January 2022

In this VETgirl online veterinary continuing education blog, Dr. Justine Lee, DACVECC, DABT reviews the top 5 things she wish she knew better as a veterinarian.

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By Dr. Justine Lee, DACVECC, DABT
Director of Medicine / CEO, VETgirl

Top 5 Things I wish I knew better as a veterinarian

OK, I’ll admit. As a double-board certified veterinary specialist, I have tunnel vision when it comes to vet med. What’s this mean?

When I first finished my residency in emergency critical care at University of Pennsylvania, I was so excited to be a Diplomate of the American College of Veterinary Emergency Critical Care (DACVECC)… that is, until a 4th year veterinary student questioned me and said “But aren’t you a jack of all trades, master of none?” While I was initially taken aback by this, I ended up telling this student that I was as a master of emergency/critical care. That I felt comfortable triaging and treating anything that walked into the urgent care or ER.

But… then add on my toxicology specialty and I was really pigeon-holed into the world of ER!

The more one specializes, the more narrow they become. After all, I don’t do much derm or ortho or surgery myself, as I’m surrounded by specialists. So I always say that a well-rounded general practitioner is MUCH better than me in many areas of vet med! So, go you!

If I could pick 5 areas that I personally wish I was better at in veterinary medicine, it would be in the following areas:

1. Diagnosing a cruciate tear.
I’ll admit. I suck at this one and often have to call the surgeon over, especially if it’s a partial tear or a really muscular, tense dog (hello, pit bull!). Granted, I think I missed the week in veterinary school when they taught how to do an orthopedic exam in a dog. And cats? I mean, can you even do an orthopedic exam in your feline patients? (Why yes you can, and we’re having a webinar on it HERE for you cat veterinarians!). BTW, this is also why we have a great VETgirl video on How to diagnose a cranial cruciate ligament (CCL) injury in a dog based on radiographs. In the meantime, more rest, more weight loss, and more NSAIDs for you dogs until you can recheck with a surgeon.

2. How to do a neuro exam.
Don’t get me wrong. I’m ALL over head trauma and T3-L3. But everything else? Get me a neurologist, STAT! Hmmm, this may have been another week that I missed in vet school, despite being taught by neuro guru Dr. DeLahunta (RIP, D) at Cornell. Thankfully, I can watch how to do The Neurologic Exam here in a quick, 30-minute lecture on neurolocalization. Because anything outside of T3-L3 is hard, yo.

Thankfully, I’m all over the use of mannitol, anticonvulsants and steroids. When in doubt, more steroids.

3. Dermatology
Derm. I mean, seriously? If I could do vet school all over, I would have paid attention to my 2-week derm rotation. For all your veterinary students out there, PAY ATTENTION TO DERM because it’s the only thing you’ll see for the rest of your life. For real. Get your derm help on here. When in doubt, more steroids?

In the ER, I’m all over a good hot spot or purulent otitis externa and even a Demodex case (Thank you, isoxazoline drugs!). But I feel terrible (not really, honestly), when I have to boot these chronic cases back to you for long-term management. Bless you. Seriously.

4. How to spay a big dog.
OK, all you GP’s have me beat here. In full disclosure, I don’t penetrate body cavities anymore unless it’s with a needle or tube. I’ll do bite wounds, abscesses, and all that jazz, but if you’re a new veterinary graduate, it’s intimidating to spay a big dog. Check out this VETgirl video, thanks to pet-overpopulation-shelter-medicine-I-can-spay-anything-in-10-minutes, Dr. Graham Brayshaw. No steroids allowed for “anti-inflammatory” properties, please and NSAIDs and locals instead for analgesia!

5. Managing chronic diseases
The pro of working in the ER is that you can acutely save lives. The cons? You don’t get feedback or long term follow up, so have no idea how the patient is doing life-long. Like diabetic patients. While it’s fun to save them in the ER from their initial diagnosis of diabetes ketoacidosis (BTW, DKA does NOT stand for Diabetes Kills Animals, as they are totally save-able!), I don’t get to tweak their long-acting insulin long-term, so it’s hard to see how they respond. Likewise, I can diagnose the protein-losing enteropathy (PLE) in that Yorkshire terrier referral of yours, and save that immune-mediated hemolytic anemia (IMHA) by perfusing and transfusing it like a criticalist-pro, but I don’t typically get the long-term follow up. This makes it harder for the expertise on how to “tweak” and adjust drug therapy.

My long-term management was limited to my internship and residency, when I followed my patients out for hyperthyroidism, CRF, and more. In some ways, I miss the long-term commitment (Gifts! Gratitude! Thanks!) but in some ways, I don’t (Still itchy! Needs med refills! Misses the recheck appointment!). Regardless of WHERE you practice, take the time to follow up – even if it’s in the ER. I put it in my Google calendar to recheck that UTI and culture response via a quick text to the owner (via your fancy EMR or whatever service you’re using) – that way YOU can learn in the process with the feedback and see if your patient is responding to your therapy!

Angell internship Justine Lee

Justine Lee as a baby intern veterinarian at Angell in 1997

So, those are my top 5 that I wish I was better at as a veterinary professional. What areas would you add to the list? Share the knowledge in the comments below!

  1. Dear Dr. J Lee, Thank you for the great material and instructions. I have a comparable situation: 4 years in the Triaj/ER , first diagnosis and redirect to specialty clinics. Thank you for your note: the more specialized you are the narrower you go and after a while you master one thing that is not that necessary nor it is used too often. I wish I would know more, there is always a list of things I want to look into, I always read and feed all “my wolves” not just one. I started in a district clinic, a small one-vet/no-technician establishment. 90% of cases needed antibiotic/NSAIDs/steroids, vaccines and albendazole. Since then I’ve seen countless such clinics. It depends on the vet how far, how high or how deep he/she wants to go. I’ve seen the life of specialists, too, whom for I feel immeasurable respect….they were not happier than those having a simpler practice, nor better paid. Thank you, so much for your article; it was as instructive and informative as friendly and encouraging. With outmost respect, Rosemarie

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