Angie (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse, Extraordinaire Jojo. And today we want to talk about your veterinarian and if they are offering tests that your pet doesn't need. Or maybe they're offering treatments your pet doesn't need. I think a lot of people worry about that.

JoJo (00:23)
And how do you know?

How do you know what's necessary? Where do you want to start?

Angie (00:29)
Well, I guess I wanna give my opinion. Cause this is

JoJo (00:32)
Okay.

Angie (00:33)
a yeah, I wanna give my opinion. I don't wanna gaslight people and tell them this isn't happening. Sometimes it is happening. And there are some I I'm not gonna name any names, but there are some clinics that sell packages that provide maybe vaccines and tests.

That are unnecessary and inappropriate for your pet. But it's just like this is the package, and you get everything in the package. And I think that that is unnecessary. And so I think there are times where practices are doing that. I've

JoJo (01:09)
Uh-huh.

Angie (01:10)
never worked for a practice or seen a private practice do that. And so I think there are

JoJo (01:15)
Offer unnecessary

tests or packages.

Angie (01:18)
I'm offer unnecessary tests. Now there are some instances where I think most veterinarians are making recommendations that are a little extreme, but I I for the most part don't think veterinarians are recommending unnecessary treatments.

JoJo (01:38)
Okay, I have a little challenge.

Angie (01:38)
Mm. Okay.

JoJo (01:41)
So I think what I'm seeing a little bit more, and I don't know if it's younger generation or 'cause we live in a more litigious, that's the right word, right? Society.

Angie (01:50)
Yeah. Mm-hmm.

JoJo (01:53)
Could it be a CYA situation where more tests are offered than are necessary to make sure that we don't miss anything so that we don't get sued later.

Angie (02:03)
Hmm. I mean, I think that's possible.

JoJo (02:06)
Yeah.

Angie (02:06)
I think that's possible.

I noticed that some instances in veterinary emergency where the diagnostics are excessive. And I have complained about that at great lengths on this podcast.

JoJo (02:21)
Huh.

Angie (02:21)
I can't remember which episodes, but I've already shared my opinion. So I think that's one time that the diagnostics have been a little excessive and

When you're in an emergency situation, sometimes it's hard. And those veterinarians see the worst of the worst things. So they're they're kind of like catastrophic thinkers because we we

JoJo (02:40)
Right.

Angie (02:40)
train them to be catastrophic thinkers. that's their job. So I think that's happening. But I I've seen some private practices where maybe they're offering things that I personally think are a little excessive. Like one thing.

my gosh, I almost feel like I have to like shield myself now.

JoJo (03:00)
Ha ha ha.

Angie (03:01)
I'm gonna say it anyways, because we tell the truth. I think in like Boulder County, when people do yearly fecals to test so like poop test to test

JoJo (03:09)
Yeah. Mm-hmm.

Angie (03:12)
for parasites, there's part of me that's like, but really? But really, like how often do you see those, you know, turn up a parasite? I mean, they could. And

JoJo (03:22)
Anything

other than Giardia?

Angie (03:25)
Anything other than Giardia. Yeah. I

JoJo (03:27)
And then now

we've made a complex conversation by getting

Angie (03:31)
Right.

JoJo (03:31)
that Giardia positive for an asymptomatic dog.

Angie (03:35)
Exactly. Then it's just like whatever. no one cares about that Giardia at that point. Or at least I hope nobody cares, but I I do kind of wonder about those things. The other thing, and this is I'm I'm gonna create some hate. I'm gonna create some hate. I have the conversation with my clients about flea and tick prevention and heartworm prevention. I say hey, unless you're traveling, you don't really have to do it year round.

JoJo (04:03)
Yeah.

Angie (04:03)
Which

I know is going to ruffle a lot of veterinarians' feathers. Like, I can just can you hear the comments? Like as soon as you post this, like it's gonna go ding ding ding ding ding.

JoJo (04:14)
Well, I noticed my tension of like,

is she gonna say what I think she's gonna say?

Angie (04:18)
Ha ha.

JoJo (04:19)
But I'll say it even another level. Another level of the heartworm. Is it really necessary to do a heartworm test before prescribing Ivermectin

Angie (04:29)
gosh, like that is the next level. Like, okay, yes and no. So when people are concerned about it, it's because they're worried that maybe if they have a dog that has like a raging case of heartworm that they're going to give the prevention. Like so let's say you have a 10 year old dog that's lived in Mississippi its entire life, and you're like, Hey, now we're gonna start preventing heartworm.

And they've never had prevention before, then we're worried that maybe we could kill off so many microfilaria that this dog could have like an anaphylactic reaction. So the vets down in the south will say, Absolutely, I need to know that your dog is heartworm negative. In Boulder, Colorado, you know, unless your dog came from Mississippi, it's

JoJo (05:18)
Huh.

Angie (05:18)
kind of it's not because

Once I like I just diagnosed a dog with heartworm disease last week and the first thing I do, and he and he got it in the south, so it it he didn't get it here, but the the first thing I do is put them on heartworm prevention because you you do need to kill all the babies in the blood so they can't grow up to be adult worms in the heart. And so yeah, that's a tough conversation, but I

I feel like the people I work for are intelligent and not I feel like I know they are. And I talk to them about like, hey, if you want to have a routine where the beginning of every month you give heart worm prevention and you just need to be in that routine all year long, that's fine. Let's say you travel, or let's say like that's just how you need to organize your life. I'm for that for you. But in January, for the most part.

In Boulder, Colorado, it is frozen here. There

JoJo (06:13)
Uh-huh.

Angie (06:14)
are no mosquitoes. There are no ticks. There are no fleas. And of course we had a really mild winter. And there were still no mosquitoes. And there were still no ticks. And there were still no fleas.

JoJo (06:26)
Nope, not till like April, May this year. That's abnormal year.

Angie (06:29)
Ex yeah. So I saw my first tick

in March and I'm like, I so I talk to people about that. And I I really like to educate people about how heartworm prevention works. If you travel, give it when you get home within 30 days, you know, all of that.

but I think a a lot of veterinarians are like, just do it year round, don't think about it. And I understand why they do it, but I also think, wow, because some of these newer all in one

Heartworm prevention, flea and tick, intestinal parasite. I mean, it's like hundreds of dollars. Yeah. And sometimes I'd rather

JoJo (07:02)
So much money. So much money. Yeah. And the testing is

not really that cheap either.

Angie (07:09)
It's about I think it's like forty dollars at Boulder's Natural Animal. Yeah.

JoJo (07:11)
Yeah. But then you have to do a blood draw just for that.

Angie (07:14)
You have to do a blood draw just for that. Yeah. So

JoJo (07:17)
Yeah. Which is

so much easier to tack it on to an annual.

Angie (07:21)
Yes. Yes.

So usually do. So I I don't know, I don't I don't love the whole like let's test a poop test every year 'cause I I don't know the

JoJo (07:30)
Yeah.

Angie (07:31)
yield, you know, the

JoJo (07:33)
Well,

I wonder what the clientele is feeling is the unnecessary test. Like what's being presented to them, you as a listener, that you're like, really? It's and

Angie (07:44)
Yeah.

JoJo (07:44)
I'm guessing it's more like radiographs or ultrasounds or endoscopies that feel excessive. Maybe?

Angie (07:53)
I don't see that. I

JoJo (07:55)
Yeah.

Angie (07:55)
don't see that at all. and I work in South Boulder. So the socioeconomics

JoJo (08:00)
Yeah.

Angie (08:01)
of South Boulder is completely different. but I don't find that like in general practice veterinarians are like, we need to do X rays and they don't need to do X rays. Now, every

once in a while there's a new doctor

Fresh out of school and the dog's vomiting and they're feeling unsure of themselves and they're like, could be a foreign body. And

JoJo (08:21)
Uh-huh.

Angie (08:22)
I so sometimes you'll see younger veterinarians running more diagnostics, and I don't think that's wrong because how else are they supposed to learn? And so that's

JoJo (08:32)
Yeah, I

was gonna say I think it might be that too. It might be just the what is the risk level of your veterinarian? And I bet

Angie (08:41)
Yeah.

JoJo (08:41)
there's a spectrum. I know there's a spectrum. Right.

Angie (08:44)
Yeah.

JoJo (08:44)
So if you have a more conservative, risk averse veterinarian, they might suggest more tests and diagnostics so that they've

Angie (08:51)
Mm-hmm.

JoJo (08:52)
covered everything and seen all the the information. Whereas if you have a more seasoned, or more risk taking vet.

Maybe they don't suggest as many. And you just have to find one that aligns with your risk tolerance.

Angie (09:06)
Right. Yeah. And it's like after 20 years, like most of the time I can look at a dog, do my exam, get the history and say, I don't think this dog has a foreign body. Or I bet this dog has a foreign body, or I'm highly concerned this dog has a foreign body. and so I think there are some veterinarians that just need more diagnostics as they feel less sure. But that doesn't mean I'm always right. So there's that.

JoJo (09:30)
I

also feel like if you feel that your vet is recommending unnecessary tests, you could break them into typically into can we start with this? And the results on this, then can we go to this? And the results on

Angie (09:43)
Yes.

JoJo (09:43)
that, then can we go to this? It doesn't have to be a let's do all of these things.

Angie (09:49)
I think that's not offered as much anymore. And I I don't know why. I feel like a lot

JoJo (09:53)
Why?

Angie (09:53)
of like the newer clinics, especially like the more corporate clinics, are like, Here's the estimate And instead of saying, Here's everything we could do, they're like, Let's just start here and then we'll go there and then, you know, we'll take it one step at a time.

JoJo (10:07)
And maybe that's where it's starting from. So if somebody's seeing that

Angie (10:10)
Yes.

JoJo (10:10)
estimate, that can feel super overwhelming where that

Angie (10:13)
Yes.

JoJo (10:14)
conversation is. Which brings me to that statistic that I shared with you. that 81%

Angie (10:17)
yeah.

JoJo (10:18)
of veterinarians say, 81% of veterinarians say they often or always recommend an alternative treatment plan when care is declined.

due to cost. So when you're coming with that estimate and they're like, yeah, I can't do this, eighty one percent of that said they're offering something else in place of it. Seventy three percent of clients say they're not being offered that. And that's just like

Angie (10:40)
Yeah.

JoJo (10:40)
this huge gap of where's the communication breakdown?

Angie (10:45)
Well, in a lot of times veterinarians aren't having that conversation because the nurses are having that conversation.

JoJo (10:51)
That is true.

Angie (10:52)
So when I so it at Boulder's Natural Animal, I'm having that conversation. But all the other clinics, you're saying, here's what I want to do. The nurse creates an estimate, goes in, goes over the estimate. And so that conversation isn't happening with the veterinarian.

So I wonder if that's like the disconnect.

JoJo (11:10)
Are you blaming it on the nurses, Doctor Angie Just kidding.

Angie (11:13)
I'm blaming it on the nurses. It's

just like how are the nurses supposed to say, Well, you can't afford this, so why don't we try this? Yeah, they can't.

JoJo (11:20)
Yeah, let's do this. Yeah. No.

Angie (11:24)
And so I wonder if if it's getting if communication is breaking down there or if veterinarians aren't, you know, as skilled at offering kind of tiers of care.

JoJo (11:36)
Hm. It'd be great if Estimates just had tiers of care.

Angie (11:40)
I know, right? Like w we could do this or we could do this.

JoJo (11:41)
Yeah. Like here's our bronze, here's our silver, here's our gold.

Angie (11:45)
Yeah. my god. It felt like I was at a mechanic.

JoJo (11:47)
And then I just realized

when I said that, well now I feel like crap if I don't choose gold

Angie (11:51)
I know, I know.

JoJo (11:53)
for my pet. No, my my pet's a gold star pet, but I'm gonna give him bronze star care.

Angie (11:59)
Yes. I know.

And some people I find some people have the money and are like, this what is this gonna what is this diagnostic gonna yield for me? I had one cat that came in and her her kidney, her ureter was obstructed. I I can't remember if it was obstructed on both sides, but I think it was just one side. And she could go in and put a stent and do all these things. The cat was still gonna have kidney disease, it was likely gonna need we're gonna replace it over and over again.

And to extend her cat's life by two years, she was gonna need to spend twenty thousand dollars. And she looked at me and she said, Angie, people are starving. How

JoJo (12:36)
Mm.

Angie (12:36)
can I put twenty thousand dollars here? And so sometimes people need permission. So we we made a different plan. We put the cat on some prazosin and did some sub Q fluids and her cat's doing great. but she kind of just decided like

It's not gonna ultimately extend her life by much. And this is I can't spend twenty thousand dollars on this.

JoJo (13:01)
That's an interesting perspective. Yeah.

Angie (13:03)
Yeah.

JoJo (13:04)
Not that she didn't have access to the funds, but was really cognitive of how those funds are spent. Like what what kind of use they have in the world. That's that's a that's interesting. So

Angie (13:11)
Yes. In the water. Yeah.

JoJo (13:16)
I don't yeah, I don't know the answer for people. Like how do you know if your vet is recommending unnecessary tests unless you're having the conversation.

Angie (13:23)
Yeah. A lot of people ask me, do I really need to do this? And I tell them it Yeah. I I like

JoJo (13:28)
Yeah, that's a great question.

Angie (13:30)
it when people engage me that way. Because I don't want to just be like, this is what I would do. And then they say, Well, whatever you want to do, like that's my worst. Like for a lot of veterinarians, that's their

JoJo (13:39)
Yeah.

Angie (13:40)
that's their dream. But for me, I'm like, No, we're

JoJo (13:42)
you don't want

to be asked like if it's your pet, what would you do?

Angie (13:46)
no, I want to be asked if it was my pet what I would do. But when some people are like, you just tell me what to do and I'll do it, I'm kind of like, no, no, we're gonna do this together. I

JoJo (13:55)
Yeah.

Angie (13:55)
want you to know what's going on. And I want you to know why we're doing it. And I also want you to know that you have options. And I think I annoy people sometimes, which they're obviously I'm probably not the best fit for them. But my my favorite people and my the best fit are when we can have the conversations of like, okay, your cat's lost weight.

Here's what their blood work looks like, we should do the ultrasound. On the ultrasound, this is what we're looking for. Here are our possible outcomes. Here's what we're gonna do. You know.

JoJo (14:22)
Mm-hmm.

Angie (14:23)
And the people that like want to get into like, okay, so if all roads are gonna lead to steroids, can I just start with steroids? I'm like,

JoJo (14:29)
Yeah.

Angie (14:29)
sure. You know, like or

JoJo (14:31)
Huh?

Angie (14:31)
I I can't I don't wanna do the endoscopy. Can we just try the steroids? Or people that are kind of into the decision making with me.

JoJo (14:39)
I think you're great about asking, you know, this is an expensive test. I'm not sure what your budget is.

Angie (14:46)
Yeah.

JoJo (14:47)
And then offering other options that are maybe lower tiered budget. In but it usually comes down to money. I think if everybody had

Angie (14:54)
It really does.

JoJo (14:56)
so much money, they'd be like, Okay, my vet's recommending it, I trust, but maybe there's a little less trust right now because right now there's a s there's an overarching story that veterinarians are greedy.

And veterinary medicine is greedy. And

Angie (15:09)
Yeah.

JoJo (15:09)
so maybe that is why this is kind of a trending question right now. Because people don't know who to trust. And if

Angie (15:14)
Yes. They don't know who to trust.

JoJo (15:17)
you can't trust your veterinarian, that's a sad state of affairs.

Angie (15:20)
Yeah, do something else. If you don't if you can't have that conversation with your veterinarian, go somewhere else. I had a single mom in my exam room. I think it was I think it was yesterday, and her dogs had all these problems and ended up she ended up spending like ten thousand dollars on it last year and she's like, I'm just still recovering from that. And I found a heart murmur and it was new.

And so then we just kind of looked at each other and I was like, I just want you to know. I was like, we'll put this on the list. But we were trying to figure out like some digestive stuff and some anxiety stuff. And I was like, when we think about your dog's everyday quality of life, let's focus on that. Let's put the echocardiogram, because it's like seven or eight hundred dollars. Let's just put that on the list of things to do. And then I looked at her and I said, I want you to know there's a lot of dogs walking around and we know they have a heart murmur and they haven't had an echocardiogram yet.

JoJo (16:13)
Mm-hmm.

Angie (16:13)
And she's like, I really needed to hear that. Because people think

like, you know, of course I want the minute I diagnose a murmur, I want that echocardiogram, but I I'm not paying for it. I want the

information. But like that's a that's a big thing to

JoJo (16:28)
Right.

Angie (16:29)
do.

JoJo (16:29)
And why would you wanna keep coming to the vet if you're gonna get news of it's gonna be another thousand and another thousand

Angie (16:34)
Thanks.

JoJo (16:35)
and then and then does it just become like, you know what, my dog's just gonna live its life and we're not gonna

Angie (16:40)
Yes.

JoJo (16:41)
go learn what's we're not gonna go find out what's wrong. Because as our diagnostics get better, we're gonna find more things earlier.

Angie (16:48)
Yeah. right.

And I tell people like when we're doing an ultrasound on a 10-year-old dog, I was like, I want you to know we're gonna find something. I don't know if it's gonna be relevant to what we're looking for, but there's

JoJo (16:59)
Mm-hmm.

Angie (16:59)
gonna be, some kind of mass or something somewhere where we're gonna say, is this just like a cyst or is this? You know, that conversation is going to happen. And I think having a good relationship with your vet is everything. And that's why I tell people, like, hey, in December.

You don't have to treat for fleas and ticks because it's the moment that we're connecting where I'm treating them respectfully and saying, like, hey, you don't just have to do this blanket recommendation. Let's think critically together. If you're gonna be traveling, then let's do it. Or, you know, if you need it for your schedule, like do you keep your do you keep saying yeah. 'Cause it's like

JoJo (17:37)
Mm. We do not.

Angie (17:38)
Yeah. Yeah. I c I can't imagine.

JoJo (17:40)
No. In fact I just had

to write it down today to start her heartworm because we've had some moisture. Yeah. Huh.

Angie (17:46)
Right. Yes. Yeah. So I

think that I cause I know you really hate parasites. You should go back and watch that bug episode, everybody.

JoJo (17:53)
Yeah. I was

like when I was doing the notes for that I'm like, how many times did I say ew

Angie (17:58)
Ha ha

JoJo (17:59)
in one episode? Ew. And I don't

Angie (18:01)
Yeah.

JoJo (18:02)
dislike bugs. I just dislike bugs on animals.

Angie (18:06)
Yeah, no, it's they're disgusting. And so I think that that's a moment when I can level with people that like, hey, I'm not gonna just do stuff so that you spend seventy more dollars on this appointment. or if people my gosh, can I do one? Can I admit one more thing that I do? The

JoJo (18:23)
Yes.

Angie (18:24)
comments, people are gonna blow me up in the comments. People that are not boarding their dog, I get I make

JoJo (18:29)
Wow. Yeah.

Angie (18:30)
it optional for them to do Bordetella I'm like, I you you don't have to do it on my account.

JoJo (18:33)
Sadus never had Bordetella

Angie (18:35)
No.

JoJo (18:36)
And I also think so she's gonna get a cold. Okay.

Angie (18:40)
Well, but we know that when we give dogs the kennel cough vaccine, they still come back to me with their kennel cough when they go on board. But we just think like

JoJo (18:46)
Yeah, that's so true. Well, and also

'cause I think sometimes I don't even know if it people give it enough time. Like they're like, I need a board tomorrow,

Angie (18:54)
The the day before.

JoJo (18:56)
so I'm gonna do this today.

Angie (18:58)
Yeah.

And just to be clear, I believe in that vaccine and I believe in its efficacy to lower the prevalence of disease when dogs get together. But for anybody's of individual dog, I, you know, I I give them that choice. And I think those are moments when people are like, yeah, she's not just trying to sell me. Yeah.

JoJo (19:19)
My talk doesn't mean yeah, no.

So it's conversation. It's trusting your vet, like having a relationship in which you trust. And it what I'm hearing is individualized care.

Angie (19:29)
Yes.

JoJo (19:30)
Like not every situation is the same. So your financial situation is the same, your dog or cat's exposure is different. your risk meter is different. So

Angie (19:39)
Yes.

JoJo (19:40)
it's conversation.

Angie (19:42)
It's conversation and some of the packages at at probably the smaller corporate clinics might be okay. But for the most part, if they're like offering your one year old cat to get blood work every year, like I don't know. I wouldn't do that, but

JoJo (19:57)
Yeah. Why is that necessary? I don't know. I I saw well, I saw a st that's okay.

Angie (20:00)
Someone's gonna blow us up in the comments. And it's gonna be a new grad vet.

JoJo (20:05)
I saw a story that kind of disturbed me about those packages. So some of these clinics are selling some of these corporate clinics are selling them and you they're like for the year or something like that. So you get so many things included for the year. It it doesn't make logical sense in my head, 'cause that's not how care works, but

Angie (20:23)
Mm-hmm.

JoJo (20:24)
This pet passed and they still had to pay for their wellness plan.

Angie (20:29)
my gosh. my gosh. So embarrassing. Yeah. Wow. Wow.

JoJo (20:30)
Because it's a contract. And I was like, that feels so bad. So bad. I think that was here

in Colorado too. But I mean, I'm sure it's not the first time I just happened to read the story of it. And I was like, this poor woman is bawling her eyes out because she lost her dog and she's getting billed for wellness plans by the month.

Angie (20:50)
Is it a place I'm we're just gonna be a little discreet about this. Is this a place I've ever worked?

JoJo (20:54)
I believe so, yes.

Angie (20:56)
that's so disappointing. Okay. well that's a

JoJo (20:58)
Yeah. Yeah. And like at this

point you are a giant corporation with lots of money. Have

Angie (21:05)
Yeah.

JoJo (21:07)
some decency. That's my opinion about it.

Angie (21:09)
Yeah, yeah. Wow.

Yeah

JoJo (21:11)
does

feel like a unnecessary reach for money, which makes the industry

Angie (21:14)
Yes. Yes.

JoJo (21:16)
feel distrusting.

Angie (21:18)
Yeah. So trust your vet.

JoJo (21:19)
Have a conversation. Yeah.

Angie (21:19)
get another vet. Get another vet.

if you want to look over your pets care with me, you can go to boulderholisticvet.com and I can give you my opinion, my second opinion, if your veterinarian is doing too much, and if it's all too much, you can hit book a consultation.

And we will collect your pets records and we'll meet on Zoom. It is recorded, so you get to keep that recording and we can sort it all out. Anything else, Jojo?

JoJo (21:50)
I think those consults are great for second opinions. Second opinions

Angie (21:53)
Yes.

JoJo (21:53)
are so useful sometimes.

Angie (21:55)
And the thing that we get to do, you and I, when we have these consultations, meaning you as the listener, not Jojo, is that we get to have time. So when I'm in an exam room, sometimes things are like maybe you're running late, maybe I'm running late, and things are not as focused. But this is just you and I sitting down. we have forty-five minutes together and the whole focus is on you and your pet. And so we get to have the conversations that sometimes you

Can't have with your veterinarian.

JoJo (22:25)
Yep, they're great. You're great at it, Doctor Angie.

Angie (22:28)
Thank you.

JoJo (22:29)
Okay, all until the next episode, which will be who knows? Who knows?

Angie (22:34)
Who knows? Okay, we

release every Friday, so be sure to subscribe so you can be notified. And we'll talk to you soon. Bye.

JoJo (22:42)
Bye.