Unnecessary Tests

What even is an unnecessary test…..?

So, one of the things that seems to upset the public most about going to the Vets is the unnecessary testing that they feel comes with a vet consult.

I like to think that actually very little unnecessary testing happens in general practice and certainly in the practice I work in. Now, it would be easy to say that the general public is wrong and to blame for the vicious rumours about the scores of ‘unnecessary’ tests that are going on all across the country. However, I think some of the blame must be shouldered by vets who simply do not explain well enough the reasons for their actions. I have definitely been guilty of this.

sorry_puppyThe problem with veterinary medicine is that quite obviously, we cannot ask the patient what is wrong. We can’t ask your cat how she feels, or ask your puppy how many ibuprofen he ate and at what time.

Veterinary Medicine works somewhat on the basis of probability. Your vets brain works a bit like a computer, sometimes functioning at Windows 98, but mostly at MacBook Pro speed. We are statisticians, educated in balancing probability, prediciting likely outcomes.   We take in all the information you give us and we add it to the information gained from our clinical exam and we search through 5 years of veterinary training and several years of experience to compute the most likely cause of your pets illness or injury. We usually come up with several lists in our head, its individual to each vet, but mine looks something like this:

  1. What is most likely to be the cause: …….
  2. What is less likely to be the cause: ……
  3. Things that could cause serious problems / death: …..

Now, this is when we give you some information. This is usually something along these lines…

“It is MOST likely we are dealing with a simple urine infection that can be treated by antibiotics. However, it could also be X, Y or Z. We can either treat for a urine infection and see what happens OR we could do some further tests to try and work out the cause of Rovers problems”

What we do next is entirely up to YOU as an owner. It all depends on how sick you think Rover is, whether you are going to worry all night in case it could be X instead, sometimes whether he is insured, or whether you are going on holiday in a weeks time.

If we think Rover is really sick or if we really don’t know what is going on, we will tell you  that and you may then feel pushed towards doing further tests. Its still up to YOU whether you decide to go ahead. Just remember, if you decide not to go ahead you run the risk that our presumed diagnosis and treatment is not correct or that Rover might get worse … its a calculated risk… but it is a risk.

Unfortunately, without further tests your vet can only tell you what is MOST LIKELY to be the cause NOT what is the cause of Rovers illness. Sometimes, even with tests we cannot say for sure what wrong, but we can say with greater certainty. We can also rule out other more serious causes. Some diseases we suspect we cannot treat without further testing, we would risk making the situation worse. It would be like trying to fix a broken leg without x-rays of the break.

Unfortunately, without further tests your vet can only tell you what is MOST LIKELY to be the cause NOT what is the cause of Rovers illness.

That being said, its time to explain a bit more about why this is all so complicated.

Lets imagine your cat has vomited a few times this afternoon, he is off his food, a bit lethargic and is drinking more. If you are anything like me, you are probably thinking that your cat is occasionally sick, so it’s no big deal. You’ll will just wait and see if he is better by tomorrow, he probably ate something funny in the garden. If he’s not better by tomorrow you will dig out the dreaded cat basket and commence world war 3 in an attempt to put your cat in a box.

how_to_get_your_cat_into_a_carrier
Follow the link below for handy tips on getting your cat into the carrier.
http://www.cathealth.com/tips/getting-your-cat-into-a-carrier

 

 

The next morning he is no better so you go to the vet, and they might suggest doing a blood sample and maybe a urine sample – seems a bit excessive? You have probably googled ‘vomiting cat’ already, and the top answer probably says your cat has a stomach bug that will get better with antibiotics. It PROBABLY does, and it PROBABLY will.

However, it could also have dozens of other conditions that could be a lot more serious.

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He could have any one of these conditions and more!
The above diagram shows just a small selection of the most likely causes of your cats vomiting. His gastritis probably just needs a course of antibiotics, but if he has eaten lillies he could die.

Some conditions are fairly easy to spot, if he had eaten Antifreeze he would be rapidly deteriorating at a speed of knots. A lot of these conditions, especially in the early stages, can present in a similar way to your cat, and he could have any of them.

I think if I had the time to draw a diagram like this every time i see a sick animal, owners would be a lot keener to undergo further testing. Ignorance is sometimes bliss. If i explained this better would clients complain less… probably.

Unfortunately, the above cat had chronic renal failure – diagnosed on blood and urine tests. The majority of cats I see who present like this have gastritis /gastroenteritis…. they get better with a course of antibiotics.

Example number 2: an older dog which has gotten a bit skinny over the last few months. images-2

He drinks a lot and urinates in the house … but ‘he is getting old now’. I can’t find anything wrong with him on clinical exam but he is very thirsty when I offer him water.

Something, doesn’t seem right here, so I offer a complete  blood test to give me the most information. I think he has cancer. The owners oblige, a little bit concerned about the price of his complete blood profile – its almost £100.

The bloods are normal. I question myself, was the test unnecessary? But I know that dogs don’t just ‘get old’. No dog has ever died from being ‘old’ – they get disease. I offer a urine test – the owners are a little perturbed, they are starting to think he’s just getting old and they should take him home. But I am not convinved – there could still be a problem here.

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Which is the cause – without blood tests its impossible to say.
Abnormal bloods can sometimes be a good thing – theres something to treat, its a place to start. Normal bloods in an abnormal patient aren’t always a good thing.

Urine tests show his urine is incredibly diluted – thats why he is drinking so much. The test gave me more information but it didn’t solve the problem. Thats £140 gone and i can tell his owners he drinks more because he is urinating more – sounds like a waste on money to me.

To cut a long story short, the dog had diabetes insidious diagnosed eventually on some specialised and expensive blood tests based on the findings of his initial blood and urine test. It’s a pretty rare condition with most practitioners seeing it once or twice during their career. Leaving it undiagnosed would have eventually lead to dehydration, coma and death. He is now on treatment for life, he is a new dog and eats his owners out of house on home.

I’m not telling you this story to prove I’m a good vet… almost the opposite… I was sure he had cancer. This dogs owners persevered, they trusted their instincts, as well as mine and my opinion. After a few negative (unnecessary?) tests they could have given up, they could have requested a new vet, or complained on Facebook to their friends – but they didn’t.

So, this extremely long post has finally got to its punchline. Most tests aren’t unnecessary.

If you are thinking they are, maybe your vet should have explained the situation better – ask your vet some questions, ask them why they think bloods might be a good idea. If they can’t tell you then the test is unnecessary. If the tests come back as normal … this is GREAT NEWS…. Rover isn’t dying from acute kidney failure. We can both stop worrying about X, Y & Z, I can be confident in my treatment choice and you can go home with antibiotics safe in the knowledge that Rover will definitely get better!

Whats unnecessary about that?

 

***My blog is limited exclusively to my own thoughts and opinions and does not reflect those of anyone else or my employers*** 

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Euthanasia – when is enough, enough?

A post to pet owners at the end …..

In 2016 the number of pets in the UK was estimated at 57 million, thats almost as many pets as people. With that many pets its unsurprising that vets practices are getting busier and busier. On a typical 8am – 7pm day shift I will see anywhere between 30-100 clients and inevitably some of those clients come in to have their pet put to sleep.

Of course not all owners come to see me wanting to have their animals put to sleep. Some people know their pet is very sick and are clinging onto hope that I can save them, others have no idea their beloved pet is so sick and others just don’t want to accept it.

When I meet new people and I tell them that I am a vet, most people will say something along the lines of ‘I couldn’t  do that, I love animals. I wouldn’t want to put animals down’. Well the truth, is I love animals too, and that precisely why I willingly put animals to sleep every single day.

To most vets euthanising an animal is a privilege, its a unique chance to end the suffering of a beloved pet, to let them slide painlessly and effortless to sleep. Now, I realise that sounds like a very romanticised version of what euthanasia is, and don’t get me wrong its very rarely easy, but its almost always right.

You see putting an animal to sleep is never a welfare concern, only ever an ethical one. Euthanising an animal will end its life and therefore any current suffering or any future suffering it may endure – and to prevent suffering is the oath we take as vets. Now the ethics are certainly more difficult, most animals I put to sleep are old and ill with a deteriorating quality of life. Most but not all. Euthanising aggressive animals, those who’s owners cannot afford healthcare and abandoned animals are also part of my job – but thats  a post for another day.

This post addresses when is the right time to put your pet to sleep. For some owners it is very obvious, when Charlie doesn’t want to eat his dinner, go for a walk or come for a cuddle, you know he has had enough. For other owners its not that easy.

As a vet, I never presume to know what your animal is like at home. How can I possibly judge whether Rosie still enjoys cuddles, can still chase the neighbours cat or will still eat her dreamies when she won’t eat anything else. In fact, how can anybody truly know how Rosie feels … you included, after all she can’t tell you. How do either of us know whether her hips hurt when she gets up to greet you wagging her tail, or her head hurts when she’s curled in front of the fire. After all dogs are notorious for hiding their pain to keep up with the pack, and cats to avoid seeming weak to other territorial cats. What I usually do know, however, is your pets state of health. Every pet owner must know what it is that makes their pets life worth living, and as they become older it is important to hold yourself to those values.

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Most cats and dogs will suffer from a similar array of diseases when the end comes. Kidney disease, heart failure and cancer are just a few, what my experience as a vet has taught me is how this will affect your beloved pet. If your vet suggests euthanising your pet due to chronic or terminal illness its because experience has taught us that time and disease will not be kind to your pet. We fear they will suffer despite our interventions and our best efforts. I would not suggest euthanasia to you if I didn’t think it would be a practical, reasonable and suitable option. I would much rather fix your pet and send them home than have to help you say goodbye. However, it must be your choice as to how and when your loved one goes and we are here to guide you to make the right decision.

It’s my opinion that if your pet dies at home, then in some occasions we have failed, both as owners and as vets to recognise and address the severity of disease present. Unfortunately, most animals do not die peacefully in their sleep like we might like to imagine, and if your pet was sick enough to die at home then we should have recognised that sooner and either attempted / adjusted treatment or if that was not possible euthanised them to prevent further suffering. Of course not all deaths at home involve suffering, especially if you and you vet have chosen to use appropriate palliative care.

“If your pet dies at home, then in some occasions we have failed, both as owners and as vets.

Some clients suggest that as vets, we are too eager to put animals to sleep – that it is easier to do so, or that we have given up too soon. However, I can promise you that I will do everything I can for your pet, just as I would for my own, but when the time is right I must do what is best your pet and not just for you. Remember, its often better for you pet to have gone a day too soon, than a day too late. It is always harder for you than it is your pet, after all it is much more painful to be left behind than to leave.

“Remember, its often better for you pet to have gone a day too soon, than a day too late.”

You will struggle to find a vet who does not own a myriad of animals, mostly missing the odd leg, or an eye. We have all been in the same position as you… we have all lost pets that we loved, and we have all had at least one put to sleep. We all know how hard it can be.

When the time is right I ask that you stay with your pet if you can, for they have spent a lifetime devoted to you and need this one last act of bravery in return. I have seen too many animals look longingly out the door after you have left, trembling and scared by their surroundings, terrified of the strangers that hold them close as they slip away. Put on your bravest face and hold back the tears as best as you can, so that your beloved pet will not feel scared, after all, all they will feel is sleep taking over and should have no reason to feel frightened unless you are.

For help or support after loosing a pet:

https://www.bluecross.org.uk/pet-bereavement-support

***My blog is limited exclusively to my own thoughts and opinions and does not reflect those of anyone else or my employers***