Changing Specialists - What Would You Do?

[vjgrey]

Some of you may've read my February 5th thread on Diamond. She woke up completely unable to use her back legs. We rushed her in for an emergency appointment with her regular vet who said she needed to see a neurologist immediately. The vet called around to various neurologists to see who could see her with no notice and found that we could take her to a specialist clinic about fifteen minutes away. We'd been referred to the clinic before with Lucy, (although that was Internal Medicine, not neurology) and had been reasonably happy with them. We also knew Diamond couldn't wait to see someone, so we agreed to take her there.

 

Long story (and long day) short, she was diagnosed via MRI with a herninated disc in her neck. The neurologist said he didn't think it required surgery at this point - he prescribed pepcid, 20mg of prednisone (10mg x 2 per day) and gabapentin. The meds worked, and she was walking almost normally within a few days, but the high dosage of pred gave her gastroenteritis, so her pred was reduced to once per day. She was on that dosage for three weeks before they asked us to start weaning her off - with pred every other day and the same dose of gabapentin. That did NOT work, and she started to lose function in her back legs again, so we're back to once a day. Here are my questions/concerns:

 

1) We haven't spoken to the neurologist since the day she was diagnosed. When I call the clinic, I'm sent to neurology's voicemail and one of the neuro nurses calls me back. If I ask to speak to the vet, they tell me they'll pass on the message...and then a neuro nurse calls me back. All of my questions so far have been answered by the nurses (sometimes after "let me ask Dr. X and call you back.")

 

Fortunately, I don't have a lot of experience with veterinary specialists, so I don't know whether this is common. Aside from the internal medicine visit with Lucy at this office (which needed little follow-up), my only experience is with an oncologist (Gabe) and a cardiologist (Lucy) - both at another local clinic. Both the oncologist and the cardiologist were extremely busy, but BOTH took the time to talk to me personally about every single concern, every med question, every issue, every single time. If I called the clinic with a question, the oncologist would even call me back on his days off.

 

After that kind of care, NEVER getting to speak to the neurologist, not once, is really bothering me.

 

2) They've expressed no interest in a follow-up visit, although I've asked about it repeatedly. She's basically doing okay right now, but with a serious issue like this, I kind of expected the neurologist to want to see her again. At the very least, I had a long list of questions about her long-term care, since they're not recommending surgery. They told me I could discuss all of my questions with the nurse - who can answer them herself or consult the neurologist.

 

3) They've expressed no concern about long-term prednisone use. Diamond has now been on it daily for five weeks, and they've mentioned that we may try to start weaning her down after another two. She's doing okay with it, aside from a few incontinence issues, but I worry about how long is too long.

 

4) The neuro nurse didn't tell me that panting was a known side-effect of prednisone even after I called twice, asking whether it was a sign that Diamond was in pain.

 

So all together, I'm really unhappy with the neurologist and would like to move her to the other clinic - the one whose oncology department saw Gabe and whose cardiologist has treated Lucy. I believe the clinic that's seeing Diamond does have another neurologist, but from what I've read, the phone relay, etc... is just standard operating procedure for that office.

 

The problem is, I know they won't agree to discuss meds, etc... without seeing her, and I cringe at the thought of facing another consultancy fee. It would be somewhere around $300 for just the initial visit.

 

Worth it? Or since she's basically doing okay now and we're just adjusting meds, should I stick it out with the absentee neurologist and his nurses?

 

And how long on prednisone is too long? When should I become really concerned that they're not more concerned about it?

 

[EnzaFerrari]

I saw the neurologist up at VSOM and loved them. LOVED them but it can take a while to get in. But it might be worth a call.

[greyhead]

Oh my, I'm so there with you. But I'll spare you that story. What I might do -- and have done -- is make an appointment and just go. It should cost around $100, give or take, as a follow-up rather than initial eval. (I've made appointments just to talk, even without the animal present, because I needed more information than I was getting through the techs.) If they ask why, you can tell them that you need to talk to the doctor about Diamond's future and you're willing to pay to do so. It will be interesting if they say "no" and you ask "why."

 

The alternative is to have a new doc have to do a complete new eval, and it's expensive, and it shouldn't be necessary. That's my thinking anyhow. Wishing you much luck with this.

[KF_in_Georgia]

You have a right to all of Diamond's records from the current neurologist: the paperwork, lab work, any films. Those files might reduce the cost of an initial visit at a new doctor's.

 

I'd worry about the prospect of an emergency for Diamond--or the possibility that something you're doing (like the prednisone) is running an unnecessary risk--while you're with the current neurologist and getting no feedback from that doctor.

 

But maybe take greyhead's suggestion and insist on a face-to-face appointment with the neurologist, and if you're not happy with that visit, ask for Diamond's records before you leave. Then make an appointment elsewhere.

 

I had one dog at a specialist. All their follow-up calls and my calls about meds went to the tech. But the doctor himself called any time he was prescribing new meds (once the results of the culture came in) or advising me to extend or stop meds.

[vjgrey]

Oh my, I'm so there with you. But I'll spare you that story. What I might do -- and have done -- is make an appointment and just go. It should cost around $100, give or take, as a follow-up rather than initial eval. (I've made appointments just to talk, even without the animal present, because I needed more information than I was getting through the techs.) If they ask why, you can tell them that you need to talk to the doctor about Diamond's future and you're willing to pay to do so. It will be interesting if they say "no" and you ask "why."

 

The alternative is to have a new doc have to do a complete new eval, and it's expensive, and it shouldn't be necessary. That's my thinking anyhow. Wishing you much luck with this.

 

For some reason, it hadn't occurred to me to see whether they'd schedule it as a follow-up, or even just a discussion with me, instead of a full initial consult. While I'm really unhappy with her current neuro, I have no reason to doubt the diagnosis, since the herniated disc was clearly visible on the MRI. All I really want is someone with a medical degree who's willing to discuss her long-term care with me and also someone with a medical degree who will be actively monitoring her meds. I kind of get the feeling that the current clinic is sort of arbitrarily raising and lowering her dosage based on my phone calls without looking at how long she's been on them or when they really need to be tapered off.

Edited March 7, 2013 by vjgrey

[greyhead]

One disadvantage to transferring responsibility for ongoing care to another vet that I have run into, I'm sorry to say, is that the vet is unwilling to change the protocol put in place by the specialist. We're struggling with that now, with both dogs. Our regular vet is a wuss about it, IMHO, but Spencer's internist thinks we should see her about his current problem. Presumably, the internist has no appointments open, not that I've asked. (We're speaking through emails, at least.) I just needed to know what could have caused him to get hot, panting, and with a badly swollen tongue!

 

Our shane's acupuncture vet said he needs to add metacam to his meds for a recent injury, but she didn't write a prescription. I called and asked his regular vet to do so; her reply -- a full 24 hours later, through the head tech -- is that if the acupuncture vet thinks Shane needs it, the acupuncturist should prescribe it. I think I detect politics and personal dislike here.

 

As you can probably tell, I'm frustrated by all three of them. But I'm moving forward, remembering to breathe, despite feeling ticked off and discouraged. Which is why I think if you can push the neuro into talking to you about your concerns for treatment going forward, I think it would be more satisfactory. And I share the concern of KFinGeorgia about an emergency and about the harm prednisone may cause.

[turbotaina]

Valerie, I'm not sure where you're going now, but I understand that Dr. Tisches at Bush (Springfield) is very good: http://bvns.net/about/our-specialists/ I have a number of friends who have gone to her with both greyhounds and non-greyhounds, and I understand her to be very personable and involved with her clients. I hope you can get it worked out - your wishes are certainly not unrealistic.

 

As far as "how long is too long" to be on pred - well, that depends on the dog. Long term use can certainly be problematic - I had a friend who treated her greyhound for about a year or so and he began to get skin infections and "'roid rage". He had GME and could not be completely taken off steroids or he'd go out of remission.

Edited March 7, 2013 by turbotaina

[tbhounds]

Not being to speak to the neuro Dr is unacceptable-period! I would make one more call to them and express your displeasure & be rather frank with them expressing your concerns. Relay to them that you would be more than happy to return for a recheck appointment where you may be able to discuss long term outlook etc.. Honestly, if this specialist is too busy to speak to you to you really want to be under their care anyway? Maybe at the very least they could supply you with an e-mail address.

[JJNg]

Have you come right out and told the nurses that you'd like to speak with the neurologist yourself, and can he please call you back? And if they say no, ask why, and see if you can make an appointment to speak with the doctor directly. It's possible that this is just their standard procedure, and the neurologist has no idea that you're frustrated and want to speak with him.

[vjgrey]

Have you come right out and told the nurses that you'd like to speak with the neurologist yourself, and can he please call you back? And if they say no, ask why, and see if you can make an appointment to speak with the doctor directly. It's possible that this is just their standard procedure, and the neurologist has no idea that you're frustrated and want to speak with him.

 

 

Yes, I have. They never say "no," they just say they'll pass along the message, and then a few hours later, or the next day, one of the neuro nurses calls me back.

 

I don't think he's avoiding me, personally - I'm sure it is standard procedure. In fact, I've read complaints about other vets in the clinic doing the same thing. That's why I'm leaning toward moving to a different clinic, rather than just asking if we can see one of the other neurologists in their practice.

[carronstar]

Not being able to speak with the specialist is unacceptable. Granted, it may take time for them to call you/text you/email you back but it sounds as though you are being blocked at every try. My specialist is not for neuro but he will return all calls/texts/emails as soon as he can. That is what I expect from my girl's doc. He doesn't have to drop everything when I call but he does have to be available to me if I need to speak to him. I do understand that he is at a teaching hospital so it could take time but he always gets back to me. Diamond deserves that! So do you.

[NeylasMom]

Just go to the other clinic. You aren't happy with the care you're getting, it's worth a couple of hundred backs to be happy, especially if this is potentially a long term issue. I'm not sure though why you think the initial appt will be that expensive? I'm in the same area as you and the most I've paid was $225 but that was the insane oncology department at Friendship. Typically I expect the consult fee to be $125-150.

[vjgrey]

Just go to the other clinic. You aren't happy with the care you're getting, it's worth a couple of hundred backs to be happy, especially if this is potentially a long term issue. I'm not sure though why you think the initial appt will be that expensive? I'm in the same area as you and the most I've paid was $225 but that was the insane oncology department at Friendship. Typically I expect the consult fee to be $125-150.

 

 

We paid a $290 consult fee for her current neurologist - although it may've been slightly higher for an emergency appointment (it wasn't marked that way on the bill - just marked as a neuro consult).

 

I think we paid $275 for Lucy's consult with a cardiologist last year and a similar fee for Gabe's first appointment with his oncologist.

Edited March 8, 2013 by vjgrey

[a_daerr]

Eh, I understand where you're coming from. You've paid a heck of a lot of money to have to start all over again with someone new. I would probably call and ask to speak to the office manager. Complain to them, and tell them you're getting fed up with getting the runaround. Tell them it's important that you speak to the neurologist directly, otherwise you will be taking your business elsewhere. That should light a fire under their arses. If not, then at that point, you'd have no other choice but to change doctors. My vet calls and has spoken to me on the phone for 30-45 minutes about my dogs (I'm neurotic and usually have a million and one questions). I can see how it would be frustrating to have to go through a middleman everytime.

[duncan41]

They don't care if you take your business elsewhere. Sad, but true. It's difficult, political and one of those situations that calls for diplomacy and a stiff backbone. Valerie, if you feel you owe it to the neurologist to give it one more try, I like the suggestion of speaking to the office/practice manager (better for you if there is a practice manager), but be prepared with a very specific list of concerns, specific questions, the person from whom you expect to hear by telephone or in a face-to-face, and a deadline. Demand (nicely) to fax/email the list so there will be no misunderstandings. The response will tell you what you need to do.

 

I wish you well and more than that, I wish a sustained recovery for Diamond.

[TwiggysMom]

I struggled a bit with switching Twiggy's specialist, too. Eventually, I got to a tipping point and didn't feel I could go back to the original one.

 

The new specialist is so much better, and in a lucky twist, is actually only half the cost of the original one - I wish I knew about him right from the start. Honestly, even if the current one was the one that cost twice as much, I'd still be happy with the change.

 

My point is, you need to be comfortable with those who are planning and directing the care of your hounds. If you feel like you would be more comfortable with another practice, then it is probably worth it to switch. I also think it is good to get different perspectives on treatment, so a fresh set of eyes could be good in many ways.