Telemedicine saves the day for vets

Pandemic or not, telemedicine continues to be an essential tool that veterinarians and their clients use to improve the health and welfare of animals.

However, as the current crisis unfolds, the use of telemedicine is gaining increased traction as a front-line method for diagnosing and treating animal patients while following public health and augmenting other social distancing protocols.

“In the current environment of responding to COVID-19, it’s really accelerated the adoption of telemedicine and practices across the province as all practices try to continue to deliver services in this new reality of physical distancing and isolation. We’re seeing quite a bit of evidence from our practices that are using the service to help protect animal health and welfare,” said Phil Buote, complaints director and deputy registrar from the Alberta Veterinary Medical Association.

Dr. Tara Risling of Cochrane Animal Clinic has seen an influx of emails, texts and videos for several weeks at her mixed animal practice in Cochrane, Alta., which does three-quarters of its business with companion animals and the other 25 percent in large animal care.

“People are really calling and asking the questions — this is what’s going on, do you need to see the animal or not? And then we’ve been choosing the appropriate path,” said the veterinarian.

Like most Canadian businesses that have adjusted to social distancing guidelines, veterinary clinics have changed the way they do business during the past month.

Clients are not allowed in the clinic, but are met in the parking lot by a technician where information is gathered and the animal is dropped off if need be.

Pets are processed using a triage system, which balances the most critical and ill animals in combination with a first-come, first-served system.

However, on the large animal side, not much has changed because telemedicine procedures and technology were already in widespread use, particularly at cattle operations said Dr. Kent Weir of Weir Veterinary Services in Lloydminster.

“I don’t think you’d notice a huge change in what we’re doing right now versus what we had been doing before,” said Weir, who is also president of the Saskatchewan Veterinary Medical Association.

“I would say at this point, on farm hasn’t changed a whole lot. Farmers are at pretty low risk, constantly in self isolation and they’re taking the social distancing pretty seriously as well.”

As beef operations continue to get larger and more widespread, cellphones have become the top choice for communicating information between the vet and client.

Large animal veterinarian Dr. Nathan Erickson said he often starts his work day looking at photos that clients have emailed or texted him on his phone.

“If I can just look at it and answer the question quickly by text I’ll do that. But quite often it requires a conversation,” said Erickson who teaches in the Western College of Veterinary Medicine at the University of Saskatchewan.

He said veterinarians have become much more reliant on having initial discussions about herd health using the phone to send videos and still images to determine a course of action before travelling to the operation.

“Sometimes there can be a bit of a time lag and management needs to be started before we can actually get there,” he said.

Buote said a recent survey studied how veterinary practices and clients communicated with each other and found more than a third were receiving information through either text message, still pictures or video.

Erickson is also seeing an increase in telemedicine with clients that had not been using it before the pandemic, particularly with companion animals, which includes horses.

“There’s more consultation going on over the phone right now with clients trying to figure out, ‘OK, can this wait a little while or can you just provide maybe a urine sample or a fecal sample or something like that and bring it in?’ ” he said.

This is where having an established veterinary client patient relationship (VCPR) is important, added Weir.

“It’s ensuring that if I’m giving advice to someone on the phone, that I actually know who they are and I kind of understand their practices, so that I can trust that if I’m going to prescribe something, they’re going to use it appropriately and what they’re telling me is indeed the truth,” he said.

For the past few years, Buote said VCPR has been top of mind for veterinary associations across Canada in terms developing animal health protocols and issue prescriptions.

“A lot of that discussion was in the context of access to antimicrobials in light of a Health Canada policy change in late 2018. So veterinarians regularly communicate with their producers and they need to oversee certain treatments,” he said.

“In many cases that’s going to need an in-person visit for an examination of animals. But in some instances, a veterinarian could be writing a prescription for animals that don’t even exist yet.”

Telemedicine has also been important for preventive medicine, such as established vaccine or treatment protocols.

This could include setting up a protocol with the producer about how to deal with newborn diseases in the spring before the animals are born.

“So they could book a telemedicine consult video conference to discuss the expected needs for issuing those animal health protocols and those prescriptions that could happen. Given the existing relationship and knowledge about the producer, knowledge about their premises and how they manage the cow herd and the vaccination status, that veterinarian could develop a protocol and issue a prescription,” said Buote.

However, he points out telemedicine is not a replacement for conventional, in-person, hands-on veterinary medicine.

“If all of a sudden a producer is in the middle of a real wreck, let’s say where there’s a high mortality because of neonatal diarrhea, it might be a stretch to think that the veterinarian could appropriately diagnose and treat those animals by video conference alone,” he said.

In a situation like that, he said vets need to be on the farm looking at the sick calves, collecting samples and doing post-mortem examinations.

“Telemedicine does not represent a huge shift or a completely alternate way of delivering veterinary medicine, but it’s going to complement the good work that veterinarians do already,” he said.

The pandemic may also be speeding up the technological development of communication platforms being used in telemedicine.

Different herd management mobile apps are playing a larger role because they can create a permanent record of discussions and information between the veterinarian and producer.

“There’s companies popping up all over the place that are trying to design platforms that allow you to connect with your patients over the phone,” said Weir.

He said the negative impacts of COVID-19 are being reduced with the use of modern communication technologies that make telemedicine possible.

“It’s huge. Twenty years ago, it would have made things a lot more difficult. It’d be very challenging to perform any kind of accurate telemedicine,” said Weir.

Added Risling: “If this had happened in a different era, our ability to protect the population would be different because we just didn’t have the technology to do the real-time sending of videos or FaceTime, etc. That would have been a hindrance and everybody’s exposure would be higher.”

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