definition of the day

If you were to look up "high-maintenance" in a Veterinary Medical dictionary, you'd see a picture of the client that has called me 8 times today about their healthy puppy. I don't mind answering questions and all, and the puppy is pretty damn cute. But seriously, spend a few minutes/hours/days/weeks gathering all of your questions together and only then call me. Or simply get a different hobby, because calling me this many times in one day is not working for me.

Edit: Sept. 3rd at 9:00am and I've already had another phone call. Don't forget that this puppy is healthy. This last phone call was to ask how I thought the puppy liked the treat I offered during the exam. Seriously? (grumble grumble)

Wait, huh?

Me: "So does Dudley eat things he's not supposed to?"

Mrs. Mechanic: "Oh gosh yes! He eats everything like they're lug nuts. Come to think of it, he did eat a lug nut once."

At some point...

...I'd really like to start a list of the Top 10 ways to really piss off your vet (or at least really annoy the hell out of them). Whenever I get around to it, me thinks this one should be on there:

Being late for an appointment is annoying, but too common to make the list on its own. But walking in 30 minutes late for your appointment on a busy Monday morning (packed full with one or two emergencies on top of my regular scheduled program) with an extra dog because you'd really like to have BOTH of them "checked out", is a sure fire way to get on my bad side.

Oh and complaining about the wait isn't going to make me get to you any faster.

I told you so...

One of our clients recently called and asked for a refill of an NSAID (non-steroidal anti-inflammatory drug). Not an uncommon request, many dogs (and people) are on one of the multitude of NSAIDs on the market for some type of pain or inflammation (usually arthritis). And the dog is a 15yr old Shih Tzu, so I'd fathom a guess that he probably has some arthritis and could benefit from it. Thing is, we've never prescribed anything to Fluff for arthritis . Oh he did get an NSAID from us once, but only a short course of something for post-op pain after a tumor excision....3 years ago. Regardless, the owner hadn't brought Fluff in for a full physical exam since that surgery was performed in 2008. Sure, the occasional "check ears", but nothing comprehensive and certainly nothing related to arthritis.

When I called the owner, I inquired if there was a reason for the sudden need for pain medicine.

"No, just the usual old age stiffness. In fact, just the other day he somehow got wedged behind the couch. He was limping pretty bad afterwards, his arthritis was really acting up from being stuck there for so long."

It's surprising how many acutely painful dogs are self-diagnosed by their owners with arthritis, or better yet hip dysplasia.

I politely explained that, although Fluff is fifteen and I have no doubt he would benefit from an NSAID, he really needed to be examined before we could dispense anything. And besides, we've never actually prescribed anything to him for arthritis before, so I definitely can't "refill" anything.

Wow, you'd think I'd just asked her to solve our current debt crisis. The extreme shock! How could I possibly ask such a long-time client to bring in her dog for something as benign as arthritis medicine?? "Do you know how difficult it is for me to come all the way down there?"

Interestingly, the owner is a family practitioner. But that's not the best part. She admitted on the phone to being completely against routine physical exams, thinks they're a terrible waste of time. She actually dissuades her patients from coming in unless they're sick. I didn't catch all of her reasoning, something about the cost of medical care, unnecessary tests being performed, too much doctors' time being wasted on healthy patients and not sick ones, blah, blah, blah. I guess the idea of preventative medicine is completely lost on her.

In the end I won out, she finally agreed to an appointment. Not because she agreed with me that Fluff needed an exam. Nope. She scheduled something because "finding a new vet was too much work, and they'd require a 'first visit' exam anyway, so why not just go to the place that has all of Fluff's records... what an incredible inconvenience you're causing!!". I think she was upset with me.

Turns out Fluff had a deep laceration on the medial (inside) aspect of one of his thighs that had become badly infected causing a significant amount of painful cellulitis surrounding the area. He wasn't limping from arthritis, he was limping because her owner (a medical doctor who disagrees with routine exams) had completely and utterly failed him. I admittedly expect a little more from my clients that are medical professionals, but this thing was huge. It's a sad and scary thing when a human physician misses something so blazingly obvious. Actually she didn't miss it, she just didn't care enough to look (which is even more sad and scary). I wouldn't allow her to examine my philodendron.

I hated seeing Fluff painful and sick, but it's a great thing knowing that he'll be fine all because you held your ground. Oh, and telling the owner told you so was icing on the cake.

qoute of the day

Overheard in the lobby:

Client #1: "Are your dogs friendly?"

Client #2: "Oh yes, a little too friendly. In fact they're borderline slutty."

Sounds reasonable...

"Hi, I was wondering what you all would charge to neuter my dog? The hospital down the road was pretty damn expensive, I think they must charge more for bigger balls."

Simple math

"We've got a real problem here doc, Frisky's eating less food and we're worried about her. She usually eats one 5.5 ounce can of cat food throughout the day. Now I can barely get two 3.5 ounce cans in her. I know it sounds weird, you'd think it was more food, but they really do pack more food in those larger cans. What should we do?"

(I'm really not making this up...)

Today's phone call

Caller: "Hi, I read on the internet that veterinarians are trained to examine tick bites better than human doctors, so I was wondering if I could schedule an appointment?"

Debbie: "Sure, what's your pet's name?"

Caller: "No, not for our dog. The appointment is for my wife."

Debbie: "Wait, I'm sorry. You want to schedule an appointment for your wife to be examined by a vet?"

Caller: "Exactly."

Debbie: "Sir, you are really going to have to call your doctor. We can't schedule appointments for humans."

Caller: "Well that doesn't make sense." hangs up

crappy day

No one wants to tell a client their dog has cancer. That's one of the worst conversations ever.

Last week a patient of mine was diagnosed with splenic hemangiosarcoma. He had surgery and is currently undergoing chemo at a referral practice.

Today I had to tell that same client that the rads of their other dog's chest revealed metastatic cancer throughout the lung fields (I'm unsure where the primary tumor is). You can imagine how that conversation went.

Damnit.

Sadly, this isn't the first time I've had to give bad news to a client about both of their dogs in such a short time. The last time though, it was in the same day. A couple of years after graduating vet school I saw a great client of mine and her two dogs for routine annual exams. The only complaint she had was that one of them had been coughing occasionally for the past few weeks, so I ordered some chest rads while I examined her other dog. Upon opening the mouth I found a rather large ulcerated mass that ended up being an oral melanoma. About the time I started talking to the client about the oral mass though, the rads from the first dog came up. She had a very large pulmonary mass. (The cough worsened quickly over the next few weeks and she was euthanized after developing secondary pneumonia. The other dog had a hemimaxillectomy to remove the oral melanoma; she lived another 2-3 years.)

And then we're expected to somehow walk into the next exam room with a big smile and act like we're excited to see Mrs. Bee's new Bichon. Any other day I would be, just not today. Sorry, it's nothing personal.

Could be. It IS quite contagious....

"So what's wrong with Squinty's eyes today?"

"I don't know doc, they're extremely red and goopy, and he's been at them all day, rubbin' on the carpet and such. Do you think it could be that 'Dog Eye' that's been going around?"

A bindi dot?

"So, I really don't want to bring Fluffy all the way down there for an office visit [aka - I don't want to pay for an office visit] if it's nothing, so I was wondering if you could tell me over the phone what this little black dot on her skin is? At first I thought it was a tick, but now I think it's just an age spot. What do you think?"

Last time I checked I was one.

I had just finished excising two tumors off of a Golden Retriever when I walked to the front desk still wearing my surgical gown, hat and mask. One of our clients Mrs. Comedian (or was her name Mrs. Ignorant?) was sitting in the lobby and immediately commented, "Look at you! You look like a real surgeon."

not even 15 minutes?

You know, when it comes to owners some dogs unfortunately pick the short straw. This was the case with the sweet 9 year old Sheltie that I saw tonight. She's unfortunately developed a rather large mass on her chest that supposedly wasn't present a week ago (according to the owner). On first glance, the tumor felt like a lipoma (a mass composed of adipose tissue that happens to be one of the more benign of all tumors that dogs can develop), but cytology proved otherwise. Many ugly bad-ass looking cells, the kind of cells that you try your hardest to avoid when they've had a few drinks at the bar. Oh, and definitely avoid the "Your mamma...." jokes.

After recommending surgery, the owner succinctly gave me two reason why he couldn't have it done. One was money, he told me that his boss cut his salary so he didn't have any. Understandable, the economy isn't great, people are sometimes lucky to have a job. Sucks, but sometimes a pay cut it better than the alternative. I was about to give him some suggestions, such as getting an estimate from a couple of potentially cheaper clinics, but he immediately threw out the second reason Lucky wasn't having surgery. "I don't have the time, doc."

Say again?

Over the next 12 months you have absolutely no time to bring your dog in for surgery?? I'm sorry, did I not make myself clear when I said that I think your dog has cancer and if it gets much larger it may not be surgically resectable? I'm not asking you to take a day off, you can drop her off the night before at no charge, heck we even have late hours.

Nope.

Disgusting. I immediately walked away shaking my head.

Funny thing though. I overheard him at the front desk asking about boarding his dog while he's on vacation in New York. "Oh, and Saturday is my 'Day of Rest', so can I drop her off on Sunday instead?"

Punching a client like him should really be legally justifiable.

Sometimes, the truth really is best.

Seven or eight years back I used to work at a multi-doctor practice a few thousand miles East of where we live now. One of my colleagues (Dr. H) had a client who owned a sweet yellow Labrador Retriever that had been coming to the hospital since he was a pup. Great dog, I remember seeing him a couple of times in the lobby. Eventually the dog developed some chronic debilitating disease (one that I can't remember now), and finally one Saturday he unfortunately had to be euthanized. This particular client used to bring their two young children, both under the age of six, with them during their appointments, however during this particular appointment they weren't present. Dr. H had told me later that after the euthanasia, the parents wanted his opinion on what to tell the kids. They were fairly young, afterall, and they loved that dog fiercely.

Well, Dr. H (having five children of his own) felt strongly that telling them the truth was the best thing to do. Hey, death is a horrible fact of life that kids end up learning at some point, so he thought the parents should take control of when and how the children learn it. Upon leaving the exam room, they agreed and planned to tell the kids later that night what had happened.

Two weeks later when they returned to pick up the ashes, our office manager asked how the conversation went.

Apparently, telling the kids that the dog had died wasn't what they originally were worried about. Death, surprisingly was easy to explain, it was how the dog died that was the difficult part. I hadn't thought about that. Sure, he had a severely debilitating disease with no hope of a cure. But how exactly do you explain to a child at that age that, not only did the family dog die, but YOU took him to the hospital to be killed.

I guess they felt it was easier to tell the kids that when they parked outside our hospital for a routine visit, he jumped out of the car, ran into the street and was hit by a car.

Wow. I'm not sure why, but I think about that story almost every time I'm faced with a euthanasia. A lot of my clients have children, and I often wonder what they're being told. Thankfully I haven't been faced with that situation yet, so I haven't had to have that difficult conversation with a child. I guarantee though that if my wife and I have to unfortunately euthanize one of our pets, we'll somehow have our kid(s) prepared from the start. Hey, I don't know how we'll prepare them, but we'll do it. I just simply can't fathom how a lie like that is supposed to somehow be more comforting than the truth.

another FYI

Dear pet owners, most veterinarians generally frown on using Ajax to clean your dog's ears. Yes, I agree that it does get the ear wax out quite nicely, just as it cleans the top of my stove quite nicely. But as a general rule of thumb, if a product is generally considered a great household cleanser and the label recommends wearing gloves while cleaning with it, then don't put it on your pet's skin. Better yet, if you won't put it in your ears, don't put it in your dog's ears. Thank you.