What Is the Holding Pattern?
“The holding pattern is what I call it when a veterinarian just repeats what was done at the last visit, without giving you any options for discovering predisposing factors or perpetuating circumstances that cause your pet to have the same problem over and over again,” says Doc Truli, “It wastes money and shows shoddy medical practice.”
Imagine this: your pet has itchy skin. Maybe a few sores, maybe a bacterial or yeast infection. You went to your veterinarian and your pet received a steroid injection and antibiotics. Probably you also took home some medicated shampoo. If your veterinarian practices integrative medicine, you likely also took home some omega 3 fatty acids and prescription skin support food. Maybe your veterinarian ran the appropriate diagnostic tests for skin problems: a skin scrape cytology, skin tape cytology, fungal culture, trichogram and maybe an endocrine and thyroid function blood panel and serum allergy tests. The cost was tremendous and the results were pretty good. For a few months.
Now imagine you returned to the animal hospital for a recheck about 2-4 weeks after initiating treatment. You are given a refill of steroids and antibiotics and sent on your way maybe another US$100 lighter. What happened? You were put into the holding pattern. Read more…
Why does 1 of my dogs have bad skin and her litter mate is perfect?
“I’m beside myself. Chica stays up all night itching and I’ve tried everything.” Rosada stood defiantly planted on the opposite side of the stainless steel exam table from Doc Truli. A 4-pound (1.8 kg) Maltese shook in her little fuzzy white paws on a pink towel on the slick silver table. “Her sister is twice her size and her skin is perfect. I know Chica was the runt of the litter, but why is her skin so bad?”
Little Shih Tzu has a Lump
Mei Mei wagged her stubby scrubby black and white tail. A tiny fur matt dangled off the end like a tail earring. Mei Mei stamped her front paws as if to say, “Give me a cookie!” Doc Truli laughed and felt the little Shih Tzu’s submandibular lymph nodes.
Mei Mei’s mom said, “Her face has been swollen for a few weeks. We know her teeth are bad We figured it’s a tooth root abscess. We really don’t want to put her through surgery. We just want to try antibiotics.”
Before launching into the discussion about why antibiotics will never cure a tooth root abscess, Doc decided to examine little Mei Mei.
“Oh Nancy, antibiotics aren’t going to help this,” said Doc Truli
How Does a Bite Wound Heal?
Remember Minnie from VirtuaVet’s last story about cat bite wounds?
Drains Prevent Sepsis
First, Minnie was supposed to come visit Doc Truli three to five days after her original surgery in order to have her Penrose latex drains removed from underneath her skin on her right hind leg.
“I had to take care of an emergency with my family, and then I was in the hospital, and it just didn’t happen,” said Minnie’s human. “I kept it clean and dry.”
Doc Truli evaluated the drains and the wound healing. “Minnie’s lucky. She’s healing really well. We have to remove these drains and make sure there are no pieces of latex stuck under her skin. They would act like a foreign body and cause a severe reaction,” said Doc Truli.
Minnie the Cat has Extensive, Hidden Trauma
“She was perfectly fine last night at 10 p.m. Today she just lays around and won’t even eat her favorite- rotisserie chicken,” said Roxy. The black, short-haired, slightly pudgy domestic kitty purred. Her golden eyes stared up at Doc Truli from the zippered opening of her burgundy polyester cat carrier. Minnie looked normal.
“Does she go outside?” asked Doc Truli.
“Yes, she loves to sleep on the hood of the car in the sunshine and sometimes she sleeps on the back porch in the afternoon. She stayed out all night two nights ago and didn’t come back until the next morning. She seemed fine,” said Roxy.
Doc Truli knew better than to just reach into the carrier of a supposedly friendly cat who may be in pain. With a gentle hand, she felt Minnie’s head and lymph nodes, then her shoulders, then her back and finally, her hips. Minnie growled.
“She hurts in the back-end. Let’s get her out of this carrier carefully and see why she hurts back there,” said Doc Truli.
“Now that you mention it, I have not seen her get up and walk in more than a day,” said Minnie’s mom. You’d think someone would lead with that observation…
Doc felt Minnie’s right hip, haunch and hind leg. The whole thigh felt crinkly with crepitus (pronounced crep-i-tuss). Doc knew immediately that anything causing that much air under the skin was extensive. Usually a bad infection or trauma will cause air under the skin.
“Minnie needs sedation and surgery to identify all her wounds and fix them,” said Doc Truli.
“I can’t believe it. She was perfect yesterday,” said Roxy. “Why does everybody say that?” thought Doc Truli.
Reality Check: Your Limited Budget Causes You to Jump from Doctor to Doctor to Take Advantage of Free or Discounted Initial Examinations
Peaches hissed from his carrier. Then he yowled and Doc Truli suspected the examination would be limited, at best. The angry, sick 4-year-old orange tabby cat had not urinated in 48 hours. During that time, he had seen 4 veterinarians for initial “discounted” visits. His mom could not afford full hospitalization and unblocking under anesthesia, especially considering he should have had blood tests and intravenous fluids therapy and other costly treatments to save his life. So each veterinarian told her that her cat would die a painful toxic death if he did not urinate and gave her a treatment plan estimate ranging from $100 for basic passing a urinary catheter and no other medications or treatment to $650 to do everything properly. Mom felt $100 was not affordable, so she declined and packed her cat off to another doctor for another opinion.
By the time she arrived at Doc Truli’s pet emergency room, the cost of the 4 veterinary examinations was $120. Basically, if she had stayed at the first clinic and accepted a basic treatment plan that would probably save his life, he would be unblocked and have chance of recovery. Instead, she already sent more than her budget and after Doc Truli told her Peaches was indeed completely “blocked,” she refused to believe the diagnosis and packed him up for a car trip to another vet office.
This is an extreme example of the craziness desperation can infuse into a situation. But it nonetheless happened. Doc Truli hopes someone was able to treat Peaches.
If You Feel You Must Consult an Additional Veterinarian, Do It Right
- If the diagnosis is straightforward and you cannot afford the plan our hospital offers, ask for a payment plan. Ask if they participant in any third-party systems like CareCredit.
- Ask if there is a doable less expensive diagnostic and treatment plan. Let them know you do not wish to harm your pet, but is there a solution that is cheaper and usually works (understanding there are no guarantees in medicine.)
- If the diagnosis is made, but the treatment is too expensive at your hospital, bring a copy of the records with you to the second opinion hospital. “Too many people are embarrassed to tell their vet they have to try elsewhere, so they don’t even let the new vet call for the records,” says Doc Truli. If the second opinion veterinarian can review the physical exam, history and diagnostic test results, you save time and money every time.
- If the diagnosis is not straightforward, pay for a second opinion with a board-certified specialist. “There is little point in dragging your pet from one general practitioner to another. Upgrade your information source to a specialist and often you will save money in the long run.”says Doc Truli.
- Ask how much and how many rechecks the vet expects to need. Budget for them. “Skipping rechecks often lands you back at the starting point of the disease and you never get anywhere with it,” says Doc Truli.
Thank you for reading!
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