Your pet may develop certain conditions that require a check before prescriptions, and then repeat checks towards the end of the medication course. This can seem frustrating if you are not sure why we need to repeat the same tests or checks. Probably the most common of these situations are ear problems and urinary problems.
Ear problems
We, as vets, can understand why ongoing ear problems drive owners mad. They also can drive us round the bend! The problem with treating ears is that there is often a larger underlying cause for repeat issues; the most common of these are allergies. If the underlying cause is not treated, the ear problems will improve during treatment but will often relapse after and will keep recurring. Occasionally ears can still be a problem even when the underlying issue is addressed but the problem is generally much less severe. If your dog is getting repeat ear issues, speak to the vet about looking into underlying issues.
As an owner of a dog with recurrent ear issues, you may be thinking ‘why on earth do I have to pay for a consult to get the ears checked when it is the same issue as before, and the same treatment works? And why do we have to check again at the end when they seem better?’. There are a few reasons why; almost all are for health reasons, but there is one legal reason.
Health reasons:
If pharmaceutical ear drops are applied to an ear canal and the ear drum is damaged, it can cause deafness. Without a vet physically checking the ear canal, there is absolutely no way of knowing if the ear drum is intact and therefore whether drops are safe to administer.
The appearance of ‘the gunge’ within the ear canal can give an indication as to the type and severity of bacterial infection and may affect our choice in antibiotics. Just because a product has worked in the past, it doesn’t mean it will work this time. The gold standard method of treatment is to send a swab to the lab to tell us exactly which antibiotic will kill the bugs.
There may not even be an infection in the ears! We regularly see dogs with itchy ears purely due to inflamed skin and allergies rather than infection with bacteria or yeasts. For these animals, antibiotics or fungicides will not help, and their use will contribute to antimicrobial resistance. The reason the drops will help and make you think they are treating an infection is that they almost all contain a small amount of steroid which calms the inflammation. The same effect can be gained from much more appropriate treatments without contributing to antimicrobial resistance.
Rechecking at the end is to assess whether the infection is going or gone. If it is nearly, but not quite resolved when medication is stopped, that infection may bounce right back, and the frustration will grow as there is another recurrence of ear issues. We can get an idea from appearance of the ear canal, but ideally, we should send a swab to the lab to confirm that there is no more bacterial growth.
Legal reasons:
As vets, we are not allowed to prescribe to an animal unless it is directly ‘under our care’. This means that we must be sure that the medication is appropriate for the current condition and will not do more harm than good. We cannot do this without putting our hands on the animal.
Urinary problems
You may be sure that your pet has a urinary infection, and sometimes your vet may be pretty sure from clinical history and examination alone. Sadly however, vets do not have the ability diagnose bacterial infections without the benefit of lab tests. There is simply no way of knowing without looking at a urine sample under the microscope or sending it away to culture/grow the bacteria. It is entirely inappropriate to blind treat for an infection without checking first as it can directly contribute to antimicrobial resistance.
Furthermore, there may not be an infection. It may be something completely different such as urinary crystals or even cancers. Not only would the money spent on antibiotics be a waste, but we might also miss an important diagnosis of another condition.
The reason we recheck urine at the end of an antibiotic course is the same as for ears; we need to make sure that the infection has resolved before stopping treatment, or we will be right back at square one with the infection once the antibiotics have finished.
Hopefully this has given a bit of clarity about why we need to check and recheck. If you are not sure about any part of the treatment of your pet, speak to the prescribing vet and they will explain the reason for their decision making.
