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Help Me Help You


Before I elaborate further on today’s topic, let’s first discuss compliance. By definition compliance from the perspective of medicine means: willingness to follow or adhere to a prescribed treatment course and/or regimen. In the field of veterinary medicine, many factors can affect compliance, such as: the ability of an owner to medicate a fractious or uncooperative pet, financial constraints to pay for medicine or treatment, a disorganized owner that is prone to forget treatments, a dismissive owner that disregards the veterinarian’s recommendations, or a pet’s intolerance (allergy or GI disturbance) to a given medicine, to name a few variables. While a few cases this week reminded me of just how much compliance affects our ability as veterinarians to succeed in improving the health of our patients, whenever I am faced with compliance issues, I am reminded of a seminar I once attended that was put on by Pfizer Pharmaceuticals a few years ago.

They were discussing a new product line that is an antibiotic that only requires one injection, as its anti-bacterial activity lasts in canine and feline tissues for 17 days. The Pfizer rep then marketed this new product line as the only antibiotic that virtually guaranteed 100% compliance, then proceeded to show us a slide of a pretty woman with a big smile on her face, holding her cat, with an arm around her big dog. He asked us, “Which species in this picture presents the biggest challenge to achieving 100% treatment compliance?” As veterinarians, we all know that from a general standpoint, felines tend to be more difficult to medicate than dogs, so most of us said cats. He then clicked his power point presentation and placed a big red circle around the woman. This is not to insinuate that women present our biggest challenge to compliance, it just so happens that the biggest challenge to treatment compliance is the human owner; and the human in the picture happened to be a female.

This part of the presentation really got us chuckling, because we quickly realized that far and above the other challenges to treatment compliance in veterinary medicine, it is the pet owner that brings the pet to us for health care in the first place that is our most common obstacle in attaining compliance. It also proved to us just how powerless we really can be in the health care of our patients, as all we can do is prescribe medication, advise preventive strategies, and make lifestyle recommendations, but as soon as the pet owner and pet step out of our clinics, the patient’s health care is 100% out of our hands, and 100% in the hands of the owner.

A study in 2011 conducted by the large prescription pet food company, Hills, detailed owner compliance statistics by comprehensively surveying pet owners throughout the country. The results were very eye opening:

1.) 17% of dogs do not receive regular heartworm screening.
2.) 52% of dogs are not kept on monthly heartworm preventive medication.
3.) 82% of cats do not have yearly well visits (exam, stool analysis, and vaccines).
4.) 65% of dogs and cats do not have preventive dental cleanings.
5.) 82% of dogs and cats are not fed therapeutic diets to manage disease when recommended.
6.) 67% of dogs and cats do not participate in senior screening/early detection programs.

A separate study conducted by veterinary pharmaceutical, Zoetis, revealed that:

1.) Fewer that 33% of pet owners will give pet medication at the correct time intervals.
2.) Only 30% of pet owners give antibiotics to completion as prescribed by the veterinarian.

In my recent blog post, What Wellness Reveals, I discussed the incredible diversity and amount of preventable and treatable disease detected on routine wellness visits in just one week. I also discussed how failing to provide well care for pets can lead to poor quality of life and decreased longevity for the pet, but potential dangerous, even tragic consequences for its human family members. While participation in wellness visits is very much an owner compliance issue, I will not revisit the importance of compliance with wellness visits today, and recommend you check out that post if you have not yet read it.

For today, I would like to focus on two cases I saw this week that were hallmark examples of owner non-compliance drastically affecting treatment success. While these cases were standouts in my mind, please bear in mind that these are only 2 examples of many non-compliance related issues I faced this week.

The first case was a recently diagnosed diabetic cat that I had prescribed insulin for after the diagnosis was made. I advised as always that, while the initial insulin dose is determined by body weight, we must closely monitor the blood glucose in the early phases of treatment in order to adjust insulin doses as the patient physiologically adjusts to receiving insulin derived from another species. Doses are frequently changed in the first few weeks, making our initial dosing calculation more a general guideline than anything we can rely on long term.

The first blood glucose re-check was supposed to be one week later, but I did not see the cat again until 2 months later when she came in on emergency in the midst of a grand mal seizure brought on by severe hypoglycemia (low blood glucose). Her blood glucose at the time was 25, meaning that she was likely just moments away from insulin coma and possibly death. Thankfully, we were able to treat her in time to stabilize her and she survived the episode. The kitty’s owners are very nice people who love their cats and I really felt for them that day, as they learned a very tough lesson about the importance of compliance.

The other case that stands out from a compliance perspective was a little dog that has battled skin problems for the past 4 years, and for the past 2 years, has virtually lived with a cone on his head as, otherwise, he would chew himself to oblivion. The cause for his severe skin disease is always apparent, as one swipe of a flea comb has always revealed 20-40 fleas in one comb through, and every time I show the flea comb teaming with fleas to the owner, he always acts very surprised. Yesterday’s visit was no different.

While I had to treat the severe skin infection and inflammation that was in front of me, like each of the last 5 occasions that I have seen this dog for the same problem, I told the owner that all the antibiotics and cortisones in the world will not clear this skin problem until he gets serious about controlling fleas. I advised veterinary grade flea control for not only the patient, but for all the other pets in the home (1 other dogs and 5 cats). I also advised that he hire a professional service to have the home and yard treated as well. Will he comply this time? For the sake of the pets, I certainly hope so, but I am unfortunately not optimistic.

From the vantage point of the examination room where veterinarians see s pet perhaps once or twice a year, we can only do so much. We can prescribe treatment, advise husbandry and life style changes, and promote wellness, but in the end, it must be the pet owner that complies with our recommendations and implements them. Since it is you the pet owner that ultimately most important factor in treatment compliance, I leave you with a quote from 90s iconic move character, Jerry Maquire (Tom Cruise) as he pleads with his client (Cuba Gooding Jr.) to work with him: “Help me, help you.”

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL and founder/CEO of Web-DVM.net.

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