By Dr. Pierre B. Bland
Most people seem to have their most challenging work days on Mondays, but Wednesdays seem to fit that pattern for me. I figure it’s because pets had the weekend and a couple of days with the family and kids to overindulge/eat something they shouldn’t have, the time and opportunity to sustain an activity related injury that is slow to heal, or just reach the point that whatever the malady, the common practice of waiting a couple of day to see if it gets better passes with no significant change, and in most cases has gotten worse.
In keeping with the latter, I present Mrs. A, a new client. She arrived promptly for her 9 a.m. appointment with her 95-pound black lab. The pet had been vomiting four to six times a day since the previous Sunday. I asked if the pet had been fed or gotten into anything unusual 24-48 hours prior problems starting, to which she replied negative.
As is common today, she was equipped with multiple videos of the dog vomiting over the previous three days as well as graphic pictures. The photos were of benefit because each of them showed multiple bits of what appeared to be black plastic in the pet’s gastric presentation, with the last photo revealing at least an initial diagnosis: the patient had chewed up and ingested a small plastic garbage bag.
I explained that this was a potentially grave situation due to the high probability of an intestinal blockage. The client stated she didn’t think that was the problem because she allowed him to chew and eat plastic bags all the time; the bag was no longer in his system; and that he had not thrown up since 6 a.m. and it was now 10:30 a.m. In fact she said she had fed and watered the pet shortly before departing for the appointment and he had not thrown up in over four hours.
I explained again the gravity of the condition: the gastric irritation, the dehydration that goes along with vomiting for three days, thus the need for diagnostics and treatment. She disagreed with me and said she was going to take the pet home. Then, as if on cue, my patient began to retch and presented about three cups of dog food and water on the exam room floor. I went into janitorial mode, started the clean-up process and sent them into the waiting area. The patient continued to wretch and presented two more janitorial projects for my attention.
Once the job at hand was completed, I presented the client an estimate for treatment of her pet. As expected, she was very unhappy with the estimate. By her reasoning, the pet has only been vomiting for three days, and couldn’t I just give her some pills and send them home? And why was the cost of the drugs so expensive?
I explained that giving oral medication was not a good option due to the continued vomiting, and this was a 95-pound dog. Medication dosages are based on weight, which accounted for the expense. At this point she shared her opinion: I was making the dog seem sicker than he was, in addition to gouging her on the cost of the medications.
Since this was going south, I opted to go with my gift and curse of being plainspoken. A modified Parliament/Funkadelic lyric came to mind which I opted to share: “Mrs. A, the bigger the headache the bigger the pill; The bigger the dog, the bigger the bill.” I don’t think she got either my point or the clever musical reference. We agreed to disagree and she opted to take her dog home without treatment.
I did hear from her just prior to closing that afternoon. The pet was still vomiting and now she was concerned. I referred her to my after-hours emergency services provider, but as expected she was waiting at my door first thing Thursday morning. Here we go again.