Wednesday, April 18, 2012

Dr. Plotnick's Response to *50 Things That Your Veterinarian Won't Tell You*




There’s a post from the Reader’s Digest website that is making the rounds. It hasn’t gone “viral”, but I’m seeing it pop up on a lot of the newsfeeds that I subscribe to. It’s entitled “50 Things That Your Veterinarian Won’t Tell You”. They make it sound like you’re getting some super-secret scoop on what really goes on behind the scenes, like Anthony Bourdain’s book “Kitchen Confidential”. 

Hardly.
Many of the comments don’t really pertain to me or my practice, since I only do cats. But I do think some of the points are worthy of commentary. I’m selecting a few that I think are relevant to me, my clients and my readers. Feel free to read RD's entire post if you like.


1. “People always ask, ‘How do you handle pit bulls and rottweilers and big German shepherds?’ The truth is, the dogs that scare me most are the little Chihuahuas. They’re much more likely to bite.”—Mark Howes, DVM, owner and medical director of Berglund Animal Hospital in Evanston, Illinois

So true. Back in the days when I used to treat dogs, I put Chihuahuas at the top of my list of dog breeds I dreaded in the exam room. They were usually decrepit, geriatric Chihuahuas, with their tongues hanging out of the left side of their face due to missing teeth. They were usually named Taco or Paco or Pepe or something like that, and were held by a woman who made sure that the dog’s feet never touched the ground. The few remaining teeth in their vicious little heads were so nasty and covered with tartar that if I did get bitten (and I’ve come close), I’d probably go into septic shock. I thank these Chihuahuas for my career in feline medicine.


2. "We know when you’re twisting the facts. If your dog has a five-pound tumor hanging from his skin, please don’t tell me it wasn’t there yesterday.”—Phil Zeltzman, DVM, a traveling veterinary surgeon in Allentown, Pennsylvania, and the author of Walk a Hound, Lose a Pound.

I’m fortunate that in my practice, my clients are so seriously in tune with their cats that they would never let a growth get too big before bringing their cat in to see me. In fact, it’s often the opposite. I usually find myself examining some microscopic little wart that the client discovered while petting his cat and is panicked that it might be malignant. I much prefer it this way. Early detection is the key to successful treatment, and my clients do not wait for things to grow before they zip the cat in to see me.


7. “Here’s a pet peeve: owners who don’t want to pay for diagnostic tests but then cop an attitude because you don’t know what’s wrong with the animal. Since you wouldn’t let me do the blood work or X-rays, how the heck do you expect me to know?”—A vet in South Carolina.

As an internist, I can sympathize with this doctor, but fortunately, I can’t relate that well. My clients fully understand that diagnostic tests are usually needed to make a proper diagnosis. I usually get permission to do the tests. If not, I can usually do a few inexpensive in-house tests (a blood sugar to rule out diabetes, a urine specific gravity to get an idea if there’s renal failure, etc.) to at least help me hazard a logical guess as to what might be wrong.


10. “Every time I save a life, every time I fix a patient, that makes everything worth it. And I love it when a client says, ‘I wish my physician would treat me as nice as you treat my pets.’”—Phil Zeltzman, DVM.

Yes, indeed. This is what motivates me to get up every morning. And when they say that they wish their own doctor treated me as well as I treat their cat, it’s music to my ears.


14. “Every time we help a pet, we help a person. The classic example is the 80-year-old grandma who has nothing in life but her cat. She’s a widow with very limited social contact, and the cat is what connects her to life. So when we help her cat, she’s really the one we’re helping.”—Phil Zeltzman, DVM.

At my hospital, we’re aware of this all the time. Of course, we do what’s best for the cat, but we know that every cat has a person attached to it, and it’s nice knowing that when we do something good for the cat, it has the added benefit of doing something good for the person.


20. “Your vet may not have gotten into vet school! Vets who can’t get into traditional U.S. veterinary programs due to bad grades and poor test scores often go to for-profit schools in the Caribbean, where, basically, if you can pay the tuition, you get in.”—A vet in California.

This is a ridiculous thing for a vet to say; it only sows unnecessary fear and suspicion in our clients. The percentage of vets in the U.S. from these schools is miniscule. Concerned? Just ask the receptionist before making the appointment where the vet went to school.


22. “I hate to break it to you, but your $2,000 designer dog is a mutt. Puppy stores and breeders have created these cute names like Morkipoos and Puggles, and now people are paying $2,000 for a dog they couldn’t give away at the pound ten years ago. Whoever started the trend is a marketing genius.”—Dennis Leon, DVM.

This should be obvious to most people. Your “puggle” is not a breed. It’s a mutt. You can only get a puggle by breeding a pug and a beagle. If you breed one puggle to another puggle, the puppies do not look like little puggles.


26. “The cheaper, over-the-counter spot-on flea and tick treatments are extremely dangerous. I’ve seen animals having violent seizures after using them; I’ve seen animals die. Ironically, most of these animals still have live fleas crawling all over them.”—A vet in California.

I cannot overemphasize how true this is. The popularity of the once-a-month veterinary-only flea control products resulted in some companies manufacturing similar-looking products that may be unsafe for pets. These products often contain concentrated doses of permethrin, an insecticide that can make pets (especially cats) very very sick. In fact, I just cut (and am pasting below) the paragraph from the article I wrote about this, several years back: In an effort to tap into the lucrative flea-control market, some manufacturers have produced flea control products with packaging similar to the veterinary products, i.e. in small, single dose tubes for topical application. These products contain permethrin, an insecticide commonly found in low concentrations in a variety of canine and feline flea sprays and shampoos. In low concentrations, cats tolerate these products with minimal adverse effects. These small single-dose tubes, however, contain concentrated permethrin (45% to 65%) as the active ingredient. Concentrated permethrin spot-on products are labeled for use in dogs only, and may cause severe and often fatal toxicosis if applied to cats, especially kittens. Be safe use veterinary products only.


27. “After their kitten vaccinations, indoor cats don’t really need to be vaccinated. They’re not going to get rabies sitting inside the house. Vaccines have the potential to create a lot of harm for cats, including possible tumors at the vaccine site.”—Jill Elliot, DVM, owner of Holistic Vet in New York and New Jersey.

Nonsense. This may be true for rabies, but rabies vaccination is required by law, and I can’t change the law. The FVRCP vaccine, however, DOES need to be given. I wrote a blog post about this and it bears repeating: The FVRCP vaccine protects cats against three viral diseases: panleukopenia, herpesvirus, and calicivirus. Panleukopenia (often called feline distemper) is not a worry in adult cats; it mainly strikes kittens. The other two viruses are respiratory viruses. Vaccination against the respiratory viruses is a little different than vaccination against rabies. The goal of vaccination against rabies is to prevent infection. The goal of the respiratory virus vaccine is not necessarily to prevent infection. The goal is to prevent clinical disease. The main respiratory virus is the herpesvirus, and as we all know, herpesviruses like to stay in the body forever. Most cats have been exposed to the herpesvirus as a kitten. They get a cold, they recover, and the virus then stays in their body, in a state of dormancy. In times of stress or immunosuppression, the virus can re-emerge from dormancy, much the same way a cold sore (also caused by a herpes virus) can re-emerge in people. Cats who are well vaccinated usually only experience mild clinical signs. Cats who are poorly vaccinated can get a whopping head cold and cat get pretty sick. Plus, the herpesvirus has been implicated in many syndromes in cats, such as eosinophilic keratitis (inflammation of the cornea), and herpes dermatitis (a skin condition that often affects the bridge of the nose in cats). Cats do not need to be vaccinated annually for the respiratory viruses. Every three years is adequate. Yes, vaccines have the potential to cause possible tumors at the vaccine site, but the modified live virus vaccines that have been developed are much less likely to do this, and of all the feline vaccines (FVRCP, leukemia, and rabies), the FVRCP vaccine is the least likely to cause problems. So I strongly disagree with Dr. Elliot’s statement that indoor cats don’t need to be vaccinated.


31. “Unfortunately, I’ve had to work in low-cost clinics, and many of them are cutting corners to make a profit. Some places give half doses of vaccines instead of full doses, which is totally illegal and ineffective.”—A vet in California.

I’m horrified if this is true. Giving half a dose of vaccine is wrong wrong wrong. It’s unconscionable, and any vet who does this should be reported to that state’s board of veterinary examiners. This is NOT how you cut corners.


33. “Some people worry that paying for pet insurance will be a waste if they don’t use it. But when you renew your fire insurance on your house, do you say, ‘Shoot, my house didn’t burn down last year—I wasted all that money’?”—Phil Zeltzman, DVM.

If you have an insurance policy that covers annual exams, labwork and vaccinations, then by all means, use it. I personally don’t like these policies. I feel that if you’re going to be a pet owner, you should understand and be willing to pay for the basic medical needs of your pet. I prefer policies that cover illness only. Most people can handle the cost of an annual physical exam, annual vaccines, and perhaps annual blood tests. But not everyone can be expected to easily handle a $4000 veterinary bill if their pet breaks its leg or swallows a sewing needle. So if you’re going to get insurance, get the kind that covers illness only, and as Dr. Zeltzman says, be thankful if you never have to use it. That’s money I would not mind wasting.


39. “One way to make sure your vet is up on the latest stuff? Ask how he puts your pet to sleep. If he says he uses ketamine or halothane gas, that’s not good. That’s like 1970s medicine. Isoflurane and sevoflurane are a lot safer.”—Rachel Simpson.

Um, Rachel… I think you mean “anesthetizes your pet” rather than “puts your pet to sleep”. Big difference. (We use isoflurane, by the way. I don’t think anyone uses halothane anymore. )


42. “Some veterinary drugs have a generic version that’s made for humans, and if your vet believes it’s a safe and effective alternative, you can get it from a human pharmacy and pay ten times less than you’d pay for the animal version. But recognize that there are legitimate reasons why the generic might not be appropriate for your pet.”—Patty Khuly, VMD.

Hey, I’m all for saving money. I’m one of those people who goes to Barnes and Noble, writes down the titles of the books that interest me, and then go home and order them on Amazon.com (or better yet, get them used and in great condition at Alibris.com) for less money. If you want to get the drug right from our hospital right at the time you need it, cut into half or quarters for you if you want, we’re happy to do it. If you’d rather have me write a prescription or call it into your own pharmacy, I’m happy to do that too. I just want your cat to get the medicine. Where you get it doesn’t matter to me, really.


43. “Don’t ever share your medicines with your pets unless your vet says it’s OK. One Tylenol will likely kill a cat.” —Amber Andersen, DVM.

I’ve written about the dangers of Tylenol in cats. I can’t emphasize this enough. Read about it yourself: http://manhattancats.com/Articles/toxic_tragediesl.html


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