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REGULAR VETERINARIAN VS. A SPECIALIST: WHEN TO USE WHICH?

Posted Nov 04 2012 12:00am
How many of you can't wait for this election cycle to be finished???  With all the robo-calls, TV ads, and extremely negative campaigning on both sides of the coin, we'll welcome the arrival of Tuesday.  Mark Twain had something to say about elections
“If we wish to learn what the human race really is at bottom, we need only observe it in election times.”- Mark Twain,  Autobiography

...amen to that!

Here's a take on the dog "election" angle

Helpful Buckeye received a question this past week that most likely describes a situation many of our readers have experienced.  Melanie, from Denver, related a conversation she had with her regular veterinarian and wanted to know if she was reacting in the wrong way.  Here is her partially-edited question:  "For the second time in six months, my vet has suggested that I consider taking my dog to a specialist for an evaluation.  Choo-Choo (her dog) has been having off and on episodes that look like seizures and my vet says she has run all the tests available to her.  So, she's advising Choo-Choo go see a neurologist.  Are these 'specialists' really what I need or is my vet really just writing me off?"

I didn't get a chance to ask Melanie if she had tried to ask the same questions of her veterinarian but that would have been my first suggestion.  Any time a new or different route of treatment is considered, a veterinarian and the pet owner should have a conversation about what is going on and why something else is being recommended.  If that conversation does not take place, it's not in the best interest of the pet, the pet owner, or the veterinarian.  Communication is of utmost importance if your pet is to get the best medical attention available.  In that light, Helpful Buckeye would like to give pet owners a little better understanding of the linkage between your regular veterinarian and any of the veterinary specialists available in your area.

Let's start with the topic of responsible pet ownership
Responsible Pet Ownership

Owning a pet is a privilege, but the benefits of pet ownership come with responsibilities.
Be a Responsible Pet Owner: 1.Commit ◦Avoid impulsive decisions when selecting a pet. ◦Select a pet that's suited to your home and lifestyle. ◦Keep only the type and number of pets for which you can provide appropriate food, water, shelter, health care and companionship. ◦Commit to the relationship for the life of your pet(s). ◦Provide appropriate exercise and mental stimulation. ◦Properly socialize and train your pet. 2.Invest ◦Recognize that pet ownership requires an investment of time and money. ◦Make sure your pet receives preventive health care (vaccinations, parasite control, etc.), as well as care for any illnesses or injuries. ◦Budget for potential emergencies. 3.Obey ◦Clean up after your pet. ◦Obey all local ordinances, including licensing, leash requirements and noise control. ◦Don't allow your pet to stray or become feral. 4.Identify ◦Make sure your pet is properly identified (i.e., tags, microchips, or tattoos) and keep its registration up-to-date. 5.Limit ◦Don't contribute to our nation's pet overpopulation problem: limit your pet's reproduction through spay/neuter, containment or managed breeding. 6.Prepare ◦Prepare for an emergency or disaster, including assembling an evacuation kit. ◦Make alternate arrangements if you can no longer provide care for your pet. ◦Recognize any decline in your pet's quality of life and make timely decisions in consultation with a veterinarian.
 
Adapted from: https://www.avma.org/public/PetCare/Pages/responsible-pet-ownership.aspx


Importance of wellness exams

Veterinarians recommend regular wellness exams for the same reason your physician and dentist recommend them – if you can detect a problem in its early stages, it's more likely to be treated and resolved with less expense, less difficulty and better success.
As the saying goes, an ounce of prevention is worth a pound of cure. Vaccinations, heartworm prevention and routine deworming are important components of wellness care and can prevent diseases that are not only life-threatening, but very expensive to treat. Your veterinarian can recommend a wellness program based on your pet's breed (some breeds are predisposed to certain health problems), age, lifestyle and overall health.

Adapted from: https://www.avma.org/public/PetCare/Pages/wellness-exams.aspx OK, you (the pet owner) have done your homework...you've accepted responsibility for your pet's welfare and you understand the importance of having regular health exams for your pets.  Now, it's your veterinarian's turn to contribute their part of the equation that leads to complete care for your pets.  The American Veterinary Medical Association, in their pamphlet The Veterinary Health Care Team, points out:
Veterinarians are doctors trained to protect the health of both animals and people.  In a clinical hospital environment, veterinarians work with large and small animals to evaluate animals' health, diagnose and treat illnesses, provide routine preventive care (such as vaccines), prescribe medication, and perform surgery.  Like physicians, some veterinarians specialize in areas such as surgery, internal medicine, ophthalmology, or dentistry.
In addition to opportunities in clinical practice, veterinarians may choose to work in zoos, wildlife parks, or aquariums; or focus on public health, regulatory medicine, academia, or research.  Personal attributes that contribute to a successful career as a veterinarian in clinical practice include a strong science and math education, the ability to work well with animals and their owners, basic business and management training, and leadership and organizational skills. Your Pet May Need a Veterinary Specialist  By KARRI MILLER When I tell someone what I do for a living, their response is usually the same. "You are a veterinary oncologist? I did not know there was such a thing. Do people treat their pets for cancer?" This usually prompts a response about what my job entails and my passion for veterinary oncology. It is interesting that in today's society, where most households have at least one pet, so few people realize there is specialty care available for their pet. Just as in human medicine, many specialties now exist in veterinary medicine. Some examples of the specialties available for your pet include: internal medicine, neurology, oncology, cardiology, surgery, ophthalmology, and dermatology. The family physician is the equivalent of a general veterinarian, who your pet visits for basic wellness and vaccines. If the family physician were to hear a heart murmur or irregular heartbeat on a patient, they would be sent to a cardiologist for tests and an evaluation. It is very similar in veterinary medicine, when a heart murmur or irregular heartbeat found by the general veterinarian may be further evaluated by a veterinary cardiologist. Your family veterinarian may be the first doctor to assess any medical problem that your pet has, but they may recommend your pet visit a specialist for additional help managing your pet's medical condition. Another question I get asked when telling people about my job is, "Did you have to undergo special training to do oncology?" The answer to that is yes! Any specialist, whether a human physician or a veterinarian, has to pursue special training after medical or veterinary school in order to specialize in one area. This typically involves an internship and residency performed under faculty and mentors that have been specialists in the field for years. There are also rigorous exams administered upon completion of a residency, to insure that each doctor is able to practice the specialty with a certain level of knowledge and standard of care. When all of these criteria are met, someone can become board-certified in a certain field. While the comparisons between human physician specialists and veterinary specialists are numerous, there are some differences in the way people and pets are treated. Sometimes treatments available for people may not yet be available for pets. Treatments that are available to both people and pets, may be administered differently in pets. Reasons for this difference include: cost, availability of the treatment, and the ability to tolerate the treatment. Dogs and cats metabolize medications differently than people, and some treatments can be ineffective or toxic in these animals. Ultimately, the goal of any treatment in pets is to maintain a good quality of life, while extending their life span. If your pet has any special medical condition, from itchy skin to a growing mass, a board-certified specialist may be able to help. Your family veterinarian and veterinary specialist work as a team to provide the best care for your pet's medical condition. Should you choose to seek a specialist's help for your dog or cat, your family veterinarian will be able to help locate the right specialist to meet your family's needs. Karri Miller works at Veterinary Healthcare Associates in Winter Haven. She is the only full-time board certified veterinary oncologist in Central Florida. Adapted from: http://www.theledger.com/article/20111211/COLUMNISTS/111219938/1002/sports?p=1&tc=pg Number of animal vet specialists on the rise By Adam Foxman When Karen VeLonda spent nearly two years saving for her Chihuahua mix's cataract surgery, friends and relatives told her she was nuts. But to VeLonda, 2½-year-old Ramona is family, so she felt she had a responsibility to get the best care possible when the little dog was losing her vision. "When I decided to keep her, I made a commitment to her to take care of her as best as I possibly could," the Los Angeles resident said before the surgery at Animal Eye Care Clinics in Camarillo. "She has her whole life ahead of her. Shouldn't she be able to see if she can?" VeLonda's view of her pet as a family member has become increasingly common, contributing to a tripling of the number of animal-medicine specialists nationwide in the past 25 years. There were 10,210 veterinary specialist certifications in the United States in 2010, compared with 3,205 in 1987, according to the American Veterinary Medical Association. Some veterinarians have multiple certifications. The association certifies specialists in areas such as expertise in dogs, cats, birds or reptiles. Other specialists are certified in animal cardiology, dermatology, oncology, ophthalmology, epidemiology and sports medicine. There's even a specialty called theriogenology, the study of animal reproduction. To be board-certified, aspiring specialists spend two to six years in residency after veterinary school and then must pass rigorous exams, said David Kirkpatrick, an association spokesman. Ventura County has about 25 veterinary specialists, said Leah Basinais, chief operations officer for the Veterinary Medical and Surgical Group, which runs an animal hospital in Ventura. The group has grown dramatically since it was founded in 1988 with one surgeon, Basinais said. Its Ventura hospital now has four surgeons, four internal medicine specialists, three emergency and critical care doctors, a radiologist and an oncologist, she said. Animal Eye Care was founded in 1992. The Camarillo clinic's veterinarians — Jeannette da Silva Curiel and Brian Marchione — are among about 350 board-certified animal ophthalmologists in the nation, according to the association. The clinic sees thousands of dogs and cats a year, and most of its surgeries are on cataracts, da Silva said. As in human cataract surgeries, animal ophthalmologists break up the patient's lenses with ultrasound, then implant artificial lenses. The surgeries are more challenging than the human version because the lenses in a dog's eyes often are larger and much harder, da Silva said. Despite the challenge, in carefully selected and properly prepared patients, the procedure has a success rate better than 90 percent, da Silva said. "It's amazing that we can do this ... that we can take a blind animal and they can see again," she said. Before Ramona was diagnosed with cataracts, VeLonda didn't know animal ophthalmologists even existed, she said. With just a bit of peripheral vision, Ramona would run into moving objects like VeLonda's legs and wouldn't play with other dogs at the park. After learning Ramona had cataracts that could be corrected with surgery, VeLonda decided it was the right thing to do, even though she was having trouble paying her rent. Because Ramona's health was otherwise good, VeLonda thought correcting a fixable problem was more important than the money, she said. After a lot of research, VeLonda settled on the Camarillo clinic, where the surgery's roughly $4,300 cost was less than at some other facilities, she said. Although she hopes to be at least partially reimbursed by pet insurance, VeLonda knew she'd have to pay for the procedure upfront, so she saved for more than two years. Friends and family gave her "a lot of grief" for spending so much money on the dog when her work as a massage therapist was declining because of a slow economy, but she made it a priority. "I'm responsible for her," VeLonda said. "She doesn't have thumbs. I'm her sole support." A few weeks after Ramona's surgery, the results were "pretty amazing," VeLonda said. "Yesterday she saw some crows and very seriously thought about chasing them," VeLonda said, adding Ramona's not allowed to chase anything during her recovery. "It makes me just tear up a little bit because she was blind and now she can see. ... It just softens my heart." Along with advances that make the specialty medical care possible, the strong bond between people and pets has helped drive the growth in veterinary specialties, said Emily Patterson-Kane, an animal-welfare scientist with the veterinary association. Fifty years ago, veterinarians' patients typically were farm animals; now, about 80 percent are pets, Patterson-Kane said. "We have people talking about their fur kids," she said. "The whole language has changed." Adapted from: http://www.vcstar.com/news/2012/mar/18/number-of-animal-vet-specialists-on-the-rise/ Angie's List advice on spending money on a  health specialist for your animals Navigating expensive veterinary care for your pets How much would you pay to save your pet? According to estimates by the American Pet Products Association, Americans will spend over 13 billion dollars on general and specialty veterinary care this year. It's that last category - specialty care - where costs can skyrocket. “A primary veterinarian takes care of the regular care for your pet, such as vaccinations and checkups every year, "said Angie's List founder, Angie Hicks. "A specialty vet is going to focus on different areas of medicine. For example, dermatology or physical therapy – just like your regular doctor and their specialists.” Medical specialties such as cardiology, oncology, neurology and internal medicine – once reserved for human health care - continue to expand into the realm of veterinary care. According to a nationwide Angie’s List poll, nearly 47 percent of respondents say they’ve sought veterinary specialty care for their pet and of those, 27 percent say they have spent more than $2,500. “When going to a specialized veterinarian, you need to plan ahead for the costs. Talk to your general veterinarian about how much it’s going to cost so you are not surprised," said Hicks. Specialty care is more expensive due to additional training, equipment and facilities. The American Veterinary Medical Association (AVMA) recognizes 21 veterinary specialty organizations that oversee 40 distinct specialties. The number of specialists in each discipline varies, but some - such as oncology - have relatively few across the globe. “When hiring a specialty veterinarian you are going to do the same research you would for a regular veterinarian," Hicks said. "You want to check their board credentials, their experience – how long they have been practicing. The same type of steps you would use in hiring a specialist for yourself.”   Angie’s List Tips: Navigating veterinarian specialty care •Check credentials: From a cardiologist to a radiologist, verify the veterinarian’s board certification. Board-certified veterinary specialists must complete an internship and residency in their specialized field which typically means an additional three to five years of training and required exams. •Do your homework: Before committing to costly care, ask the specialist detailed questions about his/her experience, training, success rate, and techniques he or she will use to treat your pet. •Know your limits: Think ahead before an accident or illness occurs about how much you want to spend on your pet’s health. While some are willing to pay whatever it takes to keep their pet healthy, others are left with stick shock. Research pet insurance options to plan for unexpected expenses, but be sure to ask about deductibles, exclusions, co-pays and caps. •Manage your expectations: Some pet health conditions cannot be resolved, no matter how much money you spend on treatment. Seek a second opinion if you’re not satisfied, but be prepared if nothing can be done. •If you run into problems: Speak with your veterinarian to resolve any issues. If a situation can’t be resolved, you can file a grievance with your state’s veterinary board. Adapted from: http://www.abcactionnews.com/dpp/money/angies_list/angies-list-advice-on-spending-money-on-a-health-specialist-for-your-animals
Vet Care - Modern Medical Miracles
Every veterinarian offers basic care such as vaccinations, neuter surgery, and parasite control. But today, just as in human medicine, veterinary specialties offer modern techniques that go "beyond the basics." Here are just a few "wow" techniques now available to our cats and dogs. Most are available only in university settings or specialty practices.  Ask your veterinarian if these or other procedures might have special benefit for your fur kids. Back Injury Treatment  An innovative preventive procedure pioneered at Oklahoma State University called laser disk ablations treats dogs with a history of back pain. Instead of surgically removing damaged disks (as in conventional treatment), lasers zap the spinal needles inserted through the skin into the disks, to vaporize the problem material--no incisions, no muss, no fuss--and no disks left to prolapse. A number of specialty veterinary practices now perform this procedure. Bone Cancer Limb Sparing  Limb-sparing surgeries allow dogs and cats with bone cancer to keep the affected leg, rather than amputating the limb. Surgeons remove only the diseased bone. They then replace it with a donor bone from a deceased pet, or use a living section of bone from a healthy part of the pet's leg. Other times, a metal rod takes the place of the bone. It takes about sixteen weeks for the graft to fuse to the dog's existing bone and heal. And in the most WOW-medicine of all, the section of radius bone with the offending tumor is removed. Then a one-inch section of healthy bone cut from the stump end is slowly moved 1 mm per day-prompting the healthy bone to grow/heal new bone in about 4 to 6 months. Vision Surgery  Pets with eye injuries or ulcers benefit from corneal transplants performed by veterinary ophthalmologists. Older dogs may develop problems that cause the cornea to turn blue, and the small central portion is removed and replaced. Cats sometimes develop eye problems resulting from chronic herpes virus infection that cause the cornea to turn brown and die. A partial thickness corneal graft can correct the defect, and in about six weeks the eye heals and looks clear and beautiful. Pets that develop cataracts also can benefit from the same surgery that treats people. Kidney Transplants  Kidney transplant can save pet lives. Cats seem particularly accepting of the procedure and don't have the high rejection rate the way dogs and people do. Don't worry, no kitties are killed to provide organs-instead, the feline that donates the kidney gets adopted as part of the arrangement. It's been reported that 59 percent of the cat transplant patients were still alive six months after surgery and 41 percent were still alive three years after surgery--some have lived for a decade or longer. About five universities and private specialty practices offer cat kidney transplants. Cartilage Transplant and Stem Cell Therapies  Arthritis, dysplasia and other joint problems damage cartilage and make movement painful. An innovative procedure patterned after human techniques harvests healthy normal cartilage (often from the patient's other joints) and transplants it in plugs in the damaged area. The bone/cartilage plugs grow more cartilage, which spreads and covers the deficit. Vet-Stem Regenerative Medicine employs a concentrated form of adult stem cells derived from the pet's own fat tissue to treat tendon, ligament, and arthritic conditions of horses and dogs. The veterinarian collects about two tablespoons of fat from the patient, which is shipped to the Vet-Stem.com laboratory in San Diego, California. Once processed, the stem cells are shipped back to the veterinarian in ready-to-inject syringes, and the stem cell treatment is injected directly into the injured site. Any extra can be stored at the Vet-Stem Bank for future treatments. Heart Repair  Open-heart surgery currently remains limited to a few universities, and UC Davis Veterinary Medical Teaching Hospital is the only place in the US that has regularly scheduled procedures for animals. They can do pretty much any procedure performed on humans, and employ a cardiopulmonary heart-lung bypass machine that allows the heart to be stopped for one to two hours. One surgical procedure replaces defective valves with cow or pig tissue. Leaking heart valves is common in small animals, especially very small dogs. Surgery requires a six- to nine-person team to carefully monitor the patient before and during the invasive surgery. The entire surgery lasts five hours or longer. Some dogs now benefit from pacemakers. But the most common congenital heart disease, patent ductus arteriosus (PDA) affects miniature poodles and German shepherds most often. Texas A&M and other specialty practices use catheters (long flexible tube) threaded through the arteries to fix the problem, sometimes by placing stainless steel fiber-embedded coils into the hole. The fibers stimulate clotting, which shuts off the hole. Research has led to new diagnostic tools, new surgical procedures, new prevention options, and new uses for existing or novel drugs. These innovative veterinary options not only save lives but also extend a pet's longevity and improve the overall quality of life. And that's just doggone good for everyone! Adapted from: http://www.pawnation.com/2011/07/29/wow-vet-care-modern-medical-miracles/ Of course, most "general practice" veterinarians will do their best to arrive at the proper diagnosis for your pet's problem, especially those with access to currently available technology.  If you live in a relatively lesser-populated area, your regular veterinarian will most likely have to pursue a diagnosis on their own.  However, if you live in or near a larger population center, your veterinarian will at some point suggest that you should see a specialist for further help with your pet's puzzling problem.  Specialists will usually have fees that are higher than those of your regular veterinarian.  If you have pet health insurance, this might not present an impossibly expensive option.  However, if you don't have the insurance, you may be faced with some decisions about how to budget the expense.   So, Melanie, I hope I've helped you understand why the process of making a referral to a specialist very often not only makes sense but also is the very best thing that can be done for your pet.  If your regular veterinarian didn't explain all that to you, it is understandable why you are asking your question.  For future reference, it still doesn't hurt for you to be the one asking questions if you don't fully understand what's going on with your pet's health care.  If you value the relationship you have with your regular veterinarian, always be willing to have a give-and-take with them.  Ask your questions...if the answers lead you to a specialist, you'll know why. Any questions or comments should be sent to Helpful Buckeye at: dogcatvethelp@gmail.com   or posted at the "Comments" section at the end of this issue.   SPORTS NEWS The Ohio State Buckeyes crushed Illinois to reach the 10-0 mark for the season.  Helpful Buckeye also enjoyed watching Oregon dismantle USC and Alabama beat LSU last night.  Since the Buckeyes cannot compete for the National Championship this year, I would like to see Oregon and Alabama fight it out for the title...with no apologies to Kansas State, Notre Dame, or Louisville...who shouldn't even be mentioned in the same breath.  In the interest of full disclosure, I will also say that, even if the Buckeyes finish the season undefeated, they wouldn't be a good match for either Oregon or Alabama.

The Pittsburgh Steelers went on the road to play the NY Giants, in the heart of Hurricane Sandy's damage.  The Steelers had to overcome a couple of bad plays on their part and several really questionable calls by the officials...but we hung on for the win! PERSONAL STUFF Even though we're now in the first week of November, there are supposed to be a couple of days this week in the upper 60s-lower 70s.  Helpful Buckeye will use one of them to do a final 70-mile tune-up bike ride before my ride in the Tour de Tucson.

~~The goal of this blog is to provide general information and advice to help you be a better pet owner and to have a more rewarding relationship with your pet. This blog does not intend to replace the professional one-on-one care your pet receives from a practicing veterinarian. When in doubt about your pet's health, always visit a veterinarian.~~     


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