Telemedicine can be useful to assess whether a pet needs to be seen in person, to monitor chronic conditions such as obesity, and to check a post-surgical incision or a superficial wound
Anyone who has tried to take a pet — especially a cat — to the vet can relate to this.
It starts at home with trying to catch the cat or cats, then escalates during the drive into nonstop crying or — with dogs — persistent barking. In extreme cases, some cats will wet themselves — or worse. Some dogs get carsick. Most pet parents dread these excursions, which also can be frustrating for veterinarians.
“We get calls fairly frequently from people saying they’re going to be late, or need to reschedule, because the cat saw the carrier and went into hiding or they could only find one,” said Kathleen Dougherty, a veterinarian who owns Kenwood Animal Hospital in Bethesda, Md. “Dogs — more often than cats — are happy to go anywhere, but most cats are indoors, so they’re uncomfortable with any changes in routine — strange people, strange environment, different smells and sounds — it’s stressful for them.”
Enter pet telemedicine, an innovation that took hold during the pandemic, just like its human counterpart.
“Some clients love it and are very happy to have it when something simple is going on with their pet, while other times they may feel better being in an exam room,” said Lori Teller, president of the American Veterinary Medical Association (AVMA) and professor of telehealth at Texas A&M School of Veterinary Medicine & Biomedical Sciences. “Many doctors are very comfortable using it, although their biggest concern is a delayed or missed diagnosis.”
It’s unclear how many veterinary practices offer telemedicine, although the AVMA estimated it at about 40 percent during the height of the pandemic, Teller said. It has dropped off since then, she said.
Pet telemedicine is useful for some kinds of care
Telemedicine is good for “triage,” that is, to assess whether a pet needs to be seen in person, and to monitor chronic conditions such as obesity, experts said. It’s also useful to check a post-surgical incision or a superficial wound. And it provides an option for people in areas without animal clinics or where vets are far away who would otherwise drive long distances — or not go at all.
Nan Iwasaki of Redondo Beach, Calif., whose cat Benji had surgery to improve mobility in his crippled back legs — the result of a birth defect — doesn’t have access to telemedicine. In Benji’s case, she wishes she had.
“After his surgery, he had so many unnecessary follow-up vet visits — an hour away — that telemedicine would have eliminated,” she said. “I had to bring in videos of him at each visit to show the vet how he walked — or limped — since they couldn’t get him to walk while at the clinic.”
Vet visits can be stressful for pets
An early unpublished study in cats found that in-person visits caused a rise in stress. Carly Moody and Grace Boone, scientists in the Department of Animal Science at the University of California at Davis, staged mock in-person appointments for 30 cats and their people at a shelter in Sacramento. They also set up video meetings using webcams with the same cats. The sessions were separated by two weeks.
Both types of “visits” mimicked a post-surgery check. The researchers measured pupil dilation, respiratory rate, lip licking and ear position. In the home sessions, pet parents lifted the cats for visual inspection and counted their breaths. All the appointments were recorded, and scientists took photos of the cats’ eyes to measure their pupils.
They found that the cats took more breaths, had larger pupil dilation and more negative ear positions during the in-person exams compared with the home sessions, suggesting increased stress and arousal. Pet parents, when asked, said they preferred the video appointments.
Dogs are not exempt from vet stress. “Some are not comfortable with strangers, strange dogs, and can have ‘white coat syndrome’ just like us,” Dougherty said, referring to the condition in which human patients’ blood pressure readings are higher in a clinic.
Heather Link of Hudson, Ohio, can’t take her rescue dog Trooper into the clinic. “He completely shuts down and enters a catatonic state,” she said. Early attempts to get him inside took more than an hour, and then “he would hide in a corner and shake and not let anyone get near him,” she said. “He gets so scared it truly breaks your heart.”
Some vets wanted to sedate or muzzle him. She tried the drugs, which didn’t work, but wouldn’t muzzle him. “He had been through enough,” she said of his origins as a stray rummaging through trash on the streets of Cleveland.
She finally found a vet willing to see Trooper on the outdoor patio. This enables him to stay current with vaccines and routine exams. For other issues, she sends Trooper’s pictures to the vet, and they consult by phone. “This vet is very understanding of his anxiety and stress,” she said.
The anxiety of the visit often prompts some animals to hide their ailments or behave differently. This makes an accurate diagnosis difficult, Dougherty said.
Some pets become aggressive when frightened or restrained, making them hard to handle. Stress also can affect temperature, heart rate and respiration in both cats and dogs — “think panting, agitated” — and blood sugar in cats, she said. Blood sugar can also change in dogs, “but not as quickly or as significantly as in cats, so is generally not a factor,” Dougherty said.
“I have had a number of pets, both dogs and cats, come in and stop whatever behavior that they were doing as soon as they arrived — this can mean anything from limping, trembling, seizure like behavior, odd or off behavior,” said Christine Klippen, an emergency medicine veterinarian at Friendship Hospital for Animals in D.C., which started telemedicine during the pandemic. “Also, if an owner is on edge themselves, this can transfer to the pet.”
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Still, “without a physical exam, things can become fairly advanced,” said Dougherty, whose practice does not offer telemedicine but is considering it. “There’s no way telemedicine can feel an abdominal mass.”
A vet also can’t vaccinate or draw blood without an in-person visit, experts said.
“Veterinarians rely upon all of their senses,” Klippen said. “When I am assessing an incision or looking for signs of infection, I’m also feeling for warmth or response to pain. I can only take the interpretation of an owner so far. Sometimes they are wrong. If I am wrong, the consequences could be dire.”
Nevertheless, she believes telemedicine is a valuable triage tool. “People will send us pictures and videos, and it’s helpful for me to see what the owner is seeing,” though, she added, laughing, “I have seen more pictures of poop than I really would like.”
How to make the best use of a pet telehealth appointment
There are some things you can do to make a virtual vet visit better, experts say, such as:
- Send photos and videos ahead of time: Take several good photos and videos to show the ailment and send them before the appointment so the vet can review them. “Consider smaller clips rather than longer ones with lots of extraneous activity,” Klippen said.
- Have good lighting and avoid distractions: Be in a room with adequate lighting and no distractions such as a television or radio.
- Check your connectivity and equipment: Like for any virtual meeting, make sure that you have a strong signal, your devices are charged and you can connect to the site used by the vet.
- Have your pet nearby: Some appointments may not require your pet’s presence, but others may. Klippen recommends the pet being hungry. “This way you can have all their attention with high value treats,” she said.
- Be prepared to provide health details on camera: The vet may ask you to do certain things such as “showing your pet’s teeth, taking his pulse, counting her respiration rate, or showing where your furry friend likes to eat and sleep,” Teller said.
The AVMA sees a role for pet telemedicine, with guidelines for using it. Most states and AVMA policy require an established veterinarian-client relationship, meaning that the doctor has already seen the pet in person, before seeing a pet virtually.
“We encourage vets to use telemedicine,” Teller said. “It’s an option for people to better care for their animals that allows us to expand and enhance the care we provide to our patients.”
Source : https://www.washingtonpost.com/wellness/2023/02/24/pet-telemedicine-vet-visits-health/