Client arrives with her kitten, who had a surgery 10 days ago. The incision was healing well, until the client started to notice red, milky discharge coming from the surgical site.
Client has an e-collar with her, but it's not on her cat.
Me: "Did your veterinarian tell you that the e-collar should be on your kitty?"
Client: "Yes, but they said it didn't have to be when I'm supervising her."
Me: "Okay, so what about at night? Do you put it on her at night?"
Client: "No, because she sleeps with us!"
Me: "...... but you're sleeping, right? So you can't be supervising her while you're sleeping. She could be licking and chewing at the incision."
Client: "Ohhhhhhhhh....... I never thought of that."
I'm dumbfounded!! How can you be an adult, yet be incapable of thinking logically??!!
Next one:
Client arrives with a Chihuahua who seems to be painful. Physical exam determines that "Chia" has pain in her neck. The client doesn't know of any trauma; Chia is never outside alone, she's always supervised. We treat for suspected disc disease, and Chia leaves the hospital.
Two days later, Chia returns because the client notices "red eyes." Typically, this complaint from a client means that the pet has very slight reddening of the eyes, like conjunctivitis, for example. Not this time -- Chia has scleral hemorrhage on both eyes -- this means that the whites of her eyes are red (it's actually quite creepy looking -- if you can handle it, go to google images and type in 'scleral hemorrhage.')
So, Chia now has neck pain, and bleeding in the whites of her eyes. The most likely diagnoses are either trauma, strangulation injury, or a clotting problem (for example, rat bait, or platelet problems).
I asked the client again about trauma, explaining that this could explain both the neck pain, and the red eyes. No, no, no way this could have happened. Chia's feet almost never touch the floor -- she's a typical "purse" Chihuahua. Testing for bleeding disorders commences.
PT/PTT were performed, and both were normal. Platelet count was normal. Chia's laboratory testing demonstrated that she was clotting her blood normally.
My colleague asked the client again about trauma. The client FINALLY revealed the truth.
3 days ago, before her initial visit, Chia had been out for a walk with the client. Two large dogs came up to them, and in fear, the client pulled Chia back by her leash. The client then pulled Chia off the ground with her neck leash, and up into her arms. This resulted in a temporary strangulation, and then the subsequent clinical signs -- neck pain and scleral hemorrhage.
Maybe the client could have just told us this the very first day!
I never understand people who bring their dog (or THEMSELVES) to the doctor and then are deliberately dishonest about the history. I mean, do you want my help, or not?!?!?
ReplyDeleteYEars ago, I had a Doberman puppy (stray rescue) who ended up having distemper (I think we probably vaccinated during the incubation period so unfortunately we missed our window) and when I took her to the emergency clinic because she had a seizure, the vet would NOT GET OFF the "could she have gotten into any illicit drugs?" line of questioning. I mean, he seriously interrogated me for 10 or 15 minutes about my supposed drug use. I wanted to punch him, but at the same time I can see how vets can end up like that after a few years!
I've definitely been that annoying vet who asks about illegal/recreational drugs repeatedly. I'm guessing that most ER vets have been in that situation.
ReplyDeleteUnfortunately, if it's drugs, we need to know. and many, many people won't tell you unless you push them pretty hard. I do try to be as non-confrontational as possible, letting my clients know that 1) I don't have reporting requirements and 2) I'm not judging, just trying to help their pet, and 3) If it's not drugs, it's something probably way, way worse in terms of prognosis. I'm sure you'll hear the adage "common diseases occur commonly" when you get into school -- illegal drug toxicity is WAY more common than clinical distemper. He wasn't judging you, he was just trying to figure out the case. Maybe he should have been nicer :)
I knew a lady whose dogs had abdominal surgery, she refused to use an e-collar, instead put a t-shirt on the dog. The dog chewed out all the sutures and literally had intestines falling out. But it was the Vets fault.. She apparently didn't suture it properly.. That woman actually told me that with a straight face.. and I swear she believed it. Total idiot..
ReplyDeleteThat's really, really sad, for the dog and the owner. How preventable!!!!!!!!!!!!!!!!!!!!!!!!!
ReplyDelete