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Saturday, February 28, 2015

A New Way Of Veterinary Education

In one of my recent journals I was intrigued by an article entitled "Urgently rethinking the way we teach veterinary medicine".  The premise behind the article is that our current method of developing new veterinarians needs an overhaul and isn't the best way it can be in the 21st century.  I have to say that I agree with many of the points made, and I want to discuss them.  I'll present a quote from the article, then my own thoughts.
"Students are still taught predominantly using centuries-old methods that make them passive recipients rather than active seekers of knowledge—the most common format is a professor standing in front of a group of students and talking...........Colleges are beginning to address the situation by converting lectures to seminars and workshops—the so-called “flipped” classroom in which students assume active leadership roles and faculty serve as coaches. This way, students also learn communication and negotiation skills. This is an exemplary model for training future professionals."
This is one of the points where I'm a bit skeptical, but it's probably my own personal bias.  I think I learn better by attending a lecture and then learning how to apply it.  I think I'd get a bit lost if there was a lack of structure in the classroom.  However, I know that many people with extensive training in teaching methods do advocate this particular way of learning.  I don't think that attending a lecture means that someone isn't an "active seeker of knowledge", so I do take exception with that comment.  Perhaps more of a blended method would bring the best of both styles into the educational system.
"A strong prior academic record is a good indicator of success in the veterinary curriculum, but it is not necessarily an accurate predictor of career success. To effectively assess students’ life-skills, admission interviews need to be mandatory and include comprehensive evaluation of communication skills, interpersonal behavior, creativity and leadership potential. Merit should be given to applicants with a broad range of experiences, both academic and extramural, and formulated prerequisites should be minimal."
I really agree with this point.  When I was applying for vet school I had to go through an interview, and I have to say that I completely nailed it.  I know that many schools have gotten away from this particular admission requirement, probably because it takes time and is more subjective.  But many people who get into and through vet school have the personality of a wet paper bag and virtually no social skills.  It's a bit harsh to phrase it that way, but I can think of many examples in my own class at vet school.  One in particular was a straight-A student, but nobody liked her and she just didn't seem to know how to handle herself in social situations.  I absolutely agree that veterinary students need to be screened for personality and communication skills, not just academic performance.  No matter how smart someone is, if they don't have good interpersonal skills they won't be very successful in their career.
"There is no reason why six-year, European-style veterinary education could not be successful in North America. One approach would be to admit students to a four-year veterinary program after two years of appropriate undergraduate education....Students benefit from reduced tuition and out-of-pocket costs, smaller debt loads, and opportunities to earn income two years earlier."
I'm a big believer in job training, no matter what the job someone wants.  As much as I value my education, I think there has become too much emphasis on a college degree as a measure of competency, when it really doesn't say much about a person's chances for career success.  I've seen too many academics in veterinary medicine insist on the importance of scientific training and development of students, seemingly over basic job performance skills.  Medicine absolutely involves science, and any doctor needs to be able to understand the scientific process, critically analyze studies, and be aware of advancements in the field.  But understanding all of this is different than being a scientist.  Let's be perfectly honest.  Some veterinary students will go into academia and research, but the vast majority just want to work as a doctor.  Most vet students want career training, not scientific training.  They want to be good at practical medicine, not learn how to conduct the latest research.  Personally I see nothing wrong with that!  By de-emphasizing the need for a 3-4 year degree before even getting into vet school we go to a more streamlined system that will help significantly decrease the debt load of new vets.  Considering that this debt is one of the single biggest crises in the veterinary field today, this could be a good solution to the problem.  It works well in many European schools, and I see no reason why it wouldn't work in the US.  The only people I see opposing this are those entrenched in the academic "ivory towers", most of whom have no idea what the real world of veterinary medicine is like.
"Biomedical faculty’s job is to help create competent future veterinarians, not biomedical scientists......Some medical schools have introduced a “clinical immersion” approach, which teaches basic medical science through the solving of clinical problems—for example, one learns practical anatomy and physiology from a patient, not a book."
The first sentence goes back to what I was talking about above.  We need to be turning out great vets, not necessarilly great scientists.  There is a big difference between the two.  Practical teaching is a great way to make book learning stick.  Now, we already do this to a degree during school.  When I was in first year anatomy class we would have cadavers from which we learned anatomy, as well as examining live greyhounds and livestock to make the jump from book to reality.  An extension of this idea is becoming more popular in vet schools, especially the newest ones.  These schools are trading typical classrooms for more clinical, hands-on learning.  There is some merit to this direction, though again I don't think a lecture setting should be completely eliminated.
"Perhaps the biggest effect of technology on the veterinary curriculum may be the growth of online coursework. “Education without borders”—any place, any time—is an apt metaphor for 21st-century learning. In medical education, so-called blended learning (which integrates online and onsite teaching) will become more common as it combines the advantages of both. Veterinary students will increasingly enroll online in courses outside their home campus, which will provide education in areas where the college has limited expertise and expand their options for focused electives."
Education is changing because of technology.  Veterinary medicine needs to follow it.  In the early 21st century online teaching is much more commonplace, and can allow interaction with specialists and educators that are far from the college campus.  This broadens and enhance the educational process. However, none of this takes the place of face-to-face interaction with instructors.  I've taught at the college level, both in the classroom as well as online.  My online students had more struggles and there was less ability for me to help them one-on-one.  I don't think we should ever get rid of that teacher-student interaction, as it's best for both parties.  However, integrating technology as a way to enhance the process is a great idea.
"Training for clinical competency without imparting a keen understanding of the economic ramifications of that training is weak at best and disastrous at worst. Veterinary students are often the victims of their emotional expectations of a career in veterinary medicine, and this fiscally impaired vision can make them easy prey to financial institutions eager to lend them money. The enormous debt load carried by growing numbers of students is the principal factor keeping them from a satisfactory lifestyle, home ownership and practice ownership."
I've been encouraged to see more veterinary colleges providing financial training and advising to the students.  This is something that wasn't emphasized when I was in school in the late '90s, and I think that has contributed to the financial challenges many vets face.  Too many vets graduate without really understanding their financial situation, and fewer still have the training to manage or own a small business.  Fiscal training is essential to the success of new vets.
Overall I found the points made by the authors to be interesting and refreshing.  But my cynical side doesn't see too many changes happening in the near future.  The problem is we have many entrenched academics who learned the process in the late 20th century, before even the Internet was widespread.  I see many (but not all) of these people being resistant to change.  But if we're going to give the best education and changes to new veterinarians, we need to make some changes in the process.

Wednesday, February 25, 2015

Drop Off One Dog, Pick Up Two

Last week something rather surprising happened at my clinic.  A client had dropped off her dog for routine vaccinations, lab tests, and checkup and had planned on picking her up in the afternoon.  All of that went fine and I called her to let her know that the dog was ready to go home and had no health concerns.  Let's call her Mrs. Saint and her dog Sophie.
The owner came in after work, around 5:00 pm.  At the same time a new client brought in a four month old puppy that they were going to have to get rid of.  They were planning on only doing an exam before trying to find her a new home.  This dog was emaciated!  Her ribs and spine were prominent and she was just skin and bones, so let's call her Twig.  They had had her for two months, and I couldn't believe how skinny she was.
Mrs. Saint was there to pick up Sophie and was standing at the front desk when the skinny dog was being checked in.  Overhearing that they needed a new home and seeing her condition, she immediately offered to take the dog.  The other people jumped at the chance, and right then and there Twig changed families.
We examined Twig, gave her a dewormer and vaccines, and determined that other than being extremely skinny she wasn't in bad health.   She was shy and rather reserved, but she was just going through a complete lifestyle change and didn't even know that she would be spending that night in a new home.
As Mrs. Saint was checking out with Twig we brought Sophie out.  This was the first meeting of the dogs and Sophie took it in stride.  However, I don't think she knew exactly what was going on and probably thought it was just another dog in our lobby.  I wonder what was going through her mind as she got into the car with this strange dog!
I've had clients adopt strays, but I've never had it happen right there in my lobby.  I was extremely impressed and awed by Mrs. Saint, and told her so.  She had my admiration for taking a new dog who was obviously malnourished, all without calling her husband or giving it much thought.  Twig was in a bad situation and needed a new home.  Mrs. Saint just couldn't let that go and will be giving Twig a spectacular home.  She started the morning with one dog and ended the day with two.
Faith in humanity restored!

Sunday, February 22, 2015

Employment Prospects For Veterinarians

In this blog I've often discussed the current rather bleak job outlook for recent veterinary graduates.  Each year new vets are accumulating more debt while the starting salaries have been stagnant or even decreasing.  What hasn't been discussed as much is the employment and underemployment status of the profession.  Prior to recent data I had only seen one study that showed the unemployment rate gradually going up.  But a 2014 study by the American Veterinary Medical Association (AVMA) shows some differences.
The study sent surveys to over 8000 veterinarians and received just under 2000 responses.  The good news is that the current unemployment rate in the profession sits at around 3.4%.  This is far lower than the national unemployment rate (no matter how you measure it), and is encouraging.  This means that finding a job as a vet is much easier than the general populace and comparing to other professions.
However, this one number doesn't tell the entire story.  And this is where it gets a little more complicated.  Of the vets surveyed, 14.5% are "underemployed", indicating that they want to work more hours per week for increased compensation.  Where it gets tricky is that 20% of the respondents say that they want to work fewer hours.  The underemployed group wants to work an average of 12.2 more hours per week, while the other group wants to work 12.7 hours less.  There is also a clear gender bias, with females overwhelmingly wanting to work the lighter schedule and males (especially more recent graduates) wanting to work more.  While the study didn't look at the reasons for the data, I would suspect that women want to eventually have families and balance children with work, which often necessitates less work hours per week.  Since men don't tend to be the primary child caregivers at home, they don't need to work less.
According ot the study here's the other good news...the number of vets who want to work less exceeds those who want to work more.  This means that about 2,000 new veterinarians could be employed to balance the difference.  Good news for those seeking jobs!
All of these statistics are encouraging and show that most vets who want jobs will get one.  But that's a rather broad statement.  It still doesn't do anything about the huge debt load that goes into getting the degree, or the relatively low starting salaries.  It also doesn't guarantee that you'll get the exact job you want.  So even though I think the news from the study is overall very positive, I wouldn't recommend ignoring the debt-to-income ratio and would still be very aware of these issues when considering becoming a vet.

Thursday, February 19, 2015

Rabies Testing--A Gruesome Job

Rabies is a serious, scary disease.  We have done a great job of significantly reducing the number of cases in the US through extensive, legally mandated vaccination programs, but we haven't eliminated it.  Nowadays most vets and virtually every American will go their entire lives without seeing a case or being exposed to it.  That rarity has the potential to breed complacency about the disease and risks.
A couple of weeks ago a young puppy was rushed in for odd neurological signs that had started the night before.  We had just seen him two days prior to that for a routine checkup and vaccinations, and he had been fine at the time.  His history was a bit "sketchy".  The owners had gotten him from someone through a Craig's List add, and the mother had died (the new owner didn't know how or why).  So there were some questions about his background and environment that couldn't be answered.
When he came in it was quickly obvious that he was having some kind of seizure activity.  It wouldn't resolve without IV medications, and even then he had one break-through seizure.  He was salivating heavily, wouldn't swallow, and was having some kind of severe neurological disorder.  The owner said that there was no toxin or medication exposure, so the origin of the seizures was mysterious, especially given the severity.  Due to the costs in stabilizing and treating, as well as the strong possibility of something that might not be treatable, the owner elected euthanasia.
When we're in vet school we are told to treat every neurological case as possible rabies until proven otherwise.  The vast majority of those cases will not be rabies, but we take appropriate precautions just to be safe.  Rabies is an incurable disease that causes severe, permanent brain damage.  Any animal or person who contracts it will in all likelihood die, and if they somehow live they will probably be in a vegetative state.  It is transmitted through bodily fluids, primarilly saliva, and can pentrate through any wound, abrasion, or mucous membrane.  Because of the severity and incurable nature we are very careful about human exposure.  This is also why the vaccine is legally mandated in every state, and why most countries are so careful about importing animals.
The chances of this puppy having rabies were very low, but not impossible.  The symptoms certainly could fit, and the questionable background wouldn't allow us to rule out prior exposure.  Due to the fact that there was human exposure and the owner had children, I made the decision to be absolutely certain and have the puppy tested for rabies.
Unforunately there is only one way to definitively test for it.  Brain tissue needs to be examined for the virus.  So there is no way to confirm or rule out rabies in a living animal.  We have to get to the brain.
This is one of the worst jobs I've had to do, and I've had to do it several times over my career.  Laboratories won't accept an entire corpse, so we have to submit only the head.  This means that we have to cut off the head.  Putting it bluntly, we have to decapitate the animal.  I can't think of a more gruesome procedure, and when I've had to do it I'm typically more subdued than normal.  I can perform a necropsy without problem and while still cracking jokes, finding the appearance of the internal organs interesting as I search for causes of disease and death.  But there is something psychologically different about having to separare the head from the body, and I try not to look at the animal's face or think too much about what I'm doing.  It's absolutely necessary to do, as part of our oath as veterinarians is to protect the public health, so I can't ignore the risks of disease transmission to families, my staff, or myself.
Thankfully the test came back negative.  We still don't know what caused the problems, but we do know that it wasn't something as serious as rabies.

Monday, February 16, 2015

Would You Eat Dog Or Cat?

My staff and I engaged in an interesting discussion recently.  Would one of us eat dog or cat meat?  Most people said no.  I said yes.
This may seem very surprising to many people.  How could I as a small animal veterinarian bring myself to eat the very patients that I treat?  Isn't that unethical and inhumane?  Let me take some time to explain my thoughts on this matter.
I'm not a vegetarian.  Not even close.  I've often joked that I'm a strict carnivore.  To be truthful, I don't eat as many veggies and fruits as I should.  I really do love the taste of most meats, and think they're perfectly fine to eat.  I simply couldn't survive as a vegetarian because I don't like the taste of most vegetables.  Yes, I know there are numerous health benefits to eating more of these foods and I'm not on a balanced diet without them.  But I've learned to live with this and make the best and healthiest choices I can given my taste preferences.
What meats someone eats and doesn't eat is completely cultural.  I don't think there is anything inherently immoral about eating any kind of animal meat, no matter what the species (other than humans, of course).  The shock or revulsion only comes when it goes against cultural norms, and that differs greatly from one culture to another.  What is repugnant to one culture is normal to another. 
There are numerous examples we can use.  Pig meat is not allowed by Jews and Muslims, yet ham, pork chops, and bacon are well received by most of western society.  Many Americans have tried to outlaw export of horses if they are used as meat sources, yet horse is considered a delicacy in Europe.  Hindus would never eat cattle, yet hamburgers and steaks are incredibly common in America, where you can find just about any fast food joint serving some kind of beef.  In much of South America guinea pigs are routinely eaten and there are even festivals around this practice, yet they are considered pets in America.  I know someone who raises rabbits as a family meat source, yet that doesn't bother me as someone with four pet rabbits.  Even within a country there are differences, such as pickled pigs' feet being eaten in the southern states of the US, while much of the rest of the country would whole-heartedly reject this food.  In my life I have eaten chicken, turkey, duck, beef, pork, lamb, ostrich, bison, snail, squid, rattlesnake, frog, aligator, shrimp, lobster, clam, and several kinds of fish.  If I took that list around the world I'd easily find countries where at least one of the ingredients was against the local culture and custom.
So that brings us back to dog and cat.  No, I could never cook up and eat one of my patients or one of my own pets.  There is an emotional bond in these cases and it would be like eating a family member.  But that bond isn't unique to what we in Western culture consider pets.  I've seen people have the same kind of attachment to pigs, cows, horses, chickens, ducks, and just about every other animal.  If an animal was someone's pet and I knew that, I don't think I could eat it under normal circumstances (other than during a zombie apocalypse, and then all bets are off).
That then begs the question "What is the difference between a 'pet' and an 'animal'?"  To me, a pet is an animal that someone keeps for purely emotional reasons and with whom they have an emotional bond to that particular individual (as opposed to the species).  So all pets are animals, but not all animals are pets.  And as far as I'm concerned, any non-pet animal is fair game for the food table.
Also, being a vet really doesn't play into the situation.  All animals used in food production are supervised at some point by a veterinarian.  In fact, some vets spend their entire careers working with poultry, swine, beef cattle, and so on.  Those vets don't have an issue with eating a sausage biscuit before going to the hog pens or coming home from work to some fresh fried chicken.  We know that these animals are being used purely for food, and that they exist for no other purpose.  Our job is to make sure they are healthy and treated as humanely as possible until they are killed and turned into food products.  It's really easy for most of us to realize that this is a living creature that one day will sit in someone's stomach.  I know that may sound very harsh, but I'm practical and a realist.  This should only come as a surprise to anyone who really hasn't thought through how meat ends up in the grocery stores.
If I was in a foreign country and my host offered a dish of dog or cat meat, I would consider eating it.  I'd think about it a lot more than if it was a meat I had eaten in the past, but I wouldn't inherently turn my nose up at it.

Friday, February 13, 2015

Don't Let Them Urinate!

Here's a big pet peeve that vets have.  A dog is scheduled for an appointment for abnormal urinating.  When the client brings the dog in they let them urinate in the parking area before bringing the pet inside for its appoitnment.  Then when we try to collect a sample for analysis the dog is empty and can't provide one.
To me it seems like common sense that if your pet is having difficulties urinating or the urine looks abnormal that the vet will want to perform a urinalysis to see if there is an infection, bladder stones, or other problems.  If your dog is allowed to urinate just before being seen, then there isn't any urine to analyze.  Maybe that's just me and it's not so obvious to most people. 
Many things can cause a change in frequency of urinating, urine apperance, and other abnormal bathroom habits.  While we may have some suspicions based on an exam, there is no way to tell for certain without performing tests on the urine.  We can identify infections, suspect diabetes, analyze part of kidney functions, and get a hint about bladder stones with a simple urinalysis.  In fact, we're usually hesitant to prescribe antibiotics for frequent urinating because we've all see cases where it's due to something other than an infection.
And if we can't get urine, we can't run these tests.  This may mean keeping the dog in the clinic for several hours to allow them to build up more urine, or even getting it in the next day.  Sometimes the only option is to have the owner collect a fresh urine sample and drop it off.  In any of these cases it can be frustrating to the owner because we can't make an immediate diagnosis and start treatment.
If you're a pet owner and your dog or cat is scheduled to see the vet for urinary problems, please do yourself and the doctor a favor.  Do everything you can to keep your pet from urinating for at least several hours before the appointment.

Tuesday, February 10, 2015

No Rest For The Sick Or Weary

Being a vet is a pretty demanding job.  It's worse when you're not feeling good.  And it's really difficult to get a day off.
I've been sick off and on for the last six weeks.  It started as a cold around Christmas that turned into bronchitis.  As I got over that I developed a different virus, this time affecting my sinuses.  I've been taking high doses of vitamin C and have been trying to get rest and drink lots of fluids.  What I've really needed was to have several days off where I'm not doing anything and simply taking it easy.  Unfortunately, that's easier said than done.
The veterinarian isn't the only important person in a practice.  I couldn't work effectively if not for my techs and receptionists.  However, if one of them calls in sick we can usually call another person in or find some way to pick up the duties among the people there that day.  The day goes on and we continue to see patients normally.  But if I or one of my associates calls in sick we can't easily find a last-minute replacement.  If we're down a tech or receptionist it's stressful and reduces our efficiency.  If a vet calls out we can't see patients.  If we're not seeing patients then sick pets are going untreated as well as our business takes a small hit to the bottom line.
This means that most vets come in to work unless they have one foot in the grave.  I'll only call out if I'm having profuse vomiting or running a fever.  In just about every other circumstance I'm pushing through the illness and loading myself up on cold medicine in order to make it through the day.  I also try to avoid direct contact with clients (such as shaking hands) in order to minimize the spread of my illness.
There are many days when I and the other doctors in my practice continue to work when we'd tell one of our staff to go home.  I hate this reality, but it doesn't change the fact that it's not easy for us to simply decide that we're sick and want to stay in bed.  In fact, I think I've done that one time in 18 years in practice. 
So if you go to your vet and they are less energetic than normal or are moving and thinking slower than you're used to seeing, be patient with them.  They are probably working while sick and doing the best that they can to keep your pets healthy.

Saturday, February 7, 2015

Spammers Are Horrible! Especially Liama Jhons!

Pardon me while I rant for a bit. 
Over the years my blog has developed a small following, and currently I average about 40,000 hits per month.  To me that's pretty cool, as I never expected to have a world-wide reach and dedicated readers.  But with the success comes a down side.....spammers.

Multiple times per week I get "spam" comments, and often multiple times per day.  Virtually every one of these posts contain a link to an outside website, and it's obvious that the person isn't really commenting on my writing.  Occasionally I'll get a post linking to a website having nothing to do with animals, such as a human hairloss site after I post about skin problems in dogs.  But most of the comments are related to the veterinary field, especially private veterinary practices.  From what I've been able to learn, it seems that the people making these comments are involved in Search Engine Optimization (SEO).  For those who don't understand that principle, it's basically a way to drive traffic to a website and increase its presence on search engines like Google and Bing.  If the SEO person puts a link in the comment, it gets that site's "presence" more on the Internet, and may cause some people to click on the link and go to their client's website.

I don't think most private veterinarians realize this is happening.  Several years ago I ended up actually calling and talking to a practice owner after someone repeatedly and annoyingly posted spam comments.  He was surprised and upset, and very apologetic.  He and others pay a company to increase their practices website recognition, and one method is to make these spam posts.

The rampant spamming is the main reason why I now moderate each and every comment that was made.  I hate having to do so, but if I allowed all comments to be published the problem would be even worse.  What frustrates me is that the people making these posts don't even bother to read the statement just above the comment box where I explicitly state that their post won't be published and they're wasting their time.  They do it anyway!  I can't believe how ignorant and hopeless these people are.

Here are some examples of the kinds of comments I get from these people.  You'll notice that they're very generic and I can promise you that they don't relate to the blog entry.  Each one of these had a link to another web site related to pet care or a veterinary practice, or even a non-veterinary site.

you are just too cool.  i really feel great to see such kind of outstanding stuff.

outstanding stuff.  i just really don't have words to explain my feelings.  please do have a looks into i.

Nice post.  Thanks for sharing this blog.  For any pet health issue I have recommend a well pet care specialist in Vista city, located in California.  This is the best Veterinary Practitioners in California.

it is too good too much impressive.  just simply loving it

Nice Post thanks for sharing information about hair loss and prevention tips more helpful for other persons.  Hair Transplant in Bangalore

After a few blog posts on your website now, and I truly like your way of blogging about Scrubs Inc.

This is an interesting blog that you have posted, you shares a lot of things about Puppy Dental Care, Basic Puppy Training and Dog Vaccinations UK.  Which are very informative to us  (This one I've had in the comments more than once, with no change in the wording).

Some of the posts start out seeming to be related to the blog entry, but quickly become generic and then have a link to a business at the end.  No matter how they state it, it's obvious to me that the ONLY reason for their post is to promote the website.  And I'm not going to allow my comment boxes to be filled up with stupid spam. 

Probably the single worst spammer is a person named Liama Jhons, who has a pet care website.  Yes, I'm calling out this person by their real name because they have been such a headache to me.  No, I won't post their website and I strongly discourage anyone from going there simply because of what an annoyance this person is.  I get comments from Liama just about every week, often more than once in a week, all rather nonsensical with a link to their website.  Liama has made more spam comments than any other person in the 6 1/2 year history of my blog.  It got to the point where I found their Google Plus profile and wrote them, asking it to stop.  I've now written a total of four times and have never received a response.  I've reported them for spam through the G+ system twice, and will probably do so again.  Despite all of these attempts to politely and not-so-politely ask them to stop making these comments, nothing has changed.  To me this means that not only are they ignorant beyond hope of redemption (ignoring my messages and the statement above the comments that I won't allow their comments to publish), but they are very deliberately ignoring me and are heartless enough that they simply don't care what anyone thinks about them.  Liama's only focus is to drive people to their website, and they don't care how they do it.  Maybe a little public shaming will help.  But I doubt it.

I know that my little rant won't make much of a difference, and these spammers will continue to try and make posts.  In fact, I will find it extremely ironic and not surprising if one comments on this blog post.


Wednesday, February 4, 2015

This Is Why She Can't Swallow

**WARNING** Mildly graphic images of surgery.......proceed at your own discretion. 

Recently one of my associate doctors saw an elderly lab mix because she was drooling and was having difficulty swallowing.  She couldn't eat well and the owner couldn't figure out why.  On the initial exam a mass was noted far back on the base of the tongue, but my associate couldn't determine whether or not it was an abscess, inflammatory lesion, or tumor.  The dog was placed on antibiotics and initially seemed to improve, but then worsened again.  The growth was so far back in the throat that it was difficult to see the full extent.  She was scheduled for a day when I was in so that she could be anesthetized, the mouth more fully examined, and a biopsy sample taken.

When I first examined the dog I had a hard time seeing much in the mouth.  She was actively resisting me, making it difficult to get a good look at that part of the tongue.  There was no way I was going to be able to really know what we were dealing with until she was unconscious.

We induced anesthesia and I opened the mouth to intubate her and look down the throat.  This is what I saw.

When I pulled on the tongue a little more it made the mass more visible.

No wonder she couldn't swallow food!  This was growing from the very back of her tongue, essentially down in the throat.  It was big enough that it was blocking the back of her throat, allowing very little to pass by it. 

I was very concerned, because as large as it was and in that location it was essentially inoperable.  It covered enough of the surface of the tongue that I wouldn't really be able to remove enough without taking a considerable amount of the tongue with it.  But as I felt around and examined it I realized that it looked worse than it really was.  There was a surprisingly narrow stalk growing from the surface of the tongue and then the mass bloomed outwards kind of like the structure of a mushroom.  In fact, it was narrow enough that I thought I'd be able to remove the whole thing with minimal damage to the tongue itself!

After a quick call to discuss the new findings, the owner agreed to let me try and take it off completely.  Here's what it looked like just prior to surgery.

And just after I removed the mass.

It appeared to be growing superficially and didn't obviously penetrate deep into the muscle of the organ.  I was able to get a small distance around the base, though I couldn't get the 2 cm margins that we ideally want when removing an unknown tumor.  The tissues came together nicely and the bleeding stopped quickly.  Here is what it looked like immediately after surgery was completed.

Here's a better look at the tumor itself post-operatively.  The whole thing was about 5 cm in diameter.

This is the underside of the mass, with the calipers showing the diameter of the tissue I actually removed.  The stalk itself was only about 1 cm wide, about 20% of the total size of the mass.

The dog recovered well and went home that night.  We talked to the owner the following morning to check on her, and they said that she ate like crazy that night.  Even with the soreness of the tongue, she was finally able to pass food down her throat!

The biopsy report came back as malignant melanoma, which I had strongly suspected based on its appearance. Thankfully the surgical margins were clean and there was no evidence of invasion into lymph tissue, so we may get lucky and not have any recurrence.

Sunday, February 1, 2015

Apparently S.H.I.E.L.D. IDs Are Valid

Any regular reader will quickly learn that I'm quite the geek.  Just search my blog for the terms "cosplay" or "DragonCon" and you'll learn just how deep down the rabbit hole I go.  Last year when Captain America: The Winter Soldier came out in theaters there was a promotion on Cafe Press for a custom S.H.I.E.L.D. identification card.  For those who don't know, this is the spy organization from Marvel Comics and has played a prominent role in most of the Marvel Studios movies, including spawning a TV show.  Originally it stood for "Strategic Headquarters, International Espionage, Law-Enforcement Division", but was changed to "Strategic Hazard Intervention Espionage Logistics Directorate".  To further confuse things, those are from the comics and the movie universe uses "Strategic Homeland Intervention, Enforcement and Logistics Division".  No matter what it spells out, S.H.I.E.L.D. is an uber-cool group of secret agents going toe-to-toe with some of the most powerful superheroes and supervillains in comics.  And I was excited to be a card-carrying operative!

The card was free and I just had to pay shipping charges.  It cost less than $5 to get four cards, one for each member of the family, and it was cool to be able to load a photo, chose a role within the organization, and wait for it to come.  It wasn't a flimsy laminated piece of paper, but a direct printed hard plastic card, like any ID card.  Honestly it was a great value and of surprisingly high quality.  Of course I put it in my wallet, right in the window where my driver's license is supposed to go.

I thought it was just neat to have it.  But one time we were shopping and the cashier asked to see my ID when I payed with a debit card.  Just as a joke I flipped open my wallet, showing her my S.H.I.E.L.D. card, and fully expecting her to give me a strange look and ask to see my real ID.  To my great surprise she looked at it and then went ahead with the transaction.  She had used it as a valid ID, rather than a novelty one that I had made up!  Okay, that was highly amusing, but it couldn't happen again, right?  She was just careless, right?  So I tried it again in another store.  The same thing happened!  I couldn't believe it! 

Here's what it looks like when I open my wallet to show my ID.

And here's what the card looks like removed from my wallet.  Look closely at the photo.  It's from a picture of me at a Renaissance Faire and I'm wearing a cavalier hat!

By comparison, here is an example of a Georgia driver's license.

Over the last year I've used it more and more, trying to see how many people will accept a S.H.I.E.L.D. card as a valid ID.  And you know what?  Almost every single store and cashier has accepted it!  Wal-Mart, Hot Topic, The Disney Store, Target, and just about everywhere else I've shopped has looked at it, confirmed the name and picture, and then finished the transaction.  There have only been two businesses that have done a double-take and have asked for my real ID:  Dragon*Con and my local comic book store.  It should be no surprise that the businesses who make their living catering to geeks and selling Marvel merchandise would immediately noticed the rather large S.H.I.E.L.D. logo and name, calling it into question. The surprising part is that other businesses have no problem with it.

On one hand this is incredibly amusing to me, and I continue to use it when asked to show ID.  But on the other hand it's a bit frightening and disappointing.  Identity theft is rampant in today's society, and the reason behind asking to see an ID when someone pays by credit or debit card is to confirm that they are the person whose name is on the card and not a scam artist or thief.  If a $2 novelty ID can be accepted by 98% of cashiers, how secure is the process after all?

Or maybe S.H.I.E.L.D. really does exist, and by placing themselves in movies and comic books they make us think that they're fictional.  The cashiers know this and don't dare question me as part of the organization.

That's right.  Chris Bern, Agent of S.H.I.E.L.D.!