Thrombocytopenia and tumor stage as prognostic indicators in dogs with splenic hemangiosarcoma

We read with interest the article “Retrospective evaluation of thrombocytopenia and tumor stage as prognostic indicators in dogs with splenic hemangiosarcoma.”¹ The authors retrospectively reviewed records of dogs with splenic hemangiosarcoma that underwent splenectomy and chemotherapy to identify prognostic factors and concluded that animals with perioperative thrombocytopenia had a poorer outcome.

However, with the exception of 1 dog that had platelet clumping on automated analysis, it was not apparent from the report that blood smears were evaluated by board-certified veterinary clinical pathologists or other trained personnel to confirm and validate platelet counts provided by the automated analyzer. Without smear evaluation for clumping and aggregates, which reduce the number of platelets counted by automated machines, there is uncertainty whether the automated count is accurate. Depending on the automated analyzer used, the printout may indicate the presence of platelet aggregates and clumps, but it does not always do so. Sometimes, samples that do not have gross clots have microclots and, on blood smear examination, substantial platelet aggregation and clumping. We understand this was a retrospective study and that fresh samples were not obtained. However, when making interpretations from machine printouts, it is pertinent to verify that the estimated platelet count from the automated machine fits what is shown on the blood smear for each patient, regardless of whether they are classified as thrombocytopenic or not by the automated method.

In addition, the materials and methods section does not list the type of hematology analyzer used or whether more than one type was used during the study period. Furthermore, serologic testing to rule out infectious causes of thrombocytopenia such as tick-borne diseases was not addressed in this report, and such diseases may have been a confounding factor in this retrospective case review.

Other studies have found an association between hemangiosarcoma and the presence of thrombocytopenia in dogs,^2,3 and Grindem et al⁴ documented that thrombocytopenia was associated with tumors in dogs. Given these previous findings, which agree with the findings of Masyr et al,¹ the retrospective analysis was likely valid. However, we believe the study could have been substantially strengthened if blood smear examinations had been done and potential concurrent causes of thrombocytopenia in this population had been ruled out.

Athema Etzioni, dvm, ms

Department of Pathobiology Tuskegee University College of Veterinary Medicine Tuskegee, Ala

Naomi M. Gades, dvm, ms

Department of Comparative Medicine Mayo Clinic Arizona Scottsdale, Ariz

Focusing on poultry medicine

In a recent letter to the editor, Osburn et al¹ reported on the decline of food animal medicine education and suggested this may not be an area of interest for veterinary students. Contrary to this assumption, students are interested, but only a few veterinary schools are able to hire academic faculty members with the background to teach these important topics.

In an article recently accepted by the Journal of Veterinary Medical Education titled “Assessing small animal and backyard poultry knowledge of veterinary students regarding husbandry, prescription drug use, and antimicrobial resistance,” students from 13 US veterinary schools were surveyed by means of Likert-type evaluations. Among other observations, the authors found that veterinary students self-reported not being knowledgeable regarding poultry medicine, antimicrobial resistance, drug use, and drug residue avoidance. However, they also reported that they would be interested in these topics if educational opportunities were available. So, the challenge for veterinary medicine is to fill this large gap with respect to opportunities for veterinary students to learn about poultry medicine and obtain the associated clinical training. The encouraging news, though, is that veterinary students want to learn about poultry-related topics.

Unfortunately, over time, there has been a trend that poultry faculty are typically present only at veterinary schools with geographic proximity to commercial poultry producers. This makes sense from the commercial poultry industry standpoint and for USDA-NIFA-funded research. However, for states like California, where there is a large backyard poultry population, limited faculty resources exist, putting veterinary students and the public behind the proverbial eight ball with respect to teaching veterinary students and performing extension services.

Veterinary schools in the United States have very limited, if any, training for veterinary students interested in backyard poultry and nonconventional commercial poultry (free-range and pastured poultry). These systems are often high-risk types of production units that are relatively common in California and other states that are not considered to be among the top poultry states. Commercial poultry veterinarians are typically not interested in or trained to work with many of these types of operations. Language barriers, lack of knowledge regarding integrative farming (crops and poultry), and biosecurity risks are some of the reasons commercial poultry veterinarians don't work with these stakeholders.

Over the next decade, it will be interesting to see how veterinary medicine approaches this educational challenge. In California, the top agricultural state in the United States, training for veterinary students and residents with a focus on small animal medicine is subsidized by state funds. However, it is clear that additional resources are needed to train future veterinarians so they can focus on the production of a safe and secure food supply for the very staples needed for daily sustenance.

Maurice Pitesky, dvm, mpvm

Lisa A. Tell, dvm

School of Veterinary Medicine University of California-Davis Davis, Calif

Looking beyond to improve veterinarian wellness

I want to respond to the recent JAVMA article about the benefits of yoga and leisure reading.¹ First, I applaud yoga as a worthwhile practice and believe there are many benefits to engaging in it. However, as a veterinarian, I am tired of being told that yoga and other personal actions are the solution to poor mental health and stress. Within that suggestion is a subtle barb, a pointed finger: the problem is you.

For the entire veterinary industry, personal well-being care and mental health awareness are good steps, but more emphasis needs to be placed on the role of systemic issues in veterinary medicine. There is only so much well-being care can do for an individual if the system within which the individual is working does not also change. Yoga is a great coping strategy, but JAVMA is not the best resource for veterinarians to learn about this type of care.

Instead, JAVMA should continue to concentrate on articles about client access to care and affordability of care, veterinary educational debt, spectrum of care versus standard of care, employment of veterinary nurses to the full potential of their education, and novel approaches to patient care beyond closely spaced appointments, among other issues. These issues and others are part of the veterinary mental health problem, and doing yoga is only part of the solution, despite its overrepresentation. The JAVMA needs to take the lead on publishing articles addressing industry-wide problems instead of reflecting those problems back to the individual.

Alice F. McCormick, vmd

Jeffersonville, Vt

More on questioning racism

I find myself needing to address the editor's note¹ responding to the recent letter to the editor² questioning racism in the veterinary profession. I can no longer support the AVMA if this is the climate it is supporting. Every recent issue of JAVMA barks “racism” and “diversity” and “angst.” I graduated in 1985 from the Cornell University College of Veterinary Medicine; live in Brooklyn, NY; and, off the top of my head, can name 5 Black veterinarians, including a professor and 4 practice owners in New York City alone, one of whom recently passed away after owning a very successful practice in Harlem, NY, for many years. I am extremely disheartened with these attitudes and offended by the entire systemic racism argument. There is no benefit in identity politics and critical race theory. That path only leads to the anger and divisiveness that we are witnessing getting worse, not better.

What happened to opting for the brightest and the best? And yes, the brightest and the best applies to everyone these days, all races and ethnicities. Many, many opportunities are and have been available to students of all walks of life for a long time. As a white female, I actually had to struggle against the tide of affirmative action as I applied for loans to open my own practice over 20 years ago. Because I am white, I did not have access to lower interest loans afforded to specific racial and ethnic groups. Why are we assuming that new students, who have been more indoctrinated than past generations in the need for diversity and equality, still have to be lectured and immersed in these theories? Why is it assumed that the current veterinary student body needs this education? That is one awful premise.

Yes, there are racist people. But veterinary medicine, as a profession, is not systemically racist. Our country is in grave danger right now, in part because of the climate of distrust and hate that is being promulgated by the media and the administration. We don't need to add to it. Proclaiming veterinary medicine to be a white profession reeks of jumping on the bandwagon to be politically correct. I'm sure I will have many naysayers, but I felt the need to voice what many will not say. It's time.

Julie B. Morris, dvm

Animal Healing Arts of Carroll Gardens at Home Brooklyn, NY

Dealing with systemic racism

We want to express our sincere gratitude to JAVMA for publishing the news stories “Being Black in a white profession”¹ and “Veterinary leaders discuss how to combat racism, be an ally,”² and for the editor's note³ accompanying the letter from Dr. William Bender.⁴ We applaud these efforts and the editor's note in particular.

It is clear that there is much progress to be made in addressing long-standing, systemic racism both in the veterinary profession and in society as a whole, and it is every veterinarian's obligation to ask themselves what they can do to advance equality and equity in society. It is not the responsibility of people of color to educate white people about racism; it is a moral imperative for white people to educate themselves and to translate that education into action. In essence, being an ally should be considered a minimum when it comes to our role in society. Although the Veterinarian's Oath doesn't specifically contain the phrase “first, do no harm,” we widely embrace the concept when it applies to veterinary patient care. It should also apply to our actions toward our fellow human beings.

With regard to the issue of “all lives matter” versus “Black lives matter,” we would point out that all lives cannot truly matter until Black lives matter. To address racism, we must not just see color, but also embrace it in all of its variations and make the effort to ensure that all races are accepted and empowered.

Although we disagree with the premise of Dr. Bender's letter, we share some of his concerns about creating special programs and committees to deal with the issue of systemic racism. However, our concerns arise not from a question of the need to address the issue of racism but whether these programs and committees will enact actual change instead of providing lip service without any real substance. We are interested to hear the details of an AVMA strategy to provide substantive improvements for our profession.

Kimberly May, dvm, ms, De Soto, Mo; Katharine Matavao, dvm, Mililani, Hawaii; Ashley Dunn, dvm, Meredith, NH: Mary McDowell, dvm, Deerfield, NH; Valeria Tanco, dvm, phd, Charleston, SC; Kris Anderson, dvm, Santa Fe, Tex; Georgina Ushi, dvm, Tampa, Fla; Dana Muir-Preston, dvm, Guilford, Conn; Jessica Voss, dvm, cva, Viroqua, Wis; Emma Watts, dvm, New York, NY; Nicole Fisher, dvm, Pawtucket, RI; Nathalie Baldwin, dvm, Chillicothe, Ohio; Claudia K. True, dvm, Ashland, Va; Annie Johnson, dvm, Ithaca, NY; Matthew W. Brunke, dvm, Vienna, Va; Mary Devlin, dvm, ms, Arlington, Mass; Kevin O'Neill Jr, dvm, ms, Lincoln, Neb; Anne Nicholson, dvm, Rockville, Md; Barbara E. Eves, dvm, Kirkwood, Mo; Jolene Tourville, dvm, Centuria, Wis; Christine Schlesser, dvm, Lake City, Minn; Nadine Latham, dvm, Milledgeville, Ga; Jana L. Norris, dvm, Agoura Hills, Calif; Jennifer L. Johnson, dvm, ms, Blaine, Wash; Debora Pettit, dvm, Auburn, Calif; Megan Stewart, dvm, Naples, Fla; Stacey Sood, dvm, mph, Buffalo, NY; Aimee Caldwell, dvm, Portland, Ore; Carrie Jenkins, dvm, Omaha, Neb; Natalie Isaza, dvm, Alachua, Fla; Kari Budday, dvm, Hartland, Mich; Dijana Katan, dvm, mph, Vancouver, Wash; Mary O'Loughlin, dvm, Waterloo, Iowa; Sara Tobias, dvm, Sharon, NH; Kaitlin Stanmyer, dvm, New Hope, Pa; Jill Klumpp, dvm, Fenton, Mich; Mary Songster-Alpin, dvm, Machias, NY; Amy Joynt, dvm, Port Orchard, Wash; Alicia O'Toole, dvm, Statham, Ga; Alana Canupp, dvm, ms, mph, El Paso, Tex; Shale Bushnell, dvm, East Greenwich, RI; Kelly McGuire, dvm, ma, Denver, Colo; Allison O'Toole, dvm, Grand Island, NY; Dana Lewis, dvm, Morrisville, NC; Sarah Eaton, dvm, cva, Saginaw, Mich; Sheilah Roberston, bvms, phd, Gainesville, Fla; Kimberly A. McMunn, dvm, ms, mph, Lafayette, Ind; Amberly Sokoloff, vmd, Roseville, Calif; Leah A. Cohn, dvm, phd, Columbia, Mo; Allison Retotar, ms, dvm, Bonita Springs, Fla; Nancy L. Peterson, dvm, New Ulm, Minn; Lisa Wilhelm, dvm, Keokuk, Iowa; Ingrid Rhinehart, ms, dvm, Ithaca, NY; Nicole Paul, vmd, Southampton, Pa; Krista Feather Whitlock, bsa, dvm, Conyers, Ga; Elizabeth Holland, dvm, cva, Adel, Iowa; Megan Brown, dvm, ms, Columbus, Ohio; Ashley Akins, dvm, Miami, Fla; Anna Ruelle, dvm, Minneapolis, Minn; Amy L. Pike, dvm, Fairfax, Va; S. Ji Hae Park, dvm, Astoria, NY; Dawn Jackson, dvm, Alpharetta, Ga; Erin Zaring, dvm, Whitestown, Ind; Mary M. Rogers, dvm, Thomasville, Ga; Robin Dettman, dvm, El Paso, Tex; Christina Kinkade, dvm, CHPV, Westford, Mass; Elizabeth Easley, dvm, Columbia, Mo; Julie Levy, dvm, phd, Gainesville, Fla; Blaine Brennock, dvm, West Palm Beach, Fla; Jane O'Halloran, dvm, Bainbridge Island, Wash; Jana Mazor-Thomas, dvm, ms, Eliot, Me; Amy Cottrille, dvm, Sammamish, Wash; Shannon Emmons, dvm, Lebanon, Me; Amanda Burdette, dvm, Niwot, Colo; Sarah Corbin, dvm, Noblesville, Ind

From the Department of Redundancy Department

Allow me to introduce myself; I'm Dr. Fred Born, DVM.

Or, maybe not.

This form of address seems to be common across the medical, dental, and even veterinary medical professions. There's just one thing. It's redundant and, thus, incorrect.

According to Robert Hickey, deputy director of The Protocol School of Washington and author of Honor & Respect: The Official Guide to Names, Titles, and Forms of Address,¹ “the rule is either ‘Dr.‘ before, or the post-nominal abbreviation for their degree after. Never both at the same time.”²

Hickey goes on to explain that, for official envelopes and for address blocks on letters and emails, the following format should be used:

(Full Name), DVM

(Name of practice, hospital, or clinic)

(Address)

Meanwhile, for social envelopes, the suggested format is as follows:

Dr. (Full Name)

(Address)

And for letter and email salutations, the format is simply the following:

Dear Dr. (Surname)

Veterinarians should sign their names on medical records and legal and official documents as follows:

(Full Name), DVM

Hickey also suggests that, for purposes of clarity, veterinarians should be addressed as “Dr. (Surname)” by staff members in the clinic, so that clients will know which person in the room is the veterinarian. Using a first name (eg, Dr. [First Name]) in front of clients or in formal or business situations is not recommended, and when introducing oneself to clients or others in formal or business situations, the following format should be used: “Hello, I'm Dr. (Surname).”

Unfortunately, inadvertent and unintentional errors in forms of address for medical professionals are common. But proper etiquette and protocol are as vital for veterinarians as they are for physicians and dentists. It is important, especially during this era of one health, that the public be reminded and understand that veterinarians are members of one of the medical professions.

Fred J. Born, dvm

Fond du Lac, Wis

A true story

There were 2 aging veterinarians who practiced together but were at or near retirement and only saw a few cases, just to keep their hands in or, more precisely, because they weren't quite ready to let go. One of these veterinarians had heard of a nonprofit clinic that took care of pets belonging to people who could not afford veterinary care, and he visited the clinic to see if he might help out. On arrival, he was greeted by an impressive staff and a veterinarian whom he had known for years and regarded as one of the finest.

As it happened, there was a young terrier in the waiting room that day, and the clinic veterinarian asked the visiting veterinarian to listen to the little dog's heart. Hearing a classic machinery murmur on auscultation, he exclaimed, “a ductus!” The clinic veterinarian grinned, because having previously auscultated the pup, he was already aware of the diagnosis.

They wondered, “What can be done?” Estimates of the cost of surgery from several referral centers ran into the thousands, so surgery was out of the question.

The visiting veterinarian left with a promise to see what he could do. Early in his career, he had actually ligated a ductus and had even done his senior presentation on patent ductus arteriosus as a student. But his expertise had transitioned to internal medicine, so he was reluctant to volunteer.

On the other hand, his colleague was just the opposite, with surgery being his forte, and he had ligated a patent ductus on several occasions in his career. He scheduled the surgery, and the nonprofit clinic indicated that it would cover the overhead expenses. After echocardiography, the dog went straight into surgery for a successful ligation.

The next day, as the staff evaluated the puppy in preparation for sending it home, the only thing wider than the surgeon's grin was the length of the dog's thoracic incision. His eyes were bright, and there was a glow on his face—the veterinarian's and the dog's. He accepted the check for the overhead expenses and endorsed it right back to the referring nonprofit clinic to help it with operating expenses. The owner of the pup rewarded them with doughnuts.

The two older veterinarians often retired to their office to recount veterinary anecdotes. In their time together, they had frequently exclaimed how lucky they were to be veterinarians. Why? Well, they agreed that they had never really had a boring day at work. They didn't have to sit behind a desk. Plus, all of their clients were pet lovers!

What a blast!

William A. Rogers, dvm

Pleasant Plain, Ohio