Contemplations on modern veterinary medicine

[swimmermom3]

Until about ten years ago, when I took our cats into the vet, the vet would examine them, possibly do blood work and then provide a diagnosis based on his/her experience. We both knew it wasn't a perfect process, but it seemed to work okay.

 

Now, we are at a clinic where everything seems to be about testing. Today, I will take my failing 17 yo cat, Butler, who has advanced kidney condition, and they will want to run a whole panel of tests that will cost somewhere over a $1,000 and will provide "possible, but inconclusive" results. Sometimes I feel like we are running tests to help pay for the fancy machines, but in the long-run the outcome isn't any better than twenty years ago, when an experienced vet said, "It looks like..." and we went from there.

 

Also, no matter how many thousands of dollars I spend on diagnosis, the treatments are still along the lines of prednisone, wellbutrin, and an antibiotic for a wide variety of ailments - the same as it was 20-30 years ago.

 

Has veterinary medicine really come all that far or is it more about the chains that are taking over practices and making it big business.

[lexi]

We've had this exact experience with our (now deceased) dog. Our first vet did some tests but often gave an opinion based on years of experience.

The new bet wants to run a million tests every time I walk in the door. Ugh! I did not like it. And I didn't feel the results were better or more accurate.

[fairfarmhand]

Is your vet a farm vet? I've found that farm vets are less likely to recommend all the extra stuff as a matter of course and they are much more conscious of the costs of treatment and testing. They will say stuff like "Well, I think it's xyz, and we can do tests to confirm that or get more information, but if you want to go with my gut feeling and try this treament for xyz, then I'm okay with that. The choice is yours."

 

Our vet treats lots of animals, cows, horses, sheep and the family pets too, so they understand the fact that many families can't pay for tons of vet costs. They're quite used to a farmer going "I can't pay $1000 to heal a $200 sheep." In my experience, farm vets are quite practical.

[swimmermom3]

Is your vet a farm vet? I've found that farm vets are less likely to recommend all the extra stuff as a matter of course and they are much more conscious of the costs of treatment and testing. They will say stuff like "Well, I think it's xyz, and we can do tests to confirm that or get more information, but if you want to go with my gut feeling and try this treament for xyz, then I'm okay with that. The choice is yours."

 

Our vet treats lots of animals, cows, horses, sheep and the family pets too, so they understand the fact that many families can't pay for tons of vet costs. They're quite used to a farmer going "I can't pay $1000 to heal a $200 sheep." In my experience, farm vets are quite practical.

 

That's something to think about.  I grew up not far from where we live now.  Our vets were people that my folks attended dinner parties with. When we got into horses, we used several of the same vets because much of the area was still rural. After dh and I got married, the vet for our first pair of cats was the father of a dear friend and the husband of my 4-H leader from high school.  The clinic where we are now belonged to the "rock star" vet my parents had known for years. He had two offices for his practice: the small animal "in town" and the large animal on the edge of town. When he retired, he sold the small animal practice to VCA , but the large animal practice went to an individual. That practice might be worth checking out. I am sure he probably does family pets as well.

 

This is our third probably terminal cat in four years. Walking into their office door is so anxiety producing for me. It's become a "prove you love your animal by emptying your bank account kind of ordeal." I think I would like to see a case study that addresses whether the cost and results of tests are in proportion to an increase in the quality of care and outcome for the animal.

 

 

 

[Mergath]

My vet always wants to run a bunch of tests. I just say no and tell them to stick to the basics. The treatment is usually the same whether you do all the tests or not. You don't have to go along with everything they recommend.

[Ailaena]

Is your vet a farm vet? I've found that farm vets are less likely to recommend all the extra stuff as a matter of course and they are much more conscious of the costs of treatment and testing. They will say stuff like "Well, I think it's xyz, and we can do tests to confirm that or get more information, but if you want to go with my gut feeling and try this treament for xyz, then I'm okay with that. The choice is yours."

 

Our vet treats lots of animals, cows, horses, sheep and the family pets too, so they understand the fact that many families can't pay for tons of vet costs. They're quite used to a farmer going "I can't pay $1000 to heal a $200 sheep." In my experience, farm vets are quite practical.

 

That's really interesting because our vets used to be farm vets but gradually integrated into the city over the last 15 years or so, and that is exactly their attitude towards treatment. The newer vet that joined their practice is all about expensive testing - wouldn't even talk about what she *suspects* the problem to be - and I never saw her more than once.

 

It's possible that some of it is also experience (and honesty). When my newborn (human) didn't poop for a few days after birth, the newly-minted PA wanted X-rays and tests and a whole host of things, but the older ER doc was like, meh, glycerin suppository will fix it up good. And it did ;)

[redsquirrel]

Speaking as the DIL of an old vet here, yes, vet medicine has changed an enormous amount over the past generation.  There is a LOT more diagnostic tech available to vets than there used to be, and lots of people expect it to be offered or done. younger vets are trained to use cutting edge medical techniques, and they are expected to use them. Their practice expects them to bring that knowledge and skill with them when they join.

 

They also have to make money. That is a fact of the vet world. It costs an enormous amount of cash to become a vet and to run a practice. Every vet I know has a clear eye on the bottom line because if they don't, they will go out of business. And they know what the other vets in the area are doing.  All it takes is one person to say "Why didn't you do XZY like they did over at the other animal hospital?" and everyone in the area is doing XYZ.

 

[fairfarmhand]

Speaking as the DIL of an old vet here, yes, vet medicine has changed an enormous amount over the past generation.  There is a LOT more diagnostic tech available to vets than there used to be, and lots of people expect it to be offered or done. younger vets are trained to use cutting edge medical techniques, and they are expected to use them. Their practice expects them to bring that knowledge and skill with them when they join.

 

They also have to make money. That is a fact of the vet world. It costs an enormous amount of cash to become a vet and to run a practice. Every vet I know has a clear eye on the bottom line because if they don't, they will go out of business. And they know what the other vets in the area are doing.  All it takes is one person to say "Why didn't you do XZY like they did over at the other animal hospital?" and everyone in the area is doing XYZ.

 

 

I'm sure competition is stiff for small animal vets.

 

However, I believe the opposite would be true for a farm vet. I can just hear the farmers mumbling now "dang fool wants to run $700 tests on that idiot cow. I think I'll just send her to freezer camp and be done with it."

 

One thing I love about our large animal vet is that I can call during office hours and they'll give me a prescription if they feel fairly confident about the diagnosis. We've worked with cattle for years and we have a good idea of what we need to bring an animal in for and what we can tackle ourselves. Most days, our vet is so busy, he;d rather have me give the shot, the pill, or whatever. He's willing to see an emergency, but for many things he knows we can handle them ourselves.

[ktgrok]

Yes, a large part of the issue is that if they don't offer the test, and guess wrong, they can be sued. Trust me, malpractice is not just in the human medicine world. They would be accused of not keeping the standard of care. So they have to offer the tests. But yes, you can decline them. 

[Carrie12345]

Our vets have always laid out our options for testing and treating and then told us whether or not they think it'd be worth it. We've never had one push anything on us.  Even when one of our cats needed surgery (sorry about the tail, Phil!) our current vet came in under the estimated cost.

 

Our most recent bill, which included tests to determine the spread of cancer, and then euthanization and cremation, was under $400.  I don't believe we've ever had a bill higher than that, and we've had 6 pets over 15 years; 2 with cancer and one with kidney disease.

[Pawz4me]

I have no problem declining tests for elderly pets. I've been with my vet for over 30 years, so he knows me well and we're on the same page about most things (he trained me well over the years!). I have no problem whatsoever questioning the younger vets in the practice when necessary and letting them know that I won't be pressured into expensive tests and treatments for elderly pets unless there will be some clear benefit in terms of quality of life.

[ktgrok]

I wonder how much is impacted by the clientele view of animals as well. Not that we don't love our horses and farm animals, but they are still viewed as animals. Not four legged people. I don't see someone paying for hip replacement for say, a goat, whereas it isn't uncommon to hear someone do that for a dog. I also wonder if all of the testing and treatments end up actually being inhumane in some ways by simply dragging out the inevitable. If you start your cat on chemo, the cat doesn't really get a say in the whole thing or a vote on quality over quantity.....on those issues I think it's easier dealing with large animals. You don't have the same amount of options (in most cases). I mean there are the extremely wealthy who could, like with race horses who break a leg and they keep them alive just long enough to harvest enough genetic material to keep it profitable, but I think that's rare. For most of us, your horse breaks a leg and it's over that day....and likewise I've never heard of chemo for a horse. At least not around my neighborhood.

 

Just to clarify, often chemo for animals is NOT like chemo in people. They don't have horrid side effects, and it isn't always expensive. 

[redsquirrel]

I'm sure competition is stiff for small animal vets.

 

However, I believe the opposite would be true for a farm vet. I can just hear the farmers mumbling now "dang fool wants to run $700 tests on that idiot cow. I think I'll just send her to freezer camp and be done with it."

 

One thing I love about our large animal vet is that I can call during office hours and they'll give me a prescription if they feel fairly confident about the diagnosis. We've worked with cattle for years and we have a good idea of what we need to bring an animal in for and what we can tackle ourselves. Most days, our vet is so busy, he;d rather have me give the shot, the pill, or whatever. He's willing to see an emergency, but for many things he knows we can handle them ourselves.

 

Yes, but large animal vets are a disappearing breed.  FIL specialized as a horse  vet, but  worked as a large animal primarily and small animal vet as needed by his practice.  By the time he retired from his own practice, of which he was a founding partner, it was no longer a large animal vet practice. Not because they didn't have the work, but because there were zero new vets coming into to interview who had those skills or interests.  Large animal vets work much more like people doctors. FIL wore a beeper etc and went out in the middle of the night to deal with a cow with a prolapsed uterus or whatever. In general, small animal vets don't deal with such things. They do, of course, but just no where near as much.

 

It isn't because people don't want to work. Any vet works a lot. But because families have two working adults now.  FIL was NEVER home, much like a person doctor. He missed most holiday dinners and school plays and never stayed home with a sick child. That is what his wife was for. Nowadays, the vets are mostly women (VERY difficult for those old vets to deal with...I have heard an earful!) and they have kids! and husbands who have jobs of their own! And they need those husbands and wives to have jobs because being a vet doesn't pay what it once did...so why would you also then work every single holiday and weekend when you could be a small animal vet and work regular hours for the same pay? 

[Spryte]

So how would one go about finding a farm vet? Growing up with horses, we had access to farm vets, it was a no brainer. But, now, if one doesn't have farm animals, but still lives fairly rural ... How to find one? We've just moved, so we're looking for a new vet. The above posts have me curious.

[JennyD]

 

I just read an article about large animal vets ... in Harper's, I think?

Here it is.  Unfortunately, it looks to be behind a paywall, not sure if there's a way around that.

 

http://harpers.org/archive/2015/10/cattle-calls/

[fairfarmhand]

Yes, but large animal vets are a disappearing breed.  FIL specialized as a horse  vet, but  worked as a large animal primarily and small animal vet as needed by his practice.  By the time he retired from his own practice, of which he was a founding partner, it was no longer a large animal vet practice. Not because they didn't have the work, but because there were zero new vets coming into to interview who had those skills or interests.  Large animal vets work much more like people doctors. FIL wore a beeper etc and went out in the middle of the night to deal with a cow with a prolapsed uterus or whatever. In general, small animal vets don't deal with such things. They do, of course, but just no where near as much.

 

It isn't because people don't want to work. Any vet works a lot. But because families have two working adults now.  FIL was NEVER home, much like a person doctor. He missed most holiday dinners and school plays and never stayed home with a sick child. That is what his wife was for. Nowadays, the vets are mostly women (VERY difficult for those old vets to deal with...I have heard an earful!) and they have kids! and husbands who have jobs of their own! And they need those husbands and wives to have jobs because being a vet doesn't pay what it once did...so why would you also then work every single holiday and weekend when you could be a small animal vet and work regular hours for the same pay? 

 

And because women are generally going to have a harder time with things that require gobs of strength. I'm a strong woman, but I need my dh to help pull calves if we don't have a calf puller. His hands and arms are just stronger. My dd is thinking large animal vet, but honestly, I can't see her wanting to come home bruised and sore after dealing with horses and cows every single day.

 

And yes, vets don't make gobs of money. When you count the costs of vet school plus your 4 yr degree, many young people will be in debt for far far longer than a medical doctor thanks to the payscale.

[fairfarmhand]

So how would one go about finding a farm vet? Growing up with horses, we had access to farm vets, it was a no brainer. But, now, if one doesn't have farm animals, but still lives fairly rural ... How to find one? We've just moved, so we're looking for a new vet. The above posts have me curious.

 

Call the local agricultural extension service. They'll know for sure.

[Ellie]

Commenting just to bump this to the first page and push off the spammer. :zombiechase:

[redsquirrel]

Our horse vet has been warning us of the same thing. He says LAV are a dying breed. I think it must be a calling. It is worrisome for me as two of the five equine vets that will come to my area are getting ready to retire. I don't know what we will do if the others should quit or relocate. I guess trailer halfway across Texas....

 

I operated for years thinking vets made great money. Then my oldest decided she wanted to be a vet and as she's gotten older we've explored the occupation a bit more. I was really surprised when we looked up and it was around $90k. Considering vet school is now about 120k (not counting undergrad) and rising, that doesn't seem like a great return on investment these days. I know that it's not all about the money for people in that profession, but I was really surprised by the numbers.

 

When my FIL went to vet school, over 40 years ago now, it was 250$ a year.  He could earn that working as a hired man on his dad's farm. He did a full summer's work and it was difficult, but he could earn it. Over the years he did make a good living, but even he admitted that that time is long over. Young vets have a staggering amount of debt and the place to earn is in small animal clinics. It just is.  I've known a few young vets and none of them wanted to do small animal work, but that was the reality of their lives.

[Wabi Sabi]

I"ve had the the best luck with older vets in established solo practices in the more working-class, blue collar parts of town. They tend to have nondescript offices in long forgotten strip malls, and the low overhead definitely translates into lower prices and a more conservative, let's wait and see approach. The only problem with this strategy is that every few years our vet ends up retiring and I have to start over looking for another older vet in a hole in the wall office space... 

[Mimm]

This is a very interesting discussion. I too have felt like I was in a position where the vet wanted me to pay a lot of money to fix up a dog who didn't have a good quality of life and I felt it was time to say goodbye to him. I took him to my FIL's vet, who is a farm vet who euthanized him for us. They were very nice about it and sent me a sympathy card in the mail the next week. They seemed more practical, but not unfeeling. I also had both my dogs neutered with them for half the price of the vets in town. They're 20 minutes away in a nearby small town.

[Bluegoat]

I have found this as well, and also that practices that have a farming component are better. 

 

What I find often is that advice seems to be done almost like a mechanic in a dealership who has to follow a flow chart - symptom X test for Y.  They don't seem to stop and think "well, what will be the possible outcomes if I test for that?  What if I don't."  It seems to be a loss of any real analytical skills.

 

I've also increasingly seen practices that won't do things if you don't have a ton of blood work and stuff done first - often things that would not be run on every human patient.  In some cases really they just want you to sign a waiver, but I have had on several occasions some very annoying vet tech or vet has given me a lecture about how this is what should be done if I really want my pet to have good healthcare.

 

We a few years ago had our vets get very excited about a tumour on our dog, sure it was cancer and had to come off immediately.  It turned out it wasn't cancer at all and there were serious problems with the recovery because of where the tumour was - it wouldn't heal.  Not only did it end up costing us about $5000 in dribs and drabs, it looked for a while like she might have to have a limb amputation or even be put down.

 

Since then I have had two other friends with similar situations (different vets and clinics), minus the extra recovery issues - they were told tumours were probably caner and needed to be removed right away before even doing a biopsy, and then they weren't cancer.  Now this is anecdotal, but along with teh way I see them recommending testing, I really wonder what is going on.

 

I've found it is worst in the clinics that have been sold to big companies.  My suspicion is that they are being told they need to do things a particular way or meet a particular bottom line - they all seem to adopt very similar administrative arrangements.

[ktgrok]

 

 

 

 

I've found it is worst in the clinics that have been sold to big companies.  My suspicion is that they are being told they need to do things a particular way or meet a particular bottom line - they all seem to adopt very similar administrative arrangements.

 

Having worked for one of the big corporate clinics (for a brief period of time) this is VERY true. There are quotas to meet. It was ridiculous. And those vets work longer hours under tremendous stress. 

[swimmermom3]

And because women are generally going to have a harder time with things that require gobs of strength. I'm a strong woman, but I need my dh to help pull calves if we don't have a calf puller. His hands and arms are just stronger. My dd is thinking large animal vet, but honestly, I can't see her wanting to come home bruised and sore after dealing with horses and cows every single day.

 

And yes, vets don't make gobs of money. When you count the costs of vet school plus your 4 yr degree, many young people will be in debt for far far longer than a medical doctor thanks to the payscale.

 

I thought I wanted to be a large animal vet until I watched the arm of our 6 foot  4 vet disappear into a mare that was being pregnancy checked. The vulnerability of that position struck me as crazy. 

 

 

[fairfarmhand]

I thought I wanted to be a large animal vet until I watched the arm of our 6 foot  4 vet disappear into a mare that was being pregnancy checked. The vulnerability of that position struck me as crazy. 

 

I don't know about horses, but cows can't kick straight back. Being directly behind one is safer than being off to the side and to the back.

 

But yeah, all that sticking arms in huge (I mean HUGE) animals is something else.

 

I do want to learn how to AI cows. But that's just my own weirdness showing up.

[redsquirrel]

FIL always wanted to have me around for lambing, said my small hands would be in great demand, but it never happened.  DH grew up tagging along to farm calls his whole life. He has some great stories.

[swimmermom3]

Well, I opted for the tests, meaning blood work and x-rays. I am fairly confident they aren't going to show us anything that we can work with, but I decided I couldn't make any end-of-life decision without having done that much.

 

The old guy has been off his food for about three days and I noticed that he was licking himself a lot after drinking his ton of water. I figured he has to be nauseous. After his testing, he got an anti-nausea shot and I have an appetite stimulant pill for every 48 hours for him. He's eaten nearly a can of his stinky recovery food, so that is a start.    The x-rays were clean except for clarification on a spot that was probably a skin-fold, but could be pneumonia. I'll get the results back tomorrow for the blood work.

 

Butler is the same age as my youngest son. Even though he is incredibly skittish, he has to sit with my son during school hours and he always takes a lap if someone is reading aloud. Ds wants him to be here for graduation, but that's probably a tall order.

 

While the testing thing causes a lot of stress, I do think highly of the two young women veterinarians that I choose to work with at the clinic. They seem to be thorough, kind, and very good with stressed pet owners and pets. I really hope they are rewarded financially, intellectually, and emotionally for the work they do.

 

 

[kitten18]

I don't know about horses, but cows can't kick straight back. Being directly behind one is safer than being off to the side and to the back.

 

But yeah, all that sticking arms in huge (I mean HUGE) animals is something else.

 

I do want to learn how to AI cows. But that's just my own weirdness showing up.

My sister and nieces AI (and BIL and nephew too).

[swimmermom3]

I don't know about horses, but cows can't kick straight back. Being directly behind one is safer than being off to the side and to the back.

 

But yeah, all that sticking arms in huge (I mean HUGE) animals is something else.

 

I do want to learn how to AI cows. But that's just my own weirdness showing up.

 

With horses, you are supposed to keep a hand on their backside to let them know you are there, and then stick close because "theoretically" there is not as much power in that close kick. Still, they could move, contract, stand on your toes. Whatever. Not fun in my book.

 

:blush: What is Al?

[swimmermom3]

Yes, a large part of the issue is that if they don't offer the test, and guess wrong, they can be sued. Trust me, malpractice is not just in the human medicine world. They would be accused of not keeping the standard of care. So they have to offer the tests. But yes, you can decline them. 

 

Katie, it would never have occurred to me that a person would sue their vet. Seriously!

[abba12]

Yep. I love my kitties. But I'm not going to spend $1000 on testing for them, not a chance. They are loved members of our family, but they are not human, they are cats. They have their place. And I hate the double standard that some animals deserve more than other animals because they're, what, cuter? 

 

I will say, there was one exception to this rule, when I was a kid our family dog saved my baby sister from a deadly snake, and in the process was bitten. My parents paid the $800 bill to save it, they felt she deserved it. Some people thought they were crazy though, it's not unusual where I live to keep dogs for the purpose of catching snakes. with the knowledge they will eventually be bitten and have to be replaced. Obviously, being Australia, our snakes are quite dangerous and we'd rather a dog take the bite and kill the snake than a child take it. There's no way to prevent them coming in the yard out in the country, no such thing as 'deadly snake repellent', and it's technically illegal to kill snakes, they're supposed to be 'rehomed'. Plenty of people don't like the concept of snake dogs, but plenty of people also don't live with deadly snakes in their backyard, so, whatever. Point is, the vets out here are quite used to putting down dogs with snake bites and were a little surprised by my parents desire to save this dog! There's none of this expensive testing out here, that's for the inner-city vets and the 'animal hospital'. 

[fairfarmhand]

With horses, you are supposed to keep a hand on their backside to let them know you are there, and then stick close because "theoretically" there is not as much power in that close kick. Still, they could move, contract, stand on your toes. Whatever. Not fun in my book.

 

:blush: What is Al?

 

Artificial insemination.

 

One hand in the rectum, one hand with the semen in the v*g*na.

 

Really good techs have like a 60% success rate. I'd like to see how successful I could be.

 

Plus we wouldn't have to pay our tech his fee every time he comes out.

[ktgrok]

Katie, it would never have occurred to me that a person would sue their vet. Seriously!

 

Oh my goodness, yes! They pay large amounts of money for liability insurance (yes, making the cost of services go up) and I know we got monthly newsletters from the AVMA or somewhere and there was always a legal section describing cases where people were sued, how it should have been ahndled to prevent the lawsuit, etc. Trust me, vets are thinking about it. If they offer the test and you decline it, and that's in writing, fine. But if they assume you wouldn't want to do it, or that you can't afford it, and don't offer it that is their rear end and their livelihood on the line. Plus, remember, they are paying off those huge loans! 

 

Not to mention, say they don't check the ear swab under the microscope to look and see if the problem is yeast verus bacteria and give you the wrong medicine, it gets worse, and then the owner starts a fit in the waiting room, in front of other customers, because her precious baby is now much worse even after paying for that "expensive" medication. Now the doctor wants her to buy ANOTHER medication, because the first didn't work, and it's all a rip off. Not good for business.

 

Lots of reasons they advise the tests. 

[ScoutTN]

I"ve had the the best luck with older vets in established solo practices in the more working-class, blue collar parts of town. They tend to have nondescript offices in long forgotten strip malls, and the low overhead definitely translates into lower prices and a more conservative, let's wait and see approach. The only problem with this strategy is that every few years our vet ends up retiring and I have to start over looking for another older vet in a hole in the wall office space...

This is a good description our the vet practice I go to. Except ours has four vets who own the practice, all late middle age. They recently took on a younger assiciate, but she too has an old school approach. The building is decidedly 1960s in an lower income neighborhood. They took great care of the lab in my avatar pic and I was happy to take our new pup to them.

[RoughCollie]

I have pet insurance for Aidan solely because vet expenses are very high for treating serious illnesses and injuries.