A Veterinary Disconnect - Reality and Owner's expectations.

I think you will agree that vets are special people - strange, but special.

Dr Liz with Tinka, with Nurse Tegan looking on at Russell
Vale Animal Clinic.

And if you are a loving pet owner - you are also very special - in fact, us vets adore you - Loving Pet Owners.

So, now picture a consultation room in a veterinary hospital.  I don't necessarily mean my own veterinary hospital, at Russell Vale Animal Clinic, but the general veterinary hospital that may exist  anywhere in the world.

Now, the scenarios I am going to go through, well,  they  don't always  play out with every single consultation, but the emotions and thoughts occur often enough, to make me want to write about it.

That is,   the disconnect between the reality of the medical condition of the pet, and the owner's expectations (of what a vet is capable of doing, of the outcome of the medical procedures or the outcome from the disease itself).

It is an unspoken expectation of many Loving Pet Owners that all diseases can be cured or fixed, and an unspoken accusation that the vet must've done something wrong if treatment doesn't work or further signs develop.

Now, in today's post, I am going to play both roles - adorable, Loving Pet Owner, and the Super Special you-beaut Veterinarian.  Perhaps you are wondering why am I doing this?

Because these two pets that I am going to write about  highlight the disconnect between the (possible) expectations of a Loving Pet Owner, and the reality of the medical situation the pet is in from the point of view of the veterinarian.

What's more, it highlights the importance of the relationship between the Loving Pet Owner, and the Veterinarian, in ensuring a great outcome for the most important thing in the room - which is the pet.

Pandora, the boss.... Really!

Oh, I forgot to mention - the reason why I will be playing both roles, as I will be talking about two of my own pets - our dog Teddy, and the boss of Russell Vale Animal Clinic, Pandora.    These cases are real, the people are real, the situation is real..... (sorry to quote Judge Judy here).    I am choosing my own pets, as I really don't like writing negatively about my own Loving Pet Owners, as they are all, well, loving and awesome (albeit human, like me)

And, no. I do not have a split personality, or some psycho disorder, I don't smoke, and I am sober writing this.... but yes, I am a wee bit mad!

Teddy.... what can I say about our Teddy.  He was an amazing dog, but he passed away, after succumbing to Canine Lymphoma in 2011.  He was diagnosed in 2009, and underwent Chemotherapy, under the care of Dr Angela Frimberger at the Animal Referral Hospital.  Teddy was (and will always be), a very special dog. His photo hangs on my filing cabinet near my desk at work, and he is the face on my Facebook page, and my Lost and Found Pets Facebook page.

Teddy as a puppy.... wasn't he cute?

Well, he got Lymphoma, and the knowledge of that, as a pet owner was devastating.  I searched the internet, and joined a support group.  I didn't let on that I was a vet, but joined as a loving pet owner.  Which I realised shortly after joining, was a wise thing to do, as some of the comments there about vets was not too pretty.... unfair, and not nice.

Teddy, my daughter Tegan, and I drove to the Animal Referral Hospital, weekly initially, then as needed for his chemotherapy.  The blood tests were done at my own vet hospital, at Russell Vale Animal Clinic.   As a loving pet owner, I wanted the best care for my Teddy, which is what he received.

But let me go back a few steps -  to the time just before his diagnosis.  As a vet, and loving pet owner, my pets receive a full check up each six months,  which included full blood work (full blood count, biochemistry profile), urinalysis, as well as Chest and abdominal radiographs once a year - really, the basic screening that all pets should have.   And Teddy's last lot of tests were done about 3 months before his diagnosis, and they were all normal. Chest radiographs were clear, spleen was normal.  (remember this point for later).

Now, think about how the Loving Pet Owner feels when she hears the diagnosis of cancer, or, even before you know, the sinking feeling that your pet is "not well"   What is one of the first questions you ask yourself?   .... how long has he had this disease? (in other words, was he sick, and I missed it? or was he sick at his last check up a year ago, and you (the vet) missed it?)

Well, the vet hat goes on, and I say " I can honestly say, that three months earlier, everything was as normal as normal can be."

Teddy our dog... photo taken in 2009

Loving Pet Owner  - " What caused the disease? Where did it come from?"  Now I will take some artistic licence, and go through some of the causes that people sprout on the Lymphoma forums - all of which are not true, and some are really hurtful, as they implied that vets would deliberately harm animals, which, well, is not true.  Such as flea control, worming tablets - these poison the pet (no, they don't), the food they feed (all of the additives),  the vaccinations the pets receives (these don't cause it either).

Now the vet hat on me says "Cancer sucks. Pure and simple. Lymphoma isn't caused by any of these things, as I see alot of pets who get lymphoma, who are on raw diet, no worming, no flea control to speak off (other than garlic) as well as alot who are on quality preventative care.  Lymphoma doesn't discriminate. It just sucks... like any cancer diagnosis. "

AS I've mentioned, this is all about disconnect.... there is the Loving Pet Owner's, almost unspoken expectation, that there must be a "cause" or "it is someone's fault" for their pet having a sucky disease.  Also.... that every sucky disease has a easy, cheap treatment that causes no effort or work on the owners part.

And the disconnect?  Well, veterinarians know that life sucks sometimes.... bad things happen to good people, and it is no ones fault.  Pets (and people) get cancer, and that just, well,  sucks.  And we all know, that there are no free lunches in life.

As a Loving Pet Owner, I listened to the recommendations of my  gorgeous vet (which was me), and Teddy underwent the full series of tests required - even if it meant repeating the tests done not less than 3 months earlier.

Our dog Teddy .... a few weeks before he had to go to Heaven.

Can you think of any other possible reaction to the news that tests need to be repeated?  The Loving Pet Owner could question why they need to be repeated, as after all, they were done recently (I have had some owners want me to rely on tests done 4 years previously to diagnose their pets current medical condition...really!), but the Really Loving Pet Owner goes ahead... trusting her vet to do the right thing by her.

Now I (and most vets I know)  would never recommend a test or a procedure performed on any pet if we didn't think it needed to be done.  Owners are allowed to query what the desired outcome of the test is hoping to be, but I don't understand the need to doubt the necessity of it.

You'll remember I mentioned earlier about the treks to Animal Referral Hospital for Teddy's chemotherapy treatment?

Well, at each visit, he would receive a full check up.  And (almost) every visit, we would be given the thumbs up.   Awesome!  And then, one visit, no thumbs up.  Teddy was diagnosed with a heart murmur. It wasn't there in the weeks before this visit, and no changes ever noted on his radio-graphs to indicate a heart problem.  And, he needed a chest ultrasound (an echocardiograph) to assess his heart properly.

Now here is the disconnect again.... what do you think a Pet Owner would say or think? Well, I will tell you, as I have been at the receiving end of these comments
"Dr ABC diagnosed a heart murmur in my dog, and you missed it.  What kind of vet are you? "
"How could this have been missed earlier?  What else are you doing wrong? "

and then... "How much is this going to cost extra? " with the silent thought that the vet is probably trying to puff out the vet bill to make more money.

Well, I am paraphrasing,  and some haven't been said that to me at all... but they are reasonable things to feel, not always to say though!   And, mostly, unfair to the vet.

As a vet though, I knew that pets can be normal one day, and then the next day not be normal. I knew that Teddy's heart murmur was not caused by the vet doing anything wrong.  I also knew that the vet didn't  "miss" the heart murmur the week before .... it just didn't exist.  But as a pet owner, you would say "well, my last vet didn't pick that up."

Frankly, whenever I read comments on other posts about vets being money hungry, filthy rich scum bags, because they charge pet owners for their services and knowledge, I just shake my head, and go "Wow! Really? Do you treat the local supermarket, or the car yard where you bought your BMW in that way too?  "

As you can see, Teddy, even after he is gone, highlights the areas of disconnect between the expectations of a Loving Pet Owner, and the reality of the veterinary condition.  How did I go at playing both roles?

Now, I wonder if you were Teddy's owner through all of these situations, how you would've reacted? What would you have said or done?

Pandora (the boss) with Pandora's Box!

Now, onto Pandora..... well, anyone who comes in to see us at Russell Vale vets, knows Pandora... the boss - she spends her time either under the building, or folding towels (sleeping on them I mean), flattening out the bed (sleeping on that too), or just trying to turn our computers off by walking over our keyboards (or write letters to clients which can't be understood).

In 2012, she developed a small sore on her head - it was about 2 mm wide, red, and she was obviously agitated, and itchy with it.  Now, Pandora isn't the best patient to deal with, she is a boss, not a patient... so we clipped it up, and it looked, well, like a small red blimp. Like she had donked her head on something!

Now, within a few days, it got bigger.... not because it did it on its own, by Pandora's back foot was working overtime, scratching, and rubbing, clawing and clawing, until you could see streaks of red where her claws had been.... And so, we had to do some serious investigations.  We gave her an anaesthetic, did some skin scrapings, fungal culture, cleaned it, and administered medications.  And then, she woke up with an Elizabethan collar on her.... as well as being caged for a few days to see how it would heal.

And, heal it (almost) did.  After a few days, it was looking good, so off comes the collar, out goes Pandora, and we think, as a vet,  "all's right with the world".

Now, as a Loving Pet Owner, how would you feel if the vet had said to you... "this sore isn't healing as well as we expected to based on the treatment we gave for the condition we think it was... (which was we thought she had grazed it, or perhaps a cat scratch from the neighbours cat - they do like to play a bit rough sometimes). "And we need to do further tests to find out what it is"

Well, there are two things the Loving Pet Owner could do - one would be to say "Ok", walk out the door, and go somewhere else for another treatment, without doing any of the tests.

Another, would be "Ok, when can I book her in for the tests", or Loving Pet Owner could say "What other treatments can I try?", and my favourite line that I sometimes hear is ... "Is that really necessary?"

Well, yes, it is.  The best treatment is the right treatment, and this is best done with a diagnosis of a condition, rather than a intelligent guess based on the possibilities of what it could be.

Well, moi, as the Loving Pet Owner allowed moi, the veterinarian, to perform these tests.  I also performed a skin biopsy on her head too.  I wanted to send that away to find out more about this poorly healing, very very itchy sore.

And lucky I did.  It came back as a severe intense allergic reaction to an insect bite with a secondary infection.   So we blamed the local white tip spider, that most houses in this area play host too... and Pandora does like to go underneath the building.

And the best treatment for that? - time.  And steroids and antibiotics and Elizabethan collar.... but it was really a matter of time.  It took 4 months for that sore to heal up till it didn't bother her any more.  If the Loving Pet Owner wasn't a vet, then they would've, more than likely, visited every vet in town, and then some, for a treatment trial, and the lucky vet that sees the patient 4 months later gets credited with the success, when the real success came with just being patient, and allowing "time to heal all wounds".

 The disconnect?  The pet owners expectation that the first treatment is going to be successful without any diagnostic tests, and in the first week of starting treatment. You'll remember I mentioned earlier about the unspoken expectation of pet owners.

I think you will agree that even vets are Loving Pet Owners too. How do you think you would've acted if you were the Loving Pet Owner of Pandora or Teddy?