Unfortunately, being a conscientious vet involves knowing when to apply a judicious touch of sadism to your work. Whether it’s yesterday’s Muscovy duck, whose broken limbs and puncture wounds I had to assess (sadly, before euthanizing him), or the circumspect exploration of a cat bite abscess (by way of determining whether surgery is required), inducing pain is a standard part of my practice.
But some of us are more tentative in our pain-eliciting methods than others. I’ve seen vets fearlessly grasp and expertly pull possibly broken limbs. Others reach deep way down into wounds for a culture sans sedation. I’m more timid on this front. I don’t tend to wait long before I pull out a syringe-full of relief.
But there are plenty less dramatic situations when evincing pain becomes a depressing necessity. It’s those situations that provoked me to write this post today. After a week chock-full of back pain cases (including my own Sophie Sue’s disc-related neck pain), I was starting to get frustrated with exam-room reactions from well-meaning owners of painful pets.
How do you know she’s painful? I don’t see what you’re seeing. Are you sure?
I’d like to think I’m pretty convincing and fairly straightforward in explaining that pets are in pain. But owners (for some ungodly reason) are not always so easily swayed by my gentle exam room tactics.
When I examine a back, for example, I run my hands along the spine, pressing gingerly between the vertebrae to flex and extend the joint. At the sign of the tiniest flinch, tensing, or flutter of the skin, I know I’ve elicited some pain. I repeat the action, now asking the owner to observe what happens when I get to L3-L4. See?
Not always.
That’s why I asked my significant other (who makes a living from surgical cases like these) how he handles owner awareness of pain. Because he doesn’t have time to secure an owner’s deep and abiding trust (as a referral specialist, he usually only gets one shot with the clients we regular vets get to see multiple times a year), he has to make his point quickly and convincingly.
His approach? Find the spot gently. If the owners aren’t sold, give the zone a very quick, firm yank, tug or push and voilà—a cry of pain.
For the record, I was slightly horrified that he would confess to causing unnecessary pain in any animal. But it made some sense. How many of my cases have gone out the door saying, “Sure I’ll give her pain meds and rest her for a month!,” only to throw the pills behind the spice rack and take Fluffy for a run the next day? Would it really make a difference to my patients to more dramatically prove my point?
I tried it out on Friday. Two back pain cases. While I didn’t make them squeal, I pushed hard enough for these guys to turn their heads quickly and give me “the look.” Saturday’s neck pain let out a small yelp (the owner was especially reluctant to admit pain was the result of her dog’s recent shaking). In all three cases, I got a much better round of client questions than I would have ordinarily. My tech was impressed (though she, too, was horrified that I would push so hard on an ouchy back).
It’s sad, really, that it takes tougher tactics to make your case and recruit serious owner compliance. But human nature inevitably says “show me—or else.” And I guess I can’t quite blame people for not understanding animal nature enough to know that displaying pain is a serious no-no in the wild kingdom.
While sadism doesn’t quite suit me, I’m feeling mighty grateful for this new technique I’ve learned. Still, it’s illuminating: almost thirteen years in practice and I’m still learning basic tricks of the trade. I guess that’s why they call it “practice.”
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Some of your clients are real pieces of work. Feel free to read into that however you see fit.
My vet has had to do the "show me where my pet is painful" thing. She's never happy to have to resort to it, but some people come with really thick skulls. She's never used such techniques with me as it's usually me that brings a painful area to her attention first. Sometimes the reason or cause for the pain is muddy, but usually the source of discomfort is where I think or say it is.
I went through the muddy source of pain alot of Angel. Her and Taz would be outside in their pen playing and she'd do something that I wouldn't see which resulted in her coming in acting gimpy or sore.
How it was dealt with and treated always remained the same. Watch her for 24 hours and see if she was still painful. If so, she would get some asprin and would be leash walked only until the pain subsided which was usually within a couple of days with the option to bring her in if the pain worsened.
Stacy December 9th, 2007 09:54:00 AM
That's sad to me, that owners can't tell when their own pets are in pain. You'd think the people who live with them every day would know their body language better.
As for causing them deliberate pain, just keep in mind that you're helping them more in the long run if you can get the point through to their people.
zandperl December 9th, 2007 11:00:00 AM
I have two breeds that are particularly stoic (Sealyham and Scottish Terriers) and to my own amazement and observation, have been able to hide huge pain they may feel. One of my breeds is known for IVDD between 3 and 10 years of age and has often gone undiagnosed or misdiagnosed in the form of aggression or personality "disorder" by the attending Veterinarian (not just in my area of the country).
I agree whole-heartedly that a thorough "pain check" is warranted and may save many a patient from euthanasia or other forms of inappropriate failed treatment. Not to mention, the advancement of symptoms that indicate permanent or irreversable damage of the affected area!
Barbara A. Albright December 9th, 2007 12:58:00 PM
That's sad that so many owners can't (or in some cases won't - do you think some of it is denial?) recognize the subtle pain symptoms animals display.
On the other hand, I really, really applaud your unwillingnes to cause undue "discomfort" unless the owner's thick-skulledness forces you to. I've known - sometimes worked with - too many vets who were willing to subject animals to painful examinations or procedures without anesthesia just because the animal tolerated it. It always seemed the ultimate injustice to me, to semi-torture a pet just because it was very good-natured, or had incredible bite inhibition, or was just very stoic while the untrained, unsocialized screaming biter always got anesthetized.
Barb December 9th, 2007 03:52:00 PM
I like to think that my own animals feel secure enough with me not to try to hard to hide pain, so if they show it, I'll get it treated as effectively as possible.
But, as you say, in the wild, showing pain or vulnerability can be the difference between who gets eaten for supper and who eats it. We often see birds and animals that are stoicly ignoring the wing twisted around backwards or the open fractures - things that however you rate pain, have to be causing great discomfort at a minimum. Pain management has become one of our criteria for vet care. While some pain can assist healing by stopping animals from making too muchl use of the injured bit, we'd rather see cage restraint (as in not enough room to try to take off or run around) coupled with a good analgesic. Pain, whether the patient is showing it or disguising it, is always a source of stress, and that by itself can be a killer.
jcat December 9th, 2007 04:22:00 PM
Wow! I had no idea people were that stupid. Of course, I own pekingese. Why do I mention this? Well, here is the story of the faking peke:
Lady - now deceased - decided she didn't like something, I don't remember what. So, she decided to start limping on one foot. We called to get her into the vet, and heard a thump. Walked in and found her sitting between my mother's Lladro and crystal bowl on the table behind the couch so she could see better outside. She saw us and picked up a paw to show it to be hurting.
Well, she jumped down and forgot which paw she had been nursing! The darned thing had been faking it for sympathy so she wouldn't get in trouble!
A second story with her:
A door barely brushed by her. About 2 minutes passed when she decided to yelp. When she decided we were too amazed, she walked away and jumped up on the couch to start snoring. I checked her later to make sure she didn't yelp or anything - she was only concerned with getting cheese.
So, some breeds, or individual dogs need to be watched for creating sympathy through faking it. I know it is not common - but it does happen.
Pax,
MLO
MLO December 10th, 2007 12:46:00 AM
Owner obliviousness to pain is probably my #1 source of frustration/anger - the post-declaw cat "looks fine", the obvious leg break "doesn't seem to be bothering him", the pus-filled ear "don't seem to be slowing her down", etc...
I still haven't figured out a way to get through to clients on some of these issues...lack of vocalization doesn't equal lack of pain, and reluctance to move doesn't indicate an animal feeling sorry for itself. Grr!
anna December 10th, 2007 01:48:00 AM
MLO -- my beloved childhood dog was a notorious liar. Towards the end of her life, she pretended to be deaf -- she'd no longer come when called, unless you said "Gypsy, lung!" (Dried lung was her favorite treat.) *That* she could hear just *fine*.
She suffered more than she needed to because of this lying of hers, though -- a boy-who-cried-wolf problem. When the wolf came, in the form of terminal cancer, we all thought she was faking again, in the hope of getting treats and fussing (her usual goals). It took us a few weeks to realize that she was being far too consistent in her misery for it to be faux.
Laura December 10th, 2007 02:59:00 PM
after watching many veterinary orthopedic exams (one of the vets i worked for is a vet for the iditarod...she's amazing at pinpointing exactly what hurts), you should have seen my physical therapist's face when he informed me that he was going to "manipulate my scapulas" and i asked him if was gonna scream ;)
Sarah December 10th, 2007 06:49:00 PM
Laura - Yep. You'll notice, though, we were completely under our peke's spell and had already made the vet appointment before discovering her deception!
Pax,
MLO
MLO December 10th, 2007 08:51:00 PM
I can't relate to people not knowing their animals enough to know when something is wrong. Several of our trips to the vet were because I could tell Agadore was in pain, or Beaner was not himself. I would NEVER require my vet to inflict pain just to prove to me the animal needs treated.
How hard is it to notice even a subtle difference in behaviour? Not hard at all. Agadore pants and gets a look in his eyes // Beaner, the pitbull, lays his ears flat and doesn't play or eat with as much gusto. Huge differences only if you know your animals well.
AGADORE'S MAMA December 12th, 2007 10:30:00 PM
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