Oncology remains one of the most exciting areas of medicine. It is very much a specialty field, and treatment options change constantly. The holy grail of treating cancer would be a therapy that is effective, has minimal side-effects, and is cost effective. One of the most promising new treatments of the past decade has been the development of a vaccination against canine melanoma.
In human medicine, melanoma is often referred to as a skin cancer, but in dogs the most devastating forms of this disease occur in the mouth and the feet. Traditionally veterinarians have treated melanoma with surgery and radiation. In many cases this can be a very aggressive cancer and treatment failures are common.
In 2007 a new vaccination against canine melanoma was developed and released with conditional licensing. Unlike most vaccinations, the Oncept vaccine is not intended as a preventative measure; rather it is administered as a treatment to patients who have already developed advanced melanomas, and is typically used following surgery. The vaccine is administered every two weeks for four treatments, then every six months thereafter. Recently this vaccine underwent full licensing by the USDA.
Oncept is a DNA-based form of immunotherapy and works by stimulating the patient’s own immune system to fight the cancer. The vaccine is produced using a human gene for an enzyme called Tyrosinase. A canine form of this same enzyme is found on each cell of the dog’s melanoma tumor. The human form of Tyrosinase is similar enough to canine enzyme to produce an effective targeting mechanism for the immune system, but is also different enough to produce a strong immune response. When the gene is injected into the dog’s system, antibodies are produced against Tyrosinase which then target and destroy the melanoma cells.
The improvement in survival with the use of this vaccine has been remarkable. Numerous studies have now been performed on the vaccine, all of which have shown remarkable improvements in both the survival and quality of life of the dogs affected by this devastating condition. The history of the development of this vaccine is as fascinating as is the product itself.
Perhaps most remarkably, the Oncept vaccine is easily administered, inexpensive, safe, and effective. While it is not a miracle, it can do amazing things to improve the quality and longevity of life for those dogs who develop aggressive melanomas!
I arrived at the hospital on Monday to find a message from an angry Mrs. X. She had purchased an ear medication from us the week before, and then after using a portion of the bottle had decided to price shop for the item at a local human pharmacy (which stocks some veterinary medications). She found that she could have saved $5 by buying from the pharmacy, and now she was demanding that we either refund the difference or take the medication back. I explained that neither of these would be possible, and then called the pharmacy to verify their price. After wading through the phone prompts and eventually reaching a pharmacy tech, I learned that the pharmacy was quoting her for a 15ml bottle, whereas Mrs. X had purchased a 30 ml bottle from us. I called Mrs. X and discussed the error with her and eventually she was satisfied that I was not the terrible criminal that she had first assumed me to be. All of this took three phone calls and 45 minutes that I can never get back.
Later that same day I wrote a prescription for a client who needed a medication called Azathioprine. This is not a drug that we normally stock, but it was available through our drug supplier at a cost of $11.54 for 100 tablets. I explained to Mr. Y that the medication should be fairly affordable and could be found at any human pharmacy. I handed him a written prescription for sixty tablets. About an hour later a very angry Mr. Y called to say that the prescription had been $142. I called and spoke with the pharmacist, who advised me that he had no control over pricing, but added that if the client wanted to price-shop for the medication elsewhere, that he would meet any competitor’s price and would refund the difference. I called Mr. Y and relayed this information. Eventually Mr. Y found that a local “big-box” pharmacy would sell the same prescription for about $18. He drove across town to pick up a written estimate, then drove back to the original pharmacy to get his refund. Over the course of the day I spoke with Mr. Y four times, and with various local pharmacists three times, accounting for almost an hour of my time wasted, and three hours of the client’s time.
On Wednesday Mr. Z arrived with a partially used prescription that he had purchased from an internet pharmacy. After purchasing it his dog had passed away, leaving him with a prescription that had cost more than $100. Mr. Z wanted me to purchase the medicine from him, “since you can re-sell it.” To his great agitation I explained that by law we could not perform a return on purchased medications, nor could I sell a medication that I had purchased from a private individual. I further explained that since we had not been the ones to sell him the original prescription his entire request was both unreasonable and a little offensive. Mr. Z eventually stormed away and threatened to never return. The whole exchange took 30 minutes.
What do all of these stories have in common? They all illustrate the myriad of problems that arise every day, as clients try to save money by purchasing their animal drugs from sources outside the hospital. And least you think that these are uncommon examples (or merely unreasonable clients) I take multiple calls just like this every single day. So how does the veterinary pharmacy business work now, and where should you be buying your drugs?
1. Traditionally, veterinarians carried all of the medications that they prescribed. In my hospitals we have a small pharmacy, which stocks about 200 different drugs. We are required to purchase these in certain minimum quantities (e.g. a 12 pack of ear drops, a 1000 count bottle of pills, etc.). Each of these medications has an expiration date, and if we don’t sell them by the time that they expire, we take a loss on whatever is left on the shelf. For some of the less common medications (ones that unfortunately we HAVE to carry) this may amount to a routine loss of 80% of the total amount that we purchase. Our costs also include ordering, stocking, dispensing, and returns on recalled items.
2. Many human pharmacies are now competing with vets by selling medications for animals. They have HUGE “advantages of scale.” (We might purchase $100,000 in drugs a year, whereas a bigger human pharmacy might purchase millions.) They also have the advantage of bulk ordering (it takes the same amount of time to order 1 bottle of pills as it does to order 100) and they often have automated pill counters, etc. that greatly reduce the amount of labor required. You would think that the human pharmacies would be much less expensive (they can be on certain “shopped” items!) but often their prices are similar to ours. Or, as with Mrs. X, the product isn’t the same. In addition, very few human pharmacists have any training in animal drugs or animal physiology, and cannot give clients any advice on dosing, safety, etc. This often means that the clients who purchase their drugs from a human pharmacy call their vet every time they have questions. In addition the human pharmacies stock only certain “high-profit” medications. They expect the veterinarians to carry the rarely sold (and hence poorly profitable) drugs, while they sell the high-volume, high-profit medications.
3. Internet pharmacies take this process one step further by eliminating most of the overhead and all of the customer service. In addition, many internet pharmacies have been caught selling counterfeit drugs, medications imported illegally from other countries, or expired medications (see this warning from the FDA). Since there are a myriad of them, price becomes the only selling point, with clients assuming that the medication that they are purchasing is equivalent (often not true, even when buying name-brand packaged products which still may be counterfeit).
I certainly understand that money can be tight and everyone wants to save whenever they can. And for some clients, purchasing their medications outside the veterinary hospital seems to be a logical place to cut costs. But, for those clients who choose to do so, please remember the following:
a) I use high-volume, high-profit medications to subsidize the less common or very expensive medications that my clients need. Thus my markup on a pill that costs $0.01 might be 500% (that is still only 5 cents to the client!) but on a chemotherapy drug it may be 10% or less. I can only afford to do this when I sell enough of the “easy money” medications. Over the past year I have had to eliminate 20% of my total stock of drugs, because I can no longer afford to take losses on them. That means when a client needs a particular medication, I may not have it. Unfortunately far too often the human pharmacies don’t either! Sometimes this can be a matter of convenience and sometimes a matter of life and death.
b) When my client shops at a human pharmacy they are paying not only for the medication, but also (in theory) for advice on dosing, drug interactions, safety, side-effects, etc. Unfortunately, since most human pharmacists have no training in animal drugs or physiology, they can’t perform this service. (All of which begs the question why they are allowed to dispense medications they know nothing about to treat medical problems in species that they know nothing about!) This means that every day I have clients who want free advice about medications that they purchased elsewhere. Unfortunately I don’t always have the time to help them. In the past year I have seen dozens of cases where dangerous problems occurred due to medications dispensed through a human pharmacy.
c) By law I cannot take back medications once they have been sold. But, I often work with clients and credit their account, etc. if they have recently purchased a medication and cannot use it (due to a medication reaction, if the pet died, etc.). We have dozens of requests each year to do this after the client purchased medication elsewhere, and we absolutely cannot help these clients.
d) Medication costs vary tremendously (sometimes by 1000% or more…yes, 10 times!) from one human pharmacy to another. It is not my job to help the client to price shop. I do my best to buy the most affordable medications that I can, and to pass these savings on to my clients. If they choose to buy their medicines elsewhere, they need to do the comparison shopping.
e) Ditto if they are going to a human pharmacy and want to change medications because there may be one “equivalent” that is less expensive. I prescribed the medicine that I thought would be effective. I refuse to spend 20 minutes trying to explain to a pharmacist why B is not equivalent to A, just to save the client a few dollars. In the end the client doesn’t appreciate the time spent and the pet often gets a less effective drug.
f) I have no idea with most medications how our price compares to any local pharmacy or internet pharmacy. And frankly I don’t care! We price our drugs based upon our cost, plus a small markup. I don’t know what human pharmacies pay for their medications, nor do I know how they arrived at their markup/cost. (I do know that in most human pharmacies the cost charged to the client often has no relation to what the pharmacy paid for the medication!) Recently I found out that our price on Frontline (flea and tick protection) was lower than Costco’s, Petco’s, or Cabelas. I’m glad to be able to give my clients a bargain, but I didn’t set out to do so, I just sold the medication at cost plus a small markup. And after I found out that my clients were getting a bargain, I didn’t raise my prices just because I could. I try to sell at a fair price and taking advantage of someone just because “the market will bear it” seems unethical.
Just like everyone else, I shop on the internet, and sometimes I score a great deal! But I also understand the risks that I take by doing so. I don’t expect my local electronics store to give me free advice when my TV stops working. I don’t expect my local scuba shop to alter their records and try to cover my warranty when the fins that I bought online break. And I wouldn’t expect my veterinarian to spend 5-10 hours per week dealing with outside pharmacies just because I wanted to save a few dollars. It would be nice if all of my clients felt the same way!
Of the serious infectious diseases that veterinarians treat, Parvovirus in dogs remains one of the most troublesome. This is true not only in terms of the number of cases seen, but also due to the severity and frequent mortality of the disease. Unfortunately Parvovirus is largely a disease of puppies, hence owners are often faced with a substantial bill for an animal that they just acquired. Many owner cannot–or will not–undertake this treatment.
The mainstay of treatment for Parvovirus is hospitalization, along with aggressive IV fluid therapy, monitoring, antibiotics, nutritional support, electrolyte modification, etc. Properly performed it can be very effective and survival rates are often very good. This sort of intense treatment can also be very expensive. Many owners decline hospitalization and request to perform at-home treatments or desire limited outpatient care. Historically survival rates for puppies who aren’t hospitalized has been poor.
Recently the Veterinary Teaching Hospital at Colorado State University developed an outpatient treatment protocol for Parvovirus. This protocol utilizes several newer injectable medications (a long-acting antibiotic called Convenia and an injectable anti-vomiting medication called Cerenia), along with aggressive subcutaneous fluid therapy. The protocol is intended to be carried out on an outpatient basis, with owners returning daily for monitoring and treatment.
In the studies performed at CSU, patients utilizing the outpatient protocol had a survival rate of 80% (compared to 90% for hospitalized patients). Obviously this new protocol still requires a substantial amount of owner commitment and in many ways substitutes owner time for money. CSU still recommends hospitalization as the preferred treatment protocol, but acknowledges that this new outpatient protocol may make treatment more affordable for many owners.
Ask any vet and they will tell you that certain health problems are seen more commonly in purebred dogs, and are most common in specific breeds. There are even entire textbooks devoted to describing these conditions and their related treatments. While some medical conditions undoubtedly do follow genetic lines or occur more commonly in certain breeds, there have been many criticisms of the studies performed to demonstrate these genetic links. As an example, it has been conclusively demonstrated that genetics play a role in the development of certain forms of cataracts (opacity of the lens of the eye). However, there are many other causes of cataracts which are not genetic in nature (trauma, diabetes, etc.). Thus in order to study the genetic heritability of cataracts, one would first have to eliminate all patients from the study which developed cataracts for any other reason. Historically this sort of “fine tuning” has not always been performed.
The flip side of the genetic coin concerns heterosis or “hybrid vigor.” The basic theory of hybrid vigor is that crossbred animals (“mutts”) have a greater diversity of genes when compared to purebred animals. It is the repetition of certain genes which gives purebreds their distinctive breed characteristics, but it has been hypothesized that for this same reason many purebred animals are prone to genetically based medical problems. In theory hybrid vigor protects the crossbred pet from this tendency.
A recent study published in the Journal of the American Veterinary Medical Association has thrown a certain amount of reasonable doubt on this conclusion. The study, performed at UC Davis, analyzed more than 90,000 medical records, looking at 24 conditions known to have a genetic link. Interestingly in 13 of these conditions (including hip dysplasia, lymphoma, and mitral valve disease) no difference was found in the incidence of purebred and crossbred dogs. 10 of the conditions did show a higher prevalence in purebred dogs (including elbow dysplasia, hypothyroidism, and allergies), and one condition (rupture of the cranial cruciate ligament) was seen more commonly in crossbred dogs.
If there is one thing that I have learned over many years of reading medical research, is to be cautious in over-interpreting their conclusions. It is not at all uncommon for one study to show a specific result, and for later evidence to refute it. But, this study is one of the largest ever performed on the subject, and was very carefully designed and carried out. If correct, these findings will cause both veterinarians and breeders to have to re-evaluate the possible advantages (or lack thereof) of hybrid vigor.
One of the most important things that you can do to ensure your pet’s long-term health is to provide them with lifelong dental care. Ideally this would include a combination of home care (brushing the teeth, use of plaque-cleansing chews, etc.) combined with regular in-hospital assessment/cleanings, performed under anesthesia. Unfortunately far too many dogs and cats don’t receive regular, quality dental care. There are numerous “owner” related reasons for this (too busy, unable/unwilling to pay for care, unsure what services are needed, no perception of the importance of the problem, fear of anesthesia, etc.).
In some cases, however, the problem lies not with owners but with veterinarians. Dental care is a relatively new field for most veterinarians, and one in which far too many of us received substandard training. I finished vet school in 1996 at Colorado State University, one of the largest and most highly esteemed schools in the country. Most of the departments had multiple specialists working in them, assuring not only that we were provided with a good foundation in the core aspects of medicine (infectious disease, surgery, oncology, etc.) but that we also had diverse training and were exposed to a wide variety of methods and opinions. When it came to dental work, however, CSU did not have a single specialist on staff. My training consisted of performing a single routine dental cleaning, under the watchful eye of a non-specialist who also oversaw the spay/neuter program. After graduation I made it a priority to receive post-graduate training in dental charting, dental X-rays, extraction techniques, bonded sealants, etc. This additional training was voluntary and was performed at my own cost.
Given my experience, it doesn’t take much imagination to realize that many vets are practicing with little or no dental training. To make the situation worse there are far too many practices which lack even the most basic equipment, including an ultrasonic scaler, a dental X-ray machine, a high speed drill, or even good hand tools. Some groups such as the American Animal Hospital Association have stepped in and tried to establish a standard of care in the form of written Dental Care Guidelines. Other groups such as the American Veterinary Dental Society provide ongoing dental training and publish medical journals and newsletters that provide cutting-edge research and training materials.
One question that I am asked on an almost daily basis is, “Why do you have to anesthetize my pet in order to clean his teeth?” The question is a good one, but built into the question is an implied assumption that is terribly important (and terribly wrong)! The issue isn’t really the cleaning of the teeth, it is the far more important assessment that goes on along with the cleaning. Most of us go to our own dentist every six months for a cleaning and assessment. At that time they carefully probe our teeth and gums, and very often perform dental X-rays. As any human dentist will tell you, this assessment is often far more important than is the cleaning that accompanies it. The reason is simple: Three times a day I brush my teeth with a fluoride toothpaste. Several times each week I floss. Before bed I use an antiseptic mouthwash. Thus at my semiannual cleaning the hygienist is removing a minimal amount of calculus both above and below the gumline. However the probing and X-rays that accompany this cleaning are very, very important, since they serve as the only way to detect dental disease early enough that it can be easily treated.
Compare your own standard of care with that of your dog or cat. Most owners don’t brush their pet’s teeth. I have never met an owner that could floss their pet’s teeth. And very, very few owners are having oral assessments performed every six months. Thus animals tend to have a lot of undetected and untreated dental disease. (Various studies have shown that 50-80% of cats and dogs have either dental or periodontal disease.)
All of which gets us to the issue of whether anesthesia is necessary in order to provide dental care to animals. In a nutshell, yes, yes, yes! Getting back to your visit to your dentist, you may have noticed that when the dentist or hygienist probes your mouth, it hurts! Depending upon whether you have a healthy mouth or existing periodontal disease it may hurt a little or a lot, but it always hurts. No animal that I have ever met will allow a full and adequate probing of the teeth (particularly the inner aspect of each tooth) awake. Add to this the problem that even if you could probe effectively while an animal was awake, you could never successfully take dental X-rays.
You might think that all of this would be a no-brainer, but unfortunately there is a growing problem with veterinarians trying to perform “anesthesia free dentistry.” So prevalent has this problem become that the American Veterinary Dental College (the group that trains and oversees dental specialists) has labeled this procedure “Non-Professional Dental Scaling” and has taken a formal stand against it. Even the American Animal Hospital Association has issued a formal warning against it (Mandatory Dental Standard) and is now refusing to certify any hospital that continues to offer this service. However the problem continues to grow and now there are veterinarians offering this service in traditional hospitals, in pet stores and vaccine clinics, and even in mobile practices set up just to provide this service. In some states there are vets working as independent contractors, who come into traditional practices on an “as needed” basis, so that now non-professional dental scaling is available where it never would have been previously. Why? First, this is a large and lucrative market. Many owners are afraid of anesthetizing their pets (often unreasonably), or are attracted to being able to save hundreds of dollars by not performing anesthesia. Second, few owners understand just how important it is to assess and treat beneath the gumline, nor just how difficult it is to assess this area when an animal is awake. Non-professional dental scaling is a purely cosmetic procedure, and is best compared to painting a house with dry rot; it may look great when you get done, but the home is still decaying.
The photo at the top of this article shows a dental X-ray of a tooth with a severe root abscess. This tooth looked fine from the outside and the owner had no idea that their pet had a problem. Unfortunately, neither did the veterinarian who cleaned his teeth just a few weeks before this X-ray was taken. This big abscess was missed because the cleaning was performed with the patient awake, and a thorough examination of the mouth was never performed. For less than a hundred dollars the owner was given the peace of mind of having a new coat of paint thrown on top of their termite-infested house (metaphorically speaking). They went home happy and their dog’s teeth looked great…until a draining hole developed on the side of his jaw a few weeks later. He underwent a dental cleaning, a full assessment, and full-mouth dental X-rays at hour hospital, leading to the extraction of six abscessed teeth. When we were done, his mouth was truly healthy and pain free–something that the anesthesia-free procedure couldn’t provide.
Dr. Maloney pursued his undergraduate training in molecular biology at the University of Chicago, received his doctorate in veterinary medicine from Colorado State University in 1996, and pursued an MBA from California Lutheran University after completing vet school. Prior to moving to Idaho he worked in various critical care practices in southern California and later served as the medical director of the multi-hospital Central Valley Veterinary Group in Salt Lake City. In 1999 Dr. Maloney moved with his family to Boise and purchased Mountain View Animal Hospital, which he continues to own and operate. In 2008 Dr. Maloney purchased Orchard Animal Hospital, serving as medical director of the two facilities.
In 2006 Dr. Maloney was certified as a specialist by the American Board of Veterinary Practitioners, Canine and Feline Practice. Currently he is one of only 2 veterinarians in Idaho to have met this certification. He has practice interests in pain management and oncology, and is an active member of the Veterinary Cancer Society and the International Veterinary Association for Pain Management. Recently the IVAPM announced that it will begin to allow veterinarians to become certified in pain management, and Dr. Maloney is now pursuing this training and specialty certification.
Both Mountain View Animal Hospital and Orchard Animal Hospital are certified by the American Animal Hospital Association, a stringent voluntary certification that has only been achieved by seven hospitals in Idaho. To reach AAHA accreditation a hospital must meet strict guidelines for equipment, training, staffing, medical protocols, record keeping, and in addition must undergo a regular physical inspection.
In his free time he enjoys scuba diving, braiding leather, gardening, outdoor sports, and spending time with his wife and his five children. He is active in a local Boise church and performs volunteer work in Scouting and with the Family Advocacy Program. He owns two dogs, four cats, several snakes, and a horse.
Robert Heinlein once famously said, “Women and cats will do as they please, and men and dogs should relax and get used to the idea.” While I won’t claim to understand female behavior, there have been many advances made in the past few decades that have helped up to understand how cats think.
Among the more interesting aspects of feline behavior are the myriad ways in which cats interact with one another. Cats are, by their nature, solitary animals and do not always do well when forced to co-mingle in the multi-cat households that so many of us keep. Studies have shown that in many cases in a multi-cat household you actually have a number of solitary animals that happen to be sharing a common territory, rather than any sort of true “pack” situation such as dogs exhibit.
One way in which casts inter-relate is though the use of pheromones, secreted hormones which other cats can smell. If you are unfamiliar with pheromones, check out this good description from Wikepedia: Pheromones and Animals. There are several products on the market which recreate cat pheromones synthetically, allowing owners to manipulate the pet’s environment in order to reduce stress or change stress related behaviors. Some of the best known of these are the Feliway products, which are available in both a spray form and as room diffusers (similar to fragrance diffusers). These products all mimic the feline facial pheromone. If you watch cats as they interact with their environment, they often rub the side of their face (the area covered by the whiskers) against objects. This is believed to be a marking behavior, as they deposit their facial pheromones onto the object in question.
Feliway products may be used in a variety of situations (moving to a new home, bringing new furniture into the cat’s environment, bringing a new pet or a new baby into the cat’s environment, taking your cat to the vet, etc.) to help reduce both the cat’s stress level as well as to reduce some of their stress related behaviors (urinary marking, “scratch” marking, aggression). We commonly use Feliway in-hospital when handling fractious cats. Studies have even been done to show that its use can reduce stress associated with surgery and to improve surgical outcomes!
Feliway products may be used as a direct spray on any solid surface on which you may discourage territorial urinary spraying or scratching (caution: may stain fabrics). The spray products are typically reapplied daily. If you have a larger area, consider the use of the room diffusers, which will effectively treat a 500-650 square foot room for up to 30 days. This is a great way to set your cats up for success when introducing a new pet into your household.
Yesterday I spent five hours having the final work done on my tattoo. At the ripe old age of 42 I began to contemplate what my next midlife crisis would be. The last one (bull riding, age 35) resulted in a fractured collarbone and a dislocated shoulder, plus a stern warning from my girlfriend (now wife) that if I did it again, she would finish what the bull had started. Now on the horns of a dilemma (pun intended) I contemplated buying a motorcycle (too expensive), having an affair (ouch!), or possibly sky diving. I finally settled on a tattoo, having decided that my bulging pecs (not!) would benefit from some “ink.” The design (a tree of life surrounded by a manta ray) was drawn by my son Jesse, then redrawn, smoothed out, and brought to life by Nick Wallersted of A Mind’s Eye Tattoo in Boise. I had the outline done in July, and returned yesterday for all of the fill-in work.
Nic is a philosophical gent, and when he is not creating art, he spends his time on various animal rights causes. While he was using me as a human pin-cushion we talked at length about various aspects of the animal world, and finally settled into a discussion of “necessary” and “unnecessary” aspects of veterinary medicine. To me this is a particularly interesting subject, since I spend a great deal of my life talking to clients about what they should, and shouldn’t do with their animals.
I think that many clients look at their vet with a certain amount of skepticism, much as they might look at a used car salesman. “We want the best for Fluffy,” they say, but they don’t want to perform annual parasite testing, don’t want to use a heartworm preventative, and don’t want to perform bloodwork before anesthesia. Frequently clients say, “He’s my family,” but then they will take risks with their pet that would never be acceptable with a human child. So, in a client’s eyes, “unnecessary” often means, “I just don’t want to pay for it.”
The flip side of this issue is that there really are unnecessary procedures which are often recommended and performed. By this I don’t mean harmful things, although when I was practicing in California I did run across one vet who was performing unnecessary surgeries. Rather I am thinking about those little “add-ons” that make money for the practice, but which don’t really help the pet in any meaningful way. Some years ago I worked for a vet who insisted that every pet who was started on any medication should first be given an injection. If he used an antibiotic, the pet would receive an antibiotic injection first. If he used an anti-inflammatory, he always began with a shot. Now, this isn’t harmful medicine, but in most cases it is unnecessary. Most antibiotics will reach good blood levels in a few hours, about as quickly as will the same drug given as a subcutaneous injection. The injections were a big source of revenue for the practice, and a way to make extra money without creating any ill will. Most clients readily accepted the idea that it was a good idea to start with an injectable drug, and so he was able to pad his pocket while still practicing medicine that no one could really criticize. Except that it wasn’t medically necessary.
Again while I was practicing in California, I worked for a veterinarian who added on a “California OSHA” fee to every invoice. Compliance with OSHA regulations is certainly not always fun, and can occasionally be costly, and had he been trying to recoup the cost of some major upgrade to the hospital that he had been forced to make, I may have been more understanding of this fee. As it was, he had decided that this was an easy way to make a little extra money on the side. Every client was charged $5.00, and this showed as a line item on the receipt. Most clients accepted the charge without comment, and the few that did question it were quickly silenced with the line that “compliance with California’s OSHA rules is very expensive, and we pass that fee on to our clients.” The only problem was that this wasn’t true. With 6500 clients a year, and a average visit rate of 2.3 vists/year, this vet managed to overcharge his clients by $74,750 each year. Certainly that would have paid for a lot of OSHA compliance, had that really been where the money was going.
By this I don’t mean to imply that most vets are dishonest. Rather it has been my experience that the vast majority of veterinarians work very hard, and aren’t paid a fraction of what they should be given the hours that they work, the amount of student loans that they have to borrow, and the number of years that they spent in school. But, our clients trust us, and that trust is a sacred obligation. We know more than they do about their pets and about medicine, and that knowledge allows us to help guide them as they make choices about their pets’ care. Given that level of trust, it is critically important that we always act as an advocate for their pet, and recommend exactly what is necessary, but also only what is necessary.
Sometimes an idea comes along that is so simple and yet so brilliant that all of us think, “Why didn’t I think of that?” (The answer, of course, is that not all of us are brilliant!) Toegrips are just such an idea.
Every day I see older pets that have difficulty walking and standing on slippery surfaces. Sometimes this is due to arthritis and sometimes due to neurologic weakness. Many of these dogs are very uncertain of their footing in the hospital, and owners report that this is a constant problem in their homes. I have had many owner compensate for this problem by carpeting their entire house, or placing rugs everywhere that their dog goes.
ToeGrips are a much more simple and elegant solution to the problem. Designed by Dr. Julie Buzby of South Carolina, they utilize an inexpensive natural rubber product to increase friction between the pet’s claws and the floor. According to their website:
“Dr. Buzby’s ToeGrips are the only product on the market that use dogs’ natural bio-mechanics, by providing traction through their toenails.
Dr. Buzby’s ToeGrips are natural rubber cylinders that slide onto a dog’s weight-bearing toenails, adhere by friction, and create the GripZone.
As seen in the illustration, the rubber cylinder fits snugly on the dog’s toenail. ToeGrips create contact with the ground at the GripZone, just behind the bottom of the nail tip. The nonslip material grips the floor in a way your dog’s hard toenails cannot. ToeGrips provide instant traction for dogs on hard-surface floors and stairs, such as wood, tile, linoleum, marble, etc.”
If you have a pet that would benefit from improved stability, check out the ToeGrips website, which has a wealth of instructional videos explaining the mechanics of the product, how to measure the toenails to ensure a good fit, how to install ToeGrips, and the history of their development. ToeGrips can be purchased directly from the website.
Not to be overly politically correct (a concept that I despise), but I like the term “companion animal.” Now don’t get me wrong; this is not going to be an article arguing for more animal rights, or suggesting that pets should be guaranteed of some sort of legal status (that will be fodder for a future article). Rather I am pondering the possible roles that a pet may play in an owner’s life. In more specific terms, people interact with their pets in a continuum that ranges from outright neglect to true companionship.
This is a picture of Banner, who is my constant companion. As a vet I have the privilege of having every day be a “take your pet to work day,” and I take full advantage of that opportunity. Not only is she with me at work, but on my days off she never misses an opportunity to go for a drive, go for a walk, or do anything that I am doing. Throughout the summer we go “otterdogging” (swimming…Notice her sleek and otter-like build). She arises with me in the morning and falls asleep on my bed as I read at night. Were she a metaphorical orange I believe that I could say that I squeeze every drop of possible enjoyment from her each day. And, that is how I believe it should be.
Every day in my chosen line of work I interact with pets, and their people. And every day I am struck by how few owners really enjoy their pets, in the way in which it is possible to really gain pleasure from pet companionship. Even more, I am endlessly amazed at what passes for quality of life in such a relationship.
So here is a “top 10″ list of my gripes about what I see:
1. Pets that are matted, or smelly or both: I’m betting that they don’t feel good and the owners don’t enjoy petting them, holding them, etc.
2. Animals with mouths that smell awful: Animals interact with the world through their mouths, and where there is odor there is often pain! At least once a week I see a pet whose mouth I can smell as I come through the door. Daily I see pets who are well past due for dental work.
3. Dogs that are aggressive: Yes, I know, your pet was “abused” before you got them (that too will be the subject of a later article), but how much do you really enjoy your dog when you can’t take them out in public? And don’t get me started about owners who get bitten by their own dogs! Most aggression is a treatable problem, but few owners with aggressive pets are doing anything about it.
4. The outdoor-only dog: Look, this isn’t a piece of machinery that you can store in the garage until you want to use it. This is a living, breathing animal that is hard-wired to need constant companionship.
5. The pet with untreated arthritis: Unfortunately many dogs and cats become stiff and painful as they get older (don’t we all!). But the pet with untreated pain is not only uncomfortable, they’re not the companion that they could be.
6. The obese pet: Ditto for everything said about arthritis. Fat is not fun (nor is diabetes, breathing difficulty, arthritis, or the host of problems that follow obesity).
7. The “too old to treat pet:” Many owners have an arbitrary point at which they decide that their pet is too old to treat for a given medical problem. “Oh, I don’t want to do any dental work on Fluffy. After all, he’s 9. I mean, I’d do it if he was 3…” In my opinion this is often a convenient excuse for owners not to provide the care that their pet needs. As I see it, if your companion is still alive, they should be provided with care!
8. The “just a dog” scenario: A surprising number of owners don’t get vaccines performed, don’t use heartworm preventative, won’t have dental work performed, won’t have regular examinations performed, etc. Their reasoning is that they don’t want to put more than a minimal amount of money into a companion, who in many cases they don’t really care about!
9. The chronic problem that “just came up:” Ask any vet about the tumor that “just came up” and you will get a chuckle. It is unfortunately common for us to be presented with a medical problem that clearly has been brewing for weeks or months, by an owner that just noticed it. Come on, folks! Did you really not notice the grapefruit-sized mass until today?
10. Untreated end of life issues: Not to step on anyone’s toes here, but chronic pain=chronic misery. If your pet is painful, you should be doing something about it. Pain management in animals has made huge strides in the past few years, but far too few animals are the recipients of these advances. And at some point, uncontrollable pain is a reason to let your companion go. Euthanasia is a gift of kindness when quality of life is gone. Ditto for chronic weight loss, blindness, tumors, skin lesions, ear infections, etc.
My challenge to you is to look at your own pets and ask yourself if you are fully enjoying their companionship. I know that not everyone can take their pet to work with them. But how often do you walk your dog? How much time each day do you spend actually playing with them? Sitting on the couch while they sit at your feet is not quality time! Do they have untreated medical issues that are adversely affecting how much they enjoy life? If you are going to share your life with pet, make them a companion, not a piece of furniture in your house. I’d like to know how those of you reading this blog feel about your own pets. And be honest. All day long I see owners whose pets fall into one or more of the categories above, who insist that their pet is their family. For the record, my kids don’t have matted hair, or bad breath, or untreated medical issues. And neither do my pets!