When do you know it...
 

When do you know it's time for a new vet?  

SkepticalEd
Originally Answered: When do you know it's time for a new vet?

Hi.  I've been with my current vet for 5 years, after my former vet retired.  Personality-wise, I like the vet, and clinic manager, but recent visits have made me question whether I should change.  I have an 11 yo shorthair male at home (my other cat, 18 yo longhair female, passed in Feb), and care for a colony of seven cats on my parents' property that I TNR'd over the last 3.5 years.  All the colony cats are fed, watered and loved on twice daily, have a heated kitty condo for the winter (though half of them prefer inside my parents' home), kept vaccinated, Revolution'd, and are taken to the vet for injuries or other needs, so, I make lots of trips to the clinic.

My first moment of concern was 1.5 years ago, with my then-17 yo female.  There for a lion cut (she'd stopped grooming herself, I asked for a full physical, including all labs, BP, and urine if needed.  The BP and urine weren't done, though the vet said she was in early stage kidney disease (high-normal BUN), and was put on an Rx KD diet.  She began losing weight quickly, so while at my mom's vet with her dog, I asked the vets (two of them) their thoughts on muscle vs kidney, and they asked what the SDMA showed.  Having no clue, I asked my clinic if SDMA was available, they said no.  

A year and multiple blood tests later, my now-18 yo female's disease is progressing, even with my reading everything available on the subject, and trying every suitable food possible to keep weight on her (she'd dropped 1/3 her weight in a year), I took her in for another full physical and labs.  Still losing weight, disease progressing, but otherwise, alert and active.  

Two months after her full physical, I took her in for an emergency visit, as she had began wobbling while walking.  Physical exam revealed an abdominal mass, confirmed on Xray.  She had lost almost 50% of her weight from 2 years earlier, and the vet thought it would not be beneficial to do surgery, given her age and disease.  I spent every minute with her for the next five days, and then made the most painful decision of my life...

My second concern was with one of my colony cats.  This was a year with a lot of rain, and lots of mosquitos.  The 5 yo longhair male had developed many little blood dots on his nose, it was swollen, and he was rubbing it raw with his forearm.  The vet said it was likely an autoimmune disorder, and a biopsy would need to be performed, and if confirmed, the treatment is a $400 tube of topical ointment.  I asked if there were other treatments, and he gave a long-lasting antibiotic shot, and said to keep him out of the sun (to which I replied he's rarely in the sun; mostly hides under sheltered areas or under bushes).

At home, not being confident and out of curiosity, I looked up feline mosquito nose, or feline mosquito bite hypersensitivity, and contacted the vet about this possibility, because online pictures of vet dermatology about feline mosquito nose looked EXACTLY like my cat, and was told no, that's not a possibility, even after telling the vet that he's not in the sun often, and there was a lot of mosquitos in the entire area that the cat frequents. 

After several weeks, with failed efforts to get rid of the mosquitos, I couldn't let the cat endure his raw nose, so asked the vet if we could just treat it as if it was feline mosquito nose, with a steroid shot.  The vet again said it was 95% sure to be an autoimmune disorder, and we'd need a biopsy, but honored my request and gave a steroid shot.  The cat's nose completely cleared after 3 days, and has remained so for several weeks.  

If it wasn't for online resources, like All About Cats and others, the 5 yo cat would still likely be suffering with his painful nose, but that shouldn't be the case, and I'd like to be confident in my vet's decisions, without researching it myself.  

I'm wondering if I need a new vet, as my 11 yo male at home is needing a dental soon, and I'm questioning the reluctance to get a BP on a patient (are BPs uncommon?), or offer the SDMA test (is it only available to some vets, and not to others?), or recommend a cystocentesis with a known CRF patient (I keep learning what might have been available for my lost older female).  I don't know if the abdominal mass could've/should've been found during her full physical, while under for a lion cut, or if they just grow that fast to take her life two months later... but I wonder...

Another thing that makes the decision difficult, is my vet is the only one who does the local TNR program spays/neuters, and offers low/no cost services to those in need (not me--I spend a small fortune there).  The vet is a really good person...  so, am I being unreasonable?  Too picky?  Are my concerns without merit?

Thanks, and sorry so long...

 


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STP
Originally Answered: When do you know it's time for a new vet?

Personally, I'd continue using him for the TNR but find a new personal vet.  It's lovely that he's a nice guy,  but the fact that he's missing diagnoses that you, yourself, are finding, tells me he's not doing his due diligence to care for your cats.


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Dr. Joanna Woodnutt, MRCVS
Originally Answered: When do you know it's time for a new vet?

Hi @SkepticalEd,

Firstly, I'd like to apologise for how long it has taken to get back to you on this. We are reviewing our protocols to make sure it doesn't happen again.

Now, onto your question.

There is nothing in your commentary that sets off alarm bells. It's impossible for me to say for sure without being party to the vet's notes too (because things can get missed, misconstrued, or misremembered) but there's nothing here that gives me cause for concern. Masses really do grow that quickly, not every clinic has access to SDMA, and autoimmune disorders respond to steroids, so he may not be wrong (and even if he was, without doing the diagnostics he suggested it is very much a guessing game). The BP should maybe have been done - but once your cat was under for the lion cut, all results would have been unreliable, so it's possible your request got miscommunicated to the rest of the team and it was too late to get one.

However, I think the answer might still be to find a new vet. The vet-client-patient relationship is key to treating pets. It sounds as though you don't trust your vet and that's going to cause problems for treatment. Having an open, honest, mutually respectful client-vet relationship is really important, and if you don't trust your vet then that relationship is failing. As you say, you can't be double-checking his decisions and you need to be confident in them. I'm not saying this is your fault in any way, just that being able to trust your vet is essential, so if you feel niggling doubts then it might be he's just not the right vet for you.

If you are happy with the practice in general, you could try asking to set up a meeting with the vet directly to discuss your concerns. You might find it clears the air and your relationship is better for it. But finding a new vet is also a valid route to go down, so if that's preferable to you then go for it.

I hope that helps,

Dr Woodnutt


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SkepticalEd
Originally Answered: When do you know it's time for a new vet?

Thanks so much for the thorough reply Dr. Woodnutt, and for your advice, STP.  Dr. Woodnutt, you addressed every issue I mentioned, and I learned some things. 

It's a strange thing, being reluctant to mention to a care provider that you may not be comfortable with their diagnosis and treatment, as compared to a contractor or mechanic... and I don't know why that is.  I'm a retired firefighter/paramedic, and would routinely ask the ER doc and nurses if my assessment and treatment of my patient was correct, if I missed anything, or should've done something different.  I was always on the quest to give my patients the best treatment I could.  

Last few years, I haven't felt confidence in my human physicians that they listen to my issues as a patient, like I'm on a conveyer belt, and there's just not enough time, and feel at times I'm not getting the proper treatment.  Not once have I expressed those concerns to them, and that seems to have followed to how I handle it with my vet.

At the risk of wearing out my welcome, I recalled the issue that spawned my skepticism with my vet:  3 years ago, I took my then-8 yo male in, as he'd began pulling the hair out from one spot on his flank.  My vet glanced at the spot, left, and returned with a bottle of pills.  One was popped in kitty, and I was told to give him one a day, and there was no end date to this treatment.

At home, seeing kitty groggy, I researched the med, and discovered it was a tricyclic.  Having had two friends who abjectly hated being on tricyclics, I didn't give kitty a second dose.  He stopped pulling hair from the spot immediately, and never has again, and that's been 3 years.  I never suspected he was depressed, or anything of the like, and think more investigation was warranted before a diagnosis. 

I guess it boils down to either my lack of confidence in my vet as a competent diagnostician, or the vet just doesn't have the time; either way, you may be right that my trust has been tarnished.

Again, thank you so much for the kind and detailed reply.  


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Dr. Joanna Woodnutt, MRCVS
Originally Answered: When do you know it's time for a new vet?

It sounds like all you want is the best for your cats. And whilst your vet isn't doing anything wrong, you need to be on the same page so that you aren't having to double-check and second-guess anything. A good vet-client relationship is a wonderful thing! If you do decide to leave, it's definitely worth talking to your vet about why. Feedback is really important for us, it helps us adjust our care and our treatments. For instance, your vet may have no idea that you stopped giving the pills - as far as he's concerned, the lesion healed so his treatment fixed it. 

It's also worth pointing out that vets see a lot of people, every day. Many of them will be less keen on testing and diagnosis than you, instead wanting a 'quick fix'. It shouldn't happen, but it's easy for us to get blinded by this- we get tired of explaining the diagnostics for 99% of people to turn around and say no. So if you're in the 1%, it may be that we just automatically assume you won't want to know, either, and just take the easy route instead. Similarly, we shouldn't (but sometimes do) judge people by their appearance or pet. I myself have fallen foul of mentioning euthanasia before discussing treatment options (although to be fair to me, I did discuss both!) in a cat after judging the owners by sight. I shouldn't have - they had insurance with £12,000 limit - more than enough for what the cat needed! It was a good lesson for me and something I've never repeated. You mentioned you seek care for strays. Usually, people that do this want the cheapest possible solution - another possibility is that your vet incorrectly assumes you're in this category too and forgets to offer you the higher-priced options. As I said, it shouldn't happen, but in the fast-paced world of veterinary medicine, it sometimes does. 

I have no doubt that you and your vet want the same thing - for your cats to be healthy - but there are lots of ways of going about this, and what suits one client might not suit the next. Some want to be told what to do, others want to explore all the options and have the pros and cons laid out. If you and your vet can get on the same page, fantastic - I think it's worth talking to them (not during a consult - see if you can book a time to meet him without distractions). But if despite that you still feel a twinge of doubt, it's absolutely fine to move on amicably. 


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SkepticalEd
Originally Answered: When do you know it's time for a new vet?

Dr. Woodnutt,

Thanks again for the wonderful reply.  I read it immediately after it was posted, and have been pondering my reply ever since.  

I (for obvious reasons) try to learn about--and am very sympathetic to--what vets go through, from the many clients always wanting the lowest-cost options, and expecting their vets to give them additional discounts, to trying to fund a clinic, with all associated staff and equipment costs, and hopefully making an acceptable living, to the horrible reality that NOMV has brought to our attention;

That said, while (as I've stated before) I really like my vet and clinic staff, I do tend to think about my totally happy and loving then-9yo kitty being quickly put on an antidepressant, unnecessarily, which, if I hadn't stopped immediately, would've been on now for 2 years.  The other kitty with the bad nose, I accept that most vets probably would've wanted to have a complete diagnostic to confirm/rule out suspicions.  

I don't have an unlimited budget, but I am willing to spend whatever is necessary to keep all these creatures healthy.  Over the last 24 months, the treatments/diagnostics that I second-guessed and either stopped or insisted on altering saved my kitty budget $1,500, and ended up being the right treatment choice for the kitties.  I--in no way--think my vet is trying to pad anything, or order things unnecessarily to increase costs; rather, I believe my vet is maybe just in a familiar place, after several decades of a wall-to-wall patient practice.  

While I may be the 20th or 30th client my vet sees that day, a trip to the vet is a stressful and infrequent occasion for each of my kitties, and every detail of the visit is at the height of my attention, and while I may be a bit more critical than most, you're right:  it's all for my kitties.  

Once again, having said all that, I just recalled an occasion a few years ago when I was returning home from work, and found a kitty in the road.  He'd been run over, but was alive.  He had a protruding eye, and had blood coming from his nose on expiration.  No compound fractures.  I dropped my work trailer, and rushed him to my clinic.  My vet and the staff dropped everything, even with a full lobby, and evaluated the kitty.  

Without a collar or microchip, my vet said it would be up to me what gets done, or doesn't get done.  After minutes that seemed like hours, we were able to contact the owner, who stated she couldn't afford the treatment, and to put him down.  My vet allowed me to be there with him, and to let him know he was loved as he took his last breaths.  In tears, I asked to pay for the cremation services, but my vet wouldn't allow it.  They took care of it all.

My vet may not be the *everything* vet, but, I think, all things considered, I should get a bit off my high-horse and remember that we are all human, and fallible, but we try. 

Thank you, Dr. Woodnutt.  


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