Growing old is the luxury of your ancestors mastering a wealth of tools. Modern medicine has become so highly specialized and advanced that it has extended life spans to triple what they were a hundred years ago. Technology has helped enable us to get real time information and share it almost anywhere in the world in the blink of an eye. We have medical innovations for every conceivable problem, and agricultural advancements guaranteeing us access to an abundance of food. A bazillion tiny steps in our species history, a few millenniums later, and we now have an excellent chance of living past our thirties. We should all feel so blessed. We really do have it easy compared to three, (or more), generations before us.
When life presents us humans with a stumbling block in our health we have so many avenues available to ponder. We live in a country where access is available to miraculous options. If you have insurance the sky is almost the limit, and, you can be carried and cared for through the halls of medicine without ever being told "there is no hope," and/or, "there is nothing more we can do." If you don't have financial resources or health insurance you can walk into any ER and the hospital is still required to help you. On the contrary, in vet med although we can (should) at least be empathetic enough to always grant and garner hope, (although I fear we are not and do not), should you not be fortunate enough to be independently financially secure, or, have insurance that pays at time of service, or, a wealthy animal loving friend, or, good and available credit, when and if it comes to lacking funds for your pet care the doors to help for them unanimously and almost immediately close. Veterinarians are happy to help if you can pay for it with a full deposit to be left with your pet. If you cannot, we have decided to chorus our voices in unison to the anthem of finger pointing blame and deflection with chants about "pets being a privilege, not a right!" (What does this serve other than to humiliate a pet parents breaking heart being forced to part with love due to insolvent ability)? When same clowder of veterinarians do have the opportunity (consent and financial stability) to treat our patients we are expected, and, have to do more, with less. Less available avenues, less access to needed specialists, and less insurance options to allow those necessary diagnostics to uncover correct treatment options, never mind pay for those miraculous medicines. We vets have to be everything to everyone who needs us right here and right now. Never mind the too frequent impatient snarky comments like; "and, if you could be snappy about it I have other things to do with my day, and my time is valuable too." (Hint, hint, this is the wrong thing to say to your vet trying to tick all those possible boxes while flying solo). As you can see, being a veterinarian with the same hopes, fears, and often expectations to take care of your four-legged kids as your two legged kids, is a big ask, with a big bunch of obstacles.
As a veterinarian providing health care options for pets for over 15 years I can testify that we are far more skilled and versed in seeing cases through from start to finish than our human medical counterparts are. We have to. The patients that walk through our front door with a presenting complaint are cared for by us to the completion of care. We are expected to figure out the problem and provide the answer in one visit, and do so based on your budget for it. We are there as the guide for the whole journey. It makes us Sherpa's with invisible tool chests of unparalleled excellence.
We veterinarians have to be a "Jack of all medical trades" as we try to be the one stop medical shop.
I guess I always knew this, but this week I lived this.
This week my life has been a true display of the stark contrasts of veterinary versus human medicine. Lack of full oversight, disjointed as it is too focused on specialized care and passing the buck was found ubiquitously on the human medicine side. This week, in one tumultuous day actually, I took my mom to one ER at 8 am for debilitating pain that left her incapacitated and bed ridden to come home at 2 pm to find my dad having trouble breathing. This led to another trip, with a brief visit to Patient First (different one in a different state), that kicked off an almost immediate transfer to the ER for immediate admission.
Let's start with my moms story.
On Monday December 16, 2019 my mom had surgery. She had elected to do this after a newly discovered mass came back "suspicious" from a needle aspirate. Within days she was given numerous options. She decided to be as aggressive as possible. She is a 23 year previous cancer survivor. She had been aggressive in her treatment and care options decades ago and it had served her well. Her new oncology surgeon was her guide. She, like every other aspect of my moms care came to her with the best medical training, a breadth of experience, and a gentle, compassionate hand. My mom believed she was very lucky to have her.
Surgery went very well. Her surgeon, as is the protocol, looked at the local lymph nodes and decided to take them all as they looked abnormal and she didn't want to leave anything she knew might be dangerous behind. Two days after her surgery my mom came home with a few drains, a new scar but a feeling of relief that this was once again behind her.
Fourteen of the sixteen lymph nodes came back positive for cancer. Her mass was also now able to be definitively labeled.
For this care she was seen by 10 doctors over 4 months, and 6 separate doctor visits. Cumulatively it accrued to about four full 24 hour days.
If she had been my patient with the same condition and the same treatment plan it would have been two visits. Here's the breakdown of a veterinary practice patient flow for this;
The first visit would have been to discuss the history, examine the patient and the mass. From here we discuss a few things.
Important key and critical discussions need to include;
1. Here is what I think we are dealing with.
2. Here is what I think we should do about it.
3. What are the goals for the patient?
Every successful client-patient discussion should stay and be focused within these.
For all patients the discussion of where to go next is usually centered on;
What are the options?
A. Religious Bliss is usually option Number One; I refer to this as; Ignore it and hope. While there are some masses that might appear relatively benign, if you don't have a piece of it, and, if it isn't examined by a credible trained person it is always a "guess and hope" scenario. Some cancers give clear early obvious warning signs. My moms was one of those.
B. Fearful Sleeper; AKA Tiny Lil Poke, FNA., What we call a "fine needle aspirate." Quick, easy, no anesthesia required. I refrain from saying "cheap" because sending that slide of cells to a pathologist is the same price as sending a far more diagnostic large piece of tissue. Pathologists like big, (the bigger the better), pieces of tissue if they have to make a diagnosis and potentially change the life of the person who provided it. FNA's are problematic for multiple reasons. First, you have to poke the correct piece of tissue. Ever try to poke accurately repeatedly and perfectly an awake unhappily to be restrained dog who weighs as much as you do? And, you have to pass that needle through skin, fat, and then a mass covered in multiple layers of tissue? You get artifact along the way to the money shot. I tell clients that you can rely on that slide smear of that aspirate about 70% of the time. In many cases the pathologist has to say "non-diagnostic sample." And there goes your $200. If it comes back as "consistent" with xxx(scary)xxx. We have to recommend a biopsy to confirm, or, a surgery to remove.
C. One Shot Answer. Go for the best chance of getting your diagnosis now and go for the biopsy. If you chose this, and based on loads of factors I always vote to start here, please, oh goodness, please go for a one kill surgery. At my clinic, for my patients I always want "one and done!" One surgery to remove the mass,, diagnose the mass and be done with the mass. In rare cases this is not possible.. all of those cases are cases where people waited too long, or, its a tumor we had little hope of slaying to begin with.
But, lets go back to our heroine. My mom. Human medicine is about hoops... and liability. It would be inaccurate to not point out that these are wonderfully intelligent saviors working in a midst of corporate medically and ethically guided steps, but still slow and cumbersome. My mom had a pretty clear problem, with a very high indication of cancer suspicion. She also had a history to match her fears. She was the duck who looked, walked, and quacked. She also was ready, willing and able to be aggressive. She wasn't the ostrich with her head in the sand.
Here's where I would argue vet med has it's incredible advantages.
If I think I have a patient that I fear has a cancer that needs tending to ASAP I can talk to you about it on the first visit. I can then discuss all of the options. We can then start down that road on day one visit one. Want an aspirate? BOOM! same day, (just give me 10 minutes to set up). Three days later = answer. Not sure you are ready for the road ahead? Let me take a chest x-ray and try to tell you if the Gods are in your favor? (Why because statistically IF there are "mets" (metastatic lesions which are an indication of the mass having spread to the lungs) the prognosis for surgery is the same as without surgery.
Now, lets stop here and take a second. What human medicine provides us and makes me cringe at as I am trying to be the expert of too many things to be anything other than the Queen of The Jack of all trades' is that we guess A -WHOLE-HECK of A LOT! Remember how we got here? We made a guess that this was cancer, and that this was a bad kind of cancer. Educated guess, sure, but we are guessing.
I suppose we should all take a second and reflect that if it is new and abnormal lets just assume it doesn't belong there and evict it. Right?
After the FNA is discussed and either returned as "inconclusive" or, "indicative of cancer" we then discuss getting that bigger piece of tissue. This is where my whole spiel about "anesthesia always has risks, and, a cost. Therefore we weigh the risk versus the benefit" happens. Biopsies need general anesthesia. This is not a decision we make blindly. The average veterinary FNA is about $300, the average biopsy is about $500-800, maybe more if I am going to be aggressive and attempt to remove cleanly. Which is always my goal, (and always should be yours too!).
If we follow my moms example we are now at the place where we have done our exam, done our FNA and now need surgery to confirm the FNA and remove the suspected cancerous mass.
My mom and my patients (almost all (wink-wink) of them) have pre-op blood work. You, me, us, the whole patient list, should have pre-op blood work. No sense going under anesthesia if we fear you won't wake up. (Next asterisk here: a GREAT vet provides help even if corners might be cut. I have done lots of "no other viable choice" surgeries without any pre op diagnostics. I have done these surgeries with all invested parties knowing, thinking, fearing, believing that if we don't do this surgery the only other option is humane euthanasia. So, what do we have to lose? (Maybe the cost of a surgery that ends without a patient walking home? (Has happened maybe (?) once in 15 years of fear-free-trying.)). (See Spencer's Stories here). (Personal plea here, since I started shouldering the possibility of free last chance surgeries I have become full-happy-purpose driven. The more I give away, the more optimism and compassion I give the more I know this is the only way to practice medicine healthy and content). Try, always try. Encourage your clients to try. Be honest. Be a pet parent next to them. It's not about money, or privilege. It's about honoring life and all the desire we all have to keep living it with one more day in the sunshine.
Here's where I would have taken my mom on a different route. I would have looked for mets before scheduling, or doing surgery. The cost for three view chest x-rays at my clinic is $150. It is so helpful to know this. I also have to explain costs, (lucky MDs get to dodge this sticky step). Asking a client to spend likely $800 to $1500 for the mass removal binds me (my ethical opinion) to being completely open and honest.
My mom had her surgery based on an FNA without anything else. Surgery, radical excision surgery was next.
She did great. It was the right choice.
A few days later she developed pain in her back. The pain over 4 days caused her to become bed ridden. I got a phone call at 8 am, "mom can't walk, she wants to talk to you," my dad sputtered.. He handed her the phone, inaudible crying... sputtered words. "Mom, call 911 or go to the ER."
Instead they called the office of their surgeon who suggested they go for an x-ray. My dad elected to go to an independent office that he had used before. He called to notify me. "WHAT! why would you go there?" stammered silence.
"Listen dad, medicine is all about preparing for worst case scenario as you uncover the clues to your situation. Go where her doctor is. (An hour and a half in the opposite direction of his choice). What happens if her xray indicates a serious problem? (Yep, on your way there now aren't you? Or, she gets admitted to a place they don't know anything about her."
He turned around and headed to more recent, although less familiar territory.
Her xray was difficult to definitively diagnose. No broken bones, no abnormal chest patterns, more good news than bad, but, alas also, no answer.
Two days later, after a prescription for ibuprofen (which sarcastic slightly annoyed me will remind you all is NOT a prescription) and she was screaming for help. Again.
This time they (over the phone) decided a CT might be a better diagnostic tool to assess her spine.. their next guess. (Pssst,, mom,, yeah, its me your vet daughter, tell them you need better pain meds. Ask for tramadol and robaxin? (cause, ya, know every doctor loves a back seat driver).
Four days later no answers, no referrals, this time they suggested she could "try the oxycodone she had post op and never took). Oh, and yes, she can have some tramadol.. (squeaky wheels get some relief).
Two days later, Friday morning (yes, yesterday Friday) after basically living at her house and not being able to ease any of her pain we decided at 4 am to go to the hospitals Urgent Care facility for orthopedics. At 8 am, the minute they opened we were there. She needed a wheelchair to get in the door. She could not sit up long enough to finish her paperwork. She was exhausted, beaten into accepting she might never feel better, and so fragile I began to see the world as a matriarch that we weren't leaving without answers I accepted. They were about to meet me litmus test. (I went to a military academy, I am feared, I make no apologies for this. Fair, feared, ferocious, F*%$# 'em.).
Within a few minutes we had a doctor to see her. We went over her history, as garbled and complicated as it was. We all collectively answered questions, provided insight, and started chipping away at her problem instead of punting for diagnostics, waiting for experts, and getting worse.
Dr Dan did an exam with her laying on her back the only place where she was comfortable, and within 10 minutes of that we ruled out her worst case scenarios. She had severe muscle pain based on her history of spinal issues, her surgery past and present and her inability to respond to palpation of her spine. She had muscle pain!" WAIT? WHAT! We were preparing for spine surgery.
"Mom, did anyone examine you the last two times (everything previously had been without me present)?
"No, they just sent me for tests."
In my head, and I am sure a few words slipped out audibly, I thought, "Are you f'ing kidding me? No one touched you? It's been over a week of crying in excruciating pain in bed, and no one touched you. You would have had your answer immediately if someone had touched your spine versus your muscles on other side of it!" In veterinary medicine if your pet sees a vet or any kind, shape, or flavor there is ALWAYS an exam,,, every,,, single,, time! It is malpractice if they do not.
We left with Robaxin and a steroid. She has been slowly improving since.
How can human medicines obsession with diagnostics to achieve a diagnosis be so blind to the basics. On my side of the fence this is "malpractice."
Want to be a skilled doctor, start by being a good listener, a thorough diagnostician, use the tools that trained you (head, ears, nose, hands, and yes, gut), and then tell your mute patients that you can figure it out on BOTH a budget AND without words.
I know pet care can be expensive, but, human care is waay more corporate profit based, waaay more inefficient, and waaay crazy pass the buck hot potato than vet med is.
Chemo is a whole different discussion. My mom has an excellent prognosis because she has a specialist to guide her. A few million previous victors to both benefit from their lessons learned, and outcomes favored, and a militia of determined men and women who all want to see the sunshine on their faces for many more days to come.
Ya know what, vet med has the same. Ya know whats even more amazing, as the mom of two oncology patients they do far better with the treatments than humans do. I would never use the all too common excuse,"I don't want to put them through chemo." If they can benefit from it, live longer lives, see more sunny days, they will probably do far better with it than you think they will." That's dogs and cats. No fear, no apologies. Living today and loving the people they spend it with.
P.S. My mother waxed and waned in pain for four weeks. Four weeks, one of which was as an inpatient hospitalized patient until she had another MRI, and then a bone scan. The bone scan 6 weeks after her surgery revealed metastatic cancer in almost every bone in her body.
Want to know how much I know vet med surpasses human medicine?
Think it might have helped if every doctor she had met had examined her as they listened to her?
Think maybe that cancer in a 23 year post cancer patient wasn't on the top of the "feared" list every time she spoke to a medical professional?
Think that pain care options are doled out in pathetically paltry pieces? (It took 2 weeks to get access to an opioid, and 6 weeks to any kind of meaningful pain relief as every doctor discussed side effects and dependency. Turns out those opioids are her only hope at life long partial relief).
Think that I couldn't have and hadn't already known what she knew about a week after a surgery she sailed through? This was bad, really bad. It is the worst. Took the human MD's 6 weeks to figure it out.
Where is the silver lining in human care versus vet care. She has a better chance at some good time than most vets can offer advanced cancer patients in her same shoes.
There is frustration, of course, but she has a diagnosis now, and options, and yes,, she has what we all universally need, hope.
For more on vet med please see my other blogs. For information on my veterinary clinic see our Facebook Page, or, website JarrettsvilleVet.com.
For more help from me on your pets care please go to Pawbly.com and ask me. It is free to use.
For educational veterinary medicine videos see my YouTube channel here.
My video on her care and the maze of human medicine here;
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| my Frippie and one of her sacred socks. |
As a veterinarian providing health care options for pets for over 15 years I can testify that we are far more skilled and versed in seeing cases through from start to finish than our human medical counterparts are. We have to. The patients that walk through our front door with a presenting complaint are cared for by us to the completion of care. We are expected to figure out the problem and provide the answer in one visit, and do so based on your budget for it. We are there as the guide for the whole journey. It makes us Sherpa's with invisible tool chests of unparalleled excellence.
We veterinarians have to be a "Jack of all medical trades" as we try to be the one stop medical shop.
I guess I always knew this, but this week I lived this.
This week my life has been a true display of the stark contrasts of veterinary versus human medicine. Lack of full oversight, disjointed as it is too focused on specialized care and passing the buck was found ubiquitously on the human medicine side. This week, in one tumultuous day actually, I took my mom to one ER at 8 am for debilitating pain that left her incapacitated and bed ridden to come home at 2 pm to find my dad having trouble breathing. This led to another trip, with a brief visit to Patient First (different one in a different state), that kicked off an almost immediate transfer to the ER for immediate admission.
 |
| Frippie and her shadow Jitterbug |
Let's start with my moms story.
On Monday December 16, 2019 my mom had surgery. She had elected to do this after a newly discovered mass came back "suspicious" from a needle aspirate. Within days she was given numerous options. She decided to be as aggressive as possible. She is a 23 year previous cancer survivor. She had been aggressive in her treatment and care options decades ago and it had served her well. Her new oncology surgeon was her guide. She, like every other aspect of my moms care came to her with the best medical training, a breadth of experience, and a gentle, compassionate hand. My mom believed she was very lucky to have her.
Surgery went very well. Her surgeon, as is the protocol, looked at the local lymph nodes and decided to take them all as they looked abnormal and she didn't want to leave anything she knew might be dangerous behind. Two days after her surgery my mom came home with a few drains, a new scar but a feeling of relief that this was once again behind her.
Fourteen of the sixteen lymph nodes came back positive for cancer. Her mass was also now able to be definitively labeled.
For this care she was seen by 10 doctors over 4 months, and 6 separate doctor visits. Cumulatively it accrued to about four full 24 hour days.
 |
| Magpie protector of the lair |
The first visit would have been to discuss the history, examine the patient and the mass. From here we discuss a few things.
Important key and critical discussions need to include;
1. Here is what I think we are dealing with.
2. Here is what I think we should do about it.
3. What are the goals for the patient?
Every successful client-patient discussion should stay and be focused within these.
For all patients the discussion of where to go next is usually centered on;
What are the options?
A. Religious Bliss is usually option Number One; I refer to this as; Ignore it and hope. While there are some masses that might appear relatively benign, if you don't have a piece of it, and, if it isn't examined by a credible trained person it is always a "guess and hope" scenario. Some cancers give clear early obvious warning signs. My moms was one of those.
B. Fearful Sleeper; AKA Tiny Lil Poke, FNA., What we call a "fine needle aspirate." Quick, easy, no anesthesia required. I refrain from saying "cheap" because sending that slide of cells to a pathologist is the same price as sending a far more diagnostic large piece of tissue. Pathologists like big, (the bigger the better), pieces of tissue if they have to make a diagnosis and potentially change the life of the person who provided it. FNA's are problematic for multiple reasons. First, you have to poke the correct piece of tissue. Ever try to poke accurately repeatedly and perfectly an awake unhappily to be restrained dog who weighs as much as you do? And, you have to pass that needle through skin, fat, and then a mass covered in multiple layers of tissue? You get artifact along the way to the money shot. I tell clients that you can rely on that slide smear of that aspirate about 70% of the time. In many cases the pathologist has to say "non-diagnostic sample." And there goes your $200. If it comes back as "consistent" with xxx(scary)xxx. We have to recommend a biopsy to confirm, or, a surgery to remove.
C. One Shot Answer. Go for the best chance of getting your diagnosis now and go for the biopsy. If you chose this, and based on loads of factors I always vote to start here, please, oh goodness, please go for a one kill surgery. At my clinic, for my patients I always want "one and done!" One surgery to remove the mass,, diagnose the mass and be done with the mass. In rare cases this is not possible.. all of those cases are cases where people waited too long, or, its a tumor we had little hope of slaying to begin with.
But, lets go back to our heroine. My mom. Human medicine is about hoops... and liability. It would be inaccurate to not point out that these are wonderfully intelligent saviors working in a midst of corporate medically and ethically guided steps, but still slow and cumbersome. My mom had a pretty clear problem, with a very high indication of cancer suspicion. She also had a history to match her fears. She was the duck who looked, walked, and quacked. She also was ready, willing and able to be aggressive. She wasn't the ostrich with her head in the sand.
 |
| Storm. All adoration, very little calculation. |
If I think I have a patient that I fear has a cancer that needs tending to ASAP I can talk to you about it on the first visit. I can then discuss all of the options. We can then start down that road on day one visit one. Want an aspirate? BOOM! same day, (just give me 10 minutes to set up). Three days later = answer. Not sure you are ready for the road ahead? Let me take a chest x-ray and try to tell you if the Gods are in your favor? (Why because statistically IF there are "mets" (metastatic lesions which are an indication of the mass having spread to the lungs) the prognosis for surgery is the same as without surgery.
Now, lets stop here and take a second. What human medicine provides us and makes me cringe at as I am trying to be the expert of too many things to be anything other than the Queen of The Jack of all trades' is that we guess A -WHOLE-HECK of A LOT! Remember how we got here? We made a guess that this was cancer, and that this was a bad kind of cancer. Educated guess, sure, but we are guessing.
I suppose we should all take a second and reflect that if it is new and abnormal lets just assume it doesn't belong there and evict it. Right?
After the FNA is discussed and either returned as "inconclusive" or, "indicative of cancer" we then discuss getting that bigger piece of tissue. This is where my whole spiel about "anesthesia always has risks, and, a cost. Therefore we weigh the risk versus the benefit" happens. Biopsies need general anesthesia. This is not a decision we make blindly. The average veterinary FNA is about $300, the average biopsy is about $500-800, maybe more if I am going to be aggressive and attempt to remove cleanly. Which is always my goal, (and always should be yours too!).
If we follow my moms example we are now at the place where we have done our exam, done our FNA and now need surgery to confirm the FNA and remove the suspected cancerous mass.
My mom and my patients (almost all (wink-wink) of them) have pre-op blood work. You, me, us, the whole patient list, should have pre-op blood work. No sense going under anesthesia if we fear you won't wake up. (Next asterisk here: a GREAT vet provides help even if corners might be cut. I have done lots of "no other viable choice" surgeries without any pre op diagnostics. I have done these surgeries with all invested parties knowing, thinking, fearing, believing that if we don't do this surgery the only other option is humane euthanasia. So, what do we have to lose? (Maybe the cost of a surgery that ends without a patient walking home? (Has happened maybe (?) once in 15 years of fear-free-trying.)). (See Spencer's Stories here). (Personal plea here, since I started shouldering the possibility of free last chance surgeries I have become full-happy-purpose driven. The more I give away, the more optimism and compassion I give the more I know this is the only way to practice medicine healthy and content). Try, always try. Encourage your clients to try. Be honest. Be a pet parent next to them. It's not about money, or privilege. It's about honoring life and all the desire we all have to keep living it with one more day in the sunshine.
Here's where I would have taken my mom on a different route. I would have looked for mets before scheduling, or doing surgery. The cost for three view chest x-rays at my clinic is $150. It is so helpful to know this. I also have to explain costs, (lucky MDs get to dodge this sticky step). Asking a client to spend likely $800 to $1500 for the mass removal binds me (my ethical opinion) to being completely open and honest.
 |
| My pups waiting for dinner |
She did great. It was the right choice.
A few days later she developed pain in her back. The pain over 4 days caused her to become bed ridden. I got a phone call at 8 am, "mom can't walk, she wants to talk to you," my dad sputtered.. He handed her the phone, inaudible crying... sputtered words. "Mom, call 911 or go to the ER."
Instead they called the office of their surgeon who suggested they go for an x-ray. My dad elected to go to an independent office that he had used before. He called to notify me. "WHAT! why would you go there?" stammered silence.
"Listen dad, medicine is all about preparing for worst case scenario as you uncover the clues to your situation. Go where her doctor is. (An hour and a half in the opposite direction of his choice). What happens if her xray indicates a serious problem? (Yep, on your way there now aren't you? Or, she gets admitted to a place they don't know anything about her."
He turned around and headed to more recent, although less familiar territory.
Her xray was difficult to definitively diagnose. No broken bones, no abnormal chest patterns, more good news than bad, but, alas also, no answer.
 |
| Jitterbug admires himself |
Two days later, after a prescription for ibuprofen (which sarcastic slightly annoyed me will remind you all is NOT a prescription) and she was screaming for help. Again.
This time they (over the phone) decided a CT might be a better diagnostic tool to assess her spine.. their next guess. (Pssst,, mom,, yeah, its me your vet daughter, tell them you need better pain meds. Ask for tramadol and robaxin? (cause, ya, know every doctor loves a back seat driver).
Four days later no answers, no referrals, this time they suggested she could "try the oxycodone she had post op and never took). Oh, and yes, she can have some tramadol.. (squeaky wheels get some relief).
Two days later, Friday morning (yes, yesterday Friday) after basically living at her house and not being able to ease any of her pain we decided at 4 am to go to the hospitals Urgent Care facility for orthopedics. At 8 am, the minute they opened we were there. She needed a wheelchair to get in the door. She could not sit up long enough to finish her paperwork. She was exhausted, beaten into accepting she might never feel better, and so fragile I began to see the world as a matriarch that we weren't leaving without answers I accepted. They were about to meet me litmus test. (I went to a military academy, I am feared, I make no apologies for this. Fair, feared, ferocious, F*%$# 'em.).
Within a few minutes we had a doctor to see her. We went over her history, as garbled and complicated as it was. We all collectively answered questions, provided insight, and started chipping away at her problem instead of punting for diagnostics, waiting for experts, and getting worse.
Dr Dan did an exam with her laying on her back the only place where she was comfortable, and within 10 minutes of that we ruled out her worst case scenarios. She had severe muscle pain based on her history of spinal issues, her surgery past and present and her inability to respond to palpation of her spine. She had muscle pain!" WAIT? WHAT! We were preparing for spine surgery.
"Mom, did anyone examine you the last two times (everything previously had been without me present)?
"No, they just sent me for tests."
In my head, and I am sure a few words slipped out audibly, I thought, "Are you f'ing kidding me? No one touched you? It's been over a week of crying in excruciating pain in bed, and no one touched you. You would have had your answer immediately if someone had touched your spine versus your muscles on other side of it!" In veterinary medicine if your pet sees a vet or any kind, shape, or flavor there is ALWAYS an exam,,, every,,, single,, time! It is malpractice if they do not.
We left with Robaxin and a steroid. She has been slowly improving since.
How can human medicines obsession with diagnostics to achieve a diagnosis be so blind to the basics. On my side of the fence this is "malpractice."
Want to be a skilled doctor, start by being a good listener, a thorough diagnostician, use the tools that trained you (head, ears, nose, hands, and yes, gut), and then tell your mute patients that you can figure it out on BOTH a budget AND without words.
I know pet care can be expensive, but, human care is waay more corporate profit based, waaay more inefficient, and waaay crazy pass the buck hot potato than vet med is.
Chemo is a whole different discussion. My mom has an excellent prognosis because she has a specialist to guide her. A few million previous victors to both benefit from their lessons learned, and outcomes favored, and a militia of determined men and women who all want to see the sunshine on their faces for many more days to come.
Ya know what, vet med has the same. Ya know whats even more amazing, as the mom of two oncology patients they do far better with the treatments than humans do. I would never use the all too common excuse,"I don't want to put them through chemo." If they can benefit from it, live longer lives, see more sunny days, they will probably do far better with it than you think they will." That's dogs and cats. No fear, no apologies. Living today and loving the people they spend it with.
P.S. My mother waxed and waned in pain for four weeks. Four weeks, one of which was as an inpatient hospitalized patient until she had another MRI, and then a bone scan. The bone scan 6 weeks after her surgery revealed metastatic cancer in almost every bone in her body.
Want to know how much I know vet med surpasses human medicine?
Think it might have helped if every doctor she had met had examined her as they listened to her?
Think maybe that cancer in a 23 year post cancer patient wasn't on the top of the "feared" list every time she spoke to a medical professional?
Think that pain care options are doled out in pathetically paltry pieces? (It took 2 weeks to get access to an opioid, and 6 weeks to any kind of meaningful pain relief as every doctor discussed side effects and dependency. Turns out those opioids are her only hope at life long partial relief).
Think that I couldn't have and hadn't already known what she knew about a week after a surgery she sailed through? This was bad, really bad. It is the worst. Took the human MD's 6 weeks to figure it out.
Where is the silver lining in human care versus vet care. She has a better chance at some good time than most vets can offer advanced cancer patients in her same shoes.
There is frustration, of course, but she has a diagnosis now, and options, and yes,, she has what we all universally need, hope.
For more on vet med please see my other blogs. For information on my veterinary clinic see our Facebook Page, or, website JarrettsvilleVet.com.
For more help from me on your pets care please go to Pawbly.com and ask me. It is free to use.
For educational veterinary medicine videos see my YouTube channel here.
My video on her care and the maze of human medicine here;
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