is this a vet school exam?

I never know what is going to happen when I walk into an exam room. Maybe the client is going to be pleasant and the patient will be healthy. Maybe the pet will be an angel, but the owner has a chip on their shoulder from a bad vet experience in the past, and they will hate me before I ever walk through the door. Maybe the cat will try to scratch my face and bite my finger, or the dog will try to lunge at me from across the room. Maybe the owner will burst into tears as I walk into the room. Or maybe I will walk into the exam room and endure a barage of questions designed to "proove" my competence. Today was a day for questions... Today, I was "interviewed" by a biomedical statistician. The interview was disquised as a simple "recheck" appointment. I stepped into the exam room expecting to discuss repeat bloodwork and changes in medication. About 45min later, I emerged from the room feeling like I'd traveled back in time and had just finished one of the legendary "oral exams" from veterinary school. An exam where one student endured a question and answer session with 1-2 faculty, answering numerous detailed questions designed to quiz our knowledge of every single aspect of a particular disease process. The exams tested our analytical skills, our "calm under pressure" attitude, and were enough to make any vet student sweat nervously in anticipation. I'm happy to report that today, I was not sweating as I left the exam room after my "interview." I'm happy to say that I feel confident in my ability to stay calm under pressure. I have to admit that I failed in my ability to recall every single case I've treated with this particular condition, and although I could say the incidence of treatment failure was approximately 3-7%, I couldn't pinpoint what exact percentage of my PERSONAL cases had a certain outcome - and I'm OK with that! Two months ago, I looked at a patient during a wellness / vaccine exam and suspected an underlying disease process. I ran bloodwork, diagnosed said condition, began proper medication, and recommended appropriate followup. I may not be able to recall every case I've seen in the last 5 years, or spout off detailed stats from my personal caseload - but I diagnosed a serious problem before it was causing clinical signs at home - and THAT is what proves my competence.

Is that normal?

I saw a case today... A case that made me want to laugh at the questions Mrs. Embarrassed was asking. And yet... there was something else there instead. Funny? Yes, it was funny. You'll soon see what I mean. But it also made me realize just how much trust people put out there when I step into a room as "the doctor." Trust that I have done nothing to deserve - nothing other than going to 8 years of school & wearing the white coat. Trust is something people don't usually give freely - it usually has to be earned, and that takes time. But somehow, many people give trust the second they step through my exam room door. And today, the weight of that responsibility hit me in the middle of an otherwise hilarious situation.

I was examining Marshmallow's eye... he was a little white dog, a neutered male. His eyes started watering yesterday and today they were very red. I stained his eyes, prescribed the proper meds, and was on my way out the door to see the next patient. But then Mrs. Embarrassed stopped me. "Doc, I've got one more question for you." Sure, I've got time... "Well, you see, Marshmallow is neutered. But he has this teddy bear. And he humps the teddy bear sometimes. And then a long red thing appears, and he licks and licks it until it goes away. What IS that? Is that NORMAL?" So I explained that even neutered dogs can get 'excited' so to speak, and that red thing is his penis, and yes, its "normal" for some male dogs to do that, neutered or not... Mrs. Embarrassed is an African American woman, but you know what? I swear I saw her blush. And then she thanked me for answering her questions, and said she was glad she knew it wasn't something to worry about.

Trust. Today I met Mrs. Embarrassed for the first time. And today, she trusted me fully - almost instantly. And I'd like to think that - funny as the situation was, and as much as I wanted to laugh - I'd like to think that I earned the trust she gave me. That is my job. And I love it.

No, I don't diagnose HUMAN parasites - thank you for asking

Typical appointment written on "to be seen" board - K9 with possible worms. Easy. Boring. Right? Bwahahaha! You'd think so... but no.

I am presented with a worm segment that appears to be a tapeworm. In the room are 3 patients - a cat and 2 dogs. They're sure this segment came from a dog. But do the others have worms? Maybe - thing is, tapeworms don't come up on fecal floats all the time. Often times, we diagnose them based on finding the segments on the pet. Thing is that this one wasn't found ON the pet - it was found on the floor. Solution? Treat all 3 pets. Easy, right? Again, bwahahaha! Owner agrees to treat all 3 pets. But then Mr. Owner says "we have three more at home. Two more cats and a dog. Can we get meds for them too?" Sadly, no... we haven't seen them in the last year, so we need to examine your other three pets as well. Ok, they say... we'll set up the appointment.

Casually, on the way out the owner says "Oh, by the way, can we get tapeworms?" I get this question a lot - nothing unusual. So I say "Only if you eat fleas. That is the only way tapeworms are spread - you can't get them directly from your pet."

Fastforward a few days... I see an appt that is a request for me. Ah, how nice. I always like requests (ok, I lie - MOST of the time I like requests - this turned out to be one of the exceptions!). Its the couple with their other 3 pets. Fabulous. Quick appt, and be done with their worm issue. Take care of the fleas on all 6, and we're golden. So this time, I enter the room, greeted by Mr. & Mrs. Owner & their other 3 pets. Mrs. Owner has a ziplock baggie. In vet med, ziplock baggie always = INTERESTING (and thats not always a good thing!). In this bag? About 30 small, dried tapeworm segments - and 4-5 LONG tapeworm segments. She says, "Doc are these tapeworms?" I confirm that they are, indeed tapes... She says "Do you know where the bag is? I need those back. I need them to show my doctor." Okaaaay.... usually people don't ask for their parasites back, and if she needs it to show her doctor... well, yes, that implies that SHE has tapeworms. I'm not going to ask. We get meds for her other 3 pets, and take the stool samples to check for other parasites, and send her on her way. End of story? You guessed it - nope! More fun is in store!

Mr. & Mrs. Owner come back in a few days for another request for me. They bring several more worm segments, a few pets, and ask "Are you sure that the only thing found in the stool samples was tapeworms?" Yes. All 6 samples negative except for tapes. "And you're sure that I can't get them from sharing a bed with them, or anything else besides eating fleas?" Correct. "And would tapeworms cause all of those lesions I see on your parasite poster?" No - those are human photos of migrating parasites, like hookworms... not tapeworms. "Well, doc, look at these marks! Don't they look like your posters?" Oh my. The woman has just lifted her shirt, exposed her entire abdomen, and is showing me multiple skin lesions on her breasts, belly, and STOP! There is no need to show me things below your belt line!! I say she should consult her MD because I'm not licensed to practice human medicine. The lines do look similar to our poster, but her pets are worm free except tapes, and even if they had some other parasites we simply didn't find, the dewormer they've been given would have gotten rid of those as well. Mrs. Owner says "but my doctor says its an infection and its not going away." Well, then you should ask for a referral to a dermatologist. "But if this was a dog, what would it be?" I'm sorry, I can't tell you that. I don't know - and if I did know, and told you how to take care of it, I could get in trouble that puts my license in jeopardy. "Well, do tapeworms cause little white things to come out in the mouth?" Noooo.... not that I know of. Why? Are you noticing white things in your pets' mouthes? "No." Mrs Owner says while reaching into her own mouth.... "Every time I go to eat, I start to salivate, and I get these white things appearing in my mouth." Really, you should go to see YOUR medical doctor! I can't help you with this... "But my doctor isn't doing anything about these things. If it was a dog, what would these be?!?" Sigh. For the last time, I can't say what those are - I do not know. What I do know is that you need to see an infectious disease specialist if your MD can't help you.

I guess that was enough information for her. Because its been a good 6 months.... and I have seen no more of Mr. or Mrs. Owner... thankfully - because I saw WAY too much of Mrs. Owner than I'd ever care to see again.

The Good Samaritan

Oftentimes, the daily experiences that stand out to us as veterinarians are the crazy, weird, silly, oh-my-goodness-did-that-just-happen moments. However, sometimes, we are struck by the wow-that-really-touched-my-heart moments. I will always remember one of those experiences I had as an ER vet...

I was working the ER on a crazy-busy day. Our ER clinic had just opened a new location, and we typically weren't overly busy - not a lot of people knew about the new place yet, and we were still "working the kinks out" of the new building. So, as usual, I was the only vet on duty. So far, the arrangement had worked well - however, this day was an exception. We were slammed all day long - a 2-3 hour wait - and amazingly enough, our clients were quite understanding. That in-and-of-itself was unusual. Its common-place in the animal ER to have clients yelling at screaming at us because they're stressed, worried, tired, etc. On this shift, my staff and I were tired and stressed, but everyone was holding up well.

We had a client with a dog that needed to be admitted to the hospital. What for, I don't recall - and it doesn't really matter. What matters is that the young woman who owned the dog didn't have enough money to provide the care he needed that day. Financial concerns are a huge part of every veterinary office, but especially animal ERs. In this case, Miss Concerned was trying to call family, friends, etc to come up with money for treatment.

Now, our waiting room was busy. But not too busy for one of the other clients to take notice of the young woman with financial concerns. When Mrs. Goodheart was checking out, she let my receptionist know that she wanted to pay for Miss Concerned's entire bill. Whatever the total, she wanted to take care of it. No strings attached, except she wanted to remain anonymous.

These are the things you hear about in storybooks. Chicken-Soup-for-the-Soul type stuff.... In the middle of our chaotic day, every one of us on staff took a moment to wipe tears from our eyes. Tears of joy and amazement as we watched Miss Concerned become Miss Not-a-Care-in-the-World.

Parasites?!? Not where WE live.

I'm sitting in the exam room, finished vaccinating "Precious" - so I ask the next routine question: "Do you need any Heartgard or Frontline today?" And I get the most interesting response... "No, my little sweetie doesn't have any fleas or ticks. I take her outside for just a couple minutes at a time to go potty." So I tell her that we should at least take care of the heartworm preventative, because mosquitos are common in our area, and it only takes a second for them to bite. Then comes the stunning reply... "Oh NO. Precious is NEVER exposed to mosquitos. Or heartworms. Or Fleas. WE live in 'hoity-toity' subdivision and there are NO PARASITES allowed within the gated community." Should I laugh, is this a joke? Oh no. Mrs. High-n-mighty is completely serious.

WAY too much information.

As a veterinarian, I'm quite honored that my clients often trust me with very personal information. Sometimes, though, the information they choose to share is much TOO personal.

For instance... Picture a typical exam room moment - me, the doc, examining a dog, answering the typical flea / tick / vaccine / heartworm questions. Then comes the odd question - "Can you see if Fluffy has a yeast infection in her mouth?" I find this a little strange, but decide to ask for more information. Is she having trouble eating? Have you noticed a bad odor? "Oh no... her mouth seems fine, but every time she kisses me and her tongue ends up in my mouth, I end up with a yeast infection. I was wondering if she was a carrier or something."

Sometimes, I just don't know how to respond.

I swear, Doc, there is NO WAY she's pregnant!

This is, unfortunately, a conversation I've had numerous times... usually goes like this...

"I think something is wrong with my (female) dog - she looks like she's getting fat and there's milk dripping from her belly."
"Is she spayed?"
"No, but there's no way she could be pregnant!"
"Has she been around any un-neutered male dogs?"
"No, just her brother."
"Well, I can feel puppies when I push on her belly, and that is in fact milk - she's likely to have these puppies soon."
"Thats impossible! Its her BROTHER - they KNOW not to do that!"

Did I hear that correctly?

While examining a terrier-breed dog, the husband and wife clients start asking me why he doesn't know how to breed their female... They describe that the male gets "all excited" when the female is in heat, but all the wants to do "is sit there and slobber - he has no idea there should be any interaction between himself and our female." So we discuss a little about how natural things like breeding don't always come naturally to all dogs... We continue our discussions, and the husband manages to work the following comment naturally into our conversation somehow.

(to his wife)
"I still don't understand why he can't figure it out. Its not like its hard. And he's watched us enough times, you'd think he'd know how by now!"

Not knowing quite what to say, I continued with the vaccines, heartgard / frontline talk, and got out of there - only to walk in back and BURST into laughter with my tech - "Did we really just hear that correctly?" Why yes - unfortunately, we did.