Hoo boy, that 20/20 piece sure stirred up some emotions, didn’t it? And it’s Thanksgiving, a week of gratitude, so I’m going to take a step back and say thank you to all the wonderful readers and colleagues who make writing this worthwhile. In honor of that, I’m going to take a moment and also share with you some of my own veterinary secrets. For the low low price of nothing, I want to explain to you what I believe, based on over a decade now in the field, is the best way to save money at the vet. No sarcasm here.
The best way to save money at the vet is….are you ready?
To spend more time at the vet. No, really.
Preventive Care is where it’s At
If one wants to know some of the best ways to save money on medical care, we need look no further than the group that has gotten the cost/benefit analysis down to an exact science: the human medical profession. It’s taken a long time for the field to come away from the model of medical firefighting: wait until something gets bad- CANCER! KILL IT WITH RADIATION! and more towards preventive care: MAMMOGRAM ALL THE LADIES! Firefight when you have to, but how much better is it to catch things early? For us, of course, it’s lives on the line, but guess what? It’s better for the bottom line too. Win-win.
Interestingly, the three situations described in the 20/20 bit as potential money grabs by the veterinary profession are perfect illustrations of why preventive care is so very important. Had we seen the extent of Marty Becker’s 90 minute interview for the piece in context, this would have all been part of the piece, by the by.
1. Cancer
50% of dogs over the age of 10 will develop cancer. I see it every day. It stinks, and once it’s diagnosed in advanced stages the treatment options are difficult and expensive. When your veterinarian finds a lump on a dog during a routine exam, for the love of everything, check it out! Trust me, I would make more money resecting it in a messy surgery a year from now when it’s huge as opposed to doing a little biopsy or fine needle aspirate here and now, but I don’t recommend that because I don’t want that to happen to your pet.
Here’s just a few examples of things I have diagnosed on a check of a lump the owner was on the fence about doing anything about:
-melanoma
-lymphoma
-sarcoma
-mast cell tumor
Early detection saves lives.
2. Vaccines
People often go to those weekend vaccine clinics to save money instead of getting it done in the office. Then what happens? They hand you a pamphlet and you have to decipher which package, A, B, or C you want like it’s ordering your kid’s school photographs. It’s confusing. Often, you overbuy. It’s a lot of work to try and stay on top of these things, and I certainly don’t expect pet owners to be reading up on current best practices for vaccines each and every time the dog’s getting boarded and you need a Bordetella vaccine.
I take vaccines very seriously. I keep up on the latest AAHA guidelines– based on research, science, and the best our field has to offer in terms of what constitutes duration of immunity and core versus non-core vaccines. I use that to tailor a vaccination protocol for each pet who comes through the door. I can’t tell you what I recommend across the board because there is no such thing as ‘one size fits all’. I’ve done the full complement, I’ve done titers, I’ve written letters asking the county to exempt an elderly pet with a history of vaccine reactions from a rabies vaccine. This is what we do. If your veterinarian isn’t open to that conversation, I agree 100% that you may want to find someone else.
That being said, the majority of my patients do stay on schedule with vaccines, because once you’ve seen dogs dying of parvo while a little child weeps, you kind of get invested in doing all you can to prevent that.
Bottom line: It’s worth it to find a veterinarian you trust. We’re not unicorns, at least in my experience; we usually can be found hanging around.
Vaccines save lives.
3. Dentistry
Here’s the one that caused the most discussion. Our profession is in the middle of some real change in terms of recognizing the importance of dental care. Since I am not a boarded veterinary dentist, I defer to their vast reservoirs of knowledge and the evidence is clear: 85% of pets have periodontal disease by the age of 4. Most of it is invisible to the naked eye. Can you imagine if we waited until our teeth looked brown and grungy with recessed red gums before going to the dentist? There is real, actual value in getting professional care even if a mouth “looks” OK.
http://www.youtube.com/watch?v=j6gNkXpRZkEThe *best* way to keep your pets’ teeth healthy at home is incidentally also the cheapest: brush their teeth daily. The other best thing is to get regular, anesthetized dental cleanings to prevent disease from developing/worsening. If you choose not to anesthetize a healthy pet at 3 years old for routine maintenance, the end result is often a 12 year old with impaired organ function and a mouth full of horrifically painful teeth that need to be removed, at great expense. I can address the anesthesia component in another post, because it’s worth a discussion all its own, but suffice to say, anesthesia performed to excellent standards of care- that’s the key- while not risk-free, is actually very safe in healthy pets.
The three issues presented above are life-savers for pets. I am not saying this hyperbolically. Done early and with forethought, they are also money-savers, because they stave off much more significant, and expensive, disease down the road. There’s a reason my own insurance has a $0 co-pay for preventive care: it works. Same goes for our pets.
And happy Thanksgiving, everyone.
Happy Thanksgiving Dr. V!
While I do brush my dog’s teeth – specifically on one side where molars have been extracted, hence no chewing so prone to tartar buildup …I absolutely believe in at least bi-yearly dental if blood work supports anesthesia…it is a great opportunity for a full exam of not only mouth and teeth but entire body…things that are just sometimes difficult without a bit of relaxing. As far as $$, it has always worked for me as a LOT can be done for the one anesthesia outlay.
And I am all for preventative…that’s what I do for me, that’s what I do for my pets. I don’t understand not doing preventative.
For the first time, both of my pets are insured also. It started with my dog – adopted at 6.5 but there was a “deal” offered via petfinders AND he came with all of his history (prev owner died). It saved my bacon. He had 2 extractions and 2 TPLO’s in the first 2 years with me.
I just adopted a new kitten and he is insured. I selected a catastrophic plan for both – the plan I selected is designed to help mitigate large expenses. Example: approx $6200 for 2 TPLO and followup…I paid about $2K, insurance paid the rest. Some good luck in that both TPLO’s occured in the same deductible period. The premium is minimal and in my mind, worth it.
Happy Thanksgiving and thank you for a year’s worth of good info that helps me take care of my loved ones!
2 TPLOs in a year!! I agree, while I’m not entirely sold on insurance policies covering preventive care, those catastrophic plans can come in very very handy.
There was some indicaton that both knees were blown when they did the first TPLO. But also some hope that not. Rats, but he came through both and we are almost a year from the first and at 9 years young, he is doing great!
I must say, I’m glad I missed the 20/20 feature. It would have made me so angry. It does anyway. I’m glad our trusted veterinary professionals are speaking out against it. Sadly, the people who will believe what they heard likely already thought that. It’s sad that the producers of the show would so blatantly misrepresent the issue.
I hope the outpouring of alternative information, from trusted sources like you Dr. V, helps the majority of pet owners to see how false and unprofessional it was. No one is a better friend to our beloved pets (beside us) than the veterinarians and veterinary technicians who partner with us to keep them healthy and happy. Anyone who thinks differently is seriously misguided.
Thank you for the link to the AAHA. (yes I am back, again) I had to blow up the cat vaccination schedule to read it! It doesn’t discuss Bordetella, but I understand from WebMD that it is not considered a core vaccine. Since I know that my vet sent a reminder for Bordetella and FeLV I will confirm that there were no core vaccines on the list. Thank you!. What I can not do, is brush the teeth of a cat that will not accept any food by hand, nor does he allow me to hold him. I get one chance to open his mouth, and then he fights me (although he has never bitten or scratched me for that – he prefers to swipe at me if I am not doing what he wants or if I inadvertently rub his belly.) He will not allow any spray treatment, either. So any suggestions on how to brush the teeth of a very stubborn cat would be appreciated. His cleaning this year was good despite my lack of cleaning.
How I wish that pet insurance was present when I had my poor cocker. Or I had it during the last days of Abby-dog’s life. I didn’t limit her care because of the cost, but the bills reminded for many months afterwards and I would have liked not to have that reminder. Finding toys buried in the back yard under bushes, 5 years later, is enough of a reminder.
When she was done playing fetch she hid her toys. I just found one this spring when removing an evergreen. –Amy
Bordetella for cats? Nope. And it’s considered non-core for dogs, too, though I give that one pretty regularly. Dr. Becker actually put up a good post today about cat dental care on Vetstreet: http://www.vetstreet.com/dr-marty-becker/getting-serious-about-your-cats-oral-health
Thank you. I think I will look at the wipes.
having volunteered at an animal shelter, I’d recommend bordatella to anyone because you never know when your dog could wind up in a shelter. An interstate ran through our town and we got dogs from car wrecks, DUI arrests, motel runaways, etc. — all pets that the owners never thought they would board. Some of our shelter dogs got sick, and most shelters can’t really quarantine very well once a disease starts running through the shelter. Why take a chance a preventable disease?
It is so true. I often have people come in that have spent way more money than they had to, to try and clear up a flea problem, than if they had brought the pet in, at the start.
Dr. V., as a avid pet owner I am forever grateful for those who answered their calling and became veterinarians. It’s not an easy job, technically and emotionally challenging, not including dealing with crazy pet parents. You don’t become a veterinarian to get rich, but for love of animals, and that is what I’m the most thankful for this week. My Vet always gives me that peace of mind and I know that when I take my dog or cats to him, he has our best interests (health) in mind as well.
Thank you Leah, and though I don’t know your vet I’m going to go ahead and mind read and say he or she is also very grateful for clients like you. 🙂
I stay on top of preventative care, but my vet actually does NOT recommend dental cleanings as often as I would like. (Other than that I adore my vet and everyone in the practice.) Neither Oscar nor Sophie will let me brush their teeth — perhaps a few sessions with a behaviorist (which I’m already considering for Oscar’s barking) would help?
Dr. V, what would you recommend for an elderly dog with partial laryngeal paralysis who is high risk for anesthesia but badly needs a dental cleaning (he never tolerated brushing)? His gums are a little inflamed. The vets can’t see any cracks or teeth that need to come out, but we don’t know what they’ll find under the gunk. Two vets recommend anesthesia-free cleaning. They said that isn’t really going to show them if there are any serious issues, but that it’s better than doing nothing. Another vet says not to worry about anesthesia and says the bacteria that can get to the organs are a bigger risk than anesthesia. But that same vet just lost my friend’s healthy dog to anesthesia. Just wanted to pick your brain and see what you would do with a dog like this. I want to do whatever is best for my dog at any cost, but I feel like I’m between a rock and a hard place with this dental issue.
It’s hard, isn’t it? I can’t say whether this is the right choice for your pet, but I will say I have routinely anesthetized older animals for dental cleanings using specific protocols to minimize risks with excellent results.
The American Animal Hospital Association and the American Veterinary Dental college are pretty clear on their feelings about anesthesia free dental cleaning, which you can read here: http://www.avdc.org/dentalscaling.html
The AAHA guidelines on dentistry are a good place to start; in particular with regards to anesthesia, which is covered in there: https://www.aahanet.org/PublicDocuments/Dental_Guidelines.pdf A summary: All dental anesthesias should include full pre-op workup based on lifestage of the animal; intubation, IV fluids, continuous monitoring, heat support during the procedure.
It is definitely worth taking some time to ask the vet, how exactly do you minimize risk with anesthesia? Do you recommend pre-anesthesia cardiac workups? Would it be better in this case to have the procedure performed by a board certified dentist? In this case with the laryngeal paralysis, that it something that the vet needs to be cognizant of. At the end of the day only you can make that decision, but it is the vet’s job to spell out for you exactly what the risks are, what the benefits are, and how he or she plans to minimize that risk.
Hope that helps!
Thanks, Dr. V. At one specialty center I had the option of hiring an anesthesiology specialist who travelled from clinic to clinic. It added a couple of thousand bucks to the diagnostic procedure my dog was there for, but it was well worth it. The next procedure at a different vet didn’t offer that option, and they said he came out of it much slower than they would have liked, so they recommended not doing a dental on him. That was even before his lar-par diagnosis. So now I’m terrified of anesthesia for him. I wish the vets who did dentistry here would offer the option of the anesthesiology specialist like at that one clinic. She brought all her own equipment, including things that many regular vet clinics don’t have. I think I would feel much better about having the dental done if I had the option of hiring her again.
My first foster died from a squamous cell carcinoma that began as a miniscule lump on the roof of her mouth, discovered during surgery for something else while she was being intubated. It didn’t respond to radiation so I just loved on her until she was unable to swallow. I’m so grateful she wasn’t adopted only to suddenly die a few months after adoption. Do vets look at the roof of the mouth in a routine exam? No, not really, and we don’t either. During a dental it would be noticed.
Again, excellent, excellent information and advice. Thanks Dr. V & Happy Thanksgiving!!
Speaking of throwing colleagues under the bus since the 20/20 piece aired…thanks so much for denigrating your colleagues who work mobile vaccine clinics. Yes, we’re all hacks who fail to competently serve our clients by giving vaccines an animal does not need. Makes sense since we’re only in it to “make teh [sic] easy money”. And what is this “A-A-HA” of which you speak? Is it a new vaccine I should be giving all the puppies and kittehs? Like coronavirus, right? Right?
*rolls eyes*
Do you even hear yourself? You sound like an ignorant client writing a rage-yelp! “review”. :
Based on what you wrote you’ve never actually *observed* a modern iteration of the mobile vaccine clinic being run by a business dedicated solely to it, have you? Versus the “rabies only” county clinics your first boss used to do and pawned off on you at his/her earliest convenience, that is. You know, clinics staffed by either a retired doctor with an instrument named after them in the Jorgensen Labs catalog, or someone who graduated around the same time as you burnt out on the dysfunction of most private practices and has yet to start his/her own practice, or by a new graduate who couldn’t find any other job thanks to the crap economy and hirers market still dominating our profession.
Or if you *have* done them yourself, you did a shitty job at it. Just saying—it’s an ‘either/or’ based on your commentary. Personally, I’d like to think it is the former versus the latter.
Where did I say any of those things? I stated that the weekend clinics present a pamphlet of choices and leave it up to the owner to determine what they need. If your service provides full examinations and counseling, that is awesome. That has not been my experience. I know veterinarians who work these in my area and they are great vets- never said otherwise-, but the time constraints and expectations don’t allow them to provide full services, which they freely admit. I’m sorry this is a sensitive issue for you. (Rabies only county clinic? I don’t even know where that came from.)
I have to admit I’m having kind of a hard time understanding your knee jerk response here. I’m actually also one of those vets who has been doing mobile vaccine clinics for a few years now. Dr. V is a friend and colleague, and I didn’t see anything in her post that denigrated what we do. You and I both know that the service we provide is limited in scope.
Yes, we help ensure animals are vaccinated at a lower cost and save people money, which is important since we all consider vaccines to be life saving, and especially in the recent economic downturn it’s been a godsend for some people. I also frequently catch things on my exams that they should follow up on (i.e. heart murmurs, masses, dentals, etc.), and I always discuss with the clients that they should consult with their regular veterinarian when I see these issues. I think I and my colleagues work hard to educate people on which vaccines they should consider for their pets’ lifestyle, but under no circumstance does our service replace the relationship that a client has with a full service veterinarian, and I think that’s all Dr. V is saying here.
In my experience, most of the mobile services do not adhere to AAHA guidelines at this point, either, and I wish that would change, but in time perhaps it will (also having a hard time understanding your jab at the AAHA guidelines).
i just stopped going to my homeopathic vet who i have been seeing for over 10 yrs. i have 3 min. schnauzers, who get reg check ups. i have spent over 70k in the past 10 yrs, this yr alone over 5k. i am so upset, b/c my oldest dog had little cysts on her. they kept changing and growing. she refused to do anything until i kept going back. then she did biopsies to satisfy me. however, the results came back inclusive. they recommended removing them for further evaluation. my dog is 12. finally she removed them, they were benign. however, b/c of her continued refusal to do anything, her health insurance refused to pay most of the bill, which should have been covered. then with my 3 yr old, i saw where she had a loose front tooth, took her in, said she had severe gum disease, she examined this dog last yr at her annual visit, said her teeth looked great. now said she needed to have over 10 teeth pulled, i was outraged. i searched the internet to find a dental specialist, the nc vet school dr was out of the country. so i went to see dr. banker at sedgefield animal hospital in greensboro, nc. he is the best. he sees dog and cats from all over for dental specialties. harley had to have only 3 very back teeth pulled, he did root planing, gum grafts. it cost only a little more than what my former vet charged for teeth cleaning and xrays. dr. banker was upset as well, when a vet does a dental exam he said you just cant look at the teeth, you have to probe. even the healthiest looking teeth may have gum disease. he said you cant just go by xrays alone as well, the xrays do not tell the whole pictures. b/c when he got into her mouth the teeth were healthy of the ones the other dr wanted to pull. dr. banker developed the dental program at the nc vet school. he also helped develop teeth products for dogs, oxyfresh. he is amazing as well as his entire staff. i later found out that on my 3 yr olds records that my former vet had put she had dental disease when she was 2 but failed to do anything or even tell me. she did the same thing with the 4 yr old, now 3. with my older dog when she had a chipped canine, i told her i wanted to do a root canal to save the tooth, she said the tooth was fine, however, the following yr at the dental exam the tooth had to be pulled. i wrote a long letter to the owner, after over 10 plus yrs, she did not even have the courtesy of writing/calling me. she had someone send me a short email, saying sorry we have not met your expectations. they also screwed up b/c when they did the blood work to take the dental xrays, they failed to use the blood work for her heartworm tests which she was do to get as well as other tests. so i had to have them done again. there were many other problems which i will not go into, but you would think after being a client for over 10yrs and spending that much money, they would have at least called me to talk abt the problems. the clinic is one of the few homeopathic clinics in raleigh, nc off creedmoor rd. i have since changed vets and drive to greensboro which is 91 miles but my 3 girls are my children and i love them insanely. if anyone needs a good dental specialist for their pets, go see dr. banker, people from all over the east coast travel to see him. in addition, i was told that dr. banker uses the old type of anesthesia, which is not true. i had a problem at my old vet b/c with my 4 yr old, when she was 3 had her teeth cleaned, it took her 2 days to get back to normal. she was out of it, and i was very scared. dr. banker has several types of anesthesia that he uses, he first gives the dogs a iv sedative, then uses only enough anesthesia to do what he needs to do. he uses what is necessary and picks the right anesthesia for the dog’s least amount of risk. my 2 dogs were up and about w/in 15 min. of the surgery, wide awake and playing. never have a seen such a remarkable recovery out of anesthesia from any of my dogs going under. he also has a special warming blanket and cover that keeps the dogs comfortable.