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September 1, 2013
A year ago, we ran an article written by our fairly regular columnist, Leslie Rugg, entitled “10 Questions To Ask A Breeder When A Prospective Puppy Buyer Visits A Litter.” It was a mouthful of a title but also a mouthful of an article, full of indispensable information and great advice. We suggested that you might want to print out that article and keep it on file. Now we have her companion article that examines how puppy buyers and dog owners can best partner with their veterinarians. You might want to print this one out as well because Leslie has given us another handy guideline, reminding us all that there are no dumb questions…although there may be dumb answers. It’s up to us in this pro-consumer, internet info-friendly modern age to be advocates for our pets. A partnership between owner and veterinarian is the best medicine for your dog or cat or iguana or cockatiel or ferret or rabbit or horse.
If you have a story you’d like to tell us about, write me. We love hearing about people or animals or groups who make the world a happier, better place to be. If we use your story, you’ll get a free pound of cookies!
5 Lessons To Ensure A Positive And Pro-Active Relationship
Between Pet Owner And Veterinarian
by Leslie Crane Rugg
Authority figures… we’re used to them in every walk and time of life. Parents, school teachers and principals, bosses, police, judges, mayors, governors, senators, presidents, and doctors. It’s that last one – doctors – that scare us the most. They have knowledge that most of us don’t know, haven’t studied, and certainly haven’t thought much about until suddenly something crops up and puts the practice of medicine in the forefront of our consciousness.
In pre-computer/pre-information technology days – yes, there was such a time just a few decades ago – doctors were rarely questioned by their patients. Not only did doctors know more about the parts of our bodies that made us the most squeamish, they also held the power of good health and poor health – our health! – in their hands. They often controlled whether and how we lived or died.
Not only was the doctor/patient relationship not a partnership, it was at best one of benevolent despotism, a step up from Roman emperors who with a thumbs up or down could dictate if one survived for another fight in the gladiators’ arena. The most a person could hope for was that the doctor had a kindly bedside manner in delivering good or bad news.
Not much was different in the world of veterinary medicine. In those same old days, for many pet owners, animal health was an even greater mystery than their own human health. At least you could buy aspirin or cough syrup or eye drops for yourself at the drug store. But having something handy for simple pet ills? Not so easy. You could buy flea collars that were as toxic to the dogs as to the fleas and maybe pet multi-vitamins from unknown sources, and that was it.
If you had the average, run-of-the-mill veterinarian, you were kept in the dark about your pet’s troubles. Maybe you’d get a glance or a word mumbled in your direction while the vet examined your pet. Okay, I’m exaggerating. My family always managed to get loquacious veterinarians who told long and involved stories of their experiences with livestock or particularly hairy whelpings producing mutants… and then they’d tell us what was going on with our dogs or cats. Not quite an ideal partnership either.
We’re lucky to be pet owners now. More veterinary students attend vet school because they truly want to treat and handle animals (no longer the frustrated person who couldn’t get into human medical or dental school). More veterinarians regard pet owners as having their own particular authority and wisdom, recognizing that we know our pets better than anyone, living with them in our homes as members of the family. More pet owners do their research, knowing the history and health quirks of their animal’s species and breed. And when in doubt, both pet owners and veterinarians are likely to do additional research, turning to veterinary specialists for advice and counsel. Luckiest of all, those experts respond not just to their fellow vets but to pet owners as well. Together, we are jointly armed with the best knowledge immediately available.
That’s the ideal situation and one that is realistically in your grasp. Neither the medical doctor nor the veterinary doctor is unapproachable. Neither has divine powers or divine right over life and death decisions. All we have to do to generate a partnership is to be proactive at the time of a veterinary visit and vigilant in interacting with our pets. In that way, we bring the most useful information to the veterinarian, who learns he or she can rely on our skills of observation, evaluation, and follow through. The trust built between pet owner and veterinarian must start somewhere…. So let’s start at the beginning when first bringing in a new pet for that first wellness checkup.
Lesson #1: Inform your veterinarian exactly what you want done to your pet. Listen if the veterinarian has other ideas or a different approach. Decide and agree before anything takes place.
If you’re still in the process of selecting a veterinarian, have you decided if you want a veterinarian who practices traditional mainstream Western medicine or one who practices holistic/integrative/alternative medicine? For recommendations in either or both approaches, ask your friends who have pets. If your breeder or rescuer is in your area, ask who he/she uses. On line, search the directories provided by the AVMA (American Veterinary Medical Association) and by the AHVMA (American Holistic Veterinary Medical Association).
Many veterinary offices and hospitals now have web sites, complete with mission statements, descriptions of services offered, and biographies of the veterinarians. Review each selection carefully, and when you first visit the office and the veterinarian, make sure that what is posted on line is what actually takes place in the examining room. It should be identical…but it sometimes isn’t. Beware and take note of this true horror story (always the fun part of an article):
A newly married couple I know recently acquired their first pet – a Pembroke Welsh Corgi whom they named Chase. Elizabeth and Leo wanted to raise a puppy as a way of determining the kind of parents they would be to a future human child. They were extraordinarily careful in selecting the right breed, the right breeder, the right litter, and the right puppy for them. They asked a well-known expert to help find a holistic veterinarian in their city. Armed with the research they had done, they knew they wanted to follow the Dodds protocol for puppy vaccines. The veterinarian, whom they were told was excellent, had a fairly identical vaccine protocol posted on his hospital web site although it mentioned other vaccines as well.
As new and inexperienced dog owners (they had both grown up with cats), Elizabeth and Leo were anxious to do right by their canine baby. However, at each visit, the veterinarian managed to sneak in – I’m writing this account from the pet owners’ point of view – extra vaccines that were not part of the Dodds protocol and that, if the couple had been told, they would have refused. They only realized upon getting the bill that their puppy had been treated above and beyond what they expected to take place not once but twice.
Little Chase was also overmedicated with antibiotics for symptoms the pet owners felt were related to overvaccination, but the veterinarian insisted were due to entirely other reasons that were never proven to be accurate. The puppy ended up being overvaccinated and overmedicated for an incorrect diagnosis as well as simultaneously receiving heartworm and flea/tick preventives – all within a one month period.
Despite the couple’s best efforts to counteract this assault to Chase’s immune system, using thuja and milk thistle, the puppy developed dermatological reactions that could only be treated with the most gentle of alternatives. Two other veterinarians treated Chase with olive leaf, rich in antioxidants that would help restore the puppy’s immune system, plus chamomile tea applications and Pramasoothe spray to reduce and eliminate her inflamed and irritated skin.
Elizabeth and Leo confronted the first veterinarian who insisted he had done nothing wrong or out of the ordinary, even in giving a rabies shot at the same time as a core vaccine. The expert who had recommended him was also told so that she would know not to recommend him again. (P.S. Thankfully, Chase seems to have recovered. Her titers show full immunity; bloodwork results are still forthcoming.)
Lesson #2: Bring all records relating to your pet to your veterinarian. No matter if you obtained your pet from a breeder, a rescue, or a shelter, there will be records about your pet, including whatever veterinary services your pet has been given. This information is vital, will help your vet determine the past and current health of your pet, and will also prevent your vet from revaccinating a recently vaccinated animal or from using medications contraindicated for your pet. The only time you probably won’t have records is if your pet is a stray you have picked up and decided to keep.
Sometimes… okay, I’ll say often… veterinarians aren’t up to date on the latest in breed-specific conditions and/or their appropriate treatment. In veterinary school, vet students are not taught about breeds. They’re taught about species. The exception may occur with a well-documented cancer that occurs disproportionately in some breeds (such as mast cell tumors) or a particular condition that overtakes a single breed (such as von Willebrand’s disease in Doberman Pinschers). Here’s a true triumphant story (we like those even better than horror stories) of a rescued Shetland Sheepdog, whose life was saved by the keeping of records and the documenting of her various conditions.
Penny was picked up by shelter personnel. She appeared to be an adult who had been bred. She was covered in fleas and unable to walk. She also presented what seemed to be a case of pyometra – a uterine infection. You’d think she would be a prime candidate for euthanasia – no owner and in poor health. The shelter veterinarian knew the dog needed an emergency spay if her life was savable. She performed the surgery, which revealed some oddities with Penny’s ovaries. Because of the oddities, the shelter vet did something not customarily done: she sent tissues off to be biopsied at a laboratory.
Penny survived the surgery and made her way to a breed-specific rescue, Sheltie Rescue Alternative (www.alternativepet.net/Rescue.html). Eva Saks, the head of the rescue and a friend of mine, is also unusual: she takes extraordinary interest in the old and infirm of her beloved breed, and she takes equal interest in providing truly superior care, thus extending the lives of the dogs who come into her care beyond all expectation. Eva has quite a track record. Part of her success is because of her record keeping. She keeps a huge notebook on each dog who comes to her. She confers with a stable of veterinarians, and she is relentless in determining all possible medical and nutritional options.
With Penny, Eva did two things, each of which proved to be a life saver on top of what the shelter vet had done for the little dog, who, it was determined, had a cystic ovarian disease rather than a uterine condition. First, Eva made sure that Penny’s intake visit at one of Eva’s many veterinary providers included blood work, urinalysis, and x-rays. The x-rays disclosed a couple of spots on Penny’s lungs. Following up at a veterinary specialty hospital, Eva okayed additional tests, including a CT scan guided needle aspirate, to determine what the spots on the lungs really were. Second, knowing an increasingly common incidence of gall bladder disease (leading to rupture and death) is occurring in Shelties, she had an ultrasound done at the same hospital.
The aspirate showed cancer to be most probable, although there was a small chance of heartworm or lungworm as the cause. Other tests subsequently ruled out the worms. The ultrasound proved the presence of a mucocele – a mucous cyst – that would likely rupture soon. Conferring with a number of veterinarians and making sure Penny’s blood work and heart made her a good candidate for two surgeries – gall bladder removal and the removal of two lung lobes – Eva went ahead scheduling each one several weeks apart. The surgeons were superb and the surgeries were successful. Redoubtable Penny never even blinked. She survived with style, grace, and irresistible sweetness. Today Penny is running around, happily barking and playing with the pack at the rescue. She is adoptable and worth much more than a mere cent.
Lesson #3: You would expect a veterinarian to know more than a pet owner, but sometimes the reverse is true. Again with breed-specific issues, be prepared to educate your veterinarian. A good vet will be grateful. If your vet doesn’t seem to be interested in the information, it’s time to look for another vet.
Sometimes your veterinarian isn’t available – vacation, scheduling error, emergency – and you are forced to use a veterinarian you’re not familiar with and who doesn’t know you or your pet. That’s the time to be the most pro-active advocate. You might luck out with a fantastic, informed practitioner or you might end up with a veterinarian who is overeager in dispensing meds. Yep – you’ve guessed it – time for another true horror story.
An article written by yours truly wouldn’t be complete without a reference to a Collie – yes, I know him although he’s not one of mine… that will come later in the article... This particular Collie named Halo, a rough sable and white boy with a spectacular heritage, developed what was most probably a severe stomach ache from eating the restaurant leftovers of a steak that his owner Vanessa gave him a day or two too late for it to still be edible. However, Halo also had a habit of running out to the end of his property where geese liked to fly in and swim in a pond. Nothing was more tasty to the dog than a little goose poop. Okay, maybe not quite pate fois gras but close enough…
Halo’s ensuing diarrhea was greater than usual, so Vanessa took the dog to her vet office. Alas, her vet was not available that day, so she and Halo saw a substitute. This veterinarian met a dog with an extreme case of the squirts, heard about the goose poop, saw that the fecal sample revealed bacteria, assumed the dog probably had coccidia or giardia or both, and prescribed the following: 2000 mg of metronidazole (brand name Flagyl) per day and doses of Imodium as needed.
Anyone raising a red flag after reading that? First off, the customary dosage of metronidazole is 250 mg at most twice a day, and many vets will prescribe half that amount. Second, Imodium????? To a Collie???? Ever hear about MDR-1, the multi-drug resistance genetic mutation in some herding and sighthound breeds that allows drugs to cross the blood/brain barrier?
The combination of way too much metronidazole (to which some dogs can have serious reactions) plus Imodium, a known no-no for MDR-1, took poor Halo down more than a notch or two. Just one megadose of the antibiotic and one of the antidiarrheal reduced him to a shadow of himself. He was lethargic yet anxious, whining and pacing, dazed and standoffish. Vanessa contacted me, and I told her to stop both medications IMMEDIATELY. I reminded her about MDR-1, and she had to admit she hadn’t yet done the simple cheek swab test.
Vanessa ended up taking the dog to an emergency veterinarian a few hours later. The first thing the ER vet asked her was if she knew about MDR-1! The vet examined Halo and was sure he’d survive and return to his full glory in a day or two. Do you think he remembered either the yucky steak or the tempting goose poop? Let’s just say that Halo was back to chasing geese two days later.
Lesson #4: Diagnosis is often a joint endeavor between pet owner and veterinarian. Describing symptoms, differentiating between the usual and the unusual, thinking in terms of known breed health issues, relating them to what the vet learned in school and at conferences and sees in practice, relating them to your pet as you live with it every day, testing assumptions along with making use of diagnostic techniques – these are the stuff of a real partnership. The knowledge you have of your pet is as important as the tools the veterinarian has available.
Sometimes you think you and your vet are doing everything right when Mother Nature reminds you who is really in charge. You may have taken care of all the environmental factors – cleansers, detergents, fabrics, trees, grasses, parasites, vaccines, chemicals, foods – that can trigger discomfort or disease in your pet. But sometimes genetics can not be denied. Forestalling a problem doesn’t mean escaping it.
The true story illuminating this lesson is my story along with all my Collies. It’s about hypothyroidism, an autoimmune-mediated disease that ranks high in the breed. National statistics cite a 33% occurrence in the breed, with the proviso that that number represents reported cases verified by laboratory testing. Among the Collies in my life so far – and that represents a dozen – 66% were diagnosed and verified hypothyroid…until a couple of weeks ago, when my tri rough male, Kirby, at age 5 years, was added to the list, changing the occurrence to 75%.
Some of my collies were closely related while others came from a variety of lines from different parts of the US. Some had minimum vaccination while others were vaccinated repeatedly. Some ate kibble while most ate raw meat and bones or other human type food. A few went to dog shows; others went for long neighborhood walks. Most were neutered; a few were not. A few drank tap water; most drank filtered water. Half had allergy panels and half did not.
I thought I had beaten the odds with my current two Collies. Apparently not in Kirby’s case. Apparently what might have happened earlier if I wasn’t so diligent with environmental matters was postponed till now. Why? I have no idea. Neither does my vet. Was there a trigger I missed? Was it like the coffee cup that gets filled past its brim and spills over – just a matter of time? Here’s how my veterinarian and I diagnosed Kirby’s hypothyroidism.
I live in a canyon with a breeze that comes perennially wafting through, carrying an assortment of pollens especially during the spring and summer. All of us, human and dogs alike, end up with runny eyes. Complicating the situation is our hill and backyard, prone to growing weeds, seeded by the pollens and brought by the wind. This year was no different, except the dogs’ runny eyes were more goopy. I washed them out with different eye rinses. I carefully removed the discharge with soft tissues. It was a battle to see if the pollens or I would win.
Then one day, I noticed that one of Kirby’s eyes seemed different. The lid skin and surrounding hair seemed inflamed. The symptoms didn’t get better and, over two weeks, worsened. Kirby could have cared less. He never blinked or scratched to indicate any discomfort. But I knew it wasn’t right and I remembered my veterinarian telling me that she’d seen a lot of odd eye issues lately in her practice. She’d diagnosed several as uveitis – inflamed inner layers of the middle of the eye. I knew from the many Jean Dodds lectures I’d attended that uveitis could be a sign of hypothyroidism. I asked my vet if this was the case with any of her patients. She said no. Hmmm….
It was clearly time to take Kirby to see his doctor. She performed a couple of tests and came back with the results: borderline uveitis and borderline keratoconjunctivitis sicca – dry eye. TWO items on the Dodds list of hypothyroid signs! The vet and I exchanged glances. She probably knew what I was going to say next. “Is Kirby hypothyroid? He can’t be.” I had always thought that, short of being diagnosed in old age, if a dog got to be two or three years old without falling prey to an autoimmune-mediated disease, you were pretty much home free. Kirby was about to turn 5 years old.
I went through my list of all I’ve done to ensure health. My vet nodded sympathetically. We had to make sure. The next step was a blood chemistry panel. T4 was pretty low. I uttered a four-letter word. The step after that was the Dodds thyroid panel. No doubt remained. His thyroid was shot. Final step was to start medication. A lifetime of Soloxine, here we come. My veterinarian and I are partners in another way: as Kirby was being diagnosed, so was her 12 ½ year old dog. He’s hypothyroid too….
Lesson #5: Open-mindedness is a virtue when it comes to treating a chronic health problem. Two points here: First, sometimes the course of action taken and the medication prescribed stop being effective. Second, both the pet owner and the veterinarian have to be willing to switch medications and treatment modalities.
One more true story – again featuring my dogs. Years ago, two of my collies – one male and one female, both in the prime of life and both neutered – became incontinent. At the time, I thought the only way to treat this inconvenience (all my dogs are in the house practically all the time and sleep on our beds) was medically. And at the time, my veterinarian initially thought so too. In the really old days, DES (diethylstilbestrol), a synthetic form of estrogen was prescribed to basically tighten up the bladder’s sphincter muscles in animals. DES had been banned from human use after its disastrous use in pregnant women, leaving their children prone to cancers and infertility problems. By the time my collies needed medication, PPA (phenylpropanolamine, brand name Proin) had become the drug of choice. I have to admit that both DES and PPA did their jobs… however….
For a few years, Boswell and Holly tolerated PPA quite well. And then the drip-drip trickle-trickle began again, requiring a tweaking of each dog’s dosage. And with each tweak came an unexpected side effect. I preferred calling them mini-glitches, but they were really mini-seizures. The tweaking had to be done as the amount of incontinence increased or decreased. It got to be an art of prediction. I could calculate to the minute when a change in dosage would prompt a glitch.
It was an awful trade-off and one I didn’t want to have to keep making. Underlining my chagrin as well as that of my vet’s was whether or not we were really accomplishing anything positive for Boz and Holly. I was ready to make a change – almost any change – and my veterinarian started doing her own research. I had already started experimenting with raw diets. Not yet brave or well-versed enough to create my own protocol, I depended on pioneering brands.
When I came across a particular new one – Steve’s Real Food for Dogs – I decided to take advantage of the phone number on the container. I called Steve Brown and asked him why his food was good and why he had decided to create a raw product. His answer was the one I was looking for. He told me that by eliminating grain, he had effectively stopped incontinence in his own older female dog. Grain as the culprit? It was a new idea to me but I was willing to do research and to try his product. Eureka! He was right, or at least right enough for me to begin to understand how food could play a role in supporting or subverting canine health.
I never gave any of my dogs grain again (except for an occasional Tigertail cookie). I was able to slowly reduce and finally eliminate PPA from the two dogs’ daily regimen, and the brain glitches thankfully ceased. My veterinarian was behind my efforts 100%, and I was grateful for her support. We both learned something valuable that would serve my current and future dogs as well as the dogs (and cats) in her practice.
Nothing is more important than being aware of what’s going on with your pet and being able to articulate your pet’s behavior, symptoms, actions and reactions to your veterinarian. If you’re a born researcher who relishes combing through books and on line articles, the information you bring to your veterinarian may prove to be both valuable and vital. If you’re not much of a researcher but you watch your pet closely, the details you notice are just as valuable and vital. Being confident (but not cocky) in your role as your pet’s care taker is key in the potential partnership between you and your veterinarian.
Likewise, your veterinarian should bring something to the table as well. The DVM earned from a vet school is not the end of a veterinarian’s training. Every veterinarian must fulfill state requirements for continuing education. While pet owners don’t qualify as part of that requirement, veterinarians should be receptive to what their clients ask and have to tell them, and they should address all concerns so that pet owners understand diagnoses and treatments. Similarly, veterinarians should not be in such a lock-step with pharmaceutical or dog food companies that they aren’t willing to go outside the box if that’s what’s necessary for your pet.
Finally, remember that your veterinarian is a service-provider. If you’re not getting the service you require or expect, seek out another veterinarian. Depending on your pet’s needs, you may need to engage the services of several different practitioners and specialists. Just make sure that you coordinate the total effort! Think of a law firm with a managing partner in charge!
Back in those old days I referred to above, the now defunct Western Airlines used the motto, “the only way to fly.” That’s how I feel about the partnership between pet owners and the veterinarians. It’s the only way to ensure your satisfaction, shared responsibility with your chosen vet care provider, and your pet’s health.