Visiting a Veterinarian vs. Physician

Having graduated in May of 2016, I’ve been a practicing veterinarian for slightly over six months now.  As such, I’ve become accustomed to managing appointments with my clients.  However, I haven’t been to a human doctor in far too long.  So last week I decided to go for an annual check-up at an M.D.’s office.  I figured this would be the perfect time to compare and contrast a visit to a veterinarian vs. a human physician.

Upon entering the doctor’s office, the first people I dealt with were a nurse and a physical assistant (PA) student.  The nurse took my temperature and blood pressure while asking some basic questions as to why I was at the office today (for me, it was an annual exam with questions about ringing in the ears, lower back pain, and some moles).  The PA student (her first rotation!) soon took over the bulk of the visit and gave me flashbacks to my terrifying first rotation as a vet student at Michigan State.  She asked me a thorough history about the reasons for my visit, my lifestyle, and my previous medical history.

This PA student also obtained a large amount of diagnostic information right off the bat.  She drew blood for a complete blood count and chemistry, told me to get a urine sample, helped the nurse obtain an ECG, and oversaw pulmonary testing.  She told me that this was all standard testing for a new client.

This series of tests is much more advanced than any I have seen a primary care veterinarian perform.  While we certainly can measure blood pressure, obtain an ECG, and do blood/urine testing, we don’t do these for all clients.  Blood pressure is a much less pertinent issue in veterinary medicine and is typically only done after heart or kidney disease has been diagnosed.  ECGs are saved for prior to anesthesia or if there  is concern for heart disease.  Blood and urine testing is done more often, but is usually recommended once in younger age, once in middle age, and perhaps annually in the geriatric years.  Of course, blood and urine testing would also be recommended for a wide variety of suspected illnesses.

After all these diagnostics were complete, the PA student began a short physical exam.  She ausculted my heart and lungs, palpated my abdomen, and quickly looked in my eyes and ears the same was as a veterinarian would.  She also quickly manipulated by back to check for pain.  The only significant thing that she did not do that a veterinarian would is palpate the lymph nodes – the PA who later came in the room also neglected to do this.

After that brief physical exam, the student moved into my specific problems.   I was impressed with the degree of basic auditory testing the PA student could perform compared to a veterinarian.  While I’m sure there are at least  couple veterinary audiologists out there, measuring animal hearing loss in a primary care setting amount to abruptly clapping your hands and seeing if the dog reacts.  At my physical, the PA student whispered different phrases into each of my ears and asked me to repeat them.  More impressively, they used a tuning fork to perform Rinne and Weber hearing testing in an attempt to localize where (if any) my hearing loss was.

After this hearing testing, the student left to present her case.  The PA came back into the room with her several minutes later.  He was professional but curt.  After validating a few things about my history, he began a series of vigorous neurological and orthopedic tests in regards to my back pain.  He checked my patellar reflexes, had me do a wide variety of range of motion exercises, and checked for any facial nerve deficits.  Overall, I was very impressed with the amount of care that went in this orthopedic and neurologic exam.

At the end of the exam, I mentioned my concern about two moles (one on my nose and one on my arm).  The PA did not even look at them, he simply mentioned that he can give me a referral to a dermatologist.  He also gave me a referral to an audiologist and a slip to go get a radiograph at a hospital.  He prescribed me a lidocaine patch for my back in the meantime and said we would do a recheck appointment in 2 weeks to discuss the bloodwork and radiograph of my back.  One last thing happened on my way out.  I mentioned that while teaching a vet assistant how to do an ear cytology, I took  a swab of my own ear and examined it.  I saw approximately 5 cocci (round bacteria) per high powered field on the microscope.  I asked what the normal flora in a human ear was, and he said that he had no idea but that 5 was probably fine.

So, how did all of this compare to a visit to a primary care veterinarian?  As far as history-taking goes, it was the exact same.  The physical exam was very similar.  While the PA did not look at my lymph nodes, he did a much more thorough auditory exam than I ever could.

Laboratory testing was done on a much more extensive routine scale.  However, interpretation of these tests and the radiograph was much-delayed.  In a veterinary clinic, routine bloodwork and radiographs are usually interpreted within 24 hours.  For a more complex case I may send radiographs to a radiologist for review or call an internist about bloodwork. Even with those delays, we almost always get back to a patient within 48 – 72 hours.

Also in regards to bloodwork and radiographs, veterinarians often discuss these results over the phone.  I always offer to discuss the results in person if the client desires, but if we were purely discussing lab results I would never charge for a second visit.  (When I return to my PA in 2 weeks I will have to pay a copay).

In regards to a referral to specialists, I always offer transferring a patient if I feel it is in their best interest.  But in regards to my mole, even if I did not any idea how to deal with a skin issue, I would still take a look at it and make note of it in the patient’s chart.  I was very disheartened that a primary care physician wouldn’t at least take a quick glance to ensure it wasn’t secondarily infected.  This goes along with not knowing the normal flora of a human ear canal.  Veterinary general practitioners routinely deal with things that human practitioners always seem to refer (most skin issues, ear infections, reproductive issues, etc.)

So, who wins this brawl?  As I would hope you’d expect me to answer, there is no winner.  In general, I feel that primary care veterinarians are better versed to deal with a variety of issues.  Taking insurance out of the picture, we are also vastly cheaper to visit than human physicians.  We are also speedier in getting results back to our clients.

However, human doctors typically have more concentrated knowledge on the things they do focus on.  This is due to their more-extensive training.  (Whereas an internship and residency is optional for veterinarians, they are required in human physicians.)  So while a primary care practitioner may not know how to diagnose or treat a mole, they are highly capable to treat the things they are comfortable with and diagnose/manage long-term diseases.

Although I do wish they would at least look at the moles.

Divergence (Part 2)

AUTHOR’S NOTE: This is the second part of a two-chapter Jimmy Neutron fanfic.  Part I can be found HERE.


“Serva ma, servabo te.” (“Save me and I will save you.”)

Petronius Arbiter


“Gas planets,” James groaned as the mocking screech of Lindbergh Elementary’s bell pierced his ears. He deactivated his jetpack and awkwardly fell to the ground; his first steps landed him ankle-deep in a puddle. Jimmy narrowed his eyes but otherwise ignored the unpleasant sensation while dashing through the school’s double doors. Cindy bursting out of the library sent him sliding to a halt; he avoided a collision by the curl of his hair.

It only took a second after pulling back in shock for Cindy to wryly snap, “Late again, huh Neutron?” She set off towards Ms. Fowl’s class at a brisk pace, and Jimmy rolled his eyes while falling in step beside her.

“And what’s your excuse for dashing to class, Vortex?” Continue reading Divergence (Part 2)

Divergence (Part 1) – A New Jimmy Neutron Fanfic

“And when you gaze long into an abyss, the abyss also gazes into you.”

– Friedrich Nietzsche


Fingers interlocked, James and Cynthia strolled down the moonlit street. Even after all Cindy had been through that night, after discovering that her parents were getting divorced and wondering if she might be forced to move, nothing but joy shone in her eyes.

For James, however, peaceful thoughts were fading with each new step. He knew that it was time to take yet another plunge – to ensure that he and Cindy never lost the progress they had just made. It was time for one last admission. “Cindy?” he shakily asked.

“Yeah?”

He steeled his resolve and squeezed her hand tight. “No matter what happens, just never doubt how much you mean to me.”

They both froze, and James stared deep into Cindy’s eyes. Shock gave way to fear, which morphed into steadfast resolve as she tenderly asked, “Neutron?”

Jimmy swallowed hard at the new fire swirling in her pupils. This wasn’t the usual licks of rage – something else seemed to be smoldering inside her. It chilled him to his core, but it seemed to beckon him. Cindy delicately placed her free hand on his shoulder and leaned her head an inch closer to his. “Vortex?” he shakily whispered. Continue reading Divergence (Part 1) – A New Jimmy Neutron Fanfic

“Three’s A Crowd” – A Script for a Proposed Fourth Season Episode of Jimmy Neutron

Two months ago, I guest starred on a podcast called The Beanholes.  This podcast discussed the attempted fourth season revival for Jimmy Neutron that I spearheaded.  Excerpts from two of the four scripts I helped write were previously posted on this blog, but for the first time a complete script is now available for the public to read.

The script that is posted is for the episode entitled “Three’s a Crowd.”  The primary focus of this episode is Cindy Vortex getting trapped in Jimmy’s lab with her rival, Betty Quinlan.  In order to escape, Cindy must come to grips with the real reason she detests Betty so.  Meanwhile, Carl leads the boys across town to recruit new members for the Llama Love Society.

The first draft of this script was beautifully penned by Saundra (I still attest that her first draft was the best of the four we wrote).  Edward, Saundra, and myself polished the script together over multiple editing sessions.  This script was also looked over and given a seal approval from Mike Gasaway, one of the directors for The Adventures of Jimmy Neutron, Boy Genius.

The full script is posted here.  Please feel absolutely free to comment on whatever you did or didn’t like.  If you do approve of this work, please share it with any other Jimmy Neutron or Nickelodeon fans you know!

 

The Beanholes – A Podcast About the Proposed Fourth Season of Jimmy Neutron

A few weeks ago I was lucky enough to be invited as a guest on a Podcast called The Beanholes.  The two guys who run this podcast, Eric and Nate, dissect a new movie or TV show each week.  After stumbling across my blog post about the proposed fourth season of Jimmy Neutron that I worked on, they wanted to talk about my journey.  So along with my writing partner Ed (who also worked on that proposed fourth season with me), I partook in the podcast.

In this podcast we discuss what about Jimmy Neutron sparked the desire to revive it, what exactly we worked on over that year, and what we learned from our efforts.

The podcast is linked here.  Please let me know what you think!

 

 

A Veterinarian’s Physical Examination

A visit to the veterinarian’s office usually consists of two major parts: the initial taking of a history and the secondary physical examination.  While the purpose and advantages of taking a history are often rather apparent, the physical examination is often more mysterious.  So today this blog will go over what exactly your veterinarian is looking for in his or her physical examination.

I always begin my physical examination with the head and then work backwards, towards the tail.

Denali the Labrador

http://www.telegraph.co.uk/lifestyle/pets/9487689/Dog-Face-canine-portraits-by-Barbara-OBrien.html?frame=2314969

Placing a hand over one eye and making a motion towards the other eye tests for the “menace reflex.”  A visual dog (unless the patient is a young puppy or kitten) will blink or pull away from that threatening gesture.  This is our primary indicator of vision.  We also check the sclera, or “whites of the eye,” for any signs of inflammation such as prominent blood vessels or discharge.  Ensuring that both pupils are the same size is important – unequal pupil size (anisocoria) can indicate a range of neurological or other disorders. Continue reading A Veterinarian’s Physical Examination

Undertale – Am I good?

A few days ago, I was trying to find a new game to play in order to kill time until XCOM 2 was released.  I’ve been out of the gaming loop for a while and so was reading about the best games from the past couple years.  One title I kept coming back to was Undertale ($9.99 on Steam).  I decided to check it out and was absolutely blown away by it.

Before I bought Undertale, I read about a half dozen reviews on it.  (Hey, $10 is a big investment for a veterinary student.)  Everyone assured me that it was worth the money, but the reviews were very superficial.  They all cryptically said that they couldn’t discuss anything more than the broadest aspects of the game; that it needed to be experienced raw.  While frustrating to read, after completing Undertale I now wholeheartedly agree with this assessment.

Yet I haven’t felt an incredible urge to write about this game just so I could go over the most superficial aspects of its design.  I need to get a lot off my chest, and the only way to do that is to go in-depth about my two playthroughs so far.  So for the first time, I’m going to give Undertale its review score early into this review, after the part without spoilers.  Then I’m going to discuss my playthroughs in detail. Continue reading Undertale – Am I good?