Posts Tagged ‘second opinion’

What is a Veterinary Specialist?

March 21, 2010

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology.  The responses have been strongly disapproving, and here is the reason why:  The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing.  (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty.  This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds.  Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon!  Veterinary specialists are found in university teaching hospitals and in some private practices.  They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise.  When this is the case, you, the lucky client, end up with access to multiple specialists under one roof.  Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

  1. A second opinion is desired by you or your veterinarian.  Yes, you definitely have the right to request a second opinion.  I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.
  2. Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.
  3. Your vet doesn’t specialize in the disease your pet has or the therapy he needs.  Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist?  Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites.  Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist?  Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian?  If so, please share your experience.  I’d love to hear from you.

Diplomate, ACVIM Internal medicine (
Diplomate, ACVIM, Cardiology Cardiology (
Diplomate, ACVIM, Oncology Oncology (
Diplomate, ACVIM, Neurology Neurology (
Diplomate, ACVS Surgery  (
Diplomate, ACVD Dermatology (
Diplomate, ACVR Radiology (
Diplomate, ACVO Ophthalmology (
Diplomate, AVECC Emergency and critical care (
Diplomate, ACVA Anesthesiology (
Diplomate DACVB Behavior (
Diplomate, ACVN Nutrition (
Diplomate, AVDC Dentistry (
Diplomate, ACT Theriogenology (
CVA Veterinary acupuncture (
TCVM Chinese veterinary medicine (
AVH Homeopathy ( or (
ACVA Chiropractic (
CCRP Canine rehabilitation (

Best wishes to you and your four-legged family members for abundant good health,

Nancy Kay, DVM
Diplomate, ACVIM
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

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Please visit to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at, local bookstores, or your favorite online book seller.

The Evil That Lurks in California

October 2, 2009

You’ve heard it in the news.  There’s the gazillion dollar budget deficit, declining academic test scores, state park closures, and never-ending heated discussion about gay marriage and illegal immigrants.  What you may not know is that there is something even more sinister lurking in California.  It is of the ilk that science fiction writers fantasize about- alien creatures that penetrate body cavities, migrate through tissues, and wreak havoc!

Take the recent case of Emma Louise, a darling four-year-old residing in northern California.  One minute she was a healthy, happy, go-lucky little girl.  The next minute she was writhing in pain.  Doctors could not figure out what was wrong.  Little did they know that an alien had invaded her being and poor little Emma Louise was incapable of describing the evil that lurked within…….

Hmm, as I write this I’m wondering if I’ve been denying in inner desire to write science fiction!  I met Emma Louise just a few days ago.  She came to me for a second opinion to try to figure out the cause of her abdominal discomfort. Emma Louise is undeniably adorable- part hound dog and part Brittany Spaniel- and there’s nothing she enjoys more than running through fields with her nose to the ground.  The problem is, the fields are loaded with foxtails- awful little bristly weeds that grow rampantly throughout California in the late spring and summer months.  They seem hell bent on finding their way into dogs’ noses, ears, eyes, mouths, and just about every other orifice.  Not only is the dog’s body incapable of degrading or decomposing them, the foxtails are barbed in such a way that they can only move in a “forward” direction.  Unless caught early, they can migrate through the body causing infection and tissue damage.  Once foxtails have moved internally, they are notoriously difficult to find- they become the proverbial needle in a haystack.

Apparently Emma Louise was a “foxtail magnet” having accumulated several in her ears and nose over the years.  Her current symptoms were different than any she’d experienced before- she appeared to have abdominal pain and was straining to urinate and have bowel movements.  Other than a mild fever and some abdominal splinting, her physical examination findings were unremarkable. I performed abdominal ultrasound and discovered a gigantic abscess tucked up under Emma Louise’s spine and extending back (towards her tail) into the pelvic canal.  Given this girl’s history, I just knew there had to be a foxtail somewhere in that huge abscess pocket.  The question was, would we be able to find it.

I prayed to the “god of foxtails” and turned Emma Louise over to one of my esteemed colleagues (a surgical specialist) for abdominal exploratory surgery. After approximately two hours of me biting my nails and some expletives heard in the operating room, there was a shout of “Hurray!” My colleague had located and removed the foxtail!  Now with some post-op exercise restriction and a course of antibiotics, Emma Louise will be good as new.  Not finding the foxtail would have meant lifelong antibiotics, unless the foxtail migratory course happened to exit the body.

Perhaps you’ve always wanted to experience the unique flavors and marvelous beauty of California.  After reading this, you might just have a change of heart- now that you know of the evil that lurks there!

Now, here’s wishing you and your four-legged family members much good health!

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

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