Thursday, April 22, 2010

My Rant for today...

Just want to start off by saying that I have tremendous respect for Vets and all they do. I so appreciate the care my Vet gives my furkids...
Anyone that knows me or that has read my blog knows I have a dog (Raider) with Addison's disease  (hypoadrenocorticism). I volunteer on the Yahoo Group Addison Dogs helping people with their newly diagnosed dogs.. Yes I am one of those dreaded online people who give suggestions on Canine Addison's ..

I am not a Vet and I make sure to tell people that, and I also tell people not to make changes to their dogs medications without talking to their Vets.
But I do know how to manage a dog with Addison's disease.

We have vets who join our list to get information or who have their own Addison's dogs and want help. We generally have the latest treatment info, and often more up to date than many GP Vets have.
We see everything from people who will do everything they can for their dogs to ones who put their dogs down when they get the diagnosis.
We see people who have great Vets and the dogs get the best care. We also see people who have Vets that either don't care or slept through Veterinary school or at least endocrinology. Now I realize that Addison's in not a common disease and it is often misdiagnosed, it is called "The Great Pretender" as it mimics lots of other things including Kidney disease. Vets certainly don't see this everyday. But can't they look it up... for crying out loud.

One of the best drugs out there to treat Addison's is Percorten V  (desoxycorticosterone pivalate). But it is not available everywhere so many parts of the world they must use Florinef. I have used that drug as well but hope to never have to go back to it for my boy.

As I said we see the good and the bad in both owners and Vets..
My rant today is on the Vets who could use some education on Addison's disease, so if anyone has suggestions on how to get the message out I would appreciate it because educating one Vet at a time is slow..

For example today we get a Vet who tells us that he is fine with reducing the percorten dose but he does it by reducing 25% at a time but he doesn't test the lytes ( electrolytes, specifically the sodium, potassium and chloride )because and I quote, " I am not a fan of  testing the lytes because they are inaccurate and questionable" ... I'm sorry but WTF... so instead he reduces the dose and if the dog is fine in a month he reduces it again.. great way to put the dog in Addison's crisis I'd say. The lytes test/BUN are the most important tools when dosing to effect..

Or the vet who reruns the ACTH test monthly to see how much pred to give the dog... another WTF ... The ACTH test if done correctly the first time is a diagnostic test for Addison's, not a management tool, there is no reason with Addison's disease to do it again unless this was a Cushing's dog turned Addisonian and you want to be sure it is not returning to a Cushing's state.

Then there is the Vet who reruns the ACTH test to make sure the dog is getting enough Percorten V... again WTF.. it measures cortisol not Aldosterone. So again a waste of money.

Or the vet who refuses to lower the percorten dose even though the dogs K is 3.8 ( 3.4 - 5.8 ) at day 28 and just gives another full dose of percorten or increases the dose because the dog gained 3 lbs... another WTF, that's like giving more insulin to a diabetic dog whose blood sugar is already too low.
Don't these vets know anything about 'dosing to effect" or using the lowest effective dose..???

Then there are the vets who have the dogs on prednisone for a week before they run the ACTH test. Prednisone interferes with the test and can cause a false positive for Addison's. Dexamethazone can be used in the short term and it doesn't have any real effect on the ACTH test other than to sometimes reduce the pre stim result a bit. But the post stim test is the biggie anyway and it has no effect on that.
We see on average a couple of dogs a month who are misdiagnosed with Addison's because of a false postive on the ACTH test because of pred being used before the ACTH test. When they are taken off of it and supported on dex until the pred clears their system they pass the test.

Or the dog who fails the ACTH test but has perfectly normal lytes but the Vet puts them on either percorten or florinef anyway. These dogs only need a steroid replacement.. They don't need the other meds.
Now I realize they can transition to Typical Addison's but that happens in less than 20% of cases.. so no need to put them on it until they actually do need it.

I don't expect a Vet to know everything but I do expect that if they don't know something that they would try and find it out..
So any advice or suggestions on how you would talk to a Vet who does some of these things?


Susan said...

Okay you should have been a vet! Seriously, you do the research, you care about animals! Although you would undoubtedly end up with more animals then you have room for knowing you!

I know if you were a vet where I'd be taking MY puppies!

Elizabeth said...

Thanks.. yes I wish I had become a vet. too late now though, I am not going back to school again.. been there done that.
How are your puppies by the way?

Joey said...

Susan's right.. you're so educated about your dogs and diseases.

I'm so GLAD I found you, Elizabeth. You have a heart of gold, and you love animals.

Janessa & Divita said...

TESTIMONIAL - My dog would not be alive today if it weren't for the love and care of Elizabeth. I don't know how to make a vet listen. Lord knows I've tried and my vet STILL thinks Divita is Atypical (WTF-ever) all I can do is hope and pray that she gets it some day and continue to be grateful that you are my angel. I love you ~E~!!!

Jenny Schultz said...

Great rant. I would like to add my own rant to your list- vets who overdose the percorten and then overcharge with a mark up of say $300 for what costs them less than $100. Those are usually the same vets that don't ever run any lytes tests to be certain of the necessary dose and don't offer the option of switching to compounded florinef if the owner can't afford the $300 monthly bill. WTF??
Ok, back to my doghouse for now...

Zoe the chocolate lab sends a shout out to the rest of your crew. She said that she would rather have Lab brothers and sisters than the naughty Danes she got stuck with as her family.