"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo

Thursday, May 21, 2015

Takes From The Trenches: An Epic Rant

This is an uncharacteristic TFtT post, which I might take down in a day or so because it is about irrational anger and despite having written this over the course of several days, it is a subject that keeps me from thinking clearly. I probably should not write any of this at all, but here it is. I am not flaming against you, my dear reader, as this is not about any friend or blogger; I'm just ranting against society in general. You can read on if you want, or you can skip this. I'm disabling comments for this post regardless because this is what I have to say about the subject and I don't want nor need to hear any more negativity. Social media is enough.

There is a lot of negativity going around in the veterinary field right now and there is nothing that makes me want to scream and break things more than reading an article like this one:

Vets are too expensive and its putting pets at risk 

Vets all over have been responding. A technician wrote this fantastic article in response. 

The AVMA (American Veterinary Medical Association) themselves also responded.

This vet defended her profession. And then wrote this additional post in response to some of the truly nasty comments she received on her original post.

This vet actually worked at our hospital before moving to a different state. She is a boarded veterinary oncologist and one of the most compassionate people I have ever met. She takes excellent care of her patients and her clients, and she goes above and beyond for them to the point of staying late after work or coming in on her day off to see a patient of hers that was going down hill coming in through our ER. Our hospital lost an exceptional doctor when she moved away. She wrote this response to the Washington Post article.

This vet admits that he is in it for the money. Seriously, why should we not make a living from our jobs? These are our jobs. We went to school for this, we are paying student loans for this, and we are trying to live normal lives just like everyone else out there. Pets are a luxury. Why should their care be free??? It is medicine. This isn't about playing with puppies and kittens all day; it's about treating them. Healing them. Saving them. Why should it be cheap???  They are the same medications and treatments that you or I receive. Look at the price of your care before insurance! The veterinary markup is nowhere NEAR what a human hospital's is. The sad thing is, we still don't make enough to make a decent living. We expect to get paid because it's what we do for a living, but no one in the veterinary field is doing it because they are hoping to get rich from it. It's a luxury for me to be working as a technician given the cost of living in modern society, even working in the second highest paid branch of the field (research is the highest paying). I would not be able to do this job if I wasn't married to someone who makes 3x what I do. There. It is what it is. I will never be able to retire from this job. And the truth of the matter is, the time is getting close when I will have to move on, either to a different job altogether, to a position as a supervisor, or into another branch of veterinary. Like research. Or veterinary product sales. Or as a lab technician for a place like Antech or Idexx. The reason why I stay is because I love what I do but there comes a time when that is just not enough.

Since starting tech school, I have worked at 6 veterinary hospitals, including the top three specialty hospitals in South FL, and currently work at the most outstanding veterinary specialty hospital  in Maryland. It's in The Washingtonian. During school I interned at an additional four hospitals, experiencing the gamut from general practice to shelter medicine to specialty medicine. I've worked in the kennels, at the front desk, in the laboratory, and in the treatment area. I have rotated through emergency and critical care, orthopedic and emergency surgery, regular spays and neuters, ophthalmology, laboratory (I can read blood on a microscope like nobody's business fyi), radiology, ultrasonography (want to know where your dog's gallbladder is? Pass me that ultrasound probe. I can also tell you if it looks normal or not. No, I didn't receive an additional degree for that), anesthesia both with a mechanical ventilator and a regular anesthetic machine, internal medicine, oncology and physical therapy, just to name a few. I can entubate a dog and monitor his anesthesia with no guidance from a doctor. You need two different people for that in human medicine, and neither one is the RN! I can place central lines and sampling lines, for which you need yet another person in human medicine.

I have worked with, and been trained by, people involved in the upper echelons of my field, including one of the founding fathers of the Veterinary Emergency and Critical Care Society, the first veterinary specialty ever created; and also with one of the top veterinary educators in the world. My resume freaking glows in the dark. So no, I'm not pulling stuff out of my ass when I defend my profession. Maybe I'm spoiled because I've worked at places that offer such a high level of care, but I have said it before and I will say it again: across the board, some of the most amazing human beings I have met in 35 years on this earth are the ones I have met in veterinary medicine. Yes, I'm including all of the wonderful, incredible people I met during my surgical rotation at the Broward Humane Society and the caring, compassionate doctor that mentored me when I was in general practice. I wish human medical doctors in this country were even half as compassionate and caring. I can lose count of how many incredible veterinarians I have met. In two countries, I can count all of two doctors and one physician's assistant that I would return to for my own care. Two of those are back in PR!

Please forgive my white rage over all of this but it simply is NOT fair. Pet owners only see one side of the story. It's easy to point fingers, to blame another when things go wrong. It is easy to misinterpret information, to hear what you want to hear. It is easy to question what your doctor, who spent a quarter of a million dollars in student loans for an education, because of something you read off of Dr. Google. Dr. Google can't touch and see your pet while doing a physical exam, he can't interpret radiographs, nor ultrasound, nor see the one result in the pet's bloodwork that clearly indicates the pet's problem is something else entirely. It is easy to hang on to a 10% chance of survival and plod on, pouring thousands and thousands of dollars into a pet that will not survive. That if they do survive, will not have quality of life. It is tremendously hard to tell a client, "You really need to stop. You need to euthanize." It takes an incredible amount of compassion and GUTS for a doctor to say that to a pet owner. Because we have pets too. Because we also get to have to make that choice of when to stop. We know exactly how it feels. And you know what? It's worse when you work in the field. Because you KNOW exactly how much that animal really is suffering, whether it's your own or somebody else's. Honest to God, we hate torturing an animal just to extend its suffering unnecessarily.  How many pet owners don't see that their animal can't breathe, that think it's okay for a cat to not be able to urinate for 3 days, that think the inability to hold down water for 2 weeks is something that will just go away? The Golden that bled out from every orifice faster than we could pour blood into her as she went into multiple organ failure from the DIC caused by her owner who though it was a good idea to take her on a 5-mile run on a 90-degree, 80% humidity Fourth of July at noon. The Boston that couldn't breathe because of her heart failure, whose owner chose to take home to "die in peace" instead of euthanizing at the hospital while still in an oxygen cage at 70% oxygen because the dog is so oxygen-dependent (for the record, room air is 22% oxygen). You're wrong lady: your dog is not going to die in peace. She's going to die slowly as she drowns from the fluid buildup in her lungs, gasping for air like a fish out of water. Except much slower. Over hours.

It is heartbreaking. And we just can't save them all. And we certainly can't save them for free. We don't do miracles for a living. It's not part of the job description. And we're also not here to do the treatments that the pet owner thinks we need to be doing. Well-informed, educated, observant pet owners are WONDERFUL and can make a huge difference in a patient's treatment and outcome because they will have noticed and will understand so much more than the average pet owner. It is okay to ask questions. It is okay to ask, "Why are you choosing this and not that?" Just please, you don't need to ask that in a combative way! Most vets are happy to explain. And believe it or not, we are not against holistic medicine. The best vets will incorporate alternative medicine when warranted. I was taught at tech school by one of those vets. She was the program director! And one hell of a human being.

If we roll our eyes at holistic treatments, it's because it is genuinely one of the fields where quackery prevails. I would love to say I'm making this shit up, but I'm not. Some of this comes from other technicians, other practices, clients and yes, even barn owners and managers:

  • Opium seeds will not help your cat's pain, because they can't metabolize straight opium. (Yes, that is used as a holistic alternative to commercially formulated pain-medications, which actually ARE opium derivatives that your pet CAN metabolize!)
  • Cranberry juice will not eliminate your cat's urinary obstruction. (Yes, that is used as a holistic treatment.)
  • Rectal ozone does not cure cancer! (Yes, that is used as a holistic treatment.)
  • Spirit water with bottled light and reiki energy will NOT help your dog's liver disease because it is alcohol-based. And seriously, if you're able to bottle light, I want to see it done. I want a ray of light to come out of that bottle every time I open it. (Yes, we've seen clients come in with this as a medication prescribed by their holistic vet!)
  • I don't care if you chant before every surgery; do whatever the hell you want to get yourself in the groove. Do the cha-cha dance or pray 10 Hail Marys. But if you don't clean your autoclave, those instruments used in surgery are not really going to be sterile. Chanting, praying, dancing and meditation are not going to make those instruments sterile. Only autoclaving properly, like the instruction manual says, will do it. God gave someone the inspiration to invent the autoclave and your practice owner the idea to buy it. Learn how to use it! (This really happened at a holistic vet's practice!)
  • Just because oats are natural and minimally processed does not mean that they are appropriate nutrition for all horses. Especially insulin resistant horses and horses that are prone to ulcers. (I boarded at a barn where the barn manager stopped talking to me when I chose a tested commercial low-starch feed for my insulin resistant horse instead of the oats she wanted me to give him. Never mind that I had to buy the feed myself either way...)
  • Diatomaceous earth will not freaking kill intestinal parasites! I don't think we'd need such potent dewormers nowadays if that were the case. (I know a barn manager that killed her young horse by giving it only "holistic" dewormers: he died as a yearling from the massive worm infestation he had.)
  • Turmeric will not make your gray horse's basketball-sized melanoma disappear. (Turmeric can help keep more from appearing, but it won't make existing ones go away.)
  • Seriously, if we tell you to not use x herb/spice/potion/lotion/etc while your pet is in treatment with us, it's not because we don't want your pet to get better! It's because a lot of things, when combined with whatever treatment you are paying us big bucks to provide, can undo our work or even make your pet worse. Because a lot of holistic treatments DO work and CAN be contraindicated with the therapy we are trying to give. We really hate to see clients waste their money, especially when their pet actually HAS a chance at survival!

I could go on for days.

Hyperbaric chambers can be absolutely amazing for treating severe burns, wounds and the worst types of trauma. Laser therapy is a recognized holistic therapy that DOES work. So does acupuncture. You just have to make sure the person providing the therapy is appropriately trained in how to do it. Phonophoresis is a pretty incredible new non-invasive therapy being used to treat chronic pain and arthritis. It is used in the physical therapy department at my hospital. High protein diets can slow down the growth of cancer, while high sugar/carb diets can speed up its growth. Essential fatty acids can make pretty much anything better. They're not going to cure a terminal disease but they will still be beneficial to the patient. Actually, there are a million and eight diet modifications that can help your pet (and yourself!) live longer depending on what condition they have. A good vet will be able to explain to you what you can do without necessarily pushing x prescription diet. There is this magical Chinese herb called yunnan baiyao that will stop anything from bleeding, whether internal or external. We stock it at my hospital for the times when we can't figure out why an animal is bleeding out; it buys us time. Jiaogulan will increase circulation, promoting healing of peripheral tissues, like those of the legs, feet, hands or hooves. It can be a huge aid in helping laminitic and foundered horses heal, as long as you still eliminate/treat what caused the laminitis/founder to begin with.

And yes, I believe in meditation and in miracles and the power of our thoughts and energy. My brother sees ghosts and I once was saved from falling over a cliff by an invisible entity. I've seen enough miracles to know that they happen. They're just not commonplace: if they were, they wouldn't be miracles, don't you think? But just because something is "natural" doesn't mean that it is "good." Cocaine is natural. But it will kill your pet. Not all species can metabolize all things, and even if they can metabolize it, it doesn't mean that it is good for them! Cats are obligate carnivores, not "cornivores." Diets high in corn and wheat ARE detrimental to the health of your cat. For that matter, dogs are omnivores; they can and will eat plants, fruits and veggies. They need them as part of their diet. (Just not onions. Nor garlic. Nor grapes. Nor raisins! Don't give them those!) Omnivores, however, still need MEAT in their diet. Just because you are vegan doesn't mean your dog can survive on a vegan diet. And if you expect your cat to be vegan, please get a different animal. For that matter, because they are OMNIVORES, your dog can't exist on a meat-only diet either. The cat can (as long as that meat-only diet has the appropriate nutrients for the feline species), but not the dog.

Raw diets can be a wonderful thing but you must do your research on the diet you are choosing. Most veterinarians frown upon raw diets because the chance of your dog ending up with something like salmonella, listeria and e.Coli poisoning are pretty high. Not all raw diets are handled appropriately during manufacture. You must know how to handle and store the food yourself. There is also a higher potential of them shedding these toxic bacteria in their feces. Hence why cats that like to counter surf should not be on raw diets. Because litter boxes. They walk in their litter boxes, hello! And will then get all of that bacteria over your kitchen counters. Yay vomiting and diarrhea for the human!

And if you want to cook for your pet, that is AWESOME. But do consult with a veterinary nutritionist. Their meals need to be balanced so that they are getting the adequate nutrients for their species. Neither have the same requirements as people and you will see the detrimental effects of a nutritional imbalance far faster than you would in a person! For example, cats will go blind and develop heart problems if they are not given taurine, which is already added to commercial diets. And seriously, your dog can't survive on boiled chicken alone. See my paragraph above on them being omnivores.

Let's talk about vaccines. There are core vaccines, like rabies, distemper and parvo (for dogs) and panleukopenia and distemper (for cats) that are recommended in every state. Rabies is the only one that's mandatory. Other vaccines, like canine influenza, Lyme and leptospirosis, might be recommended locally if it's a common disease in a region. The only vaccine that you MUST have given is rabies. (Now, if your puppy gets parvo because you didn't have it properly immunized, that's on you. And don't expect to be allowed to board your unvaccinated dog at a kennel or vet's practice: in our sue-happy society it's their license on the line if your dog becomes infected or infects another. Sick animals walk into a vet's office; an unvaccinated animal is at risk if it is allowed to board there.) Rabies needs to be given every year or every 3 years based on what it says on the vaccine label. If you want a 3-year rabies vaccine, just ask for it! That way you'll have the documentation to prove it if God forbid your dog bites another animal or person or is bitten by another animal. If your animal has had a rabies vaccine once and you don't have it administered again, you can get fined by the county if they decide to investigate for any reason. It does happen. And some states and counties are stricter than others: in some states, like FL, rabies vaccine titers are allowed for sick animals whose health might by further compromised by vaccinating. In MD and VA, this is not an option for pet owners. Why? Because there are so many more rabies vectors in our region: foxes, raccoons, skunks, coyotes, feral cats, etc. Rabies has no cure, people. It's transmitted from saliva to open skin. All it takes is one drop of a rabid animal's saliva to touch an open cut on your hand. Or to get an organ transplant from someone who was unknowingly infected! You can't screen for rabies in animals or people unless there is a suspected cause: the only truly reliable test happens post-mortem by submitting the animal's head to a laboratory for the brain tissue to be analyzed. There are other methods for testing in humans but they are not as reliable and the problem is, once you have rabies, you're a goner!

What do I do? My cats get their yearly core vaccines until they are 7 years old. Because they are indoor only, after that they only get rabies every 3 years if my hospital carries the 3-year vaccine. Otherwise, it's yearly because that's the law in my state: I have to have them given based on the rabies vaccine label. I know many a general practitioner that is fine with not giving senior pets anything other than their rabies vaccine after a certain age, if it's a pet that isn't exposed to other animals nor travels on a regular basis. When we first moved to MD and before working at my current hospital, I took Astarte into a local general practitioner for a blood draw and to give her her panleukopenia and distemper vaccine: we were trying to adopt Aengus at the time and the MCSPCA required documentation that the current cat was up to date on everything. When I requested the vaccine, this vet actually said Astarte should have enough immunity built up over her life from consistent vaccination to be okay without. (She was 13 at the time.) He was reluctant to give it. I had to insist! He was okay with it after I explained about the adoption process. And no, he did not know that I am a tech. It's not something I usually say during introductions.

Being licensed, I am required to complete 7 hours of continued education a year that I submit to the state board with whom I'm credentialed (Virginia, in my case.) I either pay for those out of pocket or do them online. I am a CE snob: I could do free CE on dentals and fleas and ticks and no one would care, but because I work with none of those things, I make sure that my CE is on blood disorders, tick-borne diseases like babesia and ehrlichia, transfusion medicine, anesthetic emergencies, trauma management, CPR, etc. You get the idea. I don't get a raise for getting that done every year.

We have a hard time affording treatment for our own pets. I have a cat that is slowly eating less and less, either because of cancer or teeth that need to be pulled. Or both. Or who knows. She has a heart murmur so she would need an echocardiogram and a workup by our cardiologist before she could be anesthetized for a dental. Anesthesia can kill an animal with heart disease fyi. She would also need an ultrasound by our radiologist to rule out a mass in her abdomen. Even with my employee discount, that is still almost double what it would cost to have Gracie worked up for hock injections and to receive said hock injections (for which I do NOT get a courtesy discount from my equine vet fyi. And yes, she knows I'm a tech and she speaks to me as an equal). Am I complaining? No. Specialty medicine is expensive! Quality medicine is expensive! Would either of these things prolong her life significantly? A diagnosis might buy her a year more. If I had unlimited funds I would maybe try to do part of this, just to know. But it would probably mean that she would spend her remaining time on oral medication, which she absolutely hates in any way shape or form. I won't torture her for her remaining days on earth. I'm just accepting the fact that my kitty is 15 and taking the time to tell her every day how much I love her.

Allow me to throw diplomacy out the window so I can keep painting a picture for you of what it's like on the inside: I work long hours. 12 hour shifts that often turn into 13. After which I often have a hard time falling asleep so I can get 6 hours of shut-eye so I can wake up the next day and do it all over again. I get 4 days off a week which I take full advantage of. I get 5 days of paid vacation time a year. That's it. But I don't complain because thanks to also getting those 4 days off a week, it's easy to take an extra-long weekend here and there. I get two sick days a year and a lot of grief if I have to call out on a day that we're short-staffed. Which is basically every day because I don't know of a single animal hospital that's not short-staffed, unless it's a slow day. Our health insurance is never the best. I'm going to be paying off my hospital bill from the concussion for the next 3 years because my insurance, which is the best my hospital offers, which means I get a good chunk taken out of my paycheck for it, only covered $100 of the bill. $100! But it is still better than what I got at the last hospital I worked at in FL, which was nothing. Zero. Zilch. Nada. No benefits. No PTO, no health insurance, no unpaid leave, no sick days. NOTHING. 

Doctor benefits are not much better. Burnout is REAL in this profession, and for some of us it is a constant. Vet med has the highest suicide rate of any professional field. So when I hear people complaining about the cost of veterinary medicine and that it should be cheap or free, I just want to scream. Or cry. Can you understand why? I don't want you to feel sorry for us, I just want you to understand. There is a thing called inflation. There is a thing called cost of living, which continues to go up the longer we are on this earth. EVERYTHING is more expensive. The can of mushrooms that I buy at Walmart today for $0.90 used to cost $0.50 only 6 years ago. Electricity is more expensive, gas is more expensive, water is more expensive, minimum wage has gone up. So why should veterinary medicine cost the same today as it did 20 years ago? Do you WANT your vet to cut corners, to provide mediocre care just so you can pay less? Really? A popular way that some vets cut corners is by hiring untrained, inexperienced staff that don't have even the most basic knowledge of veterinary medicine. They don't know potential drug contraindications, they can't spot an overdose, they don't know the differences between types of fluids, they don't know how to hold an animal safely (as in without choking it or terrifying the crap out of it), nor draw blood or place IV catheters painlessly. And then they have these inexperienced persons doing the tech work and the reception work so they only have to pay one or two salaries. Really? Is that what you want for your pet's care? Another popular way vets will save money for the client is by resterilizing used needles. Do you WANT your vet to reuse needles for vaccines? Let's consider that. Supposing they autoclaved all the needles they used in a day at the end of the day. That needle needs to be placed in a sterilization packet (which costs money), then placed in an autoclave (which costs money to run), so that it can then be re-used on the next pet. You also need to pay the technician that is taking time out of their day, time when they could be doing treatments on pets, to individually wrap and sterilize dozens and dozens of needles.

Do you know how quickly a needle becomes dull? Within two uses. If I use the same needle to poke the stopper of a drug twice, it is already going to be far more dull than a new needle if I use that same needle to inject the drug into your pet. So I swap it out for a new, sterile, SHARP needle, so I'm not causing your pet unnecessary pain when I give him the injection. Have you ever been poked with a dull needle? That shit hurts. Would you want to be poked with a dull needle that has been used on other patients by your doctor? I don't care if it's sterilized, I certainly wouldn't. And let's not even get into how unethical that would be. Though animal blood is not covered under OSHA's Bloodborne Pathogens Standard, if an employee is injured because of reusing a single-use product, OSHA can heavily fine the hospital/clinic under its General Duty Clause. You can read all about that here.

If your vet reuses needles, you might want to find another. It is unethical, both to the pets being subjected to used (and possibly not properly sterilized!) needles, and to the employees having to handle said used needles.

Yes, your farm vet is cheaper. Of course he is: he doesn't have a building and a full staff of employees that he has to pay for: he just does everything out of his truck. Feel free to use your farm vet for your dog's and cat's vaccines, but be careful when it comes to other things: farm vets are used to farm animals and the antibiotics and pain medication that are used in farm animals. Yes, gentamicin at one point was used in cats and dogs but we have developed MUCH better, safer antibiotics for small animals that won't leave your dog deaf or send your cat into renal failure. Your small animal vet keeps up with medicine and CE in small animal; your farm animal vet keeps up with medicine and CE in farm animals. They are all very different species!

I'm pretty sure your mechanic charges far more today than he did 10 years ago, despite the fact that auto technology has not advanced anywhere near what the veterinary industry has, and you don't give him hell about it. You also don't ask him for a payment plan nor give him crap when he can't offer it because he otherwise wouldn't make a living. You simply put that $2,000 on a credit card and don't say a peep.

So tell me, WHY must WE go without quality of life, why must we forego our ability to pay our bills, to own a house, to go on vacation, to pay off student loans, just so you can get treatment for your pet? Even when I worked at the tack shop, people would stroll in expecting quality products for their horses to be inexpensive. And when they weren't, they would beg us for a discount! I don't see them going into the grocery store and demanding a discount on their bread! What is it about animals that makes people assume that anything related to their care should be cheap or free???!!! I don't see anyone going up in arms about the cost of fixing their car, which can be absolutely outrageous. Why? Because cars are a luxury item and it costs money to maintain them and fix them and people understand that. And so my mechanic works in the same dingy shop with a dirty waiting room that smells like motor oil that he's been at since 1973, working normal daytime hours, and makes a lot more than I do at the 33,000 square foot specialty animal hospital with cutting edge technology. By the same token, pets are also a luxury. A privilege. If you're going to own an animal, the very LEAST you can do is to educate yourself about its basic care BEFORE you get the pet. It is ASTOUNDING how many people dive into pet ownership without even knowing the difference between a male and a female! Without knowing what it should eat! And then it's OUR fault that you made your animal sick? If you can't even be bothered to do that, there is one option that IS free: not having a pet at all. If you are not willing to spend money to even educate yourself on an animal's basic care, it's really easy: DON'T HAVE ONE. 

*Pounds fists on desk*

End rant.

No comments: