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Knowing when to consult a veterinary specialist
By Dr. Marty Becker
Knight Ridder Newspapers

When Patty VanDevender brought in her three year-old Rhodesian Ridgeback, Zipp, to see her veterinarian for lameness in her front leg, she did not suspect that Zipp would end up being referred to a veterinary specialist for a potentially fatal condition that had enlarged the dog's heart.

''When we x-rayed Zipp's leg, her chest area also was caught in the x-ray and showed something was not right,'' said Dr. Melani Poundstone, DVM at the Hampden Family Pet Hospital in Englewood, Colorado. A subsequent ultrasound confirmed Zipp's heart was enlarged as a result from a congenital pericardial diaphragmatic hernia, a condition that allows the intestines to enter the chest cavity.

''I immediately referred Zipp's owner to a local veterinary specialist so Zipp could receive the care she needed,'' said Dr. Poundstone. Poundstone said she refers cases to a veterinary specialist when a situation is outside her area of medical expertise, requires special equipment or the patient requires 24-hour care.

Today, veterinary medicine offers many of the same treatments to our pets that were once seen only in human medicine. Moreover, pet owners have become more educated about veterinary care options available for their pets, and are seeking the best treatment available and the most qualified person to perform that treatment for their pets. As a result, many pet owners are unsure if and when a veterinary specialist should treat their pet.

Pet owners also ask the question if they can contact specialists themselves or do they need a referral?

''Most referrals to specialists come from the general veterinary practitioner however, unlike people who often need a referral from their general physician before they can see a specialist, pet owners can contact veterinary specialists at any time,'' said Barry Kipperman DVM, Diplomate ACVIM, of the VetCare Specialist Care Center in Dublin, California. ''Referrals are more apt to occur in an environment in which you have a trusting relationship with your veterinarian, and you are willing to advocate that you want the best care possible for your pet.''

Pet owners may be a referral candidate to a veterinary specialist if they inquire about the benefit of a second opinion, ask what more can be done, demand a service or treatment the general veterinarian does not provide, or share that their animal is part of their family and they want the best possible care for it.

''Veterinary specialists are an extension of my healthcare team,'' says Robin Downing, DVM, Hospital Director of Windsor Veterinary Clinic in Windsor, Colorado and author of Pets Living With Cancer. ''Part of my obligation to my clients and patients is to know when to take advantage of additional expertise, and to choreograph the experience to maximize a good outcome.''

Veterinary specialists who are members of the American College of Veterinary Internal Medicine (ACVIM),, say pet owners and veterinarians making referrals typically consult with them when:

--The pet needs specialized care (cardiology, oncology, neurology or internal medicine)

--Pet owners are told there is not much that can be done, and a specialist may have access to a new treatment or viewpoint that can improve the pet's condition

--The pet's condition is not improving in response to current treatment

--The pet may benefit from round-the clock care/observation

Veterinary specialists, called Diplomates, are Board-certified and have dedicated three to six years of their professional career to advanced training and testing after they receive their degree in veterinary medicine. They specialize in areas like small animal internal medicine, surgery, ophthalmology, cardiology, neurology, radiology and oncology. Diplomates perform specialized health procedures such as implanting pacemakers, administering chemotherapy and performing kidney transplants, and they use advanced diagnostic tools, such as magnetic resonance imaging (MRI) and Doppler ultrasound.

''The amount of training an ACVIM Board-certified specialist is required to have goes far beyond the technical aspects of veterinary care,'' said Joe Taboada, DVM, and ACVIM president. ''Our training includes an extensive amount of time dedicated to all aspects of cardiology, neurology, oncology and internal medicine. This breadth of training helps ensure that we provide an optimum level of care for all our patients.''

According to Dr. Brent Calhoun, Hospital Administrator of Michigan Veterinary Specialists, specialists are an extension of the pet's regular veterinarian and their health care team. ''When the specialist and the pet's regular veterinarian work together closely,'' says Calhoun, ''all of us can provide the best care for the patients we share.''

ACVIM advises pet owners to ask the following questions of their veterinarian prior to seeking out a veterinary specialist:

--Would my pet's chances of success/improvement be better with a specialist?
--Is this a procedure/treatment you have experience with?
--Is my pet receiving the most advanced treatment possible?
--Does my pet's condition require special equipment? Is it available?
--What follow-up care is necessary?


(Dr. Marty Becker is the coauthor of the book ''Chicken Soup For The Horse Lover's Soul'' and a popular veterinary contributor for ABC's ''Good Morning America.'' Write to him in care of Knight Ridder/Tribune News Service, 790 National Press Building, Washington, DC 20045.)


(c) 2004, Knight Ridder/Tribune News Service

Distributed by Knight Ridder/Tribune Information Services.

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