Balancing Your Pets Health

     Current news has inundated us with information on the current debt crisis and the varying viewpoints on how to balance the nations budget. As intelligent human beings we understand that the budget must be balanced in order to create a healthy environment for future generations to flourish.

In nature there are numerous examples of symmetry and balance among organisms. We take it for granted that butterflies have two wings that are perfectly balanced in size, color and texture, making flight seem effortless. Birds instinctually migrate in symmetrical. balanced flocks, when they travel south for the winter.

Today, this symmetry has been scientifically proven to be inherently attractive to the human eye. In scientific studies babies spend more time staring at pictures of symmetric individuals than do at photos of asymmetric ones. The rationale behind symmetry preference in both humans and animals is that symmetric individuals have a higher mate-value; scientists believe that this symmetry is equated with a strong immune system. Thus, beauty is indicative of more robust genes, improving the likelihood that an individual’s offspring will survive. This evolutionary theory is supported by research showing that standards of attractiveness are similar across cultures.
I am often asked to describe how Integrative medicine, which combine natural therapies and modern medicine, work to heal an individual. The simplest answer is “by creating balance and symmetry in the body”.

Our Ecosystem needs to have a delicate balance in order to have all living creatures thrive. This Summer could bring an unprecedented spike in Lyme disease, according to the  Cary institute of Ecosystem studies.  The prevalence of Lyme disease is directly related to the acorn crop.  Acorns are an important food source for the white footed mouse, a popular target of the ticks that carry the lyme disease bacterium.  The Study suggests that a recent lack  of acorns will cause the mouse population to plummet, leaving more black-legged ticks to bite humans.  Up to 90 percent of Lyme infections go unreported but the national record for confirmed cases was set in 2009, That number could rise by 20 percent in 2012., due to imbalance in the food chain.

A common condition we treat with Integrative Medicine is hind leg weakness, and low endurance in older animals.  All of these animals have an imbalance that causes the symptoms of arthritis in the back and legs. The underlying problem is not only arthritis, but also, the primary problem of the bodies’ imbalance.

Last week I saw a 10 year old, stiff , weak, Border Collie, named “Charlie”. All the routine diagnostics tests (Blood, urine, X-ray) we preformed came back within normal limits.    By evaluating this patient from a natural medicine approach we were able to understand, and treat an imbalance called “Deficient Heat”.

The best way to understand this natural imbalance is to think of a car without enough, coolant fluid in the engine.   If you drove the vehicle on a warm day, the car would inevitably overheat, due to “deficient fluid” in the engine.   A pet with “Deficient heat” is similar, to a car that overheats, it runs hot.   Pets with “deficient heat” seek out cool places; pant excessively, have a bright red tongue, stiff painful joints, and exercise intolerance.  Pets with the imbalance of “Deficient Heat” respond to cooling herbs and food that have cooling properties, to correct their imbalance.  As always the natural therapies are, in addition to, not instead of, main stream medication, such as anti-inflammatory.

Natural medicine is not a “cure all” but in the case of this Border Collie, “Charlie” allowed him to have increased strength, mobility, and vigor.

Andrew Frishman DVM

Progressive Animal Hospita

http://www.progressive-vet.com

(914) 248-6220

Advertisements
Posted in Uncategorized | Leave a comment

Knowing the Right Diet for your Pet

The Importance of Food:

Food is eaten out of a  biologic necessity, it is the fuel that runs our lives. As human beings our relationship to food is complex. Food is about pleasure, community, family, spirituality, and about our relationship to the natural world.  Food is as much about culture as it is biology.  Due to our complex relationship to food, it is no wonder that we are often confused and overwhelmed about what the best diet is for our pets.

Variations among Pets

No two dogs or cats are genetically identical. Dogs and Cats have  genetic differences due to selective breeding and mutations occurring during development, these minor genetic variations, have translate to obvious differences we can appreciate visually. Consider how minor genetic variations can have such  a wide variety of body types in dogs—imagine a tiny Chihuahua standing next to a Great Dane, or a Chinese shar-pei peering from under its skin folds at an Old English sheepdog who peers back through its long hair.  It is critical to understand that these minor genetic changes in dogs and cats also affect biologic functions in an animal’s metabolism and the digestion of food.

As humans, we are 99.5 % similar, yet there are wide variations in diets among individuals and cultures. There are individuals who crave spicy food and others who can’t tolerate even the mildest ethnic foods.

The French culture has evolved and enjoyed many of the foods deemed toxic by nutritionists, but at the same time have substantially lower rates of heart disease then Americans who eat an elaborately engineered low fat diet.

Just like there is no universal eye color there is no complete diet perfect for every pet.  The right diet is as unique to each pet as their genetic code and resulting metabolism.

Chronic conditions such as itching, skin infections, allergies, and diarrhea are some of the most common mismanaged conditions I see related directly to diet.

We now have the ability to scientifically figure out what foods your pet is allergic to, and choose a customized diet that is appropriate for your pet.

Allergy shots and specific diet recommendations based on lab tests can provide lasting relief from allergy and allergy-related symptoms your pets struggle with.  Allergy testing and treatment works to not only increase an animal’s tolerance but create a life time of health and comfort free from the side affects and dependence on medication.

Its time to go from what we think is a good diet to what we know is the right diet for our pets.

Posted in Uncategorized | Leave a comment

A Tale of Two Patients

 

A Tale of Two Patients

Late last year, my 87-year-old mother developed diarrhea.  I phoned her doctor’s clinic and was answered by a recorded voice that periodically told me, “All of our representatives are busy helping other clients.  We appreciate your patience.  Your call is important to us.  Please hold for our next available representative.”  Synthetic music alternated with synthetic messages for 28 minutes before I lost my appreciated patience and hung up.  I phoned again later; after a 15-minute hold, in the midst of “your call is important . .,” I was disconnected.  I got through on the third try:  The first possible appointment was in 2 weeks.  I took it.  I would cancel my own workday afternoon to take my mother to see her doctor.

The receptionist ignored us when we came into the office at 3 p.m.  I stood by her desk, Mom beside me in a wheelchair, while she chatted and joked with the clerk next to her for several minutes.  I coughed.  Nothing.  I coughed more loudly.  She glanced in my direction, so I quickly told her we were there for a 3:30 appointment.  “Name?” she said.  Then,  “Registration card?” and “Insurance card?”  She stamped a bunch of sheets of paper, then shoved a clip-board covered with a sheaf of documents to be signed toward me.  We were directed to sit in the crowded waiting room.  When we were settled there, I started to read the forms to Mom, but they were dense and in microprint, and largely unintelligible, so she finally just signed them unread.  I carried them back to the clerk, who took them without a word.  We waited some more, At 4 p.m.  I went to the desk.  I stood in line behind more recently arrived patients and gradually worked my way to the front:  “when will my mother be seen?”  I asked the clerk.

Name?” she asked.  I told her. “Registration card? Insurance . . .?”

We’ve done all that already,” I said.

“Oh?”  She shuffled through a pile of stamped papers, found Mom’s, then put them back in the pile.

“Doctor is running behind.  He’ll see her as soon as he can,” she said.

“Does he know we’re here?”

“He’ll see her as soon as he can,” she repeated.  She sounded annoyed.

“She feels miserable and tired,” I said.

Even as I spoke, the receptionist picked up the ringing telephone and began to talk to the caller, turning her eyes away from me.  I stood firm in my spot.

“Hay!”  I said.  She ignored me.  “Hello! I’m still here.”

“Excuse me,” she said to the caller, putting her hand over the receiver.  Then to me she said:  “I’m on the phone!”

“I know that,” I said.  “When will my mother be seen?”  It was now 4:15 p.m.

“Doctor will see her as soon as he can,” she said, and resumed her telephone conversation.

I didn’t move.  When she hung up the phone, she looked around me to the next person behind me.  “Name?” she asked him “Registration card?”

I went back to my mother, who was waiting in her wheelchair holding her head in her hand “Is the doctor going to see me soon?”

“He’s running behind,” I said.

“Does he know we’re here?”

“I don’t know.”

I’m really tired,” she said.

“I know.”

“What time is it?”

“4:20.”

“Wasn’t the appointment for 3:30?”

“Yes.”

“Where is he?”

“Busy.”

“I’m really tired,” she said.  “And I have to go the bathroom.”

I’ll take you.”

“No.  The doctor might come and not see us.”

“I’ll tell the receptionist where we are.”

No, I’m afraid we’ll miss him.”

“Do you want to go home?  I can make another appointment.”

“No.  I’ll wait.”

She looked up expectantly as each new movement   occurred in the waiting room.  Periodically, the nurse would come out of the inner office with a she to paper and call out a first name.  “Bill?” she’d say, and a distinguished elderly man would get up.  Then, 15 minutes later, “Harriet?”  A woman stirred from her corner.  Each time, my mother’s hopes visibly rose with the nurse’s appearance, then fell again, and she slumped back into her wheelchair when the name called was not hers.  Finally she was called.

We were put into a cubicle, Mom’s blood pressure, pulse and temperature were taken.  It was cold.  I asked the nurse for a blanket for Mom.  She gave me a sheet.  “We don’t have blankets,” she said.

It was 5:30.  “Is the doctor coming soon?”  My mother asked the nurse.

“He’s running behind,” she said He’ll be her as soon as he can.”

“I have to go to the bathroom,” Mom said.

“The doctor may want a urine sample,” she said.  “Can you wait?”

“I’ll take you,” I said, and, over her protests, did.  On the way to the bathroom, we passed a conference room full of laughing staff.  They were having chips, coffee, cake . . . a party of some sort.  We took a long time in the bathroom to get her done.  Maneuvering Mom in and out of the wheelchair onto the toilet isn’t easy.  When we came back to the room, she was frantic.  “Did he come?  Did we miss him?”  Just then, the harried doctor came in.  He was apologetic, pleasant, polite, attentive, and thorough.  He took a careful history and did a directed physical examination.  “Her examination is normal,” he told me, then more loudly to her, “Your exam looks okay, but we should get some tests.”

“Now?” she asked.

“No,” he said.  It’s too late.  The clinic lab is closed.”

When?” she asked.

“We can draw the blood tests tomorrow.”

“What do we do now?” she wanted to know.

“You go home and eat a liquid diet until we know what’s going on.”

“No medicine?” she asked.

“Not until we know what’s going on.” He said.

He turned to me.  “I’ll give you a stool cup and urine specimen cup.  You can bring them to the lab when you bring her for the blood draw.”  It was clear that, though he knew I was a medical school professor and had a clinical, administrative, and teaching schedule of my own, this was quite secondary to the system’s constraints.  If we wanted this done, it had to be done this way.

We went home, arriving well after 7 p.m., bother exhausted.  The next day, after my early morning hospital rounds and rescheduling my non-patient care appointments, I took her to the lab, where a single, haggard phlebotomist faced about 20 patients.

Her diarrhea continued until the study results came back negative, then gradually stopped.  “Probably something she ate.” Her doctor said when I phoned him with the news.

The bill, when it came 3 months later, was for over $600, mostly paid by Medicare.

Late last year, my 10 year old boy developed diarrhea.  I phone his doctor’s office and the receptionist answered within 2 rings of the telephone.  I explained the problem and she said, in a voice of concern:  “Oh, goodness.  You’d better bring him in.  Can you come in about an hour?”

“Sorry, I said.  “I have appointments myself until this afternoon.”

Well, how about early this evening?  Five o’clock? Five-thirty?  Or we could see him this weekend.”

“Five-thirty today is good.  I’ll get a chance to swing by home and pick him up.”

“See you then.  Call if you can’t make it.”

It was a squeeze, but I managed to get away early from work and arrived at the doctor’s office only 10 minutes late.  The receptionist looked happy to see me, greeting me by title and last name, and was similarly welcoming to the patient.  He was glum and anxious, but she was sympathetic.  With 3 minutes of our arrival, he had been weighed (markedly obese, as before), and was led into a cheery, warm examination room.  Four minutes after that, the doctor came in.

She spoke first to him; “How are you doing?” she asked.  Then as he turned away from her, the poor guy.  You don’t feel well at all, do you?”  She ran her hand gently through his hair.

He didn’t answer.

“What’s the problem?”  She asked me and smiled sweetly at him.  “It seems he’s not up to talking.”

I explained.  She quickly, but thoroughly examined him.  He squirmed, uncooperative.  She didn’t mind.  A stool sample obtained by rectal exam was done immediately for microscopy.  The blood was drawn there and then by the time she finished, the stool report was ready.  “No blood, no ova or parasites,” she said.  “The abdominal exam is normal, but we can get an abdominal radiograph to check for partial obstruction.

“Okay.”

She took him to the radiography suite down the hall and returned in 20 minutes without him, but with his film in hand, showing it to me on the view box.  She said to me “perfectly normal.  We’re getting a urine sample now,” she said.  “Sometimes a urinary tract infection can do this.”

The urine and just-drawn complete blood count results accompanied his return to the examination By this time, he looked better.  I noticed that they had cut his nails, which had been a little long.  I was given dietary instructions by his physician.  “No further therapy was needed,” the doctor said and we left.  The visit, exam radiograph, pedicure and advice had taken 30 minutes and cost $175.  He was hungry again that night, and his doctor phoned me first thing the next morning to ask how he was doing and to give me his lab result – all normal.

“Probably something he ate,” the Veterinary said.  “You know how dogs are, and Igor is particularly dedicated to eating anything he can get his muzzle into.”  She laughed.  “But if it happens again, just call.”

Posted in Uncategorized | Leave a comment

Referral Fatigue: A new cause of reduced veterinary visits?

E-mail
Print
PDF

In recent months, columnists and reporters writing for the veterinary trade journals are discussing the NCVEI/Brakke consulting study which concluded that the number of veterinary visits are down largely because of the perceived cost of care and the lack of owner awareness of the necessity of annual visits.  Articles such as the headline article in the March 2011 edition of DVM Newsmagazine1, opine about the causes for this trend and ways this trend can be reversed including consumer education, standardizing pet wellness recommendations2 and educating pet owners about financing expensive procedures through loans and other financing programs3.
One item that these consultants overlooked is “referral fatigue.” Although this new and previously undocumented disorder is not the largest cause for the decline in veterinary visits, it is likely a significant contributor to the perception that costs associated with veterinary medicine are out of control. It is not clear what effect “referral fatigue” will have on the general veterinary practitioner but we suspect, overall, it is not helping the situation.

Referral Fatigue – defined
Referral Fatigue is the reluctance of pet owners to spend money, any amount of money, on a pet after they have been to a referral hospital and paid for expensive treatment on their pet. The problem is not the money they spent. It is the perception that they were fleeced at the referral hospital.   Owners affected with referral fatigue would rather see their dog die from an inexpensively treatable condition, than risk another visit to a referral hospital.
While working as a road warrior in Boston, at an imaging center in San Diego, and through numerous teleradiology outlets4, as a radiologist I fill a unique role in referral medicine and see a subset of cases that has largely not been identified or studied. The cases that I see are “kind of” referred out by the referring veterinarian who asks for assistance but remains in control of the case. In most instances, case selection is appropriate and veterinarians know which cases I can assist with and which cases to send to the referral hospitals.
Over time, however, I am seeing a trend where I am working on larger numbers of cases where the owner will not, under any circumstances, go to a referral hospital. They would rather see their pet die at the hands of their primary care veterinarian (who has implored them to go elsewhere) and watch their vet muddle through trying to treat their dying pet than suffer through what they perceive to be an unacceptable alternative of going to a referral hospital.
In nearly all cases, these pet owners had a previous bad experience at the referral hospital. Almost invariably the story goes that they went to the referral hospital, they were charged thousands or tens of thousands of dollars, treated like a red headed stepchild, and were left with an urn full of expensive ashes5. Pet owners describe these experiences with visceral descriptors such as “I got raped at the referral hospital” or “they just abused me and spit me out.”
It is not clear what effect “referral fatigue” will have on the general veterinary practitioner. It is expected that a growing number of pet owners will decline referral to regional specialty centers. On the positive side of things (at least if you are a GP) this could increase visits for the referring veterinarian and raise revenues for the GP as they are asked to tackle cases they previously would have referred.  On the other hand, we fear that it may decrease visits in general because it adds to the perception that veterinary medicine is too expensive and bad experiences5,6 at the referral hospital create an overall negative impression of veterinary medicine and all veterinarians.
This negativity created by “referral fatigue” also seems to have consequences that reach far beyond cases that should be referred. Once a pet owner is “abused”5 at a referral hospital an suffers “referral fatigue”, if they do get another pet, we are seeing more and more cases where they are less likely to spend any money (above and beyond initial diagnostics) on their pet for any reason.
We see this repeatedly when we discuss treatment recommendations with our referring veterinarians who are at a loss to understand why a pet owner would rather put down a dog with a broken toe nail or a bladder infection than spend even minimal amounts of money on these curable diseases. Unfortunately, these owners, because of their “referral fatigue”, deeply distrust any recommendation made by a veterinarian because they perceive the veterinarian to be driven solely by profit. This distrust is so pervasive that they will decline all therapy even for disorders that are curable and inexpensive to treat.
This consequence of “referral fatigue” does nobody any good. Not the pet owner. Not the pet. And certainly not the veterinarian.
Please do no target your local specialist – it is not their fault, they are not to blame, and they are only doing their job (which is getting more and more difficult over time)
In much the same way as home owners followed the advice of financial planners who told them to take out home equity loans because the price of their house would always rise, specialists (like their GP counterparts) were lead to believe that what pet owners wanted was more and more advanced veterinary care and they would pay anything. All they needed to do was build a megaplex hospital and raise fees every year and things would be OK.
Unfortunately, in many markets, things did not turn out OK and we are now seeing a “shake out” in veterinary referral medicine. Referral hospitals are declaring bankruptcy, specialists are competing with specialists (whose salaries are subsequently suffering BIG TIME), and pet owners would rather have a radiologist take care of their pet than someone who is better qualified.
Bottom Line: It is not clear how “referral fatigue” will impact veterinary medicine but it looks like things are coming full circle as we barrel forward into the days of Veterinary Medicine 3.0 where we don’t sell flea products, vaccines are not a profit center, wellness programs will be a tough sell, corporate ownership of pet hospitals will be the norm, and a specialty degree is no longer a license to print money.

_______________
1. In the same issue (DVM Newsmagazine, March 2011) there is a blazingly good article in the opinion/analysis section titled “Does the new normal seem abnormal?” where Richard Langford DVM, does a significantly better job identifying the real issues affecting veterinary medicine. Perhaps, the NCVEI should have just hired Dr. Langford. Kudos Dr. L.
2. Our early research, albeit unscientific and performed wile riding a bike and drinking beers at bars suggests that attempting to replace profits from flea products and vaccinations by “wellness exams” will flop. There is already too much chatter by pet owners who proclaim “that vet only wants to get me in there so he can tell me my dog needs it’s teeth cleaned and charge me like $1000.” If wellness is the future, we have ALOT of work to do. AVMA – you listening?
3. Is encouraging pet owners to mortgage their future really a good idea? Didn’t the housing bubble burst because lenders encouraged consumers to take on too much debt? Isn’t this another form of predatory lending? Do we really think that creative financing is a long-term solution? In our opinion this is a band-aid. Owners will reach for the creative financing option once and only once. After that, they will likely opt for no pet or inexpensive pet care (sch as a shot clinic) because they will be paying off that debt for years to come resenting the vet who pushed them to take out a loan in the first place.
4. Sight Hound Radiology and Shadowsmiths
5. Who knows what the reality of these situations is. I suspect that, in many (if not most) cases, the referring specialists were doing a fine job and adequately outlined all of the risks and costs before hand. That is irrelevant for our purposes. The only thing that really matters is the owner perception. That is a perception that is increasingly negative toward referral medicine.
6. Owning a dog will cost upwards of $15,000 to $20,000. Don’t believe it? Play with the Breedfreak Cost of Ownership Calculator and let us know what you think it costs. Breedfreak is a new project of ours. Get the book. Every vet hospital needs one in the front room. Let us do the dirty work of telling your pet owners that their dog is an expensive medical disaster for you.

Posted in Uncategorized | Leave a comment

HAS THE FAMILY PET BECOME A VICTIM OF THE RECESSION?

As we read in the news daily, the economic downturn is causing many families to tighten their belts and rethink their spending habits.  This belt-tightening also extends to one member of the clan who has little to say in the matter – the family pet.

My name is Andrew Frishman and I’m the Chief Medical Officer and owner of Progressive Animal Hospital in Somers, NY, and I work closely with many pet rescue organizations.  In a recent discussion with one such large Manhattan based program called Safety Net, I became aware of an increasing trend in pet neglect due to owner’s lack of personal finances. The Safety Net program aims to help financially distressed New Yorkers keep their pets by offering free food, and discounted veterinary care.  Since the economic downturn, calls to Safety Net hotline are up 50%.  Many owners are looking for ways to abandon their pets.

In a follow up conversation with a local pet cemetery, I was also made aware of a large increase in the number of pet owners who “walk in” with pets who have passed away due to lack of veterinary care. This is sadly what I call “economic neglect”.

As a doctor of veterinary medicine, I spend many sleepless nights asking myself how I can extend high quality and affordable health care to my patients to avoid unnecessary neglect or euthanasia.  While medication, computers, and other advances in diagnostic equipment have revolutionized veterinary medicine, they come at a high price.  A price that many pet owners cannot afford in these trying times.   I stress the importance of Pet Insurance, wellness exams, and blood tests to diagnose an illness prior to becoming life threatening.  These proactive steps save owners money.

As a general practitioner, if required, my first preference is to refer a client and their pet to a board certified specialist for the highest quality diagnostics.  In today’s economic environment, it is often out of reach for many.  For example, a specialist might want to do CAT scans, MRI’s, or ultrasounds to diagnose a problem.  While these tests are wonderful diagnostic tools, what can a pet owner do who can’t afford the cost?  My response is to provide treatment options that can alleviate an animal’s pain and distress as an alternative to the difficult decision to put the animal down.

Offering treatment options doesn’t necessarily equate to lowering the quality of care.  In my case, I offer my clients the optimum treatment course I would like to pursue.  I help pace out their pet’s diagnostics and treatment to provide an understanding of what is critical, while at the same time, what is affordable.  Offering payments over time is also an option.

Regardless of cause, as a general practitioner of veterinary medicine, it is my responsibility to care for animals.  With corporate, multi-doctor run practices becoming the norm, I take pride in being a single practitioner, much like the old-fashioned family doctor offering education, empathy and flexibility to their patients.   Economic neglect has become an unfortunate fact of life for thousands of pets.  The good news is that there are alternatives when financial stress is a factor.  It is important to seek out those options and give your pet every chance at life.

Posted in Uncategorized | Leave a comment

Area Dog Parks Offer Fellowship, Fun For Canines And Owners Alike

Dog Parks in Connecticut – Courant.com

Posted using ShareThis

Posted in Uncategorized | Leave a comment

Internet Pharmacy

Pet owners have the option of having a prescription filled at an Internet Pharmacy.  There are both advantages and disadvantages to ordering supplies for your pets online.  Advertisements make it appear simple to order your pet’s prescriptions on line; however, it is more involved to use an Internet Pharmacy than just making a phone call.  There are several important reasons why we feel that Internet Pharmacies are not always the best option for obtaining your pet’s prescriptions. 

The law requires that a veterinarian must have seen your pet within the last six months in order to fill a prescription.  This time frame may vary depending on the age and medical history of your pet.  An Internet Pharmacist has never seen or treated your pet and would have no knowledge of allergic reactions, whereas your veterinarian keeps intricate records. Furthermore, your veterinarian is always continuing their education, keeping up to date on the latest medications.  Your veterinarian may be aware of a new medication that would be the best option for your pet.

 Most often, if you call your veterinarian to have a prescription filled it will be ready to be picked up within a short time frame.  Your veterinarian may even have the medication in stock right at the office.  If you are most interested in delivery to your door, your prescription could easily be dropped in the mail.  Your veterinarian has access to all of the medications that the online pharmacies have, and more. 

Advertisements on TV broadcast the convenience of home shopping combined with discounted products but are not always the best option.  Your veterinarian’s prices are comparable to those of Internet Pharmacies. While most online pharmacies are trustworthy, some have questionable ethics.  Some of the top internet pharmacies have been fined in several states.  That these medications are available from your own pet’s veterinarian should make a difference.

Posted in Uncategorized | Leave a comment