Tuesday, February 26, 2013

back in the trenches

It's not all politics around here. Yeah, the AVMA is annoying lately with their whole "let's spend $80K on finding out whether we really need a new logo and if so what it should be like" thing. Yeah, there was an article in the NY Times about our profession & its economic issues, and I'm sure that you, dear readers, have noticed that we VBB have strong feelings about these matters. That said - there's more to life, and as we struggle to keep our heads above water and pay down our loans, we are kicking butts and taking names - and sometimes seeing patients.

I had a client call me today to find out whether or not Fluffy needed to continue his medication. Before calling the client back, I went into our trusty EMR and looked up Fluffy's history. I noticed that Fluffy is on Optimmune, and has been on Optimmune for 3 years now. I further noticed that the last several labels printed out for Fluffy's Optimmune all contained the statement "DO NOT DISCONTINUE - CALL FOR REFILL BEFORE RUNNING OUT - THIS IS A LIFELONG MEDICAL TREATMENT!" So, I banged my head on the desk a few times before making that call. It didn't help.

I've been treating a million-year-old Small Fluffy White Dog that belongs to a million-year-old dementia patient. The client's caregiver comes with the dog & the lady to our appointments, thank goodness. Last week I saw the SFWD on a recheck four days after her previous visit which had been with a colleague. When my colleague saw SFWD she'd noted lumbar pain, hind end pain, generalized weakness, and a high white count. She'd started methocarbamol & amoxi/clav. Apparently this hadn't worked so well because when I saw SFWD she was pretty flat. Dehydrated, not eating/drinking, not walking, not standing unassisted, and temp in the range of 104 F. Euthanasia was not on the table that day - you know, this dog is the demented old lady's only real family left, and the demented old lady was not capable of understanding the kindness it would be to release the dog from her suffering, it seemed to me. Certainly the caregiver wasn't about to consent. So, I did some hemming and hawing and ended up giving fluids, and sending SFWD home with mirtazapine and Zeniquin on top of the rest of the stuff. Imagine my surprise to find out today the dog is doing great! Eating, drinking, walking around normally. I just wish I could be sure - is she really better, or is this the sweet spot before they find her dead in the kitchen or something?

Today I also saw a young adult longhaired mutt cat. She was presented by a woman claiming to be the mother of the actual owner, who was a 12 year old girl. The girl was not there. The woman stated that her daughter said the cat had bumps on its skin. She further stated that they had used a Furminator on the cat four months ago, and she'd "been like this ever since," where "like this" equals "practically no hair on the caudal half of the cat." To make a LOOOOOOOOOOOONG story short, there were no significant findings on any of our diagnostics, and a trichogram revealed growth-phase hairs that were broken off rather than normally tapered. The owner did state that the cat had a history of food allergy. In despair, I decided to give 10 mg of Depo-Medrol. I had a discussion with the owner in which I explained that I really wasn't sure what was going on, but that hopefully in the event of allergic or inflammatory condition the steroid would help. Of course I also explained that if there were in fact a fungal, parasitic, or infectious condition I had not uncovered, the cat could get worse. The owner looked at me for a moment and said "ok, sounds good. Either she will get better, or she will get worse. If she gets worse, I'll bring her back for more tests. Right?" "Yes. Either she will get better or she will get worse. I realize that sounds bad...." We all laughed. It was really nice to have an understanding client for a change. I put a lot of pressure on myself to always figure it out up front, to always be right, never make a mistake, etc. This cat just did me in and it was wonderful that the owner was understanding. Here's hoping kitty improves.

1 comment:

  1. Honestly I like the she will get better or she will get worse. My dog had a really occasional cough but he's getting older and I worried it could be serious. Vet said could be blah or blah or blah but nothing really alarming on physical exam. Eating well etc. So just observe and recheck if necessary. Vet knows I'll come in (for real, the first time I took a dog in she asked if I was a tech) if he needs anything. Anyway, I called later in the week to say he was coughing every time he ate. So we did xrays. All is fine, course of antibiotics and he's healthy and back on top.

    What I mean is: I really appreciate not walking in to a vet that wants a bunch of fancy tests done for a non-life threatening problem. I'm happy (well, willing) to pay for what my dogs need but I go to the doc's because they know their shit and they tell me if it's a holy shit problem or what to look for. I don't see them for pretty machines. So thanks for being good at what you do.