Wednesday, May 23, 2012

Why Can’t Vets Diagnose My Pet Over the Phone?

By Beth Guerra, DVM

Our clinic fields numerous calls a day concerning pet emergencies. Owners will describe clinical signs and a bit of history, and then ask what could be wrong with their pet. Frequently, we encounter owners that are frustrated that we can’t give advice over the phone, or tell them what medications to give or if they can wait to see their regular veterinarian. Diagnosing a pet’s illness over the phone is almost impossible, and, if our guess is wrong, could be life threatening.  We always want to err on the side of caution to keep your pet safe.

The staff at ACCES is highly trained in phone triage, from receptionists to veterinary assistants and technicians. They will obtain basic information, such as age, breed, and prior medical problems, as well as current symptoms of concern. Their job is to determine if and when a pet needs to be evaluated by a veterinarian, but they are instructed to not try and diagnose over the phone. There are a variety of factors that go into making a diagnosis, and the most rudimentary, and often most important, are a basic history and physical exam by a veterinarian. In most cases, if there is any concern about a pet’s health, an exam is recommended.

In the veterinary profession, importance is placed on a valid veterinary-client-patient relationship. This means that the veterinarian has examined the pet and taken a thorough history. It is illegal to prescribe medications without establishing this type of relationship, which is why medications cannot be dispensed or recommended over the phone without seeing the pet. Even medications that are considered ‘common,' such as Benadryl, are known as off-label medications for pets and should not be given without direction from a veterinarian.

The most frequent request we get from owners is advice on how to treat their pet at home. In some cases, the owner may be financially restricted, or not able to bring their pet in for an exam due to a busy schedule. While it may seem like there should be a simple remedy for something like diarrhea, there can be myriad causes. Since pets can’t describe how they are feeling and often mask their illnesses, the owner may only have part of the picture. A history and exam can also help guide diagnostics to rule out certain diseases.

For example, we had a client call whose dog had been acutely vomiting. Based on the information obtained over the phone, the technician advised that the pet be seen on emergency. The owner was reluctant to come in and wanted to know how to treat the dog at home. Since vomiting can be caused by anything from dietary indiscretion to renal disease, it is difficult to determine an effective remedy over the phone. The owner was advised to withhold food and water for an hour and call if the dog continued vomiting. Several hours later, the owner did bring in the dog. A history and physical exam determined that the dog was exhibiting unproductive retching, not vomiting, and that the stomach had torsed in a condition known as bloat. The dog did well after fluid resuscitation and surgery, however, this condition can be fatal if undiagnosed and untreated.

The staff members at ACCES Seattle and Renton are available 24 hours a day to answer questions about your pet. One of our core values is client service, and we will do our best to provide you with helpful information. However, another of our core values is patient care, and that means receiving a diagnosis and proper medical care is of tantamount importance.

Friday, May 4, 2012

A Look at Canine Hypothyroidism

By Beth Guerra, DVM
The thyroid gland plays an important role in the body’s metabolism. It is a bi-lobed structure located in the neck that secretes thyroid hormone. The hormone is primarily responsible for regulating the oxygen consumption of most organs, but it also promotes overall skeletal and muscle growth. Disorders of the thyroid gland can produce too much or too little of this hormone, distorting the delicate balance of the body and leading to a variety of symptoms.
Hypothyroidism, or subnormal levels of thyroid hormone, is recognized in dogs and humans, but rarely in cats. It usually occurs in dogs around five to seven years of age, with common breeds including golden retrievers and Dobermans. Symptoms include mental dullness, lethargy, weight gain, and heat seeking behavior. Skin conditions can also occur, such as hair loss, crusting or greasiness of skin, or recurrent bacterial or yeast skin infections. It is usually a combination of these symptoms that cause a pet owner to seek veterinary attention.
Diagnosis of hypothyroidism is usually confirmed by running T4 and free T4 levels on suspect patients. Certain drugs, as well as non thyroid illnesses, can cause ‘falsely’ low T4 levels, so a full history and thorough physical exam is an important part of confirming a diagnosis. Treatment is simple and involves supplementing with oral T4, however, dose and frequency of this medication can vary between patients and therefore treatment should be closely monitored by a veterinarian. Good control of the disease is achieved through a combination of normal T4 levels as well as resolution of clinical symptoms and may take up to four months.