Good luck, my tinies: the changing of the guard

A whole class of fresh, out-of-the-package veterinarians are about to be unleashed on the world in about a week. It is almost graduation time for the new doctors!

For the past year, I, along with my faculty colleagues, have been cajoling, mentoring, prodding and bludgeoning gently guiding a new crop of senior students along the path from student to doctor. It is an arduous and bumpy road, with a few that inevitably fall off along the way.

There is an old, and not-so-nice adage – don’t get sick in June – that centers around this very topic.  Last week I had seven seasoned and experienced interns as well as six senior students working with me on the ER service.  The students had been through all of their rotations, knew where everything in the hospital was and what form to complete to get it. They were adept at moving the lumbering beast that is a teaching hospital into action.

Next week, I will have a new crop of students who might know where the hospital is, but not a lot beyond that. The month after that, my prized and much beloved interns will all spread to the four corners of the globe to either continue their education or start their careers in earnest. When they go, they will be replaced by seven new graduate doctors who will need to learn the ropes.

This cyclic progression of the noobs replacing the experienced happens every year, and always in June. Happens in human medicine, happens in veterinary medicine, and if they have medical school in Alpha Centauri, probably happens there, too. It is the only way we have found to keep the knowledge flowing,  but it is sure far from perfect.  The combination of inexperience with the medicine and lack of knowledge about how to get things done can be frustrating at a minimum, and, we must acknowledge, has the potential to be lethal in some cases.

We had a party for the interns at my house last Friday (all except the one who was left minding the shop).  I live about 90 minutes from the hospital, and they all trekked down to our house for some relaxation, wine and BBQ after a hard year. They all earned it, too. I am very, very proud of this group.  They have stuck together through thick and thin, and have grown to an amazing degree.  A year ago when they started they had a head full of book knowledge, but not really any way to apply it. Hopefully now, through the insights they gained during their internship year, they know which bits of arcane knowledge might actually be used to save a life, and which ones are just so much fluff to be forgotten about at the first opportunity.

Somehow, over the course of the year, I started calling them ‘my tinies,’ and the image that became our avatar as a group was that of Edward Gorey’s Gashlycrumb Tinies – I pictured my self as the benevolent and slightly macabre dude holding the umbrella over their wee heads.

I started the year with my crop of interns trying to learn not only their faces and names, but also their strong points and where they needed targeted help. I ended the year in a hot tub with them, toasting all we had accomplished together. Not exactly part of the standard curriculum, but for me these guys will always have a special place as they were on point when we opened the ER at Purdue and suffered through a lot of logistical headaches.

The students, about 60 in all, will from here forward be able to be called ‘doctor’ after the ceremony this Saturday. It is a life-changing event, but only the start of the adventure for them. Some will find their niche in clinical practice, and treat animals happily for years. Some will get there and find it is not to their liking. Some will move into industry careers or research at some point, while others (very few, I hope) will change careers altogether.

I am proud, and immensely satisfied, to have taken part in their training.  I hope that, from me, they not only learned a few facts than come in handy, but how to think like a doctor, and (more importantly) how to listen to the little voice inside that tells them what to do when seconds count.

I wish them all a satisfying journey, and may their skills save many lives over the years.

Photo credit: librarytypos.blogspot.com.

Editor’s note: For those unfamiliar with Gorey’s Gashlycrumb Tinies, the entire poem and famous illustrations can be viewed here.

View the original article here

Vaccine recommendations for cats are changing

Stop giving adjuvanted vaccines to cats. Right now.

That was the message that Dr. Alice Wolf, an internal medicine specialist and professor of small animal medicine at Texas A&M University, delivered to a packed room of veterinarians yesterday afternoon at the 83rd Western Veterinary Conference in Las Vegas.

Vaccines with adjuvants (substances containing aluminum that are added to vaccines to increase the body’s immune response) are implicated in the development of vaccine-associated sarcomas (VAS) in cats. For any veterinarians who might still doubt that association, Wolf laid out the case. VAS were not seen before the mid- to late 1980s, when modified-live virus vaccines were removed from the market after cases of vaccine-induced rabies developed. They were replaced by killed adjuvanted vaccines, including a new one for feline leukemia virus.

The World Health Organization classifies veterinary vaccine adjuvants as a class 3 (out of 4 classes) carcinogen. Class 4 is the highest risk. If your doctor offered you a choice of two flu shots, one containing a class 3 carcinogen and one that didn’t, which one would you choose, Wolf asked the room. Why would you make a different choice for your patients?

The incidence of VAS is 1.3 in 1,000 to 1 in 10,000, up to 20,000 cats per year.

“Even one cat is too many if this is a problem we can avoid.”

Now that leads to a conundrum when it comes to rabies vaccinations. Is it better to give a cat a killed adjuvanted vaccine every three years or a nonadjuvanted recombinant vaccine annually?

“In my humble opinion, it is better to give a much less reactive product more frequently than a much more reactive product less frequently,” Wolf says.

Are modified-live and recombinant vaccines as effective as vaccines with adjuvants? Yes. Wolf cited a study by Dr. Julie Levy (the Maddie’s Professor of Shelter Medicine) at the University of Florida showing that MLV vaccines were much more effective than killed vaccines, providing earlier onset of protection and protection of more animals. The recombinant vaccine for FeLV is as efficacious as the alternative.

In her talk, titled “Feline Vaccination: Protocols, Products and Problems,” Wolf also discussed whether cats need vaccines beyond the core FVRCP (feline viral rhinotracheitis, calicivirus, panleukopenia). In most cases, the answer is no.

Worried about something called “killer calicivirus”? Don’t be. It’s not a new disease and it is rare, Wolf says. Cats at risk are those in shelters or catteries with poor husbandry.

“Virulent calici is not a disease of household pets. All virulent isolates are different, so a single stable vaccine strain isn’t going to protect against all the mutations out there. That’s why the vaccine isn’t useful. Your patients don’t need it.”

To avoid spreading virulent calici (or any infectious disease), Wolf advises veterinarians not to admit sick shelter cats to their hospitals and to use strict disinfection, isolation and hygiene procedures for any animal suspected of having a contagious disease.

“If you have good protocols in place, you don’t have to worry about sneezing cats, coughing dogs and puppies with diarrhea.”

The vaccine for FeLV is universally recommended for kittens because they are most susceptible to the disease. Older cats are much more resistant to the disease. After kittenhood, assess the cat’s risk based on whether and how often he goes outside.

Which vaccines should cats not receive? Wolf enumerated those with little or no efficacy: giardia, feline infectious peritonitis, feline immunodeficiency virus, virulent calicivirus, and bordetella. Don’t give them to cats.

Photo credit: Feline vaccination, flickr Creative Commons (Feral Indeed)

View the original article here