Category Archives: Philosophies

Philosophies in Veterinary Care, examples include Euthanasia and other weighty decisions and practices

Come on, it’s just a dog.

Come on, it’s just a dog?

Reading the last page and closing the cover on the story of a dogs life hurts so much because we read these stories without holding back, and we try never to let ourselves consider that there is a last chapter, that the book will end and there is no sequel.

People who have never considered their dog to be their “friend“ probably would not understand the full weight of grief a person might feel.

The unconditional relationships we can have with a dog are singular in our lives. God is not a physical being, and babies grow up. Past that, the only limitation to a dog as a physical being who never grows up, is that they do grow old. And one day they stop.

It is normal to feel a tearful sense of loss.

Everyone copes differently, but I do not believe in “getting over it” or pushing it down.

I think that whenever a sad thought moves into my mind, I will answer it with my favorite memories of the departed companion. It has become a habit with my mother’s departure, so I know it will work with Ajax and Luna.

Leveraging Illness to Profit With Intent

There is a fish in the ocean called a Cleaner Wrasse, and it is trusted by numerous, amazing kinds of fish to remove disease causing organisms from them.

This cleaner fish does not want anything, it doesn’t hope for fish to get ill, and it doesn’t complicate the relationship. It’s simply “makes a living“ whenever a fish with a health problem shows up. That’s it. Not complicated.

Doctors on the other hand, are a little different.

It used to be that doctors were “individuals”in small towns with a reputation and a good name. Their kids went to school with other kids. They were accountable to the community. What they did reflected on them for better or worse.

Until in 1960, the Supreme Court ruled that corporations could own the doctors.

This broke that bond between the doctor, those things like ‘reputation’ and ‘accountability’ in the community, because the corporations were solely profit motivated.

Behaviors, marketing practices, standards of care, and the “requirements“ of customers who were about to receive care were suddenly determined by non-doctors with long-distance last names, and reputations, who could hide behind, (and blame the mercenary nature of their behavior on) the “shareholders“.
They say: “I personally would never do this, it is mercenary and extortionist, but “the shareholders“ demand a profit on their stock investments.“

That cop-out has been used since the advent of “corporate“ structure.

Some of us remember when Union Carbide destroyed the lives of tens of thousands of people in Bhopal, India.

The cost cutting and deferred maintenance that led to that disaster; while certainly they were decisions made by a couple of key people, that stained legacy does not follow their family-name and their kids, it ended with the corporation. Their individual unethical and even criminal decisions and poor choices no longer reflect on them morally, but they should.

So, where am I going with this?

Veterinary medicine has taken the same turn, because now, veterinarians are increasingly “employee“ and they get cornered by corporate practice to do things that they may or may not think are “in the best interest of the pet.“
Like mandatory bloodwork before they can attempt a surgery in a terminally ill patient. Two views on all radiology even when the penny is obviously in the stomach or the fracture is non-comminuted-transverse and you’re referring: STILL the extra $100 for the second view.
Essentially, the establishment of ridiculous “minimum database“ items that mandate more spending before an appropriate treatment can be instituted.

This experience that I had while practicing in corporate-medicine sums it up perfectly:

An owner might (did) call up and tell me that their cat had a tapeworm. There is a dewormer that controls *all* intestinal nematodes and cestodes. I could have given the cat that pill, and know “for a fact” that it no longer had an intestinal worm of any kind. That’s far more “certain” than any test!!

However, in that particular corporation, I was unable to even dispense that tablet until I had entered the #SKU for a complete physical exam, and a fecal analysis. Only then, did the dialog box for the tablet open up.

That client, unknowingly, ended up spending at least $75 more than they needed to, because someone in Arizona figured out a way to make veterinarians over-practice, and oversell.

I was ‘done’ with corporate veterinary medicine in less than a year. I’d seen enough.

Veterinary Medicine 2029

Veterinary Medicine of the Future: 2029

In 2029 veterinary medicine will be very different than it is today. In some ways it will be better. In some ways it will be much worse. The “general practitioner” will be gone, so services will be concierge or a la carte from several sources as the market gets fragmented more and more.

  1. To get your shots, (and I know you think I’m kidding) but you’ll be driving to the nearest Autozone parking lot, or Walmart.
  2. Spay & Neuter: Cut rate spay neuter clinics
  3. For a mildly sick dog, you will take him to Walgreen’s, or to Blue Pearl.
  4. For emergencies, Blue Pearl again.
  5. For sick dogs and very sick dogs, you’ll take him to Blue Pearl.

Fact is, Blue Pearl aka Mars Animal Health is going to dominate by 2029 and that’s a VERY bad thing, except they won’t be able to capture the vaccine market from Walmart and Autozone / Waffle House.

And they won’t be doing spays and neuters, either, because for that, you’ll have to drive to a bad part of town and have it done at a “Spay Neuter Clinic” by veterinarians that are, hopefully, licensed to practice in the United States WITHOUT supervision from a US Licensed vet. (Again, you think I’m exaggerating but it’s already happening in Marietta, Georgia.)

So long, family vet.

Within the next 5 to 10 years veterinary medicine will have changed drastically. Or maybe to some people, just a little bit.

By 2029 – A full 99% of veterinarians will be employees. Either as employees of a larger corporation such as Mars Animal Health, or employees in the actual clinics. Meaning, salary expectations for veterinarians will be $50,000-$100,000 less than if you went to school in the ’80s. The number and caliber of applicants to veterinary school will naturally decline in favor of more solvent careers, but that’s OK because most of these veterinarians will be going out into corporate jobs where decision-making isn’t really even in their wheelhouse anymore.

REASON: Corporate veterinary medicine will prevail by year 2029 according to experts, and in corporate veterinary medicine, the veterinarian simply checks off items on an exam, enters bloodwork values into a computer and get a rule out list that specifies what they are to test next. Their diagnostic algorithm is specified as a “minimum database” which excludes things like “instinct ” and valuable “experience“ leaving you in the hands of the corporation that actually programs the diagnostic and therapeutic algorithms that go in the computer.

I recall working for a veterinary corporation wherein I was not even able to choose the suture material I would use to close the skin. We couldn’t even enter a deworming into the computer until we had put in a complete office call at full price, plus a fecal exam. Even though dewormers exist that treat all intestinal parasites.

These veterinary corporations won’t be doing many surgeries, however; because at the same time as they are taking over the role of diagnostic-veterinarian, veterinary surgeries are going down the street to low-cost spay-neuter clinics as if pet overpopulation and roaming animals with a thing anymore. In some metropolitan areas rescue organizations are fighting over dogs that they can rescue. North Shore animal league in Long Island doesn’t have enough animals they fly them in from all over the country (Good on ’em!).

So your 2029 surgical options are likely to be limited to cut-rate employee veterinarians that earned their licenses in the Caribbean, India, can only practice with supervision* in the United States, and/or low-cost spay neuter clinics with substandard cleanliness and surgical gear.

*Tens of thousands of veterinarians from Eastern Bloc countries were out of work after the Berlin wall came down and can’t get licensed in the US. So they’ve come to the US and work as veterinary technicians, and they can perform veterinary surgeries AS LONG AS they’re supervised by a licensed veterinarian, AND the licensed veterinarian puts his or her license on the line for the performance of said surgeries. It’s happening in Marietta GA at low cost spay neuter clinics already.

Let’s say that you would “never use a low-cost spay neuter clinic“… Yes you will, if the more of the public puts the general practitioner out of business on these surgeries leaving mainly low cost spay neuter clinics LOL.

I’m not whining because I’m a one-person practice but in 1999 I was doing 10-12 spays or neuters per full business day and now I do one or two, in 2020. Again, I’ll be FINE. As a one-person practice, I’m payroll-lean. I don’t have 5 veterinarians on payroll leaning on counters waiting for clients.

To make matters worse, the vaccine healthcare discipline is going to stop happening in general practice offices, it’s already going down the street to Waffle House parking lots, real-estate offices (not-kidding)* and festival tents at Pep Boys.

*Proceeds benefit the veterinarian giving the shots. Go figure.

Card-table veterinarians under the auspices of companies like Shot vet, setting up weekend clinics with notoriously subpar recordkeeping, warm and expired vaccine, veterinarians that can’t hold a regular job, but at half the price of the regular veterinarian with a competent staff*, soon your best if not only option for vaccine is going to be in a parking lot.

*At walk-up shot clinics you hold your own animal and examinations are minimal.

Walmart and some of the other big shopping stores are opening minute clinics for veterinary services like lacerations and vomiting. Vaccinations and other veterinary essentials being performed by veterinary employees. You can bet these people really care about what they do on a Walmart salary. Giving shots but having to refer just about everything else. And again, in corporate veterinary medicine you basically do what corporate says, “thinking outside the box” could get the corporation sued, so it is frowned upon. I was literally told “not to do it at all, or check with me first!” by Charles Biersdorf at Petsmart.

If your experience or instincts say skip a step, or use something different, that leaves the corporation open for lawsuits and that is not happening. You will do as they say. I could not abide that and left corporate medicine after nine months there.

“Thinking outside the box” could get the corporation sued, so it is frowned upon. I was literally told “not to do it at all, or check with me first!” by Charles Biersdorf at Petsmart.

Diagnostics, are soon going to come at a very high price because the general practitioner will no longer be brought to bear on a vomiting dog, a dog with seizures, spinal problems or a dog with a significant laceration. Currently, corporations are advertising with items like “laser, CT scan, MRI imaging” not because these items are particularly useful from day-to-day, but they create the image of highly advanced technologies that could be brought to bear to save your pet.

Would you be more inclined to take your pet to a clinic that touts: “Now using the latest in magnetic resonance imaging MRI” or a clinic that says “We can make Xrays”     Seriously. It’s cool. But does it matter? 

So the general practitioner is naturally passed over for these more advanced diagnostics until too late, the client realizes that a $1800 test could have yielded the results the same as a $300 test. Why didn’t they tell you?

With a $100,000 machine to pay for, do you think that diagnostic is going to factor into “every possible case work-up”? You bet!

Veterinary forecast future industry 2029

 

I’m Angry

Hill’s Pet Nutrition is GREAT for homeless pets. (Click)

That’s not what makes me angry.

Hill’s Pet Nutrition saves more animals, FEEDS more homeless animals, DOES MORE for homeless animals than the ASPCA, the fund raising organization that HAS NOTHING TO DO WITH THE SPCA and earned a C-rating with Charitywatch.org.

What you should know about Hill’s Shelter Outreach. CLICK HERE

So, you move around the Interwebs and see all these pathetic ASPCA ads begging for money to feed a homeless dog, and almost NONE of it helps a homeless dog, and absolutely NONE of it goes to ANY SPCA.

ASPCA fraud
This makes me so mad. People think they’re helping actual dogs.

The ASPCA is just riding the emotional coat tails of legitimate, animal-helping SPCA’s.

So, at the end of this article is the story of a woman who has spent 11 years of her life volunteering at the Lousiana SPCA. And you look at what she’s doing, and what they’ve done.

Then you think about all those people sending  money to the ASPCA  — –  BELIEVING that they helped this woman, or those dogs in ANY SMALL WAY – –  but they didn’t. At all.

When you donate to ASPCA all you do is pay for more ads asking for more money. Oh, well they do save dogs from research, farms and bad homes. One at a time, usually. Estimates hold that if the ASPCA spent their budget on actual DOGS, and based on how few strays they save and feed, they would be spending $34,000 per dog.

Hills feeds more than 100,000 homeless dogs EVERY DAY.

Hills pet nutrition has put more than $280 MILLION dollars into feeding homeless dogs!

The ASPCA touches the lives of a ten of thousands of dogs every YEAR. (The lack of an “S” after “ten” wasn’t a typo.*)

Let’s see, that works out to:

13,000 divided by 100,000 x 365 = 0.00036

That calculates out to:

ASPCA benefits per 100K homeless animals: .036%

Hill’s benefits per 100K homeless animals: 99.96%

I’m not making this up. Here’s my reference: https://www.activistfacts.com/organizations/american-society-for-the-prevention-of-cruelty-to-animals-aspca/

So, I’m angry.

The ASPCA is just riding the emotional coat tails of legitimate, animal-helping SPCA’s.

Look at what this woman does: Without a DIME from ASPCA. And seriously consider donating to your LOCAL SPCA instead of that ASPCA sham.

So, how DOES the ASPCA spend the money you give them?

They bankroll high profile animal rescues. It’s “what they do” and it’s good press. They’ll go into a back yard or a bad situation and save an endangered dog from bad owners or caregivers. I get it. That’s really nice. So, do your fundraising based on the hundreds of animals you pull out of harm’s way and don’t imply that you’re benefiting shelter animals or homeless pets.

I think it also bears mentioning how much of the revenue is spent on a decidedly Vegan agenda, and toppling the meat industry. Face it, ASPCA is just a ‘soft’ PETA.

The Two Gallon Fish Bowl: Cool, or Cruel?

Cruel or Cool? The Fish Bowl

The two-gallon fish bowl is ubiquitous in our society and has seen the residence of literally billions of Koi, goldfish and pond fish. I would estimate that almost all of us have had a two-gallon fish bowl. The original fish is usually some hapless Comet Koi, goldfish and pond fish which lives for about a week. The reason it died is that your fish bowl had no filtration system, and therefore no bacteria to reduce the excreted nitrogen from the food it was (over)fed. Ammonia surged and killed the fish. No one knew to test this parameter.

So, you buy a second fish, which lives a week more, then dies of Ammonia poisoning despite water changes.

Eventually, a Comet survives because enough beneficial bacteria have colonized the gravel and plastic-plant to reduce the Nitrogen. You may have fed less frequently by this time as your childhood enthusiasm for Koi, goldfish and pond fish waned.  Roman numerals get confusing as you get out to Beloved Koi, goldfish and pond fish George the XIII

Just as you begin to breathe a sigh of relief that “this one” is going to make it, you buy him a “friend” and you don’t know to do any kind of quarantine. The new one and your old one perish when they get Ich. You use “Ich-Be-Gone” with Formalin, which kills off that little bit of beneficial bacteria on the plant, and you’re into another Cycle when you restock.

After another full cycle and ten more “Georges” you finally get another fish to survive, and you decide that “new friends” are a bad idea. This particular fish actually does fairly well and starts to grow. It eats algae on the sides of the bowl and starts to get kind of big.

Eventually, it gets cramped and the fins start to curl. Cataracts develop when the fish is only four years old and the skin turns pale for lack of real sunlight. The spine begins to curve for lack of space and because of the refined flake food diet. By the time the fish is five years old, it has undergone years of chronic stress due to its own crowding. It’s only grown to be six inches long and finally perishes at the age of five-and-a-half looking like a geriatric specimen.

I am not so rabid as to call for the “outlaw” of the two-gallon fish bowl. In fact, it is not the manufacturer of the fish bowl who has committed the ‘wrong’. It is our responsibility to educate as many people as we can about the proper way to keep Koi, goldfish and pond fish. We can do it with helpful support, not condemning attacks. We can do it with understanding, not intolerance. Folks using fish bowls have not ‘seen the light’ and enjoyed the pleasure of having fish in larger facilities.

Any Allergy Dermatology Case Fixed First Try

I am endorsing this protocol for folks that want immediate results and ultimately, fewer trips to the vet.

Any Allergy Dermatology Case Fixed First Try

It’s a shotgun approach I am seeing engaged by Veterinary Dermatologists in the Atlanta area, followed up with an injection of Cytopoint.

dermatology
About Yogurt and Antibiotics

In some cases it’s as simple as a couple week’s worth of antibiotics and yogurt, followed by Cytopoint.

In other more resistant / stubborn cases, the protocol in this video prevails.

It’s Fast and Foolproof. I didn’t put together these treatments. I’m no genius, I’m copying them from cases coming back from Dermatology Referrals. And following the shotgun up with Cytopoint just makes sense, and is working GREAT!

Any Allergy Dermatology Case Fixed First Try

Why I Have Never Lost a Patient Under Anesthesia

There are only two reasons why I have never lost a patient under anesthetia, and neither of those reasons has anything to do with me being amazing. Anybody could do it.

Why I have never lost a patient under anesthesia.

First, I’m smart enough to know which patients are actually likely to have a problem with anesthesia. Sometimes it’s a gut feeling, but more often it is some obvious medical impact on cardio pulmonary performance, and evident frailty that are instrumental in deciding whether or not I would risk anesthetic or not. So far I have not been wrong*.

The second reason I have never lost a patient under anesthetic is because the anesthetic protocol I use costs 41 times more than the current model of anesthetic in prevalent use in most practices today. 41 times more expensive than what the next veterinarian does. Not twice as expensive. Forty times more expensive. But, I believe that never having to call someone and tell them that their pet had an “anesthetic reaction“ is priceless.

The anesthesia that I use was developed by Dr. David Reeves at the University of Georgia more than 20 years ago, and it is the same today as it was then.

It’s a technology called “balanced neuroleptanalgesia”. It puts together four different injectable anesthetics. The dose is defined by the animals weight, and not the depth of the anesthetic at an any given moment. In other words, adjustments are not made on the fly.

So besides getting an accurate weight on the animal, there is no minute-to-minute judgment call as to whether or not it is going too deep.

But like I said, I am no genius. Perhaps Dr. Reeves is. I’m just smart enough to know when having a specific overhead cost that is 41 times higher than my competition is fiscally “worth it“.

Nothing about the “bottom line“ down at the bank is worth having to call someone and tell them that their pet is not coming home.

I’m not saying cheaper anesthesia is unsafe. I have no basis to say that. I just know that I’ve never lost a patient under anesthesia using Dr Reeve’s protocol and that’s not the statistic on gas anesthesia.

Why I Have Never Lost a Patient Under Anesthesia

Doc Johnson

 

* Sometimes you don’t get to choose your anesthetic candidates. I have had one patient die on the operating table. But not from anesthesia. It was a dog I will never forget. His name was Fatty. Not kidding. He had been hit by a car in the rain. By the time he was brought to me he had pretty much finished up bleeding out his badly shattered spleen and in the process of opening him up and assessing his injuries, he stopped breathing and that was that.

Why Some Doctors Just “Aren’t Feeling It”

Why some doctors are the way they are
Hopefully we all know doctors who followed their bliss and are working with medicine patients and surgery, living the dream.
I don’t think that is the majority.
I am sure that there are 50 reasons why someone would end up being a doctor of some kind.
But I think a lot of doctors are doctors, because their mom said so. That, regardless of what the child’s proclivity might’ve been coming to school, his or her mom said “you’re going to be a doctor or a lawyer! And that’s the end of it”
I really do believe that some of the doctors we see are there because it’s the career that was picked for them By well-meaning parents.

Which brings me to my next point, and that is “bandwagon thinking”
That, anyone who keeps up, anyone engaging modern thought, thinks the same as the majority as they cycle through one fad after another. There is a long list of things that the medical community both human and animal side have latched onto and fervently believe in, because it’s the latest thought.

These days, in both medical professions human and animal, the establishment is the emperor, and the latest “thing“ are the new clothes. And you have to decide where you stand on these issues.

I am 10 years away from the end of my veterinary career, and, I am a practice owner: I don’t have a boss or a company to tell me what I think, so I have less to lose with dissenting thought than my contemporaries. This will become increasingly true as more and more of my contemporaries are merely employees for a corporation that will specify their belief system, preempting the need to form one.
So eventually it won’t matter. “Mob thought” Will be specified in an employee handbook.

Euthanasia at Johnson Vet Services

Here, putting a dog down is done as peacefully as possible.
You can be with them for all of it.
Everything’s done in the exam room. Anyone you want can be there in your family, friends.
When you’re ready, I give a shot of Morphine.
The dog might wince for a second.
Then you give whatever treat(s) you may have brought. Some dogs aren’t eating, which is sad. Other times they can have a big old Brisket Sandwich and not worry about diarrhea tomorrow. Candy. Whatever they like.
Five minutes later they get ‘drunk’ and roll onto their side and go to ‘sleep’ with their eyes half open. Limp as a dishrag. But they’re not “gone”.
I have to give Pentobarbital for that, (the end) so I put them on the table and I give the second shot in the vein, in their arm.
They’re passed out on Morphine so they don’t feel any of that aggravation and arm pinching.
Seconds later, that’s it.
Rarely, a vein is hard to find. Again, they’re unaware of discomfort if I have to find a vein twice.
After they’re gone you can stay a while and think. Pray. Recollect. Get used to the idea that it’s done. Other people are just ready to go and head out immediately. It’s all good. Everyone’s different.
Folks like to book this first thing in the morning at 8 am – so there’s minimal waiting. Or first thing after surgery time, again so there’s no delay for a previous appointment, and some people like the last appointment of the day so it’s really quiet. Whichever you like.
What to do with the remains?
Most people select cremation with ‘no ashes back’ in which case the pet’s sent to the cemetery and we don’t request ashes.
Other times, people want ashes returned and we have them send ashes back to give to you. They can present those in something simple, and something extremely fancy. They have a picture book.
And some people like these little ‘foot prints’ where they make a paw imprint in a piece of soft resin / plaster to keep. It’s a tangible thing that represents the dog, in my opinion better than a lonely looking container of ashes. When it’s home you pop it in the oven and harden it. A lot of people write the name in the clay before they harden it.

Three Foolproof Skin Strategies for Itchy Dogs

Three Foolproof Skin Strategies for Itchy Dogs include antibiotics and a scorched-earth policy using shampoo that eliminates fungus and bacteria. Followed by Cytopoint.

Alternatives include steroids and antibiotics, or even taking your pet to a dermatologist. (In Cobb County half of them don’t require referrals anymore.)

Here’s how these three things can be ‘sure fire’ fixes for your pet’s skin.

Control of Itching ABBREVIATED_drjohnson_com_simpleskin