Don’t Wait Too Long to Get a Second Opinion

Photo Credit: Susannah Kay

 

By the time I met Lucy, her condition had deteriorated to the point that I was unable to provide her with significant help. Rather than talking about treatment options, her care providers and I were forced to discuss end-of-life decision making. If only I’d been able to get my hands on this darling little Sheltie sooner, the outcome could have been so different.

Lucy was suffering from a disease called hyperparathyroidism , an overproduction of parathyroid hormone resulting in excess calcium within her bloodstream. The treatment of choice for this disease is surgical removal of the overactive parathyroid gland. Such therapy is typically quite straight forward and results in a complete cure.

Poor Lucy. In spite of nine office visits with her family veterinarian over the course of six months because of symptoms caused by her parathyroid disease, appropriate treatment was never recommended and the extra calcium in her bloodstream over such a prolonged period caused irreversible kidney damage. By the time Lucy arrived at my doorstep, she was suffering from profound kidney failure with weakness, loss of appetite, vomiting, and debilitation. There was no going back for this little sweetie.

What gets in the way of a second opinion

There are a few reasons I can come up with as to why veterinarians will watch a patient deteriorate week by week and without a clearcut diagnosis, and yet still not discuss a second opinion. Perhaps they truly believe that there’s nothing more to be offered by someone else. Perhaps they think they “know” that their client would not want to get a second opinion because of cost and/or inconvenience. Maybe the veterinarian has a strong desire to hold onto the case, either because of their own ego or for financial gain.

Why is it so darned difficult for some folks to request a second opinion for their beloved pets? For some, veterinarians represent authority figures and their abilities are not to be questioned. One client told me that she viewed her relationship with her veterinarian to be like her relationship with her pastor- ask no questions! I’ve heard other clients state that requesting a second opinion would imply mistrust which would result in delivery of poorer quality veterinary care in the future. Some hold off on obtaining a second opinion (or they do so secretly) because they don’t want to hurt their veterinarian’s feelings.

My sense of Lucy’s caregivers is that they believed their veterinarian was doing the best job possible. They never thought to question his diagnosis (or lack thereof) and didn’t seem to know that they had the option of a obtaining a second opinion. They ultimately chose to come see me based on the recommendation of a friend who was concerned about Lucy’s decline. 

The need to be an effective medical advocate

When I hear such rationalizations from folks who have postponed second opinions for their pets, I’m always tempted to respond with a line from the movie, Moonstruck in which singer/actress Cher slaps Nicholas Cage across the cheek while commanding, “Snap out of it!” Fortunately, the grownup in me manages to intervene with more mature counsel and I encourage the individual to step up to the plate as their pet’s medical advocate. The well being of their pet must be the number one consideration.

Putting total blind faith in any one veterinarian makes no sense, no more so than relying on any one medical doctor to safeguard our health. The veterinarian is only one member of an animal’s health care team, and it is the team captain who needs to call the shots. The team captain is the one who feeds, cares for, loves, and truly knows that animal better than anyone else. When there is no diagnosis in spite of multiple tests, or the animal’s health is declining in spite of therapy, it’s time for the team captain to order up a second opinion.

A situation like Lucy’s is heartbreaking. Don’t let her story happen to one of your family members.

Have you ever obtained a second opinion for one of your pets?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

 

Be Sociable, Share!

9 Comments on “Don’t Wait Too Long to Get a Second Opinion

  1. Hi Dr. Nancy – Our nine year old Pekingnese mix recently had bloodwork done that showed elevated levels of ionized calcium. We have her records, happy to share via DM – and are seeking to get a second opinion/specialist. Our Vet informed us this is one of the challenging diagnosis/results that can go many different directions via various testing etc and we want to get to the root as to why elevated (without unnecessary stress to our pup). I love your article, and would sincerely appreciate any vet recommendations to explore how we should go about this (we live in NYC/Brooklyn). While we’re happy with our vet, the lack of knowledge/next steps for this particular case are far too grey for us to be comfortable with one opinion. Please help! Thank you in advance!

  2. Hurray for that incredible nurse!!!

  3. Oh my DOG thank you for your courage in telling it like it is Dr. Kay!

    We see this tragedy play out repeatedly in our Tripawds community. The vast majority of our members join us after their dog or cat’s limb cancer diagnosis has been delayed by several months. Their human just never thought or wanted to question the vet.

    I can relate, because before I knew better, I did the Same Exact Thing! Our Jerry’s osteosarcoma diagnosis was dragged out by at least four months. His vet kept calling it arthritis, despite our dog being fit and just 8 years young. Then one day the vet’s nurse caught us going out the door after another frustrating visit. She quietly walked out with us and said “You might want to get a second opinion at another clinic.” Can you believe that?! We did, and that awesome vet referred us to UC Davis for a third, which confirmed the cancer.

    If it wasn’t for that kind vet nurse, Tripawds probably wouldn’t be here. Jerry lived two extra years because we finally got treatment for him. Because of our experience (and your teachings), we are committed to making sure no other pet or human goes through this ordeal. THANK YOU.

  4. Back when my Chinese Crested, Ruby, was 7 years old, she was finally diagnosed with what turned out to be Atypical Addison’s disease, along with Hypothyroidism. The thyroid issue was pretty easy to diagnose, but the Addison’s took three different vets, and almost 2 years! Ruby’s lab work was all over the place, as were her symptoms. I was so lucky when the third vet ran the same labs Ruby had been through so many times before, and an Internal Medicine vet at Iddex suggested my vet do the ACTH stimulation test for Addison’s. Bingo! Diagnosis, and my dog was the only dog in this practice who had ever been diagnosed with Addison’s. Ruby will turn 15 in a few months! I believe there are many Addisonian dogs out there who never get properly diagnosed, and die. I count my lucky stars that I never gave up, and have had all of these wonderful years with Ruby, my heart dog.

  5. Dr. Kay,

    This is such an incredibly important article and I’m not surprised that your wrote it because I know who you. I have experienced this personally when I lived in a small town and the clinic where I went w/ my dog for almost 6 months for my GSD, Ginger. She had horrible breath and it smelled like blood. She would go for a few days without eating and then bounce back. I kept bringing her in explained all her symptoms in detail and since I’m neurotic, they were plenty. I don’t feel he really listened and he never came up w/ anything. Finally, I asked him to take x-ray’s of her chest, neck area and her mouth. I knew something was wrong and he wasn’t coming up w/ anything. He took her back for x-rays w/ an attitude. How dare I suggest a diagnostic procedure. Then, I heard a loud gasp and and OMG!!! I have a habit of leaving the exam room doors open, so I heard him loud and clear. I said “What?” He came in and said she has a very large tumor on her heart and he immediately gave her Lasix to take the fluid off of her heart. He diagnosed her with Hemangiosarcoma. UGH!!! She walked into the clinic that day and could barely walk out. I had to lift her into the car. She came home and barely made it to the living room where she collapsed and her breathing became very shallow. I called my vet in my home town and told him what happened and he said he should never have given her Lasix as that will kill her at this stage. She died 12 hrs later. I looked it up and Lasix is contraindicated for a tumor on the heart. The fluid was blood and what I smelled on and off. When the tumor would bleed, I smelled blood and she couldn’t eat… and and and. That’s the nature of these kinds of tumors, right Dr. Kay? They bleed and then stop bleeding and bleed again…Anyway, I counsel all my clients to get second opinions right away if their vet can’t make a diagnosis and I also strongly suggest that they don’t go to a vet who is the only vet in the practice. They rarely confer with other vets and your other reasons are pretty much right on. Thanks so much for writing this necessary article.

  6. Yes, I have sought a second opinion a number of times over the years. Some confirming my veterinarian’s diagnosis, some a differing diagnosis. Most recently, a swelling on a front foot was not improving after several months and x-rays were inconclusive. Fortunately my doctor suggested a second opinion, I would have asked for one anyway, from an oncologist and it turned out to be a spindle cell sarcoma. We opted to treat it holistically and so far so good, he is doing well and it is diminishing in size. A previous doctor always resisted my requests for a second opinion which I’m sure was seen as an affront against her abilities. My current veterinarian is thankfully very receptive to a second opinion as well as alternative therapies when conventional methods either aren’t working or might not be in the best interest of my dogs.

  7. After much sadness and learning some lessons the hard way, I finally found a vet who will look things up and who is curious and interested in medicine. He would not discourage me from seeking a second opinion or going to a specialist. Incurious and arrogant vets have caused a lot of suffering for a few of my dogs. Sadly, where I live going to a second vet sometimes means going to a second arrogant vet but eventually I found a good one.

  8. Such an important topic Nancy. Thank you. It’s exactly why I founded VetSOAP.

    Will you be at ACVIM?

Leave a Reply

Your email address will not be published. Required fields are marked *