As it turns out, a year ago I got to tag along to an Anesthesiologists’ seminar. It may surprise you to know that doctors who specialize in pain management are NOT backing away from prescribing pain meds. It’s the doctors who do NOT specialize in this field that are backing away…..perhaps because they recognize they don’t know enough about how to prescribe these drugs, that their practice guidelines are out of date.

I have ALWAYS advocated that NO PHYSICIAN other than a certified specialist in Psychiatry or Neurology should Rx psychotropic drugs [mental illness]. And yet every GP seems to think “what’s the big deal?” - but now the smart ones who are not Psychiatrists or Neurologists are rethinking prescribing them. The smart internist will refer you to a specialist who can best asses the need for such drugs. And the same goes for cancer drugs - for the most part no one but Oncologists and certain Rheumatologists should be prescribing them. [Few other types of physicians do prescribe such drugs……probably because they know that by and large they make you feel pretty darned crummy.]

Then we come to pain killers. A good orthopedic surgeon for example will have a strong standard by which to determine which drugs are appropriate and for whom. I have a highly regarded team of orthopedic surgeons and they are very well trained in pain assessment and staging. I’ve had 3 orthopedic surgeries in the last 5 years and in all cases the ONLY pain killers I was given were the ones given to me as part of the anesthesia induction. Some are longer lasting [a few days] - enough to get you through the grueling front end of recovery. If I need meds beyond that I could call the physician…..but I have never had the need.

The reality is that pain killers are essential for a good quality of life for many people who deal with chronic pain. However, such drugs should never be prescribed except by those physicians who deal with related diseases on an hourly basis. Not your GP, not your internist. And maybe prescribing certain levels of pain meds need to be legally restricted to specialists.

The NY Times article was a good one, though it failed in certain areas:
1. to present appropriate and detailed stats,
2. by catching the reader’s attention with the story of one OSTEOPATH [physician who is not an MD, but who has similar training and credentialing requirements as an MD; is trained to be more of a primary care or preventative medicine doctor and who often treats the WHOLE patient],
3. it set the tone for the rest of the story and sadly cast a pall on the good work pain management specialists are doing.

Now we come to veterinarians. I hope that soon specialization in pain management comes into being. That the smart GP DVM will recognize that this is a specialty and will likely refer you to someone greatly experienced in this area.

As I have said from the very beginning, JUDICIOUS prescription of drugs is imperative.

So now we’re back to the original topic: are country animals more pain-tolerant than city animals? I think, just like with humans, it’s highly individual.

Bernie, I thank you for reviewing the postings and consider their merit. It takes an intelligent person to give unbiased consideration to all the sides. Still, I don’t agree with the posture of the NY Times article. And while I believe the Glasgow pain assessment technique is a more than timely advent, I can not concur with part two of Marilyn’s posting.

Incidentally, you will be pleased to know that my local library emailed me to let me know that “Merle’s Door,” the book you recommended, has come in. I look forward to reading it.

I have been out of direct involvement in farming for some time but never far from it or animals of other kinds and I can recognize that I am not up on all the latest trends but the information she offered is well stated.

Notice that it lays down some very specific guidlines based on OBSERVATIONS of the animals before plunking down the presriptions which is perhaps a formalization of some of the very old methods I was attempting to describe in my grumpy old way.

If you can accept what she has posted then I can accept that as a compromise.

Thank you Marilyn!

If you feel that these guys are doing something wrong you have the correct solution. You can get a second opinion or as you said, take your business elsewhere. But, unless you can tell me that they withheld medication even when the animals were in visible distress I think that advocating the loss of their licenses is simple reprehensible and ill informed.

What I have found interesting is the presumption that the idea of wholesale and automatic medication of animals would in fact be the practice advocated in a CEU course. While you may find some school somewhere that would have a course offering to that end the outline I gave for pain as a diagnostic tool is much more likely to be the norm than and consumer’s notion of pain management vs. pain as management.

I think you will find that part of the curriculim of the modern vet school deals with client management which is not the same thing as patient management - owner vs. animal.

There is a saying among fishermen that the first thing the lure has to catch is the fisherman and not the fish. Similarly, practice management is mostly about satisfying the customer which is not the animal. Certainly, getting a good outcome is part of this but modifying practices to satisfy the sensibilities of the payer is without a doubt a motivation. This in fact was pointed out by others in this thread early on not to mention the revenue generated by selling the drugs in the first place.

Look back and read the comments by Dorene above and what her vet had told her… “because she’s a Border Collie and I want her to rest. If she feels better, she’ll do too much. The pain will tell her to rest and that’s what she needs.” 100% consistent I would say but now after reading this she is having doubts… Who would after some of the hysterics displayed here?

Perhaps I did get off on my high horse abour rural vs. city too much. Its a subject that invokes a great deal of passion with me for reasons that are too complex to get into here - perhaps another time… To that extent I appologize.

I’d suggest going back to the earlier posts on this topic. Some of the best observations were in fact made by people who turned on me a bit after I went off on that tilt. But for sure, there is a huge difference here.

1) Effective pain management is still a work in progress (in people and in animals). The fact that there is no standard protocol defined is evidence of that. To this reader, it seems that much of this discussion centers around whether our pets’ pain is viewed by us in a subjective manner or an objective manner. To me, neither is right or wrong. BUT, there is a way to bring the two together. There has been a lot of work done on pain management by the Glasgow University and they have produced a way of evaluating an animal’s pain based on their behavior. It’s called the Glasgow Composite Measure Pain Scale and can be viewed or downloaded at http://www.gla.ac.uk/vet/resea.....e/cmps.htm. The pain scale has been getting a lot of positive attention from the veterinary community, and I can tell you that clients that I have shared it with have appreciated it too. I’d be interested in reading reactions from bloggers here as well.

2) It is my impression that veterinary medicine tends to follow trends in human medicine. I think this has happened in pain management as well as other things. Over the last several years the trend in human medicine has been to use more medications to manage pain for reasons which have already been mentioned here. However, that trend may be changing as doctors are now being prosecuted for either overdosing, or allowing themselves to be taken advantage of by addicts. Many human doctors are now backing away pain management to some degree. The New York Times Magazine recently carried a piece on this issue which can be seen at http://www.nytimes.com/2007/07.....ref=slogin. This has also recently become a matter of discussion in the veterinary community as veterinarians are now seeing their prescriptions being misused by addicts and are trying to find ways to prevent that. I recently came across just this discussion on VIN (Veterinary Information Network), so it is very relevant.

Comments?

“No CEUs, sorry. But if you are wise you will take something from it.”

Who ever said that there wasn’t something to be learned from anyone? No one.

But after all is said and done, what I got from all you wrote in this blog was that yours is a “my way or the highway” attitude. That never makes good teacher/student relationships.

Vive CEU’s.

Bernie, no one here has said or implied anything remotely like this. I’m not responsible for the tapes you’re hearing inside your head.

In fact, you are the one who has been persistently describing city folks as lacking the intelligence, practicality, and moral fiber of rural folks.

CEU requirements, in the (many!) professions where they exist, apply to all practitioners, city, country, or suburban. I’m sorry if you misunderstood, but the suggestion of mandatory CEU requirements was intended for all vets, not just your favorite rural practitioner.

If you are interested in education why dont we all come down to my farm for a minute and take a class on accumulated farm knowledge 101.

If I decide to take up agriculture on even a small, urban scale (as my grandfather did, growing wine grapes and kitchen vegetables in the midst of a very thickly settled city for many years), I will most certainly seek the knowledge of farmers. I trust you’ll forgive me, though, if instead of a farmer in Wisconsin, I choose to consult a New England farmer, who actually knows the local climate and soil conditions, and is well-versed in New England’s two-crops-a-year agricultural system. (The larger crop each year is rocks.)

Before you imply that someone does not know what they should know, best you are certain that you know all you should and not assume that you have nothing to learn from them.

Bernie, you need to read and reread this, and think about it very, very carefully.

As for the rest, since you’re clearly joking, I’ll just shake my head (can’t quite laugh) and go read something that’s relevant, maybe even something from one of those *gasp* hard-studying vets who should be learning from you.

I’ve lived in the state of mind that is urban California, most of my life. (Although mind you, Sacramento is an urban oasis in the midst of some of the biggest ag counties in the nation — from Shasta, Butte, Sutter and Yuba all the way down to the Nos. 1 and 2 ag counties in the world, Fresno and Tulare.) I’ve also lived in the very rural and very poor fishing and timber communities of Franklin County, Florida. Have a passing knowledge of rural Texas (this morning I notice bruising from where a ranch gate hit me, and a cut from a barbed-wire fence!) and other parts of this truly interesting and diverse country.

I have always, always found that everyone has something to offer, and something to say, if you just shut up and LISTEN for a while.

Nobody here is saying rural people are bumpkins. Certainly not me. This weekend I listened to a PhD economist and a board-certified veterinary internist, both women, both ranchers, as well as a country vet and some really good smart stock hands. (One of whom was a young man of around 16.)

I listened to an explanation of advanced artificial insemination techniques that will mean that one great cow will have multiple offspring implanted in other cows. And I listened, too, to plans to breed a great field dog to two top males — one of them deceased. (DNA will be used to sort out the parentage on the resulting double-sired litter.)

This is not “tried and true” old methodology, but cutting-edge, high-tech modern agriculture.

And yes, continuing education is essential for country vets, farmers and ranchers, because the world is changing everywhere.

Now, on top of the interest in using new techniques and technology to advance the “production” of better farm animals in terms of yield, conformation, temperament, what-have-you, where are the open minds when it comes to making the environment more comfortable for an individual animal?

I’m seeing a disconnect here. Am I the only one?

On the original situation in Minnesota, I gotta be honest here: I think the vet needs to retire. Because when you close your mind, you’re done. Whether or not he should be struck off is up to the state board of veterinary medicine to decide, but I guaran-damn-tee-ya I’d never take a dog to him.

If you are interested in education why dont we all come down to my farm for a minute and take a class on accumulated farm knowledge 101.

Why do we feel pain?

When you sprain your ankle your ankle is sending you a message that - hey - you had better not use me for a while. We have a problem down here.

Now, you can use a cane or a crutch and you can go to a doctor and have him give you an ankle brace to keep you off of it. You can also ask for something for the pain that will not cure the ankle but will make it feel just fine.

But, if you go out and run a marathon you are likely to do yourself a huge amount of harm. In fact substances like “bute” have been illegally in horse racing for years to convince them to do exactly that.

I don’t think that anyone has figured out how to have a conversation with a dog or cow or cat explaining that although they might well feel much better after they get this pill they still should stay off that leg and not go chasing rabbits.

Pain tells the dog the lay still and is doing you and your pooch or whatever a great service. It reminds them to stay off the limb until it feels better which is the appropriate time to resume normal activity.

Of course, the effect of pain and its severity have to be monitored closely and unless you have the ability to fully sedate the dog or restrain him or otherwise enforce the inactivity sometimes the message that pain sends is exceedingly useful.

If you dont think that pain can be a useful tool in managing the behavior of animals consider what an electric fence does. It teaches the heifer not to go there where she might get into trouble.

Similarly, shock collars for dogs are used for all kinds of training from teaching a hunting dog not to run too far afield to preventing a dog from barking excessively in town. NO, I dont use these things myself but I can also accept that a particularly defyant dog can be saved from loss or death if nothing else works.

A wise vet can also use observations of pain to diagnose other problems or an animals lack of progress in healing which are completely negated when it is medicated. In fact even the most modern vet schools will teach this in discussing diagnostic skills.

Pain is an important feature of evolution and an entirely natural informative tool and as long as it does get out of hand and become debilitating any animal can and does use it effectively to help in the healing process.

These are the things that people who have spent their lives close to animals know. Their education comes from many lifetimes of observations and wise vets will accept this and learn from it themselves.

As long as people choose to intrude into their lives and livelihood there is always going to be that disconnect and resentment I see festering here.

Before you imply that someone does not know what they should know, best you are certain that you know all you should and not assume that you have nothing to learn from them.

No CEUs, sorry. But if you are wise you will take something from it.