He didn't make a sound!
A middle aged couple brought their 8 month old Min-Pin-Chi puppy, Stoic, in for a check-up. They seemed normal, at first glance, but they kept tag-teaming on the questions and asking whole paragraphs before I could get a word in edgewise.
"Hi, I'm Dr. M. How are you?"
"We're fine, well, we're worried about Stoic you see, he's been limping for two days, and well we're not sure if he fell or jumped or whatever, you see we left the room, and we didn't hear anything! But then we came back and he was holding that leg up! What's wrong with him? Maybe this is normal, is this normal? We're first time dog parents and we don't know ANYthing about dogs!! This is the first time he's been to a vet."
"Ok, so what was it that he fell or jumped off of?"
"Well it was just the couch! I mean, the couch, come on! its only what, 2 feet off the ground. And the ground isn't even hard, its carpeted! Do you think that could have really hurt him? I find that hard to believe. We didn't hear anything!"
[silent] You find it hard to believe huh? You came all the way over here because you find it hard to believe?
[aloud] "So you left the room and he was on the couch, and when you came back, he was on the ground limping. Is that correct?"
"Yes, but we didn't hear anything! So we thought it was fine since he didn't make any noise or anything. I mean, he's not in pain."
"You don't think he's in pain? He hasn't put that foot on the ground in 2 days according to you, and you just think he's holding it up because its fun to walk on three legs?"
"Oh so you think he's in pain, even though he's not crying? Why wouldn't he cry? I find that hard to believe."
"Yes, I think he is most likely in pain. This is abnormal behavior. Right okay. Is he eating/drinking/vomiting/diarrhea/coughing/sneezing/urinating/defecating/ yes ok good. Let's take a look at him."
I examine Stoic.
"Hmm, he's got a little wormy belly."
"Wormy? What does that mean? He has worms? Where could he have gotten worms? He barely even touches the ground! We haven't seen any worms. Have you seen any worms, no I haven't seen any worms either. What do you mean by 'worms' anyway?"
Cue launch into parasite life cycle discussion.
One leg is a teensy bit purple and swollen. I squeeze, bend and press on every single part of that leg, and Stoic does not make a single sound. Does not even flinch. Everything else checks out okay, including the testicles. Hmm, we will discuss those as well. Meanwhile, the couple is arguing about how many times he went to the bathroom that day. The dog, not the owner.
"Toy breeds like Stoic have very delicate bones, and can very easily break the two bones in this part of the leg. In-"
"Really? Even from a height of 2 feet?" "Less! One and a half feet really."
"Yup, even from the couch onto carpet. The problem is, there is very little blood supply in this area, so without proper fixation they have a hard time healing. I'm not sure if anything is broken, but we should take x-rays just to be sure."
"Well can we ask you some questions first?"
"Sure go ahead."
Then, The List appeared. It looked like it had about 25 line items on it. At this point I started to get annoyed since I had other appointments to get to, and this was supposed to be a limping appointment. Not a time-to-ask-the-vet-every-question-that-has-come-up-in-the-last-6-months-while-you-have-been-caring-for-this-first-time-puppy-and-never-took-it-to-the-vet-once-ever appointment.
Just some of the questions that we discussed: What should Stoic be eating? How much? Is this particular grain-free organic all natural uber expensive diet ok even though it gives him diarrhea? Should he be getting vaccines? Aren't vaccines toxic? Is there some type of training we should be doing? Why do puppies sleep all the time? He yawns a lot, is this normal? How many times a day should he poop? Should he be on flea control? When do you neuter dogs? Do you think its a good idea if we show him because our breeder wants to breed him before he gets neutered, shouldn't he have titles or something?
I patiently answered most of these questions, emphasizing that he should have finished all of his vaccines and been neutered months ago. But back to the matter at hand. It took them about 10 more minutes of arguing "should we, should we not do xrays?"
Finally they let us take some rads. And sure enough, there was a complete fracture present. I have to admit, I was surprised. Most little dogs scream at the top of their lungs at the slightest discomfort. Stoic still made not a sound.
They were still incredulous that a small fall could cause such a problem. At least now they believed he was in pain. We started talking about surgery, and I recommended referral for a surgical consult.
Then, after having neglected medical care for their precious dog for so long, they demanded an appointment with the surgeon that very afternoon.
Sigh, someone else's problem now!
*All names and identifying details have changed. Any resemblance to actual persons, animals or events is purely coincidental.
"Hi, I'm Dr. M. How are you?"
"We're fine, well, we're worried about Stoic you see, he's been limping for two days, and well we're not sure if he fell or jumped or whatever, you see we left the room, and we didn't hear anything! But then we came back and he was holding that leg up! What's wrong with him? Maybe this is normal, is this normal? We're first time dog parents and we don't know ANYthing about dogs!! This is the first time he's been to a vet."
"Ok, so what was it that he fell or jumped off of?"
"Well it was just the couch! I mean, the couch, come on! its only what, 2 feet off the ground. And the ground isn't even hard, its carpeted! Do you think that could have really hurt him? I find that hard to believe. We didn't hear anything!"
[silent] You find it hard to believe huh? You came all the way over here because you find it hard to believe?
[aloud] "So you left the room and he was on the couch, and when you came back, he was on the ground limping. Is that correct?"
"Yes, but we didn't hear anything! So we thought it was fine since he didn't make any noise or anything. I mean, he's not in pain."
"You don't think he's in pain? He hasn't put that foot on the ground in 2 days according to you, and you just think he's holding it up because its fun to walk on three legs?"
"Oh so you think he's in pain, even though he's not crying? Why wouldn't he cry? I find that hard to believe."
"Yes, I think he is most likely in pain. This is abnormal behavior. Right okay. Is he eating/drinking/vomiting/diarrhea/coughing/sneezing/urinating/defecating/ yes ok good. Let's take a look at him."
I examine Stoic.
"Hmm, he's got a little wormy belly."
"Wormy? What does that mean? He has worms? Where could he have gotten worms? He barely even touches the ground! We haven't seen any worms. Have you seen any worms, no I haven't seen any worms either. What do you mean by 'worms' anyway?"
Cue launch into parasite life cycle discussion.
One leg is a teensy bit purple and swollen. I squeeze, bend and press on every single part of that leg, and Stoic does not make a single sound. Does not even flinch. Everything else checks out okay, including the testicles. Hmm, we will discuss those as well. Meanwhile, the couple is arguing about how many times he went to the bathroom that day. The dog, not the owner.
"Toy breeds like Stoic have very delicate bones, and can very easily break the two bones in this part of the leg. In-"
"Really? Even from a height of 2 feet?" "Less! One and a half feet really."
"Yup, even from the couch onto carpet. The problem is, there is very little blood supply in this area, so without proper fixation they have a hard time healing. I'm not sure if anything is broken, but we should take x-rays just to be sure."
"Well can we ask you some questions first?"
"Sure go ahead."
Then, The List appeared. It looked like it had about 25 line items on it. At this point I started to get annoyed since I had other appointments to get to, and this was supposed to be a limping appointment. Not a time-to-ask-the-vet-every-question-that-has-come-up-in-the-last-6-months-while-you-have-been-caring-for-this-first-time-puppy-and-never-took-it-to-the-vet-once-ever appointment.
Just some of the questions that we discussed: What should Stoic be eating? How much? Is this particular grain-free organic all natural uber expensive diet ok even though it gives him diarrhea? Should he be getting vaccines? Aren't vaccines toxic? Is there some type of training we should be doing? Why do puppies sleep all the time? He yawns a lot, is this normal? How many times a day should he poop? Should he be on flea control? When do you neuter dogs? Do you think its a good idea if we show him because our breeder wants to breed him before he gets neutered, shouldn't he have titles or something?
I patiently answered most of these questions, emphasizing that he should have finished all of his vaccines and been neutered months ago. But back to the matter at hand. It took them about 10 more minutes of arguing "should we, should we not do xrays?"
Finally they let us take some rads. And sure enough, there was a complete fracture present. I have to admit, I was surprised. Most little dogs scream at the top of their lungs at the slightest discomfort. Stoic still made not a sound.
They were still incredulous that a small fall could cause such a problem. At least now they believed he was in pain. We started talking about surgery, and I recommended referral for a surgical consult.
Then, after having neglected medical care for their precious dog for so long, they demanded an appointment with the surgeon that very afternoon.
Sigh, someone else's problem now!
*All names and identifying details have changed. Any resemblance to actual persons, animals or events is purely coincidental.
Heavy sigh - how many fractures have I palpated in which the poor critter voiced not one syllable of complaint?!?
ReplyDeleteIt's funny how these things work - exactly TWO WEEKS AGO, we were making the agonizing decision to euthanize an "A" client's beloved Pom w/chronic urolithiasis & secondary renal failure after cystotomy... This morning they walk in with a new puppy!
Hell, I'm still crying over my angel Princess, lost in a tragic accident last summer. It would be an insult to her memory for me to search out a replacement dog that looked anything like her.