A question for the vets
Discussion
When doing your degree do you have to do a module on medicines?
I ask as there have been a few instances where the vets here (not all the same vets) have done things to me that seem unusual.
When my dog was a pup they gave us some wormer and if I had just followed the dosage instructions on the label rather than the instructions on the box I would have given my pup more than double the recommended dose. I questioned the vet and they admitted fault.
The in laws dog had some probs last week and their vet gave them some tablets then at a visit a couple of days later gave them another set which were essentially the same stuff (Tramadol) one was a generic and one a brand name so they ended up giving him a double dose of painkillers (they were told to overlap the medication). Poor thing was knocked out cold and very constipated all weekend.
Also recently I had some antibiotics for my dog as she had the runs and the tablets they gave me were from a mixture of opened and semi used packets.
I work with medicines so luckily I am very wary of any that I use. My partner is a pharmacist and says if she had dished out any of the above she would at minimum have got a major rollocking or with 3 errors like that probably lost her job and maybe been struck off.
I was just wondering if your vet training involves any detailed drug training for things like interactions between drugs etc or do you just get told dog has a bad belly give it this?
From my work I know that in the manufacturing stage the drugs have to go through the same strict procedures for people and animals so why does the dispensing side of things for pets seem a bit more carefree?
Or do I just have bad vets around here?
Thanks
I ask as there have been a few instances where the vets here (not all the same vets) have done things to me that seem unusual.
When my dog was a pup they gave us some wormer and if I had just followed the dosage instructions on the label rather than the instructions on the box I would have given my pup more than double the recommended dose. I questioned the vet and they admitted fault.
The in laws dog had some probs last week and their vet gave them some tablets then at a visit a couple of days later gave them another set which were essentially the same stuff (Tramadol) one was a generic and one a brand name so they ended up giving him a double dose of painkillers (they were told to overlap the medication). Poor thing was knocked out cold and very constipated all weekend.
Also recently I had some antibiotics for my dog as she had the runs and the tablets they gave me were from a mixture of opened and semi used packets.
I work with medicines so luckily I am very wary of any that I use. My partner is a pharmacist and says if she had dished out any of the above she would at minimum have got a major rollocking or with 3 errors like that probably lost her job and maybe been struck off.
I was just wondering if your vet training involves any detailed drug training for things like interactions between drugs etc or do you just get told dog has a bad belly give it this?
From my work I know that in the manufacturing stage the drugs have to go through the same strict procedures for people and animals so why does the dispensing side of things for pets seem a bit more carefree?
Or do I just have bad vets around here?
Thanks
There's a lot of questions in therre which I will try to answer, but forgive me if I miss some bits.
Forstly, as regards "medicine" training, yes there are significant courses of pharmacology and therapeutics, which give a good insight into the methods of drug actions, interactions and metabolism. Experience of using specific products is gained both during training and when qualified. Compared to human medicine, where only one species is treated, we have several, often with very different physiologies, which are all covered, but is does mean our patients can have very different requirements. As any doctor or pharmacist will know, most dose levels given in data sheets which accompany every medication, are only guidelines. Some are strict and must be adhered to, some are not, as the dosages can be adjusted to the condition. In one of the examples you cite, a worming medicine is given at a higher level than expected, this is unlikely to have been any significant risk but has to raise the question of whether your vets were familiar with what they were doing, and what they said when they admitted fault.
In the case of Tramadol, I would argue that this should not have been used as it is a human medication which can only be used either once all veterinary approved medications have been ruled out or a specific condition indicates the use of a non-approved human medication (it's called the cascade, which all vets should be familiar with). Overdosing with any drug, approved or otherwise, is not acceptable. Human medicines are supposed to be dispensed in standard packs that are not opened before dispensing, however, due to the size variation in our patients, human packs don't always fit, so to keep costs down, packs are often broken into to dispense an appropriate amount. Mixing of different makes is acceptable but doesn't give a good impression. Getting doses wrong is not acceptable.
Some of what you describe as observational criticisms, are down to your vets using human medicines and/or trying to keep a grip on cost efficiency. This is not ideal, it costs us and our clients significantly more to stay within the veterinary rules as much as possible, which gets us a slagging for otherr reasons.
Do I think your vets are bad? Not necessarily, but if you have 3 incidents of poor prescription policy, then maybe you should raise this with your vets and if you don't get a satisfactory guarantee of staying within the guidelines, you should consider moving. I can't say I'm very impressed with what you have described, it sounds poor.
Forstly, as regards "medicine" training, yes there are significant courses of pharmacology and therapeutics, which give a good insight into the methods of drug actions, interactions and metabolism. Experience of using specific products is gained both during training and when qualified. Compared to human medicine, where only one species is treated, we have several, often with very different physiologies, which are all covered, but is does mean our patients can have very different requirements. As any doctor or pharmacist will know, most dose levels given in data sheets which accompany every medication, are only guidelines. Some are strict and must be adhered to, some are not, as the dosages can be adjusted to the condition. In one of the examples you cite, a worming medicine is given at a higher level than expected, this is unlikely to have been any significant risk but has to raise the question of whether your vets were familiar with what they were doing, and what they said when they admitted fault.
In the case of Tramadol, I would argue that this should not have been used as it is a human medication which can only be used either once all veterinary approved medications have been ruled out or a specific condition indicates the use of a non-approved human medication (it's called the cascade, which all vets should be familiar with). Overdosing with any drug, approved or otherwise, is not acceptable. Human medicines are supposed to be dispensed in standard packs that are not opened before dispensing, however, due to the size variation in our patients, human packs don't always fit, so to keep costs down, packs are often broken into to dispense an appropriate amount. Mixing of different makes is acceptable but doesn't give a good impression. Getting doses wrong is not acceptable.
Some of what you describe as observational criticisms, are down to your vets using human medicines and/or trying to keep a grip on cost efficiency. This is not ideal, it costs us and our clients significantly more to stay within the veterinary rules as much as possible, which gets us a slagging for otherr reasons.
Do I think your vets are bad? Not necessarily, but if you have 3 incidents of poor prescription policy, then maybe you should raise this with your vets and if you don't get a satisfactory guarantee of staying within the guidelines, you should consider moving. I can't say I'm very impressed with what you have described, it sounds poor.
Thanks for that very good reply. 
When I told the vet about the worming overdose they just apologised said it was their mistake but it wouldn't do any harm.
The mixing of packets I maybe did not make clear. I understand what you are saying and why you do it. My partner does the same in her pharmacy. The vet one was odd as she gave us a blister pack with 2 tablets popped out of the middle of it and then 2 more tablets cut from another pack. This a pharmacist shouldn't do. They can make up tablet numbers from various blister packs but there should not be any empty blisters if you see what I mean, my fault for wording it badly.
Also I wonder are you supposed to give advice with specific medication? For example. The ones my dog had recently were erythromycin. These usually come with an enteric coating so they break down at a certain pH after passing through the stomach. Would you normally give a warning with these to tell the owner not to crush them up into the animals food as they will be fairly useless then.(we had no such warning but luckily knew the tablets)
If I am honest I am considering moving my dog to another practice as another thing that annoys me about where she is now is that she never sees the same vet twice, well I guess she would eventually.
I was talking to my sis about this and she agreed having switched to the same practice as me with her new dog.
With her last dog she went to a different practice a bit further away but loved the fact it was always the same vet she saw who remembered her and her dog from his vaccinations through thick n thin to the day the same guy put him to sleep at 12 years old. She was comforted to know she did the right thing having him put down as the vet could tell when the dog was really ill and not just having a usual down period. (sorry that's not very well worded either)
When I told the vet about the worming overdose they just apologised said it was their mistake but it wouldn't do any harm.
The mixing of packets I maybe did not make clear. I understand what you are saying and why you do it. My partner does the same in her pharmacy. The vet one was odd as she gave us a blister pack with 2 tablets popped out of the middle of it and then 2 more tablets cut from another pack. This a pharmacist shouldn't do. They can make up tablet numbers from various blister packs but there should not be any empty blisters if you see what I mean, my fault for wording it badly.
Also I wonder are you supposed to give advice with specific medication? For example. The ones my dog had recently were erythromycin. These usually come with an enteric coating so they break down at a certain pH after passing through the stomach. Would you normally give a warning with these to tell the owner not to crush them up into the animals food as they will be fairly useless then.(we had no such warning but luckily knew the tablets)
If I am honest I am considering moving my dog to another practice as another thing that annoys me about where she is now is that she never sees the same vet twice, well I guess she would eventually.
I was talking to my sis about this and she agreed having switched to the same practice as me with her new dog.
With her last dog she went to a different practice a bit further away but loved the fact it was always the same vet she saw who remembered her and her dog from his vaccinations through thick n thin to the day the same guy put him to sleep at 12 years old. She was comforted to know she did the right thing having him put down as the vet could tell when the dog was really ill and not just having a usual down period. (sorry that's not very well worded either)
You are correct in that if tablets are supplied in blister packs, they should be dispensed in the blisters, Also, if medications are enteric coated, the client should be asked not to crush up, or given and alternative if crushing is necessary for the animal to get their medication. Specific advice should always be added when necesssary, lack of advice is usually taken to mean "just get them into the animal anyway you can" which is often not the case.
The worming overdose probably wouldn't do any harm as they are tested to the nth degree for safety but doesn't instill confidence.
Seeing the same vet is something we try very hard to sort, but some days it just can't happen, it certainly builds confidence when you ge to trust someone. On the other side of the coin, it can be hard for us as well, I've just been phoned by a friend whose old pooch is father to the two pups (8yr olds) we have, with the message that it's maybe time to put him down, will be going to see them on the way home with a sense of dread, hope it's not that time yet
The worming overdose probably wouldn't do any harm as they are tested to the nth degree for safety but doesn't instill confidence.
Seeing the same vet is something we try very hard to sort, but some days it just can't happen, it certainly builds confidence when you ge to trust someone. On the other side of the coin, it can be hard for us as well, I've just been phoned by a friend whose old pooch is father to the two pups (8yr olds) we have, with the message that it's maybe time to put him down, will be going to see them on the way home with a sense of dread, hope it's not that time yet
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