A month or so ago I offered up a post on the wide variety of veterinarians newly building their second homes on the Internet. In that post I sought to build up the veterinary blogosphere, but I should have been more inclusive. Veterinarians like Dr. Phil Zeltzman are maintaining sophisticated sites that responsibly and clearly address major issues…but they’re not exactly “blogs.”
Dr. Zeltzman does have a pseudo-blog thing going, though. He writes a weekly newsletter you can sign up for (which I heartily recommend to all Dolittler fans). Apart from the labor of love that is his website and his newsletter he practices as a full-time veterinary surgeon and writes a very helpful surgical column (geared to veterinarians) in the same publication in which my monthly rant of a column appears: Veterinary Practice News.
Because I LOVE Dr. Zeltzman’s column and strongly believe veterinarian-authored sites like his deserve more play than they get, today’s post is all about my personal favorite Dr. Phil. To that end, I interviewed him. Enjoy!
K: Let’s start with why you became a veterinarian. Forgive me for asking the obvious but always seems like a different answer for every one of us so I’m curious…
Z: Well, according to my parents, the idea stuck in my head when I was 5. I loved watching Flipper, Daktari and Lassie on TV. I loved animals. So it all made sense in my mind.
Of course I had no idea how difficult it would be. And I had no clue that I’d be studying for the rest of eternity…
K: Why’d you choose a specialty like surgery?
Z: I’m not really sure… I like the concept of fixing things. I love the opportunity to make a difference in people’s lives. I cherish the idea of saving lives.
A dog comes in bleeding internally from the spleen, we take it out. A cat comes in with a shattered bone, we fix it. A dog is attached to a tumor the size of a pumpkin, we remove it.
Nothing is more gratifying than removing a slipped disc that is putting pressure on the spinal cord of a paralyzed dog.
Granted, it may take weeks to months to heal, but for the most part, if patient and owner cooperate, we should be done from a surgery standpoint.
The other thing I love about surgery is that it is incredibly varied. It requires some knowledge in multiple disciplines besides surgery. Obviously, we need to know about anesthesia and pain management, but also about anatomy, endocrinology (hormones), nutrition, internal medicine, neurology, radiology, cancer, physical therapy, emergency medicine, critical care etc.
And one more thing I am very fortunate about is that a vet surgeon is not restricted to one organ or one body part, as opposed to a human surgeon. So in one (busy) day, I could be fixing a broken bone, removing a foreign body in a Lab puppy’s intestine, removing a tumor from a cat’s chest, removing a slipped disc from a paralyzed dog, and doing a skin graft.
And yesterday, I fixed a fracture on a macaw from the local zoo!
It doesn’t get any better than that!
K: Do you teach or are you exclusively working in private practice? Which do you prefer and why?
Z: Most of my time is spent in private practice, at Valley Central Veterinary Referral Center, a specialty group in Whitehall, PA, in the far suburbs of Philadelphia.
I “teach” when we have vet students or visiting vets coming to the clinic. And I guess I teach through writing… Whether in my weekly email-based newsletter, my monthly surgery column in Veterinary Practice News or various conferences, I love to share what I have learned over the years.
My mentors shared with me what they have learned, so it’s only fair that I “pay forward.”
K: I’m always interested in veterinarians who make the leap from working or being educated overseas (Belgium in your case). Nick Trout and a few other surgeons I’ve met come to mind. Your perspective on animal health is always a bit more welfare centric, big-picture oriented and lateral in thinking. Do you think that’s true? If so, how do you think it happens? Is it nature or nurture? Or is it just that it takes more interesting individuals to endure the US immigrant experience?
Z: I’m not sure I can answer these questions… I think it depends on each individual. As far as who’s more interesting, I’ll leave it up to you!
Some vets are more welfare-centric than others, both in Europe and in the US.
I came to the US to become a surgeon. It was supposed to be for 4 years. It’s been 13…
It’s been an amazing experience. By the way, I studied in Belgium but I’m French. Initially there was a tiny cultural shock, as I moved from downtown Paris to downtown Athens, Georgia.
Since then, I’ve worked in California, Illinois, Ohio, and now Pennsylvania.
K: Why’d you start writing?
Z: One reason is simply that it enables me to share information. In my newsletter, I try to explain how to avoid getting in trouble. My idea is, if one client didn’t know that you can kill a dog by giving aspirin along with an anti-inflammatory drug, then hundreds of readers don’t know either.
Thanks to the magic of the Internet, I can share this information with people who read my newsletter all over the country, and even abroad. So statistically, one dog out there might benefit from this tiny piece of information.
My favorite story is from a lady in Ohio who spontaneously wrote to me after reading my newsletter about the benefits of spaying and how it can prevent breast cancer in pets. She was concerned that her co-worker’s Rottweiler wasn’t spayed and she told her about what she had read.
That evening, the colleague checked her dog out and found a lump around one of the nipples. The next day, the dog was scheduled for surgery with her local vet.
That’s the power of the Internet. Very indirectly and very modestly, I helped a dog I have never met, and made a difference in a family I don’t know.
That’s why I write.
K: I love your newsletter and your columns in Veterinary Practice News because I think you have a unique voice in veterinary medicine—partly because unlike me, you never offend. So diplomatic and yet so outspoken. How do you manage it?
Z: Are you really going to publish that???
You are way too kind, thanks! I love you column and your blog, too!
I guess I spend an unreasonable amount of time proof reading and correcting and changing until I am somewhat convinced that nobody will read my column and feel bad about something they did or didn’t do. I write to inform, not to blame anyone.
Oh yeah, and I also try not to use expressions like WTF :- )
K: WTF! OK, so what subjects do you most like to write about and why?
Z: The beauty of surgery is that topics are endless. Every organ can be involved. And pets constantly find new ways to get in trouble, so I like to inform other pet owners that they should be aware of such and such “new” danger.
So over a year, I could write about 52 different topics and never repeat myself.
Like you, I also interview other vets and professionals to share different perspectives. For example, early 2009, I will publish an interview of the world guru of an emerging and devastating disease in Labradors.
And in my free time (!), I am working on several book projects.
K: Are you a big reader? What writers do you admire and why?
Z: I love reading, and unfortunately don’t have enough time to read books except on vacation. I read a lot of medical and surgical stuff. Daily.
Although I initially thought it was sacrilege, I now listen to audio-books in the car. This enables me to brush up on other topics. For example, I recently listened to the excellent “Freakonomics.” I also listened to “BLINK”, which unexpectedly led to a surgery column in Vet Practice News!
These days, I am listening to a book on the history of the US…
K: What's your favorite animal and why?
Z: Possibly one of my cats. They sleep a lot, they eat well (just enough to be thin of course), they play like maniacs, and they have zero worries. Actually, they have one worry: “When is my next meal?”
Then again, they don’t do a whole lot for the benefit of mankind or world peace…
K: If you could pick another career, which one would it be and why?
Z: I often wonder myself… Is being retired and sipping a drink on the beach in the Bahamas a career? I don’t know… Journalist, maybe?
K: Do you have any advice for anyone who would date a veterinary surgeon? I need some.
Z: Who wouldn’t want to? I mean, [date] a surgeon. Surgeons are patient, open-minded, creative, mature, profound, and above all, unusually modest. What’s not to love?
Anyone else have questions for Dr. Zeltzman? I’m sure he’d be wiling to entertain them here. In lieu of that, you can support another worthy veterinary Internet project by signing up for his newsletter here. Keep it coming, Dr. Z!
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What a wonderful guest post, thank you both.
Dr. Zeltman, have you found any particular differences or common similarities in clients in the US vs. Europe? If so, would you kindly comment.
As a welfare centric surgeon, how do you reconcile surgery and quality -of-life issues with very ill, elderly, or perhaps close to dying pets? In this case, how do you advise the client and what criteria do you use?
Thank you in advance, Barbara A. Albright Chester, NH
Pocket's Story from NH December 31st, 2008 06:42:33 PM
Thank you for your nice comment. Your question is even tougher than Dr. Khuly's! Clients are said to be willing to do more (and pay more) in the US than in Europe. I would say that's overall true, although, as my English teacher used to make us repeat, “generalizations are risky.” Not every American pet owner is willing and able to do a kidney transplant on their cat. As far as surgery and quality of life, I certainly don't think they're mutually exclusive. Otherwise, I wouldn't be doing surgery. When it comes to very ill patients, one of the purposes of the consultation is to discuss what is possible and impossible, and to make sure client and surgeon (or more generally, the vet) are on the same page. As far as elderly pets, you missed a newsletter I wrote entitled "Age is not a disease." (by the way, did you subscribe to my newsletter?) I often repeat this quote. Age is NOT a disease. Cancer is, for example. And as for "close to dying pets", it all depends. Sometimes, they will unfortunately die regardless of treatment. Sometimes, surgery is the one thing that will save their life. And then they are often ways to improve quality of life, -if not quantity of life. And to address your question about how to advise the client, I often refer to a “quality of life” scale. We talk about this crucial topic often in my newsletter (see?). One quality of scale is linked on my web site (“Link” page, toward the top). If you are currently facing a difficult decision, hopefully it will help you. Good luck. Dr. Zeltzman www.DrPhilZeltzman.com
Phil Zeltzman, DVM, DACVS December 31st, 2008 07:47:19 PM
Dr. Zeltzman, Thank you for your reply, I have just signed up for your newsletter & noted your previously written topics. It addressed my second question, but other Dolittler subscribers may also be enlightened.
I completely agree, "age" is not a disease. I have had a nearly 15 yr. old dog undergo a successful eye procedure to reverse painful glaucoma, allowing 7 more mos. of quality life before succumbing to lymphoma.
And recently another nearly 12 yr. old have removal with wide margins, a mammary adenomacarcinoma. This may or may not prolong her life, but surely will add quality because of the painful mess an ulcerated gland can become.
A curious follow-up to what I suspected may be a general answer to US clients more likely to opt for advanced surgery & treatment for patients. Do you feel that this is more of an economic issue or perhaps that Europeans are more resigned to accepting animal issues or shorter lives, thinking more along " a good life, but unfortunately a short one too" (I have a foreign friend that says that from time to time)
I look forward to your e-letter, Barbara A./New Hampshire
Pocket's Story from NH December 31st, 2008 08:26:31 PM
Thank you for subscribing to my newsletter. You're obviously a wise woman! Regarding your question about Europeans and pet care... Again, it all depends. There are tons of ophthalmoligists in France, who routinely do cataract surgery. Yet some pet owners would think it's insanity. And there are plenty of vets in France who give chemo for lymphoma or do surgery for mammary cancer. Yet some people in France would never pay a dime to give that chance to their pet. Now, you can read my post all over again. Replace "France" by "USA", and the same can be said for pet owners on this side of the pond. It's not just a matter of money. Do they belong to the back yard, the living room, or do they sleep on their OWN recliner? It's also a matter of the intensity of the animal-human bond, and the place of the pet in the family. Just ask Dr. Khuly!
Phil Zeltzman, DVM, DACVS December 31st, 2008 08:57:16 PM
Dr. Zeltzman: What a very pleasant surprise to read your interview on this site! I am a European pet guardian. I have toy poodles and we spend the last 10 years in Greece, Italy, and Germany. All these European vets were wonderful and very caring doctors. However, they were not knife-happy vets. They would not rush to surgery until they had exhausted all aailable means of testing to diagnose a sick companion. Surgery was the option of LAST resort! We came back to the States in September of 2007. One of my toy poodles, a 13-year male, had GI tract problems, along with lethargy, anorexia, shaking, etc. The specialist (internist) performed an ultrasound and diagnosed an intestinal obstruction. Without any differential diagnoses, he URGED us to have my pet operated on. The board certified surgeon found NO OBSTRUCTION, and my dog died 3 days after his release from the surgeon. I know if I were in Europe, my pet would still be alive, because the European vets we experienced wouldn't rush to surgery before they were absolutely sure that surgery is warranted. In 3 months after my return to the States, the specialists misdiagnosed and mistreated my companion animal, causing his avoidable death. Yes, you are right "old age" is not a disease, however, these vets told me "What did you expect, he was 13-years old!!!" The attitude here of "jump to surgery because it pays better" is NOT in the animal's favor! US vets need to learn the compassion and sincere caring for animals that European vet seem to have!
Fotini, alabamavetboardwatch.110MB.com December 31st, 2008 11:45:44 PM
Wow... I am really sorry that you lost your puppy under such conditions. As I wrote above: - "generalizations are risky." - "one of the purposes of the consultation is to discuss what is possible and impossible, and to make sure client and surgeon (or more generally, the vet) are on the same page." Ultimately, it is the client who calls the shots and give his or her "informed consent" to move on with any procedure. As for your impression that US vets have "the attitude of jump to surgery because it pays better", this is obviously something I can't agree with. Condemning the whole profession because of one unhappy experience is a little harsh. I work with numerous referring vets, and the obvious impression after any conversation I have with them is that they deeply care about their clients and patients. They certainly don't make decisions based on financial rewards. They offer options to their clients based on their honest impression of what is in the pet's best interest. Bottom line, I am not here to argue about who is right and who is wrong. The moral of the story, for you and other readers, may possilby be to consider a 2nd opinion if 1. you are not comfortable with what your are offered. 2. it is not an urgent, life and death situation.
Phil Zeltzman, DVM, DACVS January 1st, 2009 11:52:52 AM
Barbara and Fotini, here is another way to answer your questions. I actually have a French vet staying for 3 months at the clinic. I am honored to introduce the great Dr. Adrien Aertsens to the world and the blogosphere. He lives in the Paris suburbs, curretly works as a general vet, and wants to become a surgeon. What a smart guy! Barbara and Fotini, I asked him what he thought of your questions, and this is his reply. "Answering these questions is not easy at all!! In every country you can found "knife-happy" and "jump to surgery" vets! Everything depends on the education and mentality of the vet or his/her clinic... If an intestinal obstruction is suspected, THE treatment is surgery, and nothing else. So in Europe too, every vet would have urged a surgery! Unfortunately, it wasn't the correct diagnostic, with the horrible consequences that we know... But in Europe, and in every country, in veterinary and human medecine, doctors unfortunately will sometimes make a bad diagnosis. The progress we've made in the different diagnostic techniques helps to reduce mistakes, but even with a lot of complementary exams, sometimes you are wrong and discover it most of the time in surgery... If you watch the TV series "DR HOUSE", you can realize that the art of medecine (human and veterinary) is sometimes not easy. Most pet owners don't want just an injection and a healthy animal, they want to know and understand why their animal is sick. This is true in US, but in Europe too..." So there you go, another opinion that seems to indicate that it all depends on the individual vet rather than a specific location.
Phil Zeltzman, DVM, DACVS January 1st, 2009 04:01:58 PM
Dr. Zeltzman, I am glad to hear of your training & sponsoring of Dr. Aertsens to specialized diagnostics and surgery, here in the US. Please ask him to visit my web site "Pocket's Story from NH", to learn what to avoid at all costs.
You are so right that "mentality" is an important part to assess when receiving pet medical care. Unfortunately, that can not be assessed easily nor be attached to length of and/or education. I say that if someone in this world develops a "mood badge or bracelet" to distinguish the honest, ethical professionals from the unscrupulous, ALL of us, both of you included, will benefit when seeking any professional advice.
The sad part in the US, and I am not privvy to what happens abroad, is that WE do have governmental regulations and laws in every state to uphold Standards of care, standards of service, and quality of work---whether it is a licensed electrician or licensed medical professional.
As you noted and commented, there is also a wide variety of companion owners, some have a particular "value" on their "property" and some have a "priceless" value on their "living, breathing member of their family".Still, both are dependent upon honest assessment.
It is the hope of everyone, that they receive compassionate, ethical care for themselves and their family members, be it human or animal. Unfortunately, the "bad apples" drag on a profession and particularly when the good apples allow it, cover up for it, and in short, never change it.
I can cite numerous examples of good quality care received for my pets, and am grateful for it, more than an average person, having experienced the "lowest" form of care allowed in my state of New Hampshire, to include : fraud, cruelty, abuse and inhumane 'euthanasia' to both my much loved companion at the expense of the human client (me)
Barbara A. Albright, life-long NH resident & 22 yr. USPS veteran (not to be confused with other 'infamous' Barb A.'s!)
Pocket's Story from NH January 1st, 2009 05:19:48 PM
Here's a question I should have asked up front: What do YOU, Dr. Zeltzman, see as the most important issue facine veterinary medicine today? (Sorry for putting you on the spot without fair warning.)
Dr. Patty Khuly January 1st, 2009 06:02:09 PM
Hmmm... I'm not sure if it's THE most important issue, but I think that fees are a huge issue. Nothing is more frustrating to me than knowing that I can help (or save) (or cure) a patient with surgery, but that the owner can't afford the care. I don't have a magic answer to this dilemma, but I believe that pet insurance is a good start.
Phil Zeltzman, DVM, DACVS January 1st, 2009 06:47:05 PM
In my particular case I had 3 second opinions. . all from vets and all wrong and all recommending surgery, which ultimately led to his demise. I have to disagree with your comment that ultimately it is the client who calls the shots. As you will know, we depend on the vets' knowledge and expertise for guidance in the decision-making process and very few of us would go against an opinion we consider that of a knowledgeable professional. But you are right, the vet makes us sign a document obsolving them of all responsibility before they perform. I guess those of us who own companion animals (vice pets) believe that vets should accept responsibility/liability for their actions/decisions just as medical doctors do. We think that they should admit when they make a mistake and apologize rather than "tap dance" around the issue and point to the document we signed.
Before I lost my companion animal, I had never researched the internet for symptoms and diagnoses--NOW I DO religiously! And it has helped me TREMENDOUSLY in making a really informed decision regarding my female poodle's health problem. I was the one suggesting to the vet what tests to perform for the particular symptoms--and I was RIGHT! I almost lost my female poodle to another unnecessary treatment that my vet suggested. SO THANK GOD for the internet! One of the best tools for us, the pet guardians: CORNELL Consultant.
Fees was never an issue for me, and all the vets knew it. I never negotiated fees for any procedures they indicated that needed to be done--my companion's health and life were priceless! I paid approx. $5,000.00 within a few days. My remaining poodles' health and life are also PRICELESS!
More details are on my website: http://alabamavetboardwatch.110mb.com/Asp-index.htm.
Thank you for your interest and time.
Fotini January 1st, 2009 08:17:09 PM
I signed up for the newsletter and was taken back by a couple of his recommendations:
1. Regular vaccinations. Everything seems to be pointing to the fact that most dogs are fully vaccination by any vaccination given over 6 months of age, for at least 7 years. Titer tests can confirm this or not.
2. No people food! Sure, one should not feed your dog food that you really should not be eating yourself. But most dogs foods are monotonous and overprocessed. Fresh food is crucial to all our diets and variety too.
I will read one more newsletter, but was not impressed with this one.
Eliza January 3rd, 2009 02:49:43 PM
Eliza, I believe you misread or misinterpreted what I wrote about pet food. 1. The full quote was "People food is for people! Feed pet food to pets! Choose a quality, balanced, reputable brand. I recently talked to a little old lady with a grossly obese Chihuahua who insisted that she only feeds 1/8 cup to her dog daily. "That's it, Doctor, I swear." And of course, also some treats, half a banana, some cookies, some chicken... and some ice cream." Surely, no resonable pet owner believes that half a banana, cookies and ice cream are healthy for a Chihuahua. And surely, this obese dog was not the picture of health. 2. You are what you eat. 3. I love Macadamia nuts, onions, grapes, raisins and chocolate, but would not advise feeding that to a pet. 4. Veterinarians (not me, I'm just a surgeon) routinely treat dogs who ate inappropriate people food and end up in severe pain and vomiting because of pancreatitis. 5. You will not read much about vaccines and pet food in my newsletter anyway. 6. I firmly believe that pet food is like politics. You should never talk about it with good friends. 7. I am entitled to my opinion, and you are entitled to yours. We live in a free country, after all. That said, if you disagree with me, you are free to cancel anytime, there will be no hard feelings on my part.
Phil Zeltzman, DVM, DACVS January 3rd, 2009 03:55:30 PM
Must defend Dr. Z.
1-'No people food' is still the party line for most vets because that's what's safest. As he pointed out, he gets to see the worst cases where pathological fractures and severe obesity result from poor diets.
2-Those of us on Dolittler have likely graduated from the days of 'no people food,' but do you really blame a vet for wanting to take the safest stance when most humans consider McDonald's and ice cream acceptable people food?
3-Without the proper context for more involved discussions on nutrition and feeding (as I have the luxury of presenting on Dolittler), safest is best, IMO.
4-Dr. Zeltzman is a surgeon. I am a general practitioner. Always consider the source. You would not like to hear me expound on the ideal way to treat a fracture without referencing veterinary surgeons extensively. Dr. Zeltzman references many sources for general care in his extensive links section. He does not present himself as the ultimate source for general practice issues.
Dr. Patty Khuly January 4th, 2009 08:45:05 AM
Actually, I think surgeons are amazing. I think they represent what western medicine does best.
My daughter is a veterinarian so I know all the horror stories of overfed, undernourished pets. Chihuahua's sleeping outside with minimum shelter. She calls devastated from time to time with stories of unnecessary neglect. And at the same time, I think it is crucial that we all, general practitioner and surgeon and those of us with animals in our household, speak of nutrition. A healthy animal heals faster. And no, my dogs never get nuts, chocolate or onions. There is a 5 acre vinyard where I live so I cannot guarantee about grapes, though no dog here has ever reacted, I know some do and am fairly careful. They really prefer the gophers anyway.
Thanks for responding, I look forward to reading Dr Zeltzman's newsletter.
Eliza
Eliza January 5th, 2009 01:47:35 PM
They are fine with things the way they are, it seems. Not only did we NOT succeed in getting a vet tech program established, but the ONE veterinary ASSISTANT (not LVT) training program at the community college was also killed due to lack of enrollment
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