The Vetpodcast - Talking About Animal Health

Welcome back to another episode of Better Work Stories by The Vet Podcast. I'm veterinarian, Dr. Bryan Gregor. Now, relaying bad blood results to clients can sometimes be difficult and stressful for veterinarians. But this [00:01:00] discussion with a client just takes the cake. Can you imagine, or more likely not imagine, What was going on inside this poor old guy's head?

This is, this is one of these situations where you really have to wonder what the client was thinking. It was a busy afternoon and I got a phone call from my receptionist, got a call from my receptionist and she said that Mr. Smith's on the phone and he would like to talk to you about his. Yep, that's fine.

Flick through my files and found a file there for a cat belonging to Mr. Smith. Now these cat results, blood results, didn't look particularly good. They indicated end stage kidney failure. The cat was stuffed, not too much to do so. Picked up the phone and, uh, Mr. Smith, how are you got through the normal pleasantries?

He says, right, tell me about the blood results. So I said, look and went through them. The kidneys aren't that flash and went through all of the parameters and anemia and all this sort of thing. And he was okay. So what do we do about that? I put on my best bedside manner and said, um, look, I think. Probably the best thing that we can consider would have to be euthanasia.

I think it's just the kindest. It's going to stop any suffering, which is if not happening already, will be happening soon. There was a stunned silence on the phone. Nothing. It was just dead. About 10 seconds, 15 seconds later, he came back to me and he said, Can you do that? And I said, do what Mr. Smith? And he said, Euthanasia.

And I said, yeah, of course, euthanasia is not a problem at all. Um, we can do it whenever you want, actually. And my advice would be sooner rather than later. Again, a stunned silence. And I said, Oh, do you want to book that in? Or do you just need to have a think about it or have a talk to the family? And he says, Oh, look, I would actually really, really like to talk to my family about this.

This is a huge step. I did two things. One, I didn't know you could do that. And two, I wasn't expecting these results from the blood tests. All I did was called into the doctor for my regular six monthly blood tests. And I said to him, hang on a minute, what do you mean called into the doctor for your six month blood tests?

And he says that, well, I called into the Highfield Medical Center to get My blood test taken. Then the penny [00:04:00] dropped. We are the Highfield Veterinary Center and just by coincidence we had run some blood screens on a cat belonging to a Mr Smith and this poor old bugger thought that I was suggesting that he be euthanized.

Better work stories everybody.

If you are a veterinary professional and you have your own better work story, why don't you email me at [email protected] or search your socials for vetpodcast. If you can, why not tell the world? Better work stories, eh?

After almost a year off (for reasons you will find out in the podcast!) I am back. I am Dr Bryan Gregor, a veterinarian from New Zealand. During my long life as a veterinarian, I have seen a lot of weird, quirky funny and just down right bizarre stuff! This is just one of them.
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When undertaking a scientific study on the efficacy of CBD in pain relief in dogs an issue that didn’t occur to me was the problem of getting the CBD across state borders in The USA without being tagged as a drug dealer. The answer – move the study to Canada.

We again catch up with Dr Kelly Diehl, Senior Director of Science & Communications for The Morris Animal Foundation to find out about some of their latest studies including:

·         The efficacy of CBD in pain relief in dogs

·         A hiding place for cats

·         Who cares for the carer? What is the effect on the wellbeing of being an emotional support dog on the dog?

·         An upcoming study on haemangiosarcoma

For more information on these studies and mamny more visit The Morris Animal Foundations website:

https://www.morrisanimalfoundation.org/

or listen to their Podcast "Fresh Scoop"

https://www.morrisanimalfoundation.org/articles?animal_type=All&topic=496

Having spent my working life in veterinary practice, a lot of it as a practice owner, I am well used to comments about how much veterinary services cost, some in jest, some in shock and occasionally some in anger. Is this fare criticism though? Let’s take a closer look.

Often the comments are in jest. I have been introduced a few times as “this is Bryan Gregor, my vet, the richest man in Timaru”.  I don’t think so. There is this perception that veterinarians have a license to print money. Another comment I sometimes hear is “it costs me less to see my doctor”. 

I will put this comment to bed straight away. At least in New Zealand, human medical expenses receive a government subsidy. The doctors fee, blood tests, xrays and medicines all have a large proportion of the expense covered by the government. Although this may not occur in every country, I am led to believe that it is common enough, so as the saying goes, you are not comparing apples with apples when you put the cost of veterinary treatment beside human treatment, and to reinforce this further, an ovariohysterectomy or spey of a female dog may put you back something like $350 dollars in New Zealand. Compare that with the human hysterectomy surgery which is pretty much the same surgery. I have seen a cost of $13 000 -$15 000 mentioned. 

So, lets pare back the veterinary fee and see where it goes. The kind of figures bandied around are approximately as follows. In New Zealand 15% of the fee is GST which is the equivalent of the VAT in England. About 20% pays the veterinary nurses, receptionists, and other support staff. About 20% pays for drugs and other items used in treatments, 20%ish pays for clinic overheads like the lease, insurance and management leaving about 20% as the vets income. To follow this through, if the vet didn’t actually charge for their time, the veterinary fee would only decrease by 20% so a $500 charge would only drop to $400. 

I do agree that sometimes vet bills may appear more expensive than they used to so lets look at what may have happened. When I qualified as a veterinarian, and bear in mind that this is almost 40 years ago, veterinary medicine was relatively rudimentary. Our companion animal pharmacy only really consisted of a few antibiotics, cortisone, eye and ear drops and an old anti-inflammatory called phenylbutazone. I am probably oversimplifying this but you get the point. Although blood tests were available from the commercial lab, it would take up to a week to get the results by the time the samples were put on the bus that only left the small town I first worked in twice a week. The tests were run at the lab and the results mailed out so it took upward of a week. The animal would be better or dead by the time we got the results so normally we didn’t bother. 

Anaesthetics were fairly crude, often just using intravenous barbiturates. Qualified veterinary nurses or techs were not a thing, and anesthetic monitoring was the exception rather than the rule.

You get the picture.

So these days the scope of what is available as far as veterinary treatment goes has advanced by light years. Drugs are unrecognizably advanced, but unfortunately, they come at a cost. The drug companies are always going to want to recoup their R & D spend.

It has now become the expectation that clinics will have their own in house blood analysers, ultrasound machines, x-ray – both general and dental and more practices are now investing in CT scanners. These devices have gone from being a nice to have to a must have. I probably don’t need to say but a lot of them are quite expensive with clinics often having hundreds of thousand of dollars of gear. Unfortunately, they have to be paid for.

Added to the client expectation, government and professional expectation is that practices utilize these ancillary tests. A simple example of this could be an unfortunate aneasthetic death. If a complaint is made and investigated by the regulatory authority one of the first couple of questions would most likely be “was there pre-anaesthetic blood testing done” and what monitoring was undertaken during the anaesthetic” which these days should include heart and breathing monitors, possibly an ecg, respiratory rate and the like. All requiring monitoring equipment and trained staff to operate them. 

There is a term that is used by most medical professions. Defensive Medicine. That equates to covering your backside. If something goes wrong or if a client doesn’t like what you have done have you done everything you could have done to prevent the event, and have you recorded it. Now the cynic in me says that defensive medicine can lead to over diagnosis and without a doubt, an increase in cost to the client.  

There is no doubt that the increase in knowledge, diagnostics and available treatment comes at a cost but…. There is also a great benefit as far as results. If you know what you are treating and have the drugs or surgical techniques to get a good response this has to be a good thing, right.

This increase in veterinary costs does throw up a huge ethical dilemma that vets and owners have to wrestle with. Vets by their nature want to do the best by the animal and the owner. What do you do if the owner cannot afford to pay for treatment? As veterinarians our first responsibility is to prevent suffering. If the owner cannot pay for the treatment unfortunately the course of action may not be very palatable to the owner. Some clinics will have a fund they can use at their discretion to cover some of the cost for some cases. This may have come from a bequest from someone or a fund set aside by the practice. Some clinics will take over the ownership of an animal, cover the costs of treatment and attempt to rehome it. In some areas there are charity organizations that may be able to help, either financially or some even have there own veterinarians and may be able to offer a subsidized treatment. And then of course there is the tragic situation where the only option in euthanasia. This is absolutely a no win for everybody concerned.

Of course, there are other factors that affect veterinary fees. Geography is often mentioned. Rural verses urban. In my opinion this is not a big one. There are a couple of forces cancelling each other out. It may be harder to attract veterinarians to some rural areas meaning they are paid more. As I have previously commented on, veterinary remuneration probably only makes up 20% of the fee. On the other side, the overheads of the practice are probably lower. There is often more competition in urban areas, so I am not convinced about this urban vs rural thing.

So how can pet owners keep their veterinary expenses to a reasonable amount. I know that there has been a lot of discussion on vaccinations but in the veterinary context, there are a number of potentially fatal conditions such as parvo virus, rabies and distemper which have really effective vaccinations available. Make sure your pets’ vaccinations are up to date. This is money well spent.

If you have a car, you probably get it regularly serviced. Get your pet serviced. Regular check ups which are often associated with a vaccination booster will often detect health issues early. It is often much less expensive to treat a condition in the early staged and probably will have a better outcome than when it really gets established.

Don’t skimp on the diet either. Be sure to feed a good quality balanced diet. Talk to your vet about this.

If you are getting a pet please please please do a budget first. Find out howe much it is going to cost to feed it. To house it and consider health care costs. 

Also do your homework on specific issues your potential new pet may have. Are they prone to arthritis, breathing issues, specific cancers and any other conditions. Truthfully, some breeds are a lot more expensive to run than others. 

I will finish off with pet insurance. This has become quite common place. If you have pet insurance it takes a lot of the financial stress out of any decisions if your pet gets sick. Just a word of warning though. There are policies and policies. Read the fine print before you sign.

So are veterinary fees expensive? Possibly. Are they justified? In my opinion yes and I hope that this has helped to explain some of the factors that influence the cost of your pet’s veterinary care.

Unfortunately, the veterinary profession can really take a toll on the mental health and wellbeing of those in it. In this episode of The Vetpodcast I have a frank discussion with Canadian veterinarian Dr Marie Holowaychuk who is a passionate advocate for veterinary team wellbeing. Marie is CEO and founder of Reviving Veterinary Medicine  and host of the  Reviving Vet Med podcast. If you are an animal health professional, you probably owe it to yourself to listen to this discussion.

If you require guidance or help with your mental wellbeing, many veterinary associations provide free counselling services including The NZVA Wellbeing Hub, The Canadian Veterinary Medicine Association Veterinary Health and Wellness Resources  and The Australian Veterinary Associations Thrive wellness Initiative.  

Following the disastrous floods that have hit the north of New Zealand following cyclone Gabrielle last week, I think it is opportune to revisit a podcast I recorded a year or so ago with Sue Kinsella and Alison Vaughan from RNZSPCA. If you have the responsibility of looking after animals, you should listen to this!

“Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill”  A quote directly from The World Health Organization.

This isn’t hyperbole, this is potentially our future (as if there aren’t enough other things to be concerned about!). And then we have the British Health Secretary giving her left over antibiotics to family and friends. Really!!!

In this episode of The Vetpodcast we discuss antimicrobial resistance.

One of the givens in this world is that things never stay the same, we are always learning and we are always improving. This is as true for the veterinary profession as it is anywhere else. The information changes are based on must come from somewhere though. 

Many of us will be aware of the change in recommendations as to the timing of desexing dogs. When I trained it was almost written in stone that it was by 6 months. It would now appear that the timing isn’t quite that simple. Early spey and neutering has been associated with an increase in non-traumatic orthopaedic injuries. Where did this information from?

One of the major studies the updated recommendations are based on is The Golden Retriever Lifetime Study run by The Morris Animal Foundation (https://www.morrisanimalfoundation.org/) 

The Golden Retriever Lifetime Study is one of the largest, most comprehensive prospective canine health studies in the United States. The Study’s purpose is to identify the nutritional, environmental, lifestyle and genetic risk factors for cancer and other diseases in dogs. Each year, with the help of veterinarians and dog owners, the Foundation collects health, environmental and behavioural data on 3,000+ enrolled golden retrievers and has just celebrated its 10th anniversary.

Today we have a chat to Dr Kelly Diehl, Senior Director of Science and Communication for The Morris Animal Foundation about:

·         An overview of The Morris Animal Foundation

·         What is The Golden Retriever Lifetime Study

·         Why Golden Retrievers?

·         Some of the results to date

·         The relevance to other breeds of dogs, species (even humans)

·         Future areas of interest

If you have been a listener of the Vetpodcast for a while you may recall an episode we recorded back in early 2021 with Dr Melissa Trupia discussing end of life decisions and treatment. In this episode we are taking the inevitable next step today and discussing euthanasia. It is a topic that perhaps isn’t discussed as often as it should because but lets face it, almost all pet owners have to go through this process at least once in their pet owning life. I have a broad reaching discussion with Dr Kathleen Cooney, veterinarian, founder and Director of Education for The Companion Animal Euthanasia Training Academy. This discussion may be a bit confronting in places to some people but fore warned is fore armed.

We talk about 

·        what makes a good euthanasia? 

·        as an owner, how to prepare for your pet’s euthanasia? 

·        pre-euthanasia sedation – why it is now considered “best practice” 

·        should you be present for the final act?

·        the mechanics of euthanasia

·        what are your options with your deceased pet’s body?

·        what about grief support?

Whether you are a pet owner or a veterinary professional, you should probably have a listen to this.

This is the second part of our discussion on the history of veterinary medicine with Dr Bruce Vivash Jones.  Bruce is a retired veterinarian, veterinary historian and author and has written what is possibly the most complete account of the history of veterinary medicine published.

Bruce’s comments on the events that changed veterinary medicine, the current state of our profession and the possible future are truly insightful.