Monday, October 07, 2013

Barking Up The Wrong Tree

Many people saw last Friday's opening episode of CBC's sensationalist program Marketplace, on the topic of veterinary fees. As promised, I watched the program and took notes. Part of my goal of this blog has been to be a liaison between veterinarians and pet owners, two parties who ultimately both have the same goal, but who often have issues in communication.

In regards to the cost of care, I won't get into that. It has been covered nicely elsewhere and I simply don't have time to defend that. We practice a certain standard of medicine and that standard comes at a certain cost. I would, however, like to clarify a couple of misleading points, as many people watching are knowledgeable pet owners who want to know what's best for their pets. Making an informed health care decision should not be done based on cost alone.

3 Year Vaccine Protocol

Vaccine theory is of special interest to me, and I make of point of attending quite a bit of continuing education on the subject. I even did a two week rotation on vaccine science during my final year in veterinary school. Vaccine boosters can last for many years only if
  1. A veterinarian delivers the vaccine to a healthy animal
  2. A high quality, properly stored vaccine is used
  3. A proper vaccine schedule is used
The third point is the most confusing for pet owners. If a dog has missed the proper timing for vaccine boosters as a puppy, and as a young adult, we are less likely to get good immunity. The best way to avoid future vaccines is to vaccinate properly from the start. If you go to a new clinic, bring along your vaccine records, as saying your pet is "up to date" is absolutely meaningless.

It's interesting to me that Marketplace referenced the Dodds vaccine protocol, where preference is given to a blood test called a vaccine titer, which costs $100, over a vaccine booster every 3 years (about $30). Dr. Dodds also recommends annual bloodwork to establish baseline normal values for your pet. This is what I do for my own dogs, and we are proud to offer this level of preventative medicine to our clients. However, this protocol was not designed with the intention of saving pet owners money. Also, regardless of whether he is due for a vaccine or not, your pet needs a physical exam by a veterinarian every year.

Heartworm Testing

Heartworm is a very scary disease for dogs. I treated some heartworm patients when I worked at Winnipeg Humane Society. Heartworm is much easier to prevent than it is to treat. We have those "scary" heartworm posters up at our clinic, and when clients ask about heartworm, I tell them we don't have heartworm in this area, and ask about their travel plans. We have many clients who travel to Mexico or the Southern United States with their pets, where the risk is huge, and we need to keep heartworm prevention in the discussion. I also have concerns that a combination of climate change and the importation of heartworm positive dogs could mean that one day heartworm may be endemic here in Greater Vancouver.

Why would you need to test for heartworm when your dog is on prevention? The American Heartworm Society recommends annual testing due to the fact that some dogs become heartworm positive while on prevention. This may be a combination of drug resistance, improper administration of the medication (for example, a dog who spits out the pill later, or vomits it back up), or even individual patient variation in how the medication works. If I lived or travelled in an area with heartworm, you can bet my own dogs would get annual testing. The heartworm test can be easily combined with the testing for tick-borne diseases using Idexx's SNAPP 4Dx Plus test, for a similar cost to just checking for heartworm.

Travelling within Canada? Check out this map of Canadian cases:

Body Condition Score

Everyone's pets are overweight. Ok, that's not true, but not much of an exaggeration. One thing that really trips owners up is breed. Yes, all breeds and all individual dogs have different body shapes, but they all have the same flat, sheet-like muscle overlying their rib cage. Therefore, they should all FEEL the same (beneath their fur). If I have to push down to feel the ribs, I am pushing through a layer of fat. This chart explains body condition score by appearance.

Hill's Metabolic (the food referenced in the show) worked great for my most obese patient. The measurements are a bit tricky, and should always be double-checked against common sense, as occasionally the calculations come back with a weird number for weight loss. The numbers on the scale don't matter nearly as much as how a dog feels when you have your hands on them. Coincidently, keeping your pet at a healthy body weight is the easiest and cheapest way to save on vet bills!

You Get What You Pay For

The bottom line is that high quality medicine costs money. The only redeeming feature of the program was any sentence that included "ask your veterinarian". I am always happy to discuss the pros and cons of any treatment, and to come up with solutions based on each individual case.