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Veterinary Practice News September 2010 Letters to the Editor
Laser Alternatives
Editor:
I am a board-certified surgeon who has done several bilateral cruciate repairs on larger dogs using the Securos system for extracapsular suture repairs. After reading “Speedier Recovery After ACL Surgery” [Education Series, July 2010], I want to share my experiences.
I, too, refused to do bilateral ACL surgeries in larger dogs until a client twisted my arm sufficiently. I was initially surprised that the dogs started walking on both legs almost immediately after surgery, with very little or no lameness within a few days. Dogs that are extremely symptomatic on both legs (that are not TPLO/TTA candidates) seem to do better with a bilateral suture surgery because they don’t throw all their weight onto the newly operated, stable leg and break the sutures prematurely. I have seen this happen several times in larger dogs after unilateral surgery and with very symptomatic bilateral cruciate ruptures present.
None of these dogs were treated after surgery with anything other than NSAIDs, tramadol and rest. I believe that therapeutic lasers are helpful in treating post-operative patients, but since Dr. Geoff Campbell had never done a bilateral repair before doing the single reported case, he had no control with which to compare his results.
Based on his description of the recovery, in my experience the laser did not significantly change the post-operative recovery or ultimate outcome of the bilateral ACL surgery.
Carla Salido, DVM, CVA, Dipl. ACVS
Sacramento, Calif.
Live Within Your Means
Editor:
I realize that life is hard when going to and getting out of veterinary school. The school and year of graduation do not matter.
I graduated 21 years ago. My school debt was 2.6 times higher than my fresh-out-of-school income. So no, I did not buy a new car or even a new used car upon graduation. I did not move into a high-priced apartment and I did not eat out once a day every day of the week. My husband and I lived within our two incomes in a moderate neighborhood. (No, I would not raise my kids there.)
I know some recent graduates are living this scenario. But I know many more do not; I have hired more than my share.
I do not feel for you if you rolled your undergraduate and postgraduate loans together and have a hell of a large debt load. I went to veterinary school with no previous loans and did not have my folks pay for any of my college education, I wanted to be considered an adult and take care of myself.
Though I lived at home and ate at home pre-vet, I worked two jobs. Once in vet school, yes, I had to get loans because working two hours a day seven days a week does not put food on the table.
And though my grandparents agreed to pay for vet school, they died of a heart attack, literally, when I gave them the first bill. I managed to get a $1,000 scholarship.
The way I look at it, if the average loan these days is $120,000 and the average starting salary is $71,000 (at my practice), the fresh-out-of-school vet is less in debt than I was and should quit complaining. Take an economics class or get budgeting help from a CPA or financial planner.
That said, yes, I think veterinarians are underpaid for the amount of schooling and compassion they bring to the workplace. And, yes, I would do it all again except give my grandparents that first semester’s bill.
Monika Durgin, DVM
Phoenix
Oh, Cut It Out
Editor:
When I graduated from veterinary school in 1971, the majority of dogs and cats weren’t spayed or castrated. As a result, a large part of our surgical experience was removing mammary tumors, perianal tumors and pyometra and diagnosing prostatic disease and prostatic cancer.
Today, these surgeries are almost non-existent in my practice because virtually all the patients were spayed or castrated when young. I therefore read Dr. Patty Khuly’s suggestions for tubal ligations and vasectomies with more than a bit of interest. [“The Trouble With Pet Sterilization,” Reality Check, June 2010].
With all the electronic communications at our clients’ disposal, once these procedures become known, more and more clients will be requesting them and our surgery rooms again will be filled with these debilitating surgeries of days gone by.
I have never been sued for causing urinary incontinence, but I’m sure the legal profession will be quick to jump on veterinarians who sell vasectomies and tubal ligations because pre-op disclosures will never be enough when neoplasia rears its ugly head.
Bill Bender, DVM
Granada Hills, Calif.
Not Rocket Science
Editor:
Dr. Patty Khuly wrote, “We don’t do vasectomies and tubal ligations because we weren’t taught to do them in school.”
As a doctor who can and does do them, I submit that any veterinary surgeon has the ability even if he or she was not taught it specifically in school. The anatomy, surgical approaches and surgical principles are relevant to gonadectomy or tubal ligations/vasectomies.
I consider the subject a complex issue that every veterinarian has grappled with and makes recommendations according to what he or she perceives is best for the patient.
As far as the comment that doing these procedures attracts a more intelligent client, I don’t confuse a little knowledge with being intelligent. I believe veterinarians are more qualified to make health decisions than a pet owner, but ultimately the owner is the consumer and the veterinarian is the service provider.
I hope for an absolute answer to this issue one day, but for now we will have to accept our limitations.
Siegfried Mayer, DVM
Kenner, La.
Understand Basics
Editor:
I am in favor of more useful articles like Dr. Nancy Scanlan’s “Getting Started With Chinese Herbs” [June 2010].
Practitioners need to be aware of how these formulas are used when their client walks in with one, even if they are not trained to prescribe it. Those of us with extensive training always like to see others’ top ten lists!
Marjorie M. Lewter, DVM
New Castle, Va.
Whose Choice?
Editor:
It is utterly tragic that any pet owner trying to do his best for a pet would ever be subjected to the type of elitist veterinarian who arrogantly boasts that she would “not allow an owner to make a medical decision” [“Pain Control A Necessity, Not Option,” August 2010].
If Dr. Robin Downing is ever faced with having a loved one confronted with difficult medical choices, hopefully the M.D. involved will be less condescending and dismissive.
Michael A McLaughlin, DVM
Plano, Texas
One, Two, Thank You
Editor:
Thank you for two fine articles in the June issue of Veterinary Practice News.
Dr. Nancy Scanlan’s “Getting Started With Chinese Herbs” was a helpful and thoughtful introduction to Chinese herbal veterinary medicine for general practitioners.
Dr. Patty Khuly’s “The Trouble With Pet Sterilization” was wonderful. Spaying and neutering all dogs at a young age has been the prevailing dogma for too long. I am glad the issue of dog sterilization is being discussed in a frank and thoughtful manner.
Shiri Hoshen, DVM
Santa Fe, N.M.
Fleas Didn’t Flee
Editor:
Regardless of the beliefs of the Merial marketing director [“Why Fleas Persist,” Letter to the Editor, August 2010], there is, in fact, a problem with fleas being resistant to Frontline.
In my situation, six cats were confined to one large room. The cats had fleas. At the beginning, one out of six had evidence of flea bite allergy. At the end, all six had flea bite allergies.
Frontline Plus was applied to all six cats every two weeks. In addition, Frontline Spray was sprayed directly on the fleas on one cat each day, as this cat was tolerant of spraying. Frontline Spray did kill fleas when sprayed directly on the fleas, but there was no residual effect. (The kill appeared to be due to the alcohol in the product.)
After six months of this, the cats had far more fleas than originally. The cat with flea bite allergy at the start was nearly bald—a narrow strip of fur full of fleas ran down the middle of her back. She had severe secondary infection problems and significant anemia because of the fleas.
A change to Advantage quickly fixed the problem. Since switching to Advantage, the flea numbers in these cats is minimal. The cat with severe flea bite allergy is in full coat and healthy.
I used to find that Frontline was a fantastic product, and its ability to kill fleas was phenomenal. Unfortunately, times have changed.
At this point, I will not rely on Frontline to kill any fleas.
I could try to investigate other reasons why the fleas thrived in spite of Frontline. However, the truth is that fleas in the same environment on the same cats die when Advantage is applied to those cats.
I cannot argue with the results. What counts most in veterinary medicine are results.
Rachel B. Clark, DVM
Arcadia, Ind.
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Veterinary Practice News September 2010 Letters to the Editor
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