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Our Consultants in Print

January 12, 2012 Leave a comment

Mary B. Nabity, DVM, PhD, DACVP

Proteomic analysis of urine from male dogs during early stages of tubulointerstitial injury in a canine model of progressive glomerular disease.

Nabity MB, Lee GE, Dangott LJ, Ciancolo R, Suchodolski JS, Steiner JM.

Click Here to Read the Article

 
Effect of dietary protein content on the renal parameters of normal cats

Backlund B, Zoran DL, Nabity MB, Norby B, Bauer JE

Click Here to Read the Article

Click Here to learn more about Dr. Nabity

Does Ultrasound Miss Abdominal Lesions?

November 7, 2008 Leave a comment
Of course it does. But big question is how often? Are some findings more or less reliable?

An interesting article in the recent JAAHA looks at the correlation of abdominal ultrasound findings with gross surgical exploration. Whenever I have access to the ex lap findings of a patient undergoing an explore after one of my ultrasounds, I am anxious to find out how my findings compare. We all fear a negative explore, although almost every patient I can think of who had a negative gross explore, had microscopic lesions that were helpful in patient management. Following up on the ultrasound findings is an essential part of the learning process for anyone performing ultrasound or ordering one for their patient.

This was a retrospective study looking at cases from The Queen Mother Hospital for Animals in the UK. The ultrasounds were performed by experienced radiologists or radiology residents. They looked at 100 cases who had an ex lap within 48 hours of an abdominal ultrasound. There were only 19 cats, so one has wonder whether this was an adequate sample size for this particular species. There were no stats looking at cats versus dogs. However, they did note that there was “no apparent relationship…detected between body size of animal and the sensitivity of ultrasound for the primary lesion.” I find cats much easier to ultrasound than similarly-sized dogs (perhaps that is my bias towards this fabulous species), but I do feel this is a weakness in the study.

Their results are similar to what I have found in my clinical practice:

100 primary lesions & 67 secondary lesions were found at surgery.

Ultrasound did not detect the primary lesion in 24 of these animals and secondary lesions in 11 animals.

“A total of 36 animals [out of 100] had discordant ultrasonographic and surgical findings of their primary and secondary lesions.”

Ultrasound detected peritonitis lesions in 89% of cases.

Ultrasound detected intestinal obstruction in 64% of cases.

Ultrasound detected hepatic or splenic nodules in 63% of cases.

GI lesions were most likely to be missed by ultrasound (perforations, ulcerations) followed by organomegaly.

Although not statistically significant, ultrasound missed 5 GI foreign bodies.

Gross visualization at surgery missed some lesions seen on ultrasound – prostatic cysts, renal lesions, bladder lesions, splenic/liver lesions, and a gall bladder polyp.

This study brings to light my own experience.

If I am presented with a persistently vomiting animal with radiographs that are very suspicious for a GI obstruction but my ultrasound findings do not suggest obstruction – I ALWAYS err on the side of suspecting obstruction. Depending on the status of the animal and the level of suspicion from the radiographs, the next step may be to continue supportive care and repeat rads in 6-12 hours or it may be an exploratory laparotomy. My own cat had a negative explore and a number of my patients have as well. We have always learned something from the biopsies obtained and I have been fortunate to never have an owner be angry about it. The possibility of a negative explore is an important part of my conversation with the owner prior to surgery.

When ultrasound is used as part of check for metastasis, again, I always warn owners that we may be missing something. Ultrasound is notoriously poor at seeing all lesions in a liver or spleen. It may miss a focal intestinal lesion. I cannot count how many times over the course of my residency that Mike Willard showed me pictures of horrid livers at laparoscopy that were deemed normal by very experienced radiologists. Likewise, as was seen in this study, ultrasound may be able to detect architectural irregularities in an organ (especially liver, spleen, kidney) that are not seen on the surface of the organ at surgery. In these cases, a biopsy of a “normal” organ may reveal significant pathology.

This is why I am an annoyance to the surgeons when they explore the abdomens of my patients. Ultrasound is so subjective. It helps to have the objective look at surgery (or necropsy) to verify what I have seen. I am quick to recommend surgery (unless it would be detrimental to the patient) when I have any doubt about what I am seeing with ultrasound or if the animal’s signs are worse than expected based on ultrasound. Until we get a hold of one of Dr. Crusher’s tricorders, we’re stuck with histopathology for a diagnosis in many patients.

Jennifer S. Fryer, DVM

www. veterinaryanswers.com

RSS Feeds for Veterinary Journals

June 30, 2008 1 comment

Last year, during the food recall, it seemed like new foods were being added to the recall list on a daily basis and I had great difficulty keeping up. In fact, when my own cat had eaten recalled food, I did not find out until VetCentric called me at home and at the office to alert me. It was then that I discovered the FDA‘s RSS feed on recalls. Every day, I would check my RSS reader for the latest on recall alerts and I was no longer in the dark when new recalls were announced.

Since then, I have found RSS feeds to be a helpful way of keeping up with the latest veterinary literature. I read through the abstracts as soon as they are published online & then determine if I want to read the entire article. Many US veterinary college libraries allow veterinarians in their state to request individual articles for free or a reduced fee. You can also order individual articles through the Veterinary Information Network (VIN). The Royal College of Veterinary Surgeons subscribes to many veterinary journals and any veterinarian (whether in the UK or abroad) can become a member for a very reasonable price. This keeps printed journal subscriptions to a minimum and means less paper waste. And you can keep a pdf of each article on file in your computer, rather than paper files which take up so much space and time to maintain. You can also have a separate drive or an online service like Carbonite to back up your files, so that all your journal articles are still accessible if your computer is lost, stolen, destroyed, or self-destructs.

There are numerous RSS readers out there. I like Google Reader, as it is easy to read and is incorporated in to my Google account. Yahoo has a nice reader as well.

There are also services which will search newly released articles for parameters you set and either send you an email, or place it in a mailbox for you to check when you next login. PubMed’s MyNCBI and Highwire both offer these services. On the human side, Amedeo will send you a weekly list of abstracts on the subject of your choice (from a menu) and journal of your choice (from a menu). I am trying to convince Amedeo to start a veterinary journal alert service. I will let you know if I am successful.

I have found lists of human medical journal RSS feeds, but have yet to find something similar in Veterinary Medicine. So here are the ones I have found so far. Please feel free to comment if you find additional links or have a problem with a link.

RSS FEEDS
American Journal of Animal and Veterinary Sciences
American Journal of Veterinary Research
Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine
Australian Veterinary Journal
Brazilian Journal of Veterinary Research and Animal Science
Clinical Techniques in Small Animal Practice
Equine Veterinary Education
Equine Veterinary Journal
Journal of Small Animal Practice
Journal of the American Medical Association
Journal of the American Veterinary Medical Association
Journal of Veterinary Cardiology
Journal of Veterinary Emergency and Critical Care
Journal of Equine Veterinary Science
Journal of Veterinary Internal Medicine
Journal of Veterinary Pharmacology & Therapeutics
The Lancet
Medical and Veterinary Entomology
Mycoses
New England Journal of Medicine
New Zealand Veterinary Journal
Onderstepoort Journal of Veterinary Research (must scroll down list to find it)
Preventive Veterinary Medicine
Research in Veterinary Science
Transboundary and Emerging Diseases
Tropical Animal Health and Production
Veterinary and Comparative Oncology
Veterinary Anaesthesia and Analgesia
Veterinary Dermatology
Veterinary Economics – free content
Veterinary Immunology and Immunopathology
The Veterinary Journal
Veterinary Medicine – free content
Veterinary Microbiology
Veterinary Ophthalmology
Veterinary Parasitology
Veterinary Pathology – free content
Veterinary Radiology and Ultrasound
Veterinary Research
Veterinary Research Communications
Veterinary Surgery
Zoonoses & Public Health

ELECTRONIC TABLE OF CONTENTS ALERTS, No RSS
Australian Equine Veterinarian
Indian Journal of Veterinary Pathology
Indian Journal of Veterinary Surgery
In Practice – British Veterinary Association
Journal of the American Animal Hospital Association
Journal of Animal Husbandry and Veterinary Medicine in Tropical Countries
Journal of Veterinary Behavior
Journal of Veterinary Diagnostic Investigation
Journal of Veterinary Medical Education
NAVC Clinician’s Brief – Free registration & content
Veterinary and Comparative Orthopaedics and Traumatology
Veterinary Clinics of North America: Equine Practice
Veterinary Clinics of North America: Exotic Animal Practice
Veterinary Clinics of North America: Food Animal Practice
Veterinary Clinics of North America: Small Animal Practice
Veterinary Health and Safety Digest
The Veterinary Record

AVAILABLE CONTENT ONLINE IF YOU SUBSCRIBE, No RSS
Canadian Journal of Veterinary Research
Canadian Veterinary Journal
Compendium: Continuing Education for Veterinarians
Compendium Equine
Exotic DVM – free subscription for vets, techs, students
Flemish Veterinary Journal
Online Journal of Veterinary Research
The Pig Journal
Review of Medical and Veterinary Entomology
Review of Medical and Veterinary Mycology
Standards of Care
Veterinary Bulletin
Veterinary Clinical Pathology
Veterinary Focus – free subscription for vets, techs, students
Veterinary Forum
Veterinary Technician
Veterinary Therapeutics

FREE CONTENT, no RSS
British Veterinary Dental Association Journal
The International Journal of Applied Research in Veterinary Medicine
The Irish Veterinary Journal
Israel Journal of Veterinary Medicine
Japanese Journal of Veterinary Research
The Journal of Veterinary Medical Science (Japanese Society of Veterinary Science)
Journal of Veterinary Science
Turkish Journal of Veterinary and Animal Sciences
Veterinary Neurology and Neurosurgery
Veterinary Practice News
The Veterinary Quarterly
Veterinary Review
VetScite

OTHER INTERESTING LINKS
AVMA Directory – need AVMA membership
Canadian Compendium of Veterinary Products – need annual subscription
Compendium of Veterinary Products – need AVMA membership
FDA – News, Recalls, Drug shortages, etc.
Material Safety Data Sheets – need AVMA membership
Merck Veterinary Manual – Free Content
Veterinary Biologic Products – Licensees and Permittees -USDA- December 2007

Categories: Recent Literature

EHV-1 the neuropathogenic strain

April 29, 2008 Leave a comment

by Natalie Carrillo, MV, DVM, Dip ACVIM-LA

Recent outbreaks of myeloencephalopathy caused by equine herpesvirus (EHV-1) have generated new research that provides better information about diagnosis, treatment and outbreak management. The objective of this article is to summarize this information in a practical and applicable manner.

Clinical signs

The onset of EHV-1 myeloencephalopathy is characterized by a biphasic fever. In several outbreaks2 it has been observed that only horses younger than 5 years displayed fevers and respiratory signs, whereas the older horses were febrile, but had no signs of respiratory disease. It has also been observed that older horses develop neurologic deficits more frequently and of greater severity than younger horses (<5 y) 2. The reason for this bias is unknown, but may be explained by the role the horse’s immune system plays in the extent and severity of vasculitis and vascular thrombosis2.

The neurologic deficits appear approximately 4-6 days after the onset of fever2 and develop as the result of vasculitis, thrombosis and secondary ischemic degeneration of the neuropil1. The neurologic signs reflecting spinal cord involvement range from mild ataxia to recumbency, the pelvic limbs are more frequently involved and bladder atony is common. The brainstem may also be affected and therefore deficits of the cranial nerves may also be observed.

Epidemiology and outcome

The clinical signs are of rapid onset, but they also stabilize quickly. Most non recumbent animals do well, but the prognosis for recumbent horses is poor. In an outbreak of EHV-1 approximately 20-30 % of horses will be affected by the neuropathogenic strain, and of these the mortality will be approximately 30%1, 2.

Diagnosis

If you suspect a horse has EHV-1 due to an unexplained fever after being at an event, for example. A nasal swab and an EDTA purple top tube should be collected and submitted on ice packs overnight for real-time TaqMan® PCR on both samples to diagnose and differentiate the neuropathogenic vs non neuropathogenic strains. Results will be ready in 24h post arrival3. (See references for mailing addresses).

Outbreaks and treatment

In the event of a suspected outbreak there are guidelines on the AAEP website http://www.aaep.org/control_guidelines_nonmember.htm that pertain to biosecurity and quarantine. They are to extensive to cover, and are not the objective of this article. What I do want to incur into are treatment guidelines.

On the onset of fever of a suspected animal:

First implement biosecurity measures including stall confinement. Collect pertinent samples for diagnosis and then initiate therapy with NSAIDs such as flunixin meglumine 1.1 mg/kg or phenylbutazone 4.4mg/kg to manage the fevers.

Once the disease is confirmed or clinical signs of the disease progress to a working diagnosis of EHV-1, then more aggressive therapy and prophylaxis of surrounding animals should be initiated. All animals possibly exposed should be treated with Valacyclovir (Valtrex®) 205-403 mg/kg PO every 8 hours. Acyclovir despite clinical reports of effectivity2 has shown not to reach adequate serum levels to inhibit viral replication6 therefore should not be the first drug of choice. Valtrex® is an expensive drug and this option should be thoroughly discussed with the owner.

Management for the horses displaying clinical signs of the neuropathogenic form of EHV-1:

· NSAIDs – continue flunixin meglumine 1.1mg/kg for 10 d (monitor serum creatinine every 3-5d depending on hydration status of the horse).

· DMSO (if you are a believer) 1g/kg at 20% sol IV every 24h for 3 days, as a free radical scavenger.

· Valacyclovir (Valtrex®) 205-403 mg/kg PO every 8 hours for 10 days or until clinical signs stabilize.

· Vitamin E 10.000 IU PO every 24h for 10 days7 as an antioxidant.

· Dexamethasone 0.1 mg/kg IV for 3 days then taper for a total of 10d. This therapy is controversial. On one hand it is a potent anti-inflammatory, but on the other it does suppress the immune system at these doses. And never forget the potential for laminitis. I would reserve this choice of therapy for horses showing neurological deficits, I would not administer to horses with just a fever, even if it is a confirmed case.

· If at any point a horse should become recumbent or needs assistance standing, or in general deteriorates to the point of requiring constant monitoring please talk to the client about referral to a hospital with facilities for critical care.

Vaccination in an outbreak

From http://www.vetmed.ucdavis.edu/ceh/topics-EHV-1-vaccinations.htm

· On premises with confirmed clinical EHV-1 infection, booster vaccination of horses likely to be exposed is not recommended.

· Non-exposed horses or horses that have to enter the premises should have a booster vaccination if they have not been vaccinated within the past 90 days. This does not guarantee protection against the disease; the hope is that reduced nasal shedding of infectious EHV-1 by these horses will help reduce the magnitude of challenge experienced by other horses and potentially help reduce spread.

· A current publication8 showed that recent vaccination with Rhinomune (modified live vaccine) may provide some protection against EHV-1 myeloencephalopathy. These results should be interpreted with caution because the number of animals used in the study was small.

· Vaccines that provide the highest levels of viral neutralizing titers are Pneumabort, Prodigy, Calvenza and Rhinomune. The high levels of antibodies have been shown to reduce viral shedding. It is important to warn clients of the potential side effects of the modified live vaccine such as swelling of the injection site, fever and swelling of the limbs.

I hope this article has been helpful, if you should have any further questions about a case please do not hesitate to contact me.

References:

1.- Julia H. Kydd and K.C. Smith, Equine Herpesvirus Neurologic Disease: Reflections from across the pond. J Vet Intern Med. 2006 May-June;20(3):467-68.

2.- Henninger RW, et al, Outbreak of neurologic disease caused by equine herpesvirus-1 at a university equestrian center. J Vet Intern Med. 2007 Jan-Feb;21(1):157-65.

3.- Allen GP, Development of a real-time polymerase chain reaction assay for rapid diagnosis of neuropathogenic strains of equine herpesvirus-1.J Vet Diagn Invest. 2007 Jan;19(1):69-72. M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY 40546.

4.- Garré B, et al, Pharmacokinetics of acyclovir after intravenous infusion of acyclovir and after oral administration of acyclovir and its prodrug Valacyclovir in healthy adult horses. Antimicrob Agents Chemother. 2007 Dec;51(12):4308-14. Epub 2007 Sep 10.

5.- BG Bentz, et al, Pharmacokinetics of Valacyclovir in the adult horse. Abstract #108 J Vet Intern Med. 2007 May-June;21(3):601.

6.- BG Bentz et al, Pharmacokinetics of Acyclovir after Single Intravenous and Oral Administration to Adult Horses. J Vet Intern Med. 2006 May-June;20(3):467-68.

7.- J.K. Higgins, et al, Vitamin E levels in serum and cerebrospinal fluid of healthy horses following oral supplementation. Abstract #340 J Vet Intern Med. 2007 May-June;21(3):666.

8.- Goodman LB, et al, Comparison of the efficacy of inactivated combination and modified-live virus vaccines against challenge infection with neuropathogenic equine herpesvirus type 1 (EHV-1).

Vaccine. 2006 Apr 24;24(17):3636-45. Epub 2006 Feb 13.

Canine Adrenal Testing – Which Test Should I Run?

November 28, 2007 2 comments

By Dr. Jennifer S. Fryer

Urine Cortisol:Creatinine Ratio:

· Screening test for Hyperadrenocorticism (Cushing’s or HAC)

· Low Cost, Easy to collect (voided morning urine at home)

· Normal value rules out Hyperadrenocorticism

· Elevated values can indicate stress or Hyperadrenocorticism & adrenal function testing is necessary.

Baseline Cortisol:

· Screening test for Hypoadrenocorticism (Addison’s)

· Values >2 mcg/dl rule out Hypoadrenocorticism (Addison’s)

· Cannot be used to diagnose Hyperadrenocorticism (Cushing’s)

ACTH Stimulation Test:

· Test of choice to diagnose Hypoadrenocorticism (Addison’s)

· Screening test for Hyperadrenocorticism (Cushing’s)

· Used to monitor Trilostane or Lysodren Therapy

· Can be used to differentiate spontaneous vs. iatrogenic HAC

· 60-85% of dogs with HAC will have a positive result on this test.

· 85-90% of dogs without HAC will have a negative result on this test.

· Advantages:

o Can be completed in 1 hour

o No special handling of samples

o Submit for extended Adrenal Panel to document Atypical HAC

· Disadvantages:

o High cost of Cosyntropin

o Low Sensitivity (false negatives are possible)

Low-Dose Dexamethasone Suppression Test:

· Screening test for Hyperadrenocorticism (Cushing’s)

· Helps differentiate pituitary vs. adrenal origin

· 85-95% of HAC dogs have a positive result.

· 70-75% of dogs without HAC have a negative result.

· 40% of dogs with PDH and all adrenal tumor dogs have dexamethasone resistance and will require another differentiating test.

· Advantages:

o Low cost

o Higher sensitivity than ACTH Stim

o No special handling of samples

· Disadvantages:

o All day test requiring three blood samples at 0, 4, 8 hours

o The dog should be kept as minimally stressed as possible during this 8 hour period

High-Dose Dexamethasone Suppression Test:

· Theoretically helps differentiate Hyperadrenocorticism of pituitary vs. adrenal origin.

· Similar results to Low-Dose Dexamethasone Suppression Test at 8 hours.

· Rarely performed.

Endogenous ACTH Measurement:

· Helps differentiate pituitary vs. adrenal HAC

· Single plasma sample required

· Sample handling is difficult & critical to accurate measurement.

· With proper sample handling, this test is very reliable at differentiating pituitary vs. adrenal HAC.

Abdominal Ultrasound:

· Helps differentiate pituitary vs. adrenal HAC.

· May identify adrenal tumor, local invasion or metastasis.

· High cost

· Adrenals can be normally sized in PDH

· Adrenals can be difficult to visualize in some animals

· Ultrasound does not always accurately identify extent of metastasis or local invasion of an adrenal tumor

Computed Tomography (CT Scan):

· Screening test for Pituitary Tumor or Primary Adrenal Tumor and abdominal metastasis &/or local invasion

· Brain CT is not indicated unless a macroadenoma is suspected.

· Very high cost.

· Requires anesthesia.

· Cannot detect 50% of pituitary masses.

· Cannot differentiate between functional and non-functional tumors. Adrenal function tests are still required.

Brain Magnetic Resonance Imagine (MRI):

· Screening test for Pituitary Tumor

· Brain MRI is not necessary unless a macroadenoma is suspected.

· More reliable than CT at detecting small pituitary masses.

· Very high cost.

· Requires anesthesia.

· Not indicated unless a macroadenoma is suspected.

· Cannot differentiate between functional and non-functional tumors. Adrenal function tests are still required.

 

 

References

Lennon EM, Boyle TE, Hutchins RG, et al. Use of basal serum or plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000-2005). J Am Vet Med Assoc 2007;231(3):413-6.

Nelson RW, Turnwald GH, Willard MD. Endocrine, Metabolic, and Lipid Disorders. In: Willard MD and Tvedten H, eds. Small Animal Clinical Diagnosis by Laboratory Methods. 4th edition. St. Louis: Elsevier Saunders, 2004:165-207.

Reusch, CE. Hyperadrenocorticism. In: Ettinger SJ and Feldman EC, eds. Textbook of Veterinary Internal Medicine. 6th edition. St. Louis: Elsevier Saunders, 2005:1592-1611.

 

Focus on Referral Issues

November 14, 2007 Leave a comment

This article in the recent issue of Trends Magazine, highlights many of the issues that prompted me to found Veterinary Answers. AAHA held forums to promote better relationships between general practitioners and specialists. The forums were held in Denver, CO; Orange County & Fremont, CA; Houston, TX; Chicago, IL; Boston, MA; and Washington, DC and were attended by 121 specialists & 74 general practitioners. Unfortunately, specialists were overrepresented. But I think the results are pertinent.

Please add your perspective on these issues, too.

The Referring Veterinarian’s Perspective

  • They would like “mutual respect and a non-judgmental attitude” in communications with specialists.
  • They prefer that their calls be returned during business hours.
  • They would like to have a specialist give due to consideration to consultations and advice on cases that cannot be referred.

The Specialist’s Perspective

  • Because of busy schedules, they return most calls after hours.
  • Most specialists return consult calls last.
  • Specialists are hesitant to discuss advice when a case is not going to be referred.
  • They are also hesitant to give advice on cases they have not seen for a long time.

I have been on both sides here. It is so frustrating to have a difficult case that cannot be referred, yet you and owner desperately want to help the animal. I have also been the busy specialist who didn’t see her less urgent messages until she could finally sit down at her desk at 8:30 in the evening, long after most veterinarians (hopefully) have gone home. I can’t tell you how many consults I gave on the fly to a vet who needed help. I gave the best advice I could while juggling several issues at once (an occasionally with an ultrasound probe in my hand). It wasn’t fair to anyone. My advice wasn’t as well reasoned as it should have been, I probably sounded stressed, and the veterinarian at the other end of the phone did not receive any documentation of our conversation. While doing referral work, most of my time was spent talking with owners and RDVMs about hospitalized cases, doing ultrasound, and SOAPing patients. Everything else developed a low priority so that my patients could receive the best care. Something had to give, and unfortunately, it was often the referring veterinarians who paid the price.

Veterinary Answers gives calling veterinarians their undivided attention. Every call is followed with a written report that is faxed or emailed to the veterinarian to document the conversation. We work together with veterinarians to advance the level of care they give all of their patients. We understand the limitations veterinarians face, from owner financial constraints to limited resources. Together, we will work with you to help your patients despite these obstacles.

Focus on Referral Issues

November 14, 2007 Leave a comment

This article in the recent issue of Trends Magazine, highlights many of the issues that prompted me to found Veterinary Answers. AAHA held forums to promote better relationships between general practitioners and specialists. The forums were held in Denver, CO; Orange County & Fremont, CA; Houston, TX; Chicago, IL; Boston, MA; and Washington, DC and were attended by 121 specialists & 74 general practitioners. Unfortunately, specialists were overrepresented. But I think the results are pertinent.

Please add your perspective on these issues, too.

The Referring Veterinarian’s Perspective

  • They would like “mutual respect and a non-judgmental attitude” in communications with specialists.
  • They prefer that their calls be returned during business hours.
  • They would like to have a specialist give due to consideration to consultations and advice on cases that cannot be referred.

The Specialist’s Perspective

  • Because of busy schedules, they return most calls after hours.
  • Most specialists return consult calls last.
  • Specialists are hesitant to discuss advice when a case is not going to be referred.
  • They are also hesitant to give advice on cases they have not seen for a long time.

I have been on both sides here. It is so frustrating to have a difficult case that cannot be referred, yet you and owner desperately want to help the animal. I have also been the busy specialist who didn’t see her less urgent messages until she could finally sit down at her desk at 8:30 in the evening, long after most veterinarians (hopefully) have gone home. I can’t tell you how many consults I gave on the fly to a vet who needed help. I gave the best advice I could while juggling several issues at once (an occasionally with an ultrasound probe in my hand). It wasn’t fair to anyone. My advice wasn’t as well reasoned as it should have been, I probably sounded stressed, and the veterinarian at the other end of the phone did not receive any documentation of our conversation. While doing referral work, most of my time was spent talking with owners and RDVMs about hospitalized cases, doing ultrasound, and SOAPing patients. Everything else developed a low priority so that my patients could receive the best care. Something had to give, and unfortunately, it was often the referring veterinarians who paid the price.

Veterinary Answers gives calling veterinarians their undivided attention. Every call is followed with a written report that is faxed or emailed to the veterinarian to document the conversation. We work together with veterinarians to advance the level of care they give all of their patients. We understand the limitations veterinarians face, from owner financial constraints to limited resources. Together, we will work with you to help your patients despite these obstacles.