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TOPIC: AVMA Model Veterinary Practice Act

RE:AVMA Model Veterinary Practice Act 15 Feb 2011 22:09 #181

  • mwmyersdvm
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tbloomer wrote:
The "project manager" is usually the owner. Neither vet or farrier should be expected to do project followup uncompensated. Vet and farrier aren't getting "paid to talk to each other."

I would agree that the manager should be the owner, but very few have sufficient knowledge to guide this sort of team for the good of their horse. They need to have sufficient knowledge to figure out who should run the overall rehab for the case, but this is often a very difficult issue. Vets and farriers are rarely adequately compensated for discussing cases with each other. I have personally worked through cases with one of my farrier friends on horses I have never seen. He presented me with what he saw and we discussed some options until we worked out what appeared to be a good solution. These three cases had emanated from university settings as 'unslavageable'. All three are now trail horses, happily serving their owner's needs. This is what I see out here beyond the purvue of the 'specialist team' so this is my problem with specialists who have little knowledge in the hoof. This leaves the university attending farier out on his own with no real technological support that he can use to really do his best job. This is unfair to the farrier and this is the problem I would like to solve. I was not paid anything to assist him on these cases, but that is not the point. I would prefer to see the horse, but that is not always possible.

M. W. Myers, D.V.M.
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RE:AVMA Model Veterinary Practice Act 16 Feb 2011 16:30 #182

  • reillyshoe
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mwmyersdvm wrote:
I would like it to be more of a collaboration of professionals who will refer the cases based on the best interest of the case at hand and not for the pure monetary gain a disaster may present for the initial person that sees the case. I am seeing a number of cases as the "last guy in line" and they are too far gone for me to assist. I do feel that had I seen some of them earlier I could have been of assistance. We have many diagnostic and therapeutic modalities that are either not used or not used properly even from some veterinary colleges. There are many therapies that the colleges are not aware of or they do not have the expertise to perform so they simply do not get applied.



There are boarded radiologists that do not do and do not read venograms. There are equine surgeaons that do not perform tneotomies or limb amputations. There are internal medicine veterinarians that do not keep up with equine nutrition. They simply have other interests and should refer to those out there whether they be in academia or not, for the benefit of the horse. It is not a failure not to know the answer, it is a failure not to try to find an answer. I have a great knowledge base to draw from in veterinarians and farriers that deal with hoof pathology as the bulk of their practice. They see many more cases and see the long term follow up much more than the colleges.



The team approach can work as long as there is a team member with sufficient general case knowledge to guide the team. Plus the team has to set aside ego and accept the guidance. Specialists tend to get too focussed on their specialty and fail to see the whole picture. For example, the internal medicine specialist the successfully treats the Potomac Horse Fever case but fails to provide preventative measures for the impending laminitic event. These measures have to be adequate and monitored. I have also mentioned that not all specialists look at the hoof or have specific knowledge of the hoof. They will not receive this training in veterinary schools, so how do they suddenly get this training in their specialty? The veterinarian who has a special interest in the hoof can steer this team and perform many functions that they cannot. It is not just about trimming and shoeng a horse.

As far as "evidence to suggest" goes, it cannot be presented without causing too much furor and this is to be a pleasant diatribe only. I may have a couple of more obscure cases where the names can be left out to protect the guilty, but to lay out all of the evidence so it can be thoroughly checked simply cannot be done here.



As I said, it is not about simply who can make a shoe and shoe a horse. These gentlemen have earned much respect, but they cannot perform the medical and technical diagnostic needs of the horse. They can review this data with a qualified vaterinarian and then the magic can truly happen. What is Mike Wildenstein going to do to shoe a horse with an adhesion of the deep flexor to the navicular bone and how is he going to know this has occurred? I may have a foohardy plan, but I am dedicated to assisting horses and I feel that the joining of our forces in a purely positive and noncombative mode is the best way to do it. No one is below the other. The team leader is decided upon and everyone assumes his ideal position and the case moves forward.



I really don't care what anyone wants to term this alliance. "Podiatrist" could well be a bad term. It has already come into use, mush like "live sole plane" (I really don't think anyone is trimming to "live" sole). We do need a term that everyone can recognize and is comfortable with. I did suggest that this be a positive thread. Anyone have any suggestions?




But human podiatrists can prescribe medication and perform procedures that farriers are neither legally entitled to do and most are not trained to do. There are no apprenticesips training farrier to perform the full surgical technique of a tenotomy. Are you suggesting ramping up farrier education processes to two to three years of intensive training so this can be accomplished?



Now I did ask you to be nice. If you will check the farriers I work with, I believe they will let you know pretty quickly that I value their input very highly. I take on some cases either for the convenience of the owner, get the case set up and then hand over a much easier package for the farrier and I have taken the risk in the onset if the case goes south. I do planty of team work with a number of farriers and we can do some serious magic under a horse. I may even trim while the farrier is at the forge and vice versa. As for the ICHS, I really don't know how much CE I was awarded, I value the information and the comraderie so I go every year I can.



Then why are we still having all of the issues that are presented on this forum and so many others like it? We need a better cooperative effort among farriers and veterinarians and thus far it has improved a little, but there is still a long way to go. Veterinarians do not need to be taking on cases they have insufficient training and experience to handle, and this goes for surgeons and radiologists as well. I am looking for input from anyone and everyone so we can get this done faster and better. I am not comfortable with the staus quo and I really don't think you are either.

M. W. Myers, D.V.M.


I don't want to put words in your mouth, but you seem to be suggesting that as self titled equine podiatrist your skill in surgery exceeds that a board certified specialist, at least as it applies to the distal limb. It seems your skill in imaging of the distal limb exceed that of a radiologist as it applies to the distal limb. It seems that you are of the opinion that your skill in the application of orthotics exceeds the skill of a farrier. All of this is interesting, as people dedicate years to becoming proficient in very specific areas or training.
Farrier theory is of no use if your hands are not trained to translate theory to the hoof. I will never be as good as I would like to be in this regard, no matter how much I practice. I have noticed the same occurs with surgery- knowing what to do and the ability to preform it perfectly are very different things. I mentioned Smitty's work because I appreciate the manual perfection in his work. The same could be said for Craig Trnka. I have no doubt that I would be a better clinician if I had the same skill of these experts. Conversely, I would humbly suggest that I might apply a better glue on shoe than either of these individuals (no offense, Smitty). I recognize that we cannot hone our skills to that of an expert in so many areas, even with regard to farriery.

A radiologist devotes years to imaging techniques. As you mentioned venograms, I will point out that I do not think there are studies assessing the repeatability of this procedure in the equine digit. Is there value in back-filling the circulation system to see what is going on? What is your experience with CT or MR evaluation of the lamintic hoof? I would suggest that preforming a venogram is not a technically challenging procedure. I would suggest that if a radiologist does not utilize this procedure, then perhaps their study of the subject supports their decision (the same argument would apply towards a DDFT tenotomy, which is a very simple surgery).

My point remains the same- these are all areas of specialized training, and while not perfect, should be recognized as such for their contribution to the well being of the horse. Would you clarify your comment about the role of farriers, do you envision the farrier as a technician for the veterinarian? From my biased perspective, I consider the working arrangement between veterinarians and farriers to be analogous to that of a human physician and a human podiatrist- separate occupations working next to each other, without either profession subservient to the other.
P
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RE:AVMA Model Veterinary Practice Act 16 Feb 2011 18:52 #183

  • solidrockshoer
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mwmyersdvm wrote:
I do planty of team work with a number of farriers and we can do some serious magic under a horse.

M. W. Myers, D.V.M.

Dr. Myers, being a D.V.M. you are awarded a little bit of a pass on these forums. If a farrier came to this site and started speaking of the "magic" he's performed under a horse he would be hammered!

When you start speaking of farriery, especially magic that has been performed by you, I think that pass comes to an end.

Do you have pics to show your farrier work? I personally have an extremely difficult time believing someone actually excels in both professions.
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RE:AVMA Model Veterinary Practice Act 16 Feb 2011 23:50 #184

  • Rick Talbert
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Eric Russell wrote:

Do you have pics to show your farrier work? I personally have an extremely difficult time believing someone actually excels in both professions.

Why is it hard to believe that someone could excel in both professions? Reminds me of when i was in high school and was advised that I should concentrate on only one sport. Instead, I decided to play 4 sports and did pretty well in all of them. I definitely think that a person can excel in both professions, no doubt. The only real limits we have are those we convince ourselves of. And I have no problem with someone calling themselves an equine podiatrist, whether the person is a veterinarian or farrier, as long as he can back up what the title seems to infer. I tend to agree with Patrick's line of thinking as well, in that the nature of any team approach should be on even ground. I disagree that one person has to be the team leader, unless he is asked to lead, or unless he is the one paying the follower.
Rick Talbert
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RE:AVMA Model Veterinary Practice Act 16 Feb 2011 23:57 #185

  • tbloomer
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Rick Talbert wrote:
. . . Instead, I decided to play 4 sports and did pretty well in all of them . . .
More fun than grammar and composition no doubt. ;)

Dr. Mike Miller, CJF is a board certified orthopedic trauma surgeon and a Fellow of the Worshipful Company of Farriers.
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Here's the deal. I'm trying to keep it simple.
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:03 #186

  • reillyshoe
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Pick a top-of the-line farrier, any one. Do you think they have the time to be a top-of-the line veterinarian as well? remembering that a veterinarian has to be knowledgeable in the treatment of fish, hamsters, dogs, horses and cows?

There are certain individuals who excel in both areas. Scott Morrison comes to mind. Scott, in my opinion, was knowledgeable enough about farriery to hire an exceptional farrier in Manfred Eckert to assist him with his work. I think Scott appreciated Manfred's contributions to his practice and did not try to excel in everything himself. Manfred has retired, and Rood and Riddle now employs someone else who specializes in making horseshoes. One cannot be expert at everything....

This does not begin to cover the other areas of expertise- radiology, surgery, medicine, anesthesiology (pain management) which apply to the horse's distal limb.
P
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:03 #187

  • Rick Talbert
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tbloomer wrote:
More fun than grammar and composition no doubt. ;)

Dr. Mike Miller, CJF is a board certified orthopedic trauma surgeon and a Fellow of the Worshipful Company of Farriers.

that grammar are hard :D.
Rick Talbert
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:08 #188

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Rick Talbert wrote:
Reminds me of when i was in high school and was advised that I should concentrate on only one sport. Instead, I decided to play 4 sports and did pretty well in all of them. I definitely think that a person can excel in both professions, no doubt.

I disagree. While there are a few Deion Sanders, Bo Jacksons, Thorpes, or Dave Winfields in history, there are many more examples of people who excel through specialization. Most people, including athletes, are only able to excel in specific areas rather than in many areas. Some of these, like Winfield, achieved greatness when they concentrated their efforts on one sport.
Who knows Rick, perhaps you might be a professional athlete is you had picked one sport and concentrated your efforts on that discipline...


If your goal was to assemble the best basketball/baseball/football player combination, would you choose Dave Winfield (who played all three really well in college), or Michael Jordan, Ted Williams and Jim Brown?
P
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:16 #189

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Rick Talbert wrote:
that grammar are hard :D.
Southern girl: "Wher'er y'all from?"

Northern Girl: "Where I come from we don't end our sentences
with prepositions."

Southern girl: "Oh. Where'er y'all from, B I T C H."
Tom Bloomer
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Here's the deal. I'm trying to keep it simple.
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:17 #190

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reillyshoe wrote:
Pick a top-of the-line farrier, any one. Do you think they have the time to be a top-of-the line veterinarian as well?

I think it is hard enough to be top of the line in all aspects of farriery let alone farriery and veterinary. I can't think of anyone, off the top of my head, that actually excels in all aspects of farriery.
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:18 #191

  • Rick Talbert
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reillyshoe wrote:
Pick a top-of the-line farrier, any one. Do you think they have the time to be a top-of-the line veterinarian as well? remembering that a veterinarian has to be knowledgeable in the treatment of fish, hamsters, dogs, horses and cows?

There are certain individuals who excel in both areas. Scott Morrison comes to mind. Scott, in my opinion, was knowledgeable enough about farriery to hire an exceptional farrier in Manfred Eckert to assist him with his work. I think Scott appreciated Manfred's contributions to his practice and did not try to excel in everything himself. Manfred has retired, and Rood and Riddle now employs someone else who specializes in making horseshoes. One cannot be expert at everything....

This does not begin to cover the other areas of expertise- radiology, surgery, medicine, anesthesiology (pain management) which apply to the horse's distal limb.

Shod by a veterinarian and CJF :)
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:22 #192

  • tbloomer
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I bet I can fillet a fish better than any veterinary surgeon. :cool:
Tom Bloomer
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:23 #193

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Rick Talbert wrote:
Shod by a veterinarian and CJF :)

That is very nice work, but I would prefer Smitty's horseshoeing coupled with Dean Richardson's veterinary work (no offense to the person who did this work).
P
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 00:25 #194

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tbloomer wrote:
I bet I can fillet a fish better than any veterinary surgeon. :cool:

I'll bet Emeril Lagasse can fillet a fish better than you, but I would expect you can shoe a horse better than Emeril. BAM!
P
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RE:AVMA Model Veterinary Practice Act 17 Feb 2011 01:08 #195

  • Rick Talbert
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reillyshoe wrote:
I disagree. While there are a few Deion Sanders, Bo Jacksons, Thorpes, or Dave Winfields in history, there are many more examples of people who excel through specialization. Most people, including athletes, are only able to excel in specific areas rather than in many areas. Some of these, like Winfield, achieved greatness when they concentrated their efforts on one sport.
Who knows Rick, perhaps you might be a professional athlete is you had picked one sport and concentrated your efforts on that discipline...


If your goal was to assemble the best basketball/baseball/football player combination, would you choose Dave Winfield (who played all three really well in college), or Michael Jordan, Ted Williams and Jim Brown?

I do see your point. If you were looking to assemble a best of the best team, say to represent the USA in the equine podiatry olympics, then your probably going to have specialists in the sense that I doubt the best farrier is also the best veterinarian. But, it is not beyond the realm of the imagination to think that one individual could be proficient at both, when it comes to running a business. I have seen vets that "shod their way through vet school" which ussually means (had a handful of backyarders to do for beer money) who decided they knew enough about farriery to do it themselves, and they put out some pretty poor work. But, when we talk about a term like "podiatry", I think of an expert in the equine hoof. This expertise can really only be attained by a working farrier who is passionate about the subject matter and therefore devotes many years of hard days and hard earned experience and late nights in study and proactively seeking educational opportunites. Now take a farrier with this mindset who works for 10-20 years attains his goals and decides to pursue a DVM. After graduation, this fellow could specialize in podiatry, heck he could have specialized in podiatry prior to vet school. But now he has a few more diagnostic tools in his truck. This sort of professional progression satisfies my mind, much more than a vet who after school, begins to shoe a few horses and decides he is a one man show. Why would I think this way? Because it takes longer to become a good farrier than it does to become a vet, and if the horse's hoof is the subject then the good farrier portion is much more pertinent. For example, UGA vet school offers only one class called The equine hoof and lameness, it is 1 hour a week for 15 weeks and it is an elective. Give this graduate a DVM certificate and a set of farrier tools and God help the horses. But if a good farrier decided to go to vet school, God help the competition. (I'd be glad to post the entire veterinary curriculum and we can see how much attention is given to related subjects.)
Rick Talbert
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