Giving pills to dogs: a small but useful trick

You’ve found the food that works best for hiding pills and you think you’re headed for success, getting these pills into your dog. But then the rascal rolls the food-ball around in his mouth, feels the pill, and spits it out. Now he’s suspicious!

Here’s a trick that has worked for us. Make at least two treats without pills. Give one of these first, then give one with a pill in it. Strike a balance between covering the pill adequately, and making the treat so large it isn’t gulped right down. At each point, allow the dog to see that you have additional yummy bites waiting for him; he’ll be less inclined to take his time, more willing to bolt down each treat in order to get the next one. Give a treat without a pill as the last one. If your dog is really suspicious, and you have more than one pill to give, you may want to alternate: plain, pill, plain, pill, plain.

Cheese is our usual cover for pills, and the best thing we’ve found, actually, is that spray-on cheese, the new version of Cheez Wiz. Put pill in the palm of your hand, squirt on the cheese-like substance (get some under the pill too) and watch your dog go for it. Here too it helps to use plain cheese-blobs as the lead-in, and keep your dog anticipating the next one so he’s keen.

But with the method I’ve described, we have successfully pilled even suspicious dogs with pills smushed between slices of cheddar or wrapped in a piece of lunch meat.

Total knee replacement surgery, the second time around: learn from our experience

Nearly three years ago my husband had Total Knee Replacement (TKR) surgery. It’s drastic and major surgery, which people usually only choose when the pain from osteoarthritis becomes intolerable. And, it was not done properly so that last month it had to be re-done! Perhaps our experience can be useful to others.

Why do knees need to be replaced?

Generally because of pain and restricted motion caused by loss of cartilage (which cushions and separates the bony parts of a joint) and growth of bony “spurs”. This is labelled osteoarthritis. Other causes, like trauma, rheumatoid arthritis, and infection, account for a minority of the 300,000+ TKRs each year in the US.

As to what causes osteoarthritis, that is less understood than previously thought, when it was all blamed on “wear and tear”. The knee is the largest joint in the body, and bears the complete weight of the body at each step we take, so it is indeed subject to lots of “wear and tear”. Common-sense risk factors include types of high-stress activity in work or sports, injury, obesity, infection, stiffness from lack of activity, and age (since cartilage becomes more brittle with age). However, not all elderly people develop arthritis and some who do have no significant pain. This is why I said above that knees need to be replaced, not because of osteoarthritis, but because of pain and reduced range of motion.

The biologic factors leading to the deterioration of cartilage in osteoarthritis are not entirely understood. Many experts believe that osteoarthritis results from a genetic susceptibility that causes some biologic response to injuries to the joint, which in turn leads to progressive deterioration of cartilage. In addition, the ability to make repairs becomes progressively limited as cartilage cells age.

Although osteoarthritis generally accompanies aging, osteoarthritic cartilage is chemically different from normal aged cartilage. As chondrocytes (the cells that make up cartilage) age, they lose their ability to make repairs and produce more cartilage. This process may play an important role in the development and progression of osteoarthritis. [Emphasis mine. Source: www.healthcentral.com ]

What’s involved in Total Knee Replacement surgery?

The x-rays below, from the site of a prosthetics manufacturer,

show views of a knee before and after surgery. On the left, cartilage loss has caused bone-on-bone contact: very painful. Bone spurs or bits of broken bone floating around can also cause pain in the deteriorated joint. On the right, an artificial knee joint (prosthesis) is in place. (These are not x-rays of the same knee; in fact, looks to me like one’s a left leg and the other is a right leg.)

Here are some views of prostheses. To install them, the ends of the two long-bones of the leg, tibia and femur, are sawed off (removing “usually between 2 and 12 mm” according to one source) and the artificial joint is affixed with cement, screws, etc. The work involved in removing bone and attaching the prosthesis involves considerable force and power tools. Note that the knee-cap, as well as muscles and ligaments, must be carefully moved aside to install the prosthesis. [Picture sources: 1, 2, 3 ]

There are many patented designs for artificial knee joints, and these illustrations are for general example only. Surgeons have their preferred models; many were developed by orthopedic surgeons, and those surgeons tend to prefer the ones they have an interest in. Choice of prosthesis isn’t something the patient can weigh in on, we don’t know enough, but you may want to find out if your surgeon has a financial interest in the one he is going to use; if so, perhaps a second opinion would be valuable on the pros and cons of various types as applied to your individual case. Most insurance will pay for a second opinion for major surgery.

Research continues for better, longer-lasting designs and breakthroughs are regularly announced with fanfare––but some don’t fulfill their original promise, as with teflon-lined joints which wore away much faster in practice than lab tests had predicted. You will have to rely on the experience of your surgeon.

You can see photos of the stages of knee surgery (not for the faint-hearted) here, on a prosthesis company ’s site.

Our experience

Surgery #1, 2006

Now, back to my husband’s case. Dan had knee pain for years that ruled out unnecessary walking, as in hiking or walking for enjoyment, and interfered with sleep. There was bone on bone contact and perhaps bone spurs or growths from osteoarthritis. In August 2006 he underwent total knee replacement surgery by an established older orthopedist in our area. Afterwards, the surgeon came out to me in the waiting room and told me that the operation had taken half again as long as planned because they had “run into something unexpected”. Later, when we knew more, that remark would have much more significance to us. The “something unexpected” was apparently the result of a broken leg at age ten, that had caused greater reliance on the other leg (the one that received the TKR).

The surgery was brutal, with terrible bruising all over the leg, and post-op pain and swelling were severe. From the beginning, the prosthesis felt loose and insecure, sometimes the knee buckled, and after the post-surgical pain subsided, he was still in pain sufficient to make walking difficult. At each visit with the surgeon Dan raised these issues and was told to exercise more, and that it would get better with time. Two years on, that hadn’t happened, and the surgeon then agreed that the knee was a bit loose and offered to go back in and “put a shim in it”.

At some point after the 2006 operation, when it became apparent that it had been unsuccessful, I began to research the subject. Immediately I found that it’s common practice now to use Magnetic Resonance Imaging before TKR, rather than merely relying on x-rays. MRIs provide an exact and minutely detailed three-dimensional picture of the joint. The data can be used to make a 3-D visualization that can be rotated. This way the surgeon knows exactly what to expect; the prosthesis is customized, if necessary, beforehand; the surgery is generally shorter and the incision may even be smaller. (Other advances, such as computer-assisted orientation systems to guide the surgeon in positioning the prosthesis during surgery, may also be used.) Nothing like this was done in Dan’s case, and we didn’t know to ask about it. We know now that the original surgeon does have access to an MRI, in the hospital across the street from his office, and used it to look at Dan’s hip after the bad artificial knee began to cause a lot of pain in his hip, back, and other knee. But he didn’t use it for the knee needing replacement.

Surgery #2, 2009

Finally, after the remark about putting in a “shim”, we began to look for another surgeon. I searched online for someone who used MRIs and computerized techniques for joint replacement and who was experienced in what I learned is called “revision” (re-do) of TKRs. (Some surgeons, including the only other ones in our area, won’t touch someone else’s failures.) I found a surgeon who met these qualifications, about 4 hours drive from where we live, and we went to see him. The first thing he did was to get a full-leg digital x-ray, which surgeon #1 had never done. He showed us the x-ray, and used software to examine the precise alignment of the prosthesis. It was 7.5° out of alignment. In effect, his lower leg-bone had been detached and then put back on at a different angle from the upper leg. For over two years the first surgeon had taken no steps to examine the results of his surgery, other than feeling the knee.

We liked what we saw here, added to what we already knew about Surgeon #2’s experience, and proceeded with the preparations for a revision.

In late May Dan went through the revision surgery. Pry off the old, shave off a little more bone, affix the new.

When the surgeon met with me afterward in the waiting room, he had troubling things to report but they weren’t about what had just taken place. He told me that the prosthesis he had removed was badly installed. He actually used the word “sloppy”––and you know how rare it is for doctors to criticize one another’s work! The lower part was out of alignment both front-to-back and side-to-side; the upper part was supposed to be stabilized by the bone growing into it on all sides, but this had not taken place (he remarked that he did not use this model because sufficient bone regrowth often failed to occur). So this artificial joint had been loose and seriously mis-aligned, with every step stressing both parts of the prosthesis, the ends of the bones, the muscles/ligaments/tendons, and the other joints involved in walking (back, hip, other knee). It was clear, said the surgeon, that this had been causing Dan considerable pain, and he felt confident that the new prosthesis was going to be a great improvement.

Today is post-op day 19, and there is no comparison between the two post-op experiences. The day after the surgery they got Dan on his feet, and the first time he put his weight on the new knee he said that it felt more solid than the old one ever had. The next day he was walking the hall, slowly, and walking without hip pain for the first time in ten years. Bruising of the leg is minimal, the incision is shorter, and pain is less. The first time he was using fentanyl patches, very heavy opioid painkiller, and was still in too much pain. This time it is Tylenol-3 every 4 hours, and ultram (tramodol) occasionally when needed.

The incision is closed with superglue, covered with crossways lengths of what looks like strapping tape: no staples to distort the skin and then have to be removed. He was able to take a short shower on post-op day 5. Last time the first shower was not permitted nearly so soon and he was in so much pain he had to sit down on a plastic bench in the shower. This time, he was easily able to stand and feel secure. He’s in pain, but not nearly as much as last time, and the solidity of the knee makes it possible for him to get around the house carefully but confidently, only occasionally using his walking stick for stability (and to keep the dogs from bumping him).

Like the first time, the anesthesia was a spinal block (not general anesthesia) but the new surgeon added a femoral nerve block. As I understand it, the spinal keeps pain messages from reaching the brain during surgery; the femoral block keeps the nerves immediately affected by the surgery from registering pain which gets the nerves excited even though the brain doesn’t hear about it. It’s supposed to lessen post-op pain and it certainly seems to do that, especially for the first 24-36 hours.

There is swelling, but it’s not bad unless he keeps his leg bent too long while sitting; last time he was still mostly in bed for at least 2 weeks, and the swelling was severe from above the knee to the foot. Perhaps this is related to another difference in surgical procedure: this time a drain was placed near the incision with a receptacle attached which had to be periodically emptied of fluid, partly blood. Before the drain was removed, 1200 cc of fluid had been collected. The first surgeon did not place such a drain, the leg continued very swollen, and at the two-week check-up the surgeon had to use a syringe to remove at least 200 cc from the still very swollen knee. Doing this is risky because in raises the risk of infection, which would be a dire complication.

At this point the future looks very good for this new knee, and we are talking about being able to get out and hike with our dogs again. I still have limited energy (fibromyalgia) but more than I used to, since getting off of methadone which I took for pain.

Lessons learned

The parts of our experience that I think may be useful to everybody facing joint replacement surgery are these:

Research and ask questions. Get a second opinion.
This is major surgery which will shape your everyday life for the next decade or more. Revisions are to be avoided: not only because of pain and expense, but each surgery removes a little more bone. Don’t be afraid of getting a second opinion, even if your orthopedic surgeon seems great. Believe me, if your orthopedist were going in for brain or heart surgery, he or she would ask around, not just take the first name in the phone book! Insurance generally covers second opinions for major surgery.

Educate yourself about the surgery in general: what can go wrong, and why? what are the different methods?

In choosing a surgeon, standard advice is to find someone who has done this particular surgery a lot and does it regularly. That’s good advice, but incomplete. Our first surgeon had lots of experience and he performs knee replacements regularly. But based on results and what we’ve learned since, this fellow has not kept up with new methods: MRI’s, femoral nerve blocks, post-surgical drains, etc.

Of course nothing is better just because it is new. Some things provide an advantage even the layperson can evaluate, such as the use of MRI’s to see exactly what the joint and surrounding bone look like, so that the operation can be planned using that information. There’s no real downside for the patient in providing better information to the person doing the cutting and sawing. As for the high-tech implantable prostheses used in TKR, there’s always something new coming out, which may or may not be better. You can at least ask a surgeon how long he has been using the device he intends to implant into your body, what the failure rate is, and when and why it fails. Does it fail to be stabilized by bone growth, or do components or surfaces wear out? Does it loosen in 2 – 5 years, for whatever reason? Do particles get ground off and act like grit in a bearing?

Read up on the subject and you’ll get an idea of what to ask. Take notes on your reading and your concerns, and bring them with you; then take notes on what the doctor says. Have someone else come along to help by writing things down, reminding you of questions, and in general giving you moral support. The doctor is the expert, but your body is what’s at risk; don’t be timid about asking. In my mind, a doctor who won’t answer my questions fully, as fully as I want, doesn’t get my business.

Also ask what to expect after the surgery. Surgeon #1 kept stringing us along, telling us that things would get much better. Now we hear from others that isn’t really true, that you “know” right away. And indeed the bad job felt loose from Day 1 and never changed; the recent revision felt solid from Day 1. Certainly, telling us for 2 years that there would still be improvement, was unrealistic (charitable interpretation) and dishonest (blunt interpretation).

More information on Total Knee Replacement

There’s an encyclopedia-style summary of the procedure, risks, failures, etc. here that looked good to me, and another page on this site deals with TKR revisions (re-doing the TKR).
Wikipedia also has good information.

How to reduce the chances that you’ll need knee replacement surgery

It’s no fun, really. And you’ll get stopped by airport security for a special check, every time.

Photo from Wikimedia Commons.

Here’s the advice from the National Institutes of Health––

How Can People Prevent Knee Problems?

Some knee problems, such as those resulting from an accident, cannot be foreseen or prevented. However, people can prevent many knee problems by following these suggestions:

Before exercising or participating in sports, warm up by walking or riding a stationary bicycle, then do stretches. Stretching the muscles in the front of the thigh (quadriceps) and back of the thigh (hamstrings) reduces tension on the tendons and relieves pressure on the knee during activity.

Strengthen the leg muscles by doing specific exercises (for example, by walking up stairs or hills or by riding a stationary bicycle). A supervised workout with weights is another way to strengthen the leg muscles that support the knee.

Avoid sudden changes in the intensity of exercise. Increase the force or duration of activity gradually.

Wear shoes that fit properly and are in good condition. This will help maintain balance and leg alignment when walking or running. Flat feet or overpronated feet (feet that roll inward) can cause knee problems. People can often reduce some of these problems by wearing special shoe inserts (orthotics).

Maintain a healthy weight to reduce stress on the knee. Obesity increases the risk of osteoarthritis of the knee.

What Types of Exercise Are Best for People With Knee Problems?

Ideally, everyone should get three types of exercise regularly:

Range-of-motion exercises to help maintain normal joint movement and relieve stiffness.

Strengthening exercises to help keep or increase muscle strength. Keeping muscles strong with exercises – such as walking up stairs, doing leg lifts or dips, or riding a stationary bicycle – helps support and protect the knee.

Aerobic or endurance exercises to improve function of the heart and circulation and to help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints.

If you already have knee problems, your doctor or physical therapist can help with a plan of exercise that will help the knee(s) without increasing the risk of injury or further damage. As a general rule, you should choose gentle exercises such as swimming, aquatic exercise, or walking rather than jarring exercises such as jogging or high-impact aerobics.

So there it is, same old thing: exercise and lose weight. If you really really do not want a titanium and plastic knee, losing weight is probably the best thing you can do. “Data from the first National Health and Nutrition Examination Survey (HANES I) indicated that obese women had nearly 4 times the risk of knee osteoarthritis as compared with non-obese women; for obese men, the risk was nearly 5 times greater.” Moreover, if you already have knee pain, losing even ten pounds can significantly reduce both pain and the ongoing deterioration of the knee. Being only 10 pounds overweight increases the force on the knee by 30-60 pounds with each step. You don’t need to reach your ideal weight; any reduction will help. And maybe that will be encouragement enough to keep going, slowly, losing weight and feeling better. (Thorough discussion of weight loss and osteoarthritis, here.)

More about credit cards, debt, pyramids, and eschatology

My recent post “Why I’m canceling my Bank of America credit card” brought a comment pointing out that cancelling credit cards can adversely affect one’s credit score, perhaps making it difficult to borrow for cars and houses. That may well be true, but it seems to spring from a view of credit and debt quite different from mine. Rather than dump this on the hapless commenter as a reply, I’ll say it here.

First, the companies have no incentive to restrict credit, and I expect they’ll soon be back to sending out credit apps to dogs and kindergartners. When the banks lose money through extending credit unwisely, they raise rates on the rest of us to recoup. Worst case, as now, the taxpayers bail them out, they buy each other up, write off debt, get tax breaks for losses. So I think people can safely cancel all but one or two cards, and still be able to use credit to make major purchases.

Second, I’m hoping that ordinary people, who DO have an incentive to learn from the present debacle, may start restricting their debt to large necessary items. Cars and houses usually do require going into debt. But I’m old enough to remember life without credit cards; my mom had a metal “charge-a-plate” for Macy’s, and there was layaway at some stores, but no credit cards. If you wanted something you saved up for it. If you couldn’t afford to go out to dinner, you didn’t go. To those accustomed to incurring chronic credit-card debt for indulgences, such a life may seem a bleak prospect. But actually I recall very few people growing despondent for want of cruises, concert tickets, and designer handbags.

Back in the 1980’s when I saw items at an Oregon department-type store bearing tags that said “Want me? Buy me!” and a credit card logo, I viewed it as a dangerous & selfish attitude to cultivate. Along with it came the re-definition of human beings as “consumers”.

The present economic system is a pyramid scheme because it is predicated on continual growth. We do not live in a world of infinite resources and space, therefore neither population nor consumption/production can continue to increase forever. Business interests, and even the administration, expect increased consumption to get us out of this depression. If it does, it can be only a temporary fix.

I know there are a lot of optimists out there who say not to worry about dismal stuff like the economy, climate change, and all that, because the world is going to end in 2012 (Mayan Calendar theory) or “soon” (some Christian fundamentalist theories). But I just can’t be that optimistic. Call me crazy, but what if we’ve got those Mayan numbers just a little bit wrong? Or some translator introduced an inaccuracy into the Book of Revelations? What if God has changed His mind, and now thinks it might be amusing to see how His little creatures manage with these challenges? We just can’t know. Better to keep our eyes on the ball, as it were (in this case the planet & its inhabitants) and not count on the Umpire calling the game on account of End of Time.

An early warning system for health threats: the invaluable work of ProMED

ProMED Mail is one of the most important information resources on the net, and most of us have never heard of it. It’s an email list which describes itself as a “global electronic reporting system for outbreaks of infectious diseases and acute exposures to toxins that affect human health, including those in animals and in plants grown for food or animal feed”.

Unlike the official clearinghouses run by WHO and CDC, ProMED is, in its own words, “open to all sources” and its reports are freely available to us all. ProMED was first to raise concern about the aggressive respiratory disease spreading in China in 2003, which became known as SARS. Before the Chinese authorities had permitted their officials to report the disease to WHO, Catherine Strommen, an elementary school teacher in Fremont, California, spotted a post in an international teachers’ chat room from a concerned teacher in China describing “an illness that started like a cold, but killed its victims in days”.

Alarmed, Strommen emailed an old neighbor and friend, Stephen Cunnion, M.D., a retired Navy physician and epidemiologist who now lived in Maryland. A practical, no-nonsense man, Cunnion started searching the web. With no success, he tried a new tack—sending an email to ProMED-mail, a global electronic reporting system for outbreaks of emerging infections and toxins. After quoting Strommen’s missive, he asked: “Does anyone know anything about this problem?”

The tiny ProMED staff conducted its own web search. It, too, came up empty-handed. On February 10, it sent out to tens of thousands of subscribers a posting headed: “PNEUMONIA – CHINA (GUANGDONG): RFI,” or Request for Information.

Thus did the world first learn of SARS, the new and deadly infection that would kill 774 people and infect 8,000 in 27 countries.

From an article by Madeline Drexler in The Journal of Life Sciences.

H1N1 Reports (Swine-avian-human Influenza A)

To keep up on H1N1 flu [I agree with the pig farmers, “swine flu” sounds like your big risk is getting it from pigs and pork, not human sneezes and handshakes] check the ProMED main page. While all the media is now frothing over with “news” about this disease, some of it sounds as reliable as alien abduction accounts. ProMED is timely and scientifically accurate but understandable by non-biologists. It includes valuable, and interesting, commentary on reports and questions: “this has been reported, but here’s what we don’t know, or here are local factors that must be considered in evaluating it”.

What ProMED does

ProMED is a program of the International Society for Infectious Diseases which began in 1994. It does not simply print whatever comes in—this is an extremely well-moderated list. A group of specialists checks and filters the reports, seeks more information from local sources and other experts, and provides judicious commentary. This group also “scans newspapers, the internet, health department and government alerts, and other information sources for inklings that an infectious disease, perhaps not yet reported widely, is threatening animal, plant and/or human health.”

I think I first signed up to receive the digests back when “mad cow disease” was emerging, and have since used ProMED to follow diseases such as anthrax and Ebola.
A topic of interest to me recently concerns outbreaks of measles and mumps in Western nations due to falling rates of vaccination. And as a former zookeeper I keep up on diseases of wildlife and zoo animals, including the fungal disease threatening whole populations of wild bats in the Eastern US. ProMED also covers plant diseases (mostly of crops).

All of this, infectious diseases of humans, wildlife, and crops, is of greatly increased urgency because climate change, global transport, and destruction of wild areas all lead to the spread of familiar diseases to new locales and the emergence of “new” diseases previously only found in remote wild areas. With regard to contaminants and toxins, governments are unable to deal with this effectively due to the political power of corporations and lack f oversight in producing countries. ProMED can’t make your food and furniture non-toxic, but it can sound alarms that might otherwise be silenced.References to a topic’s prior appearances on the list are attached to current reports, and archives are easy to access. Editions in French, Portuguese, Russian and Spanish are now available.

“Each posting is limited to 25 KB bandwidth—to ensure that it slips through an old-fashioned dial-up modem in the most remote areas of the world (where new infectious threats tend to smolder). ‘We use technology that was state-of-the-art in 1994. We use email—plain-text email at that. We don’t use fancy fonts,’ Madoff says. ‘The power of the Internet is its ubiquity and speed; it’s not necessarily in all the neat things you can do.’ [from Drexler's article cited above]

You can subscribe here.

Toxins and contaminants

ProMED also collects, evaluates, and disseminates reports of health problems related to toxins and contamination of food and medicines. These can be quite unusual. For example, the case of the toxic leather sofas in Britain:

Photo: Effect on leg of reaction to toxic chemical contained in sofas. From BBC.

A judge [in the UK] is expected to order several retailers to pay millions of
pounds to people who suffered burns and rashes from faulty leather
sofas….

More than 1600 people claim to have been affected by the problem. Tens
of thousands more people could have burns not yet traced to sofas.
The High Street stores, along with 11 others, may have to pay more
than 10 million pounds [USD 14.3 million] in compensation and legal
costs, the shoppers’ lawyers say. They claim that makes it “the
largest group compensation claim ever seen in British Courts.”

The sofas, which were manufactured in China, were packed with sachets
of an anti-mould chemical called dimethyl fumarate to stop them from
going moldy during storage in humid conditions.

Commonly known as DMF, the toxic, fine white powder has been used by
some manufacturers to protect leather goods like furniture and shoes
from mold. Even very small amounts can be harmful.

One sofa customer, who is well aware of the health problems caused by
her purchase, is a customer who bought a leather sofa suite from
Argos in April 2007. Almost a year later, she started to notice a
rash developing on her arms and legs. After a few weeks, her skin
started flaking off. She says the irritation was so bad, she was off
work for 2 months. This customer was seen by more than a dozen
doctors, who couldn’t work out what was causing the rash.

She said: “It was very, very painful; I couldn’t sleep at night; I
couldn’t walk about; I couldn’t drive; every time I did walk about,
the skin would fall off, and I would leave a trail of it, therefore,
I couldn’t go to work.”

Reliable histories of outbreaks/events

ProMED doesn’t just present breaking news and requests for additional reports; it frequently publishes very useful summaries of what’s been learned, and what action governmental agencies have taken. For example, “Melamine contaminated food products – Worldwide ex China” and “Prion disease Update 2009 (01)” (Mad Cow Disease and its human infectious disease, the fatal “variant Creutzfeldt-Jakob disease”.

Supporting ProMED

Believe it or not, ProMED is supported by individuals, with not a penny of funding from any government. That means they are independent (remember the movie Jaws, where the city council wants to suppress news of the shark attacks?) and fast to react. They sift a lot of news from all sorts of sources, put out calls for more information, and disseminate news in a responsible way.

If the work of this group seems like something you’d like to support, here’s your chance. They’re having a brief Spring fundraising campaign. To quote their email,

Your gift funds quick information every day – The economical, low-tech computer programs we use enable us to speed ProMED to your mailboxes, to post it online where anyone can find it, , and to provide the administrative services (accounting, office space, cell phone connections, etc.) required to support a small, agile worldwide enterprise.

ProMED-mail reaches over 50,000 public health officials, students, journalists, agricultural specialists, infectious disease professionals and others around the globe. Because it is free, subscribers in more than 187 countries have an equal opportunity to know when a disease outbreak occurs — and can spring into action when necessary to prevent or minimize its spread.

If the Spring campaign is past, here’s the main donations page.

Helping National Guard and Reservists “re-enter” after deployment

Sometimes local news should have a wider audience across the country.

Our US Senator Ron Wyden (D-OR) has earned great respect in this state for his humane principles and competence at building coalitions to get things done in DC. Here’s an example from the Oregonian newspaper on an issue that, typically for him, is not at all parochial but affects all of us deeply.

Sen. Wyden proposes extending Guard pay

The Oregon lawmaker wants to give soldiers returning from war 90 extra pay days

Wednesday, April 08, 2009

JULIE SULLIVAN, The Oregonian Staff

When Oregon Army National Guard soldiers returned from Iraq four years ago, fewer than half had a job waiting.

Employers wanted to help. Within a week, the Guard organized a reintegration fair that offered an estimated 500 jobs. But not a single soldier took one.

It was too soon.

“They are not ready to leave a combat zone and seven days later, go back to work,” Brig. Gen. Mike Caldwell said.

State and federal officials say they’ve learned how to do it right. U.S. Sen. Ron Wyden, D-Ore., wants to extend federal pay for National Guard and reservists for 90 days to ensure a “softer landing” when they return.

Oregon has posted some of the highest percentages of Guard members serving in Iraq and Afghanistan. Another 2,700 are training to deploy Iraq in July.

Unlike the regular Army, where soldiers return to their stateside military jobs and bases, the Oregon Guard and reservists scatter to hometowns. They lose their military salary, and more than $600 a month in other hazardous duty and separation pay.

When Oregon soldiers returned from Afghanistan two years ago, fewer than half of them younger than 35 had a job waiting. The younger the vet, the worse the outlook, with nearly 65 percent younger than 25 unemployed.

“About 79 percent returned to poverty,” said Sgt. First Class (Ret.) J.D. Baucom, a career assistance liaison for the Oregon Guard. He’s concerned in today’s economy those numbers are bound to get worse.

Wyden said paying the Guard for up to 90 days after they return would give them time to rebuild their lives before hitting a financial wall.

“We not willing to sit around and watch soldiers go from the front lines to unemployment lines,” he said.

Oregon has led in veterans’ advocacy. The Guard’s re-integration program — launched by wounded Alsea and Albany infantrymen in 2004 — is a national model. In 2007, the Legislature created a new veterans hiring preference for public employees. Now it is considering extending that preference from 15 years to a lifetime and granting 15 days unpaid leave to spouses of deploying soldiers.

Wyden’s bill covers returning soldiers so it would help only a fraction of the 350,000 Oregon veterans. He met former service members at the IBEW Local 48 in Northeast Portland on Tuesday morning in part to highlight job opportunities in the building trades. One federal program, Helmets to Hardhats, has put more than 1,757 veterans nationally into union apprentice programs. Across the hall, three young military veterans had found union jobs a good match on their own. They said that learning discipline, attention to detail and the ability to work in a team in the service has helped them apprentice as commercial electricians.

“I tried college, but I was working full time and going to school full time and that didn’t work,” said Craig Enneberg, 28, of Sherwood. “This works.”

Still, veterans advocates — and veterans themselves — told Wyden that a far more targeted approach is needed. Among the suggestions:

Reduce paperwork. “If we can’t get through the process, how we can we ask a 20-year-old from eastern Oregon who doesn’t know where to call?” said Sgt. 1st Class Phillip Maas, who manages career assistance for the reintegration team.

Connect veterans. Ret. Master Sgt. Mike Eschete, who recently graduated from Portland State University, proposed a mentoring program using military retirees. “They speak a different language and understand a dimension that is invisible to others,” he said.

Educate gatekeepers at agencies. “Put someone in that position who gives a damn,” said Erik Burris, a 12-year veteran of the Navy. Burris said one state employment specialist, Rene Garcia, helped him.

But little else has helped Burris in this economy.

The 41-year-old aviation structural mechanic and flight deck troubleshooter in the Navy has been laid off from four jobs in Portland since 2002. Wyden invited him to the Tuesday meeting. He arrived in a stylish blue shirt and tie, his carefully clipped hair and leather organizer in hand. He handed a reporter his resume.

After being laid off from jobs in quality control, sales, tech support and as a contractor at Intel he hasn’t worked since January 2008. He keeps applying, whittling his three-page resume into a one page “cram ad” and checking 12 job boards online a day. He does all the family cooking for his wife, Jeanmarie, and their daughter and keeps the kitchen immaculate in their “inexpensive” 900-square-foot Tigard apartment.

“Home is what you make it,” Jeanmarie says.

“You lose your pride and a little bit of yourself every time you get laid off,” he says. “And we have so much to give.”

juliesullivan@news.oregonian.com

2009 Oregonian

Why not let your senators and representatives know that you support this? The following pages help you get contact information and send emails:

for US representatives; need to know your ZIP code + the four digit addition to it

this one works for both representatives and senators (also yields info for state legislators); use the search box at the left to get names, click on name, click on “Contact” tab above the person’s photo.

Apple’s short video tutorials

Mac users know that OS X, and its included applications such as Mail and Preview, can do more than we realize. One place that provides an easy review and demo of new functions is the tutorial site, Apple Business Theater. Beneath the video viewing window are dozens of titles. Here are some examples:

The video tutorials I sampled were only a couple of minutes long: tightly targeted to doing just the one action described. I was particularly interested in the new capabilities of Preview (Apple’s viewer for pdfs, images, and other things) to work with pdf files. In the past I have spent hours searching for and trying out various third-party apps to merge or edit a pdf, since we didn’t own Adobe’s expensive Acrobat editing program, only their free reader.

OS X enables “Print to pdf” from any app, and some apps such as Nisus Writer offer “Save as pdf” too. Either way, it is easy to create a pdf now without Acrobat. Now, using Preview, we can merge 2 pdfs, delete and re-arrange pages, add pages, and annotate pdfs.

Many other handy tips are demonstrated here; take a look!

Back to the past: Return of the percolator

Over three decades our household has averaged a new coffee-maker every three or four years. We’ve had Braun, Gevalia, Black and Decker, Krups, and other brands I’ve forgotten. A couple of times we got the $90 model but mostly they’ve been about half that price. Either way, eventually they quit working and this big non-repairable piece of plastic and electronics goes into the garbage.

As years have passed they’ve gotten more complicated, and that seemed to be the downfall of last week’s purchase. It was a Krups with an added water filter (good for us, with mineral-rich well water, but also one more thing to have to find, buy, and replace––profit’s big on consumables, like printer cartridges!). It also had an extra idiot light feature: a “low water” display and override which would keep it from running if it thought there was not enough water. This was not a feature we wanted, in fact we did not discover it until it malfunctioned on the third day of use. Push ON and all that happened was a cryptic pattern flashing on the display.

In the morning, when you want your coffee, reading a coffee-maker manual is not on your list of desired activities. Before consulting the manual we tried the chimpanzee approach, pushing the four control buttons in various combinations. Luckily we did not happen to activate any of the more arcane features, which can only be guessed at, nor (since we live in such a remote location) did the machine’s electronic calls for help manage to bring its plastic comrades jetting to its aid in time to defend it from our mishandling. Nor did we fix it, even after we deciphered the display message. We plugged and unplugged it, emptied and refilled it, all to no avail. Then we called the Customer Service number and listened to music for 20 minutes before a polite woman with a southern accent came on, heard our story, and informed us that by unplugging it and plugging it back in, we had “done all the troubleshooting” that we could do and our next step was to pack it up and ship it to their service center. Or, she said, we “might be able” to return it to the point of sale for a “straight-across trade”. Yes, I said, thinking “But not for another one of your brand!”

By then, we had made our morning’s coffee using a kettle and a flat-bottomed gold filter set in a sieve over a large pyrex measuring container. It was good. Caffeinated, we discussed our next step. Something simpler, not plastic and electronic, would be good; perhaps it would even have been Made NOT in China. We decided on a percolator, since Dan said he’d seen one on the shelf when he chose the Krups, and I remarked that when I was a kid people had the same percolator for 20 years, perking on and on. We marvelled that the coffee-makers of our childhood were still being sold. Maybe we weren’t the only people tired of having to read a manual for something that should be simple, and tired of the (planned or unplanned) short life-span of the new coffee-makers.

For $45 we got a shiny stainless steel West Bend percolator. It has no controls. Fill with water (there is a clear water gauge on the side, one new feature); insert the tube up which the hot water flows; put coffee in metal basket, put on lid, place basket on tube, put coffee-maker lid on, plug in. Less than a minute later hot water is flowing up into the clear knob on top and down onto the coffee basket. There is no possible programming, no clock, and only one “feature”, a plastic light on the base. I thought the thing was already broken, when the light did not come on after the percolator was plugged in. But no: the light comes on when the coffee is done. It keeps the coffee hot until unplugged, so you have to remember to do that to avoid cooked-all-day coffee remains. Unlike all the coffee-machine carafes we have ever had, the percolator does not drip when you pour too fast. Also, it takes up less space on the counter.

And the coffee? We like it better than what we were drinking before. The perking noise is pleasant, unlike the hissing and puffing of the previous type. Only one part didn’t turn out as we hoped: it was “Made in China”. But we hope it’s the last coffee-maker we buy for a long long time.

Listen up, retailers and retail employees!

You know you can’t afford to lose customers these days. We’re having an economic situation/blip/slowdown/downturn/recession/crisis/depression, ah––cut to the end: when the train finishes pulling into the station, it’ll be “Economic Disaster”.

Businesses spend money and effort on advertising, but often are oblivious to how they treat the customers themselves. When I walk into the tiny local florist to send condolence flowers and the person greets me coolly, asks only “How much do you want to spend?”, has no prices posted on anything, and no pictures or samples to show me, does it seem likely I will return? If there’d been another similar business within 15 miles I’d have walked out and gone elsewhere.

This subject has been on my mind for a few years, because my experience at the florist is far from an isolated incident. I fantasized about making my million with a company issuing videos and doing workshops about how to treat customers. But that’s not likely, and American business needs this now, so I’m going to write a little about it. Maybe it’ll be worth more than the traditional value of free advice.

Keep in mind, much of what I will say may seem obvious. It is. But if you work with the public and you aren’t practicing this, you need to hear it. And more than just hear it; consciously work at it and get some sort of feedback on how you are doing. My plan for teaching “customer service” included video illustrations of right and wrong; role-playing; and finally videotaping “students” for them to see themselves, because in all aspects of life we need a mirror, an objective reporter, to show us what we really do and say, as opposed to what we believe we do and say. Think about how true that is of other people you know. And it is just as true of you. And me.

Attitude

If you are going to work with the public, in a gas station, a library, a restaurant, a retail store, behind any sort of service desk, accept these basic realities:

• No customers, no job.
• Every customer advertises you to people they know, with praise, condemnation, or silence.
• Making a repeat customer is like gaining a new customer without the expense of buying ads or running special deals.
• You’re “on” every minute.
• Customers get to act tired, cranky, stupid, and demanding, but you do not. You must be polite, helpful, inoffensively cheerful, and competent.

These are habits of thought and action like any others, and you can learn them and make them mostly unconscious and routine. Even virtue, Aristotle said, is a habit.

If you absolutely can’t accept and act on these realities, then public service/retail is the wrong place for you. You won’t be effective or happy in your job. And eventually it may catch up to you, as your boss decides you don’t add anything to the business, or your own business fails.

Attentiveness and Greeting

If you’re otherwise engaged when a customer arrives, you must show that you know he or she is there. Maybe you’re on the phone or helping someone else when Joe walks up to the counter. Make eye contact with Joe, smile, return to what you are doing.

Don’t keep him waiting more than a couple of minutes unless it is clear to him that your current transaction has a clear end coming up, as for instance ringing up the customer ahead of him. (This doesn’t apply to a grocery checkout line, or other situations where customers know they are waiting and know their place in line. Although even there, send a smile to the customer who’s waiting behind that person sorting through a zillion coupons, and it will be appreciated.)

If your transaction may go on and on, use your judgment; probably you should say to the customer in front of you, “Excuse me just a moment,” turn to Joe, and say “Hi, can I answer a question for you?” He asks whether your store has Acme Widgets in stock, you tell him yes (and where they are) or no (adding, but if he can wait a moment, we have something very similar) then turn back to your current customer. Or if there is another employee available, get that person over to help Joe. Joe doesn’t walk out thinking you don’t care about his business, and you may have a customer.

On the other hand, don’t let attentiveness to the newly arrived customer make you abandon the one you were working with. Same with phone calls; that’s what the Hold button is for. Fairness is important to us humans, and the person who was there first can reasonably expect you to finish his or her transaction before going on to another. If Joe’s “quick question” turns into something longer, you must gently interrupt and promise to help him just as soon as you’ve finished with the other person’s business.

[Supervisors, take note: should your sales desk people really be answering all the incoming calls, too? You think you’re saving money but it means someone who is right there with money to spend has to wait while the clerk answers questions and routes calls.]

Do not do personal business in front of customers. Everybody needs to make a phone call at work sometimes, or talks to other employees during a slow period about non-work stuff, but make it a rule: never when a customer is present. Tell your babysitter you’ll call right back, quit discussing the weekend, the hot new clerk in Shipping, or the prospect of layoffs. Even if the call or conversation is really work-related (informing another staff member that the new shipment of extra-large widgets hasn’t arrived yet so we don’t have any on the shelves right now), the customer needs to come first. Make eye contact (as above) and end the other matter at once.

Each customer should feel that they have been noticed, that they will have your attention soon, and that during that time they will be your primary focus.

Helpfulness

All of us have had the experience, on the customer side of the counter, of being either smothered with attention or wandering lost and alone. We want someone to pick up on our signals and act appropriately.

As a salesperson (or library assistant, waitperson, etc.) you can learn to read minds. Yes, it can be done. Offer initial assistance, then ask if you can help; if the answer is “No, I haven’t quite made up my mind,” or the old standby “I’m just looking around,” then say “Just let me know when you’re ready” or “Let me know if I can help you find something.”

And then, you don’t forget about this customer. If I sit staring at the menu for ten minutes maybe I need to be asked, “Would you like to hear about our specials today?” or “Can I tell you more about any of these lunches?”––and not in a tone of “Would you please get on with it!” Restaurant staff are usually much better at this than retail staff, since turning the tables over in restaurants is so important. In a store, people searching the shelves or aisles in vain for what they need have a certain look, which you don’t have to be a master of human expression to recognize.

Make your interchanges genuine. What you say, how you say it, body language, all can have a positive or negative effect. One of my pet peeves is the “drive-by wait-person” who asks, while rushing past our table, “Everything okay here?” And if it’s not? If my hamburger is raw inside or I need more water, do I have the impression that this person has time to care? Waiting table can be a high-stress job with a lot of things to juggle at once, but if you’re going to talk to me, please stop, face me, make eye contact, and then talk.

At the store’s cash register, as you are asking me whether everything was okay, and did I find what I needed, same thing: make eye contact, take that extra 5 seconds to see me, and then listen and respond to what I say. I like it better, and you may get valuable information: there’s no ground beef left at the meat counter, I couldn’t find what I came in for and am heading elsewhere for my main purchase, the directional signage is wrong and I’m ticked off, somebody spilled coffee all over your bin of blue widgets.

When there’s “nothing to do”

Most jobs have slow times: no customers, no calls, waiting for a part to arrive or for someone else to do something. In work that’s mentally or physically demanding you need little bits of rest. But, especially in retail or public service, there really are things to do even when––especially when––the store or restaurant is quiet and the phone isn’t ringing. This is your chance to make the coming busy times easier for yourself, and improve the service you are able to offer. Some of it’s obvious: fill the condiment containers, put away the unsold merchandise that has made its way to the counter, check your supplies, replace the cash register tape, tidy things up. That’s the kind of thing a boss will be pleased not to have to remind you about.

There’s more that’s not as obvious: you need to know a lot about whatever goods or services you are in charge of, so look over the stock, check out the new stuff, notice that you now have some of those special items someone asked about last week, ask the cook about today’s soup (or even taste it!). Find the answers to questions you haven’t been able to answer, and next time you won’t have to consult someone else or confess ignorance. Have the answer that will help the customer, and result in a sale. “I need something for a baby shower, but she already has 2 kids.” “How do you use this chutney stuff, can I use it for a marinade?” “All these dry dog foods are confusing, what are the differences?” “Can I do my taxes online here at the library?” “What’s a good flowering plant for a shady location?” “I need some left-handed scissors.” This can be an enjoyable part of your job, learning more to help people toward what they are looking for.

And if your store hasn’t got those left-handed scissors, or your restaurant doesn’t have a wide vegetarian menu, you’ll earn the customer’s gratitude by being able to suggest an alternative, or even another place that has what’s needed. I had to return a plastic lap desk (for a laptop) to an office store because it just wasn’t adequate, and nothing else they had was any better. I won’t forget that the staff person recommended a big book store to me as a good place to look; I would never have thought of going there and was getting tired of the search. I followed the tip and found what I wanted. Now, I think of that office store as a more helpful place, and I’m more likely to go there instead of to their competitor. An interchange can be very successful (in terms of your business) even if it doesn’t result in a sale.

Personal Satisfaction

This is the part about what’s in it for you, if you change your attitude and behavior so customers leave feeling good about their experience in your workplace.

Now, it’s obvious that you are very likely to increase your own chances of success at work by doing this, whether you own your own business or are an entry-level employee someplace.

What if your boss is an SOB who only cares about the bottom line, treats customers and staff poorly, and is never going to die or retire in time for you to benefit? Sounds like a good place to move on from, and if you understand and can express good principles of customer service, you have an advantage in the coming job interviews. The surly or spaced-out shirker isn’t at the head of anyone’s hiring list.

Deciding to look for ways to be better at what you do is not equivalent to resigning yourself to being at your present job forever. Just the opposite, in fact; bad attitude and bad performance are not attractive to potential new employers. Nor are they conducive to promotion (except in the financial industry and high-level corporate management).

Beyond that though, is another realm of benefit entirely. It actually is true that if you work at doing your job well you are very likely to feel better about it. That is not a falsehood spread by the capitalist bosses, it’s a psychological fact. If you don’t think your own job is worth doing well, then you are telling yourself that every moment at work is a waste of time, something to be resented and avoided. In other words, “Over half of my waking life is worthless.” If you don’t have any sense of satisfaction except when you manage to work as little as possible, you go home feeling pretty crappy about all those hours and effort, and about yourself.

And now, a word to the “capitalist bosses”

Most of what I have written has been addressed more to employees, but it is employers who set the tone of their businesses, and they have a lot to lose if staff are providing poor customer service. If that is the case at the business you run, don’t blame your the people who work for you––train them, encourage them, and set a good example including in your behavior to the employees themselves.

This may only be possible in small businesses, since larger ones get drawn astray by greed, ego, and isolation of management from the product and customers. Management starts to think that the end product is money, and they start viewing everyone else in the world as either tools or fools. Employees are tools to be used, customers are fools to be scammed. But we always hear that small businesses generate most of the new jobs in the US, so if they can accept a model based on good products, good customer service, good treatment of employees, then that will be a significant change.

Our current economic debacle can be directly traced to poor practices on the part of those in charge, whether they were causing bad loans to be made, or failing to listen to consumers when designing cars. Greed is always a pyramid scheme: it pays off only if you bail out at the right time. A risky business model, that: it’s really just gambling (with other peoples’ money).

If you’re in business, you have customers. Act toward their greater satisfaction, strive to do what you do better than anyone else, take a long-term point of view, keep your debt down, and invest in your employees. You may not end up with the biggest widget company in the world, but you are likely to be still operating when the big guys have vanished in debt and disgrace.