Noblevet

Archive for the ‘Uncategorized’ Category

Quote of the Day

In Uncategorized on March 13, 2018 at 10:31 pm

“My dog doesn’t like men, he gets upset when my husband gets friendly with me”

This is such an interesting concept on so many levels. I often get the “dog hates men” deal which I used to take as a personal challenge then realized I didn’t have to address it at all as I worked with 5 other veterinarians, all female. Let them deal with the unhappy dog.

The reality is that dogs are likely poorly socialized to “men” at an early age – whether it is a dominant large tall deep voiced individual or simply someone different than the woman/child who they got to know. I do agree that a bad experience with a person who mistreated them can have last effects (“the dog was abused”) but it makes more sense to me that they recognize as ok that which they experience and especially at a young age.

It feels like a bit of a disservice, socially, what we do with our dogs when we keep them to ourselves while getting their vaccines. Until 4 months old. They should get out there around all kinds of people and vaccinated healthy dogs.

Which brings us back to the client with the amorous husband. I don’t think that “man hating” really had to do with men (or me) at all. This was more of a dysfunctional triangle where the top resource (her) was being competed for by husband and dog.

CS

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Go Yelp Yourself

In Uncategorized on March 4, 2018 at 7:34 pm

Social/Media scrutiny is always a double edged sword for us veterinarians. It’s the 80/20 rule all over again. Most of the great people clients of ours write glowing reviews which of course we skim over then live and die over the relatively few “bad” comments which of course our version is going to be somewhat different. Should they be responded to? It’s so tempting.
I’ve seen vets go so far as to threaten legal action, right there on the site(s). Any response feels like it’s only going to fan the flames. I’ve finally resolved to not bother even reading them anymore and now I’m generally a pretty happy person. It’s interesting the path people will go to complain – you gotta tell me directly if you want any action. Most will just leave quietly and I get that.

The most recent face off in my lobby this week involved a client with a number of concerns including a “by the way” which ended with suggesting that I am no Dr Noble (the founder of the clinic who it’s named after). Ouch. And he stated that he had already made these complaints, yet I knew nothing of them until that moment. When going through the confirmed and bad things I agree we did do and the more paraphrased stuff I realized perception may be reality but hearing the account from the different people involved were quite a bit different. It makes me want to put all the parties in the same room and hash it out. But instead mea culpas were offered. We’ll see how that goes.

Which brings us to “Sophisticated Lady” who Yelped us, in the “not recommended” section but since disappeared. We’ll call him Bob (yes male) who owned a rabbit. He broke up with his veterinarian for what reason I don’t recall and traveled over 45 minutes to see us. I have come to realize those clients that complain about their previous vets I can be the hero for until they inevitably find something wrong with us. The rabbit has an abscess (infection) requiring multiple surgeries and lots of expense. Bob is what I consider high maintenance but I’m up for it. The medical challenge of his rabbits care being paramount. Both of my managers tell me they can’t deal with him – this should have been enough of a flag. But I persevere telling them to leave him to me. We have rapport, see?

And then we overcharge him, he thinks. Bob wants $27 back. Goes from being a fairly sweet talkative guy to a serious bully. Accuses us of horrible things, poor care, incompetence, malpractice, and says he will absolutely sue.  And yes god forbid Yelp us unlike we have ever been Yelped before. Which of course is not the way to get me to give in. Poof goes our relationship. He goes back to his original veterinarian who simply increases the dose of medication and everything heals. Which of course I’m happy about but the fact that I don’t know how to prescribe for my patients has been confirmed.

The Yelp review was remarkable. I truly wish I had saved it for my own future entertainment. Just a rambling recitation of events painting the picture of Dr Evil and my minions with the recitation of a bill of $x including all the various items when he was expecting $x – 27 and he was suing me to get justice. (The bill was over $600, mind you) He never sued, natch. But the moniker was just special.

Another No Rec was one written by the out of state breeder of a puppy that I told my client I wasn’t sure of a health issue and we would just watch it. No big deal. The breeder calls me up to read me the riot act for questioning the puppy and his reputation by extension which I was certainly not. Then the classic Yelp review had a “$” for every “S” implying I was just out for money. I suggested no test and no return of the puppy for any clear defect. Sigh. Do I go into the Yelp wars and review him as a breeder with questionable tactics? There is not enough time in the day.

CS

 

Bites to the Face

In Uncategorized on February 16, 2018 at 2:14 pm

This week has brought two incidents of dog bites to the face intimately to my awareness. One was a child in the care of my employee. Many dogs frolicking and the 5yo was in the middle of it when the oldest pet who had never shown indication of this before with no provocation bit her on the face = cheek and lip. Other was a medical professional handling a dog with another medical professional and totally out of the blue got bit on the lip, inside the lip and nose. Both dogs are small, less than 20 pounds.

We only hear about Pit Bulls due to the amount of damage that they can cause. True fact: chihuahuas are the most common listed breed for veterinarian related disability claims. They are wicked fast and can be angry little dogs. These dogs were a chihuahua and a terrier mix.

What is going to happen with these two animals? The terrier is moving out of state to a family member who has a ranch, lots of dogs and can handle this situation. My employee is besides herself because this one was her favorite, of course. And the child keeps asking for the dog. The chihuahua is a shelter animal. It is going to remain to be seen after it gets out of bite quarantine (10 days to be sure it doesn’t have rabies).

Unfortunately in the shelter world pets with a bite history are often given the benefit of the doubt. Like there was an adequate explanation for what it did. The concern of course is that it will get out, some young child (see other incident listed here) will bear the consequence of that decision. I would have no issue with euthanizing a dog with the information I have available. However veterinarians rarely have a say in these matters. Incidents are swept under the rug, erased from records, which can endanger those working with the pet in the shelter even. So tragic.

Back to our injured medical professional. There is a long unfortunate ER story of (poor) care provided, lack of knowledge regarding Rabies post exposure prophylaxis. But more significantly is the effect on ones psyche. She thought she understood dogs (“cats, I have no clue, I can’t read them”) and knew better than most the non verbal cues when an aggressive action may occur. Through a combination of not knowing the dog, poor hand off between people, inability to read absent signals an injury occurred. Now she questions her ability to be sure of any dogs intent. And recognizes that if she can’t tell how can most anybody tell? The public, staff, volunteers, etc.

This has absolutely been a severe learning experience.

For all of us.

CS

(BTW, don’t ever get bitten in the nose. When you sneeze it really hurts)

 

Cat named after me

In Uncategorized on February 13, 2018 at 3:26 pm

Clients do funny things. From the little old lady who would bring in a street wasteling and when asked its name, says the name of the person helping her hoping to gain favor to the appreciative client who names their next pet after you in some way when they get the new replacement pet for the one you ministered to when it was passing away. I’ve gotten referral notes from the teaching hospital at the school I graduated from, starting “My Name” (a pet) was presented for care on “date” …

The most unusual way I found that there was a pet with my full name (unusual) out there was when I walked into the VIN (veterinary information network) office in Davis, 70 miles from my home and visited the CEO founder in his office. A fellow was sitting at a desk. I said hi and introduced myself. Sometimes a guy will nod, just say, shake hands or present first and/or last name. Because I thought I may know this person by name if not in person I gave him my whole name.

He looks at me and asks if I know a fellow named (for anonymity sake, initials only) VY? Boy did I. One of the more eccentric clients ever from my time in corporate practice in Oakland a few years previous. This guy had an old car that barely ran. Only a Pit Bull or two that I took care of over about 10 years. had this wild look in his eye with wispy hair never changed his clothes in 10 years which is not to say he was unclean. And the single most identifying characteristic was the single cracked lens of his glasses. He wasn’t particularly financially well off. And as such I would generally give him a break.

Needless to say he was one of the more eccentric of my clientele, with the proverbial heart of gold. He never barely had any money to care for the dogs but brought them in regularly for care. He found creatures in the street and took them on. One of those. Usually with pretty wild stories about how they got in a fight and what he did to break them up, graphic details included including angles his body parts took in order to do so and acted out right there in front of me. That kind of thing.

So the mysterious stranger tells me the story of meeting my old client one day in a casually, but at VY’s house. Apparently a kitten (cats? kittens? I had only known VY to have dogs) was on the what passed for a dining table eating from an opened can of tuna. Of course. The stranger asked about him. VY says “here, you want him?” and pops it into his arms. Then:
(wait for it)
“His name is (my full name)”

This guy, I had just met, took him home, renamed him “Goofy” as there was more than a physical resemblance (usually how pets get named) but a behavioral one to the animated dog character. The cat would meet people/visitors at the door, bug them, hop in their arms and love all over them. In the words of the fellow, “the greatest cat ever.”

Of course he was. He was named after me!

A reminder had not come to mind for him for the few years it had been since he met VY until I walked in and said hello. With my full name.

What are the odds?

CS

Referrals

In Uncategorized on February 12, 2018 at 9:46 pm

As a veterinarian, I am a creative problem solver. Our relationship with local hospitals means that both the perceived lower cost humane society sends patients when they are too busy or the clearly more expensive specialty 24 hour emergency hospital sends patients when clients don’t have enough funds to fix and very sick or badly injured animal. Some people simply call around until they hear what they like.

So we play “Let’s Make a Deal!” and attempt to provide borderline specialty level care. The latest patient comes from far away. The dogs owner called saying she had been to over 5 hospitals having been told they could fix her pet but when she gets there they say they are unable. Or won’t. Or it’s too expensive.

I request records be forwarded so I can properly determine if/how I can help. The records sent to me from the large corporate place have no useful information so I call. Dr Unaware tells me he wasn’t the one who examined the poor dog, “my nurses say his femur (thigh bone) is in many pieces.” Then adds “no, wait, the records says it was the tibia (leg bone below the knee) — pause — ah, it came from the Emergency Hospital, you need to call them.”

Sigh

The Emergency records are very informative. Perhaps too much so. They include financial estimates which really aren’t appropriate and long paragraphs about how difficult the client was being, verbatim. Also probably not appropriate but it did aid my understanding of this clients mind set. It appeared to be precipitated by the client not accepting the 5 digit estimate. 5 digits. As well as that euthanasia (chemical induced “gentle death”) was advisable. Which a veterinarian should NEVER instruct a client to do. Our position from my perspective is to support the decision if or when it comes up as appropriate almost always brought up by the client pet caretaker, but not initiate the conversation. It certainly belongs at the bottom, as the last of the list of options when all other choices have been exhausted.

But having reviewed the information, indeed poochers had a very badly broken pelvis on one side and a barely broken tibia on the other side with a degloving injury which is the most difficult thing to overcome. Degloving is like it sounds = a skin defect where the skin is removed as if a glove is peeled off/back. I told her owner I could indeed help this dog, if it was worth it to her and she really needed to bring the dog to me so that in hand we could go over all of her injuries and make a plan that was mutually acceptable.

Dog (trying to keep some her identity confidential to protect those that may be considered less than capable) comes in with a magically healed 2 weeks later pelvic injury as evidenced by her use of the leg. Which was key because she couldn’t use the other broken degloved leg. She needed A leg to stand on and had it. The broken tibia was protected only because she couldn’t step on the badly swollen foot secondary to the massive degloving wound which was trying to heal poorly and had a huge stuck scab that works against things. So sad. Amazingly she was a sweet pet despite being clearly in a lot of pain.

Her owner was somewhat brusque. She didn’t trust vets anymore. She had a human medical adviser on the phone. A nurse? They can be very difficult for veterinarians to interact with. The first sentence out of my mouth included an incorrect pronoun Dogs owner thought so she corrected me harshly.  I never would have made that mistake with the obviously female named pet, I was simply misheard me. Dog also hasn’t been spayed which is going to be a problem for another day, in a dog of her middle age.

I was told that this dog had seen at least 4 other veterinarians beyond the two known so far in the two weeks since her injury. She is going to forward me those records so I can complete my understanding. Currently Dog was on a wimpy dose of pain medicine and no antibiotics. The owner had been instructed to sanitize (ouch!) the open wound with a provided solution and put neosporin on it. NOT the way to heal a wound of this sort in my experience. The original prescribing Dr gave one week of medication and clearly Dogs owner did not obtain additional care until after that. Poor creature.

The badly injured non healing wounded unused leg should be amputated, I told Dogs owner. She wouldn’t accept that. She is prepared to spend an equivalent amount attempting to fix it which will require bandage changes every 2-3 days for at least a month. With no guarantees that it will work and may end up with the same expense amputation and Dogs suffering in the meantime.
We’ll see

I still don’t know how Dog found her way to me

CS

 

 

 

QOD (quote of the day)

In Uncategorized on February 7, 2018 at 8:03 pm

Haven’t been around lately. The search for the ultimate web site (bogged down) has taken precedence. Recent activity has reinspired with the added insight of not needing to make a super long daunting entry. This is the first of many simpler additions, where I ask  my married for a long long time clients their secrets to the successful marriage they have clearly carried out or just the humorous things that get blurted out by clients and/our employees.

Couple married for 50 years.

What is their trick?

The first time it has been the woman ONLY responding (it’s always been both or just him):

“I ignore him and do what I want”

 

CS