Wednesday, March 6, 2013

Pet Prescriptions - You Have Options

 Veterinary clinic clients always have the option of having a prescription filled at an internet pharmacy or even at a human pharmacy like CVS or Walgreens.  In most states Veterinarians are required by law to provide you with a written prescription if you ask for one.  In some cases you may be able to save significant money by filling your prescriptions outside your Veterinarian's office, but there are some things you should be aware of when attempting to do so.

Human Pharmacies

All human pharmacies like Walgreens, Target and Walmart will accept prescriptions written by Veterinarians, however not all pharmacy techs may be aware of this.  We have had clients become very frustrated with human pharmacies because their staff is not aware that they can fill a script for dog or cat.

Also you should be aware that not all drugs used in veterinary medicine are available through human pharmacies.  Many drugs are specifically labeled for use in certain animals only.  In these cases, you may not be able to get these drugs through a human pharmacy.

Human Pharmacists are trained in human usage of the drugs they sell.  Dosages and uses of medications vary widely between humans and other animals and if your pharmacist is not trained in veterinary uses, they cannot answer questions about the medication or side effects.

Occasionally our clients are shocked at the prices they pay through human pharmacies.  Human medication is expensive.  Those of us with health insurance rarely see the retail prices for the medications we take, but when you go to buy medication for your pet, you will certainly see the retail price.  One client recently took a script for medication for his cat to a human pharmacy where he found it was going to cost $365 per month for the medication.  When he called us seeking alternatives, I calculated the priced for the same medication through us - it would be $35 per month.

Internet Pharmacies


Using an Internet pharmacy may be a little easier than using a human pharmacy.  Online pet pharmacies are targeting veterinary patients and are more likely to stock the medication your pet needs.  However, online pharmacies also present some unique issues of their own.

Often, internet pharmacies are unable to dispense less than full bottle prescriptions—for example, if the doctor prescribes 14 tablets, the online pharmacies will want to sell you a whole bottle of 100 tablets.  Please note, it is illegal for doctors to alter a prescription, unless there is a medical need for your pet to have more medication than was originally prescribed.

Pharmaceutical manufacturers will only honor product guarantees when the medications are prescribed by and purchased from the pet’s Veterinarian.  Internet and mail order catalogs do not qualify for those guarantees.  If your pet has an adverse reaction to a medication you purchased from an online pharmacy, you are on your own to seek care for your pet.  When the medication is purchased through your veterinarian, the manufacturer will often help with the care of your pet.

Any prescription medication purchased from your Veterinarian has been inspected and approved by the FDA, and manufactured and packaged according to U.S. government regulations.  Medications purchased online may have originated outside the United States.  If approved by the FDA, it should be labeled “Caution: Federal law restricts this drug to be used by or on the order of a veterinarian”.  Dot not use products that do not have this warning or have had the label altered or removed.  Medications filled in your Vet's pharmacy are always handled and stored properly and expired medication is never dispensed.

Final Words Of Advice

  • Never assume that your Vet's office will be more expensive than human or online alternatives.  When asking for a prescription always ask for the cost of the medication from your vet's office.  
  • Remember to consider shipping costs when comparing online prices..
  • Ask your Vet's office if they have their own online pharmacy or mailing service.  It is becoming more common for clinics to offer these services.
  • Be aware that online pharmacies may attempt to sell you more than you need or offer you a different product based on their stock availability.
  • If you use a human pharmacy, call before you arrive to find out if they carry the medication you are looking for.
Never be embarrassed to ask for a written prescription, it is your right.  But be sure to do you homework to make sure that you are getting the deal you think you are getting.  Remember, pet prescriptions are a big business and there are a lot of companies that want your prescription dollars.

Thursday, February 21, 2013

New Puppy Vaccinations

Sam & Isabel
Oh Happy Day!  You got a new a puppy. Now what?

The number one thing I hear from new puppy owners is that their puppy already has all its shots.  The first thing you need to understand is that a puppy will get a series of vaccinations starting around 8 weeks of age and ending no earlier than 16 weeks of age.  So if your puppy is only 8 weeks old, he has definitely not had all his shots.

If you got your puppy from a reputable source, they will provide you with written vaccination records.  If the person you got your puppy from does not have written records, you should probably assume that you puppy is not vaccinated.

It is very important that your puppy receive all of his vaccinations.  After the initial vaccination, he will come back every 3 weeks for a booster shot until his vaccine series is completed.  Most dogs will complete their series by 16 weeks of age, but some, especially small breeds, may require vaccinations past 16 weeks.  Your puppy will get his rabies vaccination at 16 weeks or when he has developed adult teeth.

Core Vaccines: These are vaccines that every dog should have.
  1. DA2PP – vaccinates for Canine Distemper-Adenovirus Type 2-Parainfluenza-Parvovirus Vaccine.  Given every 3 weeks starting at 8 weeks of age and continuing through at least 16 weeks of age.
  2. Rabies – Vaccinates for canine rabies virus.  Given no earlier than 16 weeks.  This vaccine is required for public safety and licensing.

Non-Core Vaccines: These are vaccines that are only recommended for certain dogs.
  1. Bordetella (Kennel Cough) – vaccinates for Bordetella Bronchiseptica.  Recommended for dogs that come into contact with other dogs on a regular basis.  Dogs that visit the groomer or are boarded in kennel facilities are often required to have a current bordetella vaccination.  This vaccine is boostered yearly thereafter.
  2. Canine Influenza – vaccinates for the new Canine Influenza virus.  Recommended for dogs that come into contact with other dogs on a regular basis.   Initial vaccination requires the initial injection and on booster three weeks later.  This vaccine is boostered yearly thereafter.
 Be sure to protect your puppy by getting all of his shots, and please keep your puppy indoors and away from other puppies until he has been fully vaccinated.

Monday, February 11, 2013

Pet Insurance De-Mystified?

Pet Insurance Can Be Confusing
Here is what the insurance companies show you, the consumer, in their commercials.

It's 2 AM and your dachshund, Penelope can't breathe and is whining in pain, you scoop her up and run to the nearest Emergency Vet who tells you that Penelope needs an emergency surgery, it will cost $4000.00 and he can't start until you have paid.  It'll be ok, you purchased pet insurance for Penelope when she was a happy little puppy, 12 years ago.  Everyone smiles - cut to Penelope, good as new, chasing the family cat.

Here is what the insurance companies show veterinary hospital staff when they are trying to convince us to sell their insurance to our clients.

Your client comes in with a sick animal.  It is something that you can fix, but the client probably can't afford the treatment. You give her your estimate and she says "No Problem, I've got insurance!"  Everyone smiles, even the pet. No paperwork for the staff and the pet gets the treatment.  Hooray!

Marketing makes the world go round.  I have no problem with the basic messages delivered.  The problems come, as you might have expected, in the details.  Most people understand how their own health and dental insurance works - you pay a monthly premium and maybe a co-pay when you actually visit the doctor.  The actual mechanics of the doctor getting paid is "under the hood" so to speak.  Your doctor or dentist employs people to file your insurance claims and follow up with them until payment is received, you just pay your co-pay.  This is why you usually can't go just anywhere for your care - you have to go to a doctor in your plan's network.  You have to seek out a doctor who accepts your particular insurance.

Pet insurance is altogether different.  The main difference is in the filing of the claim and the billing process.  With pet insurance you don't have to worry about which doctor you use because the doctor's office does not file the claim, you do.  Super huh?  Well here's the catch.  You have to pay the doctor just like normal, file the claim yourself, and then wait to be reimbursed by your insurance company.   Still, that is not so bad, unless you don't have the cash or credit available to cover the expense while you wait for the insurance company to reimburse you.

It may seem like I am trying to dissuade you from buying pet insurance, but I actually feel that it is a good thing to have if you can afford it and you fully understand exactly what it is you are getting coverage for.  Unfortunately, pet insurance is very much like all insurance.  They are for-profit companies and their goal is to pay out as little as possible.  Keeping this fact in mind, you must be sure to ask a lot of questions before committing to a policy.  Some of the gotchas I have seen in our practice are outlined below.

Pet Insurance Gotchas

1. Breed specific exclusions.

  Many companies will exclude specific ailments from specific breeds.  For example, in our first scenario about the dachshund, it would not be unusual for a company to exclude back problems for dachshunds because it is genetic for the breed.  You should always ask to see the exclusions for your pet.  We have had cases where the owner paid for treatments that were later determined to be related to breed-specific exclusions and subsequently denied payment.

2. Reimbursement Time

Be sure to find out how long they take to process your claim and issue a check.  Some companies are very good about this and take less than a week, while others will take weeks to months to pay you back.

3. Incident/Yearly/Lifetime Limitations

Many policies will limit the amount of money they will pay on any single claim, or per year or even per lifetime.  A $20,000 lifetime limit may seem like more than enough, but pets are living longer lives now and you may find yourself up against a limit.

4. Deductibles

Just like your car insurance, you can affect your pet's premium by accepting higher deductibles.  The deductible is the amount that you will be responsible for from any bill.  Some deductibles are per claim, others may be per year.  Be sure you understand your deductible choices.  If you have a $1000 deductible and your pet's bill is $1500, the company will figure your payment on $500 ($1500 - $1000).  If your policy paid 80% of your covered loss, you would collect $400.

5. Payment Schedules

Some companies will pay you a set percentage of your costs.  Others use payment tables.  Payment tables are lists of procedures and what the insurance company thinks is a reasonable price.  they base their payments on this table.  An example would be a hospital stay you paid $200 for.  If your policy pays 80% of your loss, then you might expect to get paid $160.  However, if your company uses a payment table that determines the hospital stay to be only $150, you will get paid 80% of the $150, or $120.

6. Accident Vs. Illness

Some companies make a distinction between accidents and illnesses like cancer.  Accidents will generally be covered, but expensive diseases like cancer or diabetes may have separate exclusions and limitations.  


Even with all the potential problems with pet insurance, it is still a good idea for most people.  You just need to make sure you understand what it is you are buying.  Although pet insurance has been around for a long time now, the industry is really getting going now.  I have been bombarded with insurance salesmen looking to get us to recommend their particular products.  It is difficult for us to do that because each client may be better served by a different policy from a different company.  

My best advice is ask a lot of questions.  Ask your friends that have pet insurance and have used it.  Ask the receptionists at your vet office about which ones they have seen used.  Call the companies and ask them specific scenarios - "Would my cat be covered for diabetes?", "Do you have specific exclusions for Yorkies?", etc...  

Hopefully this article will help guide your pet insurance decisions. Let me know if you have any questions about pet insurance and I'll do my best to answer them.

Tuesday, January 29, 2013

6 Questions to Ask Your Veterinarian Before Surgery

Isabel was spayed at our hospital
Isabel was spayed at our hospital
We do hundreds of surgical procedures each year at our hospital.  I have watched our doctors do spays, neuters, C-Sections, dental extractions, foreign body removals, spleenectomies, mass removals, and even orthopedic procedures.  Some procedures take only minutes while others can take hours.  The one thing that I have learned over the years is that there is no such thing as a routine procedure.

When you are talking about anesthetizing your pet for a procedure, you should never take it lightly, and your veterinarian shouldn't either.  

If you have ever called multiple vet offices to compare prices for a spay or some other procedure, you probably heard a pretty wide range of prices.  You have to understand that all spays are not equal, to get a real comparison, you need to ask more questions than "How much for a spay?".

So here are my top 6 questions to ask your veterinarian before scheduling a surgery:

6. What kind of anesthesia do you use?

There are many anesthetic options available to veterinarians, but they fall into two general categories:  Inhalant and Injected.  Inhalant anesthesia like Sevoflurane and Isoflurane are the safest, but more expensive option, while injected anesthetics are less safe, but less expensive.  Hospitals that use inhalant anesthetics have invested in expensive machinery to deliver the agent and can precisely control the amount of agent your pet receives.  On the other hand, hospitals that use injected agents cannot control the amount or effect of the agent once it has been injected.

5. Who does the anesthetic induction?

In California, only a licensed Veterinarian or a licensed Registered Veterinarian Technician is allowed to induce anesthesia.  If the hospital does not have any RVTs then the doctor must do all the inductions.  Induction is the point in your pet's procedure that she is first put under anesthesia.

4. Do you monitor my pet's vital signs?

Does the hospital provide an assistant to monitor your pet's vital signs during the procedure?  If so, which vital signs are monitored and how are they monitored.  Hospitals that monitor your pet during surgery have equipment to monitor blood oxygen levels, CO2 levels, blood pressure.  They have trained personnel to take temperature, pulse and respiration readings at regular intervals.

3. Are the surgical instruments sterilized after each use?

A busy surgical hospital has to maintain a lot of surgical equipment if they are going to use fresh, sterile tools on each patient.  Sterilization of a surgical pack can take more than a hour in an autoclave.  If you take your pet to a spay clinic that does dozens of surgeries in a day for next to nothing prices, this may be one of the corners they cut.

2. Does the hospital have a dedicated surgery room?

In most cases, vet med law requires surgeries to be performed in a dedicated surgery room that meets some minimum standards.  You can read California's minimum standards here.

1. Can I tour your facility?

Seeing is believing.  Ask if you can tour the facility.  A hospital that will give a client a tour is confident that they are providing the best medicine and are happy to show you how your pet will be cared for.  

I hope this helps you the next time you find yourself in need of surgical care for your pets. Never be embarrassed to ask these kind of questions, it is your job to make sure that you are getting the service you think you are getting for your pet.

Thursday, January 24, 2013

Pet Dental Month

Wow, is it really that time of year again? 

Pet Dental Month is not exactly a greeting card holiday, but it does serve to get us in the pet health field to talk about something that we should be talking about everyday of the year - your dog's mouth.  If you have ever been to the vet and they didn't look at your pet's mouth, then your vet is not getting the whole picture of your pet's total health.  So much of your pet's health relies on what is going on in her mouth - bad oral health often leads to systemic health problems like (cue scary music) heart, liver and kidney problems - that your pet's mouth should be on your vet's mind every visit.
So in honor of Pet Dental Month, I have put together a list of my top 5 favorite pet dental health questions and my answers for them.

5) Should I be brushing my dog's/cat's teeth?

         Yup.  You should.  Imagine what your mouth would feel like (and smell like) if you never brushed your teeth.  The tartar build up presses on the gums, causing the gums to recede and become inflamed  As the gums continue to recede, the tooth becomes infected and will ultimately have to be extracted.

4) Can I use regular toothpaste?

         No. No. No.  Never use human toothpaste as it is toxic if swallowed.  There are pet toothpastes available at pet stores and at your vet's office that are specially designed for your pet (and they have yummy pet flavors). 

3) How come dentals are so expensive?

        Sometimes your pet needs a lot of dental work.  If you went your  entire life without brushing, I'd imagine your dental bill would be much higher.  But seriously  pet dentals, when done thoroughly, require a lot of time to complete.  In our hospital we have a room and a technician dedicated to dental work and still can only do 2-3 procedures in a day.

2) Do we have to extract those teeth?

     There are many things that can cause a tooth to need extraction.  Besides that fact that infected and broken teeth are painful, bacteria from the mouth can gain access to the tooth pulp and infect the tooth. Eventually, the tooth will die and become a bacterial haven. The bacteria can then leak out through the  bottom of the tooth, and infect the bone in that area, eventually causing bone destruction around the root tip. Next, the blood vessels in the area will pick up the bacteria and spread it to other areas of the body, causing other health problems.

1) I take my dog to the groomer and they do non-anesthetic cleanings.

        Not technically a question, still I have something to say.  Non-anesthetic cleanings are a short term remedy for bad breath.  They do very little to address the  underlying problems that are causing your pet pain or other symptoms.  If you are concerned about the anesthetic aspect of a dental procedure, you should talk to your vet about the risks for your individual pet. 
(oh yeah, and non-anesthetic dentals are illegal in CA and most other states if not supervised by a licensed veterinarian.)

Happy Pet Dental Month.  Don't forget to brush!