The "Misdiagnosis"

Our living, breathing pets have as complicated a physiology and anatomy as we humans do. Because of this complexity, Veterinarians are not always able to come up with an immediate answer as to what is wrong with a pet at the time of an initial visit.  No matter how well trained or how experienced the Vet is, if a serious problem arises, it is rarely the case that a diagnosis can be made on the spot. Typically, if a serious problem arises in human medicine, the family physician examines the patient, refers them for blood and urine testing, EKG, Xrays, Ultrasound, MRI or any other countless number of diagnostic tests and then sets up the appointments for the specialists to step in to try to get closer to the diagnosis.  The need for testing and further investigation is the exact same in Veterinary medicine for complex medical problems especially because our patients can’t talk to us and answer questions related to how they are feeling.

One of the more common complaints voiced on review sites is "the Veterinarian made a misdiagnosis".  The reality is often that a diagnosis was never made to begin with.  Many times the Veterinarian has not had an opportunity to make a diagnosis for reasons, such as: (a) the disease is in its very early stages and with time the symptoms become more evident and the issues more recognizable (b) the pet's owner has declined the necessary diagnostic tests that were recommended (c) the owner has decided not to follow through on a suggested referral to a specialist or (d) there is no diagnosis able to be made by anyone despite attempts to do so.  Some diseases (especially those developmental in origin) can only be diagnosed upon detailed autopsy examination and therefore questions remain unanswered if the pet's owner declines such tests at the time of death.  

Reviews only provide a snippet of a complicated story and can often be grief and anger misplaced.  Sadly not all medical issues are treatable. Some have poor outcomes or are outside of any practitioner’s ability to heal. These cases are most disheartening for Veterinarians and their staff.  The goal is always to help and heal pets in the most caring and compassionate way.  

Internet Myth #20: Veterinarians are just “in it for the money”

Ahhh… the ole “you’re only in it for the money” statement. I think Veterinary Medicine is rather unique in this regard because I’m not sure I know of another business where a client or patron would say this to the goods or service provider. Can you imagine blurting this out at the supermarket when buying your peaches? Or, how about to your auto mechanic? Maybe to your dentist? I don’t think so. Yet, I don’t think there is a Veterinarian alive who hasn’t heard that phrase in one form or another. I’m pretty sure even the beloved James Herriot has heard that one. Perhaps its used because we are such compassionate people and by trying to lay a guilt trip on the Veterinarian the client thinks they’re going to get a deal?

Typically, the first time we hear it is from a pet owner who claims to have no money but owns 6 dogs and 3 cats. One of their pets is in serious trouble and off they go to the nearest Veterinary Clinic expecting free or deeply discounted services. What they don’t realize is that the vast majority of Veterinary Hospitals are owned privately meaning they don’t receive any donations and any free services provided come directly out of the owner’s pocket. When this happens 3 or 4 times a week it can have serious repercussions for the overall health of the practice. Running a Veterinary Hospital is a business and like any business the bills must be paid. How heartless to expect to be paid for providing services!

The Veterinarians that I know (and I know quite a few) are some of the most compassionate people on the planet. If you ask them how or when they first became interested in working with pets, typically the answer will be “for as long as I can remember… ever since I was a little child”. My own story is no different. I cannot remember a time when I didn’t love, respect and want to help animals in some way. Some of the earliest pictures of me show me holding a goose or a kitten or whatever animal was within reach. Initially I thought I might become a Zoologist but with time it became clear that Veterinary Medicine was my calling. I can honestly say that when I was researching in high school how to become a Veterinarian I never once considered how little or how much I was going to make. In fact, it never crossed my mind. I didn’t really care. Call it being young and naïve.

Unfortunately, times have changed for the newer generation of Veterinarians. No longer can they afford to be so carefree as I once was about what they are getting into. A recent article in the New York Times summarizes it pretty well… see this link… http://www.nytimes.com/…/high-debt-and-falling-demand-trap-….

From that article and several other sources some important points are raised which might be surprising to you:

1) The average U.S. Veterinary Student is now graduating with between $250,000 - $350,000 of debt. Less for Canadian students but still out of control.

2) While the debt has skyrocketed the average starting salary for a newly minted Veterinarian has dropped 13% in the past 10 years to an inflation adjusted $46,000/year.

3) The average salary for a Veterinarian (regardless of years of experience) is around $80,000.

Can you imagine going to University for 8 years, racking up a debt of $300,000 and then graduating and being paid $50,000/year? Some of these poor students will never pay off their debt. No other profession with the level of education that we have makes so little money. It is estimated that the debt to income level ratio is about twice that of a medical doctor. And despite having the equivalent or more education, the average Veterinarian makes about 1/3 to 1/2 that of a dentist.

Veterinarians are highly intelligent people with extensive amounts of education. I can assure you that if a Veterinarian was concerned with making a lot of money they would be smart enough to realize they shouldn’t have decided to become a Veterinarian in the first place. This is starting to happen. Recently, application numbers for Veterinary School have been plummeting and many male students with high credentials who ARE interested in making a lot of money are looking elsewhere.

In summary, I can assure you that the vast majority of Veterinarians are in it for THE RIGHT REASONS. To make the statement that Veterinarians are “only in it for the money” shows a complete lack of understanding about the monetary rewards with being a Veterinarian. The entire profession is poorly paid relative to our education. However, being a Veterinarian rewards us handsomely in ways other than money and I certainly would not want to do anything else.

High Debt and Falling Demand Trap New Veterinarians

The cost of veterinarian school has far outpaced the rate of inflation. Meanwhile, there is a boom in supply (that is, vets), and a decline in demand for services.

nytimes.com

Internet Myth #19: NAD (Non-Anesthetic Dentistry) is a safe and effective alternative to a full dentistry done under anesthesia at the Veterinary Hospital

Anesthetic Free Dentistry for pets is a relatively new phenomenon that we are seeing gaining strength in pet care in many parts of North America. It seems that everyone is jumping on board and the service is being offered by groomers, trainers, pet stores, boarding kennels, and surprisingly even some Veterinary Clinics.

The procedure involves the scraping or scaling of visible tartar off the surfaces of the teeth that are accessible with the pet awake. The argument for this service is that it avoids an anesthetic and therefore is less risky and less costly.

However, what most don't realize is that there is a huge cost in other ways. The vast majority of Veterinarians and Veterinary Dentists have the following major concerns:

1) Most pets will not allow a detailed examination and scaling of all teeth surfaces including those surfaces that are on the insides of the mouth (towards the tongue) AND the sub-gingival regions (portions of the teeth under the gums). Therefore, the end result is purely a cosmetic one. The teeth might look better to the untrained eye but the procedure has done nothing for the area where the disease occurs under the gums.

2) The procedure gives the owners a false sense of security by making the owners think they have done something beneficial for their pet. In reality, only the cosmetics have improved and the disease and/or pain can continue unabated. This can delay appropriate professional treatment which the pet really needs.

3) The public are paying anywhere from $75 - $175 for a procedure that is cosmetic only and ineffective at addressing the real problem (periodontal disease).

4) The procedure can and will cause head-shyness and may be inhumane in dogs and cats who are forcibly restrained for the procedure against their will.

5) It is a potentially dangerous procedure for both the pet and the provider. Pets gums can be lacerated by sharp instruments, teeth can be fractured during restraint and jaws can be broken. Dogs and cats will bite when forced against their will.

6) Oral health issues can be worsened by irritating and inflaming painful gums. No pain control is generally used during or after the procedure.

7) The practice is being offered by lay people who do not have special training in dental anatomy, physiology, diagnostics or therapy.

8) Anesthetic fears are overstated and in this day and age anesthetic procedures done by competent professionals are very safe. See my Myth #11 and Myth #12 below.

9) The practice is ILLEGAL in at least one district of North America (Ontario, Canada). It is considered the practice of Veterinary Medicine without a license.

10) The American Animal Hospital Association (AAHA) calls pet dentistry without anesthesia "unacceptable and below the standard of care". Here is the link... http://www.aaha.org/…/AAHA-announces-new-mandatory-dental-s…

11) The American Veterinary Dental College (AVDC) has issued a position statement warning against its use. Here is the link... http://www.avdc.org/dentalscaling.html

In summary, Non-anesthetic Dentistry is a potentially painful, sometimes dangerous, fear-inducing cosmetic procedure being offered and done by many non-professional lay people who are taking your money and providing a service which will be of limited long-term benefit for your pet. Despite the way it is being marketed, it is in NO way comparable to a professional Comprehensive Oral Health Assessment and Treatment (COHAT) provided by a Veterinarian while the pet is under anesthesia.

Please always seek the advice of your Veterinarian when it comes to the health care of your pet. What may at first look like a bargain can end up costing you and your pet a lot more in the long run both monetarily and in pain and delay of professional treatment.

For those of you in Ontario, Canada if you see or hear of a lay person offering such services please contact the College of Veterinarians of Ontario to report them for illegally providing Veterinary Services without a License. Thank you.

Internet Myth #18: It's best to let your pet have a litter prior to spaying.

This myth is an old one and unfortunately has contributed to the very serious problem of pet overpopulation in North America. There is no evidence that having a litter is beneficial in any medical or behavioural way. Every year there are millions of pets euthanized because shelters cannot find homes for them all. To allow your pet to have a litter for the sole reason of allowing them that "special experience" is irresponsible and contributing directly to this overpopulation problem.

There have been some recent discussions in the Veterinary circles about "when is the best time to spay." Traditionally, most Veterinarians have recommended spaying at the age of around 6 months and prior to the pets first heat period. There are some medical reasons for this. For example, if the spay procedure is done before the first heat there is a markedly reduced chance of the pet developing breast cancer later in life. However, there are some recent and ongoing studies in certain breeds (ex Golden Retriever) that are making us take another look at this recommendation. It is possible that for the Golden Retriever our thinking might change. This does not mean that for all breeds it will change.
 
In the past few years, Humane societies and Shelters have been pushing the envelope and doing VERY young spays and neuters (ex 2-3 months). Many Veterinarians have concerns with this practice as we still don't know all of the potential ramifications of doing these surgeries at such a young age. We may find in a few years that we are dealing with a whole generation of new problems because of this practice. As an example, one concern is Urinary incontinence in the older female pet by having a very young spay. Estrogen is an important hormone for the sphincter muscle of the bladder and sometimes an early spay can contribute to its becoming an issue later in life.

Knowledge in Veterinary Medicine is continuously in flux and our goal is to always do what is best for our patients. Rest assured that as new information comes in we will be on top of it for you in order to help guide you with the latest "best practices" recommendations

Internet Myth #17: "I called my breeder and she said that the vaccines caused my dog’s allergies."

Unfortunately, we as Veterinarians have to deal with this Myth quite frequently. It is not true that a Vaccine caused the allergy or allegies. The truth is that a whacky immune system is responsible for any allergic reaction. A vaccine given to an animal that has a perfectly normal immune system should not cause any problems. However, if the puppy has an inherited faulty immune sys...tem, the vaccine can trigger a response and so is blamed for the reaction.

Rather than address the problem responsibly and reflect on their breeding practices as to why they are producing puppies with defective immune systems, breeders find a scapegoat and play the blame game. As a result, vaccines and often Veterinarians end up getting blamed for something out of our control when the real issue is that the mother and father dogs used to breed those puppies should not be used again.

Internet Myth #16: Giving your dog or cat Garlic and/or Brewers Yeast is a great natural method of flea control.

Unfortunately, not only is this inaccurate but in the case of Garlic it can actually be harmful. A scientific study was done using Brewers Yeast and submitted for publication in a very reputable Veterinary Journal... the link is http://www.ncbi.nlm.nih.gov/pubmed/6885593. The results of the study showed that there was no benefit to using Brewers Yeast to contr...ol fleas. Interestingly, it should also be noted that some of the growth medium used to actually grow Fleas in a laboratory setting contains Brewers Yeast.

Garlic not only has no proven efficacy against Fleas but can actually be Toxic. Colorado State University School of Veterinary Medicine (a World respected Veterinary Teaching facility) released an article on just this topic and can be found here... http://csuvets.colostate.edu/…/Natural%20Approaches%20for%2…

Internet Myth #15: A pregnant woman should get rid of their cat.

WRONG!!!! I've actually had a human doctor give this advice to a client of mine. This kind of advice drives me crazy. It shows a complete lack of understanding of the disease called Toxoplasmosis. Unfortunately I have found over the years that many human doctors have not had adequate training in Zoonotic diseases (those which are transmissible from animals to humans).

Toxoplasmosis is caused by a parasite which can be dangerous to a developing fetus in the human being THE MOST COMMON WAY THAT A HUMAN IS INFECTED WITH TOXOPLASMOSIS IS EATING RARE OR RAW MEAT. Although it is true that a cat could potentially transmit Toxo to a human a whole series of specific events would have to occur that are quite rare.

The cat gets a bad rap because it is the only species whereby the Toxoplasmosis organism uses as an intermediate host. Usually what happens is the cat eats infected RAW meat and the organism undergoes development within the cat and for a brief period (about 2 weeks) the organism can be shed in the feces of the cat. Typically on a farm, cats use the grain storage facilities to defecate and then cattle, sheep, goats etc become infected by eating that grain. That is how the organism gets into meat that humans eat.

In order for Toxoplasmosis to infect a human and do damage to a developing fetus from a cat the following events would have to happen:

1) The woman would have to be in her first trimester

2) The cat would have to be fed RAW infected meat during this time

3) The cat would then shed Toxo for approximately 2 weeks OF ITS ENTIRE LIFE AND THEN NEVER SHEDS AGAIN.

4) The woman would have to eat or ingest that infected cat feces (possibly by cleaning the cat litter).
So, you can see that you might have better odds of winning the lottery than having your developing baby getting Toxo from a cat.

What should a woman do if pregnant?

1) DON'T EAT RARE OR RAW MEATS

2) Don't feed your cat RARE OR RAW MEATS

3) Let someone else clean out the kitty litter during your first trimester.

4) Avoid gardening or wear gloves when gardening in case cats have been defecating in the garden.

5) Relax and enjoy your pregnancy and for heaven's sake DON'T GET RID OF YOUR CAT!!

Oh, and by the way, if you eat rare or raw meats did you know that you may already be infected by Toxoplasmosis and don't even know it? It has been estimated that if you are 30 years old you have about a 30% chance of already having Toxo. If you are 50 years old, you have about a 50% chance of having come into contact with Toxo. And, if a woman has Toxo already there is no concern to the baby. The woman has to get infected during her first trimester.

Should I have my cat tested for Toxoplasmosis? Not necessarily. IF your cat is positive for Toxo that doesn't mean they are a danger. In fact, it means the opposite. It means they have been infected at an earlier age and no longer are a danger (they can no longer shed the toxo). What might make more sense is for the woman to be tested. If a woman is positive for Toxo it means she has come into contact with it earlier and is no longer at risk of developing it during the first trimester. If a woman is negative she is at risk and should make sure she does not eat rare or raw meats, should not give her cat rare or raw meats and avoid the cat litter box or gardening during her first trimester.

I hope this has been helpful information.