The vet house-call: realistic goals

There are many big animals, not easily transported, seen regularly in their paddock, but smaller beasties are usually ambulanced to clinic or hospital.  To owners of pets that suffer deep and profound fear when approaching a clinic, whether it be innate or secondary to horrific memories, house-calls often seem like the best solution. However,  before dialing for the mobile vet, it’s important to understand the limitations of what can be realistically achieved in the home environment.

From the vet’s perspective, we always prefer seeing animals in the hospital setting. We can be lazy, waiting in the air-con for you to come to us. We can enjoy all the hospital resources: nurse to help with restraint, nail clipping and sample collection; X-rays and ultrasounds; laboratory and microscope; anaesthetics and medical oxygen.

Animals are usually quieter and easier to handle in a clinic. A dog, emboldened by the confidence of home territory, is more likely to fight examination and restraint. The cat that escapes a house-call vet’s grasp, with full knowledge of the domestic landscape, can disappear under lounge, behind fridge, or out window, and not return for several days. Cats turned angry can quickly transform consultation into a scene from a circus act, minus the flaming hoops.

For some dogs, undignified procedures, like anal gland expression and urethral catheterisation, may be simply out-of -the-question, no matter how much finesse is attempted.  Few pet owners enjoy wrestling with their pet, seeing their loved companion growl with rage through a nylon muzzle, and risks for all parties escalate as placid puppy turns psycho.  There’s no doubt the statistics would confirm that, per hour of labour performed, work related injuries in the field would far exceed those of a hospital.

Chemical restraint is always an option: injections of sedatives, or even brief  IV anaesthetics. But these carry their own problems. Drugs can be slow to act, with protracted recoveries, extending beyond the vet’s visit, leaving an owner with a drunk dog, prone to falling down stairs.

Calmly and quietly performing minor surgeries in the home environment, under twilight sedation and local anaesthetic, would seem ideal. In reality, the resistant patient, like an aggro alcoholic in A & E, may leap from operating table, mid-procedure: something most vets would prefer to avoid. We can minimise this risk by upping the drugs, but then we increase risks of another kind; especially given the lack of hospital oxygen and equipment for monitoring and stabilising the anaesthetised patient.

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That being said, house-calls have many pluses.  Most vets admit to enjoying  the scenic benefits of getting out  of the hospital bunker.  Most non-surgical consultations can be  performed, including: routine physical examination, vaccination, worming, injections of heartworm preventative, microchipping, treatment of eye, ear, and dermatologic problems, and collection of blood, urine and lump aspirates for later analysis. Initial assessment of  acute, weight-bearing  lamenesses  and chronic mobility disorders, such as spinal and arthritic disease, can also be made.

Observing animals in-situ, surrounded by their full ecosystem including humans, and built and natural environments, can offer a vet insights not apparent in the clinic setting. Breakthrough understanding of stubborn flea infestations; mysterious allergies and intoxications; behavioural problems; long term management of mobility problems; and forensic investigation of weird diseases that emerge from backyard biospheres, are all situations where the house-call may trump hospital visit.  Similarly, pets with diseases that only manifest at home, and miraculously resolve when the patient is distracted by the terror of hospital visit, may be easier to diagnose at home.

As macabre as it may sound, euthanasia is the moment when the house-call comes into it’s own. Without risk of public spectacle, or concern of unnecessary stress for the patient, owners are comfortable to grieve with candor. For the vet, ‘Home-Euths’ offer some of the more surreal and poignant  moments in a career of observing the human/animal bond. See Exit Strategies.

Techniques for getting the most out of your next house-call:

  1. Be realistic about the likelihood a vet will be able to manage the problem without hospital facilities.  Calling a mobile vet to a see a dog with leg that is bending in a place that it shouldn’t, or a collapsed, semi-conscious cat, may just waste time and money.
  2. Confine the pet to a sealed room, the smaller and less-furnished the better. A surface for raising small pets off the ground is good.
  3. If there is an eye problem, a room that can be darkened is helpful.
  4. If there is a urinary problem, collecting a sample, even a non-sterile one in a kitty litter tray or dish, can save time and money. Otherwise you may get cornered into restraining your Rotty for urethral catheterisation.
  5. Be prepared to help the vet restrain your pet. This may be as simple as having an old towel or blanket on hand.

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