Have you ever struggled to follow the advice provided by your veterinarian?
If so, you're not alone.
Earlier this year, I diagnosed Ninja, a 14-year-old cat, with an overactive thyroid.
This caused Ninja to experience profound weight loss, a ravenous appetite, frequent vomiting and a rapid heart rate.
Fortunately, there are multiple treatments available to manage the condition.
Ninja's owner considered all options, and decided that the best option for her and Ninja was daily oral medication.
I demonstrated how to administer the tablet to Ninja as he sat on my consulting table.
He swallowed the pill and walked himself back into his cat carrier.
But at his recheck appointment six weeks later, Ninja's health had declined. He had lost even more weight, was eating everything in sight and vomiting profusely.
Then came the bombshell: during the weeks since their last visit, Ninja's owner had not given Ninja a single tablet. In fact, she had never given a cat a tablet in her life.
And Ninja wasn't going to let her start with him.
For all his charm in the vet hospital, Ninja was a bit of a real-life ninja at home, physically resisting his owner's attempts to restrain him in order to give him the tablets.
Ninja's owner adored him, and didn't want to cause her cat unnecessary distress.
She also revealed that she hadn't wanted to admit her reservations about giving Ninja pills, especially when he had been so compliant in the consulting room.
When we reviewed published scenarios depicting ethical challenges faced by veterinary teams, one of the most common was situations where clients didn't adhere to instructions or follow recommendations.
These situations can prolong or even worsen illness and associated animal suffering.
Both clients and veterinary team members can become frustrated with disappointing outcomes.
However, if we know about potential challenges and barriers (like Ninja's habit of struggling, spitting out tablets or simply just running away at medication time), we can find workarounds.
For animals that are tricky to medicate at home, there may be alternative treatments. For example, cats with an overactive thyroid can be treated with radioactive iodine. This safe and effective treatment is initially more costly, but is associated with better long-term outcomes for cats with thyroid disease and may eliminate the need for tablets.
Alternatively, we can prescribe a transdermal cream which is applied to the skin on the inside of Ninja's ears twice daily.
For animals that are difficult to tablet, there may be long-acting injections, oral liquids or even the possibility of compounding the medication into a flavoured suspension.
If we know what the challenges are, we can usually find a creative solution.
For example, there are some difficult-to-medicate animals that require daily medication in the short term, or animals that require strict post-operative confinement.
Short-term boarding in a veterinary facility for the duration of treatment can help ensure they are treated while taking the pressure off their owners.
If you can anticipate barriers to following advice - whether you don't agree with it, or - like Ninja's owner - you don't think your pet will tolerate it - tell your veterinary team.
We may be able to provide further information, additional options, or an alternative plan that suits you and your animal better. The plan has to work for everyone.
Since starting the transdermal medication, Ninja has gained weight and stopped vomiting. His condition is well managed for now. All without taking tablets.
Quain A, Ward MP, Mullan S. What Would You Do? Types of Ethical Challenging Situations Depicted in Vignettes Published in the Veterinary Literature from 1990 to 2020. Veterinary Sciences 2022;9:2. doi.org/10.3390/vetsci9010002
Dr Anne Quain BVSc (Hons), MANZCVS (Animal Welfare), Dip ECAWBM (AWSEL) is a lecturer at the Sydney School of Veterinary Science and a practising veterinarian.
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