Dr. Walt's happy tails: May 2003

Specialty Veterinary Care for those Special Companion Animals in Our Lives
Like people, animals can develop complex illnesses that often defy the diagnostic skills of even the best general veterinary practitioner. Other times, needed treatment requires specialized equipment or expertise not often available in most veterinary facilities. What is available to address the specialized needs of these veterinary patients? Veterinary specialist -- veterinarians who have acquired additional academic training to focus their skills on becoming more proficient or knowledgeable in a specific area or discipline of veterinary medicine.

These veterinarians will often return to veterinary teaching hospitals, generally associated with our colleges of veterinary medicine, to embark on internship and/or residency programs very similar to those available to human health care professionals.

The additional training takes from 1 to 4 years and culminates in most undertaking an extensive examination process to become certified as true specialists in their respective areas of expertise. To be able to sit these examinations generally requires a minimum of 2 years of post-graduate training, mentorship by colleagues who are already specialists in the area of study, publishing one or two scientific manuscripts that add new information to the veterinary literature, and finally, writing two sets of examinations that span 3 days in total.

Areas with recognized veterinary specialties include internal medicine, cardiology, oncology, dermatology, surgery, anesthesiology, ophthalmology, radiology, dentistry, behaviour, pathology, exotic animal medicine, and general veterinary practice refined to focus on one or two specific species of animals (e.g., companion animals, feline, avian, equine, etc.). This list is not complete by any means but does underscore the availability of advanced veterinary care for the companion animal owner. Generally, these specialty veterinary practitioners see cases by way of referrals from the primary care veterinarian, similar to the referral process in human medicine, and often practice their specialty with other specialists under one roof, containing state-of-the-art diagnostic and therapeutic equipment, including computed tomography (CT) scanning, radiation therapy for cancer treatment, and specialized surgical suites for performing advanced surgeries, such as hip replacement. Surprised? You shouldn't be because not only has this expertise existed for quite some time, the demand is steadily increasing as we all strive to provide our furry companions with the best care that veterinary medicine has to offer. What has changed however, is that where once this specialty care was the domain of our colleges of veterinary medicine through their teaching hospitals, many free-standing specialty hospitals exist separate from veterinary colleges, especially in larger urban areas, thereby increasing pet owner access. Many also offer critical care services making them open and available 24 hours per day, 365 days per year.

Why am I raising this issue? The answer is two-fold. First, as veterinarians we are at times forced to confront our limitations and are fortunate to have this heightened level of care available to support the animals we treat as patients. Referral is often misinterpreted by some pet owners as a lack of knowledge by their veterinarian. Nothing could be further from the truth -- knowing your limitations and when to seek outside assistance is in the best interests of all concerned, particularly the pet receiving the care. Second, is that many of the questions that are forwarded to me by way of this column, defy my providing a responsible answer; because they are so unique and specific to that animal, they require direct veterinary attention, and at times specialty veterinary attention, for diagnosis and treatment. Two examples will help underscore this latter point.

Recently, I received two e-mails from separate pet owners expressing concern and asking for my advice regarding their dog's escalating aggression. In the first situation, the owner had recently adopted a mature German Shepherd dog that was becoming increasingly aggressive to other dogs. In the second, the owner was struggling with a Rottweiler puppy that was demonstrating food-guarding behaviour that had resulted in the owner being bitten on two occasions. While both pet owners were diligently trying to address the behaviour (via obedience classes and discipline), they were not making progress and the behaviour was escalating. For me to provide advice other than recommending that they seek the input of a veterinary behaviourist would be irresponsible because the aggressive behaviour displayed by these dogs has the potential to result in harm to the owner and other dogs. Aggressive behaviour in dogs can be the result of illness, territorial behaviour, dominance, and fear, to name a few, with treatment, such as behavioural modification, medication, or other modalities, differing depending on the root cause. As such, the treatment of aggression cannot be generalized and this problem is best addressed under the auspices of a veterinarian with expertise in this field of study.

The second example relates to two cat owners who are frustrated over the ongoing skin problems that their pets are experiencing. Both describe an excessive skin sensitivity that is resulting in overgrooming and self-inflicted hair loss or skin lesions in their respective cats. One of the cats also demonstrated a reluctance to be petted, especially over the back region. While this is a relatively common problem in cats, it is a symptom that can have a number of underlying causes. Inhaled or food allergies are one, skin infections with bacteria, fungal agents, or parasites is another, and in some cats, this behaviour may be the result of anxiety. Again, because the underlying causes are so different, it generally requires a more involved diagnostic evaluation to determine the cause and therefore the specific treatment required. This often involves blood tests, hair sample evaluation, skin biopsies and/or cultures, and allergy testing before treatment is initiated. Because determining the root cause may be complex, many pet owners choose the input of a veterinary dermatologist to assist them through this problem.

Hopefully you will never be confronted with a more complicated health care issue in your pet; however, should this occur, don't hesitate to discuss the possibility of utilizing the services of a veterinary specialist with your own veterinarian.