Size matters

Your dog is big. So are you, really - I mean, you're about 6' tall & relatively muscular. I'm not petite by any stretch but you're bigger than I am, and your 100 lbs of aggressive guard-dog could definitely take me down. So, in the size contest - points to you.

You came in asking me to run some tests. Happy to oblige, but it's not clear which tests you want done. When I saw your dog last week and spoke to your wife, I referred her to a specialist. I subsequently spoke to the specialist to advise her of the incoming referral and discussed your dog's history and recent findings. The specialist told me we had done all the tests required so far & nothing further was needed. This is why I asked you which tests you wanted, and when you told me that "the specialist says we need a full blood panel - whatever that means - just do all the bloodwork you can," I got somewhat confused. That's when you told me you'd spoken to two specialists and it was the second one - not one I had spoken to - who recommended the "full panel." So I started to explain what various tests are available, which ones we had already run in the past six weeks, and which others might or might not be useful at various stages, and that's when you decided your innate size advantage wasn't enough. You had to make me feel even smaller. You had to tell me that I was obviously being obstructionist, I was obviously trying to prove that I am smarter than you are, that I was obviously feeling defensive because the specialist made recommendations I didn't understand, and that you should probably just leave without doing any tests.

It's funny the way you intended that to sound like a threat. You know. As if somehow, removing from my office a dangerously aggressive dog who does not actually require any tests to be done is going to ruin my day. GUESS WHAT? I didn't want to see this dog in the first place, and I don't want to take your money for tests that we don't need to do, so leaving really makes no nevermind to me. In fact, I'd prefer it....

What's sad though is that it did kind of ruin my day. I feel like a failure. I failed to communicate effectively. Your experience here was not positive. I replay the incident in my mind and I don't know how I could have done anything differently. I mean - I could have just smiled and said "full blood panel? Sure, no problem!" and then run a gazillion tests for no particular reason - but that feels really wrong to me.

Or, we could not do that...

Because life doesn't put itself on hold in troubled times, even though VBB central is under a lot of stress today, I still had to walk the puppy. We walked up the street through the neighborhood for about 40 minutes this morning. Oh neighborhood. Why hast thou forsaken me?

Believe it or not, I expect people to be nice. I expect polite, intelligent, kind people to populate my world. I am constantly disappointed, by the way.

The guy with the obstructed dog wasn't out, though I saw his dog pee yesterday, so there's that. But a few homes past him is "my dog wants to play with your dog" man. This man drives me to drink. His dog is a land shark and shouldn't be allowed in polite society. But today his dog was not home (it's at the groomer! Yay!) so instead he just wanted to chat about his new "invention." He insisted that he was going to create a dog food system that involved feeding the dog a capsule and then 20 minutes later, dog food. The capsule dissolves to reveal a baggie that waits in the rectum to be filled with stool. Then the dog poops out a bag of stool. Honestly I was LMAO but he became quite put out & insisted he was "extremely not kidding." Then he said "you know I hadn't thought of it but we'd make a great team. We could market this in your clinic." I just looked at him, & raised one eyebrow, and left. He's probably blogging now about his bitchy-ass neighbor, the vet who blew off his big business idea.

The Notebook - The reality version

I have a heartbreaking story to tell.  One that does beg to differ with those who accuse us of doing things only for the money.

I have these wonderful clients who love their dog, Mr. Sweets.  Mr. Sweets does not hurt for food and is overweight.  I used to harp on them about his weight, until one day - only a few visits after I'd first met them - the owner (Mr. Z) pulled me aside and informed me that his wife (Mrs. Z) had advanced Alzheimers, can't remember when she feeds Mr. Sweets, and therefore the dog will not be able to lose weight.  He also informed me that "that damned dog keeps her alive" and that anything else I can do to work with him would be greatly appreciated.

Okay.  Totally new rules to this game, I can see.

So Mr. Sweets secretly takes Slentrol, a drug that can help dogs lose weight.  It doesn't do much other than keep him from being a total ottoman, and it's something that Mr. Z can give in secret without Mrs. Z finding out.

Then I started noticing how often they were coming to see me - nearly every day some weeks.  So again Mr. Z and I had a discussion.  I told him I didn't feel right about charging them for exams every day when there is never anything wrong with Mr. Sweets.  He told me that he knew there was nothing wrong with "that damned dog" but that every time he sneezes, Mrs. Z (with advanced alzheimers) goes into a panic and demands that he go to the vet.  Who happens to be me.

Okay.  So now I really understand the game.

I think about it, and I call Mr. Z and tell him this:  "Mr. Z, you are a wonderful person and I don't know how you make it through your day.  Your wife of 50 years doesn't know who you are most of the time yet you take exquisite care of her and her dog every single day.  I saw you at the grocery store on Sunday and you were buying a whole bunch of beer, I presume for yourself.  So I'm gonna offer you something that I hope helps, and hopefully will make your life a little easier.  You deserve a break."

I told Mr. Z that he is to bring Mrs. Z and Mr. Sweets down as many times as he wants, to see me.  I will do a full exam on Mr. Sweets in front of Mrs. Z so she will know he is OK.  The only condition to be met is that he comes during the hours when I am not slammed with appts - anytime at all between noon and 2pm.

And I will not charge him a dime.  Ever. 

He was so touched that he cried, and of course we saw Mr. Sweets a LOT.   The truth is that Mr. Sweets could come see me at noon, and then go home, sneeze, and then be back in an hour, because Mrs. Z wouldn't remember that he just saw me at noon.  But this made her happy and gave Mr. Z some peace of mind that his beloved wife of 50 years was up and about and still functional to some degree.

This went on for about 6 months.  Then we recently learned that Mrs. Z is now in the hospital and not doing well.  Mr. Z is still by her side, not leaving the hospital.  It is the real life version of The Notebook.

And we are still taking care of Mr. Sweets because that's what we do. 

My boss is a bleeding heart

Either that, or I’m a cold-hearted, hard-assed bitch.

My boss is the sweetest person you’ll ever meet but she has a hard time saying no. She lets clients walk all over her, and takes on hard-luck cases.

It’s a nearly daily occurrence that someone will bring in a patient who has a serious illness or injury and the person can’t (or won’t) pay to treat the pet. Our hospital policy is that in certain cases if a staff member is willing to sponsor a pet, the owner can sign over ownership to the hospital. The pet will then be treated and adopted out to a worthy home. The important part is that the employee must take complete financial responsibility. Before we instituted the “put your money where your mouth is” policy we had numerous sign-overs whose treatment drained the hospital’s budget.

In fifteen years, I’ve had exactly one patient signed over to me. It was a Boston terrier with dystocia and dead puppies. I only took the dog because we had a vet student who needed experience performing a cesarean and I already had in mind a sucker loving person to adopt her.

But my boss, the compassionate soul, has a habit of taking in pets whose owners can’t afford treatment. A few months ago she took over a pit bull with parvo. Granted, it was a sweet puppy, but our hospital is in the ghetto and our neighbors are meth dealers, so pit bulls aren’t exactly an endangered species. Now she’s taken over ownership of another parvo puppy, a runty Aussie mix. I admire her for caring for animals when their owners don’t, but I can’t do it myself.

Having a pet is a privilege, not a right. If I weren’t a vet I would still have a dog. A dog, as in one—not the four dogs, one cat, five birds, two rabbits, and one guinea pig I’ve had since vet school. If you can’t afford a pet, don’t get one. And by “afford,” I’m not talking just food and vaccinations. I’m also talking about a slush fund for the inevitable illness or injury. A few days ago I saw a six-month old Pomeranian puppy with a fractured leg (tibia and fibula, transverse, overriding). We talked about options: orthopedic surgery (best), amputation (okay assuming the other leg stays healthy), splinting (likely to fail), or euthanasia (obviously not ideal but would end the puppy’s suffering). In the end we splinted the puppy but I wouldn’t have had a problem with euthanasia. The puppy is suffering and I don’t want a Pomeranian. I can’t care about my patients more than their owners do or it will break my heart.

Voicemail FAIL

Some readers may recognize this story.

Please note, details have been changed, as is typical for healthcare blog posts.

This message was received on a Tuesday following a holiday weekend on which we closed at noon on Saturday. Our hours were clearly posted on our door as well as being repeated in our outgoing message on the voicemail. This voicemail was left at 4 PM Saturday.

"Hi, this is Ms. Placedpriorities, I'm calling about Fluffy. He's beenon the medication since October you know and we were away for a week and got back this morning and I think it's time, because he's in a lot
of pain and clearly hasn't been eating. But, you aren't there. I called your emergency line but they said we'd have to go see a total stranger at an emergency clinic which obviously I'm not going to do.
So, as soon as you get this message, please call because Fluffy really should probably be put to sleep right away because he's really suffering. Thank you."

So, I got the message Tuesday morning when I arrived at the office and, because I am the sucker
who does stuff like this, I immediately called the owner. A man answered the phone and yelled at me for calling so early and hung up before I could say anything. I called back and no one answered. 


These, my friends, are the moments when your friendly neighborhood veterinarian wonders if he's in the right line of work.

Non compos mentis

The VBB, you may have noticed, complain about clients a lot. That is not to say that all clients are terrible. There are many we simply aren't mentioning here, because honestly - would it be any fun to read about my perfectly lovely day with perfectly lovely people bringing perfectly normal pets for perfectly routine visits? No. That's not funny, and it's not fun. So anyway, there's one segment of the frustrating client population that I don't believe we've mentioned yet. We've covered the rude, the abusive, the ignorant, and the stupid, but not the ones who are not of sound mind.

So.

It may not be obvious to all, but the mentally ill/mentally disabled/demented are a group which is present in society, and that includes the population of people who bring their pets to a veterinarian's office. I happen to have a lot of elderly clients, and a good number of them are very sadly in various stages of dementia. This is terrible. I feel terrible for them, and I feel terrible for their pets. I usually start out trying to help by making them large-print schedules of when to give their pet medication, and often I will ask for an additional contact person and then try to get their son or daughter or whomever to help out. But unfortunately, more than once, I've had a client become so incompetent that he or she has actually become confused, and thought I was a physician, and then gotten distraught when he or she realized there was an animal in the room. These were clients who used one of those "elder transport" services, so no one was with them. It's heartbreaking all around when these things happen. Luckily I've never had one of these people decompensate to the point that I had to call 911 or anything. The few times it has been really bad I have led them into my personal office, sat them down with a bottle of water and a cookie, and had a tech babysit them until they pulled it together enough to move forward, or their ride showed up, whichever came first.

Along the lines of mentally ill, I've been keeping a diary of my client/patient encounters since I entered practice, and I was reviewing it recently and found this from many years ago:

Saturday, I'm giving a cat an enema when I hear yelling from the reception area. I go up to the front desk and see a client literally screaming to the receptionist  "You are EVIL. You are an EVIL LIAR. I can NOT BELIEVE you would say that!" The receptionist is sitting mutely and staring at the woman. I interrupted the tirade and asked if I could help. The woman sweetly said that yes, she had Fluffy here for an office call. I brought them into an exam room, did an exam, chatted about Fluffy, and prepared to send her home when she said "and by the way, I will need all of the records for all of my pets because I can't come back here. I can never trust that SHE won't harm my animals." I said I was sorry to hear that and that I was sure my boss would be sorry to lose her as a client, and asked if there was anything I could do to make her happy today. She said all I could do was fire the receptionist, which of course I couldn't do, seeing as how I just work there, so I said ok, I will ask the receptionist to get the charts ready for transfer. So, we did, and the woman freaks out on me "No, no! I must have the ORIGINAL forms. You are SO SNEAKY. No copies!! Just ORIGINALS!" I offered her the phone number of the state board of veterinary medicine and explained that if she called them she'd see I was not lying when I told her that I was legally required to keep the originals. She then jumped down my throat, called me an "EVIL LIAR" and stalked out. Half an hour later, she called and apologized, and has been doing so twice daily since then!

Clearly, that is a mentally ill person, right? I mean, no one mentally sound would do something like that, right? Another one from my archives: I have also had a middle-aged man start taking his clothes off in the exam room. When I exclaimed "stop that right now!" he looked befuddled and said "oh! sorry, I thought I was told to disrobe and wait for the doctor." I said no one had told him that and he meekly apologized. Then he asked me if I knew where the lettuce was. I said I did not have any lettuce, and asked if he wanted me to go ahead and examine his dog now. He said "yes please, but is it ok if I wait out there? There are too many people talking in here." I sent him to the waiting room happily. He and I had been the only people in the room.

Vets do not receive training in how to handle this sort of situation. We muddle through as best as we can. It can be pretty difficult at times.

Sex Education 101

A call to the emergency line at our hospital:

Caller: " I think that my cat is having trouble giving birth. She is rolling around on the floor and meowing real loud!"

Vet: "How old is your cat?"

Caller: "She's 9 months old, never been out of the house."

Vet: "Do you have any other cats? Any tom cats?"

Caller: "No, no other cats. Just her and she never goes outside."

Vet: "Well, I think your cat is going into heat. If she hasn't been around any male cats, it is unlikely that she is pregnant."

Caller: "Oh, ok."

*******few minutes later the guy calls again******

Caller: "I forgot to tell you, we do have a chihuahua...he's real close to her size."

****vet laughing******

Caller: (mad) "Well, you don't have to laugh, is she having chikitties or not?"

Seriously. And this guy had kids. Public education fail, folks!