VETERINARY MEDICINE AS AN ENTRY TO HUMAN HEALTHCARE
Transcript of VETERINARY MEDICINE AS AN ENTRY TO HUMAN HEALTHCARE
VETERINARY MEDICINE AS AN ENTRY TO HUMAN HEALTHCARE
William Gilles, Liddy Alvarez, Ruthanne Chun
(& Pancake)
Veterinary Social Work Summit, 2018
AGENDA
• 2:35 WisCARES overview (5 min)
• 2:40 Introduce Case 1 (5 min)
• 2:50 Small group activity (10 min)
• 3:00 Large group debrief about group ideas/discuss actual case outcome (10 min)
• Repeat for Case II and III (25 min. a piece)
• 3:25 Case II
• 3:50 Case III
• 4:00 Final debrief (10 min)
OBJECTIVES
• Understand the effect of poverty on chronic disease management in veterinary medical patients.
• Recognize how the Veterinarian-Client-Patient Relationship (VCPR) can impact housing and human health.
• Recognize when/why/how veterinarians should partner with other professions to maximize positive impact on human and animal lives.
WISCARESWISCONSIN COMPANION ANIMAL RESOURCES,
ED UCATI ON, AND SOCI AL SERVI CES
• Initial thought: Veterinary Medical Care
• Expanded vision:
• Collaboration between Schools of Veterinary Medicine, Pharmacy, Social Work
• Practical one-health based approach
WISCARES PROGRAMMING
• Clients/Patients:
• Veterinary Medical Clinics
• Outreach
• Boarding and Foster
• Student Education:
• Veterinary Medicine, Pharmacy, Social Work,
• Nursing, Human Medicine, Undergraduate
INITIAL VETERINARY MEDICAL SERVICES
• 2015: Primary Care "Sick Pet" clinic one day each week (VM4 Students)
• Limited resources (diagnostic and therapeutic)
• $25 for tests
• Donated medications and preventatives
NEW WISCARES FACILITY
• 2018: New WisCARES facility Low-Cost, Full Service Veterinary Clinic!
• 4200 Square Feet
FULL SERVICE CLINIC
• Open 6 days a week
• Receiving Monday, Tuesday, Wednesday, Friday, Wellness Clinic on Saturday
• Surgery and Dentals
• Radiology
• In-House Laboratory
• Pharmacy
SMALL GROUP ACTIVITY (10 MINUTES)
• Split into groups!
• Case overview provided
• 10 minutes small group on one of the following:
• What challenges might exist for delivering successful veterinary medical care to this patient?
• What owner-related challenges may exist?
• What are One-Health considerations or opportunities for collaboration for this case?
SWEET PEA
• “Sweet Pea” 13yr old, Male/Neutered DSH (Domestic Short Hair) owned by a white middle-aged female (Chris) who is currently couch-surfing
• Presenting complaint: 2-year history of pulling out fur/over-grooming near rump/tail
• Currently has on a flea collar and has tried Advantage (spot on) in the past
• Tried multiple food changes and using a steroid spray on the skin (no improvement)
• Upon further questioning discovered:
• 8-month history of increased thirst & urination
• 2-month history of weight loss (despite a good appetite), hindlimb weakness, as well as sleeping more
SWEET PEA
• Physical Exam:
• Wt. 13.5lbs (obese) T: not taken (stressed), HR: 200bpm, RR: 45 brpm, MM: pink
• ORAL: Moderate generalized tartar and calculus, severe gingivitis
• SKIN: Poor hair coat, diffuse dandruff, multiple areas of alopecia
• Test Results:
• Chemistry blood screening: Elevated glucose (blood sugar) level
• Normal Thyroid level
• Interpretation:
• Diabetes Mellitus (newly diagnosed)
• Generalized poor hair coat (seborrhea and alopecia)
• Dental disease
A LITTLE ABOUT DIABETES
• Overweight, male cats most commonly suffer from type II diabetes
• High carbohydrate & low protein diet and underlying illnesses may predispose need for insulin
• Factors to consider for treatment
• Cats with severe unregulated diabetes can develop Diabetic KetoAcidosis (DKA) a condition where the body acts as if it is “starving”
• Emergency treatment is required to correct glucose and electrolyte derangements
• Cats with hypoglycemia (too much insulin given) can also be a medical emergency
• Leading to lethargy, seizures, coma
• Early intervention with consistent insulin therapy and introducing prescription diabetic diet can lead to remission (no longer requiring insulin therapy)
• (*Note: Diabetic therapy can go well or really, really bad)
GROUP ACTIVITY (10 MINUTES)
• What challenges might exist for delivering successful veterinary medical care to this patient?
• What owner-related challenges may exist?
• What are One-Health considerations or opportunities for collaboration for this case?
WHAT HAPPENED…
• Sweet Pea was started on a diabetic diet as well as insulin therapy
• Able to supply discounted insulin and syringes and donated prescription food
• Set up “safety net” with local low-cost veterinary practice in case of emergency
• Extensive communication with Barbara about Diabetes
• Coordinate a dental procedure with many extractions
• After his dental infection cleared, Sweet Pea was able to go into remission (no longer requiring insulin)
TANGO
• “Tango” 9yr old, Female/Spayed Springer Spaniel
• Owned by a white middle-aged female (Billie) who is currently living in her van
• She has disclosed that she has a history of mental illness and a therapist
• Not currently undergoing therapy
• Also disclosed inability to access local housing resources due to criminal history
• Past history as a WisCARES patient:
• In intermittently for dermatologic issues
• Overall healthy dog
• Presented on ER to teaching hospital for ‘scooting’ and straining to defecate:
• Mass lesion in left anal sac
TANGO
• Physical Exam:
• Wt. 21.8kgs, normal TPR
• Only significant PE finding: 3 x 2 cm firm mass associated with L anal sac
• Test Results:
• Chemistry blood screening: mildly elevated liver values (AST and ALT)
• CBC: within normal limits
• FNA of anal sac mass: anal sac adenocarcinoma
• Staging:
• Thoracic radiographs: no evidence of metastasis
• Abdominal ultrasound: regional nodes normal size and shape
A LITTLE BIT ABOUT AGASAC
• Middle-aged to older male or female dogs
• Usually unilateral, bilateral in rare instances
• Prognostic factors
• Hypercalcemia (25-50% of cases)
• Size: >3.56 cm2 is worse
• Surgical removal if possible associated with prolonged survival
• No metastasis, surgery alone, median survival of 952 days
• N.B. even with ‘dirty’ surgical margins
SMALL GROUP ACTIVITY (10 MINUTES)
• What challenges might exist for delivering successful veterinary medical care to this patient?
• What owner-related challenges may exist?
• What are One-Health considerations or opportunities for collaboration for this case?
WHAT HAPPENED…
• On-line application for financial assistance through a pet-oncology-care foundation
• Surgical removal of the tumor
• Uncomplicated recovery and healing
• The complicated part was the ‘going home’ part
• And the rest of the story
SADIE & WYNONA
• “Sadie” 4yr old, Female/Intact Lab Mix “Wynona” 6yr Female/Intact Shephard Mix
• Owned by an older white male (Dennis) who is currently hospitalized in need of a surgical procedure (tracheostomy) for terminal cancer treatment plan
• Outside of hospital currently living in vehicle
• Presenting complaint: Human ER nurse called stating that there are dogs locked in a car in the hospital parking lot
SADIE & WYNONA
• Dogs are both overweight, overdue for vaccines, otherwise apparently healthy
• Owner is reluctant to allow his dogs to be taken from his car
• Does not consent to any medical care for the dogs
• Procedure owner is hospitalized for is necessary and life-saving
SMALL GROUP ACTIVITY (10 MINUTES)
• What challenges might exist for delivering successful veterinary medical care to these patients?
• What owner-related challenges may exist?
• What are One-Health considerations or opportunities for collaboration for this case?
WHAT HAPPENED…
• Hospital visits with dogs
• Trust building before preventative care discussions
• Dennis had multiple ER visits with improved transitions for boarding
• Communication with WisCARES at each visit
• Facilitated another PCP provider for Dennis
QUESTIONS
• Name three potential barriers that may impact management of a chronic disease in a veterinary patient.
• What is an example of a non-clinical service a veterinarian could provide that would help increase access to housing or healthcare?
• Name one human health or support profession that veterinarians could partner with and how co-management of an animal and human could improve the human’s outcome.