Getting into trouble is simple; just try every new fad


The easy way into trouble is simple; immediately jump upon, endorse, and adopt every new product, every new technique, every new concept and every new drug.

The easy way into trouble is simple; immediately jump upon, endorse, and adopt every new product, every new technique, every new concept and every new drug.

The pectinious muscle removal for hip dysplasia was performed on dogs until we found out, nope, not the thing to do.

Then came the first nasal vaccine for cats. Cats that took it became ill. A cardiomyopathy study of cats was terminated because diltiazem cats were living while the propranolol group (standard treatment at the time) was dying.

And if we are so good with equine reproduction, and all the new techniques, why does fecundity continue to decline?

We are told for years that we need to cause vasodialation in laminities cases - but, oops, now the Australians advised us that vasodialation is associated with increase morbidity, at the least.

Braunamid and Vetafil sutures were used in spays and neuters and knees for a time before it was discovered that they fistulate- right out through the paralumbar tissues.

The other side of this issue is the reluctance to accept change. Dental care in dogs was joked about for years before the profession took it seriously. Many laughed, and still do, at the thought of the existence of hypertension in dogs and cats. But now hypertension management is an important part of the renal failure therapy.

Other side of coin

The groans at AAEP still ring in my ears when Dr. Thomas Bello announced, decades before it was finally accepted, that tubeworming would be obsolete (some still don't believe) and that twice-a-year deworming programs were just ineffective.

Practitioners have learned, will learn, better learn, need to learn to adopt the advice of "don't be the last; don't be the first," as a pretty good guideline for the adoption of new products, new techniques and new concepts.

On the table before us are new issues to deal with. Do we pick up the FIV vaccine or watch for a while? Do we grab the new NSAIDS and run with them, or introduce them slowly? Do we go quickly to the tibia tilting for cruciates and the triple pelvic osteotomy or refer all such cases (even if you have completed 1,000 knees using other techniques)?

How about Neutersol for male dogs and skip the surgery (and, like vasectomy dogs, come back three years from now to remove the testosterone maker testes)? Do we get serious about equine dental disease or leave it to the farrier dentists?

And let us not forget about the vaccine issue. Just when we prided ourselves with the latest and greatest technology to prevent diseases, we now hear that some of our immune patients may have come to us via the vaccine. And there are other gray areas in small animal medicine. Do we stick with tried and true halothane or just jump to sevoflurane? Do we skip and destroy our pentothal supplies and go strictly to propofol?

How about horse anesthesia? Dr. Elizabeth Martinez at Texas A&M has testified under oath, that, she along with her department head at Texas A&M, believe that using halothane in the horse is malpractice. Yikes, and how many horses this year will go to surgery under halothane gas anesthesia? (Answer: a bunch.)

Dr. Tim Hanosh in New Mexico, has testified that it is below the standard of practice, and thus malpractice, to fail to demand and require a complete blood work-up for virtually any procedure. Specifically, the veterinarian should turn down the case whether it is a basic castration or simpler procedure if the client refuses lab work. Where does that leave the 20 percent of practices in New Mexico that don't even offer pre-surgical laboratory tests? (And, Dr. Hanosh sits on the New Mexico Board of Veterinary Practice).

At the AAHA meeting, we heard that a boarded dermatologist is using out-of-date Mitaban (amitraz) to treat demodex. This makes it okay as a standard of practice, but the law says, such is a violation of law, or does it?

The human literature, in the New England Journal of Medicine, documents that in 10 percent of drug sales people will lie to make a sale. And clearly all drugs companies, at the least, are going to put a good spin on their product.

Without bias, it can be noted that the AAHA vaccine report does not look like the vaccine company's literature.

Then again, consider lepto vaccine - there are those who say don't give it, but then the JAVMA Vol. 222 page 1230, reports that "...leptospirosis may be one of the most under-diagnosed diseases in the dog."

Of note, this author began looking more aggressively for lepto, and guess what we found? Answer: more tick-borne diseases.

Anyone can take any stand and press their case on either extreme of any issue.

Practitioners are faced with extreme positions, fanatics, and yet we try to balance continuing education with reality. That's when the stress arrives.

The information era brings on many new challenges to the practice arena.

Think these issues are easy? Well, forget it; they are not.

So, what should we do? Try these steps:

In need of answers

  • Accept that only a percent of the new ideas will stand the test of time. (Be sluggish to accept the new.)

  • Read and study your practice act (Though they may try, state officials will have a difficult time forcing us to do things that are not included in the practice act.)

  • Bring new ideas into practice slowly, carefully and with eyes open.

  • If something is working, don't just abandon it. Remember, aspirin still works and so does valium.

  • When introducing new drugs, document 10 cases or 100 cases and look, genuinely look, to see if the product in your hands matches the hype.

  • Stick to a select group of drugs that you really know and understand. (It takes about 100 propofol inductions to understand the differences with pentothal.)

  • Go into NOAH and VIN and listen, look and assess the polarized views.

  • Take time to read the literature that clients present that they have downloaded from the Internet.

  • Get informed, be informed, gather your own statistics from your clients.

  • Spend more time fine-tuning your practice offerings, especially vaccines, to your client needs.

  • For every case that has a gross billing of more than $250, make sure to sit face-to-face with your client and address each and every concern (and document it in the record).

  • Do not get pressured beyond your comfort zone, but be prepared to refer or move your position.

  • Admit medical controversy openly before clients bring it to your attention.

  • Get involved with the local political process to monitor your state board activity to determine its accountability, objectivity and fairness. (Don't take your practice freedom for granted. Just talk to 10 colleagues who have faced a board hearing to see if they feel like the "system is working.")

  • Make sure the medical record is clear, clean, understood and readable.

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