This post is taken from the notes I made in preparation for a presentation on Thursday morning. I am a member of BNI international and each week, a member gets to give a presentation about their business.
I want everyone to think about their veterinarian, specifically, ask yourself if you like your veterinarian. If the answer is no, then this is a short discussion and you have to ask yourself why you still go there. If the answer is yes, or yes, but, then you should ask why you like your veterinarian.
Some people will answer that the doctor is nice, or he/she loves animals. The hospital is pretty, or modern. The facility is clean, and there is no smell. The staff is courteous and helpful. These things are all important, and they are things that you can see and make a judgment on. You certainly don't want to go to an animal hospital that is dirty, or smells bad. You don't want to go where the staff or doctors seem to be unhappy, or don't seem to like animals. But what you can't see, or know, is what goes on once you leave the exam room.
Even in the exam room, you should have a good interaction with the doctor and staff. Do they ask about your pet? Are recommendations made specifically for your pet and it's lifestyle (more about this in a future post), or do the recommendations seem canned and applied to all animals? Do they do a complete physical examination, looking into your pet's eyes, ears, and mouth? Is the chest listened to with a stethoscope and is the abdomen carefully felt for abnormally sized organs or tumors? Are the medical records complete, legible and can you get a copy if you want it? Are all of your questions answered?
While you are asking questions, there are some other things you want to be aware of. If the pet is going to be anesthetized, who will monitor the anesthesia. In NY State, only veterinarians, and Licensed Veterinary Technicians (LVT) can administer medications, anesthesia, and monitor anesthesia. Do they have monitoring equipment? In our hospital, a LVT monitors anesthesia using several machines, keeping an eye on the heart rate, respiration, the oxygen saturation, and body temperature. It looks like a scene from ER, your pet is hooked up to many monitors so that we can do our best to assure a successful outcome.
During anesthesia, do all pets have an IV catheter placed, and do they get fluids to help support them during anesthesia? What types of medications are used and is the pet intubated to maintain a safe airway.
Does the hospital have an in house laboratory for running blood tests. At Crawford Dog and Cat Hospital, we have a complete in house laboratory. This enables us to run blood work the morning of surgery to make sure that everything is OK. It also allows us to get results back for sick pets in under an hour, so that a diagnosis can be obtained and a treatment plan formulated. If your veterinarian does not have an in house laboratory, how long does it take them to get back blood test results? This could be important if your pet is critically ill and time may make a difference in the outcome.
Now I know that everyone assumes that the surgery suite is sterile and clean, but it is important to make sure that the operating room is an operating room and used for nothing else. Here is a picture of ours :
http://www.crawforddogandcathospital.com/site/view/102351_SurgerySuite.pml In addition, ask if a clean sterile pack is used for every procedure. One would think, "of course", but I assure you that this is a place that many low cost clinics keep their overhead down. They re-use packs for multiple surgeries.
The technique for performing surgery is very personal. We use a laser seen here http://www.crawforddogandcathospital.com/site/view/102352_Laser.pml because we feel there is less bleeding, less pain, and a faster return to function. Many practices use scalpels, and this is fine, both are just a way to cut tissue. The important thing is that the surgeon be comfortable with what he/she is doing. It is also important that adequate pain control measures be taken. Yes that's right, surgery hurts dogs and cats just like it hurts people, and all of our pets should have pain medication after surgery.
Speaking of some painful procedures, remember your last visit to the dentist? Now I'm not talking about a simple tooth cleaning, although this needs to be done for our pets regularly. I'm talking about extractions, tumor removals form the gums, or even root canals. Dentistry, including cleanings, cannot be done with the dog or cat awake. It is impossible to safely, and effectively evaluate and treat dental disease above and below the gum line in an awake pet. In addition, dental radiographs should be taken, just like when you go to the dentist. See? http://www.crawforddogandcathospital.com/site/view/102350_Dentistry.pml
Everything that we talked about for surgery and anesthesia holds true for dental procedures as well. Adequate monitoring, good technique, competent, trained staff, appropriate well maintained equipment, and post procedure follow up including pain medication when indicated.
I hope that this little glimpse into the workings of our hospital will give you an idea as to what you need to be aware of when selecting a veterinarian for your pet. Check out our full web site at www.crawforddogandcathospital.com, especially the library page where you can search for articles written by specialists about a variety of topics concerning your pets health. We will be posting on this topic again in the future, so follow this blog for more information. You can also follow me on www.twitter.com/knvet for less detailed postings about our day to day activities here at the office and on the road.
Keith Niesenbaum, VMD
Crawford Dog and Cat Hospital
Garden City Park, NY
Tuesday, March 10, 2009
Monday, March 2, 2009
The Youth of America
So two posts in a week. Must be the bad weather here in New York. Regardless, I had an excellent experience yesterday and I wanted to share with anyone that happens to be out there. No I'm not talking about the run in Riverside Park along the Hudson River, although that was spectacular as well. I'm talking about the New York City Science and Engineerig Fair at City College.
What? you might ask. I know I did when I signed up to judge at the preliminary rounds. Ididn't even know where the campus was (135th street and Amsterdam Ave) That's right, it is Harlem. But boy is it a beautiful campus. http://portal.cuny.edu/portal/site/cuny/index.jsp?front_door=true
There were 400 high school students with science projects on all topics. Some were quite well done, some, not so much. All of the students were very energetic and proud of the work that they had done. I judged animal science projects (6 in all). Makes sense I guess, although next year I might ask if I could do health and medicine. Each student presented their research project, the hypothesis, the experiments they designed, their reults and conclusions. I think I was more nervous than they were. The six projects that I had to judge were all quite good and the kids seemed proud of their accomplishements. The top 25% from each group will advance to the finals later this month. I am going to try to make it to that competition as well and I hope to see the six students that I met there as well.
I don't know if they are accepting judges for this year's finals or not, but if you have a science background you should look into this for next year. http://collegenow.cuny.edu/sciencefair/judges/
Don't forget to check out our practice web page at www.crawforddogandcathospital.com and our on line site at www.petsneedfood.com.
What? you might ask. I know I did when I signed up to judge at the preliminary rounds. Ididn't even know where the campus was (135th street and Amsterdam Ave) That's right, it is Harlem. But boy is it a beautiful campus. http://portal.cuny.edu/portal/site/cuny/index.jsp?front_door=true
There were 400 high school students with science projects on all topics. Some were quite well done, some, not so much. All of the students were very energetic and proud of the work that they had done. I judged animal science projects (6 in all). Makes sense I guess, although next year I might ask if I could do health and medicine. Each student presented their research project, the hypothesis, the experiments they designed, their reults and conclusions. I think I was more nervous than they were. The six projects that I had to judge were all quite good and the kids seemed proud of their accomplishements. The top 25% from each group will advance to the finals later this month. I am going to try to make it to that competition as well and I hope to see the six students that I met there as well.
I don't know if they are accepting judges for this year's finals or not, but if you have a science background you should look into this for next year. http://collegenow.cuny.edu/sciencefair/judges/
Don't forget to check out our practice web page at www.crawforddogandcathospital.com and our on line site at www.petsneedfood.com.
Friday, February 27, 2009
I may be getting the idea
I think I am finally getting my head around this entire networking thing. I have been exposed to Linkedin.com as well as twitter and see the value of expanding our presence on the web. Of course, this takes time and the majority of my time needs to be dedicated to the hospital, which has been quite busy the past couple of weeks. I am going to try (I know, I've said this before, but as no one was listening, it didn't matter until now) to post regularly.
We have seen several cases of pancreatitis in both dogs and cats in the past week. As I explained to my kids when they were small, "itis" means inflammation. Pancreatitis is inflammation of the pancreas.
This little organ serves two major functions. First it makes insulin so that we can utilize carbohydrates as an energy source. Insulin helps the body drive glucose (sugar) into the cells. Without adequate insulin, you got it, the animal becomes diabetic. That is why diabetic animals need insulin injections. (maybe we can talk about diabetes another time).
The other function, the exocrine function, involves the secretion of digestive enzymes into the small intestine. These enzymes, amylase and lipase, help the body to digest our food. In pets with pancreatitis, these enzymes leak out of the pancreas. OUCH! This painful condition causes loss of appetite, lethargy, and vomiting. Dogs and cats can become quite ill during acute episodes and without aggresive intervention, can become dehydrated. In severe cases, prolonged hospitalization is needed as patients cannot eat or drink anything. Sometimes it can be fatal. In chronic cases, there is enough damage to the pancreas that it cannot make enough insulin and the pet becomes diabetic.
The diagnosis is made with a complete physical exam and blood work. It two of the three cases we saw this go round, we also got ultrasounds to look at the pancreas and give us an idea of how serious the disease was. The jury is still out on all three cases.
One dog, a little (ok, not so little, this guy weighed in at over 20 lbs) Lhasa Apso, was admitted and responded very well to IV fluids, pain medication and anti emetic medication. Another case, a Golden Retriever, was treated as an outpatient at the owner's request. Today he was not vomiting but was still not eating normally and was acting lethargic. The third case is a cat that is not doing well. This big guy weighed in at 20 lbs as well. Right bigger than a dog. It presented initially two weeks ago as a diabetic and resonded to insulin but soon regressed and stopped eating. Now we have a full blown acute attack of pancreatitis. Severe enough that the cat has hematology abnormalities and we needed to add steroids to it's treatment program, a problem in diabetics. Today she started eating, and the sugar is in the normal range. Steroid dose is stable and the blood count is stable as well. Hopefully, we will be able to get this guy under control and home to mommy in short order. Stay posted and we will let you know how it turns out.
Follow my short updates at www.twitter.com/knvet. Check out our web page at www.crawforddogandcathospital.com, and check back here regularly. And let me know if there is anyone out there.
We have seen several cases of pancreatitis in both dogs and cats in the past week. As I explained to my kids when they were small, "itis" means inflammation. Pancreatitis is inflammation of the pancreas.
This little organ serves two major functions. First it makes insulin so that we can utilize carbohydrates as an energy source. Insulin helps the body drive glucose (sugar) into the cells. Without adequate insulin, you got it, the animal becomes diabetic. That is why diabetic animals need insulin injections. (maybe we can talk about diabetes another time).
The other function, the exocrine function, involves the secretion of digestive enzymes into the small intestine. These enzymes, amylase and lipase, help the body to digest our food. In pets with pancreatitis, these enzymes leak out of the pancreas. OUCH! This painful condition causes loss of appetite, lethargy, and vomiting. Dogs and cats can become quite ill during acute episodes and without aggresive intervention, can become dehydrated. In severe cases, prolonged hospitalization is needed as patients cannot eat or drink anything. Sometimes it can be fatal. In chronic cases, there is enough damage to the pancreas that it cannot make enough insulin and the pet becomes diabetic.
The diagnosis is made with a complete physical exam and blood work. It two of the three cases we saw this go round, we also got ultrasounds to look at the pancreas and give us an idea of how serious the disease was. The jury is still out on all three cases.
One dog, a little (ok, not so little, this guy weighed in at over 20 lbs) Lhasa Apso, was admitted and responded very well to IV fluids, pain medication and anti emetic medication. Another case, a Golden Retriever, was treated as an outpatient at the owner's request. Today he was not vomiting but was still not eating normally and was acting lethargic. The third case is a cat that is not doing well. This big guy weighed in at 20 lbs as well. Right bigger than a dog. It presented initially two weeks ago as a diabetic and resonded to insulin but soon regressed and stopped eating. Now we have a full blown acute attack of pancreatitis. Severe enough that the cat has hematology abnormalities and we needed to add steroids to it's treatment program, a problem in diabetics. Today she started eating, and the sugar is in the normal range. Steroid dose is stable and the blood count is stable as well. Hopefully, we will be able to get this guy under control and home to mommy in short order. Stay posted and we will let you know how it turns out.
Follow my short updates at www.twitter.com/knvet. Check out our web page at www.crawforddogandcathospital.com, and check back here regularly. And let me know if there is anyone out there.
Wednesday, December 3, 2008
A sad day at Crawford Dog and Cat
We had a busy but somewhat sad day at work today. We started with someone that was watching their brother's dog call in to say that the dog had died suddenly last night and wanted to know if we could do a necropsy examination to find the cause of death. These are often unrewarding and I am often reluctant to do them as they cost the client a fair amount of money and are inconclusive as often as not. Not so the case this time. This poor dog was a golden retriever and they are very prone to cancer. I was relatively certain that we would find some sort of bleeding tumor, associated with either the spleen or the liver. I searched through the abdomen and was unable to find anything too far out of the ordinary. Photo's were taken for the record, but I will spare you all the gore.
The chest was a bit more informative. The heart was grossly enlarged so I decided to remove it and the lungs from the chest, no easy task as most of these structures are associated with large blood vessels and if the dissection is not done carefully, it really turns into a bloody mess, with little hope of gaining any useful information.
The organs were successfully removed and the heart was huge, or at least the pericardial sac was huge. I'll explain. The heart is encased in a sac called the pericardium. There is usually a small amount of fluid in the pericardium that lubricates the heart and allows it to move freely in the sac. Here is a picture: http://www.lausd.k12.ca.us/Figueroa_EL/images/Mystery%20to%20Medicine/pericardium.jpg.
This poor dog's pericardium had about 250 cc of unclotted blood in it form a bleeding tumor on the base of the heart. This restricts the heart's ability to contract and caused this poor pups demise. The woman watching the dog was relieved that the dog did not suffer, as death is somewhat rapid once the bleeding starts. I was also able to assure her that she did nothing wrong and that there was no way for her or her brother to have known that this catastrophe was brewing.
Then my final call of the day was to deliver the cremated remains of a cat to a house call client. She is an older woman, not in good health herself. I met her and the cat about a month ago when she had me out to the apartment to trim the pet's nails. I examined the cat at the same time, and to the owner's surprise, diagnosed a large tumor on the cat's liver. She was shocked, and even worse, when I told her that the poor pus only had a short while to live, she broke down and cried. Unfortunately, my prediction was accurate, and I had to go back out to the home to euthanize the cat just before the holiday. It is always a little awkward when I don't really know the owner or the pet. She was sobbing and the poor cat was almost comatose. Today I returned the ashes to her and we shared a hug. She had about 4 cases of cat food which she gave to me. I'll use it to feed orphaned cats or get it to a shelter.
She was clutching one of her pet's toys in her hand and she pressed a bill into my hand for "gasoline" I tried to refuse but she insisted. I'll use it to buy toys for the strays at work.
Although both people suffered a great loss, I felt lucky to have met them both and fortunate that I was able to help them in some way during their times of need. We all have those unpleasant interactions, especially this time of year when people are very stressed. It is enriching to meet nice people that appreciate the good will of others. Hopefully this will rub off on everyone they meet and on those that I meet going forward.
The chest was a bit more informative. The heart was grossly enlarged so I decided to remove it and the lungs from the chest, no easy task as most of these structures are associated with large blood vessels and if the dissection is not done carefully, it really turns into a bloody mess, with little hope of gaining any useful information.
The organs were successfully removed and the heart was huge, or at least the pericardial sac was huge. I'll explain. The heart is encased in a sac called the pericardium. There is usually a small amount of fluid in the pericardium that lubricates the heart and allows it to move freely in the sac. Here is a picture: http://www.lausd.k12.ca.us/Figueroa_EL/images/Mystery%20to%20Medicine/pericardium.jpg.
This poor dog's pericardium had about 250 cc of unclotted blood in it form a bleeding tumor on the base of the heart. This restricts the heart's ability to contract and caused this poor pups demise. The woman watching the dog was relieved that the dog did not suffer, as death is somewhat rapid once the bleeding starts. I was also able to assure her that she did nothing wrong and that there was no way for her or her brother to have known that this catastrophe was brewing.
Then my final call of the day was to deliver the cremated remains of a cat to a house call client. She is an older woman, not in good health herself. I met her and the cat about a month ago when she had me out to the apartment to trim the pet's nails. I examined the cat at the same time, and to the owner's surprise, diagnosed a large tumor on the cat's liver. She was shocked, and even worse, when I told her that the poor pus only had a short while to live, she broke down and cried. Unfortunately, my prediction was accurate, and I had to go back out to the home to euthanize the cat just before the holiday. It is always a little awkward when I don't really know the owner or the pet. She was sobbing and the poor cat was almost comatose. Today I returned the ashes to her and we shared a hug. She had about 4 cases of cat food which she gave to me. I'll use it to feed orphaned cats or get it to a shelter.
She was clutching one of her pet's toys in her hand and she pressed a bill into my hand for "gasoline" I tried to refuse but she insisted. I'll use it to buy toys for the strays at work.
Although both people suffered a great loss, I felt lucky to have met them both and fortunate that I was able to help them in some way during their times of need. We all have those unpleasant interactions, especially this time of year when people are very stressed. It is enriching to meet nice people that appreciate the good will of others. Hopefully this will rub off on everyone they meet and on those that I meet going forward.
Thursday, November 20, 2008
A promise is a promise
So those of you that follow me on Twitter, (I know there are at least 5 of you) know that I promised to keep the blog more current, so here is a quick post to acknowledge that.
The ever popular media star, Brian Spar BVMSC has just been contacted by the Today Show and they are going to whisk him off in a limo on Monday morning for an interview. He has gotten quite a bit of attention since his marathon debut. Check out his blog at: www.dmbhealer.blogspot.com
I have been in contact with several cat rescue groups in the Whitestone Area of Queens. Now, we've been down the Trap, neuter, release (TNR) road before, but it seems that these particular organizations are doing a good job controlling the feral cat population and are in need of some professional help with their colonies. So, perhaps we can give them a hand. We'll see how that plays out. I'm sure that it will yield some interesting photo opportunities and hopefully I'll become technologically proficient enough to get them posted here for your education and or amusement.
The ever popular media star, Brian Spar BVMSC has just been contacted by the Today Show and they are going to whisk him off in a limo on Monday morning for an interview. He has gotten quite a bit of attention since his marathon debut. Check out his blog at: www.dmbhealer.blogspot.com
I have been in contact with several cat rescue groups in the Whitestone Area of Queens. Now, we've been down the Trap, neuter, release (TNR) road before, but it seems that these particular organizations are doing a good job controlling the feral cat population and are in need of some professional help with their colonies. So, perhaps we can give them a hand. We'll see how that plays out. I'm sure that it will yield some interesting photo opportunities and hopefully I'll become technologically proficient enough to get them posted here for your education and or amusement.
Tuesday, November 18, 2008
Time to Get serious
OK. The races are over and now we have to get back to business. NO more excuses such as I have to run, ride, swim, lift. OR, I'm too tired, sore, busy... I need to focus on what is going on here at Crawford Dog and cat Hospital and try to keep everyone up to date as much as possible.
First things first, I'll post a detailed race entry later this week so that those that care (if anyone other than me) can read about the Ironman experience as I saw it.
For now, I have been busy trying to set up some networks so that I can stimulate some growth here at the practice. There are many things that I would like to do to help our patients but as with most expansion plans, they take money and money takes patient visits so ...
I have joined a business networking group, BNI. We meet
Thursday mornings and our goal is to help each other by referring potential contacts to each other. It is a novel idea for veterinarians as we rarely look outside of the animal industry for new business. So, I thought I would give it a chance. The web site for the national group is: www.bni.com and you should give it a look. I'll let you all know how it goes in the near future. For now, off to make a house call.
First things first, I'll post a detailed race entry later this week so that those that care (if anyone other than me) can read about the Ironman experience as I saw it.
For now, I have been busy trying to set up some networks so that I can stimulate some growth here at the practice. There are many things that I would like to do to help our patients but as with most expansion plans, they take money and money takes patient visits so ...
I have joined a business networking group, BNI. We meet
Thursday mornings and our goal is to help each other by referring potential contacts to each other. It is a novel idea for veterinarians as we rarely look outside of the animal industry for new business. So, I thought I would give it a chance. The web site for the national group is: www.bni.com and you should give it a look. I'll let you all know how it goes in the near future. For now, off to make a house call.
Wednesday, July 9, 2008
Busy Spring
Well I know I've been remiss about posting, and no one wants to read a blog that is never updated. I will try to be better about regular posts, but you all know how life gets in the way.
After a very smooth transition, we have said good bye to Dr. Wu and hellow to Dr. Spar. Dr. Wu is settling in up in Ct. working through the chores associated with moving into a new house and a new job.
Dr. Spar seems to have stepped right in and it's almost as if he was here all along. He has gotten into the NYC Marathon and is raising money for a charity that combats childhood obiesity. A noble cause that is close to his heart. As you may or may not know, Dr. Spar was featured in last spring's issue of Men's Health Magazine for loosing about 180 pounds. (He knows the exact number and will let you know if you ask.) We will be posting a link for those of you that want to help him reach his fund raising goals.
The challenge for our staff is that the marathon is the same weekend in November as my Ironman Triathlon. Since we both will be out beating ourselfs up on November 1 and 2, I thought it only fair if we both work on that Monday. So come on in, stop by with or without a pet and watch us try to get around the hospital. I'm sure we'll be happy to tell you all about our races.
After a very smooth transition, we have said good bye to Dr. Wu and hellow to Dr. Spar. Dr. Wu is settling in up in Ct. working through the chores associated with moving into a new house and a new job.
Dr. Spar seems to have stepped right in and it's almost as if he was here all along. He has gotten into the NYC Marathon and is raising money for a charity that combats childhood obiesity. A noble cause that is close to his heart. As you may or may not know, Dr. Spar was featured in last spring's issue of Men's Health Magazine for loosing about 180 pounds. (He knows the exact number and will let you know if you ask.) We will be posting a link for those of you that want to help him reach his fund raising goals.
The challenge for our staff is that the marathon is the same weekend in November as my Ironman Triathlon. Since we both will be out beating ourselfs up on November 1 and 2, I thought it only fair if we both work on that Monday. So come on in, stop by with or without a pet and watch us try to get around the hospital. I'm sure we'll be happy to tell you all about our races.
Subscribe to:
Posts (Atom)