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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

In the battle of vet vs. pet care experts, who best to handle husbandry?

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November 04, 2010 / (18) comments


Big dog’s got a bone. So what does he do with it when a little one comes around? He snarls and growls, showing off those big white teeth and prodigious hackles so as not to let the itty-witty thing below him get the wrong impression. ‘Cause no way is he planning on sharing. 

 

So it goes with veterinarians and the army of pet care providers who offer ancillary healthcare services such as chiropractics, massage and acupuncture, for example. If the person providing these services is not a veterinarian or under the direct supervision of a veterinarian, my profession is staunchly opposed to the practice. ‘Cause no way are we planning on sharing.

I got to thinking about this perennial issue after one of you posed this question:

Every now and then I see [an] attempt to pass legislation that will outlaw common husbandry practices by anyone except a veterinarian. Here is an example of the fallout: www.mofirst.org/news/Freedom-Center.html. This case has to do with floating teeth in horses, but the law is so vague it could apply to other things as well, even to dog trainers. I have a great deal of respect for veterinarians, but I don't think they are the experts in everything to do with animals, so I am concerned about attempts to take over husbandry. Do you have any thoughts on this issue?

Why yes, as a matter of fact, I do.

But first up, some basic background on this case, one that pits a trained, experienced "floater" (someone who provides a common dental service to keep horses' teeth nice and even), Brooke Gray, against the Missouri Veterinary Medical Board. According to what appears to be her legal counsel’s website:

On September 9, 2010, the Attorney General’s office filed a lawsuit accusing Brooke (the offending floater) of practicing veterinary medicine without a license. The Veterinary Medical Board, the plaintiff in the case, invoked the authority of a 1992 law that makes it a criminal offense for any non-veterinarian other than an owner or the owner’s full-time employee to change an animal’s physical or mental condition. Violation of the law is punishable by a fine of up to $1,000 and a year in prison for each separate animal involved.

"The breadth of this law is truly astonishing," said Dave Roland, the attorney who has taken up Mrs. Gray’s defense. "The law offers no exceptions or narrowing definitions, meaning that if it chose to do so, the Board could prevent non-veterinarians from providing such common services as horseshoeing and cattle branding — or even dog grooming and training!"

The page offered no link to the statute, but if their claim with respect to its language is correct (and no, it would not surprise me if it were), this example offers more of the same kind of professional protectionism we veterinarians have been increasingly guilty of. Here’s what I mean:

With our culture’s seemingly inexorable drive toward a more enlightened appreciation of animal welfare principles to consider, and more of the same barn-to-backyard-to-bed evolution to look forward to, it only makes sense that the public demand higher quality care for all animals.

The veterinary profession has responded to these social and economic pressures by ramping up production of specialists, drugs, procedures, and specialty facilities, among other niceties. In so doing, it has sought to enact restrictions on the degree to which non-veterinary service providers could commercially offer procedures we veterinarians now consider worthy of greater quality care (e.g., equine floating vs. veterinary dentistry).

So you see, the point here is ostensibly all about ensuring that our animals are treated with a high standard of care and not at all about making sure veterinarians are the ones to reap the available economic benefits of floating, chiropractics, acupuncture, etc.

But is it really?

In many cases I’ll hasten to agree. Our animals really do deserve the higher quality of protection afforded by the kind of work that only a licensed practitioner can provide. Traditional medicine and surgery fall into that camp. I happen to be conflicted over the twin issues of chiropractics and acupuncture. But floating and horseshoeing?

Just as for dog training and grooming ... not so much. These are highly skilled areas where those who do lots of it will almost always do it better. And while attention to medical issues is critical to both practices, they're amenable to the kind of schooling these trade groups offer.

So back to the question: Is it fair to let veterinarians take over husbandry? Not at all! Veterinarians should not be the de facto boss of all things related to animal care. Nonetheless, if veterinarians are charged with standing up for what’s best for animals' healthcare, is it not our role to try and raise husbandry standards across the spectrum?

I think so. The trouble comes when instead of lending our related trade groups a hand when it comes to training, certification, and adoption of higher standards, we prefer to snarl and growl and bare our teeth. Which helps animals not at all.

 

 

 

Dr. Patty Khuly

 

 

Pic of the day: "I could eat a horse" by publicenergy

 

 

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COMMENTS (18)
1
by babysweet on 11/04/2010 09:48am

This hits me on so many levels.

First, because I am a rescuer and trainer. Second because I used to work in a pet supply store.

It's my opinion that veterinarians should stick to what THEY do best. And that should be the scope of their reach.

What do they do best? Well, that depends on the veterinarian.

I have a great parallel example. When I worked at a clinic here in Canada, it was legal for technicians to perform certain surgeries under veterinary supervision. Namely, cat neuters and declaws were almost ALWAYS performed by technicians in the tech room while the surgical suite was used for spays and other surgeries. The vet was never more than ten feet away, and after twenty years of performing the same two surgeries a few times a day, our head tech could whip through declaws and neuters like they were nail trims. She even did my cat George (this was a long time ago, and sadly I chose to have my cats declawed - a decision I will always regret). He received pain meds for three days following the surgery and was slightly tender - as you would expect following surgery - but not in serious discomfort afterwards.

About a year later, they discontinued this practice when the powers that be decided that only vets could perform these surgeries. The results were DISASTROUS.

Vets hadn't performed these surgeries since school! For our head vet, that was almost two decades. My second cat, Jasper, was one of the cats that was declawed by a vet about two months after the law was changed. You can still clearly see how mutilated his paws are. He was in serious pain for weeks following his declaw and had complications with his neuter.

In this situation, a vet wasn't even the best choice to perform a surgery.

My point is that no dog trainer is the best at handling EVERY dog. No groomer is best at EVERY breed. And most would never claim to be.

Yet vets consistently try to undermine recommendations from trainers, groomers, nutritionists, naturopaths - basically anyone who is not a veterinarian. (I of COURSE mean vets as a majority, NOT all vets)

Vets would be outraged to find a trainer doling out medical procedures, and yet they have no problem doling out training advice.

What it comes down to is Vets Know Best. I see this every single day, even when I'm giving my clients scientific studies to take to their vets as proof that say for example... blood serum allergy testing is unreliable - only to have the vet dismiss their concerns. Not because of lack of validity, but because of where the suggestion came from. Not A Vet.

The most successful vets I know are the most open minded, the most willing to consider new ideas, the first to recommend a specialist or alternative therapy when their treatments fail. These vets work on results over all else, and treat their ego LAST. To me, these are the signs of a great vet.

In fact, I'll take a vet fresh out of school as described above over a Vets Know Best type of individual with 30 years experience and a top of the line facility.

That being said, I think that vets do have the unfortunate role of being the enforcers when they see animals who have been injured by people Who Are Not Vets. A farrier who mangles a horse's feet. A groomer who cuts or burns their client. A trainer who causes tracheal damage or who recommends unsafe practices. We do rely on vets to speak up when these tragedies occur - so the line is a fine one.

But I think the answer lies in the culture and attitude of veterinarians and their organizations. And of course consumer choice. When you choose to give your money to veterinarians that promote only those ideas that serve their own interests, you as a client are just as guilty as they are. When you choose veterinarians who are open minded, who seek alternative answers and who are willing to go beyond what they learn from textbooks, you are sending a very clear message to the establishment that we as pet owners are demanding more inclusive, rounded, comprehensive care - and we want our vets to be a part of this, not on the outside screaming in.

Kudos to Dr. Khuly for once again tackling a subject that will be unlikely to gain her any mainstream veterinary friends - but needs to be addressed. And then think back to Dr. Khuly musing about the use of medical leeches and ask yourself which category she fits in. ;O)

Let's hope she catches on.

2
by Esmee on 11/04/2010 09:52am

"if veterinarians are charged with standing up for what’s best for animals' healthcare, is it not our role to try and raise husbandry standards across the spectrum"

I can't help but think of the AVMA's support of factory farming. I find the idea that the veterinary industry considers itself animals' protectors kind of laughable in light of that. Clearly individual vets are a horse of an entirely different color than the association.

If people are to believe that the "industry" actually cares about animal husbandry, developing humane standards for food animals would be the place to start and the veterinary industry has failed disgustingly so far. So no, I would not be looking to veterinarians for that when they have stepped up against activists working to raise standards.

3
by babysweet on 11/04/2010 10:19am

EXCELLENT point, Esmee, and one I hadn't even considered.

Thank you for bringing up that side of the equation. There certainly is a high level of hypocrisy going on.

4
Horse Dentists? ACK.
by Buttonmouse on 11/04/2010 12:52pm

Having been a horseman for the past 30 years I can honestly say that after watching a so called "horse dentist" work on several horses at my barn, they should be outlawed. I've watched horses with blood pouring out of their mouths with this so called "horse dentistry" they have NO business tranq'ing a horse or working on it's mouth. NONE...vets go to school for a reason, and you have a vet for a REASON. Horse dentists....a horses life can depend on it's ability to process food. Why would a horse owner subject their animal to a backyard practice? Would YOU get your teeth done on the sidewalk but someone wearing a hat saying "im a people dentist?"

These people have NO training in a horses mouth, teeth, how to float etc...if you "jack" up a horses molars they will not be able to process feed, and then you'll have a nice colic bill on your hands, providing you can afford the surgery. Once the "horse dentist" looked at my horse and said "oh i can fix all that" so I called the equine hospital to ask what a "horse dentist" was...they said "there is NO SUCH THING, you bring that horse in" so I did, the hospital did my horses teeth. When they were done, the vet said "let me show you something" and we walked back into the recovery stalls. There were about 15 horses all standing with colic surgery bandages on their bellies, the vet said "see this? THIS is from the "horse dentist". Always have your equine child cared for by your VET

5
by babysweet on 11/04/2010 01:21pm

Buttonmouse - I sympathize with your experience. However, you state in your comment that "horse dentists" have no training. This is from the legal site:

"Brooke received her initial training at a highly-respected school of equine dentistry and she also did a five-month apprenticeship, perfecting her skills under the guidance of master floaters. She now has seven years of experience in the field and a large group of horse owners eager to take advantage of her talents."

Something tells me that this is much more specialized training than veterinarians receive - perhaps Dr. Khuly could comment.

I should also add that there wasn't a complaint lodged against this individual by a customer who was unhappy with her services, but rather by a veterinary organization.

I am in complete agreement that inept, uneducated, unskilled "experts" and "professionals" have no business doing ANY business, period. I dare say there are schooled and licensed vets that fall into this category as well.

However, that's not what happened in the case being discussed.

Does your vet do your farrier work as well? Because there are many large animal veterinarians who would much rather turn work such as regular maintenance dentistry and foot care over to the real professionals - those that are specialists in their field.

6
by EmilyPK on 11/04/2010 03:03pm

Pet dentistry, on horses and dogs, is being done by incompetant people as well as competant non-veterinarians. Sometimes with horrific results. If it is not limited to veterinarians it has to be limited to some other class of qualified and insured person to give owners of pets subject to malpractise some recourse.

7
by Equine DVM on 11/04/2010 03:48pm

>>Something tells me that this is much more specialized training than veterinarians receive - perhaps Dr. Khuly could comment.>>

Actually, as EmilyPK said, it's a lot more complicated. Some veterinarians hate dentistry and do a lousy job, honestly. In contrast, some veterinarians have received advanced training in dentistry, enjoy dentistry, and perform dental procedures on a daily basis. Want your horse's heart, lungs, temperature, and gut motility evaluated before I sedate him? Call me. Want intraoral x-ray films of your horse's teeth? Call me. Want a fragmented, infected molar extracted with both regional pain control and sedation, as well as antibiotics if warranted? Call me. Does your horse need a root canal? Call me, and I'll send you to one of my colleagues who has even more advanced training in dentistry. I'm privileged to have received training from some of the giants in the field: David Klugh, Dennis Rach, Michael Lowder. All are veterinarians.

OTOH, if you want the sharp points knocked off your horse's teeth, call a floater. Some floaters are certainly better than others. How do I know? Well, when the horse doesn't eat for a week following a float by a lay person, the owner invariably calls the veterinarian. I charge for the emergency call, an exam, and, if necessary, dentistry... again. Buyer beware.

>>Does your vet do your farrier work as well? Because there are many large animal veterinarians who would much rather turn work such as regular maintenance dentistry and foot care over to the real professionals - those that are specialists in their field.>>

Straw horse. I've never met a veterinarian who wants farriers put out of business.

The entire argument against lay floaters actually isn't over floating teeth. The real issue is: lay floaters and other non-veterinarians want free access to the powerful sedatives available only to veterinarians. Some floaters want access to these drugs so they can perform surgery: extractions, wolf teeth and molars.

Not such a great idea, IMO. If you want to float teeth... stick to floating teeth. If you want to sedate and perform surgery... apply to veterinary school.

Clients: there's a lot more to equine dentistry than sharp points, but it's your horse, and your choice.

8
by babysweet on 11/04/2010 04:32pm

"Not such a great idea, IMO. If you want to float teeth... stick to floating teeth. If you want to sedate and perform surgery... apply to veterinary school."

I have no issues with this statement - in fact, I agree. Sedatives should be used only by veterinarians or under the supervision of a veterinarian, unless specific training is provided and legal issues are not in play.

"Straw horse. I've never met a veterinarian who wants farriers put out of business."

Not a straw horse by any stretch of the imagination. According to this law (if written as suggested), veterinarians are the only ones legally capable of doing farrier work.

If outlawing laypeople doing surgery and using anaesthetics was the point of the law, then it should have been worded as such.

If instead the law is as MissouriFirst.org claims it to be, I don't really see this woman deserving prosecution due to the law's extreme reach and lack of definition.

I also would like to point out that it wasn't until I visited the website of her governing body that I realized that some of these people are in fact performing surgical extractions. Where I come from, a floater floats - and defers to a vet when truly serious issues arise. However, ALL preventative dentistry is done by "laypeople" - and the Missouri law targets BOTH.

Although at the same time I find it interesting that the owner and/or the owner's employees are legally allowed to... do whatever they please?

9
by babysweet on 11/04/2010 04:49pm

BTW, EquineDVM - David Klugh, I'm sure you know, is the head of the International Association of Equine Dentistry. As in, one of the organizations that certifies Equine Dentists.

On his website, he seems to have removed the "current members" list, however one of the posted articles starts out with a horse owner explaining how his vet recommended an Equine Dentist to him.

It appears that some of the "giants in the field" disagree with you. The same expert (and I don't disagree that he is an expert) that taught you as a DVM is the one promoting these actions by "laypeople".

10
To Esmee
by Dr. Patty Khuly on 11/04/2010 05:50pm

I would never disagree with your assertion that my profession needs to look deep within before denying others a role based on our superior track record when it comes to agriculture species. But when it comes to companion animal medicine ... we're almost invariably talking about a whole different set of veterinarians. Which is the subject of an upcoming post. Stay tuned!

11
by Equine DVM on 11/05/2010 10:29am

>>it wasn't until I visited the website of her governing body that I realized that some of these people are in fact performing surgical extractions>>

Happens all the time in my area. Many of the floaters also carry their own bottles of sedatives. Where do they obtain the drugs? From my colleagues, of course, especially those who don't perform dentistry but would rather sell drugs to an untrained layperson than refer to a veterinary colleague.

Of course, the client whose veterinarian tells her to call a floater has no idea that the floater shouldn't be sedating horses or extracting teeth.

>>Although at the same time I find it interesting that the owner and/or the owner's employees are legally allowed to... do whatever they please?>>

Yes, because animals are legally your possessions under the law. That's why I don't personally care if horse owners call a floater, just as I don't care if you order your vaccines on line.

Re: David Klugh... he can speak for himself, because this is a complex issue. Consider he's also the first person to pursue board-certification in equine veterinary dentistry. He's actually considered a fellow vs. boarded because that the equine specialty is still in the process of being created. Of course, no floater will ever be eligible for board-certification or fellow status, because the first requirement is a veterinary degree.

12
I with Esmee
by P on 11/05/2010 03:27pm

In the election that passed a measure to uphold minimal care for puppy mill animals on Tuesday in MIssouri, the veterinarians were against the measure. My friend's vet even lobbied her to vote against the measure when she took her dog for care.

I may not buy the whole HSUS story, but there are measures that reasonable people can support. To me it is cruel to keep dogs confined in cages with wire floors their whole life for the production of puppies. And the vets didn't stand against the practice and even lobbied against the bill.

When they don't stand up for humane treatment probably because it might not be in their economic interest, why are we to believe the restriction of services by other practitioners isn't also about cornering services in their own economic interests. Maybe make a slave of the person who provides "floating" services. Hire the person so they can "supervise" the person and pay them as a form of slavery. It is about veterinarians cornering the market. Gatekeeping.

13
P, I stand corrected
by Dr. Patty Khuly on 11/05/2010 05:29pm

You're right, of course. In some arenas within companion animal medicine veterinarians are not playing nice with animal welfare, citing unintended consequences –– one of which often involves their/our bottom line. Which was the whole point of this post to begin with.

14
by EmilyPK on 11/05/2010 05:46pm

The thing about Prop B is that pretty much everything in it is already in the existing law. What is lacking, and is *still* lacking, is enforcement. Maybe the veterinarian in question saw having parallel laws on the books might actually make things worse? Or at the very least it might distract from the real problem that both laws are unfunded and unenforced?

15
Prop B
by ckaybruce on 11/05/2010 10:27pm

I would love to read a post on your opinion of Prop B. I live in KS, but just 15 minutes from State Line so I am in Missouri all the time. My point is that the vets who went on the news and opposed Prop B specifically said things like "this is backed by HSUS and PETA and these are politically corrupt organizations and anything their hands are in can't be good." It's an abomination and I for one, am ashamed of Missourians. Prop B literally passed with only 52% approval. Utterly disgusting! So what if the laws are already there? If Prop B means the laws will now be enforced (because they set aside the funding for enforcement), then how can it be a bad thing? Seems like every day there is just another reason to be ashamed to be a human being. And the 48% of people who voted "no" on Prop B were just my reason on Tuesday.

16
by EmilyPK on 11/07/2010 10:07am

I agree that sniping at humane groups is counter-productive and mean-spirited. But Prop B is *not* funded. So now we have two parallel but slightly different laws on the books. Will this help either of them get funded and enforced? Will it perhaps hinder this? I don't know. I suspect it will not make getting a prosecution any easier.

I suspect Prop B will acheive very little but to increase hostility and confusion between the parties who need to cooperate to really deal with the problem. And both sides have some responsibility there. I mean "[veterinarians] don't stand up for humane treatment probably because it might not be in their economic interest" strikes me as just as bad as "these are politically corrupt organizations".

17
by cesg on 11/14/2010 09:53am

I think that in an ideal world, only people who are trained, licensed and who continue with their education should be allowed to deal with this sort of thing.

But in the world we live in, to say that only vets should do certain things is kinda like saying everything on the internet is junk. Broad strokes leave so much uncovered and will leave so many with out proper care.

It is a shame that something like this was even considered to be proposed. You know it is because of those few who are out there to make a quick buck at the expense of others. There will always be those who find loopholes to pad their wallets, and legislation like this will only hurt those who really care.

18
vets vs "lay" floaters
by tallenhrsdntst on 09/24/2011 05:36pm



Kudos to Dr. Khuly!
Regarding the issue of veterinarians vs. "lay" floaters: The term lay means "not belonging to a profession, especially legal or medical". It is intended to indicate "uneducated, or untrained" in reference to the subject being discussed, and considering equine dentistry, the veterinary schools have only recently begun to offer any decent coverage of the subject (and although they hate to admit it), so four non-veterinary equine dental practitioners (or "lay" floaters) were hired by vet schools to teach equine dental methods to the vet students. You are not likely to find evidence of this on the schools' sites nor in their literature.
Also: in no state in the U.S.A. has there been a reqirement for veterinarians to show ANY proficiency in equine dentistry to be legally allowed to offer/perform equine dental care. The difference is that many/most "lay" floaters gain their capabilities by apprenticing with very experienced floaters for several hundred horses before they venture out on their own. For example, the International Association of Equine Dentistry, (IAEDonline.com)was started by non-vets, offers ANONYMOUS testing of equine dental skills, and certifies passing candidates after passing the written and practical tests and submitting 250 case records.

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About fully vetted

Patty Khuly, VMD, MBA

Photo of Dr Khuly

Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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