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!

Jinx or superstition

Veterinary medicine is a scientific world that is froth with superstition. There are so many things about which we are superstitious. Never say a day doesn't look busy because it will then explode into chaos. Never say things can't get worse; TRUST ME, they can!! Never call an owner before their pet is fully awake from anesthesia or the pet will die. Never name a pet "Lucky" because it surely won't be. You get the idea.

Today, I have a perfect example of one of our common superstitions at work. Anytime an owner comes in super worried about anesthesia, something is bound to go wrong. With the large number of surgeries that I do on a monthly basis (not just routine spays and neuters, either) we have very few anesthetic deaths. They are so rare that I can name all of them from the past year and they are so few that I can count them on one hand.

This morning, an 11 month old 5 pound Chihuahua came in for a spay. I had first seen the dog when she weighed a mere 10 ounces at 4 weeks of age when her owners found themselves with a bottle baby. At that time, she presented hypoglycemic and virtually lifeless. It's easy to see why she is so very special to them but when they were telling me how concerned they were this morning, I was not a happy camper.

Needless to say, I was super careful and guess what happened...yep, she arrested. One of those stupid unexplainable anesthetic reactions. Thankfully she responded to CPR and is fine. She is now spayed and whenever another anesthetic episode is required the protocol will be altered. Hopefully she'll like a different drug combination better!

I've always wondered if this is truly a jinx or if there is some intuitive sense that warns people of a potential problem. The problem with that theory is that I am typically very intuitive and the pets with whom I have had the most reservations about anesthesia had no problems at all. Go figure!

On a separate note, I must comment that I'm less than impressed with Starbucks coffee. I've never had anything other than hot cocoa from Starbucks before today. I am not a fan of flavored coffees and typically like dark roast. (Chocolate and coffee are approached the same. No contaminants, dark; I'm a purist of sorts.). If it is a good coffee, I drink it black; if just mediocre, I add sugar. No cream and definitely none of the flavored creams. To me, Starbucks coffee was no better than your average grocery store coffee. For the price they charge, it should have been superb. No wonder I never spend my money there. Why did I have Starbucks coffee? My boss bought coffee for everyone yesterday. Now my cynical pessimistic self is still wondering why. He has done several uncharacteristic things like that lately. Not that he's not a nice person, he's just not typically the type to show appreciation by providing "treats". Makes one question the ulterior motive...

Replies

Nice to know there are more fans out there. No one amongst my friends are familiar. I'm constantly amazed by the things I hear wrong which is probably one of the reasons I do much better with written media. Incidentally, we were shown "Brainstem" in vet school during our neuroanatomy class as well. Thanks for the confirming info.

On personality types, I have to mess with you a little. Myers-Briggs says I'm an INTJ. It is a fairly accurate assessment overall and I've always found it entertaining that there are supposedly so few females of that type. Maybe it's why I think a little more like males in general. On the animal scale, I'm primarily a beaver which is equal to a melancholy which is equal to a "C". Secondarily, the "S" and "D" are nearly equal, phlegmatic and choleric, golden retriever and lion, which is odd because these two are polar opposites. Lowest is the "I", otter, sanguine. Clearly, all systems agree I'm reserved / introverted and task oriented rather than people oriented.

On the veterinary personality field I'm a surgery junkie with ophtho as a strong second and emergency / medicine coming in third. Unfortunately I have a gift for oncology. Derm and repro I'd prefer to pretend are nonexistent.

Can't Spell and I were discussing this last night and determined that in our world, we would need to do multiple personality assessments because our world requires multiple personas to show the public. I've developed my public persona so well that many of the employees think I'm an extrovert who enjoys people. Now that's truly frightening...

Mistaken?

I'm questioning the possibility that I may be mistaken... It would seem that "dinky" appears in the opening of each Pinky and The Brain episode. Perhaps it is deliberate. With my ear problems, I cannot accurately differentiate if they are singing "d" as in "dinky" or "p" as in "pinky" for certain. Any other fans out there that knows the answer to this piece of trivia???

Pinky and The Brain

I'm still on my understanding personality kick. Some people say I can be obsessive at times but I wouldn't know about that...

It all began, or maybe I should say was triggered, innocently enough and for an upstanding, admirable reason. (Okay, so I was interested before as well; this particular obsession was triggered, though.) I ran across my old Myers-Briggs profile from when I was 16 and it struck me how accurate it was with a couple of explainable quirks thrown in for good measure - I can't be totally understandable, you know. Then, yes, a brilliant idea hit me. What if I could determine the personality profile of everyone with whom I worked? Not only would I understand them better but I could also communicate with them better and then...take over the world!

There are several attempts that have been made at characterizing personalities. Many are actually the same just using different words. For instance DISC is equivalent to choleric / sanguine / phlegmatic / melancholy is equivalent to the animal one using lion / otter / golden retriever / beaver. There is also the previously alluded to Myers-Briggs which is somewhat based on the same concepts but further characterizes based on how one receives and interprets information. There is also the birth order idea I talked about previously and other ideas floating around. Tonight, however, it suddenly hit me, sorta like a flying cow in a tornado...all of those ideas are over rated and too complicated. I propose a new, simpler, and better characterization...

The Pinky and The Brain test.

Suddenly, I made sense to myself because I realized why I've been so hard to figure out. Pinky and The Brain are polar opposites and I...I am both! So if one is a genius and the other's insane, what does that make me? An insane genius???

(Incidentally, if you watch the opening song carefully, you will notice there is a typo where it says "dinky" rather than "pinky" just before the bar of gold squishes them. At least there is in the second season. I'll have to watch the rest to see if it is there, too. There's also an interesting typo in the Walker, Texas Ranger series opening on some of the episodes as well. My grammar and spelling Nazi side can't help but notice...)

Now, on to some political commentary. After I take over the political system in the US, the following changes will take effect:

1. We will eliminate the electoral college so that every vote counts as an individual.

2. We will eliminate ad campaigns. No billboards, signs, radio, internet, television, etc. commercials. The money saved there will be put to good use rather than wasted on lying ads.

3. There will be debates but any mudslinging results in that candidate being evicted from the debate and not allowed to participate in future debates until they have fulfilled 100 hours of community service.

4. Each candidate will be required to release a record of past voting history if applicable and a statement (in print) of their platform.

5. Once elected, the official can be removed by public vote if they fail to display integrity in fulfilling their promises and maintaining their platform.

Or, we could just promise free ice cream and see who gets the most votes. I'd bet on the ice cream...

And in the veterinary world it feels as if summer has arrived months early even for the deep south. Fleas, ticks, and allergies are in full swing. Business has picked up even though it failed to ever really drop off much this time. I had an awesome surgery day Tuesday where I never even had to talk to anyone all day... Then I wanted to hurt everyone the following day because we weren't as busy but they somehow created chaos. I love being busy especially when things run in a smooth, organized, and efficient manner. Besides, I find that if I am kept busy and not allowed to become bored I create far less mischief and get into far less trouble. I despise it when chaos occurs at all but even more so when there is no reason for it. So tonight, are you pondering what I'm pondering?

People do the weirdest things!

This evening I had a client come in with a request that came near to my previous experience when the lady yanked up her shorts in the middle of a crowded lobby to ask about a skin lesion on her rear. Today, a male long time client came by wanting "to speak to the doc." I invited him back to one of the exam rooms after finishing the appointment that I was with, primarily because there were a lot of people in the lobby and I had no idea what he needed.

After carefully closing the door he said he had a strange request and proceeded to unbutton his shirt. Apparently a "friend" of his had removed a growth from his chest and given him some thumb forceps and a small disposable scalpel with which he could remove the sutures himself. He wanted someone to "supervise" and make sure he wouldn't hurt himself. I was afraid to ask if his friend was truly a doctor and why his friend didn't remove the sutures.

I advised him to go to a doctor or at least to get some suture scissors rather than a scalpel blade...

Birth Order Personality Traits

I find attempts to understand ourselves and how we relate to the world to be fascinating. Some of the ideas seem valid while others are clearly a crock. I'm not sure where the birth order idea falls...

In some ways, it makes a lot of sense that a firstborn will approach life far differently than a middle child, singleton, twin, or last born. The people who started researching the idea believe it is very important and that certain traits are universally to be expected. For instance, a firstborn should be more conscientious, more rigidly adherent to rules, and mature earlier taking on more responsibility. A baby should be more rebellious, creative, and less observant of rules. Okay, makes some sense when you consider it, right?

There are problems with the theory, though. First, research has failed to fully support the conclusions. Second, far too many fail to fit the mold. I'll use myself as an example since I know me well. I'm a last born. By the books, I should be rebellious and creative. Check. Got that right. Problem is I'm also super conscientious, hyper-responsible, and tend to take on leadership roles more appropriate for a firstborn. Hmmmmm... Oh wait, say the proponents, didn't we mention that age differences between siblings, gender, stressful episodes during childhood, early loss of a parent, and relationship to your parents also has an effect?

With all those influencing factors, you really want to tell me that birth order determines your personality? I think not. Why don't we just admit that personality, like so many things in life, is shaped multifactorially.

Or maybe I'm just a really messed up last born...