Wednesday, August 21, 2013

Ringworm or decide

Ringworm was one of the first things I learned to recognize quickly when presented with an effected animal on my exam table. Now, this is no great accomplishment. Ringworm is an easy one. Dermatomycosis. That’s what we call it in the medical record, but not when trying to communicate with you folks. You know what ringworm is, so we work with the language you know. A fungus of the skin. Very contagious, especially between kittens and between kittens and people. And that summer, we saw some nearly every day.

 I was still the young enthusiastic veterinarian, having only been burned by reality a few times. I’m no fool, so each burn taught me a lesson. What seemed the right thing to do is only right some of the time, so I learned to reel in my enthusiasm. I learned I cannot fix it all, but that I must hold back and fix what I can. I could only fix what they’d let me fix.

A woman I knew opened a pet store in town, selling pet food and cages, hamsters and some fish, and she thought she could save the world by taking in kittens and selling them for a pittance hoping for good homes for many. She built a chicken wire enclosure, and all the kittens went in there, and people came by and said, “I’ll take the orange one, that one over there”. And one of those kittens went in that enclosure with ringworm, and it rubbed up against all the other kittens, and all summer long, we saw kittens purchased from this store, and they all had ringworm. And usually, it was Mom and the kitten with ringworm, and the kid with ringworm. So I got real good at spotting ringworm. And no, the woman who owned the pet store wouldn’t listen to me about all that ringworm stuff, because all she wanted to do was sell kittens. What happened after that did not concern her.

Now, this veterinary practice was in a town that was pretty much the lowest common denominator, and folks there kept to a pretty marginal standard. So if you owned a veterinary practice and you wanted your kids to get a decent education, you didn’t let them attend the local schools. You spent the money and the kids went to a private school in the fancy town over there. And they made friends with the rich kids from the fancy town. And that is what my boss did. 

So when one of those friends had a kitten, and the friend’s mom thought the kid had ringworm, but the kids physician thought she might have lupus instead, somehow that family drove over the hill to let me examine the kitten, and she brought her daughter along. And so on my exam table was a young cat with classic ringworm, and the lovely 18 year old daughter standing next to my table had a perfect, absolutely textbook example of ringworm on a human, the perfect red circle on her neck, which does in fact sorta resemble lupus in some young women. And I had to say something about this.

And I had to get real careful about what I said.

First….yes Mrs. Richlady, your kitten does have ringworm. No doubt about that one. And yes, ringworm in a kitten is very easily transmitted to a young lady who hugs a kitten to her neck. Your lovely daughter does have a nice red perfectly round skin lesion on her neck which could easily be a ringworm lesion. I am not a physician, so I have no opinion on whether that round perfect ringworm lesion on your daughter’s neck is actually ringworm. But if it were my daughter, I’d be talking with a dermatologist real soon, and maybe the lupus specialist a moment later. 

Now, I might have gotten hung over that statement, for as a veterinarian, I have no right to say anything about a human medical condition. No right whatsoever. For as a veterinarian, I know less than the drunken homeless guy living in the bushes behind my clinic, when it comes to the medicine of that species call human. Just ask any attorney or judge who thinks I got my degree by sending in six box tops from my breakfast cereal. Sure, that young lady did have ringworm, and it was stone obvious. But I had no business claiming I knew what was wrong with her.

Now you might wonder why I have adopted such a pissy attitude about a veterinarian talking about human medicine. Didn’t I spend those years of pre-med college courses right next to those who went on to medical school and dental school? Didn’t I outperform many of those students on my way to qualifying for veterinary school? Don’t I have four years of post-graduate veterinary medical education? Don’t I know far more than the average physician about those things called zoonotic diseases, those diseases easily spread between animals and humans? Well, that all is nice, but I am not a physician. So what I know does not count for butkis, if applied to a human.

And here is why….

A year before the summer of ringworm, I had the misfortune to examine a rather nasty Siamese cat belonging to an annoying, knowitallknownothing man. The cat had some nasty lesions on its skin due to its incessant licking. The licking was about allergies combined with the irascible annoying incurable and frustrating habit of Siamese cats who like to lick sores on their skin. In those days, we gave them injections of reposital steroids. Today we know better, and we don’t use reposital steroids. Now we pretty much do nothing. But back then the shots sorta helped, so I suggested we give this cat an injection. The owner agreed.

Now, these steroid injections stung. No lying about that. They annoyed these cats something awful. So as I set about to give this cat an injection, I prepared for the worst. The owner, bless his stupid heart, had a better plan. 

I was going to grasp the cat by the scruff of its neck with one hand whilst injecting the hind leg with the other. Often the cats were so distracted by the one hand that they didn’t notice what the other was up to until too late. This was a win. 

And if they did notice, and they decided to launch for the stars, the cats were aimed away from me, and so they attacked air instead of me, or any other people in the room. The worst I expected was some scratch marks on my forearms, and no one would die.

This owner knew better than me. HE wanted to hug the cat. I was young and stupid, and so I let him make his case. He loved the cat and it loved him. Sure, it bit him regularly, but she didn’t really mean him any harm and he had always recovered. So no, he wasn’t going to let me inject the cat unless he was hugging it.

I should have left the county about then, but I was young and stupid. And he proceeded to hug the cat.

I looked at him in total disbelief. The way he held the cat guaranteed that the cat would bit him on the forearm. Guaranteed. I mentioned this to him. He dismissed my concerns. The cat always bit him, and he didn’t worry about that. He was going to hold the cat, or no shot was to be given.

This is where youthful exuberance will get you every time. I actually thought the high moral ground, and Darwin, established that this stupid dipshit deserved to get bit on the forearm, so I let him hold the cat against my direct instructions, and I went ahead and injected the cat.

I was right! The cat bit him on the forearm….rather effectively.

OK, I’d done my job. The injection was given, and the lick sores would soon, albeit only temporarily, disappear. The man stood there bleeding from the four nice punctures in his arm. He commenced to tell me that this was nothing, that the cat bit him all the time. And I kept interrupting. 

You gotta take wounds like this seriously. They can get terribly infected. Don’t try to blow this off.

Nah, it’s nothing. The cat bites me all the time.

You gotta take these wound seriously. If you see anything that looks like infection you must get the wounds looked at and treated. This is serious.

It’s nothing! The cat bits me all the time.

(You dumb f^^^ing idiot!!!) Would you please at least wash off the wounds in my sink!!?! These can be serious, and you need to pay attention to me. This part was that thing that stuck in my head about washing out the wound from the bite of a rabid animal, for at the time this was recommended before you even called the physician. 

No problem doc. She bites me all the time. It’s nothing.

When the letter came, I was surprised. I was young, and stupid. I didn’t know reality yet. But I soon learned.

I was being sued because the owner of that Siamese cat was self-employed, and he had lost six weeks of work because of the infections caused by that cat bite wound, the wound I had told him would be just fine if all he did was wash it in my sink. It was all my fault.


Well, my insurance company settled with this guy’s attorneys because they really had no defense, for I had acted as a physician when I told him that all he needed to do was wash the wounds, and he would be fine.

And I am not a physician. I’m only a …….veterinarian. 

The lying part never came up. No really…the lying part never came up. Guess who they believed?

So to this day, if your animal scratches you, or bites you…regardless whether this happened at your home, in your car in my parking lot, or as you lift your cat onto my exam table after I asked you not to do precisely that, I will tell you to go see your physician, and then I will walk out of the room. I will not offer you a Kleenex to mop up your blood. And even though that drunk homeless guy in my bushes can give you a band aid, I cannot. So don’t ask. I cannot afford to do for you what I know is right for you, and that I am fully qualified to do as a breathing adult, much less as an educated and experienced medical professional. I’m not allowed to do that.

Just a few years ago, I needed to administer some subcutaneous fluids to a dehydrated, and very sick cat. I didn’t yet know what was wrong with this cat, and would not until the fax machine in the morning spilled out the test results, but I knew the cat needed some fluids so we set out to do just that. So my highly skilled and experienced, not to mention very compassionate assistant calmed and gently restrained the cat as I let the fluid flow through the needle under her skin. All was well.

Until the owner, a well-intentioned but completely brain free human body stepped in to help. She charged in with both hands, and the cat exploded. My assistant managed to keep the cat from ventilating her owner, but in the process she was severely bitten. She did not lose the function of her hand, and in fact still works for me, but this is only because she was uncommonly lucky.

To this day, we will not touch a cat for this one owner unless there are at least two closed doors between her and her cats.  Because I own the veterinary practice, and therefore I am responsible for the bad effects of anything I do wrong, or my staff does wrong, and whatever completely insane thing you do wrong, regardless how hard I try to keep you from living up to your full potential.

So, if you ever wonder why your veterinarian won’t let you hold little Precious, but she insists upon having her trained staff do that, please STFU. There is a reason.


  1. "You may know your dog/cat, but I know my business, my practice, and how any lawyer in the city will come after me when the trauma that may happen if I let you have your way happens. I don't show up at your place of employment and tell you how to do your job, don't show up here and tell me how to do mine."
    -- Any Veterinarian Who Doesn't Want To Get Sued

  2. I once worked with a vet who would let owners restrain their pets until someone'e dog bit them in the face so badly he needed to be taken away in an ambulance and needed expensive plastic surgury to repair the damage.

  3. I've had two serious cat bite infections. I will very gladly let you and your trained assistants handle my tabby patch cat who can be a demon spawn.

  4. Ahhh, ringworm. We are one of the few families that will foster kittens with ringworm, so we have a steady supply of very adorable, slightly patchy babies in the summer. Clotinazole is our current favorite OTC, and our house always smells vaguely of sulphur from their twice weekly lyme dips.

    And yes, we end up getting some spots, mostly because we aren't any good at locking the kittens into an easily cleaned space (ie bathroom) and after the initial quarantine, they have full run of the house/couch/beds etc. spots are a small price to pay to get to snuggle and socialize all these sweeties!

  5. Do you think it's necessarily irresponsible for the vet to ask the client to hold the patient, or does it depend on the animal and their temperament?

    1. I have seen the sweetest, most loving pet try to rip your face off because a vaccine just hit a nerve the wrong way. And there are those rare down-right, nothing but plain vicious dogs that can normally only be approached while under full sedation allow the vet to examine it if the owner holds it a certain way. So while I would say it was irresponsible for the vet to allow the owner to hold the pet, it is not a 100% rule and there are the few exceptions.

    2. Thanks for the explanation. I was just wondering if my vet's office is irresponsible, because they seem great with everything else, but they have asked me to hold my dog. He may be one of the few exceptions. He's an exceptionally sweet dog, and if you do cause him sudden pain, his first instinct is to let out a big ol' heartbreaking yelp.

    3. At my office we do sometimes have owners hold their animals. I don't fully agree with it but we don't have a lot of staff so I can't have a tech come in to hold every animal. If there's any sign of fear or aggression or if the owner seems at all uncomfortable, I'll still call a tech (but it might take a little while to get them) but a big goofy lab who's just trying to lick me to death...I'll admit to taking the risk.

  6. Thank you. Best stated case for the closed doors I've heard to date.

  7. I have come across your website looking for some information about ringworm and what is vet's attitude towards it and and what you are saying is really important. Ringworm can be a real nuisance. Unfortunately people do not take the necessary precautions because of lack of knowledge but also because some vets fail to make them aware of the gravity of the situation or even fail to spot the disease! In my case, I found a stray cat that was in a horrible physical condition. I have been to three different vets and all of them failed to notice the ringworm on the cat (while pointing out some other diseases). The result: me and my other animals (2 golden retrievers and 8 cats) have been contaminated (even though the infected cat was isolated from the beginning). The treatment of so many animals is just inimaginable. If you are interested you may read that story here (only in French) as a warning but also how to handle it:
    I hope that will help. Thank you.

  8. The concept that your own pet bites you in my building and this is somehow my responsibility is one of the most idiotic concepts in jurisprudence!!!!!!!!!!!!!!
    How any given vet chooses to cope with this sad fact of our ridiculously litigious society is thier personal choice. Most clinics allow most dogs to be held by the owner for the initial temperature and exam phase. Really cats should never be handled by owners in the clinic because they are intensely neophobic and prone to suddenly become aggressive due to fear. I saw one owner bitten 6 times in 10 seconds by a particularly nasty feline before I could round the exam table and physically seperate the two. This was on a known bad cat (bit the owner at home which makes it not a worthwhile pet in my book)
    And we had instructed the owner NOT to touch the cat!!! He stepped in to "comfort" the malicious little critter while a tech was holding it for the exam????? But even though he had a screw loose when it came to the cat (it was a hand reared singleton [shudder] hence the discordance) he was upstanding enough not to sue me for his own stupidity at least. As for ringworm the wise assumption is to assume ANY rescue/feral/backyard born under some old ladies porch/stray kitten has ringworm and isolate it for a few weeks from other critters with stict hand washing for any humans in contact. If it gets through 2 sets of shots with you asking your vet to check specifically for to ringworm then it's time for release to gen-pop. Oh and always train and socialize your dogs please.