Friday, February 17, 2012

BTW, over the counter medications are not really medications.

Dear Great Dane Owner,
Maximus is a beautiful dog, really. But at 8, he has long passed his salad days and is currently sliding down the other side of the hill. It is understandable that he is having a bit of trouble getting up and down lately. A dog of his breed, at that age, is like a man closing in on 85.
While I was glad to make recommendations a few months ago about increasing his fatty acids and starting some massage therapy, I am more than happy to add in a non-steroidal pain medication to the mix. The NSAID panel didn't show anything that would bar him from starting rimadyl, previcox, or one of the other approved NSAIDs. Now, for the difficult question: is Maximus on any other medications? Tylenol, Ibuprofen, aspirin? God forbid, Naproxin? Ok, no. Great. Any supplements besides the fish oils? Oh, vitamin B? Ok, that is fine. Now are your sure that there are no other medications that I need to know about? No prescription pills that you have lying around? No one else could be giving him any medications, right? *insert explanations of how the medication works and risks, etc*

Dr. Repeatable Questions

*************** One Week Later************

Dear Great Dane Owner,
Maximus is now here blowing out black tarry diarrhea and vomiting blood. What part of the question "Is he taking any other medications?" did you fail to understand. I even gave you the benefit of the doubt by asking about specific medications. See, when I ask if Max has been taking any aspirin, that means *aspirin*.... Not too hard to understand. I even used short words, just in case. You even got written instructions of what *not* to give him
So, how in the holy hell do you fail to mention to me that Max has been getting his prescribed anti-inflamatory medication AND aspirin AND prednisone that you had laying around from some skin disease from 5 years ago? What do you mean you gave him an extra dose of each when he started acting nauseous? How does that even make sense? Oh, since you bought the medications over the counter, you thought that they didn't count as medication?
I am sorry to tell you that Max is pretty sick now. The signs point to a bleeding and perhaps perforated ulcer. Things have suddenly gotten much more critical and much more expensive.

Thank you,
Dr. I didn't realize that OTC meds were not really meds


  1. Just experienced that last year..."well Doc, she had a rough day with that arthritis, so we just gave her some baby aspirin to help her out until the next rimadyl dose...are these just side effects from the rimadyl??" Nope, that would be the now $2000 aspirin dose that caused this...

  2. I'm in vet school...we were just talking about this today in our emergency medicine lecture. We talked about how to keep questioning clients about specific meds since they often don't consider OTC stuff as meds, but what do you do when you ask about specific drugs and they still say no? ugh.

    1. Have you ever gone into a room as a student and taken the history, asking all of the questions that you are supposed to ask, then when the clinician comes in there, they repeat the questions and get *totally* different answers. I happened to me during my fourth year and I remember turning to the clinician after the exam and saying, "I really did ask that question and they told me the exact opposite."

      The wise clinician told me, "Well, that is part of why we ask them so many times and in so many different gives them time to think about it."

      Well, you have to do this too: First the techs ask. Then you ask. Ask in a billion different ways, list all possible medications. Warn them about interactions. And write it all down. Then get used to people not listening. And get used to people that really don't believe that aspirin is medicine. And like akdvm666 said, weep.

    2. The three comments above mine are spot on. A philosophy that has guided me in my questioning of owners (it applies to go-home and post-operative instructions, as well) is this: Proceed as if talking to a second grader. Not by the tone of your voice, but in the simplicity of your words, thoughts and explanations.

      And document and weep.

    3. Wow, thanks for all the great advice...I was actually asking rhetorically, but this was really helpful.

      SMHDVM, I'm actually a 3rd year, so I haven't really experienced this in school yet, but I have when I've been working over the summer. I run through all of the questions I'm supposed to ask, get told no to everything, and then when the doctor comes out they've managed to get completely different answers. My favorite is when the person in the room gives me an answer, then when I go back in and they've been on the phone the story has totally changed.

    4. I'm a fourth year and I know it happens, but it is still frustrating! I hate being made to look like a complete idiot, especially in front of cocky interns... ugh!

    5. That's my fave! Tell me one thing at the desk, tell my tech something different & then tell my doc a 3rd story that is completely different. WHY???

  3. Replies
    1. True, but I DO wish they could be charged with animal cruelty. Just wishing.

  4. I was having menstrual cramps the other day - and taking ibuprofen for them. My cramps were coming back before the allotted 8 hour window where I could take more, and I was telling my boyfriend I was hurting. This man, who has been to college and some post-grad work, asked me if I'd like a naproxen to "get me through." I about bit his head off! It is amazing to me sometimes how much laypeople don't even think about what medications they are taking themselves, much less administering to their animals. Especially when the meds are "OTC"


  5. We get the same thing with human patients. I have to SPECIFICALLY ask if they are taking any OTC medications or vitamins or herbal supplements or laxatives, etc. In fact, I often have to throw in the phrase "non-prescription" medications, because, after all that, 5 questions later he will mention (in passing) ibuprofen, or potassium tablets or something equally significant.

    That's when I make a show of stopping, turning away from the computer, and ask the patient why he did not tell me this when I asked what medications he was taking, and did he happen to mention this to the doctor? "Uh, no, I thought you were talking about REAL medicine."

    Night Nurse.

  6. I had a St Bernard come in for break through seizures. He was on a good dose of Phenobarb. Finished my exam, was discussing all the things we needed to do, what other meds we may need to add and the fact that since he's having these break through seizures may make it more difficult to control the seizures.

    I start asking again about his Phenobarb, how much he's getting and how often.

    It ended up the teenager was giving the meds to the dog when he got home from school. An entire 24 hour dose at one time. He didn't like how groggy the dog was after getting the meds.

    So his dad said just give him half of the dose.

    Yep, he was only getting half the phenobarb he was supposed to get.