Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled “Debunking myths about “rip off” veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice.

My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it’s different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it’s an unavoidable part of our job description.

One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it’d be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn’t leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs.

We took all the usual precautions to ensure Sam’s safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end.

Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn’t feel that I could go ahead with this without permission.

While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn’t working. What should I do now?

If I went ahead, I’d be carrying out unauthorised work on someone’s pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay?

The safest legal approach would be to make a note of what needed to be done, and then to inform Sam’s owner that he needed a follow up anaesthetic in a few weeks, during which we’d tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam’s dental issues would probably not be treated, and he would suffer as a consequence.

I made an “on the hoof” decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner’s response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn’t afford more than the estimate that I had given her?

I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it.

But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated.

What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?

 …

Is your doggy going doddery? – Cognitive Dysfunction in dogs

Cognitive Dysfunction, a condition similar to Alzheimer’s, is very common in older dogs. 50% over the age of 10 year will show some sort of symptoms and this only increases with age. In the early stages these changes can be subtle and often the condition is only noticed when the pet’s behaviour becomes more severe. However, recognising and treating the condition early is vital to have the best chance of halting or even reversing the changes in the brain.

The symptoms of cognitive dysfunction will vary between individuals but can include;

Confusion or vacancy – these are often the first signs to manifest but are also the most difficult to pick up on. Affected dogs will have periods (which can initially last just a few seconds) of seeming confused or lost in familiar surroundings. In the early stages a call or command can bring them out of it but later on it can be more challenging.
Pacing or circling – again this can begin as quite a subtle problem but gradually becomes more apparent. Dogs will often move from room to room in the house, resisting all attempts to stop them or move in small circles. They can appear quite distressed during the activity, panting and wide eyed, but they won’t stop….

Ask a vet online-‘ My chinese crested wanted to stay outside, saw today his penis is hanging and the end skin colour pink’

Question from Samantha Mihlo Grobler:

Hi. Hope you are well? My chinese crested wanted to stay outside for a week now which are very uncommen for him as he lies inside the whole day. Think somewhere in the block were a female in heat. Saw today his penis are hanging and the end skin colour pink. Could he have broken it or something??? Will send photo on request. Thank you

Answer by Shanika Winters:

Hi Samantha and thank you for your question regarding your male Chinese crested dog. What you are describing sounds like a condition called Paraphimosis, this is where the penis cannot be retracted back into the prepuce (the skin in which it is normally found). This condition is an emergency and your dog should be taken to your vet straight away.

There is a bone in the penis of the dog called the os penis, this can break but is very unusual. However the resulting pain and swelling if the os penis was to break could cause paraphimosis.

Normally the penis is able to move in and out of the opening of the prepuce freely, this can however go wrong and the penis can be prevented from coming out Phimosis or from going back in paraphimosis.

If the penis becomes stuck outside of the prepuce then the tissue can become damaged, infected, cause trouble with urination and be very painful to your dog.

Why has my dog got paraphimosis?….

Hack, hack, hack – Hairballs! – Invaluable advice for cat owners

There’s nothing quite like being woken up at 2am to the oh-so-unpleasant sound of your cat producing a large hairball at the foot of your bed. Or perhaps quite so unsettling as stepping in it the following morning. Hairballs, also known by the fancy and somewhat horrifying name of ‘trichobezoar’, are something that most cat owners will have to deal with at some point. But how do they form and how can we help prevent them?

What is a hairball anyway?

A hairball is pretty much what it says on the tin – a ball of hair. Except it isn’t often in the shape of a ball, more cigar-shaped due to its passage through the oesophagus on the way out. They’re usually quite small, a few cm in length, but can be quite impressive at times. Cats have tiny barbs on their tongue that are perfect for picking up dead hairs in the coat. When the cat grooms itself, it swallows a significant amount of hair which usually passes without issue in the stools but sometimes accumulates in the stomach instead. Hairballs are, as one might expect, more common in long-haired cats and older, more experienced groomers who have more time to spend cleaning themselves each day. They also tend to occur seasonally, at times of increased shedding. Sounds like a pretty normal process, and in fact, it’s not uncommon for most cats to have a hairball once or twice a year (a spring clear-out of the stomach if you will…). But are they really ‘normal’?….

Ask a vet online-‘How often should an 8 week old kitten be using the litter tray’

Question from Janine Anne-Ruby Law:

How often should an 8 week old kitten be using the litter tray, I got my kitten on Saturday afternoon and she has only pooped twice is this normal? She seems to have settled in really well but I am a bit concerned about this help please?

Answer from Shanika Winters:

Hi Janine and thank you for your question regarding your kitten and toilet training. From what you are describing about how well your kitten is settling in to her new home and the fact that she is using her litter tray you probably have very little to worry about.

Cats and kittens will pass faeces (poo) when they receive a signal from their bowel (large intestines) that faeces are present and ready to be passed. The exact frequency with which faeces are passed will depend on each individual, their diet, and if they are stressed or have any underlying problems such as bacterial, viral or parasitic infection.

It is normal for kittens to pass faeces as often as they are fed a meal, so at eight weeks old your kitten is probably being fed 3-4 times a day and could therefore be expected to pass faeces up to four time a day, however as your kittens digestive system becomes more efficient and dealing with food and waste products this may well decrease down to once or twice a day. An adult cat would usually pass faeces once or twice a day….

Debunking myths about “rip off veterinary fees”

“Rip-off veterinary fees” were the subject of a recent poll on a vets-only website.
In answer to the question “How often does your practice receive complaints about the prices it charges?“, the results were:

  • All the time – 16%
  • Fairly often – 53%
  • Hardly ever – 30%
  • Never – 1%

So around 69% of vet clinics get regular complaints about their fees, and given that many people may feel irritated about fees without vocalising their concern to the vet, the true level of discontent is likely to be even higher. This is clearly an aspect of veterinary care that pet owners feel strongly about.

I always find this a difficult topic to discuss: as a vet, I can’t help feeling defensive, and it’s all too easy to write a self-justifying commentary. Sceptical readers may then brush off any of my explanations: “well, he would say that, wouldn’t he?”….

Information overload? – Trusting online pet advice

From the minute you bring a new pet home, as well as the companionship, fun and general entertainment there will always be a lot of questions and there will always be plenty of people more than happy to give you their advice and opinions. From your mother (always!) to the lady down the road that’s owned dogs for years, to the man in the pet shop, to your vet (listen to them!) and, of course, the internet. However, sometimes views vary wildly and it can be difficult to know who to trust.

With any health related issue a vet should always be your first port of call; either by booking an appointment or ringing for advice. A good clinic will always be happy to chat on the phone but in many cases will want to see your pet before giving you a definitive answer. This can sometimes put people off but if you are concerned enough to ring, very often your suspicions are correct and there is a problem. However, there are many simple queries that can be handled over the phone, so do pick it up! Even at night and weekends, with a single call you should be able to speak to a vet or nurse, as in the UK all practices are required by law to provide a 24 hour service.

Sometimes though, you might have questions that are more mundane or trivial or want the answer right now and that is when you will fire up Google! However, this is when things can get tricky. There are loads of brilliant sites out there giving excellent quality advice but there is also an awful lot of old wives tails, self-important pontificators and downright bonkers information as well! How do you decide which is which and what to believe?…

Are your cat’s kidneys crock? – The signs of kidney failure

Kidney failure is very common in cats, between 20% and 50% over the age of 15 will suffer to some degree. Unfortunately, it is often missed until it becomes advanced because the early symptoms are subtle and our feline friends are very good at hiding illness. However, the sooner it is caught the better

In most cases the cause for the kidney’s failing is unknown, it is just a gradual dying off of the tissue, particularly in elderly cats. If younger animals are diagnosed with the problem then can be a more obvious cause but it doesn’t often change the treatment plan.

The kidneys are the filtering organs for the blood. They remove all the waste products and toxins, sending them out in the urine. When they start to malfunction they become less efficient, these by-products stay in the body and, as they are effectively poisons, make the animal feel unwell and mildly nauseous. They are often mildly dehydrated, so it is not unlike a permanent hangover.

Feeling sick understandably means affected cats have poor appetites and to survive the body has to break down its own tissue. Unfortunately, this creates very high levels of toxic metabolites, which stay in the blood stream, make the cat feel worse, so they eat even less and so the vicious cycle continues. The toxins themselves also directly damage the kidneys, further exacerbating the problem….

Ask a vet online- ‘My 10 year old dog has a lump not sure if I should take him to the vet?’

Question from:

Sheree Lu

My 10 year old dog has a lump around the size between a 10-cent/20-cent (Australian) coin. It’s round, soft to touch and when I touch it, it didn’t seem to cause him any discomfort or pain. It’s located on one of his hind flanks, on his thigh-ish area. Like if he sits down, the lump would be on the ground but it’s not near his anus. I’m not sure if I should take him to the vet..?

Answer by Shanika Winters Online vet

Hi Sheree and thanks for your question, with any lump you find on your pet I would advise that you take your dog to be seen by your vet. I will try and explain in my answer some of the possible causes for the lump and how it can be monitored, treated or removed.

Why has my dog got a small soft lump?

A small soft lump can be caused by an infection, reaction to a parasite/foreign body, swelling in response to an injury/allergy, a tumour or a combination of these.

Infection tends to lead to an area of reddened/hot (inflamed) skin, which may then swell up as it fills with fluid/puss. An infected lump would usually appear over a few days, may be painful to the touch and might burst followed by crusting over. An infected lump may be due to a skin infection, where a parasite has bitten, where a foreign body (e.g. a grass seed or thorn) has entered or is trying to exit or maybe on top of an existing lump…

How to get your kids involved in your cat’s care

Everybody loves a kitten. They’re cute, they’re cuddly and they do lots of funny things which make great YouTube videos. Your kids may have been pestering you for years to get a kitten and at first, all eyes are on the new little ball of fluff. Over time, however, the children’s interest in the little critter often fades along with their promises to help with their daily care. Sure, you could easily care for the cat on your own, but don’t give in that easily – learning to care for another living creature is a lesson that not only your kids will benefit from, but your cat as well. Here are a few ways to get your children more involved in the care of your cat.

1. Have your child take responsibility for feeding the cat every day

Most children can learn to feed a cat, and many get great joy out of watching them eat their meals. Wet food can be fed in a different place every day – your cat will start to follow your child around the house as they choose the next spot, providing exercise and entertainment for everybody involved. Dry food can be scattered on the kitchen floor, to be chased and caught by the cat, or placed in a treat ball so they have to work at getting it out. This may sound a bit mean at first, but is actually closer to their natural feeding behaviours. Of course, you could just ask your child to put the food in the bowl every day, but that can get a bit dull after a while….

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