Some clients are sweet as sugar…but clueless. Here’s a recent example: Owner on her way to a ballet recital with her daughter spies kitty in the driveway unable to rise. Pressed for time she scoops him up and encloses him in his top-clip cardboard kitty carrier. Arrives ten minutes later to drop him off with a complaint of: cannot walk.
Thus informed by the reception staff after the client’s long gone, I hurry him back for a look-see. For sure George can’t walk. His cardboard carrier’s full of blood and scooping him up gently ensures I get a good look at his problem: a dangling leg, crushed at the hock (ankle).
I mean, how do you miss that??
Busy a s our lives are I can understand some degree of unawareness of our pets’ issues. But a broken leg? Ouch!
Help me out here? How to understand this one…
Then Monday’s. Three year-old Bull mastiff comes back from his weekend stint at the kennel with bloody diarrhea—they’d changed his food and he’s notoriously GI sensitive. He’s looking skinny and sluggish but puts on a good show of perkiness at the office. Full labs are normal save the blood in the stool and a slight elevation in his white blood cell count.
Owner calls yesterday afternoon as requested, reports that said Bull mastiff is looking crappy (a medical term) but can’t come in. After I’m gone for the day he calls in a panic saying things are declining. The receptionist sends him to the 24 ER.
This morning first thing I’m busy trying to get down the first part of this post and he screeches in on two tires with the dog flat out with a temp over 106 and pouring bloody diarrhea. Just before sitting down to finish this post the poor boy died in a fit of seizures and a sudden discharge of copious brown fluid from both nostrils.
Could it have been prevented if he’d taken the receptionist’s advice and stayed overnight at the ER? I don’t know.The diagnosis still eludes me and the techs are collecting samles as I write this. But it’s still hard to believe that a dog this sick could’ve lain overnight in a blistering fever without medical attention.
These are the cases that stress me out. In the end, neither animal lacked for medical care. But client awareness and action was inexplicable in both circumstances. I don’t get it. Help me figure it out.
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How incredibly sad. When I was working in a grooming salon as a bather there were a few times where I saw a similar degree of negligence - the rough collie with the tumor the size of half a basket ball, the golden retriever with nails so long they were curling into his paws.. No one was bleeding, but how, HOW do they not notice? When we would inform the owners of things of this nature, their response was usually something like, "Oh, really?"
I'd be interested to know what the Mastiff died of.. it sounds horrific.
Ali April 2nd, 2008 11:32:00 AM
Very sad. Sounds like parvo to me, but that's only based on seeing a litter of labs die of that once. Not pretty, and not something you can easily ignore or shrug your shoulders and say, "I had no idea it was that serious!"
Poor Dr. Khuly..don't know how vets do it some days.
Shasta April 2nd, 2008 11:55:00 AM
Ali: I'll keep you posted. I've been in touch with the authorities at out local Animal Services department and we'll be sending out samples to check for the usual suspects and something recently unearthed around here lately called Strep zooepidemicus. The owner has already been in contact with his kennel to inform/warn them.
Dr. Patty Khuly April 2nd, 2008 11:57:00 AM
I hate to get involved in hearsay, but I recently read a story that fits nicely into this topic. According to the author, there was a professional woman, reading her pet's medication instructions to her daughter as they were leaving the clinic, who said, "Give 1 tablet orally..." Her daughter asked, "What does that mean?" The mother replied, "It means you put it in his bum." Apparently staff overheard the error, and corrected her before she left. But the author went on to describe other incidents where, what were supposed to be oral tablets, were given rectally and, much to the dismay of the puzzled owner, caused defecation...often in the house, not to mention being rather ineffective in treating the particular condition.
Don't get me wrong. We're all ignorant...about a lot of things. And while you don't have to be a veterinarian to provide good care to a dog, or a mechanic in order to keep a car in good running order, a basic understanding is expected.
Accepting that ignorance, itself, isn't necessarily something a person should be embarrassed about (i.e. the only stupid question is the one not asked), I guess all we can do is gently help to get others up to speed, while acknowledging far too many pet owners view their animals as little more than objects (and thus aren't especially involved in learning about their anatomy, physiology, behaviour, or their care).
Marjorie April 2nd, 2008 12:01:00 PM
On the topic of "How Could they Not Know" -- yeah, those stories really raise that question. And I will help you figure it out, but the answer isn't pretty.
The example I will give is a case where I have to ask the same question about a vet -- "How could he not have known?'
The vet left my cat with his son during a medical board His son was an individual with no formal training who was not a licensed technician (or even an unlicensed one). His son used the wrong syringe to give my cat insulin -- a tuberculin syringe rather than an insulin syringe. They found my cat having massive seizures, hypothermic (temp not even registering), hypoglycemic.
They reported to another vet hospital that his blood sugar was 30 when they found him. (I didn't know this till months later).
Still the next morning, when I went to pick my cat up, the vet told me he thought my cat was having seizures because of a brain tumor or seizure disorder. This -- in spite of the fact that unbeknownst to me, the night before he had sent a blood sugar reading of 30 on my cat to the ER hospital. That night, he was given glucose IVs and recorded that the seizures slowed down. He knew his son gave the shot. He knew the wrong syringe was used. In the informal vet conference, his son said that night when the vet showed up, he said: "You've given the cat an overdose."
Yet, he didn't say anything the next morning to me when I went to pick up my cat and found him nearly dead about blood sugar or insulin overdose. He told me my cat must have a brain tumor or seizure disorder.
Later that day, showing up thinking I was going to have to euthanize my cat because of some massive brain tumor that had erupted virtually overnight (I was so dumb and in shock and naiive) he told me he had come to believe my cat had gotten an OD. He admitted this for four months, and this was consistent with the neurologists observations of my cat, as well as his admissions to her and an entire hospital full of veterinarians AND his insurance company.
Then, some months later after my cat was out of the hospital and the reality of this had time to sink in - WHY this was allowed to happen? WHY was someone there who would use the wrong syringe? -- I requested a meeting with the vet, at which I asked him WHO exactly was on duty that weekend (he had not yet admitted it was his son - he didn't until the board investigation, he just kept calling this person a "technician") and HOW much training they had and COULD I SEE THE SYRINGE?? And WHY were my cats medical records LOCKED in his office when I had come the previous weekend to try to get a copy of them?
Quite magically, VOILA! The next day he wrote me a letter saying his "technician" had never given my cat an overdose after all. You see, he had conducted an "interview" with the "technician" more than four months later and the "technician" pointed to a line on the syringe that indicated the right dose was given. Except -- the technician wasn't a technician. It was his son. I only learned this from a former employee. B.S.
Even in his response to the board, he told them that morning he thought my cat was sufferieng from a neurological disorder, not an insulin OD.
My the question is -- on that morning -- how could he NOT have known it was an insulin OD? (The neurologist testified that she believed this to be the cause of his problems and his symptoms and damage were absolutely consistent with it, and it was admitted for months).
The answer to that question "How could he not have known" is the same answer I have for your question about the lady with the cat and the broken leg.
I don't believe them. In either case, I don't believe them. They merely PRETEND not to know. I am of the opinion that the lady knew full wll the cats leg was broken, she isn't that blind, just probably embarrassed because she DID IT and she wants to play dumb. Same with the vet whose negligence I hold responsible for OD-ing my cat.
As for the dog, that is just people not wanting to cough up the money for emergency care. That is very reprehensible.
But I have to ask -- do dogs get bloody diarrhea simply from food change? Diarrhea I can understand, but BLOODY? Maybe there is some other test that should have been run on him Monday. What other tests could have been done? What diseases can cause bloody diarrhea? Parvo? (I'm just asking, I don't know the answer -- but what communicable diseases might he have picked up while boarding?)
In any case, they should have come back in on Tuesday; then they should have taken him to ER as advised. But are there some tests that should have been run on Monday that were not? A fecal?
I know you will answer "no" to that. And I, as an owner who is not like these people you describe, might have asked for more tests if it had been my dog. But then, I would have taken him to ER, too. Which may or may not have saved his life, BUT . . .
Stefani April 2nd, 2008 12:45:00 PM
I'm not going to defend these clients...obviously, they were too preoccupied with the stress and busyness of life to make conscious choices on behalf of their pets. That said, I do understand the dilemma pet owners have when it comes to knowing WHEN to take a pet to the vet. I'm not a veterinarian, but I worked at the Colorado State University Veterinary Teaching Hospital for 20 years and picked up on a lot of "vetspeak", treatment protocols, etc. And, even with the Animal Cancer Center there, I heard a lot of docs tell clients to "keep an eye on it for a few days and, if it doesn't improve, come back..."
As a non-medical person, I don't really know what the limits are on "not improving"---so often diahrea, lethargy, not eating, etc., go away on their own. You can tell yourself to give it a little more time for a long time... I'm sure I could spot a broken leg and even I would know that BLEEDING is cause for a visit to the vet, but some symptoms just aren't that obvious to those of us who aren't medically trained.
In a case like the mastiff, I had many clients tell me that they didn't call their vet because they felt they had already bugged her enough or they had already spent hundreds of dollars and couldn't afford another emergency fee, etc., etc. In my opinion, if you look at each case and take time to evaluate the circumstances of your clients' lives, along with their emotional anxieties, you often find a client that actually is an advocate for their pet, but who has some hang-ups about dealing with the human interactions that go along with vet care...
Laurel April 2nd, 2008 12:55:00 PM
I am sure the ER vet that had to put my Snoopy cat to sleep probably thought the same of me.
One day he was fine, staring down the dog at the water dish and nothing amiss. The next day, he spent most of the day napping in the upstairs bathroom - not unusual, he likes it in there. However, what I didn't realize was that he wasn't napping - I was catching him exhausted in between seizures. :(
Later in the evening I caught him mid-seizure and rushed him to the ER vet, but they couldn't stop them. I still look back and wonder if there was something I missed before that day, but I keep coming up empty. I think even if I'd seen him have a seizure earlier in the day, the end result would have been the same, just a few hours earlier.
But I still will always wonder if I was totally clueless or if this really was something like a tumor that just finally hit it's tipping point.
Cindy April 2nd, 2008 01:24:00 PM
Dr. Patty, is it possibly Hemorrhagic Gastroenteritis (sp)? Lottie had that once after a long meet-up with lots of dogs and it was horrifying. Blood was pouring out her bum. At first it was bloddy diarrhea, and I called the Vet. They said to go straight to the ER. While I was on the phone with the ER giving them a heads-up that we were coming, major blood/mucous started pouring out of my 7 pound dog. It was shocking. Once she was stabilized, the Vet explained that they don't know what causes it, but that it can kill very quickly if left untreated. She was treated successfully with fluids and flagyl, and was back to normal in 2 days. But I have warned all of my dog-friends, that blood coming out of the bum is serious, go straight to the ER. Better safe than sorry.
Please keep us posted on what you find.
Creature of Habit April 2nd, 2008 01:40:00 PM
Laureal and Cindy, you raise good points. I think the case of the dog with the bloody diarrhea is not as clear as the cat with the crushed leg.
If the client was told that the bloody diarrhea was most likely caused by a change in diet on this dog known to be "GI senstive"; if they were told that the bloodwork was OK and to "watch" it . . . then they probably interpreted everything they saw after that in light of the expert diagnosis of probable stomach upset due to diet change.
The dog had bloody diarrhea on Monday, and apparently this was believed to have been caused by a diet change. That baffles me (diarrhea yes, but BLODDY??? I can't imagine that diet change would cause that), but hey, I'm not a vet.
So as they saw things decline, they probably thought that they just had to wait it out.
Still, I can't say that any of this excuses them not taking the dog to the ER.
Stefani April 2nd, 2008 01:52:00 PM
Stefani, oh yes...changes or irritants in diet can indeed cause bloody diarrhea and a LOT of it. My terrier went through almost a year of intermittent hospitalization and diet changes trying to determine what her food allergies were. Very messy and distressing condition. I thought she was going to have to eat white rice and chicken broth the rest of her life, but we finally got it sorted out and she's right as rain now on Hill's I/D.
Shasta April 2nd, 2008 02:57:00 PM
Shasta, wow, that is an eye opener for me.
I have a very sensitive-tummy kitty. Anything with beef = vomit. Anything with pork = vomit. And other things that I can't nail down = vomit.
I had been feeding them all Wellness intermittently, and then for a couple of weeks I got a deal on a case of it and was feeding them Wellness exclusively. I didn't occur to me that it could be the food since she'd had that food before and I'd never noticed the vomiting associated with this food.
She started vomiting what looked like ENTIRE meals 4-8 hours after eating. That really disturbed me because I thought it should have been processed and out of her stomach by then. After many days of this intermittently, I went to ER, sure that she must have a blockage.
$500 and some xrays later, vet sent me home and told me to "watch it." She didn't see the point of doing ultrasound just yet. Nothing on the xray. Normal bloodwork.
I got home and someone said something to me that made me wonder about the food. Switched her back to fancy feast and roasted chicken. She stopped puking.
Maybe I should have tried that first, but I was happy to know it didn't look like she had ingested anything. No bloody diarrhea, though. !!!!
Now she is eating Feline's Pride. I have seen one pukie. I am "watching it."
What makes an animal have a sensitive stomach? Is there something else wrong with them?
Stefani April 2nd, 2008 03:21:00 PM
Stefani--the list of things that can cause a "sensitive stomach" can be quite long! Food allergy, Irritible Bowel Disease, liver inflammation and cancers are all high on the list. The there are things that have nothing to do with a "sensitive stomach" that can be interpreted as such--pancreatitis in cats can cause vomiting and be very difficult to diagnose accurately. FWIW, cats and dogs don't always react to the same disease in the same way--IBD and food allergy often causes bloody diarrhea off and on in otherwise fairly healthy seeming dogs, while cats seem to vomit more....so being a cat owner, you have not really been exposed to the Joy Of Canine GI Upset. But you do get Joy of Feline Vomiting instead.
I also wanted to add that its really easy to do sort of the armchair quarterback thing like what is happening with the mastiff discussed in this post. I would suspect that when Dr. K talks about cases she is not divulging every detail of them--so she may well have done a fecal smear and requested a fecal sample for testing if she was unable to obtain one. We also don't know a lot of what went on during the exam beyond what we're told. Sometimes it can be easy to go "Oh, I should have made a different decision" when other things come to light--things you didn't know because the sign had not developed yet, or because you were not allowed an opportunity to test for something (because you didn't know about a disease, or didn't think of it, or the person holding the leash said no)
drsteggy April 2nd, 2008 04:45:00 PM
Shasta wrote:
<<<<<<Stefani, oh yes...changes or irritants in diet can indeed cause bloody diarrhea and a LOT of it. My terrier went through almost a year of intermittent hospitalization and diet changes trying to determine what her food allergies were. Very messy and distressing condition. I thought she was going to have to eat white rice and chicken broth the rest of her life, but we finally got it sorted out and she's right as rain now on Hill's I/D. >>>>>
My collie, Lucy, was diagnosed with IBD back in 2004 (biopsy during her spay) and it took us about 9 months to get a handle on it. A single milk-bone could result in bloody diarrhea. Turns out she was sensitive to most grains and when she was in a flare up, those grains include white rice. It was pretty confusing when the typical bland diet of chicken & white rice made her worse. She on one of the fish & sweet potato dog foods (we rotate between Wellness, Eagle Pack, Premium, & Solid Gold) and her IBD has been in remission for 3 years with only a few minor flare-ups. When she does have a flare up, I feed her an easy to digest protein (Chicken or egg) mixed with sweet potato / mashed potato.
chris April 3rd, 2008 05:41:00 AM
Stefani - you may want to consider Weruva wet food. Its all human grade food - no additives, no preservatives, no glutens. Its not a pate - you can actually see the pieces of fish or chicken its made with. Its made at a facility in Thailand that processess food for the EU market (people that is). Since the cat food is made on the same lines, it must also be made to these standards. Tikki is another brand that is very similar. Once you get into mushy food, you don't really know what's going into it. At least at my pet store, its the same price as Wellness.
I had a cat that was throwing up several times a week. Since I've switched to Weruva - its become a rare event...like once every 3 months.
2CatMom April 3rd, 2008 08:59:00 AM
hmm, I'm not sure that I really want to defend this, but here goes anyway.
I know when I'm discussing an area I know a little about with someone who is an expert, I try to guess as little as possible. I'd rather tell them only the facts that I'm absolutely sure of than speculate on things I've heard of, but are probably wrong.
Maybe this comes from working in computers, where most of the things you hear on t.v. (and people repeat) ARE wrong.
But, maybe it was a broken leg, maybe it was a dislocated leg, maybe it was a fractured inner perifancywhatzit with ruptured cyclodoodads. Maybe she got hit by a car, maybe she got mauled by another animal. In a case where I didn't witness it, and the vet can see what's wrong as well as I can, I'd probably stick with the really simple: 'bad leg'
Which is the point at which I feel like I'm defending those who don't deserve it, because she sounds like more of a jerk than someone lacking in diagnostic confidence.
ellipsisknits April 3rd, 2008 01:49:00 PM
More than once over the last 20 years, I've thought of applying for a job as a part-time animal assistant at a vet clinic to help defer my high costs of veterinary bills (had 8 dogs and 2 cats at one point!!)---but surely realize I wouldn't last too long.
I think it is hard for an average single pet owner to discern between true emergency and possible temporary illness (crushed bleeding leg excluded!!). Terriers and out- door cats often have dietary indiscretions, causing some pretty nasty vomiting or diarrhea. Gosh, I can remember one Scottie with impending pyometra that was gulping water and just slightly "quieter" than normal(no vomiting or loose stools). I called the clinic, brought down a urine sample and was told the symptoms weren't terribly abnormal for a bitch "post-heat"----well it sure became evident a week later!!!
And speaking of such, I agree with Stefani---if owner's are clueless---what gives with the THREE Vets and Techs (licensed too) that saw Pocket in her last days---all telling me she was "improving and becoming well" ----despite a phosphorus 17 hours post IV fluids of 18!!! If I knew she was dying, and shaved her front leg before admittance---how was it NOT apparent to a Cornell-Tufts DACVIM graduate??? BTW, I have a saved unsolicited answering machine message left on the 7th day, stating she was "slightly disappointing from the previous day's improvement"---how's that for pure FRAUD???
Barb Albright April 3rd, 2008 05:58:00 PM
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