Caring for the Creatures: WNC Veterinarians

Veterinarians are a breed apart. Dedicated to the well-being of domesticated animals, they have to be prepared to sometimes encounter the unexpected. A Western North Carolina vet recalls a recent patient visit: "Following a telephone call that started with 'we hear you'll see anything,' a rescue transporting a 680-pound tigress and her 300 pound cub showed up at our office for a health certificate." It's all in a day's work for those dedicated professionals who look after the health of the region's non-human creatures.

There are more than 175 veterinary practices in Western North Carolina. Many administer standard care to household pets, but quite a few -- especially in agricultural areas -- have practices that expand to (or even specialize in) care of farm animals, horses and more exotic creatures. The range of services and procedures offered varies, and many veterinary practices provide care that goes beyond the range of Western medicine. No matter where one roams in the 18 counties of WNC, there are veterinary professionals ready to meet the health needs of our four-legged friends.

It takes all kinds
The lion's share of most veterinarians' visits consists of dogs and cats. Some, like Dr. Beth Hampton Jones of Asheville Animal Acupuncture, see only feline and canine patients. Susan Reinecke of Broad River Animal Hospital in Weaverville says that her practice is "about 45% cats and 55% dogs, plus the odd rabbit or rat." Dr. Tami Shearer of Smoky Mountain Integrative Veterinary Clinic in Sylva says that she also focuses primarily on dogs and cats, but notes some interesting exceptions. "I have treated a few chickens, a turkey and a goat with acupuncture. The chicken was egg bound; shortly after her acupuncture treatment, she was able to pass her egg. I also helped a pet turkey that impaled itself on a fence."

Dr. Brittany Beil, on the other hand, doesn't treat canines or felines at all. She says that her Whiskey River Large Animal Mobile Veterinary Services sees "approximately 70% horses and 15% goats. The remaining 15% is a hodge-podge of cattle, sheep, llamas, alpacas and a handful of chickens and pigs." She notes that she does tend to a few exotic patients as well. "We currently care for a small zoo with black bears, brown bears, monkeys, lemurs, and some tigers. In the coming year, that facility plans to expand to include wolves, otters, sloths and possibly giraffes."

Asheville's Haw Creek Animal Hospital sees a wide variety of animal patients, says Dr. Heather Sinclair. While three-fourths of its patients are cats and dogs, the remainder is a menagerie. "We see many birds, rabbits, rats, ferrets, snakes, lizards, and pocket-pets on a regular basis," she says. "Pigs and goats are less common, but by no means unusual at our practice." And her practice's proximity to the WNC Nature Center means an occasional visit by a wildlife patient.

An integrated approach to care
Most of the region's veterinarians offer wellness visits, surgery, dental care and some degree of internal medicine. But the services provided can go far beyond those. More and more practices are embracing the concept of integrative medicine, a patient-centered approach that Duke University describes as 'address[ing] the full range of physical, emotional, mental, social, spiritual and environmental influences that affect ... health." Integrative medicine was first developed to treat human patients, but its concepts transfer seamlessly to veterinary medicine as well.

"I offer pain management, rehabilitation, hospice and palliative care," says Dr. Shearer. "Because of my background in pioneering the area of veterinary hospice, I decided to really focus my practice on helping pet owners and their pets by creating a practice that nurtures the human-animal bond."

Alternatives to Western medicine
As is the case with human health, some pet owners find that the traditional Western approach to medical care doesn't meet the needs of their animal. In such cases, they seek other solutions. And an increasing number of veterinary practices are prepared to address those needs. Dr. Shearer cites some of the reasons that clients come to her: "Pet owners have made a decision not to pursue curative treatments; there was a diagnosis of a life-limiting illness or symptoms of a chronic illness that were interfering with the routine of the pet; or a pet had a disease process where curative treatment was possible but failed." She also mentions that some pets present problems that require long-term intensive care but also have additional associated health complications requiring a more complex treatment.

Dr. Beth Hampton Jones' suite of treatment options includes Eastern and Western approaches for her animal patients. "I do acupuncture, cold laser therapy and Chinese herbal medicine for dogs and cats," she says. "My focus is on approaching my patients and their problems holistically and individually. I used to own a general practice, and I practiced general medicine for many years. My patients and clients come to me now for a more natural and holistic approach."

"We try to practice a two-medicine view, both traditional, and alternative," says Dr. Brittany Beil. "We carry ultrasound and digital x-ray [equipment] on the truck, and we provide dental care, vaccines and surgery." But Beil's practice is also certified in equine acupuncture, and will soon offer equine spinal adjustment (chiropractic). "We try to look at the whole animal and decide the best course of action for its healing and utmost health," she says.

"Clients want to improve the quality of life for their pets by seeking out unique services," says Dr. Shearer. "I see more and more clients in need of alternative care for their pets because conventional care has failed, or because their pets do not tolerate [certain] medications." Clients' positive experiences with human hospices lead many to consider similar care for their pets, she says.

"We are seeing more requests for alternative therapies and gentler preventative medicine, says Dr. Beil. "We have always offered acupuncture for horses, and often will transpose these skills to other animals -- goats, alpacas and sheep -- as well."

Dr. Jones has noticed a trend among her clients toward increased interest in diagnostic testing. "And they're willing to spend more to get that testing," she says. "Now we have CT scans, MRIs, and hyperbaric chambers. We have specialists who are ophthalmologists, oncologists, and cardiologists." She also notes greater interest in the nature and quality of the food given to pets. "Pets are more like family today, and that is reflected in their owners' actions," she says.

The role of medicines and pharmaceuticals in veterinary care
When it comes to sourcing pharmaceuticals for their patients, most of the veterinarians interviewed rely on national distributors. "Local suppliers don't exist," says Dr. Reinecke. "Most pharmaceuticals that are labeled for animal use are not locally available," notes Dr. Sinclair. "Increasingly, as the larger players in the veterinary industry acquire more integration in their business, smaller hospitals have to rely on buying through national consortia in order to remain price competitive." She notes that her practice can sometimes source compounded medications in tablet and capsule form from Sona Compounding in Asheville.

Dr. Beil works with a national supplier that maintains a regional warehouse in Browns Summit, just north of Greensboro. "That usually allows us to order or send medications within 24-48 hours," she says. And Dr. Jones orders her acupuncture and herb supplies from a local company, Golden Needle.

Dr. Sinclair observes that more and more clients are using online pharmacies to fill their pet prescriptions, and she's fine with that trend. "While there are some caveats to this practice, we have never based our business success on high drug markups," she says. The trend "has allowed us to focus our onsite pharmacy more on what our clients need on an immediate basis." She believes that the migration to online pharmacy has kept her practice very aware that "it's the hands-on work that sets us apart. We practice high quality medicine so clients return for services, not for sales."

"With vaccines currently being in the national limelight, we often get questions about efficacy and duration of the protective properties of vaccines for horses and others," says Dr. Beil. "We recently have joined forces with GenSol Laboratories to begin developing affordable titer [immune-response antibody] testing for routine equine vaccines."

Going mobile
With a goal of meeting the needs of patients on location -- especially important for larger animals -- a number of mobile veterinary services operate in Western North Carolina. About 20 veterinarians offer mobile vet services as their primary or secondary method of treatment. Several mobile veterinarians -- most notably ones located in or near Tryon, home to the Tryon International Equestrian Center -- limit their practices to horses, but most provide medical care to a range of animals. "We travel from farm to farm with the equipment in our truck and handle most medical care for large animals and farm animals right where they live," says Dr. Beil. "We cover routine, preventative, basic surgical, and emergency care."

Essential training and certification plus people (and animal) skills
Veterinarians complete a postgraduate four-year course of study to earn their DVM designation, but that's just the beginning. "We also need to pass national boards and state licensure exams, says Dr. Reinecke. "And as with any practice in North Carolina, DVMs must hold a current license from the North Carolina Veterinary Medical Board," says Dr. Sinclair. To stay current on the latest topics, Doctors of Veterinary Medicine practicing in in North Carolina must also complete 20 hours of continuing education each year.

There exist several additional and very specific certifications that veterinarians can choose to obtain, many focusing on non-invasive methods. Dr. Shearer lists some of these, all of which she has earned: "Certified Canine Rehab Practitioner, Certified Vet Pain Practitioner, Certified Vet Acupuncturist, Certified Hospice and Palliative Care Veterinarian and Certified Traditional Chinese Veterinary Medicine Palliative and End-of-Life Practitioner." She is also nearing the end of a course of study that will earn her a Masters Degree in Traditional Chinese Veterinary Medicine.

When it comes to support staff, North Carolina-based licensed veterinary technicians are required to have state certified training, licensing, and biannual continuing education as well. The role of veterinary assistant doesn't require state registration or certification; as a result, the tasks they are permitted to perform are more limited. "But generally," says Dr. Beil, "they can accomplish their training on-the-job." Dr. Sinclair notes that her office is typical in that it has a mixture of the various levels of skilled staff.

Even when there aren't stringent certification requirements, many vet practices focus on staffing their offices with experienced personnel. "I have trained my staff with the special skills to handle the cases that we see," says Dr. Reinecke. She notes that one of her team's experience in hospitality makes her well-suited as a communicator. "And I have trained her to help me with the patients, too," she says.

Clients tend to look beyond training and certification when choosing a veterinary practice for their pet. Dr. Sinclair lists some of the qualities that clients look for. "In addition to being medically competent, creativity, honesty and transparency are very important," she says. "Our clients really count on us to come up with creative solutions for their pets when there are challenging health problems."

"Clients like to know and trust their veterinarian," says Dr. Jones. "They like someone who can explain things well and communicate effectively; they want someone who seems to genuinely like their pet and care about his well being." Dr. Beil concurs, adding, "If someone can't feel comfortable with you, they are not going to trust your judgment or follow your recommendations." She emphasizes that clients want to feel that they are involved in the decision-making regarding their animals' care, and they want to know that the doctor takes their concerns into account when treating their pets. She quotes a well-known catchphrase that serves as a guide: "They don't care how much you know, until they know how much you care."

Dr. Reinecke says that "mad vetting skills" top the list of what her clients seek in a veterinary doctor. "But mostly," she concludes, "people want you to be nice and show you care."

In case of emergencies
Many veterinary practices limit their work to business hours; quite a few are open with limited hours on Saturdays, but comparatively few offer Sundays or late-night hours. When emergencies happen, many vets serving the Asheville area refer clients to REACH Veterinary Specialists, about a mile north of Asheville Outlets. REACH sees animal patients 24 hours a day, seven days a week, 365 days a year. The web sites or answering machines of many veterinarians outside Asheville provide contact information for emergency services in their areas.

But most of the veterinarians interviewed do try to provide some measure of support to clients after hours. While Dr. Reinecke's practice refers after-hours emergencies to REACH, she notes that during regular business hours, "we just drop what we are doing" to deliver emergent care.

"I actually give my clients my cell phone number and try to be available to answer questions and help direct the care of their pets after hours," says Dr. Shearer. "At bedtime, I turn my phone off and direct clients to local emergency care facilities." Whenever practical, she makes a point of educating her clients ahead of time on how they can deal with certain emergencies themselves. "For example, a client may call me and say that their pet with a heart condition is having some trouble breathing. I may advise them to use emergency oxygen therapy that I sent home with them, or to give an injection of Lasix under the skin, and then I would see them first thing in the morning."

"I do speak to clients about emergencies and potential emergencies after hours," says Dr. Jones. She refers clients to REACH when circumstances warrant.

Dr. Sinclair's practice in Haw Creek offers longer than typical hours. "We are open seven days a week until 11 p.m. to accommodate urgent and emergency cases," she says. "It's not unusual for our doctors to perform surgery or continue care into the wee hours, but we will also refer to one of the local emergency hospitals when intensive overnight care is in the patient's best interests."

Dr. Beil's mobile vet service does handle emergencies. "As long as we are in town and the emergency is within our service area," she says, "we do everything we can to get there in a timely manner. For the most part, we see all our clients' own emergencies, snow, rain, night or day." Reciting her practice's mantra ("What's best for the animal is what's best"), she makes the point that "sometimes, the best is not us." In those cases, she refers clients to other vets who are closer by or have specific expertise.

Tourists are relatively common visitors to standard care veterinary practices, especially during the warmer months. The more specialized veterinary practices see fewer out-of-towners dropping in for pet care, but it does happen. "I had a patient show up who needed help with an allergy shot," says Dr. Shearer. "We were happy to help out."

Dr. Beil's mobile service sees visiting non-locals as a matter of course. "We partner with many of the public equine camping locations up and around the Great Smoky Mountains National Park and other hot-spot trails," she says. "They often will call on the tourists' behalf when someone from outside the area is visiting and needs help. We welcome these folks just as we do regular clients."

Animals on board
Approximately 30 to 35 of the veterinary practices in Western North Carolina also offer animal boarding. Most others refer clients to businesses specifically designed to offer animals a place to stay during the day, overnight or long-term.

"I don't have staff to supervise hospitalized overnight patients, so we really try to get pets home at nighttime," says Dr. Shearer. But, mentioning a paralyzed coonhound named Leroy, she admits, "when that is not possible, at times I have taken pets home with me. Leroy laid next to my bed."

Dr. Sinclair says that like all of the vets interviewed for this story, her practice doesn't offer boarding. "But we do provide some 'medical boarding' for clients who have animals requiring more care than clients feel they can depend on at regular boarding facilities." Her office also provides to its clients some limited boarding of exotic pets.

But it's Dr. Susan Reinecke who likely best expresses many veterinarians' feeling about pet boarding. "I always tell people it's like your pediatrician offering day care," she says with a laugh. Acknowledging that boarding is a good convenience for clients, she says that it's often a distraction from practicing medicine.

Expecting the unexpected
Most veterinary visits involve routine matters. But like any other profession, vets in Western North Carolina have their stories of unusual encounters. The tigress and cub mentioned at the beginning of this story are among the most memorable. "Huge cages on flatbed trailers drew quite a crowd," recalls Dr. Sinclair. "But perhaps the most memorable part was when I handed a six-inch long fecal loop to a newly-hired assistant and told him to go get a fecal sample." Dr. Sinclair notes that handlers distracted the cats with raw chicken breasts while exams were performed.

Other vets relate similarly unusual stories. One doctor recalls "a big burly Harley biker guy who had a venomous snake as a pet; he was a little intimidating. He made an appointment to bring in his new dog for an appointment, and I was thinking he was going to bring me a vicious giant killer dog. When he arrived for his appointment, he pulled a tiny Chihuahua from his leather jacket!" Turns out the man was a social worker at a local school.

Dr. Beil relates two unusual stories from her years of experience. "Libby the horse had a very specific type of colic that had essentially stopped her intestines from moving. This caused her to fill up with air, which is very painful until the pressure can be released so the intestines begin moving again. We had to come up with a plan, and fast. We decided to do a procedure called cecal trocarisation. We passed a large needle through her side, into her intestines, and then left it in place while gas escaped! Libby did very well, and survived to be a happy healthy mare."

Another tale with a happy ending from Dr. Beil: "Katie the goat was attacked in her pasture by dogs; she was injured very badly in her back leg. Although the skin was not even cut, her muscles were very damaged and were making her very sick. She came to live in our office for quite some time, and we had to manage her wound extensively as the tissues started to die. She ended up with a large wound that was difficult to bandage over her hamstring area. She also became very sad living away from all her goaty friends. We had to think outside the box to come up with a way to keep her wound covered and healing while she was able to go back home and into the pasture.

" So we used a tie-on bandage, honey and sugar to help with wound heal. And then we got creative. Our assistant went to the thrift store, and got some cute toddler pants. We fashioned the pants to a dog harness with mattress sheet-keepers, and made a changeable, washable bandage cover that strapped on like suspenders. Katie was much happier! And after four months, the wound was completely healed." Dr Beil says that she hopes one day to create a children's story about the episode; she already has a title: Katie, the Goat Who Wore Pants.

Another veterinary doctor rattles off a seemingly endless list of strange tales. "There was one woman who, once she was secure in the exam room, told us her son waiting in the lobby wanted to kill her. I had a mother-in-law come in and pay for her son's dog's ashes, only to find out she was really stealing them from her estranged daughter-in-law. I've done a home euthanasia where I had to wait while the owner took a shower and put on special clothes for the procedure." But that vet's strangest story of all -- so far, at least -- is this: "A woman asked me if I saved her cat's testicles after his neuter, because she wanted to make earrings out of them!"

Steadfast dedication to animals' well-being
Every veterinary practice -- and every doctor, for that matter -- is unique. But in the end, what all share in common is a love for animals, and a desire to make their lives as full as possible.

"The personal relationship I have with my clients and patients is very rewarding," says Dr. Jones. "I truly enjoy my job every day, and I bring pain relief and extend quality of life to grateful dogs and cats." Dr. Shearer emphasizes that her integrative approach "addresses not only the physical health of the pet, but also the emotional well-being of the pet-family unit. We apply the philosophy of hospice and palliative care to every family we serve," she says. Dr. Jones runs a one-woman practice. "I answer all my phone calls and schedule all the appointments," she says. "I personally know every client and patient."

Dr. Beil makes the point that all of the staff members at her primarily equine-focused practice "come from natural horsemanship backgrounds. The way we simply approach animals, introduce ourselves, and stay open to different ways of interpretation comes from a place of deep love and respect. We view our clients as equals, and try to explain their options as if we were speaking to a good friend or our parents. If they understand the 'why' of what you are doing, they are much more likely to believe in your recommendations, and the animals will improve.

"Our promise to all our clients and patients is to be more informed, more experienced, more educated and skilled each time we visit," says Dr. Beil. "We laugh with them. We cry with them. We are an extension of their family, and we like it that way. The animals are often family; why can't their doctor be, too?"

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