A:  I became a veterinarian to help animals and the people who love them.  I have learned that the best way for me to do that is to detect problems early and intervene before suffering begins.  My favorite appointments are the ones that allow me the opportunity to do that.  My least favorite are the ones where the owner has not given me the chance.  I will share two real life examples to help illustrate my point. Only the names have been changed.

Hudson is a five year old Labrador Retriever.  Just six months ago he visited my office, had his annual examination, and updated all his vaccinations.  There were no health problems noted at the time.  Hudson’s owners believe in preventive care, so they made an appointment for a six-month wellness check-up even though no problems were noted at home and no vaccines were due.  Using my ophthalmoscope during Hudson’s examination (as I always do), I detected small cataracts beginning to form on the back of his lenses.  That might not seem like a big deal, but cataracts can lead to glaucoma.  Glaucoma causes pain and leads to permanent blindness.

Right now nothing has changed for Hudson, but I will measure the cataracts six months from now so I can determine how quickly they are progressing.  Once they get larger, I will start monitoring intraocular pressure to be sure he is not developing glaucoma.  If his pressures ever start to rise, we will have the cataracts removed before Hudson ever experiences pain or blindness.

Compare that to what would happen with only annual visits.  Hudson’s cataracts would still be undiagnosed.  I would see them for the first time six months from now.  At the following yearly visit, I could finally start to gauge progression – a full year after I will have that opportunity with six month exams.  With all the lost time, the “annual visit” pet will have a significantly increased risk of painful glaucoma and permanent blindness.  In fact, many patients like this are seen when it’s too late to help them other than by removing one or both eyes.  While I can help the pets in both circumstances, I much prefer to prevent suffering from ever happening.  I bet if you were the dog, you would prefer Hudson’s owner’s approach, too.

Another owner brought me a cat that illustrates my least favorite type of appointment.  We’ll call this poor kitty “Fluffy.”  She was twelve years old and had not seen the doctor since she was a kitten.  Her owners had been noticing weight loss for over a year and blindness that began about six months ago.  Recently Fluffy had stopped eating and started vomiting on a regular basis.  Her owners “just knew she must have cancer,”  after all she was “just old.”  When I finally had the opportunity to examine Fluffy, she was skin and bones, had teeth literally rotting out of her mouth, a heart murmur, and detached retinas.

A twelve year old cat that has been cared for properly is really not that old – roughly equivalent to a person in her early sixties.  I know that this cat most likely developed a fully treatable condition called hyperthyroidism several years ago.  Since it wasn’t detected, it progressed causing heart and kidney damage.  The chronic tooth infections likely damaged the kidneys even more.  With hyperthyroidism and kidney disease, Fluffy developed high blood pressure that blew her retinas right off the backs of her eyes – causing instant blindness.  Now her problem had become overwhelming for both the owners and the cat. There had been much unnecessary suffering and Fluffy’s owners were ready to say goodbye.

I am glad that I was able to end Fluffy’s pain, but I really wish I had been given the opportunity to help her sooner.  If her owners had been more like Hudson’s, I would have detected the thyroid hormone imbalance before it ever caused symptoms.  With an early diagnosis, the thyroid disease could have been cured completely and painlessly.  I also would have known about Fluffy’s dental disease before her teeth became abscessed and her kidneys had become damaged.  Without kidney failure or hyperthyroidism, Fluffy would never have lost her vision or developed a heart murmur.  She could have lived a longer, happier life with fairly minimal intervention.  Unfortunately, I never had the chance.