My Mistakes

Mistakes I've Made

When you graduate veterinary school, you take an oath. A part of that oath is to stay up to date on medical advances. As you know, medicine is ever changing in the latest and greatest. In North Carolina, we are required to take 20 hours of continuing education each year in order to renew our veterinary license. I believe very strongly this is something I owe to my you and your furry family members. Yes, sometimes with advances in medicine, veterinary services cost more money. Yes, not everyone can or wants to pursue every diagnostic or treatment for every disease process out there. Nor do I think all should be pursued. At the end of the day we keep the quality of life of the animal in mind and weigh risks versus benefits. However, it is my job to give you your options.
Not everything that is the “latest and greatest” has to cost an arm and a leg. I promise. Research is being done continually in areas that you use every day (nutrition, behavior, etc). It's my job to bring back to you not just fancy diagnostics and treatments, but things you can use to better your relationship with your furry family member. As research changes, so do my opinions and recommendations. This is one reason I recommend annual examinations. What I recommend one year may change by the next year. This may seem scary to some people, but it also means that sometimes I have to admit I'm wrong.
As some of our clients know, I was recently out of town attending Continuing Education Courses. It was in Texas and yes I had to try their barbeque and compare it to our great bbq here in NC. I also spend 25 + hours attending educational courses on dermatology (itching, scratching, etc), dental surgical techniques and problem solving, behavior courses, puppy socialization and more behavior courses, talks on clinical reasoning, emergencies, immune mediated conditions and treatment, chronic liver diseases, intestinal diseases, the list goes on. Some things were affirming that makes me happy we are offering still the “latest and greatest” and are ahead of the game on. There are also areas I need to personally improve on and I'm going to tell you the mistakes I've been making after two things I want to reiterate to our clients.
Things I'm proud of and believe in strongly
-Our Allergy treatments.

1. There is no one size fits all! All patients need to be treated individually. We utilize all sorts of therapies including immunotherapy.
   
2. I've been telling people for a long time if they are doing the food allergy testing they are wasting every dime they are spending on it. This is still true
   
3. Doing over the counter allergy tests (even for environmental causes) are a waste of your money
   
4. Only 1-2 laboratories have developed serum allergy tests that actually parallel intradermal allergy testing. There is only one in the U.S. Yes, we already have been using this one. Most, if not all, other labs are a waste of your time and money. If you're using over the counter testing, I promise you're not using this lab.
   

-Our Vaccine Protocols

1. We still utilize the best standard of care for which vaccines we recommend and use.
   
2. We are very proud of not just jumping on board with every vaccine out there and study the clinical data behind it first.
   

Things I have been failing at
Puppy Behavior

1. I went to behavior lectures and puppy boot camp/training courses. I learned that I am recommending socialization a little too late. I have been so wound up in asking owners to wait until at least the 12 week-ish visit that I have been missing a huge window. The 8-12 week window has been found to be CRITICAL to socialize your puppy to the following things
   
   1. Other dogs -both dominant and submissive
      
   2. All races of people
      
   3. People in costumes
      
   4. People in wheelchairs or crutches
      
   5. Louder noises
      
   6. Healthcare visits
      
2. This doesn't mean that socialization cannot be done at a later time, but almost always managing a problem is harder than heading it off before it starts.
   
3. Things to do to keep your puppy safe during socialization
   
   1. Be sure your pet is only around other fully vaccinated pets
      
   2. Be sure your pet is in a controlled environment that could be sterilized if it recently had a parvovirus carrying or other sick pet in it.
      
   3. Use positive reinforcement to interrupt any negative behavior or play
      
4. What do I plan on doing to resolve this issue?
   
   1. Obviously work harder on stressing socialization with new puppies in the clinic
      
   2. Having mini “healthcare training” visits for each new puppy
      
   3. Try to partner with other local veterinarians or trainers to get puppy classes more available to people.
      

Physical Therapy
Aster (Brandon's dog and therefore my “step-dog”) a 6.5 year old GSP x Lab injured her cruciate ligament. She resolved within 72 hours with rest and NSAID therapy (Yay!). She then reinjured it 8 weeks later and for the last 5 weeks has been toe touching lame. We had a specialist surgeon (Thank you TarHeel Surgical Specialists come to our clinic and she repaired the ligament and removed the meniscus with a TPLO surgery. Due to this coming up, I went to several physical therapy lectures and learned that I was failing in not recommending physical therapy enough.


Even with conservative management-physical therapy is a very important part of healing a cruciate injury. Even if an owner isn’t' going to pursue surgery it is important. Obviously this makes sense if you think about that many people need to go to pre surgical physical therapy and post surgical physical therapy. There is no way a human surgeon would perform a cruciate (ACL) repair if a patient's limb was not fit enough to handle it. There is also no way a surgeon would not recommend going to physical therapy after a surgery like this. In fact, many that I have talked to report a correlation with how well a patient does post op with how well the patient stuck to doing physical therapy. Obviously this is something we should be pursing more.

Do you know why we don't often pursue it? Because yes, these things can take time and money. Yes, a lack of time and dollarapenia (sciency pun there!) are the most reasons we cannot pursue the best care. However, not everything has to cost an arm and a leg.

What are we doing to do? Our technicians are going to work together to start helping teach clients how to do range of motions exercises and other activities at home. That way we can arm owners with at least a basic understanding of what is “too much” or “too little”. While this doesn't replace a trained eye on your pet during therapy, it is better than just sticking them in a cage and hoping their body will heal without hurting their range of motion! Obviously our technicians will be willing to help do the program for those owners that would prefer to have us do the physical therapy for their pooches.

Ok, this blog article is getting way too long. I could go on and on about things I'm so proud that we're ahead of the curve on and things that I'm so excited to bring back to help owners with.

Thank you for reading and we hope you continue your education in pet ownership!
Mindy S Wesely