Saturday, April 7, 2012

Magic Shot

This is not a new complaint but it sure seems as if it has come up more frequently the past few weeks to the point that I'm about ready to do physical harm to the next person who walks through the door with the request. Everyone wants the magic shot that I can just give to their pet and cure whatever ails said pet without any effort on the owners' part. By cure, I mean they expect an absolute cure for everything ranging from allergies to cancer to the common upper respiratory infection.

What is it that makes people believe we have a magic power that enables us to not only diagnose without any type of testing or expenditure but also cure with a single injection?

Over the past couple of weeks I have very seriously been asked to cure allergies, flea infestation, cancer, an upper respiratory infection, parvo, feline leukemia, hyperthyroidism, and even old age with an injection. I've made several people angry and a couple may never return. More power to whatever poor veterinarian inherits them as new clients who are angry with their old vet and seeking a second opinion. I'm sorry, I get super blunt when people come from another vet complaining that they failed to cure the aforementioned ailments and they want a second opinion. The one with the hyperthyroid cat is actually an long-time client of ours that I won over to "love" me when I diagnosed the cat. The problem is that although I put an extensive amount of time into explaining the disease and treatment options as well as the fact that the only cure is radioiodine or maybe surgery dependent on the location of the tumor as well as the fact that the medication is lifelong, the guy still doesn't get that his cat's weight is not going to stabilize until we have the cat on a consistent dose and actually regulate the thyroid. This has been going on for a little over a year now...

My favorite interactions are recorded below:

New Client presents with dog with severe otitis externa as well as evidence that all four feet have been chewed on extensively. Owner wants second opinion because previous vet failed to cure ear. I look at the dog then look the owner in the eye and state, "I cannot cure your dog either."

I don't think they were very happy that the visit started out that way. I explained atopy in grave detail and that it is impossible to cure; all we can do is try to control it. I also explained that with the foot and ear involvement I was highly suspicious of food allergies. At that point I was told quite definitely that food allergies were impossible because the dog had eaten the same food all of its life. Besides, they didn't want to take the time to try to get him to eat something different or go to the expense of a prescription food. The dog also had grade 4 periodontal disease and I recommended a dental (probable full mouth extraction would be my guess) but, once again, we love our dog but that is too expensive. The medications prescribed by the other vet were fine so I only tweaked the frequency of dosing since they were only doing that twice weekly (probably a misunderstanding). I also added an oral antibiotic for kicks and giggles in case the topical was just not reaching a good enough concentration to kill the cocci that were very much in evidence on cytology. They then complained that they had to give medication at home and do the ear flushing and topicals more frequently. Oh, and by the way, why can't I flush the ear while they were there. I explained that the only way I could flush it better than they could at home was if I anesthetized the dog and that if we did that it would make the most sense to schedule it for the next day and perform a dental as well... I doubt they will return for their recheck appointment in 2 weeks.

The second was also a new client who had seen "that other vet down the road" who thought the dog had neck pain and gave him steroids but it didn't do any good. I'm summarizing what took me over 45 minutes to elicit from the owner. For some reason, he wanted to make me guess why he was there. My first response was severe flea infestation since they were running all over the dog visible from across the room. Very haughtily, I was informed that they had not treated for fleas as usual because they were afraid it might not be okay with the medication. I told them using a topical such as Frontline, Advantage, etc. would be fine at which point I was informed that they used a flea collar and they knew his neck hurt and they were afraid the collar would make it hurt more. Sigh...

I agreed with the previous vet's findings that the dog had neck pain as well as mild pain at the thoracolumbar junction. Given breed and age it is most likely intervertebral disk herniation but there were no other neurologic deficits so the dog is not really a surgical candidate at this time. I offered referral for imaging to verify the presumptive diagnosis since "that other vet didn't do anything!" I was declined due to cost (big surprise). I explained that we could take radiographs but it wouldn't give us a definitive answer unless there was a bone tumor or something other than a disk problem. The owner was very unhappy when I mentioned the "C" word. He settled on pain control and I explained that changes in weather such as we've been experiencing lately can often cause a flare-up in painful conditions and that his dog might require long term pain control. I also explained that it could get worse as in the dog becoming paraplegic; I used the term unable to walk in an attempt to make it more clear at which point the owner told me the dog already couldn't walk. By that he meant that the dog was walking hunchbacked and taking small steps and was reluctant to move.

I finally got the guy moving out of the exam room at which point he wanted to know if I wanted to give his dog an enema. "Why?" I asked. "I thought you said you had seen him defecate." "Oh, he did a normal bowel movement but I just thought you might want to because the other vet mentioned it." Okay.... I thought you didn't like the other vet. And it was probably mentioned that it might be painful for him to posture and might be necessary if he became constipated. No, can't say I really do want to put your sweet little dog through that for no apparent reason. Few more steps, almost to the front desk, hold your breath... "Oh, by the way, how much are shots?" I gave a rough cost for routine vaccines while continuing to walk away and was asked to repeat it as if it were a horrendous amount. And, no, I'm not giving your dog vaccines today if for no other reason than that would mean we have to go back to the exam room and I have to go through the process of moving you out all over again!!

And the last one that I'll relate is probably my most priceless favorite so far. A younger woman that worked at the clinic previously (not while I was there) who bought a purebred dog that is known for having allergy issues came in for an "allergy shot" meaning steroid to stop the itching. The dog always has fleas when she comes and usually the main areas of hair loss are classic for flea allergy dermatitis. Our conversation, no kidding, went as follows:

Crazy Lady: I'm tired of getting steroid shots - they don't last long enough. I don't want to treat my dog for fleas and I don't want to treat my house or yard. I'm tired of doing medicated baths and giving medicine. I just want her to have perfect skin and no hair loss and a beautiful, long, glossy, healthy hair coat!

May B. Insane: So basically, you are asking me for a magic cure, correct?

CL: Exactly!

MBI: Well, there is nothing I can do to help you so I guess you may as well just leave now and stop wasting my time...

I then turned to leave the room while she stared at me open-mouthed. In the end, I delivered a lecture about atopy and flea allergy dermatitis. She refused to pay for allergy testing (it is too expensive and I just don't know if I can give her shots!!) or a hypoallergenic diet trial but did agree to follow my recommendations regarding medicated baths, adding omega fatty acids to the diet, adding consistent antihistamine therapy, and adding a consistent flea control product that may actually help the flea allergy dermatitis issue. At least in theory. I doubt, however, that she'll actually carry out her part because, gasp, it means she actually has to do something.

I swear, sometimes I think people in general should just have stuffed animals and be done with it!