Why does 1 of my dogs have bad skin and her litter mate is perfect?
“I’m beside myself. Chica stays up all night itching and I’ve tried everything.” Rosada stood defiantly planted on the opposite side of the stainless steel exam table from Doc Truli. A 4-pound (1.8 kg) Maltese shook in her little fuzzy white paws on a pink towel on the slick silver table. “Her sister is twice her size and her skin is perfect. I know Chica was the runt of the litter, but why is her skin so bad?”
Little Shih Tzu has a Lump
Mei Mei wagged her stubby scrubby black and white tail. A tiny fur matt dangled off the end like a tail earring. Mei Mei stamped her front paws as if to say, “Give me a cookie!” Doc Truli laughed and felt the little Shih Tzu’s submandibular lymph nodes.
Mei Mei’s mom said, “Her face has been swollen for a few weeks. We know her teeth are bad We figured it’s a tooth root abscess. We really don’t want to put her through surgery. We just want to try antibiotics.”
Before launching into the discussion about why antibiotics will never cure a tooth root abscess, Doc decided to examine little Mei Mei.
“Oh Nancy, antibiotics aren’t going to help this,” said Doc Truli
How Does a Bite Wound Heal?
Remember Minnie from VirtuaVet’s last story about cat bite wounds?
Drains Prevent Sepsis
First, Minnie was supposed to come visit Doc Truli three to five days after her original surgery in order to have her Penrose latex drains removed from underneath her skin on her right hind leg.
“I had to take care of an emergency with my family, and then I was in the hospital, and it just didn’t happen,” said Minnie’s human. “I kept it clean and dry.”
Doc Truli evaluated the drains and the wound healing. “Minnie’s lucky. She’s healing really well. We have to remove these drains and make sure there are no pieces of latex stuck under her skin. They would act like a foreign body and cause a severe reaction,” said Doc Truli.
Minnie the Cat has Extensive, Hidden Trauma
“She was perfectly fine last night at 10 p.m. Today she just lays around and won’t even eat her favorite- rotisserie chicken,” said Roxy. The black, short-haired, slightly pudgy domestic kitty purred. Her golden eyes stared up at Doc Truli from the zippered opening of her burgundy polyester cat carrier. Minnie looked normal.
“Does she go outside?” asked Doc Truli.
“Yes, she loves to sleep on the hood of the car in the sunshine and sometimes she sleeps on the back porch in the afternoon. She stayed out all night two nights ago and didn’t come back until the next morning. She seemed fine,” said Roxy.
Doc Truli knew better than to just reach into the carrier of a supposedly friendly cat who may be in pain. With a gentle hand, she felt Minnie’s head and lymph nodes, then her shoulders, then her back and finally, her hips. Minnie growled.
“She hurts in the back-end. Let’s get her out of this carrier carefully and see why she hurts back there,” said Doc Truli.
“Now that you mention it, I have not seen her get up and walk in more than a day,” said Minnie’s mom. You’d think someone would lead with that observation…
Doc felt Minnie’s right hip, haunch and hind leg. The whole thigh felt crinkly with crepitus (pronounced crep-i-tuss). Doc knew immediately that anything causing that much air under the skin was extensive. Usually a bad infection or trauma will cause air under the skin.
“Minnie needs sedation and surgery to identify all her wounds and fix them,” said Doc Truli.
“I can’t believe it. She was perfect yesterday,” said Roxy. “Why does everybody say that?” thought Doc Truli.
Reality Check: Your Limited Budget Causes You to Jump from Doctor to Doctor to Take Advantage of Free or Discounted Initial Examinations
Peaches hissed from his carrier. Then he yowled and Doc Truli suspected the examination would be limited, at best. The angry, sick 4-year-old orange tabby cat had not urinated in 48 hours. During that time, he had seen 4 veterinarians for initial “discounted” visits. His mom could not afford full hospitalization and unblocking under anesthesia, especially considering he should have had blood tests and intravenous fluids therapy and other costly treatments to save his life. So each veterinarian told her that her cat would die a painful toxic death if he did not urinate and gave her a treatment plan estimate ranging from $100 for basic passing a urinary catheter and no other medications or treatment to $650 to do everything properly. Mom felt $100 was not affordable, so she declined and packed her cat off to another doctor for another opinion.
By the time she arrived at Doc Truli’s pet emergency room, the cost of the 4 veterinary examinations was $120. Basically, if she had stayed at the first clinic and accepted a basic treatment plan that would probably save his life, he would be unblocked and have chance of recovery. Instead, she already sent more than her budget and after Doc Truli told her Peaches was indeed completely “blocked,” she refused to believe the diagnosis and packed him up for a car trip to another vet office.
This is an extreme example of the craziness desperation can infuse into a situation. But it nonetheless happened. Doc Truli hopes someone was able to treat Peaches.
If You Feel You Must Consult an Additional Veterinarian, Do It Right
- If the diagnosis is straightforward and you cannot afford the plan our hospital offers, ask for a payment plan. Ask if they participant in any third-party systems like CareCredit.
- Ask if there is a doable less expensive diagnostic and treatment plan. Let them know you do not wish to harm your pet, but is there a solution that is cheaper and usually works (understanding there are no guarantees in medicine.)
- If the diagnosis is made, but the treatment is too expensive at your hospital, bring a copy of the records with you to the second opinion hospital. “Too many people are embarrassed to tell their vet they have to try elsewhere, so they don’t even let the new vet call for the records,” says Doc Truli. If the second opinion veterinarian can review the physical exam, history and diagnostic test results, you save time and money every time.
- If the diagnosis is not straightforward, pay for a second opinion with a board-certified specialist. “There is little point in dragging your pet from one general practitioner to another. Upgrade your information source to a specialist and often you will save money in the long run.”says Doc Truli.
- Ask how much and how many rechecks the vet expects to need. Budget for them. “Skipping rechecks often lands you back at the starting point of the disease and you never get anywhere with it,” says Doc Truli.
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Reality Check: We Used to be Able to Afford Top Veterinary Care, Now the Vet Takes Us for Granted and We’re Embarrassed to Tell Them
Hershey’s dad was a model top-end veterinary client. The 6-year-old chocolate labrador retriever received all preventative care, including hip x-rays and regular anesthetic tooth cleanings and all diagnostics when she started showing symptoms of diabetes insipidus.
Reviewing her medical history was a dream for Doc Truli. “What could this family’s previous vet possibly have done to lose such a good client?” thought Doc Truli, wishing to avoid the same scenario if possible.
The answer.”They took me for granted and stopped explaining anything they were doing. I still trust them, but I felt disrespected and frankly, I lost my high-paying job and can no longer afford to just say ‘yes’ to everything without prioritizing,” said Hershey’s dad.
So he left. Flew the coop. Sashayed up county to Doc Truli. Wished to start a new veterinary relationship from a fresh perspective. The problem? “Continuity of care is invaluable to saving you money on veterinary care over the years,” says Doc Truli. “If you feel you need to reset the relationship with your veterinarian, go ahead and address it with a trusted nurse or the doctor themselves. If you frequent a large multi-doctor practice that you love and trust, ask to speak with the manager. It’s their job to facilitate your needs.”
How You Save Money Sticking With an Excellent, Trusted Veterinarian
- No repeat work-ups. Your veterinarian knows you have already investigated certain avenues.
- Understanding your goals for your pet. Some people value longevity, some quality. Some people believe in surgery and medical intervention at any cost. Some people believe in keeping a pet comfortable, but not in the hospital setting. A veterinarian who knows your wishes can tailor a plan for your family.
- One mind holding a long-term diagnostic and treatment plan for skin disease, ear disease, eye disease, and many different internal conditions, like diabetes mellitus. Miscommunication and missing medical records will cause a veterinarian new on the case to retrace your steps, redo testing, and maybe misunderstand and actually cause a decline or death earlier than you expect for your pet.
- A new veterinarian might just keep doing what the record says your old vet did, instead of forwarding the plan and building on any progress you have made. For example, not curing a skin infection, but just keeping it under control so it seems like you cannot ever get your pet off the medicine.
The Phrase That Causes the Veterinarian Stress and Complicates Open Communication
This is not your problem, but let Doc Truli share a secret:
“When you say, ‘go easy on me Doc’ meaning you lost your job, your pension, you’re disabled, you only brought $40 with you, or whatever, it causes me to worry about money, even subconsciously, when I really should only apply my brainpower to the medical care for your pet,” says Doc Truli. Basically, why are you paying for a consultation and then asking the veterinarian to limit their recommendations and not tell you all of your options? You should demand a full consultation and a written record of all of your options for the price of your office call and examination. Your veterinary team can then help prioritize the plan for you and make a plan to fit your budget and your priorities. But only after you know the situation at hand.
You only add tremendous stress on your veterinarian’s shoulders when you air your personal problems. In fact, in decades past, it would be unthinkable, degrading, and downright embarrassing to tell a medical professional, or anyone, that you are broke, jobless, homeless or unhealthy. Nowadays, it seems to be a calling card. Where have manners and civility gone? No wonder modern society has so much stress!
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Reality Check: We Cannot Afford Our Own House or Apartment
Ralph the American Bulldog camps out in a back bedroom of his grandparents’ house. The two bedroom, two bathroom, single story white stucco one-car garage home built in 1979 as a retirement retreat on the west coast of Florida now sits on a street of young families with children, renters, and a few elderly men who have outlived their wives. Doc Truli’s clients retired 15 years past and welcomed three cats and a chihuahua into their abode. A tight fit, the pets enjoyed each other’s company and took turns sharing the bed with mom, disabled and bedridden many days of the week.
Enter the 35-year-old son, his 25 year-old girlfriend, their 6-month old American Bulldog puppy and a bad case of post-traumatic stress disorder after two tours in Afghanistan for the son. This little family moved into the second bedroom when they could no longer swing rent on their own apartment. Doc Truli was called for a behavior consult. “Why is my chihuahua biting my son’s girlfriend?” The final diagnosis: too many people and pets, too few rules, too much anxiety and erratic behavior, a chihuahua guarding a bedridden mom and viola: the girlfriend receives a chihuahua bite when she reaches down for the harness in order to put a leash on the chi and take him for a walk.
Soon Bulldog puppy is biting disabled mom’s hand as she walks by swinging her arm for balance, and two cats have licked their bellies bald from stress grooming. Sheesh.