How Do Our Perceptions Lead Us?

Rizzy, sleeping at the Receptionists desk.

"To change ourselves effectively we first had to change our perceptions." Stephen R Covey.

We all have a foundation of belief that motivates us to move in a certain direction. As we move down that path the question becomes; How does our perception influence our belief? If the foundation is a belief is the rest of the road determined by perception?

I had a long talk with a rescue advocate today. We were talking about joining forces to help each other with the common goal of helping pets.

After a long conversation it seemed to me that she was trying to assess where I stood on many "hot animal topics." She is obviously dedicated to helping rescue pets (a subject very near and dear to my heart), and understanding how her efforts to address their challenges, needs, and problems can be resolved. She was also asking me about my perceived role in doing the same. Seems like a reasonable question. Vets have the answers to so many pet problems, So why wouldn't vets be doing more to help alleviate them?

The questions seemed to center around utilizing veterinarians to provide more for less. Hence, bridging the gap between need and availability. They included questions about; Why are we charging perceived high prices (example $15 for a nail trim)  for what we do? If we gave our services away, or charged less, the services and goods would help more people and save more pets. A simple marriage of ethical obligation and economics.

So, how did her perception of where the help is needed become a query into how vets can do more for less?

It got me to thinking? DO people think that vets are the source? Or even a part of the pet,,,,whatever,,,problem?

I  suppose people do.

Her litmus test for me, as a way to seek out my intentions and beliefs revolved around two questions.

Question Number 1. "How do I feel about vaccinations? Because veterinarians use yearly vaccines as a way to get people into the office AND because we over vaccinate."

Was I offended by the question? No, I wasn't at all surprised by it. It is a commonly held perception.

"At my clinic we use a three year distemper combo vaccine, and a three year rabies after the first year." That's my official answer. I gave her what she wanted to hear..but it isn't the whole truth.

Perception vs Reality Statement Number 1

Why don't other veterinarians use three year vaccines? Because I think that they believe that most people won't come back for their annual physical examination unless their pet also needs a vaccine.

For this reason there are veterinary practices now offering "Free for life vaccines." How is the perception different from the reality? Well, I believe that the most important part of bringing your pet to the vet is in the conversation that you have with me, and the things that your pet tells me. It is in the yearly examination,,not the vaccines. How do you get the most value out of your pets yearly exam, regardless of the vaccines needed? The primary care giver(s) should go with the pet. For some pets the examinations should even be more often then yearly. For young (1-6 months old) and older pets (cats and small dogs at age 8, large dogs age 5) I recommend an examination every 6 months.

The answer was given to address her underlying question, and still the perception is not wholly reality. How do I address the belief that the people won't come back? I recommend Lyme, Leptospirosis, and kennel cough vaccines be given yearly (the interval they are good for). For cats we stagger the 3 year vaccines..so that at least two out of every three years we see them..and I beg for the other. Do we over vaccinate pets? Yes, we probably do. That's why titers are a great option. But the problem with running a vaccine titer is that they are about three times as expensive as vaccinating. Ask me what's better for your pet. I will give you a list an arm lengths long. But it will be tailored to your pet. That's the value in my service and expertise.

And, sometimes, regardless of my deep seeded discontent in repeating this over and over, I still say, "I don't make any decisions based on money." Although should you ever be foolish enough to open your own business you SHOULD make decisions on what to do based on what is profitable. But for whatever reason it is not ethical to make decisions about running a business focused on pets based on profits..

I often want to remind those seeking free and discounted pet services, that I spent four years in high school and vet school getting A's so that I could get into vet school. It was decades of grueling, stressful sacrifice. And, after all of that I am asked and often expected to work for free, undermine my own business, and feel terrible guilty with every decision. It is not a profession any successful, business person who truly loves animals should ever venture into. There is a reason veterinary medicine is becoming corporately driven and owned. They can do it without guilt or remorse from a tower far, far away.

Bentley, here for his dental yesterday.

Question Number Two;
"How do I feel about RAW diets?"

Perception vs Reality Point number Two;

I am a scientifically trained doctor. If the evidence points to something as being inherently dangerous why are people still choosing to use it? There have been multiple statements made and published and still the public ignores this. Is it because they think we are paid by food companies? (See the AVMA policy below).

I use prescription food exactly the same way I use prescription drugs. Do I make money off of the drugs I sell and the food I sell? Yes. But I don't care where you buy them. You can buy your drugs from me, from the human pharmacy, and the same goes for food.

Do I think that some people believe that their pet benefits from a raw diet? Yes. But did they try other diets? Did they ever get a professional opinion? If you, or your child were ill would you go to the grocery store to get advice about what to feed them? Do you think that the untrained attendant at the grocery store isn't going to sell you a food that they don't carry? They are trained to sell only what they carry. I don't know of one person on a raw diet because an accredited veterinary expert recommended it. People really hate that answer, I know. Although I still don't understand why?

She then went on to regurgitate the same slanderous misleading jargon that I hear everyday from people with no business calling themselves an "expert" in anything..it is usually about "prescription diets being inferior because the label starts with"..., or "the benefits of grain free, holistic, all natural," etc. etc. Unfortunately, the public has been mislead into believing that the perceptions of good food companies, and good products are not reality. Worse yet, you all were lied to by other food companies..or people who are willing to risk you and your pets lives because they no longer trust "the establishment."

If you want advice about food see a nutritionist..and if you don't believe that we have your pets best interest in mind then we have failed you and your pet.. Every nutritionist that I know is only providing advice for one single thing..(like the rest of us in veterinary medicine),,  to help your pet. But be careful who lays your foundation of belief and who provides your perception of what is optimal for your pet..

Somewhere along the line the people who spent decades learning about how to help you take care of your pet lost their credibility and the advocates for pets became the outspoken but untrained.  A veterinarian spends years to earn their DVM. Then we spend many more to understand the big picture and how every single participant influences it. You can't do it with one dog, one case, and one perception.

My advice; If you need expert advice for your pet go to a medically trained certified veterinary professional. If you don't like that advice get a second opinion..and if you are looking for an answer that's not the answers you get then ask yourself why? And what your perception might be?

Skittles. Found on the side of the road.
The people who found her believed that she was blind and suffering.
They believed she should have been killed.
In fact, she is visual, happy, and will be just fine.
She is with us, and looking for a home.

Where is my reality fading from perception?

I believe that helping each other is group effort, and this infighting divides  us from our goal. And, I don't want to be a part of the problem as I try to be a part of the solution.

What do I believe is at the heart of her questions?

Trust.

That one simple word. It defines everything we do, are, and hope to become.


Related Articles;
The Raw Food Blog

Raw Pet Food AVMA Policy

Charlie.. Whose perception and reality are one in the same..
Magpie is going to school him about who is in charge.

I appreciate your thoughts and comments.

And if you have a pet question you can ask me, or any of the rest of us pet lovers, at Pawbly.com. Pawbly is an open platform to help people and their pets. It is always free to use.

Or find me at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice.

And as always,
Always Be Kind..

The REAL value of the annual exam

I was running with my very good friend the other morning and we were talking shop as we always do. You see I live about 5 minutes away from a veterinary hospital, and that hospital is owned by my very good friend Amy. We run together at least 4 times a week and those 4 miles blow by when you have a comrade to commiserate with. We swap stories, gossip, medicine, and go over the hard cases together. We also bring our dogs. We both agree that the dogs love the run more than we do. For all 5 of us its usually the best part of our day.

We were discussing how the face of veterinary medicine has changed over the years and venting a little. I know that for both of us it’s nice to have an understanding shoulder to lean on and ear to chew at. It’s a great combination of cardiovascular exercise and psychotherapy.

I was telling her about a case I had just seen of a 6 year old Chihuahua male neutered dog named Nacho. He had come in for his yearly physical examination and shots. He was brought in by his very caring concerned involved parents and their late teenage daughter.

Nacho, unlike many of his small counterparts is a gentle calm trusting patient. He was a tiny bit nervous but not aggressive or excited. After I said my “Hello’s!” to everyone in the room and especially to my patient (tip to vets: always greet your patient!) I asked my usual list of questions. I am a big believer in the question and answer part of the exam. I get very concerned when a client requests a “drop-off appointment” because your pet can’t tell me the things I need you to answer for on their behalf. Therefore, in my opinion, if you are dropping your pet off and not getting a dialog with your veterinarian you are not getting the full value of what you are paying for.

This gets me back to my point on my run with Amy. We were discussing how many of our clients don’t want to pay for an exam, they just want to get the “shots their pet needs.” We were discussing how frustrating it is to try to impress upon our clients that the most important part of the annual examination and vaccines is the annual examination and probably less the vaccines. She reminded me that as a profession we drilled into our clients head that “they needed to return every year to get their shots,” and that we “sort of did this to ourselves.” 

I said “I agree, and now that so many of the shots are available as tri-annual we are finding it even harder and harder to convince owners to bring their pets in to see us.”

Ten years ago when there weren’t three year shots available, and so many more pets died of diseases that we don’t see much of anymore, like distemper and parvovirus we were right in pleading for annual shots. But these days the diseases are less prevelant in household pets that get their initial series of shots, so the importance of vet care has shifted from disease prevention through vaccination to disease prevention through veterinary care and intervention. 

We started talking about how many annual exams that we have done on pets that were apparently healthy in the eyes of their owners where we inadvertently found major issues. I have found splenic tumors, diagnosed thyroid disease, Cushings disease, and all sorts of cancers.

The REAL value we agreed these days is not so much in the vaccines, but in many cases it is in the question and answer period, the review of diet and lifestyle, and the behavioral issues many pet owners deal with. As an example these days I  prescribe many annual exam pets Thundershirts, Prozac, and “more exercise less treats” and give fewer vaccines.

To all of you pet parents out there overdue, or questioning the importance of calling the vet to schedule the list on the post card stuck on the fridge I encourage you to call and schedule your pets exam. 

When you are scheduling and get there think about the following;

1.       Avoid the drop-off examinations at all costs. If you do have to drop-off, make sure you have a lengthy conversation with the vet first, so that you can both discuss your concerns and costs.

2.       Discuss the vaccine protocol that the vet is suggesting for your pet. Ask if there are 3-year vaccine options available for your pet? And whether they are appropriate.

3.       Discuss food/diet, and treats.

4.       Discuss activity level and exercise regimen.

5.       Discuss any and all behavioral issues, and remember that behavioral issues tend to worsen and magnify over time. So if it doesn’t seem like a big deal now, will it be if it is twice as often as it is now? Or more?

6.       Stress plays a role in your pet’s lives and health. So if there are any different members of the family (kids, parents, other new pets), noisy activities in the house, or changes to the household, etc. mention them. Things that we see as being a minor change (like moving furniture, redecorating, etc) can really stress out your pets.

7.       Anything that you feed your pet (be honest!), or your pet chooses to eat, or gets into (stealing food) are also important pieces of information. I currently have a client who is using homeopathic herbs and additives and I suspect is causing kidney diseasein her 6 year old house cat. It took 20 minutes of Q & A to get this information because she thinks “homeopathic is equivalent to harmless.” In some cases it is and in others it isn’t.

8.       Leave the appointment with a good list of things to think about, remember to-do (monthly heartworm and flea & tick preventative), upcoming future appointments and re-checks, etc. At our clinic we give out report cards for each visit. It really helps go over all of the information we discussed, and provides a good overall summary of our PE findings.

Last week at Nacho’s appointment I immediately noticed that his hair is very thin, sparse, and flaky, especially around the top of his head and ears. When I inquired about this his owners told me that “he has been like this for years.” I was shocked! Why would this be disregarded? A skin issue can be a health issue, especially if it is a chronic problem. We began our exam with a lengthy discussion of Nacho’s diet, lifestyle, and history of this condition. I asked them to start a long term plan with me to try to get to the bottom of what the skin issue might be caused by. We decided to start with the easy things like a good diet, an omega-3 supplement, and taking a picture of his head every month.  I also reminded them that hair re-growth is a slow process. It took years to get to this point, it will take some time, like months, to start to resolve.

Base of the ear. Note the sparse hair and big flakes of dead skin.

Thickened ear pinna (flap), lots of dead crusty skin flaking off.

I ask clients to take pictures/document their pets because in the day to day progress of a disease (or response to a treatment plan to identify a disease) the owners doesn’t often notice the subtle changes. So I either have them come in for regularly scheduled visits over set intervals of time (like every 1, 2, 3 weeks, or monthly, etc.) so I can help them monitor. I also take a picture of the pet every visit to keep in my phone, or on a hard drive. Or we print a picture out in the clinic and staple it into the chart that way no matter which vet does the follow-up we know where we were at the last visit.

I am notorious for assigning homework to my clients. It helps get everyone involved and provides a much more consistent patient monitoring.

I will keep you posted on little Nacho.

His initial treatment plan is as follows;

1.   Better food. No little gravy cans with funky colors and junk food ingredients. Very hard for small dogs, they get used to junk food, they want to keep eating junk food, so a transition to a better food takes time, patience, and persistence.

2.   Start Welactin daily, the omega-3 fatty acid supplement from Nutrimax.

3.   Use monthly flea & tick prevention. We switched him from intermittent to almost negligible to monthly revolution.

4.   Re-check in 1 month.