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Tuesday, March 26, 2013

Skin Problems In Egypt

I love the fact that the Internet allows me to interact with people from around the world.  Here's a question from Nagwa in Egypt.

I am writing to you from Cairo, Egypt. My beloved friend is Lucy a female cat. I found her when she was a few-days-old kitten. She is now about seven years old. Although she is so cute; she aggressively refuses to go the veterinarian because of previous painful experiences. As she was treated from tooth decay and the doctors took off many teeth, in addition to being treated by painful injections from Pus on the uterus.  

Now, her top complaint is in her scalp and hair. I don't know how to describe it, please refer to the attached pictures. Knowing that these pictures were taken about two months ago, it is spreading allover her body now. It was treated before as allergy with no use. I hope that you would be able to help us by these pictures. 

Moreover, she is very aggressive against the other three females I have (I found them on different occasions), and I was forced to keep her in a separate room as she beats them badly. At first, I was able to get her out of the room for several hours daily while keeping the others in another room, but ten months ago I couldn't do this anymore because she sprays everywhere (like males) when she gets out of her room. I know that she is sad for being kept in the room while seeing the other three cats going around, but I can't help it. I try to play with her several times during the day in addition to spending the night with her in the room but she is not happy. 

Would you please advise me what to do? 

I'm not posting the pictures, but Nagwa did include some photos in the email.  One of the big things to consider in this case is that there are often geographic and regional differences in what parasites and diseases are common.  I'll be honest in saying that I have absolutely no idea what may be found in the Middle East, so my answers are going to be limited to my knowledge of feline medicine and diseases in the US.

I hate to say it, but Lucy really does need to be seen by a vet.  The pictures show some shortened hair and what appears to be hair loss on the legs and tail.  While I can speculate on some possibilities, nothing is going to take the place of a vet looking at her and doing some diagnostics.

The first possibility is something simple....fleas.  Here in the US that would be my number one possibility, even for an indoor cat.  However, fleas do better in warm, humid environments and are rarely found in desert areas of America.  So I would imagine that they wouldn't be extremely common in Egypt.

Itching and chewing can also be due to other ectoparasites, such as skin mites and lice.  These can be easily diagnosed by vet and are normally easy to treat.  Lice can be seen with a close exam, but skin mites require a microscopic exam of skin scraping samples.  

The other big possibility would be allergies.  This isn't as simple to diagnose and treat as would be imagined. Allergies can be caused by numerous things, including dust mites, pollen, mold, fleas, and food ingredients.  Nagwa, you said that she was treated for allergies, but there is not one treatment.  For contact allergens treatment may include antihistamines, steroids (injectable or oral), and medicated shampoos.  Food allergies won't typically respond to such medications, and the only real way of handling that situation is a diet trial of two to three months of a specific hypoallergenic diets.  These foods must be fed exclusively with no variation at all.  If all of these possibilities weren't considered or attempted, there are still options to try.

The behavioral issue is another situation entirely.  A possible treatment that doesn't require veterinary prescriptions would be Feliway, a duplication of a pheromone in cats' cheek glands, and a chemical that has been shown to reduce anxiety and stress in the majority of cats.  I have no idea whether or not this would be available in Egypt, but it's easy to find on the Internet so perhaps you could order some internationally, depending on the shopping sites you have access to.  Other than something like Feliway you may have to look at prescription antianxiety drugs such as amitriptyline, fluoxetine, or clomipramine.  These all require a veterinary prescription and will require the vet visit.

I'm not sure if any of this helps, Nagwa, but I appreciate you asking me.  I hope a local vet can give you more answers.

Thursday, March 21, 2013

NO Immunity To Heartworms

Sometimes I just don't know where misinformation comes from.  Especially when it is so far from the truth.

Recently a client brought a new dog to us that they had adopted from a local rescue group.  That group had an information sheet they sent home with all new pet parents.  That's a good idea, but it contained the following statement:   "A puppy has a natural immunity from its mother up to 6 months of age for heartworms."


This is absolutely, positively false.  And it bothers me that an animal rescue group would promote such falsehoods, essentially telling people that they didn't need to start their dogs on heartworm prevention until they were at least six months old.  Sadly I've had a few clients come in from time to time that were told by other people to wait until six months old before using prevention.


Let's briefly review heartworm disease and prevention.  Heartworm larvae are transmitted to a pet by a bite from an infected mosquito.  If the dog is not regularly on preventative medication the larvae will grow and develop into adults within the heart.  Most preventatives are monthly tablets or topicals and need to be given year-round for complete protection.  Dogs are extremely susceptible to heartworm disease and have no natural immunity whatsoever.  Even if they develop antibodies against heartworms, that typically isn't enough to fight them off.  Additionally, mosquitoes do not discriminate based on age.  They will bite a one-day old puppy just a readily as a 10 year old dog.  

A mother dog will pass on some immunity through the milk, granting temporary immunity to the puppies.  However, the mother must first have that immunity herself, so there is none passed on to prevent heartworms.  If a mother is vaccinated properly some of her antibodies will be given to the puppies.  However, those antibodies start to be cleared out of the puppy's body somewhere between six and 16 weeks old.  By four months old there are no maternal antibodies remaining, and they usually decrease even sooner.  We have to give multiple vaccines over a period of time to give the puppy its own protection after the mother's antibodies are gone.  So even if there were antibodies to heartworms passed on from the mother, they certainly wouldn't last six months.  

Part of the "six month" thing may come from the timing of testing.  Heartworms have to be in a dog's body for a minimum of 6-7 months before we can detect them.  The absolute youngest a dog should or can be tested is six months old.  Honestly, parasitologists say that a better testing age is between seven and ten months old.  Any younger than that and we will get a negative test, even if there are heartworms in the dog.  Hearing this recommendation from experts on heartworm disease is also a strong indication that heartworms certainly can be in a dog less than six months old.  I've personally seen dogs test positive at nine months old, meaning that they were infected at younger than three months old.  

So what do you do?  Start your dog on heartworm prevention around 6-8 weeks old.  Never take them off. Have them tested annually.  

I emailed the rescue group, trying to correct their misinformation.  It shouldn't be shocking that I never heard back from them, even though I offered to discuss it further.  So consider this my little way of trying to spread the right information.  Be sure to pass this on to anyone who thinks otherwise.

Wednesday, March 20, 2013

Yvaine Saves The Day

Our two-year-old lab, Yvaine, is a sweetheart and a bit of a coward.  If she hears a noise she'll bark loudly at it and then often squeeze her 65 pound body under our bed.  She is my wife's baby, having been picked out when she was two weeks old.  And yesterday she was a hero.

My wife was in the bedroom working on her laptop.  Yvaine comes into the room barking and acting really strange.  She wouldn't stop barking and wouldn't settle down.  She didn't act really fearful, but also wasn't simply barking at a noise.  So my wife got up to try and figure out what was wrong.  Yvaine went downstairs, still barking and acting restless and odd.  This wasn't even her typical attitude when she heard a noise and my wife couldn't figure it out.

Once downstairs she noticed our other dog, Inara, standing and looking out of our back door.  She was calm and not barking, though was interested in something outside.  My wife went over and started to look outside.  That's when she noticed that the back door wasn't completely shut.  It was closed enough to not appear ajar at first glance, but wouldn't stay closed if pushed against.  Apparently when our son let the dogs outside to use the restroom he didn't close it completely.

Yvaine was still barking behaving strangely.  My wife opened the door, looked outside, and saw one of our cats, Pippin, crouched at the edge of the deck.  He was very obviously freaked out, as he's never been outside.  She picked him up and brought him inside.  Then Yvaine stopped barking.

This is one of those very odd tales that is absolutely true.  Yvaine doesn't normally bark and carry on like this, even with noises.  She had noticed Pippin outside and was apparently really freaked out by this.  She acted this way to alert my wife to the fact that the cat was somewhere he shouldn't be.  I know it's anthromporphising a bit, but it was like Yvaine was saying "Hey, Mom!  Hey!  Um, my buddy's outside and he shouldn't be!  Hey!  Go check on him!  Hey!"  Without the barking my wife may not have noticed the missing cat until he had run off.

Pippin and Yvaine actually are buddies and will sometimes snuggle together.  She was just worried about her kitty friend, and we're glad that she's smart enough to let us know.

Monday, March 18, 2013

Interviewing Your Vet

This weekend I had someone come to our clinic because she wasn't happy with how she was treated at her other vet.  She was trying us out, seeing what I and my staff were like.  That's not unusual, as I get new clients every day.  What surprised me a little was that she wanted to be open about the fact that she was interviewing me, but was also hesitant and embarrassed to say so.  I quickly assured her that this was nothing about which to be ashamed, and I always encourage this kind of behavior.

A relationship with your vet is an important one.  You want to feel like you can completely trust your pet's doctor.  There needs to be comfort in who that vet is, how they will treat you and your family, how they will make decisions, and what their skill level is in various areas.  When it comes time to have to make fast decision about your pet's health, you don't want to have to wonder about or second-guess the doctor.  Clients also want someone with whom they can have a real relationship over time, letting the vet get to know them and their pet.

Everyone should feel comfortable interviewing a new vet.  Recommendations from friends are always good, but you want to check the place out yourself.  Make an actual appointment and pay the initial office visit fee. This will give the doctor dedicated time to talk to you, rather than just popping in and hoping someone is available.  Ask to see their facilities.  As long as everything is clean and there is nothing gross going on, a vet should be very comfortable letting you look behind the scenes.  Ask about the experience of the doctors on staff and ask if any have a particular area of interest, or perhaps things they don't do (for example, I don't do orthopedic surgeries).  Ask about their hours and the services the clinic offers.  Do they do boarding or grooming?  Do they take emergencies?  Where do you call after hours and do they refer to a local emergency clinic?  Do they have specialists they refer people to?  Who can you talk to if there are any problems at the clinic? Above all, just get a feel for the vet and who they are as a person.  In the end it's all about your trust level in that person.

You don't have to reserve these questions for a vet you're just starting to see.  It's also appropriate to ask things like this to a vet you've been seeing for a while.  If a vet isn't willing or able to adequately answer these questions, a red flag should go up in your mind.  You should never be made to feel that questions like the ones above are inappropriate.

Sunday, March 17, 2013

Struggling As A Vet

Katrina emailed me and I wanted to respond publicly because this is a very relevant topic, and one I've touched on a few times before.

I've recently discovered your blog and have been really interested in a lot of your posts, views and opinions. I'm a Canadian studying veterinary medicine in the UK. I came here because it didn't take as long to get qualified (6 years as opposed to 8 years in Canada). I liked the idea of coming straight to vet school after finishing high school and not having to complete an undergrad first. 
I'm currently in my fourth year and to be honest, I'm losing the will to carry on.  
I have wanted to be a veterinarian my whole life and when I first came to vet school, I was bursting with enthusiasm and love for the career.. but over the years I have struggled with the immense stress and pressure associated with a course like this, felt disheartened by the realities of the profession; a very stressful and highly demanding job .. and not to mention discouraged by the current employment prospects for newly graduated vets. 

My final two years ahead of me are going to be the most difficult of them all, and I won't succeed unless my heart is completely in it. 
Right now, I feel like giving up.. but I know I might regret this in the future. 

I was just wondering if you had ever encountered difficulties like this.. and how you managed to pull through? 
Or if perhaps you wish you had gone down a different path and pursued a different career? 
And also.. with your career as a vet, do you have time for yourself, your own interests, your family, etc.. or is much of your life "your job" if you know what I mean? 

Going through veterinary school is one of the toughest things a person can do.  It's physically, mentally, and emotionally draining.  I think many of us have points where we wonder if we can go on and make it through. Somehow most of us do so.  Personally, I don't have any real secret.  I'm just so stubborn that I don't seem to know when to stop.  Often when faced with adversity I stop looking at the long view and just concentrate moment to moment, focusing on putting one foot in front of the other.  That's how I keep going.

When we enter school we do have a certain rosy attitude, filled with hope and idealism.  As we go through we realize that good intentions aren't enough and it takes a lot of hard work.  The closer you get to graduation the more you realize that you're actually going to have to find a way to pay back the loans and somehow make a living.  Reality comes crashing down and that can be discouraging.

All of this was hard enough 16 years ago when I graduated.  I can't imagine having to deal with it now, as the situation is different and far more challenging.  Heck, I get depressed looking at and talking about the prospects for the profession nowadays, and I have a very good, secure job.  

I have dealt with depression many times and for many years, but am finding ways to overcome it.  Part of that is the stubbornness I mentioned.  A large part of it for me is my faith and reliance on God.  I also have a very loving, supporting family that I could not live without.  Everyone needs support structures like this to survive the difficult periods of life.

Have I wished for a different career?  Yes.  Many, many times.  If I had to do it all over again I wouldn't go into veterinary medicine.  My current thinking is that I would get a PhD in History and become a professor.  But I might be disillusioned with that job if I had chosen it, so it's hard to say.  I also have an amazing wife and kids and being a vet has brought me to this point in my life.  If it means giving all of that up I wouldn't change anything, even though I don't always like my profession.  

I've gone back and forth over the years.  At first I loved my job and was excited every day.  Then for years I struggled and got to the point where I dreaded every moment and wanted to quit every day.  Now I've reached an equilibrium where I don't exactly "love" my job, but I'm also comfortable with it and realize I have a great job and am well respected.  I'm at a point where I no longer hate what I do, even if I would like to do something different, and don't have to dread going to work.

Time outside of work?  It's taken me a long time to find the right work-life balance, and I'm still working on it.  One of the revelations for me was that being a vet is what I do, not who I am.  I try not to think about work much once I'm home, and actively carve out time for my family.  It's not easy to do, but more and more vets want to get away from the 60-80 hour work weeks of a generation or two ago where a vet was on call 24/7.  

I'd love to hear insight from my colleagues and even other students on how they overcome these challenges. 

Thursday, March 14, 2013

How "Obamacare" Will Affect Pet Owners

Here in the US the government is in the early stages of starting to implement the Affordable Care Act, more commonly known as "Obamacare" since it was heavily pushed by President Obama.  I'll try to stay mostly politically neutral, but it's no secret that I am socially and politically conservative, so you can probably guess my opinion on this particular piece of legislation.  The idea is that it is supposed to provide more and cheaper access to health care for people who don't normally have health insurance.  This is going to significantly increase costs in the US and will affect all citizens.  In order to help offset some of the costs of health care there are going to be new taxes and charges.  Okay, I understand this even if I disagree with the policy.  What surprised me was recent news of how this will affect the veterinary industry, and how this is a very unintended consequence of the law.

One of the new taxes is a 2.3% excise tax on all medical equipment.  Anything manufactured for the human medical industry is subject to this tax, effectively raising the costs of this equipment by 2.3%.  That cost will be passed on to the consumer, but is supposed to somehow be offset by lower costs elsewhere.  Okay, maybe some will understand that.  But there is a problem.

The tax is applicable to anything made for use in human medicine but not veterinary medicine.  Anything labeled exclusively for veterinary use is excluded and not taxed.  However, there is a lot of equipment we use in this profession that is also used in on humans.  That means that when we order this equipment for use in our veterinary practices we will pay 2.3% more.  And that increased cost will be passed on to the pet owner in the form of increased fees.

This isn't a good thing.  Some reports that I've read say that the costs will be minimal, but the end result is that veterinary care will increase, even if a little bit.  Unlike what is happening with human medical care in the US, the government isn't paying for our pet care.  In fact, the government is taxing pet care, even if unintentionally.  Because of the attempts to fix our broken health care system in people, we are putting more of a pinch on the purses of pet owners, and this may mean that people won't be able to provide their pets the care they need.

There are many unintended consequences here.  I wish the politicians had thought this through better.

Wednesday, March 13, 2013

Do Vets Love Science?

Bonnie sends this in....

My daughter is a sophomore in high school and has wanted to be a vet for some years.  She is getting a taste of honors biology and chemistry and says she doesn't love science (except she does like biology).  She thinks she needs to be a science buff to be a vet. I'm sure many vets loved the science.  But I wonder, do some vets go on to be successful in the field and say they toughed their way through science classes to enjoy/excel at the rest?

Science is obviously important to a veterinarian.  We have to have a strong grounding in various scientific disciplines, especially biology.  But that doesn't mean that we have to love all sciences.  

I'm not sure if the standards have changed, but when I was in my undergraduate pre-vet program I had to have extensive biology courses, a lot of chemistry, and two semesters of physics.  In fact, I had to take so much chemistry that I took one elective chemistry course and qualified for a minor in that field.  Basic physics is necessary because there are certain principles that apply to medicine, especially the equipment, that makes it easier to understand with the proper background.  These are the core sciences that an aspiring veterinarian needs.

While I love science in general, beyond the above disciplines I don't have much interest.  Geology is uninteresting, and I know meteorology mainly through my wife's paranoia about bad weather.  I actually don't even like ecology, even though it's related to biology.  So being a "science buff" isn't necessary.

I graduated with a BS in Biology and a minor in Chemistry.  But that's not even necessary for veterinary school.  Many of my classmates had a degree in Animal Science, which is more focused on the practical aspects of animal management, especially livestock.  In a way, that may be a more appropriate major as I had no experience at all with livestock until vet school, yet my classmates with an Animal Science background had already been exposed to this information and found it easier to remember.

Your daughter needs to keep focused on biology and chemistry, but it's also important to have good communication and writing skills, so don't neglect the English classes.  Math is also important, though don't ask me why calculus is required....I received an A in both semesters in college, but can't tell you exactly what calculus is and certainly don't use it in practice.

Best of luck to her!

Tuesday, March 12, 2013

When A Clinic Comes To A Screeching Halt

It was a busy but otherwise pretty normal day.  We had lots of appointments, routine surgeries, and patients dropped off for minor illnesses and well visits.  Thought it was a little hectic, we were getting through okay and I anticipated being able to get a short lunch break for the first time in over a week.  

I should have known better.  

It started with a hollered "Kain is seizuring in the car!"  Kain is a 120 pound Presa Canario who started having seizures a few months ago.  He is a sweet boy but rather large and strong.  At seven years old we were worried about the seizures, but they were mild and infrequent and all lab tests were normal.  We had elected to not start him on antiseizure medication yet because it only happened a few times.  Until today.

Kain had been seizuring off and on for nearly and hour by the time the owner managed to get him in.  He couldn't walk in on his own and wouldn't stay on the wheeled gurney, so the owner somehow was able to carry Kain into the treatment area.  The dog was scared, breathing heavy, and disoriented.  Everything in our well-planned day came to a grinding, screeching halt.  Three assistants tried to restrain this dog that outweighed at least one of them and was stronger than all of them while a fourth tried to place an intravenous catheter.  Between his struggles and poor positioning this wasn't an easy task.  My associate was trying to get our surgery cart over to him so we could get oxygen up to his face.  That's when we discovered that the tube from the machine wasn't designed to reach all of the way to the ground, something that had never been an issue before.  Putting him on an exam table wasn't an easy prospect given his weight and the fact that he kept trying to struggle and move around.  It was better for him to be on the floor, and easier for us to work on him there.

Out of the six people in the back of the clinic I was the only one not directly involved in the case.  And that's because I thought it was best for me to stay back and not add to the crowd around the dog.  I tried to help from afar, getting drugs and materials, but knew I'd only get in the way if I tried to get in the middle of things. While that many people on one pet may seem excessive, it really did take that many to keep him restrained and allow work to be done.

Unfortunately, that meant that there was nobody available to do the dental cleaning and spay that had yet to go under anesthesia.  And since we only have one anesthesia cart which was being used to give Kain oxygen, it wouldn't have mattered much if someone was free to help me.  So for nearly two hours the team worked on this one dog until we manged to get him controlled, oxygenated, and heavily drugged.  As we reached this point we were finally able to start allowing people to take lunch breaks and could start to concentrate on the remaining procedures.

Of course, by this time we were well into the normal afternoon appointment times.  I had anticipated this happening and had the receptionist start calling to reschedule appointments.  In the end we had to move six different appointments, having gotten about 90 minutes behind, even with us doctors basically skipping lunch.

We're not sure what is going to happen to Kain.  The owner can't afford to take him to a specialist and we don't know if we can control seizures like this easily.  Tomorrow we'll find out how he did overnight and see if he still has some time left before they make a final decision.

This also illustrates how even in a general practice we never know what is going to come through the door and how that will affect us.  Experienced vets and staff know exactly what I'm talking about.  Vet students?  This is your future.  And to pet owners out there who don't work in the field, please understand that if we ask you to reschedule because we had a sudden emergency, we don't do so lightly and we really do have times when we have to drop everything to save a life.

Friday, March 8, 2013

Reconstructing A Face


I enjoy surgery, especially soft tissue.  So when a dog came in with a large mass on his jaw my associate had me take a look to see if I could remove it.  The dog was a sweet, older lab mix, and the mass had started as what appeared to be an insect bite or small puncture.  It grew quickly and didn't respond to antibiotics, so the decision was made to remove it.  By this time the mass had gotten large and was tightly attached to the jaw.  After the exam I decided that I could probably take it off, but it was going to be tricky because there wasn't much loose skin.  This meant that I would have a challenge trying to close the wound I would make.  

Here is the "before" picture.

As you can see, this was a really nasty mass that had eroded through the skin.  It was deep enough that I was worried about having to scrape the bone once I got in there.  For days before the surgery I kept running through my mind how I would put everything back together.  It was a daunting task, but I like a challenge and like this type of surgery.  I wasn't completely sure how it would go until I started cutting.

Here's some intraoperative pictures.  I got a new phone that I'm using to take pictures, and it made this look redder than it actually was.  However, this absolutely was a bloody surgery.

The mass went quite deep, but didn't quite reach the bone.  And you can see that there is a significant gap that I had to pull together.

That's where a bit of creativity comes in.  The skin doesn't stretch enough in this area to get the edges together.  So I cut the corner of the mouth and loosened the tissue so I could advance the skin forward.  To allow for a relatively normal ability to open the mouth I sutured the top of the incision backwards, preserving the anatomy pretty well.  Here is the post-operative appearance.

Not bad!

The dog recovered well and was doing well a the time of the suture removal ten days later.  Unfortunately the case doesn't have a happy ending.  The biopsy report came back as squamous cell carcinoma, an aggressive cancer.  It has a low risk of spreading in dogs, but still isn't a good thing.  A couple of weeks later he came back because he was having difficulty walking in his hind end and seemed possibly painful.  He was placed on pain medications and antiinfalmmatories, but this didn't improve his condition.  Less than a week after the medications he was unable to move his hind end or stand.  When I examined him he seemed to have neurological deficits related to his spine.  I suspected that either there was spread of the cancer to his spine, or a blood clot had lodged in his spinal cord.  Regardless of the cause it wasn't good, and the owner decided to euthanize him.

Even when a surgery goes well the case may not end happy.  Those are the ups and downs of being a veterinarian.

Tuesday, March 5, 2013

Choosing A Vet School

Kerrie sent me this....

I have been accepted to 2 vet schools, Minnesota and UPenn.  Both are out of state so the tuition is the same.  I've been trying to collect people's opinions on how to decide which school to go to.  I've heard some students/recent grads say that all schools provide roughly equal education because they can be so picky with the students they accept, I've heard some say the caseload of the hospital is the most important thing, and I've had others tell me how important the early hands-on experience is.  As someone who has been practicing for quite some time, what things about the school you attended were most beneficial to you once you became a vet?  Are there certain things you wished you learned or were exposed to while in school before you started practicing?

Here are a few examples of things I am comparing, I'm just wondering how much of a difference each makes in the grand scheme of things:

MN has professional development classes in the curriculum and begins clinical skills practicals the first year, whereas UPenn doesn't include professional development as part of the curriculum and hands-on things don't start until the 3rd yr, but there are opportunites to do both early on through clubs and workshops.

MN also claimed to have a higher annual caseload at the teaching hospital (45,000 vs Penn's 30,000).

MN class size for this upcoming year is 100, UPenn's is 125.

UPenn recently built a new hospital, MN is in the process of renovations so the facilities were comparatively dated.

Many students who hope to become vets are happy to get accepted in just one school.  But some are lucky enough to get multiple acceptance letters and then have their choice of schools.  How do you make that choice?

If you talk to the academics, each school will list all of the reasons why you should go there rather than somewhere else.  They'll bring up things like Kerrie mentioned:  case load, new facilities, etc.  There will be points and counter-points about the particulars of a given school's instructors and what they can offer.  Then you have to weed through all of that and make a decision.

As someone about to enter my 16th year in practice, I look at it very differently.  I've also seen many new graduates from virtually every vet school, including some outside of the US.  I take a very practical approach  to the situation, and look at it in the light of whether or not it will make a difference after you've been out a few years.  And in my opinion, it doesn't.

Seriously.  When I'm interviewing a potential hire, which vet school they attended is really only a point of conversation, not something that I really weigh in my decision.  If you're going into general practice, the choice of vet school doesn't matter much.  Sure, you might get some different experiences at one school versus another, but after you've been out a couple of years your practical experience outweighs and evens out what you learned at the university.  

What would I have liked to have more of?  Dentistry and finance.  When I was going through school the former was barely discussed and the latter not at all.  Knowing how to do basic extractions and dental care is something you deal with on a daily basis.  Personal and business fiance is essential to daily life.  Both of these are far more important than learning how to do a total hip replacement or using the most advanced method of radiation therapy.

Due to AVMA accreditation, all schools must meet certain standards, and I honestly don't think graduates from any one school have a particular edge over another.  I graduated from North Carolina State University, which consistently ranks in the top five veterinary colleges in the US.  I don't think I got a better education than anyone else, and don't think I was better prepared than a lower ranked college.

So which do you chose?  In my opinion, chose the cheapest.  Always go in-state if you have that option, as it will be cheaper.  When looking at out-of-state schools pick the least expensive.  The debt load on newly graduated vets is crushing and only getting worse.  The best thing you can do in your career is help yourself out financially.  

When you combine a basic education with practical experience, the knowledge and skills of being a vet will take care of themselves.  And you'll continue to learn as you go along.  I've learned as much in continuing education seminars as I did in school, and in some cases far more.  Pick a school you like, and most importantly, pick a school that will put you in the best financial position.