VPN Plus+ ExclusiveVeterinary chiropractic: A friend or foe to your patients?November 18, 2020By Brennen McKenzie, MA, MSc, VMD, cVMAChiropractic is primarily the manipulation of bones in the spine in an effort to treat or prevent disease or to reduce discomfort. Though therapeutic manipulation of bones in the spine has a long history, chiropractic—as it is understood today—was invented in the late 19th century by Daniel David Palmer. He conceived the notion that all disease results from vertebrae in the spine being out of place (so-called "subluxations"), and that their forceful manipulation (an "adjustment") can prevent or treat disease. He gave varying explanations for this idea over time, often claiming nerves carried a spiritual energy called "innate intelligence," and that obstruction of the flow of this energy by vertebral subluxations caused medical symptoms.1,2 Few chiropractors today still adhere to the notion of a mystical energy such as innate intelligence as the source of disease or the focus of chiropractic treatment. However, there is a split in the field with respect to the subluxation concept.3,4 Most chiropractors still view subluxation, or the vertebral subluxation complex (VSC), as a real entity causing illness and that can be corrected by chiropractic manipulation. These practitioners also sometimes reject modern scientific explanations of illness, such as germ theory, and may recommend their patients avoid …
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VPN Plus+ ExclusivePlaying monopoly with real money: How veterinarians are losing the price warOctober 30, 2020By Patty Khuly, VMD, MBACompetition is alive and well in veterinary medicine. But as our industry confronts increased corporatization and consolidation, the word has acquired a new resonance for many of us.
VPN Plus+ ExclusiveWhen bad reviews happen to good veterinariansOctober 14, 2020By Patty Khuly, VMD, MBAEveryone reacts differently, but there’s no getting away from the fact negative reviews hurt, which is exactly what the reviewer is trying to achieve.
VPN Plus+ ExclusiveFood is love—So why is nutrition a problem area for veterinarians?September 29, 2020By Brennen McKenzie, MA, MSc, VMD, cVMAAs a child, I was a big fan of the Peanuts cartoons. One of my favorite characters was Snoopy, a suave, bipedal beagle who wrote novels and engaged in breathtaking aerial combat with his nemesis, the Red Baron. Though Snoopy was unlike most other beagles I have known, he had one characteristic in common to others of his breed, and indeed most dogs. When suppertime arrived, all other activities were forgotten, and he often launched into an exuberant, joyful, food-induced dance. Every feeding was a celebration for Snoopy, not only of food but of the bond between dog and owner. Few subjects generate the same intensity of emotion in pet owners as the question of what to feed our animal companions. Feeding our pets is the quintessential act of caring and love. And based on how most dogs and cats act at feeding time, it certainly seems like a highlight of the relationship for them. There is also a deep sense in most pet owners that choosing a pet food has tremendous significance for the health and well-being of their pets. Everyone wants to give their pets the "best" food that will keep them active and happy and prevent illness …
VPN Plus+ ExclusiveThe muzzling of science and the veterinarian's roleSeptember 16, 2020By Patty Khuly, VMD, MBAAn acceptance of “un-science” is happening despite the fact most of us carry the bulk of this planet’s available information on our person at all times. The facts are literally at our fingertips.
VPN Plus+ ExclusiveA gentle rant on medical infantilization and the "pet parent" trapAugust 6, 2020By Patty Khuly, VMD, MBASmack in the thick of Miami's COVID spike, I had to have minor surgery to correct a bony defect caused by Rottweiler skull-induced trauma to my nose. The timing was technically elective. It needed to be done eventually, but the sooner the better, cosmetically speaking. I chose vanity over safety weeks in advance, not knowing my zip code would zoom to the top of COVID's bell curve of casualties on that exact day. At least it was an excuse to test myself ($350 for a 24-hour "concierge" negative) and take a much-needed mental break––a two-week staycation––after powering through the first full half of 2020 without so much as one whole day off (Sundays included). Despite the pain I anticipated, and the unsightly bruising, I was looking forward to the propofol and midazolam. Sweet, medically sanctioned oblivion! Sadly, I suffered a rough night during my required stay at the surgical center. The food was inedible, the meds made me vomit, and the nurse was on my case. Let's just say I wouldn't wish her on anyone. Among other transgressions, she blamed me for vomiting on my blankets when she didn't lift a finger to bring me a receptacle, constantly woke me …
VPN Plus+ ExclusiveAntimicrobial stewardship: What it is and why it mattersAugust 4, 2020By Brennen McKenzie, MA, MSc, VMD, cVMAAntimicrobials have tremendous therapeutic benefits in human and veterinary patients. After vaccination, antibiotics are probably the most important medical intervention of the 20th century in terms of reducing suffering and death. Of course, antimicrobials can also have significant adverse effects. And any use of antimicrobials, including appropriate therapeutic use, creates a selection pressure that can result in emergence of antimicrobial resistance (AMR) or an increase in the abundance of resistant bacteria. Adverse effects and the development of resistance reduce the potential benefits of antibiotics. Antimicrobial stewardship is the concept of using antibiotics in a manner that maximizes their benefits, minimizes risks, and conserves the effectiveness of these important drugs.1 Changing when and how we use antibiotics is the key to achieving these goals. Antimicrobial stewardship involves three general strategies: 1) Preventing infectious disease occurrence 2) Reducing overall antimicrobial use 3) Using antimicrobials in ways that maximize the benefits, minimize the adverse effects, and reduce the development of antibiotic resistance Preventing infections Preventing bacterial infections automatically reduces the need for, and hence the use of, antimicrobials. This involves encouraging clients to provide appropriate husbandry and preventive care, including vaccination, proper nutrition, isolation of sick animals, and other prophylactic measures. Prevention of …
VPN Plus+ ExclusiveSurviving a pandemic as a veterinary professionalJune 24, 2020By Patty Khuly, VMD, MBAIf you're a veterinary professional and you feel like you're being squeezed from every direction, welcome to my pandemic-warped world. It's gotten so bad that sometimes I feel like a Cuban sandwich, all thin slices of ham, cheese, baby pork, and pickles smushed between two halves of buttered baguette, which is then compressed by an industrial press so powerful the edges of the bread burn and the cheese sizzles while the bread soaks up the excess. Further indulge my Miami metaphor by envisioning our suppliers as the bottom half and elite specialty providers as toppers. We, the tender baby pig (arguably the least equipped to tolerate the pressures), are becoming but a smear of protein. To be sure, it's delicious in the end. Nevertheless, it's still kind of sad the bread ends up with more than its share of all the butter. Culinary fantasies notwithstanding, it's clear things are getting tougher for the average veterinary practice. Increased ER income is keeping specialty services humming, while as many as a third of the practices in my area have temporarily shuttered, possibly never to reopen. This rearranged game board has given an edge to the larger, more established practices, along with …
VPN Plus+ ExclusiveFrom the trenches: Veterinary musings from a pandemic-rattled brainMay 5, 2020By Patty Khuly, VMD, MBAIt's difficult to explain how I feel, but I'm fairly certain you can relate. It's like I'm being asked to perform all my normal functions as a veterinarian, practice owner, mother, and parental caretaker from beneath a thick layer of practical wariness while wrapped in a smothering blanket of fear. It's all so different––so suddenly––that I haven't had a proper chance to process it. I awake every day to find the game has changed, variables have been added, and assumptions altered. It's like playing a game where all the pieces get continually rearranged and the rules are always changing. It wouldn't be so bad except the stakes keep getting bigger by the day. At the top of my list is my family. My son refuses to come home from college and my elderly father is constitutionally incapable of "sheltering in place," which reduces my poor mother to apoplectic handwringing episodes interspersed with marathon rosary sessions. Then there's my own health, impacted by the fact I have little choice but to work with a variably compliant public among mostly young, "invincible" team members whose movements I have no control over once they exit the building. Moreover, as I revealed in a …
VPN Plus+ ExclusiveFrom the trenches: How life has changed since COVID-19 came into our livesApril 23, 2020By Brennen McKenzie, MA, MSc, VMD, cVMAThe hospital is quiet as I walk in at the start of my shift. The usual bustle of clients, staff, and animals has been replaced by empty hallways and only a few masked doctors and nurses going about their work quietly, careful to keep their distance from each other. I stop at the screening table and start my day by taking my temperature. It is under 100.4 F, and I have no cough or other respiratory symptoms, which means I can work today. I set down my belongings at my desk and go to change my clothes. I wear scrubs every day now, and I have a pair of dedicated work shoes that stay at the hospital. I also have a collection of beautiful cloth face masks sewn by one of our employees—I wear a clean one every day. At the end of my shift, all of my work clothes go into the laundry. When I get home, everything I took to work stays in the garage. I pass quickly through the house and take a shower before I greet my family. I am especially mindful to keep my distance from my elderly mother, who lives with us, and …
