PAIN CONTROL IN COMPANION ANIMALS

Research has shown that pain is self perpetuating and that each episode of pain triggers the next, making it easier to experience the pain. Therefore, after the animal begins to experience pain it is much more difficult to control because the pet is already cycling through this pain “loop.” Additionally, research studies indicate that pain will not only cause the animal stress but that the stress will release steroids which will delay healing and recovery.

Interpretation of pain in the various animals we care for can be extremely problematic. In the veterinary field we not only deal with various animal personalities but also various species that show pain differently. As an example, a budgie that is painful will often just sit quietly and appear slightly fluffed, but a Husky will often vocalize at the smallest pain stimulation. Animals, like people, have various levels of pain sensitivity and some animals will be very vocal with minimal pain stimulation whereas others will never show pain sensitivity even though we know they are experiencing a painful condition.

Because of the difficulty of interpreting pain in various animals/species and because of the difficulty of halting pain once it has begun, veterinarians, as your pet’s health care provider, must control pain before it starts. We know if certain procedures are likely to cause pain and we can administer pain control prior to the procedure to prevent the pet from 1) experiencing the pain, & 2) entering the difficult to control pain cycle.

The importance of multi-modality pain control should also be addressed. We are fortunate to have a large spectrum of analgesics (pain medications) available to us in the veterinary field, and by combining different types of analgesics we can often get additive effects, where the combination of drugs work better together than either one alone. A good example of this is the use of a non-steroidal anti-inflammatory drug (NSAID) and a true analgesic such as a morphine derivative. The NSAID will eliminate the swelling and the morphine derivative will directly control the pain providing a broader spectrum of pain control.

In conclusion, veterinarians understand that animals do experience pain much like we do, but the presence of pain and its control are subjective and difficult to interpret. Therefore, my ideal pain control involves the administration of analgesics prior to a painful event and the prevention of any discomfort. Veterinary medicine of the past poorly understood this concept and approved drugs were not available, however, veterinary medicine has changed and today pain control is an important part of our acceptable standard of care for your pet.

Jill M. Patt, DVM

Veterinary care is really the best bargain in the medical professions today. Actually, the cost of veterinary care has risen very little over the last 20-30 years, especially when compared to the cost of human health care or almost any other service.

Bear in mind that your veterinarian is not only your pet’s general physician, but also the surgeon, radiologist, dermatologist, neurologist, psychiatrist, ENT, and pharmacist.

Your veterinary bill is a reflection of the costs of maintaining a quality facility, equipment, and personnel to provide the level of care that is expected in animal medicine today. Remember, too, that the original cost of the animal has no bearing on the cost of services we provide. The question is: “Can all people afford a pet?” If they can’t, then who should subsidize them? The veterinarian? Although most veterinarians wish they could, it simply is an economic impossibility. Just look at what is happening in human medicine when those that can afford to pay must pay enough extra to cover the cost of those who cannot pay.

One reason you sometimes feel you are paying more for your pet’s health care than for your own, is that you probably have adequate health insurance for your own health needs; thus, you’re never hit with a true bottom-line figure. If you sat down and added up your insurance costs, deductibles, and drug costs, you will find that veterinary medicine is really a bargain!

“Isn’t the cost of veterinary medicine out-of-sight and unreasonable? I mean we are “just talking about animal care.” I thought my vet really cared and would go the extra mile for me.”

The extent of care given to any animal is determined ultimately by its owner. If you place a low value on the worth of a pet yourself and are not willing to provide adequate care, you probably should not accept the responsibility for keeping a pet since you are sentencing that pet to less than the best that can be offered to it.

Every pet owner has different ideas as to what is acceptable pet care. Veterinarians can only make their clients aware of needed services and products available. It is up to the client to decide what level of care is to be provided for that pet. Veterinarians are willing and do go that extra mile for pet owners, but expenses must be covered. This includes staff salaries, costly equipment (such as X-Ray machines, state of the art body system monitoring devices) staff education and so on.

“Should I be wary of “bargain basement” veterinary care? If so, why?”

YES. Generally, you get what you pay for. If the price is too low, your expectations may not be met. You are entitled to a full explanation of any service you are paying for. You are entitled to an estimate of the services needed before they are provided. The bottom line is that quality care is expensive. There are no free lunches. You must choose the level of care for your pet.

“What about low cost spay/neuter clinics?”

Spay/neuter procedures are perceived as a minor procedure by most people. Spaying is major abdominal surgery of a female to remove the internal reproductive organs. The same anesthetics, drugs, instruments, and procedures are used as for a woman. We are committed to help control the pet overpopulation to the point that these procedures are actually performed on a cost basis. If we were to lower fees more, we would have to compromise your pet’s safety or lower our technique procedure standards. Frankly, we are not willing to use cheaper anesthetics with higher risk factors, or use the same bloody instruments on more than one pet without proper cleaning and autoclave sterilization. For clients concerned only with low cost rather than pet safety, we would refer them to cheaper clinics. We stand behind our techniques and are always close by if problems develop either while the pet is hospitalized or during its recovery at home.

“If my veterinarian doesn’t clear up my pet’s problem, can I get a refund?”

Fees cover what is done for the pet including the examination, lab tests, treatment, and medications. Some problems can be long-term or involve multiple and/or changing causes. Treatment may be on-going. To effect a cure is not always possible. You are paying for an HONEST attempt to diagnose and treat a problem. There is NO implied guarantee of successful outcome. We just try our best. Our clinic continues to grow due to the high percentage of successful outcomes we produce.

“My pet’s bill adds up to a lot of money. I just don’t have that kind of money all at once. What about terms?”

Our veterinary fees are based on payment at the time of service. To keep fees low as possible, we must eliminate all unnecessary factors that would raise fees. The hospital business manager will be able to clarify the payment policy of our clinic.

Many needed procedures can be staggered over a period of time, rather than “doing everything at once.” Discussing the pet’s health care needs on a spread out basis is one way to diffuse the cost over the year. The pet owner should not expect the veterinary practice to be the banker for the pet’s health care needs. We accept credit cards and also offer Care Credit. The bottom line from the business standpoint is that if a pet owner has no money, no checking account, no credit card, and no job, there is little solid evidence that payment will ever come. This is sad for those of us who really care about pet care, but it is a business fact of life we must live with or we will not stay in business very long.

“Why do prices vary from clinic to clinic?”

Prices are established by a clinic that will cover its cost of operation to provide the services requested. Often phone shopped prices do not reflect the same set of services. For instance, spays, neuters, and declaw packages may vary from clinic to clinic. These procedures are once-in-a-lifetime procedures for your pet. The important thing is that they be done right!

Every veterinarian sets the fees for services based on varying criteria, such as different drugs, anesthetics, antibiotics, and quality of supplies, to be used. You will usually find the difference in getting quality services does not cost that much more than the cheapest price you get. And it certainly can make a difference to the outcome for the pet.

“My injured (sick) pet needs to be seen by a veterinarian, but:

a) I just lost my job

b) I don’t get paid for another 2 weeks

c) I barely have enough money to put food on the table

d) etc.”

If there were no satisfactory financial arrangements made for payment, veterinary practices would end up operating at a loss, eventually to the point of having to close down.

Most responsible pet owners have a regular veterinarian and most will work out a payment plan with their regular clients. The problem arises with people who have pets that do not get regular veterinary care, but demand and seek services in an emergency situation without guaranteeing payment.

“I recently took in a stray that appeared injured. I took him to a vet and paid the initial bill. I am unable to afford further treatment. Is this my reward for trying to do the right thing?”

If you “adopt” the animal, you become the owner and therefore are responsible for the animal’s care. Hopefully, a healthy animal is your reward for trying to do the right thing.

We understand the emotions that we can get caught up in when we see an animal that is homeless and needs help. However, making the decision to take in a stray should only be done with the same careful consideration that is involved in purchasing or adopting a new pet. The veterinary expenses are not assessed based on the method by which a pet is acquired. If you are not willing to take financial responsibility for a stray animal, it should be referred to the local animal shelter.

“Why can’t the veterinarian advise, diagnose, and prescribe over the phone and save me a lot of time and money?”

Not only is it unethical and illegal to prescribe for an animal that hasn’t been physically examined by a veterinarian, it is also impossible to come up with an accurate diagnosis and rational plan of treatment.

A veterinarian can’t make a diagnosis based on signs only as observed by an owner. The outward signs may be an indication of any number of internal causes with a variety of clinical treatments. A complete physical examination is required to determine the cause of signs and best course of treatment.

Asking your veterinarian to advise, diagnose, and/or prescribe over the phone is the same as having your physician prescribe over the phone. If you were told to take an antacid for what was, in actuality, a heart attack, the results could be disastrous!

“How much should I anticipate spending for veterinary care for a new puppy or kitten initially, and then on an annual basis thereafter?”

Puppies and kittens need basic health examinations and worm checks. Depending on their age and health status they need to complete a vaccination program. The cost varies with each pet. Our clinic will be happy to provide you with a suggested preventive health care program for your new pet at the time of the initial examination and consultation. We can provide the same thing for annual visits as your pet ages.

“Does my pet have to get a full set of inoculations to get a rabies tag and license? What shots are absolutely necessary for my dog/cat and how much do they cost?”

To get a rabies tag and license, only a rabies vaccine is needed according to law. It is in the best interest of your pet to get a routine checkup plus all the necessary vaccines as determined by our veterinarian for your pet so that your pet remains healthy and is a good companion for you. There are many diseases around, many of them fatal. Administering vaccines is an easy way to prevent pain, suffering, and death. Prices will vary and we will be happy to provide you with a treatment plan for your particular pet.

- David Garrity

MRSA in a Pet Dog

Angus, a two year old neutered male Yorkie presented to us in July for a wound on his back. The owner was unsure as to what caused the lesion, but did say that possibly it happened from a fight with the other dog in the house or a scrape from his kennel. At the time of presentation, Angus was mildly dehydrated and his blood work revealed no other significant abnormalities. The wound was approximately 2 inches by 2 inches. The wound was cleaned and Angus was sent home on antibiotics and pain control.
On the recheck exam 3 days later, the wound had become quite extensive

MRSA in a Pet Dog

and areas of the skin on his back were dying and falling off. An additional antibiotic and anti inflammatory medication was started and the wound was thoroughly cleaned and bandaged. Additional testing was submitted to check for Valley Fever and Addison’s disease; both of those tests later came back negative.
On his recheck exam in 3 days, the skin around the wound had become affected and his entire back was red and the skin was raised. The skin of the presenting wound continued to peel off as it was no longer healthy. With the wound becoming substantially more severe and not improving with his current therapy, a skin biopsy was submitted as well as a fungal and bacterial culture of the wound to try and determine the underlying cause so that the appropriate therapy could be initiated. The bacterial culture came back that he had a Methicillin-Resistant Staph Aureus infection, or MRSA. The importance of diagnostic testing cannot be reinforced more strongly than by looking at the case of Angus and his skin wound.
The treatment plan for Angus was altered by changing his antibiotics to Clindamycin and Doxycycline, both antibiotics were useful in treating his strain of MRSA. His wound had become quite extensive and a large portion of skin on his back had fallen off. Daily bandage changes and wound care were performed to keep the wound as clean as possible and promote good tissue healing. When the skin was healthy enough and the dying portions had fallen off, the skin was closed surgically and wound management was continued post surgery. Angus was cared for approximately 7 weeks and he is healing extremely well and now has hair growing back over the previous lesion. Nasal and rectal culture swabs were taken and no MRSA was isolated from those samples. Angus is a happy, healthy boy at this time and is thankful for the care he was give here at Alta Mesa Animal Hospital.

A little about MRSA…(information taken from www.aahanet.org and more information can be found by searching that site)
Methicillin Resistant Staph Aureus is a bacterial strain that cannot be treated by the Penicillin class of antibiotics. This bacterial strain has developed resistance to antibiotics often used, thus making it more difficult to treat. MRSA has become a very serious cause of infections in human medicine and is responsible for many nosocomial infections, or infections acquired while in the hospital. Bacterial infections can be diagnosed by taking a sample and submitting it to a lab where they can perform a culture to determine what bacteria is present and a sensitivity to see what antibiotics will be appropriate for getting rid of that type of bacterial infection. In our animal patients, MRSA should always be considered when dealing with non-healing or necrotic skin wounds. Proper hand washing hygiene and isolation protocols should be taken whenever you suspect a possible MRSA infection. Contact your veterinarian if your pet has a skin infection and make sure to contact your human physician if you have any concerning lesions yourself.

PLAN: Patient was placed under general anesthesia following per-surgical work-up including blood testing. A breathing tube was placed to allow control of breathing and anesthesia gas and the tail was surgically prepped. Using our co2 surgical laser the tail was amputatued and the remaining skin was sutured over the tip of the tail bone. Patient was initially placed in e-collar but he quickly removed this so he was recovered with a tail bandage until sutures were removed. Histopatholgoy revealed a cartilage based tumor with good prognosis.

OUTCOME: Patient healed fully and is doing well.

Take away message

Birds Like Shoes

If you own a pet bird there are many things you need to do in order to ensure its safety.

All birds should have their wings clipped if given any potential access to the outdoors.

In addition if you take your bird outside with you for a walk or to visit others, you should invest in an avian flight harness to keep your pet with you and not up in the trees. Remember even a bird with trimmed wings can get uplift on a breezy day and may get far enough away from you to get lost or enter a dangerous situation. If you invest in a flight harness you will need to very slowly train your bird to allow you to place the harness on your pet – go slow!

Lastly, all bird owners should have current photos of their pets and

also have their pets chipped. A microchip is a very small chip implanted into the muscle by a needle injection and provides a permanent number through a national registry allowing anyone that finds the bird to access your information and return your lost pet to you.

What is it?

An artificial sweetener found in many sugar free products such as chewing gum.

What does it do? In dogs it causes either a profound episode of very low blood sugary or sudden liver damage.

How toxic is it? Potentially as little as one stick of sugar free gun can cause liver failure and death.

How is it cured? Avoid the source! Once the animal has shown signs of disease only supportive and life saving care can be offered. The goal is to keep the pet alive long enough for the liver to begin healing.

Does it hurt people? Not based on current information, the product appears to react much differently in dogs than in humans.

What do I do if I suspect that my pet ingested one of these products? Bring the pet to your doctor immediately and they will discuss how to proceed to keep your pet safe.

Link to ASPCA & further information on xylitol: http://www.aspca.org/site/DocServer/vetm0207f_095-100_.pdf?docID=10462

Jill M. Patt, DVM

The puppy was placed under general anesthesia and a surgical prep of the leg was completed. A large area of skin was taken from the puppies side using a surgical laser to reduce pain, swelling and scaring. The graft was then prepped for placement on the hock including making multiple “holes” to allow better stretch over

wound bed and drainage. The graft was secured to the underlying tissue using multiple sterile surgical stapes. A bandage cast was applied. During recovery the patient had to be kept in hospital and under strick confinement to allow the new graft to grow vessels into the wound bed. The bandage was replaced weekly with wound cleaning for approximately 6 wk. After 2 weeks the staples were removed but the bandaging was continued until significant healing was noted.

Able to save leg and >70% uptake of new skin and a healthy happy puppy!

Images shown during surgery.
First images shows the cleaned wound bed on the hock surface, and second image shows placement
of the new skin graft onto the hock using surgical staples.

Close up of placement of mesh skin graft during surgery.
Second images is 7 days after surgery and shows up take of graft tissue

Image one shown 2 weeks after surgery with substantial healthy pink tissue.
Image two shown after staple removal

Image shows uptake of graft with healing of skin and start of hair growth on graft.

Bullet the Cat

Case:

Recently, a caring gentleman brought in a feral kitten (~14 weeks old) that he thought may have to be put to sleep. The kitten was one of a wild litter he had been feeding and the day prior he noticed that this particular cat was dragging her back legs when coming in for her meal. She had been apparently normal prior to this day. We examined the kitten and found her to be in alert and responsive with 2 wounds at the middle of her upper spinal area and wounds on the top of both back feet. The foot wounds were apparently from dragging them on the cement while attempting to get back for her meal. The wounds on her back were suspicious for a bullet injury or two. As a result the doctors elected to take x-rays of her back and found a bullet (pellet) lodged directly in the center of her spine. While “Bullet” is able to move her back legs to a small extent she is unable to walk or stand. She has been treated with steroids to reduce the pressure on her spinal cord and lots of TLC for the spirit. While we don’t ever expect her to be normal we do feel that she has a good chance of having a happy life. She currently is able to “scoot” around the hospital and is quickly becoming a loving and sweet kitten. We have been expressing her bladder but, happy days, she urinated on her own today. We may place her with a family in the near future but they would need to be special people willing to provide the intensive care she will require.

<span What do you do if you find or know of a feral cat?

AZ CATS is a rescue group that works hard to keep AZ cats healthy. This group frequently has spay / neuter catch and release programs and are a good source to contact if in need. How do you keep your cat safe?

Unfortunately, there are always going to be malicious people who take joy in hurting animals so the best way to keep your cat safe is to keep her indoors. If you have a cat that “must” have outdoor time the safest method is to build a kitty door with an attached outdoor run. There are many commercial kits for outdoor kitty exercise and an enclosed patio will work just as nicely. In additional to saving your cat from deliberate injury you will also be protecting her from fatal viruses, accidental injury, wild animal attacks and parasitic infection.