Full Dog Pod Transcript : Episode 4
Scott: Welcome to another Dog Pod podcast. We are here in breezy Burleigh this morning. I am here with Dr. Kevin Cruickshank, our award-winning vet, our resident vet here on the podcast. Welcome, Kevin.
Dr. Kevin: Thanks Scott. Good to be back.
Scott: This morning, I thought we would talk about the Google patients – it is the people that come in armed with information from Google, and just some of the challenges and some of the advantages I suppose that it also brings to you as a vet. But it’s no doubt something that has changed in the last decade. You would not have had people researching and being as educated the way they are today.
Dr. Kevin: Very much. It is Dr. Google, I know him well. It definitely poses a lot of challenges but it is also a very helpful resource sometimes. The challenge is what information do people trust? Where is it helpful to them?
Scott: Okay. Now, you are a lot more open-minded when we sort of chat together off-air and stuff. You have got a very good approach to this and like, I know myself personally, if I go to my medical doctor and my GP, I sort of– if I go in armed with too much stuff, you get very different reactions and very different attitudes. I think from certain medical experts in the field, but your approach is quite different because you welcome it in some circumstances and there’s other times where it can be just really detrimental because the information is so off-kilter.
Dr. Kevin: Yes, I think it is a balanced approach. I don’t blame people turning to the internet and doing research and looking things up. It is what I would be doing if I was a dog owner because I do that for just about everything else before I go and make a purchase or book accommodation. I do my research there. So why wouldn’t you with either your own symptoms or your pet’s symptoms? But we have a little bit of a saying, please do not confuse your Google search with my Veterinary degree, and that is probably quite true. It is how to interpret the information that we get. That is the thing. Also, whether it is a trusted source that people have. Probably the most useful thing is actually once you have had a diagnosis made. So, once you have seen your vet and then you know with a lot more certainty what your pet probably has, then go and find out further information on how you might be able– what treatment options there might be, management tips and those sorts of things, because I think the biggest pitfall is in making a diagnosis over the Internet.
Scott: Yeah, that makes total sense. So, with the day-to-day stuff that you see through your veterinary clinic and the actual hospital itself. What– I guess what are the common things that sort of people come in with? I mean, obviously there are certain common conditions that they are coming in for quite regularly; this is stuff you see on a weekly, monthly basis that’s pretty common. Is that information fairly consistent from people that are doing their doctor Google search?
Dr. Kevin: No, I think it actually varies a lot, just this week, I had a lady – I could see she was like really, really anxious and worried in the appointment. As the conversation flowed, it came out that she had done her Google research and she really was convinced that her dog had cancer and that I was going to tell her that it needed to be put to sleep.
Dr. Kevin: It had completely benign lumps that did not even actually, in this case, need surgery or anything like that. So, that is probably one of the big pitfalls. It is that you can actually panic yourself that things are worse than they are, because the difficulty with medicine is that lots of symptoms can be present in the same conditions and it could be something really minor. A very common presentation is in animal vomiting. And that can vary from something really serious and being a stomach cancer. It can be kidney failure, or it might just be that they have eaten the wrong food or overeaten or something very minor. And it is difficult for people to know, their dog has one vomit, do they rush it into the vet? How worrying is it? Sometimes, time is really of the essence. So, under those circumstances, we have got to look at a lot more than just one or two symptoms, and putting those together is what is very difficult for an untrained person to do when you are just gleaning some information off the internet.
Scott: Yeah. Absolutely. That makes total sense. I was going to ask you about, I guess, just how much it has changed is probably a starting point from… you have been doing this for twenty-two years in the veterinary space and twenty-two years ago, there was not much with internet stuff. So, it is something that you have no doubt just witnessed evolve. If you go back a decade when people were starting to be savvy online (and we will talk about trusted sources and other stuff as we get into it), but how have their questions changed or even their own approach. Are people coming in more anxious?
Dr. Kevin: Not overall more anxious, sometimes it is a good thing. They know some of the symptoms to mention to us and talk about because they have read about them or they have gone down a list of symptoms and said, “Oh, yes, my dog has this, my dog has that.” So, they are coming in quite informed. I think there are still a number of people who do not necessarily turn to it straight away. But where it is really useful is once you have got a diagnosis and then to actually go and research that condition that your pet has and look at extra things that you can do. That is where it is a real aid to us as a professional, is that we only have twenty minutes with the person, and a lot of that time might be taken up in actually working out what is wrong and they can be a lot more information to convey. So, we might say, “Well, look I really recommend the concept of crate training for your dog for its behavioral problem or something, but I don’t have half an hour to talk you through the steps of training your dog for crate training, but I would suggest you go and have a look at some internet sites that will give you a step-by-step guide to crate training.”
Dr. Kevin: So, I just need to mention the thing that might be helpful for them and they can get glean a lot more information themselves. Also, looking at every website or every person will have a slightly different take on things and a different opinion. Nobody is necessarily perfectly right or outright wrong. But you can see the variance in the different opinions by doing further research and having the time to do that. So, there are so many more resources available for people online these days.
Scott: Yeah, the resources you use, I imagine are quite different to what probably the general dog owner is going to come across as well. You have access to other sort of veterinary science level stuff.
Dr. Kevin: It is certainly has revolutionized the way that we are able to work. We have sites that are specifically set up for veterinarians and that will vary from ones where there is a whole host of further information, both published information, so it has been proven. Then also, sort of posts where we can post questions to further specialists in the field. Now, it does not matter whether they work in the States, whether they work in Europe or here in Australia. The transfer of knowledge is so much quicker for us. We utilize the internet for a lot of webinar training and that sort of thing as well. Even looking up the latest drug doses or newest developments in products and medications that have not even had time maybe, to get into a textbook and be printed. But we have got access and the power of searching. We might know the drug we want to use, but it’s maybe a drug that we normally use in dogs and us wanting to see, could we use it in a cat and what sort of dose should we use? That type of thing. Yes, we wouldn’t really be able to work as well as we do or be as up-to-date without the resources of the internet.
Scott: Are there any examples that spring to mind, for you, where something that you learn whether it was from a customer, we’ll them the Dr. Google patient coming in, or even through those veterinary medical sources that you are talking about now, that have really changed your approach? Like a really big sort of light bulb moment where it just really sorts of gave you a whole 180-degree direction in how you treat animals. Have stuff like that come up a fair bit or…?
Dr. Kevin: Yes. I think you do have to be open-minded and consider that somebody might have found some information that you are not aware of. I certainly know with treating certain types of cancers and they might be a more uncommon tumor that we do not see very often. I can think of some examples where people have come to me with– you know, their dog has a particular diagnosis and especially unfortunately when it might be a terminal diagnosis, so they are really desperate to try and find anything that might work and some that then we’ve said, “Well, yes, it is not commonly used yet, but there does seem to be some suggestion this treatment may work and we have tried it,” under the guidance also sometimes of a specialist’s opinion.
Dr. Kevin: One case comes to mind that didn’t work so well. But then also when it comes to alternative therapies, it is not something that we are widely trained in but there can be some that can be very very helpful. There are some conditions where dogs have a bleeding tendency and some supplements that really work from Chinese herbs and medicine that used to be used in times like the Vietnam War and were well known to help stop bleeding gunshot wounds and those sorts of things. Say, a dog that has a problem with severe nosebleeds. I’ve had a case where I didn’t know about this product at all and it has really been very helpful to control that.
Scott: Yeah, fantastic. That was just like a supplement that someone found?
Dr. Kevin: Absolutely.
Scott: This is a patient not a–?
Dr. Kevin: Yes, it was a patient? The dog and– how this particular supplement works, it is improving the trotting ability of the blood. It was very helpful.
Scott: That is great. What have you found that sort of people come in with that they maybe have read online that is just blatantly dangerous, that they just shouldn’t be doing or trying? No doubt there are great sources of websites and there is some real charlatan sort of stuff out there. But is there anything springing to mind that you have just gone, “Woah, hang on put the brakes on, do not do that,” that is just so far from what you would recommend doing for a dog with a certain condition or anything like that?
Dr. Kevin: It is a tough question. I cannot think of a specific example, but I certainly have had that sort of scenario, because of the issue of not having the diagnosis correct. So, making some assumptions… I guess one example might be putting olive oil down in dogs’ ears when really that is a complete opposite to what you are going to want. You do not want that greasy oily environment, you want it to be able to dry out, you want to be able to clean out the wax and the oil that the body is making; yet you will find that as a recommended treatment on some sites for ear infections or whatever.
Scott: Right. Oh good. That is a great example– because we were chatting about Lagotto dogs. This is one of the dogs that we really like the look of and my wife is really keen on – but they have ear trouble.
Dr. Kevin: Unfortunately, they have very hairy ears so their issue is that they do not get a lot of fresh air down into the ear canals. We all make normal earwax, and so if they are unfortunately prone to ear infections and they enjoy water and swimming, that contributes to their ears being too wet and getting yeast infections commonly.
Scott: Yeah, and they are an Italian dog, Italian Water Dog.
Dr. Kevin: Yes.
Scott: No olive oil [laughter].
Dr. Kevin: Correct. Absolutely.
Scott: Okay. Is there any… I guess I will ask about websites. Are there good sources and obviously there are some really good probably– there’s no doubt there are great Facebook groups and there are some great websites out there in the human space. You see there are so many things popping up. I mean, Google’s indexing of all sorts of stuff is just an incredible resource of course. Is there any that sort of spring to mind for you that you recommend, and what do you guys do yourselves? Because I know you got a very active Instagram, which shares beautiful photos of dogs with the cute bandages around their paws and all that sort of stuff, which is amazing. But in terms of sources, what is a nice trusted place that people who go to, to get some information?
Dr. Kevin: I guess that is another curly difficult question, because I don’t go looking for those sorts of information. I probably do not have a particular one that I would recommend. I am not so familiar with that space. There is so much to keep across. Probably the areas that can be very helpful; there is actually a behaviorist vet out of Brisbane, Dr. Cam Day and he has a very active website particularly on behavioral issues and he is very dynamic in the internet space and online with a lot of sort of self-help, that sort of guided questions, that will lead you then so that it is hopefully the more appropriate information for what you need. His website is all the www.pethealth.com.au. It’s more focused on behavioral things than overall health, but is a trusted source coming from a specialist veterinary behaviorist. That is a good one to look at.
Scott: A big thing people Google as dog owners is a lot of the alternative stuff, the supplements especially, a lot of the different nutritional stuff that is out there. Twenty years ago, it used to be a can of pet food. That is what you would give your dog once or twice a day and some dry food maybe but it’s come so far – this industry. The pet industry is now hundreds of billions of dollars globally. I guess talk us through, and we could do a whole podcast on this itself I suppose when we try to talk about food and supplements and other stuff as well. But what are some of the things that people are kind of Googling and finding that is probably off-limits and what are some really good trusted sort of food and supplements sources that they should be giving their dogs? Does it vary per breed?
Dr. Kevin: Not necessarily varied per breed, but maybe per breed types. So again, some of your larger breeds are more prone to arthritis and there are a lot of supplements that can help in that area. If you are feeding a good quality premium dog food, it really will be balanced to meet all their nutritional needs, that you shouldn’t actually need to give any sort of multivitamin type of supplements with that. But then when you are looking at treating certain specific conditions, then products like glucosamine and chondroitin, green-lipped mussels, turmeric, the fish oils can be very helpful. There are good products available also to help with skin conditions and for trying to naturally reduce itchiness. So again, either fish oils or plant-based oils like flaxseed oil and that sort of thing is very helpful. I actually had another example just this week, where somebody was trying to do the very best that they can for their dog, but did not actually realize what really were the ingredients in the products they were using. They were– luckily not to the harm of the dog– but they were really double-dipping, because they had a product that was a combination product, that had glucosamine, green-lipped mussel and turmeric in it. They were also buying a separate product that had green-lipped mussel and a separate turmeric product. None of these are cheap either, they are really… you know, between the fifty to a hundred dollars a month on the supplements. They were unnecessarily overdoing it. They would have been absolutely fine with just the one combination product and they did not realize what all it had in it, and then they were going out of trying to do the very best for their dog and getting each of the additional ingredients separately.
Scott: So, it wasn’t dangerous to the dog?
Dr. Kevin: It was not dangerous but just an unnecessary spend for them because they did not really understand what the ingredients were in the one product that they had.
Scott: Already meeting the nutritional requirements… So just like normal meatloaves, normal tin can dog food and that sort of stuff typically will meet or…
Dr. Kevin: No, so again, a lot of those types of products that you will get in supermarket dog foods are made a lot from by-product foods. They will meet the bare minimum requirements. What will often happen with those products is, their actual ingredients will change from batch to batch and so, you can then sometimes… A lot of dogs will be fine with that but others will often easily get an upset stomach because, although you think you are still feeding the same brand, what’s in it has actually changed. One time when they are making a batch, it might be the beef off-cuts so they can get them really cheaply. Another time, it might be– there’s a glut of kangaroo. So, the price of kangaroo meat is down. So, they will still use meat in making it, but the actual ingredients vary a bit from one batch to the next.
Scott: It is a mass supply.
Dr. Kevin: Yeah, also something else we can talk about another time is dental care and that sort of thing. But as a generalization my recommendation is to use a dry food over wet food. So, wet foods being canned or rolled and that sort of thing, because chewing on a dry food has more of an abrasive action on the teeth and leads to less dental tartar. But also, a lot of those, especially the dog rolls, are rarely by-product manufacturing. Whereas, your really balanced dry dog food is going to be completely appropriate. They can’t selectively pick out different bits that they like in that.
Scott: Yeah, I got you.
Dr. Kevin: The bigger brands, they employ a lot of specialists, nutritionists, vets. They do a lot of quality control and that sort of thing, so they will be the ones that will make sure that they really are balanced in their nutritional requirements.
Scott: It will be a good topic. We will talk about nutrition in another podcast. I think it is such an interesting topic and one we could probably do multiple on. Just to finish up on the Google vet one. We spoke about this on a previous podcast too, with dog owners being a lot more educated, the health of dogs is improving dramatically. I suppose there is a bit of a positive tick for doctor Google. It is allowing people to become a lot more educated and much more aware of certain conditions that dogs can suffer from and what they can do about it.
Dr. Kevin: I think awareness is a very big one. It’s beneficial in that regard but it is about not over-interpreting symptoms. I guess that is what we are trained to do. It is to put together a number of symptoms, perhaps some test results, and then come up with a diagnosis from that. That is a really difficult skill, because if you take individual symptoms or look at the disease, look at it in the back way around. “Okay. I think my dog has got disease XYZ,” and then read a list of symptoms, you can start convincing yourself that “Yes, my dog has got a whole lot of those,” and inadvertently get sort of a very narrow tunnel vision and decide that your dog has that when you have not had an open mind to see the other possibilities.
Dr. Kevin: I guess just another point to wrap up on an area where the internet is really growing a lot is the online pharmacies that are available. It certainly can allow at people access to some medications a lot cheaper, but what people do not realize or do not see when they are looking at a price on there is that that pharmacy is just giving you the raw price for the product. They may compare that to the price that they have been paying for the exact same product at their vet, without realizing that as vets, we give you the completely upfront all up cost. So, that cost actually includes the prescription fee that is built into the price, the dispensing fee, and the medication. And so, when you look at it just separately as the price– and obviously an online pharmacy has far lower overheads, they do not have to keep the emergency drugs in stock that we do as a physical pharmacy.
You could say at the vet, where we need to have emergency drugs available that we hope we do not ever need but if your dog comes in, in a crisis, we can’t wait a day to order it in from the wholesaler. But unfortunately, often those drugs go out of date and so the costs of that have to be built into your markups and the costs of running a physical pharmacy.
So, people then often get quite surprised when they look at the price listed on online pharmacy and what they have been paying at their vet, not realizing that if they then want to get it. Because you will still need a prescription from your vet, that prescription fee covers the skills of the vet in deciding that that is the right drug for your dog, that it’s still the correct drug to carry on, that the dose is correct, and that it does not need any adjustment.
We then also, when we prescribe a medication, we give out advice on how best to give it, what time of day, medication assistance if you are having difficulties with that. Very, very importantly, we take responsibility for any adverse effects or if we have made a mistake in dispensing that medication. If the online pharmacy sends you the wrong medication and you give it to your dog and you have a problem with that, good luck trying to get them to accept any responsibility.
Whereas, a medication that you get from the vet – we have professional indemnity insurance. We would cover if we had made a mistake in dispensing that product for you. So, we are taking a huge amount of responsibility when we give out a medication or prescribe a medication. That is part of the peace of mind that people are paying for. Never also forget that there is nearly always a shipping cost as well.
So, by the time people put in those different components, it is not as much of a price difference as it initially looks.
Scott: There must be quality issues too, I would imagine. I mean some of these websites are overseas and other things. So, the quality control must be questionable in some circumstances, maybe not all.
Dr. Kevin: That used to be the problem when a lot of the only sources of online pharmacies were overseas. What I have had happened to a few of my clients and they very quickly came back to wanting to get them from us is a costly medication that might be sort of over a hundred dollars for them to get that they were ordering from an overseas online pharmacy, to have it confiscated at customs. Then they had no comeback. It was a legitimate product. But it is illegal to import medications from overseas.
So, even though it wasn’t illicit or anything like that. But that is no longer so much of an issue. There are Australian based online pharmacies for that so that is not too much of a problem. It has its pitfalls.
Scott: Because even just the behavioral training of it; how a dog reacts, how do they take it, what is the best way to be able to dispense it and get the correct dosage into a dog, is where your expertise and skills come in. Look, Kevin, thank you again.
It is such an interesting time and just to finish on, I was just going to ask you about Covid-19, because in the human health space, we have seen a lot of tele-health with medical doctors doing Zoom appointments. Have you had much of this in the vet space?
Dr. Kevin: Yes. We have been and we were actually starting to offer it before Covid-19 came along, because it does offer a lot of convenience for people. You know, we get it. It’s hard to get your dog in the car, bring them into the clinic and even harder often with cats. They hate to go in their carrier and they meow all the way to the clinic. It obviously does have limitations.
You are far better off to physically handle and examine a pet, and you cannot determine as much using a camera and video conferencing, and that sort of thing. But for certain conditions, something like behavior for a check-up after the animal’s had surgery, which is a lot more– it is just finding out from the owner how things are going and maybe just being able to see the dog or the wound a little bit.
It definitely has its applications and can be very very helpful. The interesting thing we have been offering – telemedicine for probably about eighteen months now. But I have found the demand actually really low.
A lot of people far prefer a face-to-face conversation; getting to actually examine their pet, show them things on their dog or cat.
Scott: It makes sense to me. There would be a lot more peace of mind knowing that the vet has their hands on the dog and… yeah, that makes total sense to me.
Dr. Kevin: But I have had a number– especially we had some people a little while ago who were sort of trapped in northern New South Wales. So, we were not able to– we can only do telemedicine if we already know the patient; if there is an established patient-doctor relationship, not for new things. We can do it for new things and also in remote communities.
That is where the application in Australia really first started, is providing it in remote communities where distance is an absolute barrier to people getting in, to do what we call a triage.
So, just deciding how urgent, do they have to get in their car and drive two hundred kilometers to the vet or can we just give some advice over the phone? So, in Northern Australia, it is used quite a lot for after-hours types of situations, and you can triage. You wouldn’t prescribe something without having examined the animal but you can say how urgent you can provide some first aid advice over at tele-consult.
Dr. Kevin: Then, I have also had clients who used to live here and have either moved interstate and a few of them overseas, who still would like maybe a second opinion or advice. Again, I am not able to prescribe things but I have consulted with dogs living in Seattle, living in Las Vegas, and several living in Sydney and that sort of thing now still. So, doing either phone consultations or more commonly telemedicine with a videoconferencing platform.
So, it is definitely just another tool that makes things more convenient for people. It’s not a replacement for a physical examination, but it can be an adjunct or helping people with further advice once we have seen them initially. Now they say, “Okay, now this is happening. What should we do?” We already know the patient. We have already perhaps made the diagnosis, but adding value to their abilities.
Scott: It’s a small part of technology and it is a wonderful world out there on Google. Look, Kevin. Thank you again for joining us. It has always a pleasure, your wealth of knowledge, and we look forward to seeing you on the next one.
Dr. Kevin: As always, only a pleasure.
Scott: Thank you Kevin.
Dr. Kevin: Cheers, Scott.