Disconnect

Last night we received a call from a frantic pet owner.  Her 4 year old dachshund was no longer able to walk.  The most likely all-to-common and devastating condition was intevertebral disc disease, and is notorious amongst the breed.

She arrived, and a physical exam confirmed my suspicions.

Tearfully, the client explained to me that her dog was "her child" and she'd do anything for him.  I explained to her that her dog needed a hemilaminectomy, a detailed and complex surgery near the spinal cord to relieve the problem and allow her pet to (most likely) recovery completely.  The surgery is typically only performed by surgical or neurological specialists, given the difficulty of operating near the spinal cord.

 Without surgery, his prognosis to walk again was significantly worse, meaning he might end up paralyzed or need a cart in the future.


"What! The surgery costs WHAT?  There's no WAY I'd spend more than $300 on this dog! It's just a dog!"


.....?


Glad I'm not your kid.

Doctor google

Today I saw a young female puppy for the symptoms of bloody urine, straining to urinate, and small frequent urinations.  In a female dog, these signs typically indicate lower urinary tract disease; such as a urinary tract infection, bladder stones, or other causes.

I recommended a urinalysis, a simple test to look at the urine under a microscope to look for bacteria, crystals, or cells indicating the cause.  The clients and I talked about the likelihood of their puppy having a recessed vulva (a poor conformation), resulting in an easier pathway for bacteria to reach the bladder.  Other possible causes included ectopic ureters, which may require surgical correction in the future. Read more about that here.

Pending test results, I recommended starting amoxicillin, the most common first line urinary tract antibiotic, as it actually is excreted in the urine, making it an exceptionally effective choice for UTIs.  A typical course of therapy for an uncomplicated UTI is 7 days. (Many other reasons may indicate longer therapy).

The clients called a technician into their room.

"We looked on google, and we read that amoxicillin is a bad choice for UTIs", they said.  "We want cephalexin for now, and a 30 day supply of baytril to go home just in case."

Oh GOOD! You read google for 5 minutes, so you are DEFINITELY more qualified to choose antibiotics than a doctor who spent 10 years training to do this job.

I tried to be patient and explain that cephalexin is typically a choice for skin, based upon the properties of the drug. Baytril is reserved for more serious or resistant infections, and is avoided in puppies because it may have a risk of cartilage damage in puppies under a specific age.

The clients didn't argue any more, but you could tell they weren't happy.  I just CAN'T understand this mentality. Of course it's not the first time this has happened - I've had people diagnose their dogs with many, many ailments based upon google, only to find out that they've diagnosed their dog with a disease that doesn't even occur in our area. (Or similar. You get my point).  Google search is an amazing tool, but is NOT even close to a substitute for medical training, testing, and experience.

whoops.

Around 2am, an older woman and her basset hound arrived.  He seemed painful, and the client was concerned.  During my examination of her sweet old dog, Fritz, the client let one rip.

"My, oh my, I don't know what I've been eating lately that's just made me a gas factory!"

It was the fart heard 'round the world; as she was still farting, she was already apologizing.  I managed to maintain my composure, and dismiss it as not a big deal, but through the doorway, I could see my staff absolutely losing it.  They turned bright red, tears of laughter, and had to go outside to avoid being offensive. 

Much needed comedic relief for a stressful shift!

Spaying saves lives.

It's incredible how much something as seemingly simple as the recommendation for spaying female dogs can become a controversial issue.  

Last night I received a patient on emergency for evaluation of difficulty breathing.  She was 12 years old, and a large mass was present in association with her mammary gland.  The clients approved radiographs (x-rays) of her chest, and unfortunately the result was catastrophic - she had widespread cancer throughout her chest.  Unfortunately, at this stage, there was no therapy that could help my patient, and her family was forced to say goodbye.

What could have prevented the development of mammary cancer? The common spay procedure (medically known as ovariohysterectomy), if performed prior to the first heat cycle, reduces the risk of mammary cancer to nearly zero percent.  Incredibly, dogs who are allowed to have more than one heat have a risk of almost 1 in 4.   Up to half of these cancers are treatable, but the other 50% may not be curable even with aggressive care.  As with any medical conditions, PREVENTION is always better than treatment.   You can read more about mammary cancer in dogs here.  Spay also prevents ovarian and uterine cancer as these organs are removed and obviously cannot develop cancer if they are no longer left in the patient.

What other reasons do you need to spay your dog? More? Sure! I have plenty more!

You may recall my post, titled "Happy Freaking Fourth of July."   Across the country, veterinarians witness thousands of cases of unwanted pregnancies in dogs and cats every year.  In the "best" case scenario, puppies are delivered easily, with no medical intervention.  These puppies add to the pet overpopulation problem and many end up in shelters, roaming, or being euthanized due to lack of a forever home.  In the worst case scenario, as in the story above, the female has difficulty delivering the puppies, requiring either emergency c-section and putting the mother's life at risk.   Each and every time I talk to a client who doesn't want to spay their dog or cat, they think they can keep their female away from a male while she is in heat - but biology is a powerful thing.  The male cat or dog's drive to find female dogs in heat and the female cat or dog's biological drive to be bred are instinctual - and the only 100% error proof way to prevent these tragic situations is by spaying your dog or cat.    

  (I've even had a client with both an unspayed female and an un-neutered male living in the SAME household tell me that she didn't think the female would get pregnant because the dogs were littermates and "they wouldn't want to do that".  Sorry, but dogs don't have social stigma or logic - they just have instincts and hormones).

Reason #3: Pyometra prevention

So, if your unspayed female dog is lucky enough that she doesn't accidentally experience pregnancy, and doesn't develop mammary cancer, what other risks of illness could she possibly have?

Another life-threatening disease of female dogs is pyometra; or infection of the entire uterus.  Each time a female dog cycles, the lining of her uterus changes. Over time, the lining can harbor bacteria, and result in a uterus that is enlarged and actually full of pus (disgusting!).  If left untreated, the bacteria spread throughout the bloodstream, causing kidney failure and severe metabolic derangments.  The only treatment for pyometra is a spay surgery; although these patients are much older, usually very sick, and with a uterus full of pus, the surgery has many more risks than a spay on a young dog.  This condition is 100% preventable.  You can read more here.

It seems pretty obvious - spay your dog (or cat) before her first heat cycle, and remove her risk of mammary cancer, ovarian cancer, uterine cancer, life threatening uterine infections, and unwanted litters, and also help prevent puppies and kittens from being euthanized or living their lives alone in a shelter.

Questions? Any theories you've heard why NOT to spay your dog? Ask me in the comments!

~Erdoc

This is what makes me tick

On a quiet, rainy weeknight shift, the doorbell rings at 1030pm.  Even after all this time in the ER, my heart still flutters a little each time - what will it be? Will the client be friendly? Will they be able to treat their pet? Will I be able to fix it?

An older gentleman approaches the receptionist.

"My dog had a c-section here about 4 months ago, and I was sort of wondering if the doctor who did the surgery is here, and... " he trails off.

I panic a little inside. Instantly, I focus on the worst things --  Was it me? Is something wrong? Is he angry? Did the puppies die? Is he here to demand a refund, or complain about care?

The receptionist types in his information and brings up the chart.  I review it  -- and it WAS me who did the c-section, but I retrieved 100% of the puppies alive, and they all went home doing well.  What does he want?

I nervously head up to the lobby - and and amazed by the truth.

"I just wanted to know if you wanted to see the puppies you saved" he said.  "I also wanted you to know how thankful I am, and I just wanted to come by - I don't mean to impose, but if you want to see them, they're in my car."

"OF COURSE I want to see them!" I exclaim (Fortunately, we're not that busy at the time). "Please, please bring them in!"

The gentleman brings in two beautiful, bouncy, playful, healthy, well cared for puppies.  They bounce around the lobby and are truly a joy to behold.

A simple act of thank you renews my passion for the profession.  Invigorates my empathy, inspires me to be a better doctor, and compels me to always give people the benefit of the doubt and not to anticipate the worst.  Thank you, kind client, for reminding me why I love my job.

~ERdoc

Stupid client phone call of the day AWARD!

Today was an insanely busy day in our emergency room, full of very sick pets, trauma, and animals who truly required our attention.  In the midst of our hectic day, trying to efficiently manage multiple emergencies at once, I happened to have the misfortune of answering this phone call:

SCOTD: (Stupid client of the day)

"Hi, my dog has some sort of swelling on his butt, and I didn't know what it was, so I cut it open, and now it's bleeding and I can't get it to stop.  He doesn't seem to be in pain or anything, but it's bleeding a lot."

Me: "Well, I'd definitely recommend you bring him on in so we can take a look; apply pressure and head on in. If your dog is bleeding then we want to get that stopped right away"

SCOTD: "Well, just tell me what you guys would do and I'll do it at home."

Me: ".... You want me to tell you what I would do on a bleeding area of your dog that I can't see over the phone? We might do surgery, we might need to ligate something, we might need cautery. You expect me to tell you how to do that over the phone?

SCOTD: "Ya, just tell me what you'd do and I'll do it myself."

Me: "That's just impossible.  If your dog is bleeding, bring him in right away."

SCOTD:  "Right, fine"

-They never showed up.  Do people call their human physician and act like this?

She's not your "sweetie"

I'd sat around for the first 13 hours of my 14 hour shift, anxiously watching the clock and waiting for the time to go home.  Having no patients for an entire day renders me a little stir-crazy.
And then it happened, 45 minutes before the end of my shift.  Doorbell rings, technician greets a new client at the door. Dog is a 7 year old, muzzled, growling Sharpei.  The client is bleeding from her face, hands and both legs. We all don gloves and start to ask for details of the situation.

"My dog got attacked by a pit-pull!" she screams. "You know how them pit-pulls are!" (no, that is not a typo.  She wrote and pronounced it in this manner).

My technician answered "yes, I do know how they are. I have one, and she's the sweetest dog on earth.
....
Now, why are you bleeding?"

The woman replies that her OWN "sweetie" bit her on the face, legs and hands. She baby talks her dog as it snarls, growls and snaps at her and everyone who approaches it.  From a distance, I can see he has multiple bites and lacerations over his back and neck, which require flushing and surgery, as well as probably drains and closure.  These are big wounds - but I can't get near enough to actually see the extent of the injuries.

I've dealt with a lot of scared pets over my years in the ER.  I know how to read them, approach them, and when to give them space. This dog wasn't simply scared, this dog was unsocialized, aggressive, fearful AND dangerous.  In order to be able to even get within 4 feet of her, we had to find some way to protect ourselves from the client's fate. I wish I had a dart gun (like they use on wild animals), but alas, we don't keep those lying around since 99% of our patients are friendly (or at least approachable!).  We sent the client to the human ER to get her wounds addressed while we took care of her dog.  As she left, she didn't seem to understand the gravity of the situation.

"Bye sweetie, mommy loves you" she cooed, as the dog growled and snarled AT HER. "Mommy will be right back to take you home."  I was dumbfounded - how do you get bitten in the face, and not realize that your dog is a terror, a danger to society, and could someday kill a child, someone's pet, or at least seriously maim an adult!?

Unfortunately, this patient was so nasty that it took all of my staff's strength, a rabies pole, three broken leashes, a broken muzzle (meaning she could now bite us un-hindered), three doses of drugs and 45 minutes to be able to get this dog even close to a handleable state. Once an adequate level of sedation was finally achieved, I took care of her gnarly wounds and recovered her, carefully.  The great news was that none of my staff or myself got injured - but the bad news is this dangerous dog is back out in the world, with no hope of training, rehabilitation, or any sort of behavioral therapy to help treat her obvious anxiety, fear, and socialization issues.  Regardless of the fact that we risked injury to ourselves, had to clean up the poop and urine sprayed around the clinic for hours, and cared for this woman's dog, she still would complain about the fact that my record indicated that her dog "had bitten."  You know what? I'm here to tell the truth, not the truth as you see it.

I ended up leaving work 2 hours late that night, exhausted, frustrated and with no real reward.  Usually I'm happy to have fixed an animal, even if the owner is awful, but this time, I worry that fixing the animal could result in future harm for some other creature. Euthanize? I think it probably would have been the right thing to do, but there's no way that this client could see her "sweetie" for what she truly was - anything but.

~Er doc