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One Veterinarian to Cure “The Holding Pattern”

November 11, 2014

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.

“Skin problems have initiating factors, predispositions and perpetuating factors,” says Doc Truli. “For example, an initiating factor may be a flea bite. A predisposition is a family history of allergies and a perpetuating factor may be obesity causing skin folds to rub together and prevent adequate air and sunlight from healing the skin.”

Ideally, you would like every veterinary visit to advance your pet’s health and your understanding of your pet’s healthcare. You were all excited to go to your recheck and you were scheduled with a different veterinarian. (Or worse, you switched the hospital to get a “free first visit.”) They did not know you or your pet. They had medical notes, but they did not know where you were in your understanding of medicine or skin and they did not know your goals. Also, in a 10 minute recheck, they looked at your pet (having not seen the original condition of the skin) and they refilled your medications and sent you on your way. Is that worth your money? No!

Now, what should have happened? You should have continued your pet’s care with the original veterinarian. Why? Well, do you think that a picture or a medical description can really explain the details of your pet’s skin? No! Seeing, smelling and touching your pet’s skin stays with your veterinarian. Notes can only cover so much. You reached a point of understanding at the initial visit. Your veterinarian who saw your pet initially knows whether or not you can give your cat pills or whether you can clean your dog’s ears. They know if you can name an antibiotic and they know if you confuse the steroid and the antibiotic unless they place the pills in different colored bottles. All the personal details matter so much.

One Veterinarian is the Direct Path to a Cure

Most importantly, your veterinarian had another step in mind. A proper follow-up recheck visit should include a plan for the next step of management for your pet’s condition. For example, maybe the underlying factor that caused your pet to acquire an infection is still present. Maybe you need to treat your dog’s oak tree allergy or else an infection will just recur. Perhaps you need to eliminate a predisposing factor like a hairy ear canal, and now that the ear infection is better, your pet is comfortable enough for the ear cleaning procedure. Does a different veterinarian know to advance the health of your pet in these ways? Probably not. Therefore, do not let your animal hospital book your follow-up care with a different veterinarian. Even if you like and trust all the vets at your local animal hospital, continuity of care is critical to improve your pet’s health and save money.




7 Comments leave one →
  1. Lynette Sanders permalink
    November 12, 2014 1:25 pm

    My cat Bailey who has been diabetic since 2007 was sailing away nicely, he has had his ups and downs since then a year ago in June he had some seizures, his body was going into remission and the insulin was to much for him, I started home testing and wasn’t before because the vet said per his curves and Frutosimine levels he didn’t need to be home tested. So I started home testing and now Bailey only needs insulin on a PRN basis. Since June a year ago he has had a major pancreatic attack along with some mild ones, he was in the hospital for 10 days and then went into renal failure, while everyone told me there was nothing to be done about teh renal failure I researched it and found there was, Bailey gets fluids at home twice a day and is on a host of Renavast, azodyl, potassium, phos binder, now on a B complex. rehnannia 8 and 6 gentle pets, Bailey was doing very well until recently for teh past month I have been struggling with anemia and him not wanting to eat, so I had to incorporate Nutra-cal and the B complex, Bailey was on Cerenia shots which did nothing and then moved on to the pill form which did nothing for him, his body started retaining fluids either from the Mild HC or the anemia, I cant seem to get any place with any kid of treatment for his nasius or his inappptience. I have learned to not trust vets and feel like I spend a ton of money just to get the diagnoses and then I have to do all the reasearch to find the answers on what I can do, it is just a shame and is very hurtful for our pets, still dealing with him not wanting to eat, he gets excited at meal times takes a few bites then walks away.

    • November 12, 2014 3:38 pm

      You need a better veterinarian.

      • Lynette Sanders permalink
        November 12, 2014 4:04 pm

        I know but to get a vet to prescribe this is another story, his last numbers were at 20% then I put him on a b complex and nutrcal for the vitamin e I was trying to avoid his anemia from getting worse, his numbers were elevated the next blood draw but he was dehydrated and they told me his levels may be sewed because of it, they increased his fluid intake because he is a CRF kitty with a heart murmur and Mild CM, he is due to go back this week to have his levels read again. Vets in Iowa frankly suck, I wish I could get a recommendation for a vet in my area I have gone to 5 different vets since bailey was diagnosed in 2007 for diabetes

      • November 12, 2014 4:11 pm

        Has he seen an internal medicine specialist? You also have the veterinary teaching hospital in Iowa.

      • Lynette Sanders permalink
        November 12, 2014 4:22 pm

        He has not seen an internal medicine specialist, he has been going to IVRC which is pet hospital and they have critical care vets there who have been tending to bailey, I have had a bad experience with the vets and teams at the teaching hospital in Ames, they are very cold people and did nothing to help my Lymphoma kitty who was also anemic and was receiving epogen shots but only after I took her to IVRC, we lost her 6 months after she was diagnosed. I tried everything to save her as well, including both IVRC and the teaching hospital in Ames as well as my holistic vet and regular vert

      • November 12, 2014 9:07 pm

        Dear Lynette,
        I’m sorry to hear you were treated coldly. That’s a shame. I think you are doing exactly right by researching and advocating for your cats. You are their representative in the human world and they need you to look out for them. Fantastic job!

        Good luck!
        -Doc Truli

    • November 12, 2014 3:43 pm

      If his anemia is below 20%, he is a candidate for erythropoetin injections per the International Renal Interest Society (IRIS).

      This is the most comprehensive Western medicine website regarding kidney disease in cats.

      Renal Cats eat better and live longer with anemia treatment.

      Dr Springer

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