Dr Nuala Summerfield
BSc BVM&S DipACVIM (Cardiology) DipECVIM CA(Cardiology) MRCVS
RCVS, American and European Specialist in Veterinary Cardiology
With the demands of a busy caseload, high client expections and an ever-expanding (and ever-changing) knowledge base available, it can feel like the easiest option is to refer all but the most routine cases externally. We’ve probably all been in this situation and then worried that we’ve referred a case that we “should” have been able to, and more importantly would have liked to, work-up in-house. With the demands of a busy caseload, high client expections and an ever-expanding (and ever-changing) knowledge base available, it can feel like the easiest option is to refer all but the most routine cases externally. We’ve probably all been in this situation and then worried that we’ve referred a case that we “should” have been able to, and more importantly would have liked to, work-up in-house.
Many commonly encountered conditions that are typically referred externally are in fact relatively straightforward to deal with in a well-equipped first opinion practice. Understandably, these cases may feel a bit out of your comfort-zone to work-up by yourself, BUT with a helping hand from Virtual Veterinary Specialists they will be well within your capabilities!
How can VVS help you?
Virtual Veterinary Specialists (VVS) has been developed specifically to empower first opinion vets who want to diagnose and manage more of their own cases in-house. By working with VVS, you not only ensure improved patient outcomes, but you also reap the associated benefits of retained practice revenue, improved case follow-up and a unique ‘hands-on’ learning opportunity, not typically associated with external referral.
All of our specialists are highly qualified and experienced Diploma holders, so you can be confident in the level of expertise that you, your patients and your clients will benefit from. It’s like having your own multidisciplinary referral service in-house, enabling you to add a whole new level of service for your clients!
VVS uses patented, user-friendly collaboration technology to allow unrestricted sharing of video, voice and data securely and reliably over the internet, enabling you to have virtual consultations with our specialists whenever and wherever you need us.
So, which cases can VVS help you with?
Well, of course this depends on the interests of you and your colleagues in your practice! However, here are some examples of the sorts of cases ideally suited to VVS:
How confident are you with performing cardiac ultrasound and interpreting ECGs? Are you confident staging cardiac disease and advising your clients on prognosis for their pets? Are you aware of the latest evidence-based treatment recommendations and how and when to implement them?
Dogs with asymptomatic Mitral Valve Disease (MVD)
Asymptomatic MVD has received a lot of attention in the veterinary press recently. This is because the recently published EPIC1 study showed that early treatment with pimobendan in MVD Stage B2 dogs will delay the development of symptoms of congestive heart failure (CHF) by an average of 15 months. Yes – that’s an average of 15 months MORE symptom-free, good quality life for your patients! BUT are you confident that you can distinguish MVD Stage B1 from B2? If not, let our Cardiologists help you stage your MVD patients so you can confidently identify those Stage B2 dogs that need treatment, and improve your cardiac ultrasound technique at the same time!
Dogs with early-stage Dilated Cardiomyopathy (DCM)
More than 50% of all Dobermanns will develop DCM in their lifetime. This is a very worrying statistic! BUT, we now know from the PROTECT2 study that in Dobermanns with early-stage DCM (i.e. heart enlargement on ultrasound but no symptoms of CHF), treatment with pimobendan delays the onset of CHF by an average of 9 months. That’s an average of 9 months MORE symptom-free, good quality life in a disease with a previously very poor prognosis! Understandably many vets find diagnosing DCM challenging, especially in the early stages of the disease. Affected dogs may not have a heart murmur and the cardiac ultrasound findings may be subtle. So why not let a VVS Cardiologist help you to make that call!
Cats with heart murmurs
It’s those middle-aged and older cats that present for annual vaccination or perhaps a routine procedure like a dental. You detect a heart murmur – but is it significant? Unfortunately, you can’t tell from listening with a stethoscope which murmurs are benign and which are not. To complicate matters further, there are many cats that have advanced underlying heart disease and no heart murmur! So heart murmurs in cats understandably cause a lot of confusion and anxiety amongst vets in practice – confusion and anxiety that our Cardiology specialists can help to relieve.
Confusing and complex internal medicine cases seem to be becoming more common – probably because dogs and cats are living longer with multiple comorbidities. However, increasingly your clients (quite rightly) expect the same high standard of care for their geriatric pets as a younger animal would receive. That’s where the option to ‘phone a friend’ as an intrinsic part of the VVS consultation comes into its own. Having a friendly and reliable specialist on-hand to disentangle your complex cases not only improves the patient outcome, but also keeps the client happy and retains revenue in the practice.
Why not let our Internal Medicine specialists help you manage your patients suffering from conditions such as:
Thrombocytopenia and other bleeding disorders
Chronic diarrhoea and vomiting
Unexplained weight loss
Pyrexia of unknown origin
Hepatic and pancreatic disease
Unstable diabetes mellitus and other endocrine disorders
So if you would like one of our VVS specialists to help you with any of these case scenarios, or any other cases, then give us a call!
1. Boswood A, Häggström J, Gordon S, et al. Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study – A Randomized Clinical Trial. J Vet Intern Med. 2016. 30:1765–1779.
2. Summerfield NJ, Boswood A, O’Grady MR, et al. Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT Study). J Vet Intern Med. 2012. 26(6):1337-49.