I've had 2 patients recently who required several medications to control their conditions.
Both are old. Both have been owned by the same families their whole lives. Both are difficult to medicate.
I understand not every pet is "dumb" enough to fall for the cheese or hot dog or peanut butter trick. I understand that not every owner is astute enough to pill a difficult pet. And I really do feel badly for folks with uncooperative pets that require multiple doses of challenging oral medication.
But, you know what, at the end of the day, it is not my fault. I did not raise your dog to bite you when you touch its mouth. You did. I do not control the formulations manufactured by the drug companies. They do. I can only offer medications compounded into liquids or chews, I can not control your willingness to pay the cost for those medications, neither can I guarantee your pet will consume them.
I am sorry your pet's heart or liver are shutting down. But the fact that you are unable to medicate your animal is not my fault. Therefore, you don't get to blame me when your pet fails to recover. But I know you will.
Tuesday, May 13, 2014
Sunday, May 11, 2014
Happy Mother's Day
I hope everyone has a fantastic Mother's Day, whether your children are of two- or four-legged variety.
Wednesday, May 7, 2014
Rest in Peace, little lady
Today, one of my favorite patients was euthanized. And due to a particularly cruel twist of fate, I was unable to be there to say goodbye.
She hadn't been a patient for long. She was a rescue dog, owned by a young man and his girlfriend. I'd venture to get the young man had the dog before the girlfriend and I suspect the girlfriend resented it. The owners are not...how does one say politely...eligible to Mensa membership? Likely to be offered Rhodes Scholarships? They're not smart. Not even close. But, like most folks in their position, totally unaware of their shortcomings, believed they were smarter than me and KNEW FOR DAMN SURE the internet was smarter than me.
I saw this darling pup after she'd been sick for 2 years, but had only been losing weight for 1 year. On initial exam, I felt for the pair when they expressed dismay that no other vets had listened to them. Their dog is sick, they know it, but no one will take them seriously! Well, turns out they were chronic clinic hoppers and never provided previous records or followup, so I'm sure every clinic they went to started with the same basic tests and first line medications because - who wouldn't without previous records? That's what I did and asked for a 1 week follow up. One month later (after they didn't return my calls to see how the dog was doing), I got a request for records to another clinic. Sigh.
About a week after that, Miss Owner called me up, demanded I prescribe a fairly specific medication and informed me I misdiagnosed her dog. I reminded her that I hadn't actually diagnosed her dog. Well, they went to a specialist and the specialist said... I politely requested they have the specialist send me the notes from the visit. I know, dear reader, this will come as a shock, but the specialist did NOT say...
We had a small come to Jesus moment on the phone then & there - are you working with me or are you on your own program? Because if you're working with me here are the ground rules. You will follow medication directions, you will not go off on your own program and you WILL communicate! I feared at this time the dog was already a lost cause, having been sick for 2 years, but I was willing to give it a shot. And give it a shot, we did. Including keeping the dog at the clinic for a solid week so that I could medicate her to know how she was doing and if she wasn't getting better because it wasn't working or because they weren't following instructions. While she was with us, we used to sit outside in the grass and enjoy the sunshine. Sometimes she's snuff around on a long leash, investigating the smells and even dig a bit. Sometimes she'd roll in the grass and roll down the hill. Sometimes she'd sit with me, and lay her head in my lap and close her eyes while I stroked her head. We were definitely pals.
On a separate note, they were convinced this dog was aggressive. She showed ZERO aggression while she was with us. Never even offered. But to hear them tell it, she was Kujo's twin at home. Makes one wonder...
They called this morning, my day off, saying she wasn't doing well and wanted to talk to me. Sadly I was unavailable, and they ended up making an appointment to come in. I could not unencumber myself quickly enough to get to my work to meet with them, and they elected euthanasia. Probably the right answer as now the dog was leaking protein (I'm assuming, based on their description of clinical signs). But I guess the owners would not pick up the dog, insisted she be muzzled, wanted the muzzle off and then immediately remuzzled her because she was "snarling" at the staff. Except that she wasn't.
So I feel horrible that my favorite patient, who I only knew for 2 months, died today and I wasn't there to be with her. Because she should not have died with a muzzle on.
She hadn't been a patient for long. She was a rescue dog, owned by a young man and his girlfriend. I'd venture to get the young man had the dog before the girlfriend and I suspect the girlfriend resented it. The owners are not...how does one say politely...eligible to Mensa membership? Likely to be offered Rhodes Scholarships? They're not smart. Not even close. But, like most folks in their position, totally unaware of their shortcomings, believed they were smarter than me and KNEW FOR DAMN SURE the internet was smarter than me.
I saw this darling pup after she'd been sick for 2 years, but had only been losing weight for 1 year. On initial exam, I felt for the pair when they expressed dismay that no other vets had listened to them. Their dog is sick, they know it, but no one will take them seriously! Well, turns out they were chronic clinic hoppers and never provided previous records or followup, so I'm sure every clinic they went to started with the same basic tests and first line medications because - who wouldn't without previous records? That's what I did and asked for a 1 week follow up. One month later (after they didn't return my calls to see how the dog was doing), I got a request for records to another clinic. Sigh.
About a week after that, Miss Owner called me up, demanded I prescribe a fairly specific medication and informed me I misdiagnosed her dog. I reminded her that I hadn't actually diagnosed her dog. Well, they went to a specialist and the specialist said... I politely requested they have the specialist send me the notes from the visit. I know, dear reader, this will come as a shock, but the specialist did NOT say...
We had a small come to Jesus moment on the phone then & there - are you working with me or are you on your own program? Because if you're working with me here are the ground rules. You will follow medication directions, you will not go off on your own program and you WILL communicate! I feared at this time the dog was already a lost cause, having been sick for 2 years, but I was willing to give it a shot. And give it a shot, we did. Including keeping the dog at the clinic for a solid week so that I could medicate her to know how she was doing and if she wasn't getting better because it wasn't working or because they weren't following instructions. While she was with us, we used to sit outside in the grass and enjoy the sunshine. Sometimes she's snuff around on a long leash, investigating the smells and even dig a bit. Sometimes she'd roll in the grass and roll down the hill. Sometimes she'd sit with me, and lay her head in my lap and close her eyes while I stroked her head. We were definitely pals.
On a separate note, they were convinced this dog was aggressive. She showed ZERO aggression while she was with us. Never even offered. But to hear them tell it, she was Kujo's twin at home. Makes one wonder...
They called this morning, my day off, saying she wasn't doing well and wanted to talk to me. Sadly I was unavailable, and they ended up making an appointment to come in. I could not unencumber myself quickly enough to get to my work to meet with them, and they elected euthanasia. Probably the right answer as now the dog was leaking protein (I'm assuming, based on their description of clinical signs). But I guess the owners would not pick up the dog, insisted she be muzzled, wanted the muzzle off and then immediately remuzzled her because she was "snarling" at the staff. Except that she wasn't.
So I feel horrible that my favorite patient, who I only knew for 2 months, died today and I wasn't there to be with her. Because she should not have died with a muzzle on.
Thursday, May 1, 2014
But it wasn't helping
I suppose most people take pills for headaches. Like, today I have a headache. Therefore I will take 1 Advil (or whatever) and - BOOM - headache gone.
They probably don't pause to reflect on instances where they had, say, an infection. One where treatment required several pills, taken on schedule, and multiple doses before relief started. Or, even more dramatic, something like a statin to lower cholesterol. Something where the desired results were obtained only after months of consistent treatment.
I guess today was my lucky day. Two pets with chronic problems, and two sets of owners who wanted instant results. One hypothyroid dog and one asthmatic cat, both of whom did not immediately improve upon instigation of medication. As in, 3 pills did not solve all their ills. So now, several days later, they're calling saying, "My pet isn't better. But I stopped giving the medicine because Fido/Fluffy wasn't better right away so I thought it wasn't working."
*facepalm*
They probably don't pause to reflect on instances where they had, say, an infection. One where treatment required several pills, taken on schedule, and multiple doses before relief started. Or, even more dramatic, something like a statin to lower cholesterol. Something where the desired results were obtained only after months of consistent treatment.
I guess today was my lucky day. Two pets with chronic problems, and two sets of owners who wanted instant results. One hypothyroid dog and one asthmatic cat, both of whom did not immediately improve upon instigation of medication. As in, 3 pills did not solve all their ills. So now, several days later, they're calling saying, "My pet isn't better. But I stopped giving the medicine because Fido/Fluffy wasn't better right away so I thought it wasn't working."
*facepalm*
Tuesday, April 29, 2014
Spayded, an update
Perhaps you remember the story of the yorkie pyometra. How excited we all were that she lived. Well...seems we spoke too soon.
Given how long she'd been sick prior to surgery, and how toxic she was at surgery, we kept her on antibiotics for a long time. She came in for suture removal at 2 weeks and looked good. Shortly after that, she finished her antibiotics. Our staff called for a follow up call and we were told she seemed a little dull, picky about food but she's always been a picky eater. Maybe pickier than normal, not as energetic, more dull than when she was on the antibiotics. Recheck appointment? Well, gee, how much will that cost cuz, see, we're kinda out of money again.
A few days later, we received a fax from the emergency clinic that she had presented with septic abdomen and was euthanized.
Could we have saved her (again) if they'd come in a few days prior? Obviously we'll never know but it would have been nice to have gotten the chance to try.
:( RIP little girl. This one I feel badly about.
Given how long she'd been sick prior to surgery, and how toxic she was at surgery, we kept her on antibiotics for a long time. She came in for suture removal at 2 weeks and looked good. Shortly after that, she finished her antibiotics. Our staff called for a follow up call and we were told she seemed a little dull, picky about food but she's always been a picky eater. Maybe pickier than normal, not as energetic, more dull than when she was on the antibiotics. Recheck appointment? Well, gee, how much will that cost cuz, see, we're kinda out of money again.
A few days later, we received a fax from the emergency clinic that she had presented with septic abdomen and was euthanized.
Could we have saved her (again) if they'd come in a few days prior? Obviously we'll never know but it would have been nice to have gotten the chance to try.
:( RIP little girl. This one I feel badly about.
Sunday, April 27, 2014
Career Fair
About a week or so ago, I attended a career fair. It was put on by a local service organization and hosted some very official attendees. And then there was us, Awesome Critter Clinic. We had a table mostly due to Dr. Old's relationship with the service club. We were the most popular table there, because we had a puppy.
It was really hard, because I love my profession. However, I don't love the $12-15,000 I see fly out the door each year in student loan repayments. Graduates these days with debt between $150-200,000? I don't know how they live, especially if they're single.
Afterwards, the Army guys told me I should be a recruiter. Because, see, every time a kid asked about vet school, I said - you better figure out a way to pay for it. Don't do it on loans. If you really want to go to vet school, join the Army & have them pay for it. Otherwise you're going to be busting your @ss for the next 30 years working at a semi-thankless job and watching 40-60% of your salary go out the door to repay loans.
It was painful, sure, to discourage kids from attending vet school. But someone needs to tell them the truth.
It was really hard, because I love my profession. However, I don't love the $12-15,000 I see fly out the door each year in student loan repayments. Graduates these days with debt between $150-200,000? I don't know how they live, especially if they're single.
Afterwards, the Army guys told me I should be a recruiter. Because, see, every time a kid asked about vet school, I said - you better figure out a way to pay for it. Don't do it on loans. If you really want to go to vet school, join the Army & have them pay for it. Otherwise you're going to be busting your @ss for the next 30 years working at a semi-thankless job and watching 40-60% of your salary go out the door to repay loans.
It was painful, sure, to discourage kids from attending vet school. But someone needs to tell them the truth.
Friday, April 25, 2014
Shredded, Part 2
A few days later, they bring in Dog #2. See, this dog had "only" ripped up his mouth, so they thought he didn't need to be seen. The sister "who works at a vet clinic" was bringing over medicine, so proper veterinary care wasn't necessary. Until it was.
I'm kinda surprised they actually paid, but pay they did to collect dog #1. Dog #2, upon initial inspection, did not appear as bad off. However, he was less cooperative, and required a muzzle to anesthetize. Yay.
Once under, it was decided that, yes, he did need a drain tube in the gaping hole in his chest. He also had some of the larger wounds on his lips stitched. Due to the wounds on his face, however, he had developed a very nasty case of cellulitis along his entire lower face. There was no distinct wound or abscess, instead, his entire face oozed pus. There were rips & tears in his tongue that had begun to turn necrotic, again, nothing that could be stitched.
And, the coup de grace, he fractured his upper canine almost in half, with the full extent of the fracture running up under his gum line. Pulp was exposed, and the tooth would bleed when touched.
This dog is patched up now too, with a bill very similar to the first dog. Even with the fractured canine, had we seen the dog the day it all happened, we might have been able to save them a bit of money, I suppose. They didn't want us to do anything that wasn't necessary, but it was all necessary!
The best part of this whole story is that, when we walked into the room to talk to them about Dog #1, it was like walking into a wall of alcohol & marijuana. And perfume/cologne. I'm not sure who they thought they were kidding with the cover-up, but we had to air out the space after they left.
I'm kinda surprised they actually paid, but pay they did to collect dog #1. Dog #2, upon initial inspection, did not appear as bad off. However, he was less cooperative, and required a muzzle to anesthetize. Yay.
Once under, it was decided that, yes, he did need a drain tube in the gaping hole in his chest. He also had some of the larger wounds on his lips stitched. Due to the wounds on his face, however, he had developed a very nasty case of cellulitis along his entire lower face. There was no distinct wound or abscess, instead, his entire face oozed pus. There were rips & tears in his tongue that had begun to turn necrotic, again, nothing that could be stitched.
And, the coup de grace, he fractured his upper canine almost in half, with the full extent of the fracture running up under his gum line. Pulp was exposed, and the tooth would bleed when touched.
This dog is patched up now too, with a bill very similar to the first dog. Even with the fractured canine, had we seen the dog the day it all happened, we might have been able to save them a bit of money, I suppose. They didn't want us to do anything that wasn't necessary, but it was all necessary!
The best part of this whole story is that, when we walked into the room to talk to them about Dog #1, it was like walking into a wall of alcohol & marijuana. And perfume/cologne. I'm not sure who they thought they were kidding with the cover-up, but we had to air out the space after they left.
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