One vet’s fight for his license brings modern pain management into forefront
By Gina Spadafori
December 17, 2007
Larry Oakes of the Minneapolis Star-Tribune has an excellent article on the changing attitudes towards the treatment of pain in pets. The “hook” is the fight for his license of the a long-time Minnesota veterinarian — which we also blogged about back in October — who holds on to the equally long-time belief that pain can be beneficial to an animal who’s healing.
From the article:
[Dr. Carl] Seemann, who with his wife, Margaret, operated Hilltop Animal Hospital in Bemidji from 1957 until the Board suspended his license a year ago, has argued that he is the victim of overzealous regulators and a professional shift based on pressure from animal rights activists as much as on science.
He said that veterinarians have known for generations that some of the pain their patients experience is good. It is, for example, what convinces an animal to be still when it needs to heal.
“I don’t want animals to suffer, that’s why I became a veterinarian,” Seemann said. “But you can’t just obliterate all pain until you’ve made a diagnosis, and with some conditions, if you block the pain, you can’t tell if they’re getting better.”
That’s the old thinking, it’s perhaps understandable that an 84-year-old veterinarian with a long and by all accounts proud history of caring for animals should maintain that view. But it’s not the current one. Again, from the article:
“Pain management has come progressively more to the forefront as we get a better understanding, more research, and more effective drugs,” said Dr. John King, executive director of the Minneapolis-based board, which is scheduled in January to decide whether to take further action against Seemann, including possible revocation of the license he has held since 1948.
A national magazine for veterinarians did a cover story on Seemann, linking his case to an emerging “unwritten mandate” by the public and regulators to aggressively treat pain.
Well, uh, yeah. And it’s not because we’re fur-besotted city folk, either. Studies show that animals (people are animals, too) heal more quickly once the stress induced by pain is managed.
Many of Seemann’s colleagues like him personally and respect him for his decades of dedicated service. He is credited with developing a surgical procedure in the 1960s that reduced excruciating back pain in countless animals, and in 2003, the Minnesota Veterinary Medical Association gave him its Distinguished Service Award.
But those colleagues aren’t lining up to support him in this battle, which he said has cost him more than $80,000 so far. They say he has dug his heels in on the wrong side of this issue, and they flatly reject the notion that rural veterinarians don’t want to manage pain as aggressively.
“I would say that in the last 10 or 15 years there’s been a huge awakening in the veterinary community” about pain management, said Dr. Tom Dougherty, owner of Dougherty Veterinary Clinics in Duluth and former president of the Veterinary Medical Association.
Go read the read the rest of article. And remember that our Dr. Marty Becker and Christie Keith previously wrote about pain-management for our syndicated Pet Connection page for our client newspapers. You can find that article here.
Now … remember when I visited my rancher friends in Texas and watched a trio of bull calves quickly turned into steers by a skilled large-animal veterinarian? One bull calf bawled like the dickens, the other two just sort of grunted in the squeeze chute and accepted their fate. The cost was $10 per castration — the least expensive veterinary bill I have ever seen in my life. Would it have hurt anyone if the calves were hurt less, with a local anesthetic? Even at three times the cost for the procedure?
Well here we go again!
Last time I got beat up over this and at the risk of having it happen again Ill weigh in.
Has it occurred to anyone that there is more than one way to look at this?
Do we just toss our decades of experience because of some study that probably didnt look at this particular vet’s cases.
Doesnt it bother anyone that this vet makes it very clear that he is talking about specific cases where it was necessary to observe the patient before masking over the results with medications?
Yes, Gina. It would makea huge difference in trippling the cost of the castrations. That $20 is likely to be the difference in a profit and a loss in raising the calf in the first place. And without a post procedure observation of any residual pain the calves could well walk off and die with no one ever knowing that there was a problem. Pain (or lack thereof) was the diagnostic tool that told the vet it was OK to go to his next call. Ask him.
Comment by Bernard J. (Bernie) Starzewski — December 17, 2007 @ 1:54 pm
I don’t know about anyone else but I did read the details that were made available about the contentious case and think using no pain medication at all is out of step with good practise. You might argue it is in the extreme range of employing clinical judgement, but don’t expect too much agreement (just as with the recent blow up over euthansia by cardiac injection).
Pain relief for dehorning amd castration is an issue I wouldn’t bring in to the debate, personally. The pain although not insignificant is not quite the same and there are a great any practical, economic and regulatory obstacles to giving livestock pain the same consideration pets get. But routine local anesthesia for these procedures is coming eventually and today’s graduates will adapt to that or end up in similar binds.
Comment by emily — December 17, 2007 @ 2:07 pm
Well, with all due respect, the vet never glanced at them again. We took them home in a trailer and we checked on them later.
If giving pain relief to an animal before cutting off his testicles is the difference between making a profit and not … there’s something wrong with that system.
Not beating you up, just saying.
And yes, I DO pay more, by choice, for food that isn’t factory farmed. I’d happily pay more (or eat less) for a little pain control.
Comment by Gina Spadafori — December 17, 2007 @ 2:53 pm
Doesnt it bother anyone that this vet makes it very clear that he is talking about specific cases where it was necessary to observe the patient before masking over the results with medications?
I asked an orthopedic surgeon about this and he ROLLED HIS EYES and said that is a non-issue — he said there is not one single procedure where they need uncontrolled pain to judge recovery. None.
Comment by Christie Keith — December 17, 2007 @ 2:56 pm
I still shudder whenever I let myself think about Dina by previous Border Collie who at three years old had back surgery and WALKED out of the office with no pain meds. Vet told me it was natures way of keeping her quiet and that she was fine and we “can’t make a dogs pain because she will hurt herself.”The operation was a success, but when “newer ideas” prevailed, I felt like shit.
-Nancy
Comment by nancy freedman-smith — December 17, 2007 @ 4:41 pm
Since you’re not in the animal’s body and cannot tell whether he’s in pain or not, or maybe just hiding it well, doesn’t it seem logical to you that the compassionate thing to do is to ensure that the animal is NOT in pain [and give him pain management]?
The old way is not always the best way. There’s tons of documentation out there that supports pain management.
Comment by Lynn — December 17, 2007 @ 5:53 pm
Just got a little upset when I heard Huckabee speak about his son killing a dog that was mangy. He said that the son thought the dog was going to attack him so he put him “down”.
This was tonight on CNN on the Larry King Live show. Always blame the dog. I wondered what pain that dog must have suffered.
Comment by Colorado transplant — December 17, 2007 @ 9:27 pm
Dr. Seemann is entitled to his educated professional opinion. I have yet to visit two human doctors for the same ailment who agreed with one another over the the diagnosis/treatment. To suspend his license is going a bit far. Perhaps licensing boards should limit themselves to an intended purpose (set/enforce written rules/regulations). Emotions should not be a determining factor when deciding to suspend, fine or otherwise punish a licensed professional.
Did the pet owners have an established client/vet relationship upon which to rely or do they only seek veterinary services when absolutely necessary? Did they have a conversation with the veterinarian regarding funds prior to or during the treatment? Did the family members send mixed signals about the treatment or finances (this happens more frequently than you can imagine) causing confusion? Did they subsequently ‘blame the vet’ when the results were not satisfactory?
Did Dr. Seemann ignore excrutiating pain and appear uncaring to the client?
Be careful about making assumptions. There are so many more questions than those listed above.
Licensing boards should properly guide the licensee in writing and protect the public through diligent management of their responsibilities. I think too often these days they are overly impressed with their position and their power to remain suitably objective.
Comment by Lucinda Wainwright — December 18, 2007 @ 11:37 am
Everyone is entitled to an opinion, but some are unacceotable to their peers and clients en mass. Thus the bear the consequences.
Comment by emily — December 18, 2007 @ 11:56 am
Have you ever heard a grown dog cry in pain? Witnessing this is not something I would wish on my worst enemy.
My dog had a small piece of needle migrate through his esophagus and rest by his thyroid. It had to be removed due to infection. It is a long story but the short version is that he had to have multiple surgeries because it was difficult to locate. They cut all the way into his neck. They finally removed it and he was released to me on pain meds but with the next dose due in two hours.
I brought him home and he laid down and just cried. It was a persistent, unrelenting mournful agonizing cry “Hawoooooooooow, hawooooooow, hawoooooow” over and over and over that continues to haunt me to this day. Thank goodness for narcotics and Pill Pockets is all I can say. He got his dose 1 hour and 52 minutes early (with permission) and stayed well medicated for many days without another cry.
Any person who could say that animals should be allowed to be in pain has never witnessed an animal truly in pain. And since animals instinctively hide pain, they should be medicated under situations that common sense says this is painful. Could you imagine how it feels to be cut open and have your bones rearranged and then sent home without pain medication. Shame on that vet.
Comment by Nicole — December 18, 2007 @ 2:53 pm
The only rational arguement Ive heard here is from Lucinda. Thank You!
Also, in the original blog on this topic Marilyn (a vet tech) weighed in and said that the current wisdom is to back off wholesale medication for a variety of reasons. You might want to look that discussion up and link it here.
I think its interesting that Marilyn and I are the only two people Ive seen blogging here with actual vet related experience. (I farmed).
Like the Huckaby situation sighted by Colorado Transplant there are so many many more important issues we need to be concerned with regarding decent care and respect for all sorts of animals this is a tempest in a teapot and not worth the division its causing.
Gina, that vet certainly did look at those animals before they left but he did it so matter of factly that your inexperienced eye never caught it. And as Ive said before large animal vets are used to dealing with professional farmers and ranchers who themselves would know what to look for or would probably have done the work themselves saving the $10.
Comment by Bernard J. (Bernie) Starzewski — December 18, 2007 @ 6:33 pm
Bernie, you know we love you and value your input. I may be city girl, but I’ve been around animals and veterinarians all my life. Please don’t suggest I’m such a dope that I don’t know what I saw. :) With that, shall we let the matter drop?
Comment by Gina Spadafori — December 18, 2007 @ 7:07 pm
I suppose the argument could be made that farmers are so very, very busy that they “tune out” or simply aren’t around to observe the animal in order to witness the animal’s pain.
If you had a serious ailment, would you go to a physician who got his MD 60 years ago? Or would you want to be worked up by one who is up to date on medical science and techniques?
Comment by Lynn — December 18, 2007 @ 9:22 pm
Comment by Bernard J. (Bernie) Starzewski — December 18, 2007 @ 6:33 pm
“I think its interesting that Marilyn and I are the only two people Ive seen blogging here with actual vet related experience. (I farmed).”
You’re forgetting that on the earlier thread you reference, I discuss my first exposure to the rural perspective while I was in *vet tech school*.
Sorry - you and Marilyn are NOT the only people blogging here with actual vet related experience (and I’m sure there are others who simply haven’t mentioned it. Yet.)
Comment by The OTHER Pat — December 18, 2007 @ 10:11 pm
My partner’s a vet, and I asked her about this. Her verdict: Yes, small-animal vets are increasingly concerned with pain management, and are making drastic changes in protocol to deal with it. (Not, I might add, without considerable prompting from the owners of said small animals. But enough from this small-animal-owning peanut gallery.)
She disagrees with the idea that there’s no case in which pain is instructive in healing. Torn muscles are one example. The pain you feel is your body’s way of warning you that the muscle is damaged and needs to heal. If you mask the pain completely, you run the risk of continuing to use that muscle, adding to the damage. That’s true in humans, too, of course; but it’s even more so in animals who can’t comprehend the doctor’s advice to “take it easy.” Crating helps some, but not all.
That said, there’s no reason not to ameliorate that pain as much as you can - and most other pain isn’t instructive, so there’s absolutely NO reason not to control it, aside from concerns about side effects (minimal) and cost (up to the owner).
Re large animals - most LA vets are hesitant to use pain control not because they don’t care, but because of two factors: price and residue. Any drug that controls pain can pose a problem (and a lot of paperwork) if it’s introduced into an animal intended for human consumption. And while there are some palliative agents that metabolize and leave the body quickly, those tend to be a lot more expensive, and most farmers (especially those with big operations) simply can’t or won’t pay for them.
Hope this helps to clarify.
Comment by LauraL — December 18, 2007 @ 11:15 pm
Gina, Im only suggesting that you are not familiar with large animal practice.
Lynn, old is not equal to bad. Most of us would prefer accumulated wisdom over the young and inexperienced.
I think LauraL has about the best attitude here. But lets consider just exactly what constitutes “as much as you can”. Does that mean that more is always better? Lets let the vet speak for himself.
“I don’t want animals to suffer, that’s why I became a veterinarian,” Seemann said. “But you can’t just obliterate all pain until you’ve made a diagnosis, and with some conditions, if you block the pain, you can’t tell if they’re getting better.”
Read this phrase again “…until you’ve made a diagnosis…” And then “with some conditions”.
In other words he is NOT saying that he does not use pain medication. He is reading the actual condition of the animal to determine 1) if the treatment is working and 2) if further treatment is required.
I see no cavalier prohibition of pain medication here! I hear an experienced veterinarian who knows and cares for his patients with all of his accumulated wisdom and skill. And, that is the way it should be, not a practice managing modern who is doing more the treat the angst of an overly empathetic owner than the patient itself.
I also take exception to the picture posted at the top. Is THIS the actual animal in question or a stock photo chosen for its shock value? Anyone who looks at that certain imagines the pain that poor dog is likely to feel. In the end I think this is the battle Im fighting here. It is NOT about good and wise treatment, it is about what we IMAGINE an unidentified animal MIGHT have felt.
Much like the Congo controversey, none of us were there. We dont know the animal. We dont know the owners. We do not have the specifics of the case and very few of us are qualified to judge.
Take two valium and call me in the morning.
Comment by Bernard J. (Bernie) Starzewski — December 19, 2007 @ 6:45 am
The only rational arguement Ive heard here is from Lucinda. Thank You!
Yes, Bernie, Lucinda is the only one making a “rational” argument—an argument purely from authority, an argument that says that the licensing board has no business passing judgment on whether the vet is adhering to a professional standard of care, an argument that says that the dog’s owners must have been irresponsible and ignorant or they’d know it’s not their place to question the godlike vet, that the rest of us should just shut up.
Quite the rational argument, there.
I worked for several years for a law firm that did a lot of medical malpractice defense. “Standard of care”—which the failure to maintain can land a doctor in serious trouble—is not solely a matter of officially adopted mandatory rules or even officially recommended guidelines. It’a also a matter of what’s in the medical literature, what’s widely done in clinical practice, what the medical schools have started teaching (even if they weren’t teaching it when you were in school.) “Standard of care” at the time the incident occurred can protect a doctor who adhered to it even if, in the time between the incident and the case coming to court, the standard of care has changed. And it can whack a doctor pretty hard, if he didn’t adhere to the standard of care at the time of the incident, even if what he did do was the accepted, recommended practice—the standard of care—for his entire forty- or fifty- or sixty-year career prior to that.
Human doctors are expected to keep up with changing medical knowledge and standards. It’s fair to say that vets have a tougher job, having to be medically knowledgable about many different species. That’s not an excuse for not keeping up with stuff that appears to affect, at a minimum, all mammals.
Comment by Lis — December 19, 2007 @ 6:59 am
My vet said that if the condition causes pain in humans it likely causes pain in animals. Makes sense to me ~ and I want my animals comfortable enough to eat, drink and heal. I also had a lot of experience when CJ was so sick this last year and she showed little/no sign of pain until she was very, very sick requiring care in the ICU at the MSU Vet Clinic. Can’t imagine this older vet is withholding any pain medication because he wants the animal to suffer, but probably believes he’s doing the best thing for the animal. Times change and we learn a lot. BTW, IF I was a meat eater, I would be more than happy to pay extra for animals raised humanely (including pain meds when necessary). And since when did the USDA or FDA have REAL concerns about what goes into the foods we eat?
Comment by catmom5 — December 19, 2007 @ 7:40 am
Indeed Lis. Couldn’t agree more. Calling everyone else irrational and assuming unique authority on the matter didn’t work for Minnesota vet and isn’t going to change minds here either. Most of us have some kind of expertise and experience and are not just blathering from a position of blithe ignorance. No one is calling the man a sadist but he should have realised his approach was no longer accepted. A similar sea change will reach livestock production where the mainstream of professionals are already moving proactively to embrace refinements of technique such as scientifically supported off-label analgesia use with appropriate withdrawal times.
Comment by emily — December 19, 2007 @ 11:41 am
OK, I heard my name mentioned, so I’ll take that as an invitation to join the discussion. :)
Bernie, the dog in question is Jazz, a yellow labrador retriever. So, no, the dog pictured above is not the actual dog. I looked for and could not find, Jazz’ picture on the internet, so I guess the owners have not made it available for publication. I bet Gina would have used it if she could have found it, right Gina??.
This case is causing a stir here in Minnesota, primarily because there is not one accepted standard for managing pain. Every clinic develops their own protocol. Research is continuing, but meanwhile pain management is a moving target. Even Glasgow University, which is on the forefront of pain management research, does not suggest intervention until the animal demonstrates a certain level of pain (5 out of 20, or 6 out of 24 on the Glasgow Composite Measure Pain Scale).
For purposes of this discussion we have no information to tell us whether Jazz did or did not demonstrate that level of pain. Individual animals do react differently to pain just as people do and there is nothing in the newspaper article that describes Jazz’ behavior and overall condition. We also do not know what anesthesia was used. Some anesthetics take 12-24 hours to completely leave the body and even though the animal is awake and alert, they are still somewhat sedated and comfortable during that time. So without more specific detail, I can’t make assumptions about this dog’s treatment.
At our clinic we give pain meds with every surgery and send pain meds home with each patient, explaining why to the clients.
But even our clients are all over the map when it comes to pain management. For every client that wants it for their pet, there is a client that does not. Reasons why not vary from clients who cite past pets who never needed pain meds, gender differences (men take a pass on the pain meds more often than women do), a reluctance to see their pet drugged (fear of adverse effects), and financial considerations. Some clients flatly refuse to purchase the meds, others purchase them reluctantly and then do not administer them at home. Obviously, we deal with a lot of different attitudes and opinions and try to be sensitive to them all.
Comment by Marilyn — December 19, 2007 @ 3:15 pm
re: The picture. No, I probably wouldn’t have. It’s unethical to lift copyrighted material off another’s Web site (for example, that of the Minneapolis newspaper), so we don’t do it. We follow “fair use” guidelines as ethical bloggers.
I don’t think there’s anything wrong with the photo. The story is not about that dog, but about shifting standards of care with regard to pain management, at least in companion animal care.
Anyone who thinks an animal who went through the surgery the Labrador in the story did wouldn’t have been in pain afterward … well, you’re invited to have the surgery yourself and let us know how it feels.
As for the idea that pain “helps” an animal more than it hurts him, Christie has already addressed that point above. Educated practitioners who remain up-todate on their continuing education think the idea is total bunk — including surgical specialists.
But again, you’re welcome to go cold turkey after your next orthopedic surgery and let us know.
Those who refuse pain meds for their hurting pets … we’re aware of that situation (Christie covered it in an earlier post, referenced above). If they’re choosing pain for their pets to save money, well, that makes me sick to my stomach, to be honest with you. If it’s because of a lack of understanding, fear of side effects, etc., that’s entirely different.
I bet we’ll be having a different discussion on this in a few years. As the article says, the times are changing.
And thank heavens.
Comment by Gina Spadafori — December 19, 2007 @ 4:29 pm
Re comment by Bernie — December 19, 2007 @ 6:45 am
Bernie, I never said that “old is not equal to bad” and I thoroughly disagree with you in that “Most of us would prefer accumulated wisdom over the young and inexperienced.” Are you kidding? Do not presume to know what MOST people want. In fact, I’d wager that MOST people would WANT pain meds for their pets.
Why would anyone choose to a dentist who uses a drill and other equipment from 40 years ago? It’s all about CEU’s to keep up to date. I wonder when this vet last attended a seminar? If he has trouble making a diagnosis or prognosis while an animal is on pain med, he may need to go back to school. I’ll say it again: I would rather the animal have pain meds. Why would I want to frighten him?
Too, you need to consider the psychological ramifications of NOT having pain abated. To animals incapable of understanding what is happening, it borders on cruelty to allow them to remain in pain.
I’ll throw this out there - though I don’t know if this is the case: Sometimes older people, practicing in a field where technology has made great strides, feel left behind and are intimidated by their own lack of knowledge compared to their peers. These older people often become stubborn, hanging on to old beliefs and practices. We see this everyday.
I’m a frequent flier when it comes to orthopedic surgery. All I can say is for the kind of surgery that dog had……..well, my heart bleeds for him.
[Sorry, Gina, I had to respond.]
Comment by Lynn — December 19, 2007 @ 5:20 pm
Oh Gina, I wasn’t suggesting that you should do anything illegal or unethical! I’m sure you would not do that. :) If a picture of Jazz had been available, a link to it would have sufficed. However, that is a moot point since a picture is not available. Frankly, I did not think anything of the picture at the top of the page either until Bernie mentioned it. He got me thinking about the selection of pictures for articles and the various dogs I have worked with post-surgery. We all know that pictures are powerful. They draw us in, make us want to read the article, and they do influence us. If I had pictures of all the dogs I have worked with after surgeries, those pictures would show a great range of conditions. Some would look like the dog at the top of the page or much worse. Others would look like nothing very much had happened to them. If this discussion had been accompanied by a picture of a dog (sutures included, bouncing around on all fours, ears up and smiling, how would that influence this discussion?
That is why I went looking on the internet to see if a picture of Jazz was available. I was interested to see what her actual general demeanor was after surgery if possible.
I don’t think anyone suggested that Jazz would not have had any pain given the surgery she went through. I certainly did not say that. What I did say is that animals react differently to pain, just as humans do. And I said that we do not have enough information about this case to know what her condition was post-surgery. Her owners pulled her from Dr. Seeman’s care, which was their right to do. We do not know from the article at what point they pulled her. Was she still somewhat drugged from the anesthesia? Was she howling in pain? We don’t know. The newspaper article does not tell us. Which is why I said that we can’t make assumptions here about her care.
As far as having surgery myself, I have had. Following my most recent surgery I was in a room with another patient who had essentially the same surgery on the same day. We were both on the same pain medication. She kept asking for more medication which they gave her, while I kept reducing the dose. Again, individuals react differently to pain.
I would like to see this discussion go beyond the simple pain meds vs. no pain meds. If this discussion is about pain management, then I would like to see discussion about the management part. To me, that includes discussion about establishing a common standard, about using the scientific method to determine when and how and which meds are used, about actually being able to measure pain in animals so that we can use both subjective AND objective methods to better help our pets, and how to manage the drugs that are sent home with pets to ensure the pets are getting them, and that vets are not being taken advantage of by drug abusers. These are all serious issues. Personally, I do not want to see the veterinary profession follow the same swinging pendulum that human medicine has followed in pain management, but we seem to be doing that. I think we can do better.
I’m curious… When this discussion was started a few weeks ago, I posted a link to the Glasgow Composite Measure Pain Scale. Did anyone read that? Did anyone have occasion to utilize it to measure any of their pet’s pain? I’m always interested in feedback on it. Since we started to use it in our clinic, the reaction from clients has been terrific. When we give people pain meds, they often ask “How will I know if she’s in pain?” They are grateful for an objective way to make that evaluation.
Comment by Marilyn — December 20, 2007 @ 7:47 am
Marilyn, I was just clarifying on the point about the pictures. A lot of blogs and Web sites lift pictures from others, and I’m sure they don’t know it’s often a violation of copyright.
We buy stock photos for many posts, and TRY to choose seems to go with the story. And inexact science, as you’ve pointed out.
Here’s information for all on the GCMPS. Facinating stuff.
The thing is, though, it’s better to pre-medicate and ease off than to “chase” pain. Since in the latter case, you can’t catch it without higher doses.
Although there has been some heated discussion in this thread, I’m happy for it. We’ve had good, thoughtful discussion, and we’ve certainly raised awareness of the pain-management issue. Maybe some pet-lovers will now feel more empowered to discuss the issue with their veterinarians, and that’s always good.
Comment by Gina Spadafori — December 20, 2007 @ 7:57 am
Here’s a link to the entire report of the Judge. http://www.oah.state.mn.us/alj.....report.htm It’s kind of long, but it definitely shows that neither the Judge nor the Board have been unfair to Dr. Seemann. He should have admitted his mistakes and either agreed to update his practice standards or sought to retire gracefully instead of making this case into a vendetta. Contrary to what Dr. Seemann implies, licensing boards are not “out to get” anyone; they exist to protect the public.
Comment by Donna — December 21, 2007 @ 10:31 am