The Wagging Tail

Do veterinarians practice evidence-based veterinary medicine?  In the human medical profession, evidence-based medicine (EBM) has become established and clinicians have accessible EBM tools to support clinical decision-making. 

What exactly does EBM mean to a practitioner?  EBM is the conscientious and implicit effort to apply current best research evidence to medical decision-making.  EBM should enhance clinical expertise in concert with consideration of patient needs and client circumstances.

For veterinarians, EBM is gaining momentum, but it is not widely employed in clinical practice. In addition to published research evidence, veterinarians still rely heavily upon textbooks, anecdotes, faculty expertise, and peer consultations.  Depending on the clinical question, these may be the only resources to utilize, but they are often inadequate, outdated, and unproductive.   Why has veterinary medicine been slower to adopt the practice of EBM?    Is it because there is less rigorous, controlled research conducted and published in the peer-reviewed literature?  These challenges create a gap between new knowledge and the practice of EBM in veterinary medicine. 

How can the veterinary profession close the knowledge-to-practice gap?  The gap represents a barrier to high quality care for individual patients. Where can veterinarians go to get evidence-based, synthesized information?   Who teaches veterinarians how to incorporate it into clinical settings?  The US Preventative Services Task Force (USPSTF) is well-known for providing physicians with recommendations and guidelines based on research evidence.  According to their website, the USPSTF is “An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.”  

Could similar guidelines for preventive care and screening be developed for veterinarians?  These guidelines would support the most efficacious screening for optimal pet care.  The BARK (Banfield Applied Research and Knowledge) team is using Banfield’s large database to generate new knowledge, in addition to critically appraising existing knowledge from a variety of sources, to create preventive care and screening guidelines for the common diseases of middle-aged and senior pets. 

Next month, BARK’s Research Medical Advisor Associate, Patrick Shearer, BVMS, PhD, will talk about periodontal disease.  Please join us, post your comments, and engage in a discussion about what we know about the disease and how as veterinarians we can promote the highest quality evidence-based dental care for the pets that we see.

• Each month thereafter, the BARK team will blog about topics such as:
• EBM and evidence dissemination initiatives in the profession
• Strategies to best apply evidence in clinical settings
• Current and future research initiatives at Banfield

Let us know if you have ideas about questions or topics that are of interest to you, especially in relationship to evidence-based medicine and getting new knowledge to our patients!

Further Reading: Click on the links below for two articles on EBM that recently appeared in the Banfield Journal. The current edition of the Banfield Journal can always be viewed online at www.banfield.net/banfield-journal. 

• Banfield Journal May-June 2009
• Banfield Journal July-Aug 2009

My husband is crazy about fly fishing.  I, on the other hand, am not.  Until recently, the discrepancy hadn’t been much of an issue.  A combination of luck and cleverness on my part had helped me successfully dodge the fly-fishing bullet since our nuptials, 19 years ago. We had kids soon after getting married, which meant there was little time together, early on…coupled with the fact that we live far away from extended family, and you can see why “together time” was next to impossible.  Lucky for me, as soon as my son was old enough to hold a fishing pole, fly-fishing became synonymous with father/son bonding time, which, conveniently, got me “off the hook.”

Now, don’t get me wrong, I’m not a girly-girl who’s afraid of getting dirty or wet or waking up at 4:30 a.m.    I’ve avoided fly-fishing for one reason and one reason only:  It didn’t sound like fun.  I don’t care how beautiful the surroundings, the mere thought of casting over and over again all day made my eyelids droop.  

But as it is with everything in life, circumstances change. My children are grown-up and my son prefers to do things other than fish with Dad.  He’s now 18 and my daughter is 16, which means we can leave them safely home alone. As soon as this revelation hit, another one rapidly followed . . . my jig was up!   My husband’s long-standing fishing partner was no longer a given.  I knew it was time to face the inevitable.

I really didn’t want to go, but I made up my mind to do something I didn’t want to for the right reasons. So I put on a pair of my yuckiest sneakers and my best happy face and joined my husband on his next fly-fishing adventure. And you know what? It wasn’t horrible.  The anxiety that once surrounded the “thought of fly-fishing” is gone because I understand what’s involved, and I gained new insight into the world and who my husband is now. I’m actually open to going again! In the end, I showed my husband that the second half of our lives together didn’t have to be all about me.  I’ve matured and I’ve proved it to both of us! 

Why do we recoil at the thought of attempting new things?  And why is it we can find a hundred reasons to support our inclination to leave life as it is and not venture out? 

The unfamiliar is fertile ground for growth. Maybe it’s time to consider going to a VMA meeting, speaking at a conference, giving a presentation to future veterinarians  or organizing a fund raising event for a local shelter.  Or maybe it’s time to try fly-fishing.  I have found that when I pause to allow myself to be open to a new experience, I’m always happy I did.  There is something to be said about taking a risk, creating a little internal friction, and allowing yourself to be open to learning something new.  Moving outside your proverbial “comfort zone” isn’t always comfortable, but it can push you to a higher level of success in your personal and professional life.

In this day and age with “YouTube” and countless reality television shows, the attraction of fame has become a part of our daily lives. We probably know the names and faces of more people today than we have ever known as a society before. So I wonder, was the desire for fame and adoration in any way a factor in my choice to become a veterinarian? Was it part of yours? I must say in all of my conversations with my colleagues, even the few who have obtained some type of notoriety, the desire to be “famous” was never a part of their dream. 

Many of us decided to become veterinarians at a young age because we love animals. I often ask the new doctors I interact with, “When did you decide to become a veterinarian?” The response is often something like: “When I was 9-years-old!” And  when I ask “Why?” it’s usually: “Because I love animals.” In no other profession do we decide so definitively to become a part at such a young age.
 
As we struggle with all the hardships of studying hard in high school and college, volunteering to get experience, the rigorous process of acceptance to veterinary school and the difficulty of getting through veterinary school itself, do we need to be encouraged to keep going because “you will have fame and fortune in the end?”

I had to push myself hard to become a veterinarian, but I’m okay if fame and fortune are not part of the package. And I’m willing to bet you feel the same way too. It’s my mission to care for the sick, to be a voice for the voiceless – and I find great joy day-to-day interacting with our non-human friends. The rewards far outweigh any notoriety. What motivates and sustains you as you practice veterinary medicine?

Maybe our young people who dream of being a reality television star or the next “Idol” need a different kind of hero to admire. I nominate an individual whom represents hard work in academics, continues to develop skills throughout his/her lifetime, and who cares for the little creatures who can’t speak up for themselves. But whether or not I am ever sprinkled with fame and fortune for my contribution to society, I will still consider veterinary medicine the most rewarding profession in the world.

Does anyone remember the story of how penicillin was discovered?  Alexander Fleming was discarding some contaminated Petri dishes in his lab and he observed that a plate culture of Staphylococcus had been contaminated by a blue-green mold and that colonies of bacteria adjacent to the mold were being dissolved. Curious, Alexander Fleming grew the mold in a pure culture and found that it produced a substance that killed a number of disease-causing bacteria. Naming the substance penicillin, Dr. Fleming in 1929 published the results of his investigations, noting that his discovery “might” have therapeutic value if it could be produced in quantity.  Wow, pretty neat stuff when you consider he could have just said, “Hmmm,” and thrown them away. 

So you are at work, and you have lots of appointments scheduled, drop off patients and procedures.   A few are having routine survey radiographs taken.  Many are having fecal exams and blood work. You take a look at a blood smear slide, everything looks o.k.  What’s that little spot there?  Probably nothing and we move on. Could we have missed something new?   Have many of us have been seeing the same thing and disregarding it as an artifact?

There are discoveries waiting to be found everywhere.  Whether it be a new drug, a disease or some as of yet unknown species of parasite, we will never find it if we don’t let ourselves be open to discovery.  A mindset of “opportunity vs. monotony” can change the way we see each day and how we practice veterinary medicine. 

So many of us can get into a rut that leads to professional burn out.  How can we keep our practice exciting?  Try not to look at each day as a day full of the “routine” vaccination appointments or the “typical” surgery.   Look at each case for its unique nature and not its sameness to the rest.   An attitude of discovery and opportunity can change our entire perspective in veterinary medicine.  

Just when we think everything is “known under the sun,” someone finds a whole new animal species or family of bacteria, even in impossible places like boiling geysers – that discovery lead to the polymerase chain reaction!  Try to find the opportunity in each day, in each case and you may be shocked at what you find.

Why is it when people decide to “lose weight and get healthy” they take on a kind of wanton fervor, like those contestants on popular reality shows? The premise of many reality-based shows is rooted in the saying, “He who gets there fast-eth, win-eth”. Take The Amazing Race. I’m not exactly a huge fan of the show, but I’ve seen bits and pieces, so I get the gist. People tune in to watch teams intensely compete with one another, working ’round the clock to arrive first at a particular destination, so they can win the big prize which is a marriage proposal from someone they met three months ago. Wait a minute. I think I might be a little confused. No matter. The point is that imposing time constraints on these shows is paramount to viewablity, not to mention big, big business; after all, nobody wants to watch people strolling leisurely along the Tibetan marketplace, or watch a drawn-out relationship that develops at a natural and healthy progression, right? B.O.R.I.N.G! If you think about it, you probably face the same type of expectation from time to time with clients who assume you will just “cure” their Pet now and don’t consider ongoing management or treatment.

So what about The Biggest Loser? It is currently the eleventh most popular reality show on TV, and If there’s any reality show that can make a difference in the lives of its viewers, it should be this one, right? No big surprise, Americans are progressively becoming more out of shape. (In fact, the populace has grown 1% fatter since you started reading this blog! Not really, but I’m trying to make a point here.) Seriously, if there’s anything to be gained (excuse the pun) from watching a reality show, The Biggest Loser should be the reality show that earns a Golden Globe for it’s role in making a life-changing impact on it’s audience.

So here is my problem with the show:

While I love the fact that people on the show end-up losing weight and, I believe, keep it off, I have concerns about some of the underlying messages. Number one, when I tune into the first few episodes, I see morbidly obese people who haven’t exercised in years, moaning from the pain, struggling to achieve nearly impossible goals, like climbing some huge mountain with a 20 lb. backpack atop their bodies. Good for ratings? Inspiring to watch? Absolutely. Okay for the average overweight Joe or Jenny to attempt? Not so much. Exercising at this intensity is neither necessary nor recommended. Long term results come from small incremental changes that occur gradually, over time.

Imagine if you asked a client with an overweight pet to strap on a five pound weight and run them around the dog park every day. It would be absurd (not to mention dangerous). Instead, you prescribe a logical course of action, that is appropriate for the pet in your care.

The other problem I have with the show is the large amount of weight people lose each week. Losing twelve-pounds a week isn’t a realistic goal and, frankly, doesn’t happen in the real world, yet, no one on the show tells you that. In our profession, we can be “coaches” for our clients. After prescribing a plan for weight loss, we can check in with clients to monitor progress and adjust as necessary for the pet. This not only ensures better long-term success rates, but helps us see potential problems before they arise.

Now, I’m not saying don’t watch The Biggest Loser, I’m just saying, the show is more about drama and less about useful fitness info. Changing an attitude, a set of beliefs and behaviors takes time. It’s so not about getting there quickly because the fast approach never really works. No matter how entertaining it may be.

Don’t you just marvel at the way life’s lessons seem to come at you in so many different ways, from lots of different sources and, sometimes, from out of the blue? More times than not, we learn about what’s really important and how to live a better, more fulfilling life, when we aren’t deliberately looking for enlightenment. Now and again, we stumble upon wisdom when someone says something we hadn‘t thought of before and it stops us in our tracks and makes us think, then rethink, our attitudes and beliefs. I guess you could say wisdom is sneaky.I had one of these sneaky moments last month, when I was flying back from Banfield’s Veterinarian Symposium. I was at the event to provide a presentation on the topic of balance, specifically, to help our vets with the struggles they face that inherently go along with managing a practice and a personal life.

On the plane ride back home, I started thinking about my presentation, brainstorming ways to improve the overall message, when I suddenly found myself distracted by one of the flight attendants, as she gave the standard speech we’ve all heard a hundred times: “Welcome on board Flight 2452,” she then moved on to the part about the nearest exits and ended with a description of how and when to use the oxygen masks. Nothing newsworthy here, but as she spoke, and went to demonstrate the use of the masks, I honed in on the part about when to place the mask on, if traveling with small children. It went something like this: “If you are traveling with small children, please remember to secure the oxygen mask over your mouth and nose, before assisting children with theirs.”

Well, that’s an interesting concept, I thought. So, if the cabin loses pressure or something catastrophic happens, we should first take care of ourselves and then help others. It’s like that in life, easy to go directly to helping others, forgetting about our own basic needs.

I think the big-picture message that the flight attendant so eloquently delivered is about rethinking the importance of self-care. Instead of always putting yourselves on the back-burner, consider the small amounts of time it takes to focus on your own well-being to be essential in keeping your head above water and necessary in helping others.

Wish I had thought about the oxygen-mask analogy on the way to, not back from, Symposium. I think it’s a good visual and I would have used it in my speech. What about you? Are you so busy securing everyone else’s mask in place that you forget to secure your own? I find that if I don’t take time to take care of my physical and emotional self, I eventually hit the wall, my productivity and happiness-factor goes down and my stress level goes up. Take a minute to think about your life. Do you always place your mask on last…or maybe not at all?

Volunteering your time (and energy) is a great way to give something back to the community you serve. I have a personal interest in reaching out and educating our youth by introducing them to the veterinary profession. I happen to feel that there will always be a need for competent compassionate veterinarians in the future.

Through my hospital, for example, I participate in what we call future vet presentations for my friends’ kids at their schools. The program addresses what being a Pet doctor is all about while stressing the importance of the human-Pet bond. Depending on the age group, kids are given goodie bags and:

- are encouraged to assist with tests and using instruments
- participate in discussions and mini labs
- look at x-rays and
- play the role of veterinarian

We’re all crazy-busy these days, juggling simultaneous work-family commitments. But I think it’s important to make time to support the people who support you. The hard part is how you choose to give and to whom. To help you with this task, I first recommend you take a look at your calendar for the next month and figure out how many hours you would have in a week or a month to give. Do you have regular open blocks of time?

Secondly, make a list of your talents and interests and match them up with organizations you are interested in. Consider your local humane society or shelter?

You can also attend a meeting or event held for the organization you’re interested in to meet its members and see if you fit in personality and culture-wise. Be sure to find out how much time other members or volunteers contribute so you can see if you have enough available time to give.

 

Do you remember when you were young and everyone asked you what you wanted to be when you grew up? Some veterinarians knew from the time they could talk that a veterinary career was right for them — however most of us didn’t have any idea. Making the right profession choice was so vitally important for the outcome of my life and my happiness.

I remember actually sitting down in a quiet place and asking myself these questions: “What makes me feel alive? What makes me want to get up in the morning?” I had a passion for helping furry family members and also loved people so clinical veterinary medicine was for me. It was a good thing that I didn’t make the mistake of loving animals and disliking people — all Pets are extensions of their people and I wanted to serve both. I truly care very deeply about both Pets and people.

On a side note, there were some not-so-good-reasons I decided on veterinary medicine, to be perfectly honest. I wanted the degree, I wanted to be called doctor and I wanted my family to be proud. What I have come to learn, though, is that it doesn’t matter what anyone else thinks — what matters is the passion I have inside of me. My passion defines who I am, my passion pushes me to do great things, my passion will determine my success in my career and, more importantly, in my life.

I have been blessed over and over again in this wonderful profession that I chose. I have found my niche and have utilized my degree to tap into my passion for serving people, building relationships, helping Pets, and being able to be a great and available mom. The veterinary degree opened doors that no other degree could open and I don’t regret my decision for one minute.

It was important that I made my decision for the right reasons — being passionate about my profession will not only make me the best in my field, but it will also make me the best person I can be during this short lifetime. What better legacy is there than to be the person who impacts this world because of my joy for living?

Can it be? Is summer over? As the season changes to autumn, the days become shorter, the weather chillier and school buses roll down our street. In my family, September is a particularly important and busy time of the year.

My husband, Chuck, is a high school English teacher and a cross-country coach. Chuck prepared for the start of school and the running season weeks ago. I can always feel the change in the season simply by observing Chuck’s life, changing as he moves from “summer” to “teacher” mode. It is ready-set-go from now to June.

This fall was particularly special as we had a big event in our family. Olivia, my 3-year-old, attended her first day of school this week. As a pre-schooler, we prepared for the day with new clothes, school supplies and a “hello kitty” lunch pail. It was such a thrill watching Olivia become ecstatic over school. It reminded me of my first year as a student at UC Davis.

As a campus liaison for Banfield, I spend much of my time at veterinary schools. My greatest joy is observing the freshman veterinary students during the first week of instruction. These students are motivated, excited and have a fresh attitude about our profession. I can also relate to the overwhelmed and anxious facial expressions when they realize the mountain of learning before them. Spending time on campus is a special experience as it reminds me of the veterinary school journey.

I enjoy this time of year as I observe the changes in the season and the “baby” veterinarians starting their own path towards a profession in veterinary medicine.

When I tell people I’m a veterinarian, the second thing out of their mouth is, “That’s what I wanted to be when I grew up.” The first thing of course is, “Why does my dog ???” (I’ll let you fill in the blank). For many veterinarians, including myself, it’s that want, coupled with a love of animals that push us into the field.

Most veterinarians, however, will tell people that there’s a lot more to it than the want and love. The first semester of undergrad brings the sudden realization that science is now a major function of our everyday life. We hold a variety of jobs to help us gain valuable veterinary experience, like cleaning kennels, mopping the floor and placing the occasional I.V. catheter, hoping to get that precious referral for the vet school admission application.

Vet school brought a whole new set of challenges for us like managing time between a day full of classes, study groups and anatomy labs. The four years flew by and we were on our way to the first day of our career, stethoscope in hand, lab coat starched and pressed, ready to help Scooter stop “scooting.”

Before the first patient is seen, there is a very important part of veterinary medicine that many of us are still unaware of by our first day — and that is management! Terms like boss, mentor and leader were never talked about. Suddenly, you find yourself longing for the days of endless anatomy labs, and ophthalmology lectures.

Understanding business and managing those around you are skills I picked up as I journeyed into my career. I found the key to successfully honing those skills was utilizing my peers and employer for information. Different practices offer different resources to their veterinarians, which can include electronic record keeping systems, on-call support, and mentorship programs.

I personally benefited from a mentorship program. Now with eight years of practice under my belt, I am giving back and mentoring others. I’m confident in saying that people I have mentored benefited from my experience and perspective on good management and communication skills, in addition to everyday medicine.

My advice to anyone starting their veterinary career is to accept the fact that they will wear many hats: doctor (including both medical and psychological); manager (including operations, human resources, financial & marketing); teacher; leader; and, most of all, compassionate human being.

The sooner new veterinarians acknowledge the need for good management and communication skills, along with smart business and medical practices, the faster they will be able to achieve career success and happiness.