Thursday, February 25, 2016

Before Getting a Second Opinion: Something Not Right? Speak Up

Don't leave until satisfied

When I come back from the vet I like to feel reasonably confident both about the [working] diagnosis and the treatment. This can be easier said than done. Not every diagnosis can be achieved by one listen with a stethoscope. The main point is to feel that things are on the right track.

Does the diagnosis make sense to you?

Diagnosis is usually a work in progress. Often it requires further tests and imaging. Most diagnostic tests depend on their interpretation ... There is more than one explanation for many issues.

Does it all seem to make sense? To exaggerate, did you go to a vet with a limp and come home with a nasal spray?

During the consultation, it is important to keep things on track. Good, two-sided communication is crucial. I do not leave the office until I feel we’ve got a solid plan and are on the same page.

Are you cool with the treatment?

However good the treatment might sound on paper, is it going to work for your dog? Will you be willing or able to administer it?

There is no point in taking the meds, leaving the office and then never giving it because you’re not comfortable giving that kind of stuff to your dog, or your dog won’t accept the drops, the pills or spray ...

Only agree if your going to go through with it

On number of occasions various vets suggested steroids for Jasmine. They would probably, at least temporarily, make her feel better. Because that’s what they do. They make about anything feel better. There is very little they actually treat, though.

For me, steroids are a Hail Mary, last resort medication. I am NOT going to agree to giving it unless there is absolutely no other solution.

The first time ever I agreed to steroids was when Jasmine’s neck went bad. If there was a time to reach for steroids, that was it. And even then the treatment did almost as much bad as it did good.

The point here is that I did not walk out of the office with the prednisone in my pocket the vet thinking I was going to give it.

What other treatment options are there?

JD happened to get ringworm at the same time Jasmine was recovering from knee surgery. The vet wanted to use some great treatment which would require JD wearing the cone of shame. JD, with a cone of shame on, in our house, while trying to keep Jasmine’s leg safe? Not happening.

“We can’t do anything that requires a cone of shame for JD,” I said. The vet was not impressed and I could see some swear words going through his mind. But he got over it and came up with a treatment that didn’t require JD wearing the cone.

When Cookie was diagnosed with iliopsoas injury for which the mainstay treatment is strict rest, I voiced the issue immediately. It wasn’t going to happen without some serious chemical help. What would be the point of walking out of there with recommendation for strict rest knowing that it was impossible to follow through with it? Instead, we walked out with medication to facilitate the recommendation.

Treatments only work when they are actually applied

You’d think people don’t do this but they do. They accept whatever their vet says and whatever medication they get but come home and never do anything. Even the best of treatments only work when actually applied and applied properly.

Did your dog get antibiotics but it’s making them sick? Don’t just stop giving it! Talk to your vet. Ask about injectable alternative, different antibiotic or supportive medication to deal with the nausea.

Working with a hypothesis

There were enough times when the symptoms I was concerned about could had been from pain. Whether from Jasmine’s IBD or some of her musculoskeletal challenges.

We came home with medication that should address that to see whether it would make any difference. That sounded like a reasonable approach to me under the circumstances. So we tried the treatment.

We tried it as recommended but it didn’t do anything. It was time to go back to the drawing board. So we did.

What is the treatment’s expected outcome?

Is the treatment actually not working or are you expecting too much too fast?

Along with every medical report, Jasmine’s vet always included a disclaimer regarding the treatment to call back if for any reason we weren’t able to follow the recommendations or if we had any questions. It also included a rough timeline of expected response to treatment so we’d know what we should expect and to call back if things weren’t going the way they should be.

I found the expected response to treatment timeline very helpful. It would look something like this:
Overall a 25 % improvement is expected by DAY 2
50% by DAY 4
75% by DAY 6
100% by DAY 10
With more complicated things, such as surgery, his instructions and expected progress were in much greater detail. Day by day, week by week we could look at the information and know whether we were where we were supposed to be.

The dialog continues until your dog is all better

Is your dog not accepting the medication?  Is it making them sick in all new ways? Is your dog not getting any better? Getting worse?

The treatment might not work because the diagnosis or hypothesis is wrong. I might not work because the treatment itself is wrong. Or it might not work because that particular treatment isn’t going to work for your dog.

Go back to the vet. Work it out. And if you’re not getting anywhere, seek a second opinion.

Related articles:
Veterinarians Are People First
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Making Tough Medical Decisions For Your Dog
It's Your Dog's Health
Does Your Vet Listen To You?


  1. So many vets fret over compliance, but then get testy when owners - who know their pets best - say that the course of treatment isn't going to work for them.

    Actually I think we have an epidemic of vets who think that what they say should be the end all and be all of treatment, and owners should simply comply - and if it didn't work then it is the owner's fault.. it is a shame.

    1. Compliance comes from communication, understanding and cooperation. If any of those things are missing, compliance is out the window. Instead of fretting over compliance, they should ask themselves WHY are clients non-compliant?

      Yes, some owners are just lazy or don't care. But what about the rest? If I get nasal spray for a limp, yeah I'm not gonna give it. Doh.

  2. Great post!
    When Scout had his fever, we were lucky to be working with vets who took the time to explain everything to us, answer the most ridiculous questions, and call us back to respond to follow up questions.

    It was an amazing experience.

    1. That's how it should always be but these days, it is very special. I'm happy you have such great team of vets.