Asking Questions Before Treatment...Dog World 23/4/14

Asking questions before treatment by Steve Dean
Created: 23/04/2014

There are three ways of treating a dog with an injury or illness. Total inactivity or moderate treatment to alleviate the symptoms or encourage healing; treatment with a medication to cure or ameliorate the disease; and surgical intervention to repair or remove damaged tissue. On occasions it is possible two or more of these might be employed at the same time but the problem for the owner is understanding what is best for their dog.

Owners rely upon their vet for advice and guidance as what they should do. When the result is good an owner will be pleased but when things do not work out as expected they might feel they should have taken a greater part in choosing how their dog was treated or may feel they did not do their best for their companion.

There are some relatively simple questions to be asked at the time of diagnosis to ensure you have understood the veterinary advice you have been given and have understood the relative merits and problems associated with the options available for the treatment of a dog’s illness or injury. The first is – what is the consequence to the dog of the problem it is suffering? For example if there is a cough and it is suspected of being due to kennel cough infection, then the consequence for a fit adult dog is minimal in the vast majority of cases. Therefore relative inactivity is reasonable perhaps with some mild relief for the cough and discomfort to assist your dog’s suffering and isolation as far as possible from other dogs. Over a few days the infection will be dealt with by your dog’s immune system and the cough will resolve as tissue repair follows.

If however the cough is due to a lungworm infection it is clear that treatment with a suitable medication to remove the lungworm will be the minimum that is required. However this should result in death of the worms and will be followed by healing of the damaged tissue and the cough will stop. However, now consider the cough caused by a tumour or more malignant cancer where radiation therapy, chemotherapy and even surgery could be the best choice or a combination of all three. In this case the next question needs to be asked – what are the likely expectations of each treatment option?

It is surprising how many owners assume a cure means there will be no residual damage which is frequently found to be an unreasonable expectation. There may be a range of permanent effects dependent upon the illness, injury or the severity of either. So, a serious leptospirosis infection will damage the liver or kidneys. The liver is quite good at recovery and regeneration but the kidney is not and so if treatment is effective, although liver damage may return close enough to normal function not to be a problem in the future, a badly damaged kidney may compromise renal function for the remainder of a dog’s life.

Rupture of the cruciate ligament is another example, a surgical repair may well stabilise the stifle joint but joint function may not be sufficient to ensure your dog can walk without lameness or at least a gait change. This is true of nearly all surgery where removal or repair of damaged tissue may speed up or encourage healing of the surrounding tissue but the potential for scarring and effects on future health and function may be unpredictable. So a dog may be much improved following surgery to repair a fractured bone but it may not be without consequence for its future ability to move soundly.

So question three is for those times when there are a number of treatment options – what are the relative benefits for each option and how much better is one treatment compared to another? Take the broken leg situation. There are times when an external cast might be as beneficial as surgery to place metal support structures across the fracture site. The surgeon may not always agree but the owner may not appreciate any difference. For more complex fractures that might involve a joint, for example, surgery may have clear benefits over any other action and provide a better chance of success in terms of sound movement.

The last question you may wish to ask is – how much will the treatment cost? This should be the last question as you will want to know the various chances for success for the options you will be offered before allowing cost to influence your choice. If the cost of the best treatment is prohibitive then you will by now be able to understand the impact of any compromise you reach.

Anyone who has been through this process will realise that it is not quite as easy as this article might suggest. Vets may have perfectly reasonable personal preferences for treating common conditions but by asking these questions the owner is in charge of the decision not the vet. Remember if you and your vet are left undecided on how best to approach treatment of a specific illness or injury then there is always the option to ask for referral to a specialist. This can be expensive but very often the expense of getting a treatment right first time is well worth it.

So to close this topic for today, consider the case for controlling the cycle of heats in a bitch. Just short of total inactivity is the option to keep your bitch away from entire males for the duration of her seasons, which for most female dogs come around twice per year. This is effective in preventing unwanted pregnancy but there will be the risk of error and pyometra along with a higher prevalence of mammary tumours. The surgical option removes the womb and ovaries (spaying) which will obviate the need to deal with the seasons as they will no longer occur. Although there is claimed to be a reduced risk of some mammary tumours there is an increased prevalence of incontinence in spayed bitches and in some breeds of dogs increased risks of developing bone cancer.

The intermediate route would be medication to either manipulate the heat cycle or stop unwanted pregnancy (should an accidental mating occur). They are both associated with side-effects associated with the medications or their physiological effects on the bitch. So there you have it, there are no clear options and across a spectrum of dog owners the choice will be influenced by a number of differing factors. However this common example, where the choice is so often channelled towards the surgical option, demonstrates some of the complexity in choosing what is best for you and your dog.

Contact me with comment, argument and ideas for articles by writing care of Dog World or by email to stevedean@tyrianborder.com.
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Shisa wrote:Here is South Africa insurance is very expensive - it's about R180.00 per dog at the discounted rate - and you still have to pay the whole amount. They then work out if or what % you will be refunded.
With Pugsley I would not have received a cent as he has a genetic issue.

Caryll wrote:I do agree Lynda, but it beggars belief that one practice can do something for one price (and still make a profit) and yet another charges twice the amount for an identical procedure!