer seasons, and then a separate year round heartworm preventative. However, I now feel we need to consider the risks carried by being bit by these parasites. Most flea and tick products act by killing the parasite after it has bit your pet. This is not very helpful if you want avoid the infectious diseases that are acquired by being bit or if the pet is allergic to fleas and their bite triggers allergic responses. This spring we changed our recommendations to a product called Advantix made by Bayer. It is topical, once monthly, it repels fleas, ticks and biting flies and is well tolerated. There is also a product that we suggest for cats and it does have a heartworm preventative, since cats that go outside should be protected from fleas, ticks and heartworm from April to November.

The choice of which product to recommend is not an easy one and it actually is not a decision that you or I should take lightly. Not all flea and tick products are of the same quality or efficacy. Recently I have had a few pets presented through the emergency service that have had serious reactions to flea products they purchased at the pet store or grocery store. Their choice was driven by the low cost and the claims that they did everything the more expensive product did. Here is how the ‘grocery store alternatives’ vary from the veterinary recommended products:
1. The chemical/drug being used – the cheap stuff has old school pharmaceuticals, they are strong and they have a small margin of safety, that means you are more likely to have problems with that drug than others because they have more potential side effects. This is exactly why the other products have been formulated, to create a product that is more safe and effective.
2. Topical flea and tick control products are not as tightly regulated as other medications. It is up to the companies to make the effort to provide the safe products. The companies that are true pharmaceutical organizations, that have ties to veterinary medicine, and a reputation to maintain go the extra step to be sure that their product is safe and adequately labeled so that professionals, ie. veterinarians, will support their products.
3. Higher grade chemicals, more research, accurate and complete labeling, all these things result in a safer product.

Keep this in mind when you are making choices regarding flea and tick control: The skin is the largest organ system in (or on) our body. Even if these chemicals remain solely distributed in the skin, they are affecting our pets whole body - by affecting a major organ system. Be careful, choose wisely.

Read more...