Sunday, September 14, 2014

Taking Your Pet to the Vet in Berlin: An Expat's Experience

Flash enjoying the Berlin sun during a cone-free moment

When we were preparing to move to Germany, we didn't know what to expect from the veterinary system here. We've had to put it to the test over the last few months because our cat, Flash, has had some unexpected health problems. We would say that, given the right doctors, Berlin is a great place for your pets. The quality of care is equal to that in the US. The biggest challenge is the language barrier. A smile goes a long way, as do tearful, pleading eyes. And there are English-speaking vets out there, you just have to find them.

Finding a Vet

The symbol of a veterinary practice
A veterinarian is called a Tierarzt in German (Tier means animal, and Arzt means doctor or physician). Veterinarians seem to be relatively ubiquitous in Berlin, possibly because they are often small, individual practices. Walking around the city, they are easy to spot because they all have the same little sign above their doors - a black snake pole-dancing above a white "V" on a red circle. In the urban part of Berlin, most people are walking, riding bikes, or taking public transit, so you tend to see the same cluster of services - pharmacy, doctor, grocery, kebab stand, two cafes, four bars, etc. - every few blocks. But if you don't want to spend the time just wandering around hoping to come across your neighborhood vet, you might do what we did and Google it.

If you search Google in English, you're likely to come across some helpful advice from other expats on forums such as Toytown and AngloInfo. But it's best in combination with searches in German that include the name of your neighborhood - in our case, "tierarzt Neukolln". You'll find many listings this way, and often with starred Google reviews to help you pick one. But, if you need a lesson in Google search, remember that the perfect vet for you may not be one of the first ten results.

Before we left the US, we also used the German website of Hill's Pet, the maker of our cat's prescription food. This was initially just to be certain that we could get his food in Germany, but it was also a pretty good mapped listing of vets in Berlin. We found Dr. Kai Uwe-Dix in Prenzlauer Berg this way, and his office was our source of food for the first few months here.

Flash in his cone
Because we didn't want to take the time to find a new vet, and because we thought Flash would only have to go once, we took a taxi all the way from Neukölln to Prenzlauer Berg to see Dr. Dix when Flash started having trouble. But when it became clear that Flash's problem was more complicated then expected, we decided to find a new vet that was closer and that had more resources, expertise, and availability.

We were able to find the Zentrum für Tiermedizin, a full service, 24-hour veterinary clinic over in Schöneberg. It's still about 20 minutes away in a taxi, but we chose it because it has a large staff of good doctors - including one of the only animal neurologists in Berlin - and a modern facility with an in-house lab and imaging. Many of the small vet practices have limited hours, only one doctor on staff, and fewer on-site resources.

When he has his cone one, we have to hand feed him :)

Our Experience at the Vet

We've taken Flash to the vet five times so far in Berlin - twice to Dr. Dix, and three times at the Zentrum. Overall, the vets here in Berlin seem to be on par with those in Los Angeles. At Dr. Dix's office, there was a very small waiting room, which means that when there are two rowdy dogs, for instance, your cat will be in a living hell. Luckily, it wasn't too crowded when we visited. The exam room was large and doubles as the doctor's office. They have an x-ray lab in the back, but it's not digital, so when Flash needed an x-ray, we had wait for it to develop for thirty minutes. They kept Flash back there unnecessarily while we waited, which was another reason we decided to look for a new vet. The nurse assistant speaks relatively good English, which is very important. Dr. Dix's English was comparatively poor, but his manner and skill in handling Flash was excellent. He seemed kind and caring.

At the Zentrum, the waiting room is much larger but it is consistently busier than at Dr. Dix's practice. There is a second waiting room area off to the side that is a little quieter and more comfortable, and there is a consultation room behind heavy glass doors that you are allowed to bring your pet into while waiting, if it's not in use. It's quiet in there, with a little bubbling aquarium with fish and turtle. It's a blessing for Flash, who can't stand the barking dogs out in the echoey waiting room. The receptionists and nurses vary in their English proficiency, but the doctors all speak excellent English, which is fantastic for us.

The Zentrum facility is very modern. There are exam rooms on both the ground floor and the upper floor. The labs and surgery rooms are also upstairs. All of the exam rooms are networked, so no matter where you are, the doctors can pull up your file in an instant. This is particularly useful when you have to see different doctors, as we have. Flash has been seen by three doctors here, Dr. Wagner, one of the younger emergency doctors, Dr. Kück, one of the senior general physicians, and Dr. Deutschland, the resident neurologist. Yes, Flash's German neurologist is named "Dr. Germany".

Flash has a complicated condition, which is why we've had to take him in so much. Months ago, we noticed that he was licking and chewing on his back foot a lot. We took him to see Dr. Dix, who wasn't too concerned, and thought Flash may have slightly injured one of his toes somehow. He sent us home, with the instruction that if the problem didn't resolve itself in one week, that we should come back and he'd take x-rays. A week later, Flash was showing the same symptom, so we went back. Dr. Dix took an x-ray (Röntgenaufnahme), which showed no break or fracture. But the toe still appeared inflamed, so he gave Flash a 14-day antibiotic injection.

After about a week, Flash's foot was still about the same and he began showing other symptoms. Once or twice a day, he would have a fit where he would lick and bite at one foot, and then the other. His lower back and haunches would twitch, and he'd randomly bite at his skin. His eyes would be wide and he'd seem very agitated. We sent Dr. Dix a video of this, and he suggested that the problem could be neurological. This kind of freaked us out, so we thought it would be a good idea to get a second opinion. We chose the Zentrum because they advertised so many on-site diagnostic services and were open 24 hours, like a hospital. At this point, Flash's symptoms were concerning but he seemed mostly ok. We took him to the Zentrum and he was examined (examination is Untersuchung in German) by Dr. Wagner, who also suggested a neurological condition, and suggested we make an appointment with Dr. Deutschland.

Dr. Wagner also drew Flash's blood, which was a very traumatic experience for Flash (and us). It seemed to be very painful for Flash, as well as terrifying. Despite everything he's been through in the past - a life-threatening liver disease, a surgical procedure to install a feeding tube in his neck, multiple blood draws, many vet visits - this particular blood draw was worse for some reason. He's never howled so loudly, never become so violent, and never been so withdrawn afterwards. We've always been able to approach him and handle him no matter what he's been going through, but this time he was lashing out defensively even at us. Back at home, he still seemed traumatized, and even had a nightmare later where he growled in his sleep, something we've never seen him do. And every subsequent vet visit has been more difficult than ever - in the past, even after surgery and hospitalization, his return visits to the vet were pretty easy and he didn't seem especially stressed. But now, he's extremely stressed and strikes at anyone who comes close to him.

In fact, at Flash's first visit with Dr. Deutschland, Flash wouldn't allow anyone near him, so the doctor could only visually inspect him from afar and listen to our descriptions. Dr. Deutschland wanted us to spend two to three weeks eliminating possible environmental factors such as allergens and irritants. Dr. Deutschland was also concerned about Flash's skin health, observing that it looked oily and scaly. He gave us a bottle of Omega-3 and -6 oil to add to his diet. But, predictably, Flash wouldn't touch any food that smelled or tasted of the stuff, and got really nauseated and freaked out when we tried to give it to him directly. Our instincts told us that allergies or skin health were not the issue, but we took Flash home and tried to follow his instructions to the best of our ability.

Looking sharp in his Comfy Cone
One other possibility was a condition called Feline Hyperesthesia Syndrome, or Rolling Skin Disease, a rare and mysterious condition that is a diagnosis of exclusion. However, it seemed to fit more than anything else. Our research online indicated that stress could be one of the factors in causing or exacerbating this condition, so we also dedicated ourselves to reducing any stressors in Flash's life. What is ironic is that we have to take him to place that terrifies him, and that his treatment at home has consisted of of bathing him, oral injections of medicine, and wearing a cone - all things that stress him out.

The treatments mentioned above were prescribed by a third vet we saw at the clinic, Dr. Kück. We took Flash to see her after about a week of watching Flash's symptoms get worse. It got to the point where we were desperate to get him some relief. The biting and licking and twitching fits were more intense and frequent, and Flash seemed really uncomfortable. After an extremely difficult exam, in which Dr. Kück utilized heavy gloves fit for a falconeer and a big blanket, we were sent home with a whole bunch of things to do for him. A two week course of the anti-inflammatory steroid Prednisolone, a week of antibiotics, a daily anti-bacterial shampoo, anti-bacterial ear drops, and the dreaded Elizabethan collar to prevent any further infection caused by licking.

Paper towel to prevent licking the cone
While the treatments did clear up his infection, the licking and biting behavior continued, and we were stuck with keeping his E-collar on him all the time. The next step was to have Dr. Deutschland put Flash under light anesthetic and give him a very thorough examination and perform diagnostic radiology (Strahlendiagnostik) of his entire body. Fortunately, the doctor found that Flash's body was in very good health - no spinal problems, no arthritis, no problems with his organs. So, we're down to these possible conclusions: an unidentified seasonal allergy; an irritant or allergen in our apartment that hasn't been identified; feline hyperesthesia syndrome; or some version of allodynia, which is basically the sensation of pain without a reason or cause. Dr. Deutschland thinks it's possible that Flash is more sensitive to stimulus, like flea medication and the blood draw. He believes that we may never know the exact reason, so we're trying to treat it symptomatically. Currently, we're experimenting with a medication called Gabapentin, which is an anti-convulsant and analgesic that relieves the symptoms of both hyperesthesia and allodynia. We're seeing some reduction of the symptoms - and we're able to keep the E-collar off as long we're watching him closely - but it is still an ongoing process.

This looks way different than what it looked like on Amazon

Cost, Payment, and the EU Pet Passport

Your average examination (Untersuchung) is pretty cheap, from 10 to 15 euros, and then they add on charges for things like an injection (Injektion, 10 to 30 euros depending on what it is), taking blood pressure (Blutdruckmessung, 9 euros), etc. Blood tests (Blutanalyse) can get expensive if you do a full diagnostic, which cost us about 120 euros total. A whole set of full-body x-rays (Strahlendiagnostik) at the Zentrum cost 75 euros, while just a single x-ray of Flash's foot cost 36 euros at Dr. Dix's office. We paid less than 5 euros for his prednisolone, and his gabapentin comes out to roughly 17 euros for a month's supply. The initial visit with his neurologist cost 62 euros, but the follow-up was only 30 euros.

Neither vet we've used accepts credit cards, so you have to pay with a German debit card or cash.

If you're living in Germany, you should buy an EU Pet Passport (about 7.50 euros) from your vet - it's an official document for your pet so they can travel within the EU, and a record of their vaccinations and such.


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