Clevengers Corner Veterinary Care

Q: I haven’t brought my dog to my vet in about two years. Now she has stopped selling me heartworm preventive. The staff tells me I not only need a heartworm test, but the doctor insists on examining the dog. Is this really necessary?Heartworm prevention products are all prescription drugs because they have the potential to cause harm. Dispensing a prescription medication without a valid veterinary-client-patient relationship is a violation of both medical ethics and federal law. According to the American Veterinary Medical Association, a veterinary-client-patient relationship exists when “the veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of an examination of the animal(s), or by medically appropriate and timely visits to the premises where the animal(s) are kept.” If your dog has not had a check-up in more than a year, he has not been “recently seen… by virtue of an examination.” Your veterinarian would be violating her ethical and legal obligations were she to prescribe anything for your dog, including heartworm pills. Q: I am a nurse and have diabetes myself. I have a diabetic cat that I keep regulated using a home glucose monitor. I have helped several friends do the same. Why didn’t you mention monitoring glucose at home in your diabetes column? A: The main reason is that I have very few feline patients that need insulin. The message I hoped to get across was that with early detection and proper nutrition, insulin can frequently be avoided in cats. However, there are some cats that will require insulin. Many of these are caught late because owners waited until symptoms were noticeable at home to run blood tests on their cat. Others are obese and the necessary weight loss would take too long. Others are just cats who haven’t read this column and just insist on requiring insulin injections. In feline patients managed without insulin, I typically rely on in-clinic tests, sometimes combined with home urine glucose testing, to monitor their control. Purina makes glucose-detecting flakes that can be added to cat litter. They will change color when urine sugar is too high. Sometimes I even use these flakes to “rough tune” an insulin-dependent diabetic at home before running more expensive in-clinic tests to “fine tune” their control. If a patient is difficult to keep controlled and/or they require insulin, then home monitoring does become an option. There are several obstacles to widely recommending this technique. First, the owner has to be willing to prick their cat with a needle several times daily on a routine basis. In my experience, this eliminates most cat owners. Second, the cat has to be cooperative. Again, many are not. Third, proper equipment must be used. There is copious data showing human glucometers are inaccurate in cats. It is possible to use human glucometer readings to help regulate a cat. However, what is happening in the cat’s body may not be exactly as controlled as the monitor suggests. For owners (with cooperative cats) wishing to use home monitoring, a monitor calibrated to cats would be the best choice. The monitor I recommend uses the same strips for dogs and cats, but a different code must be entered into the machine depending on which species you are testing. I have two cats currently under my care that receive insulin injections. That’s right, only two. Of these two, one owner is using home monitoring. She is able to perform the tests regularly and accurately. She records the results in chart form and submits them to my office. I review the results and make recommendations by phone. It has worked well for everyone involved. To conclude, it is important for me to note that home monitoring does not eliminate the need for periodic visits to the veterinarian. The frequency can usually be reduced and expensive glucose curves can typically be eliminated. However, additional testing beyond home glucose readings is required to appropriately monitor any diabetic patient.

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