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Newf Know How: Referrals and Second Opinions

by Judi Randall & Tracy Warncke

 

Cardiologist, ophthalmologist, orthopedist, oncologist, allergist, Board Certified, EKG, CAT Scan, echocardiogram, TLPO, the Gold Standard.
If you own dogs, sooner or late you will hear at least one of the words above. Just as with human medicine, veterinary medicine has specialists and equipment specific to each. Science and technology have brought many wonderful advances in veterinary diagnostics and treatment. The internet has also made this information more readily available to the average dog owner.
The availability of this information, however, has led to more questions. Which new technique is best for my dog? Which diagnostic test will give me the most accurate and interpretable results? Is there more than one way to interpret the results? Which drug will be most effective and have the fewest potential side-effects?
Perhaps the most important questions, though, might be “Can my vet do this? Does he have the facilities and the training? Are all of these procedures even available within reasonable driving distance?” Just as in human medicine, no veterinary clinic is equipped to handle every possible disease, and all veterinarians are not trained in every specialty.
Let’s think of this in terms of human medicine for a minute. Not every doctor’s office has the capability to take an x-ray, mammogram, have an in-house laboratory to run sophisticated blood tests or an EKG, let alone the trained experts to read them. Your doctor often refers you to other medical facilities. The same is true for veterinarians. Most veterinarians recognize their limitations (and the limitations of their clinics) and will gladly offer to arrange referrals to specialists (often at teaching hospitals). As an owner, you should never feel embarrassed to ask for a referral. After all, both you and your vet have your dog’s best interest at heart.
A second opinion can be useful or necessary when: reading x-rays, interpreting ultrasound images, more than one surgical treatment option is available, more than one interpretation of test results is possible, a variety of treatment options are available (surgery vs drug therapy vs alternative therapies vs none), different drug protocols/options are available, a variety of alternative approaches are available (acupuncture, chiropractic).
Let us give you an example. A friend had a dog that was recently diagnosed with lymphoma (cancer of the lymph glands). The prognosis was six-nine months. Working with her veterinarian they explored all forms of treatment. A visit to an oncologist laid out all of the standard treatment options which included surgical removal of the affected gland, radiation, chemotherapy, steroids, and their likely outcomes. A visit to a veterinarian experienced with homeopathic remedies added other options. By working with the vet and the specialists they decided to try a combination of steroid and homeopathic treatment as “quality of life” was the foremost issue in everyone’s mind. We’re sad to say that the dog did pass on but she was happy and comfortable until the final day when she just gave up.
Some of us are fortunate enough to have a major veterinary teaching hospital within driving distance. Most major cities will have several “specialty” practitioners to choose from. But what if you do not live near enough? Many specialists will be happy to do long-distance consultations. Do not be embarrassed to ask your vet to make a few phone calls or internet inquiries (Vets have their “lists,” too!). Your vet will make sure that the consultant has whatever records are necessary to help make an informed diagnosis. Do keep in mind, however, that the consultant has not seen your dog in person.
Once all of your options have been laid out, it is always helpful to ask other owners and breeders what their experiences have been. Which treatment worked best for you? Again, please remember that not everyone’s dog’s health history will be identical to that of your dog, and as they say in advertisements, “your mileage may vary!”
There are times when you cannot afford the opportunity to investigate a second opinion. IF YOUR DOG’S LIFE IS IN IMMEDIATE DANGER DO NOT, WE REPEAT, DO NOT SEEK A SECOND OPINION. Immediate danger includes, but is not limited to, being hit by a car, bloat, poisoned, or bleeding profusely.
The reason behind asking for a referral is fairly straightforward—your vet doesn’t have the equipment or special training to diagnose/treat a particular problem. Even when a vet has been trained in a specialty, such as orthopedics, if that vet does not do it on a regular basis, a referral to someone who does, may be in the client’s best interest.
Asking for a second opinion, however, is a bit more delicate. Webster’s Ninth New Collegiate Dictionary (1983), states: “‘opinion’ implies a conclusion thought out, yet open to dispute” (italics added for emphasis). It is very important to recognize that differences in opinion do not mean that one veterinarian is “right” and another “wrong.” While second opinions usually confirm the original evaluation (in our vets’ experience), they can help shed light on the particular problem, by coming at it from a different angle. The goal is for you to feel completely comfortable knowing that you have done everything possible to ensure the right course of action regarding the health of your dog.

reprinted from NewfTide 2000

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