I'm sure this is going to tick many people off, but... I just wonder what others think about annual fecals, if we can not fight about it. In 20+ years of taking dogs to vets, I've only once had a fecal find anything, which was blood (a bad gastro issue), which was obvious to the eye (along with the bloody vomit). I have known dogs in rescue that had worms (rounds, obvious in stool), and a neighbor's pups actually had worms that were found as eggs in the float. But, heretical as it sounds, I think the average fecal float test is just about a waste for any adult dog that isn't showing any signs of illness (and often even if they are), as they so seldom find anything. A fresh smear along with the taking of a temp seems to find a lot more (bacteria-wise) information when a dog isn't eating well or has diarrhea or is vomiting. I'd gladly pay for smears, but don't like annual floats as they so seldom find anything.

KateH March 9th, 2009 07:53:26 AM

And she rides too? Is that a sweet BMW I see? Hope the pup has a sidecar ... Dr. Khuly has to be the coolest vet ever.

Jim March 9th, 2009 08:01:02 AM

(Raising hand and speaking in small voice....)

Um, I had a dog come back with a positive fecal last fall. He was struggling with diarrhea and I was having fecals done about every 3 weeks (IOW, anytime anything changed). He came back positive for round worm. (I had a couple of "guest" dogs right before that or maybe he picked something up running around.)

I've also had a fecal come back positive for Giardia 13 years or so ago on an annual exam. (No symptoms.) The bad thing about that one is that it's transmissible to humans. 

So twice in 14 years of owning dogs. Still, I consider the fecal exam to be cheap insurance. But I admit I don't get them done annually and often not unless there seems to be a problem of some sort.

Deanna March 9th, 2009 08:06:14 AM

Good article. Yes, its a constant battle for our clients to understand that prevention is better than treating down the road. But we still see clients who have left things too long. Thankfully most of our clients are good owners that we see on a yearly basis.

Kathy March 9th, 2009 08:26:24 AM

KateH: I live in Miami so the fecals come up positive all the time (at least a couple every day). And remember, it's very helpful for determining whether patients have excess bacteria...and what kinds. I agree with Deanna that it's cheap insurance. Plus, if you get out of the habit of doing great fecals with every annual (we centrifuge, float and smear) you'll almost certainly miss the obvious in many animals, no matter where you live.

And finally, the fecal can be done so quick and dirty and cheep that it almost qualifies as malpractice not to do one either annually or when patients have GI signs. 

Of course, if you feel it's a waste of your $, you can always decline. That's why I love having it built into all my annuals––no one ever complains. 

Dr. Patty Khuly March 9th, 2009 08:51:04 AM

Oh--and, not my ride (or my dog)--wish it were. ;-)

Dr. Patty Khuly March 9th, 2009 08:51:52 AM

KateH: my 7YO pooch showed no symptoms but came back positive for hookworms last year after her fecal during her annual. Surprised the heck out of me since she always acts like a puppy. The way I see it, a dog will always have a 50% chance of a positive fecal, so it's worth it. This will be the first annual for Daisy that I refuse vaccines. My vet's office is VERY big on preventative wellness check-ups and dentals, but they do seem to automatically give the vaccinations without confirming with me what exactly I want. I think it's probably because I'm a pretty regular customer. This year, I think I am going to refuse the rabies vaccine. My city requires a vaccine every year, but now that Daisy is heading into her golden years and has a current, 3-year vaccine, I simply won't have her get another until she's actually due. Same goes for kennel cough, I believe. I've heard that you don't have to issue the boosters unless they will be boarded or hanging out with other dogs. Since that's not the case with my dogs, I'm considering skipping that one this year.

Shasta March 9th, 2009 09:59:53 AM

Good article, Dr K. It puts everything in perspective and explains the reasons behind differing fees etc. I live near the DC Metro area and pet care is expensive here. It does reflect things involved in running a business-lease payment, area wages, and expectations of the clientele and level of care-more LVT's on staff, etc. Also, you talked about how a pet with multiple issues can involve a longer office visit, reviewing labs-case management, etc and the fees will reflect that, too. 

We have a number of clients who use CareCredit and also Pet Insurance, and we offer alternatives, such as breaking up an exam visit, then Labs as a Technician appointment, and then dentistry next etc. Yes, sometimes those clients fail to return for those things in a timely fashion, but most do. 

Teri and the cats of Furrydance March 9th, 2009 10:09:39 AM

Interesting post, especially seeing as I just left work early because I refuse to cold call clients to tell them that their pets vaccines are overdue.

A majority of the pets that are overdue are clients that are educated enough to realize that their pet does not need to follow our protocol of a bordatella vaccine every six months.  Don't get me wrong, if Fido hasn't been to the vet in four years, I have no problem calling to ensure that he is seeing a veterinarian. 

We have been informed that we are no longer allowed to note in the medical records that Fido's owners do not want to be pressured to give these vaccines at every visit (even if it is motivated by illness).  It is we who are the educated ones, we know what is best for the pet, not the owner of the pet.  The internet is afterall, full of only lies.  Who would you believe, the doctor who spent four years in veterinary school, or the internet?

I'm sorry, but I'm a tad annoyed right now.  The worst part, with the current economy, the veterinary job market isn't all that hot.

So, for the time being, "Yes, even though Mouser is an indoor only 16 year old cat with lymphoma and likely will not be alive in two months, it is my duty to ask you if you would like to pay us to administer a worthless feline leukemia vaccine today."

Jackson March 9th, 2009 10:43:11 AM

Almost forgot.  Regardless of how often you have seen a positive fecal examination, it's still a good idea as a majority of the parasites are zoonotic.  The fecal examination is part of the bi-annual examination that I push clients to accept, much more important than a six month bordatella vaccination in my uneducated opinion. 

Jackson March 9th, 2009 10:46:20 AM

I guess it's just that I'd so much rather spend the $$ on bloodwork, especially for an older pet, that a fecal, unless there's 'bad poop' isn't something I'm going to do. Where I work it really seems that people have been indoctrinated into thinking the fecal is more informative, and cheaper, than bloodwork, which I don't agree with, personally. And as for the zoonotic part, yeah it can happen, but I also guess I'm either sheltered or lucky in that, with giardia as the only exception (and it's found best on a fresh smear), I've never known, or known of, anyone getting worms from their dog or cat. When clients bring in a dog they haven't had on heartworm for years or has lost or gained weight suddenly, and say that the HW test or bloodwork is too expensive, but hand over a baggie of perfect poop, I wish I could say "Ya know...." But again, that's just me.

KateH March 9th, 2009 11:26:01 AM

I'm a HUGE proponent of not only annual fecals, but also annual bloodwork.  We do the occasional thyroid panel (generally breed based and usually only when symptoms or behaviours suggest glandular issues..) and will do a urinalysis if bloodwork comes back requiring further clarification or symptoms are even slightly suggestive of the need to do one.

I have had WAY too many dogs come up positive for a myriad of diseases, parasites, viruses, immune issues and bacteria with either minimal or zero symptoms to discount such simple and (compared to treatment of fullblown disease/infection) cost effective testing.

My own veterinarian provides us with a volume discount (I know you disagree, Dr. K - but I can say from personal experience it does make me more likely to bring in dogs/cats who aren't really due during a group visit, in order to save a few dollars.  In the long run, we spend MORE money, because the critters are wellness tested far more often than they would be otherwise, however I'm satisfied with the exchange). 

We bring in whoever is in need of a treatment or checkup (we don't vaccinate for the most part aside from parvo/distemper/rabies puppy vax and a one year booster) and the rest of the gang tags along for good measure.  This way we avoid paying the $50 fee per pet for the office visit, and my vet doesn't mind because we run a full gamut on everyone - CBC, fecal, heartworm test, and any other test/treatment deemed necessary.

Have we spent a truckload of money on wellness exams and testing?  You betcha!!  But in my mind you simply can NOT put a price on the solid knowledge that comes with such frequent and thorough examinations.  Not only do I know at any given time exactly the state of health each and every one of my pets is in, but I also have an ongoing, constantly updated picture of their regular levels and chemistry profiles.  This means I am FAR more likely to notice any deviation from the norm, even when said deviation is within the set "standard" a la the lab.  A chronic or sudden/severe increase or decrease in any value is reason for concern, and without such frequent testing could very easily be overlooked, even by the most astute professional.

The other area of disagreement we have, however, is the idea of annual dental treatment.  While I am in full agreement that dental disease is a serious and far too often overlooked malady of the dog and the cat, I feel very strongly that annual (or even frequent) dental cleanings are severe overkill when simple preventative measures and safe, OTC solutions are available.  Chicken wing or turkey neck, anyone?  ;O)  There are, of course, exceptions to every rule, and there will always be some animals, like some humans, whose teeth simply rot from their heads regardless of treatment/prevention/care.  These animals obviously require a more aggressive form of treatment.  But far too often these days I am seeing more and more animals who have very little, mild or moderate plaque buildup recommended for full anaesthetic and dental cleanings with no mention even given to the more natural, safer alternatives.  Some have even been recommended annual cleanings as a "preventative" on animals who have such small amounts of buildup it could most definitely be considered malpractice in human medicine to expose an individual to the risk of full anaesthesia when such risk is so obviously not warranted (a simple change in regimine or the addition of a plaque removing product/chew item would easily accomplish the same task with little to NO risk).

All in all, though, I must say that I admire your dedication to annual COMPLETE checkups, with individualized priorties.  Sadly, too many practitioners are still standing by the tried and true quick prod, quick client questions "any concerns today?", followed by a jab with whatever they could get the client to agree with - and the more the better.

My apologies for the long and rather windy post... lol.  But this is a topic I feel incredibly strongly about.  Far too often I have clients asking me what to do about their cat who won't keep weight on (diabetes?  hyperthyroidism? cancer?) or their dog who won't keep weight off (hypothyroidism?) or whose hair is falling out (allopecia? cushings? addisons?) and the response I receive when I ask what the vet thinks is inevitably something to the tune of "well, it's been a while... a few years or more..." and of course then they scoff when I suggest bloodwork and give them an approximate ballpark cost.  If more people invested in preventative care, perhaps these illnesses would be found before the animals became symptomatic - before permanent damage was done.

It just makes me so incredibly sad to think of all the suffering that could be avoided...

Kim March 9th, 2009 11:56:16 AM

Nearly three years ago, as I left my preferred Houston vet, I said "see you next year" and the scheduling clerk said "oh, no, you get three years this time".  Now, admittedly, I was still in relatively dazed post-stroke brain confusion.  I was more confused by her statement but also not up to figuring out the issues.  LOVE this post, will be printing and making my checklist and, since I do trust that vet more than most, will be getting with him to sort out if we aren't understanding each other on what I want for my "kids".

Jackson, I understand what you're saying but I have to say I'd appreciate that call.  If you called me, I might even be gruff on the phone.  I'm often annoyed with myself when reminded of my failures and don't even realize it's coming out in my voice as annoyance with someone else.  It's tough to admit you don't remember things or can't afford it or whatever the underlying reason is so tread gently and let them know you'll still be there when they're ready and then call them back in a month or two (which is about the max my brain usually holds information these days).  And then ask for an email address so you can send them a link to this blog ")

There's definitely some SWEET deals on real estate near you Dr. K.  Even so, that's relative to it being Florida because Houston comps are running 1/3 of FL properties.  I don't see how any of you afford to live there! :)

PJBoosinger March 9th, 2009 12:15:41 PM

Jackson: I can't resist: How would you like to be the one scaring the bejesus out of people into a lepto shot every 6 months, even though your area hasn't seen a positive lepto case yet (but they sure are hoping to)?

Early education away from vaccines should have started a decade ago. Some started late, and some still refuse to comply with the new(?) recommendations. Dr. K: your package deal is great for marketing, that should take hold elsewhere to catch on and make the transition. I used to love the "Antech package": comprehensive CBC, Chem & T4. BTW, since techs are employed at some of these clinics, has anyone heard of verifying a blood smear for the CBC irregularities, or just check RBC morphology & WBCs? Jeepers? That is another thing I miss.

Kim, I hear you. Of course the owner that has gotten annual bloods, sometimes semi-annual is going to pay attention to a trend, even though not outside "normal range"! Hello, your pet's hematocrit declines from upper 40's to mid to low....hey, something's happening! Always dread that calcium rise too!

One thing that blows me away.....5-6 months after a dental, Vet opens mouth and says "My goodness those teeth need to be CLEANED!" Hey, I need to add, my 2 12yr. old beanies got their first and only teeth cleaning this past year (never needed it before), and their teeth look brand NEW...like a 2 yr. olds!

Barbara A. Albright/New Hampshire

Pocket's Story from NH March 9th, 2009 01:10:05 PM

It's sad that people can't afford yearly exams. But it reflects the sad state of the government and economy more than the change in vaccine protocols. IMHO

your pricing on the exam/bloodwork can't be beat however....wish I could get those prices. I paid almost 200.00 for my last set of labs, which did not include t4/heartworm.

LorriM March 9th, 2009 07:32:26 PM

IMO annual fecals, done with a sugar solutions and a centrifuge are cheap and necessary insurance and ought to be done with every exam. I wonder how many places that 'never find anything' on a fecal are using a salt solution or similar. Sorry, but simple science says that if you're using salt solutions, even though they're much touted by company reps, the specific gravity isn't high enough to float much besides toxoplasma. Sugar solution is cheaper (though no company's making a profit off it so it gets less advertisement), easy, and will float just about everything you could possibly be looking for- including giardia and crypto.  Yeah, yeah, fecasol comes with those handy little 'kits,' but how hard is it to go to the dollar store and buy a tea strainer and some sugar if it means practicing better and more accurate medicine?

In the interest of disclosure, I'm actually in the midst of my parisitology course atm. I should be studying for my test tomorrow actually...

lindabcs March 9th, 2009 08:28:27 PM

Oops, KateH...didn't mean to suggest you were complaining (sounded harsh, sorry). But yeah, if pets come up negative year after year I can see why it can seem relatively useless to you. And as for others' perception that the magic stool test will find all ills...I think only Salvador Dalí had any real claim to that concept (and he was nuts).

Dr. Patty Khuly March 10th, 2009 02:09:05 AM

You do change Oil though. I find that attractive. A woman as versatile with a wrench as she is with a  stethoscope.

Evet March 10th, 2009 12:52:42 PM

Okay if all these newest and  latest tests, new protocols, and precautionary measures were broken down what would we be doing taking our pets to the Vet twice a month?

Evet March 10th, 2009 12:57:31 PM

Airline Pilots have traditionally been the most seriously and frequently probed,  poked, and prodded creatures to get a Class A Medical to continue flying.  Not sure my Pet is ready for a career in that.

LOL

Evet March 10th, 2009 01:03:57 PM

I try and practice by the motto:

It is better to prepare and prevent than repair and repent

J.C. March 10th, 2009 02:14:00 PM

J.C. - I'm totally hawking that quote.  ;O)

Kim March 10th, 2009 04:43:09 PM

Kim - knock yourself out - I didn't invent it and I really don't remember where I got it from....I know I read it in some article or something. :)

J.C. March 11th, 2009 06:34:27 AM

I can't believe all the belly-aching I'm reading about annual checkups. How do our pets differ from US? Don't all of you visit your PCP (primary care physician) once yearly at a minimum for ALL tests required by your age bracket? If you don't that's YOUR choice and it shouldn't be put on people's pets. The MAJORITY of pet owners are NOT vets/vet techs/rescuers which alot of you seem to be - annual physicals whether shots are administered OR NOT are absolutely REQUIRED for pet health. I give my own pets/rescues shots/I know more than most about meds & diseases/yet I take all my dogs for annuals regardless of appearance AND I GET FECALS AND HW/ERLICHIA TESTS living in S. FL as behavior is NOT indicative of disease. I have a chow/sharpei mix that acts like a runaway locomotive yet he had erlichia to the point that had he been cut he may have bled to death; others dogs with erlichia in my history were unresponsive and low key - but not this one. Without his blood test I'd never have suspected he had an issue. I also until last year was unaware that erlichia can RECUR - hence I REQUEST irregardless of HW prevention the combo HW/erlichia test annually as a safety precaution. Also my dogs don't seem to have diarrhea issues however one wound up with whipworms which is rare BUT hard and hard to eradicate hence ALL dogs gen an annual fecal as a safety. I could give preventative Panacur or similar 2/x or more annually but why when a $25/test per dog doesn't require poison unless the dog actually needs it? Pardon my rant but I also today had an "acquaintance" basically diss me for referring them to a vet that's "rescue friendly." Their "stray" cat happened to go into a tented facility for termites and they found her shaking and pupils dilated. I'd told them a specific vet offered rescue discounts; this vet SAVED THE CAT'S LIVE AND SPAYED HER FOR $260 TOTAL yet this acquaintance thought the cost was outrageous. I gave her 3 other vets to check for spay costs alone; point is: people think vet care and things for strays in life should be free well, who reimburses the vet for their time and costs? What a bunch of MORONS we have in this country. I'm embarrassed daily by the lack of common sense and compassion the majority of Americans portray ... or don't ... usually it's DON'T. Lee

Lee March 17th, 2009 11:07:14 PM

Enjoyed the article and comments.  Our practice has placed a great deal of effort into education regarding the points listed by the author. We stuggle with pet owners who go to other practices in the area because they don't require pre-anesthetic blood work, they don't require exams prior to vaccination, and they don't promote annual preventative medicine. Yes, it's cheaper in the short term and potentially very much more expensive over the long term.

Most clients that truly listen to our recommendations are more than willing to have the necessary steps taken once they understand why we highly recommend the annual wellness and additional testing. It's not an evil plot to bring in more revenue but a genuine desire to keep their pets safe and healthy throughout their entire life.

We offer annual wellness packages and they have been received very well by clients because it takes the guess work out of knowing what their pet needs. Each base package is customized based on the individual pet's needs and age.

Josh March 21st, 2009 02:48:29 PM

شات

amal_ May 22nd, 2009 05:11:21 AM

good information

sem

search engine marketing

adfdasf June 1st, 2009 03:29:52 AM

[url=http://lgl-3ink.com/vb]منتدى[/url]

ali June 4th, 2009 09:51:04 PM

sdfsddsd32z

شات  
< June 4th, 2009 10:27:25 PM