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Medicine versus Mom

What Exactly Does Overnight Monitoring Mean?

October 5, 2015

Have you ever been told that your pet would be “monitored overnight”?

Think for a second about what that term means to you, and then see if the following information matches your definition.

Unfortunately, “overnight monitoring” or “monitored overnight” doesn’t mean the same thing in every veterinary or boarding facility, and I believe this causes a lot of confusion among pet parents. Determining the appropriate level of monitoring necessary for your pet when boarding overnight depends on a few different variables. Specifically, the level of care that your pet needs, AND the facility.

One of the best examples I can give comes from my years as a vet tech.

During the holiday season, a family brought in their cat named Tank for his annual exam, a few days before Tank was to board at our hospital. Tank was an overweight male cat who had a history of urinary issues (and he was one of my favorite patients). During his annual exam, his mom mentioned that he was drinking and urinating excessively at home. We knew this might lead to a diagnosis, so we began running bloodwork and a preliminary urinalysis. After a few tests, we determined that Tank was diabetic (Diabetes in Cats: PetMD).

Tank was going to need insulin injections to regulate his blood sugar. Standard procedure is to determine their ideal insulin dosage by performing a glucose curve. Essentially, Tank would need to come into our hospital for a day, and we would record his blood sugar every 2 hours over the course of 10-12 hours. However, we only had a few days before Tank was scheduled to board with us at the vet hospital.

Our veterinary hospital didn’t have a complete boarding facility. However, we did offer overnight boarding for cats. Although the cats had a place to sleep comfortably overnight, no one would be at the hospital during non-office hours. Normally, Tank staying the night would be no problem, but in light of his new condition, we didn’t feel it was wise to leave him unattended overnight so soon after starting him on insulin. Therefore, we referred his mom to our local emergency facility where Tank would have veterinary staff nearby to check on him in case his blood sugar dropped suddenly.

In this example, Tank wasn’t going to be monitored overnight either way. However, some pet parents may have made that assumption based on a few things:

1) Boarding at a Veterinary Hospital = Overnight Monitoring: Unless your veterinary hospital is open 24 hours a day, it is likely that they will not have staff on site overnight. Therefore, your pet will only be available to veterinary staff during regular business hours. Secondly, unless the veterinary staff determines that your pet is in need of monitoring, they will simply be fed twice daily, given their necessary medications, and walked regularly (unless we are talking about cats, of course). At our hospital, we also kept brief medical record that included: daily food intake/output, necessary medications, and daily weight. This record helped us monitor the pet’s health during their stay. On occasion, we determined that a pet needed additional monitoring and brought them to the doctor for an exam. If necessary, the cat would be brought to the main part of the hospital to be monitored.

2) Emergency Hospital = Overnight Monitoring: This definition depends on the facility and the classification of your pet (i.e. boarding versus patient). The true definition of overnight monitoring (as far as I am concerned) means that your pet’s vitals are being recorded, and your pet is being physically checked on every hour at minimum. If your emergency hospital offers boarding, it is not safe to assume that they are also monitoring your pet overnight.

These assumptions can lead to significant communication issues between pet parents and veterinary staff. Therefore, to clear the air, it is wise to ask the following questions when considering a facility for your pet to stay:

1) Is your hospital open 24 hours a day? If not, will someone be here with my pet during non-business hours?

2) Will my pet be monitored by your veterinary staff as if they were a patient?

3) If my pet doesn’t need monitoring throughout their stay, how often will your staff check on my pet?

4) What type of medical record is kept while my pet stays at your facility? i.e. do you track their weight or food intake?

5) How far away will my pet be from veterinary staff while boarded?

6) Is your boarding facility separate or connected to your veterinary hospital? i.e. are they operated as two completely separate businesses or the same business?

7) Do your hours change over the holidays?

Lastly, it is important to understand that boarding facilities don’t necessarily have veterinary staff on site. That’s right. Although your pet may be receiving medications and being watched by the employees of the facility, it does not mean that they are receiving veterinary care. There is no guarantee that they have any veterinary background or experience. Here are pertinent questions to ask your boarding facility:

1) Does your staff have veterinary experience? i.e. do you have a veterinarian or veterinary technician at the facility at all times?

2) Does someone with a veterinary background administer medications to my pet if they need them?

3) Is your staff required to be Pet CPR certified?

4) What type of medical record is kept while my pet stays at your facility? i.e. do you track their weight or food intake?

5) Is someone at the facility 24/7 or only during business hours?

6) If there are times when no one is at the facility, where will my pet be housed?

7) Do your hours change over the holidays?

Although some of the answers to these questions may seem simple and intuitive, these questions may provide you as a pet parent with better insight to the term “monitoring”.

Boading-Questions

Have you ever been in a situation where your boarding staff or veterinary hospital did not meet your expectations?

To read Carol’s Mom perspective on this same topic, please visit her at Fidose of Reality, here!

MedicineVsMom

The Evolution of Pet Insurance

September 22, 2015

PetInsuranceMVM

As it turns out, September is Pet Health Insurance Month, so there is no greater time to discuss the Evolution of Pet Insurance. I first learned about pet insurance back in 2010, when I started working at the veterinary hospital. When I mentioned the concept to people I knew, they often gave me this look like a) your crazy, and b) I hear pet insurance is a rip off.

Typically, people thought I was crazy because they didn’t realize that pet insurance even existed, and who could blame them? As of 2012 less than 1% of pets were covered by pet insurance in the U.S (Embrace).

People who felt that pet insurance was a rip off had either experienced or encountered people who felt duped by the pet insurance industry. Somehow, pet insurance got a really bad rap with pet parents, and I wasn’t totally sure why. I began asking the veterinary staff I worked with, “What’s up with people hating pet insurance?”. As it turns out, there are several factors that helped form notions of pet insurance; history of mistakes, differences in regions, and lack of information.

History of Mistakes:

Pet insurance in the U.S. is only a little over 30 years old. When the concept was new, many pet parents were still trying to figure out what was covered and what wasn’t. Still to this day, many insurances don’t cover wellness exams, preventative treatments, or preexisting conditions. Unfortunately, in its early years, the pet insurance industry simply did not live up to clients expectations.

When speaking with clients who felt they were duped by pet insurance, they would often say that their insurance never covered them when they needed it, OR that they were dropped from their coverage when their pet became sick.

Although I couldn’t find any evidence online that people were wronged by pet insurance companies in the past, it’s possible that there were simply misunderstandings about what the companies COULD cover and to what extent.

I have not had this experience first hand, nor have I seen this happen to a client. However, it is possible that in the early years of pet insurance there simply wasn’t enough money being invested into the industry to provide comprehensive coverage. Basically, the more people invest in pet insurance, the more claims insurance can cover.

What I can tell you is that as of today, I have had several patients who have significantly benefited from pet insurance.

Lack of Information:

Many people still assume that pet insurance works the same way human insurance does. Which is inaccurate. Pet insurance allows you to make small monthly payments which go toward paying for any claims you might have in the future.

When you are faced with a large veterinary bill, you will pay that bill up front, and you will then be reimbursed by the insurance company if they decide to cover your claim. Recently, however, some pet insurance companies have added on express claims that allow the insurance company to pay the covered portion of the bill directly to the hospital.

Additionally, many people don’t believe they will use pet insurance. However, according petinsurancequotes.com, 75% of pet owners will make a claim within their first 3 years of having pet insurance, and 35% of those claims will be for chronic conditions. In the 3.5 years that Rooney has been insured, we have made at least 8 or 9 claims, many of which were for his allergies, which are chronic.

The important thing to remember is that as we continue to use pet insurance, the industry will continue to improve, and the companies will cover more and more.

Differences by Region:

As it turns out, the history of pet insurance outside of the U.S. is much longer than you would image. The first pet insurance claim was filed in 1890, but was primarily focused on livestock and horses. Additionally, the first dog received coverage in 1924. However, despite many policies and companies being in place, the North American Pet Health Insurance Association wasn’t established until 2007. Perhaps its because the industry is more established outside the U.S., but 25% of dogs and cats in the UK are insured and 45% of dogs and cats in Sweden. This is compared to the 1% that are insured here in the U.S..

Photo Courtesy of petinsurancequotes.com

Photo Courtesy of petinsurancequotes.com

I have always wondered why pet insurance was more popular in the UK, and my own personal opinion is that there are two main reasons for the increased coverage in the UK:

1) History: As stated above pet insurance is a more established industry in Europe.

2) Health Insurance Mentality: The human health insurance industry is much more comprehensive in Europe, where as here in the U.S. we pay extensive amounts of money for our own insurance. Therefore, the disparity might make pet insurance seem more plausible and affordable to UK residents.

Employee Coverage:

I live very close to Silicon Valley which is the epitome of employee competition. Companies like Google and Facebook offer everything under the sun to their employees so that they can hire the best of the best. Some companies even offer pet insurance coverage these days. Companies that offer pet insurance to their employees include:

Deloitte

Walgreens

Caterpillar Inc

Amazon.com

Google, Inc

American Express

and the list goes on…(Yahoo)

I am hopeful that as more companies provide pet insurance for their employees, the industry will continue to grow, and more animal lives will be saved.

How does a vet choose who to recommend?

Often times, your veterinary office has an established relationship with one type of pet insurance. I have worked for hospitals with relationships with VPI and Trupanion. Just because your veterinarian has a pamphlet in their office doesn’t necessarily mean its the best pet insurance for you and your pet.

A great way to determine what would work best for you and your pet is to ask the veterinary staff who they use as their pet insurance provider. For example, I have Trupanion and I have had an excellent experience with that company, and have shared my experience with many of our clients.

How will I know what is right for my pet?

The North American Pet Health Insurance Association has a buying guide that is very comprehensive and I recommend reviewing that document before making a pet insurance purchase.

Now, jump over to Carol’s blog Fidose of Reality to read her Mom perspective on the Evolution of Pet Insurance.

MedicineVsMom

Should You Get Your Pet’s Medications from an Online Source?

April 5, 2015

MVMOnlinePrescriptions

Everything is available online these days. In fact, according to Business Insider, 78% of the U.S. population, age 15 and above, bought something online in the first quarter of 2014. Although online shopping is clearly hear to stay, my question is, should you buy your pet’s medications from an online source?

In the veterinary field, this is a very popular topic. Many veterinarians have it out for online pet medication sources. Why? Well, many pet parents don’t realize that there are many non-credible sources out there, looking to get the cheap sale, and these medications could potentially threaten your pets health.

Let’s break this down a bit further.

The Food & Drug Administration, or the FDA, has a regulatory entity called the Center of Veterinary Medicine (CVM). According to their website, “CVM regulates drugs, devices, and food additives for over 100 million companion animals, plus millions of poultry, cattle, swine, and minor animal species. (Minor animal species include animals other than cattle, swine, chickens, turkeys, horses, dogs, and cats)”.

So to be clear, the veterinary pharmaceutical industry is regulated by an entity within the FDA. However, just like the human pharmaceutical black market, there are unregulated vendors pedaling their medications at pet parents on a regular basis.

The FDA has even made statements acknowledging that this is a problem, and advising pet parents on how to avoid these traps.

According to the FDA, it is dangerous and risky to purchase pet prescriptions online, especially those that use claims like, “Discount Pet Drugs” and “No Prescription Required”. The FDA has indeed caught companies selling unapproved and expired pet medications.

“Pet owners who purchase drugs from these companies may think they are saving money, says Hartogensis, but in reality, they may be short-changing their pet’s health and putting its life at risk.” – Martine Hartogensis, D.V.M., deputy director of the Office of Surveillance and Compliance in FDA’s Center for Veterinary Medicine

The CVM wants pet parents to know that there are several reputable and honest online pet pharmaceutical companies. As a matter of fact, I have been approached by a few online pharmaceutical companies, and my very first question is, “What is your process for ensuring your medications are delivered directly from the manufacturer, and are completely up to veterinary standards?”. There are a few that have passed my interrogation, and I will be sharing those with your in future posts. However, what us veterinary professionals fear, is that many pet parents don’t know to ask these types of questions, and therefore are duped by these terrible companies because they want to save a few dollars. I completely understand wanting, and needing, to save a few dollars, but I want to give you the tools to make sure that it isn’t at the risk of your pet’s life, or health.

Tips for protecting your pet while shopping online:

I highly recommend purchasing your pet’s medications from your veterinarian, or from a reputable pharmacy recommended by your veterinarian. However, if you are going to purchase your pet’s prescriptions online, here are some things that you should be aware of.

Red Flags

Foreign online pharmacies: Although you can make purchases online from other countries, it doesn’t mean that those medications are approved here in the U.S..

Not needing a prescription: According to the FDA, there are some pharmacies that allow pet parents to fill out a form, and a “veterinarian” on staff evaluates your pet’s health and then decides if they need the medication, or not. No medications should be prescribed without a proper veterinary exam, ever.

Purchasing NSAIDs (Non-Steroidal Anti-inflammatory Drugs) online: Although NSAIDs are often prescribed by veterinarians, no pet parent should self-precscribe their pet with the need for NSAIDs. Why? The use of these medications can cause significant health problems if your pet’s kidneys and liver are not in perfect condition. Therefore, bloodwork should be performed before starting your pet on these medications.

Purchasing Heartworm Preventative online: If your pet has heartworm, giving them heartworm preventative can do further damage to your pet’s health. Therefore, veterinarians recommend keeping your pet on year-round heartworm preventative and testing them yearly for heartworm to ensure that the preventative is indeed working. Although these medications can be purchased online, it should not be without annual veterinary exams and heartworm testing.

No licensed pharmacist to answer questions: Every pet parent should be able to ask questions if necessary. If a professional of the industry will not put their name behind a company, it is probably not very reputable.

No physical address, phone number or contact information: Not providing legitimate contact information is a huge red flag for any website, let alone a pharmaceutical company. What if something goes wrong with your pet’s health? How will you be able to hold the company accountable?

Prices are too good: If the prices are too good to be true, they probably are! Please be aware that medications do have a cost to the manufacturer and the company, so the price will need to be above that cost at least.

Tips

NABP: Make sure the site is licensed by the National Association of Boards of Pharmacy. Check specifically for Vet-VIPPS (Veterinary-Verified Internet Pharmacy Practice Sites) which are online sites that are legally selling veterinary prescription products.

Report any suspicious sites: All pet parents should look out for each other! If you notice any red flags associated with an online pharmacy, be sure to report it!

Always be in communication with your veterinarian: Nothing is more beneficial to your pet’s health than honest and open communication with your veterinarian.

In conclusion, I recommend purchasing your pet’s medications from your veterinarian or other established pharmacies. However, if you are going to purchase pet prescriptions online, please do so with caution, and significant research.

For Carol’s Mom perspective on this topic, please click here.

MedicineVsMom

If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, your really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with your even more reasons why Carol is awesome! 

I want to thank IndyVet.com, the FDA, and the CVM for providing such excellent information.

Should You Buy Your Dog’s Food From Your Veterinarian?

March 22, 2015

MVMDogFood

There are so many options when it comes to purchasing your dog’s food. Some of you may even be able to buy your dog’s food from your veterinarian’s office, and the question may have crossed your mind; Does my dog need a prescription diet that I need to purchase from my veterinarian?

Well, let’s address the first part of this question. Does my dog need a prescription diet?

When searching for dog food, there are a plethora of options available and a myriad of locations to make your purchase. Therefore, buying dog food can quickly become a tall order, instead of a simple task.

I highly recommend on your first veterinary visit with your dog, and every subsequent visit, discussing your dog’s food requirements and any potential changes you are considering. Different stages of life can require different supplements and nutrition, therefore changing your dog’s food throughout their life may be necessary. Secondly, certain medical conditions can be improved using specific prescriptions diets.

For example, Rooney suffers from inhaled and food allergy, like many other dogs here in the Bay Area. Therefore he needs to be on certain types of diets (non-prescription). His diet is not prescription, but its made of certain ingredients that reduce allergies, and its the food my vet uses for her own dogs.

Additionally, there are prescription diets available that can improve your pet’s urinary health, skin health, oral health, weight, and allergies. I recommend never purchasing these health specific diets without a diagnosis from your veterinarian (and sometimes you can’t). If your pet requires a complete diet, you will definitely want them to have one.

Many veterinarians I have worked for, have carried prescription diets, and many people aren’t sure if they should get them at the veterinary office or not.

Firstly, I will say that many of the veterinarians I worked for, did not mark up the prescription diets by much, and therefore were a financially responsible option for purchasing your dog’s food.

Secondly, I will say that I have worked for veterinarians who honor price matches if your find the food cheaper in another location.

Lastly, I will say that many veterinary prescription diets are not available anywhere except veterinary offices (as it should be). This further reinforces my point, that no one should be giving their pet a prescription diet without a proper diagnosis from their veterinarian.

Therefore, I would highly recommend that you speak with your veterinarian about your dog’s food options, their price matching possibilities, and certainly buy your prescription dog food from your veterinarians office.

When it comes to other dog food options, i.e. non-prescription dog food, feel free to purchase these at your local pet food store. 

HOWEVER, please do not ask employees in the pet store about your dog’s medical issues in order to find the appropriate dog food to treat those issues.

One day, my best friend the veterinarian and myself were in a pet food store when we overheard the pet store employee telling pet owners that their dog was probably urinating in their home because she was angry and that she should be on a specific brand of dog food in order to prevent this issue.

Not once did this employee recommend seeing their veterinarian since their dog’s urinary issues were probably not be behavioral, but medical.

Please, under no circumstances, change your dog’s food for medical reasons without speaking to your veterinarian. I even recommend not changing your pet’s food at all without speaking to your veterinarian. It may not seem like a big deal, but think about it in terms of your nutrition. If you completely changed your diet every 3 to 4 month, this might not bode well for your health in the long term. The same is true for your dog.

In summary, if you think your dog needs a prescription diet, please seek out the advice of your veterinarian.

If your pet does need a prescription diet, please purchase it at your veterinary office, and ask about price matching.

If your pet does not need a prescription diet ask your veterinarian about dog food recommendations.

Lastly, many pet store employees are very knowledgable about pet food, but please don’t ask for medical advice, especially when no medical history is available.

MedicineVsMom

For Carol’s Mom perspective on Fidose of Reality, please click here.

The Femalization of Veterinary Medicine and Why it Matters

March 8, 2015

MVMFemalization

Some dogs see a veterinarian as an extra pair of hands to pet them, and some of course see them as imminent needles and nothing but bad news. However, in my experience, some dogs are sensitive to their veterinarian’s gender.

At the veterinary hospital, we frequently received calls from new clients stating that their dog preferred a female doctor over a male doctor.

Fortunately for these dogs, a female veterinarian is not too hard to find. In my three years working in veterinary medicine, I worked with 8 female veterinarians and 2 males veterinarians. The same was true in my Animal Science courses at UC Davis which were dominated by the female gender. My question has always been, why the trend?

According to Veterinary Practice News, as of 2010, women hold 78% of veterinary school seats. Additionally, as of 2009 female veterinarians exceeded male veterinarians for the first time.

femalevets

Photo courtesy of the AVMA.org

Why such a dramatic shift?

The theories are varied.

Many credit this long term change to the Title IX legislation of 1972 which eradicated gender discrimination in federally funded education (Veterinary Practice).

Many studies state that women are simply attending college at a higher rate than men. Since 2000, 57% of enrolled college students have been female. Additionally, females are dominating education at the graduate level (Veterinary Practice).

The next, and probably most depressing, theory is that veterinary medicine does not provide a large enough salary to attract men to the field (Veterinary Practice). My own personal choice for not attending veterinary school did relate to the very high debt:salary ratio of veterinarians, so I understand the decision making process from my (apparently male) point of view.

Lastly, some attribute the increase in female veterinarians to the caring nature of veterinarians portrayed on TV and in movies (NCBI).

An Australian study of veterinary students and recent graduates analyzed the factors that males and females used to determine their veterinary career path.

Male Decision Making Factors:

1) Desire for independence and a lack of supervision in the veterinary field.

2) Financial attractiveness (debt:salary ratios may differ in Australia, but remain high here in the U.S.)

Female Decision Making Factors:

1) Love of animals

2) Image of veterinarians portrayed on television

3) Interest as a child in living things

4) Scientific study of disease

The reason I chose to pursue an Animal Science degree, and the reasons I almost become a veterinarian included a combination of numbers 1, 3 and 4. However, my decision NOT to attend veterinary school was partially due to financial unattractiveness of the veterinary profession.

Are there any issues with the femalization of the Veterinary profession?

Interestingly enough, Food Animal Veterinarians are still 82.5% male (Veterinary Practice). Which means, that many people are concerned about the ability of female dominated veterinary schools producing the necessary number of male veterinarians needed to keep up this trend.

Sadly, some studies have concluded that female veterinary salaries are, and have been, lower than male veterinary salaries. Further, this lack of increase in female veterinary salaries mixed with the femalization of the field has led to a decrease in the  profession’s salary overall (NCBI).

Lastly, studies concluded that females have less of an interest in owning a practice which may lead to a decrease in veterinary practices in the future (NCBI). Truthfully, two of the practices I worked for were owned by the only male veterinarian that worked at the practice. That being said, one of the practices I worked for was co-owned by two women, a decision they made that give themselves the flexibility to raise their children, and be practice owners.

What is the solution for the future?

We need to encourage female veterinarians to be practice owners. How do we do that? Professor Colette Henry argues that veterinary schools need to integrate business education into their curriculum. When I was working toward veterinary school, I only wanted to be a veterinarian if I was going to a be a practice owner. However, only a handful of veterinary universities offered an integrated DVM/MBA program. I wholeheartedly agree with Colette, that in order for femalization of the veterinary profession to be a positive effect, which I KNOW it can be, we have to set women up for success from the get go.

Personally, as a female in business school, I am confident that the lack of female interest in practice ownership we see today, will not be what we observe in the future. More women are owning businesses, and slowly but surely, we are making strides in the corporate world. I truly believe that veterinary medicine won’t be far behind. The femalization of veterinary medicine will continue, and mark my words, it will be beneficial to the field.

So now that we have determined that females are indeed dominating the veterinary field, the question is, how does this affect your dog?

An article written by VetStreet, gathered some information that dogs prefer women in general, due to a variety of factors.

1) Women tend to be the primary caretaker of a dog in the home.

2) Dogs prefer people with soft voices and more calming body language, which women in general innately possess.

3) Women dominate the field of veterinary medicine.

Therefore, can a correlation be observed that dogs prefer female veterinarians because they are simply the norm in small animal medicine?

MedicineVsMom

Carol from Fidose of Reality provides more information to this question in her Mom perspective of this topic, please click here.

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