Thursday, August 22, 2013

Those Tests We Run, Just To Confuse You..

Veterinary medicine is an ever evolving science. Seems the more we dig for medical cures, breakthroughs, and advancements the more we feel like we are still just hitting the tip of the iceberg. It can be incredibly overwhelming, frustrating, and confusing. I get it, I really do.
One of the things I love about Pawbly is that it is a place for anyone to go and seek answers and help. It is a way for the world to join together to help pets. But, we all need to remember that nothing surpasses the relationship and importance of having your own personal vet. But all of us vets utilize and require a network of people to help advise us. It is one big giant intricate web of people helping people take care of pets.
When I get asked about something that is not universally accepted as the "correct standard of care" I don't always know what to say? How do I stay respectful to my colleagues, and honest with a person? It can be a fine line of dancing and tip-toeing and tryng to NOT sound elusive.

Here is the question I got today:

"My 13 year old mixed Lab was recently diagnosed with ehrlichiosis through a blood test. I have gotten some conflicting information through my local animal hospital and my own research, so I thought I'd try you guys. My dog shows none of the symptoms of ehrlichiosis but the vet has prescribed a 60 day course of 250 mg of doxycycline to treat it. This is about $400 worth of pills at my local pharmacy. Are there other treatment options and does my dog even need treatment if he has no symptoms?

Here is my answer:

Of all the questions to ask!! This is a doozie...primarily because there is heated debate on why we use this test, and what to do about it if you get a positive test in an asymptomatic dog...
In the interest of maintaining my "always be honest" viewpoint, and my ever present belief that it is not my place to be second guessing a fellow colleague, I will try to provide a basic overview of the discussion that I have with my clients when a situation like yours arises.
I am assuming that your vet used an in house 3 or 4 DX snap test..these are used to screen for Lyme, Erhlichia, and heartworm disease (or Anaplasmosis), but they cannot tell you whether the disease is acute, chronic, active, or passive. Lots and lots of dogs have been exposed to these tick borne disease, and hence show up positive on our in house snap test. They cannot, however, tell you what the dog tells you, that they have been exposed but are not sick. In other words if they are displaying clinical signs.
For some of these positive tests we use a titer to decide whether or not to treat. This is something that you can discuss with your veterinarian.
Also, I am assuming that your veterinarian was prescribing doxycycline, which for some reason that totally baffles me has been on short supply, and hence ridiculously priced..there are cheaper options, but this is also something to discuss with your vet. We use a compounding pharmacy to help keep the cost affordable.
At my clinic, with an asymptomatic dog, I would recommend a CBC, Chemistry, and urinalysis. If they were all normal and your dog was asymptomatic we may decide that treatment is not warranted. I also remind my clients that it is imperative to protect your pets against any and all tick borne diseases by using a reputable effective flea and tick preventative.
I hope this helps, and I would encourage you to go back to your vet and discuss all possible treatment options and affordability.
Best of Luck,
My tribe, all on monthly flea & tick prevention and
all vaccinated yearly for Lyme disease because we live in the woods,
in the Mid-Atlantic states where Lyme is a prevalent part of life.

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