Last week, I represented the MVMA New Graduate Task Force at a veterinary school mixer for first years. That’s what every incoming veterinary student wants to do, right? Party with a pregnant lady? Anyway, it was refreshing to talk to some of the new grads and even give advice. Most of them are in that excited, giddy stage before veterinary school. You know, the euphoria you have about getting into one of the most competitive programs in the country before veterinary school totally knocks you on your butt in one to two weeks. When you’re in veterinary school, you watch it happen to the incoming class every year. Their strides down the hall transition from a confident strut to a tired slump in a matter of days. That was me eight years ago. That’s right, EIGHT years ago. Optimistic, confident, hopeful, and maybe just a wee bit naive. As interesting as the transition from college student to veterinary student is, we’re going to discuss the tricky transition from veterinary student to veterinarian. I’ve touched on this subject before in other blogs, but it’s a dramatic enough change that it warrants its own post. The euphoria you get leading up to and following graduation from veterinary school can be quite similar to the euphoria of the young graduates I had the pleasure to meet last week. You’ve fought and worked through four years of a grueling curriculum. You’ve passed your classes, your clinics, and your board exams. That diploma represents YEARS of hard work towards a hard-earned dream. You should be euphoric! If you have a job offer after graduation, you have even more to be excited about as those student loans won’t pay themselves. After all the parties, get-togethers, and goodbyes to classmates, the dust settles and it’s time to get to work. However, living the dream (as I like to call it) isn’t always easy. If you’re a new graduate, you may experience some of the following things: 1. Isolation- One of the many great things about veterinary school is your support network. I met some of the best friends I have ever had in veterinary school. A plus is that you get to spend pretty much everyday with those best friends or battle buddies. When you graduate, it’s very likely you’re going to have to say goodbye to most of them. You may be taking a job in a town where you don’t know anyone. Even if you desperately want to make friends, it’s hard to find the time and energy to do so. Young associates are the workhorses of many practices and put in long hours. There are a lot of challenges when you first get out of veterinary school. You have a top-notch education, but you’re also probably pretty inexperienced. Facing those challenges after you have lost your support network is hard. It’s easy to feel alone, but the thing is, you’re not. I would fret about things for weeks and forget that my friends were only a phone call away. Most of the time, my friends were experiencing the same things I was and even had advice. I found myself wishing I would have talked to them weeks ago. When we made time to meet for dinner and hang out, all we could do was talk about veterinary medicine. It was like therapy! It’s true that your battle buddies are the only ones that truly understand this transition. Keep in touch with your classmates and make an effort to meet up with them as much as you can. Also, as a fellow, tired, hard-working veterinarian, make the kind of friends that come over in PJs, drink wine, and watch smut television with you. Not judging you on the clutter in your house is also a plus. 2. You will make mistakes. This is not unique to new graduates. However, there’s a lot to be said from learning from experience. They can’t teach you everything in veterinary school. A colleague of mine received some great advice from their boss: “...you will be ‘practicing’ medicine your whole career, and when you are practicing something you don’t always get it right.” I’ve discussed in previous blogs the impact early “mistakes” can have on new graduates. One thing a lot of us have in common is that we’re very hard on ourselves when we make those mistakes. I often think of patients I couldn’t save or cases I could have handled differently. The most important thing is that you learn from your mistakes. It’s okay to be a little bit hard on yourself because that’s what prevents you from repeating those mistakes. Being hard on yourself isn’t always a bad thing, and it can make you a great doctor. You probably won’t find that on a motivational poster, but it’s true. However, it can reach a point where being hard on yourself doesn’t make you better, but miserable. I’m my own harshest critic. It’s made me into the person I am today, but it’s probably also why I have slightly high blood pressure. Learn from your mistakes and push yourself to be better. You’re the hero of your own story, but remember that heroes are as much the sum of their faults as they are the depth of their positive qualities. Use your “failures” as opportunities for growth. That is what truly makes a successful person. 3. Your clients may doubt you or take time to get used to you. Coming to a practice in a rural area where both veterinarians were older men, my arrival was a bit of an adjustment for some clients. On my first few farm calls when I would pull up to a farm to deliver a calf with my blond ponytail and smile, I could literally see the look of “Oh s$#*!” on the producer’s face. Nine times out of ten, most of them were perfectly fine when they figured out I was competent and could do the job. Some of them were even easily impressed. On one call where I delivered live twin calves, a producer said, “Wow, you get right in there, don’t you?” Well, yeah. I want to get the calves out as quickly as possible. Not only so they will survive, but also because I have Netflix to watch. Also, I should add that it is technically impossible to daintily stick your arm in a cow’s vagina. Remember that change is hard for a lot of people, so don’t take it personally if people doubt you at first. Use that as an opportunity to prove yourself. It’s impossible to win everyone over, but most people appreciate hard work, a positive attitude, and most importantly, someone who is willing to listen. 4. Your bosses will probably laugh at you. Yes, part of being the new associate is that people are going to pick on you. I provided my colleagues and staff plenty of material for this. Things I got a hard time for included (but weren’t limited to) writing a “book” for my medical records, being slow in appointments and surgery, leaving things everywhere (like my coffee cups or my purse), not carrying a pen on me at all times, being “short” (by the way, I’m 5’ 6”, not exactly short but when everything in the clinic is set up for a 6’ tall male, you can have a hard time reaching things), getting covered in crap all the time (I’m a poop magnet, what can I say?), and many other things. Apparently I’m not the only one. A colleague of mine says, “I still remember my first patient. Older dog for an annual exam and I found a new heart murmur. I did a huge cardio work up and my boss laughed.” I’ve certainly been laughed at for similar things. Most of it is in good fun, so try not to take it to heart. If your boss has a good sense of humor, don’t be afraid to dish it back (but not too often because they write your paycheck). 5. Pets are easy (most of the time), but people are hard. So many times when I hear young kids or college students asked why they want to be a veterinarian, they respond with, “I love animals, but don't like people very much.” Veterinary medicine is actually not a good profession for those individuals because to be successful in this field, you very much need to be a people person. That's not to say that dealing with people doesn't come without its challenges. One thing my colleagues and I have discussed at length is how to approach the subject of euthanasia with clients and navigate them through that process. Learning to read clients and knowing when and how to approach the subject of euthanasia is an art form that isn't taught in veterinary school. In vet school, they mention the dreaded question of, “What would you do if it was your dog, Doc?” They teach us to dodge that question like the plague. There's somewhat of a good reason for this in that not every client will be in the same financial situation as you or have the same relationship with their pet that you do. However, I've found that most people that ask this question, especially in the context of euthanasia, just want to know that it's okay to say goodbye to their pet. They just want your honest opinion of what they should do. If you think about it, it's a reasonable question to ask, and there are ways to answer that question without causing a liability issue but also being compassionate. As a new graduate, I was afraid to even mention the word euthanasia, even if I thought it was the best thing for the pet. In veterinary school, they make you feel like you could get sued for even broaching the subject. It takes most veterinarians at least a couple of years to become comfortable with having these difficult but necessary discussions. Remember that these conversations are hard for everyone when you start out, but they get easier with experience. 6. You will probably give your clients too many options. Maybe it's just me, but I feel like my training in veterinary school taught me to give each client a whole host of diagnostic and treatment options. If you only offer or recommend the gold standard workup and treatment for pets, some clients may think you're just money-hungry and completely shut you out because they can't afford it. If you offer them every option, from the Cadillac plan to the Ford Pinto plan, clients just get confused. They may not fully understand the risks involved with the cheaper approaches. Giving too many options also kind of makes you sound like you don't know what you're doing or know what's best for their pet. If you only offer the bargain plans to people, you're really not practicing the best medicine. Not only that, but you're basically assuming the client can't or doesn't want to care for their pet adequately, which is a dangerous assumption to make. So what is a practitioner to do? My advice to new grads is this: throw everything you learned about the multi-option approach out the window. Most clients are coming to see you because they want your opinion on what is best for their pet. Make your recommendations with confidence and conviction. If you notice hesitation or think money might be an issue, let them know that there are other options available if that doesn't work for them. Some may disagree with this approach, and sometimes even four years after graduating, I still find myself giving clients too many options. It's a hard habit to break, but don't be afraid to give clients your best opinion. That's what they're paying you for and why you went to school for an ungodly amount of time. 7. You are probably going to feel (and be) broke. Having a “big kid” job for the first time is a great feeling. For once, you're making money instead of paying tuition. However, don't get carried away with this feeling. Remember, that six-month grace period on student loans runs out fast. I remember my first year out I spent a bunch of money on Christmas presents for family. I could finally afford “real” gifts instead of just making everyone in the family loaves of banana bread. Talking to a young vet student at the mixer event, I expressed excitement over getting some of the free plastic cups from Harpo’s (the bar) to sip my water in. The young woman said, “You know you have a big kid job when most of your cups aren't Shakespeare’s cups anymore.” Confession: my cabinet is still full of Shakespeare's cups. Confession #2: It’s probably best to be that practical. My advice to new graduates is that there's no shame in continuing to live like a college student for at least a few years after graduating. It's allowed me to make extra student loan payments, buy a practice, and build a house. Get your feet on the ground first and you can make those big-kid purchases later. So shop at Aldi’s, eat a lot of eggs, continue to drive a beater car, make homemade gifts (because all your family really cares about is that you thought of them, spent time with them, and hopefully don't have to leave to treat a horse colic in the middle of Christmas dinner), and don't buy expensive glassware because if you're like me, you'll probably break it all before too long anyway. Most importantly, just don't make stupid decisions with your money. School debt is a real issue, but if you're living like a Kardashian after veterinary school, it's hard for the rest of us to have serious discussions with leaders in our state and profession about lowering student debt without them laughing at us or shrugging us off as entitled whiners. 8. You'll soon learn that sometimes it's best to not tell people what you do. A colleague of mine gives some advice, saying, “Don't tell people you're a veterinarian if you ever want a normal hobby. I loved joining a running group where no one asked about my job or talked about their pets.” This may seem harsh, but most of us don't want to answer questions or hear about all of your dog's quirks on our off time. However, when you practice in a small town, it's impossible to live incognito. Sometimes you just want to get in and out of the grocery store after work and go home without spending an extra 20 minutes answering questions. Many of these people are repeat offenders and you learn how to recognize them in public quickly. I've hid behind things before. More advice to new grads is to never EVER tell the person next to you on a plane that you're a veterinarian. Another colleague of mine says, “I tell people on planes I'm a mortician...works like a dream!” Personally? I go with insurance salesman. 9. Work-life balance is difficult to obtain. As mentioned earlier, new associates are the workhorses of the practice. New graduates haven't mastered the efficiency of their more seasoned counterparts, but they make up for it in hard work and dedication (usually). I'm also pretty sure I was sore for the first year of practice. You use a lot of weird muscles in a mixed animal practice. I can castrate many 800 pound bulls in a row now, so don't even ask to arm wrestle me in a bar. Anyway, new graduates arrive at their new jobs psyched to save every animal and the world. We grew up looking at veterinarians as heroes. Sometimes the beginnings of a career don't meet expectations. At the end of a 65-hour work week of anal gland expressions, euthanasias, biting teeth and claws, and cranky clients, you may not feel like a superhero. This is because you're not a superhero. You're a veterinarian and a human being. Yeah, yeah, I know I said earlier that you're the hero of your own story, but that was symbolic. Veterinary medicine is a noble calling. Most veterinarians (including myself) love their job and care deeply for their patients and clients. But vet med isn't everything, and it can't fulfill your every need. In the end, veterinary medicine is a job that we do to make money so we can pay our bills and hopefully have a little extra left over to do the things we love to do. That's it. Understand that most of us love our job and care deeply for our patients, but I'm becoming more and more convinced that the notion that veterinarians are heros and our profession is a life choice and not a career does more harm than good and leads to dissatisfaction and compassion fatigue. No, that doesn't mean veterinarians only “do it for the money” as many of us are often accused. Most of us volunteer heavily in our communities and we truly care about your pets. However, I don't know one single person (including the people throwing out those accusations) that would show up to work without getting paid. So FYI, saying that any person only does their job for the money is an ignorant statement to make. I'm digressing here, but my advice to new grads in this regard is to get off your phones and your computers and go adventuring. Find things outside the profession you enjoy doing. Filling your bucket is so important, and you can't be the best doctor you can be without doing just that. A colleague of mine puts it best in saying, “..our profession doesn't define us, but if done well allows us to make a positive impact on our world.” In the very least, it allows us to make a positive impact in the communities we live in, which makes it worth fighting through so many of the challenges we face. All in all, chin up new veterinarians! Remember that first time feeling you had going into middle school, or high school, or Starbucks, then you felt like you got punched in the throat with stress and disappointment? Don’t worry, it evens out. Just take some of these tips so the aftermath isn’t as bad as it has been for some of your slightly more experienced, but still willing to help colleagues. Take the advice while you can because soon we’ll turn into old crotchety vets, saying things like, “They need to get it together and stop cryin’ and whinin’ and just get to work. Back in my day….” You get it.
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Ahhhhhh, just relaxing. This is the good life. Well, almost. I just need to find a dog. I made sure to get up here on this leaf pretty early, so I’d have my pick of fluffy, big dogs, with lots of blood to munch on. I’m just hanging from the edge of this leaf, ready to drop on my next meal. I had it pretty good for a while. I’ve spent some time feasting on a pretty large buck, but then he hit the wrong highway, or should I say, the wrong highway or giant metal box on the highway hit him. Thankfully, I was smart enough to jump off after the impact, and I watched as they loaded him up and drove him away. I had a few friends on his neck. I hope they’re doing okay. Anyhoooo, now I’m just waiting ‘til the next meal. That buck used to hang around this trail early in the mornings, so I’ve seen quite a few large dogs taking walks with their humans that I can pick from. Stupid deer! Saw a doe and just ran blindly. She didn’t even turn around, just kept on running. I’m a female hard tick, so I have a reason to run off from my counterparts. I get one shot at laying eggs, then I die, so I will not mate, not yet. I’m enjoying the good life. Today, I will get fat. I can eat 100 time my weight, and I’m gonna do it. I’m hangry! I’m a little worried about this pet situation though. I’ve heard stories from other ticks. I usually stick to deer, but I’m pretty hungry, so I’ve got to take a chance. I’ve heard that some dogs are just great prey. They don’t even notice you’re there, and then by the time they do notice, you’ve already started your meal. If you pick the right spot, they can’t even reach you. Other dogs are trickier. I’ve heard that I need to look out for skinny collars. They have some sort of magic that will drop a tick dead in no time. If you’re really desperate though, or if you don’t notice before it’s too late, just make a mad dash to their butt - too far away from the collar to hurt a tick, or so they say. I’ve also heard of a topical that they take, and somehow the stuff will kill ticks, but Rover usually hits a few ponds, so it doesn’t work as well, and may stun a few ticks or make them talk funny like my pal Stewart. Basically, it wears off, so more likely than not, I’d be safe to jump on one of those dogs. But, there’s this other thing that’s got us all concerned. It’s probably just a tall tale, but it still worries me. A couple of my buddies jumped on a dog, seemed pretty excited and found a good spot right away, but they never returned, except one. He came back missing half his legs. He says he fell off because he felt dizzy and hadn’t attached yet, but he doesn’t even remember how he got back here, but obviously he was poisoned. He is not right anymore. Disappeared a few weeks back. The only thing he could remember, and what he kept repeating, was beware the veterinarian, but I don’t know what that is. Must be a scientific name for a bug or something. Oh wait! I’ve found my perfect specimen! A long haired, very large dog is approaching with its human running behind. It’s so big, I just know I can snack forever. I don’t see a skinny collar, just some frilly looking collar that must be totally embarrassing for the dog to wear, but personal preference, I guess. I’m going to aim for it’s head or neck and climb under a leg. I want a good spot to hide under all that luscious hair (and make it difficult to scratch me off). When I first attach myself to the dog, I’ll spit in a product that is very similar to lidocaine, so they can’t feel it. That’ll give me time to settle in. One, two, three! Jump! Whooooaaaa! Perfect somersault and landed smack dab on the neck. No one noticed - Jackpot! Now we’re just trotting along and I’m going to slowly make my way to my spot. This is the perfect dog! Warm, furry, and totally oblivious. I’m living the life! 24 hours later…. Blahhh...I don’t feel good. DUN, DUN, DUUUUUN! Tick dies…. That dog had a veterinarian! :) Now if you’re looking for some specific information about ticks, how to protect your pet, and more about this awesome creature called The Veterinarian, keep reading: 1.) Ticks are usually found in the neck and face area on a pet, but they can be anywhere, and will go anywhere that’s easy for them, hence, certain collars don’t work well because it only protects its close vicinity. 2.) Ticks can cause anemia, Lyme disease, Rocky Mountain Spotted Fever, Ehrlichiosis or a whole host of other diseases, and even paralysis. Ehrlichia is the most common tick-borne illness in the Missouri region (in dogs and people). Many people get concerned about Lyme disease, but it’s actually quite rare in Missouri. Thirty to forty percent of dogs test positive to Ehrlichia in our region, meaning they either have an active infection or have been exposed in the past. Symptoms to watch for are lethargy, decreased appetite, fever, and sore joints. 3.) If you find a tick on you or your pet, remove it gently, but immediately, using tweezers if possible. The engorged ticks that look like gross, large peas are females, and they may feed up to three weeks to engorge. The males take in shorter meals, moving from female to female to mate. Females will engorge, drop off, and lay 3,000 to 6,000 eggs on the ground. Ever wonder why sometimes you find an engorged tick with a smaller tick underneath it? That’s a dirty male tick that’s after the female. Be sure to crush them both with extra gusto. 4.) Use a preventative that has been prescribed by your veterinarian. It will not only work better than ones you get off the shelf, your veterinarian will be able to prescribe a medication that works just for your pet’s needs.
5.) Many people may think that tick prevention is just necessary during certain times of year. Many think ticks will die after the first frost, but this is not true. Some species of ticks, like the American dog tick and Lone Star tick just aren’t as active in fall and winter months. Other species, like the Blacklegged or Deer tick can remain active in their adult stage from fall to winter as long as temperatures are above freezing. Snow on the ground can also insulate ticks and help them survive temperatures below freezing. I have seen dogs come into my office covered in ticks in January. Ticks are hardy little buggers. This is why year-round tick prevention is important. Fall is approaching, and you might be tempted to lay off the tick prevention through the winter months. I discourage you from doing this for all the above reasons. If your pet is not on year-round tick prevention, they are at risk for acquiring tick-borne illnesses, which can be deadly. 6.) There’s three main forms of tick prevention: topical medications (between the shoulder blades), collars, and oral or chewable tick preventatives. I sell varieties of all three at my clinic. Probably the most popular preventative with my clients is the Bravecto. It’s a chewable flea and tick preventative that lasts for three months. There is one type of tick (the Lone Star Tick) in which it is only effective for two months. That’s the tick with the dot in the middle of its back, so they’re easy to pick out. I tell clients that if they start to see Lone Star Ticks attached to their dogs after two months or before the three months is up, to go ahead and redose the Bravecto at two months. Another popular product is the Seresto collar, a flea and tick collar that lasts for eight months. Most of the generic flea or tick collars you find at Wal-Mart or other farm stores don’t work very well, but this particular collar does. According to the drug company, swimming should not affect the efficacy of the collar. Another plus is that the insecticide is impregnated in the collar and reacts to the lipids (fats) specific to the skin of the dog or cat. So if we touch the collar, we don’t absorb the insecticide. I always point that out because people get concerned about that, especially with children in the house. We also carry a couple of monthly topicals. Certain monthly topicals work well. However, in my experience, the chewable product and the collar is more effective, probably because there is less variability in the way it is absorbed. For instance, a dog can go swimming and rinse some of the topical off, or roll on the ground and rub it off. Even if clients don’t intend to buy flea and tick products from their vet (which they should for a number of reasons), they should still consult their veterinarian before using a product. I have had certain over-the-counter products kill patients. Others have a tendency to cause horrible reactions. It’s also important for people to know that some products are over-the-counter while others are prescription. If it is a prescription flea/tick preventative, the veterinarian has to have seen the pet in the past year to dispense it. If not, they have to make an appointment for an examination before those products can be purchased. But over-the-counter products can be purchased without an office visit. For example, the Seresto collar (the 8-month flea and tick collar) is over-the-counter while the Bravecto chewable tablets are prescription. 7.) Last, but certainly not least, because I get asked all the time, so I’ll make it very clear, if you live in Missouri, yes, the ticks are bad here. They are bad here every year. If you didn’t see many this year or that year, it’s only because you were lucky. They are everywhere (so go check yourself using a mirror or a spouse). So go take a walk, explore the outdoors, and make sure you give yourself enough time to check yourself and your pet for ticks, and check with your veterinarian about the best tick preventative for your pet. Pregnancy brain. Most people have probably heard of the term. To be honest, I used to think this was a made-up condition. I now know that is not the case. Being a veterinarian, especially a veterinarian that owns a practice, requires you to juggle a lot of different tasks and projects at one time while getting constantly interrupted and somehow keep track of everything. Add a tiny human stealing your brain power to the mix? It can make for a pretty interesting day. I’ll briefly describe a day inside the clinic to paint a picture of how hectic it can be. I wake up VERY early to squeeze in my morning run before work. My morning runs actually seem to not only improve my state of mind, but they also help me wake up and organize my thoughts for the day (a plus for a pregnant lady). I then get ready for work, and if I’m on call, I may get a few phone calls while eating breakfast or brushing my teeth. These calls could be anything from appointment cancellations, appointment requests, emergencies, or people just wanting free advice very early in the morning. I used to be an overachiever and made mental notes or wrote things down in order to make those changes to the calendar when I got to work. If it’s something simple, I now just tell people to call the clinic after 7:30 A.M. when someone is there that can look at the calendar and make necessary changes. I arrive at the clinic, coffee in hand. I make some charges for some farm call emergencies I had the night before. I check my inbox to see if I got any mail I didn’t get to yesterday, taking mental notes of drug promotions going on that month, writing down things I need to order, and read through outside lab results. I make notes to call those clients with those results later in the morning as most people don’t exactly appreciate a phone call at 7:15 A.M. I check on my hospitalized patients and adjust any treatment plans if necessary. I look at the schedule for the day and decide what bad cases I’m going to brush off on my associate (just kidding!). The phone rings, and since my receptionist doesn’t come in until 8 A.M., I answer, “Howard County Veterinary Service, this is Dr. Stroupe.” The frantic voice on the other line says, “My dog has been vomiting all night long after eating the two pounds of lard we threw out (this is an actual case I have seen, by the way). Can I bring him in first thing this morning?” I look at the calendar and see that I have a bunch of appointments scheduled first thing in the morning while my associate is out on a farm call. I tell the owner to bring the dog on in and we’ll work them in as quick as we can. Meanwhile, someone walks in (without an appointment) with an itching cat. “My cat has been scratching itself until it bleeds, Doc.” My first reply, “Is your cat on a flea and tick preventative?” The owner says, “Yeah. I’ve been giving that real cheap Hartz stuff from Wal-Mart and give flea baths periodically, so I know it ain’t fleas.” I check the cat in and take him back to the exam room. I manage to convince the owner that the cat is itching, in fact, due to fleas by running my flea comb through it’s fur and showcasing the fleas that are jumping off of it. We send the pet with a flea preventative that isn’t complete crap, just in time for the morning emergency to come in. As I’m examining the emergency in the exam room, I hear the phone ring in the background. One of my technicians answers, and I can tell the person on the other line is asking to speak to me with some questions. My technician writes down their name and phone number and posts it on my bulletin board for me to call back later. We check blood work and take radiographs (x-rays) on the sick dog. After discovering he just has a rip-roaring gastroenteritis from his fat feast the night before, we send him home with some medications. I walk to the bulletin board and call the client with the question. I then start catching up on my medical records for the morning so far. Another phone call with a request to refill a medication comes in. I grant the request and print a label for the medication. Okay, where was I again? I continue to finish (or attempt to finish) filling out the medical records. I hear one of my technicians holler from the kennel room, so I walk back there. Buddy, my patient on fluids, had just ripped out his IV catheter. “#$&!” I say under my breath or very loudly depending on how my mood is at this point. I replace the IV catheter and move on with morning. Wait, where was I again? My receptionist yells from up front, “Dr. Stroupe, your 8:30 A.M. is here.” As I’m walking to the exam room to see my appointment, I remember, “Oh! I almost forgot! Could you refill Mrs. Smith’s medication? She’s going to pick it up later this morning. I printed a label for it, or at least I think I did.” I finish seeing the appointment and tell them we can check them out and send them with their preventatives up front. The client says, “Wait, weren’t we going to trim Frisky’s nails?” “Crap!” I think to myself. She just told me to do that two minutes ago. I say, “Yes! Certainly!” and trim the dog’s nails as it squirms in my technician’s arms. I secretly hope that my client doesn’t think I’m suffering from some sort of dementia. After that’s done, I stand in a daze for a second and then go look at my bulletin board (my guide for the day). I see several things posted that I need to order from our distributor. While I’m on hold with the distributor, I look up purchasing history on different products and decide how much of each product I want to order. When I’m done with that, I either catch up on medical records while on hold or just daze off if I’m not feeling particularly productive. My technician says, “Dr. Stroupe, you forgot to charge our last client for that nail trim and anal gland expression.” Great. Oh well, that client gets a little bit of a discount today. My distributor answers and I place my first order of products for the day. While I’m talking with the distributor, my phone dings with someone sending me a Facebook message with a pet question. I think to myself, “Seriously? Do they not know how to pick up the phone and call the clinic like everyone else?” I ignore the inquiry seeing as it’s not an emergency and I haven’t spoken to the person since high school. Another thing I stopped doing with age and wisdom: acting as a 24/7 vet advice line for my “friends” on social media. I have plenty on my plate as is. I see several more appointments and frantically type in records in my little time between appointments. I get a tinge of hunger and grab some Ritz crackers from my desk so I don’t get hangry before lunch. I answer a few more phone calls. Another client calls and asks, “I have some pigs and I’m looking for a dewormer that I can add to their water or feed. I also have a sick goat. Do you think it got worms from the pigs?” I answer their questions and tell them I’ll have to research some products they can use. While I begin the lengthy process of finding a product with the right concentration that isn’t too expensive but also isn’t backordered, another appointment comes in. It’s a dog with a fresh laceration. We tell the client the dog needs to have the laceration sutured, and my technician goes over the permission paperwork with them. We prep for surgery and suture up the dog. I then call the client after to give an update. I wash my hands and roll into the lounge and heat up my lunch. I collapse into the chair and munch on my food. I’m starving! (another permanent pregnancy condition). I’ll go ahead and stop the description of my day. That gives you a bit of an idea of why I might a little scatter-brained. You have probably also gathered that in this profession (and many others) your brain needs to be organized and juggle a lot of tasks at one time. We have to be problem solvers and utilize a lot of critical thinking. While I have found ways to manage, my brain no longer functions the same as my pre-pregnancy brain. I’m hoping things will return to normal once Pip is born, but I’m told that it only gets slightly better once the baby is born. Things kind of leveled out and became normal during the second trimester, but as I approach my third trimester, pregnancy insomnia has kicked in. That certainly doesn’t help my cognitive performance. No worries. I double check everything I do, so I haven’t made any terrible mistakes at this point (so please don’t be afraid to bring your pet to me). However, I struggle to juggle my many tasks much more than I did before. I have literally stopped in the middle of a sentence while talking to a client because I couldn’t remember what I was saying. I struggle to recall information that I learned in veterinary school years ago (which didn’t used to be a struggle) and have to utilize my reference textbooks more often. Sometimes I have trouble recalling names of basic pieces of equipment (or anything really). I might say, “You know, the thingy that spins down tubes of blood and urine?” My tech replies, “You mean a centrifuge?” with a look on her face that clearly shows I’ve lost my mind. My co-workers don’t really buy the “pregnancy brain” thing. They point out that I was a bit forgetful before I was pregnant, which is fair enough. But don’t listen to them, it’s totally pregnancy brain! Another interesting component is my new-found lack of coordination. I tend to fumble and drop things a lot. A couple of weeks ago, I had to draw blood on a geriatric cat with kidney disease for a send-out lab test. The lab wanted 1 mL of serum. Seriously?! Have these lab people tried to get 1 mL of serum out of a geriatric cat before?! They should be slapped for requiring that. Anyway, I finally got enough blood and put it in the tube. As I grabbed my blood tube to hand it to my technician for it to be spun down, I dropped the tube. There was a look of horror on both our faces as we watched the tube fall to the ground (seemingly in slow motion) and it shattered. I kneeled down on the ground and just stared at the clotted blood on the tile floor and nearly started to cry. In talking to my colleagues who are currently pregnant or have been pregnant, they have had similar experiences as I have. A colleague of mine who has four children (a pregnancy/pregnancy brain veteran) says, “I still have the thought train run right off the tracks sometimes. I couldn’t remember the name of a ‘drip set’ in my first week back from maternity leave. I asked my tech, ‘What’s that thing? That thing that the fluids drip through?’ He looked at me like I was totally insane.” Another colleague in her last month of pregnancy says, “My techs also understand pointing with mindless stuttering at this point. I can’t drink any caffeine or my legs twitch all night long. It’s killing me!” Which brings us to caffeine. Another colleague due the same time as me says, “I max out the acceptable caffeine levels….(for pregnant women).” I’m the same. I keep telling myself I’ll drop down from two cups of coffee a day to one, but now that insomnia has kicked in that probably won’t happen. We all know pregnancy is not for the weak of heart. Practicing medicine while pregnant obviously adds an interesting component. The good news is that my colleagues and I are fairly smart to begin with (not to brag), so even on our worst days, we’re likely functioning at a much higher level than our dogs. Obviously, our cats are superior in every way and they know it. So if your vet has a baby bump, rest assured your furry friend is still in good hands. I’m going to end with a little advice for all the pregnant vets out there experiencing pregnancy brain:
* HAHA! Jokes on you. Wheatgrass and spinach are gross, and bananas make you constipated. Just eat some chocolate. Geez! If you’re a parent, you may have received a reminder this month about National Immunization Awareness Month as a reminder to make sure your child is caught up on their vaccinations. Veterinarians are a very practical bunch, so we decided it’s easier to coordinate events, and since most of us see our pets as another child, we might as well talk about vaccinations during the month of August as well. When you get a puppy or kitten, you should schedule an appointment as soon as possible. It’s important to get a check up and start vaccines on time. If you know you’re getting your pet ahead of time, go ahead and schedule an appointment with your veterinarian as another stop on your way home. If it’s one of those vulnerable moments, when you just can’t resist the fluffy puppy licking your face and yapping happily, well, then you should just call and schedule as soon as you can. If your child has managed to rope you into this new pet, you might as well start with the responsibility routine and have them make the call. Heck, make them pay for it too! Puppy Vaccines - Yes, He/She Will Be Mad At You Vaccines for a puppy should start at six weeks, with a multi vaccine that’s just one shot for Distemper, Hepatitis, Leptospirosis, Parvovirus, and Parainfluenza. It is condensed to its acronym DHLPPv. At nine weeks, your puppy should receive the second round of the combination, and at twelve weeks a third round might also include a Lyme disease vaccination, but in my location or area, it is not a common illness, so we do not vaccinate for it. At sixteen weeks they will receive the final round of the combination vaccine with a rabies vaccine around this time as well. If your dog is boarded and groomed frequently or taken to dog parks, your veterinarian will likely recommend the Bordetella or Kennel Cough vaccine. If it’s the first time your puppy or dog has received the kennel cough vaccine, it will need a booster three weeks later. Kitten Vaccines - Yes, You Will Get The Cold Shoulder From Here On After Kitten vaccines are divided into two types: core cat vaccinations and non-core cat vaccinations. Core cat vaccinations are for the common diseases like feline rhinotracheitis, feline calicivirus, and feline panleukopenia. These diseases are commonly found in cats, so the vaccines are given to all cats. They start at six weeks and then again every three to four weeks until sixteen weeks of age, with a rabies vaccine at twelve weeks of age. Non-core cat vaccinations are for high risk pets. That risk is determined based on their lifestyle and the surroundings they live in and are assessed at their first appointment. Some of these vaccinations are for diseases such as feline leukemia (FeLV) vaccine and the feline immunodeficiency virus (FIV), which most pet owners have heard of before, but there are other vaccinations that are in the non-core category that are less common and even rare. If your cat goes outside at all or is exposed to other cats that go outside, the feline leukemia (or FeLV) vaccine is recommended. What are we vaccinating for? In order for you to better understand the importance of vaccination, I have provided of brief description of the most common diseases we vaccinate for in dogs and cats. Dogs 1. Canine Distemper- this is a serious virus that attacks the gastrointestinal, respiratory, and nervous systems of puppies and adult dogs. The virus can be found and spread by wildlife, including coyotes, skunks, raccoons, minks, and ferrets. It has also been reported in tigers, lions, leopards, and other wild cats as well as seals. Puppies and dogs are usually exposed and infected from airborne exposure (via coughing and sneezing) from other infected dogs or wildlife. Infected dogs and wildlife can shed the virus for months, and pregnant dogs can even spread the virus to their puppies through their placenta. All dogs are at risk of being infected, but puppies younger than four months of age and dogs that are unvaccinated are at the highest risk. Symptoms to watch for would be watery or pus-like discharge from the eyes, fever, coughing, nasal discharge, decreased appetite, lethargy, and vomiting. In some dogs, you may even see thickening of the paw pads. Infection with this virus is often fatal and dogs that do survive often have permanent damage to their nervous system. Distemper can be diagnosed almost anywhere in the US, but it is seen most frequently in the southern United States. I have personally diagnosed dogs with Distemper in Central Missouri, where I practice. 2. Canine Adenovirus type 2 (Canine Infectious Hepatitis)- This virus is related to canine infectious hepatitis, but it is also one of the viruses involved with Kennel Cough (along with Bordetella and Parainfluenza). This virus normally causes respiratory disease in dogs. Dogs that are boarded frequently or taken to dog parks or other places where dogs congregate are most at risk. Symptoms to watch for are a dry, hacking cough, retching or gagging, nasal discharge, or fever. Symptoms normally develop three to ten days after exposure. Treatment of this virus is usually limited to supportive care, which may involve fluids, rest, and antibiotics to treat secondary infections. Dogs with adenovirus need to be isolated from other dogs as it is very contagious. 3. Canine Parvovirus (“Parvo”)- this is hands-down the most common vaccine-preventable disease that I treat. This is a very contagious virus that attacks a dog’s gastrointestinal tract, causing vomiting diarrhea, lethargy, and decreased appetite. This virus is spread by direct contact with contaminated feces. Avoiding exposure is nearly impossible as the virus can live in the environment for years. If you notice these symptoms in your dog or puppy, contact your veterinarian immediately as puppies and dogs can die quickly due to dehydration and shock if treatment is not initiated quickly. Treatment normally involves supportive care, including IV fluids, antibiotics for secondary infections, and medications to control the vomiting and diarrhea. Treatment can be quite expensive as most animals need to be hospitalized for several days. For more detailed information on parvovirus, visit our website at: http://howardcountyvet.com/canine-parvovirus-what-you-need-to-know/ 4. Canine Parainfluenza- this virus (not to be confused with canine influenza virus, which is a different virus altogether) is another common pathogen that causes Kennel Cough. Like canine adenovirus, this virus causes cold-like symptoms of a dry, hacking cough, fever, nasal discharge, lethargy, and decreased appetite. This virus is spread via aerosol (coughing, sneezing) and can be shed up to two weeks after infection. Dogs with this virus should be isolated from other dogs. Treatment is supportive care until symptoms resolve. 5. Leptospirosis- this is an infection caused by Leptospira bacteria. There are many different strains of this infection. This disease is zoonotic, meaning that it can spread from animals to humans. Infection in people can cause flu-like symptoms and kidney or liver disease. This infection is most common in areas with warm climates and high annual rainfall, but it can occur anywhere. Dogs are at risk of this disease if they drink from rivers, lakes or streams and roam in a rural area where they can be exposed to infected wildlife (even in a fenced-in yard). The symptoms of infection in dogs can vary. Some dogs show no signs of illness while others can develop severe illness and death. Signs include fever, muscle tenderness, shivering, increased thirst, changes in frequency and amount of urination, vomiting, diarrhea, dehydration, decreased appetite, lethargy, jaundice (yellowing of the mucous membranes or whites of the eyes), and inflammation around the eyes. Treatment of this infection involves antibiotics and supportive care. If treatment is initiated early and aggressively, chances of recovery are good. However, patients can have residual and permanent kidney and liver damage. 6. Bordetella (Kennel Cough)- this is the classic bacteria or pathogen involved with Kennel Cough. But as mentioned above, adenovirus and parainfluenza can be involved as well. Kennel Cough is the common name for Infectious Canine Tracheobronchitis. It is a contagious respiratory disease among dogs caused by Bordetella bronchiseptica. This disease infects a high percentage of dogs at least once in their lifetime, but is non-life-threatening. Symptoms include a persistent, dry hacking cough, retching, and a nasal discharge. With mild cases, dogs are often active and eating well. Treatment can depend on the severity of infection, from rest and supportive care to hospitalization with antibiotics. Dogs who go to shows, are frequently boarded, taken to dog parks, or congregating with many dogs should be vaccinated for Bordetella. All dogs should be vaccinated for adenovirus and parainfluenza. Cats 1. Panleukopenia- also known as feline distemper. This is a highly contagious and deadly virus. Symptoms include fever, vomiting, diarrhea, extreme listlessness, and decreased appetite. Some cats may die suddenly with few clinical signs. This virus is shed in the feces of an infected cat and can survive in the environment for long periods of time. This virus is resistant to most disinfectants. Panleukopenia used to be a common serious illness that killed thousands of cats every year until recently after effective, widespread vaccination. 2. Feline Herpesvirus and Feline Calicivirus- These two viruses are responsible for 80-90% of upper respiratory infections in cats. While these two viruses don’t generally cause serious illness in adult cats, they can cause serious illness and death in kittens. Common symptoms include sneezing, runny eyes, nasal discharge, and redness or inflammation around the eyes. Lameness and chronic oral inflammatory disease can be associated with calicivirus. Both of these viruses are spread by the secretions from nose, eyes, and mouth of infected cats. Other cats become infected by direct exposure, like by sneezed droplets or sharing water or food bowls. Once infected, cats often do not completely rid themselves of these viruses and symptoms can reappear during times of stress. Carrier cats can shed these viruses continuously or intermittently for their lifetime. Vaccination for these pathogens minimizes the severity of the disease, but does not always completely prevent infection. 3. Chlamydiosis- This disease is caused by a Chlamydia bacteria. Conjunctivitis (inflammation of the tissues surrounding the eye) is the most common symptom, but sneezing and nasal discharge can also be seen. Cats at highest risk are from 5 weeks to 9 months of age in multiple cat environments. 4. Feline Infectious Peritonitis (FIP)- This disease is caused by a feline coronavirus. Many different strains of this virus can infect cats, but most do not cause disease. Approximately 1 to 5% of cats infected with coronavirus develop FIP. This virus is spread in the feces of infected cats, and most cats are infected by ingesting the virus in the feces. Exposure is much more common in multiple-cat households. Most cats that become infected with FIP are younger than two years of age, but any age of cat can be infected. There is a vaccine for this virus, but its effectiveness is controversial. 5. Feline Leukemia Virus (FeLV)- this disease is the leading viral killer of cats. This virus is spread via the saliva and nasal secretions of infected cats. Most cats become infected from prolonged exposure to infected cats. It is estimated that fewer than 20% of infected cats will survive longer than three years after being infected. Anemia, secondary infections, and cancer are the most common consequences of this virus. Outdoor, indoor/outdoor, and cats exposed to outdoor cats are at highest risk of infection, and vaccination is recommended for cats at risk of exposure. 6. Feline Immunodeficiency Virus (FIV or “Feline AIDS”)- This is another virus that kills many cats. Infection is primarily through bite wounds from infected cats. Cats that get outdoors and fight frequently are at greatest risk of infection, while cats living in an environment with a stable social structure are at low risk of infection. Cats with FIV can live normal lives for years, but this virus eventually compromises their immune system and makes them very susceptible to infections. Keeping cats indoors reduces their risk of infection. Spaying and neutering cats also reduces their risk as it decreases fighting behavior. There is a vaccine available for protection against FIV, but it is not commonly used among veterinarians. This is partly because current tests for diagnosing FIV cannot differentiate between vaccinated and infected cats. This can cause problems as cats that get lost and picked up by a rescue could be euthanized with a positive FIV test result. Also, not all vaccinated cats are fully protected against FIV. Dogs and Cats Rabies- Many of you are aware of this disease. It is responsible for killing about 55,000 worldwide each year. In 2014, there were 6,000 reported cases of animal rabies in the United States. Rabies is a virus that is most often transmitted from the bite of an infected animal. The rabies virus targets the central nervous system (the brain) and causes death. Rabid animals can sometimes become aggressive. A dog may bite or snap when stimulated, including other animals, people, or inanimate objects. Sometimes, rabid animals can become more docile. Symptoms may progress to being extremely sensitive to touch and light. They can also develop paralysis of their jaw, leading to the well-known symptom of foaming at the mouth. Disorientation and staggering can be observed, as well as paralysis, seizures, and eventually death. If you are bit by a domestic animal or wildlife, please contact your local health department and veterinarian. If you are bit by a dog or cat, animals are often quarantined at a veterinary clinic or at home and observed for at least 10 days. Local health departments have to be consulted before initiating post-exposure prophylaxis. The Aftermath and Vaccinations in Adult Pets Just like a child, your pet may hold a bit of a grudge, but just like a child, give them a treat for being so brave and they will forget all about it. Most veterinarians will even bribe your pet with treats! They may be sore or tired, but if they show other signs of a problem after a vaccination, like being unresponsive, definitely contact your veterinarian as soon as possible. They could be having a bad reaction to the vaccine, but that is rare. Less than 0.5% of animals have vaccine-related reactions, and most of those are mild. After the series of vaccinations for puppies and kittens, they will only need to receive their vaccinations once a year. If your veterinary clinic uses a 3-year rabies vaccine, that vaccination may be given every 3 years. This can be done during their annual wellness exam where your veterinarian will be checking your pet’s overall health. Annual wellness exams are extremely important as your dog ages seven years for every year that we age. Your veterinarian will check your pet from head to tail and discuss any health or behavioral concerns with you. It’s also recommended that your pet receive an annual heartworm exam and possibly even bloodwork to check out any possible serious problems, but that’s usually only suggested for older animals. There has been some discussion in the veterinary community about vaccine frequency in adult pets. Some veterinarians will vaccinate adult cats and dogs with certain vaccines every three years instead of annually. However, studies have shown that the DHLPPv vaccine has a 75%-80% likelihood of being protective for three years. At my clinic, I like to get an A in protection, not a B or a C. Also, the portion of the vaccine that protects against Leptospira is only protective for one year. Because of these studies, the fact that there is a very low incidence of vaccine reactions, annual Leptospira vaccination is necessary for most dogs in this area, and animals need to be seen annually for a wellness exam, I have continued to give annual vaccinations at my clinic. Other facilities, like the University of Missouri College of Veterinary Medicine, have continued annual vaccination of core and non-core vaccines for that reason as well. For those that are concerned about over-vaccination, vaccine titers can be done on your pet each year. The vaccine titer tells you if your pet still has protective immunity against various diseases and can guide you as to when the next vaccination is necessary. However, I will point out that vaccine titers can be quite expensive, so don’t get sticker shock if that’s the route you decide to take. It’s no surprise that fear of vaccinations has spread into the veterinary world. Thanks a lot, Jenny McCarthy! There is no reason to be afraid of vaccinations. They keep our pets safe and healthy. It’s heartbreaking to have a patient die of a preventable disease, and I have seen it happen more often than I would like. However, if your pet has a history of vaccine reactions, please notify your veterinarian so they can find a vaccine protocol that can work for you and your pet. So go ahead and check your records to make sure your pet is caught up on vaccinations. While you’re at it, you might as well check your kid’s records as well. Unless vaccinated, because they tend to lick, touch, and wipe snot where they shouldn’t, they could be one step away from a serious illness. Keep them safe and happy! |
Jessica Stroupe, DVM
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August 2017
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