PSA

When your dog has SO MANY TICKS that little suckers (haha) have attached themselves to your dog's EYELIDS in an effort to stake out the last square centimeter on non-infested flesh, IT IS TIME TO GET SOME FRONTLINE! Or insert-preferred-tick-preventative-here. Whatever. No more averted glances and mumblings of "I have some at home", K? Cough it up.



Might also be time for a Lyme vaccine.

Check Please

A client's first visit with a new vet is sort of like a first date. Both parties try to make a good impression (mostly) while trying to figure out the other's interests and philosophies (regarding pet care) - and of course, there's a bill at the end.

In some cases though, somewhere in between the bread and the appetizer, the conversation slowly but surely turns from pleasant banter to a one-sided, deeply embittered bashing of "the ex" - how he/she was a crazy pyschopathic jealous angry horrible scum of the earth freak of nature. Etc etc. You attempt to gently steer the conversation towards more progressive, at-hand topics, but your dinner partner stands his/her ground. After the third glass of wine, he/she is throughly convinced that "the ex" was the devil incarnate - but you, YOU are AMAZING. You're nothing like the ex, they say, you are PERFECT.

Then you spend the next two weeks pretending to have an especially contagious strain of Ebola.

Maybe that's a bit extreme, but that's what I'm reminded of whenever the topic turns from the findings of a pet's exam to how horrible the Last Vet was. Whether it's a perceived improper diagnosis, getting ripped off, or just general mistreatement, the client obviously holds a deep resentment against their previous vet, and is intent on revealing every last gory detail - more than just "I left Dr. X because of XYZ. The End". The problem is, sometimes the complaint is 100% true and fair, but it would still be incredibly unprofessional for us to respond with the agreement the client is hoping to hear, unless there's a previous medical history that reveals evident malpractice. We don't know the vet or their side of the story, for better or for worse. In addition, it makes my spidey sense tingle - if we are this client's third vet this year, how long before we "mistreat" them and send them off to Vet #4 with tales of woe about how evil we are?

I want to crush your dreams

I love it when kids come to shadow for the day.

And by "love it", I mean I loathe it, of course.

Don't get me wrong - I love the one in ten kids that actually pays attention, asks questions, and shows half an interest in doing anything other than sitting around and asking where all the puppies are.

The remaining majority of veterinary hopefuls tend to quickly lose interest when they realize that the most/all of the day consists of smelly infections/fecals/animals/owners, and nary a puppy or kitten in sight. I can give the middle-school ones a break, but the seniors in high school drive me insane. Even though their little dreams are quickly crushed, they still have x amount of days or hours to complete for their school requirements. While they may be content to spend this time sitting at the front desk contemplating their next career path, we feel obligated to give them something to do - usually this means walking dogs in the kennel. If I'm feeling especially dedicated to the future of our youth, I may try to keep teaching them how to set up fecals - however, after the TENTH repeat of "put poop in tube, add floaty stuff, mix well" fails to stick in their heads, I give up.


The young ones do come in handy, however, when it comes to dealing with difficult clients - no one wants to mean in front of a twelve year-old.

TOBASH

I'M BACK!

Yay?

_______________________________

As a general rule, Saturday mornings are the busiest days at any vet clinic, as everyone and their cousin's girlfriend wants an appointment for that day, and we're only open for 4 hours. Hence, you can always bet that we'll be booked solid with "limping x2 wks" and "adr x? - outdoor cat, 16yr" and "discharge from 'pee-pee parts', per owner". (On that note, c'mon people, say it with me - "penis" and/or "vulva/vaginal area").

Anywho, Saturday 8am is very bad time to call up your beloved local vet clinic to declare your immediate need for medical attention for a problem that has been going on for the past 2, 3, or 4 weeks. You see, the people who procrastinated slightly less than you have already booked us up with THEIR 2, 3, or 4 week-old problems, and we're scrambling like crazy to squeeze in the truly sick pets.

"Fine", you might say. "I'll just walk in there and plop myself in a chair and demand to be seen", you say. I know this will come as a surprise to you, but when we are a receptionist and tech short and only have one doctor scheduled, open slots in our book will not spontaneously generate. Therefore, you and your ridiculously unsocialized animal will sit in our lobby for an indefinite period of time, despite our attempts to placate you with a smorgasbord of appointment options for Monday.

Finally, you strike up a conversation with the nice man next to you as he patiently waits for his SCHEDULED appointment. With a lovely touch of class, you inform him that if we fail to see you promptly, you intend to take your pet home and shoot it in the head.

Congrats, you got your appointment slot after the nice man insisted upon rescheduling his exam for later in the week so you could be seen for your minor, x4wk problem. I'm not sure what all your fuss was about, however, since "diagnostics" and "medications" were not part your extensive lexicon to begin with. Since our magic wand is in the shop, a physical exam can't really CURE anything.

I know, that's our fault too...

No. No prescription for you.

Also, breathlessly/angrily declaring "IDON'TWANTANEXAM" as soon as I pick up the phone is not conducive to getting your request passed along to the doctor.

"I think he's got a UTI - can I get some of that antibiotic stuff like last time?" (last time = 3 years ago)

"OMG, I'm TOTALLY out of Novox, I need a refill NOW!" (last exam - '06, last bloodwork = hahahhahah. Also, how did you manage to stretch 14 tablets over 2 years if you're giving it every day?)

"His allergies are getting really bad again, he's all red and scabby...last time y'all made me buy like 3 medications, I don't need that antihistamine stuff or antibiotics, just gimme those little white pills." (little white pills = prednisone)

"More Ace, please"
Me: "Ma'am, you just got a refill of 30 tablets a week ago...and we haven't had any thunderstorms..."
"Yeah, but he barks alot."

I thought elementary school was mandatory...

Flashback to 2 weeks ago...

Husband brings dog in. Has raging ear infection in the left ear. We do a cytology, send him home on ear cleaner and antibiotic ointment for 14 days. I go over meds with husband, and ask him if he wants me to do the first ear cleaning for him (for a nominal fee, of course) - he says no, that's ok, my wife handles all the dog stuff, she can do it. Ok sweet. Cya in a couple weeks for a recheck.

Present Day.

Wife brings dog back for recheck. Says oh yes, I've done the meds everyday, the ear looks great. Whines about paying for the recheck, even though she called and scheduled it out of her free will. Blah blah blah.

Vet examines ear. The left is now far worse than before, complete with pus and ulcers on the outer ear and pinna, and the smell of yeast has grown from "faintly like bread dough" to "oh my god why didn't I bring a change of clothes today...OH GOD MY EYES THEY BURN"

Vet asks how Poopsykins handles his daily ear cleaning. Fantastic, apparently. Vet tells owner the infection is getting worse and presents the evidence.

"Oh! Well, I didn't clean that ear, the directions said the LEFT ear."

"But...this IS the left ear."

"No, that's the right ear."

Vet and I look at each other, wondering who in the room is insane.

"See!" (Owner stands in front of dog, and puts her hands on either side of the dog's head.) "This is my left hand, so THIS (motioning to the ear under her left hand) is his left ear."

"Um. No."

Even though this woman could tell her left from her right just fine, she honestly and truly believed that because the dog was not human, then he could not possess his own left/right side, and therefore the all directions were relative to HER left/right. I haven't yet figured out if that was a result of just innocent ignorance, or an incredibly, incredibly large ego.

Either way, I think I heard the tiny death rattles of a few more precious neurons.

I remember trying to talk an owner through a similar situation on the phone...after she got home, she became hopelessly confused as to whether the "Clean right ear once a day" referred to her right or the dog's right.

"Ok, ma'am, it means the dog's right."

"His right...when he's facing towards me or away?"

"....::headscratch::....His right is always his right, ma'am"

"But how do I tell which side is his right?"

BWWAGGHHH!!!

So if we leave the rotten teeth in there, eventually they'll just fall out, right?

"Super, no need to do this whole "surgical extraction" thing and waste all that money then."

I'm pretty sure there's a special circle of hell reserved for bad veterinary staffers - for all eternity you are forced to wander through an endless wasteland of tight-fisted clients with 10-yr old Yorkies who steadfastly deny the existence of this "periodontal disease" you speak of. You are armed only with a "Pets Have Teeth, Too" brochure, and you alone must lift the shroud of ignorance from their eyes and bring them to the light of regular dental care before you can proceed to Purgatory.

The gehenna of Dental Health Month approaches.

Oh, sure, in theory it's a fantabulous idea - let's all pick a month to shower our clients with enlightening education about periodontal disease, and take some extra time to go over preventative at-home care techniques and the importance of dental cleanings. Let the knowledge flourish among ye. Hey, we can even offer a discount on dental procedures done during February as an incentive. Yay!

Except...

Our base dental cost for dogs (anesthesia, dental cleaning and polishing, X-rays, pre-surgical Rimadyl injection, and go-home antibiotics) now exceeds $400. Yup, that's without the recommended pre-surgical bloodwork, IV cath, or OraVet. And extractions? Hahhahhahahahaha. Sigh.

Granted, if people would stop hitting the mental "mute" button whenever we mention dental care during Fluffykin's annual exam and invest a little time/money in brushing teeth, feeding t/d, using OraVet, chlorhexidine chews/rinses, SOMETHING other than NOTHING - Fluffykin probably wouldn't need an $1100 dental and his canines and molars wouldn't be scattered on the surgery room floor.

I wish it wasn't so expensive, but 1.) we only have 1 surgery table, so time-consuming dentals have to be comparable in cost to other surgeries we could be performing at the time (according to Boss Vet) 2.) many dental cleanings could have been significantly delayed or prevented if the owner would have invested in at-home care.

Still, those rationales don't help much when I feel my soul withering under the death glare of the client as I go over the $400+ estimate. But, erm, you get a discount. No, not on the whole thing. Just the cleaning. Please stop looking at me like that.

My cat is very prone to packing on the tartar, and if I were to do nothing he would work up a horrible infection at warp speed - I know this, so I feed him dry food, give him a couple C.E.T. dental chewies a day and brush his teeth a couple times a week. He's not too thrilled with the brushing, but that's just too bad. I check his mouth a once a month just to make sure the tartar isn't re-appearing - it rarely does, but when it does I can pin him down and scrape it off with my fingernail. During his annuals, I do a good dental scrape (no sedation needed). Total yearly cost? Probably $60.

Moral of the story? Find a way to take care of your pet's teeth AT HOME. In the end, you'll save a small college fund worth of money and your pet will keep his/her teeth around for awhile. Oh, and all that kidney/liver/heart damage stuff.

Why it's ok to let your kid eat dirt and lick the dog

One of my ecology courses requires us to do these incredibly annoying little "current events" projects - basically we just have to find an article relating to the last few lectures, write up a blurb, and then present it to the class (150 people) and tell about how AWESOME and INTERESTING our topic is, even though you just found it ten minutes ago in the university library and could care less about CO2 flux and corn production. But anywho. The other day, a kid presented an article that actually registered some merit with me - http://www.boston.com/news/globe/ideas/articles/2006/05/07/our_allergies_ourselves/?page=1 . It discussed the "hygiene hypothesis" - the link between an increase in hygiene and an increase in autoimmune diseases and allergies. Basically, the immune system is a like a workaholic phalanx - it likes to fight, it NEEDS to fight, and if you kill off the little germs and parasites and their other daily "jobs", the immune system gets bored and starts picking fights within the body, or over-reacting to minor things (aka, allergies).

At the risk of drawing too many parallels between human research and veterinary medicine, I though it was very interesting in terms of the incredibly large number of cases of allergies and autoimmune problems that we see on a daily basis. It makes me wonder if dogs and cats, more recently removed from their distinctly un-hygienic ancestry, are more greatly affected by all the dewormers and hygienic measures we impose on them in the interest of keeping them healthy.

I started thinking about this today after getting into a heated discussion with an owner, who was livid over his dog's "re-contamination" with the almighty giardia - we had originally treated the infection, and subsequent fecal samples were negative until today, when it re-appeared with a vengeance. Barring the possibility that the infection had never really cleared at all, just gone into hiding, the dog must have picked up from any number of contaminated sources. I discussed this with the owner, who declared on no uncertain terms that re-contamination was "impossible" since the dog has "never set foot outside in its whole life".

Huh? Never?

Never. The puppy was never taken outside by the breeder, and the owner uses "potty-pads" inside. No walks. The paws have never touched the ground.

I was too absorbed in mediating the Giardia War to dwell on this, so it wasn't until everything was resolved that I really started to think about it. I feel so bad for that poor little dog. I mean, my cat hasn't been allowed to venture off his 4 foot lead during our porch sessions since I adopted him, but DOGS are MEANT to go outside, go for walks, run around the yard, etc etc...

Anyway, I am willing to put money on that dog's future allergies, if the article's hypothesis is correct. Maybe it's something to consider that instead of only working so hard to shield our pets from every microscopic enemy, we should also concentrate just as hard on keeping their immune systems happy and occupied.

Maybe someday I'll do a brilliant research study on little white dogs and allergies and make lots of money.

Nah, too lazy.

Identity Crisis

Father and 12-ish daughter came in yesterday, hauling a giant pink cat carrier with a fatish tabby cat outfitted in a pink rhinestone collar. They were new clients, just moved to our area from some state on the other side of the country. The cat was a 10 year old spayed female, due for annual exam and other such fun. Her name was Princess Muffykins or something along those lines. Yay.

We went through the usual speel of extracting a fecal sample, giving vaccines, recommending senior bloodwork and urine tests, and watching their eyes glaze over at the mention of dental care and weight loss. In other words, the usual.

Then came the good part.

Associate Vet was finishing her usual painstakingly thorough exam - we moved from the head to the heart and lungs to the abdomen, rolled the cat over on her belly, etc etc etc...then for the last part, she lifted the tail to check the rectal and genital area.

I'm not so good at writing suspense, so let's just say she paused, grabbed the chart, then went back and picked up the tail again. Then something to this effect took place:

Vet: "Have you had her since she was a kitten?"

Father: "Yup yup"

Vet: "Well..."SHE" is definitely a "HE""

Father: "Huh? What? That's impossible!"

::Vet flips cat around and shows father the small and empty but very real scrotal sac::

Father: "But we had her spayded! She had a big incision on her belly and everything!"

Vet: "Uh huh, I see, but he's definitely a boy. A neutered boy, but a boy."

Father and daughter sputter on in disbelief as to the impossibility of this matter.

Father: "But they charged us for a spay! They didn't do a spay?"



Ah, yes. Yes they did. How? Any variety of ways - the kitten gets sexed wrong at the first visit, and no one doublechecks before the surgery, or maybe the owner tells the clinic the cat is female without really knowing, and no one corrects his assumption during the exam. Either way, some one screwed up and instead of telling the owner, apologizing, and charging for the correct surgery, they just quietly neutered the kitten and hoped that no one would find out for awhile. I would really have liked to have seen the alerts in that patient's chart - "ALERT - CAT IS MALE, OWNER THINKS HE'S A FEMALE BECAUSE WE SPAYED HIM/HER. DON'T TELL OWNER. ALSO, MUST KEEP OWNER AS A CLIENT FOR LIFE OF CAT, OTHERWISE OTHER VET MAY SPILL THE BEANS AND THEN WE'LL GET OUR PANTS SUED OFF." He he. Whoops.

The best part is, the family still refers to he as a "she", and has yet to re-name him. Poor Mr. Princess Muffykins.

If in doubt:
http://www.thepetcenter.com/exa/kitx.html

Annual visit, 2 year old MORBIDLY OBESE miniature dachshund mix. As in, wider than she is long. As in, 30+ pounds when she should be around 10.

Owner: So, I, uhm, heard about that one drug, Slim-, no, Slen-something? (c'mon, we all know you've spent the past three hours before your appointment furiously pouring over Pfizer's webpage)

Me: Slentrol? (internal sigh)

Owner: Yes! That's it? Do ya think it'd work for her?

Me: Well, have you tried cutting back on her food or increasing her exercise?

Owner: Well....no....(clearly)....she doesn't like to move around too much, ya know....and the kids feed her stuff from the table, I just can't stop them...(I bet I can.)

I want to beat you over the head with this giant stack of shiny Slentrol brochures I have no use for.

Full disclosure: We have yet to actually prescribe Slentrol for a case, so I can't truly comment on it's effectiveness. Maybe it's really liquid magic, but like all diet drugs, I highly doubt it. I am currently neck-deep in slick, colorful Slentrol handouts emblazoned with fat, sad dogs with big eyes and "Body Assessment Rating for Canines" thingies, compliments of Pfizer. Apparently, February is National Canine Weight Check Month or something like that (according to Pfizer).

Of course, it's supposed to be used in addition to exercise and calorie restriction - but what fun is that? Chances are, if your dog is fat, too little exercise and too little calorie restriction got him into the mess in the first place. And why, WHY, would you pay for an expensive medication when you could pay LESS by JUST NOT FEEDING SO DAMN MUCH? I just can't fathom why it's so hard to just say "No. 1/2 cup a day for you. No more. Go chase a ball or something." I have yet to see a euthyroid dog that failed to lose weight if the owners really stuck to cutting back on food (or switching to a lower-calorie food), and made an effort to increase the exercise.


On a different note, after a run on coccidia-laden puppies and counting out sixteen thousand tablets of Primor, I'm convinced Pfizer has an obsession with little blue pills.

Speaking of which, we have this middle-aged male client that always comes in wearing Viagra t-shirts. I really hope he's a urologist or something.

An open letter to the family I house/pet-sit for:

Seriously, y'all, it's been a couple years now. You pay me great, your house is awesome, your dogs and cats are sweet and all that shiz, but what do you think I'm up to? I swear, I'm not throwing keggers, I'm not practicing Santeria in the back yard, I'm not running an opium den in the basement - do you really feel the need to orchestrate "random" drop-bys of your friends/neighbors/family members? Really? Don't you think that by now, you would have found at least one stray beer can or chicken head? Honestly, when I'm not working/studying/going to class, I spend 95% of my time lying in your bed, eating Taquitos and pot pies and watching Dirty Jobs on the Discovery Channel, fantasizing about Mike Rowe following me around for a day at my job, wincing at castrations and making snarky double entendres about fecal loops or something (afterwards, we could go out to dinner, have a few drinks...you know...maybe take a shower and wash off the cat pee?). Anyway, I digress. The remaining 5% of the time is spent walking back and forth from the kitchen, nuking more pot pies and Taquitos.

Why is this an issue, you ask?

Well, you see, their dogs are very high maintenance - they HAVE to go out every 2-3 hours, or they pee/poop on the rug that cost more than my car - this is very frustrating as I am not able to run home every 2-3 hours, and there is no reason why adult, perfectly healthy dogs can't hold their bowels for a couple hours. Clearly, it makes me look like a bad pet-sitter when the owners come home to gajillion pee spots, and I can only clean up so many in secrecy before they start to notice their supply of Nature's Miracle is starting to diminish. So, I took to putting them in the laundry room while I was at work/class - and magically - they went 5-6 hours with no accidents. Much more manageable. And, their laundry room is at least three times the size of my freshman dorm, so it's more than enough space for two medium-sized dogs, plus their giant beds and toys. Guilt level = 0.

Until, yesterday, I came home to the dogs running free in the house, with a sticky note attached to the laundry room door:
"Locking dogs in laundry room is UNACCEPTABLE." Underline, underline. No signature. Uhhh, OK whatev.

(1.) Technically they weren't "locked", just closed in.
(2.) Just WHY is that unacceptable? What do you think the dogs do in a giant house while no one's home? Run from room to room critiqueing the artwork? No. They sleep. And in this case, pee.
(3.) Who are you and why were you in the house?

This isn't the first time people have popped up out of nowhere - I can't count the number of times I've woken up to the housekeeper dusting my nightstand, or come home to some form the anonymous note "Stopped by - you weren't here. I'll be back." WHAT THE HELL? The worst was the time I was taking a shower upstairs, and I heard the dogs go crazy over something downstairs - I though it was the UPS guy or a squirrel or something since they stopped after a few minutes. I got out, put on a towel, and trotted downstairs just to make sure - I turned the corner and ran smack into a delivery guy and his partner dragging a new dishwasher. I screamed (managed to hold up my towel, at least), and they just kind of stared at me blankly and said "Well, she gave us the garage code so we just came in."

I just can't help but to assume that the only reason to NOT give a simple warning the person staying in your home "Hey, so-and-so is coming by to do such-and-such" is to hope to catch them in the middle of something. Grrrrrrrrrrrrr.

Procrastination

Sorry no updates for the past few days. Classes started last week - ew. Disgruntled rants about Slentrol coming soon, I promise!