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David Baxter

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I'm lucky to have a veterinary clinic that is reasonably priced and very compassionate.

Better still, I found one of those vets seems to be particularly good with cats; Mindy almost likes going to see him except for the cat carrier and the car ride. :)

But Ottawa is probably like most cities with a real mix of vets, some who are very expensive and more interested in using their expensive diagnostic machines instead of actually examining the animal and finding out what is really wrong with the poor animal. One of my sons went there with a sick dog and after $5000 the vert decided on exploratory surgery where he discovered half a chewed up Frisbie - which was why he was in pain and not eating.

All that $5000 was a waste of money and they all somehow missed the Frisbie. Moral of the story: (1) medicine first, then fancy equipment; and (2) if you're going to buy fancy technology and sell it as services to customers and patients, make sure you are properly trained in its use and interpretation of the results. This was half a Frisbie: A CT scan should have detected that.
 

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The whole industry is messed up to me. Like others, I don't expect human-grade care with $30,000 treatments. But I expect some science/research/clinical trials going on--even just to make money selling a drug to pet owners. And such research could eventually help human pharma.

This is the second dog I have had who is hungry much of the time with prednisone. It is heartbreaking since it has been going on for over a year. It's a common problem, but the two vets I have seen are mostly dismissive about it. So I when I bring it up, it is like pulling teeth to get alternatives prescribed. So I am now again looking for another vet.

I may eventually try a specialist, but they are very hard to find for respiratory/pulmonary issues, even in Phoenix. Most specialists are in cardiac care or even eye care. And some specialists are not necessarily better than the average vet. One negative review for a heart specialist in my area:

He diagnosed my dog with pulmonary hypertension - this is literally life or death for my dog and it appears he could care less. Spend your hard earned money elsewhere. At this point I don't even know if he has been diagnosed correctly.
 
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David Baxter

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I had to take Prednisone back in 2008 for a while after some leg surgery and stents in my leg and abdominal aorta. Had the same side-effects — eating everything that was close enough, but I didn't necessarily feel hungry, just wanted to be chewing on and eating something.

My doctors at the time just basically said it was a known side-effect. No comments on managing the side-effects.

Mind you, I was only taking it for a few months, not for the rest of my life. The doctor (who was my surgeon, by the way) knew that and knew the side-effect would subside when I stopped taking the drug. I suspect his advice would have different if he had known it was going to be indefinitely and not just a few months.
 

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My dog is so desperate for food she has fallen a few times trying to get the cat's food. She wakes up before the other dogs, looking for food. She is looking for food right now. On the positive side, the searching for food does give her exercise.

I feed her low calorie or low carb snacks throughout the day and also give her rawhide chews, but it doesn't seem to help much.

(And, of course, from an animal rights point of view, dogs are not able to consent to take these medications -- unlike humans.)
 
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Yeah, she goes through phases where some days/weeks are worse than others. It is worse this week, but I just got some new ideas I am going to ask the next vet about, e.g. anxiety medication like trazodone to lower her cortisol-based hunger motivation. She was on trazodone before (25 mg twice a day) for anxiety anyway.

I had thought of this before, but at the time, she wasn't doing as well regarding her breathing because she was on a lower dose of prednisone. Since I learned to listen to her lungs with a stethoscope, I can adjust her prednisone sooner than later since the dose is somewhat variable and based on how well she is doing.

If I ever find an easy, affordable solution, I am going to share it all over the Internet and even pay for Google Ads to let every dog owner know who searches for dog + prednisone :)
 
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In the last four years, approximately 400 complaints have been reviewed by the Arizona State Veterinary Medical Examining Board, where pet owners have alleged everything from serious injury to death of their pet(s) while in the care of a veterinarian.

Reviewing the publicly available complaints, approximately 80% were dismissed and frequently, through a unanimous board vote...

It was hard to fathom the board letting these vets completely off the hook with all this evidence staring them in the face, but they did...

Unfortunately, I found my experience with the Arizona State Veterinary Medical Examining Board to be the norm, not the exception.

At a time when the number of licensed veterinarians is skyrocketing nationally, and going from 2000 to nearly 3000 in a few short years in Arizona, more, not less oversight, is needed. Trying to find a quality vet for a beloved pet is more challenging than ever.

I devised an easy four-step method that can hopefully help pet owners find qualified and competent veterinarians. I call it the HARPER Care Method, or—Help Animals Receive Proper Essential Restorative Care.
  1. Check the reviews on both Google and Yelp by looking for the names of the veterinary practices. Use the sort feature to get to the lowest rated one and two-star listings. Read those and cross vets off your list that did something to a pet that you would not want to happen to your pet. Keep in mind that some businesses pay for and even post phony positive reviews. This is why you look through the bad ones.
  2. Make certain that the veterinary practice is AAHA accredited. Simply enter your zip code. This national veterinary organization has much more rigorous standards than the state minimum.
  3. Check your state’s veterinarian licensee directory, which lists the vets’ discipline database. Arizona’s is here. You search here by the veterinarians’ name. Any case that resulted in discipline should be listed, helping to narrow your list.
  4. Find a place that is somewhat close and convenient to you. Ideally, the closest one to you that passes the first three steps.
I believe that if I had used a checklist like this…Harper would still be alive today as the vet we took him to would have failed.

Both in Harper’s case with the state’s veterinary examining board and the seven years of cases I have personally and painstakingly reviewed—having an attorney on only one side (the side representing veterinarians) has resulted in obvious inequitable decisions...
 
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I just used the above method and already made an appointment for Friday (using the vet hospital's real-time appointment tool). The vet hospital is the same one my husband suggested earlier today since we drive by it all the time. I did not realize until now they were accredited. It is also good for chronic cases since they offer unlimited exams for a monthly rate.
 
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One of many reasons the vet board is so lax in AZ:

For your information the chair of the board is Jim loughead, he is an animal vaccine salesman that works for Boheimer Animal pharmaceutical company…. this is very clearly where he gets his customers and it’s a huge conflict of interest that he would be the chair of the board in Arizona when his livelihood and his job depends on selling animal vaccines to veterinarians… outrageous…
Source: comment section
 
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You stuck me with this exorbitant bill much higher than the agreed upon cost, made me feel guilty for not wanting to make it even higher, never bothered to tell me what was wrong with my cat, made it clear you didn’t give a shit about her one way or another, and you have the nerve to ask me for a donation?
 

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We live in a society that increasingly allows us to spend our way out of almost any dilemma. Yet no matter how hard we try, we can’t make our pets live as long as we do. Attempting to do so could put us in the poor house. At some point, the sentimental relationship we have with our pets has to become an economic one. If we do make that ultimate decision, however, we can console ourselves with having given our animals the best life possible. After all, any cat or dog that has escaped living on the street or in a cage in a shelter has won the lottery, regardless of whether we spring for that kidney transplant.
 

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At the top of a holistic vet's reply to my e-mail inquiry about palliative care:

"CASH OR CHECKS ONLY. THANK YOU"

At least she is more honest about her motivations than some other vets :coffee:

The primary advantage though with having a "holistic" vet is they typically spend much more time with you. But the animal hospital I am going to today has an "unlimited exams" plan, if you need more frequent visits for some intractable problems.
 
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Had the same side-effects — eating everything that was close enough, but I didn't necessarily feel hungry, just wanted to be chewing on and eating something. My doctors at the time just basically said it was a known side-effect

That is what the vet said today. She is not really hungry. With the prednisone, she is more like other dogs who are just very food motivated. He switched her to a different oral steroid to see if that helps, both with the food seeking and her bronchitis.

We go back in a week for a recheck, and all exams are "free" with VCA hospital's monthly wellness plan, including annual bloodwork, x-rays, etc. So the dog with cancer is going on a wellness plan too since he may need even more follow ups. And you can always cancel and get a refund, minus any services that the plan paid for. So it is not like a gym membership where you are stuck.

It was a long, very educational visit. The vet is the director there and has more years of experience than our previous vets, which is why I picked him. Without the wellness plan, their prices are higher than average for some services, but it is a much more professional experience over there so far -- no pulling of teeth to get answers.

(VCA is in Canada too where they also have a wellness plan.)
 
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For animal care, things are so bad that corporations may actually be animals' best bet--the lesser of two evils. VCA has 1000+ hospitals and is owned by Mars, Inc. ("the company known for Snickers candy bars and Pedigree dog food"). Animal hospital/clinic chains like VCA, Banfield, and AniCura (in Europe) are all under the same corporate umbrella of Mars Petcare. So they can only have more rules, protocols and standardized care than a single animal hospital. Even VCA's website provides way more information than some mom-and-pop vets and private equity hospitals about some issues, like feline hyperthyroidism.

Not only does Mars have their own laboratories for bloodwork (which could give them lots of healthcare data), but they also have their own radiologists to interpret x-rays if need be (at $110+ for interpretation, but could save lots of money down the line by preventing misdiagnosis or unnecessary surgery).

Mars also funds its own research institute:


In stark contrast, a small sample of Google reviews for the CVO (vet collage/board in Ontario, Canada):
In our opinion veterinarians should be government regulated. CVO seems prejudicial against the public & shows favor/bias towards vets.
This institution does not protect the public from veterinarians who perform well below practice standards. Even when the complaints committee determines that important standards have been breached by veterinarians and even when animals are harmed or die due to the actions of such veterinarians, offending vets seldom receive anything more than mildly worded written “advice”. Almost entirely lacking in transparency, the CVO does not post information about negligent, substandard veterinarians on the public register, unless the veterinarians have been disciplined. Few are disciplined. As a result, members of the public lack critical information they could use to protect themselves and their animal friends.

Be sure to ask any vet you see about the risks, dangers, and alternatives to a procedure that he or she wants to perform on your pet. Resist any tendency to decide based on “trust”.

Google reviews for Arizona's vet board:

This Board is supposed to be advocates, not only for us, but for our innocent animals that are often disregarded and looked at as cash money. My Benny was sent home to die and he was worse off than he was prior to surgery; a surgery that should not have been done.
First off, if you are expecting veterinarians to be held accountable for what they have done to your pet you won't get it here. The best they will do is fine them, maybe probation and a slap on the wrist. The vet will have an attorney. Good luck trying to find an attorney to help you. It is already stacked against you and the board has no desire to make the proceedings equitable.

They say they investigate, but very very secretive what they do. An investigation should be gathering all the information and talking to all parties about the situation and any differences in each side has off the situation. They do none of that.

Before you even speak, they have already made up their mind how they are going to vote. If you don't show up it will be used against you, but the vet can phone it in. There should be no phoning in. Any reputable investigator knows you want to see how the person reacts to the questions.

Look up vets on their site. You would be horrified to see what vets have done to people pets and are still practicing.

In my case the vet lied. The case, according to the board, was a case of "he said, she said." They didn't question why the vet didn't preserve the video or had any of the other employees testify for him. I took a polygraph to prove I was telling the truth. That wasn't enough for them. Even if you win your case, you haven't won anything. The vet will keep practicing, kill or injure another animal and the board will continue to give them a slap on the wrist.
I filed a complaint and it took 3 meetings and 8 months to get to the point where the Vet actually showed up. I had the pleasure of listening to the Vet lie under Oath to a group of his peers. That's all I expected and it was gratifying .
 
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Daniel

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Daniel

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Relatively low cost cancer treatment for dogs:



Metronomic chemotherapy is a relatively new type of chemotherapy that uses low doses of oral (pulse) chemotherapy given on a continuous treatment schedule. Since it is given daily or every other day, the chemotherapy is given at lower doses then typical chemotherapy, often with a reduced toxicity profile. That reduction in toxicity usually results in fewer side effects.

Most of the cost is in followup bloodwork (basic bloodwork like CBC).

In human and increasingly pet medicine, common medications are being repurposed for cancer therapy. Low-cost prednisone or piroxicam (never both) is often prescribed for anti-tumor effects (and/or pain management). The beta blocker propranolol has been used in a recent clinical study for a canine cancer:


So polypharmacy may be a benefit in elder pets--as it is in humans:
Polypharmacy in the elderly on immunotherapy: Problem or opportunity? Venniyoor A - Cancer Res Stat Treat

Current evidence is confined to combinations with agents such as bevacizumab and tyrosine kinase inhibitors in cancers such as of liver and kidney;[7] these needed extensive trials to ensure safety and are expensive. It is known that commonly used drugs such as metformin, propranolol, antiepileptics, antibiotics, and angiotensin-converting enzyme inhibitors have similar immune stimulant and anti-angiogenic properties.
 
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There are 12+ million cases of pet cancer at any time. Most cases are treated without an oncologist. (There are less than 500 board-certified vet oncologists in the US.) If a consultation is wanted, an online video consultation is becoming more the norm--but is between the regular vet and the oncologist (and costs the pet owner up to $300 or so).

For pet owners that are on the fence, oncologists will often recommend trying something for a little while and just going from there. In cases where there is no standard treatment, Palladia is often used or part of a treatment plan.

More info regarding lower-cost cancer treatment:

Palladia also has some pathways that help activate the immune system to fight the spread of cancer. “We call the result stable disease,” Dr. Wood says. “It can last anywhere from 3 months to a year. That doesn’t sound like a lot of time,” the doctor says, “but compare it to 2 to 3 weeks. It gives human family members time to adjust to the reality. It gives time to say good-bye.”

Personally, when I start these protocols I re-check every two weeks for four to six weeks. After that, I start re-checking every four to six weeks, depending on the case. At these visits, I am doing my exam, comparing weight, running some basic blood work, and periodically checking tumor response (which often requires chest X-rays or ultrasound, depending, again on the case). If we are having side effects, I may adjust the dose adjustments and/or take a treatment break.


2016 AAHA Oncology Guidelines for Dogs and Cats :acrobat:
Every primary-care companion animal practice will encounter canine and feline oncology cases. A successful, full-service practice should be prepared to diagnose, stage, and treat cancer in dogs and cats, and should have a relationship with veterinary oncology specialists for purposes of selective case referrals. Cancer cases are often among the most sensitive and challenging that a practitioner will encounter. Few areas of expertise can do more to strengthen a practice’s relationship with its clients...
 
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Youtube comment:

"I'm an MD and yes, the system in medicine whether veterinarian or human is totally broken. Its driven by money. I'm so sorry this happened to you. Medicine is no longer a calling, its a business."
 

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Palliative chemotherapy can be considered for metastatic disease or for the primary tumor that has not been treated with surgery...

While response to injectable therapy has been disappointing in treating metastatic disease, a study evaluating the biological activity of Palladia in solid tumors demonstrated close to 50% clinical activity in 23 dogs with metastatic osteosarcoma (10 dogs with stable disease and 1 with a partial response) (London et al.).
 
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