Who let the crazy in?

Here at the VBB South-Central outpost, we receive a LOT of phone calls. We don't get calls just from our clients and suppliers and colleagues. We also get calls from random strangers, both related and unrelated to veterinary medicine. You know - people looking for free veterinary advice because they have no actual vet they work with, or people wanting to know how late the dry cleaner down the road is open, but the dry cleaner never answers the phone so they are just calling to see if we know their hours. Yeah. Hazard of doing business, I guess.

Anyway, recently we have had two particularly memorable phone calls. One was from a client, and one was not. My ReceptionistBB was kind enough to help me reconstruct them for you here.

<ring, ring>
RBB: VBB South-Central Outpost, how may I help you?
CBB: Hi, this is Ms. Epicure, I'm calling about Sir Pees-A-Lot.
RBB: Oh, hi there! How is Sir P doing today?
CBB: Well, I'd like to come pick up some more antibiotics for him.
RBB: Really? Hmm. It looks like we haven't seen Sir P in almost 3 years. What's going on?
CBB: He has a UTI and I need antibiotics for him.
RBB: I'm pretty sure our doctors will need to see him before they can prescribe. We need to  get an accurate diagnosis.
CBB: Oh, I diagnosed him myself. See, I found this wet spot on my bed, and I wasn't sure what it was, so I tasted it. It was definitely urine with blood in it. So obviously Sir Pees-A-Lot has a UTI.
RBB: Oh, let me put you on hold for a minute & talk to the doctor...
[puts on hold, tells rest of office about this story...calamity ensues...then we all calm down & she gets back on the phone]
RBB: Hi. So sorry but Dr. VBB can't prescribe for a patient we haven't seen in more than a year without getting in trouble with the state board. We'll need to schedule an appointment.
CBB: but I already tasted the urine! You know, that is how they used to diagnose diabetes back in the day after all.
RBB: I understand, but dogs can have bloody urine for lots of reasons. How is Tuesday at 4:30?

I just don't even know what to say about this. Really. I mean - I was just not prepared for this to have actually happened. I am not sure how I will look at this client in the eye ever again, either.

Moving on to our non-client phone call....

<ring ring>
RBB: Hello, VBB South-Central Outpost, how may I help you?
StrangerBehavingBadly: Hi - I have a really important question I could use your help with. It's about my purebred, registered Angolan Swizzle Hound.
RBB: Ok, I'll be right with you, just please hold for a moment [puts on hold]
SBB: [hangs up]
<ring ring>
RBB: Hel-
SBB: Hi it's me again, I don't really have time to hold, I need to know if my purebred registered Angolan Swizzle Hound had sex with our neighbor's dog.
RBB: Sorry?
SBB: How do I know if she had sex with our neighbor's dog? He got into our yard.
RBB: Well, is your dog in heat?
SBB: What does that mean?
RBB: You know - in season? fertile? accepting of males?
SBB: How would I know?
RBB: Well, what makes you think they had sex?
SBB: I saw him in the yard, he got on top of her, and he was on there for a while. But I didn't see his peter out, so, I don't know. But I'm worried they might have had sex.
RBB: Well, I wasn't there, so I really can't say. It sure sounds like they may have. You can bring her in for a checkup if you like.
SBB: Isn't there a rape kit for dogs or something?
RBB: No. Well, when did this occur?
SBB: five days ago.
RBB: OK, well - after five days, we might not find microscopic evidence even if that was something the doctor was going to look for which I would have to ask her anyway. If it was right away, surely we could look at a cytology but after five days, I'd have to check with the doctor.
SBB: Well how do I find out if my dog had sex?
RBB: Would you like to speak to the doctor?
SBB: No, he's probably as useless as you are. [hangs up]

Please share some of your phun phone calls in the comments!

Do Not Call

Here at VBB Residential, we are on the National Do Not Call Registry. I don't really perceive that it has helped to reduce the annoyance-call volume, though. I handle these calls in different ways, depending on my mood. Sometimes I just feel like slamming down the phone. Other times I feel like stringing them along. Still other times, I try to engage them in real discussion. Before anyone calls me out for playing games with these people who are "just trying to make a living," I would like to add that I worked at a phone bank in college, trying to raise money for the university, and I am WELL AWARE of the trying conditions such people are working under. Makes no difference to me. Anyway. Just last night....
 
The phone just rang here as we were finishing dinner:

<ring ring>
Me: hello? 
Me: hello, hellooooo, may I help you?Bob: [heavily accented, Indian] Hello, this is Bob from Healthwatch calling to- 
Me: excuse me, you are who from where?
Bob: Hello, this is Bob from Healthwatch. I am calling to-
Me: I'm sorry. One more time. Slowly please. You are who, and you work for whom?
Bob: This is Bob from Healthwatch and I am calling to inform you if you have suffered from side effects from prescription-
Me: Oh wait. Do you work for an attorney's office?
Bob: This is Bob from Healthwatch and-
Me: No, wait. I'm trying to figure out what you are bothering me about. Do you work for an attorney, is that it?
Bob: Yes, I am Bob from Healthwatch and I am calling to inform you if you have suffered or a loved one has suffered from side effects from prescription drugs, then-
Me: OK, wait, again, you work for an attorney, and what you're doing is soliciting people to file medical malpractice suits of some kind?
Bob: Yes.
Me: OK, I understand. I have another question. How do you sleep at night?
Bob: Miss, I am not understanding you.
Me: I do not think I could sleep at night if I had this kind of job, it seems like a kind of scuzzy thing to do, to solicit people who have no intention of filing a lawsuit to file a lawsuit.

Some time during that last remark, he hung up on me.

Walk softly & carry a large tranquilizer gun

This story from the remote VBB outpost known as VBB Ambulatory Service illustrates part of the problem our farm-call colleagues have every day. Small animal vets may recognize the archetypal Mr. Nopay in this dramatization of a routine inquiry by phone:


VBBAS: Good morning, VBB Ambulatory Service.  How can I help you?

Mr. Nopay: I wanted to make an appointment for spring shots for my horse.  How much will that cost?

VBBAS: That depends upon what vaccinations your horse needs.  How old is your horse?

Mr. Nopay: He's three.  Is it too late for his boosters?

VBBAS: Do you mean annual vaccinations?

Mr. Nopay: No, his boosters.  The other veterinarian said I needed to make an appointment for his boosters.

VBBAS: Okay.  When was this?

Mr. Nopay: I don't think I should have to pay to start over.

VBBAS: When was your horse last vaccinated?

Mr. Nopay: The veterinarian gave him the five-way when he was six months old.

VBBAS: Has your horse received any other vaccinations?

Mr. Nopay: My horse doesn't like men.  That's why I thought I'd try VBB Ambulatory Service.

VBBAS: When was your horse last seen by a veterinarian?

Mr. Nopay: I hope you're better than the other veterinarians.

VBBAS: Who is your regular veterinarian?

Mr. Nopay: Well, I use Dr. Doesitall for my dogs, and he gave my horse the five-way, but now my horse is afraid of male veterinarians.  He is very rough.  The last time he vaccinated my horse he broke the pasture fence.

VBBAS: Was this last spring?

Mr. Nopay: No, when he gave him the five-way.  He said I need to make an appointment for a booster, but I didn't want to make it with him because after the last time my horse is afraid of male veterinarians.

VBBAS: Did your horse receive any vaccinations after the first shot?

Mr. Nopay: No, that's what I've been trying to tell you.  Dr. Doesitall doesn't travel with a technician.  Do you have a technician?

VBBAS: We can schedule the appointment on a day when the technician is with me.

Mr. Nopay: You shouldn't need one.  My horse is very well-trained.  He works at liberty.  I've taught him to rear.  Have you ever seen a horse rear at liberty?  He's so beautiful.  I'll have to show you the photo I used for my Christmas cards last year.

VBBAS: Let me make sure I understand.  Your horse received his first five-way when he was six months old...

Mr. Nopay: Yes.  Do you do castrations?  Dr. Doesitall doesn't do castrations.  Neither does Dr. Newgrad.  Dr. Deathwish wanted me to bring my horse to his hospital, but his hospital is expensive and my horse is afraid of men, anyhow.

VBBAS: I see.  Yes, I perform castrations.

Mr. Nopay: My horse only has one testicle.  Would there be a discount?

VBBAS: Actually, I don't perform cryptorchid castrations in the field, but we can talk more about that when I come out to your farm.  Now, your horse needs all of his vaccinations, and it sounds like he will need both the primary and the boosters because he didn't receive the full series originally.  I can work up an estimate for you so there won't be any surprises when I arrive for the appointment...

Mr. Nopay: Last spring Dr. Newgrad didn't bring her tranquilizer gun.  Do you have a tranquilizer gun?

VBBAS: ...Let me give you the phone number for Dr. Wild.

Mr. Nopay: But he's a man.  My horse doesn't like men...

Not cheaper by the dozen!

Sitting in my office, I can hear the receptionist out front on the phone with a caller. This is what I heard just now:

[ring, ring]

Receptionist: Hello, VBB Animal Hospital, how can I help you? [pause] Yes, we do boarding. [pause] Absolutely we do. Hang on let me see - yes, there's room that week. [pause] How many cats? NINE cats? Well that would be $22/cat/night. Yes. Yes, that's $198/night inclusive. No, there's no group discount. So have we seen these cats before? [pause] Oh you just moved to the area a year ago, I understand, but has any veterinarian seen these cats before? [pause] Well, we can't board them unless they are up to date on their vaccines. No, no. We cannot sell you the vaccines. Yes, even if they are indoors only, they can't stay here if they aren't up to date on their vaccines. [pause] Well they would need an examination so the veterinarian is sure they are healthy and free from infectious disease and parasites, and then they would need vaccines, and if you hang on I can get you an estimate - ah, yeah, that's what I thought. Well, pets are expensive. I know. I'm sorry. [pause] Actually I do know. Actually I take off one day a week to watch my grandson exactly because daycare is so expensive. But, the cost of daycare isn't really something that we take into account when we set our fees. [pause] You might have better luck finding a petsitter to come to your house. [pause] I don't know what else to tell you. [pause] Well you have a nice day too, maybe someone can call you at work and curse you out for doing your job. Thanks for your inquiry. Goodbye.

[slams down phone]

Is it any wonder people burn out in these jobs?

Getting Crispy Around the Edges

Burnout can be insidious. I noticed the signs in myself today as I prepared myself to call a client regarding the findings on his dog's physical exam. The dog had been dropped off for grooming & my exam had revealed some significant progression of the dog's heart disease. I could hear the conversation playing out in my head before I picked up the phone. I was sure it would go like this:

[ring ring]
Mr. Apathy: Hello?
Me: Hi, Mr. Apathy. This is Dr. VBB from VBB Animal hospital. I'm calling about Foxglove.
Mr. Apathy: Well, I'm at work. What do you want?
Me: As you requested at drop off, I did perform a physical exam on Foxy today and-
Mr. Apathy: Can we discuss this when I pick her up?
Me: No, Foxy needs additional diagnostics and treatments because her heart is-
Mr. Apathy: She saw a cardiologist six months ago. We already did the heart stuff.
Me: well, today she is having trouble breathing and -
Mr. Apathy: I'm not talking about this again right now. I'll discuss it at pick up.
[click]

I was so sure I would be having that conversation that I postponed making the call for probably an extra ten minutes. I got myself all worked into a frenzy internally. I'm sure I ground off some tooth enamel. However, after a few deep cleansing breaths I psyched myself up for it. I made the call.

[ring ring]
Mr. RealGuy: Hello?
Me: Hi, Mr. RealGuy. This is Dr. VBB from -
Mr. RealGuy: Doc! How's Foxglove?
Me: I have some concerns, and -
Mr. RealGuy: is it her heart? I know, I was supposed to bring her back to the cardiologist for a recheck in December, but I got so busy and she seemed fine. Is she in trouble now? I feel terrible.
Me: well, I think her medication needs some tweaking. I'd like to go ahead and give her some extra diuretics today, but I do want her to see the cardiologist as soon as possible too.
Mr. RealGuy: I was actually planning to take her next week, but they almost always can get me in same day. I'll call them right now and see if we can go there this afternoon or tomorrow.
Me: Great. I'll have her records ready to go for you.
Mr. RealGuy: thanks doc! See you soon!
[click]

I was of course really pleased that my patient will get the specialty care she deserves. I was also really pleased that I had a nice client interaction. I was DISPLEASED by the realization that I am starting to always expect the worst. This bothers me a lot. I don't want to be one of those old and crispy burned out people!! I want to be able to think positive! Or even be like the Whether Man from The Phantom Tollbooth, who said "Expect everything, I always say, and the unexpected never happens!" But to always expect the worst - well, it's draining. Any creative tips on dealing with burnout??

One lunch special to go please.

They are crawling out of the woodwork today.

My RBB just told me one of our clients phoned and needed to speak to me. Apparently this client was completely irate that when her husband picked up her dog after boarding, the dog was not sent home with a package of our house diet so that she could transition him back to his regular food slowly. No amount of explaining that this was not standard procedure seemed to calm the client down, and the client was apparently insisting on a prescription for the house diet, which the client could take with her elsewhere, because heaven forbid she ever give us one red cent ever again.

I did pick up the phone and call this client, but unfortunately (can you feel the sarcasm??) got voicemail. I left the following message:

Hi, this is Dr. VBB calling about Fluffy. I got a message that you wanted a prescription for our kennel diet. Unfortunately, I can't write a prescription for anything for Fluffy without examining him. We do feed Food X here at VBB Hospital and you are certainly welcome to purchase that from the food vendor of your choice. I wonder if perhaps there was some misunderstanding regarding Fluffy's dietary status, or regarding your request, because no one has ever made this kind of request in the twelve years I've been here at VBB Hospital. Please give me a call back at 1-800-VBB-HOSP if you have additional questions or concerns.

Either the client has no additional questions or concerns, or is not interested in addressing them, or has not gotten the message because we have not heard back.

Puppocalypse

On the lighter side, a friend of ours is having a problem in her practice with zombie puppies. She explains:

We had a recent phone call that had me scratching my head.

Mrs Necro Whelper: My dog was pregnant, but she died before the puppies were born. Only one of the puppies survived. I've had him since he was two days old. He's 18 days old now, but his eyes are still not open. Should I be concerned?
 
Technician: I can't say without seeing the puppy. I would recommend that you bring him in to be examined by the doctor.
 
Mrs Necro Whelper: Oh, I don't have the funds for that. click
The technician told me about the call. Problem one: WHAT HAPPENED TO THE BITCH? Seems like important background info! Problem two: if it was the caller's bitch, how is it that she has only had the surviving puppy since he was two days old? Who had him when he was one day old?? Was he BORN two days old? Obviously the only rational explanation for a 2 day old puppy being born from a dead dog: zombie puppy. The technician and I agreed that neither of us were experienced enough with zombie puppies to know when they open their eyes.

Guest post: Dear whoever you are

Dear hysterical lady who calls literally in the middle of the night: 

1) I cannot understand hysterical crying, whether in a voicemail or while on the phone. 

2) Calling 4 times in 5 minutes does not necessarily get me to call back any faster, especially when (#1) applies. I need to understand your phone number at the very least.

 3) $150 plus euthanasia costs is not "insane" (thanks insensitive husband in the background) when I'm the one getting woken up in the middle of the night to take care of a cat that you "don't think" I have ever seen before in my life.

4) "Do you live here in town?" The location of my residence relative to the hospital does not get you a reduced emergency fee.

5) I really do hope he passes quickly so the trauma stops, because I feel bad that you are hysterical, and it doesn't sound like your husband is going to "let" you bring him in.

After this call, it's to the couch I go so I don't keep my fiancé up for the next 2 hours that I won't be able to sleep.

Do you have a mouse in your pocket?

I recently had the very great pleasure of being presented with a dog for the purpose of emptying his anal sacs. His owner informed me that he'd brought the dog in several days prior, and a licensed tech had done the sac-emptying, but maybe didn't do a good job because the dog was still scooting. So, I assessed the situation digitally, as one does in these circumstances, and I found that in fact the sacs were empty. "Guess what, TBB? You actually did a great job! These are empty! Now let's see...." I said, as I looked for another cause of scooting in this pup. "Aha. See that little protrusion there, sticking out from the dorsal rim of the anus, where 12 o'clock would be if this were a clock?" I asked the owner. The owner expressed agreement that yes, there was something there. "Well, I'm not 100% sure what that is, but it's only about 2 mm wide, and it's on a less than 1 mm wide stalk, and it's a tiny bit irritated - this could be the issue." I gave them some cream to put on it and explained ultimately we could just remove it if it continued to be a problem.

About an hour or so later, the owner's other half called me. I was instructed to take the call.

Me: Hello, this is Dr VBB, how can I help you?
Mrs. Knowsit: Yes, my dog and my husband were just there. Why didn't you run a fecal?
Me: Oh, you mean on little Fluffypants, with the scooting problem? Well, you didn't send in a fecal sample, and I didn't feel one was indicated for any reason, so I didn't do one.
Mrs. Knowsit: but obviously she has worms, she is scooting.
Me: That doesn't mean she has worms. It could be something else.
Mrs. Knowsit: well, but most likely it's worms. I just don't understand why you didn't do a fecal.
Me: I don't believe she has worms. A fecal was not indicated. She's 12, she's on a monthly dewormer, she's never had clinical signs referable to worms before, and she has a perfectly reasonable cause for scooting in any case.
Mrs. Knowsit: Oh? What's that?
Me: The mass on her anus.
Mrs. Knowsit: The what?
Me: The mass on her anus, it was a little inflamed.
Mrs. Knowsit: (laughing) I've never heard it called that before!
Me: What do you mean? You've never heard a mass called a mass, or you've never heard of a mass being called inflamed? Sorry I don't understand.
Mrs. Knowsit: Wait a minute. A mass? I thought you said she has a mouse on her anus.
Me: No. Your dog does not have a mouse on her anus.
Mrs. Knowsit: OK. But I still think she has worms.
Me: I'm more than happy to run a fecal for you any time. Just drop off a sample at your convenience.
Mrs. Knowsit: Ok, thank you doctor.
(click)

The fecal was duly dropped off and was run. GUESS WHAT? It was negative. But how much do you want to bet that this client will tell me she doesn't want to spend whatever my next recommendation was cost because she just "had to" spend "so much money" on a fecal? HMMM? I did try to avoid taking her money for the fecal. Honest.

In which I *obviously* don't know what I'm talking about.

(ring, ring)

Client: Hello?

Me: Hello, this is Dr. VBB calling, am I speaking with Mr or Ms Message-leaver?

Client: This is Dr. Message-leaver, who are you and why are you calling?

Me: This is Dr. VBB from VBB Animal Hospital, returning your call about Fluffy. What can I do for you?

Client: My wife must have called you. Hold on.

Me: (holds on)

Me: (plays a turn in Words with Friends)

Me: (signs a few faxes & puts them in the outbox)

Me: (plays another turn in Words with Friends)

Me: (changes my Facebook status)

Me: (puts line on hold, releases a barbaric yawp, picks up line again)

Me: (plays another turn in Words with Friends)

Client's wife: Hello? Who's calling please?

Me: Hi, this is Dr. VBB returning your call about Fluffy. What can I do for you?

Client's wife: Oh. I wanted you to talk with my husband, the doctor. He says you don't know what you're talking about.

Me: Excuse me?

Client's wife: He read the label on that medicine you prescribed and it says it is approved for use in dogs. Doctor, I don't know much about this but I know Fluffy is a cat and not a dog.

Me: Yes. Of course. As I explained in your take-home instruction sheet, we are using that medicine in an extra-label fashion. That means that it isn't approved for this particular use, but that's ok. I'm within my prescribing authority to use it, as long as I've explained to you the potential down-side, and why we are using it, and I believe it is appropriate and you agree the benefit outweighs the potential risk. You said you understood this.

Client's wife: well, my husband says you don't know what you're talking about. Here, talk to him.

Client: Hello? What's going on?

Me: (sigh) your wife says you have a concern about Fluffy's prescription.
Client: What are you talking about?

Me: Gosh, well - I guess that depends who you ask. Your wife tells me you think I don't know what I'm talking about. That's what I'm talking about. Did you have any questions or concerns about Fluffy's prescription?

Client: No.

Me: Well, ok then. If that's all, I'll let you go. Have a nice-

Client: wait a minute. Are you the one that sent home the dog medicine for our cat?

Me: yes.

Client: Why would you do that?

Me: I'm using it in an extralabel fashion because there is no approved cat medicine for Fluffy's condition. 

Client: Well I'd prefer you used cat medicine.

Me: Sir, there-

Client: I'm Dr, not Sir.

Me: Excuse me. Dr Message-Leaver, there is no medicine approved to treat Fluffy's condition in cats.

Client: I don't believe that for a minute.

Me: Well, it's true.

Client: why would that be true? Do cats even get this disease? if they did, there would be medicine for it. At least some kind of clinical trial.

Me: The thing is, most drug companies aren't interested in going to the expense of obtaining approval for drugs when the market is going to be really small, and the profit very low. In human medicine I believe they call them "orphan drugs," right? But I've read a lot of studies about the use of this drug in cats and talked to some experts and I think it's fine. It's not like there is anything approved for use in cats that would be helpful here.

Client: you think it's fine? why should that mean anything to me? Who the hell are you?

Me: I'm Dr. VBB and I'm Fluffy's doctor, unless you'd like me to send Fluffy's records elsewhere. Would you prefer to seek Fluffy's care elsewhere?

Client: (silent)

Me: (plays a turn in Words with Friends)

Me: Hello?

Me: Dr. Message-Leaver? 

Client: I still think you don't know what you're talking about. (hangs up)

I'd like to buy an N please....

So, here at VBB central we get a lot of interesting phone calls. Today, a new kitten owner called us to follow up regarding her kitty who had been seen here by a colleague of mine last week. She told the receptionist that she'd informed Dr. VBW (that's Vet Behaving Well) that her cat was seizing all the time at home, but his response had been to tell her there was no apparent nasal discharge on exam, that perhaps there was a lot of dust around, and she shouldn't worry unless the kitten developed additional clinical signs of upper respiratory infection. She told the receptionist she found that strange but went along with it at the time, however, over the past few days the seizing has increased to the point where it is nonstop, and she wanted advice.

VBB staff: So you're saying the kitten is seizing? not sneezing?
Owner: yes. seizing. having seizures.
VBB staff: and you told this to Dr. VBW? Because it seems he thought you said "sneezing." Like, when you have a cold, or allergies.
Owner: Yes, seizing. Not sneezing. It's awful to look at. Her whole body is involved.
VBB staff: this sounds like an emergency beyond our ability to handle at this time and we'd like to refer you to the VBB Critical Care branch 4 miles down the road. They'll be able to try to stop the seizures and provide ongoing critical care afterwards.
Owner: Well that's ridiculous. She probably just has a cold, after all.
VBB staff: wait. so she's SNEEZING? With an N?
Owner: Yes, of course. And she has these sneezures.
VBB staff: OK, look, I don't know what you're trying to say. If she is having seizures or fits, go to VBBCC. Otherwise, you can bring her here and we'll see what's going on.

What the hell?

Magic parvo shot

I had a discussion with a breeder yesterday. This client of mine had a puppy she'd just obtained from this breeder. The breeder had told my client that although the puppy had previously been diagnosed with parvovirus 10 days before leaving the breeder's premises, she had been successfully treated by way of a long-acting antibiotic shot called Convenia, after which injection the puppy's diarrhea and vomiting had immediately stopped. The puppy had not required any fluid therapy, special food, or other medications.

Now, I'm no virologist - but I'm pretty sure that a repository cephalosporin isn't some kind of magic cure for canine parvovirus infection. So, I said to my client, as I looked at an apparently perfectly healthy 10-week-old Rockwelder Rottweiler puppy, "I don't think that this puppy had parvovirus. Maybe you misunderstood the breeder?" and the client said "definitely not. She said they did a special test to prove it was parvovirus, and that parvovirus can kill dogs, especially Rockwelders, so we got lucky with this one."

This, I had to hear for myself. So, I called up the breeder.

<ring, ring>
Breeder: yo, hold up a second, hold up. [pause]. OK yo, wassup?
Me: Hi, is this World's Best Rottweilers of Outer Dumbassia?
Breeder: yo, that's us, you wanna puppy, man?
Me: No thank you. My name is Dr. VBB, and I'm calling about the male puppy you sold to Mr. Gull Ibble on February 4th.
Breeder: which puppy is that?
Me: Well, the paperwork you gave him says "male puppy #4 parvo" on it. Does that mean anything to you?
Breeder: oh, yeah, man, that the puppy that had the parvo, man.
Me: so, about that - did this puppy see a veterinarian at any point?
Breeder: oh, yeah - I got one who comes by and writes the certificates. You got his certificate there, right?
Me: well, I have a "puppy passport" that lists all the vaccines and dewormings you gave.
Breeder: yeah, that's it! see the stamp there? That's the vet stamp.
Me: You mean the stamp in the corner that says "PASSED INSPECTION" ??
Breeder: yeah! that the one!
Me: So, nothing with the doctor's name or contact information?
Breeder: no, he don't work like that, you know. It's kind of on the down low.
Me: the down low?
Breeder: yeah. Cause his boss prolly don't want him working side jobs.
Me: Oh. I see. So, who gave this puppy the Convenia?
Breeder: Oh, I got that at the house. I gave that myself. I buy it off ebay, yo.
Me: I see. OK, well, I think I have all the information I need. I really want to recommend to you that you hire a veterinarian in the future to oversee your operation, because I think you are either working with someone who isn't a vet at all, or something else is going on here, because you seem to have a lot of misinformation.
Breeder: naw, it's all good, man. I got this down. Been doing this two years now. Only lost five puppies, man!
Me: OK, well, thanks anyway. Bye.
<click>

When I encounter this type of situation, I find myself wondering - why is there no way to stop this type of situation from happening? Why isn't there some phone number I can call to report these people? But let's face it - his operation is too small for USDA oversight. There probably isn't any actual actionable cruelty here. Is there some type of fraud going on? Sure, but I don't have the name of the alleged veterinarian. I don't even know if there is one. Maybe the breeder is pretending a vet came in. I have no idea why this guy would want to say one of his puppies had parvo if it didn't. The whole situation is just basically completely beyond my understanding. I just wish I could shut this type of place down.

The good part of it is the puppy I saw was adorable and apparently healthy, though somewhat wormy. He'll probably end up being a perfectly fine pet for his affable, if moderately ignorant, owner. Hopefully after coming through our office a few times for all the puppy visits, the owner won't be ignorant any more, either.

I went home after work and opened a nice bottle of red wine. I had a couple of pieces of Trader Joe's 100 calorie chocolate bars, and tried to fuggedaboutit. Obviously I failed in that!

She can't live like this!

Thursday morning:
Ring! Ring!

VBB's Receptionist: Hello, World's Best Veterinary Hospital, how may I help you?
Client: My cat is dying. What should I do with the body if she dies while you're closed?
VBB's R: Hold on. What's going on with your cat? Do you want her to see the doctor?
Client: No, I don't want to pay for a visit. I just want her to die at home but then I don't know what to do with her body when she dies. Is there someone who will come get it?
VBB's R: We can see her today. Do you want to come in today?
Client: No, I just think she's dying. Please tell me what to do with the body.
VBB's R: Well, you can wrap her in trashbags and keep her in the freezer or garage until we open and then bring her to us for cremation if you like. But are you sure you don't want to have her see the doctor, even for euthanasia?
Client: No. I said I want to let her die at home!
VBB's R: Ok, I'm sorry. I'm sorry your cat is sick. Take care.

Friday morning:
Ring! Ring!

VBB's R: Hello, World's Best Veterinary Hospital, how may I help you?
Same Client: It's my cat! she's having trouble breathing. I'm on my way in with her.
VBB's R: Wait. Is this the cat that was supposed to be dying at home?
Client: Yes, but, I didn't think she was going to have trouble breathing! She can't live like this!
VBB's R: Well, no. When an animal dies, it stops breathing, and stops living. So, you're coming in?
Client: Yes, of course, I'll be there soon. [hangs up]

The client and her poor cat did arrive shortly after, and the cat was in fact having trouble breathing. The owner wanted us to fix the breathing so that she could take the cat home to die - but wanted to make sure the cat wouldn't continue to have episodes of trouble breathing. On the one hand - I do understand it is horrible to watch someone you love struggle to breathe. I have watched countless animals as well as a couple of humans do this, and it is just awful. On the other hand, like my receptionist said - when you die, you do stop breathing. Sometimes, when you're in the process of dying, you breathe irregularly for a while, and then do some gasping, because of the way CO2 builds up and triggers a reflex to breathe. Death is not like a Hollywood movie.

We ended up euthanizing the poor kitty because I could not promise that there would be no additional episodes of dyspnea. I hope the client wasn't too disappointed that her kitty didn't get to die at home.

Guest Post: VBB Student Edition!

We received the following submission for anonymous guest posting from a current student of veterinary medicine. Thank you, young grasshopper.

No Brainer

 

Set the scene:  12:30 pm on emergency; shift should end at 11:00 pm

Characters:  One exhausted senior vet student, several busy emergency/critical care technicians, one exhausted intern… and the smartest client in the world!

Phone call on the Emergency/Urgent info line: 

Client: “Hi, I’m calling to see if I should bring my dog in right away or if we can wait a few days to see our normal vet”

Student (stifling a yawn):  “Can you tell me a bit about your dog and what your worried about?”

Client:  “Well, there a few things I am a little worried about; she has blood in her eyes, she can’t see, she is coughing up white mucous, she is having trouble breathing, she can’t walk, she hasn’t eaten in two weeks *deep breath She won’t pee and I haven’t seen her poo for 5 days, her breath smells bad and she isn’t responding to attention…  Also she is kinda old…

Student: (mouth open, eyes wide): .…..

Client: “well, do you think her symptoms are serious enough I should think about bringing her in?” (hint of frustration in her tone)

Student: “I highly recommend bringing her in right away!  It sounds like she is critical condition, can you be here soon?”

Client:  “Weeeeelllll… how much does it cost?”

Student: “ the exam fee is blah blah and any testing will be additional”

Client: “hmmmm I think I will wait until I can make an appointment with my regular veterinarian”

Student: (face-palm)

What was the point of the conversation you ask?  I’ve been trying to figure that out since I talked to this woman! If you or a loved human had these symptoms (even one of the above symptoms) you would be on the way to the hospital, why is there even a question that an examination by a veterinarian is warranted?  Moral of the story, don’t call the nearest veterinary teaching hospital (or emergency hospital) at night around bedtime to ask if symptoms are severe enough to be seen.  If your pet has a symptom you would worry about for yourself, take it to the doctor for love of all that is holy (and for F’s sake)!!

          -sadly the above conversation did happen as related here-

Voicemail use - a primer

My office, like most veterinary hospitals I'm sure, has voicemail. We have an outgoing message along the general lines of "You have reached World's Best Veterinary Hospital. We are not available to answer the phone. Our office hours are (time) to (time) on (days). If you have an emergency or need to speak with a specific doctor urgently, please call (answering service number, where clients can arrange for a callback or receive emergency clinic information). Otherwise, for routine business, please leave a message after the beep." Seems straightforward enough, doesn't it? But oh, the huge manatee - it apparently is not. So, without further ado, a list of:

The VBB's Dos and Don'ts for voicemail. 

DO: leave your name, your pet's name, any additional identifying information, and a valid phone number. "Hi, this is Mr. John Jacobjingleheimerschmidt, spelled like it sounds. My dog JohnJacobJingleHeimerSchmidt (his name is my name too) is due for an annual exam. Please call me at (actual working phone number) to let me know if Tuesday the 5th at 4 PM works. Thank you."
DO NOT: leave a long drawn out message about your extremely ill pet, identified only as "Smokey," include your first name only, and request a call back "at my home number if you call before 9:01 AM, but my cell number between 9:01 and 9:23, and my work number after 9:23 until 4:30 PM but then go back to cell," without leaving any actual phone numbers.

DO: explain the problem and desired action clearly and concisely. "My dog has had several episodes of explosive diarrhea. I'd like you to call and advise me if  I should bring him in or if you can prescribe something."
DO NOT: start talking about how your dog had diarrhea all over the rug and then you had to go to the store and get carpet cleaner and then you just had it cleaned up when suddenly he let loose again and then there was diarrhea on the sofa as well as the carpet and boy was your husband mad and also he isn't eating, but he hardly ever really eats that much so that's not so much a concern except for the vomiting he did four or five times yesterday but that was on the tile floor so it wasn't important and BEEEEEEEEEEEP.


DO: follow instructions in our outgoing message regarding how to handle emergency situations, and follow up with the answering service or head directly to an emergency clinic if the problem is, you know, EMERGENT.
DO NOT: leave a recorded, middle-of-the-night message like "Hi, this is Notta, Notta Lottabrayne. I'm calling about my Australian Boomerhound, Dumasz. I think you have him under the name of Sumguy, not Lottabrayne. Anyway, I think he's actively dying. If you could please give me a call back when you get this, I would appreciate it. I need to know what to do. Thank you."

DO: Be polite. You catch more flies with honey than with vinegar. "Hi, this is Ms. Calmreasonable. My dog Chowhound is vomiting and I wonder if he picked something up in the boarding kennel. I'd like to bring him in and discuss this. I can be reached at (number). Thank you."
DO NOT: Leave a message full of abuse and obscenity, such as "I picked my dog up last week from your kennel and he was FINE before I took him there and he seemed fine for three days afterwards and today he vomited and you damn well better pay to have my fucking carpet cleaned and I'm going to be there in 20 minutes and you fucking well better give me the medicine free, too, or I will badmouth you on the internet."

Sex Education 102- Loving your pet too much

It seems that the emergency service gets crazy call awards. Who else is going to get the 3 AM call: "My cat is staring at me and won't stop." Dude, go back to sleep, your cat is just imagining you encrusted in cat nip and braised over some coals. Sweet Dreams!

Seriously, as I am sure happens in human medicine, we get some really messed up stuff. One night, my tech came screaming into the on call room....

"Doc, K (receptionist) is on the phone with a crazy." Due to the hysterical look on her face, I hoofed it to the front office.

K was staring at her note pad, decorating the words "crazy freak" with her pen, unblinking eyes wide.

After she hung up the phone, she relayed this conversation:

K: "Blah, Blah Emergency clinic, may I help you?"

Female Caller: "Is there a way to get a dog loose once it is tied up?"

K: "You mean from a chain?"

Caller: "No, when it is mating...and the male ties up with the female, you know, in her parts, how do you get it loose?"

K: "Well, you just have to wait, once the penis is less, um, engorged, they will separate on their own."

Caller: "But, my husband is almost home and I can't get my dane loose."

K: "Ok, well, it is just going to take a little bit of time. Can you put them in a bathroom or something?"

Caller: "No, my great dane, Cujo, is tied up with me. I can't get him out."

K: "Well, you just have to wait for everything to go...WHAT!?!?!? Ma'am, I think you need to call an ambulance."

Real life: stranger than videos you accidentally see when you click on some random link.

The drop off exam

For some reason, the drop off exam is in high demand among pet owners, to the point that at least around here a practice can't stay competitive without offering it. I get it. People are worried about keeping their jobs if they take time off, and they don't want to waste their valuable free time at my office, and they don't understand why they need to be here anyway. I hate the drop off, though, and here's why.

Every owner dropping off a pet is required to fill out an intake form. This form will contain a phone number at which the owner can be reached while the pet is here, an explanation of why the pet is here, a lost of services requested, and other information. Despite the fact that owners are told prior to coming in that the form will need to be filled out, no one ever admits to having heard of it before. Most people just put their carrier on the floor, scribble random stuff on the form, and leave "because I'm late already and don't have time for this." Then, when I later examine the pet, it is unclear what the pet is here for. So, I call the number on the form. Turns out that's the home number, but the owner is at work. So I find the work number somewhere (or use social engineering to get it from the person at home) and call that, asking for Mr. Bob Petowner like it says on my form. Gosh, no one there by that name? I'm, do you have a Robert Petowner? No? Anyone work there who has a cat named Killer? Oh. Jim in accounting? Great. Put him on.

Then Jim in accounting rips me a new one for bothering him at work because he isn't allowed to have personal calls. Also he explains that he goes by Bob Petowner for his personal matters, and Jim Rockefeller at work, because of a licensing issue. Okaaaaaay. So I ask BobJim, as long as he's on te phone, why is Killer here today, and he says he wanted me to do something about the urination outside the litter pan. I start asking follow up questions and am immediately cut off with "if I had time to discuss it I would have come in myself. Figure it out!" and the line disconnects.

It can go two ways from here:

1. I proceed with a full diagnostic workup and when the owner comes to get the cat, he reams me out for doing it without permission.

2. Not wanting to run up the bill without permission, I do the bare minimum, and write a lengthy note explaining the next steps we can take. The owner comes to pick up the cat and reams me out for not getting it all done today.

There are many flavors of this type of visit - this is just one example.

This picture is of a dropped off patient who is obviously obese. That's a quarter on her back. She weighed 3 lbs less than her last visit, but I couldn't reach the owner to find out if the cat had been dieting or had unexplained weight loss. At pickup time the owner yelled at me for not doing any diagnostics to find out about the cause of the weight loss.... I said I tried to reach her but she didn't answer her phone & she said she's a teacher, she can't answer. Somehow I should have just known what to do without talking to her.

Sigh.

Quick update to this: I was thinking as I wrote this about how no one would ever try this type of thing at a physician's office - I mean, people don't drop their kids off at the pediatrician, do they? I've never seen it. But then I realized how prominently the signs at my son's allergist's office say "children under 16 MUST be accompanied by a parent to receive injections," and I realize - they probably do. So, it's not just happening here - it's happening everywhere. It must be stopped!

The Phone

I don't know if any of my colleagues enjoy callbacks. Personally, I get nervous calling someone back. What if they ask me something I don't know? (That's a rhetorical question. In fact, if someone asks me something I don't know, I will generally say "I don't know, let me check and get back to you." But I don't like it!) I do enjoy teaching things to people who are both interested in the subject matter and intellectually capable of grasping the subject matter quickly - but unfortunately for me, it seems my client base is not largely made up of such individuals. I therefore end up teaching things, or attempting to teach things, to other types of people, and to put it as politely as possible - I simply do not enjoy it as much when that happens, so, I generally dread callbacks, because I never know who I'm going to end up talking to - even if I'm calling someone I know, often, a third party answers the phone, after all.

That aside, here's a list of things that drives me crazy about phone calls:

1. "The person you are calling has not yet set up a voice mailbox. Please try again later." Really? In 2012?
2. "The number you have reached has been disconnected. Please check the number and try again." This is almost NEVER a data-entry problem on my end. I'm just saying.
3. I call, the phone is answered by a person who says "what do you want?" or "who is this" or some other vaguely hostile non-greeting. I say "Hi, I'm Dr. VBB, and I'm calling about Jane, is this Ms. Dogowner?" and the person responds "Ms. Dogowner? You think I'm a woman? FUCK you, bitch!" and hangs up. Honestly, I feel terrible about making such a grievous error, but I am but an imperfect human. Perhaps if the person who answered the phone did not take such high doses of anabolic steroids, he would have been less aggressively reactive AND maintained a more masculine sounding voice. I'm just saying.
4. I call with lab results, and the owner becomes so hysterical that I am unable to get even halfway through them, and they aren't even that bad. I try to be sympathetic and I always preface any "bad" results with the caution that "this might sound bad, but we have a plan to deal with it," if possible, but some people will hear that their dog had a weak positive on a Lyme antibody test and freak out beyond all reasonable belief. Then I have to be the asshole who has no feelings and has to get off the phone with a crying person so that I don't end up three hours behind in office visits.
5. The chatter. Sometimes, the recipient of the phone call is such a Chatty McChaterson that I wonder if they realize to whom they are speaking. Of course God forbid one of these people shows up for an appointment and I am running five minutes late because I was trying to be polite to Chattina McChatful on the phone that day.
6. Having to give bad news. That just sucks all around.

I could go on, but I've got to go make some calls.

*yawn*

Well, it's 2012. My son remarked to me that he was surprised the world didn't end last night - he apparently believed that the Mayans predicted the world would end at midnight as 2012 began. I had thought the world was supposed to end NEXT New Year's. I guess we'll find out in about a year.

I started the new year of eating off pretty well, with chicken & waffles & a flight of mimosas. No complaints about my first meal of 2012! But, the new year of everything else? Yeah, no. Not so great. I was awakened this morning at about  6 AM by a panicked phone call. I'm not going to say who made the call, but suffice it to say it was not someone on the list of people ALLOWED to call me at 6 AM on New Year's Day. The caller was freaking out because apparently someone had knocked over their fishbowl during the evening's revelry, and the fish was missing, and they wanted to know what to do.

I'll just wait while you let that sink in.

Yes.

You read that right.

Now, maybe our blog audience isn't the right group of people to ask, but I'mma ask anyway - Really? When you knock over your goldfish bowl and you can't find your goldfish, the first thing that comes to mind is "I better call my cousin's friend's old neighbor's ex-girlfriend's brother's co-worker's former roommate, the veterinarian, and see what to do?" Even "gosh, I'm going to call my veterinarian with whom I have a warm and mutually respectful relationship to find out what to do" is a stretch, IMO. What was I supposed to do other than say "Hmm. I guess you should continue to LOOK FOR IT until you FIND IT, or else wait til it starts to smell and follow your nose!" ? Right?

So. That happened.

I also had the subject of a relative's newly-acquired dog come up in conversation. Changing the details - the dog had some outpatient surgery, and was acting weird when it went home, and cried all night. I suggested to the relative telling me the story that perhaps the dog had a) been discharged before it was fully recovered, and b) not had adequate pain medicine. The storyteller advised me that was impossible because a) the vet called the owner to say the dog was ready to go, and b) the vet told the owner that that particular surgical procedure was nonpainful. I didn't have the energy to argue. I just calmly said "oh, well, without knowing more details, I couldn't say what happened. Hey, who's watching the game today? What game? Um, I don't know. Isn't there a game today?" and then the kids and men started talking about game schedules. Phew. But in my secret heart of hearts I have to wonder: who doesn't just automatically KNOW that surgical procedures are by definition going to be painful, and that a dog who is up crying all night the night after a surgical procedure IS IN PAIN?

Sigh.