When I graduated from veterinary college in the early 80’s, specialists were as scarce as hen’s teeth. Almost all of them were at the vet school hospital or they were scattered in a few major cities. This basically meant, if I couldn’t do it or I needed technology that I didn’t have, I would send the pet off as a referral to the specialist. This might be a complicated surgery like spinal surgery or doing a brain scan. Otherwise, I dealt with it myself.
This was both good and bad because it forced me to deal with a lot of things that might have been easier to send down the road to the specialist. Learning by fire was a great way to get to know things. The bad side, was there was always a learning curve with a lot of mistakes.
Nowadays, in most large cities, there are many veterinary specialists. Here in Spokane, which is not a very large city, we have two internal medicine specialist, two radiologist, a dermatologist and three board certified surgeons. And, the veterinary college is only 80 miles away.
Over the past decade or so, I have seen a shift in the routine for a lot of veterinarians. It seems that if the pet’s problem is in the least bit complicated, they pack the pet up and send it down the road to the specialist. As an alternative veterinarian, I often worked with the internal medicine specialists as they are handling the western medicine perspective while I am handling the alternative approach. I remember both of them saying how unbelievably busy they were because they had to deal with so many uncomplicated cases.
I had been working with an elderly lady who had a dog with lots of chronic problems. The lady was a delightful lady who was a retired nurse. She was not only charming but very intelligent. One day, she brought her dog into my office for its acupuncture treatment and told me that she wanted me to look at her dog’s eye.
She had given her dog a bath and some shampoo had gotten into the eye. The irritation from the shampoo caused the dog to paw at its eye and in doing so, a claw had scratched the surface of the eye. Corneal abrasions are very common and really pretty simple to repair. I told her what had happened and told her that she would need to go to her conventional vet for treatment.
I suspected that the vet might likely send her to the ophthalmologist at the college for treatment and I told her so. This 80 year old lady, living on social security, did not need to drive all the way to the college and spend a thousand dollars on a simple corneal treatment. I took out a piece of paper with specific instructions for the vet to follow and the medications the dog needed for it to heal.
A month later, during the next acupuncture treatment, the eye was back to normal. She chuckled a bit when we started talking about the eye. She said, “You were right about the vet. He said that the dog should go to the ophthalmologist but he agreed to treat it in the clinic. It is fine now.” The treatment probably cost her $125.
Surgery is another consideration. Like most skills, good surgery requires a lot of experience and the vet students don’t get this in vet school. If they are lucky, they might neuter a cat and possibly spay a dog, but that is all they are allowed to do. Needless to say, the newly graduated vet is not the one to do a critical spinal surgery.
There are a lot of vets in practice that have very good surgical skills and lots of experience. When I was in practice in Dallas, Texas, we had a vet hospital that specialized in working field trial Labradors. Because this breed has a high incidence of ruptured anterior cruciate ligaments, we did about 5 or 6 cruciate repairs every week. That was about twice the number as the local certified surgeon was doing. However, he charged three times the amount that we charged for the exact procedure. Obviously, the specialist designation comes with a price.
This is not to depreciate the surgeon’s value. As a surgeon, that is all they do, and the result is they do a lot of surgeries and get very good at it. They also have the technical equipment that most general practitioners don’t have.
Not all surgeries need to go to a board certified surgeon. If a large dog tears a cruciate ligament and the general practitioner is not comfortable doing the surgery, he will likely send it to the surgeon. If he has done them with good success, then he will likely do the surgery in his clinic. There is a natural assumption that the results will be the same and if so, the only difference is the cost. Again, most surgeons charge 2-3 times the amount of what a general practitioner does. I have heard of pets that were euthanized because the caretaker could not afford to go to a surgeon and were not given any other options. It is not hard to find a vet that would likely do the surgery.
As a pet caretaker, we often have to take the lead in making these choices. If the general practicing vet recommends that the sick or injured pet needs to go to the specialist, then we should ask exactly why. If the vet does not desire to treat the pet, then the caretaker should seek a second opinion from another general practitioner, preferably one who is willing to do the work. Obviously, if it is an emergency or critical situation, then the caretaker should rush the pet to the specialist ASAP.
As pet caretakers, one of our best tools, is the right for a second opinion if the situation allows. Take your time to search around for that person. Ask friends and colleagues for recommendations. Most likely, you will be directed to the person who will do the job for you, with or without the specialist.
