Category Archives: Dog Health

The internet is not the enemy

Knowledge has never been so readily and easily available. It is instant, mobile and has the power to revolutionise how we operate as vets and work together with clients on their pets’ healthcare.

phone, knowledgeThe problem is NOT that people look on the web; they will continue to do so more and more. The issue will not cease to be and nor should it. The internet is the ultimate learning resource.

What is at fault is that we are generally POOR at knowing HOW to LEARN and critically appraise the quality and reliability of information, especially that found on the internet.

A classic example is that of dog breeding/ puppies. I saw a Pug owner the other night whose female had been ‘accidentally’ mated (there are no accidents in these situations as there is a widely advocated option known as neutering) and so we are now looking at said bitch being due to whelp in the next 2 weeks. The owner in question admitted that they had never had any experience of breeding dogs but had “looked online” and was alarmed to “learn” various things, all of which were quite frankly sensationalist at best and downright incorrect at worst. The advice I gave, in addition to dealing with the immediate issue for which the dog had been presented to me in the middle of the night, was to advise the owner – nay, urge the owner – to visit their nearest well-stocked book store, buy and READ a comprehensive guide to dog breeding, especially the sections pertaining to whelping and puppy care. Books are great in as much as they generally still do undergo some degree of review before publication and so it is less likely that the information contained is plainly wrong, in contrast to much of what can be found online with the universal ability for anyone with a connection, voice and opinion to fire their musings out into the world. Hell, I am one of those same people as demonstrated by virtue of this very blog! How can you be sure that what I write on here isn’t just a load of inaccurate bollocks? You can’t is the truth of it. The same goes for much of what is published online, especially that found on forums/ discussion boards and blogs. Therein lays the challenge and risk associated with relying blindly on “the internet.”

I was fortunate enough to benefit from a rigorous training in the importance of critically appraising information for reliability and so do feel that I am able to mix my information sources (online versus print, etc) relatively safely. Many, unfortunately, do not and in the veterinary profession we still hear “but the breeder said..” or “a website I looked at said this (completely fanciful/ sensational/ wrong) thing…” again and again. Our battle is becoming more and more against the swathe of half-truths and inaccuracies that swirl around in the electronic ether and set against a client base that is becoming generally less trusting and more questioning of what we do, which is not necessarily a bad thing in and of itself.

I love the internet and the educational power that it contains. From TED talks to online courses, blogs from recognised experts and amateur enthusiasts alike, to social networks and their power to engage in real-time conversations and information dissemination, the web is and will continue to be utterly transformative. It is vital, therefore, that in order to get the most value out of this precious resource people know HOW to LEARN, what information to accept and what to question and potentially reject. Part of our role as modern day veterinary professionals is more and more going to be as information curators and sign-posters, directing our clients and the wider animal-owning and caring population toward sources of information that will lead to sound healthcare decisions and outcomes. As old-fashioned as it may sound, books do still serve as a good place to start and this is why I often still direct my clients to their local bookstore.

Scared of Ticks?!

Small but serious

I had a cracker this week after apparently failing to remove every single tick off a dog that was presented to me during consultations. In spite of safely removing those that were found during the fifteen minute appointment on a very busy weekend consulting block, and both demonstrating safe removal and disposal whilst also clinically examining said dog and spending time imploring the owners to effectively treat their pets against ticks, including examining the environment to try and identify the likely source of the acute infestation, prescribing safe and efficacious measures and discussing the potential health implications of ticks for both their pets and them as humans, it was apparently all insufficient due to the fact that they had ended up having to remove further ticks at home.

I won’t go into why the complaint was just silly as it is basically a waste of good electrons but it is worth picking up on one of the daft comments made as part of their groundless gripe: “it almost seemed as though the vet was scared of ticks.” Brilliant!

On that point, however, they are correct. I am scared of ticks. Terrified. As should everyone. They are serious little parasites who can and do kill as a result of some of the horrendous diseases that they carry, and I am not only referring to pets here.

“I am scared of ticks. Terrified. As should everyone.”

The big concern with ticks here in the UAE is the risk of ehrlichia, and it is a disease that we sadly diagnose and treat – not always successfully – all too often. It is also a potentially serious zoonosis, meaning that we can contract it if bitten by an infected tick. This is why we preach about effective and regular tick control over and over again, sounding like broken tick-themed records. It is a serious business that sadly too many people do not fully comprehend. So yes, I am scared of ticks. I approach them with caution, removing them with care and the respect that a dangerous killer attracts, and it is exactly why it may well seem as though I am being ‘over-cautious’ in the consult room and why I implore owners to treat their pets AND to take home the means by which to safely remove and kill any further ticks that almost certainly will be found by the owner at home.

“The battle against ticks does not begin and end with the vet.”

At the end of the day all I can reasonably do as a clinical veterinarian is to do my best to deal, in the time reasonably allotted, with the immediate issue (ie the ticks that were found and removed) and both educate and equip the owners to do the correct thing by their pets. The battle against ticks does not begin and end with the vet; it is an ongoing battle that is best fought in a preventative manner at home and taken as seriously as the “terrified” vet seems to take it. The long-term health of both you and your pet may well depend on it.

For more detailed information on ehrlichia in dogs, click here.

Further information on ehrlichia in humans can be found here.

For Life?

It is a sad fact of life, and especially of veterinary life, that people feel compelled to buy or otherwise home a pet to then seemingly get bored and ultimately abandon them. There are, of course, a number of completely legitimate reasons for why a person might no longer be able to care for a pet and thankfully help is on hand from well meaning charities and individuals who do their best to ensure such animals do not remain homeless, something I fully support. Similar to having a welfare system in place to provide much needed support in times of acute economic crisis, such as the unexpected loss of a job, having such organisations and mechanisms in place for pets is vital and they provide real options for well meaning, caring but unfortunate pet owners. However, much like welfare systems, there will always be the malignant few who take the piss.
Taking on a pet is not – or certainly should not – be a decision that is taken lightly or on a whim. Responsible human beings realise that they are making a commitment to care for an animal for the rest of it’s life, not simply the remainder of it’s “interesting life.” I, along with many other vets, see far too many examples of people ignorantly taking on a dog or cat, either for themselves or as a misguided gift, and to then quite frankly get bored of them and look to offload them on to someone else as if they are a second-hand car or last season’s smartphone. An example this week reminded me of such aspects of human behaviour as we have had a lovely, if vocal, young dog in hospital who it appears is no longer of interest to his young owner and, more disappointingly, their family who you would hope should be serving as positive moral role models for their child. Alas, all the example that seems to be getting set is one of disposal and “easy come, easy go.” The child has become bored with the dog and so the family no longer want the dog and had expected to simply be able to leave him with us as if we were some repository for discarded pets rather than a hospital. No good reasons exist for why this animal is being abandoned other than the fact that the child’s family made an all too common stupid decision to buy a puppy for their child, who was probably already used to stamping their feet and screaming “I want” and promptly getting, before getting bored of their new plaything. This is fine with toys. Or gadgets. Or shoes. Or clothes. Or anything that doesn’t have a pulse, feelings, a life. But not a pet. Abandoning an animal simply because it no longer amuses you is abhorrent and simply marks a person out as irresponsible, unreliable and unfeeling. Not great character traits in anyone.
Thankfully, after insisting that THEY do the legwork in finding THEIR dog a new home and that they come and collect their pet and pay for it’s treatment with us, as is their responsibility as both pet owners and consumers of our services, a new owner was presented and, fingers crossed, the dog can now look forward to a life in a caring home with people who actually give a shit. I know, however, that he won’t be the first ill-advised, ill-conceived pet purchase and ultimately abandoned animal we see this year. Depressing? Yes, it is.


The past two weeks have seen the launch of our 24-hour service, meaning that the clinic is now open round the clock, with a vet available any time of the day or night, much as we are used to having in the UK.

With two new vets enlisted to take it in turns being on overnight on alternate weeks, backed up by a night nurse and our existing night animal care staff, the service officially kicked off at the start of the month and has so far proven to be popular. There have, inevitably, been some adjustments to the way the rest of us regular day staff operate, such as some new shifts and a few later than expected or usual finishes, but we’re all optimistic that once the initial adjustment period is complete it will actually make our lives less hectic and stressful.

One of the changes has been that naturally we need to do a handover with the night vet going into the day shift, and so one of the vets is assigned to the hospital for the week. This basically means that they come in for an earlier start at 7am, which gives them an hour to effect a detailed handover with the night team, before being in charge of checking, planning, updating and generally doing what is required by the various in-patients. Given that our wards are usually pretty well populated, this can result in quite an intense shift, with the hospital vet then consulting from about half ten until their finish time at 4pm. The early finish clearly makes for a nice end to the day, although that does assume that they get to actually walk out at four, which so far I don’t think has really happened.

The other vets come in as usual for an 8am start and crack on as before with admitting surgeries and seeing consults, or getting on with the various procedures booked in for the day. Trying to get our full compliment of two hours of lunch (sounds like a lot but bear in mind we are in from 8am to 7pm) is still a challenge, although when it happens it really does help to set us up for the afternoon/ evening consulting period, which is usually pretty busy. One change that certainly seems to have occurred is that the couple of hours leading up to 7pm have become a lot busier, with more of what we can refer to as the genuinely ‘sick’ animals booking in. As such the final couple of hours have been, on the whole, very busy. With the consults being booked up to, and even beyond 8pm, it does mean that when 7pm, and hence our scheduled home time, comes round it is usually the case that we either have results pending for a case we have seen in the afternoon, or there are simply more clients waiting to be seen than would be fair to leave the late vet to deal with solo – after all, we’re all nice people and we’re not the kind of individuals who can knowingly walk out leaving both clients and our colleagues delayed and inconvenienced. That has meant several late finishes which, again, I am sure will even out as the new system becomes established and when we get some new vets on the team.

Last night was a particularly intense affair, with both an in-patient requiring a blood transfusion at the end of the day – never a quick process – and a ‘sick, off-colour’ dog coming in which turned out to have some seriously nasty business going on internally and so required surgery that evening, including, again, a blood transfusion. As such we all stayed on until gone 10pm, well into the night shift, although sustenance was provided by a much welcomed, and oh so chocolatey cake, that one of my colleague’s clients had dropped off earlier.

The cases in question, for those of you with an interest in such gory details, were a cat with a severe immune mediated haemolytic anaemia, most likely secondary to tick-borne disease and not helped at all by being FeLV positive. A lovely little young cat, she was presented the evening before with, again, a history of just not being herself and was found to be very pale. Her bloods revealed the true extent of her predicament, as she was sadly diagnosed with FeLV (Feline Leukaemia Virus) and had both a severe anaemia, with a red blood cell percentage very much on the borderline of needing an immediate transfusion, and a raging high white cell count. Aggressive treatment was started but the response was not enough to prevent needing a blood transfusion last night.

The second case was that of a geriatric dog who, as with the cat, was presented with a history of just being quieter than normal. Again, pale and lethargic, bloods revealed a low red cell count and concerns about possible internal bleeding were confirmed by ultrasound, as we found her abdomen to be full of blood due to a ruptured splenic mass. As such, the options were starkly binary: euthanase or operate to try and save her. Her owners opted to try and save her so after bringing in a blood donor we took her to surgery and removed her spleen, complete with nasty, ruptured splenic mass which was the cause of her abdomen being full of blood. The surgery went well and at the time of writing the patient was recovering well, although is certainly not yet out of danger.

So there we have it…. the next chapter in the vetty adventures here in Dubai, complete with a new 24-7 element. Things should continue to be very interesting and, I daresay, remain intense.

If your pet does need to be seen overnight, then Al Safa Veterinary Clinic, on Al Wasl Road, Dubai, is now open 24 hours, 7 days a week, and can be contacted on +971 (0) 4 348 3799.

No such thing as stupidity? Not true!

I am used to seeing examples of simple, innocent ignorance doing the job I do, and it is actually gratifying to a certain degree when you can make a difference to both the lives of an animal and their owners by filling in the obvious gaps in their knowledge. However, there are also occasions when you just despair of people and the fact that they can possibly be so blinkin’ stupid!

Friday at our clinic is mental – no other word for it. The hours, officially anyway, are 9am until 5pm, but considering that during that time, which is normally fully booked with appointments and with at least one or two ‘walk-ins’ plus ’emergencies’ plus repeat prescriptions to attend to, the vet on duty also has to deal with all of the clinic’s in-patients, the day actually has to start much earlier and inevitably ends much later, with lunch but a pleasant idea. As such, by the time you find yourself getting towards the end of the day tolerance levels are waning and the last thing you want to find yourself dealing with is a problem that really shouldn’t exist.

The clients I called in to my room were new to us, having purchased two kittens only the evening before. All fine so far. We see many new puppies and kittens and I actually quite enjoy seeing them for their initial check-ups. What I don’t enjoy however is being faced with underage, underweight, clearly disease-riddled specimens and to then be informed that 5000 AED (roughly equivalent to about £1000) was spent on said kittens. I just wanted to scream at these people and ask them how they could have been so bloody stupid to have parted with so much cash for cats that were, even to an untrained child, clearly not right. I have a deep rooted disdain for the fact that people pay so much for pets anyway, especially when there are so many perfectly good, healthy animals in adoption centres. In fact, we have a clinic full of kittens all looking for homes. The best part? They had purchased the kittens for their young child! OMG!

Needless to say the scumbag who duped these two, not on the face of it unintelligent people, refused point blank to take them back or refund them. As shitty as that is I guess it was to be expected. If you’re unscrupulous enough to advertise and trade in diseased babies, which is what we’re effectively talking about here, and you find someone dumb enough to hand you their money, then of course you’re unlikely to have the moral fibre that dictates you do the right thing by them after they discover their mistake. The fault lies with the idiots who seek out and then pay obscene amounts of money for these animals – they are creating the demand for such a disgusting trade.

Anyway, I thus had the pleasure of informing my clients that they had paid a lot for two kittens who had, in no particular order, ringworm (a fungal skin disease that is zoonotic – ie, we can get it), worms, raging upper respiratory infections, with one of the kittens having awfully gummed up eyes, ear mites, and were both very underweight and in poor general body condition. There may well be additional health issues which come to light, such as the risk of diseases such as giardia (again, something we can pick up) and FIE (Feline Infectious Enteritis, a form of feline parvovirus and bad news). To even attempt to rectify the various health issues they had was going to take considerable time, effort and more money. Oh, and with no guarantee of having healthy, alive kittens by the end of it. Always a fun conversation to have at the end of a crazy Friday!

If anything I would like this post to serve as a wake-up call to those looking to acquire a kitten, or indeed any animal: THINK! It isn’t rocket science. If you’re buying a young animal from a man in a van, with no paperwork, previous history and it clearly looks underweight, in poor condition and has physical evidence of disease – I think we can all recognise a snotty nose and eyes when we see them – then think really long and hard about whether it is a good idea to part with a wedge load of cash, because all you’re going to end up doing is doubling that amount on vet fees and giving the dodgy seller ample good incentive to go out and ‘replenish his stock’ with more sickly specimens to flog to unsuspecting suckers. If you really must get a kitten or puppy then I urge you to, first of all, consider rehoming an animal from a shelter or vet clinic – they will have been vet checked, passed as healthy and probably already wormed, vaccinated and, depending on their age, neutered. If, however, money is simply burning a hole in your pocket or you must have a specific breed (!?) then seek out a reputable breeder, insist on seeing the mother and, if possible, the father too, and go and view the puppies or kittens with the rest of the litter before going back and forking out money. As for pet shops, don’t go near them. Period.

The depressing thing is that I daresay I am going to see many more such cases, especially if the past week has been any guide to future events.

Compulsory Microchipping – Hmm…

dog being scanned (microchip)APRIL 2016 – this is the date by which every dog in England will have to have a microchip by. This comes after an announcement recently by the Environment minister, Owen Paterson. According to figures, nearly 60% of the 8 million dogs in the UK are already chipped, which is excellent, but with so many remaining untraceable, especially in light of the numbers of dogs dumped, lost and euthanised each year due to their owners being impossible to contact, there is still a long way to go.

Of course, the Holy Grail is to arrive at a point whereby every dog owner is responsible and stumps up the negligibly small amount of money required to implant a chip – a quick and safe procedure in the right hands – to ensure that their pets are traceable should they ever go missing, for whatever reason. There have been announcements by various dog charities, most notably Dogs Trust, that they will be willing to supply free microchips to practices in order to spearhead the campaign. This is to be applauded but unfortunately I personally feel the whole matter rather misses the main points.

There are some important questions that are raised by the issue of compulsory microchipping and which we still don’t have the answers for. The first is how will the new legislation be enforced? Even if vets do start getting better at routinely scanning dogs when they come into the clinic and subsequently find dogs that are not chipped, what are they to do? Will it be our responsibility to “dob in” our clients – a rather precarious position to be in – or will we have to issue said owners with an ultimatum of “we either chip your dog now or report you.” The danger of this stance is that we may simply not even see those dogs when they are ill, with the risk being that people attempt more home treatments or abandon their pets in preference to taking them to a vets to seek help. This would definately not be in the best interests of dogs. Are the police really, honestly, going to be that interested in enforcing this law as well? Personally, as much as I support the idea of all dogs and cats being microchipped, with the cuts being placed on the Police and Crime Prevention in general, I would not be overly chuffed at the thought of Police resources being directed to policing and enforcing microchipping. It just doesn’t sit high enough up the Crime and Prevention register to make sense to most people, even to a vet such as myself.

Another issue I can see with the plans are that they are likely to make no difference whatsoever to the small minority of dog owners who are, quite frankly, irresponsible. Good, considerate, well educated, sensible, responsible pet owners listen to veterinary advice and see the sound logic in microchipping – after all, what good reason can there possibly be not to have your pet chipped?! – and are happy to cough up the nominal fee to have a veterinary professional implant it. In the grand scheme of pet ownership costs, the £10-40ish that is charged for the service is insignificant, and as much as offering free chipping makes sense on the face of it as an incentive to owners to do the decent thing, I don’t personally see it doing anything other than take even more revenue out of practice. I would hazard a guess at the very same owners who take advantage of the free chipping service being the exact same ones who would have happily paid for the service anyway, in which case the only difference between the two scenarios is that the clinic loses out, having had to pay for the vet or nurse’s professional time. Once people get used to the idea of free, whatever form it may come in, it is very very difficult to revert back to a paid-for model. If by offering free chipping this would achieve a significant rise in dogs being identified then I would be all for it and personally spearheading a concerted campaign to “Get Your Chips For Free” but I am personally not convinced. Unfortunately no matter how easy it is made for some people, they will choose to ignore advice, even the law. And the key issue is what to do about those owners and those dogs? I am not sure I know the answer to that question.

One very important point that was made in relation to microchipping was the importance of keeping your details linked to your pet’s chip up to date. I have, in my working life, seen many cases of stray animals being handed in, or presented as emergencies, with a positive scan raising hopes of a reunion, or at the least informed owners, only to have those hopes dashed frustratingly when its discovered that the contact information on file is out-of-date and invalid. I would argue that this can even more frustrating that the animal not being chipped at all. I, personally, try and ensure that I scan every cat and dog I see in the clinic, as part of a routine health check, and ask if the details are still likely to be up-to-date. With the busy lives we lead, our pet’s hidden microchip is often the very last thing on our minds and I am fairly sure that if I were to move house, remembering to update my dog’s chip details would slip right to the bottom of my mind. A gentle nudge and reminder, whether from my vet, or even technology in the form of the annual email vaccination reminder or an app on my phone, would be all that is required to prompt me politely into action.

As a vet and, I would like to think, responsible member of society in general, I personally strongly advocate the principle of all dogs and cats being microchipped and see our role, as vets, nurses, pet owners and, well, animal lovers being to continue to educate, advise and guide pet owners to make the right decisions. Unfortunately, as much as the principle behind the changes to the law is sound and well meaning, I don’t see very much changing as a result of compulsory chipping and believe there are still many questions that need answering. Lets hope I am wrong.

Vet Lessons

Various chocolateMany of you found discussing a real veterinary clinical case interesting last month and so here’s a seasonal problem that we get faced with pretty much every year during the festive period: chocolate toxicity. Some of you may already be aware of the fact that chocolate is actually toxic to dogs, but for lots of people, clients included, this is something that they have no idea about.

Dogs being dogs will generally eat anything and everything, and with lots of advent calendars and selection boxes around in December, it is more likely that they will eat chocolate and get into trouble. So, get your teeth around this case and help reduce the number of dogs we see on Christmas Day 🙂

This month’s festive topic is….

Chocolate Toxicity

Virtually every Christmas, and Easter for that matter, we get phone calls from worried owners who report that their dogs have managed to devour a load of chocolate, either as a result of being typical dogs and seeking out food, or by inadvertantly being fed the stuff by a well meaning individual, normally a child who thinks its fun to share their chocolate with the family dog. It is not a great surprise to learn that the vast majority of these cases I have seen are Labrador Retrievers, such is their almost manic love of food.

Now we all know that chocolate can be bad for our waistlines but the thought of one of our favourite treats actually being toxic seems like a completely alien concept. The reason chocolate is of concern in dogs is due to a substance called theobromine, which is a natural component of chocolate, with dark chocolate containing more than milk and white chocolate. Theobromine is actually toxic to humans, if consumed in large enough quantities, but it is the fact that dogs metabolise it much slower than humans which makes it significantly more likely that we see signs of toxicity in them.

The clinical signs associated with chocolate toxicity generally include nausea, vomiting, diarrhoea, collapse, seizure, abnormal heart rate and rhythm, and increased urination. When we get calls from owners who say their dog has eaten chocolate the main questions we ask, before advising them to head straight down to the clinic, include:

  1. How much, in terms of total weight, of the chocolate do they believe their dog ate? This helps us to determine whether the amount of chocolate, and thus theobromine, is considered to be at toxic levels.
  2. What type of chocolate was it and what is the percentage of cocoa contained (eg 70%). Darker chocolate contains more cocoa, and thus theobromine, than milk chocolate. Knowing the percentage of cocoa and the amount of chocolate eaten allows us to accurately determine whether toxic levels have been consumed. This relies on us also knowing the dog’s bodyweight, which we double check when they come in to see the vet.

Some of the dogs we see who have eaten chocolate will be bright as buttons, whilst others will come in collapsed and showing obvious clinical signs of poisoning. These dogs are usually the ones who have either eaten chocolate several hours before, and so had time to absorb the theobromine and develop signs associated with it, or who have eaten very large quantities recently. I normally perform a clinical exam on the patient, take a fuller history from the owner, confirm the answers to the questions above and ask to see the packet of the chocolate, assuming the owner has brought it with them, which you should really ask them to do. I then weigh the dog and give the Veterinary Poisons Information Service (VPIS) a call, as they are a fantastic source of advice and guidance on currently known toxic doses of various substances and advice on ideal management and treatment.

If the dog has eaten chocolate less than 2 hours before we see them then we make them sick, usually by giving an injection of apomorphine, which is a powerful emetic (makes animals vomit). This often works within five minutes of giving it and the result is usually a nice, sticky, sweet-smelling pile of vomit for all to enjoy – lovely part of the job!

If it has been over 2 hours since ingestion then it is often too late to make them vomit, as most of the chocolate will have been digested and the theobromine absorbed. Whether our patients are made to throw up or not, we usually take a blood sample to check the dog’s kidney parameters, as the kidneys can be affected by theobromine. We then start the dog on a drip, to keep the dog well hydrated and help flush the kidneys through. If the dog will eat, which many will, then we start feeding them bland food with activated charcoal in it every few hours. The charcoal acts to bind and absorb any chocolate still in the dog’s intestines and prevent it being absorbed into the blood. We continue with this measure until we see the dog passing black charcoal in it’s faeces. Sometimes the toxic effects of theobromine can take up to 72 hours, or 3 days, to show and so we usually keep the dog on fluids for at least 24 hours, but often longer, and recheck the kidney values regularly, in case we see any evidence of late kidney effects. As a result, the cost of treating a case of chocolate toxicity can be very high, something that pet owners may have trouble appreciating and understanding, especially when what they can see is an apparently fit and healthy dog.

If there are any other, more serious signs associated with chocolate toxicity, such as seizuring, then we deal with those. These measures may well include:

  • Vomiting & Diarrhoea – we give gastro-protectants (medicines which help reduce acid production in the stomach and protect the lining of the intestines), anti-emetics (medicines to prevent the dog feeling nauseous and throwing up). We may also offer kaolin-based gels, which help to reduce diarrhoea and make the stools firmer.
  • Cardiac (heart) arrhythmias – we monitor the dog’s heart rate and rhythm with an ECG and give medication to correct any abnormal rhythms if they occur.
  • Seizures – giving anti-seizure medication, such as barbiturates (eg diazepam) is the method for dealing with seizures.

Assuming that the patient responds well to treatment, and we catch the case early enough, then they often make a full recovery and can be sent home. It is vital that the owners are well educated about the dangers of chocolate in dogs in order to significantly reduce the chances of toxicity happening again.

Vet Lessons

I had an interesting case the other day which made me think how cool it would have been to learn about, well, interesting cases when I was applying to actually be a vet. So that’s the inspiration for this little feature: an interesting vetty subject to get your teeth into around coursework, exams, and other stuff that passes the time 🙂

The first topic is…..

Luxating Patella

I saw a 1 year old CKCS (Cavalier King Charles Spaniel) bitch for X-rays under anaesthetic due to a history of intermittent lameness on her left hind leg. The vet who examined her initially thought she might have some back pain and so booked her in for X-rays to delve deeper. On taking a look at her before we knocked her out (medically, I hasten to add) I noticed that her left knee-cap (patella) wasn’t sitting where it should, which was within the trochlear groove, which is basically the channel that runs over the end of the femur and  directs the pull of the large muscles of the hind leg over the knee (stifle) joint to insert onto the tibial crest on the tibia, resulting in extension of the lower leg. This little dog’s patella, however, was sitting to the inside of the knee, and although I could easily move it back into place, every time she flexed (bent) her stifle, it popped back to it’s abnormal position (luxated).

X-rays of her spine, pelvis, hips and stifles were all normal, and her right patella was normal. There are four grades of patellar luxation, with grades 1 and 2 not requiring any intervention. This case was a grade 3 and so will benefit from surgery to a) deepen the trochlear groove – think of it like having an egg on a saucer versus then placing it in a bowl where it will be much more likely to stay – and then b) shift the tibial crest with the muscle insertions still attached over to a new position and fix it there with a pin, so that the direction of the pull of the muscles is along the correct line, resulting in less pull to luxate the patella. Pretty cool stuff!

The Overcharging Vets Myth

I was a little disappointed recently to read a certain celebrity vet’s blog post about ‘overcharging vets.’ Despite a couple of sentences that attempted to act as somewhat of a balancer by ‘hoping that their view is coloured by bad personal experience’ and acknowledging that not all vets overcharge, I couldn’t help but feel that the comments were misguided, unhelpful and may simply act to further add to the list of grievances, both reasonable and unreasonable, that some may wish to level at the veterinary profession, whom the vast majority of the general public still imagine rake it in and live the lives of monied privilege, whilst the opposite is usually the case.

Although it is undoubtedly true that some vets may be tempted to propose additional tests and treatments that may ultimately, in hindsight, prove to be somewhat superfluous, I firmly believe that the motives for 99.9% of vets to make recommendations and suggest preventatives, procedures and other treatments are clinical, sound and ethical, with little or no concern for their own material gain. Granted that with the introduction by some veterinary employers of incentive schemes and bonuses linked to things like turnover, some individuals may feel the pressure to over-emphasise certain options in the pursuit of a boost to their salaries. However, if the vet in question is paid appropriately for their skills and expertise then I don’t see how the potential promise of a few extra quid in the monthly pay packet can really lead to their clinical morals becoming corrupted. If they’re the kind of person who is overly motivated by money then they probably wont spend a lengthy career in veterinary anyway and will probably work out that there are significantly easier, and possibly less stressful, ways of making themselves rich than trying to fleece the pet owning public. Personally I don’t view financial incentive schemes as being a particularly great idea in veterinary as I fear that they do introduce the risk of conflicts of interest developing, even if those conflicts never actually manifest themselves. Most organisations that employ turnover based bonus schemes use them as a means by which to justify keeping base salaries towards the lower end of the scale, especially as vets on lower salaries can “earn more of a bonus as a result if they exceed their monthly turnover targets,” due to the difference between the target monthly turnover figure, usually based on the current salary and the actual monthly turnover figure achieved, which can ultimately vary with the cases that walk in the door that month. I had a debate about exactly this when trying to negotiate a perfectly reasonable salary increase with my first employer a year after graduating and starting work as a vet. I ultimately left as a result of their refusal to appropriately value my training, skills and experience, preferring to espouse the apparent merits and “additional earning power” of the bonus scheme. Myself and my colleagues at that practice, and others that I have since worked at, did not make clinical recommendations because option A was going to make us an extra £15 compared to option B, but instead used our training and judgement as vets to discuss the various options with the owner and ultimately make recommendations, with the owner ultimately making the decision having felt satisfied that they were getting value for money.

The example given by the author of a friend whose dog was taken to the vets suffering from “mild intermittent digestive upsets for a while” and subsequently received a bill for £1700, which was then derided for being unjustifiable and clearly motivated by profit seemed to me to be one-sided, emotive and jumped to a number of conclusions, which was unfair to air publically without offering the vet in question the opportunity to justify the charges. There was no mention of the dog’s previous treatments or the nature of the digestive upsets that had been the problem. Nor did it make clear whether the owner had been involved in any discussion about the investigation options, including potential costs, and thus whether in spite of the final amount being quite a lot and the ultimate diagnosis – note that a diagnosis was reached – being fairly benign (hindsight is a wonderful thing), the owner knowingly consented to the range of investigations carried out and their cost. If not then yes, there is a problem, but that problem is one of proper client communication and customer care, not of profiteering. £1700 is not a lot of money for such an exhaustive, all encompassing investigation into a problem that by the sounds of it had been grumbling on for a good while. The alternative, of course, could have been to conduct the various tests over a longer period of time, but then that may have involved having to administer multiple anaesthetics (additional cost and risk to the patient), and may have simply served to prolong the period that the animal was suffering from the problem and the course of supportive therapy, such as prescription diets, that may have been used in the interim. The result? That the final bill would have potentially been significantly greater than £1700 and that the vet is accused of dragging the entire process out in order to maximise profit. Damned if you do and damned if you don’t.

People talk a lot more with each other than they ever used to and one result of this is that if there is something that people don’t like, whether it be poor service or excessive charging, then it is not long before everyone is made aware and if the issue is not addressed then the individual or organisation runs the risk of being adversely affected, especially if the messages are consistently poor. Vets that overcharge – and it is easy to ascertain whether this is the case by comparison with other vets, offering a similar service – will find that word gets out and they will either have to bring their prices and practices in line with their professional peers or risk not remaining in business for very long. As such, I simply don’t believe that overcharging is a real problem in veterinary medicine. In fact, I think that pet owners get a very good deal considering that they have access to exceptional standards of private medicine, often with the convenience, clinical and cost advantages of same-day diagnoses and treatments, especially when you compare that humans pay many times more for similar tests and procedures privately themselves.

I will be very interested to hear the kind of stories that are submitted to the author and predict that he will undoubtedly receive an electronic sackful of complaints and countless accounts of “profiteering” within the veterinary profession. However, what I suspect won’t be accompanying those stories are clear, detailed explanations for why various treatments, tests and procedures were advised, what the animals’ previous histories were, or whether the options were clearly discussed, explained and ultimately consented to, including knowledge of potential costs. Incidentally, you don’t see many vets driving Aston Martins, living in mansions or sending their kids to Eton, so I do wonder where all of these scurulous profiteers are hiding out?