Thursday, January 19, 2012

Why breeders drive veterinarians up the wall.

Recently, I was confronted with the worst of the worst. The know-it-all breeder. She brought in her brachycephalic breed puppy for sudden onset of neurological abnormalities and respiratory difficulties. The puppy was about 8 weeks old and looked very poorly bred.

After examining the puppy, I decided that chest xrays were the place to start. The presentation of the case was very strange - a previously very normal, active puppy that had suddenly declined over about 8 hours. He (Peter the puppy) began having trouble walking, he was staggering around, and he had started to have difficulty breathing. None of the other puppies were showing any symptoms. My initial thoughts were a type of pulmonary edema called non-cardiogenic. It can occur secondary to seizures, choking, electrocution, and head trauma. The owner reported that her very young (and VERY obnoxious, as evidenced by his behavior in the waiting room) son could possibly have dropped the puppy on its head.

Xrays showed an interesting pattern in the lungs that could be consistent with non-cardiogenic pulmonary edema. There are other differentials for this type of pattern, but NCPE is by far the most likely.

I went to speak with the owner. Said "breeder" had already informed me that she thought the puppy was either suffering pneumonia or head trauma. I explained my differentials to her. At that point, the conversation really started to go downhill.

Her: "I respectfully disagree with your diagnosis."
Me: "Ma'am, I have not made a definitive diagnosis. I have given you a list of possible diagnosis that are causing these signs and xray findings."
Her: "Can I look at the xrays? I've seen a lot of aspiration pneumonia."
Me: speechless. As if I - THE VETERINARIAN - have not seen a lot of pneumonia.

I showed her the xrays. She looked at them and clearly had no idea what she was doing. She then proceeds to tell me that the puppy is suffering aspiration pneumonia (there is NO evidence of this on xray) and requests Clavamox. I declined, stating that I generally start pneumonia puppies on enrofloxacin and doxycycline.

Her: "Are you a neonatology specialist?"
Me: "No, I'm an ER doctor, and I treat puppies and kittens ALL the time."
Her: "Well, my doctor is a specialist in this area."
Me: "Is your doctor available at this time?"
Her: "No, I don't think so."
Me: "Well, I am, and if you want my medical opinion, that's it."
Her: "You probably don't  know that flat-faced breeds are prone to aspiration pneumonia. They do it all the time.
Me: SPEECHLESS.

Finally, I looked at her and said, "ma'am, you obviously do not respect my opinion." Her response? "I've been doing this for 8 years (breeding)."

My response? "I've had teeth for 32 years. That doesn't make me a dentist."

In the end, I sent her out the door with Clavamox. I told her that it wasn't the best antibiotic for the pneumonia her dog didn't have and reiterated that her VERY sick puppy needed hospitalization and oxygen therapy (which she declined). The stupid breeder was supposed to see her veterinarian today for a recheck of the puppy, but when I called, she had never been seen.

Shocking.

This is why we hate breeders. I went to school for 8 years and have worked in ER for 4 years. I might - JUST MIGHT - have some clue what I'm talking about when I look at an xray.

Oh and FYI breeders, if you're just going to waste our time and tell us your uneducated diagnosis, please just do us a favor and stay home.

31 comments:

  1. I feel sorry for the poor pup. Wouldn't be surprised if he didn't make it. NCPE ( non cardio pul edema ) would be my Dx too.

    I like to show them the rads & ask for their opinion on what they're seeing there....w/o me telling them anything. Most have no idea of various structures & normal vs abnormal.

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  2. That's not a breeder. That's a criminal. I know - I see them every day.

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    1. Hey! Officer Cynical! You know, I found your blog like TWO DAYS before you closed it or took it down or whatever. What a bummer THAT was. Sigh.

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    2. Some people just can't leave a good thing alone, and I can't afford to lose my job over a blog.

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  3. Getting veterinary advice from a breeder is like getting gynecological advice from a pimp.

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    1. "Stupid things pet owners say"...SCORE!!!

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  4. No, no, no, no, no! See, this post is exactly why this VBB blog is such a bad idea. All you did here was demonstrate your complete inability to explain yourself to a client. She probably smelled your disrespect the moment she walked in the door, and stopped listening.

    Here, read this: http://www.leospetcare.com/how-really-listening-to-a-veterinary-client-might-save-a-life/

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    1. Hah! That is so funny. For s second, I thought you were serious. After all, as an emergency vet I had to make connections with several people who were in a really tough situation everyday... that means about 40 per shift, about 1/2 of them who have issues with funds. This means people that have no bonding with me what so ever and have unexpected, highly emotional problems. And most of them are fine. Even the puppy producers and the breeders. But some of them come in the room with a piece of the Eiffel tower on their shoulder. No amount of mirroring, humor, or empathetic listening will help. And if you have not had this happen, then you are lucky. But I am thinking that maybe you just don't like to talk about the ones that didn't work out.

      Oh, and way to advertise your blog. Awesome.

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    2. Greg -
      1 ) These blogs are set out as humor and satire. Clearly this vet masked her true feelings in the exam room. Have you never been irritated at a friend/family member/client/stranger and had to keep it to yourself, later telling the story they way you WISH it had gone down?

      2 ) Have you never experienced a client who truly believes that they know more than you? No amount of listening, empathy, or client counseling will change the fact that WE are doctors and THEY are not. Being a breeder (excuse me, allowing dogs to reproduce the way they do in the wild without any intervention) does not give unto you magical knowledge properties to INTERPRET RADIOGRAPHS. Only medical training does that.

      3)Or maybe this was just a way to post your blog? Guarantee I won't be reading it, but maybe you'll get some snarky new clients who think you're the bee's knees.

      And lastly, if you ONLY KNEW how many lives VBB, myself, and similar ER docs had saved you would feel ashamed of the title of your post.

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    3. Greg, all you did here was demonstrate your complete inability to explain yourself to a colleague. We smelled your disrespect the moment you posted, and stopped listening.

      Maybe you should read this: http://vetsbehavingbadly.blogspot.com/2012/01/who-are-vbb.html

      PS - Trolling while attempting to get hits for your admittedly under-performing blog is a bit passive aggressive, don't you think?

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    4. Holy cow, Greg. That's a mighty high horse you're on there. Careful stepping down... it's a long fall.

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    5. Greg- I've taken a look at your blog and clearly there is a difference in personalities (VBB authors are snarky and funny; you seem a bit, erm, Pollyanna), goals (the VBB are blowing off steam; you appear to be reaching out to clients to build your practice), and intended audience (for VBB it's colleagues; for you, again, clients). I don't think either is wrong, they're just different. I respectfully suggest that if you don't enjoy this blog and its intent bothers you, you simply don't visit it. I seriously doubt the VBB writers are going out of their way to visit your blog.

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    6. Holy smokes, I thought I was cynical but after visiting here I truely believe my veterinary life is a veritable bowl of cherries...I agree that blowing off steam is necessary but really, in a public forum...how are you bettering our profession here??? At least Greg has the balls to put his name and his picture behind his posts!

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    7. @justacowvet Well, I'm not bettering the profession here. Here, I am being funny. I am blowing off steam. I am blogging. I better my profession by showing up at work, and doing my best by my patients. By going to the religious school my children attend, and teaching the children how promoting animal welfare relates to the principles of tzedakah and tikkun olam. By going to the local schools and teaching about how children can be safe around animals, and by teaching parents how to prevent zoonotic disease transmission from their family pets to their children. I better my profession by volunteering as often as possible at the local animal shelter, and bringing groups of children to the animal shelter to see what happens when animal owners are irresponsible. I do a lot of things to better my profession. I do not believe that writing this blog (well, part of it) takes away from the good that I do in the rest of my life. In fact, I believe it brings smiles to the faces of many of my beleaguered colleagues, and that makes me happy. If it brings a frown to yours, I respectfully you suggest you GO AWAY.

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    8. oooo, well if YOU PUT IT IN BOLD AND ALL...I better run!! Lmao! I think your blog is fucking hilarious, but that is not the point. You are reaching, what hundreds of thousands of people??? Don't you think a better forum for your 'blog' might be VIN, where the people reading it understand your frustration and you aren't doing a disservice to our profession by 'going off' on the dumbasses out there?? I appreciate good ol' sarcasm more than the next person and its great to make us laugh but...Oh and your rant here kinda reminded me of 'Coach' from Survivor...just sayin'

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    9. I'm a client, not a vet. I love this blog for the honest truth, as facepalmingly funny it is. I'm not going to find a sucking-up blog as entertaining. I'll stick with this one, thankyouverymuch. The sort of people mentioned in the blog probably aren't the sort that read vet blogs anyway...

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    10. Greg,
      I did look at your link but I was so confused by the tone of the article I then searched the rest of the site thinking that surely your practice was hoax, but alas it appears to be a legitimate bussiness. All I can say is that if you truly only tell your clients what they want to hear then I would never trust you with my dog's health.

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  5. Hi Greg! Obviously are stories are not exact word-for-word transcripts of client interactions. Surely you have had a client - at least one client - come in with a huge chip on his/her shoulder, sure of the diagnosis, WRONG about the diagnosis, and refusing to listen to you? If you have not, well, you are a lucky man. I wish that I were lucky enough to practice among your client base. My friends and I are not quite so lucky. I will grant you that I am not the world's best teacher - when I try to explain to a client what's going on, well, sometimes I must resort to gutter language as previously mentioned... ha ha... but seriously, sometimes no matter WHAT I say, my client says I'm wrong. I once had a client tell me I could not diagnose my way out of a paper bag. That client went to my boss, and then to another outside veterinarian, and just for the record, I was correct in my diagnosis. All three involved veterinarians had the same experience with the client, though, which was that the client had already decided the diagnosis and refused to listen to what it actually was. It wasn't that the client "smelled [my] disrespect," (which, btw - what does disrespect smell like? anything like Teen Spirit? ha ha), it was that the client was, himself/herself, DISRESPECTFUL OF VETERINARIANS.

    This blog would not be useful to me, personally, if all I did was sit around and write about the fun parts of the job. I enjoy those while they are happening. Interactions like the one described above leave me sad. This story is not my own, btw, but I've had similar. When I have this happen I feel angry that I could not make my client understand, I feel sad and angry at having been treated so disrespectfully, I feel sad for the pet who often does not get the necessary care. I am glad that you never have these problems. It must be nice to have clients who are never rude, judgemental, defiantly ignorant, or stupid. Hey, maybe you're taking more than your fair share of the kind, understanding, intellectually curious ones - maybe that's our problem!

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  6. I'm not a vet (my molecular bio grades were too crappy). But I am one of those dog owners I never thought I'd be: my dog is absolutely everything to me, and I would do absolutely anything for him, regardless of cost. I hope, if that day ever comes, my vet will look past any of my hopes, fears and contrariness, and tell me straight up what he believes is best for my dog. In the end, that's the only reason I'm there.

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  7. I'm a former vet tech (stopped working to have a two legged kid) and when my aging greyhound showed all the signs of congestive heart failure I took him in to confirm MY diagnosis. Told my former boss what was going on, had him shoot a chest xray to confirm and low and behold....tumor...huge tumor...right at the top of the heart...pushing on EVERYTHING. A GOOD owner will look past what they think is going on, and listen to their vet, and believe the proof right in front of their face. And IDIOT is an IDIOT and their background as a breeder doesn't really matter. I've seen dog and cat owners swear up and down that Fluffy 2 had this or that because that's exactly what Fluffy 1 had....and they couldn't be convinced otherwise...and they were not breeders. So really...replace "Breeder" with "Idiot" in this story.

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    1. Like the owner I had yesterday who swore her dog was constipated. Quite the opposite, I'm afraid. I'm still not sure she believed me about the diarrhea, hopefully she'll give meds anyway!

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  8. Taking medical advice from a breeder is like taking gynecological advice from a pimp

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    1. Whoops!! I skipped right over that looking at the next reply. Sometimes it's all I can do not to say that to clients that question treatment.

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  9. It is really sad that so many people think they know-it-all about whatever the heck they produce and they call themselves breeders. It's sad because there are some great people out there that are breeders.
    Unfortunately they are in the minority, as with everything else the cream rises to the top.
    So most of the 'breeders' we deal with in vet medicine, particularly at the ER are, in fact, idiots. They are idiots of the worst kind. They've told people stuff and the people believed them. So they think that stuff is true. So they think they are smart. In fact it most of that is bunk. In fact the idiots do the craziest things with their pets medically and do not have a clue about the dog's actual health needs. Again - some are great. It's the idiots that ruin it for all the rest.

    As far as this blog post goes, why do you think this vet automatically didn't communicate well? I'm sure this vet communicates exceptionally well. So I don't think the problem was the vet. So the vet functions fine. The vet building, staff and equipment functions fine. Hmmm, what other factors then contributed? Maybe it was the idiot with the know-it-all attitude that was the factor. Hmmmm, what do you think?

    BTW how much time do you think an ER vet may have to spend with any particular client? Or an ER doctor? Minutes is typical.

    Guys, when you go to the ER you are going to get more of your money's worth by shutting up and/or giving correct history and stop it with the attitude and hype. You are wasting your $$ on that.

    The ER doctor just may be juggling a number of critical patients and sane and insane clients at the same time.

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  10. Guess VBB blog is so bad Greg wants to advertise his own here & get all the exposure for potential clients....like free advertising ehh.

    He must live in a totally different world of people than what the rest of us are seeing. sigh.

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  11. My esteemed colleagues,

    I'm PROUD of my profession and the people we serve. And yes, I will gladly refer anyone who asks to my blog, because even though very few people (mostly current clients) read it, I'm proud of what they're reading.

    Like it or not, anonymous or not, when a group of veterinarians publishes a blog you are representing the profession. Somebody has to remind your readers that no, this is not how every veterinarian out there wants to be represented.

    Come on, don't yell at me and call me names for stating my opinion. This job is HARD. Don't be disrespectful, be FUNNY!

    Yup, I Pollyanna Trolled your blog, LOL! I've been called worse.

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  13. Humoragenesis. It is a real and dangerous phenomenon. Like Noassatall or Dragonass, insidious and often goes unnoticed by the people that are suffering from it.

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  14. Greg, you impugned me first by insulting my listening skills. You don't know me obviously, but I take great pride in my history taking skills and client communication. You were not there, and you did not see this interaction, but you automatically assumed that *I* was at fault, and not the owner. Only then did I point out that you were trolling.

    If you're interested in the kind of breeders I deal with - you can read my blog at www.returnofthederelict.blogspot.com. My lateest story was about the "breeders" who waited almost 3 days AFTER their pregnant mastiff started passing bloody, foul-smelling uterine fluid from her vulva and having dead puppies BEFORE taking her to the vet. Before doing that, they gave her some random shot they procured from a "breeder friend." NO, they didn't know what the shot was. At that point, she underwent c-section at her vet's office, then transferred to me. Guess what? Septic. I had to euthanize a sweet, helpless dog that wouldn't have been in that situation to begin with if her owners hadn't made such terrible choices.

    But *I* have the problem? If you don't like the blog, don't read it. Continue seeing your perfect patients that take all of your recommendations and never have ill animals that they refuse to care for. Meanwhile, I'll continue to treat the parvovirus puppies that received feed store vaccines and have NEVER seen a veterinarian (therefore, no failure of communication occurred), the dogs in caval syndrome, and the dystocias.

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