3 Things I wish I had known about small animal orthopedics the day that I graduated…

Welcome to “The CE Summit”, CSUVetCE’s new Blog where we explore some of the roads less traveled or at least travel them while wearing a slightly different lens. We believe that there is value in sharing thoughts, ideas and perspectives with one another even in the world of scientific discovery and evidence-based medicine…perhaps particularly in those worlds!  So, sit back, relax, and let’s explore this exciting, challenging, and crazy career of veterinary medicine together.

I’ve spent decades in my career as a veterinary orthopedist and I’ve seen, diagnosed and treated a lot of animals for lameness along the way. I’ve worked in both academia and private practice; I’ve spent almost as much time in general practices as I have in specialty hospitals. I’ve been an associate and a practice owner. What, through all of this, have I learned? … after all, if I’ve been “practicing” all this time, I should be better at something today than I was the day that I graduated!  That brings us to today’s question – What are 3 things I know today, that I wish I had known about small animal orthopedics on day 1 of my career?    Had I known these things, I would have been a better diagnostician, a better teammate and better at prescribing impactful and effective therapies and preventative strategies for my orthopedic patients.

Communication is the key. To say something is the key implies that something else needs to be unlocked and only the key will do it … so what is it that needs unlocked?  In my case, I’d say it is the world of success as a veterinarian that is locked up and only effective communication will unlock it.  When I graduated, I don’t think that I fully understood that we are, ultimately, in a customer-service business and that my effectiveness in identifying those customer needs and effectively serving them was based squarely on my ability to foster effective two-way communication. Perhaps the most difficult client communication skills are asking the right questions and then learning to LISTEN. Listening to my clients’ words, and even between their words, often unlocks powerful insights that often prompts my next clarifying question.  Many of us have heard the wise advice “Seek first to understand, then to be understood”. To that end, before I launch with the pet owner into a monologue or memorized schtick about this or that, I need first to understand what concerns prompted them to sacrifice their valuable time and money today to come see me. Then, and only then, can I be of help to them. Helped clients are happy clients…happy clients are loyal clients…loyal clients are the foundation of a healthy veterinary practice and successful veterinary career.

Effective communication is needed outside the consultation room too.  Let’s be honest here, veterinary medicine is a team sport. Like you, I like to play on winning teams. Effective, healthy, open, supportive communication is at the core of every winning team that I’ve ever been on; conversely, ineffective, weak, and sometimes destructive communication habits have been characteristic of the less healthy teams.  Communication skills are a habit and they are contagious. The most effective leaders that I have been around … the ones that built and maintained the most effective teams … all of them had excellent communication habits that included the ability to actively listen, support, challenge and encourage.  And it was the contagion of those habits that helped to make their teams so effective.

Today, I try to think about those great veterinarians, educators and leaders that I’ve had the privilege to observe in my career … and I try to emulate them in my own way as I practice my communication habits. I know that I have my own good- and bad-communication days, but I continue to “practice” on developing the healthy, effective skills of those that I admire … I am a better communicator today than the day that I graduated, and I certainly understand that unlocking a successful veterinary career requires a key and that key is effective communication skills.

Evaluation of lameness is as much an ART as it is a SCIENCE. As a newbie graduate, I wanted to reduce everything to rote and robotic routines that I either could or could not properly perform. As a result, I was focused on developing those hard skills. While hard skills such as the drawer sign, the tibial compression test and the Ortolani test all hold great value, effective evaluation of lameness is largely an artistic expression. Whereas, I was once eager to get my hands on the patient and to start performing the rote list of orthopedic maneuvers…today, it is often my ability to step back (not forward) and observe the subtleties of patient posture, conformation, stance and movement that provide important initial cues as to where the problem might be.  As I meet and greet my client and take a patient history, I am watching my patient out of the corner of my eye. They are giving me cues, not only about their problem, but how they might prefer to be approached.

I’ve often been struck by the fact that you and I, faced with an orthopedic ailment, start our conversation with our doctor with 3 powerful words … “it hurts here”… as we point to the source of our discomfort. Given that I treat patients who are not fluent in my native language, what can I do to create an environment where they will be more likely to tell me where they hurt? … and what can I do to understand their language as they attempt to communicate that message?  Say what you want, but that is an ART my friend!  If that is an art that intrigues you, please let me know in your comments below.

Art gives beauty and expression to our world, unfortunately, I’ve not been particularly gifted with the ability to express myself artistically through music, the graphic arts or dance. That said, I think it is the ART of veterinary medicine that can make it so satisfying … at least to me. The ability to express myself to another being (my patients) of a different species and to say in unspoken words “I care about you”, “I am safe”, “I want to help you … please tell me on what terms you can accept my help” … that is my art. My daily practice is my canvas. I love some of my body of work and I am less proud of others … but I enjoy my craft. I am better at it today than the day that I graduated and I love the challenge of the journey to become a better veterinary artist each day.

Don’t ever be afraid of developing your veterinary “artistic” skills through continuing education and open, honest, frank conversations with your colleagues about your struggles with those soft skills. If you’d like more training in this area, leave us a comment below … we’re listening!

A lean body condition is kryptonite for orthopedic disease. Okay, I’m almost afraid to say those words out loud…after all, if the pet owning world had known that fact and had practiced it, my kids may well not have gone to college on my dime!  Instead, we live in a world where pet obesity is rampant and I’ve been kept busy as an orthopedist for decades because the secret isn’t out.

When I graduated from veterinary school … okay kids, that was back in the former millennium … nutrigenomics wasn’t exactly a word. That was the day when genetics was king … you were either born with this or you were born with that. Well, not to discount the promise of genetic engineering to effectively address a myriad of dreadful human and animal ailments in the near future, but we must recognize that genetic expression can and always will be influenced by external factors including nutrition. That is to say, genetics may reflect “the cards that we are dealt”, but we can still control how we “play that hand” via nutrition. One powerful example of this was the Labrador Lifespan Study sponsored by Purina. In this landmark study, a paired- feeding experimental design was used in a group of Labrador Retrievers. One group of puppies was assigned to the free choice (ad libitum) feeding control group and they were fed as much of a given canine ration as they desired each day. The other group of puppies (the experimental group), consisting of body weight- and sex-matched litter mates, were fed the same ration but it was restricted to 75% of that consumed each day by their study-mate in the free choice control group. Every other study variable including housing, activity, etc. was the same for each group.  Then, they followed these groups of Labrador Retrievers for their entire lifespan. Good stuff, huh?  Well, out of myriads of publications, there are at least a few key points worth making here and now:

  • Dogs fed 25% less weighed about 25% less. This lends some validity to the study design.
  • Those same “calorie restricted” dogs developed much less osteoarthritis (OA) over time. In fact, whereas 77% of the free choice fed dogs developed multi-joint OA by 8 years of age, only 10% of the calorie restricted dogs developed multi-joint OA at that age.
  • Euthanasia prompted by loss of life quality resulting from OA was the #1 cause of death in this study, but calorie-restricted dogs had median lifespan of 1.8 years longer than the free – choice fed dogs!

Read those bullet points one more time and let them sink in. We have the power to add both life quality and life quantity to our patients through lifelong nutritional management … proving it is not only WHAT we feed our pets, but also HOW we feed our pets that is important.

We could go on to talk about the effect of lean body condition upon the severity of those OA symptoms, the incidence of cruciate ligament disease, and more … but the point is clear: A lean body condition is kryptonite for orthopedic disease. I wish I’d known that when I graduated because I would have helped A LOT more dogs and clients in my career. As it stands, I’m a bit of “get ‘em lean” evangelist because some of the most remarkable breakthroughs in restoration of patient mobility, comfort and life quality that I have seen in my career have come from attaining that lean body condition through nutritional management combined with rehabilitation and therapeutic exercise. Attaining lean body conformation, along with other pain-relieving measures, has given me the ability to give the gift of comfort, mobility and well-being back to so many of my patients and their families.

So, there you go, my list of 3 things that I wish I had known about small animal orthopedics on Day 1 of my career. I’m not saying that there aren’t more or even that some other “secrets” might be more important, but I AM saying that by sharing our thoughts and our perspectives and by challenging ourselves and each other to get better each and every day through “practice”, we can find joy, fulfillment and success in this crazy veterinary profession.

 

How about you? … What are 3 things that you know today, that you wish you had known the day that you graduated?


 

Dr. Palmer’s career has spanned both private practice, as an associate and as a practice owner, and academia. Ross is currently a professor of Orthopedics at Colorado State University and a frequent speaker / educator at conferences around the world. As the Associate Director of Education at the CSU Translational Medicine Institute, you’ll increasingly be able to track him down at CSUVetCE! 

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