Saturday, May 31, 2008

Ticks, Ehrlichiosis, and Vet Care

Back off, buddy!

As usual, I have to make the disclaimer that when I talk about any situation, I refer only to what I know.  Sometimes that's just Potrerillos, sometimes that includes David, sometimes it's the country as a whole.  I usually try to make it clear how narrow the focus is.

In talking about the vet situation here, I want to say immediately that I've seen reports saying that there is outstanding vet care in Panama City.  But when you have a crisis, you need someone close to home.  And "close to home" is, for all intents and purposes for us, David.  Supposedly there's a Panamanian vet in Dolega, which is a lot closer to us, but given our overall experience with vets here in the province, I haven't even bothered considering leaving our current vet.  There's been too much anguish on our part and suffering on the part of one of our cats to consider another option at this point.

There are at least three problems, serious ones, for those of us who have dogs and cats.

1) Finding competent vet care. There IS good vet care in David, but there are a disproportional number of incompetent vets and outright frauds in the area, including David. I speak from bitter personal experience. I would classify our vet from "very good" to "excellent" depending on what's involved. I really, really like him for preventative medicine and for non-invasive techniques. He's a good vet surgeon. He knows well the parasite problem here in the tropics. And, rare with the vets I've encountered here or have heard stories about, he's careful with dosages. I have had a vet in David toss a box of medication at me and tell me to give it to one of our cats. When I asked him about the dose, he carelessly gave me a number. I looked it up on the Internet, and found that it was too high--appropriate for dogs but not for cats.  In addition, there was no indication that the medication itself was appropriate for cats.  There are many times where the two animals need very different medications for the same problem.   Our vet, who freely admitted to me early on that he had little experience with cats, is gaining that experience because increasing numbers of ex-pats are bringing cats to him, and Panamanians as well.  At that time, he told me that his practice was 90%  dogs and 10% cats but that his cat practice was increasing.  I'm sure the percentage of cats is now much, much higher.  Two vets, whom I will hate until I die, prescribed acetaminaphen, the basis of Tylenol, for one of our cats as a pain medication after surgery.  I didn't realize it at first, because the one vet bought the stuff, gave it to me--and it said paracetymol, which is how it's known outside the US and Canada. It's deadly for cats. The one vet had already killed two kittens in this way. We had to use him on an emergency basis, but I knew better than to give what he gave me to our cat.  I call the one The Butcher and the other The Cat Assassin; the latter is as well nearly totally incompetent at surgery.  But they're cheap, I'll given them that.

But our vet is basically a "family" vet, not a specialist. He misdiagnosed Chloe with kidney failure, based on blood tests, not on a specific test for Ehrlichiosis. First, Ehrlichiosis is supposedly rare in cats, and second, renal failure is one of the symptoms of the chronic phase. Plus, Chloe never did have an acute phase.  So, the mistake was easy to make.  Only when the usual avenues of medication didn't work did Chloe see a specialist. 

Which leads back to--did Chloe have some mutated form of the disease? Was it some other disease, given the difficulty in identification? We'll never know.  Frankly, given the usual prognosis for an animal showing the symptoms of chronic Ehrlichiosis, I don't think that an early diagnosis would have made much difference.

2) Tick control. The only spot insecticide available here in Chiriquí and most likely in Panamá is Revolution. Revolution is effective only against D. variabilis; it does not work against R. sanguineus, the more usual Ehrlichiosis carrier. I'm sure this insecticide was developed because this tick is a major vector of Rocky Mountain Spotted Fever.  Our neighbors import a broader spectrum spot insecticide.  Yet, what happened with Chloe?  They've been using that insecticide for 4 years.  None of us have any reasonable ideas.

The other method of tick control is keeping the grasses and shrubs, where ticks thrive, cut low.  There are any number of reasons why I spend so much time weed eating, but that's a major one.  Examining the dogs daily if not twice a day is yet another way, although even that isn't foolproof against the tiny forms of the red dog flea.

3) Obtaining medications.  You would be surprised what is not available in this country, never mind Chiriquí.  For example, according to the farmacia at Rey, you can't get Bufferin in this country.  I had thought it was just a provincial thing, because we had been searching high and low for it, but like some other products, it just isn't imported into Panamá.  You can get cardioaspirina, which is buffered, in 80 mg doses suitable to take daily as a preventative against stroke (which both of us do), but the usual dose size of Bufferin (and Tylenol, aspirin, and ibuprofen) is 325 mg, perfect for large dogs.  Aspirin is ok for dogs (but will kill cats) but the buffered variety is much, much safer.  Given the cost of the cardioaspirina, it would be prohibitive to use it except in a dire emergency for the dogs.  So, every year when Mary returns to the US to visit family, she goes with a list of things to bring back that we can't get here; that list includes large bottles of Bufferin for both animal and human use. 

 Another vet medication, a common one, that is not available here is PPA, which is used to control incontinence in dogs.   We use an herbal medicine especially formulated for canine incontinence, but we have to import it from the US.  Recently Panamá imposed a $15 import tax on all medications, even vitamins, regardless of quantity.  So, we order quarterly. Although I will say that our last shipment, which arrived recently, seemed to have an import duty of only $12.  Who knows.

Doxycycline is used to treat animal Erlichiosis as well as the human form.  I know that our neighbor had to get it from somewhere because it wasn't available in Chiriquí.  Whether she had to get it from Panama City or from the US, I don't know.  I imagine that Panama City would have a medication like that.

When you look at the country of origin of most vet medications bought in David, it's Costa Rica.  I have been able to buy quite a lot of the routine vet meds for the dogs here, but more specialized meds need to be imported, usually from the US.

There is no laboratory in Chiriquí devoted exclusively to veterinary medicine. Our vet routinely sends his samples to Hospital Chiriquí. I have no problem with this.  A more inconvenient problem is that at the moment, no vet in Chiriquí has a functioning x-ray.  There is one callous fraud who has a machine, but either it doesn't work or he doesn't know how to use it.  He took x-rays of one of our cats, made pronouncements about the lack of certain things we were looking for--and then charged us $66 for the two x-rays.  Later, when we finally discovered our current vet and he recommended x-rays, I showed him those that had been taken; he threw them aside with the comment that they were no x-rays--they were incredibly overexposed.  He then sent us to Hospital Cattan, which of course is a facility for humans, but the technician there is very used to doing animal x-rays.  I showed him the x-rays The Fraud had taken, and he just laughed.  After we saw the ones taken at Cattan, I could see why.  The price for two x-rays?  $15.

I often wonder if the massive dose of x-rays from The Fraud aggravated Tulip's cancer.  The Fraud, by the way, has no idea how to medicate.  He told me proudly that he uses only medications prepared for humans.  The only problem with that is many human medications won't work on dogs and cats.

Not that our current vet is perfect.  He tends to make snap decisions in ordinary sorts of things.  I have to slow him down with questions, but sooner or later we get to a satisfactory result.  Nor do I wish to imply that he's the only good vet.  There may be others, especially those who might have moved into David in the last year or so.  We're satisfied with ours, so we don't go looking.

Incompetent vet care is not limited to David and surroundings.  Where we lived in the US, in our area, there were exactly two vet clinics.  One was and probably still is run by an incompetent vet.  His associate is very good.  The other is run by a very good vet.   But for specialists, you have to go into Seattle.

I often reflect on what we ask of vets and doctors, which is nothing less than perfection.  Both are our mediators between life and death for us and our families, including our animal families.  Both vets and doctors are human; they make mistakes.  Sometimes, those mistakes result in the deaths of those we love.  Physicians are held to a higher standard of accountability than are vets.  After all, as I heard someone say not too long ago, pets are "just animals".   For those of us who consider our animals as part of our families, that's simply not true.  I remember well when my children were infants, before they could talk--when they became ill, I agonized because they couldn't tell me what was wrong.  I feel exactly the same way about our dogs and cats.

When we made the decision to move here, there was never a question in our minds about the fact that all our animals would go with us.  For us, it would be equivalent to deciding to leave a child behind. That included our three cats, two of whom had terminal cancer but in the early stages and could expect to live a quality life for a while longer. Moving those animals internationally was absolutely the most hair-raising part of the whole experience.  I might add that all five of them came through with flying colors (I can never resist plays on words), especially the dogs who thought it was a lark, while the humans barely survived.

Making such a move, no matter how well you are prepared, is still a jump into the unknown, a break with comfort, an acceptance of risk.  We deliberately decided that all seven of us would take that risk together, as a family.  


La Gringa said...

I feel your pain, Joyce. It is so tough to feel confident in vet care. We only have two vets in La Ceiba. One, who seems to be the more popular, scares me to death. I've heard so many horror stories, first-hand from the people whose pets were killed, maimed, or left to suffer a horrible death.

Doing your own research on the internet as far as treatments or medication dosages is really the best bet.

It is a sad and scary situation.

Joyce said...

Thanks, LG. I haven't even written why I hate those two because the memories, even after three years, are so painful. The Cat Assassin almost killed Tulip through a massive dose of anesthesia. In the US, we're used to gas anesthesia. Here, they give something by injection. This murderer did not know the correct amount for a cat. Tulip was out cold for nearly 12 hours. There's more, but I prefer not to go into it.

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