Monday, April 19, 2010

Veterinary Experience Antedote

Well the 2 hardest finals are over. I do not think I did great on the one today, but I do think I passed by some slim margin. It is a relief to have that beast of a class behind me. Less than 2 weeks, 2 more finals and 1 paper to go.

As promised, here is my story about taking Spokane to the vet a few weeks ago:

Spokane was lethargic and not acting right for a few days. She vomited twice and was having some intermittent diarrhea. I had faith that it was simple dietary indiscretion and withheld one of her meals and gave her half of her dinner that evening. The next day she had a mild fever of 103 and didn't want her breakfast at all. I started to worry it could be a systemic infection and thought I should take her in.

First of all, the vet tells me it may not be a real fever, she may just be hot. I explained that I took it twice after she was calm and inside and it's real. He believed the diagnosis to be dietary indiscretion, but worthy of a fecal. He quizzed me on the most obscure parasite on the fecal, which I learned as Giardia, but he said was whipworms. Spokane is on a heartworm preventative that kills whips, and while of course it is possible she could have them, it is less likely the culprit.

The fecal was normal and he thought she was acting fine. I clearly wanted him to do something else since it had been 4 days of lethargy and she was now showing systemic signs. He came back in the room, told me she should be on a dog food for a bigger, more active dog instead of a food for her current weight (she is not underweight) and then offered a subcutaneous injection of penicillin G to "reset her GI flora." He indicated that sometimes this helps get them back on track.

Dr. Leib never mentioned resetting GI flora with penicillin and I was pretty sure that wouldn't kill the possible bacteria that could be causing the problem. He also claimed that dietary indiscretion was just a nice word for food poisoning, which I also didn't recall from GI class.

I went ahead with the shot. I thought to myself, "he thinks it works because in the past the client was happy that the doctor gave them something, but their animal would have gotten better anyway. And of course the next morning Miss Spokane was back to her old crazy self, but no thanks to penicillin G.

Since we have talked a lot about antibiotic usage in clinical pharmacology, I decided to speak to my professor about it. I learned that not only is using penicillin or any antibiotic one time only to reset GI flora not true or useful (you would want the normal flora present to compete with the real "bug"), but a subcutaneous dose would not even reach her GI tract in the first place. We started cracking up. Another professor was there and said that at least I recognized that she was better because she would have improved anyway, not thanks to the good old pen G.

It is hard to be a vet and a pet owner. I understand why the vet did what he did, but he also created more antibiotic resistance and stuck a needle in my needle-averse dog (she takes after her mom). Clients often want a fast fix when there isn't one, but many vets give one anyway if it's not too harmful. It was also hard for me to withold food for the more appropriate 24-48 hours, which would reset the flora, because I was worried (like most owners) that she would be hungry. I also use whether an animal will eat as a sure sign they are feeling better.

It was quite the learning experience. I will face many challenges as vet and these some of the most common are client happiness and compliance. I am glad I recognize the situation as a learning experience and I will be reflecting on how I as a new vet can balance these issues to provide the best care for the animal in the most responsibly way.


NylaWoodcock0502 said...

may the blessing be always with you!! ........................................

dean said...


I feel so behind in reading your blog, but I thought this story worth commenting on. You will find yourself under so much pressure from the client to to SOMETHING even if there's nothing wrong. You will spend more time explaining why nothing is wrong than you will ever do explaining a disease process or treatment plan. You will also have to get past client's preconceived notions, which they won't tend to appreciate. When you're talking with a client, determining whether they think something or whether they BELIEVE something will set the stage for how far you can get giving them information. If it's a BELIEF, you're not going to get anywhere. The problem with just doing something that treats the client and not the animal is just like you said - you have now set the stage for them to think something false such as PenG resets the gi flora. I understand why vets will take such shortcuts, because it is easier than explaining things or taking the time needed for a client to truly understand what needs to be done, even if its nothing. But, its still not correct to do that. The temptation will be great, because clients DO want something done. It just takes a lot of talking and explanation and some vets won't take the time. Okay, this was long-winded and hopefully made sense.