A couple came in for a second opinion on two puppies they just acquired that were diagnosed with "kennel cough." Kennel cough is a coverall term for several infectious agents, the two main ones being a virus called Parainfluenza and a bacteria called Bordetella bronchiseptica. The technical term for kennel cough is Infectious Tracheobronchitis. It generally causes a self-limiting, hacking cough in vaccinated, mature dogs. Kennel cough can progress to pneumonia in immunocompromised or untreated individuals.
A few stories were floating around before the dogs arrived. First was that they had come from a breeder and the first opinion was the breeder's (not a real first opinion - did your breeder go to vet school?). Second was that they had gone to another vet who didn't treat them appropriately (also hardly believable). I dropped all misconceptions, but as soon as I walked into the room, I knew there was a terrible problem. The puppies both had a respiratory rate of over 100 (normal ~40). They were underweight, had fleas, and were clearly very ill.
I examined both puppies and told the new owners (who had rescued the dogs, not from a breeder) that the pups were extraordinarily ill and would likely require several days worth of hospitalization. I handed them a $1600 estimate that would cover the first 6 hours of initial care. They looked into my eyes and I could see they really cared about the pups. But, they just didn't have the funds for such care.
We reworked the estimate, took chest x-rays for free (I had to see what was in those lungs), and sent them home with detailed instructions on how to care for two puppies with severe infectious pneumonia. The previous vet's records came in, and I added on to their treatment plan with additional antibiotics, flea control, and instructions on nebulization and coupage.
I gave them a guarded prognosis with one ray of light: these were puppies. Healing machines. Their bodies wanted to heal, they just needed some help. Hopefully what we could do would be enough to save two sweet little dogs.
They thanked me. Several times, actually. With real words, and meaning. Even though I had discounted more than their entire bill came to, and we spent a decent amount of time with them, for once I felt like our efforts were sincerely appreciated in a crappy situation. And I really do hope the little dogs make it.
UPDATE: The owner came in today to bring me cookies and say thank you again. The dogs are looking 10 times better! They still have a long way to go but I think they're gonna make it! Yay!