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View Full Version : Not Sure If I Should Change My Vet



ByFloSin
21st March 2014, 08:17 PM
I have a real problem here, which I hope I can get plenty of opinions about, because I just don't know what to do.

You may remember the thread I started about how to use Tramadol. I mentioned there that I was unhappy with the vet and hoped that somebody could give me some advice about the correct use of Tramadol, because I have lost all confidence in the vet Rebel has been seeing.

When Rebel first developed symptoms of SM he was howling and in a terrible state. I got an emergency appointment with the vet and Rebel was lucky to be seen by his usual vet, who he is very attached to. She told me she hadn't any experience or knowledge of SM, so I went through a copy of CR's matrix with her and promised to send in some literature on the defect, i's symptoms and more about the variious treatments. That was fine she said and started him conservatively on a low dose of Frusemide, which really helped for some months. I kept up the supply of information, which te lady said was most helpful. Eventually he progressed to 100 mgs Gabapentin a day, then twice daily and now up to 500 mgs a day if needed. Tramado was also to be given in a low dose, but only if really needed. All that was fine and I felt lucky to have the benefit of such a caring vet, who was also so willing to learn.

Everything was ticking over so well until the recent bad weather conditions, where air pressures rose and fell in rapid procession. Rebel was due for his 3 monthly check at the vet and was in quite good form when we set off, but there was another sudden dip in air pressure with wind and rain worsening with every minute, so by the time we had waited for the vet to finish her surgery list and see Rebel, he was screaming with pain and very bitter about life in general, so much so that he growled at the vet when she got out her stethoscope to check his heart.

She stepped back, very shocked. She told me she had never seen him like that before and asked if I realised that SM is a progressive disease and did I realise there was no going back and that things would only get worse for Rebel and never better. She wanted to euthenase him then and there, telling me she only wanted what was best for him and that if I was a caring owner I would end his suffering now. It goes without saying how shocked I was, both about her obvious ignorance also Rebel's reaction to the drop in air pressure, because if she had read the information I had taken the trouble to give her, she would have known that I was talking sense and that she was over reacting. I found myself saying, no, no, no and lots about this only being a blip which I should have been able to avoid and eventually I got through to her that Rebel deserved further treatment.

She agreed to give Rebel a week to improve, but said her expertise and experience of Rebel told her it would not. Of course he was back to his old wagging, kissy self the following week and I started to breathe huge sighs of relief. This was short lived, because I had brought in a print of Clare's latest treatment matrix. I wondered if there was now an improved cocktail of drugs which would increase Rebel's quality of life, but instead of considering that the lady decided to question me on my reasons for giving up to 500 mgs of Gabapentin, then the odd day or two that I had told her I had had to increase the Tramadol, which is pretty low dose anyway. I was shocked when she said I should space the drugs out over a 24 hour period, never starting him off on 20 mgs in the morning, 'just because the air pressure might drop, which might affect some dogs'. She then told me 200 mgs daily should be quite enough for a dog of his age and weight!!!!!!!!!!!! I made as rapid an exit as I could, agreeing to bring Rebel in for monthly check ups instead of quarterly, which means that he is due there again on 1st April.

As you can imagine I am not happy dealing with this vet any more if it means a constant battle to get Rebel the treatment he needs to give him a relatively pain free life. Apart from arthritis and a low grade heart murmour, he is a very active and lively dog for his age. My first reaction would be to find another vet, either at the same practice or to go elsewhere, but I dont know what it would do to Rebel to make the change. He absolutely adores this lady, smothering him with kisses and expecting and receiving cuddles in return. A couple of times we have been asked to see another vet while the lady has been operating, but Rebel will start howling and barking if he is taken into anyone else, growling and drawing away when they try to touch him. He will also make an awful fuss if he senses that the vet is there but not seeing him, to the extent that it is a standing arrangement that he will have the first appointment in the afternoon, to avoid upsetting Mr Rebel.

So what would you do if you were me?

Have you had similar experience and solved the problem one way or another? If so, how?

Should I start all over again with the information sheets, selecting, downloading and printing them up for her to read again, because after recent experience I doubt that she bothered with any of it in the first place. Could it be that the lady has realised she is wrong and might want to start over again?

Please tell me what you think. Something that somebody else has to say is likely to solve the problem and of course you all know the old saying about two heads being better than one.

meljoy
22nd March 2014, 12:47 PM
Wow what a reaction she had......surely as a vet she's been growled at before.....Im no expert on SM but even I know a dogs pain can change from day to day with air pressure and a change of medication!
My only advice would be that you have to trust your vet....she's got got Rebels comfort in her hands and if you cant trust her to do that maybe you should look for one that you know can.
It very hard especially if you've been with them for a long time. Is there another vet in the practice you could see?
Im sure she didn't want to see Rebel suffer and in her opinion Euthanasia was the only option but it sounds like a knee jerk reaction to me.

Good luck what ever you decide.

Soushiruiuma
22nd March 2014, 03:23 PM
I have one vet who I absolutely trust, and who I know listens to me. Unfortunately, they are not on the same continent with me and Guinness, so we don't use them anymore.

If you are unhappy with your vet, go elsewhere. I wouldn't hesitate to switch. Perhaps look for one more experienced with SM, and more willing to listen. You see your dog far more than any vet will, and your observations on how things are day to day are very important, if your vet doesn't recognize this I would question their judgement.

Sydneys Mom
22nd March 2014, 03:30 PM
I agree with the others. You are the spokesman for Rebel and your concerns should not be dismissed so easily. I would telephone her before your next appointment and have a heart to heart conversation about how you are feeling. If you still feel she is ignoring your concerns, then it may be time to find someone else.

CSutherland
22nd March 2014, 05:29 PM
I've had concerns almost from Day One with Bentley but our vet nicely dismissed them so I pushed it out of my mind. This all came to a head about a month ago when Bentley started having the "frozen in place" and crying spells. I took him to the vet and he prescribed an anti-inflammatory. A couple days later their office called to inquire about him - something they had never done. A week later he was having more trouble, I took him back, and the day after I took him the vet himself called, this time telling me that he was arfaid I had been correct in my suspicions all along. He then referred me to the university for the MRI. Last time I had him to the vet he shook his head and said, "Such a sweet, nice dog; I'm so sorry he has this condition..."

Dillboy
22nd March 2014, 06:21 PM
A difficult one. I had serious issues with my vet (who happens to be the only one on the island where I live) concerning his views on boostering of vaccinations. I found I was getting really stressed out about the problem, particularly as one of my cavaliers Dillon adores said vet.....I found that when in the surgery with all its noise and goings on, I simply could not engage my brain in the way I wanted to. So I went home and emailed my vet about the issues which troubled me. As it happened, I got a good outcome; my point in telling about this is, yes, I think you should outline again your concerns, but put it in writing, thereby making it arguably more 'serious' and steer clear of the telephone. You should expect a response - if you aren't happy, then move vets. That way you have tried all that is possible. I wish you and Rebel lots of best wishes. Katerina

Kate H
22nd March 2014, 09:14 PM
Sorry you and Rebel are having all this trouble, Flo. It seems to have taken the researchers some time to agree that the effect of changing air pressure on CM/SM dogs was more than an old wives tale or over-anxious pet owners, so I suppose it's not surprising that GP vets find it difficult. The change from day to day can be spectacular when meeting it for the first time, and if it happens regularly with Rebel, it makes sense to watch the pressure and stave off pain emerging if giving extra gabapentin works for him. I wonder if Rebel would accept a different vet if it was in a different practice - obviously if he goes to the same building he expects to see his favourite doctor and is miffed if he doesn't. Is he insured for his SM? In which case, what about taking him to the Willows? He could be under a neurologist experienced with SM there, and although the initial consultation can be pricey, they would be at the end of the phone if you needed advice about tweaking medication and so on. And a neurologist there could liaise with your present vet, so that they work together on keeping Rebel comfortable and as active as possible. Seeing a specialist is normal in human medicine, and your present vet sounds a bit out of her depth.

Kate, Oliver and Aled

TomA
26th March 2014, 06:10 PM
Sorry Rebel is going through do much. Our Charlie has been on Gabapentin three times a day since we rescued him two years ago and, fortunately his symptoms have remained steady. He does a lot of scratching and walks funny sometimes but doesn't have these worse symptoms. You're probably aware that there is surgery available. I don't know how expensive it might be. Could there be more than AM going on?

Best of luck.
Tom

ByFloSin
26th March 2014, 07:36 PM
Sorry you and Rebel are having all this trouble, Flo. It seems to have taken the researchers some time to agree that the effect of changing air pressure on CM/SM dogs was more than an old wives tale or over-anxious pet owners, so I suppose it's not surprising that GP vets find it difficult. The change from day to day can be spectacular when meeting it for the first time, and if it happens regularly with Rebel, it makes sense to watch the pressure and stave off pain emerging if giving extra gabapentin works for him. I wonder if Rebel would accept a different vet if it was in a different practice - obviously if he goes to the same building he expects to see his favourite doctor and is miffed if he doesn't. Is he insured for his SM? In which case, what about taking him to the Willows? He could be under a neurologist experienced with SM there, and although the initial consultation can be pricey, they would be at the end of the phone if you needed advice about tweaking medication and so on. And a neurologist there could liaise with your present vet, so that they work together on keeping Rebel comfortable and as active as possible. Seeing a specialist is normal in human medicine, and your present vet sounds a bit out of her depth.

Kate, Oliver and Aled

What you say makes a lot of sense Kate. Yes, my GP vet is way out of her depth. I am very annoyed because I have given her print outs of most of the literature surrounding the illness, including of course Claire's algorythm, but it seems from recent events that either she hasn't bothered to read it or has forgotten what she has read in the past couple of years. Perhaps I expect too much of her?

I spoke with the vet some months ago to ask for extra Gabapentin to treat air pressure related symptoms. The vet had misgivings about giving him too much. She mentioned liver complications because he also has Metacam for arthritic pain, but I remember saying that in a dog of almost 11 at the time I didn't think it was the prime consideration, the average lifespan of the modern Cavalier being around 12 years., so she reluctantly increased the supply. Maybe the lady thinks I'm too old to know what I'm talking about:sl*p: Next visit Tramadol was added at my request, to be given as required.

I have more or less decided to keep the follow up appointment next Tuesday. Rebel had another severe pain related screaming episode at 4 a.m. this morning, which shook me, as they always do. I gve him more Gabapentin, then went on to half a capsule of Tramadol, which helped him get back to sleep before I went off for my Wednesday teaching session. When I came back he was his usual happy self, but I gave him the afternoon Gabapentin as usual.

Age and symptoms seem to be taking a heavy toll on Rebel and I have a feeling that I will have to make a horrible decision before many months have passed, so I think I should maintain his quality of life, whatever that takes, even if I have to plead his case again with the vet, because she is the vet he loves and therefore part of the equation.

So far as Willows is concerned. I went through that one when Rebel first developed symptoms, but they cannot deal with him because he was first scanned and diagnosed at Chester Gates. Chester Gates will be pleased to see him if I take him up there, but, sensibly, do not agree to prescribe for him after so long without seeing him again. I think the journey there will be too much for a frail dog, who is now distressed by travelling.

ByFloSin
26th March 2014, 07:46 PM
Sorry Rebel is going through do much. Our Charlie has been on Gabapentin three times a day since we rescued him two years ago and, fortunately his symptoms have remained steady. He does a lot of scratching and walks funny sometimes but doesn't have these worse symptoms. You're probably aware that there is surgery available. I don't know how expensive it might be. Could there be more than AM going on?

Best of luck.
Tom

Thank you for your good wishes Tom. I am so glad that Charlie is stable on the Gabapentin. Rebel was on 100 mgs twice daily for a couple of years, but then the symptoms progressed so much that during the recent severely fluctuating bad weather he was having 500 mgs plus Tramadol twice daily and Frusemide. He has had Metacam primarily to relieve arthritic pain, but this has now been included in the treatment matrix as being good for SM pain too, so I have slightly increased his dose.

Than you so much for your reply.

Yes there is more than SM going on. He has CM, curvature of the spine and now severe arthritis too, so quite a lot going on in there.

Despite all the problems and prescribed medication, for the majority of the time at present he is a typical elderly Cavalier, a perfect gentleman, who loves his little toddles in the park and is very affectionate. When he feels well he is still ruling over the three younger dogs with an iron paw held in a velvet glove, because underneath it all he's always been a real softie.

ByFloSin
26th March 2014, 07:48 PM
A difficult one. I had serious issues with my vet (who happens to be the only one on the island where I live) concerning his views on boostering of vaccinations. I found I was getting really stressed out about the problem, particularly as one of my cavaliers Dillon adores said vet.....I found that when in the surgery with all its noise and goings on, I simply could not engage my brain in the way I wanted to. So I went home and emailed my vet about the issues which troubled me. As it happened, I got a good outcome; my point in telling about this is, yes, I think you should outline again your concerns, but put it in writing, thereby making it arguably more 'serious' and steer clear of the telephone. You should expect a response - if you aren't happy, then move vets. That way you have tried all that is possible. I wish you and Rebel lots of best wishes. Katerina

Thank you Katarina. That is such a sensible suggestion about putting my concerns in writing. I will sit down over the weekend to type up something concise but suitable and hope that the vet takes notice of what I say.

ByFloSin
26th March 2014, 07:52 PM
What you say is so right Mel and thank you for saying it. I feel the same way, but after a lot of thought, I really want to keep Rebel happy for the time he has left, so I am trying again with a written presentation and will see what happens. If that doesn't work I will have to find another vet.

Kate H
27th March 2014, 12:11 PM
Also having an old dog with multiple problems (though less severe SM than Rebel), my attitude is like yours (and hospices), Flo - the no. 1 priority is to keep them pain free and comfortable and worries about possible addiction to morphine (in humans) or liver damage really don't apply.

I was surprised by what you said about the Willows. I haven't had to use them for Oliver's SM, but as he hasn't been near Chestergates since his last mini scan 5 years ago, I wouldn't dream of dragging him up there on trains and buses; our local vets have done their homework on SM and keep him pretty stable anyway. If the Willows refused to treat him for SM I think I would kick up a real fuss with them!

Best of luck with the literary composition!

Kate, Oliver and Aled

cavie3
30th March 2014, 04:49 PM
Hi Flo, this must have been devastating when your vet suggested euthanasia, any of us who have a dog with CM/SM issues know that the condition can fluctuate from day to day and our main aim is to keep them pain free. Kookie isn't 2 years old yet and he is normally on 500mg Gabapentin daily and increased to 600mg when there are sudden changes in air pressure also increasing his usual dose of tramadol (3x25mg) if necessary. We recently took part in the comfort study research (Clare Rusbridge) so it will be a good thing for all us owners when the results are published so we don't have to justify the need for increased meds with our vets. I can understand where you are coming from that Rebel has got used to this particular vet and any change might upset him. Hope the next visit goes well and they take on board that you know Rebel better than anyone.

TomA
31st March 2014, 02:21 PM
I have found that twice a day isn't sufficient. Charlie gets his three times a day and he is always needing it by then.
Tom A

Kate H
31st March 2014, 08:08 PM
I'm always puzzled as to why Clare Rusbridge's algorithm starts with gabapentin twice a day, because very few dogs seem to be able to go that length between doses. I find Oliver is better on 100mg four times a day, with an extra when air pressure is being difficult (though he seems to be affected by low pressure rather than high).

Kate, Oliver and Aled

Karlin
1st April 2014, 01:37 PM
I think because initially, it does suit many dogs, and can be upped as needed. Leo was on 2x for a couple of years before he went up to 3x, as I recall... she has said that it depends on the dog, how it metabolises gabapentin, what type of pain it is addressing... goal is always to start at the lowest dose of anything but the problem to my mind is that too many vets and neurologists never consider the overall algorithm and never increase dosage when it is clearly needed.

Karlin
1st April 2014, 01:45 PM
Flo, I agree with so many here on your main issue in the thread. I do think sometimes it helps to get words on paper. But also, I would expect more from a vet, especially one who knows a dog well. Maybe she was having an off day herself.

I am pretty picky on the vets I use long term, for the same kinds of reasons you note. I wouldn't hesitate to move if I was getting frustrated with a vet's approach. A good vet should realise that progressive conditions also have up and down days and the view should be a holistic one -- are bad days outnumbering good days, and is the pain manageable? There would seem many other options open yet. Not sure if you have tried Lyrica but had a great improvement in Leo with it, at a lower dose. But it is more costly. There are also a couple of different add-on painkillers that can be tried. Different dogs do better on different mixes.

ByFloSin
3rd April 2014, 10:22 AM
Sorry to have taken so long to write this update, but I have been so busy with other things!

I took in my written appraisal of the situation, the disease being sometimes distressing and of course progressive, coupled with Rebel's condition and left it with the receptionist for the vet to read before our appointment on Tuesday.

It was all an anticlimax, because instead of being called in first as promised, we were kept waiting for half an hour in an overcrowded waiting room before being called in. When the clients who had arrived before us came out it was obvious their plight was more serious than ours, because they were in awful distress, with the man carrying a bloodstained cat carrier, so when we went in I chose the patient and diplomatic approach because I could see that the vet had been through the mill too!

Much to my surprise I was put very firmly in the driving seat, with the vet asking how Rebel has been and what drugs were needed. She listened to Rebel's heart for a long time, then said she could not hear a murmour and invited me to try to find one, but I couldn't hear it either. I explained that now the air pressure is more stable I had been happy to reduce the Gabapentin to 200 mgs a day and withdraw the Tramadol. Some notice must have been taken of what I had written because she then asked was I sure I had enough meds in stock to cope with another relapse if the weather changed again. Phew :rolleyes: Rebel got his usual cuddles and that was it - nothing more said on either side. Perhaps it's better that way.

So Rebel keeps his beloved vet and he does not need to go back there for another 3 months, so I'm sure the lady realises what a big mistake she made and has learned from it.

I am so grateful for all the support and advice; it really was helpful.

Kate H
3rd April 2014, 11:08 AM
I'm so glad the situation has sorted itself out - which such things often do with a cooling off period and a chance to put your point of view in a less charged atmosphere. Well done for your literary endeavours! It's a sensible vet who realises that it's the responsible owner who lives with the dog 24/7 who is best able to assess pain levels and adjust medication accordingly, not the vet who sees the dog for a few minutes every few months. I hope you will be able to keep Rebel comfortable for a few more years yet.

Kate, Oliver and Aled

Dillboy
3rd April 2014, 11:41 AM
I'm so very pleased to read this today. I'd say a good outcome for all parties concerned. My best wishes to you, Rebel and of course your vet....:)