Its an emergency!

My boss and I are always discussing why clients finally decide something is an emergency after it has been going on for awhile. A guy calls, and makes an appointment for his dog who is having trouble walking. At his appointment time, he rushes the dog through the door carrying him (it is a large breed) and the receptionist takes this as a sign of an emergency and grabs the dog and rushes it back to treatment. The dog is in fact down and seems unable to stand, but vital signs are all normal. My boss goes out to talk to the owner.

"How long has he been unable to walk!?"

"About 2 months."

[pause]

"Oh."

"Well we need to run some bloodwork, do a few survey radiographs, and we should sedate him because he is pretty painful."

"Oh okay, sure. Hey, I just put money on my credit card so you won't be able to run it until tomorrow."

Hold the phone.

"We will need payment at the time of services unfortunately. Do you have any previous records so we can see what other vets have done?"

He hands a piece of paper to the receptionist with the phone number of the last vet on it, and it is a bill! Turns out he owes them several thousand dollars.

I just don't understand people. Do you think we can't see through your little game?

And why now? Once in the ER, a woman brought in a little dog for an ear infection at 4 am. An ear infection. It had been going on for, wait for it..... four months!!!!! And suddenly one morning at 4 am, it became an emergency. So she paid probably double the cost of what she had paid if she had brought her dog to its regular clinic, during normal hours.

The last few days have been filled with cases that are really depleting my reserves. I can only help people so long as they want to be helped. I cannot fix things in one day that have been going on for months. I cannot - nor can the internet - give people a veterinary education in 10 minutes. Some days I really wish I had chosen a different career. This is one of them.

Drug doses are really just guidelines anyway

The next 5 blog posts are all cases from the same week. It's a wonder I still have all my hair.
__

I really try to come up with happy, warm and fuzzy stories to tell you all but somehow its always the A-holes that make it to the blogs, isn't it?

Today I had a new client come in with a cat having urinary problems. This is probably one of the most common presentations I see (like on a daily, sometimes twice daily basis).  I've got my spiel down pat.

This one was a little weird... since the owners decided to consult Dr. Google prior to coming in and had administered bits of a 1000 mg Amoxicilin over the past few days. Have I mentioned how much I hate Dr. Google?? That jerk doesn't even have a medical degree.

They also recently changed the food because the cat was itching and clearly that means he had a food allergy, it could not possibly be a flea problem, no sir.

After we discussed how the cat likely did not have a UTI, although now it would be near impossible to tell for sure since they had decided to self-medicate, and they agreed to some basic things like flea control, I found out that they had been using "the bigger dose" of OTC flea control and splitting it between 4 cats.

Me: "Well, that's not really how it works. And what bigger dose?"

"It has a dog and a cat on it. Dogs and cats are the same."

"No, actually they're not the same. Not only are you not giving anybody an effective dose but if you put dog medicine on a cat you could make your cats really ill."

"Well can I just split this one (holds up prescription flea control)? It has a lot of liquid in there."

"No, this is meant for one cat. It is the full dose for one cat."

"But I can just split it."

"You can, but you will actually end up spending more money in the long run because its not going to work the full month, in fact you won't even know when it stops working. Then you'll have to apply more doses."

"But only two cats go outside."

"Well fleas can hitch a ride and they are going to jump between cats. You have to medicate all of them, or its just a complete waste of money."

Finally they at least accepted my answers, and left, if not actually believing them. Why even bother coming in if you are not going to listen to the advice you are paying for?

I wish these were April Fool's Jokes

Receptionist: "Hi, its been a month since we saw Mr. Kitty. We're calling to remind you about his senior bloodwork, which you were unable to do at his appointment."

Ms. Priority: "I can't afford bloodwork for my cat right now, I'm getting a new tattoo."

         

        -------------> for more info, see post describing cannot afford vs. will not afford

---

Guy walks in, new client, no appointment. Old dog in the crook of his arm.

Receptionist: "How can I help you?"

Owner: "My dog is having trouble getting all of the poop out."

R: "Ok, would you like to make an appointment with the doctor?

Owner: "No, I don't want to see the doctor. I just need you to tell me what is wrong."

R: "Here is the information for the emergency clinic."

---

A lady walks in with her dog in the afternoon complaining that her cat scratched him in the eye. As it turns out, she had called that morning.

Receptionist: "Good Morning, how can I help you?"
Can'tPayHerBills:  "Hi, my cat scratched my dog's eye, and I thought it was going to be okay, but now he can't open it."
R: "Ok, that sounds like something that needs to be seen. What time can you bring him in?"
C: "I don't have any money. Can't you just give me something to fix it?"
R: "No, you'll need to see the doctor. Our exam is $X, and after that we will give you an estimate--"
click 

Later that day, the door opens.

C: "Hi, I called earlier this morning about my dog's eye?" {dog urinates on books in lobby}
R: "Ok, we can see you, but since you didn't make an appointment we will have to charge you a walk-in exam."
C: "That's fine, my friend is paying for this visit.
R: "Oooh..."

After I've spoken to the woman and diagnosed a large corneal ulcer, a conversation during which she said several rude and contradicting things, I walk outside to tell her about it. She is sitting in our courtyard on her iphone smoking a cigarette. She looks at me, so I begin to speak.

"Hi, so -"

She actually holds up her index finger in order to stop me from talking. She continues her conversation regarding going out with her friends to get drinks later that night.

I turn tail, walk back to my office, and proceed to sit there for 20 minutes while I cool down. By the time I felt like going back to talk to her, she had left.

The absolute nerve of this woman, walking in on someone else's dime and doing all of the things she did, left such a bad taste in all of our mouths. I will never understand how some people can behave the way they do. Shameful.


All names and identifying details have been changed, and any resemblence to actual persons or events is purely coincidental.  

The Value of Service

Our clinic does free shelter exams for first time visits of just-adopted animals. This is nothing unusual, virtually every animal hospital in the area will do free shelter exams. It is a way to get these animals checked out fairly quickly after leaving the shelter, and also to get new owners to develop a relationship with a clinic.

Last week, a woman came in with her new dog. She was a new client to us, and brought all of her paperwork from the shelter. The dog had just gotten neutered, and was coming in for his first healthy visit to the veterinarian.

The owner was very friendly, open, and had a very interesting job.  She was very funny and interactive and we had a good conversation which lasted about 30-40 minutes, while I also examined the dog and figured out which vaccines it would need next. I knew I didn't have any appointments after her, so I didn't mind spending the extra time, even though I knew the exam fee was waived.

Then, as we were wrapping up, I mentioned the dog would need two more vaccines and some flea/heartworm control, and that I would have the receptionist come in with an estimate for those services.

That's when the owner said that if the dog needed vaccines, she would take him to her regular veterinarian.

What??? I just spent 40 minutes with you, talking to you about your dog, the shelter, vaccines, training, plus a number of other things, for free, and you're going to take him to your regular veterinarian? If you already have a veterinarian, why on earth didn't you just go there to begin with? I guarantee the clinic that you go to does free shelter exams as well. So thanks for coming and wasting all of our time.

NY Times Article on New Grad Debt and Vet Economics

Just wanted to share this article which appeared in the NY times in case anyone hadn't seen it.  I am so so glad to see the state of veterinary medicine appear in the popular press, and truly hope that more people start to understand what we are facing as a profession.

“It’s not a sustainable model,” he says of vet school economics. “For the long-term success and health of the veterinary practice, we’ve got to look at every end of it.”

http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html?pagewanted=all&_r=0

Of course, now I read some of the comments and people are missing the point entirely. Sigh.

Microchips and Hermaphrodites

Last (whatever day it was) was crazy, but the craziest case happened at the end of the day.

An Eastern European man, new client, brought in a cat. The cat was big, orange, and presumably male.  It was covered in fleas (what else is new). My boss noticed that the man had written female on the information sheet. Naturally, he commented on this, since orange female cats are rare. But, the cat had the long anogenital* distance typical of males.

"What makes you think she is a female?"

"Vell, she acts like a female."

My boss scratches her tail base and she sticks her butt in the air.

"See? Just like that. That must be a female thing to do."

"Not necessarily. Some cats just like their butts scratched."

"Oh really?"

The owner had found the cat approximately 8 years ago, and had never had it spayed or neutered.

He came back and told me about the conversation, and said the cat had a prepuce but he couldn't exteriorize a penis. He said, "Maybe its a hermaphrodite!"

See, I'm not the only weirdo in town. Other people think crazy like that too.

The owner took flea control but declined all vaccines. As the receptionist was getting ready to check him out, my boss reminded her to scan the cat for a microchip.

"The guy said he doesn't have a chip, but okay."

She came back from the room and guess what? The cat was chipped. Of course.

We called the microchip company and got the name of the registered owner. It wasn't the current man.

While we were explaining that the cat had an owner somewhere, the phone rang. It was the cat's previous owner! The microchip company had called the number on file and gave the owner our phone number.

She called and said the cat had disappeared about 8 years ago, asked if we were going to euthanize him. My boss said no, the current owner loves it. (Loves it, but never took it to a vet or updated its vaccines. Hmm). The previous owner was glad to know someone was taking care of her cat and didn't want him returned. She agreed to call the microchip company to allow his owner information to be changed.

Also, before they hung up, the previous owner confirmed the cat was male and had been neutered.


We spent the rest of the week posing this question to everyone: What if you were the one who lost the cat? Would you want it back?



All identifying details have been changed, and any resemblance to actual persons or events is entirely coincidental. 

*Distance between the anus and genitalia.

40 year old Aspirin

I have a bit of an obsession with nutrition these days. It's actually more of a mission I guess, I don't know, I can never seem to think of the right word. I'm working on a long post about pet food. Anyway yesterday I had 2 separate discussions with clients about dog foods. One of them is kind of crazy. She calls about 30 times a week and drives the reception staff nuts. She is very sweet and has very good intentions but she has no idea how to raise a dog, and if that weren't bad enough, the dog ended up being kind of a lemon and he is in every week it seems. She was in with her dog for some simple recheck that took about 30 minutes and then we started talking about food and after about a 10 minute discussion on that, she told me I should write a blog.

I thought, Well I do and it's about crazy people like you!!!

On Thursday one of my clients came in. He is an older gentlemen with a very old dog. He was complaining that the dog was sneezing. He had given it a tablet of a medication that probably was about 40 years old. The bottle was small and yellow with a brown cap and the label was faded yellow and cracking. It was a combination anti-histamine, aspirin, and decongestant. I picked it up and asked how long he had had it. He said he's been saving it for awhile because they don't make it anymore.

He likes to tell me things that he thinks I don't know. Especially about his breed. Yeah, he's one of those people that think their breed is very special and different from other dogs. He started out today by saying, "Now, that's a sulfa drug which I know because the pills are a yellow color like sulfur, with an anti-histamine, and I know that because they told me to take it for allergies."

"Well," I say, "it's not a sulfa drug. It has aspirin in it, and you probably shouldn't be giving it to your dog."

As I set the bottle down I had to wonder if the pills even had any viable drug left in them, literally it was THAT old.

I couldn't find any reason for the dog to be sneezing, and dropped some steroid down into his nose hoping that any inflammation would subside. I couldn't wait to get rid of him and I can't even wait to finish writing about it.

The same day I saw several of my other clients who are, let's just say not my favorites. People that have no business owning animals and with whom I am quickly losing patience. People that would probably feel like their money was better spent at a séance than at a vet.

Sometimes I really wish I could just say what I am thinking out loud.


All names and identifying details have been changed, and any resemblance to actual persons or events is entirely coincidental.