“Patient is odd”

“The cat is acting odd which my daughter and I disagree about and we wanted to know what you thought of this.”

This is all I was told, no further information was forthcoming without my prodding, 3 sets of expectant eyes gazing upon me waiting for me to work my magic (client and daughter, both older than I, and cat).

I elucidated that the “odd” behavior which this middle age indoor cat had never displayed before consisted of avoiding the floor in the bedroom, staring under the door entering the room, trying to get up to high places and vocalizing. Otherwise perfectly healthy. Then I asked the key question = any fleas? “No, but I did get bitten by one recently.” Aha!

Sure enough fleas were found on the cat which I showed to all and flea preventative medication was administered as well as dispensed and I’m pretty sure the odd behavior will now subside.

It is always interesting to me that people are so impressed that veterinarians can figure out what is wrong with animals, as “they can’t talk.” But they certainly exhibit some kind of changed activity which their owner caretakers pick up on and through the process of history, physical exam, testing and/or treatment/medication trials we can usually figure out what is happening or at least make them better.

Often is takes just the right query or use of the proper instrument (in this case a quick sweep of a flea comb) and away we go. From a starting point of “odd”, which may have been conjecture or strictly behavioral and I might have had to conjure up a presumption of the presence of roof rats in this case to mild or significant medical distress – it all starts as a mystery but definitely requires the client appreciating that something is amiss. I just help them focus to the best of our ability on what the problem is at hand.

This is a close cousin to our vague friend: “Ain’t Doing Right” abbreviated (unfortunately) ADR in medical records.

WIHCTU

Even though subtle, our pets give us clues to their state of health if we pay close enough attention

CS

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Surgery went “well”

All things medical can be a dicey proposition. As a professional I can not ethically make any guarantees of the outcome of any test or procedure. We discuss liklihoods. Based on the knowledge we currently have or experience that has been brought to bear. Surgery is where this comes true more than any other area.

Buzz words abound: routine, as expected, nothing out of the ordinary occurred. But there are so many ways that the surgical process can go awry, and clients/patients are understandably wary. And they don’t know all there is to know about these things. They rely on the medical people to do what they say they will (and what was that exactly?) and hope for the best possible outcome. On the medical side we do things so often we don’t think much about the bad possibilities, often not fear what can go wrong.

What I have come up with, having worked with animals for going on 30 years over half of them as a veterinarian, is that equal parts to how a patient does medically/surgically is shared 3 ways: me (the hospital experience, my surgical skill, our team etc.), the patients inherent ability to heal not to mention deal with the process including anesthesia, and the client who plays a key role in following instructions and administering medications and being watchful for things going awry. If things don’t go well we all have different psychological mechanisms that drive our behavior.

Some vets assume it was all their fault, others don’t imagine that anything they did could have been a problem. I personally feel you should learn from each circumstance in order to help that patient and others that follow. There is a fair amount of soul searching involved – “could I have caused that pets injury or demise?” It can be a sobering process.

The reason this comes up at this time is a patient that has had 4 surgeries at this point we are currently treating. The first surgery did not go well and ever since we have been fighting the results. There are $ considerations and every time the client states that she will have to euthanize her pet friend “next time” but has ended up not being able to do so. Most recently a specialist surgeon did some of the work. Hopefully for the final time (hope, hope, hope!!!). According to this client I can do no wrong. To myself I wonder if I haven’t terribly failed and put the patient through a horrible experience that is all my fault not to mention spent a bunch of my clients money that she didn’t have. Sigh.

WIHCTU

A little bit of fear can be a very educating thing

CS

QOD

Another in the long line of board posted statements made (Quotes of the Day), this time by a client:

“… and then he had a wound by his peenieweenie.”

This statement was humorous both in its specific use of the euphemism for the embarrassing anatomical area as well as the way this good ol’ boy (for lack of a better stereotype) dramatized just that word in a cartoony way. The poor dog did look a tiche taken aback (“do you have to discuss my parts?”).

It never ceases to amaze me the creativity that people come up with for organs or functions that are not easily discussed. Are these suddenly conjured up on the spur of the moment or the regular term used by this person’s family? Relates somehow to how they were raised? Is there a whole series of generations at BBQs talking this way?!?

The use of inappropriate terms (not the actual medical/physical one) also reflects a lack of knowledge in my mind. These people may simply not know what to actually call that “xxx” thing. They couldn’t pick it out of a lineup, look it up in a book or find it on the internet. Don’t really know what it does and in fact are kinda scared of it and would rather not look directly at it if at all possible.

Or maybe I’m over interpreting here just a little.

WIHCTU

It’s a good thing vets are around to decipher what people really mean when they tell a story about their pets.

CS

Inspecting

My most recent career arc has added inspecting veterinary hospitals. I was asked to do the job. Strictly flexible and on a consultation basis so that it doesn’t have to interfere with anything else I do. Originally I wanted to go through the training and see if my own hospital was up to snuff and then decide if I wanted to do it. Much to my chagrin it turned out we needed some help. Doh!

Then before I could accept the position I was told I was an inspector and handed a to do list. Well, ok, no big deal because there was no time expectation. When I got done with the few they assigned (this is the state) I would turn them in and get a few more. And their are some cool parts. I have a state ID which has some benefits. A discount at hotels. Some other paid things, meals etc.

I do get a ‘you will respect my authoritah!” sensation a la Cartman on South Park for some reason. And I am on the inside to expectations and changes as to the rules that regulate veterinarians and the standards they are held to. Thus I have to keep myself there if I am going to tell other vets what to do.

Ultimately it is a fascinating job and I realize I do a necessary important and educational thing for other veterinarians and by extension the patients they care for. So I am helping the pets in another more significant way. And most, probably 90% of veterinarians want to abide by the rules. They just don’t always know what they are. And the others really need to get up to speed or the veterinary medical board needs to know about them.

Now I give talks to veterinary groups about how to prepare for inspections, and perform complaint related inspections all over the state. It all really is very satisfying.

WIHCTU

Regulation is not necessarily a bad thing for all involved.

CS

Quote of the Day

“”My male cat keeps mounting my female. I think he may need to be re-neutered”

Back to this again. People just don’t get it. Our client said this with all earnestness. There is a significant difference between the primitive urges of our animal patients and *behavior*.

Now, this particular pair of cats had surgery a couple weeks before so the question was about whether the original surgery “took” and the reality is that a castrated (neutered) male cat can impregnate an intact female for longer than a month after surgery because of hormones that take time to dissipate as well as the stuff that can impregnate to die off or be used up.

Does this represent someone not being able to compare themselves as a human to the animals? The biology is generally similar. Just kinda shaped different. Or is it a basic lack of education, or rather knowledge about how even this basic physiologic process works?

Hmmm

WIHCTU

It’s all gonna be confusing if it’s about cats or sex, put them together and thank gosh for vets

CS

Bunny MRI

One of the more remarkable stories of pet dedication to me involved a rabbit with a particularly daunting medical problem. One of which I had been unable to resolve on my own. Many people don’t get what can be special about a bunny, how interactive they can be or how much one can bond with them. This rabbit was especially well loved and his caretaker was going to spare no expense or effort to get him well.

Specialists were involved. A MRI was recommended to further suss out his condition. The place to do MRIs was conveniently located. Much to my chagrin, however, is when called the imaging center claimed “we have never done a rabbit MRI before.” To the caregiver! Now I happen to know that they do zoo animals so the fact that this wasn’t a cat or dog shouldn’t have phased them. And in my mind you NEVER admit to the potentially upset “parent” of a sick pet your limitations in this manner. This is a vet to vet conversation to be had behind the scenes.

Luckily said rabbit Mom decided to proceed and everything went fine (whew!) and the information necessary was gleaned. I ended up on the phone with the radiologist who read the MRI to discuss a fine point in the interpretation. He claimed to have personally reviewed 70,000 scans in his career and only 3 were for rabbits!!!

All ended up well. The procedure performed subsequent to the MRI was a success and the rabbit is currently doing quite well. I always appreciate it when my clients trust the process enough to invest financially and otherwise to do things that may not work but are our best chance and when things turn out for the best, that is one of the greatest feelings in the world.

WIHCTU

Never underestimate a clients desire to do the best possible thing for their pet

CS

“The biggest mistake I made was…”

One of the best things I like about other veterinarians is their ability and willingness to learn from their mistakes and more importantly admit and even share them. With gusto. Usually this is about medical things but can be about most anything. For whatever reason I think veterinarians, perhaps more than most others, use the fact that things go wrong as lessons in life.

Most of us can remember any time a patient has an unfortunate outcome and we vets take it very personally that we either caused or could have prevented that from happening. It may not be true, but if we can take any little thing and sear it into our minds as “I’m not going to do that ever again!” then we will. This teaches something that takes hold much more strongly than ALL the times something worked for us. The bad things that happen are ever remembered.

This came to me with the recent conversation I had with a vet with a lot of experience who had built a large vet hospital complex with ancillary stores and in fact owned the whole shopping mall complex. The intent was to build a 24 hour facility and he was happy to share the fact that he lost all this money over the unbuilt water therapy area among other things. He had sunk all he had into this dream project and the economy had hit him hard.

And what he had to share was a minor financial point, using the quote above. Which just amazes me that somebody I barely knew was willing to show how he “blew” it just to let another of his kind (a veterinarian) know so that maybe they could prevent it from happening to themselves in the future or would share with other vets. Just remarkable.

WIHCTU

Making mistakes and sharing them can be a key to learning

CS

Funny quotes/Racist?

At the clinic we write down those things we find humorous. Invariably these are things either clients or staff say. Usually not intentionally (to be funny that is). It helps to relieve tension and laugh at ourselves. Often quite morbid. I have noticed a trend lately:

“His Spanish has an accent”

“A hint of French! A french mexicans”

Now the way I was raised you simply did NOT bring somebody’s race into a discussion. To describe who somebody was or to differentiate them. It wasn’t proper and had no bearing. I constantly tell my high school teen that when telling a story he doesn’t have to mention the race of the person who he is telling a story about, unless it directly pertains to the content.

But I have started to see a comfort level of the new Generation (do they have a name, yet?) where it seems race is a comfortable casual thing. Especially because fewer are the standard check off boxes anymore. It seems a mix is going on and it is a good thing. It is almost Dr Seussian. Half white/half asian = whasian. Half black/half mexican = blaxican. This is really a very interesting thing.

WICHTU

The coming together of who we are as a people has beneficial effects.

CS

Vaccinology

Giving vaccines to patients is VERY important. One of the primary reasons people bring their animals to the veterinarian. Unfortunately, we vets have used this as the focus of our care, which is not the right thing to do in my mind. What is important is that I as a veterinarian put my hands on your pet. To determine if they are healthy and discuss their health needs. The vaccines are an important part of any health care plan, but not the primary part.

The industry has started to realize that maybe vaccines don’t have to be given as frequently. And that there are a LOT of vaccines out there and we don’t have to give them ALL to the pets ALL the time. Three year staggered schedules instead of annual shots are gaining acceptance as the industry standard. Side effects can occur, up to and including cancers directly caused by vaccines in cats and chronic stimulation of the immune system (which is what vaccines are formulated to do) may cause older age conditions.

So please take your pet to a veterinarian (NOT just the vaccine clinic, these are an unfortunate outgrowth industry that are not serving your pets’ needs, just falsely serving your pocketbook) and in thorough consultation determine EXACTLY what your pets needs are. Not just show up “for shots.”

WIHCTU

No more “annual” vaccines for the pets

CS