Monthly Archives: June 2016

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Dr Google, Dr Dog Walker and Dr Vet, which one to choose I wonder….

We’re not living in easy times and the trend I have noticed these days is the emergence of different client approaches to pet care.

A client might come to the surgery, starting to tell me what the problem is and I can see their eyes fill up whilst the client voices in a quivering way “I think he might have cancer.  I looked on Google and it said that it might be cancer!”.  Dr Google is free, Dr Google is not necessarily accurate nor able to examine your pet from the safety of its screen and parallel & serial processors…..no matter how fast those run.

Another scenario that’s on the increase is that of the new specialist on the block, Dr Dog Walker.  Recently a client came in with a dog with extremely red eyes.  Apparently Dr Dog Walker in the park, where she takes the dog for a walk, had volunteered the wisdom that she could use baby shampoo to bathe the eyes with.  It doesn’t harm babies so it shouldn’t harm dogs, right?  Shocking!!!

I agree, Dr Vet doesn’t always know what’s going on but then who has 100% knowledge?  Aside of the knowledge, who is then practical enough to do something about it or help the client make decisions from an informed point of view?  Again, not 100% fail proof.

However, it must be said that with 5 to 6 years of training, some vets go on to add quite a few more years to this initial training through specialisation, a trend I have increasingly witnessed during my 24 years as a veterinary surgeon and there are some amazing vets out there.  Can you tell one vet from another?

In my opinion, the importance really in veterinary medicine these days is not just what you know but also who you know and who you trust to give quality of care.

I don’t profess to enjoying orthopaedic surgery. I have done some orthopaedic surgery in the past at the expense of a few kg of sweat lost in the process.  It’s not easy!  To become a great orthopaedic surgeon in veterinary medicine, just as much as becoming an olympic champion, you have to put the hours in.  So, how may hours veterinary work has Dr Google and Dr Dog Walker?  That’s where “who you know” comes in.  I have a network of specialists whom I work with to refer clients with their pets to (if they wish), so that they can have access to the best care I can think of to come towards the client’s need if they wish to have their pet death with in this way.  At other times, I have enough experience if clients don’t want or can’t afford referral to help them make informed decisions for their pets.

Don’t take me wrong, Dr Google is great to have access to knowledge.  Where it starts failing is if you’re finding the wrong bit of information about what’s going on and start frightening yourself with it for days or weeks before going to Dr Vet with your worries.

Also Dr Google isn’t good at a practical approach.  It can’t cross-reference the symptoms, history of the sickness/environment etc, the possible diagnostics for the problem you’re facing, nor has a plan at hand on how to narrow it down.  That might change again in the future, who knows.  They’re already talking of approaching difficult law cases this way (using IT). Who’s to say that years down the line there won’t be an IT solution to find out what’s wrong with your pet.  For now, Dr Vet, unless recently qualified, has put the hours in seeing patterns, dealing with what’s common, finding out the rare & networking with colleagues to come to a solution for the pet and/or answers for the client.

I don’t know of many colleagues who are talking during a consultation about what they’re doing during the consultation.  For clients it may just look like we’re stroking animals and come up with something.  The process of a consultation usually runs as follows, even if the vet doesn’t talk you through this process.  Initially when you start with the consultation, the vet will try to find out what the issue is and in very common cases there can already be a suspicion of what might be going on at that point and some more directed question can be asked.  For more complex situations the list of questions might be a lot longer.  Once the questions are asked, the vet will then start with a physical examination.  This is something that has been taught extensively at University and is a sequential method for examining your pet by palpation and auscultation initially.  A lot of information will already be conveyed to the vet at that point about the general health of the pet and the information may at that point well be enough to reach a diagnosis.  If however the “gross” health of the pet is fine but the pet is not, if you see what I mean, then you will need some extra diagnostics to help to visualise what’s going on or to analyse through for example blood work.  Again, the type of presentation of symptoms will influence the “decision tree” that’s going to be taken and this usually will be discussed with clients at that point.  The vet starts talking again.  Following those investigations, which hopefully may have narrowed down the issue, then it’s time to make decisions on how to proceed forward if at all.  If at that point the vet is with their back against the wall (I am talking about general practice, not referral practice, they have different walls there), it may be time for referral.

One example springs to mind.  Kiko, a beautiful Akita, was brought in one evening as he was screaming in pain.  I could feel something in his abdomen and I decided to get the ultrasound people in to investigate it the same night as the dog was in agony.  They came and they went and even thought there was something felt in the abdomen, the main issue was a tumour in the chest, very very close to the heart.  I checked with the client what he wanted and he wanted to do anything he could for his beloved dog.  I checked with one referral centre who told me it wouldn’t be worth doing this, not the attitude I was looking for.  I went back to another, more remote referral centre I had used before because of it’s excellent treatment of client/pet when open chest surgery was needed to remove a tumour.  Off he went to the referral clinic and underwent surgery and now is undergoing 3 weekly chemo sessions at Cambridge.  The client is happy and the dog is doing really well. Cooperation between vets is key and so is communication with all parties involved.

What follows is a list of problems we encounter in practice and for which I would strongly recommend that you take your pet to Dr Vet first before going to Dr Google.  Don’t even bother talking to Dr Dog Walker for advise with these ones!

  1. Male cats straining in the litter box.  Male cats sitting in a litter box and straining to urinate – and not passing urine-  are an emergency situation.  With female cats, this is usually not the case.  Male cats can have a “plug” or a small stone sat in the urethra, blocking the exit for the urine.  Not dealing with this emergency can lead to kidney failure or even bladder rupture & death.  I’ve seen both in practice.  With females you have a little more time to have her bladder issues seen to but with male cats, often larger neutered male cats, it’s very important to check the bladder within a few hours of noticing this, especially if no urine has been produced at all and the cat is getting increasingly vocal, depressed, anxious or even aggressive.  I don’t tend to see this issue much in dogs but it’s also possible if they’re having crystals/stones in the bladder and one blocks the exit.
  2. Laboured breathing.  Snuffles are different from laboured breathing.  With laboured breathing I mean that a pet is straining to breathe, may refuse to move because it’s struggling to breathe, is open mouth breathing.  With those pets you will often see that the normal flowing breathing pattern of the in-breath effortlessly flowing into the out-breath and back to the in-breath is changing into a more jagged pattern of “forced” breathing.  At the beginning when they’re starting to do this, it’s not always easy to spot when you’re not used to looking for it.  Often when pets start to open mouth breathe in distress, it’s not a good sign.  Often we see “pleural effusions”, which means that fluid (can be gas/air after a traffic accident with fractured ribs or perforating wounds) is building up between the chest wall and the lungs.  This can have several causes but the initial approach is to help the pet breathe before investigating further.  There could also be fluid on the lungs with heart failure etc.  The most critical case I have dealt with and needed referral was a Nocardia infection in the chest cavity of a cat.  For non-vets, the best I can describe this is like taking a sample from the “fluid” in the chest in a  syringe and smelling like you’ve hit a sewerage pipe big time.  This pet needed a referral to Liverpool University and for weeks was fitted with about 4 tubes, two in each side of its chest to drain the pus out and flush, a tube into its stomach to feed it and one in its bladder to monitor urine output.  The treatment plan was intense and the cat only just pulled through from this.
  3. Seizures.  I admit, if you’re not used to seeing a seizure in a pet and you’re a pet owner witnessing this for the first time, it’s awful!!!  Your pet may collapse on its side, convulse, go rigid, may vomit afterwards or void bladder/bowels.  It usually lasts a few minutes.  That may be the only one your pet is going to have and in that case it’s not an emergency. Monitor closely and have your pet checked out soon at the vets.  If however, your pet doesn’t seem to be able to come out of the fitting or partially comes round to have another round of it, it is an emergency and will need to be seen immediately.  Some poisons can start fitting, some neurological issues but also some non-neurological diseases.  Continuous fitting is dangerous to the pet and for that reason needs treating immediately.
  4. Persistent vomiting.  As pet owners, you’ve all seen your pet go to its dish, gulp all its food in Guinness Record speed, only to throw all of it back up again in the most inconvenient place.  That’s just a pet being plain greedy and not been able to hold the greediness.  It’s different however, when a pet starts vomiting persistently and with that I mean in the same day.  Each time a pet vomits, it’ll bring up stomach juice which is acid.  Doing so will start causing an imbalance in pH in the body and the pet will deteriorate.  Those pets will need help and this help will depend on what they’ve been doing.  Treatment for vomiting during cancer treatment is different from treatment for vomiting when a pet has eaten a foreign body (such as a stick/bone).  It needs checking.  The most bizarre case I have seen both in a dog and cat (they must have been exchanging notes as they belonged to different owners) was vomiting after ingestion of a cassette tape.  I only found out on opening the mouth of the Boxer & cat involved and finding some of it strung around the base of the tongue.    Giving medication to stop it from vomiting wasn’t an option and the surgery to remove this “foreign” body was quite lengthy as multiple openings had to be made throughout the intestinal tract to “thread through” this cassette tape.
  5. Bleeding.  I guess this one is self-explanatory.  If you see blood pumping out, you don’t wait.  If not sharp objects are lodged in that area, apply pressure and go to Dr Vet.  There are other types of “bleeding” that are more hidden types.  If a pet collapses and you check the inside of the mouth, i.e. the gums, and they’re very pale, your pet may be bleeding on the inside.  Another one that clients wouldn’t necessarily think of is that if pets have a huge amount of fleas/ticks, they’re also taking blood from your pet and your pet may become anaemic through that experience of parasitic infestation.
  6. Staggering and stumbling.  It’s difficult to know for clients whether pets need seeing when they find their pets staggering and stumbling.  The causes are multiple from an over controlled diabetic, an anaemic pet, neurological problems such as for example disc problems, muscular problems to name but a few.  Best policy is to have your pet checked as some of these issues can pretty quickly escalate.
  7. Lameness where the pet is not putting a limb down at all (non-weight bearing lameness).  A full-on refusal or inability to put a limb down needs to be investigated. Hobbling a bit may well be from a sprain or some mild issue and if not improving then be investigated.  However, if the leg is just “hanging & dangling”, it might well be a fracture, a dislocation or a ligament tear.  With fractures, undue delay in dealing with the fracture may also delay healing or result in non-union of the bones.
  8. Any symptom that lasts for more than 48 hours or gets persistently worse.  This mops up the rest I’ve forgotten to mention.  I guess it’s pretty self-explanatory.  If it lasts a day and a bit and is improving, there may be no need to see Dr Vet but you do when it start off with a bit of a snuffle, then it progresses into coughing and vomiting.  A final note as well on weight loss and water intake.  If pets over a short period of time start loosing weight, have it checked.  Not uncommonly I will have clients bring in pets that have lost a “bit” of weight.  That then turns out to be around 30% of their body weight as we’re keeping track of pet’s weights as they’re coming through the door.  Again, multiple reasons why and it just needs to be checked.  The same with water intake in pets.  I often ask clients to measure the water intake of their pets and if the amount they take in per 24 hours exceeds 50ml/kg pet per 24 hours for cats and 75ml/kg pet per 24 hours in dogs, it’s time to start investigating.

So final food for thought, rule of thumb, if you were to feel or look like your pet  right now, would you go to the doctor or A&E?