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| Tizzie and Kenai, photo courtesy Nikki K |
It's probably easiest for me to argue the points brought up in the show on CBC tonight. The main points were:
1.) Vaccinations are major source of income for your vet, and given unnecessarily to pad their bottom lines and get you in the door.
2.) Heartworm testing is an unneeded expense if your pet is on preventatives
3.) Veterinary diets are recommended (particularly for weight loss) and may not really be needed, and the brands are pushed by manufacturers to veterinarians.
4.) Vets recommend seeing specialists/extra tests as a way to pad their bottom lines
5.) Medications are more expensive through your vet, and they do not tell you about ways to save money going through a pharmacy.
It is likely if you are reading this and you have a pet, you have brought your animal to the vet for generalized health visits which include vaccinations. At the bare minimum, states require all animals to be vaccinated against Rabies. This is not simply for your pets protection, but yours as well. In the United States and Canada the canine strain of rabies has been eradicated, in large part due to the vaccination of our pets. Yes, rabies still occurs in wildlife, but it is a different strain. Comparatively, the undeveloped world, and developing nations have seen the canine strain of rabies as a number one killer in humans. They do not have the same vaccination standards that the US/Canada have.
Your vet recommending other vaccines may sound like foreign language. In my opinion one of the biggest issues that veterinarians need to become better about addressing is the language barrier between clients and themselves. We go to school for four years, and learn a "foreign language" that allows us to accurately describe conditions we see to other veterinarians. This language is not always conducive when we are trying to explain things to our clients. Telling someone their animal needs Leptospirosis vaccination, or Bordatella often means nothing and brings a confused look to their face. People blindly agree or decline these without actually knowing what it means. A good veterinary practice will explain all available vaccines, and tailor a program to your animal's need. They may even give you a handout that explains the vaccination schedules and reasons each is given. The program on CBC tonight found that "6 out of 10 veterinarian's recommending boostering a vaccine even though (the dog) was up to date". What this statistic fails to mention is when the last time the dog actually had the vaccine was, what the manufacturer of the vaccine recommended, and what the dog's lifestyle is. In general, vaccination schedule has been spread out to three years for many vaccines. Certain vaccines, such as Leptospirosis and Lyme Vaccine are not good for three years. Part of the reason for this is that those vaccines are fighting a spirochete bacteria, as opposed to rabies which is a virus. This changes the immune reaction that the animal's have to the vaccine and therefore decreases the length of time that they could adequately mount a response against a disease. The major vaccines given (rabies, distemper, leptospirosis etc.) offer the option of having a titer checked. This entails your veterinarian drawing a blood sample and shipping it to a lab to have the level read. While rabies does have a titer level that can be returned it should be noted that due to the nature of the disease, most labs will not return a result stating the titer is protective. Instead, that titer is often used to determine whether or not there are ANY circulating antibodies present to protect your animal. The distemper titers will give you a level of protection idea, and can help you formulate a decision as to whether or not vaccinating your pet is necessary. It is up to you, as the pet owner, to do your research of any recommended vaccinations, to ask your veterinarians for other recommendations, and advocate for a plan that best suits your pets needs.
Moving on to heartworm testing. For the sake of argument, I will focus on Canada and the Northeast region. It is true, that heartworm disease is fairly low in prevalence throughout the northeast and Canada. Mosquitoes however, are not rare- as anyone living in Vermont this summer can attest to. The mosquito is a vector for heartworm disease. Heartworm disease IS a killer of dogs, just look at the data from animals living in the southern United States. For some time the current belief was that heartworm disease was not found frequently in the Northeast, and preventative medications were even questioned as being necessary. In the years following hurricane Katrina, and the subsequent influx of southern dogs moving to the north, heartworm cases have been on the rise. Animals from the south often come up with heartworm disease, and before they begin their treatment it is possible for a mosquito to bite them, become infected, and then spread it to your unprotected animal. Treating heartworm disease is not cheap, easy, pain free, or risk free. It is also difficult at times to get the medication to do so. This summer alone, one of the clinics I worked for saw multiple cases of heartworm disease. Preventatives cost money, for sure, but the cost of treatment for heartworm disease is much higher, and the life of your pet is on the line. Additionally there is new research out stating that there are now heartworms that are resistant to the medication used to treat animals with the disease. The prevenatives prevent not only against heartworm disease, but also intestinal parasites that are found in the environment all around.
Aside from heartworm disease prevalence perhaps being on the rise again, many clinics utilize a heartworm test that does not only test for heartworm, but for other diseases as well. Idexx Laboratories offers a test known as the 4DX- it checks for heartworm disease, but also lyme disease, anaplasmosis, and erlichiosis. The last three are tick borne diseases which pose serious threat to your pets. If you are not testing your pets yearly for the reason that you use monthly preventative medications for heartworm and fleas/ticks you should know that no product/medication is 100 percent effective. In particular, topical products for fleas and ticks in endemic areas for Lyme disease will not be enough to protect your pet. Vaccinating against lyme disease can be an important aid in protection, but you are not protecting against the other two tick borne diseases with any vaccination. Early detection allows for the veterinarians to recommend further testing, and treatment to prevent systemic damage to your pet from circulating pathogens. I have heard owners refuse testing before, stating they have never seen a tick on their pet before. The ticks can be smaller than your fingernail and difficult to see, and it is entirely possible they fed on your pet, and fell off before you even realized they were there. Additionally, if your pet is at risk for lyme disease, or other tick borne diseases- you are too. Sometimes being aware that your animal has an exposure allows you to become more proactive about your own risk.
Veterinary nutrition is often an area of contention for owners. When a vet recommends trying a diet for your animal, often owners wonder if the recommendation is based on a kickback from the manufacturer. I would be lying if I said that the nutritional companies do not do things such as provide lunch lectures surrounding their products, or that they did not offer software that allowed a clinic to assess weight, or other offers to entice veterinarians to use their food. They are trying to sell their food just as much as the next person. However, the diets that are marketed for veterinary prescription are put through scientific research, take years in development, and have proven results- it is why you so rarely hear of problems with recalls, and why you see results. Diets formulated for kidney health, for liver health, for urinary health, and for weight management all exist (along with many others), and because of the research and the care that is put into their manufacturing, their prices reflect that. Food for animals is not cheap, especially as the quality and specialization in the food increases. Even at cost to your clinic the food is not cheap. However, when you consider that the nutritional diet is preventing you from spending money doing additional medications, and potentially prolonging your pets life by actively targeting organ systems that are not working properly, the cost is worth it. The best example is the diet for urinary tract uroliths and crystal. Animals that develop crystals, particularly male cats, are prone to stones and urinary blockages. These blockages are potentially and rapidly life threatening. In many cases, nutritional management goes a long way in treating these animals by altering the pH of their urine to prevent crystals from forming. When you consider what you are paying monthly for food, and compare to what the cost of treating a blockage is (ranging from 1000-1500 or more in some cases!) it is often much more manageable to pay for the food monthly.
When your veterinarian makes a recommendation for you to see a specialist, or makes a recommendation for additional testing to determine the extent of an abnormal finding, it is not simply because they do not know, and not because they are looking to charge you more money. When we as humans have physical exams, we can verbally tell the doctors "It hurts here" or "When I do this, this happens". Animals do not have the full verbal capacity we do. Sometimes they can tell us where they hurt, and sometimes they are stoic and though you know something is wrong, it is impossible to tell on general physical exam where that problem is. Sometimes a physical exam will highlight a problem, but not give the information necessary to make informed treatment decisions. As an owner, if a veterinarian recommends doing tests, ask questions! Why is that test being recommended? What information will that test give you? If I do not do this test, what would the next likely outcome or treatment option be? We are taught to offer you the optimal treatment options so you are aware of what we would fully recommend. Not every person wants to, or is able to do every test recommended. We are also sensitive to that. It is not my job to judge you as a person for making a decision pertaining to how much money you can spend on your pet, or how much you are willing to do for your pet. My job is to offer you treatment plans that work with you, your pet, and your budget. My job is to present you with gold standard treatment, but also to be realistic and present you with treatment options if you cannot or do not wish to pursue all testing. Not every veterinarian is capable of walking this line, and if you feel uncomfortable in your relationship with your veterinarian, I encourage you to either be vocal about it, or look for a clinic that suits your needs better.
The patient on the CBC show this evening was told that they had an eye condition, and given a few different diagnoses/treatment options tonight. They then went to the specialists for a follow up report based on the recommendation of the veterinarian's who saw the animal. The animal received a different opinion from the specialist, and was put on medication to treat the issue. The show's viewpoint was that the owner A) paid veterinarians to tell her the problem and then they wanted her to go to a different veterinary and pay more money and B) veterinarian's were inconsistent in their findings, so perhaps there was education lapses. Interestingly enough, as a pet owner if a veterinarian recommended to me to go to a specialist, I would feel confident that they were referring me on because they wanted me to have the diagnosis from someone who was confident with the organ system involved. Additionally, the eyes being such an important organ, are also complex with multiple conditions. To ensure proper treatment, that is also currently recommended, the best option is to go to a specialist who can confirm or alter diagnoses through additional tools. It should bring peace of mind that your vet was astute enough to recommend another opinion to you. Additionally, no vet is right 100 percent of the time. No person is. No doctor, human or animal, should ever claim to be. Having additional opinions in general can only lead you to a more refined diagnosis. Again, these things are not cheap, and they are not for everyone, but the option is out there.
It is no secret that medications are not always cheap. The first thing to be pointed out in the argument against paying veterinarians versus paying human pharmacies, or online pharmacies is drug safety. Some drugs are specifically formulated for animals. Yes, there are medications like antibiotics that are human drugs utilized in animal medicine. However, just because your veterinarian prescribes a medication, it is not safe to assume you could also pick up the medication at your pharmacy. I know several veterinarian's who will write prescriptions for drugs to pharmacies if they know it will be cheaper for you to get it there. What I also know is that veterinarian's have little control over the cost of medications. If you want to fight a battle over the cost- contact the drug suppliers. As with the food, there is a mark-up so that the clinic can make a profit- just as there is a mark-up if you go to the human pharmacy. However, the base price is not often that different. Secondly, the use of online pharmacies can be cheaper for you as an owner- however you should know that not all online pharmacies are created equal. There are some that are not inspected. In order for you to be sure that the drug dispensed to you, is the drug meant to be, you should utilize your vet clinic or pharmacy. I will not lie, there are some pharmacies online that are cheaper than your veterinarian, however you should also be aware that receiving medications online does not exempt you from a legal prescription from your vet. Many state laws require there to be a patient/doctor relationship for medication to be dispensed, and that typically requires a yearly physical exam at the bare minimum.
I won't be so naive as to say that there are not vets out there who pad their prices, take advantage of economic circumstances, or in general are not current with education- but the common theme is that all the veterinarians went to school to earn their degrees, and they care about your pets. If you feel that you are perhaps the victim of a bill being padded, then you need to ask more questions- find out why certain charges are as they are, or tests are recommended. It is easy for veterinarians to forget that transparency is needed to eliminate concerns regarding costs and level of care. Estimates at most clinics can give you an idea of what is being done, and for what cost- if it isn't offered to you immediately then you could always ask for one. If you are not comfortable with what is presented to you, then consider finding a vet who better fits your needs. If your animal does not have a critical concern, then take a day to decide if you want to pursue further testing- go home, do your research, think of more questions. If it is critical, don't be afraid to ask for further clarification.
I apologize for this post being as long as it is- below I have included some links to information I may have referenced in this post. What is written is my opinion, you may form your own, ask me more questions, or discuss your feelings with your vet. It is unfortunate that the popular press and media present one sided arguments geared towards what people want to hear- after all, if you hear what you want to, why ask any more questions? Asking a question never hurt, and it may even allow your veterinarian to consider something they previously had not.
Heartworm disease information: http://www.heartwormsociety.org/ This link is EXCELLENT for vets, students, and for owners
http://www.idexx.com/view/xhtml/en_us/corporate/home.jsf has information regarding the 4DX test, as well as other profiles they offer for diagnostic purposes.
http://www.cdc.gov/rabies/ information regarding rabies both in the US and Worldwide. Excellent resource!
https://www.aahanet.org/Library/CanineVaccine.aspx This is the AAHA site with recommendations for canine vaccines. AAHA accredits hospitals that are high achieving, high standard and work to maintain progressive standards. Their site is useful in learning many things
http://www.cbc.ca/marketplace/episodes/2013-2014/barking-mad The CBC Marketplace Episode, so you can watch for yourself (It's a half hour show... may not work in the US, though you might be able to find alternatives)
Lastly, I encourage you to do your own research. I caution you to avoid using sources that are not verified by knowledgeable or reputable people- you can always find something to go with your side of the story!
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