Lately I’m trying to go out on the porch whenever I can, to talk to clients in person. That’s right, I’m still practicing curbside. I have one staff member recently exposed to COVID whom I’ve asked to stay home this week. Then my husband was exposed somewhere else. So far they are both testing negative, but due to my family’s specific health concerns, I have to be very careful. I’m grateful that people have been wonderfully understanding.
But I miss talking to folks … and I know owners feel better when they can speak to their veterinarian face-to-face. Or at least socially distanced face-to-face. So I bought an indoor-outdoor rug to define that distance, and set up an al fresco office in my parking lot. I sit on the porch steps. There’s a chair at the end of the rug for the clients. We get to chat about their pets. I get to feel the sun on my face. It’s nice. Usually we discuss medical things in depth. Sometimes I just want to catch up with someone I haven’t seen in ages. I don’t really have time to do either of those things, but it makes my day more meaningful, so I do the best I can.
When I was in veterinary school, a million years ago, one thing that was heavily emphasized in clinical rotations during senior year was the importance of getting a good history. My staff tries to get a description of what’s going on when they initially go outside to bring a pet into the office, but I always end up with more questions. When did Barfy start barfing? Did he have anything unusual to eat recently? (Yes, birthday cake à la mode is something unusual.) Exactly where is Felix the cat urinating? How long has it been going on? How many boxes do you have? Where are they? What kind of litter do you use? Are you absolutely positive Dopey the dog didn’t eat an edible? Absolutely positive? Really? You’re sure? It’s legal now, so please fess up, because honestly we see a lot of marijuana intoxication these days, and Dopey sure looks, well, dopey.
You get the idea. Being a veterinarian is part auto mechanic, part psychologist, part therapist, part detective, and part doctor. The detective part starts with getting that thorough history — everything that happened hours, days, even weeks before the patient arrived. It can be challenging. Owners give inaccurate information for all kinds of reasons.
For example, the classic case of the couple who bring their pet to the vet together. “Barfy got into the trash Tuesday,” she says. “But there wasn’t anything that would make him sick,” he says. “There were corncobs,” she says. “No, that was Monday’s trash, which I took out,” he says. “You didn’t take out the trash on Monday, like I had asked you to … so the corncobs were definitely still in the trashcan,” she says. I’ve been caught in the middle of quite a few such domestic disputes in the course of my career. No judgment here. I’ve been married for almost 30 years myself. But I just need to know if Barfy could have eaten the corncobs or not.
Then there are the ramblers. I love these folks, but it’s hard when we’re so busy not to get impatient. The conversation goes something like this. “What do you normally feed Pudgy, Mrs. Loquacious?” I ask. “Well, let me see. He used to get Purina Dog Chow, but then we switched to one of those grain-free diets, but we heard that wasn’t good, so I wanted to try something else. We did get a bag of that one, I can’t remember the name, but it’s in the big blue bag with the wolf on it. But he didn’t like it. He does like canned food, and I give him steamed broccoli sometimes. And treats.” I sigh and try not to glance at my watch. “So what are you currently feeding Pudgy, Mrs L.?” I ask again.
You’re probably wondering when I am going to get to talking about a disease or something. Yeah. Maybe not. It’s been a long summer already, and it’s only half over.
Recent porch discussions? A little dog who gets overstimulated and barks crazily when kids are having rambunctious fun in the yard. Another that is biting people who come in the front door. (Those I rescheduled for behavior consults.) Way too many times explaining what an asymptomatic Anaplasma test result means. Then all the itchy dogs, often with oozy “hot spots” from excessive scratching, licking, and chewing. I get sunburned in the time it takes to discuss these on the porch. First rule out underlying causes. Parasites, food allergies, inhalant allergies, et cetera. Then discuss diagnostics. Elimination diet for food allergies. (No, over-the-counter “sensitive skin” diets aren’t adequate. Yes, you have to commit to feeding prescription food only for eight to 12 weeks.) Allergy testing, either by a blood test or referral to a dermatologist for intradermal testing, followed by desensitization shots. (No, it doesn’t always work. Yes, you have to give it six to 12 months to see.) Then all the treatment options: Cytopoint injection (usually effective, lasts a month, minimal side effects, expensive). Corticosteroids (cheap, easy, effective, all kinds of possible side effects). Other options such as cyclosporine ( a.k.a. Atopica) or oclacitinib (a.k.a. Apoquel) and all their pros and cons.
Often, after all this, the owner declines everything and asks, “Can I just give Benadryl?” Yes. But it often doesn’t help enough. It can make the dog groggy. You need the right dose. Don’t buy one sweetened with Xylitol, which is dangerous for dogs. Make sure it doesn’t have a decongestant or pain medication added … and so on, and so on. So, my apologies for rambling myself. Help us out. Give your veterinarian concise answers to their questions, and as accurate a history as possible. I’ll meet you on the porch.
