Wednesday, September 3, 2014

How Client Behaviors Dictate Your Pet's Treatment Options

Katie, recovering well from  untreated Cushing disease.
Another JVC miracle..and her new  mom.

There are conversations that silently and secretively occur in the head and heart of every vet about every case to the oblivious acknowledgement of our client.

In a perfect world a pet arrives and we quickly, cheaply, and accurately realize the diagnosis.  The ideal treatment plan is then proposed to a willing, able, financially sound pet advocate, without regard to price, reluctant participation, or liability to either party.

In real-life the scenario is rarely ever close to this.

Here are a few good examples of how my real-life treatment decisions are influenced by my real-cases;

Case Number 1, The Cat Who Only Sees The Vet For A Wound;
A middle-aged outdoor cat arrives with a large infected, painful wound to the side of his face. The cat has been to see us twice over the last 8 years and always for the same presenting cause (festering abscessed wound). We have never vaccinated him, we have never performed an intestinal parasite examination, and we have never had the luxury to discuss all of the things that are a part of a normal routine physical exam.

Does this owner know that there are important health care topics outside of believing that our hospital is a minute clinic? Probably not. We treat the cat as if this is the only healthcare he needs, and the owners actions reflect this.

My approach and treatment plan for this cat is different than it would be for a cat I had seen for a routine physical exam within the last year. 

Why? Well, because I would be foolish and negligent to believe that this owner is going to view my services to their cat any differently in the next 8 years as they did in the past 8 years. I am also leaving myself open to getting my heinie slapped by all of the regulatory authorities that govern and enforce pet vaccination requirements.

Here's what this cat is going to leave my office with this time;

A rabies vaccination. Not ideal to be given while fighting an infection, but I'm hedging my bets this cat won''t be back in the three weeks we have requested twice before. AND, if he bites someone who is going to be questioned? Me!, and why would I want to live with the guilt of consequences of a person who dies from rabies?

An injectable antibiotic. The chances of this cat getting their full dose of antibiotics is low. We know that compliance is a real challenge for pet owners. Most people don't complete their own prescribed course of antibiotics, are we crazy to think that it's higher in our pets? And how many cats will willing return to their owner twice a day to be restrained, have their mouth pried open, and be pilled? You will likely get two chances and by day 3 be unable to find your cat for another week.

A cat with wounds this frequent, (and do I think that he's only had two in 8 years? No. I think that he's only had two severe festering abscesses in 8 years. I would bet he's had about a fight wound a week over 8 years), is at significant risk of FIV, BUT, this time he will go home with written instructions and a disclaimer about vaccines, parasites, wound care, routine care, etc. etc.. (always cover your heinie!).

Case #2, The Acute and Mildly Injured Lab and the NSAID;
The middle aged Lab with a sore joint  from playing too hard at the new doggie day care facility. I don't prescribe a once a day NSAID (non-steroidal anti-inflammatory) for these acutely injured first timers. Why not? They exist, in fact every NSAID has the ability to be reduced to once a day dosing, but for the acute recently prescribed NSAID I am asking the pet parent to use the lowest effective dose. The best way to insure this is to use the well documented poor compliance to the pets benefit. The  chance of overdose and potentially adverse side effects are significantly reduced by prescribing twice a day versus once a day. (For more information on NSAID's and lowest effective dose see here).

My Jekyll. Recovering from cruciate surgery, but on LED of Rimadyl

Case #3, The Incontinent Spayed Female Dog;
"Hey, Doc, Old Lil is leaving wet spots on her bed most mornings." For these girls I have always chosen the newer, perceived safer, PPA vs the old estrogen replacement because it is believed to have potential detrimental side effects to unborn offspring. Not such a grave concern in a spayed dog, but what about the woman who gives it to her pet and doesn't know she's pregnant. Yes, I would prefer to live without this on my regret list.

Case #4, "Hey, Doc I need more meds.."
I don't prescribe large amounts of narcotic prescription drugs. Why? Well, when the same sketchy guy comes back to your clinic weekly for more valium for his dog with storm phobias in January, "Doc, I keep spilling them in the toilet," and you get a little paranoid your stuff in on the playground poisoning your kids playmates.

My other pup, Charlie, who not only suffers from storm phobia,
but also yellow jacket phobia, and my husband dressed as a zombie.

Case #5, The Cat and the Harried Housekeeper;
I don't declaw young cats with behavioral issues, or older cats. Young cats need a back-up plan and the removal of the ends of their toes takes options off the table that they may need later in life. After all life will throw you curve balls, and life is all about keeping your options open.  I have had too many cats with "mysterious spontaneous litter box issues" develop "unwilling to tolerate any longer" parents that decide to evict and banish the declawed cat to the neighbors barn. Older cats have a tough time recovering from declawing even when it is done with a laser, post-op pain meds, and all the TLC we can deliver. It is a painful surgery and a cat with a behavioral issue becomes a pissed off painful cat with a vendetta.

Loon, surrendered for bad bathroom habits.
Now one of our residents.

Case #6, The Uni-quely Endowed Intact Dog;
I will not neuter a dog with only one descended testicle without an exploratory surgery. I have heard this being done (i.e. just removing the easy testicle you can find and calling it a day). The theory being that you save a nickel and look neutered. BUT, no ones' testicle's belong in their belly, and, this is in my opinion, more accuratley referred to as "mal-practice." Those testes are anatomically designed to be hanging low, where they are cool and left unrestricted. (Remember in elementary school when the health teacher scared the boys into wearing looser fitting shorts?) A pet with a retained testicle is called an exploratory surgery in my book. This surgery is about 4 plus times more expensive than a routine neuter. But that retained testicle will likely come back to haunt you if it is not found and removed before the pets first year. They will turn up later as a tumor in the belly. Talk about an expensive surgery, and hard lesson to learn. These cases often have a poor and grave prognosis.

For clients that are actively participating in their pets care, diagnosis, and treatment plan, the options are often varied and limitless. Ask your vet why they are recommending the options that they are? Ask about the costs, the consequences, and the amount of time your participation is expected to be? Also, ask about how the options you choose might affect future treatment options?

For those who prefer are more reserved hands-off approach you are in luck, the field of veterinary medicine is providing more and more treatment options. Ask about the differences in costs, and how to monitor best if you are not handling your pet daily?

The cost of convenience is more than just on your pocket, it is often the oversight and monitoring of the health, care and well-being of your pet.

Veterinarians are trained to treat pets. We should be prescribing treatments that put the pets condition first, but the only way a pet receives their medication s through the hands of their parents. The vehicle of delivery weighs heavy on our minds and significantly influences our treatment decisions. Talk to your vet about your abilities, concerns, and fears. We will listen.

Jangles, (in search of a home), and Loon.

If you have a pet question of any sort you can find me at, where I answer any pet care related question, post photos of my pets and help others trying to navigate through the twists and turns of veterinary pet care.

Or find me on Twitter @FreePetAdvice, or even in the clinic, Jarrettsville Vet, in beautiful Harford County


  1. Interesting post. I guess I'm naïve to think that if you explained the rationale for your suggested treatments and concerns, pet parents would comply. I assume it's more about building a relationship and trust with your veterinarian. It's something I keep trying to find.

    1. Hello,
      For the huge majority of my clients I explain all of the available options, advantages, disadvantages, and associated costs. But there are a few cases that cause me to take pause and ponder the health and safety of society, my obligation to state and federal laws, and the care and well-being of my patients.
      But, you are absolutely correct that it is all about trust and building a relationship with my clients, although it is not always an easy task.

      Many Thanks for reading and commenting,