Veterinary Endoscopy for the Small Animal Practitioner. Группа авторов

Surgery (Small Animal Orthopedics) Veterinary Minimally Invasive Surgery Training (VetMIST) Beaverton, OR, USA

      Branden C. McKiernen DVM (Retired) Diplomate, American College of Veterinary Internal Medicine (SAIM), Watkinsville, GA; Department of Veterinary Clinical Medicine University of Illinois Urbana, IL, USA

      Reto Neiger Dr. Med. Vet PhD Diplomate, American College of Veterinary Internal Medicine (SAIM) Diplomate, European College of Veterinary Internal Medicine‐CA (Internal Medicine) Clinical Medical Director IVC Evidensia DACH, Germany Munich, Germany

      Rod Rosychuk DVM American College of Veterinary Internal Medicine (SAIM)Colorado State University CVMBSFt. Collins, CO, USA

      Natalia Ribeiro dos Santos American College of Theriogenology Ecole Nationale Vétérinaire d'Alfort, Unité de Médecine de l'Elevage et du SportMaisons‐Alfort, France

      Christiane Stengel Dr. Med. Vet Diplomate, European College of Veterinary Internal Medicine‐CA (Internal Medicine) www.zweitmeinung‐tierarzt.de Giessen, Germany

      Preface

      While writing this book, my 50 year anniversary of graduation from Veterinary School occurred. Fifty years! This has been an incredible journey! Beyond my wildest dreams. I never thought that I would be where I am today and would have done the things that I have done. I never dreamed that the first edition of this book would be translated into Russian or that I would be invited to Russia to launch its sale and teach Russian Veterinarians. I never dreamed that I would travel to teach in 14 countries and 23 states. That I would publish books about my professional work.

      It is amazing that I was even able to become a Veterinarian. I am so dyslexic that I struggled to learn to read. When I started the fifth grade, I was reading at a second‐grade level. Spelling was impossible. In the third grade, I was able to get 49 out of 50 words WRONG on a review spelling test even after spending uncountable hours with my parents trying to learn spelling using flash cards. People with really bad handwriting are probably dyslexic and with really bad handwriting no one can tell how the word was spelled. I think that I got into Veterinary School with the lowest grades in the history of Veterinary Medicine, but Baxter Black and I debate who's was worst. If it were not for Dr Don Bailey, I would not have been accepted. He worked for Dr Davis who was head of the admission committee all through Veterinary School and graduated at the top of this class. I managed to not flunk out and graduated at the bottom of the class, again Baxter Black and I argue about who was really “last in class.” And they call the person who graduates last in class “Dr.”

      It was obvious in my first job out of school that I wanted to do surgery. Residency programs for advanced training were a new entity 50 years ago and they were few and far between. Then how does someone with grades barely above 2.0 get into a residency program? NOT! I finally thought that I needed to try CSU, my “amalater.” They did not have a residency program but there was the graduate program at the Surgery Lab. I interviewed with the head of the program and during the interview it was obvious that if I applied for the master’s degree program, there was no chance that I would be accepted but if I applied for the PhD program, I was guaranteed to be accepted. Interesting, but it worked. Six years later, I passed the ACVS examination and became a board‐certified surgeon and in a few years later won my PhD. ACVS recently initiated fellowship training in minimally invasive surgery and I was selected as a founding fellow in this program for both small animal soft tissue surgery and small animal orthopedics, the only veterinarian to qualify for both categories.

      At my 25 year class reunion, I was informed that at a previous time I had been unanimously selected as the classmate least likely to go back to school AND they were “Stunned” that I was board‐certified. My reply was that no one is more stunned than I.

      Getting into endoscopy happened totally by chance. I got a call from a local veterinarian asking if I wanted to buy a used gastroscope that he had. As a surgeon, I had never really thought about doing GI endoscopy but thought, “hey why not” since no one in the area had one. I did not buy that endoscope but bought another one that was in better shape for $550 with a light source and all the instruments that I needed. A little later, I bought a laparoscope to do liver biopsies and then an arthroscope. I never thought that I would pay for this equipment, but I thought it would be fun, I might be able to practice better medicine, and I could afford the expense.

I started putting endoscopes everywhere and added to the list of procedures that could be performed by trying new things on my patients. Many of the endoscopic first‐ever procedures were performed on patients with clinical problems. Using the axiom of “Above all do no harm” and combining endoscopy with transition to traditional approaches, there were an unbelievingly low number of problems or complications. Very few firsts were planned or thought about ahead of time and many were spur of the moment events added to an already ongoing procedure or immediately prior to surgery by asking the question, can I do this with a scope? In cases where the question was asked before surgery, the discussion with the client was, I would like to try this with minimally invasive technique, I have never done this before or this has never been done before, if I cannot do this with minimally invasive technique I will do it the traditional old way, and the cost will by the same how matter how it gets done. I never had a client say no to this plan. Sure, I had to eat some of the cost on many early cases, but this is the easiest, most effective, cheapest continuing education I have ever gotten and has benefitted the patients, clients, my practice, my happiness, plus my pocketbook thousands of times over the cost. Sixty endoscopes and over 7000 procedures later I am writing the second edition of this book.

      I know that I am different and do not follow the book. I am so dyslexic that I cannot read about what I am not supposed to be able to do. I also never learned to come in out of the rain because my mother took me out in the rain. In the first grade when we had art class all the class got coloring books, but the teacher did not give me one. Being a typical first grader I was devastated and did not understand why I did not get a coloring book. The teacher then brought me a large blank piece of paper and told me that my mother did not want me to have a coloring book but wanted me to make my own drawings. So, I never learned to color between the lines. In fact, I never learned that there were lines. When someone says something about thinking outside the box, my question is, what is a box?

      As I said at the beginning, my career has been an incredible journey. But it has not all been easy or fun. There have been times of miserable struggle. I belong to the face book group; “Not one more vet,” because I am a suicide survivor. Twice in my life I have been at the edge. Fortunately, I never acted on my thoughts of suicide and am here to tell about the experience. If I can through this, so can you. I looked for and got help from my friends and great help from some great Psychologists. I also have to admit that I am really stubborn and was not going to let the b's win. If you are in trouble, get help! Working with a psychologist has changed my life. It does not mean that if you see a Psychologist that there is something wrong with you. Get over this mental block. Unburden yourself to them, that is, what they are there for. At my first visit with my first Psychologist, I unloaded everything that was bothering me, things that I never thought I would ever tell anyone, at the end of the session she said that I saved about nine months of therapy because I was ready and she did not have to spend that time breaking down my resistance. We went from there. I am a much happier person, I have eliminated my anger issues, and I am much more resilient to the stresses in life.

      Early in this saga I made the statement in my lectures: “Endoscopy is a quantum leap forward in our diagnostic and therapeutic armamentarium.” This was and still is true. Now I say “A patient comes into every veterinary practice every day who would benefit from a minimally invasive procedure.” This is also true or when I get pushy: “Every patient who comes into every veterinary practice every day would benefit from a minimally invasive procedure” and this is almost true.

      Enjoy your endoscopes. They are the best burnout protection that you can buy.