I started my day at the Boai veterinary hospital. Dr. Qiu sees many cases of preventable issues. In fact, he sees about ninety percent walk- in sick patients. In his hospital he had a case of parvo, distemper, pneumonia, a kitten from the shelter with an upper respiratory infection and a dog that had been hit by a car with an expertly fixed comminuted femoral fracture. I watched him work up a dog with bleeding for rat poisoning. Most often, these animals are hospitalized for intravenous treatments, regardless of the severity of the illness. This means most patients will stay for five to seven days. A caregiver in China will often stay by his or her animal, even throughout the day. Dr.Qiu explained that some people are retired and have the luxury to do this but many others take their personal holidays off of work to attend to their pets.
Part of the reason for his extensive use of intravenous treatments over oral prescriptions is because our oral pharmaceutical options greatly outweigh his. Phenypropanolamine and Keppra? These and many other medications are not available for oral use in Chinese veterinary medicine. In fact, Dr. Qiu cannot use most medications unless they are specifically labelled and tested out for use in the species being treated. On the face of it, this rule is to protect the pharmaceutical companies and the effort and expense that it takes to get a medication on the market.
With some probing, I discovered another problem with extra-label prescriptions. Dr. Qiu explained that if an issue arose while using an extra-label medication, regardless of the cause, he could, and would, be held responsible by the client. This can happen in the United States, too, and technically we should be getting signatures every time we use a medication off label. However, in the United States we rely on a standard-of-care that is established at the university and specialty practices. We know specialists rely on extra-label drug use as much as we do and therefore believe we can justify our decisions.
These are valid reasons but still did not satisfy my curiosity because neither seemed strong enough to put such strong limits on treatment options in China. After further discussion, I came to believe the problem is actually one of timing. Modern small animal veterinary medicine is a relatively new field in China. In the late eighties, when Dr. Qiu was in veterinary school, he was taught exclusively large animal medication. These animals were mostly raised for meat. Later, he returned to study small animal medicine. The original strict rules against using medications intended for humans, especially controlled substances, arose as a practical way of keeping these drugs out of the food chain. Now that small animal medicine is thriving in China, the rules have not caught up. For euthanasia, Dr. Qiu has to anesthetize an animal with Telezole and then use Potassium Chloride. He cannot induce anesthesia with Ketamine and Valium. He cannot use Phenobarbital for Status Epilepticus and he cannot treat a cat with an Upper Respiratory Infection with Zithromax. His tool box is much smaller than ours and it makes me thankful we have all the options we do.
At the same time, I now realize I shouldn’t take the extra-label use of medications so lightly. When there is a labelled medication, I should reach for it first. I will be looking at our medications through a new lens. I consider that a good reminder from the East.
Even with a limited pharmacy, especially in regards to controlled substances and oral medications, I am very impressed with the quality of veterinary medicine at the Boai hospital. Patients get state-of-the art care. Most have life threatening illnesses which we rarely see in my hometown due to preventative medicine and strong leash laws for dogs. Yet most patients seem to pull through and are able to go home after being treated aggressively with intravenous medications and intensive support. I am very impressed with Dr.Qiu and his staff!