Jessica Vogelsang's Blog, page 8

EOTW: Back to School for Brody One Ear!

Today we bring to you our second Ear of the Week:

Yes, the kids are back to school this week, but why should they have all the fun? Just because a dog only has one ear doesn’t mean he can’t be fully functional.

Really, in many ways this ear surpasses the original one. His old ear didn’t have a pen holder, after all.

He’s already learned that the hat and the camera mean fun time and treats, so rest assured no one is more on board with this ear project that Brody himself.

Now if only I could teach him to make coffee…

SuperBrode is back- but now he’s BIONIC!

Our hero SuperBrode has been enjoying the relative peace and quiet of Muttropolis, lounging in semi-retirement.

However, evil was afoot! The Malevolent Mast Cell Maniac was on the loose, wreaking havoc on SuperBrode and the good citizens of Muttropolis!

When we last left our hero, he was recovering from their last vicious battle…

SuperBrode survived, but it cost him dearly. Or should I say….D’Early?

Nonetheless, he was well on the road to recovery-

Something seemed….different. Without his Super Fluffy Ears of Wonder working in concert, he felt a little deflated. Or just cold, maybe. So he put his sidekick Tenacious V to work on a Super Secret Project. He thought it was just a hat, but she had other ideas.

When he put it on, his Super Senses were heightened! Treats were falling from the sky!

And even crazier than that, his Bionic Ear seemed to lend certain…powers.

Can it be? Does his Hawaiian ear actually bring to others the spirit of…

He certainly seems to be spreading sunshine wherever he goes.

Tenacious V has built a prototype hat with interchangeable Bionic Ears. Who knows what the future will bring for Bionic Brode?

Dear Pet Owners: Stop saying your pet doesn’t hurt!

If I had a nickel for every time a person said, “Oh, my dog isn’t hurting, I can tell because he doesn’t cry” I would have a nice little nest egg by now. It makes me nuts, because it’s not true, and pets suffer for it.

Maybe people will take it better from this older, distinguished-looking actor in a lab coat.

Have you ever been sore, or had a headache, or tweaked your knee? Did you cry every time you moved? Probably not. Acute pain, the type you get when you stub your toe on the doorjamb or slice your finger cutting lemons, is sharp enough that you might cry out “Oh !@$@$!# that hurts!” And the people around you react with sympathy and bandaids.

But chronic pain, that dull, throbbing, always-there ache of osteoarthritis or bulging discs, doesn’t usually manifest with vocalizations. If you’ve ever spent time walking around a senior citizen center, you’ll notice two things:

they walk very slowly, probably because many of them are nursing sore bodies;
they don’t spend a lot of time screaming.

So what does pain look like?

The descriptors people most commonly give for a pet in pain are not ‘loud’ but this: tired, mopey, crabby, tired, ‘old’, cranky, fine.

Dogs with rotting teeth are in pain. They may not yelp when they eat, but they sure do eat less, or eat slowly. Most people don’t even notice this until after the problem is fixed, when all of a sudden their pet has a voracious appetite.

Cats with arthritis in their spine are in pain. They may not yelp when they walk around, but they move gingerly. When their pain is treated, they start jumping back on counters again.

 

pets manifest pain through behavior, not noise. Some pets don’t manifest it at all.

The rule of thumb for pain management specialists is Assume Pain, meaning, if a pet is likely to have a painful condition, go ahead and treat for it even if they aren’t obviously in pain.

If you’re a veterinary professional, stop making pain medications optional for painful procedures. That implies pain control isn’t just as vital as every other aspect of your medical management.

Dogs in pain do not act like an Excedrin commercial

The safety issue: Which is worse? Pain meds or pain itself?

Now that we are all in agreement that painful conditions are often underdiagnosed, we come to the next problem: many people are under the mistaken belief that most pain medications are so dangerous it’s better not to try them at all. Veterinary NSAIDs, the most commonly prescribed class of pain medications, are also the most indicted as a Bad Thing.

Yes, NSAIDs can have side effects. All drugs do. Some of them are severe. It is incumbent on veterinarians to ensure owners are aware of that potential and educate owners as to safe administration. They are not an appropriate choice for all pets. However, this can be mitigated:

 If owners are aware of the potential side effects and discontinue the medication if any symptoms arise, the chances of long term problems are usually minimal. In my own experience, the vast majority of patients have an excellent experience with NSAIDs* when given as directed. Most of the adverse events are related to people who either wait too long to report side effects, give more than the prescribed dosage, or refuse the recommended monitoring. In other words, most are avoidable.


There are other drugs out there besides NSAIDs. Tramadol, gabapentin, Adequan, just to name a few. We can also use adjunct treatments like acupuncture, laser, and physical therapy. The more combining of medications you do across categories, the less you need of any one and the better the overall pain control. This is called multimodal pain management, and it’s the best way to deal with chronic pain.


Those cheaper, OTC remedies you read about on the internet (aspirin, Advil, Tylenol)- you know, the ‘good old days’ approach- are not only less effective, but more dangerous. The worst pain medication reactions I’ve treated have all been to OTC human meds. And a reminder: one teeny Tylenol will kill your cat.


When it comes to the pain of joint disease, the best treatment/prevention is free: keep your pet at a healthy weight.

Educated owners make good decisions. We all want that.

Pain can be managed, even in very senior and frail patients. And yes, even in cats. We just need to acknowledge that it’s there first. Don’t wait for your pet to tell you- he can’t talk, but we can see it nonetheless.

*This message has not been brought to you by a sponsored shill.

 

Ask Me Anything TOMORROW on reddit! (Plus reddit primer)

If you know and love reddit already, here’s the short short version:

Tomorrow (8/11/15) I will be on Reddit doing an AMA from 2-5 PST (5-8 EST) on /r/books. I’d love for you to join me!

If you don’t know reddit, you might need a more involved primer:

What is reddit?

Reddit is a website where people talk about, well, just about everything. Some people talk about football. Some people talk about cars. Others talk about knitting, politics, cat videos, just about anything under the sun.

As a massive catchall, it can understandably be very confusing to navigate. To help organize things, reddit is organized into topical categories, called subreddits. Some of them include:

books
Adorable pictures
science
Game of Thrones

I point this out because reddit sometimes usually is getting attention for bad things really annoying people do, and that scares some people off. Those people are on reddit as well, but if you stick to the subreddits where there are decent people talking about things you enjoy, you can avoid the purulent underbelly of gangrenous misogyny that makes some people nervous to check the site out.

What is an AMA?

One of Reddit’s claims to fame is their “Ask Me Anything” posts, where people from all walks of life go on to discuss their work, or experiences, or latest projects. Sometimes it’s an airplane pilot talking about their job. Sometimes it’s Woody Harrelson, or perhaps Elizabeth Warren. Sometimes it’s some guy who lost a leg in a tragic crocodile incident.

In the books subreddit, they limit their AMAs to authors, and this is what I’ll be doing tomorrow.

 

This is an opportunity for anyone to ask me about the book, the writing process, my dog’s cancer, veterinary medicine, what type of wine I prefer, my shoe size, literally anything. (That doesn’t mean I have to answer, if anyone was wondering whether I would answer what my weight is. No.)

For an example of a typical author AMA, here’s one from Robin Hobbs just a few days ago.

How do I participate?

Step One. Create a reddit account. It’s free.

Step Two. Come on to reddit.com/r/books between 2-6 PM PST Tuesday and find the thread (I’ll link it here too.)

Now here is how you do things on reddit. Let’s use this example of a post discussing an adorable baby bunny photo:

 

The post at the top is the topic everyone is discussing. Here it is a baby bunny; on Tuesday mine will be a description of the book. My username there, selected many years ago, is dogrelish. Get it? Because I relish dogs
The box underneath is where you add your comment/question. After you do that, hit “save” to submit the question. (ie Hey Dr V, do you still own the Jimmy Poos? etc)
If someone else has a comment you want to respond to, you do so by clicking “reply”
See those little up/down arrows? Reddit thrives on these. Clicking the “up” arrow means more people will see my thread. Clicking the “down” arrow buries it further down in the bowels of the internet. Use the arrows. They help!

Lend me your ear

Get it? Because we’re short one over here.

Warning: Blood ahead.

When it comes to my dog, I am just as nuts as any other client. I can’t think logically, I panic, I just gnaw on my fingernails and try to figure out what’s the best thing to do. For this reason, I had no interest in doing Brody’s surgery whatsoever and instead entailed the services of my friend, board certified veterinary surgeon Dr. Tracy Frey of Soft Surg and the lovely staff at Animal Urgent Care, who took amazing care of us both.

I would like to state for the record that even though Pet Doctor Barbie occasionally runs into situations similar to my own in my posts, I am not her, much as I wish I could be. I’m not that cool. Dr. Frey, though, may actually be the living embodiment of Pet Doctor Barbie in flesh and blood, just with more appropriate clothes.

And when I say that, I mean it as the greatest of compliments: a beautiful and accomplished woman who kicks ass in a tough field while unapologetically maintaining her sense of self and style (it can be done!) Pouf, her amazing and adorable Pomeranian who needs to have her own Instagram account stat, also accompanied her to the surgery.

Before: when he has no idea what he is in for.

Right after induction, shaving up his ear and discovering just how pale he is under all that fur.

Getting a 3-dimensional field sterile in multiple planes takes some derring-do.

The surgery instrument wrap is, of course, also pink.

And we’re off! First stop: hunting for lymph nodes. These will be removed and sent to pathology to check for evidence of metastasis. (say no! It has to be no!)

Planning out the incision. We needed to get 3 cm past the edge of the prior biopsy in order to maximize chances of complete excision.

Click here to view the embedded video.

Eew! This was stuck in a bag and is currently being examined in a lab in Sorrento Valley. Kind of makes those pig’s ear treats a little less appealing, no?

Blood and stuff. This is why I prefer internal medicine and dermatology.

A hemostat works to clamp down on one of the major blood vessels of the ear while Dr. Frey plans a closure. One of the benefits of working with a board certified surgeon, in addition to their technical expertise in surgical technique itself, is the cosmetic outcome. Cartilage can do weird bendy things (have you ever seen a botched ear crop?) so we spent a little time discussing the possible looks for Brody’s ear nubbin:

-teeny tiny pittie point

-flat space

-rounded nubbin

We went for the third option. Being a surgeon’s work the incision line is so precise you can barely tell it’s there.

Then we spray painted him silver so he could look like a cyborg! Just kidding. That is collodial silver spray and it is actually medicinal in nature.

He woke up super fast. Groggy, but good. I sat in the cage the whole time

Post op warm compresses and lovin’ at home.

Every time I look at him I think of this scene from Harry Potter:

So I’ll be happy when his hair grows back. Until then he is simply “The Dog Who Lived.”

And guess what! Our neighbors brought toys and love and this is him yesterday.

Dr. Frey was right! He did just fine.

So now, I wait for the various parts of Brody scattered around the country to be analyzed, and we’ll go from there. So far, so good.

Pet Doctor Barbie and the Pet Food Dude

It’s been a while since I’ve done a Pet Doctor Barbie post. It’s past due for a new episode, yes? I think it’s time for Pet Doctor Barbie to meet one of her self-appointed arch nemeses, Pet Food Dude.

 

Episode 8

Hi Mrs. Sandford, good to see you and Muffin. It’s been a while!

I’m really glad you’re doing housecalls now. I want to get Muffin’s bump looked at again.

OK, I’ll just look at my notes here- 1 cm, top of head…mm hmmm… So where we left it one year ago was that you were going to go talk to your husband and then we were going to aspirate it.

Oh….yes. It’s grown quite a bit since then. We really need –

Yes, I wanted to talk to you about that. I’m a bit upset that you didn’t mention last time how his kibble might have caused this.

We don’t really understand why cancer occurs, Mrs. Sandford. The important thing now is to take care of this mass. I’d hate for you to blame yourself because of your food selection.

I don’t blame myself. I blame you. How much do you make from Big Pet Food anyway?

Actually nothing. But aren’t you feeding a boutique brand anyway? You told me last time you were feeding…let me check…organic grain free non-GMO preservative free all natural Wolf Chunks.

Yes, and you told me to stop and to go back to that one full of corn and despair!

Actually, no, I said Wolf Chunks were fine if that’s what you wanted. But about that mass…

I’ve been using turmeric on the advice of Pet Food Dude. Do you know Pet Food Dude? Can I borrow your computer? This guy knows all your tricks.

Sure, have at it. May I ask what tricks you are referring to?

Vaccines. Pet food. You know. Poison. They are full of free radicals that are overpowering the antioxidants and preventing cellular apoptosis no matter how many carrots I add.

Here’s his site. He knows your medicine is a lie and you’re really just after our money.

I’m going to log on and see what the forums say about your “cancer just happens” line. Oh wait….shoot. My membership is expired. Can you hand me my wallet?

Oh, I think I’ve seen his site. Is he the one who sells supplements and seminars on dog juicing?

Yes! He’s a pioneer. OK, credit card updated, I’m in.

OK, here we go: Have I at any point in the past fed kibble from Big Pet Food or gotten Muffin vaccinated? Yes, 10 years ago. So they say here that this is why he has cancer and it isn’t responding to the turmeric. They also said you would say exactly what you said about it not being their fault, and not to fall for it. What do you have to say to THAT?

Mrs. Sandford, I need to level with you here.

It really doesn’t matter to me what you’re feeding Muffin. I am glad you care about him and want to do what’s best for him. I do too! I promise! I’m having a really hard time talking to you when you’re typing at someone who is convinced I’m out to hurt you both. Right now I am just really worried about the size of this mass on his head. I think we need to get him in for a full evaluation ASAP.

*tap tap*    I’ll think about it. I haven’t tried coconut oil yet.

May I ask why you even had me come out?

I just wanted this all on DropCam- see it over there? It’ll be on Pet Food Dude’s YouTube tonight. He’s doing a “Vets Revealed” bit. Well, since you didn’t do anything I’m sure you aren’t expecting payment. You can see yourself out.

TO BE CONTINUED….

Save tons at the vet! How to keep your dog from dying of cancer

As a veterinarian, I’ve seen lots of cancers: lymphoma. Melanoma. Osteosarcoma. Hemangiosarcoma. Mast cell tumors. Wait, those are just my own dogs I’m talking about. When I factor in my clients, I think I’ve seen it all.

Dogs get cancer, at very high rates: about 50% of senior dogs die of it, if the statistics are to be believed. Why? Well, if you read overly simplified, graphics-intensive websites by people who really don’t know what they’re talking about, they will tell you that they know why cancer happens: GMOs. Preservatives. Kibble. Microwaves.

I wish it were that simple. It’s not. And the reason that line of thought drives me nuts is that it has sent so many lovely people into spirals of depression when their dog dies and someone on the internet convinced them it was their fault because they, the owner, did something terrible like feed their dog kibble or use a plastic bowl. People end up in therapy because of things like this.

Cancer is not a singular diagnosis; the type and breath of neoplastic disease means there’s often little resemblance from case to case; a transmissible venereal tumor bears very little resemblance to a splenic hemangiosarcoma. If we could pinpoint cancer to one cause, we’d all be rich. And yet, with all this secret knowledge, overall cancer rates aren’t budging.

Because I love a breed known for having one of the highest rates of cancer (is it the fact that Golden Retriever owners feed worse food overall? Or is it genetics?) I watch Brody pretty closely. Knowing that 60% of Goldens get cancer in their lifetime, I spend a lot of time inspecting him for lumps. As we speak, the largest observational study of its kind is currently underway to help us better understand what’s going on. In the meantime, you do the best you can but truthfully, there’s not a whole lot of ability to predict and prevent cancer. Even for the people who home cook organic food (sorry. Do it because you want to, not because it will make your dog live forever.)

You can save money (and life expectancy) by doing some simple things:

Knowing he is an at-risk breed, I do what I can to try and keep Brody healthy. When he gained too much weight on his food, I got the weight off. Obesity is thought to be a risk factor for cancer. Just as importantly, I get his bumps evaluated and when I find one, I don’t mess around.

The dog eats like a king; I give him the good stuff because I care about quality ingredients, though not enough to condemn people who can’t afford it. But even with his high end diets, at age 6, he’s on his second cancer. The first one, a melanoma, was excised two years ago and has yet to recur- because we caught it early. And now we have this: a little teeny ear lump.

I thought it was no big deal, but I got it evaluated anyway. See? We vets do it too. A lump is a lump is a lump. Until you get it microscopically evaluated, you just don’t know. I just got the call last week: it’s a mast cell tumor.

I’m thrilled we got this diagnosis

Am I thrilled Brody has a mast cell tumor? Of course not. They stink. Despite the fact that the visible mass is only half a centimeter, this type of tumor has tons of microscopic disease and is notorious for requiring huge surgical margins for a complete excision. For that little tiny tic-tac mass on his ear, he is very likely going to need to lose his entire pinna. (I’m getting a surgical consult this week.)

However, losing an ear is minor compared to where these things end up when people wait. You can lose an ear, but you can’t lose an entire head, for example. This is small beans compared to what lots of pets need to go through later in the game when masses grow. If we get a complete excision, this should be a closed case. And guess what? It’s so much cheaper than tons of radiation and chemo and massive surgeries. Win-win for the dog and your wallet. I’m not happy he has it, but I’m happy I know now, early.

Why wait? Aspirate that shizz!!

What one thing can you do to guarantee your pet won’t get cancer? There isn’t one.

What you can do is maximize their chances of survival and recovery: Don’t mess around. Dr. Sue Ettinger, veterinary oncologist and all-around brilliant person, has an initiative called Why Wait Aspirate that is as simple as can be: when a vet tells you that a lump is ok to “just watch”, what does that mean? When do you do more than watch it? Here’s Dr. Sue’s guidelines*:

ASPIRATE OR BIOPSY IT!

Easy peasy, no pun intended. Of all the things you can do to help your pet live long and live healthy, none matters more than early detection.

*Photo Credits: Calendar by Michael Hyde, Flickr Creative Commons license; Peas by Isabel Eyre, Flickr Creative Commons License

 

 

 

 

 

 

The Big 5 of Vet Med: You know you’re a vet when….

If you have ever had the good fortune to go on safari, you know that everyone talks about the “Big 5″: rhino, lions, elephants, cape buffalo, and leopards. The term was coined by game hunters and refers to the difficulty in getting all 5 because of their ferocity when cornered, but now is mostly used by safari operators as a virtual checklist of animals one must see in order to consider it a successful outing.

When I was working on the book, I tried to pick out a combination of stories that laid the foundation for life in general practice. Along the way, I discovered some of the stories that I thought were so hysterical and weird has happened to EVERY SINGLE VET I know. Now that I’ve been out for a long enough period, my classmates and I can all nod our heads like the sage old people we’ve become and say yes, we’ve earned our stripes, done that.

So in honor of this, I present to you the Big 5: You know you’re a vet when edition. Once you’ve experienced the Big 5, you know you’ve made it.

1. The undercover detective dog

Dogs eating underwear is like the giraffe of the veterinary world: yeah, you see that everywhere. No big deal. The rare and treasured lion of the underwear eating world, on the other hand, is the dog who manages to not only eat something unpleasant, but bust a cheating boyfriend/girlfriend/spouse in the process. Dogs who poop out a red thong that doesn’t belong to the wife. Dogs who vomit up a condom wrapper. Interestingly enough, the dog is almost always the closer companion of the wronged party. They know. They always know.

Family picture of three lions. Taken in Masai Mara national park, southwest Kenya.

Animal rating: lion. It’s messy, it gets your adrenaline going, and you are so glad you are in the car and not out there with the lion when they go in for the kill.

2. Involuntary nude client exam

No veterinarian wants to see a naked client. This is why we are veterinarians and not physicians. Nonetheless, with the MD shortage out there and the easy access to veterinarians, it is only a matter of time before a client tries to slip in a totally inappropriate question while you’re examining a pet, complete with stripping. In my case, it was a woman who pulled her shirt down and asked me to examine her breast. I consider myself lucky: a colleague once had a client ask her about hemorrhoids and was halfway to dropped trousers before she got him to stop.

Animal rating: Leopard. It sneaks up on you. You can usually chase it away by yelling.

3. The accidental grope

Physical examinations are, by their nature, very hands on. Most clients get this, but on occasion there will come one who refuses to let their pet out of their protective embrace. Usually the pet in question is a small, heavily haired squirrelly dog. There is only so much you can do when a chihuahua is placed squarely in a woman’s bosom before getting an unintended handful of human. This can vary in embarrassment level from mildly mortifying to near criminal, depending on the client, the location of the pet, and their outfit. Lesson learned: any male clients in running shorts must place the pet on the table, no exceptions.

Animal rating: elephant. Fine from a distance, dangerous up close.

4. The client who makes ass-umptions

I don’t think we spend a disproportionate amount of time dealing with pet’s rear ends: anal glands, rectal exams, fecal exams are but a small part of the work we do- but for some reason some clients get it in their heads that 99% of our interactions with a pet is via their rectum. “Oh no!” they say, when we get the thermometer ready. “Gird yourself, Tommy!” etc etc. These same clients have a hard time believing that medications are administered in any manner other than per rectum. Here’s the kicker: You don’t get to check this item off your list until you’ve been asked about whether each of the following is administered in this manner: Advantage, dewormer, antibiotics, pills of any kind, chlorhexidine scrub.

Animal rating: cape buffalo. Comes in herds. You never know what they’re thinking.

5. Face full of anal glands

You are a seasoned practitioner. You know all the tricks about how to angle your thumbs and cover your target area with a paper towel. You know to evaluate glands by feel, how to note the tell-tale pressure of an impacted gland that is prone to blow. It will never happen to you, you say. You are careful.

It will happen to you.

It will happen to you in a moment you let your guard down, when you’re looking over your shoulder to answer a question and the glands sense an opening. You won’t see it coming. One minute you’re chatting about someone’s tapazole refill, the next moment you’re standing over the eye flush station screaming for Altoids and crying. Two hours later, you will relay the story to your family at dinner with great relish, laughing while the waiter makes a moue of horror and rushes away as quickly as possible. Because that is how vets roll.

Animal rating: rhino. A rare and memorable interaction you are unlikely to repeat but will talk about forever and ever.

How long does it take the average vet to complete the Big 5 Vet Safari? Did I miss any? I’m sure I did.

 

Painting the Roses Red

It’s pub day! The book is out at long last! I really hope you all enjoy it- All Dogs Go to Kevin has truly been a labor of love. (That link goes to my new website. Did I mention I have a new website? It’s been so busy around here I think I forgot.)

Last weekend I went to Warwicks to sign the preordered books. Brian and the kids were at ComicCon, so I went to Warwicks by myself. It was a short task, no more than 20 minutes, so I couldn’t figure out why I was so bummed about going alone, and then I realized ohhhh. It’s another one of those moments.

The thing I will miss most about my mom is not the big celebrations, the ones everyone goes to: holidays, book signings, that sort of thing. It’s the little celebrations, the moments no one else would think mattered, but she always did. If she were around, she would never have let me go alone. She’d go with me, we’d get lunch, then she’d talk me into shopping for a little while in downtown La Jolla. But she’s not here, so my twenty minute task was just that- 20 minutes in a little bookstore office with a Sharpie feeling terribly sad.

I’m trying not to let my sadness get in the way of being happy, but it’s so hard not to have her here. We have a series of white rosebushes in our backyard that bloom almost year-round, and I really like them because they remind me of my parents’ yard. Plus, it made it really easy to send random nosegays to teachers and the like since they were always blossoming, scattering white petals all over the grass like confetti. Mom loved them too, of course.

Brian- not so much. He’s been threatening to pull them since we moved in. He’s been talking about it again the last few weeks, and I made him promise to leave me at least one or two, for Mom, and he said, “OK.”

This afternoon he had someone come over to give us a quote for doing some of the backyard work. I peered through the window to make sure Brian saw me giving him the evil eye- not ALL the rosebushes, ok??- and I noticed something I had never seen before in all the time we’ve been here:

Someone’s been painting the roses red.

The roses stay, obvs.

It’s funny how the moments that impact are not the large and grandiose gestures, but the fleeting surprises that hit you like a much needed breeze. How I can be sad about a less than perfect rose in my garden when so many people in this world know nothing but weeds? Mom’s here in every sunset and every butterfly and her love feels no less potent for the lack of her physical presence.

It’s a beautiful day here in San Diego. The book is out and it’s my fourteenth wedding anniversary- a date traditionally marked by ivory but now the theme is “animals.” Mom sent flowers. How can I complain?

 

Balancing the scales in medicine

I am becoming increasingly convinced the communication gap between veterinarians and clients is the number one problem we’ve failed to solve. We’re just not on the same page a lot of the time, it seems, and it makes me sad. I can’t read a single article online without coming across “veterinarians are money grubbing pigs that suck” (true blog title) and someone else saying “if you can’t afford x/y/z/q you shouldn’t have gotten a pet, jerk.” I feel as though this is perhaps a bit extreme, but it’s what happens when we don’t work together to identify our goals.

Common Fallacies of Bad Client Interactions

(In just as many cases, the vet on the left is an associate up to his or her ears in student debt and just trying to make it through the day without getting yelled at one more time, and the client on the right is a stressed out single parent who just spent a grand fixing her car.)

Much of this angst comes from the pervasive assumption that in all cases we will do everything we can medically, no matter what, which was fine a while back when “everything” meant “antibiotics” but as veterinary medicine has advanced, has come to mean “MRI, spinal tap, radiation.”

This assumption, of course, carries over from human medicine: if you’ve got the insurance, you’re getting the treatment. Everyone’s happy, right? Right?

Not so much. Satisfaction with a medical course of action relies on multiple factors.

Sometimes getting to “Everyone Happy” (Square B) is impossible. D’s not so bad either, but A and C are no-fly zones.

Human Medicine Satisfaction

I would argue that satisfaction with outcomes is directly correlated to the balance between the amount of treatment pursued, and its benefit.

So really, the goal here isn’t to push everyone towards the far extremes of treatment; it’s about getting to that center line of balance. In human medicine this change is slowly creaking along with things like hospice care, which moves people from C to D in low treatment benefit situations, and increased access to insurance coverage, which moves you from A to B in high benefit situations. With Mom, we were squarely in the D category, and while we’re not HAPPY, it’s a hell of a lot better than if we had treated her to death.

Make sense?

So how does this apply to veterinary medicine? It’s similar, except we tend to find ourselves walking a line most strongly related to finances.

The Veterinary Experience

There’s a whole lot of people in square C these days, who spent more than they really had on treatments they weren’t sure they wanted, because they felt like they had to, and when things go downhill as they often do with very ill pets, people can end up really, really disillusioned with the profession.

Now, since we have no ability to magically divine which people are up for specialty treatment and which people are not, we always offer all the options to clients- as we should. There are people who spend thousands, lose their pet, and are still ok with the outcome- but they were also very clear on the risks and made an informed decision. Many clients, it seems, feel as if they are not.

So what do we do to improve outcomes? In my experience, the best way to move the dial from A to B is pet insurance, at least for emergency situations. There are few situations more likely to prompt a Facebook mob than a pet who died a preventable death because the owner couldn’t afford treatment and the ER vet wouldn’t do the treatment for free- nor should they. Owners need to shoulder some of the responsibility here of financial preparation, and if they refuse to take even basic steps to be prepared, maybe they really are a crappy client.

And conversely, moving the dial from C to D involves good veterinary communication, and a willingness to understand that lots of factors go into the decision about whether or not to seek treatment. If a veterinarian talks a senior on a fixed income into a kidney transplant for a 15 year old cat in renal failure, after she expressed concern about paying her rent for the month and her own upcoming surgery- maybe they really are a money grubbing vet.

But I like to give everyone the benefit of the doubt. Clients and vets both have work to do here. And I believe with all of my heart that the better we get about empowering clients to make informed decisions, the more that will carry over into human medicine- which is a wonderful thing.

I realize this is a vastly oversimplified explanation of some really complicated issues, but hey, we have to start somewhere. Whatever it is we’re doing now sure doesn’t seem to be working too well.