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Medicine versus Mom

Can Dogs Suffer from White Coat Syndrome?

MVM-White-coat

Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

I have worked for two veterinarians in the past who didn’t wear white coats. They did so for a number of reasons.

Firstly, they felt that not wearing a white coat made them more approachable to pet parents. Often, they would wear scrubs or regular work clothes to avoid pet parents feeling like they were being patronized, or talked down to.

Secondly, being a veterinarian or a veterinary technician is a messy job. White should be avoided whenever possible.

Lastly, both doctors felt that white coats made their patients less comfortable in the exam room.

It isn’t a secret that humans suffer from what doctors like to call white coat syndrome. The Mayo Clinic describes this phenomenon as white coat hypertension. This occurs when patients blood pressure rises in the hospital, or in the presence of a doctor (Mayo). Meaning, many humans fear the doctor in some way even when they know that they have to be there, or have willingly visited the doctor on their own.

Now imagine how those same people, who suffer from white coat hypertension, would feel if they didn’t know where they were going, and were brought to the hospital where no one could explain to them why they were there, or how it would benefit them.

We can’t improve the human-animal communication in any way, but what we can do is everything to make our pets more comfortable inside the veterinary hospital.

Research conducted by Ohio State University found that a group of retired racing greyhounds did experience higher than normal blood pressures when they were taken inside a veterinary hospital as opposed to their home (Ohio State University). The study also concluded that the blood pressures were still lower at home even when taken by a veterinary student (Ohio State University).

Now the question is….

Although studies have proven that dogs can suffer from white-coat syndrome as it is defined in human medicine, does this actually relate to the white coat, or to the hospital environment in general?

Sharon L. Crowell-Davis, DVM, PhD, DACVB wrote an article about understanding white-coat syndrome. In her article, she stated,

“…[fear] can be caused by the sight of a white coat, stethoscope, or metal examination table; the smell of the hospital; or anything else that patients associate with unpleasant, uncomfortable, or sometimes painful experiences…” (Vetlearn).

Although it can be determined that the white-coat itself its not necessarily the issue, it can add to the overall fear of the veterinary hospital. Therefore, my friends and coworkers were right in their decision to omit the white coat, to avoid adding to the overall fear of the veterinary hospital.

My dog doesn’t like the hospital or white coats, what can I do to help?

Veterinary hospitals can become significantly less scary to patients through the use of classical conditioning. Classical conditioning as discovered by Ivan Pavlov and his dogs states, “classical conditioning involves learning to associate an unconditioned stimulus that already brings about a particular response with a new conditioned stimulus, so that the new stimulus brings the same response (Simply Psychology)”

Classical Conditioning through Fun Visits

First things first, if you have a puppy or young dog, who doesn’t fear the vet, please bring them to your vet’s office to receive treats and socialize. This will prevent your pet from seeing the veterinary hospital as a threat.

Puppy or not, your pet should visit the veterinary hospital for fun visits. Meaning, your pet walks in the hospital and back out of the hospital without every receiving any treatments. Perhaps they receive some treats from the staff, and it never hurts to plop them on the scale for some treats.

Classical Conditioning through Desensitization

If your pet has already exhibited fear to specific stimuli associated with the veterinary hospital, it may be a good idea to bring some of those stimuli home to help with the desensitization process. For example, let’s say that your dog does indeed fear the white coat, and expresses a lot of resistance and tension around white coats. Ask your veterinarian if they have any spare white coats (we had a few at the hospitals I worked at), or order one from a clearance medical sale online, and bring it home. Get your pet used to the object one step at a time. After your pet has accepted that the white coat is in their home, put the coat on and give them lots of treats and spend quality time with them. This desensitization will help tremendously (Vetlearn)!

Always consult your veterinary for alternative options for desensitization. More than anything, it is important that your dog feels as comfortable as possible at the veterinary hospital. This not only will make your life easier, but make it easier for the veterinary staff to treat your pet and monitor their health.

Does your pet have any fears of the veterinary hospital?

For Carol’s Mom perspective on this topic, please visit her blog here.

What is a Pet Dental and Why is it Important?

MVMDentals

Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

In case you haven’t heard, February is National Pet Dental Health Month.

Pet parents are told time and time again that Pet Dental Health is important. I mean, an entire month is dedicated to it, right?  Today, I want us to understand why pet dental health is important and what a pet dental entails.

What can dental plaque do to your pet’s health?

When a pet’s dental health has gotten to the point where they have oral lesions, as seen below, bacteria can get into their blood stream through these oral legions. This is referred to as bacteremia (PetMD).

petdentallesions

Photo Courtesy of www.mypetdentist.com

Is this just a regular bacterial infection? No.

Bacteria in the blood stream can lead to bacterial endocarditis, which is where the bacteria have reproduced and settled in the lining of your pet’s heart or heart valves. Often, this results directly in kidney damage and joint problems, that all started in the mouth (PetMD).

If my pet’s veterinarian has recommended a dental, what can I expect?

First, it is important to understand the severity of your pet’s dental disease.

If your pet is seen by their veterinarian for their annual check up every year, and this is the first time that your vet has mentioned your pet’s dental health, this will probably be a routine cleaning procedure that will take care of the initial signs of dental issues, and serve as a preventative for future issues. Take it from someone who just had two route canals (because I missed an annual dental cleanings) they are important!

If your pet hasn’t been seen by their veterinarian regularly, and they mention that your pet is in dire need of a dental, this may include an extensive cleaning and possibly some extractions.

Regardless of severity, your pet will need to have some pre-anesthetic bloodwork, to ensure that they are healthy enough for anesthesia.

Once your pet’s dental procedure has been scheduled, you will need to drop your pet off in the morning on an empty stomach, and you will pick them up in the evening post-op.

Is my veterinarian the right veterinarian to trust for this procedure?

I have worked for a handful of veterinarians and I must say there are a few things a veterinarian should have in order for me to trust them to perform a dental procedure:

They should require pre-anesthetic bloodwork: this is paramount to determining if your pet is healthy enough for anesthesia. I have seen patients get their surgeries delayed because their bloodwork indicated that their liver or kidneys were not healthy enough to process the anesthesia. The pre-anesthetic bloodwork and the decision to delay the procedure, may have saved their life.

They should have a dental x-ray machine: dental x-ray allows your veterinarian to see if the roots are healthy enough for the tooth to remain, and also ensures that they have removed all of the root when a tooth has been extracted. Extracting teeth that don’t need to be extracted will cause you to pay for needless treatments, not to mention, your pet enduring more procedures than necessary. Additionally, roots that are left behind from extractions can cause serious problems for your pet’s dental health in the long run.

What happens during a dental procedure?

Once the patient is safely anesthetized, we begin to examine their teeth. We take note of fractures, chips, missing teeth, crowded teeth, severity of calculus (plaque), etc. We document all of the pertinent information regarding the health of the teeth on a chart like the one seen below. It is important that all information is documented for future health issues and dentals.

Photo Courtesty of www.dentalvet.com

Photo Courtesty of www.dentalvet.com

After we have documented the teeth, we begin cleaning (some technicians prefer to do this simultaneously). We clean the teeth with an ultrasonic scaler that allows us to clean the surface of the teeth without scratching or damaging the enamel. Additionally, we are able to clean plaque from under the gum line using the ultrasonic scaler.

Ultrasonic scaler photo courtesy of www.dentalvet.com

Ultrasonic scaler photo courtesy of www.dentalvet.com

After the teeth are cleaned, we determine if any of the teeth need to be extracted. Any tooth whose health is in question, is x-rayed. The below is a dental x-ray which provides an example of bone loss.

Dental X-ray: example of bone loss. Photo courtesy of www.dentalvet.com

Dental X-ray: example of bone loss. Photo courtesy of www.dentalvet.com

If it is determined that no teeth need to be extracted, we proceed with polishing the teeth. The fluoride polish hardens the outer layer of the tooth, helps decrease sensitivity, and reduce plaque (AVDS). After the teeth have been polished, we update out dental chart to note any other findings, and extracted teeth. Then, we wake the patient up from anesthesia.

Throughout the procedure, there is a technician monitoring heart rate, respiratory rate, blood pressure, refill capillary time, temperature, IV fluid rate, iso levels, oxygen levels, time under anesthesia, etc. While waking up from anesthesia, your pet is monitored until their are awake enough to swallow on their own, and show signs of responsiveness. Then they are repeatedly checked on and monitored throughout the rest of their day at the hospital.

When your pet’s dental procedure is complete, their teeth should look like this:

Photo courtesy of http://wilmingtonanimalhospital.com

Photo courtesy of http://wilmingtonanimalhospital.com

For tips on how to care for your pet’s teeth to prevent the need for dentals, please visit Carol’s Mom perspective post here.

Why does is it Seem Like the Vet Costs So Much?

MVMVeterinary-Costs

Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

While working in veterinary medicine, it was often my job to go over estimates with clients when their pets needed to have diagnostic work done.

I was always sure to take the time to thoroughly explain the tests, why they were recommended, and what they would be able to tell us about their pet’s health. I never made the assumption that someone could afford the diagnostics, nor did I assume that they wanted to.

More often than not, clients were floored by the prices of our diagnostics, and on a few occasions they took it out on me, or other members of our staff. Here are a few of the colorful phrases that I have heard client’s use toward veterinary staff while discussing the cost of diagnostics:

“You deserve to die” (Yes, this was actually said to us because we wouldn’t help her dog for free).

“You are taking food right out of my children’s mouth!”

“You all are just in this for the money!”

Don’t get me wrong, I didn’t expect people to just fork over money like it was no big deal. As a veterinary assistant, I made $15 and hour and our rent was $1450 a month, so I was in no place to drop money on a $500 veterinary bill either. However, I signed Rooney up for Trupanion pet insurance for just this reason.

What I expected:

1. For people to let me explain the benefits of the diagnostics.

2. For people to consider what they were paying for, and how it compares to the costs of human medicine.

I always checked with the doctor to see if there was something, or a few things, they felt comfortable delaying. Basically, we always had a low-end of an estimate and a high-end. Not to mention, there are services that you can get approved for, that will let you pay over the course of 6 months with no interest. Occasionally, veterinarians will offer payment plans as well.

I think much of the issues is perception. People don’t typically know what they pay for in regards to their own medical services (due to insurance coverage) and therefore think that veterinarians have very high margins and make very high salaries.

Both of these assumptions are false.

Being a veterinarian means you have the highest debt-to-salary ratio of any profession! (According to Veterinary Team Brief, in 2012 this was reported to be 2.3:1). I once spoke to a girl who had just graduated from veterinary school, and she had $250,000 in debt and was making a salary of $60,000. Her loan payback schedule had her paying $1500 a month until she was 50 years old.

Based on the current information available in regards to veterinary salary, I think its fair to say that veterinarians DON’T make a lot of money. Certainly not relative to the standard of living in their working area.

In regards to margins…

 According to Veterinary Business Advisors, the average profit margin for small animal practices was 9.9%.

This is compared to private practice doctors offices at 12.4%, outpatient care centers at 14.1% and dentist offices at 13.1% (Cardiovascular Business). Now of course these numbers vary year-to-year, and also vary with respect to private versus commercial practice, but what I am trying to illustrate is that most veterinarians are not rolling in excess cash.

So the question still remains, why does it seems like veterinary costs are so high?

I think the best way to answer this question is to examine the prices of medical costs that we don’t often see.

The average cost for an Xray for the El Camino Hospital, The Hospital of Silicon Valley is $291, but can cost as much as $971, according to their website. At this same hospital, an ultrasound on average costs $277, but can cost as much as $570, and laboratory diagnostics cost an average of $205, but up to $1,571. Those costs are actually the out-of-pocket costs for uninsured patients.

For insured patients, their out of pocket costs average $289 (up to $2171) for an x-ray, $314 (up to $2731) for an ultrasound, and $155 for laboratory testing (up to $1884).

VeterinaryCosts

Veterinary costs for the same diagnostics are not only significantly lower (although performing the same task), they also don’t vary based on whether or not you have insurance coverage, and certainly don’t vary $700 from one patient to the other. (These costs were taken from veterinary clinics in the same general area as the hospital mentioned above).

For Carol’s Mom perspective on veterinary costs, please click here.

9 Things to Look for in a New Veterinarian

MVMNewVet

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

How do you know when it is time to find a new veterinarian and what do you look for in your new doctor?

Personally, I think the #1 reason anyone should look for a new veterinarian, is if the veterinarian’s practices aren’t in line with their needs as a client.

From my experience, there are several different aspects that clients look for in their veterinarian:

1. Medicinal Practices: How generous or conservative is this veterinarian when it comes to pain management and anesthetic protocol? Don’t be afraid to ask how they monitor anesthesia and control pain during surgeries and procedures. It is important that they provide a level of transparency with you and your pet’s health.

2. Difference Makers: What does this veterinarian provide that another veterinary hospital couldn’t? Do they have exceptional experience? Unmatched equipment? Find out why they will be able to provide your pet with the best treatment available in your area.

3. Ability and Willingness to Answer Questions: Have you ever been in the room with your doctor, or veterinarian, and felt like they weren’t willing to explain? Or even worse, that they were patronizing you during their explanation? This is enough to make anyone change their doctor or veterinarian. Definitely take the time to look for someone who will do their best to help you understand, and doesn’t make you feel unintelligent when doing so.

4. Understanding Finances: Everyone has a different budget and disposable income when it comes to their pets. A veterinarian should be as understanding and flexible as possible when it comes to your pet’s treatment. They should be willing to explain to you the difference between the absolutely necessary treatments, and the treatments that could wait for another day (if applicable).

5. Diversity of Medicine: Look for a veterinarian who is highly educated and accredited. Veterinarians often seek additional education and certification after attending veterinary school, which furthers their knowledge and ability to treat your pet. All veterinarians and veterinarian technicians are required to keep up with their states CE or Continuing Education requirements, but some professionals in this industry go above and beyond the required education.

For example, Dr. Summer Godfrey who works at Pleasanton Veterinary Hospital not only graduated from UC Davis with her DVM (Doctor of Veterinary Medicine), she also graduated from the Chi Institute of Traditional Chinese medicine in 2008, which allows her to treat patients with a combination of eastern and western medicine. She provides her patients (Rooney) with more tools to improve their health.

6. Location: Let’s face it, location matters when it comes to a veterinarian. Not only is it more convenient to have your veterinarian near by, it is also better for your pet’s health and safety if you ever experience an emergency situation. The area that we live in also supports 24 hour veterinary emergency, and it just so happens that Rooney’s doctor mentioned above, works there also.

7. Willingness to Make Adjustments: Sometimes, your pet needs adjustments to their treatment plan. For example, we had this one patient who would lose her mind the second we brought her in the hospital. However, if we examined her, and did most necessary treatments outside by the grass, she felt totally fine and very comfortable. Obviously, if this patient needed a procedure or some major treatment, we would have to bring her inside, but for her annual exam and vaccines, why not leave her where she is most comfortable?

Now that I think about it, we had a few patients like that, and we were always willing to make adjustments for our patients, and I think this was important to our clients.

8. Relationship with Specialists: If your veterinarian is unable to perform a specialty surgery or procedure, are they able to put you in contact with the right doctor? If your veterinarian isn’t available 24 hours, can they put you in contact with an emergency or other 24 hour hospital? These are important things to consider when evaluating a veterinarian.

9. Bedside Manner: this is a fancy term for how much tact a doctor has when dealing with you and your pet. I have worked with veterinarians who are very friendly and have excellent bedside manner, and I have worked with veterinarians who are a little on the quirky side. Regardless, the initial first impression of a veterinarian is something that usually gets burned in a client’s brain.

Most important, is whether or not your pet likes your veterinarian’s personality and disposition. Sometimes, certain pet’s tend to gravitate toward one gender or another, and it is important that they feel comfortable.

If your veterinarian isn’t meeting your expectations, how do you go about finding another doctor?

1. The American Animal Hospital Association (AHAA) provides pet parents with a list of accredited veterinary hospitals. Each AHAA accredited veterinary hospital meets AHAA standards on 900 different measures of veterinary excellence.

2. Be weary of local review sites and forums. Although some reviews provide some truth, people are motivated to write reviews when they are upset, so take what people say with a grain of salt.

3. Don’t forget to ask your pet parent friend’s who live in the area, but make sure your questions are specific to exactly what it is that they like about their veterinarian.

Have you ever made a veterinary switch? What motivated this move?

For Carol’s Mom perspective on this subject, please hop over to her blog here.

Medicine Versus Mom: How to Approach a Veterinarian About a Second Opinion

MVMSecond

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

Today, we want to discuss some difficult subjects: Asking a Veterinarian for a Second Opinion, and Explaining to Your Veterinarian that You Buy Food and Treats Elsewhere.

What are some situations might I face, that would lead me to need a second opinion?

1. When your veterinarian’s knowledge limits you to only one option: I don’t know about you, but I am what I like to call an “information gatherer”. I tend not to accept information right off the bat, and prefer to conduct some research of my own. If your veterinarian is saying that you only have one option for treatment, no matter the issue, it might be a good time to seek a second option. If it turns out that your veterinarian was correct, there is only one option for treatment, then you can go back to them with confidence regarding the necessary treatment for your pet.

2. When its time for a Specialist to step in: More often then not, your veterinarian will know all of the specialists in your surrounding area. Veterinarians exchange phone calls regarding the transfer of cases, and therefore know each other to a certain extent. Additionally, many general veterinarians co-treat with specialists because, from a business sense, they are referral partners. By co-treat, I mean that the general veterinarian diagnoses the issue, the specialist performs the surgery or treatment, and the follow up exams are completed with the general veterinarian. This means that you shouldn’t be afraid to ask for a specialist’s contact information. In fact, your veterinarian should be very willing, and even proactive, about providing you with this information.

 We have a veterinary dentist in our area, and she is excellent! When I worked at the veterinary hospital, our doctors referred clients to her for difficult dental extractions. Why? Well, we knew that we could do the extraction at our hospital, but our clients would be charged per 15 minutes of surgery time, and the specialist was going to take less time to complete the extraction than our doctor would.

Curious to see if you have a veterinary dentist? Here is a list of Board Certified Dentists in the U.S. from Healthymouth.com.

3. When its time to try something new: For example, I worked with a veterinarian who was certified in Eastern Medicine, so we often received clients who were looking to try acupuncture or herbs to remedy their dog’s ailments. If you feel another veterinarian has more tools to help improve your pet’s health, don’t be afraid to explore those opportunities.

My best advice in seeking a second opinion is to be honest. Even here in the Bay Area where there are tons of clients and a good number of veterinarians, the veterinary community is very interconnected. Many veterinarian’s and veterinary technicians work relief at other hospitals, so to avoid burning bridges or letting a good relationship go sour, be honest with your veterinarian. Perhaps they don’t currently offer acupuncture, but hearing that another client is interested is exactly what they need to hear in order to pursue certification. You as a client can be more influential on your veterinary practice than you think, but you have to speak up.

How to Explain to Your Veterinarian that You Buy Food and Treats Elsewhere

Most veterinarians are aware that pet owners like to save money where they can. Veterinary medicine isn’t typically a place to pinch pennies since that money is going toward your pet’s health. That being said, you may like to try to save on buying your food and treats from other locations, and that’s okay.

Firstly, many veterinary practices don’t sell dog food, or they only sell prescriptions diets. Many, don’t even get an opportunity to carry their favorite foods due to restricted space or inventory costs. Therefore, they are not surprised if you, as a consumer, don’t purchase your dog food at their office.

However, lets say that your veterinary hospital has a full service pet store associated with it, and that is of course where they want you to buy all of your food, treats, and other pet related items from.

Once again, my advice is to be upfront. Let’s say that the food you normally buy for your dog is $35 a bag at the other pet store, and your veterinarian is selling the same bag for $46. That is simply too big of a difference for you to justify buying from the vet’s store. The first thing you should do is tell your veterinarian what the competition is selling their dog food for, and ask them if they have any available discounts. If your veterinarian says that they can’t bring their price down today, say no problem, but tell them, if you were selling it for $38, I would buy it here instead of at the pet store (of course only say this if this is true, but you want to support your veterinarian and are willing to pay a little more, but not a premium).

Once again, your influence on your veterinary practice is larger than you think. Veterinarians and practice owners want to make their clients happy. Without you, they don’t have a business, and they can’t continue their dream of helping pets live happier lives, so I urge you to be very forthcoming with your veterinarian regarding your consumer opinions.

For Carol’s dog mom perspective, be sure to hop over to her blog post, here.

Have a wonderful day everyone!

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