Veterinary Medicine

Gold bars

Is ‘Gold Standard’ Care Always the Best Option? 

It Depends.

Every day, in exam room conversations with clients, our veterinarians describe what we consider to be the “gold standard” of care as it relates to the patient’s situation. 

To us, gold standard care represents the most advanced care our profession currently has to offer. It’s a standard constantly evolving in our medical journals and the continuing education seminars we attend to keep up with the latest, greatest advancements in veterinary medicine. 

We accept gold standard diagnostic and treatment protocols as objectively ideal. When a client chooses gold standard care for one of our patients, our work on the leading edge of medical practice tends to be especially satisfying.  

Does that mean gold standard care is always the best option for all clients and patients?

Actually, it depends.

The Original Gold Standard

Originally, “the gold standard” referred to a monetary system linking the value of a country’s currency directly to gold. The gold standard is no longer used by any government, but the notion of a gold standard as an ideal lives on in many settings where there are options to be considered and choices to be made. 

As veterinarians, we are medically and ethically obligated to offer gold standard care as something of an ultimate option to all our clients—often as the first option we present. 

We would be remiss in our duties if we didn’t.

There are times when the client stops us right there, hearing only “gold standard” and insisting they want nothing but the best available exams, tests, procedures and treatments for their pet. 

More often, after defining the gold standard, we talk about other diagnostic and treatment options as well, aiming to help our clients sort through sometimes difficult choices and ultimately discern the wisest, most loving way forward for themselves and their pets.

We understand for any given client and patient, the best choice may or may not be our profession’s currently agreed-upon gold standard. 

Quality of Care Considerations

Calling any one diagnostic and treatment plan “the gold standard” seems to imply that other approaches are somehow substandard. 

That is not necessarily the case. For many clients, for many reasons, gold standard care is simply not an option, or not the best option. 

At Brownsburg Animal Clinic, in addition to the gold standard, we offer multiple levels of care to make our services accessible to as many of our clients and patients as possible.

As long as the alternative diagnostic and treatment approaches are evidence-based good medicine and we agree our services will benefit the client and patient, we want to offer them. 

Cost Considerations

We know gold standard sounds expensive. Often it is. 

Advancements in veterinary medicine over the past decade or two have made previously unimaginable diagnostic and treatment options available now. 

These advancements have come at a price. Leading edge medicine often requires substantial investments in research and development and in technologically advanced new equipment. The very latest tests, drugs and procedures are almost always more costly than more traditional approaches.

We understand for most of our clients, cost is an important consideration in choosing the most appropriate care option. We are happy to explore lower-cost alternatives to gold standard care. Just speak up and let us know your concerns.

Your Pet’s Temperament and Quality of Life

Some pets love trips to the vet. They tolerate all sorts of processes and procedures well, apparently taking surgeries, therapies and even prolonged hospitalizations in stride. 

For others, the stresses of testing and treatment can be traumatizing. 

If your pet is the anxious, fearful type, the best care option for you may well be the least disruptive and invasive one. 

For any pet, the discomfort that comes with some forms of treatment, such as surgery, radiation and chemotherapy, must be weighed against quality of life.

Regardless of cost or a possible increase in your pet’s length of life, you may decide you simply don’t want to put your pet through a full treatment protocol, opting instead for plenty of treats and palliative care. 

Your Capacity to Provide Home Care

Veterinary care often requires at least some degree of cooperation with the pet owner in the form of supportive home care. But depending on your family and work responsibilities and any physical limitations you may have, care options requiring extensive home care may not be a viable choice for you and your pet. 

If you don’t have the time or the ability to administer medicines and participate in rehabilitation, you may opt for a care plan that fits best with your capacity to provide home care. 

Your Pet’s Age and General Health

We can never be certain as to how well a particular pet will respond to a given course of treatment. We do know in general, the pets we expect to experience the best long-term outcomes tend to be younger and, apart from the condition being treated, in better overall health. 

In choosing a care option, your pet’s age, normal life expectancy and general health are all factors to consider. For a pet already nearing the end of its natural life, the more complex and radical approaches—promising as they may be—are probably not the most appropriate for your pet, who if given the choice, would likely prefer to live out the rest of its life in comfort and peace.

The Choice Is Yours

At Brownsburg Animal Clinic, we see every case—every pet, every owner and every situation—as one-of-a-kind. Just because the most advanced, cutting-edge diagnostic or treatment option is available doesn’t mean it’s the right option for you and your pet. 

In our exam rooms, you can count on our veterinarians to present you with a range of available care options, of which our profession’s current agreed-upon gold standard is only one. Once we’ve presented the possibilities, it’s up to you to decide the best choice for you and your pet—our patient. 

We encourage you to ask questions and let us know your concerns—financial, physical, emotional and otherwise—so that together, we can come up with a workable, guilt-free plan that best suits you and your pet. 

Whatever care option you choose, we consider it our moral and ethical duty to respect your decision and practice the best possible medicine we can to improve your pet’s comfort and quality of life for the rest of its life with the resources at our disposal. 

Puppy and kitten

When to Spay or Neuter? It’s Complicated.

February is Spay/Neuter Awareness Month, with World Spay Day to be observed on the fourth Tuesday. 

Like most veterinarians, we at Brownsburg Animal Clinic generally recommend spaying or neutering any pet not intended for breeding. 

But in recent years, we’ve been following research that indicates we should fine-tune each pet’s most appropriate age for the procedure, ranging from five months to as old as two years, depending on the pet. 

If you’re the owner of a kitten or puppy, our veterinarians will discuss the best time to spay or neuter your pet. 

The Benefits of Spay/Neuter

The practice of routinely spaying and neutering pets has long been recognized as the best way to reduce the pet overpopulation problem while saving pet owners the trouble and expense of unwanted litters.

Spaying helps protect female pets from serious health problems such as uterine infections and breast cancer. 

Neutering male pets can reduce the risk of developing an enlarged prostate and testicular cancer.

Many owners find their pets’ behavior improved after surgery to remove their ovaries or testes. While the procedures have no effect on a pet’s intelligence, activities or performance, spaying and neutering can reduce unwanted behaviors associated with mating instincts, such as roaming, aggression and marking. 

Many people believe spaying and neutering makes pets better companions.

When to Spay or Neuter? These Days, It’s Complicated.

During the past decade, veterinary researchers have come to understand the hormones that make procreation possible and cause undesirable mating behaviors may also affect pets’ overall health. For dogs, it now appears the most appropriate age for spaying and neutering can vary widely from pet to pet. 

While the consensus among feline specialists is to spay or neuter all kittens not meant for breeding before five months of age, evidence is accumulating to suggest routinely spaying or neutering all dogs at the same young age may increase the risk of orthopedic problems and some types of cancer for some animals. 

One 2020 study of 35 dog breeds suggested early sterilization in some dogs appeared to increase the risk of diseases such as cranial cruciate ligament rupture, hemangiosarcoma, mast cell tumors, lymphosarcoma and hip dysplasia. 

According to the study report, “The overall major finding from the present study is that there are breed differences—and sometimes sex differences—with regard to the increased risks of joint disorders and cancers associated with neutering at various ages.”

The study’s authors encourage using data-based information to make case-by-case decisions with your veterinarian about the appropriate age to neuter your puppy or young dog. 

The authors noted, “an elevated risk for a joint disorder or cancer occurs in relatively few of these breeds. In other words, with most breeds or sexes, neutering can apparently be done without referral to a particular age, at least with regard to the joint disorders or cancers covered in this study.

“To just delay neutering by a year or so to lower the risk of a joint disorder or cancer in those breeds where the issue is relevant, is a noteworthy goal, making it worthwhile [for veterinarians] to discuss appropriate ages to neuter with caregivers who have a new puppy.”

Our Advice

At Brownsburg Animal Clinic, we strongly recommend spaying and neutering at the appropriate age as the best option for any dog or cat not intended for breeding. 

For kittens, we agree with our colleagues specializing in feline medicine that the procedure should be done before five months of age.

As we learn more about the long-term risks of routinely spaying and neutering dogs at a set young age, we are taking a more individualized approach to recommending the ideal age for the surgery based on your pet’s breed, size and gender. We’ll talk with you about what the latest research indicates is the best time to spay or neuter your pet. 

Additional Reading

The American Veterinary Medical Association offers general background information for pet owners on spaying and neutering.  

The AVMA website also has a page about spaying and neutering for veterinarians, offering guidance on making the best recommendations for their feline and canine patients.

The American Animal Hospital Association’s article, “When should I spay or neuter my pet?” outlines the considerations to discuss with your veterinarian when deciding the appropriate age for spaying or neutering.

Frontiers, a publisher of scientific research papers, offers the full text of the 2020 study report referenced above.

The 35 breeds included in the study are, alphabetically, Australian Cattle Dog, Australian Shepherd, Beagle, Bernese Mountain Dog, Border Collie, Boston Terrier, Boxer, Bulldog, Cavalier King Charles Spaniel, Chihuahua, Cocker Spaniel, Collie, Corgi (Pembroke and Cardigan combined), Dachshund, Doberman Pinscher, English Springer Spaniel, German Shepherd Dog, Golden Retriever, Great Dane, Irish Wolfhound, Jack Russell Terrier, Labrador Retriever, Maltese, Miniature Schnauzer, Pomeranian, Poodle-Miniature, Poodle-Standard, Poodle-Toy, Pug, Rottweiler, Saint Bernard, Shetland Sheepdog, Shih Tzu, West Highland White Terrier, and Yorkshire Terrier. 

In addition to general guidelines related to body size, the report includes specific recommendations for each breed. 

Google home page screen shot

Calling Dr. Google

Within the medical community, doctors and staff sometimes refer disparagingly to “Dr. Google”  and the clients who search the Internet for medical information.

67% of pet owners bring Internet research on their phone or web page print-outs.

At Brownsburg Animal Clinic, we choose a more enlightened view of our Internet-based colleague. We appreciate it when our clients take the initiative and try to learn more about their pets’ health so they can ask better questions and make better-informed decisions.

To get the greatest benefit out of online resources as a complement to the medical advice you receive from our veterinarians and staff, we suggest you stick to mainstream veterinary medical sites. In our experience, sites maintained by professional societies and colleges of veterinary medicine offer more reliable information than sites maintained by individual veterinarians.

Here, in no particular order, are some of our favorite online sources:

The American Heartworm Society’s web site has a pet owner resources section that is ideal for learning the basics about heartworm disease and its treatment and prevention.

The Companion Animal Parasite Council (CAPC) maintains an informative web site with guidelines for controlling internal and external parasites that threaten the health of pets and people. There are sections for dog owners and cat owners and one containing articles of interest to families. Clickable maps show the prevalence of various kinds of parasites in the United States. Click on Indiana and see a county-by-county breakdown. The Resources tab reveals a list of brochures and articles. has a wealth of reliable veterinary medical information for pet owners. While the site design is busy and dated, the search function makes it easy to find articles about specific topics.

The Cornell Feline Health Center web site,  published by the Cornell University College of Veterinary Medicine, focuses on all major aspects of caring for cats.

Cornell’s Canine Health Center web site offers similar resources to help care for dogs.

Six St. Bernards lying in the grass

Emergency and Specialty Referrals

Have you ever brought your pet here or to some other general veterinary practice and been referred to a specialist or advised to head over to the local emergency clinic?

There was a time, 30 or 40 years ago, when small animal general practitioners did, or at least tried to do, everything. We still do a lot. Most of us do some dentistry and many are comfortable and capable handling some orthopedic procedures.

But with the recent advances in veterinary medicine, specialization has flourished. The American Veterinary Medical Association currently recognizes 22 veterinary specialty organizations. These range from veterinary dermatology to surgery to ophthalmology to dentistry to critical care.

If you bring your pet in, and one of our doctors refers you to a specialist, or an emergency clinic or a 24-hour veterinary care facility, chances are it’s because we believe your pet would benefit from specialized and/or round-the-clock care.

So, you ask, what do we “regular vets” learn in vet school then?

We learn a little bit of everything! In many areas of veterinary medicine, we actually learn a lot, and we keep on learning through continuing education. Our veterinarians are all very knowledgeable and comfortable diagnosing and treating many common ailments. But from time to time, we recommend a specialist as the best person to diagnose and treat rare, complicated, chronic or severe cases.

For example, if your pet has been hit by a car and has multiple fractures, like most regular clinics, we do not have bone plating materials that may be indicated for the types of injury your pet has. So we send you to an orthopedist who has what’s needed to care for your pet.

Or if your pet has severe allergies, and we’ve tried dozens of diets and medications, and your pet is still itchy, we may send you to a dermatologist for allergy testing.

If you come in at 5:45 p.m. and the clinic closes at 6:00, and your pet has been vomiting non-stop for 24 hours, we may send you to an ER as they offer 24-hour care plus a critical care specialist who can take the time and apply the specialized expertise to be sure your pet has the best possible chance of recovery.

So if you come to the clinic and one of our doctors recommends a specialist or sends you to the ER, rest assured it is because in our best judgment, we believe your pet will experience the best outcomes being cared for by someone with more experience and more sophisticated, specialized equipment for diagnosing and treating the particular illness or condition. And that means your pet has the best chances of healing in the shortest amount of time.

Two retriever puppies chewing sticks

IVMA Response to Indy Star Series

The Indy Star’s “Pets at Risk” series raised a number of important issues that affect all our clients in their relationships with their pets. At the same time, the articles also suggest that some veterinarians are unduly influenced by our desires for financial gain at the expense of our patients’ health and our clients’ wellbeing.

I encourage you to read the response of the Indiana Veterinary Medical Association to the series.

If you have questions or concerns about the articles, or any aspect of your pet’s health and our recommended treatment and preventive measures, please talk to me or one of the other doctors at the clinic.