Vet Confidential : An Insider's Guide to Protecting Your Pet's Health

From an experienced and highly respected authority in the veterinary world comes a comprehensive must-have guide to everything you need to know to ensure high-quality health care for your beloved animal companions. Our pets mean the world to us and we go out of our way to pamper them, from gourmet cat treats to doggie daycare. We should, of course, also demand the very best when it comes to their health. But how do we choose the right veterinarian? How do we know if our pets are receiving proper medical treatment or the most effective therapy when they are sick? Remarkable progress has been made in veterinary medicine, but there is still much disparity in the health care provided for pets. Dr. Louise Murray cuts through the confusion, addresses the common concerns of pet owners, and arms you with knowledge so you can avoid substandard care. Inside you'll find information on how to choose a veterinarian what to look for during your pet's exam when it's time to seek out a specialist how to make sure your pet is protected by up-to-date technology, safe anesthesia protocols, and advanced surgical techniques proper pain management and adequate nursing care for your pet the lowdown on vaccinations the growing realm of alternative veterinary medicine the latest pet insurance plans the use and misuse of steroid medication She also gives counsel on where to turn if you suspect improper care, and provides comforting advice on saying good-bye. Vet Confidential is an honest and vital source that will help pet owners make sure that their cherished pets will live a long, happy, and healthy life. From the Hardcover edition.

Louise Murray, D.V.M., is the director of medicine at the ASPCA’s Bergh Memorial Animal Hospital in New York City. A specialist in veterinary internal medicine, she has been honored with many awards, including the Martin A. and Beatrice R. Weiser Memorial Award for outstanding research and the Carola Warburg Rothschild Human Animal Bond Award, and has been elected into the Phi Zeta Honor Society of Veterinary Medicine. Dr. Murray has appeared on national and local television, including ABC’s Good Morning America and World News Tonight, CNN’s Anderson Cooper 360 and American Morning, The Early Show, Fox News Live, and the NBC Nightly News. She has also appeared on national radio, including XM’s “Oprah & Friends,” and in print publications, among them USA Today and The New York Times. She lives and works in New York City.

www.drlouise.com

CHAPTER 1


On the Scent: Tracking Down the Best Veterinary Practice for Your Pet

You’ve decided to become an informed veterinary consumer, and this decision is going to greatly benefit your pet’s well-being. The first step toward your goal of ensuring that your pet receives the very best health care available is to carefully select a veterinarian. Just as in every profession, there can be real differences among veterinary practices. By learning what to look for (and what to avoid), you will be able to make educated decisions with your pet’s particular needs in mind. There are many excellent practices providing up-to-date, high-quality medicine, and others that are unable to offer the same level of care or have fallen behind. The key for pet owners is to possess the tools to make an accurate assessment and choose wisely.

How do I choose the right veterinarian for my pet?

There are various times when you need to select a veterinarian. Maybe you’ve just brought home a new pet (or two). Or perhaps you’ve recently moved and are searching for a good practice nearby. If your pet has developed health problems, you may suddenly find it more important than ever that she has the best care available. You may even have concerns about your current veterinary practice and be considering a change.

When you find yourself looking for a veterinarian–for whatever reason–what’s the best way to go about choosing the right one for your pet?

If you’re like most people, you have some personal preferences that may influence your choice. Maybe there’s a practice that’s in a particularly convenient location or has hours best suited to your schedule. Perhaps you feel your dog is more comfortable with a female doctor, or your cat is happier in practices that handle only felines. There may be a local veterinary hospital that your family has trusted for years, or that a friend recommends.

These considerations are indeed important, but you should also weigh some objective criteria when deciding which doctor to entrust with your pet’s well-being. If you have a choice of practices in your area, you want to use the one that offers your pet the highest standard of care and avoid those that aren’t achieving the quality of medicine you’re seeking. To help you in your search, I’ve compiled a list of questions that will enable you to evaluate various aspects of each veterinary practice you consider. The areas covered include patient care, equipment, staffing, philosophy, and how up-to-date the facility is. Using this checklist, you will gain the ability to more knowledgeably oversee your pet’s health care.

THE CHECKLIST
The checklist is divided into two sections. The first contains questions about the veterinary practice you’re considering that can be answered over the phone by a staff member. The second section contains topics that are best evaluated during an appointment. There are two worksheets at the end of the chapter where you can record the information you gather.

One option when you’re evaluating a new practice is to schedule an appointment to take place without your pet. This will allow you and the veterinarian to focus on your concerns and have enough time for an informative discussion. Also, since your pet won’t have been seen at the practice, you may feel less awkward if you decide not to return. Be prepared to pay the normal fee for the appointment, even though your pet is not present. Don’t feel hesitant about letting the veterinarian know that you are trying to pick the right practice for your pet; many parents interview several pediatricians before selecting a doctor for their children, and you, too, have every right to do some investigating.

If this suggestion is not convenient or affordable for you, you can evaluate the practice during your pet’s first visit. You probably shouldn’t expect to be able to stop by a practice your pet has never been to and speak to the veterinarian without an appointment.

What if I am too shy to ask these kinds of questions?

We all sometimes find ourselves losing our voice: at the doctor’s or veterinarian’s office or even the hair salon. We don’t want to annoy or impose upon anyone, and we feel embarrassed to speak up. Keep in mind that veterinary practices are there to serve you and your pet. You are entrusting them with your pet’s well-being, and you are paying for their services. You certainly wouldn’t buy a car or choose a vacation spot without asking plenty of questions and having a sense of what to expect. I bet you feel more strongly about your pet’s health than either of those. So ask away!

I appreciate clients who care enough to ask questions; they allow me to practice the best medicine. Always remember that a veterinarian should value a client like you and be gracious in addressing your concerns. If not, you may want to consider another practice.

What if I have concerns about my pet’s current veterinary practice?

You can use the checklist to help you evaluate your current veterinary practice and perhaps pinpoint the cause for your concern. I’m surprised by how many pet owners stay with a practice despite being uncomfortable there or dissatisfied with their pet’s care. They may not realize that there can be significant differences among practices, or they may feel awkward about leaving, particularly if they are long-term clients. The truth is that veterinarians are accustomed to clients coming and going. As professionals, they see this as a normal part of doing business. Like any other relationship, there must be a good fit between you and your veterinarian; if it doesn’t feel right, it is perfectly natural to consider a change. Your pet’s health must always be your top priority. Your decisions should be made with that responsibility in mind.

Sometimes people are unsure about how to diplomatically go about shifting their pet’s care from one veterinarian to another. If you decide to try a different practice, simply ask that a copy of your pet’s complete records be mailed to you. You don’t need to indicate the reason why you want the file, or that you have decided to take your pet elsewhere.

How can I narrow down the practices in my area?

You can start by finding out which practices are accredited by the American Animal Hospital Association (AAHA). Participation is voluntary, and whether or not a practice has chosen to be evaluated by the AAHA can be an indication of its commitment to providing a high level of care. AAHA accreditation involves an on-site evaluation to determine if the practice meets all the standards established by the association, and then periodic reviews to ensure that it continues to meet those standards. The practice is graded in many areas, including the facility, staff, equipment, and patient care. Only veterinary hospitals that meet the rigorous AAHA standards receive accreditation.

You can look for accredited practices on the AAHA’s website (www.healthypet.com) or in the phone book, or by calling local practices to inquire about their status.
TIP Another good way to find a practice in your area is to get a recommendation from an equally concerned pet owner. Ask your friends, neighbors, and colleagues for the name of their veterinarian and how they feel about the practice. But be sure to ask specific questions, such as the ones that follow. It’s wonderful that your neighbor loves her dog’s doctor, but you need to make sure the practice provides the level of care you are looking for.

CHECKLIST: BEFORE YOU MAKE AN APPOINTMENT

To see if a practice meets your needs, you can ask the following preliminary questions over the telephone. A staff member should be cheerfully willing and able to give you this information. If the person who answers the phone can’t supply all the answers, ask to speak to the office manager or medical director. Explain that you are looking for a veterinarian for your pet and that you would like to learn more about their practice. It is perfectly acceptable for them to request to return your call if they are busy.

1. How are patients in the hospital monitored during the night?

If your pet should ever require overnight hospitalization, you must be confident that he will receive adequate care. Some pets are hospitalized primarily for the purpose of cage rest–for example, an animal with a bandage, splint, or fracture who may suffer further injury from too much movement. In situations such as this, the pet doesn’t necessarily need to be observed during the night.

A pet who is ill or recovering from surgery, however, can benefit greatly from being monitored overnight. For example, the animal will be able to receive necessary medications and intravenous fluids throughout the night. Patients who are on IV fluids should receive them continuously, and this must be closely supervised. And if something serious happens, such as bleeding, severe discomfort, or deterioration of the animal’s condition, overnight monitoring can prove crucial and sometimes lifesaving.

The degree of overnight care provided varies widely among veterinary practices. Some practices are unable to provide any type of care at night; some have an employee who intermittently stops by to check on the patients or administer treatments. Other practices have one or more veterinary technicians and/or doctors treating and monitoring the patients throughout the night.

A practice that does not provide overnight care may suggest that your pet be hospitalized at another facility until she is more stable. Some practices have an arrangement whereby the animals are transferred to an overnight care facility during the night, and then returned to the practice during the day. This can be cumbersome for owners, who are generally the ones transporting their pets back and forth, but it does provide a safety net. In any case, the situation you want to avoid is one in which your pet is left alone overnight when doing so may threaten her health or comfort.

Many excellent veterinarians practice in situations where the cost of having an overnight employee is not warranted. Naturally, some smaller practices are not as equipped as larger animal hospitals to deal with very ill or postoperative patients. What matters is that the practice handles these situations appropriately by referring patients to another facility when needed. It’s crucial that the practice recognizes that the need for overnight care can arise, and that they have established a plan ensuring that such care is provided when necessary for the patient’s safety, whether at their office or at another facility. Avoid using a practice where sick or postoperative patients are kept alone at night.

Questions to ask:
How do you handle overnight care for your patients?
Is there an overnight employee? If so, is she monitoring the patients continuously, or does she stop by periodically?
Is the overnight employee either a veterinarian or licensed veterinary technician?


2. Does the practice use adequate and modern equipment?

Veterinary practices vary widely in their equipment. Still, certain types of equipment are so essential, I recommend you select a practice that has them on the premises. These four examples can be used as benchmarks to help assess whether the practice is well equipped and up-to-date.

Blood pressure equipment: Just like in people, many health conditions cause animals to develop perilously high or low blood pressure, and this relatively simple equipment can make an enormous difference in your pet’s care. For example, animals can have high blood pressure that leads to a stroke or blindness (especially those with kidney disease or hormonal disorders), and animals who are under anesthesia or very ill may develop dangerously low blood pressure. You might be surprised to learn how many veterinary practices do not have this basic item and cannot measure their patients’ blood pressure.

PCV centrifuge: A PCV centrifuge allows veterinarians to quickly measure an animal’s red blood cell level using a small blood sample called a PCV, or packed cell volume. This equipment can be lifesaving for patients who are anemic or have blood loss. For example, during surgery, an animal may lose enough blood to require a transfusion. With a PCV centrifuge, the patient’s red blood cell level can be measured immediately, instead of waiting for a blood test to be sent out to a laboratory. Without this equipment, it is difficult for a practice to safely handle such situations.

Pulse oximeter: A pulse oximeter is used to monitor an animal’s oxygen level. This is critical for patients under anesthesia as well as for those who have difficulty breathing, such as pets with pneumonia or heart failure.
Radiology equipment: Most veterinary practices have radiology equipment, but not all of the equipment will be of the same quality. For example, older machines require the X-rays to be developed by hand; newer automatic processors for film development result in higher-quality diagnostic radiographs. Poor-quality radiographs are much harder to interpret, and important information can be missed. The latest technology in this area is digital radiography, which is more commonly found in very large or specialized practices. I recommend you choose a practice that uses an automatic processor–or has digital radiography, which does not require developing.


If possible, choose a practice that has all these pieces of equipment. If this is not available in your area, choose the one that seems best equipped or best meets all the other standards.


Questions to ask:
Do you have equipment to measure patients’ blood pressure?
Do you have equipment to measure patients’ red blood cell levels, such as a PCV centrifuge?
Do you have equipment to measure patients’ oxygen levels, such as a pulse oximeter?
Do you use an automatic processor to develop X-rays? (Or do you have digital radiography?)


3. Does the practice refer patients to specialists?

There are many veterinary specialties, and at some point referral to a specialist or advanced care facility may be necessary for your pet. I’ll be discussing this in much more detail in chapter 4. For example, an animal who needs major surgery may be referred to a surgeon, one with a heart murmur may be referred to a cardiologist, and one with liver disease, kidney failure, or another organ problem may be referred to an internist.

Besides offering expertise in particular areas of medicine, specialty practice groups also provide a heightened level of care. For example, an animal who is very sick or in need of major surgery may be referred to a facility with an intensive care unit (ICU) featuring advanced monitoring capabilities and nursing around the clock.

You want to be sure that your chosen veterinary practice is willing to refer your pet, when it’s in his best interest, to a specialist or advanced care facility. Think of it this way: Referring a patient to a specialist is like passing the ball to someone who is in a better scoring position–an unselfish act for the greater good. You don’t want to be on a team with someone who hogs the ball.

You should be concerned if the practice’s approach is We don’t need to refer, we can do everything here, especially if the practice does not offer a variety of board-certified specialists as well as twenty-four-hour care. This philosophy should make you concerned about your pet’s safety as well as the practice’s priorities.

Questions to ask:
Do you refer critical patients to an advanced care facility? If so, which one?
In what situations do you refer patients to a specialist?
Do you refer patients to specialists for major surgery or advanced diagnostic procedures such as ultrasound?
Do you refer patients who have conditions that are difficult to diagnose or treat to specialists for a second opinion?


4. Are modern anesthetic techniques employed?

I cannot stress strongly enough how important this issue is for your pet. When evaluating whether a practice is using the safest and most current methods of anesthesia, there are three critical factors to look for.

First, find out the type of anesthesia that is used by the practice. The current standard of care is that patients undergoing surgery are anesthetized using one of the modern types of gas anesthesia. Only very brief procedures such as replacing a splint or taking an X-ray should be performed under injectable sedation.

TIP The two modern types of gas anesthesia commonly used by veterinarians are isoflurane and sevoflurane. Halothane, an older gas anesthetic, is not as safe. Do not use a practice that performs surgery without using modern gas anesthesia.

Second, any patient under anesthesia should have an IV catheter in place. During an anesthetic emergency, the catheter is used to quickly deliver potentially lifesaving drugs and fluids. For example, if an animal’s heart rate becomes dangerously low, a drug called atropine can be injected; if her heart stops, a drug called epinephrine can be given; and if her blood pressure drops too low, intravenous fluids and drugs can be delivered to correct this.

Third, patients should be intubated while under anesthesia. Intubation, which is the placement of a tube in the trachea (windpipe), greatly increases the safety of a patient under anesthesia. The tube delivers oxygen to the patient to keep levels adequate, and if his breathing slows or stops, or his oxygen level drops too low, the tube can be used to assist the animal in breathing. During respiratory or cardiac arrest, the tube can be used for prompt resuscitation. In addition, while the animal is anesthetized and unable to swallow or cough on his own, the tube prevents saliva, blood, or regurgitated food from entering the trachea and lungs.

Questions to ask:
What types of modern gas anesthetics are used at the practice?
Do patients have an intravenous catheter placed prior to anesthetic procedures?
Are patients intubated during anesthesia?


5. Are patients properly monitored during anesthesia?

With current technology, there are many ways to monitor a patient under anesthesia. The oxygen level, heart rhythm, and blood pressure can be measured continuously. This type of monitoring is crucial in preventing anesthetic fatalities; by warning the doctor and technician that the patient’s oxygen level or heart rate is falling, it allows intervention to occur before it is too late.

Ideally, the practice should use equipment that allows all three of these vital signs to be followed during anesthesia. At a minimum, the pet’s oxygen level and pulse rate should be monitored during the procedure by a pulse oximeter, which displays the blood oxygen level and heart rate continuously. If your pet has had anesthesia, you can ask to see her medical file, where there should be a record of her vital signs noted throughout the time she was anesthetized.

It is safest if a technician or another doctor monitors anesthesia while the veterinarian performs surgery: It’s difficult to effectively focus on both patient monitoring and the surgical procedure at the same time.

Questions to ask:
What kind of monitoring equipment is used for patients under anesthesia?
Is a pulse oximeter attached to each patient to monitor oxygen levels?
Is the equipment used during every anesthetic procedure, or only for certain patients?
Who is monitoring the patient during anesthesia? Is there a veterinary technician assisting with anesthesia, or is the veterinarian alone with the patient while performing surgery?


6. Does the practice have licensed or experienced veterinary technicians?

The laws regarding veterinary technicians vary from state to state. Some states require veterinary technicians to be licensed, similar to a registered nurse for humans; others do not. Licensed technicians receive rigorous training in many areas, including how to properly measure and administer drugs, draw blood, place intravenous catheters, take radiographs, use anesthetic equipment, and monitor animals under anesthesia.

If your state requires licensing, check to see if the practice uses only licensed technicians. Even in states where this is not required by law, some practices will have licensed technicians. The more licensed technicians they have, the better for your pet. If the practice has unlicensed technicians, it is important to find out their level of experience, since they must learn their skills on the job rather than through formal training.

TIP The first step is to find out whether your state requires all veterinary technicians to be licensed. You can do this by calling the American Association of Veterinary State Boards at (877) 698-8482, or by going to their web-site, www.aavsb.org.

Questions to ask:
If the state requires licensing of technicians: Do you use only licensed technicians?
If the state does not require technicians to be licensed: Do you have any licensed technicians on staff?
What is the level of training and experience level of any unlicensed technicians?


7. Is the practice AAHA-accredited?
As I discussed earlier, the American Animal Hospital Association (AAHA) provides voluntary accreditation to veterinary hospitals that meet stringent standards. AAHA accreditation provides you with assurance that the practice has met benchmarks in a variety of areas, including up-to-date facilities, equipment, patient care, and staffing. If there is an AAHA-accredited hospital in your area, this accreditation is a reassuring sign that the practice strives for a high standard of care.
Question to ask:
Is the practice AAHA-accredited? (You can also check the AAHA website, www.healthypets.com.)

8. How many veterinarians are at the practice?

Although many wonderful veterinarians are solo practitioners, multidoctor practices may offer some advantages.

When there are several veterinarians in an office, your pet gets the benefit of the doctors’ combined experience and knowledge. If a particular radiograph or test result is confusing, a veterinarian can confer with one or more of the other doctors, who may have encountered something similar or who are particularly skilled at interpretation. Additionally, different veterinarians have different areas of expertise. One may be adept at treating skin problems, another at surgery. Because it is difficult for any one practitioner to read every recent article or study and attend lectures on all the latest advances, you may feel more secure in going to a group where the doctors have complementary skill sets and knowledge.
In a group practice, there are also different levels of experience among the doctors, which can be an asset. More seasoned veterinarians are able to advise younger doctors; recent graduates, who tend to be very up-to-date on all the latest theories and technology, can help keep veterans on their toes. (Unfortunately, it is easy to quickly become obsolete in the practice of medicine, human or veterinary.) Unlike the situation in human medicine, veterinarians are not required to perform an internship after receiving their degrees, but can go straight into practice. Many do choose to undergo this valuable postgraduate training, however, and it is an advantage if any of the veterinarians at the practice have completed an internship program.

Some group practices have one or more board-certified specialists on staff, which is a bonus. Additionally, multidoctor practices are often able to afford more advanced equipment and a larger staff, such as overnight employees. They may have more extensive office hours as well.

Questions to ask:
How many veterinarians are in your practice?
Have any of the veterinarians completed an internship program?
Are any of the veterinarians board-certified specialists? If so, in what areas?
What are the office hours of the practice?


What if a practice does not pass every question?

The ideal practice would answer every question with flying colors, yet realistically you may not find one in your area that does so. Look for the practice that satisfies the highest number of these criteria, and also use your common sense and instincts to decide which practice seems to best meet the spirit of the standards we have discussed.

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Excerpted from Vet Confidential: An Insider's Guide to Protecting Your Pet's Health by Louise Murray
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.