A Vet Looks At Longevity & Euthanasia

Published September 8, 2011 by glaumland

Another subject we covered in my Human Healthcare class was the Longevity Revolution. We all hear about the Baby Boomers getting older, but it is interesting to consider that our healthcare industry is aging, as well. And anytime you focus on longevity, you also have to look at the end of life. Choosing for animals is very different than choosing for people.

THE LONGEVITY REVOLUTION

OK, enough griping.
Now I’ll focus on some of the topics that I really liked this time and how I
see some of them in my veterinary practice. You know, sometimes my kids are
really impressed by how I seem to know everything (that ‘eyes in the back of my
head’ thing); at other times they roll their eyes because they can’t believe
how ignorant I am. I’m not ‘hip’ or ‘with it’, although I know those terms are
as dated as I am!

I really liked the
information about the aging population and the need for more general
practitioners. (I never really considered about the medical practitioners aging
as a group…hmmm.) I totally agree that there needs to be a move towards
family doctors. For many years the medical industry was gaining so much
specific knowledge and technical abilities, and it seemed like medicine became
very ‘targeted’ – if you had a joint problem, you went to a joint specialist,
etc. Of course, many people still technically had a primary physician, but
often it seemed that they did little but authorize the trip to the specialist.

For instance, I
never took my kids to pediatricians. My children are a part of a family unit
and need to be treated that way. They don’t live in a vacuum. And I think this
is the best example of how human medicine has gotten so off kilter. I’ve been
lucky enough to have found some really good family doctors who take the time to
do thorough histories. (Darned if they don’t leave just about the time I really
get them trained.) Doctors who take the time to listen and ask the right
questions are way ahead in treating the whole patient, not just throwing some
medicine at some symptoms.

In my practice a
good history is a must, especially since my patients can’t talk for themselves.
I think the biggest problem is that doctors have to get so many patients
through a day to make it profitable. Also, I think the culture of medicine
needs to get back to teaching the doctors about how important gathering
background information is. Or maybe just that it needs to be done. When you had
small practices in small areas, the doctors probably already knew most of the
family information about their patients because they were a part of the same
small community. That’s just not likely to happen today.

Another point that I
think was really well made this week was that lifespan does not equal
health-span. Whenever the legislature talks about raising the retirement age, I
consider it an interesting issue to tackle. When you look at the older people
you know, some people are ‘old’ at 65 and some are ‘young’ at 85. How do you
differentiate between those people who really need to slow down in their 60’s
(or even 40’s or 50’s), and those who are active and able into their 70’s and
80’s? I don’t see that there is a way to legislate this problem as it would
need to go person by person and case by case.

Hospice is one of my
favorite parts of the medical industry. My grandmother went into a hospice
house in Topeka after a massive stroke, and it was the best experience ever
(relatively speaking). Everyone I’ve ever talked to who have used hospice homes
have had good things to say about them. I don’t know as much about hospice done
at an individual’s home (I really haven’t heard of any in the last decade
personally), but I would imagine there is a move to get people into the hospice
facilities where there would be better access to staff, equipment, medications
and facilities.

To choose hospice is
to choose the right to die with dignity and comfort. But can the same be said
about euthanasia? As a veterinarian, I can say that euthanasia is one of the
most difficult things that I do. I hate the days when I transform from ‘Dr Glaum’
to ‘Dr Gloom.’ I appreciate being able to end the suffering and pain for the
pet of a family. Since I don’t like the ‘Dr Gloom’ I usually try to push the
animals and the families to put that decision off as long as we can maintain
the quality of life.

Once I have a
terminally ill patient, we have a ‘pet hospice program’ we use that helps the
patients stay comfortable and helps the families know when it is time for
euthanasia. This has been one of the best programs that we have instituted in
the past few years. We have a scoring sheet that looks at different topics
(like movement, hunger, pain) so that the pet owner can evaluate their pet, see
trends, and better communicate with us. If something is trending downwards, we
know that is an area to work on (like installing ramps, changing food types,
adjusting pain meds). Better quality of life (QOL) means that pet and parent
have more time together. And it relieves some of the worry and guilt that they
experience when that time does come.

One of the
non-scored topics I have to deal with though is the burden on the caregiver. I
know how important this is to people on the human side more than even the pet
industry. It is one thing to carry a 10# Poodle outside to go potty, but a very
different thing to move a 100# Labrador around. Sometimes the problem is the
clients can’t afford meds or have ‘people’ family commitments they need to
attend to. We, as veterinarians, have that luxury of being able to say,
“That’s OK, it’s time.” I have seen my parents caring for my
grandparents as they aged, and frankly, I’m scared that when it is time for me
to step into that role I may not be up to it. I hope I can find a way where it
is my responsibility, but not a burden. Time will tell.

The last thing I
wanted to note on euthanasia is what a burden it is to have the power over life
and death. It isn’t easy, at least for me. Perhaps that is because of my belief
that animals are all unique as God’s created creatures; I just don’t know. I do
feel honored to be allowed to be a part of the intimate time when the pet
owners say good-bye to their pets. I try not to cry at the moment, but often
the tears come on the way home. One especially bad period a few years ago, I
lost 12 pets in 9 days; it was a hot August and the little old guys just
couldn’t handle the heat stress on top of everything else.  Anyway (probably TMI), I went into a
depression that lasted for months. The point is, euthanasia is really tough and
I don’t think the human medical industry needs to go to that difficult place. I
think that hospice can fill that need.

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A Veterinarian’s Look At Human Healthcare

Published September 8, 2011 by glaumland

I took a class this summer about the Administration of Healthcare Organizations. I wasn’t looking forward to it and was very nervous going into it. But it actually turned out to be a VERY interesting class. With respect to my own health issues, I learned a great deal. I also discovered a lot that I will be able to apply to my practice of veterinary medicine.

Part of what we did in that class was to journal each week about our studies. Since I spent time on my journal and not posting to my blog, I thought I would publish some of my class journals on the blog. I’m not sure it will mean anything to anyone except me, but I hope you find some jewels just like I did. Sorry the formatting is so funky…I’ll try to work on that.

INTRODUCTION TO HEALTHCARE

OK, I have to admit
that prior to this first week I was very nervous. The subject of human
healthcare is way outside of my expertise, even though I have been a chronic
consumer. It is interesting to hear healthcare referred to as an industry,
because it makes it seem so large and expansive and over-reaching. As a
veterinarian, I know I’m part of the animal health industry, but my goal is to
peel away all of the layers and bring vet care to a personal level in the exam
room. I think that is why my clients like me. I feel like I spend a lot of time
talking, but my goal is to ask the right questions and find the answers that
the clients often don’t know that they have. Good pet care begins with getting
knowledge and ends with giving knowledge back to the client. I like it when I
get the same kind of personal care from my doctors, so thinking in terms of an
‘industry’ is overwhelming and a little scary.

One of the most
interesting parts of the presentations this week was the John Stossel segment
on Whole Foods and their approach to purchasing services from health
practitioners. It makes a great deal of sense and would seem to be very
effective. But as a doctor, I have to confess I don’t know the prices of
procedures and services that my clinic offers. Size of patient and length of
procedure are just two variables that can affect cost. However, I do have my
staff print off estimates and I will go over them with the client. The other
issue that I have to consider, which I think may also have great relevance to
this topic, is that I have to be careful not to only offer services that I
think my clients can afford. It isn’t my place to make those decisions for
them. Offering plan ‘A’, ‘B’ & ‘C’ can help the client receive services
that benefit the patient and also stay in their budget. We’re seeing more people use Care Credit (a medical credit card) and various
forms of pet insurance. I really do recommend that clients have these tools
available; what many don’t realize is that the cost of veterinary care is
closer to what their own health care should be without medical insurance.

Perhaps that’s why I
don’t think ‘healthcare reform’ is a practical approach to addressing this
issue. Because the industry is so big and changing rapidly, you cannot just
whisk in and make sweeping and effective changes. I think compartmentalization
is the key; break the healthcare industry down into its various sections and
functions and work on them one at a time. I also think another key to efficient
healthcare is to keep the administration as close as possible to the consumer.
Too many layers of bureaucracy create waste and inefficiency. Think of the
restaurant owner who walks through his dining room full of customers; he can
get feedback on their favorite dishes, what they’d like to eat, and what isn’t
working (be it food, staff, environment, etc.). The restaurateur is in a much
better position then to address the important topics to improve his customers’
experiences. Ha, if only it were that easy!

I hate that this
topic has become so partisan and so political. It keeps people from coming up
with good solutions that are practical and efficient. And when things get
stalled out because everyone is so busy hammering away at their point of view,
real opportunities are missed. I’m really bothered by the term ‘equality’, and
I’m hoping to learn more in this class about how it is applied. I do think that
everyone should have equal opportunities for health care (and everything else),
but it is unreasonable to expect equal outcomes. So much can happen on that
journey from A to Z, and I believe that the direction of that journey must be
decided by the individual, not by a third party, and  especially not by a government that can’t
even run itself well. I’m sounding more and more libertarian all of the time.
That is too funny.

I love the fact that
the history of public health was brought up. I love history. Here I wish we had
LESS compartmentalization. It seems that most people think that history is for
historians, but we can/should learn all there is about the background of our
professions, families, and politics. Why repeat someone else’s mistakes. Figure
out what worked and what didn’t. There is a lot of interesting knowledge out
there, much more applicable to today than most people realize. In my public
health area, there are diseases that are emerging much in the same way that
they emerged centuries ago.  I think
there are some basic public health principles (like sanitation and quarantine)
that need to be ‘rediscovered’ as people have become so dependent upon
antibiotics and hospital care.

It’s Not Twin Peaks…

Published June 2, 2011 by glaumland

Thank you Ace for the best and funniest thing I have read today.

He looks guilty because he’s guilty.

He acts guilty because he’s guilty.

He talks guilty because he’s guilty.

He doesn’t call the cops on the hackers because he’s guilty.

He calls the cops on reporters because he’s guilty.

He doesn’t deny the picture is his because he’s guilty.

This is not complicated. This is not Twin Peaks.

This whole “Weinergate” thing is sooo funny. And so sad.

Funny, well because the poor guy has a name that just begs for laughs. You know, like the Oscar Mayer ‘weiner song’:

Oh, I wish I was an Oscar Mayer weiner,

That is what I truly want to be,

‘Cause if I was an Oscar Mayer weiner

Everyone would be in love with me!

See, I think poor Anthony took that song to heart and really thinks that everyone wants to be with him. Or at least his twitter pal. Especially if you’re young and hot. And you think he’s hot. Add in the big (R) after my name and that leaves me out on all counts.

But the sad part is what his wife must be feeling. At least I hope she’s feeling something. Because if she doesn’t come out and say anything, I’ll come to the conclusion that she’s alot like Hillary and stickin’ to her man for the money and fame and power. IMHO.

Also sad that folks just can’t man up and admit when they’ve screwed up. (OK, this sentence could be read sooo many different ways!) The guilty who admit they are guilty look a lot less guilty than those who try to convince you they’re not guilty. Don’tcha think?

Thanks, Ace, for the clarity. The funniest part is I was watching a youtube video of Twin Peaks Lego’s just the other night and have had Twin Peaks memories going through my head.

It isn’t Twin Peaks.

Until next time…

The Hypocrisy Of It All – First Amendment & Separation Of Church & State

Published June 2, 2011 by glaumland

The ACLU, the Americans United for Separation of Church and State, and this federal judge

http://www.foxnews.com/us/2011/06/02/prayer-prohibited-at-graduation-ceremony/?test=latestnews

want to keep all traces of ‘public prayer’ out of a TX high school graduation ceremony. However, kindly, the judge did allow that students could wear religious clothing or kneel towards Mecca.

Really, I say. Really?

Most parents and educators I know would be much more concerned that students dress appropriately (wearing nice clothes and none of the flip-flops or pants-on-the-ground) and act respectfully (not disrupting the service_oops! did I call it that?_ by getting out of their chairs and moving around) than that people would say a quiet “Bow your heads…” or “amen.” Two things really struck me about this article.

First, how about we have some folks dress up in religious habits or arab garb, then come into Judge Biery’s courtroom. Then, whenever they like, they can get out of their seats and assemble in the aisles, kneeling on their knees towards Rome or bowing towards Mecca. I bet he wouldn’t stand for that disruption in his courtroom, but he says it’s OK for a graduation. HYPOCRITE!

Secondly, if it is true that there is entirely separation of church and state, then it seems to me that Judge Biery has no right to tell a school how they should hold their graduation ceremony. That is a private matter for the school officials and the parents to decide. I don’t care if the school does receive federal dollars, separation should work both ways. Unless there is an obvious physical danger (like yelling ‘fire’ at the movies) anything said at that graduation shouldn’t matter to anyone outside of the auditorium. The school should be able to conduct their ceremony as they deem appropriate, and for Judge Biery to rule otherwise actually creates a relationship between church and state. HYPOCRITE! (Just to add to this point, I really do think the US government should get out of Education and turn it back over to the local governments.)

I’m not entirely certain how the Schultz family can claim that they would “suffer irreparable harm” if someone prays. Maybe it’s like spontaneous combustion or something. My advice to the Schultz’s: don’t pray, don’t go, or get over it. As this is being read, I’m sure prayers are already going up to Heaven on their behalf. Better keep the extinguisher handy!

Hypocrisy is claiming that there is separation between church and state, and then the state tries to assert control over the church. The First Amendment really prohibits the government from establishing a state-sponsored church (like Uncle Sam’s Church of Democracy). As Thomas Jefferson said, the separation is to put a wall between church and state, but it doesn’t mean that you can’t see over that wall or shake hands over it. Good fences (and walls) make good neighbors. And if you don’t like what your neighbor is saying, then leave. Or put your fingers in your ears. Or hum. Or talk louder.

It’s time for Americans to do some studying and read our Constitution for themselves. If you don’t agree with it, you’ve got that right, and the First Amendment protects your right to vocally disagree. But it doesn’t give you the right to be offended by what you see or hear. Get over it, or get out of here.

Until next time…

Softball & Hotdogs

Published June 1, 2011 by glaumland

I’m trying to post while waiting for Little Girl to start her game. Goofy Maggie, the crazy hound, decided to hop in the car as we were leaving to come. She’s pretending to be a farm dog, out running around and enjoying freedom, because the baby goats have been imprisoned in the dog pen until the get too big to escape from their pen.
So Maggie is sitting here with me at the game, and being a really good dog considering what a clown she is. I’m going to try to get a pic of her with her new cool summer hard.

Blessed Are The Antihistamines, For They Shall Relieve Us From Our Allergies

Published June 1, 2011 by glaumland

Ouch!

I’ve added a new pest/allergy to my list. I was sitting by the open window in the fancy music room when ZAP! I noticed I was being attacked by bugs. Little, tiny brown bugs, about 1/3 the size of a flea, crawling around the window sill. Ewww!

I did some web crawling (very appropriately) and discovered they are probably clover mites. Makes sense, with all of the clover we have in our yard. And they are so tiny, I think the attic fan is just sucking them in through the window screens.

Country living strikes, so time to strike back. Grabbed my bottle of fly spray (for the ponies, with a lovely citrus-y scent) and went to work. Those little bugs aren’t crawling any more! Yea chemicals!

I hate that creepy, crawly feeling you get after you see fleas or ticks, or in this case clover mites. I’ve been itching and scratching all afternoon. After I spotted the lovely rash on my face and arms caused by the micro-bites, I took a quick shower and some antihistamines. That should put an end to the itch.

June bugs and moths I can handle. You just scoop them up and toss them outside. Guess I’ll have Dear Hubby get his giant spray gun out and attack the house with insect spray again. I ain’t gonna let no pests keep me from having my house open to the fresh air.

Until next time..

Is There An App For That?

Published May 30, 2011 by glaumland

I just got a new phone, one of those kinds that you can have apps on. Not one made from fruit, more like a little robot. You know, one of those that has an age limit on figuring out how to use it.

I still haven’t figured out how to answer a phone call without hanging up on the caller. Oops! Sorry! (Leave a message and I do know how to call back.) And if you touch it in the wrong places it makes all sorts of weird beeps at you, as though I were physically harassing my phone. Harumph!

But I do have a GPS-thingy now so I should be able to get to places I’ve never been before. And I have a beeper to remind me to take my medicines. And I can see texts messages and email. The camera/camcorder has great resolution with tons of storage. I’ve found some games and some trivia apps (name that president, international countries & their flags, name that periodic element, name that letter from the Greek/Russian/Hebrew alphabet…all for free).

I have an Adobe viewer and a micro-Office program. That’s tremendously helpful for school and work-related items. Unlimited internet with lots of weather information – a must for this time of year. I especially like the little weather show that occurs when my phone comes on…if it is raining a little wiper cleans the screen. How cute is that?

My favorite apps though so far are my Kindle viewer and Google Sky. The Kindle (free version for phone) ‘clouds’ with my laptop Kindle (free version for laptop) so I can keep up wherever I am. And there are lots of good, free books out there (many classics). I’m reading Ben Franklin’s Autobiography – what a really interesting man.

Google Sky is pretty cool. It figures out where I am with the GPS thing and shows me the stars and constellations that are overhead. Then as you turn different directions it rotates the display. So totally awesome, and beats using flashlights and books.

Next I’ll be looking for the apps that make the kids do their chores or change their attitudes. I’m sure they won’t be free, but a peaceful summer would be worth any price.

Until next time…