Do you ever wish you could go back in time and change your past? This veterinarians certainly does.
I turned 60 on Thanksgiving Day last year, and found myself reflecting reflected back on my 35-year career as a veterinarian. The differences in how I practiced when I began in 1980 and how I practice today — and what I preach as a veterinary medical communicator — are dramatic. In some cases, they make me feel ashamed at my past.
In the very early 1980’s, I did the following as a practicing veterinarian and owner of several veterinary practices:
- I did routine surgeries (like spays and neuters) with no mask, cap and gown — just surgery gloves.
- We routinely did most surgeries without doing pre-operative blood and blood chemistry tests, a catheter, IV fluids, or patient heating devices.
- We didn’t have a tech anesthetist for routine surgeries, and typically self-monitored our patients with rudimentary tests such as heart rate, respiration rate, and capillary refill. In fact, many surgeries were done by what we know now was a risky, long-acting injectable anesthetic.
- Oral care consisted of ultrasonic cleanings. There were no digital dental radiographs, local nerve blocks, polishing, or sealants, and root canals were about as common as leprechauns.
- I was trained in and did declaws, ear crops, tail docks, and even debarked some dogs.
- We didn’t make sure to have a diagnosis before we came up with a treatment plan. For example, if the dog came in urinating blood, we would assume he probably had bladder stones and/or cystitis, and prescribed antibiotics and products to dissolve any crystals or stones.
- We were not trained in, nor did we focus on, pain management. In fact, and this is true of many of my colleagues from the same era, we were taught that pets don’t feel pain like humans, and if they did, it was good because we didn’t want them moving around.
- We thought when the stiches were out after a surgery our job was done.
- I could count the referrals I did to specialists and veterinary teaching hospitals on one hand each year.
- I didn’t make continuing education a priority.
- I was concerned almost exclusively with the physical well-being of the pet without regard for emotional well-being and/or behavioral issues.
- Worst of all, I did convenience euthanasias (the owner doesn’t want the pet and pays to have him or her killed).
There are many specific cases I remember from those years that literally come back to me as nightmares, tinged with the deepest possible regrets. Some would argue that they were “standard of care for the times,” but why would we have believed that animals didn’t feel pain or suffer from emotional harm? God forgive me.
But through purpose, passion and plan, here’s what most of my colleagues and I do today to provide veterinary care to pets that is both state-of-the-art and state-of-the-heart — and, I hope, provide some expiation for the sins of the past:
- We fully gown and glove for all but the most simple surgeries (like a simple mass removal).
- We require pre-operative blood tests to help insure the pet can handle the anesthetic and to catch other problems early on. We insert a catheter so we can give fluids and have a portal in case of emergency care. We give warm IV fluids and the pet is cradled in products that help in maintain warmth.
- Surgery is at least a two-person job, with somebody systematically monitoring the pet’s anesthesia. Sophisticated equipment monitors many parameters including blood oxygen levels, allowing us to catch potential problems at the earliest possible moment and take action.
- Oral care is a priority. We recommend pet owners do some kind of daily oral care, and when a pet needs professional cleaning, we take digital dental radiographs, check each individual tooth for lesions, clean, polish, and use sealants. We also make pain control a priority and not only do dental procedures until general anesthesia, but do local nerve blocks and give pain meds before, during, and after surgery.
- I will not do ear crops, tail docks, declaws, or debark dogs. I work with owners to help resolve behavior issues effectively instead of the last two.
- We make it a priority to diagnose before we treat. Even the most talented veterinarians at the most prestigious vet med facilities can misdiagnose problems without adequate tests, which can include blood work, urinalysis, bacterial culture and sensitivity tests, radiographs, ultrasound, biopsies and histopathology, aspirates, etc.
- Multimodal pain management is a priority for every patient in need.
- Stitches out can be the mid-point of our obligation to an orthopedic patient, for example. Our job is done when the pet has returned to near full function of the limb or body. If we don’t offer physical rehabilitation in-house, we’ll often refer a pet to a facility that does.
- We know that referring early and often is the sign of a very good vet (not a poor one).
- We constantly seek to sharpen our saws by attending conferences, doing online CE, and getting counsel from online platforms such as the Veterinary Information Network.
- In a profession-wide initiative to create Fear Free visits for pets, we focus on the physical and emotional wellbeing of every single pet, every single visit. We work to remove or reduce anxiety triggers and, if common fear-busting tools don’t work, we reach for sedation early and often. We take behavior problems seriously now, and work to put the pet owner in touch with positive-based trainers and veterinary behaviorists to improve issues that at the least diminish the Bond and at worst can be life-threatening.
- No healthy pet is put to sleep simply because he doesn’t have an owner who wants him. In fact, every effort is made to facilitate finding the pet a forever home.
For those of you in the profession, how have you changed? For pet owners, how have you changed what you expect from a veterinarian or veterinary practice?