GETTING THE MOST OUT OF YOUR VET VISITS
A VETERINARIAN IS THE INTERMEDIARY BETWEEN YOU AND YOUR pet. He or she is the much-needed translator who interprets the signs you are noticing, assesses their significance and seriousness, and determines the best course of action. In my experience, pet owners are not only looking for solutions; they are also looking for reassurance and a plan, even if the prognosis might be poor.
What Clients Want from a Veterinarian
Confidence and competence
Advocacy for their pets
Love for their pets
Well-informed, sensible options
For things to be easier rather than harder
For their pet to be evaluated within the context of their lives and to develop a plan for health
Nothing medical should be so complicated that you can’t understand it on a basic level.
Visiting the vet can be stressful. Animals are keenly attuned to fear, worry, anxiety, pain, and illness of other animals. Most pets take their emotional cues directly from their owners. So a relaxed owner can calm down the whole vet visit. When we take blood pressures on dogs and cats, we routinely subtract about 15 percent or more from the values because of the “white coat factor.”
Many clients bring their complicated or “hopeless” cases to me. It is understandable that they are stressed before they walk in. Don’t hesitate to let your vet know you are anxious. My colleagues in veterinary medicine are some of the most dedicated and kindest people I know. They may be able to quickly alleviate some of your anxiety.
Years ago a keeper brought a cotton-top tamarin monkey to the zoo hospital because of an intestinal problem. Several options were discussed. We were finally settling on a surgical solution when the keeper burst into tears. The young tamarin immediately began to struggle and panic.
We had assumed that because the keeper was a professional and had dealt with medical procedures daily, she would be fine with the idea of surgery for the little one she had raised. But the emotional attachment between an animal and a person cannot be underestimated—even among professionals.
In this case, it was essential to alleviate the fears of both primates, the human and the little tamarin. We explained to the keeper that the procedure had been successful on a number of tamarins and that we didn’t anticipate any issues. As she calmed down and dried her tears, the monkey calmed down as well.
During stressful situations, the adrenal glands begin to fire. Adrenals produce either adrenaline, glucocorticoids, or mineralicorticoids. Systemic effects of these hormones can hinder healing. Alleviating stress can prevent the onslaught of these volatile hormones. This can improve the chances of unblocking an animal’s own immune response. In addition, therapeutic treatments, anesthesia, and blood tests are more accurate, and negative reactions, as well as side effects, are decreased. A little attention to detail and a calm explanation make clients and their pets less stressed. As busy vets, we can be focused on clinical details and miss the signs of distress. Don’t be reticent about telling your vet your concerns.
Questions I Discuss with Owners About the Care of Their Pets
What would you like to do, what can you do, or what are you willing to do, to restore the wild health of your pet?
Other than being a chauffeur to the vet, do you feel you can be an effective advocate for the health of your pet?
What have you tried, or what have you been told to try, but cannot?
From food choices to pharmaceuticals, do you feel you are overwhelmed by options or out of options?
Does your pet’s condition make you sad, stressed, or fatigued?
ROYAL TREATMENT TIP
Bring your dog to the vet office for random visits—
without having an appointment—so he can just be there
with you and greet everyone. This way he will have a
good association with the vet instead of tension about
medical procedures. Be sure to give him a treat there.
Exam Room Etiquette
Animals should typically be examined in the presence of the owner. But there are exceptions to this. If the exam needs to be done in a different room, ask why that is the case. Logistics or restraint issues may be the reasons. Or it may be necessary in order to do multiple procedures quickly—this can save time and decrease stress to the animal. Or it may be warranted because the pet does better without the owner.
If your trusted vet feels strongly that your pet needs an exam without you there, defer to his or her judgment.
Blood drawing and other invasive procedures are often best accomplished in a different room than the exam room. This ensures that the exam room remains a happy, calm place for communication and examination, and, in my practice, a comfortable place for acupuncture. A calm animal benefits more from acupuncture and other treatments than a stressed one.
Where possible, have your vet draw routine blood work from the jugular vein in a dog or cat. It may seem barbaric, but it is just the opposite—a much less painful and easy-to-heal area for venipuncture. If, in the future, an IV catheter needs to be put in a leg vein, it won’t be as scarred from multiple vein sticks over the years.
Radiographs must be taken without the owners present because of radiation exposure and adherence to the rules specified by the Occupational Safety and Health Administration.
Make sure that the tests make sense to you, and that the results will not only provide information, but also directly affect a course of action and treatment.
STANDARD OF CARE
“STANDARD OF CARE” is what would be considered cautious, reasonable, and prudent for any diagnostics procedures or treatments used in veterinary medicine. While a generally accepted measure of any doctor’s basic plan of treatment, standard of care is not a specific set of guidelines. It is only a subjective and changeable checklist that comes into play when a treatment is questioned between veterinarians or in a legal action. This measure is a way to make sure that veterinary care maintains a level consistent with the current standards of excellence. But it can also be a deterrent to innovation, as it may encourage practitioners to blindly follow accepted protocols, even when the outcomes continue to be negative. If everyone is doing it, it must be correct (and vets are safe from lawsuits). Standard of care helps define tests and procedures that most vets in the same circumstances would perform.
If you can’t understand your vet, or they can’t explain the process, the action, or reason for testing, think twice.
When there is no better plan in place, a test or procedure may be the only action a vet can take. There are times when it is better to avoid a false step and more information is needed before proceeding. But it is always reasonable to ask how any diagnostic test might affect the overall treatment plan.
Ask Your Vet:
Is the test painful or stressful, or does it pose other risks such as bleeding or infection?
If you have a small animal, your vet should minimize the blood taken for testing. Tiny animals do not have large volumes of blood and can’t spare much for testing.
Is there a less invasive way to find this information?
Does the benefit of the test outweigh the risks of the test?
Is the test itself more of a risk than the possible disease?
Will the test yield a treatable result?
Will the test results prove the obvious or are the results predictable without the test?
Will the test results change the treatment plan or the outcome?
Is the test looking for something highly unlikely?
Is the test exorbitantly expensive?
Will the test results be reliable, specific, and sensitive?
And then ask yourself:
Does the test make sense to you?
Tests themselves may cause a problem that didn’t exist before.
Tests and procedures should be governed by efficacy. Of course, an animal can’t choose for itself, and we, as advocates for our pets, are responsible for developing a medical plan that makes sense. Choose tests and procedures that will improve the prognosis and/or quality of life, and make sure the chosen tests are the best way to provide answers. Sometimes a test may be needed for a vet to rule out a hunch or follow a thin lead. As long as you can see some logic, trust your vet.
Because they have the technology to do them, veterinarians increasingly rely on diagnostic tools. However, test results do not always provide information that leads to a correct diagnosis. A thorough physical exam can sometimes preclude invasive tests. I was taught in vet school to obtain as much information as I can prior to testing, and then move into clinical diagnostics.
One of the many advantages of integrative medicine is that I can treat an animal without relying solely on a “Western diagnosis.” I can treat animals using holistic protocols that heighten an animal’s own response to disease in general. These protocols include alternative methods such as acupuncture, massage, supplements to support the immune system, improving diet, decreasing debilitating medications, and improving emotional conditions, as they impact the patient’s specific condition and needs.
Small, spiny, and prehistoric-looking, the echidna is one of the few egg-laying animals that are mammals. It weighs between four and eight pounds.
Long ago, researchers in England seemed to have proved that captive echidnas develop anemia over time. Monthly blood draws showed this to be true. But other conclusions can be posited: 1) Researchers may have drawn so much blood from the tiny animal that it could not compensate for the blood loss and therefore became anemic. 2) Echidnas may regenerate blood loss at a slower rate than other species. 3) The stress of the testing suppressed the echidna’s red blood cell regenerative process. And I’m sure there are others.
When Should the Vet Take a Rectal Temperature?
A rectal temperature may be unduly stressful to an animal. Some pets tolerate it with no problem; others will fight it valiantly. This can exacerbate other conditions and take valuable energy away from their healing process.
A vet must ascertain whether a fever is a real concern. If it is not, the rectal thermometer can be put away. I may forgo taking the temperature in view of the totality of the situation, resorting to taking the temp later or using a less accurate ear thermometer.
Are X-rays Safe?
Radiographs (X-rays) are useful diagnostic tools. While no amount of radiation can be considered unequivocally safe, radiation from the newer radiograph (X-ray) machines is minimal. To put things in perspective, the veterinary X-ray machine in my practice will give 0.05 mSv of radiation—significantly less than just one transcontinental airline flight.
If a radiograph is required for treatment or diagnosis, I don’t hesitate to take one. It is possible to take great X-rays without anesthesia. In my practice, it is a rare case that requires sedation for an X-ray. If your vet requires anesthesia for all X-rays, I would ask why. Sedation may be required if you have a pet who rolls like a croc and stings like a bee; needs X-rays of sinuses, head, or teeth; or is in too much pain to hold the correct position for an X-ray. However, the trend to routinely sedate all animals to take X-rays should be reconsidered.
Blood Test Ranges May Not Always Be Correct
Another common issue that may confuse pet owners is a pet’s BUN (blood urea nitrogen) level. If you are feeding an appropriately high- protein diet, your pet’s BUN may be higher than some laboratories’ normal ranges. When an animal eats more protein, the body will have more protein by-product (blood urea protein) in the bloodstream. In fact, there are several laboratories that have increased their normal value range to accommodate the expansion of BUN values in normal animals. Even though some of my patients have BUN levels slightly above the normal range, it is not due to any kidney malfunction. Their kidneys prove to be healthy. The increase may be a normal number for an animal eating appropriate protein.
Many reference ranges were originally determined using laboratory animals, often beagles, eating a “normal” diet of kibble. But the typical kibble foods were much lower than 30 percent protein. It is possible that most normal BUN ranges in laboratories may be set too low.
WHERE THE WILD THINGS ARE HEALED
FEELING APPREHENSIVE IN A place that is designated for healing is counterproductive. Here are five reasons to keep patients and clients relaxed.
1. Physiologic reactions to stress release hormones and chemicals that make the body ready for flight, rather than mobilizing forces for healing. This makes healing a more difficult task.
A calm animal has better results from acupuncture and other treatments than a stressed one.
2. Animals and humans who are stressed present a side of themselves that may not be typical, a side that could mask an illness or lameness. When an animal is stressed it overcompensates, attempting to appear healthy. Not wanting to be an easy target, its primary concern becomes escape.
3. When stressed, the brain does not readily absorb or retain detailed information. A pet’s health depends on the owner’s understanding and implementation of a plan outlined by their vet. Stressed owners aren’t as likely to follow through fully on the health plan.
4. The nervous system of a stressed animal may not respond readily to acupuncture needles, and the beneficial neurological effect could be lessened.
5. It is far healthier for a regular patient to be excited about coming to the vet than to be dragged in with blood pressure soaring and heart racing in fear—and that goes for the owner, too.
Owners are often reluctant to mention supplements and herbals they have gotten over the counter, for fear of ridicule. Therefore, they don’t always tell the full story to their doctor. I often hear new clients say, “I’ve never told my vet, but I have been giving . . .” or “I found these things online, but I was afraid to tell my vet I’ve been giving them . . .” or “I love feeding from the table, but my vet disapproves, so I don’t mention it” or “Please don’t tell my veterinarian I told you this . . .” Owners may feel their concerns are either too frivolous or in conflict with “real medicine.”
I have designed my practice to have a soothing atmosphere, conducive for healing. I believe it is a place where both the pet and the owner can feel comfortable. When a new client comes to me, I encourage them to provide a complete picture of their pet’s life.
My clinic has pinewood walls, high ceilings, superior ventilation, large windows, and an abundance of natural lighting. The waiting areas have individual barnlike stalls designed specifically to decrease the stress of animals having to interact with other animals. The walls between the stalls are three feet high. This protects pets from other pets while allowing owners to be able to talk to each other. My exam rooms have Dutch doors that can be fully closed or open halfway to decrease the feeling of isolation for both client and patient. The upper door has a window in it, letting in natural light. Rooms are equipped with a dimmer switch to lower the lighting when it is needed to calm a patient.
The textured, blue-painted concrete flooring in my clinic provides good footing. For most animals, the exam and treatments take place on a large athletic mat on the floor. A massage pillow is on the client chair.
Make sure your pet knows you feel comfortable at your vet’s office. This alone can make a big difference.
Elements of a Great Vet Visit
Your common sense
Treats for your dog, maybe for your cat, too
List of questions/concerns
Be ready to describe your pet’s health issues—write them down beforehand
Complete list of food, treats, medications, supplements, and ingredient lists
Ask your vet to put these lists in your pet’s record
A muzzle, if your pet needs it
A favorite brush for your pet
A book for yourself. If possible, just focus on your animal and the issues at hand. This may not be the time to multi-task.
A comfortable distance between you and your pet—If your pet wants to be near you, move your chair closer. If you prefer to sit on the floor with your pet, ask for a towel or a blanket if there is no mat.
Ask first—Avoid misconceptions about how to appropriately pay for your vet’s time and expertise.
Enough time—There are important health decisions to be made, so try to schedule enough time. If time runs out and you have more questions, make sure to ask the best way to get them answered—either by phone message, email, or another appointment.
I tell my clients that our first appointment will last at least an hour. I like to have time to listen to my clients, and I have a lot of opinions.
FINANCES AND YOUR PET
DISCUSSING FINANCES IS STRESSFUL for many clients. I make a point of talking about the cost of treatments, or diagnostics. If finances are causing clients to lose sleep at night, I want to know about it. Treatments, diagnostics, foods, supplements, and medications have to be affordable to be sustainable. There are times when an owner has to make difficult decisions based on cost. Ideally, a vet should be able to help find alternative ways to proceed in a financially feasible way.
One of my clients instituted a treatment fund for animals in need. We now keep a log of services and items that people donate to help other clients in need. This has made a difference in many cases.
INDIVIDUALITY AND YOUR PET
IT CAN BE USEFUL to categorize dogs and cats by general personality traits and constitutions to get better results in handling and treatments. Letting the veterinarian know your dog’s tendencies is not a bad idea.
In traditional Chinese medicine, the Five Element Theory describes five constitutional types that relate to the animal’s overall genetic and emotional type. They correspond to an increased susceptibility to specific health conditions. Determining which constitutional type your pet is can aid diagnosis, treatment, and preventive medicine. It is also an enjoyable exercise to see how well these descriptions may fit your pet.
The Five Constitutions:
Fire, Earth, Metal, Water, Wood
Here are descriptions of the five Chinese constitutional categories as they relate to pets (based on a combination of my experience and Cheryl Schwartz’s book Four Paws, Five Directions).
Example: The Yorkie or small cat that is hyperactive, superhappy, overaffectionate, and, at times, anxious to the point of frantic behavior when they are left without their owner in a strange place. They overheat easily, and dream actively—appearing restless and paddling through their dreams. They may be so happy to see their owner reappear that they pee nervously. This pet would be subject to conditions, such as cardiac disease and metabolic disorders, relating to the heart and small intestine.
Example: The chocolate Labrador or fat cat type that is food-motivated, willing to please, gently friendly, or an overweight couch potato. She would sleep late and improve in energy as the day progresses, but can have low stamina and be a worrier. Her health issues could be related to the spleen/pancreas and stomach and she may show possible signs of periodic GI upset or arthritis or possible lipomas or tumors.
The schnauzer or Siamese cat that is tough, somewhat aloof, and clever. He bonds strongly and has trouble recovering from loss of a fellow pet or a human. He may have issues with the lung or large intestine. He could have a constantly runny nose, congested sinuses or asthma, or loose stool, and may have problems with the sense of smell.
A tabby cat or a Dalmatian that is terrified of strangers, noises, the vacuum cleaner, anything new. She is slow to rise from a prone position and is chronically thirsty, and craves salty foods. She may have medical problems associated with her kidneys and urinary bladder such as chronic urinary infections, and urination issues, which worsen in the winter and cold weather.
A calico cat that frequently picks fights or a terrier mix that barks at visitors. The type of animal that is suddenly testy when being petted. Possessive over food and is small but powerful. She has health issues that relate to the liver and gallbladder. These relate in Chinese medicine to the skin and to eyes. She would often have red eyes that may have a discharge, a strong-smelling allergic skin, and possibly skin allergies. Because of the connection to the digestion through the gallbladder and liver, she could have loose stools with blood in them.
IN REAL LIFE, ANIMALS rarely have just one of these types. Most animals have a predominant characteristic constitution, and then one or more subtypes.
Some Basic Dog Personality Types
Knowing each personality type can make a difference in how the pet is handled in the clinic, and how they respond to treatment.
1. A nervous shadow. Standoffish, somewhat protective or shy, may be head-shy. Difficult to keep engaged, or to bring out from under a chair. Synced into owner’s emotions and movements.
2. Territorial teenager. Appears benign, but doesn’t hide from confrontational circumstances. Can be provoked to bite apologetically and usually won’t break the skin.
3. Equal-opportunity saliva-sharer. Overly friendly, hyper, jumping, aggressive licking, and nervous urination. Ask vet to bring in a towel. Would never bite anyone.
4. Everybody’s best friend. Relaxed and friendly, moves comfortably between humans, involved, happy to please, looking to owner for cues. Happy tail-wagging causes colorful shin bruises.
5. Mr. Chill. Everything is fine; not all that interested in human activity and will tolerate almost anything. Has a vibrant inner life.
6. Everyone is a postman; everyone should be bitten. Aggressive/protective of space, may lunge, bite, or snarl. May even consider biting owner.
Aggressive dogs (number 6) require some serious consideration and handling. A dog like this may be protective of their space. At the vet, this means they may feel compelled to guard the exam room. If you have an aggressive dog, the vet should not enter the exam room where you and your dog are waiting. It is wiser to have the vet go in the room first. It can be tricky logistically, but well worth it in terms of safety for all.
Aggressive Dogs Take It Down a Notch Tips
Ask if you can enter the room when the vet is already there. This means you need to be told when the vet is ready to come to your exam room.
When the vet is outside the door, immediately leave the room with your dog and have the vet go into the empty room.
Wait a few seconds and return to the room with the vet already there. With the vet claiming the space, your dog will not guard the room when he and you return to the exam room.
Inform your vet if your dog resents being looked directly into the eyes, as some aggressive dogs do, or is head-shy, or hates the color red.
Do not be offended if a muzzle is used. Many aggressive animals are less stressed and less aggressive if their mouth, their major aggressive feature, is under control. When muzzled, they are forced to relax. Never underestimate the stress level in a room where there is an aggressive, unmuzzled dog. Once a muzzle is on, staff, vets, and even the pet’s own family members are more relaxed. The calm is contagious. Consequently, your dog will receive better care.
Bring a favorite toy such as a tennis ball or laser light, or bring a treat. Let the vet offer it to develop a rapport.
Divert the dog’s attention. I have been known to take the leash and walk the dog out of the exam room. I have even escorted the dog outside for a full change of venue. This shows the dog that I am allowed to be in charge. Distracted by the walk, they are less worked up when we get back. If need be, I can even do the exam outside.
CATS IN THE EXAM ROOM
The best way to keep cats from becoming fractious is to not let them get out of control in the first place.
Fibber was a Rottweiler who hated acupuncture. He had already bitten several acupuncturists. It was the owners’ last shot at alleviating Fibber’s severe hip arthritis pain. I asked his owners what distracted him, and they told me, after a lot of thought, that the only thing he was transfixed by was a cat in a storefront near their home. I put our clinic’s cat, Chainsaw, in a carrier in front of Fibber during his acupuncture sessions. It was amazing how well it worked. Fibber stood motionless staring at the cat. Needles were totally ignored. Chainsaw didn’t mind; he was used to dogs. Eventually I was able to do acupuncture by just showing Fibber a carrier with a stuffed toy in it, then just the carrier, and finally nothing at all. We became great friends and he tolerated his acupuncture treatments well.
WHAT WILL CALM YOUR NERVOUS CAT? Nothing. Cats are always thinking, “I must get home.” Cats, unlike people-oriented dogs, are place- oriented. Their home is often the only place they are comfortable. Cats are less interested in who is with them than where they are. Unlike dogs, who generally feel better if their owner is with them, cats are not impressed by anyone pretending to help or be sympathetic. Some cats will not be happy until they return to the comfort of their windowsill. Don’t expect cuddling to fool them. Exam, testing, and treatment for a cat should be relaxed, yet speedy.
That being said, a vet should still take a little time to relax them. They sometimes do respond to face rubbing. This is similar to being licked by their mom when they were a kitten. They often can be more easily examined on the doctor’s lap on a thick towel.
If you know your cat likes a good ear rub, or has another favorite place to be scratched, don’t hesitate to tell your vet this useful information.
How to Tell If Your Cat Is Stressed
Dilation of the pupil (black part of eye) indicates stress level. A stressed cat tends to dilate her pupils—leaving a black-looking eye, with a very small strip of color around the edge.
A panicked cat may simply freeze or may turn into a wild thing.
Cats may flatten their ears and fluff out their fur and tail when threatened.
How to Alleviate Stress in Cats
Rub around the face in smooth strokes, starting from behind the head and quickly moving around the eyes, until the iris (color part of eye) responds by widening and the cat is not dilating her pupils as much. This is a more relaxed condition for healing.
Let them hide their head under a towel or under your arm if they’re on your lap.
Full-body-wrap them in a towel or give a mild pressure with open hands on the shoulders—this can simulate a “hug” feeling that calms some cats.
I find that cats can usually be managed with a combination of gentle, slow intention and efficient, speedy exams. They respond well to firm but gentle restraint. I usually do my cat exams with the cat sitting on a towel in my lap. I can easily feel when they tense their leg muscles for a spring, or shift their heads before turning to bite. It also makes my legs a human force plate to help diagnose musculoskeletal problems.
Not all cats are calmed by being wrapped in a towel and so they manage to crocodile-roll out of it, regardless of any restraint. Those cats can do better wearing a firm Elizabethan collar or a pointy conelike plastic mask. It is impossible for them to turn and bite as long as this stays on. Nails trimmed before the appointment improves the chances of a bloodless interaction with the vet.
Leave Your Vet Visit With:
A healthier pet
Your questions answered or at least addressed
A plan for the short term, and maybe the long term
Peace of mind