How we get behind schedule.

This was one of those days where I had it all figured out…until the doors opened.  Then we began adding things, like the dog whose house-mate bit him and broke one side of his jaw.  Like the cat who just hadn’t been feeling 100%, and was losing some weight.  She turned out to have diabetes mellitus (sugar diabetes).   Fortunately, she didn’t have a bunch of concurrent diseases (as diabetics often do), but we still have to spend a little more time explaining diabetic care than we would to say, treat tapeworms.  Okay, a lot more time.

Then there was the dog who had nine puppies yesterday afternoon…but wasn’t finished.  Big dogs rarely have trouble delivering, but this one had a puppy who had somehow gotten his head turned down, making him too big to exit.  Three puppies who lost their lifeline about eighteen hours ago were making mom pretty sick.  The uterus has a pretty intimate connection to mom’s blood supply: the puppies get their nourishment there and get rid of their waste there.  Nasty stuff in the uterus makes mom sick pretty quickly.  So, a C-section/hysterectomy combo moved to the front of the line.  Lunch and the previously scheduled dental cleaning got postponed to another day.

AND THEN there was the cat with a history of episodic bloody urine… seventeen times in his eight years of life.  He’s always been treated with antibiotics, but no X-rays or tests or anything.  If you’re a regular reader, I know what you’re thinking: "This guy’s got a stone or a tumor."  Good guess.  He could also have "interstitial cystitis" (or the cat equivalent thereof): the bladder has a recurring inflammation that is usually self-limiting and the cause is really not understood. 

All good guesses, but all wrong.  This cat also has pretty significant weight loss.  X-ray shows nothing; ultrasound shows a few floaters, probably blood clots.  Blood chemistries look pretty good, but his complete blood count is a little wacky.  For starters, his red blood cells agglutinate: they gather together in clumps in the test-tube.  Dilute them with saline and they still do it.  That’s not too normal.  He’s also low on red blood cells (but high on white blood cells, the infection-fighters), and I can’t find any platelets on his blood smear.  Kitties with no platelets have a tendency to bleed. We’re sending some more tests to an outside laboratory because we suspect he may have an auto-immune disease (where the body’s defenses go haywire and attack "self").

All these guys were first-timers here at KVC.  That means we didn’t just talk about "today’s problem".  We had to get their life-story first, then figure out how our presenting complaint fits in.  This just takes time to do it right, not to mention the time to actually perform the procedures.  The next time your doctor is "a little behind", try to be a little understanding.  Everybody’s time is valuable, including yours: we’ve all got something more important to do than wait.  I appreciate it when you do wait for me.

My clients today were super-nice and understanding about the situation, and so was my staff (they worked through their lunch hour, too).  That makes a good day out of a long, hard day.