Browsing tag: cost of vets

Is Paul O’Grady mad to spend so much money on his terminally ill dog?

Paul O’Grady, the comedian-turned-dog-advocate, hit the news this week when he talked about spending over £8000 in vets’ fees to treat his nine year old Cairn Terrier Olga for cancer of the kidney. The Daily Mail reports that Paul has ignored advice to have her put down, and instead he’s paying for intensive chemotherapy and surgery to keep her alive. The story has ignited a debate about veterinary fees and pet insurance: Judith Woods, a feature writer for the Daily Telegraph, has added her own tale of spending £3600 when her Manchester Terrier, Daisy, developed a rare form of kidney disease. She had her pet insured, so her feature extols the benefits of pet insurance for these unexpected occasions.
Paul and Judith are clear in their opinions, with no doubt that they have made the right decision for their own pets. It’s the online comments on the stories that are interesting, with members of the public sounding off with their own thoughts on expensive treatments for pets, and the pros and cons of pet insurance.

The Daily Mail readers’ comments to Paul’s story are mostly short and positive: “It’s lovely that he’s done this for his beloved dog”, “Good on you, Paul, you are a true dog lover” and “If I was as rich as him, I’d do the same”.
Telegraph readers have responded in a predictably more loquacious way to Judith’s feature.
First, of course, there are many “dog lovers” who are supportive of giving pets all reasonable treatment that can be afforded, accepting that high quality veterinary care can be costly, and agreeing that pet insurance can be a sensible way of budgeting for unexpected health crises. When completing a survey of attitudes to dogs on a recent trip to a slum in Delhi, I found that around 60% of the local population “liked dogs”, with 40% disliking them: I now find myself wondering if a similar proportion of attitudes exists in the UK population. For the 60% who care for their pet dogs, it’s hard to consider withholding treatment.

There are plenty of comments from the opposite side of the spectrum – perhaps the 40% who aren’t so fond of dogs. Some of these “anti-treatment” comments are worth discussing in more detail:
“All pet insurance does is persuade owners to consent to prolonged and possibly invasive treatment of their pet. Unless they own a valuable breeding animal they would be kinder and more sensible if they had a really sick pet put to sleep.”
While it’s true that it may make objective sense to have an ailing animal euthanased, when it’s your own pet, surely it’s wise to analyse the options available? Once a clear diagnosis has been made, vets are often able to give a reasonably accurate estimate of treatment, prognosis and life expectancy. If you are able to pay for the treatment (via insurance or otherwise), and if the vet can reassure you that your pet will not suffer during the process, many people conclude that the correct course of action is to give the animal extra life. Why should anyone else feel that they have the right to tell them otherwise?

“Look at the dog and think, ‘If that was me what would I want?’ Or, ‘Am I keeping the dog alive for the dog’s sake, for my sake or I do I lack the moral fibre to do the right thing?’”
I am sure that most owners look at their pet and ask these questions before making a treatment/euthanasia decision. And most vets take time to guide owners through this process. Most vets and owners would agree that if a pet has no hope of living a good quality life, euthanasia is the kindest option. And treatment for serious disease may not be as uncomfortable as people expect in pets. Treatment modalities like surgery, chemotherapy and radiation treatment are often deliberately used in lower doses in pets compared to humans, so side effects are usually less severe. Nobody want animals to suffer pain or discomfort for the sake of a few more weeks or months of life.

“These poor animals haven’t a clue what is happening to them in the vets’ surgeries, all the pain, trauma and strange smells….. people aren’t doing it in the interests of the animals they are most of the time doing it for themselves. Better IMO to let the animal have a peaceful end – a right denied to humans. And don’t get me started on animals with limb amputations.”
Anyone who has owned an amputee dog will know at once that the person who made this opinionated comment has not known any animals with limb amputations (they often have marvellous lives, with no discomfort or visible disability). I suspect he’s also had a similar lack of experience of vets’ surgeries and sick animals recovering from illness.

“I have come to the conclusion that Veterinary Surgeons generally, are individuals who parasitically feed off pet-owners emotions. The fees they charge can bear no resemblance to costs incurred. Have their charges ever been investigated? I suspect this is yet another bunch of rip-off artists. They know you will pay to save a soulmate… So they take you for an expensive ride.”

I’m sorry that this person has such a negative view of my profession: what else can I say?

“As for vets, I told my son to be either a vet or a lawyer. They make the fees up as they go along, nobody really questions the amounts and they get paid even if the client dies.”

This person should really do some proper research before making recommendations to his son. Vets’ salaries are not as high as people may expect. In the USA,  $80460 (£50824) is the median pay, with veterinary graduates struggling to pay off huge university debts. In the UK , according to this website, “the average starting salary is between £21,800 to £33,500 a year, depending on experience. Further training and experience can increase salary to £36,500 per annum. Senior vets can earn around £44,000 to £53,000+” .
So while vets may earn a substantial salary, it’s nothing special compared to doctors (Salaried GPs earn between £54,319 and £81,969). solicitors (between £25,000 and £75,000)  or dentists (between £50,000 and £110,000). And did he tell his son about the high suicide rate in vets – higher than any other profession, and around four times the national average? The job of a vet is not the easy, money-spinning dream career that some people seem to believe.

“I have heard that vets in England charge more if you have insurance, but it wasn’t made clear if this is because they run every test necessary when the insurers are paying but stick to the bare minimum for hard up punters.” 
This person probably is closer to the truth than they realise. The reason why vets “stick to the minimum for hard up punters” is that these clients are unable to afford anything else. Is there anything wrong with this?

Something else needs to be explained: this odd statement in Judith Wood’s feature. ” Vet fees have doubled in a decade, and are rising at an annual rate of 12 per cent.”
Vets’ fees per item have certainly not “doubled in a decade”, nor are they rising at 12% per year. But more advanced tests and treatments are now available to those who can pay for them, which is why the amount spent on pets may indeed have “doubled in a decade” and may be continuing to increase.
The key truth that seems to have been missed by everyone writing on the subject is this: diagnostic tests are amongst the most expensive items on the veterinary menu. The specialised machinery needed to carry out laboratory tests, ultrasound scans, x-rays, MRI scans and other work-ups can cost tens or hundreds of thousands of pounds. Yet these pricey investigations are often the only way to achieve an accurate diagnosis, which is the key fact that’s needed to decide on treatment and to predict the prognosis.

Do you want to be able to do the best for your pet if he or she falls ill? If you do, get your pet insured so that you can give your vet the go-ahead to carry out the tests needed to give you the best advice possible. And don’t listen to the “objective” scoffers who tell you that you would be better to have your pet euthanased: talk to your vet and make the decision for yourself, based on facts, not opinions.

 

 

Horses and money – is it really either/or?

With the new financial year, and the recent bad weather, everyone involved in and working with horses is trying to make money go a bit further. Among other issues, the cost of medicines is rising every month (many drugs have seen their manufacturers put the price up 10 or 15% in the last few months), and feed bills are rising due to poor cereal harvests.

As a result, I’ve put together a list of “top tips” for saving money in the coming year.

Firstly, 5 things to do…

1) Make sure you worm smart - which doesn’t necessarily mean often! Many owners still worm religiously every 6-8 weeks; however, recent studies have shown about that 80% of the worms are in 20% of the horses. If your horse doesn’t have a high worm burden, it may be a waste of money pouring expensive wormers down him every other month. In addition, the more wormers we use, the higher the risk of worm resistance – there has been recognised round- or redworm resistance to every active ingredient available in the UK, so the less we use them, the longer they’ll be effective.

The way I like to recommend people go forward is to use Worm Egg Counts – your vet will be able to do these, or will have a lab they send them away to. The test simply takes a faeces sample and counts the worm eggs in it, giving you a good estimate of the number of worms in the horse. Remember, this test can only be done in the warmer months (the worms don’t lay eggs in the winter!), and it only tests for nematodes (round and redworms). To test for tapeworms, your vet will need to take a blood sample, but this usually only needs doing once or at most twice a year.

Depending on the test results, your vet will be able to advise you on the best worming strategy, and if you’ve got a low burden, it may not be necessary to worm at all, as long as your pasture management (poo-picking etc) is decent. I’ve seen horses wormed every month come back with such low counts that we stopped worming completely and, because they weren’t mixing with lots of other horses, they were still worm free a year later. That said, I’ve also seen horses that really do need that regular dose, so it does depend on the yard, the herd and the individual horse.

2) Consider warming up with unaffiliated competitions – and beware direct debits! Skip past this one if you’re not competing – but if you are, it may be possible to affiliate part way through the season, saving money by starting with cheaper unaffiliated events. How much you save depends on your sport, and your area (down here in Devon and Cornwall, unaffiliated events are are usually perhaps half to three quarters as much as an affiliated event), but at the very least you save the up-front cost of affiliation and membership.
That said, you can’t decide to cancel your affiliation if you’ve got a Direct Debit set up to automatcally renew it (as my brother found out this year, when he accidentally rejoined BE…!)

3) Buy medicines online. This is a fairly new area, and can be controversial. However, without any doubt you can save money on prescription drugs if you buy them from a reputable online pharmacy or dispensary. If your horse needs a prescription medicine, your vet is legally obliged to give you a written prescription if you ask for it (although they will normally charge an administration fee). In general, you can get the same medicines online for about half to two thirds the price.

However, its important to make sure you deal with a reputable company: as a rule of thumb, if they don’t ask for a prescription, or they’re not based in the UK, don’t touch them. In addition, you should check to see who is in charge of dispensing the medicines at that company – if they’re legit, they’ll be able to tell you the name and registration number of the pharmacist or vet who is responsible. Having worked in this sector, there are four companies I’ve dealt with who I would consider safe and reliable to buy from (AniMed Direct, MedicAnimal, MyVetMeds and VioVet), but that doesn’t mean that there aren’t other good ones out there. Bear in mind as well that a few companies change their prices through the day, and also make sure that the price includes VAT – if in doubt, phone them up and ask!

Although it seems like a hassle, for long-term medication (like bute or Prascend) or really expensive drugs (like Gastrogard), you can make a massive saving buying online.

4) Shop around for insurance… It may be you can get a better deal from a different company! However, before you change, make sure that your level of cover won’t be affected, and remember that you are legally obliged to disclose any relevant medical history. There are a couple of very bad insurers out there, and some fantastic ones, so do your research before changing – a company with a really cheap premium but who won’t pay out when needed are a false economy.

The other option is to cancel your insurance, and then set aside some money each month in a separate acount to cover vets bills. Do your sums first, but if you’ve got several horses it can save money to do it this way, and there’s no worry about exclusions or wondering if they’re going to pay out.

5) Does your horse NEED all those vaccines? Tetanus is a genuine life-saver. However, not every horse needs every other vaccine. If they’re not competing, not mixing with other horses much and aren’t on a big yard, its worth talking to your vet about flu vaccine, and if they’re not breeding stock either, herpes vaccine probably isn’t worth it.

6) If you have any health concerns about your horse – phone your vet! Most practice do not charge for a phonecall, and your vet will be able to advise you as to whether you need a visit, and if there’s any treatment or first aid you can give. Beware of consulting “Dr Google” – its an easy way to scare yourself, because for some reason, Google always lists the most serious and rare diseases first. If you do want to check out your horse’s symptoms online before calling your vet, I’d advise you to use the VetHelpDirect Symptom Checker – but talking to your vet is likely to be even more reliable!

I once had a client call to arrange a visit for us to “sew up her mare after foaling”. We thought that she meant the mare had torn a bit, but it turned out that she thought the foal was going to come bursting out of the mare’s side like a alien parasite, and she was delighted when we were able to tell her that she didn’t need to spend the £50 for an evening visit as long as the foaling went well…

So, thats your things to do, now five things to watch out for:

1) DON’T skimp on Preventative Health. Tetanus vaccination is a genuine life-saver, and regular, routine dental care will save money in the long run. I once had to spend five hours basically repairing an 11 year old stallion’s mouth because he’d never had any teeth rasped and the hooks had overgrown so much that one day he couldn’t open his mouth enough to chew. For the previous six months the owners had been pouring expensive concentrates into this pony to try and get the weight back on, but it was due to his inability to chew properly. If they’d kept up to date with routine dental care, it would have saved them a lot of money, effort and time!

2) Be cautious with cheap paraprofessionals. There are a lot of horse dentists, chiropracters, massagers, physios and assorted back people out there. Many of them are very good, some aren’t, and a few are downright dangerous. However, it isn’t immediately obvious which is which… There are a couple of things to bear in mind when you’re calling someone out.

Firstly, it is a criminal offence for anyone who isn’t a vet to diagnose a medical problem in a horse (with limited exceptions in the case of farriers dealing with a hoof problem, and BAEDT qualified dentists dealing with dental overgrowths). This means that your insurance policy will be invalidated if they make a diagnosis and act on it; it also means that in law you have no comeback if something goes wrong. In addition, if you allow anyone except a vet to prescribe or dispense a prescription only medicine to your horse (e.g. a dentist giving sedatives), you’re both breaking the law. Remember too, even qualified physios technically need a referral from your vet before they’re permitted to work on your horse.

Secondly, it isn’t necessarily a money saving technique to call in a paraprofessional. I remember seeing one client who had spent nearly a thousand pounds on physios, back people, chiropracters and alternative therapists, all of whom had given her a different diagnosis of her poorly performing pony. When my colleague was called out, she realised immediately that the horse was lame, and dug out an abscess from her nearside hind hoof. The horse was right as rain two days later – all for the princely sum of £48 plus a packet of animalintex.

Thats not to say there isn’t a place for paraprofessionals – BAEDT dentists, farriers, qualified physios and some other practtioners can be great to work with and bring a horse right again, but it needs to be a team exercise, as we all bring our different skills and expertise to the case.

3) DON’T buy ultra-cheap feed and fodder. Cheap, poor quality hay and haylage are never a good place to save money – if you’re lucky, you’re horse will need to eat more to maintain condition, and if you’re unlucky, they’ll suffer lung and sinus problems from spores, and possibly even listeria infection from bad haylage.

4) Be cautious about chopping and changing vets - many people use one vet for vaccines and another for out-of-hours and emergencies, or stud work. Sometimes this can save you money, but it can also lead to problems – a client of mine (who also used two other local vets) nearly lost one of her broodmares to a bad reaction to penicillin. It turned out that one of the vets had noted that the horse had reacted once before, but because they didn’t know she was using the other practices, they didn’t know to tell us. Fortunately in this case the mare survived, but it just goes to highlight the necessity for good communication. If you are going to use more than one practice, make sure that everyone knows who’s involved and who’s doing what, so that we can share notes if needed. Better still, make up your mind who you want to treat your horses, so they can provide continuity of care.

Keeping horses is, by its very nature, expensive. However, with care and forethought, you can make the money stretch a bit further, even as the prices are going up.

Ask a vet online- “My 9 year old GSD has a black disk like cataract in one eye. Can it be removed safely. Would this be expensive to remove? Is this usually done by my vet or a specialist eye vet?”

Question from David Keown
My 9 year old GSD has a black disk like cataract in one eye. Can it be removed safely and what’s the prognosis for a good recovery. Would this be expensive to remove? Is this usually done by my vet or a specialist eye vet? Thanks.

Answer from Shanika Williams MRCVS online vet

Hi David, thank you for your question about the black disc in your GSD’s eye (German shepherd dog).

Firstly I will describe what a cataract is; I do not think that your dog has a cataract but an iris cyst.

A cataract is an area of discolouration in the lens of the eye, the lens sits in the middle of the eye and is usually colourless and clear, it sits just behind the iris (coloured part of the eye). Usually a cataract can only be seen without the use of specialist equipment if it is very large or the lens has dropped out of its correct position and has fallen into the front chamber of the eye.

So what is the black disc?


The black disc that you are describing in your GSD’s eye is most likely to be an iris cyst. Iris cysts are fluid filled black discs of varying size that bud off from another part of the eye. They vary in size (usually few millimetres in diameter) and can move around or are fixed in position; they are usually found at the front bottom half of the eye. I have personal experience of this condition as our family GSD had several mobile iris cysts.

Does my pet need any treatment?


Iris cysts rarely cause a problem to your pet; they are not painful and rarely have any impact of your pet’s vision so we tend not to treat them. It is however important to distinguish an iris cyst from an iris melanoma (benign cancerous growth). Iris melanoma is a condition where there is a slow growing area of black visible within the front chamber of your pet’s eye. Iris melanoma can lead to cataracts, glaucoma (increased pressure in your pet’s eye) and pain. If iris melanoma is suspected then it might be advised that your pet’s eye is removed. Most pets cope incredibly well after removal of an eye, it is considered to be better not to have an eye than to have one that is diseased and causing a lot of pain.

So I would advise that your dog is examined by your own vet and then if required a veterinary ophthalmologist (eye specialist), if it is an iris cyst then your pets prognosis is excellent. If however iris melanoma is suspected then after the correct treatment which may involve eye removal then again the prognosis is good. I hope that this answer has helped you and your dog.

Shanika Winters MRCVS (online vet)

Cost of Vets – A sad story but an important message

This week I was in a situation which made me feel angry, sad, frustrated and powerless all at once. I wanted to share it because I think it highlights a really important issue about vets, pet care and cost. However, I will warn you it doesn’t have a happy ending.
There was an appointment in evening consults for a euthanasia, which in itself isn’t unusual, but this one was for a Staffie who was only six and who hadn’t been seen for a year. The history we had was brief, she had last been seen for an ear infection but not since. So, I didn’t know why her owner’s had decided to put her to sleep; I was thinking that maybe she had been under the care of another vet for a problem which had become terminal or that this was a behavioural problem like aggression.

However, when she arrived it was quite clear what the issue was. The poor dog had a terrible skin problem; she had sore and swollen feet, a nasty infection in both ears and in places has scratched herself red raw. Despite this she was lovely, happy, friendly girl, desperate for a good fuss. It transpired that she had been like this since she last came to see us, over a year ago, but her owner hadn’t brought her back or taken her to another vet because ‘the treatment hadn’t worked’ and it was ‘too expensive’, meaning that the poor creature had been itchy and painful for all this time.

I did try to speak to the man about her condition and how we might help her. Itchy skin is a common problem in dogs and although it can be difficult to find the underlying cause, most cases will respond to treatment, which is usually inexpensive. Like many illnesses we can offer different options for investigation and treatment depending on what an owner wants and the funds available but the outcome is generally an itch-free happy dog who can go on to lead a normal life. However, in this case the owner wasn’t interested in any treatment at all. He had decided he wanted her euthanased and nothing would persuade him to change his mind.

What made me so upset about this situation was not really the fact the owner of this dog wanted her put to sleep, (although I did find this difficult when I knew I could do so much to help her), she was his dog and so it was his choice but the fact that he had allowed her to suffer for such a long time before deciding to do something about it. I completely understand that the costs of veterinary care can be a worry for some people but that is no excuse for leaving a pet to struggle for any length of time. We are quite used to working within people’s budgets and we can always explore the option of finding charitable help or arranging payment plans. However, we can’t do anything unless owners get in touch, are open with us and let us know their concerns.

So, the message of this article is; if you have a pet who is poorly but you are worried about the vet fees; please speak to your vet, be open and honest about your concerns and work with them to come to a solution which you can afford but that helps your pet. This is far, far better than leaving them to suffer, which is not only unnecessary, it is also cruel. Yes any treatment will require payment but as a pet owner it is your responsibility to provide this for your animals and we are animal lovers too and will do what we can to help!

What should vets do about negative comments on their Facebook Pages?

Most vets realise the value of social media for marketing their services, but many have reservations about the possible downside of this type of direct engagement with the public. In particular, vets are often put off interactive online activity like Facebook because of their fear of negative comments by disgruntled pet owners. Is this a genuine concern, and if it does happen, how should vets deal with it?
I’ve just had my first experience of a “grumpy customer” on Facebook and I learned a few lessons during the exchange. I’d be interested to hear what other pet owners out there feel about the way I handled it. For the sake of confidentiality, I’ve changed some of the details.
It happened on a Sunday evening: an email notification arrived alerting me to a new posting on my Facebook page: “You refused to treat a sick kitten: shame on you!”. I responded immediately, by logging on to Facebook and telling the poster that I knew nothing about the situation: we are a four vet practice and it’s impossible for any one of us to know about all events happening in our clinic. The reply came back at once: “You turned a friend away because they had no money. It’s cruel to turn away a sick, dying animal”.
I responded again, explaining that our practice had a fair policy to all sick animals, prioritising their welfare, but that in order to respond properly to the comments, I would need to find out more about the specifics of the situation from the practice during office hours. I also said that it was inappropriate to discuss confidential issues in a public forum like Facebook, and I asked the person to send a private Facebook message if they wanted to discuss it further. The person responded by reposting the public allegation that it was cruel for me to turn away a sick kitten.
I then did what I had been tempted to do from the start: I used the Facebook “nuclear” option to delete the postings and block the person making the posts. This is the first time that I’ve ever blocked someone: I like the idea of Facebook being an open forum, with as little “censorship” as possible.
I followed up the situation the following day by checking our practice records. It turned out that a long-standing bad debtor – someone who had had several hundreds of pounds written off previously because of a refusal or inability to pay – had turned up with an unwell kitten, and no money. The vet on duty examined the animal and gave advice on first aid, but refused to admit the animal for intensive investigations and treatment without some money being paid in advance. The client had no money at all with them. They were advised to seek help at a local charity clinic, or to borrow a nominal sum of money to allow us to commence treatment. We had heard no more from them until the Facebook posts, which apparently originated from one of their friends.
At the moment, it seems that my actions in deleting the posts and blocking the user have resolved the issue of having an unwanted public argument about a private matter. Facebook provides enough control for Facebook Page administrators to allow unwelcome content to be easily removed and for unwanted posters to be rapidly blocked. The automatic email alerts that are sent to notify administrators about new posts mean that as long as someone is watching incoming emails, inflammatory posts like this are unlikely to be missed.
I do have some questions. Was I right to delete the posts? Or should I have left them there, as evidence of my willingness to interact online, dealing with complaints as well as compliments?
To me, the key issue here is vets’ professional obligation to maintain confidentiality. It is not possible to deal effectively with a complaint without discussing the precise detail of the accusations, and these are often private. Even if it had been the kitten owner posting, rather than one of their friends, it would still be inappropriate. Holding a contentious discussion of this type on Facebook is like having a similar type of discussion in a busy waiting room. Suggesting that the poster sends you a Facebook Message instead is the online equivalent of asking a client into a quiet room to discuss the issue in private. This seems like a more appropriate way of dealing with an emotional situation where facts may be disputed on both sides and tempers may flare.
Meanwhile, I hope that the sick kitten is doing OK. How far should vets go to help people who don’t wish, or aren’t able, to make any financial contribution to the costs of treatment? And should people with “no money” be allowed to keep pets at all? Perhaps that’s a subject for another blog……

Part 3: Surgical Colic

As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.

This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:

1) Heart rate over 60 that isn’t relieved by injectable painkillers.
2) Dilated loops of small intestine on rectal exam.
3) Positive stomach reflux from the stomach tube.
4) A definite rectal diagnosis of a surgical problem.
5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.

We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover – there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer’s helpline.

However, colic surgery is one of the most genuine emergency operations there is – and it can be truly life-saving.

So, what causes a surgical colic? Probably the most common are:

1) Twisted bowel. If a length of bowel twists around itself, it can cut off the circulation. At this point, the gut begins to die, and unless it can be removed by surgery, and quickly, the horse will go into toxic shock and die. This commonly happens in the small intestine or occasionally the colon, but there’s also a condition where the caecum gets turned partially inside out (an intussusception).

2) Small intestinal blockages. Horses rarely eat things that get stuck in the small intestine (although it can happen). More commonly, a really heavy worm burden can simply block up the bowel; with the bowel overfull, the blood supply starts to fail, and the gut, again, can die. I once had a patient who was a little foal with a severe colic; we removed two gallons of worms from her small intestine!

3) Strangulating Lipomas. These are really common in older horses and ponies. A small, benign, fatty tumour forms somewhere in the abdomen, causing no harm at all. However, it grows on a stalk, and eventually, the stalk gets wrapped around a length of gut, cutting off the blood supply… This results in the bowel dying, as if it had twisted. Fortunately, these are usually really simple surgical procedures; unfortunately, older horses and ponies are less likely to be insured for surgery.

There are also a number of medical conditions that can mimic those requiring surgery – particularly peritonitis and anterior (or proximal) enteritis. Horses with these conditions are often referred for possible surgery because it’s very hard for the vet in the field or on the yard to be 100% certain they’re not surgical. I think that most of us would say it makes a lot more sense to have the horse at the hospital, with a surgeon on call, to make the definitive diagnosis, rather than waste time in the stable, and risk having to then decide it needs surgery when it’s still an hour or more away in travelling time from the hospital!

So, what happens when the vet decides that a colic case isn’t suitable for medical management?

Firstly, they’ll talk to you about the options. If a horse isn’t insured, or there’s no money for treatment, it is a perfectly respectable and responsible decision to decide, sadly, to put the horse to sleep rather than prolong its suffering.

Hopefully, of course, that won’t be the case. Once you and the vet have decided that referral is the way forward, your vet will get in contact with a referral hospital. If you’re very lucky, it will be one run by your vet’s practice, but in most cases, it will be a specialist referral hospital. I must say here that not every centre with surgical facilities is able to cope with emergency colic surgery – they need not only to have the facilities (knock-down box, operating theatre, recovery box etc), but also the staff (not only a surgeon, but also enough vets and nurses to take care of your horse in the vital recovery period). Your vet will have a list of suitable referral hospitals – generally, its best to send the horse to the closest one with the shortest transport time, but your vet will be able to advise you.

Making an emergency referral is simple – but only your vet can do it. A referral hospital will not accept referrals from the horse’s owner! Once you’ve made the decision to refer, your vet will call them and speak to the veterinary team on call, who will be available 24/7/365 (when I was part of one such team, we ALWAYS seemed to get our referrals at about 10pm!). They’ll let him or her know what they want done during transport – generally, they’ll describe what painkillers they want given, and what samples they want taken (don’t be surprised if your vet gives you a couple of blood tubes to take up and give to the referral team). In addition, they’ll sometimes ask the vet to put in a stomach tube and tie it in for the journey – this is to prevent the stomach from getting over-full and bursting if there’s an obstruction in the small intestine. Don’t forget your horse’s passport – legally, they do need it even when being rushed to emergency surgery.

Your vet will generally give you directions and a contact number for the hospital, and send you on your way. Remember, they can’t normally go with you, because your horse’s colic, while devastating, is probably only one of several cases they’ll have to deal with.

If there’s a problem (e.g. your horse getting distressed) in transit, call your vet or the referral number you were given – but if at all possible don’t stop unless they tell you to! Remember, you’re on your way to the best equipped help available.

On arrival at the hospital, you can expect to be met by the veterinary and nursing team. Your horse will be rushed to an assessment area, and you’ll probably be given a lot of scary-looking paperwork to sign. Generally, this comes into 2 parts – firstly, you’re signing to give consent for whatever they need to do (and remember, a lot of drugs aren’t technically licensed for use in horses, because the manufacturers haven’t paid for an official license for that drug in horses. It doesn’t mean a drug is dangerous or experimental, it’s probably used on a daily basis by the hospital. You’ll have to sign consent to use unlicensed medication – it’s absolutely routine, and nothing to worry about). Most hospitals will also ask to see your passport – if you haven’t got it, or it isn’t signed to mark the horse as “not intended for human consumption”, legally the hospital can refuse treatment (although they rarely do).

The second set of paperwork you’ll sign is a bit more pedestrian – you’ll be signing to say that you will pay for any treatment!

While you’re contemplating the paperwork, your horse will be undergoing another examination by the veterinary team. This is to establish what’s going on, and what’s changed since your vet examined him back on the yard. They may well repeat some tests – most colic conditions are dynamic (i.e. constantly changing), and sometimes the change is more useful in working out what’s going on than a one-off test. Other tests they may wheel out include ultrasound – the powerful ultrasound systems available in a hospital environment can give the vets a lot more information about what’s going on. The vets will then make a decision about what to do – don’t be disappointed or worried if they don’t rush immediately to surgery! They may decide to try a course of medical treatment first (remember, they don’t have to rush as much as your vet does – if your horse’s situation deteriorates, they can operate at a moment’s notice).

In many cases, however, they will decide to take the horse straight to theatre. If so, you normally won’t be able to follow, so I’m going to describe what happens once you’ve been gently steered in the direction of a waiting room.

To begin with, the horse will have an intravenous catheter fitted, to allow easy access for fluids and drugs. A horse with colic is systemically weakened, so will almost invariably be given intravenous fluids during surgery. He’ll then be given a premed – this is a sedative, designed to make induction into anaesthesia gentler. It will usually contain the drug acepromazine, because the use of this before surgery has been demonstrated to reduce the risks of anaesthetics.

He’ll then be led into a knock-down box: this is a special padded room, designed to make induction of anaesthesia safer. Then he’ll be anaesthetised with an injection containing (usually) a mixture of 2 anaesthetic agents, ketamine (no, it’s not a tranquilizer, it’s an anaesthetic) and diazepam or a similar drug. Shortly after the injection, he’ll go wobbly, and then quickly lie down.

Once he’s asleep, the team will swing into action: a tube will be passed down his throat to help him breathe and he’ll be moved into the operating theatre. While this was going on, the surgeon(s) will have been scrubbing up, ready to start.

Once he’s in theatre and safely ensconced on a well cushioned table (to prevent pressure sores etc), he’ll be put onto anaesthetic gas to keep him asleep.

Colic3 - SurgeryThe surgery involves a long incision down the midline of the belly. The surgeons can then have a good look through all the intestines, to find the problem. This is the exciting, sexy bit, but it’s actually pretty simple in principle: “if in doubt, cut it out”. In other words, removing devitalized (dead) bowel, emptying out anything in the bowel that shouldn’t be there (e.g. a caecal impaction), replacing anything that’s got stuck in the wrong place (e.g. an entrapment) and untwisting anything that’s tied up. There are usually at least 2 surgeons, because one person is needed to hold loops of intestines (and they don’t stay still – sometimes they wriggle around in your arms)! Meanwhile, the anaesthetist will be carefully monitoring all sorts of parameters (heart rate, blood pressure, ECG, reflexes, breathing and blood gasses can all be monitored at many hospitals) and adjusting the anaesthetic and any other drugs to give the safest and most effective anaesthetic.

Once whatever the problem was has been found and (hopefully) sorted out, your horse will be returned to the recovery room. In many ways, this is the most dangerous part of the procedure. Horses are very prone to breaking things when they wake up, so everything is done to keep it as calm and quiet as possible. Sometimes, the veterinary team will help the horse to rise, using hoists and lifts; other times, it works out better to let him get up in his own time. In either case, he will be moved into a padded room, and left in dim light, as quietly as possible, so he wakes up slowly.

Once awake, and steady on his feet, he’ll be moved to an intensive care box; he’ll almost certainly be on a drip to keep him hydrated. At regular intervals through the next 24 hours (or longer) he’ll be checked by vets and nurses. In some cases, the guts don’t start working properly on their own, and medication may be needed to encourage motility (e.g. a lidocaine drip). Although everyone gets excited about the surgery, it is this recovery period that is in many ways the most important in getting a good long-term prognosis.

As time goes on, the vets and nurses will try and tempt the horse to eat – normally, we’ll try and get him eating fresh grass as soon as possible. As soon as he is stable enough and eating on his own, he’ll be sent home – most horses do better in their own home environment, so as soon as they no longer require advanced medical intervention, they can go home. Once home, it’s important that the discharge instructions from the hospital are followed – it can be tempting to try and speed things up, but don’t rush it! Major abdominal surgery takes time to recover from.

Colic is a worrying condition to have to deal with as an owner, especially as it often seems to come out of the blue. However, if you ever have to go through it, I hope that having read these blogs, you’ll have some idea of what’s being done, and why. Remember, our aim as vets is to help your horse and, if at all possible, send him home to you fit and well.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

Thinking of getting a puppy?

Bichon Frise puppyThis week I have seen two different families who each bought a puppy with very little thought or planning and then ran into problems that caused the animals to be rehomed (with one narrowly avoiding being euthanised), as neither could cope with or afford the issues they faced. What is particularly sad is that with a little forethought and planning, all of this could have been avoided.

Before you decide to buy a dog (and tell the kids!) you must make sure you can afford them. As well as the day-to-day costs of feeding, you also have to consider vaccines, worming and flea treatment, neutering and training classes, not to mention vets fees if things go wrong. Owning a dog can cost many thousands of pounds over their lifetime, even if they don’t have any particular health problems. Pet insurance is vital but it won’t cover routine medications or surgeries. A lack of funds was what caused the problems for both the families I saw recently.

milly puppySecondly, do your research into your chosen breed and make absolutely sure they are going to be suitable for you and your lifestyle. All dogs need a reasonable amount of exercise, aim for at least an hour a day, but some require much more than others. For example, Border Collies and Springer Spaniels are popular breeds but are not always suited to family life because they need large amounts of stimulation, both physically and mentally, and can become easily bored, and potentially aggressive, without enough. Dogs which make great family pets include Cavalier King Charles Spaniels and, contrary to popular opinion, Staffordshire Bull Terriers, as they tend to be very good with people, tolerant of small children and don’t require the high levels of exercise and interaction that some breeds do.

You must also ensure that your new pet comes from a reputable breeder who has mated their dogs responsibly, ensured all the pre-breeding testing has been done, has brought their puppies up properly and are registered with the Kennel Club. The KC has come in for a lot of criticism recently but breeders who are registered with them are far more likely to be responsible that someone who has just bred their dogs for fun or, more likely, for the money. You must visit the pup at the breeders home, see where it has been living (which should be in the house and not in a shed outside), see it with the litter and the bitch (this is absolutely vital, if the breeder cannot or will not show you them altogether, it is likely they are hiding something) and good breeders will always be contactable after you have bought your dog to help with any questions or concerns you may have. If you have any worries about the breeder or feel in any way you are ‘rescuing’ a pup from them, you must walk away and, if you are really concerned, contact the RSPCA.

Charlie puppyFinally, why not consider a rescue dog? Many rescue centres have pups that need homes and will have wormed, flea’d and vaccinated them, as well as being able to give you support for neutering costs if you need it. However, although puppies are adorable, they are a lot of work and they will also have lots of adult dogs desperate for their forever home!

Deciding to buy a new pup is an exciting time but I have seen too many people rush into it, make the wrong decision and suffer heartbreaking (and expensive) consequences. By making the effort to buy as healthy (both mentally and physically) and well bred a puppy as possible, although you cannot guarantee you won’t have problems, you are giving yourself the best chance of gaining a family member who will be with you, in good health, for years to come!

Please discuss any concerns about the health of your dog or puppy with your vet, they will be happy to help. You could also check on any specific problems with our Interactice Dog Symptom Guide to see how urgent they may be.

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Pet Emergencies Happen When You Least Expect Them

A couple of weeks ago I was enjoying a Sunday afternoon walk along the seafront with my husband and our dog, when we came across a couple crouched over a small dog on the pavement. At first I thought they were drying the dog after a dip in the sea, but when we got close I could see that the dog was having a fit. I asked if I could help at all, and they were very relieved to find an off-duty vet on the scene.

Luckily all that was needed in this case was some advice and some reassurance, and the fit soon stopped. The owners were able to take him home to rest, and I advised them to phone their own vet to discuss what to do next. Blood tests to rule out certain problems would be helpful, but could wait until Monday. If the dog continues to have fits it might need to take medication to control them. If the fit had not stopped within 10-15 minutes, then an urgent call to the nearest vets would have been needed.

I have already written about fits in dogs in a previous blog, so I won’t repeat it all here. More detailed advice about dog seizures and fits can be found in the blog Epilepsy in Dogs and Cats.

Emergencies can crop up at any time, wherever you are. One tip that could help to reduce the distress in an emergency is to make sure that your usual veterinary surgery’s telephone number is in your mobile phone. If you take your pet on holiday with you, it would also be worth locating the nearest vets when you arrive and take a note of their number. Even if a problem occurs out of hours it should be possible to get help quickly by dialling the usual surgery number.

All veterinary practices in the UK have a duty to provide 24 hour cover for their patients, but the way in which they provide this may vary. In some practices, the regular staff will provide out of hours cover in the usual place. The advantage of this is having access to all the pet’s history, as well as familiar people and surroundings for the pet and owner. Other practices may share a rota with neighbouring practices. This might mean taking your pet to a different practice from your usual one, but each practice being on call less frequently can be a very efficient way of providing the necessary service. Another way is to use the services of a dedicated out of hours veterinary centre which is staffed by vets and nurses working shifts to cover all hours.

The single most important thing to remember when you have an emergency is to telephone first. Even if you know that your pet definitely needs to be seen, it will save time if you turn up at the right place and the staff are expecting you and are prepared for your arrival. In some cases, you may find that advice is all that is needed.

BrodieThe most common injuries which arise when out and about are things like cut pads, bite wounds, stick injuries and of course road accidents. Many illnesses can also have a fairly sudden onset, sometimes needing an out-of-hours visit to the vets.

Carrying a small first aid kit with you can help with emergencies such as cuts, bites or torn nails. If bleeding is part of the problem, then a temporary bandage applied just until you can get to the surgery can save a lot of mess but could also stop your dog from losing so much blood. A hankie or a sock can be very useful substitutes for a bandage, or anything clean with which you can apply pressure for a few minutes.

However, there is a risk of making matters worse if a bandage is too tight or applied for too long. The circulation may be reduced so much that tissue starts to die, so just use a bandage as a first aid measure until bleeding stops or you can get to your vet’s surgery.

The other thing that can reduce the stress when the unexpected happens is having your pet insured. This can give peace of mind by removing concerns about the cost of emergency treatment, allowing the owner to concentrate on getting their pet better as quickly as possible. Insurance policies vary in what is covered, so do compare the cover provided and not just the cost of premiums when taking out a policy.

Working as a vet seeing emergencies outside of normal working hours can be very interesting and exciting because you never know what sort of case the next one will be. As pet owners, we would all prefer not to have to make use of the emergency service but we are glad it’s there if we need it.

If you think you have an emergency please contact your vet or check your pet’s symptoms with our Interactive Pet Symptom Guide if you are unsure how urgent the problem may be.

“No! Not on the carpet!” – Vomiting in Cats

I knew it was going to be a rough day when I walked in and saw that three of my ten morning appointments were vomiting cats.  Second only to the chronically itchy dog, vomiting cats can be one of the most frustrating things we have to deal with as vets because there are so many possible reasons why it can happen.  Anything from what the cat had for dinner last night to metabolic diseases that may have been brewing for years could be the cause, and distinguishing between them can take a lot of time, money and effort.  And that’s just for the vet – as the owner of a cat that vomits frequently myself, I understand how unpleasant it is to walk downstairs in the middle of the night and step in a pile of cat sick.  Be it on the new white carpeting or the beat up old sofa, it’s not pretty.  It may be a harmless hairball, but it can also be a sign of serious illness in your cat so it’s definitely worth getting it checked out by your vet.  If you are unlucky enough to have a vomiting cat, here are some things you may want to consider.

Why do cats vomit so much?

Amber prowl cropVomiting in cats is extremely common, but that doesn’t mean that it’s normal.  Some cats are simply prone to hairballs, especially long-haired cats or those that groom excessively.  Others are particularly sensitive to the kinds of food they eat and may not be able to tolerate a particular protein such as beef or additive such as wheat gluten.  Intestinal worms can cause vomiting sometimes, and you may even see them wriggling around after they come up!  Poisonings are rare (cats have a much more discerning palate than dogs) but do occur.  Sometimes playful kittens will swallow things such as pieces of string which can be very dangerous indeed.  Metabolic disorders such as kidney disease, hyperthyroidism, diabetes and liver problems can all cause vomiting too as can tumours of the intestinal tract such as lymphoma.  Pancreatitis (inflammation of the pancreas, an organ which secretes digestive enzymes) or inflammatory bowel disease are other common causes which can present themselves in a wide array of confusing ways.  And of course there is one of my favourite terms, “dietary indiscretion”, which can describe the ingestion of anything from rancid rat remnants to last week’s chicken chow mein from the bin.  With such a huge range of possibilities, it’s easy to see how difficult it can be to find the underlying cause.

What should I do if my cat vomits?

Amber-drinkAs with any medical condition, the best thing to do is contact your vet.  They may tell you to simply starve your cat for a few hours (cats should never be starved for long periods of time though, and should always be brought to the vet if they go more than 24 hours without eating, as this can lead to other serious problems) and reintroduce a bland diet such as plain boiled chicken, as this may fix many acute cases of vomiting.  As always, fresh water should be available at all times.  Or, if your cat is displaying other symptoms such as lethargy, inappetence or diarrhoea they may recommend you bring him straight down to the clinic.  The vet will do a physical exam and take a detailed history, so try to remember as many details as you can about your cat’s behaviour in the past few days.  They may take a blood test or check the urine to rule out metabolic diseases.  Depending on the symptoms they may also choose to take some x-rays of the abdomen to look for anything that the cat may have swallowed, or perhaps perform an ultrasound scan to check for any tumours or other problems with the internal organs.  Because there are so many possible causes for vomiting, sometimes many different tests will be needed so it can become quite expensive at times.  Yet another case where pet insurance is a real plus!

How is vomiting treated?

As previously mentioned, if your cat is otherwise well, you may be asked to feed him something bland such as chicken or white fish with no flavourings or fats added.  Although dogs often appreciate rice or pasta mixed with their meat, cats usually do better without the addition of a carbohydrate.  Or, if you’re not up for cooking, there are a number of prescription pet foods available that can help as well.  If hairballs seem to be the problem, there are special pastes and foods that will help them pass through the body instead of being vomited up.  A worming tablet or liquid may be prescribed if there is evidence of worms.  An anti-emetic (medication that stops vomiting) can be given to help calm things for a bit, and sometimes other medications such as antibiotics or steroids are used as well.  If a foreign body is found (in other words, your cat ate something that got stuck), surgery will be performed to remove it.  Surgery can also be used to remove some types of tumours, or to take biopsy samples of different parts of the intestinal tract to help diagnose the problem.

Some cases of vomiting will resolve on their own, while others can require weeks of intensive diagnostics and treatments.  If left untreated, excessive vomiting can make the cat very ill and you also risk missing any underlying medical problems so make sure you talk to your veterinary surgeon right away if you are at all concerned.  But please be patient with your vet if they can’t fix the problem right away – and remember that we can be just as frustrated by it as you!

If you are worried about your cat vomiting, talk to your vet or use our interactice Cat Symptom Guide to check how urgent the problem may be.

Choosing the Best Vet Practice for your Pet

Just what do you look for when you are choosing a vet practice for your pet?  For some people it is an easy decision as there is only one local vet practice in easy travelling distance, for others it can be a bewildering  choice. A good feeling about a vet practice counts for a lot but there are differences between clinics, understanding what these are can help you to make an informed decision.  The choice will not be black and white, local vet practices will be strong and weak in different areas, it is finding the vet practice that is right for you and right for your pet that matters.

Word of mouth recommendation is a good place to start, pet owners in real life or on social networks are usually delighted to help. There is  a fairly comprehensive list of vet practices on the Royal College of Veterinary Surgeons website, you can also look at the usual local directories and, of course there is the Vet Help Direct Vet Practice Directory. We are biased, obviously, but believe our directory is extra useful as we provide information, images and, in some cases, video of the vet clinics. You can also try googling the name of the vet practice as most have websites.

Next you need to go and visit, don’t be embarrassed to explain you are choosing  a vet practice, the staff should be happy to arrange a convenient time for you to look around. Its vitally important that you and your pet feel comfortable at your vets so make sure the staff seem friendly and approachable.

Ask about the staff, do they have any special interests? Have they attended any courses recently? Are there any vets or nurses with extra qualifications? There are no right or wrong answers but it can help you to get a general feel for the vet practice. If you are the owner of an exotic animal you should check that there is a vet at the practice with experience of treating your species.

Good facilities are certainly not the be all or end all of  a vet practice but they should have the basics and it should, of course all be clean and in good working order. If I was choosing a vet practice for my dog I would want one with an opreating theatre, x-ray, ultrasound, anaesthetic and dental machines, a microscope and in house bloods (or a same day arrangement with a local laboratory), separate kenneling for dogs and cats and an isolation area. Beyond that extra facilities are nice but they can always refer you somewhere else in the unlikely event that more complex treatments are required.

The set up of the clinic is also important, are all the facilities there or do you have to travel further away if treatments are necessary? All veterinary surgeons are legally obliged to provide 24 hour cover for emergencies but it is worth asking how this is provided, is it the vets from the surgery or is the out of hours cover provided by a different practice? Whilst it may seem inconvenient to go further afield in the middle of the night don’t forget there will be benefits in seeing vets and nurses that have not been working the day before, they will also be on site all night providing round the clock care for your pet.

To save you having to look into the facilities and staff in too much detail the Royal College of Veterinary Surgeons run a practice standards scheme . Inspectors regularly check they meet the standards for their level to give you peace of mind using the practice. If a practice is certified under the RCVS practice standards scheme you can feel confident using them, but a word of caution, some practices opt out so if they are not registered it doesn’t mean that they have not passed, they may have chosen not to take part.

Prices do vary from practice to practice, staff should be able to refer you to a list of the prices of the top selling products and provide you with the prices of consultations and vaccinations. Appointment times might also be important to you if you work long hours , many vet clinics now offer late night surgeries at least once a week.

Once you have made your decision it is a good idea to register in advance to speed up care if your pet becomes ill. There should be no problem at all changing vets although its important to let both practices know what is happening so that notes can be transferred. Its perfectly acceptable and often sensible to change vets but its not usually a good idea to keep swapping around; its less stressful for the pet if they get to know the vet and premises and you can expect a better standard of care as the vet will get to know you and your pet personally.

More Useful Information

Examining your pet

Simple ways to check the health of your pet. Vets use these techniques as part of their clinical examiniation.

Medicating your pet

Arming you with the same simple techniques for stress free pill giving.

Worming & Flea Treatment

Information and advice in treating your pet for worms and fleas.