Wednesday, December 18, 2013

Jack, Orbax and an excessively dismissive vet..



So I went to pick up Jack last night. $1500 He apparently got two whole liters of fluids which seems like a lot to me. They also gave him some antispasmodic pills to take home and some Orbax. (antibiotic) and annoyingly they did not wipe him down and sent him home COVERED in blood.. His belly (seen below) his tail, his legs, his front leg and his chest and mane.. I was NOT pleased..



This is the first time he has been given these meds, and I know it is a very new drug and know nothing about it so I read over the packaging to see a) if it needed to be refrigerated and b) to learn about it.

I called the clinic and asked the receptionist if it needed to be refrigerated. She said no. I said the packaging said it was for abscesses and skin issues, and so why was it prescribed for Jack? and that she could not answer so she transferred me to the vet on duty (who has been 'doing this for 30 years' - can you tell this conversation didn't go well?)

I started out by telling him that Jack came home covered in blood.. which he half apologized for and said that shouldn't have happened.. and then I started asking him about Orbax.

As I said, I know nothing about it. I wanted to know what he knew about it.

He said they prescribe it because they have better luck with it. I asked what this better luck means. I asked if he knew of any information I could read about it and he referred me to the web and told me to go to the manufacturer website. I asked him why he prescribed this over clavamox, and he said it was more broad spectrum and clavamox was "basically useless" these days, "or so some say" meaning he immediately started back peddling right after the words were out of his mouth. I tried to explain that I strongly preferred to give medications that had been around a while due to the known side effects and the Orbax insert says it can have adverse reactions with the retina. This means this drug can cause blindness. Clavamox does not cause blindness. Clavamox might cause diarrhea or an 'allergic reaction'.. and Jack is not allergic. I talked to him about risk vs benefit, and he believes the benefit of Orbax are worth it, and every drug comes with side effects but he could not point me to anyone, but the company making money off it, as to why.

And they are using it off label. It is not approved for this.

Veterinarians routinely use drugs “off label.” When a company wants Food and Drug Administration (FDA) approval for a new medication, it has to prove that the product is both safe and efficacious. The approval process is long, complicated, and expensive. To simplify matters the company typically picks the most prevalent (lucrative) condition that the drug could be used to treat and runs with it.

Once the medication is on the market, veterinarians start thinking outside the box. With knowledge of the drug’s mechanism of action, the physiology of veterinary patients, and how related compounds are used, doctors will try it for other conditions. source (but it has pop ups)

So instead of testing something to make sure it works for what they are using it for, they test just one thing (in this case skin issues/abscesses) and let the vets make your pet their guinea pig while they try it out and see if it works. I told him I do not trust the manufactures, due to what is going on with Metacam and Covenia to which he interrupted me and basically said wait what? and he 'hadn't heard of side effects with Covenia' I said that it kills cats by killing all of the bacteria in the gut and since it has such a long half life that fighting it is near impossible, to which he immediately got defensive and said you can't believe what you read on the internet.

That got me. That set me right off. There are many vets.. VETS.. who believe Convenia is dangerous. There are pet owners who have watched their pets die from it, or nearly die from it that I know of. If he hasn't heard of any negative side effects with the drug than he isn't paying attention.. and I told him as such. I harped on it, and he admitted that he had heard of it but it was all 'anecdotal' - like his anecdotal evidence that clavamox was useless (which I did not say) not to mention that the chance of dying from clavamox is well.. no one is making websites to warn people about that risk..

You do NOT get dismissive of "the internet" with me and get to get away with it. Yes, there is a lot of information out there that is junk and if not insane, but to dismiss ANYTHING read off the internet simply because it came off the internet - especially in this day and age.

So I continued to explain why. I gave examples after examples until I actually heard his eyes roll, and then looped back around to the Orbax and said look, I'm sure you are feeling attacked right now, and that was not my intention. I want to know why YOU think this is better.. and he said he has been using it for a few years and it was broad spectrum and it works 'better' but could not really give me a reason why it was 'better' - which sounded so much like a sales person pitch that it took everything for me to not bang the phone against the wall. But really what it came down to was compliance. He wanted to make sure the cat was getting the medicine (because that is SUPER important. If you are EVER prescribed antibiotics, you have to give ALL of them) and a once a day med that apparently tastes OK has better compliance. I nearly hit my head against the wall, and said I can pill a cat and I was NEVER ASKED if I might have an issue pilling a cat. Seriously it takes half a second to ASK THE CLIENT if they have any issue pilling a cat... Guess vets are sick of having that conversation - or maybe the sales people who pitch these 'convenient' drugs tell the vet that they can avoid having that conversation (and sell a MUCH more expensive drug and thus make bigger profit) all together..

then..



wait for it..



he tells me to stop feeding raw food..




(moment of silence while you picture me banging the phone upside his virtual head)




and yes. I went off on him. I told him EXACTLY why C/D 'works' and how filling a food full of plant based ingredients that cause the urine to become alkaline and then sticking a low quality acidifier (DL-Methionine) in to balance it out was pretty much equivalent to giving a diabetic human a cookie and then giving insulin, and how I was NOT going to do that..

I have so much evidence and research and scores of vets on my side on this - including my own holistic vet that is also recommending raw and staying away from plant based ingredients for an obligate carnivore.. (and I'm not linking them here.. I'm tired and I want to get this post scheduled, but if you are new to this blog and haven't seen me linking them before, start off at catinfo.org and feline-nutrition.org )

So this vet who has been "doing this for 30 years" (which means practicing medicine, not researching urinary issues in cats - which I have been doing for 5-8 years) ... well lets just say I didn't hang up on him but darn I was close..

I doubt I made any impact on him, but wouldn't it be nice if I did.. if maybe he read the ingredient label of the food he was shelling out.. or looked for the research on this med on his own so he can share that with that 1% of people who might ask..

*

Update: Yes, I did decide to give the meds mostly because I knew they would not be refunding me for it if I refused it. I did reading on it from several trusted sources and the consensus seems to be at this point it is safe enough.. on par with Baytril if I needed to get a comparison for you (which also has the warning about retina). I got the meds out and wasn't I ticked off even more since I have to give the other pill TWICE a day, so telling me that I only need to give the antibiotic once a day argument goes right out the window. I have to pill already, I have to do it twice a day already.. so (insert frustrated reaction here) Seriously, what is the rational logic on this one?

When I did give him the pill I noticed that he has a fat lip. I AM PISSED! (oh and it gets better) and so I gingerly gave the pill and then I gave the antibiotic and he immediately started foaming at the mouth and running from me!! Yup, I am beyond frustrated and angry and plain ol mad. This med is supposed to mask the antibiotic taste and make compliance easy.. *headdesk*

Any wonder why I am having a hard time finding a vet..

19 comments:

  1. I totally get this post. I have been going to the same vet for the last 13 years because the senior vet understands that I will do my research on the Internet and ask him questions. Sadly he is rarely at the clinic now and the new vets are intimidated by me, apparently. I am now shopping around for a vet who is knowledgeable, willing to discuss issues with me and most certainly not intimidated by a client who doesn't accept everything they tell me without question.

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  2. I totally get this post, too. One of the local vets got offended when I told him that I want him to get the cat out of the carrier before sticking a needle in her and after that he refused to treat her! He sent me out of his office! We should not be afraid to stick for our kitties and educate those who should know more than we do.

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  3. Oh, I get this. My vet literally eppeared out of nowhere and bought the practice I had been going to, and we had a talk early on about my internet sources (he isn't a fan, but admits I usually know the latest before he does). When I lost my access to PubMed and the veterinary journals, he actually suggested I could probably sneak into the library of the nearest veterinary school, where he studied, so we have an understanding, of a sort. Some vets, like some human doctors, are too likely to listen to the pharma sales reps and adopt things that they think are "easier" -- either easier for client compliance, or easier for themselves. If a vet can't stand being questioned, well, if you can't stand the heat, get out of the kitchen. A subset of pet owners are becoming more and more educated,and they won't take the same old answers any more.

    About Jack's fat lip... that's the one thing we imagine could be self-inflicted, if he was trying to escape a cage. Newton has beaten himself up pretty badly on his own carrier door a few times.

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  4. I am sorry you are going through this hassle. I have learned that we need to be our cats' health advocate because they obviously can't speak for themselves. ITA with the comments above--and am glad you stood up for yourself (and Jack) and asked questions. (This post is also scaring me a little, since my vet is soon leaving the practice. . .)

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  5. I think I know the vet you're referring to. I took Bella to that particular emergency clinic when she started the day with projectile vomiting and then started having trouble breathing -- I was afraid she'd aspirated some of the vomit. The first thing he did when he got into the exam room was give her an emetic, and she promptly puked the rest of her breakfast on the floor. He then gave her a quick examination, took her in the back and gave her an anti-anxiety medicine because apparently the vomiting had created a panic reaction, said she was OK and to engage in "watchful waiting."

    I'm glad to say that my other experiences with the vets in that clinic (during Dahlia's brief illness last year) were much more productive, the vets actually listened, and they did a great job saving Dahlia's life when I first brought her in. I had to take her to that clinic to have her released from her suffering because it happened WAY after hours, and the vet who did the procedure was very compassionate and kind.

    But yeah, it always sucks to get a vet who seems to brush off your concerns and doesn't really explain why a certain drug is given or listen to you.

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  6. SO frustrating. I have been going to the same vet for the past 15 years and I have him perfectly trained. He is always prepared for my questions and knows never to prescribe something without letting me know all of the options. I think it helps that he's very open-minded and loves our conversations. I wish they were all like my vet but unfortunately I know that isn't true. Purrs that Jack feels better soon!

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  7. apparently after 30 years this guy needs to retire. ugh..... from beginning to end this was a disaster - to Jack getting sick while you were gone to a conversation with a stupid person. makes me feel very lucky that my regular vet and our rescue vet are so wonderful. though having dealt with er vets before, I get the frustration...

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  8. Poor Jack...and poor you too having to deal with this. I hope Jack gets over his illness soon and the vet does the honorable thing and retires!

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  9. That is SO frustrating! My human says that human doctors aren't really much better, and she never goes to them. We still have not found a vet she is happy with for me and my roommates. I'm sorry you and Jack had such a bad experience with this one, especially since you were out of town for part of this ordeal.

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  10. So glad that Jack is back home with you but that is awful that they sent him home like that for sure. I know...it's so hard sometimes with Vet care, deciding what the right course of action/medication is, finding a Vet that is caring and understanding when you are emotional or have concerns...

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  11. My vet just started my Nathan kitty on Orbax. He has already had his teeth extracted due to severe stomatitis but it never cleared up. We've tried several other antibiotics and cortisone shots have helped in the past but not as much lately so we are trying the Orbax now. So far I can tell he is getting more relief and was actually playing yesterday which I haven't seen him do in a long time so I know he feels better too.

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  12. My vet just started my Nathan kitty on Orbax. He has already had his teeth extracted due to severe stomatitis but it never cleared up. We've tried several other antibiotics and cortisone shots have helped in the past but not as much lately so we are trying the Orbax now. So far I can tell he is getting more relief and was actually playing yesterday which I haven't seen him do in a long time so I know he feels better too.

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  13. Well, I would ditch that vet too! My vet of 15 years is retiring, and I'm going to try going to the other doctor in the practice that I like the best. All of my cats have their own personal complications so I hate to move them at this point, but I guess my next batch could try another vet if this doesn't work out.

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  14. I get all this too, even without your years and level of research and experience. I've learned to do my own research first as well, and dig my heels in and stick to my guns.

    But there's not one vet I'd trust implicitly.

    I've not been to my new clinic long enough to say how things will go, but when I switched, I wrote up a list of demands (essentially that's what it was, though couched in better terms): things like no Convenia ever, no Metacam, how I wanted end-of-life dealt with, diet and homeopathic options for chronic issues FIRST, before pharmaceuticals, etc. The vet they gave me is fresh out of college, graduated in April 2013. I'm not sure if that's a good or bad thing. LOL. I must say, though, that she DOES consult with the other more experienced vets there.

    Anyway, here's hoping that Jack heals quickly, that you can find a vet who will be open to your preferences, etc. Lots of hugs and Light to you both.

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  15. Purring Jack gets better fast! And good for you for telling that jerky vet off!

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  16. Oh dear. I haven't heard of this med, but I am so sorry you [and Jack] are going through all this!!

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  17. I'm just glad I have got a good vet,xx

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  18. Hope Jack gets well soon!xx Rachel

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  19. Poor you ! We hope Jack gets well soon, and that you find a better V-E-T ! Purrs

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