Everyone, spread the word. Bloat kills. Any owner of a deep-chested at-risk breed should know the signs and symptoms.
Tonight, a young, intelligent client called. "My dog has a distended abdomen, and he's trying to vomit. This has been going on for three hours. What can I give him?"
My tech immediately, and directly informed the man that this is a critical emergency, and that his dog required IMMEDIATE medical attention.
The client arrived, and his dog was already deceased. We attempted CPR, to no avail.
His dog was only 9 months old, and if he had come in when he first noticed the problem, we could have saved her. The saddest part is that I saved her after being hit by a car only 4 months ago, and now this.
I know I've posted on GDV before, and I know that sometimes, if you aren't home, there's nothing you can do. But if you ARE home, don't wait. These symptoms require IMMEDIATE action, or it's quickly too late.
Spread the word, save a life.
Thursday, February 2, 2012
The things we do....
A few days ago, I saw a 2 year old male cat for straining to urinate. After a physical exam, he was quickly diagnosed with urethral obstruction, a life-threatening emergency and a common problem in emergency medicine. I spoke with the client, a woman in her 50's who was acompanied by a child. At first, I thought the kid was poorly behaved; he beat on the doors, screamed, slammed the chair into the walls, and made it nearly impossible for me to speak to the client. His yelling was louder than I am capable of speaking, and many times I stopped, waited for a pause in the yelling, and then would continue. After a few minutes, I realized the child likely was autistic, not poorly behaved. I tried to be as understanding as possible however his activity made discussing the situation with the client very, very difficult.
Urethral obstruction in male cats is a complex process. Many times, urethral obstruction is due to a build up of crystals in the urinary bladder, urethral spasm, and blood clots that form a plug in the urethra. Inability to urinate quickly results in pressure on the kidneys, causing build up of dangerous toxins, electrolytes, and eventually, if left untreated, kidney failure and death. More information is available at veterinary partner.
The treatment for urethral obstruction is pain control, resolution of electrolyte abnormalities, and anesthesia in order to pass a urinary catheter and relieve the obstruction. Cats should remain hospitalized for 24-48 hours, depending on the duration and severity of their condition to allow urine to be flushed, kidneys to be healed, and to decrease probability of a second obstruction. Urethral obstruction can reoccur, and often cats who experience this condition will be placed on a prescription diet, or a canned food-only diet. Some cats experience multiple obstruction episodes and require surgery to enlarge their urethral opening.
The client began to cry, and her autistic son began to scream. "I don't have any way to pay for this" she said. "The cat helps my son, and I just don't know what to do. There's nobody who can help me. I just can't let him go."
The preferred medical treatment was out. I had to find a way to help this kitty with a budget that could barely cover the exam fee.
I gave the kitty pain medication, and emptied his bladder with a small needle and syringe to relieve the pressure. I applied a local numbing agent to his penis, and then attempted the impossible- catheterizing an awake cat. This method is not recommended, as it is painful and usually unsuccessful. I'm sure most of you can imagine trying to even touch a cat when they don't want you to.... add on top of that, trying to insert a catheter into a cat's penis! Nevertheless, I had to give it a try, for if I couldn't find a way to unblock this kitty, he would face certain euthanasia.
I discussed with her the risks of this, and we discussed euthanasia as well. While her autistic child screamed, she cried, explaining to me how this cat helped her son cope with his disability. I couldn't bear not giving the cat a chance.
We attempted the procedure, and fortunately, were successful. I sent them on their way with medications, instructions, and strict monitoring parameters. She called me 3 weeks later to let me know that despite the odds, her kitty had not required further care, and our willness to help her had saved her cat's life. She thanked me, and I knew we had done something very important for her family.
Urethral obstruction in male cats is a complex process. Many times, urethral obstruction is due to a build up of crystals in the urinary bladder, urethral spasm, and blood clots that form a plug in the urethra. Inability to urinate quickly results in pressure on the kidneys, causing build up of dangerous toxins, electrolytes, and eventually, if left untreated, kidney failure and death. More information is available at veterinary partner.
The treatment for urethral obstruction is pain control, resolution of electrolyte abnormalities, and anesthesia in order to pass a urinary catheter and relieve the obstruction. Cats should remain hospitalized for 24-48 hours, depending on the duration and severity of their condition to allow urine to be flushed, kidneys to be healed, and to decrease probability of a second obstruction. Urethral obstruction can reoccur, and often cats who experience this condition will be placed on a prescription diet, or a canned food-only diet. Some cats experience multiple obstruction episodes and require surgery to enlarge their urethral opening.
The client began to cry, and her autistic son began to scream. "I don't have any way to pay for this" she said. "The cat helps my son, and I just don't know what to do. There's nobody who can help me. I just can't let him go."
The preferred medical treatment was out. I had to find a way to help this kitty with a budget that could barely cover the exam fee.
I gave the kitty pain medication, and emptied his bladder with a small needle and syringe to relieve the pressure. I applied a local numbing agent to his penis, and then attempted the impossible- catheterizing an awake cat. This method is not recommended, as it is painful and usually unsuccessful. I'm sure most of you can imagine trying to even touch a cat when they don't want you to.... add on top of that, trying to insert a catheter into a cat's penis! Nevertheless, I had to give it a try, for if I couldn't find a way to unblock this kitty, he would face certain euthanasia.
I discussed with her the risks of this, and we discussed euthanasia as well. While her autistic child screamed, she cried, explaining to me how this cat helped her son cope with his disability. I couldn't bear not giving the cat a chance.
We attempted the procedure, and fortunately, were successful. I sent them on their way with medications, instructions, and strict monitoring parameters. She called me 3 weeks later to let me know that despite the odds, her kitty had not required further care, and our willness to help her had saved her cat's life. She thanked me, and I knew we had done something very important for her family.
Wednesday, February 1, 2012
The true meaning of irony.
These two cases still make me giggle. You'll soon see why.
A client called, screaming into the phone. " I'm coming with my dog, RIGHT NOW!" Before my technician could ask her what was wrong, she hung up.
20 minutes later, a car comes tearing into our parking lot, headlights flashing, brights on, honking her horn like a crazy person. My techs are already on their way outside when the client flings open her door, screamng hysterically. In the process, she manages to scratch the bejesus out of the car next to her. "He's dying, he's dying!!!" She screams.
My tech takes a look, obviously concerned that this pet might be critically injured. While performing a brief evaluation and carrying the pet inside, my tech starts to get a patient history. "What happened? Did he get by a car, or...?"
The dog cannot walk well, is ataxic (means literally 'without axis,' or off balance), stumbling, and hypersensitive to noise and sound. He overreacts with any sort of stimulus. His mucous membranes are pink, his pulses are strong and his heart rate and body temperature are slight slowed. He's also dribbling urine.
It becomes clear that this dog is definitely not dying..... He's stoned.... and so is his owner.
We notify the owner of the other car, and I talk to the client about her pet. Shockingly, it is revealed that marijuana is in the household. I offer testing to confirm my suspicions, but also let her know that her dog is likely to be fine by the morning.
Even she laughs a little about the way she arrived, and the other car she scratched
Case number two:
A 3 year old, otherwise healthy doberman presents for suddenly being unable to walk. She was fine when the family left for work, and upon arriving home, was in this state. The dog, "Lizzy" was brought in on a stretcher. Her heart rate was slow, about 60 beats per minute, but her pulses were strong. Her body temperature was low, and she was mostly non-responsive, however if startled, would completely over-react, flail and panic, then return to her near coma state.
Lizzy had been in a kennel all day, but prior to the clients leaving for work, she had been outside, out of sight. No known toxins were available, but based upon her history, some sort of toxicity was still the most likely diagnosis. Her family authorized all testing, including antifreeze testing (negative) electrolytes, blood sugar ( normal) and urine drug screening.
Can you guess what she got into?
Yes, that's right. Marijuana. I had a suspicion from the inital symptoms, however her family swore up and down that couldn't be possible. They also didn't seem like 'the type,' but you just never know.
I saved the drug test cartridge and took it with me as proof to show the clients. This was good news, as marijuana poisoning, even severe exposures, are very treatable.
The clients looked at me and listened. When I showed them the positive drug test, they laughed incredulously.
"Do you know who I am or what I do for a living?" The female client asked.
"No, I'm sorry, I have no idea. Should I know?"
"I'm the chief of police!" She laughed, almost too hard. "And I have a stoned dog!!!!!"
A client called, screaming into the phone. " I'm coming with my dog, RIGHT NOW!" Before my technician could ask her what was wrong, she hung up.
20 minutes later, a car comes tearing into our parking lot, headlights flashing, brights on, honking her horn like a crazy person. My techs are already on their way outside when the client flings open her door, screamng hysterically. In the process, she manages to scratch the bejesus out of the car next to her. "He's dying, he's dying!!!" She screams.
My tech takes a look, obviously concerned that this pet might be critically injured. While performing a brief evaluation and carrying the pet inside, my tech starts to get a patient history. "What happened? Did he get by a car, or...?"
The dog cannot walk well, is ataxic (means literally 'without axis,' or off balance), stumbling, and hypersensitive to noise and sound. He overreacts with any sort of stimulus. His mucous membranes are pink, his pulses are strong and his heart rate and body temperature are slight slowed. He's also dribbling urine.
It becomes clear that this dog is definitely not dying..... He's stoned.... and so is his owner.
We notify the owner of the other car, and I talk to the client about her pet. Shockingly, it is revealed that marijuana is in the household. I offer testing to confirm my suspicions, but also let her know that her dog is likely to be fine by the morning.
Even she laughs a little about the way she arrived, and the other car she scratched
Case number two:
A 3 year old, otherwise healthy doberman presents for suddenly being unable to walk. She was fine when the family left for work, and upon arriving home, was in this state. The dog, "Lizzy" was brought in on a stretcher. Her heart rate was slow, about 60 beats per minute, but her pulses were strong. Her body temperature was low, and she was mostly non-responsive, however if startled, would completely over-react, flail and panic, then return to her near coma state.
Lizzy had been in a kennel all day, but prior to the clients leaving for work, she had been outside, out of sight. No known toxins were available, but based upon her history, some sort of toxicity was still the most likely diagnosis. Her family authorized all testing, including antifreeze testing (negative) electrolytes, blood sugar ( normal) and urine drug screening.
Can you guess what she got into?
Yes, that's right. Marijuana. I had a suspicion from the inital symptoms, however her family swore up and down that couldn't be possible. They also didn't seem like 'the type,' but you just never know.
I saved the drug test cartridge and took it with me as proof to show the clients. This was good news, as marijuana poisoning, even severe exposures, are very treatable.
The clients looked at me and listened. When I showed them the positive drug test, they laughed incredulously.
"Do you know who I am or what I do for a living?" The female client asked.
"No, I'm sorry, I have no idea. Should I know?"
"I'm the chief of police!" She laughed, almost too hard. "And I have a stoned dog!!!!!"
Tuesday, January 24, 2012
Grief
Unfortunately, in my line of work, I see a lot of grieving people from all different causes; unexpected tragic losses to expected but not quite ready long term cancer patients. I am extremely sympathetic, as I love my own pets dearly and know what it feels like to be on the other side of the exam table.
I am no psychologist, but from experience, I can tell you that there are many variations of normal grief. Some people hide their tears and break down once they walk out of the room, others cry openly and accept my condolences and even a hug after their pet has passed. Others do not talk, and some are even slightly rude with the reception staff at the counter. 99% of my clients grieving, even given the most extreme circumstances, thank me for helping their pet at their final minutes, and are courteous and kind.
Yesterday, I had the misfortune of dealing with someone who could not control herself, and took it out on me and my staff.
"Sissy" was her cat, a 14 year old domestic longhaired cat with extreme difficulty breathing. At triage, my technicians immediately recognized the urgency and placed Sissy on oxygen. The client had stated that an asthma attack was the cat's presenting complaint, that she had had this before, and she had been trying to wait for her veterinarian to open (in another 24 hours). Sissy was cyanotic (blue gums), and very pale. She was open mouth breathing and fluid was coming from her nose, and she had a low body temperature. When I listened to her chest, I heart a high heart rate and moist lung sounds, or "crackles" that often occur when fluid builds up. The most likely causes of these findings is congestive heart failure, however other possible diagnoses (or 'differential diagnoses' in medical terminology) include pneumonia, neoplasia, or asthma. These differentials were much less likely given the picture as a whole, but none of the possibilities can be completely ruled out without testing, like chest radiographs (x-rays) or an echocardiogram (ultrasound of the heart).
I went into the exam room. I inquired further about the history; it turns out that Sissy had never had any testing to confirm asthma, furthermore she had not had any treatment or flare-ups in 4 years. This is not consistent with asthma, and certainly my physical exam findings were not consistent with asthma as the most likely diagnosis. I recommended oxygen, chest radiographs, and hospitalization with medications to be determined based on imaging. The client refused any testing and screamed at me. "JUST GIVE HER A STEROID SHOT! ALL SHE NEEDS IS A STEROID SHOT!!"
Steroids are a prime treatment for asthma, however can worsen heart failure. I explained this to the client, as well as the findings that did not go along with asthma. I discussed that we could try medications alone, but that Sissy might decline. I also discussed that given her critical condition, even with all diagnostics and no limitations, she was at risk for sudden death or respiratory failure. I have pulled cats back from this condition before, but there are no guarantees in medicine. Further complicating the issue was that the client did not want to spend any of her own money on her cat.
The client screamed at me again. She then put her hand up in my face, dialed her phone, and called someone. I excused myself to go check on her cat, as well as to give her time to make her call, despite her rude behavior.
Five minutes later, I came back into the room. Her sister had joined her and was also hysterical. "CAN'T YOU JUST FIX HER? FIX HER! WHY CAN'T YOU JUST FIX HER?!" Calmly, I explained the medical situation again, and that I could definitely try to fix their cat, but ultimately, the clients decided upon euthanasia.
"NOW what's going to happen!?" She screamed. "I want my cat right now!"
Sissy had been resting in our oxygen-enriched incubator, where she was still struggling to breathe, but had more comfort than the room air environment. I explained this to the client. I offered for her to come sit with Sissy while we provided oxygen via a face mask to help her stay comfortable.
I brought the client to the treatment area, and an assistant placed Sissy in her arms with a blanket. I brought over an oxygen mask, and told the client "This oxygen will help Sissy to breathe easier while you spend time with her." I slowly moved the mask into place, and the client screamed at the top of her lungs in a tone that could have fightened a demon;
"WHAT IS THAT!!!!!!!!!!!!!!!!!! WHAT ARE YOU GIVING HER?!?!?!??!!!!!!"
Somewhat dumbfounded, I replied "Ma'am, this is OXYGEN to help Sissy breathe while you hold her." (What did she think it was? Poisonous gas we were going to make her and her cat breathe?)
When the clients were ready, and amongst screaming, yelling, and swearing, I administered the euthanasia solution. Sissy stopped struggling to breathe, and passed peacefully. I knew we had done the right thing, despite the drama associated with the decision.
As sad as the loss of a pet is, there's no reason to treat the veterinarian like an enemy!
I am no psychologist, but from experience, I can tell you that there are many variations of normal grief. Some people hide their tears and break down once they walk out of the room, others cry openly and accept my condolences and even a hug after their pet has passed. Others do not talk, and some are even slightly rude with the reception staff at the counter. 99% of my clients grieving, even given the most extreme circumstances, thank me for helping their pet at their final minutes, and are courteous and kind.
Yesterday, I had the misfortune of dealing with someone who could not control herself, and took it out on me and my staff.
"Sissy" was her cat, a 14 year old domestic longhaired cat with extreme difficulty breathing. At triage, my technicians immediately recognized the urgency and placed Sissy on oxygen. The client had stated that an asthma attack was the cat's presenting complaint, that she had had this before, and she had been trying to wait for her veterinarian to open (in another 24 hours). Sissy was cyanotic (blue gums), and very pale. She was open mouth breathing and fluid was coming from her nose, and she had a low body temperature. When I listened to her chest, I heart a high heart rate and moist lung sounds, or "crackles" that often occur when fluid builds up. The most likely causes of these findings is congestive heart failure, however other possible diagnoses (or 'differential diagnoses' in medical terminology) include pneumonia, neoplasia, or asthma. These differentials were much less likely given the picture as a whole, but none of the possibilities can be completely ruled out without testing, like chest radiographs (x-rays) or an echocardiogram (ultrasound of the heart).
I went into the exam room. I inquired further about the history; it turns out that Sissy had never had any testing to confirm asthma, furthermore she had not had any treatment or flare-ups in 4 years. This is not consistent with asthma, and certainly my physical exam findings were not consistent with asthma as the most likely diagnosis. I recommended oxygen, chest radiographs, and hospitalization with medications to be determined based on imaging. The client refused any testing and screamed at me. "JUST GIVE HER A STEROID SHOT! ALL SHE NEEDS IS A STEROID SHOT!!"
Steroids are a prime treatment for asthma, however can worsen heart failure. I explained this to the client, as well as the findings that did not go along with asthma. I discussed that we could try medications alone, but that Sissy might decline. I also discussed that given her critical condition, even with all diagnostics and no limitations, she was at risk for sudden death or respiratory failure. I have pulled cats back from this condition before, but there are no guarantees in medicine. Further complicating the issue was that the client did not want to spend any of her own money on her cat.
The client screamed at me again. She then put her hand up in my face, dialed her phone, and called someone. I excused myself to go check on her cat, as well as to give her time to make her call, despite her rude behavior.
Five minutes later, I came back into the room. Her sister had joined her and was also hysterical. "CAN'T YOU JUST FIX HER? FIX HER! WHY CAN'T YOU JUST FIX HER?!" Calmly, I explained the medical situation again, and that I could definitely try to fix their cat, but ultimately, the clients decided upon euthanasia.
"NOW what's going to happen!?" She screamed. "I want my cat right now!"
Sissy had been resting in our oxygen-enriched incubator, where she was still struggling to breathe, but had more comfort than the room air environment. I explained this to the client. I offered for her to come sit with Sissy while we provided oxygen via a face mask to help her stay comfortable.
I brought the client to the treatment area, and an assistant placed Sissy in her arms with a blanket. I brought over an oxygen mask, and told the client "This oxygen will help Sissy to breathe easier while you spend time with her." I slowly moved the mask into place, and the client screamed at the top of her lungs in a tone that could have fightened a demon;
"WHAT IS THAT!!!!!!!!!!!!!!!!!! WHAT ARE YOU GIVING HER?!?!?!??!!!!!!"
Somewhat dumbfounded, I replied "Ma'am, this is OXYGEN to help Sissy breathe while you hold her." (What did she think it was? Poisonous gas we were going to make her and her cat breathe?)
When the clients were ready, and amongst screaming, yelling, and swearing, I administered the euthanasia solution. Sissy stopped struggling to breathe, and passed peacefully. I knew we had done the right thing, despite the drama associated with the decision.
As sad as the loss of a pet is, there's no reason to treat the veterinarian like an enemy!
Friday, January 13, 2012
The full moon.
Wow.
I woke up this morning after finally getting a night of sleep. Work this week has been outrageous, and actually this entire winter has been busier than usual. To give you some idea of my schedule this week, it went something like this:
Wake up in the afternoon/early evening, shower, get ready for work. Feed my pets. Stumble around the house for awhile, trying to figure out what day it is and get rid of my sleep-deprivation headache. Leave for work, drive somewhere to find food (since there's no groceries or time to go to the store while on 15 hour shifts), arrive at work. Eat my dinner at the staff break table. Clock in, put on lab coat and stethoscope. Run around like a mad-woman for 14-15 hours dealing with situations like the one below. Try to maintain patience, poise, and make sound medical judgements. Finish shift, clock out. Drive home (trying not to fall asleep at the wheel), crash into bed, try to sleep (it's been sunnier than usual this winter, so I've been having a hard time with the sleep part, and additionally, we just moved, so it's even more difficult with everything askew). Repeat. No time for household tasks, cooking, eating, or other such silly things. Needless to say, I'm exhausted.
So after arriving at work one night this week, it was blessedly quiet. Nothing hospitalized, no patients waiting to be seen when I arrived. I got a few things done that have been waiting for weeks, and enjoyed a few hours of peace and quiet. We took a few phone calls, but none of the callers would agree to come in.
The night looked golden - usually after about midnight, the caseload drops off as most people are asleep and not able to know what their pet is or isn't doing. Unfortunately, that wasn't the case this night.
Four clients, three of them disasters, all arrived within 15 minutes of each other.
Client #1 - Young, otherwise healthy dog who had had his first seizure. Fortunately, this patient was stable. Unfortunately, the clients were ridiculous. I spent about 20 minutes talking to them about the most likely diagnosis, epilepsy, and the usual therapy for their pet. As their cute young dog tried to get me to throw his toy so he could fetch it, these clients actually asked me to euthanize their dog. Again, I explained that their pet was stable, that he may never seizure again, and even if he did, it was (usually) manageable with medications. In the middle of my third go-around explaining, I was pulled away for the next client.
Client #2 - 1 year old pomeranian, Sid, presenting for "just not being himself." She stated that this had just happened in the last hour or so. "Just not himself" was a ridiculous understatement - Sid was laterally recumbent and nearly comatose, dripping blood from his penis and definitely critical. The client was acting bizarre, attempted to leave several times, and stated that she had no money to spend to help Sid.
She refused to apply for CareCredit to help herself help Sid. She contacted 3 or 4 relatives, who then each separately called our hospital multiple times.
While I waited for the client to sort out her drama, I tried to help Sid, regardless of the fact that she couldn't pay for services. I passed a urinary catheter, and found that he had multiple bladder stones, including some stuck in his urethra. My technician inquired again about symptoms, and the client changed her story - now stating that she had been holding him all day and that the bloody urine had started that morning. In truth, poor Sid probably had been unable to urinate for several days, and probably had kidney damage as a result.
I went in to speak with her. Any normal human could see that this dog was suffering. It didn't take doctor status to be able to look at the poor thing, unable to move, body temperature falling, dribbling bloody urine and nearly in a coma to make that decision. I gently explained the situation to her. She made multiple more phone calls, gave me way too much information regarding her multiple estranged husbands/baby's daddy/boyfriends, and finally agreed to euthanasia, TWO HOURS after her arrival. She refused treatment for Sid, and without treatment, she knew, even in her drug-altered state, that he would continue to suffer and eventually die. I thought we had resolution of this awful situation.
Client #3 had been waiting in an exam room for much of this time. This client had been calling our office multiple times with a 1 year old chihuahua having difficulty with labor. The dog had one stillborn puppy, and 8 hours had gone by with no further puppies. Green discharge was now coming from her vulva. This is BAD - the remaining fetuses are probably either near dead or already dead, and if the fetuses aren't removed from the uterus, they can decompose and make the bitch very, very sick.
Unfortunately, these clients were complete morons. (You may think I'm being harsh, but just wait and see for yourself). They refused an exam by a doctor (so why did they come in?), they refused to apply for CareCredit (the only payment plan that is available). My technician got vitals on the bitch, who thankfully appeared stable at this time, and recommended they see a low - cost spay/neuter clinic as soon as they opened in the morning, about 7 hours' wait. He explained to them that the wait was not ideal, and she could be very, very sick quickly based on their poor decisions. We gave them contact information for the most affordable low-income spay clinic in our area. The next day, they continued to call, had NOT taken the bitch to be spayed, and her symptoms were worsening. By 5pm, when the spay clinic closes for the day, they never made any sort of arrangements for her care and continued to call us. The spay clinic is subsidized by donors and local government and is able to perform spays well below cost, therefore the cost of a spay at this clinic is actually LESS than our exam fee ALONE. We gave them the tools to save their dog at a VERY low price (we're talking less than $100), and they did nothing. I feel bad for their poor, poor dog, but I feel nothing but contempt for the humans.
Client #4 had also been waiting a very long time to speak with me. I was so happy to walk into the exam room and find a normal person, a friendly dog, and a minor problem which I remedied quickly. The client was friendly, asked good questions, and genuinely loved her pet. I apologized for her long wait and she thanked me for my care of her pet.
Back to client #2
Despite signing the paperwork for euthanasia, which we were performing for free, and was the only right thing to do for her poor dog, the client continued to call family members. Her estranged baby's-daddy-creepy-douchbag-ex-husband came down to the clinic after hour number two of this drama, and refused to let us euthanize the dog.
I argued with him for an hour, but he was completely irrational (and probably on drugs). He said really smart things, including that he had a dog with this problem before who he had fixed by giving it yogurt. Oh, right, yogurt totally clears up KIDNEY FAILURE and bladder stones. Sorry, I forgot when they taught that in EIGHT YEARS of school. My bad.
After the fourth hour of this saga, my patience was completely gone. I informed this man that he needed to put his feelings aside and do the right thing for his pet. He refused. I then told him that he either needed to authorize treatment, to euthanize his dog, or he needed to leave. If he chose to leave, it would be against medical advice and I would contact the animal control authorities and report him for cruelty.
He chose to leave, and signed against medical advice paperwork.
So incredibly infuriating. I contacted the authorities the next morning, and they will be doing a full investigation. I hope they throw the book at him.
I woke up this morning after finally getting a night of sleep. Work this week has been outrageous, and actually this entire winter has been busier than usual. To give you some idea of my schedule this week, it went something like this:
Wake up in the afternoon/early evening, shower, get ready for work. Feed my pets. Stumble around the house for awhile, trying to figure out what day it is and get rid of my sleep-deprivation headache. Leave for work, drive somewhere to find food (since there's no groceries or time to go to the store while on 15 hour shifts), arrive at work. Eat my dinner at the staff break table. Clock in, put on lab coat and stethoscope. Run around like a mad-woman for 14-15 hours dealing with situations like the one below. Try to maintain patience, poise, and make sound medical judgements. Finish shift, clock out. Drive home (trying not to fall asleep at the wheel), crash into bed, try to sleep (it's been sunnier than usual this winter, so I've been having a hard time with the sleep part, and additionally, we just moved, so it's even more difficult with everything askew). Repeat. No time for household tasks, cooking, eating, or other such silly things. Needless to say, I'm exhausted.
So after arriving at work one night this week, it was blessedly quiet. Nothing hospitalized, no patients waiting to be seen when I arrived. I got a few things done that have been waiting for weeks, and enjoyed a few hours of peace and quiet. We took a few phone calls, but none of the callers would agree to come in.
The night looked golden - usually after about midnight, the caseload drops off as most people are asleep and not able to know what their pet is or isn't doing. Unfortunately, that wasn't the case this night.
Four clients, three of them disasters, all arrived within 15 minutes of each other.
Client #1 - Young, otherwise healthy dog who had had his first seizure. Fortunately, this patient was stable. Unfortunately, the clients were ridiculous. I spent about 20 minutes talking to them about the most likely diagnosis, epilepsy, and the usual therapy for their pet. As their cute young dog tried to get me to throw his toy so he could fetch it, these clients actually asked me to euthanize their dog. Again, I explained that their pet was stable, that he may never seizure again, and even if he did, it was (usually) manageable with medications. In the middle of my third go-around explaining, I was pulled away for the next client.
Client #2 - 1 year old pomeranian, Sid, presenting for "just not being himself." She stated that this had just happened in the last hour or so. "Just not himself" was a ridiculous understatement - Sid was laterally recumbent and nearly comatose, dripping blood from his penis and definitely critical. The client was acting bizarre, attempted to leave several times, and stated that she had no money to spend to help Sid.
She refused to apply for CareCredit to help herself help Sid. She contacted 3 or 4 relatives, who then each separately called our hospital multiple times.
While I waited for the client to sort out her drama, I tried to help Sid, regardless of the fact that she couldn't pay for services. I passed a urinary catheter, and found that he had multiple bladder stones, including some stuck in his urethra. My technician inquired again about symptoms, and the client changed her story - now stating that she had been holding him all day and that the bloody urine had started that morning. In truth, poor Sid probably had been unable to urinate for several days, and probably had kidney damage as a result.
I went in to speak with her. Any normal human could see that this dog was suffering. It didn't take doctor status to be able to look at the poor thing, unable to move, body temperature falling, dribbling bloody urine and nearly in a coma to make that decision. I gently explained the situation to her. She made multiple more phone calls, gave me way too much information regarding her multiple estranged husbands/baby's daddy/boyfriends, and finally agreed to euthanasia, TWO HOURS after her arrival. She refused treatment for Sid, and without treatment, she knew, even in her drug-altered state, that he would continue to suffer and eventually die. I thought we had resolution of this awful situation.
Client #3 had been waiting in an exam room for much of this time. This client had been calling our office multiple times with a 1 year old chihuahua having difficulty with labor. The dog had one stillborn puppy, and 8 hours had gone by with no further puppies. Green discharge was now coming from her vulva. This is BAD - the remaining fetuses are probably either near dead or already dead, and if the fetuses aren't removed from the uterus, they can decompose and make the bitch very, very sick.
Unfortunately, these clients were complete morons. (You may think I'm being harsh, but just wait and see for yourself). They refused an exam by a doctor (so why did they come in?), they refused to apply for CareCredit (the only payment plan that is available). My technician got vitals on the bitch, who thankfully appeared stable at this time, and recommended they see a low - cost spay/neuter clinic as soon as they opened in the morning, about 7 hours' wait. He explained to them that the wait was not ideal, and she could be very, very sick quickly based on their poor decisions. We gave them contact information for the most affordable low-income spay clinic in our area. The next day, they continued to call, had NOT taken the bitch to be spayed, and her symptoms were worsening. By 5pm, when the spay clinic closes for the day, they never made any sort of arrangements for her care and continued to call us. The spay clinic is subsidized by donors and local government and is able to perform spays well below cost, therefore the cost of a spay at this clinic is actually LESS than our exam fee ALONE. We gave them the tools to save their dog at a VERY low price (we're talking less than $100), and they did nothing. I feel bad for their poor, poor dog, but I feel nothing but contempt for the humans.
Client #4 had also been waiting a very long time to speak with me. I was so happy to walk into the exam room and find a normal person, a friendly dog, and a minor problem which I remedied quickly. The client was friendly, asked good questions, and genuinely loved her pet. I apologized for her long wait and she thanked me for my care of her pet.
Back to client #2
Despite signing the paperwork for euthanasia, which we were performing for free, and was the only right thing to do for her poor dog, the client continued to call family members. Her estranged baby's-daddy-creepy-douchbag-ex-husband came down to the clinic after hour number two of this drama, and refused to let us euthanize the dog.
I argued with him for an hour, but he was completely irrational (and probably on drugs). He said really smart things, including that he had a dog with this problem before who he had fixed by giving it yogurt. Oh, right, yogurt totally clears up KIDNEY FAILURE and bladder stones. Sorry, I forgot when they taught that in EIGHT YEARS of school. My bad.
After the fourth hour of this saga, my patience was completely gone. I informed this man that he needed to put his feelings aside and do the right thing for his pet. He refused. I then told him that he either needed to authorize treatment, to euthanize his dog, or he needed to leave. If he chose to leave, it would be against medical advice and I would contact the animal control authorities and report him for cruelty.
He chose to leave, and signed against medical advice paperwork.
So incredibly infuriating. I contacted the authorities the next morning, and they will be doing a full investigation. I hope they throw the book at him.
Thursday, January 12, 2012
MIA
Hey readers,
I apologize for my long absence. Work has been unusually busy this winter, and I'm struggling to stay caught up. I'll try to get back into the swing of things soon.
~Er doc
I apologize for my long absence. Work has been unusually busy this winter, and I'm struggling to stay caught up. I'll try to get back into the swing of things soon.
~Er doc
Sunday, December 18, 2011
Um..................... really?
Today, an older female client arrived at the front counter. She did not have a pet with her.
"I'd like to report a lost dog," the client stated. My receptionist gathered the form necessary to record this information and assist the woman in finding her dog.
"Okay, where did you last see him?" The receptionist asked.
"He's lost INSIDE my house," she stated plainly. "I've looked everywhere for him, and I just can't find him. I've looked under the beds, under the couch, and he's nowhere. I know he's in the house because I haven't left today and he slept on the bed with me."
"..... Ma'am, I'm not going to be able to help you find the dog inside your house - Lost dog reports only work if someone else finds your dog. If your dog is in your house, nobody else is going to find him. Can you have someone come over and help you? Have you tried shaking his food dish?"
....
Really? You lost your dog INSIDE YOUR HOUSE and you came in to report him lost?
"I'd like to report a lost dog," the client stated. My receptionist gathered the form necessary to record this information and assist the woman in finding her dog.
"Okay, where did you last see him?" The receptionist asked.
"He's lost INSIDE my house," she stated plainly. "I've looked everywhere for him, and I just can't find him. I've looked under the beds, under the couch, and he's nowhere. I know he's in the house because I haven't left today and he slept on the bed with me."
"..... Ma'am, I'm not going to be able to help you find the dog inside your house - Lost dog reports only work if someone else finds your dog. If your dog is in your house, nobody else is going to find him. Can you have someone come over and help you? Have you tried shaking his food dish?"
....
Really? You lost your dog INSIDE YOUR HOUSE and you came in to report him lost?
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