Dispensing/prescribing for Wildlife Rescue Centres

Re: Dispensing/prescribing for Wildlife Rescue Centres

Mark Hedberg — Thu, 09 May 2013 22:30:54 GMT

[quote user="Evelyn Barbour-Hill"]

Can that be true? It doesn't sound like the Harris Hawks that I have known.

[/quote]

Does that sound like an owner who doesn't want to spend £30?

Re: Dispensing/prescribing for Wildlife Rescue Centres

Fable — Thu, 09 May 2013 22:01:44 GMT

[quote user="Evelyn Barbour-Hill"]

Can that be true? It doesn't sound like the Harris Hawks that I have known.

[/quote] Have to say I don't have much (read no) experience with Harris Hawks, but she was maintaining that this one would likely savage someone.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Thu, 09 May 2013 21:43:54 GMT

Fable - there is no way I would prescribe antibiotics in that case.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Evelyn Barbour-Hill — Thu, 09 May 2013 21:37:17 GMT

[quote user="Fable"]After a rather long and heated conversation with the owner, where I was browbeaten with the fact that it wasn't fair for the animal to go untreated, I stood by my guns and refused to prescribe anything.[/quote]

[quote user="Fable"] refused to bring it into the practice for examination claiming that she wouldn't be able to and that it would pose a danger to staff and other animals anyway.[/quote]

Can that be true? It doesn't sound like the Harris Hawks that I have known.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Mark Hedberg — Thu, 09 May 2013 21:35:28 GMT

[quote user="Fable"]Interesting and thought provoking discussion so far. I had a vaguely related sort of situation today where the owner of a Harris Hawk with a swollen foot phoned our practice requesting antibiotics and pain relief for the bird. She point blank refused to bring it into the practice for examination claiming that she wouldn't be able to and that it would pose a danger to staff and other animals anyway. I told her that I was unwilling to prescribe anything for an animal that I had not had the chance to assess and she informed me that she had previously been able to pick up antibiotics for another bird that had had been prescribed by one of my colleagues without an examination. Said colleague was unavailable today. After a rather long and heated conversation with the owner, where I was browbeaten with the fact that it wasn't fair for the animal to go untreated, I stood by my guns and refused to prescribe anything. I felt bad about leaving a sick animal untreated, but I'm sure it would feel equally wrong to have handed out medication for an unknown condition. Just curious to know what others would have done in this situation?

[/quote]Stick to your guns. If it's bumblefoot, for example, then antibiotics and pain relief won't sort the underlying causes that may be either poor diet, inappropriate perching, poor hygiene, or even overweight bird. If you do treat the bird without seeing it and it gets worse, don't worry, it would be absolutely laid at your door by this owner because you've obviously prescribed the wrong thing. The fact that she is unwilling to seek correct veterinary advice will be conveniently ignored.

Don't accept a bully's treatment of you under any circumstances. She's quite right, it's absolutely unfair for the animal to go untreated, and she would be well advised to read up on section 4 of the Animal Welfare Act 2006 where she's committing an offense by letting her animal suffer. Under section 9 she's also required to provide for the animal's needs, such as pain, suffering, and disease.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Mark Naguib — Thu, 09 May 2013 21:33:27 GMT

[/quote]

Exactly the same. There is no good reason why she shouldn't bring the bird in. The hawk posing a danger to staff and other animals is totally ridiculous! Any bird of prey with a swollen foot needs properly assessed - there is a good chance it'll need more than just antibiotics. It is the owner who is choosing not to treat her bird, not you.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Fable — Thu, 09 May 2013 19:50:30 GMT

Interesting and thought provoking discussion so far. I had a vaguely related sort of situation today where the owner of a Harris Hawk with a swollen foot phoned our practice requesting antibiotics and pain relief for the bird. She point blank refused to bring it into the practice for examination claiming that she wouldn't be able to and that it would pose a danger to staff and other animals anyway. I told her that I was unwilling to prescribe anything for an animal that I had not had the chance to assess and she informed me that she had previously been able to pick up antibiotics for another bird that had had been prescribed by one of my colleagues without an examination. Said colleague was unavailable today. After a rather long and heated conversation with the owner, where I was browbeaten with the fact that it wasn't fair for the animal to go untreated, I stood by my guns and refused to prescribe anything. I felt bad about leaving a sick animal untreated, but I'm sure it would feel equally wrong to have handed out medication for an unknown condition. Just curious to know what others would have done in this situation?

Re: Dispensing/prescribing for Wildlife Rescue Centres

James Laidlaw — Thu, 09 May 2013 09:50:27 GMT

No, you point is talking to them, helping them, AND giving them drugs beyond their current requirement to treat patients you haven't yet seen. It's a subtle but important difference in our approaches I think.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Thu, 09 May 2013 09:26:13 GMT

[quote user="James Laidlaw"]Most people appreciate someone talking to them and helping in this way more than just having drugs given to them.[/quote]

That has been my point from the very start!

Re: Dispensing/prescribing for Wildlife Rescue Centres

James Laidlaw — Thu, 09 May 2013 07:47:51 GMT

Michael, I know that we don't control the drugs once they leave our clinic. That was my point. I think dispensing large quantities of medications be it bottles of injectables or boxes of tablets is inherently not a good thing to do. I've met clients in locum jobs from cat rescue centre owners to pet store staff and talked to them about these practices and in most cases changed how they get and use antibiotics or other medications by explaining the risks and regulations. Most people appreciate someone talking to them and helping in this way more than just having drugs given to them.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Thu, 09 May 2013 00:29:06 GMT

[quote user="Gillian Mostyn"]Did you read the original post fully Michael?[/quote]

I did. It seems full of speculation and conjecture:

[quote user="ellypittaway"]but it sounds like [my edit] [/quote]

The OP seemed to be doing some fact-finding before speaking to the people at the centre. That was my reading of it. If the other practice had been just supplying them with drugs and no input the OP should know that.

[quote user="Gillian Mostyn"]Anyway, we've all given our personal opinions - I guess the OP just needs to decide what works for them.[/quote]

Something we can all agree on!

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Wed, 08 May 2013 23:52:10 GMT

[quote user="James Laidlaw"]But a bottle of injectable is ok? Once it leave your clinic you aren't in control of it.

[/quote]

James, just as you are not in control of all the medicines you prescribe. Whether the owner gives the dog the month of antibiotics for the bad skin, or sells the tramadol to his mates down the pub but insist the dog is doing so well on it at check ups.

Doesn't matter that the drug is in tablet or injectable form. You never get the owners bring you the lame dog that has been on Metacam for a week left over from the dead dog, or had 3 days of out of date Canaural from the back of the cupboard? That has never happened to you? I have seen dogs given horse bute, even a dog that cut its leg on a weekend and the owner put it on some left over amoxycillin from her doctor having checked the dose on the internet.

We have a couple of prescribed human medicines from the doctor in the back of the medicine cabinet that we never finished the course of. You never know when you might need half a course of slightly expired erythromycin

Re: Dispensing/prescribing for Wildlife Rescue Centres

Gillian Mostyn — Wed, 08 May 2013 23:38:28 GMT

Did you read the original post fully Michael?

[quote user="ellypittaway"]We've recently been approached by a local Wildlife Rescue Centre, asking us to purchase/dispense medications (POM-Vs) for them to use. [/quote]

[quote user="ellypittaway"]Obviously vets are meant to prescribe only for patients "under our care" - but it sounds like the practice the Wildlife Centre has previously used simply ordered the medications from their wholesaler and then gave them to the Rescue Centre to use pretty much at their discretion (including whole bottles of injectable POM-Vs eg Bisolvon).[/quote]

The rescue centre obviously feels they already know what they are doing - they simply need the drugs supplying. I answered accordingly. You seem to be referring to a theoretical rescue centre with a different approach, and who is looking for a veterinary consultant. This doesn't seem to be the case here.

Anyway, we've all given our personal opinions - I guess the OP just needs to decide what works for them.

Re: Dispensing/prescribing for Wildlife Rescue Centres

James Laidlaw — Wed, 08 May 2013 23:05:36 GMT

But a bottle of injectable is ok? Once it leave your clinic you aren't in control of it.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Wed, 08 May 2013 21:58:21 GMT

Just because there are bad rescue centres and bad vets doesn't mean we need to tar everyone with the same brush.

I suggested sitting down with the person who runs the facility, find out what animals they see, what conditions they have been treating and how they are using the medicines. That discussion will give you a lot of information how much they know and what it is they are treating, and whether they are doing it properly. Depending on their skills, expected usage etc I would base the prescribing on that.

It may be acceptable for them to have a bottle of antibiotic for specific usage. There is nothing wrong with them contacting you before it is used for other things. I get calls/emails/texts every day from clients wanting to know what to treat specific conditions with. A reasonable proportion of the time it ends up in a visit or them bringing the animal down. I remain in control. I have had people abuse the privilege and misuse products and in 1 case I will not prescribe any more than immediate needs.

Kennel cough may have been a bad example, but there are cases where it may be appropriate in small animal practice to prescribe POM-Vs when the specific animal was unseen. How about a bitch that you had seen recently and the owner wants some Milbemax for the puppies. You going to insist each puppy subjected to a full clinical examination? That doesn't mean I am going to hand out a pot of 500 Amoxycilin tablets to a rescue centre.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Chris Geddes — Wed, 08 May 2013 21:35:37 GMT

Speaking personally, I'm very much on the side of not giving rescue centres drugs to use as they see fit, even for things like kennel cough since I picked up a 4-5 month old puppy from a rescue centre.

The dog was scurfy, had a pot belly, had a cough, and slightly loose motions. It was a textbook wormy dog with coughing due to larval migration. Blindingly obvious to a vet, clearly not so for experienced animal handlers. Wormed him, he spent a week bringing up ascarids from virtually all orifices, and was fine.

But....when picking him I was given a load of amoxicillin which they had been giving for weeks for "kennel cough" and I was asked to continue with them (I disposed of them as didn't want to cause a fuss) - this emphasised to me the reason why prescription products should be dispensed on case by case basis. What about ear treatments where there is a grass seed down there, or a ruptured TM, or an ear that progresses to end stage as owner had been constantly shovelling the wrong ear treatment down the ear?. When I asked rescue centre if a vet had seen the dog, I was told no, it was from a big pot their vet gave them for treating infections themselves....No doubt they took themselves when they had a cold etc too...

Re: Dispensing/prescribing for Wildlife Rescue Centres

Christopher Saul — Wed, 08 May 2013 20:57:27 GMT

I have to confess that I am still inclined to reach for antibiotics with kennel cough , but perhaps because I am always subconsciously worried about a complaint rather than really thinking it is indicated.

I do admire your approach Bob. As a profession we really do need to practice better antibiotic stewardship, and not simply prescribe antibiotics because the owners want us to, under fear of complaint if we don't. We will miss the antibiotics when they are gone, then we wont have a choice

Re: Dispensing/prescribing for Wildlife Rescue Centres

Bob Russell — Wed, 08 May 2013 18:03:34 GMT

[quote user="Michael Woodhouse"]

[quote user="Bob Russell"]Is red star man back or does someone genuinely think that antibiotics are useful for kennel cough?[/quote]

I have tried without and they get better faster with antibiotics. Bordetalla susceptible to antibiotics.

Antibiotics remain the main treatment for whooping cough in children.

[/quote]

Treatment for very young babies with whooping cough (similar situation as very young puppies) but children and adults rarely receive antibiotics.

http://www.nhs.uk/Conditions/Whooping-cough/Pages/Treatment.aspx

My clinical cases symptoms generally resolve with meloxicam within a few days. We have cultured Bordetella from BAL's and found very complex resistance patterns so I am not convinced that cases do get better, faster with antibiotics.

I am only talking about cases where the animal remains well. My golden rule is 'if it is bothering the owner more than the dog it is unlikely to need antibiotics'. I have not lost one yet!

Re: Dispensing/prescribing for Wildlife Rescue Centres

James Laidlaw — Wed, 08 May 2013 17:30:00 GMT

I've done it and altered my treatment because of varying degrees of severity of clinical signs, presence of purulent discharge, pyrexia etc. I don't see this as profiteering or inappropriate. I'll ask again, how can you know everything that's going on if you don't see the patient? Granted you can take a good guess, but it's a guess. If you're happy to diagnose and treat on assumption, I'm not going to stop you or try and change your mind, but I do resent the fact that others might call what I decide to do "profiteering". Especially when I don't own any of the practices I've worked for. I get paid per day and no more or less.

Re: Dispensing/prescribing for Wildlife Rescue Centres

Michael Woodhouse — Wed, 08 May 2013 17:27:08 GMT

[quote user="Bob Russell"]Is red star man back or does someone genuinely think that antibiotics are useful for kennel cough?[/quote]

I have tried without and they get better faster with antibiotics. Bordetalla susceptible to antibiotics.

Antibiotics remain the main treatment for whooping cough in children.

Re: Dispensing/prescribing for Wildlife Rescue Centres

David Mills — Wed, 08 May 2013 17:21:10 GMT

[quote user="Michael Woodhouse"]You know what's wrong with them. They are under your care. This is when vets are accused of profiteering.[/quote]

I agree with this, and there is a considerable amount of ego-massaging on clients' expense too. To those who would examine, how many times have you done this and found it to be anything else?

Re: Dispensing/prescribing for Wildlife Rescue Centres

Bob Russell — Wed, 08 May 2013 17:21:04 GMT

[quote user="Bob Russell"]

I don't routinely use antibiotics for kennel cough anyway so that argument would be irrelevant. I put them onto a NSAI's to reduce the inflammation and reduce symptoms that way.

I would want to see the very young and the elderly or those with heart or lung issues anyway (ie high risk cases)!

[/quote]

Is red star man back or does someone genuinely think that antibiotics are useful for kennel cough?

I believe that my role is to ensure that medicines are used carefully and appropriately (especially antibiotics) and this is what I expect from any rescue I deal with!

Re: Dispensing/prescribing for Wildlife Rescue Centres

Martin Atkinson — Wed, 08 May 2013 15:09:51 GMT

I supply a wildlife rescue service (I wouldn't say it's a centre - he's an expert who deals with several organisations and patients vary from orphan garden birds to elephants with (almost literally) everything in between. I trust his knowledge and am prepared to dispense POM-Vs on request after discussion about an individual case or a group of animals to the extent that I've supplied LA Immobilon for his dart gun but only after he signed a form to say that I had advised him on the safe use and that he had shown me he had the skill to use the stuff plus he had a safety protocol in place. However more often than not I'm involved in the diagnosis directly or indirectly and he is also in touch with zoo vets who suggests medication but doesn't have a means of dispensing so I provide for him. I trust him but would not just hand out POM-Vs for general use on whatever came in and certainly wouldn't for someone with virtually no training or expertise at all. I fear Michael's cavalier attitude to his irresponsibility in this matter are akin to his dismissal of his responsibility in the use of his signature on incomplete vaccination records.

Re: Dispensing/prescribing for Wildlife Rescue Centres

James Laidlaw — Wed, 08 May 2013 13:32:11 GMT

[quote user="Michael Woodhouse"]

[quote user="Hannah Wynne Richards"]

PS to above I certainly wouldn't give the other dogs antibiotics without examining them-special appointment at end of surgery or examine in car Why on earth SHOULD I stretch the definition of "under my care " so as to cheat myself out of examination fees????????????????????

Wynne

[/quote]

So would that be 3X1st consult?

You diagnosed the problem in the first dog. By spreading to others that serves as further confirmation of your diagnosis. I'd put the Norodine out (unless there was a specific reason not to).

You know what's wrong with them. They are under your care. This is when vets are accused of profiteering.

[/quote]

Does it serve as confirmation, or just a likely assumption. What if it's something different? You don't know if you don't look, do you?

Re: Dispensing/prescribing for Wildlife Rescue Centres

Bob Russell — Wed, 08 May 2013 13:19:01 GMT

I don't routinely use antibiotics for kennel cough anyway so that argument would be irrelevant. I put them onto a NSAI's to reduce the inflammation and reduce symptoms that way.

I would want to see the very young and the elderly or those with heart or lung issues anyway (ie high risk cases)!