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

INTERDISCIPLINARY TEAM

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)




DEBRIEFING

DEBRIEFING

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

DEBRIEFING

DEBRIEFING

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


• What challenges might exist for delivering successful veterinary medical care to these patients?



DEBRIEFING

DEBRIEFING

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.

veterinary medicine as an entry to human healthcare

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