A quick look at the foreleg of the yellow Labrador in front of me and I see that he's got a lick granuloma. I tell the owner
we need to break his habit of licking the site to allow the inflammation to regress and the wound to heal. The owner has already
tried topical products, such as bitter apple, without any success, but I tell her I have just the right thing in our pharmacy
to get the job done. I leave the exam room and tell my technician that I'd like to prescribe Synotic/Batril. Unfortunately,
I'm told we don't have any. I ask when it will be in and receive that dreaded answer—it's backordered.
A TOUGH ADJUSTMENT
Backordered—the word I dread the most in veterinary practice. When you use PropoFlo in a good percentage of your induction
protocols and then suddenly have to do without for a while, it can be a tough adjustment. When injectable Fentanyl is not
available, you have to rework your pain management strategy. When Immiticide is in limited availability, how do you treat
your heartworm-positive dogs? And now that Cisapride has joined that list, how do you medically manage a cat with megacolon?
True, some of these drugs will come back into the fold eventually, but others are gone for good. And sometimes there are adequate
alternatives available, but other times there aren't.
Now I'm not a pharmacologist or an executive in the pharmaceutical industry, so I can't explain how or why certain drugs drop
off the radar. I do know, however, that we aren't the only industry affected, as some of these drugs are used in dentistry
and human medicine. I also know that when these situations do occur, it forces you to be resourceful. You find other sources
of the medication. And when that's not possible, you get creative and find other ways to treat your patients.
CHANGE IS NEVER EASY
It's easy to get in a comfort zone after a while, to prescribe the same antibiotic or the same pain medication for a litany
of situations. But what's great about medicine is that there are always newer, better medications coming down the pipeline
to improve the care we give our patients.
There are some doctors who are comfortable with what they've been doing for years and don't want to change. But what happens
when the drugs these doctors depend on are no longer available? They have to adjust, whether they want to or not. Change
is never easy, but sometimes it's necessary.
THINK OUTSIDE THE BOX
When I hear that a favorite drug is no longer available, I reflect on how easy it is to take things for granted. There was
a time when PropoFlo or Synotic/Batril didn't exist and we still managed. Veterinary medicine has made incredible strides
through the years and will continue to do so in the years ahead. But there are times when the rug is pulled out from under
us and we have to adjust. Even though we practice a science, there's certainly an art to it as well, and we are often forced
to get creative and think outside the box.
So the next time I hear the word "backordered," it'll probably still send a chill up my spine. But I'll be forced to think
and adjust, and every time I do that, I'll grow a little bit more as a veterinarian.
Dr. Andy Rollo is a Veterinary Economics Editorial Advisory Board member and an associate at Madison Veterinary Hospital in Michigan. Head to http://dvm360.com/rolloblog/ for more blogs from Dr. Rollo. Please send questions or comments to firstname.lastname@example.org