The “spectrum of care” concept may have been born out of budget constraints, but there are many other reasons we might need to weigh Plan A against Plan B or Plan C. Sometimes the care limits are defined by something totally apart from finances. For example, a handful of my patients live outdoors and can’t receive medicine on a daily basis. Although we do have a (very) few extended-release injections, the vast majority of ongoing medical conditions will require daily treatment. This type of scenario may therefore require us to go with Plan B or Plan C. I’ve had a patient that could only be snared once a day for his twice-a-day medicine. He was not using it according to the label, but some treatment, in that case, was better than none.
Some of my patients can’t be medicated with pills at all because of aggressive behavior when their mouth is handled. These pets can sometimes still receive their medicine every day (without any casualties) if we team up with the compounding pharmacy. Some drugs can be made into an ointment that is dotted onto bare skin and produces the same effect as a pill or capsule. The development of this technology was a godsend for veterinary medicine, but it only works for a very small number of drugs. Compounding pharmacies that work with pets are very creative at reinventing pharmaceuticals in the form of biscuits, chews, and tasty liquids, but there are still some patients too stubborn to concede. If someone is at risk for injury in the process of giving the medicine, then we might have to go with Plan B or C.
One particularly frustrating scenario is the pet that is nearly impossible to transport to the clinic. This might be due to their temperament or size, or the transportation constraints of their owners (e.g., don’t own a car, or can’t get time away from work to travel to the specialist). One way to approach this is to make a connection with a house call service or perhaps a telehealth veterinarian, but those are not easy to find. This situation may force us to offer a lower standard of care, because some is better than none at all.
The need for numerous prescriptions is not unusual as animals age and develop multiple health issues. If balancing all the pharmaceuticals is such a burden that it is actually diminishing the pet’s quality of life, then we need to make some challenging decisions. Because the patient’s comfort is paramount, we might even need to settle on Plan D, where no intervention is used and the illness is allowed to take its course.
Plan A comes from the doctor; it’s always intended to be the safest and most effective. For various reasons, however, plan A isn’t always realistic. The best medical care for the situation is always going to come when our clients are open about their limitations, whatever those might be. Then we can work as a team to create a brand-new strategy, somewhere along the “spectrum”.
Dr. M.S. Regan