In the past few months, I’ve been trying to get to the bottom of some distressing symptoms exhibited by my 14-year-old dog Otto, by using every one of the three veterinarians that make up our veterinary healthcare team.
Yes, three. Following the precepts described 20 years ago by one of our long-time contributors in “Finding a Balance Between Conventional and Holistic Dog Care,” I have assembled a team to meet all my dogs’ veterinary needs. It’s the only way I’ve been able to access the totality of the care I feel like my dog needs!
Our most local vet is more or less Otto’s primary care doctor. Her clinic is located less than two miles from my home, making it most convenient for picking up Otto’s prescriptions and for routine visits. She’s terrific and her clinic is well-equipped. I can usually get an appointment within about two weeks there. But until recently (and this might be changing as we speak), once the pandemic started, she would see patients only in her clinic without the owners present. Having a conversation about your dog over the phone is better than not having a vet to talk to at all, but it’s not always ideal, so if I feel it’s important to be able to see the doctor examine my dog and be able to point out things and discuss things she observes in that moment, I sometimes use veterinarian number two:
This veterinarian practices in a rural clinic, where in this day of COVID she is happy to see patients with their owners outdoors (weather permitting, and in our climate, this is almost always viable). This vet also offers acupuncture, which we’re using in an effort to reduce some of Otto’s arthritis pain. The down side is that she’s farther away and a little less up-to-speed with the latest diagnostic tools. When my dogs need advanced diagnostics, I go to veterinarian number three:
This veterinarian is board-certified in internal medicine (a Diplomate of the American College of Veterinary Internal Medicine or DACVIM), and practices at the gigantic 24-hour clinic about a half-hour’s drive from here. She has good lines of communication with our primary-care doctor, and they share tests results quickly and easily so they both know what the other doctor is thinking. This practice has almost all the bells and whistles, and while care at this clinic is expensive, the insurance provider I use has never balked at any of the bills.
These are our three go-to providers, but we’ve used other specialists, too:
I took Otto to the Veterinary Medical Teaching Hospital at the University of California (Davis) for a dental procedure some years ago. Radiographs taken during a routine dental cleaning found that Otto had two cracked teeth, and the local vet thought they might be candidates for crowns, rather than extractions. Given our good health insurance, I opted for this additional visit to the dental experts at UCD, hoping we could save two of his teeth. Alas, the much more powerful imaging equipment at the university hospital were able to reveal that the damage to the teeth was deeper than previously seen, and the teeth had to be extracted after all.
This experience has led me to conclude that, at least for older dogs with more complicated dental histories, it’s likely best to go to a bigger, better-equipped hospital for even routine dental exams and cleaning; we could have saved Otto from one of those two general anesthesia events had I taken him to UCD for the first of those two exams.
Otto also had surgery at a specialty veterinary hospital for a lesion found on his liver.
I’ve known so many friends whose big dogs died from hemangiosarcoma (a disease that has a decent prognosis only if detected super early), that I have asked for Otto to receive an abdominal ultrasound examination as part of his annual well-dog visit. About six years ago, while conducting the ultrasound, our DACVIM observed a lesion on Otto’s liver, making these annual ultrasound examinations not just a matter of reducing my paranoia, but medically necessary. About three years ago, with the lesion growing, our vet recommended that Otto receive either exploratory surgery or a CT scan to better visualize the lesion, followed by (if at all possible) immediate surgery to remove it if indicated. She referred us to a specialty clinic about 90 minutes away, where we were able to schedule the CT scan and, potentially, time with a surgeon, in the same time slot, so Otto wouldn’t have to undergo general anesthesia twice again.
As it turned out, the CT scan showed that the lesion was quite possibly problematic, so Otto went right into surgery after the imaging. Fortunately, after the mass was sent out to a pathologist, we learned that it was not malignant. We keep his liver under observation, however, as it’s shown signs of further (though thankfully still minor) abnormalities.
The surgeon at that practice – and really, the whole staff – was amazing. Otto had to spend the night before the surgery at the practice, so, on the day he was admitted, I brought along copies of WDJ and a WDJ calendar to show the staff, so they knew they were caring for a celebrity. When I got to visit him post-operatively, I was thrilled to see that they had hung the magazines and calendar on his kennel door, so every person walking by him could see what a superstar he is. If Otto ever needs surgery again, that’s where we’ll go.
I know I’m incredibly lucky to live in an area where I have access to all these gifted professionals. Otto has a better healthcare team than my husband and I do! But I have to say that it’s largely the fortunate choice I made for Otto’s health insurance (discussed recently here*) that has made it possible for me to provide this level of healthcare for Otto.
* Otto is covered by a plan from Nationwide. This is not a blanket recommendation for that company, though it’s been very beneficial for me. For more information about choosing pet health insurance, see this article.
We live in an area with two veterinary teaching we are very fortunate to live in an area where great vet care (including specialty care) is so readily available (and at the vet teaching hospitals and a critical care center, care is available 24/7). Frankly, we had a chance to move to another area but chose to stay here simply because of the availability of vet care here. While, we hope we never need the critical care center, we have had to use it in the past and they are wonderful there–you can call any time day or night and talk with the vet tech actually caring for your pet (and if you need to speak with the vet, they will either talk to you right then or call you back within a reasonable period of time–which can be up to several hours if the vet is in surgery, but it’s most often within 15 minutes). Our dogs and cats aren’t superstars like Otto, but I think they kind of get treated like they are. The staff there has been just great. Of course, I was sold on the owner of the critical care center when we took a Great Dane puppy into rescue whose owner had broken his left rear leg in two places and then broken the hip (the puppy nipped at the guys fingers–an 8 week old puppy nipping? Yep, guy felt perfectly justified in throwing the puppy across the room and then kicking her to within an inch of her life; he then dumped her at the shelter who kept her for one week with NO vet care, no x-rays, no pain meds, etc. and then they called us to take her–that day–a 14-hour drive. Luckily, we found a wonderful couple who agreed to drive over and pick her up and bring her back. Problem? They’d be pulling into town in the wee hours of the morning (they arrived here about 2:45 a.m.). Owner of the critical care center? Here’s my cell phone number. When you get to exit X, call me and I’ll meet you at the clinic and we’ll have her into x-ray and possibly surgery within the hour. And you know what he charged us?? COST. His cost. So, yes, I’m happy to patronize his center even though, yes, it is expensive. And, btw, happy ending for the puppy. She had x-rays and surgery and we had a fund raiser for her and made more than our goal, and she was scooped and adopted once medically cleared by a wonderful family. They offered to foster her through the rest of her recover, but we left her in her original foster home throughout her recovery).
Wow! What a great story! Thank you for sharing that — and we agree that a clinic owner like that is worth any amount of loyalty.
Can you tell me the name of your pet insurance?
It was mentioned at the bottom of the post: Nationwide.
Thank you for your info & advise. My dog is almost 11 years old. I will probably line her up with the bigger Vet hospital. We have had a similar situation as Otto. My dog had a surgery at that bigger hospital mid-town & the staff are amazing too.
Nancy –
Thank you for the wonderful reassurance that having more than one vet on speed-dial doesn’t mean you have gone overboard! We have a wonderful nine year-old Goldendoodle mutt who has IVDD. We live in an area where vet care is fairly limited but when Shiloh blew his second disk this past summer, our local vet was wonderful. Of course it happened off-hours but he came to the clinic, determined where the best neurologic care would be in Phoenix, gave Shiloh something for the pain to hold him for the two hour drive and then, delivered great care when we brought him home. In a good news/bad news story – the surgery was very well done but the post-op care in Phoenix was not and when we got Shiloh back he had chewed off half of his tail (which they didn’t bother to bandage) and pressure sores on each hip bone. Thanks to our local vet and he recovered, had a partial tail amputation and got back on his feet, just a bit slower even after laser treatments.
Our UPS driver (Shiloh shares Otto’s need to announce that the big brown box is near!) told us about another vet in town who only works part-time but was doing great things with stem cell therapy … so we took the plunge and are very glad we did. Along the way, she also recommended an allergy test for him (probably because he had “explosive” diarrhea all not long the night before the procedure!) and we learned that he is allergic to almost all the common foods (chicken, rice, lamb, turkey …). Today, our boy is sprightly again … though no longer allowed on furniture or to jump …. and I am committed to having two vets for one beloved dog … and more if needed. Thanks for reassuring me of my wisdom and … please keep up the writing! I love WDJ!
WOW. Losing part of his tail and with pressure sores on hips? What on earth did they say to explain that? Great job with all you are doing for Shiloh!
Thanks for the encouraging words! They didn’t even try to explain why the tail and pressure sores or even apologize, and I was so angry, I just wanted to get him home. I knew we would do a better job of care!
Hello Nancy – my 5 year old male rescue is Woody’s twin – Am Staff, Lab and Boxer mix. 3 years ago he got his first dental and xrays revealed root absorption disease. My vet and his team are the best diagnostics team I’ve ever experienced, but he said there is nothing he could do, traditional Western medicine-wise. His office manager tipped me off to a nearby holistic vet who has since been treating my boy with monthly acupuncture, strict home made diets using “cooling” meats, vegs and grains, plus supplements, and three blends of Chinese herbs. Plus dentals every 6-9 months to keep his mouth in good shape. A lot of work and $$$, yes, but it’s WORKING! His mouth has not gotten any worse in 3 years. I just couldn’t stand by and watch my dog’s teeth fall out, and with the help of others I found a way – that is working, at least for now. So I’m a big fan of multiple vets. For your readers, my message is – don’t give up and keep looking! (PS – I’m the one who wrote into the Journal asking for an article about root absorption disease, which you published a couple years ago.) – Your avid fan of WDJ, Laura from Odenton, MD
Thank you for that article inquiry!
It totally makes sense to me that not even the most brilliant veterinarian in the world can be “all things” to all animals. Can you imagine primary care physicians who do surgery and dermatology and internal medicine and gastroenterology and nutritional consultations AND provide complementary care? Vets who appreciate a collaborative team approach are worth their weight in gold.
I use multiple vets for my 12.5 year old toy poodle and my 8 year old toy poodle with Inflammatory Bowel Disease. Without the different vets I feel certain their care would not be as good. Our primary vet is close by and he is great but his practice is different than a specialist. We also use Colorado State University Teaching Hospital for dental (I would not take them any other place because of x ray and skill) and for IBD treatment for Cullie and now for Shanti as she ages. We also have a vet/PT who comes to the house once a month and uses laser, acupuncture and physical therapy. She works with owners to provide a good home program. I also use the Assisi loop on both of them for inflammation. Look it up on the internet. FDA approved and I believe it has helped both of my dogs.
Thank you for this post. I’ve been using a multi-vet approach for years with my pets and have always felt a little ashamed of having to “cheat” on my regular vet by seeing others in order to get the spectrum of services that I want. I’m so glad to know that others do the same. It is very difficult to get the right mix of conventional and holistic care all with one vet or clinic, at least in my area. For those who can access such a mix, be very grateful. It is rare. Is the articule that you referenced still available? I’d love to read it.
Living in a small rural area with very limited veterinary care available with basically only x-ray diagnostic equipment is a huge concern for me. I lost my last girl within a few hours to hemangiosarcoma, she was just 6 yrs old. That day I took her to the vet knowing there was something not right with her, a call later I was told she likely had pancreatitis as enzymes were off and signs of anaemia. Later when I went to get her she couldn’t even stand but I was told to take her home and return in the morning for additional fluids. It was obvious she needed further monitoring and I made the decision to take her to the emergency clinic almost 2 hrs away. By this time she was crashing and the vet immediately did an ultrasound where it was discovered she had a belly full of fluid. The chances of her surviving surgery were extremely poor and I had to make that awful decision to let her go. Had the initial vet had an ultrasound available perhaps by girl would still be here or at least not suffered all day bleeding out. I have since registered my dogs with a clinic further away that offers 24/7 emergency and has more diagnostic equipment. I keep detailed files on all their treatments and visits and go back and forth between the two practices, the first for routine visits as my confidence in them was shattered. So yes having multiple avenues available for our pets care is paramount.
So sorry for your loss! Hemangiosarcoma is THE WORST.
I live in a rural area of northeastern Vermont, with the closest large (i.e. well-equipped vet hospital) nearly 2 hrs away, so I have relied upon one of our local vet clinics for all my dogs and cats routine care. Previously I was fortunate to have a holistic vet about 2 hrs drive and he gave my Goldens (one had a congenital heart problem and both developed cancer) a good quality of life; sadly, that vet retired. Fast forward to the 3 young rescues who now occupy my home and all were healthy until last July when the older male (age 4) suddenly developed severe gastrointestinal issues – and was diagnosed with chronic enteropathy (Irritable Bowel Disease). We were then referred to a very large veterinary hospital in Massachusetts, and the Internal Medicine Specialist there has taken over primary care of this dog. It makes sense to have a “team” of doctors who are willing to consult with one another, especially for a pet who is aging and/or has chronic health issues. I can’t say enough about our regular vet and for our IMS who is readily available by email to answer questions or calm concerns !!!
I also take my dog to a chiropractor regularly for preventive care.
I won’t go into my issues with Nationwide.
I am lucky to live in a large city so have my choice of vets and there are several animal emergency hospitals offering 24/7 care in the area.
I recently switched from the practice that the family has used for 50 years to the only “fear free” veterinary service in the city central. One of the reasons was that after three changes in ownership, our original veterinary clinic simply did not provide the level of care it used to. There was to much turnover in staff and almost none of the doctors worked full time so when appointments were needed it not only was a wait but you often didn’t get the same doctor twice. I like my dogs to have a primary care vet who they see each time rather than whoever is available. That way they get to know my dogs and more importantly the dogs get to know them. This is especially important now because Diana pawPrints developed a serious aversion to vet care, primarily I believe because of the treatment she received at the first clinic. They still don’t allow you to go in so I cannot observe exactly what she is doing in response to what they are doing. But we have gone from happy to see everyone to a muzzle to tranquilizers to sedation for routine vaccinations. They wanted me to take her to a behavioral therapist (at $500 a pop). Well, she has a legitimate reason to react the way she does and I don’t think she should be trained out of it.
So we switched to the fear free clinic. They have been wonderful. They are excellent at reading body language and are not in a hurry to get it done and move on to the next patient. Yes, she did need both tranquilizer and some mild sedation the for a blood draw. But this last time she only had the tranquilizers for an exam on her skin condition (she has an allergy resulting in a bacterial infection). She has made such good progress I have hopes eventually she won’t need the tranquilizers. I think her fear was situational/locational. Those people hurt her, these people don’t. And she gets plenty of pets, cheese and Vienna sausages. One of the vets on staff is also trained in holistic medicine and they do acupuncture, should that be needed in the future.
Thankfully I have not had to take Diana or Freyja to the emergency hospital but I have taken previous dogs. They are also very good. Not sure what all they have but it’s enough to diagnose and treat.
I’ve opted to use CareCredit as my “insurance”. It works like PayPal. Depending on the amount you have 6-12 months to pay it off and as long as it is paid off in that amount of time, no interest. This works for me. I added up Ramses’ vet costs over his life, the premiums and my out of pocket versus reimbursement and have opted for no insurance this time around. My dogs will still get the same care but I will be paying it myself rather than relying on the insurance to approve or deny.
I also do a lot of preventative with annual check-ups, some extra vaccinations (lepto), healthy diets and exercise, limited high quality treats( I am a rabid ingredient reader) to maintain an ideal weight, socialization and “hobbies” (Diana does Scentwork). Knowing your dog to detect anything early and then getting treatment immediately is really the key, no matter how you pay for it or who they get it from.
I am amazed by all of this information. In 2020 we moved approximately 50 miles to a new area. Bad timing for many reasons. Our rescue corgi mix developed a chronic cough. We have taken him to four different veterinary practices 1 local, 1 an hour drive, 1 2+ hours & 1 3+ hours. Plus we have paid thousands of dollars which was ok he’s my baby. However none have been able to find the reason for his cough despite all the different tests & procedure’s. He eats well, enjoys his walks but the coughing makes me crazy. Any ideas? Thank you