Reportable diseases - for Wisconsin vets?

I've been trying to figure out who I would talk to if I was a vet in Milwaukee looking for the public health department to report a zoonotic disease to.

Enter the internet:
City of Milwaukee's Public Health Links

This is broken down into sections:
1. government agencies, both state and federal
2. water - beaches, great lakes, EPA, hygiene
3. academic, including Marquette, UW Milwaukee, but also EINet (emerging infectious network)
4. resources - mostly CDC and Medscape's news-like service
5. biohazard and interesting randomness - more CDC sites, but also parasites, fungus, and aspergillus

Does this actually answer my question?
Um, no.

Now, there is the Milwaukee Public Health Laboratory. Sounds promising.
Let's see, they list a bunch of items in their mission statement: food safety, emergency response, disease surveillance...all good things, all good things, but where's reportable zoonotic diseases go?

How about MADACC? (Milwaukee Area Domestic Animal Control Commission, aka the humane society)
A little better -- hey, at least there's a list of how many pets you can have in a household.

Still not quite what I'm looking for, though.
Maybe I'm too focused. Probably just the state vet would do, right?
I'll do a search for "veterinary", there we go...

Hey, look, actual rabies guidelines! That's handy...okay, now what about other zoonotic diseases?

And, at long last, I find the reportable diseases page.
It splits them up between categories I, II, and III. Interestingly, the vast majority of Category II are zoonotic (not a surprise). Some of them I suspect are diagnosed not infrequently by veterinarians in animal patients; I do not know how often vets actually report these cases. For that matter, although I would think the state would be interested in the presence of these diseases in animals, I don't know that they do-- anyone remember hearing "Report your blasto cases here!" at the last WVMA convention?

Challenges of professionals blogging

I have not written any posts for this blog for over a year, not because interesting and educational and exciting things have failed to happen (interesting&educational&exciting is the working definition of an internship and of starting a new job, right?). But rather because I haven't found a good way to relay those interesting etc. etc. things in a way that doesn't leave me wondering if I am going to miss some detail that leaves me open to a legal issue.

I am not invested enough in sharing the day-to-day escapades of being a practicing veterinarian, or for that matter a public health student, to look into the exact legal standards for sharing stories about clients. I have seen discouragement dished out on VIN which targets new veterinarians who fail to write to the exacting standards of (non-blogging) grown-ups, and which in rather the same way as a homeowner's association eyeing your untidy front yard, says "This reflects poorly on all of us. Conform!" (Vin has a certain passive aggressive streak, and if perchance this comes to its attention, I am sure will lambast me for my unprofessional, uneducated mutterings. I am making no particular effort to pare this down to a concise and readable message, so perhaps I deserve it).

At any rate, figuring out the balance on how to relay interesting stories and information with appropriate sourcing and courteous obliteration of identifying markers makes for a lot of anxiety. This pretty much wrecks the writing experience, and removes some of the benefits of "practice" writing, so I am planning to officially discontinue this blog.

The cost of knowledge for your sick pet

Coming into the internship from a public health angle has been interesting. There's a lot of frustration among the veterinarians about clients who don't understand the costs associated with care, or who are trying really hard to learn about medicine but getting it wrong.

For people on a strict budget, taking an animal to the vet is a luxury. I suppose there are some ethical issues about whether you should have a pet if you can't afford to take care of it, but many of these people take terrific care of their animals, they're just not equipped to handle the sorts of health problems that require multiple tests and hospitalization. I am not going to blame anyone for not knowing how much it costs to go to the vet.

In just one month I've seen a lot of shocked faces when we tell owners that the basic work-up for their animal is going to be 500-1000 dollars.

1. Internal medicine is always expensive. Finding answers is expensive, and by expensive I mean $1,000 and up.
2. Pancreatitis is expensive and super frustrating to treat, since it can last for weeks. Hospitalization tends to be $400 a day, for all the meds and monitoring that we do. 
1. For a dog that has to be on fluids for a week or more, that quickly turns into a $3,000 bill. Even the affluent owners start to squirm at that point.
2. There are some wonderful drugs out there to reduce nausea. They cost a lot. I assume people have successfully treated pancreatitis without these wonderful drugs. However, many clients are hospitalizing their pets because they want Fluffy to feel better, not just eventually get better. And one of the fastest ways to get Fluffy better is to make her feel better, so the circular logic says it's worth the investment.
3. Feeding! I love the fact that medicine has started to come around to say that feeding dogs with pancreatitis probably actually helps. I am a huge proponent of starting enteral nutrition as soon as possible, which given my relative inexperience and lack of commitment to a specific line of treatment on almost every disease process in the world, demonstrates either huge personal bias or the power of selective attention to rapidly develop understanding of a disease process. I saw a lot of pancreatitis dogs last month.
3. Big dogs are more expensive. They need more fluids, they need more drugs, and they can be much harder to manage at home.
4. Imaging in a perfect world is radiographs AND ultrasound. We try to look at everything with ultrasound, but it's like making a map on foot vs. doing a fly-over and getting a snapshot of everything. I don't know what the average cost of ultrasound it; here it is $300, while radiographs (two views are so much more helpful than one) are $125.
5. Kitty replacement value. Animal Control routes a fair number of strays through the clinic. These are cats who get maybe an x-ray or some bloodwork and that's their $100 cap. There are some perfectly healthy strays we never see. Yet each one is a potential crash'n'burn. And in the meantime, we have cats who are total wrecks, who have already done a crash'n'burn, and their owners are investing multiple grand to keep them going. It is a weird mindframe, to go back and forth between minimal and absolute max investment. It is all based on human-animal bond, so one of my other burgeoning opinions is that owners visiting is to be encouraged. Because especially with cats, the replacement value of a cat is completely determined by the bond with the owner.

Are DVMs paid less 'cause we're girls?

This is gonna be long.*

I've been wondering how much veterinary medicine's current problems--with salaries underperforming student debt, that is--are linked to the huge shift in who is going to school, i.e. classes made up of 80% women. Considering that our society hasn't got its mind wrapped around paying an equal wage to women, that might actually be part of the problem.

My two main sources for facts on this TATUAH (Today's Analytic Topic Unrelated to Actual Homework):

Gender and Veterinary Medicine

An editorial on gender and MDs

Plus this one on why men aren't applying to vet school: Feminization in Veterinary Education

Looking at veterinary medicine, there are problems. Low income makes high expense of school a major problem down the road. 

1. Women accept lower pay.

How much of a role does gender discrimination play? How much of a role does gender actually play? It seems like women accept lower salary, which is a problem. They are less driven by financial considerations than career satisfaction based on relationships. I've read a lot of anecdotal references to the fact that women approach work differently than men, but haven't found a legit study to pin it to yet. But I remember financial advice from vet school about not underselling yourself when negotiating a salary. And I remember reading that a living wage for a man tends to assume that he may be supporting a wife and kids, while a living wage for a woman...well, it doesn't assume she's supporting a husband and kids. 

Are women less likely to become perfectionist surgeons? Well, I would guess that in general, yes, women are a little better at life balance--and so even when they are doing the same amount of work, it looks a little more relaxed. And they may not push themselves quite so hard at work because they are pushing themselves hard on ALL fronts.

How does this play into professional salaries? Subtly, I would guess. 

2. Women are less likely to aim for practice ownership.

Conversely, men may be discarding the profession because they see decreased opportunities for practice ownership. It is difficult to approach this topic without it starting to sound like a blame game, you know "you women are ruining the profession with your lack of incentive" vs. "well, you men are dropping it because all you care about is money." 

But if women don't own the practices, then they are not in charge of paychecks for the other veterinarians there. 

I was discussing this all with a friend, who wanted to know if men are just more willing to work crazy hours and take lousy jobs that get them better pay down the line. Which is the point at which I want to go dig in the data and start making box-and-whiskers plots. 

3. Women take time off for having kids.

This one sucks. Women are penalized in their careers for having kids, but society expects us to revere family and babies. And medicine is the sort of career that is physically and emotionally challenging as it is. Women do not receive any kickback, however, for being more understanding or more well-rounded (that is not supposed to be a pun). Instead, the system pokes them in the eye and says, "well, it's only fair that people who don't take maternity leave at their time of peak productivity get several pay grades higher salary." And then the system pokes them again and says, "But seriously, you are bringing down the professional average."

4. Veterinarians are not MDs

Which is just baffling. I wonder how much this has to do with gender. Doctors these days are both men and women, and as far as I can tell, it is relatively equitable. I think because the people who go into medical school are all recognized to be workaholic psychos. Because there's still relative gender balance, MDs have maintained an even spread. Also, medicine may be changing, but no one is blaming doctors for not wanting to work in rural areas where they might not get paid enough to cover their loans.

Vets, on the other hand. Vets are also workaholic psychos, but the shift to women takes the focus off that. Again, anecdotally (time for a coding exercise! And I don't mean with a defibrillator), I hear complaints that women just want to practice small animal medicine, settle into a cozy practice, and start in on maternity leave. It is true that fewer men are going into veterinary medicine in total. But this may be a case where men are more likely to go into veterinary medicine if they want to practice in large animal medicine, which is going to skew the numbers and make it look like women are eschewing large animal, when in fact that entire field is in significant decline.

5. Women just ain't men. Oh, and a few massive sociologic upheavals that just happen to be right now.

One point to keep in mind, women are outnumbering men in getting college degrees overall, and men who make it through the system without retreating to video games (will-to-power, topic for another day), tend to funnel into fields that provide enough prestige (money, title, or geek cred) to overcome that tendency. freak out when they see the classrooms full of females.

80% of the vet class is female. 4% of the females go into large animal medicine

20% of the vet class is male. 13% of the males go into large animal medicine.

Out of the class, over half of the students going into large animal medicine are female.

And large animal medicine tends to be in rural areas where people cannot pay enough to cover a young doctor's school loans. It may just be that large animal medicine is undergoing its own massive upheaval, namely, the shift to herd health and techs who are more than happy to take over ultrasound and DA surgery in return for a steady job.

6. Maybe it's a good thing?

If veterinarians did not learn the exact same medicine as MDs, this would not be as obnoxious. Vets have a couple of advantages. We can practice on our patients much earlier in the learning process, we have at least a modicum of financial education, and we can start practicing without an additional four years of low-paying residency. 

I want to know if women are just less interested in prestige. They are okay with practicing and being good veterinarians, but they're not going to rock the boat over a few grand a year and greater recognition of their medical prowess. Because vet clinics tend to be small and privately owned (or small and franchised, like Banfield) they don't jockey for prestige like hospitals trying to be the biggest and best. Because insurance doesn't obscure the costs, because people don't (can't) put as much money into their animals, there's not the same quantity of money at stake. 

In summary, women in veterinary medicine is most likely linked to the pay disparity between this medical profession and every other profession that requires 4 years of maniacal devotion to studying. It is probably multifactorial; women may not be coming into the profession with the financial underpinnings for running a business, which is still a part of veterinary medicine. Lingering gender discrimination hurts the bargaining power of women at the beginning of their careers. Our culture's expectation that professionals establish their careers through long hard hours straight out of school conflicts with societal pressure and biological prudence to have kids around the age of 30. Because there are disproportionately more women in veterinary medicine hitting that stage now, it draws attention to the gender imbalance, and decreases the likelihood of young men seeing themselves as potential veterinarians. Lastly, veterinary medicine has some strengths in terms of practicality that may make it more robust than it currently appears, provided that veterinarians--both men and women--are prepared to apply that practicality to the shifting environment of modern medicine and economics.

*I plan to rewrite this with real stats and examples and stuff, since it was written off the cuff.

Crummy bike thieves

So today my bike was stolen.
In addition to stealing my bike, they dropped my helmet on the road and drove over it. Honestly.

I was (still am) upset. This was my bike for fourteen years, I'd added a rack and fenders to it so I could ride in the rain to the clinic all through vet school. I'd locked my bike up on the rack outside my apartment, pretty typical, considering that I usually bike every day. However, the rear tire went flat overnight, and I was planning on taking it to the bike shop as soon as I was through the first half of finals. So I didn't take it down to the basement, where I normally move it if I'm not riding for a couple of days. Besides, while I love my bike very much, it's not shiny or even new; I think Schwinn stopped making it in 1990. The paint has been scraped off in multiple places. The gears are a bit gap-toothed. Nonetheless, when I came home today, the cable was cut, my bike was gone and my helmet was shattered in the middle of the parking lot. It's an unpleasant wake up call, not just that people steal, but that people steal with bolt-cutters. (yes, I'm sheltered)

I feel like I let the bike down. This is anthropomorphizing a utilitarian mode of transportation, of course, not to mention the fact that it was some thief who chose to cut the cable and make off with my bike. There is a question on the police report asking, "Did you give permission for the theft of your property?" No no nope no no.

In retrospect, I should have done things. I will do them with my next bike. I make a list of them here:

1. Locking inside overnight. Kryptonite locks can be picked, not as easily as cables cut, but breaking into an apartment complex is another level of theft.
1. High visibility, multiple locks, make the bike unattractive, yada yada yada. My bike was non-descript, but it only had a cable and it was tucked away at the end of a quiet cul-de-sac.
2. Evidently barely being able to squeeze the lock through both bike and anchor is good, as it makes it harder to use leverage to break the lock.
2. Documentation
1. I hear the VIN (BIN?) is under the pedal base. This would explain why I had so much trouble finding it the last time I looked (the internet has come a long way since I was in high school).
2. Photographs. Astoundingly, I don't think I have any pictures of my bike, despite bike riding and photography both having been fairly major parts of my life. 
3. Receipts: I should, theoretically, have the receipt from its last tune-up, but I hadn't planned on my bike being stolen, especially not when it was sporting a flat tire. And it's been a trouble-free 14 years, so receipts are few and far between.
3.  Insurance
1. This is complicated. Basically, you can get renter's insurance to cover your bike. But if you use it, your premiums go up. If your bike is stolen, you file a claim and get paid, and the bicycle is then recovered, you have to pay the insurance company to get it back.
1. Given the dismal recovery rates for stolen bikes, it's probably worth it.
4. Registration: Minimally helpful, apparently, as this usually means pieces of paper floating in one small region, and bikes are so very transportable, but it tends to be cheap and it may help a little. And what else are you going to do?
1. http://www.nationalbikeregistry.com/ According to forum boards, the closest thing to a useful registration system.

Brand:
Model:
Year:
Color:
Serial Number:
Special Features/ Components:
Comments:
  
In short, my bike wasn't a target for theft until someone stole it and drove off, at which time it was too late to get paperwork in order or to move it inside. I am kicking myself for not moving it inside.

The best vet school application essay

Courtesy of some smart folks at the student doctor forums.
http://forums.studentdoctor.net/archive/index.php/t-529897.html

"When I was five, I treated a wild squirrel's broken leg with creative use of grape popsicle sticks and barbie clothes; I also cured his rabies. Then when I was ten I raised a litter of bear cubs; they still live in my backyard and their names are Larry, Moe, and Curly. Of course, I realised that strictly animal experience was not enough and, at the age of 15, I started volunteering at an emergency clinic, while working full time at a mixed animal practice and doing relief work with zoo vets on weekends. As each animal was cured, I sobbed profusely with an abundance of soaring joy."


And so on. 

complaints about grad school

Extra frustration today, as all the projects come due. These are realistic problems, by the way. Defining the problem can show the path to the solution...or so they say...at any rate, things that trip me up, and "working harder" is an ambiguous, unhelpful solution.


1. When I sit down to read (articles and schoolwork, that is) I get so bogged down in details and trying to think carefully about each bit that I don't even finish the one article.
Or, I get scroll through the endless pages and start panicking and can't concentrate at all.

2. There is always an assignment due, which means I'm always working on an assignment at last minute, which means it's always too late to ask for help.

3. There's that one class that I don't learn anything useful in and that has waaay too much homework. It is responsible for 50% of #2.

4. Most of what I'm learning is either too in-depth and I'm lost. Or it's too superficial and it's not gonna sink into my head at all.

5. Talking takes too long. And requires that I actually remember something, instead of reading from my notes.

6. Taking notes is hard. There's too much detail to capture and you just know you aren't going to be looking at them again. Like, ever.

7. They don't let you ask for refunds on classes like #3.