I've noticed a trend. Some of our most difficult and frustrating clients that we've acquired over the years have come as referrals from other clients of ours. Flattering, yes. There's supposedly no greater compliment for a small business (I prefer tips, but whatever). It seems, when someone tells me that they referred their Aunt, cousin, neighbor, dentist, or local grocery store cashier, he or she will inevitably be a royal pain in the arse.
We've only seen this person twice, but I guarantee that Mrs. Dingleberry and her cat Harry that I saw yesterday will be a prime example.
She was seen for the first time 2 days ago because her cat wasn't defecating and she believed him to be constipated. An associate on duty at the time took radiographs and agreed, but didn't think Harry was in dire need of an enema 30 minutes before close on a Tuesday night. So she gave him some SQ fluids and instructed the owner to give Miralax.
Mrs. Dingleberry called yesterday afternoon to schedule a recheck with me that evening because, "that girl didn't do anything". That was what the receptionist put in the 'reason for appointment' space on the schedule. Not "constipated" or "recheck", but "that girl didn't do anything". So it wasn't a surprise when the owner introduced herself and followed with, "So and so referred me and told me you guys were great, but when Harry and I came in here 2 days ago, that girl doctor didn't do anything. Harry's still not pooping!". And it was equally not surprising that she offered the Miralax, but when Harry refused to eat it on his own, the owner decided to not give anymore.
So this was my introduction to Mrs. Dingleberry, I suspect we will have a lovely (professional) relationship. You see, after agreeing with my plan to keep Harry for the afternoon so we could sedate him and perform the enema, the owner sternly demanded that I return her cat to her alive. It turns out that her last vet killed two of her previous cats, Snowball and Tom. I was aghast too, that was until she told me how. Her first cat Snowball was unfortunately diagnosed with liver cancer several months after coming in for her shots. She believes that it was impossible that they couldn't have known her cat had liver cancer when she got the vaccines. For some weird reason they simply decided to keep that information to themselves and Snowball died without the proper treatment. Her second cat Tom developed diabetes. No, she didn't accuse them of giving it to him, that's what I thought she'd say too. Instead, she accused them of causing the diabetes to put poor Tom into a coma which killed him.
Now, obviously I wasn't present for either of those events, so it is possible that they did know about the liver cancer and didn't say anything. And who knows, it's equally possible that they made the disease put Tom into that diabetic coma.
But I am fairly certain that she'll accuse me of killing Harry because I couldn't perform the enema that we planned on. You see, it appears poor Harry has some form of cancer causing a blockage in his colon. Oh, and his hematocrit was 18%. Last night when we were discussing my findings, I tried to explain to her that without further workup and treatment for the cancer, Harry will most likely die. And unfortunately, depending on the type of cancer and how widespread it is, treatment may not be successful.
Oddly though, even after all of that, the first thing out of her mouth was "You mean you guys STILL didn't perform the enema??"
Poor Harry.
Friday, December 24, 2010
Wednesday, December 22, 2010
Rhinotillexomania (seriously, it's a word)
I've unfortunately diagnosed Mast Cell Tumors (MCTs) on dogs many many times, and the conversation that follows is NEVER a fun one.
(now stick with me on this one, I really will make the connection from MCTs to nose-picking)
You see, a MCT is considered a type of cancer and HAS to be surgically excised (at least in the opinion of most family-practice vets and veterinary dermatologists). Sure there are three different grades of MCTs, and many return as Grade 1s which are generally considered to be surgically cured when the margins are clean. But regardless, they're still considered a type of cancer that needs to be excised, and the discussion is usually very somber and serious.
For context, I'll explain that if the results of the pathology reveal the tumor to be a Grade 3, then it's expected to be very aggressive and most likely will return soon after surgery and metastasize. Really bad. Grade 2 is the "go-to" diagnosis for most pathologists these days (at least in my opinion). It's like the Goldilocks of MCTs, not too cold, not too hot, but just right. (...hmm, that analogy sounded better in my head...). Seriously, the pathologist was probably too scared for whatever reason to give the dog a clean bill of health with a Grade 1, but the cells didn't look nasty or dirty enough to be called a Grade 3. Thankfully though, somewhere in the range of 75% or so of Grade 2s end up being cancer free after 2 years (hey, I've got to admit that it's late and I'm too lazy to look up the EXACT numbers, but that's pretty close. So please don't pull out the studies and yell at me if it's closer to 23 months or something similar).
Then I have to explain the diagnostics we do prior to surgery such as bloodwork, a buffy coat analysis, thoracic radiographs, etc, and why we need to do them. Oh, and I also like to explain to the owners that sometimes the surgery isn't a complete success depending on the location and size of the mass, and what to expect in those situations. And man that post-op conversation really sucks! Regardless if the report shows a Grade 1 or worse, no one likes to tell the owner over the phone that the margins were dirty (meaning there are cancer cells extending to the edges of the sample) and a second surgery is needed.
Crap, I'm out of breath just typing this, and I've probably 5 minutes from diagnosis to my next appointment to explain all of this (AND give a surgery estimate).
Sooooo, imagine trying to have this conversation with an owner that doesn't stop picking his nose. Really. And I'm not talking about the casual but repetitive "nose-rub" that you might do when you think someone is watching, but "damnit there's just something up there!" Or the super fast "hit-and-run", the kind that's most likely seen in line at a store - you think you saw them pick their schnoz, but the finger was in and out so fast that you unfortunately blinked.
No, this was literally a "deep sea fishing" expedition. The finger just kept going! And when that failed, he turned to a kleenex that was rolled by his fingers at one end into this deadly spiked dagger-looking contraption that he persistently jabbed into his nostril and twisted it about. And yes, it really was that painful to watch.
Oddly though, I couldn't turn away either! It was just so weird that someone could possibly have such little social ineptness. But admittedly, I felt this need to keep score or something.
Thankfully, the fishing trip must have been a success because we were able to finish the discussion when I returned to the room after giving him some privacy (that wasn't asked for, mind you). And equally (or more so) thankfully, he didn't have his catch on display like some prized Swordfish.
You can be sure that it wasn't a coincidence that my hands were full when he tried to shake my hand as he left the room.
(now stick with me on this one, I really will make the connection from MCTs to nose-picking)
You see, a MCT is considered a type of cancer and HAS to be surgically excised (at least in the opinion of most family-practice vets and veterinary dermatologists). Sure there are three different grades of MCTs, and many return as Grade 1s which are generally considered to be surgically cured when the margins are clean. But regardless, they're still considered a type of cancer that needs to be excised, and the discussion is usually very somber and serious.
For context, I'll explain that if the results of the pathology reveal the tumor to be a Grade 3, then it's expected to be very aggressive and most likely will return soon after surgery and metastasize. Really bad. Grade 2 is the "go-to" diagnosis for most pathologists these days (at least in my opinion). It's like the Goldilocks of MCTs, not too cold, not too hot, but just right. (...hmm, that analogy sounded better in my head...). Seriously, the pathologist was probably too scared for whatever reason to give the dog a clean bill of health with a Grade 1, but the cells didn't look nasty or dirty enough to be called a Grade 3. Thankfully though, somewhere in the range of 75% or so of Grade 2s end up being cancer free after 2 years (hey, I've got to admit that it's late and I'm too lazy to look up the EXACT numbers, but that's pretty close. So please don't pull out the studies and yell at me if it's closer to 23 months or something similar).
Then I have to explain the diagnostics we do prior to surgery such as bloodwork, a buffy coat analysis, thoracic radiographs, etc, and why we need to do them. Oh, and I also like to explain to the owners that sometimes the surgery isn't a complete success depending on the location and size of the mass, and what to expect in those situations. And man that post-op conversation really sucks! Regardless if the report shows a Grade 1 or worse, no one likes to tell the owner over the phone that the margins were dirty (meaning there are cancer cells extending to the edges of the sample) and a second surgery is needed.
Crap, I'm out of breath just typing this, and I've probably 5 minutes from diagnosis to my next appointment to explain all of this (AND give a surgery estimate).
Sooooo, imagine trying to have this conversation with an owner that doesn't stop picking his nose. Really. And I'm not talking about the casual but repetitive "nose-rub" that you might do when you think someone is watching, but "damnit there's just something up there!" Or the super fast "hit-and-run", the kind that's most likely seen in line at a store - you think you saw them pick their schnoz, but the finger was in and out so fast that you unfortunately blinked.
No, this was literally a "deep sea fishing" expedition. The finger just kept going! And when that failed, he turned to a kleenex that was rolled by his fingers at one end into this deadly spiked dagger-looking contraption that he persistently jabbed into his nostril and twisted it about. And yes, it really was that painful to watch.
Oddly though, I couldn't turn away either! It was just so weird that someone could possibly have such little social ineptness. But admittedly, I felt this need to keep score or something.
Thankfully, the fishing trip must have been a success because we were able to finish the discussion when I returned to the room after giving him some privacy (that wasn't asked for, mind you). And equally (or more so) thankfully, he didn't have his catch on display like some prized Swordfish.
You can be sure that it wasn't a coincidence that my hands were full when he tried to shake my hand as he left the room.
Thursday, December 16, 2010
Great video
Here's a great video created by the Best Friends Animal Society for the holiday season. See, I don't always post negative threads!
Tuesday, December 14, 2010
A little heads up, please...
Note to owners:
I'm a vet. OK sure, you knew that (or hopefully since you walked into our hospital to see me). As a vet though, I like dogs. And since I like dogs, I don't mind if they lick me, even on the face.
So now that we've cleared that up, if your dog is a frequent poop eater and just happened to eat some feces of any type this morning, please mention it to me BEFORE your dog licks me.
Off to wash my face....
I'm a vet. OK sure, you knew that (or hopefully since you walked into our hospital to see me). As a vet though, I like dogs. And since I like dogs, I don't mind if they lick me, even on the face.
So now that we've cleared that up, if your dog is a frequent poop eater and just happened to eat some feces of any type this morning, please mention it to me BEFORE your dog licks me.
Off to wash my face....
Sunday, December 12, 2010
Mrs. Argumentative, the final saga
If you've somehow found yourself with absolutely nothing better to do than to read my previous posts, than you're no doubt familiar with my arch nemesis, Mrs. Argumentative. Well, our heartwarming (or is that heart-worming...) relationship has finally come to an end.
As long as I've been seeing her and her pets, I only recently discovered that as a profession, she teaches medical and nursing students how to properly communicate with their patients. Yeah, I thought SHE was joking too.
Anyway, last week she called and told Rachel (one of our receptionists) that it hadn't been an easy decision over the past few months, but she had finally decided it was time to put her oldest and most beloved Sheltie down. Despite the fact that Mrs. Argumentative has been nothing short of a righteous Witch to Rachel, we've all been there and understand the pain that you feel when making that decision, so she sincerely gave her condolences and asked if she would want to come in that afternoon (the call was around 11:00am).
Oddly, Mrs. Argumentative declined and replied that she'd have to call us back. End of conversation.
Mind you, this isn't that strange of a thing, many people have to coordinate with other family members, so the initial call is just to find out what the protocol is and what times were available. They don't always immediately set up a time.
What was odd was the fact that we never heard back from her. I could have called, sure. But she's been thinking of euthanizing her 15 year old Sheltie for some time now for various medical and age-related reasons, and considering we aren't the best of friends, I simple-mindedly guessed that she changed her mind.
It was 4 days later that her neighbor, another of our clients, called us extremely irate and concerned because, when the unfortunate time came that HER dog needed to be put down, would we also be as insensitive and unprofessional to them as we were to Mrs. Argumentative and decline to perform the procedure.
???
Apparently when our friendly communication expert called and said the words "it was time...", she meant that literally. Not in a couple of hours, but right this very second. She was SO appalled with us as a hospital that Rachel would even consider the possibility that Mrs. Argumentative would be able to wait a few more hours. So why in the hell didn't she say that to begin with?? We try to schedule appointments for this procedure, but if someone wanted to come in right away we would never say no.
As one of my favorite t-shirts says (thanks j.cakes tees)
Fare thee well, Mrs. Argumentative. It's been real.
As long as I've been seeing her and her pets, I only recently discovered that as a profession, she teaches medical and nursing students how to properly communicate with their patients. Yeah, I thought SHE was joking too.
Anyway, last week she called and told Rachel (one of our receptionists) that it hadn't been an easy decision over the past few months, but she had finally decided it was time to put her oldest and most beloved Sheltie down. Despite the fact that Mrs. Argumentative has been nothing short of a righteous Witch to Rachel, we've all been there and understand the pain that you feel when making that decision, so she sincerely gave her condolences and asked if she would want to come in that afternoon (the call was around 11:00am).
Oddly, Mrs. Argumentative declined and replied that she'd have to call us back. End of conversation.
Mind you, this isn't that strange of a thing, many people have to coordinate with other family members, so the initial call is just to find out what the protocol is and what times were available. They don't always immediately set up a time.
What was odd was the fact that we never heard back from her. I could have called, sure. But she's been thinking of euthanizing her 15 year old Sheltie for some time now for various medical and age-related reasons, and considering we aren't the best of friends, I simple-mindedly guessed that she changed her mind.
It was 4 days later that her neighbor, another of our clients, called us extremely irate and concerned because, when the unfortunate time came that HER dog needed to be put down, would we also be as insensitive and unprofessional to them as we were to Mrs. Argumentative and decline to perform the procedure.
???
Apparently when our friendly communication expert called and said the words "it was time...", she meant that literally. Not in a couple of hours, but right this very second. She was SO appalled with us as a hospital that Rachel would even consider the possibility that Mrs. Argumentative would be able to wait a few more hours. So why in the hell didn't she say that to begin with?? We try to schedule appointments for this procedure, but if someone wanted to come in right away we would never say no.
As one of my favorite t-shirts says (thanks j.cakes tees)
Fare thee well, Mrs. Argumentative. It's been real.
FYI
In case you haven't found that perfect gift to give to your ever so beloved but overworked and stressed vet this holiday season, I recommend alcohol. Wine, vodka, beer, whatever. I gotta admit, there are few things in this world that can make us smile after seeing a shaggy English Cocker Spaniel with explosive diarrhea. Someone handing you a big bottle of booze is one of them.
Saturday, December 11, 2010
Umm, try the hospital down the road....
Our hospital occasionally has the unfortunate responsibility to euthanize really sick or injured stray animals that the local Animal Control picks up. They'll allow us to treat the animals that may have a chance, but there just isn't enough money or space to care for the ones that need extensive hospitalization, surgery, etc. Heck, I'd treat all of them if we had the facilities and help to do so. Thankfully, this doesn't happen very often.
Our relationship with the Animal Control, however, doesn't just end there as much as I would like it to. We also get the privilege to examine dogs and cats that have been quarantined by the Animal Control for 10 days after biting someone. If the Rabies vaccination history is questionable, we always prefer to quarantine that animal since the alternative is to euthanize it and send samples of its brain for testing. Prophylactic treatment for rabies is not a wonderful experience to have, so it's best to find out for sure whether it needs to be done.
On occasion though, the owner of the pet requests for us to euthanize it after the quarantine. Sure it's sad, and I hate doing it, but usually it's a very aggressive dog or cat and the bite wasn't the first. I've seen MANY aggressive dogs, and as terrible as it sounds, sometimes putting them down IS the best thing. Sadly, not every pet can be rehabilitated.
Such was the case with the person that called us the other day. His 150 pound intact male Rottweiler was finishing up his 10 days of quarantine, and needed to be examined by a vet. And since the owner didn't know of any (unvaccinated, un-neutered - are you surprised?), Animal Control recommended yours truly. He's apparently very territorially aggressive to people and other dogs, and he's bitten several of the owner's friends that have come over to visit. As a result, the owner requested to have the dog examined as required, and then immediately euthanized. The problem is, he wanted us to do a house call because, and I quote, "He gets upset and stressed at the vet hospital."
Seriously? At the scene of his crimes? Did you have a specific room in mind? Like on his dog bed surrounded by all of his toys and dog bones? Honestly, I'd rather have tea and crumpets with Hannibal Lecter. I'm not endangering myself or my staff to do an exam and then euthanize a 150# intact male T-Rex in HIS territory. Maybe with a dart gun and enough room to run when I miss, but otherwise, no thanks.
I feel bad having to euthanize animals for behavioral reasons as it is, I keep thinking that maybe there's something or someone that can help this poor misguided animal. But really, I don't want to feel bad AND have 20 stitches.
Our relationship with the Animal Control, however, doesn't just end there as much as I would like it to. We also get the privilege to examine dogs and cats that have been quarantined by the Animal Control for 10 days after biting someone. If the Rabies vaccination history is questionable, we always prefer to quarantine that animal since the alternative is to euthanize it and send samples of its brain for testing. Prophylactic treatment for rabies is not a wonderful experience to have, so it's best to find out for sure whether it needs to be done.
On occasion though, the owner of the pet requests for us to euthanize it after the quarantine. Sure it's sad, and I hate doing it, but usually it's a very aggressive dog or cat and the bite wasn't the first. I've seen MANY aggressive dogs, and as terrible as it sounds, sometimes putting them down IS the best thing. Sadly, not every pet can be rehabilitated.
Such was the case with the person that called us the other day. His 150 pound intact male Rottweiler was finishing up his 10 days of quarantine, and needed to be examined by a vet. And since the owner didn't know of any (unvaccinated, un-neutered - are you surprised?), Animal Control recommended yours truly. He's apparently very territorially aggressive to people and other dogs, and he's bitten several of the owner's friends that have come over to visit. As a result, the owner requested to have the dog examined as required, and then immediately euthanized. The problem is, he wanted us to do a house call because, and I quote, "He gets upset and stressed at the vet hospital."
Seriously? At the scene of his crimes? Did you have a specific room in mind? Like on his dog bed surrounded by all of his toys and dog bones? Honestly, I'd rather have tea and crumpets with Hannibal Lecter. I'm not endangering myself or my staff to do an exam and then euthanize a 150# intact male T-Rex in HIS territory. Maybe with a dart gun and enough room to run when I miss, but otherwise, no thanks.
I feel bad having to euthanize animals for behavioral reasons as it is, I keep thinking that maybe there's something or someone that can help this poor misguided animal. But really, I don't want to feel bad AND have 20 stitches.
Subscribe to:
Posts (Atom)