Your Pet's Best Friend

Over-the-Counter Pain Medicines for Dogs? Not so much, no.

 Dogs tend to be good-natured and stoic, and often conceal their pain.  Many times we find older patients who have really painful arthritis, and the owner describes the problem, as:  “Well, he’s slowing down some.  Just getting old.” A short round of anti-inflammatory pain medicine sometimes reveals that he wasn’t “just getting old” – he was hurting.  You relieve the animal’s pain, and folks are calling me to say, “I’ve got my dog back”.  Which is very cool.

The other side of the coin is when the owner is pretty sure that the dog is hurting.   When your canine buddy is hurting, you want to do something for him.  The thing is, you have to be safe when you are doing this.  There are some really good drugs that have been tested for safety in dogs and approved for their use.  It is important to consult your veterinarian before giving your dog medications.  While dogs can take a lot of medicines used in people, over-the-counter pain medications are not a great choice for your dog.  

The over-the-counter (OTC) pain relievers give inferior pain relief, with vastly greater potential for harmful side-effects, compared to the drugs that are approved for dog use (like Rimadyl, Previcox, Deramaxx, and Metacam).  Any of these drugs have the potential to create problems, and if your dog shows signs that he is feeling worse instead of better, you should stop using them and contact the veterinarian who prescribed them.  Still, they typically give better relief and are much safer for your dog than the OTC medications.

Do not use Ibuprofen:

Ibuprofen (Advil, Motrin, Caldolor) has been known to cause bleeding stomach ulcers with a single dose.  Sometimes you get by with it, but sometimes you don’t.  We do not recommend ever giving Ibuprofen to dogs.

Do not use Naproxen:

Naproxen (Aleve, Naprosyn, Naprelan) is similarly dangerous.  I have had one client kill a dog with Aleve.  The dog had numerous bleeding ulcers the size of a quarter.  Not recommended.

Acetaminophen:

We sometimes do use acetaminophen (Tylenol).  For occasional or short-term use, it usually doesn’t cause problems.  Long-term, frequent usage has a significant risk of causing liver disease.  You don’t want that.  If you want to use this drug, you should consult your veterinarian about an appropriate dose for your dog.

Aspirin:

Aspirin causes two problems.  With chronic administration, it inhibits platelet function, which makes you a free bleeder.  That doesn't usually happen with occasional use.  We used it more for inflammation many years ago before we had the much improved options that we have now.   I recall one case where I was using it for an eye injury.  The dog cut his ear, and it just would not quit bleeding.  Even after being sutured closed and bandaged, it took a long time to stop bleeding, due to the inhibition of the platelet function.

Second, aspirin is anti-secretory, so when it hits the stomach lining, it interrupts the production of the protective mucus that coats the stomach lining.  This allows the stomach acid to damage the lining.  I am told that we lose 1/4 tsp to one teaspoon of blood for every regular strength aspirin tablet we take.

Buffered aspirin doesn't really protect the stomach.  The stomach acid is much more powerful than the acidity of the aspirin. 

This is why enteric-coated aspirin (like Ecotrin) is used by heart patients who take one every day.  This inhibits platelet function, reducing the risk of clots, and the coating keeps it from dissolving until it gets past the stomach.

Cutting one in half would remove the coating, so people often use the lower strength tablet and take as many as needed (like one to two of the 81mg "baby aspirin" strength).

There was a period of time about 30 years ago when the American Heartworm Society was recommending daily aspirin during the post-treatment period, but this was later shown to be unhelpful, and the recommendation was dropped.

Again, if you wish to use aspirin, you should contact the veterinarian who knows your dog about a safe dose.

The bottom line is this:

It is important to consult your veterinarian before giving your dog medications.  You can do more harm than good with some of them.

 

Cat Bite Abscesses Revisited

My uncle used to be in the law enforcement profession.  He told me stories of prisoners being stabbed with a “shiv” and not even being aware of it until they weakened due to internal bleeding.   Something like an ice pick makes a very tiny hole, and when you stab someone in the back, it’s not a very sensitive area. The weapon goes deep, however, and penetrates a big blood vessel, with fatal consequences.

Cat bite wounds are a little like that.  Not that they are fatal, but the initial wound often doesn’t amount to much.  You don’t have as much crushing as you do with dog-bite wounds, and usually  not much tearing.  You just have these tiny punctures, only a couple of millimeters wide. They don’t bleed much, and the cat licks that off, and the hair covers them up.  I've posted on this before, but these recent cases bring it to mind again.

They are a lot deeper than they are wide, much like the ice pick, and cat fangs are a lot dirtier than the ice pick.  A cat’s mouth is full of nasty bacteria, and that tooth takes them deep into the tissue of the victim.  Often, the cat’s amazing healing power gets them under control, and the wound heals without the cat’s owner even knowing it happened.

Sometimes the cat’s defenses are not adequate to control the bacteria.  At first, there isn’t really anything to see, but the cat seems a little tender when touched in the area.  Over the next two or three days, the bacteria multiply and damage the surrounding tissue.  The body fights back, but if it doesn’t win pretty quickly, battlefield casualties mount. Dead germs, dead white blood cells, and tissue fluids combine to make a real mess. 

Sometimes this spreads through the surrounding tissue like water in a sponge.  This is called cellulitis.  Sometimes it accumulates in a “pocket” and that pocket full of pus is called an abscess.

When this is getting started, the area is really sore. The bigger the pocket gets, the more pressure you have, and the more destruction ofctissue, and the more painful it becomes.  If you pet the cat in this area as this pressure is building, he won’t like it.  You will be able to tell it hurts – he will let you know in no uncertain terms.  This can happen even if you cannot see any evidence of a wound.

This cat was presented because “it hurts when I pet him”.  These folks didn’t know he’d been in a fight, but it’s very common for them to remember that “Yeah, he was in a fight about 3 days ago, but he seemed okay.”

 I felt a little swelling on each side of his back, but could not feel the little pencil-point scabs that I felt sure must be there.  A bite-wound was for sure the top of my list, but there was no evidence.  Then I shaved the area to probe for an abscess and lance it if it was there. 

Now the original wound is visible. See the tiny dot next to my finger?  What you see below that is where I lanced the abscess.

“Lancing” means cutting a big enough hole in the abscess that the hole will stay open and the pus can drain.  After we make the incision and flush out the yuck, we don’t want it to close right up.  Our antibiotic treatments will only get into the wall of the pocket, not the middle.  Thus, we don’t want the  middle to fill up again.  Cats treated this way usually heal rapidly with few complications.

That may look pretty tough, but the alternative is to just let the abscess keep getting bigger and bigger until finally it destroys the skin on top and bursts open.  That’s what happened to this guy.  Of course, with him being a long-haired cat, they didn't realize anything was wrong until the abscess burst.  Then they saw blood in that white hair, and they thought he must have gotten cut on something.  Of course, they hadn’t tried to look underneath the hair.  At least, they didn’t try very hard, because the cat resented it mightily. 

As awful as this looks, it healed up in about two weeks with frequent bandage changes and antibiotic therapy.  If it had been lanced early in the process, the overlying skin wouldn’t have died (to say nothing of the damage to the underlying tissue). 

The bottom line is: when you find a swollen place or a sensitive place on your pet, it’s better to get to the veterinarian sooner than later.  Aside from how the cats felt, the black cat’s bill was one tenth of the white cat’s bill.  So it’s better for both of you.

Pet care and the language barrier

When I was in high school and college, there was a certain time when it was considered "mandatory" to take a foreign language class.  I'm sure that in some schools you could have taken German or Japanese. In Kennett it was French or Spanish.

I chose French, having the odd notion that it might be fun to read Dumas or Hugo in the original French.  I loved The Three Musketeers and The Hunchback of Notre Dame.  Of course, 2 years of high school French and ten hours of college French didn't get me there.  Then I transferred to the College of Agriculture before I went to Veterinary School.  French...

It's pretty obvious now that I should have chosen Spanish.  Even then, it was more likely that I'd be near our southern border than our northern one, much less go to Europe.  Of course, I had no inkling of how our local Hispanic community would develop.

When I was a kid, there was one Hispanic family in the county.  The head of the household was known to one and all as "Injun Joe".  He was not an Indian (or native American) and his name was not Joe, but everyone called him that.  He was a very hard-working guy, and well respected, and his descendants still live in the community.

Now we have a very significant Hispanic community in our area.  I have been concerned that the language barrier could hamper my ability to care for their pets, so I bought a Spanish-English veterinary phrase-book. You know, what's the Spanish for "How many times has your dog pooped in the living room?"  Fortunately, most of them speak English just fine, which is good. That book would really only be helpful to somebody who speaks both Spanish and English, but doesn't know the veterinary terminology.  The folks who don't speak English very well have always brought a friend (or child) to interpret. Until yesterday.

This very pleasant lady came in with a very thin and not very healthy-looking puppy. The receptionist told me, "I think she wants booster shots."  She thought that because the lady would smile and nod to just about anything you said.  If you had asked her if she wanted the dog made into sausage I think you would have gotten the same smile and nod.

It took me a minute to realize this.  I called my friend, Jerry Mercier, who is very fluent in Spanish and he was kind enough to come help. When I returned to the exam room, I found that the lady had called a friend who was interpreting over the phone.  We took turns speaking to this lady and passing the phone back and forth.  This was a good start, but very awkward.

You could see the relief on the lady's face when Jerry came in and began speaking with her.  I am sure that there was even more relief on my own face.  Naturally, things took a little longer than average, but with our tranlator's help we were able to do a good job.  I can easily imagine how it feels to be unable to communicate in a strange land, because it was just as hard for me as for her... for that little while.

Dogs Jumping Up On You - Natural, but annoying

It is very common to have a problem with a dog that jumps up on you.  It is the natural greeting behavior of dogs to lick one another in the face.  [ See “Super Puppy” by Peter Vollmer] How could your dog lick your face without jumping up toward it?

Despite the fact that this is a natural behavior, it is not really an acceptable behavior.  Perhaps  you personally always wear heavy canvas overalls and enjoy the physical interaction.   It is unlikely that everyone in your family and all your acquaintances would feel that way.  Sometimes they may be wearing nice clothes, or they might be easily unbalanced and fall down.

BE CONSISTENT

Dogs generally become confused if you reward a behavior at some times (when you are wearing your grubby clothes) and punish it at other times (when you are dressed nicely, or when grandma gets knocked down).  You need to be consistent and always let the dog know that the jumping up behavior is not okay.

THE LONG TERM FIX – Something Constructive to do instead

The long-term fix for this is to substitute a positive behavior for this undesirable behavior.  [We will get to the short-term fix later.]  A commonly recommended (and usually effective) remedy is the "nothing is free” approach.

In the “nothing is free” approach to behavior problems, the dog must perform a constructive behavior before he receives anything that he desires.  This includes petting, toys, treats, food, or anything  else desirable that the dog will get from you.  This is no more unreasonable or demanding than asking a child to say, “please”.  It is just good manners.  It requires the dog to look to the person for leadership, rather than just randomly bouncing off the walls (or the person).

The constructive behavior we want as the dog’s “please” is for the dog to sit down.  He must sit down  before receiving anything he wants.  We use the sit behavior because it forces the dog to exercise some self-control and restraint, and because you can’t be jumping up if your butt is on the ground.

Step one is to teach the dog what the “Sit” command means.  The older, more authoritarian methods of obedience training suggested that you pull up on the dog’s collar while pushing down on his rump.  A method that is often simpler is to take a small treat and hold it in your closed hand in front of the dog.  Give the command,“Buddy, SIT” and keep moving the treat backward over his head until he has to sit down to see your hand.  When he sits, give him the treat and say, “Good sit!” Most dogs learn the sit command pretty easily.

When you are certain that the dog knows what the “Sit” command means (he will always sit rapidly for a treat), then you require him to sit before he gets anything that he wants.  He comes to be petted, he begs for a treat, he brings you his food bowl, he brings the ball to play fetch – it doesn’t matter what.  You give him the “Sit” command, and he doesn’t get what he wants until he sits. 
Then you reinforce that constructive behavior --  “Good Sit!” and give him what he wants.

DON’T ACCIDENTALLY REWARD THE BAD STUFF

It is important not to accidentally reward behaviors that are undesirable.  Much like a child who misbehaves in order to get attention (negative attention being more desirable than being ignored), the dog may actually view your yelling at him as a reward.  He has done something that has brought you into his sphere of influence.  You may be “bawling him out”, but at least you’re talking to him.  Maybe you’re getting into the spirit of the thing and cheering him on – in his mind, anyway.  So you don’t want to do that.

So, instead of yelling at the dog to “Stop!” or “Stop that!” or “Quit it!” or “No!” or “Bad Dog!”, we want to briefly distract him from the undesirable behavior with a stimulus that is not personal attention from us.  Many trainers use a “shaker can”.  This is an aluminum can with a few BBs or pennies in it (and the opening taped shut).  When the dog begins the undesirable behavior, you make enough noise (that is impersonal, it’s just a noise) that he is distracted enough to stop what he is doing for an instant. You don’t want him to be terrified and run away, you just want to distract him long enough to stop for a second.  During this brief instant, you give the “Sit” command.  If you have
been consistently applying the “nothing is free” approach with the sit command, he will sit down.  You reward him with “Good sit!”.

Now you have rewarded a constructive behavior (the sit) instead of the undesirable behavior (jumping on the door or whatever).

STEP BY STEP – Be certain of Step One before going to Step Two

With a dog who has been accustomed to jumping all over everybody, this will take a little time to change his behavior.  Take it a step at a time. First be sure that he knows the “Sit” command and will perform it reliably for a known reward (like a special treat).  Second, start the “nothing is free” approach to everything he wants.  When he is accustomed to this, begin the shaker can distraction, followed by the “Sit” command, rewarding only the constructive behavior of sitting down (not the undesirable behaviors).

THE SHORT TERM FIX

The short-term fix is not a good handling because it requires some practice and timing, and it requires everyone who encounters the dog to perform it.  Still, it is okay to use it.  This method is from “The Koehler Method of Dog Training”, by William Koehler.  Koehler was a very successful professional dog trainer.  His authoritarian methods are somewhat out of fashion, but are usually effective.

The goal is to make the jumping-up behavior unrewarding for the dog.  When the dog jumps up on you, you bring your knee up sharply right under his breast-bone.  You give him a shove so that he is
overbalanced and falls backward.  This is not a matter of force, but of timing.  If you catch him just right, it doesn’t take much of a shove to push him over.  You are not trying to cause pain, but simply change the outcome of jumping up.  If he falls down every time he jumps on you, it becomes something that is no fun. 

Don’t yell at him, don’t strike him with your hands, don’t do anything except overbalance him so that he falls.  It should be impersonal.  Dog jumps up, knee pushes him over.  It is as though the laws of gravity changed – “Man, every time I jump up, I fall down. I think I’ll quit doing that.”

PREVENT THE PROBLEM

This whole mess can usually be prevented with a new puppy.  You just accustom the new puppy
to licking your hand as a greeting instead of jumping up to find your face. 

I highly recommend the “Super Puppy” books by Peter Vollmer when you bring a new puppy into the home.  He has very concise explanations of the common puppy-rearing situations, and simple, step-by-step instructions on how to handle them.  The book is very short and very inexpensive.  It’s an owner’s manual for your dog’s head.

Big Bladder Stone

 I’ve posted a case like this in the past, but it never ceases to amaze me.  This dog doesn’t look like she feels very happy, and that’s accurate.

“She doesn’t feel very good.   She has to go out a lot, and she’s drinking a lot of water. I think I saw some blood in her urine.”  How long has that been going on?  “Just a couple of days.” 

She is an older female that has never been spayed, so I’m worried about the possibility of a uterine infection.  The first test I want is an abdominal ultrasound.  I really want to get a look at that uterus. 

The uterus looks okay, but there’s this huge acoustic shadow from the bladder makes it hard to get a good look at the uterus.  It takes a minute for me to shift my point of view from this huge shadow being “in my way” to it being “the thing I’m looking for”.  That’s what a huge bladder stone looks like on an ultrasound, because it doesn’t let any sound waves through.

I took an X-ray to get a better look at it.  Wowsers! That’s a big one.  Not only that, but if you look closely you can actually the bladder wall.  It is so thick from chronic inflammation that you can see it on the X-ray.  Normally, you just see a silhouette of the bladder.

The only remedy for this situation is surgery, which is usually pretty straightforward.  Any surgery can have complications, but these usually do quite well.

So here’s the weird thing: this dog has only been showing outward signs noticeable to the owner for a couple of days.  You can see that this thing is pretty doggone big, and very rough.  It looks like a whole bunch of tiny stones packed together, which is what it is.  These are struvite stones (calcium magnesium phosphate) and in dogs they occur secondary to bladder infections.  Something like that takes months to form.

You might say that this dog’s owner just couldn’t have been paying any attention to the dog or he would have noticed this a long time ago.  I might say that, too, except that I have run into this several times before, and with clients that I knew well – people who do NOT ignore their pets.  I don’t know how it can happen that such a long term problem shows no outward signs, but sometimes it does. 

Bottom line, when you first notice that your pet is having problems, it may not necessarily be something that is just starting.  Maybe instead of “watching it for a few days” you need to get it checked out as soon as you can.

How Tight Should a Collar Be?

Some animals wear crazy costumes.  Some wear bandannas, and some wear harnesses, and some wear halters like the “Gentle Leader”, but a collar is still the most popular item of pet apparel.

I had an interesting case this morning that really shows how important it is do a good physical examination of the patient, no matter how sure you are of what the problem “probably is”.  Or, as Sherlock Holmes once said, “It is a capital mistake to theorize in advance of the data.”

This very nice lady brought in her little poodle puppy.  He had been having some coughing problems.  She had owned the puppy for about a month, and it was fine at first.  In the last two weeks, he had begun to cough, worse after exercise.  In the past week, he had begun wheezing when exercising.  And, now, he had begun to vomit after eating.  He seemed to be choking on his food,  then spitting it up.

Well, he could be having a little tracheo-bronchitis, or maybe some tonsillitis.  In other words, he probably has a sore throat.  It’s common enough.

He’s a happy little guy, very active and playful.  He has lots of long curly hair.  In fact, one of the first things I noticed was that he needed a little hair trimmed around his bottom where some poop had gotten stuck.

His chest sounds okay, so let’s take a look at his throat.  The tonsils are a little swollen, but not much.  I’ve seen worse lots of times, and that doesn’t really look like the problem.   Hmmm…  Let’s watch him eat, and see how that goes.

He gobbles up some hard treats pretty eagerly, but he does make some funky noises, and he does seem to have some trouble swallowing. 

I pick him up and play with him a little bit.  That’s when I notice that under that long hair is a collar.  Actually, there are two collars, a flea collar and a nylon collar.  They are both so tight that you couldn’t get a playing card under them.

I removed the collars, and we offered the pup some more treats.  Again, he ate eagerly, and this time there was no choking, no weird noises.  My goodness – he was choking and wheezing and coughing because his collar was too tight, and I almost missed it.  Like his owner  (who was incredibly embarrassed about this), that long hair kept it “out of sight, out of mind”.

Little puppies grow amazingly fast, attaining half of their adult size by four months of age, two thirds by six months.  It is pretty common for people to put a collar on their new puppy and not realize how fast he is growing.   While a situation like this one is unusual, I often see puppies who need to have their collars let out and the owners just haven’t realized it was getting too tight.

So, how tight should the collar be?  Snug over two fingers.  That will give the dog plenty of room to swallow and breathe.    If the collar is too loose, the dog could get it hung up on something, even get it caught in his mouth.  Too tight, and well… you know.

Dog's can't really digest bones.

I've posted before about why we don't feed bones to dogs.  They really don't get any nutrition out of them, and they can certainly cause some problems.  Today we have another example.  This guy looks pretty calm and snoozy, and he is... now.  When he came in, he was unhappy and straining.

The owner knew that the pup had been feeling bad ever since he ate that rib bone a couple of days ago.  He just kept straining and straining to poop and just didn't feel good.  A rectal exam was even more unpopular than usual, and I poked my finger on something jagged.

Fortunately, an X-ray showed no other major chunks of bone.  So, we sedated him (hence the calmness and snoozyness), used a big syringe to fill his hiney with lubricant, and extracted this raggedy jaggedy chunk of rib bone.  Everything in the picture was inserted into the dog (except the quarter).

He'll need a little diaper-rash treatment, and will be fine.  That is, as long as he doesn't eat any more bones.

Microchip Identification in Dogs

“So, on those microchips, what kind of range do they have?”   About three inches.  When people don’t really understand what microchip identification is, they can have some unrealistic expectations.

Look at this little thing: do you see any room for a power supply?  I mean, I’ve heard of the “button battery”, but you’d have to have the “grain of millet” battery.  The whole thing is no bigger than a grain of rice.  There’s just no way you could track it from the black helicopters.

There are GPS tracking collars, but the units are as big as a deck of cards.  It just wouldn’t be practical to implant them under the skin. 

The microchips used for animal identification aren’t big enough to accommodate a power supply, so they can be easily injected through a needle.  No sedation is required.  If a dog will accept an injection with the smaller needles usually used for vaccinations, they usually don’t flinch (even though a 14-gauge needle looks big enough to scare superman – ask folks who have them inserted for dialysis treatments).

What you have, then, is an “identification tag” that cannot be lost, or seen, either, for that matter.  Since the microchip is invisible, I always recommend that the pet wear an I.D. tag.  That way, when someone finds your pet, they can just call you. 

If the tag is lost, or the pet winds up in a shelter, or there is some dispute about the ownership of the animal, the microchip is a great thing to have.  Chips can be seen on an X-ray, but you have to use a scanning device to read the number and get the pet home again.  The number can then be referenced with databases found on the internet, and then one contacts the owner.

The chips are registered first to the individual who purchases them from the company.  Some chips require the pet-owner to register the chip at an additional fee.  Some have the individual registration included in the price of the chip.  In the first case, a veterinarian would keep a ledger and put you in touch with the pet-owner, if the owner had declined to spend the extra money for individual registration.

That’s the theory, at least.  But things don’t always work out the way you think they might. 

Last week, one of our clients found a stray Beagle and brought it in to us because the animal control officer was on holiday for the MLK weekend.  The dog looked a bit rough, no collar, no sign of identification. He had infections in both ears, and was wormy. I scanned him for a microchip, not really expecting to find one.  Lo and behold, the scanner beeped to signal the finding of a microchip and there was the identification number.

Man, I was stoked.  I always scan, and this time it paid off.  This dog was going home to his folks… or not.  When I checked the number, it was an “unregistered microchip”.   We can handle that.   The next thing is simply to call the manufacturers and see who bought the chip.

“Well, I’m a breeder, and I sold the dog to Joe Blow.”  And Joe Blow sold him to John Doe because he wouldn’t hunt to suit him.  And when we called John Doe, we found that he had sold the dog to Joe Doakes because he wouldn’t hunt to suit him.  And Joe had sold him to Billy Bob Bubba and the dog wouldn’t hunt to suit him, either.  He told us to put him to sleep, or find him a home.

He’s on the way to Beagle rescue now, and he will find a home, even if it’s in spite of his microchip rather than because of it.  He may not hunt to suit anybody, but he’s friendly and happy, and will make a good friend.

Communication is more than just words.

I was at a veterinary convention and heard a report from our state licensing board.  They told us that the vast majority of complaints they receive don’t involve actual bad medical care.  The complaints almost always arise from poor communication. 

Sometimes the veterinarian failed to give the client a realistic expectation of what could be done for the pet.  If you’re expecting the miracle cure and don’t get it, you would naturally be unhappy. 

Sometimes the veterinarian just isn’t seeing what the client feels, so she (or he) doesn’t give them what they consider an appropriate response.  This gives the client the impression that the  veterinarian doesn’t care about what is happening.  That is very unlikely to be the case, but if you thought your doctor didn’t care, you would NOT be happy.

I can recall an instance of this a few years ago.  I was out of the office and had a great relief doctor covering for me.  He was great at the medical stuff, but he didn’t really know how to read this one particular client. 

In performing a very thorough physical examination, he noticed a grade 1 (out of a possible 6) heart  murmur.  This is a very tiny noise that you almost can’t hear.  It usually means that one of the heart valves has a tiny leak.  This is certainly not a cause for alarm.  It’s the kind of thing you make a note of and plan to recheck in six months or so.  It doesn’t indicate any loss of function and may never get any worse.   When you know this, it’s no big deal.  It could seem appropriate to just toss off “…and we hear a little heart murmur” as you go through the exam.

The problem is: the client doesn’t know it’s not a big deal.  This particular client didn’t hear “no big deal”.  When the veterinarian said “a little heart murmur”, she heard “my dog has heart trouble and it’s about to die.” When he said this like it wasn’t important, she was livid.  She was thinking, “My dog is about to die, and you don’t even care?!”

When I got back, I found this dog scheduled for a cardiac workup: chest X-rays, electrocardiogram, cardiac ultrasound, the works.  I looked at the chart and found a grade 1 of 6 heart murmur.  I couldn’t believe Dr. Substitute would have recommended such a big workup for such a non-problem.  So, I called the owner to talk about it.

It didn’t take long to hear how upset she was, and how worried she was about her dog’s health.  She was afraid it would die before I got back and handled the situation.  When I explained the significance (or lack of it) of the murmur, she was no longer angry, no longer worried, and she cancelled the appointment for the workup.  “We’ll just check it in six months”, she said.  And we did.  And it didn’t get any worse.

So here we had two people with the same goal in mind: taking the best care of that dog.  Yet, because of their very different frames of reference, we had this major upset.  As Strother Martin said in “Cool Hand Luke”, what we have here is a failure to communicate.  There was nothing to worry about, but that wasn’t communicated to the client.  The client was plenty worried, but the doctor failed to pick up on it and address her fears.

When your veterinarian does or says something that doesn’t seem right to you, tell him (or her) how you feel.  Sometimes it’s something as simple as one misunderstood word.  Sometimes we have seen something so many times that it is commonplace to us, yet it is your one and only experience with your one and only beloved pet.  In a hurried world, we don’t always pay enough attention to how the other person is feeling.  Don’t feel bad about telling your doctor when you are not getting what you need.  Taking care of your needs is our job.

When somebody starts crying, right away I know they are upset. I should see that long before the tears start to flow, but if I don’t it’s okay to tell me about it.

Taking the Doctor’s Advice

You’ve probably seen the TV ad where the doctor rushes across the ball field trying to make a catch. 
“You wouldn’t want your doctor doing your job, so why try to do his?”  It’s about folks trying to diagnose themselves and treat with over-the-counter remedies.

Some do this because they want to save money (and who doesn’t?).  Some do this because they don't want to think about how serious the problem might be.

I have  a family history of heart attacks, so when my cholesterol began creeping up, I probably should have taken my doctor’s advice to start statin-type drugs to get it down. I wasn’t enthusiastic about the side-effects, or about taking medicine in general.  Since I eat a pretty Spartan diet and exercise vigorously on a daily basis, I felt like I’d be in better shape than my father and his siblings. 

Besides, some folks couldn’t get their cholesterol as low as mine when they ARE taking medicine.  I mean, mine just wasn’t that high, right?

 I didn’t exactly ignore my doctor’s recommendation.  I more disregarded it (okay, that’s not much different, is it?).

And then I began having chest pain.  I couldn’t ignore THAT.  A dye study showed that I had an 80% blockage in a major coronary artery.  Fortunately, it was readily treated with a stent.  I narrowly avoided a massive, probably fatal, heart attack.   I sent my doctor this text: “You were right, I was wrong, and I almost died.  What can I say?”  I can say I’m very happy to have dodged the bullet.

So, I don’t have the moral high ground when I get frustrated by clients who either ignore the pet’s problem or my advice.  I’m no better as a patient, myself.

Still, I DO get frustrated by this.  This is really common with dental problems.  I’m really happy that I was able to extract two teeth yesterday.  Six months ago, we found that the dog had two broken  teeth, with the pulp chamber (the NERVE) exposed.  I don’t know how long they had been that way.  I’m just glad that the situation has been handled. 

It was a major oral surgery, and a major bill.  I can see why people would put it off.

Imagine that you’ve had two teeth broken open to expose the nerves.  Now imagine that it’s been six months and you couldn’t do anything about it.  Now for the hard one:  imagine that it doesn’t hurt.

Dogs and cats are pretty stoic, and often don’t exhibit pain in the way you might think.  Sometimes you’ve just got to put yourself in the animal’s place.  If you know you’d be hurting, then so is the pet.

You and your veterinarian have the same goal: for you and your pet to enjoy life together as much as possible for as long as possible. When he/she recommends something, it’s about helping your pet and helping you.

 I know that we all have limitations on our resources, and we cannot always go with “Plan A”.  The important thing is confront the situation and deal with it in the best way that you can. 

Don’t wait until you have chest pain.  And if you do, don’t ignore it.