"I'm worried about my cat" says Mrs. Contradictory. "He's been occasionally vomiting and is just not eating as much as normal. He's lost about a pound in the last 2 weeks... I'm really concerned that he might have kidney disease, or diabetes, or liver problems." Yes, those are all things to be concerned with, given Sylvester's history... So lets run some bloodwork and see what's going on, ok? "Yes, absolutely. I want to do whatever you feel is needed to make Sylvester feel better."
... so we draw the blood ... and I recommend some symptomatic care for Sylvester to make him feel better. Nothing too involved, given that he's stable and I want to know the results of his bloodwork before we nail down a treatment / management plan. I offer some SQ Fluids (a pocket of fluids placed under the skin that is slowly absorbed - it helps keep the patient hydrated despite his decreased water intake) - an injection for nausea - and some appetite stimulant pills (that are given once every 3 days). Does this sound like a good plan to you? Well, before I can get those words out of my mouth, Mrs. Contradictory is cutting me off. "No, I will not do any fluids. Or injections. Or medications. When Sylvester was here last month, that guy Doctor gave us some eye meds - it was easy, and simple. Then at the recheck exam, that other lady Doctor gave us a medicine to give by mouth - and that was a nightmare. So I am not doing any medications this time." Ok, but I can give injections and you won't have to do anything... and Sylvester will feel better until we find out what is wrong. "No. I will not do it. I'm NOT being argumentative, I am just refusing complex treatment." Ohhhh-kaaay. Then we will do the bloodwork and nothing else. "Yes, that is what I want. Bloodwork only. I really want him to feel better."
So I get the bloodwork back... no major issues with diabetes, renal failure, etc. So I call Mrs. Contradictory - and again I recommend some symptomatic care... thinking she will refuse. Surprisingly, she willingly agrees to make another trip to the clinic for basically the same treatment I offered in the first place - and she is very thankful for my phone-call and treatment recommendations. Sometimes I just don't understand.
Subscribe to:
Post Comments (Atom)
You will never understand. But it makes great blog material and that's all that matter right!
ReplyDeleteMy cat has IBS- probably a similar case and is up and down (I think depending on his mood and the weather), and I've done the same thing, gone to the vet. Sometimes he gets better on his own, but prednisone works quite well too. It is however about $35 per 20 pills Canadian dollars, and as a student with only a part-time job, this is a quarter of my paycheque. So it is sometimes a matter of waiting to see if his weight improves on it's own, or if I can change his food, or play with him more often to avoid paying for this prescription. It is difficult having a pet with an illness like this, and it sounds like your client's mother is stressed about the cost of a vaccine versus buying groceries perhaps?
ReplyDeleteArtdoc... I appreciate your point of view, and IBD is a very difficult disease to deal with - costly and frustrating for sure! I do try to be very sensitive to financial matters - I grew up not in a poor family, but in a large family with limited finances for animal medical care. So I've been there and know what it is to want the best for your pet and yet not be able to afford it. I get angry when people who have PLENTY of discretionary income refuse to spend it on their pet... and choose to let them suffer because they cannot go without a gourmet meal out on the town, or because they want to spend the money on yet another pair of expensive shoes. However, I have tremendous compassion for people who have to choose between their own bills / needs and the medical care they so desperately wish to provide for their pets. I have worked in very low-income areas, and consider myself very good at providing the best medical care at the most reasonable cost possible. I will work with people to find the very best medical option within their financial means. And actually, in this case, it wasn't a financial decision at all. The client was basically telling me "there's no need to give my pet these medications because I don't want to give medications. I don't trust you because I don't like what the last doctor did when I was here before." The treatment I offered wasn't the most expensive, and it wasn't extensive... it was simply aimed at treating the patient's nausea and discomfort until the bloodwork let us know what long term treatment we needed to pursue. What I found odd was that the client was insisting that her cat did NOT need medication, she did NOT want him to get any injections, and she did NOT want to try a change in food. And yet, a few hours later, when I recommended the same thing again, she acted quite thankful for the options I offered and was 100% on board for the same treatment I had suggested earlier in the day. Strange...
ReplyDeletesounds like that lady just liked to argue!
ReplyDeleteIt sounds as though she thought about the treatment between the time you suggested it and when she talked to you later, and reconsidered. I have a dog who has hypothyroidism. When the vet told me the med was b.i.d., I really doubted my ability to do that, but actually, I can see such a change in her that I don't forget. As long as the woman doesn't have to administer the injections or subQ fluids, I don't see the problem. Those pill pockets are wonderful, too.
ReplyDeleteAhhh... i c
ReplyDeleteShe has lots of money and can't deal with her borderline/bipolar decision-making projections~ :-+o
Very sad, but seriously...
This society is turning into such a self-absorbed massage.
After the earthquake yesterday in Ontario/Quebec/Upper East US, everyone on the news was talking about how many "tweets" people just had to do.
It was an earthquake, yes, but seriously, is it really safer to evacuate an 11 story building down the stairs with thousands of un-fit business professionals trodding down without even having some sort of breakfast or coffee? Can we say, vasovagal syncope anyone? How about CHF? Blech. We unfortunately live in an over-cautious and self-absorbed society and neglect to actually look after our own health care in a preventative way. This woman probably needs some sort of mental health care, but instead, like Se7en, she feeds her life full.
Sad.
Here's my cat: http://artdoctor.wordpress.com/2010/06/17/gus-the-cat/
ReplyDeleteI think he has S.A.D., because now that the weather is great and he can go outside on his harness, with a half-pill of prednisone every other day, he's fine. He's also back on his ID diet. The wet food helped control vomiting, but it is expensive over time. It was maybe a good break for him to have wet food though. He drinks two bowls of water a day (back to normal). Waiting for a couple weeks when I can take him to get a lion cut ;). I help the groomer hold him so he doesn't bite, but afterwards, he loves it so much and rolls around the floor, runs around the house...ahh.. bliss...I'm going to miss him in two months when I go to school, but will visit sometimes (can't bring him to the apartment but my mom's gonna look after him). I'm going to post a pic today of his eyes when there was a lot of daylight in my room- he looks like an alien ;)..haha. He's turning seven on July 1st. I brought him home as a tiny cottonball (oh, so cheesy, I know) on the eve of the blackout in August 2003 at only 4 weeks.
Keep doing great work, Dr. Woof-Woof. It's obvious in your writing that you care about the animals, and that's the important thing. With big issues, I've learned it is best to focus on the problem, versus the people.
All the best.
A.D