Videos related to pain management

When I come across an online resource of veterinary information that I find interesting and think others would find useful, I like to share it here! This week, I came across some videos on Vimeo that demonstrate some important concepts in veterinary pain management. Here they are:

1. From Dr. Rick Wall: m. psoas major examination & treatment – As the veterinarian palpates the affected muscle belly (psoas major), you can clearly see from the dog’s reaction that the area is painful and needs treatment. Two patients are demonstrated in this video, a black dog and a boxer with short haircoat/lean figure. Dry-needling is also demonstrated, both with and without sedation. Be sure to watch the whole thing!

2. From Dr. Rick Wall: Feline Hyperesthesia Syndrome – This cat is extremely agitated and uncomfortable due to fleas. You can see by the convulsing that his response is far more intense than one would expect in a typical cat. The veterinarian gave him gabapentin, which modifies how the central nervous system perceives the pain signal, and you can see in the video that his agitation is less severe after receiving it.  [I had trouble embedding the video–click this link to see the video on vimeo.]

3. From Dr. Mark Hocking: Canine pelvic quadrant trigger point examination – Helpful narration explains what is being done and you can clearly see the dog’s response where he’s painful.

If you’re interested in learning more about trigger point examination and pain management in general, I highly recommend you join the IVAPM (International Veterinary Academy of Pain Management)–you will learn so much!!

Another resource I found recently (and it’s free!) is the Yahoo! group: triggerpointvet – you must be a veterinary professional to join, as membership/access is limited.

Do you know of other valuable pain management-related resources others might find helpful? Share them in comments below!

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How veterinary medicine is like pediatric medicine…and how it’s not

Almost daily, I hear pet owners justify their behavior towards their beloved pet by saying, “She’s like my child,” or “He’s my baby!” Does this mean the person thinks their four-legged animal is equivalent to a human child?

I can’t answer that–partly because every situation and relationship is a little different. What I do find intriguing is how similar my job is to that of a pediatrician–with some important differences.

Top 5 List of How Veterinary Medicine is Like Pediatric Medicine

  1. Our patients can’t talk. Both pediatricians and veterinarians must rely on their history-taking and diagnostic skills to achieve a diagnosis. The parents need to be able to give us the information we’re looking for, and they can’t always answer our questions. (Although a pediatrician probably doesn’t hear, “I don’t know, he goes in the backyard” when asked if a child has been having loose stools!)
  2. Our patients don’t understand what we’re saying.  This is hard to accept, but it’s a reality that our patients may be scared out of their mind, and we can’t explain what’s happening to them, or why we have to get a blood sample, or what to expect with a particular test or treatment.
  3. Our patients require a caregiver. Unlike an adult human patient, who you can give instructions to, our patients rely on someone else to follow the doctor’s instructions. Some parents follow the doctor’s instructions to a T
  4. Parents–of any kind–just want reassurance that their baby will be ok. I was reminded blatantly of this when I took my three-month old daughter to the pediatrician with RSV. The nurse practitioner was talking fast about a bunch of stuff that I didn’t fully understand, and all I really wanted to hear was, “She’ll be ok.” I try to remember this when faced with a similarly-anxious pet parent: talk slow and be reassuring (when possible).
  5. As the doctor, be prepared for an interrogation of sorts regarding the why’s, what-if’s, and how-t0’s. Because of all the reasons I just listed above, the parent feels a huge responsibility and wants to be sure he/she understands the situation well enough to do right by their little one.

…and how it’s not:

  1. Due to completely different rules regarding insurance, pet parents are required to pay in full, at the time that services are rendered, which can vary from hundreds to thousands of dollars. That is a hard pill to swallow for the average American family that already has their own health care to pay for.
  2. Ultimately, pets are NOT humans, so no matter how strong the human-animal bond is, there will be some unavoidable differences between a relationship with a pet and owner versus a child and parent. We know the life expectancy when we bring an animal into our lives–we may want it to live as long as we do, but we know that it won’t. We also can’t take the pet with us everywhere we go (usually), like we would a child.
  3. We can’t even begin to compete with the federal assistance programs (social welfare) that are in place to help children in troubled homes. Although many non-profit organizations exist to support the welfare of animals, they are not federally mandated or funded, nor should they be. Animals will always be lower on the totem pole in our society, so it’s an inescapable truth that pets (in a general sense) will never receive the full spectrum of care and support that humans do. But it is thanks to those non-profits that some pets can receive help and support.
  4. Veterinarians see patients through the pets’ entire lifespans, not just the pediatric stage, so we see a wide spectrum of age-related illnesses. Pediatric doctors obviously just see people during their early life stage.

Of course, there are many more reasons and ways that veterinary medicine differs from pediatric medicine. Can you list some?

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It’s never a good time for an emergency…

At vets

Photo credit tamurray5 (flickr)

…but you can make time to prepare for one!

I’m a firm believer that planning for emergencies is one of the most important things anyone can do, for any type of situation! Perhaps I say this because I’m the founder and president of the Johnson County Animal Response Team (JoCART), and have climbed a steep learning curve to understand the ins and outs of disaster preparedness. Or maybe there’s an element of Murphy’s Law at work–if you’re prepared for a worst-case scenario, then it won’t happen!

Regardless, I felt a voice calling me to action this morning after reading a Clinician’s Brief article, Lessons Learned: Breathing Difficulty in a “Well” Cat (April 2012).  (A side note–I really love these Lessons Learned articles that spotlight a case gone wrong and what could have been done differently for a possibly better outcome. What a way to turn a negative into a positive and help others learn!) The article describes how a cat who presented for a wellness visit developed severe dyspnea, became cyanotic, and was euthanized due to a rapidly deteriorating condition. It was truly frightening to read and, like most veterinarians, I found myself wondering, “What would I have done in that situation?”

And with that, I announced to the staff that we would take advantage of this particularly slow morning we were having by running through an emergency scenario.

A short time later, one of the receptionists charged into treatment carrying a cardboard box with a lifeless toy dog inside.

“He’s not breathing!” she said.

“Here,” I said, taking the box from her and setting it on a treatment table. From there, three technicians swooped in and began assisting–one held the lifeless patient in her hands, another wheeled the anesthesia cart over and began administering pure oxygen via face mask, and another started retrieving and recording the items I was requesting. I told the receptionist to escort the imaginary distraught client to our comfort room so we could get to work.

It was hard not to feel at least a little silly “intubating” a stuffed animal, but everyone agreed that going through the motions and thinking through the different possibilities was very valuable. I loved seeing the great team work of our staff in action.

We know that emergencies come in all kinds of varieties, and they never show up at a convenient time, but I am truly grateful that this “Lessons Learned” article spurred us into action on an otherwise sleepy Tuesday morning. The cat featured in the article I read may not have survived, but thanks to the impromptu emergency response training it inspired today, perhaps we will be more ready to save a life tomorrow.

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Coming Full Circle

Almost one year since my last post on this blog, I am returning to writing here. I have thoroughly enjoyed writing blogs for Clinician’s Brief (under the heading The Learning Vet), and will continue to do so, but on more of a quarterly basis. So I thought I would reflect on where this experiment started, where it has taken me, and where I hope to go.

When I started this blog, I wanted to focus my posts on experiences or observations that I felt were educational, either to myself or others. I figured my audience would primarily be veterinarians and students of veterinary medicine. Fearing criticism, or perhaps just disdain from those more knowledgeable and experienced than myself, I chose to write anonymously.

But afterall, this blog is about experiences, new and revisited. Not all of the experiences in my career are clinical in nature. In fact, only a relatively small percentage of them are directly related to the medicine I practice on a daily basis. An overwhelming, and exceedingly important, amount of what I do is all the “in between” stuff–communication, social media, finding life balance, etc. As I return to writing my own blog on my own site, I want to use a broader definition of learning–not just what I learned in veterinary medicine, like how to catheterize a female rabbit or how to spay a bearded dragon, but what I’ve learned about transitioning into a corporate setting at work, why I love AAHA, and even what I’ve learned about just writing itself.

Writing for the Clinician’s Brief blog did two things (at least): 1) I realized I could actually get paid money (not a ton of course, but still!) for writing, a previously foreign concept for me; and 2) putting my experiences and thoughts into writing taught me that I highly value the perspective one can gain by reflection–something I hadn’t really appreciated before. And a third thing: it exposed my identity, thus I open myself to adoration and admonishment alike! An uncomfortable feeling, but I’m along for the ride to see where it takes me!

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Exciting news for TLV readers!

Last week, I received a call from Clinican’s Brief asking me to consider blog writing for them! As you could probably tell from my previous post about Clinician’s Brief, you know I’m a huge fan. So needless to say, it was quite exciting to discuss the prospect of providing blogs for them. I’ve put together about 5 posts that I’ll submit to them, to give them an overview of what my posts would be like, and then I’ll find out if they want me to keep writing for them!

It also means my identity will be shared with anyone who cares to know, although I intend to keep this site relatively anonymous for the time-being. My main reason for this has more to do with my reluctance to risk sounding like I’m self-promoting too much. Not that there’s anything wrong with self-promoting oneself, but it so does not come naturally to me and makes me squirmy and uncomfortable.

On that note, I unknowingly signed myself up for a crash course in leadership and personnel management. For reasons I can’t clearly remember, I agreed to coordinate and organize an open house for our hospital. The event takes place this Saturday. If I don’t have a stroke due to the crushing stress I feel, I’ll be sure to write more about this learning experience in a future post. (Note to self: I’d really like to learn how to not care when people aggressively and offensively complain about the job I’m doing, and how to not care about stepping on people’s toes or feelings when telling them what I expect them to do.)

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What’s the big idea?

Thinking...

Photo Credit: "Thinking" by Klearchos Kapoutsis

Where do ideas come from? Blogging offers the writer an opportunity to explore thoughts and ideas, as I’m doing here. It’s hard to say whether I’ve had more ideas since starting this blog, as I’ve always had a busy mind and am always thinking about fun projects and things I want to do to help others/improve my own skills/network/build ideas. As time goes on, perhaps I will explore some of these ideas I have through this blog (such as my desire to create a student externship program at our hospital; build greater camaraderie amongst  veterinarians through our local VMA–of which I am the current president; my interest in building my speaking skills and possibly offering lectures around the country; and many other smaller (and some much bigger) ideas that like to bounce around in my head).

Many of my ideas stem from the inspiration I feel when reading innovative thoughts and creative processes from others. For example, a pediatric gastroenterologist, Dr. V, has what I find to be a very interesting blog on the human side of medicine called 33 charts. Dr. V is foremost a medical doctor, busy seeing patients all day, but he has a deeply-entrenched interest in social media–much like I do. It was from him that I learned about the concept of “portfolio careers.” As he stated on his blog, in reference to a post from BMJ:

“For the uninitiated, portfolio careers have been known in medicine since at least the 19th century, when Anton Chekhov combined his medical practice with writing plays.”

Ever since I read that, I feel like I’ve been granted this freedom to further explore social media, writing, and video editing.

Dr. V has also introduced me to a previously unknown concept: social health. He posted a lot about SXSW, and I kept thinking, “What does a music and film festival have to do with medicine?” So I explored his posts, one thing led to another, and now I have a totally new area of interest.

Other seemingly random sources of inspiration that have absolutely nothing to do with veterinary medicine keep cropping up.

  • @Jessedee’s Slideshare Presentions – “I make presentations that don’t suck.” I didn’t think I cared about SXSW, but the online presentations he’s made available documenting his experience day-by-day were so captivating, amusing, and innovative, I couldn’t stop clicking. Before I knew it, I’d spent an hour looking at a variety of his presentations. I felt totally inspired.
  • Chris Brogan: Chris’ blog is heavily social media-oriented, but he also talks about how to be successful at writing, at business, and at life. I love the diversity, as it carries a surprisingly universal message. He also offers a list of Blog Topic Ideas, which can be adapted for almost any sort of blog.

There’s so much to be learned from others. Whether it’s related to vet med or not, I love playing connect the dots and see what kind of picture comes up. Ultimately, I’ve come to realize that my ideas are like little children born out of my brain. I want to nurture them, help them grow, and perhaps send them off on their own when, or if, they become self-sustaining. Not all of them survive, but I love each and every one of them.

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Do you know what Dog Leggs are?

I decided to try something at the conference–I conducted a video interview (of sorts). I got this idea from a tip I read on SocialMediaExaminer.com (see tip #5). Ok, I didn’t hire a videographer, and I only interviewed two people, but I’m just getting my feet wet.

So I bring you my minimally-edited, difficult-to-hear-due-to-background-noise “interview” of Lisa Fair, a representative for DogLeggs. One of the reasons I chose DogLeggs for one of my only two interviews is because I love how innovative and practical their products are. There are a lot of things they don’t teach you in vet school, and how to treat hygromas and dropped hocks are just two examples of why I love the DogLeggs products. They have a bunch of other products to help a variety of limb-related injuries (and other things) in dogs and cats, but they also accept custom orders for just about anything you can imagine.

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