When it isn’t good.

This was a hard blog to write. I love my profession and I feel very strongly that the vast majority of veterinarians practice their craft with their hearts and minds in it one hundred percent. There will be times, however, when even the best of veterinarians drop the ball or come up short. This week the main message I want you to take away from this is that you have the right to hold us accountable when we do this. Let us know when you’re not happy and I promise you any decent veterinarian will try to make it right.

Complaints.

All of my clients love their pets. The way they show their love may differ but it is indisputable that all of my clients love their pets. It is because of this love that things can become emotional at times. This week I’m writing to say, “That is ok.” If you don’t understand a diagnosis or a treatment plan, ask a question and don’t hear from one of us, it is understandable to be upset. If the outcome of a case upsets you or you experience a loss and become upset, blame us or say some things you didn’t mean; that happens. We really won’t hold it against you. This is not a license to act the fool every time you get a bit upset but we are all human and we understand that sometimes emotions get the better of us. If you have ever studied neurology you might call this an amygdala hijack.

There will be times, even if I’m your veterinarian, where your veterinarian does something that is just plain wrong. Maybe it’s something simple like forgetting to call you back or maybe it’s something more serious. When these things occur there are multiple ways that you can voice your concerns and, if need be, take action. While you are legally a consumer of a service we provide, we would prefer it if you felt like a member of your pet’s medical team.

No one likes to hear that they’ve done a bad job or that a client is unhappy with the medical care they’ve provided for their pet. In many cases we take it very personally when there is a negative outcome or a patient’s owners aren’t pleased but in every case that comes to mind, the owner that complained directly to us pushed us to make changes to improve the quality of our veterinary care. So while you might not want to seem like a rude person or you might not want to hurt our feelings, please understand that if you are not pleased with any aspect of your experience with us, we want to know right away. More often than not a simple conversation will leave you feeling better and will open our eyes to something we might never have thought of before. I understand not wanting to make a fuss, I’m like that almost all the time, but if you don’t tell us you’re not happy then we won’t ever know and if we never know we won’t ever try to do it better. From another perspective I can tell you that most of us would much rather have a conversation with someone who doesn’t want to be rude or hurt anyone’s feelings than with someone who doesn’t care about those things.

It might happen- I really hope it doesn’t- but it might. You might find yourself in a situation where you don’t think the veterinarian treating your pet has your family’s best interests at heart. It’s times like these where I would recommend that you need to have a conversation with this veterinarian and let them know just how you feel. If they can’t explain themselves or they aren’t willing to have that conversation with you huge red flags should be raised in the back of your mind. No matter what kind of service you receive at a veterinary clinic, restaurant or human hospital you can be sure of one thing, it is probably similar to the level of service everyone else receives as well. That is great when you receive really good care, follow up and follow through. In those cases you may wonder just how they do it and you might call all of your friends and let them know. We certainly hope you do! It’s less great when the service is lacking and the professional providing the service is less than professional and you can be sure if someone is less than straight with you then that is most likely their standard operating procedure and you are not alone. In these cases after having that conversation with the veterinarian (or accountant or real estate broker or tattoo artist) and not reaching any resolution you might want to consider filing a formal complaint. A formal complaint is a legal complaint with your state’s professional licensing board. This sort of thing is serious business and should not be entered into lightly, that being said there are a multitude of check points along the way to opening an investigation that prevent petty and dishonest license claims from clogging up our boards. A license claim is just that, it is an investigation into a professional’s license and their ability to adequately perform within their vocation. You can find more information on the complaint process by visiting the website of your home state’s office of professional regulation.

Every veterinarian I know- and I know a lot of veterinarians- is deeply committed to their work. For the four years of eduction and then most of our careers we have had it ingrained in us that this is a way of life- not just a job. That being said, I don’t know a single perfect veterinarian. We all make mistakes, we could all stand to get a little better at what we do and a big part of getting better is recognizing what we’re doing wrong. If you’re not happy with your experience please let us know; it might be hard to take but it will ultimately allow us to offer you, and everyone else we care for, better veterinary medicine in the long run.

Have a safe and happy Halloween!

Thanks for reading.

 

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That gotta go feeling…

Cats are hardy little survival machines. They tolerate us a lot more than they require us. There are few times when Cuddles needs you to come to his rescue. This is one of them.

Your cat has been going to his litter box every few minutes, maybe he hasn’t left it for a few hours. He’s crying out in what sounds like pain and you haven’t noticed any urination. If he does come out of his box he might drop down and lick at his private areas but still no urine comes out. Please call a veterinarian at this point. If left untreated a blocked cat will build up toxins and will die from changes in their blood chemistry in 3-6 days. It is a fairly painful and treatable condition.

Male cats block for a number of reasons. They may form plugs made of crystals, mucus and/or tiny bladder stones. They may have severe urethral spasms due to stress. They may have a combination of both plus additional factors. The end result is that they can not void urine from their bladders. This causes the kidneys to stop producing urine and the toxins that the kidneys filter from the blood end up building up. These toxins can make your cat very sick. Vomiting is not uncommon and life threatening heart arrhythmias can also occur.

What are we going to do about it? Treatment depends on just how sick your cat is when you bring him in. If he is alert and manageable we might sedate him before we go any further. If he is very down and out and we are concerned that sedating him might be dangerous we may start to check for electrolyte abnormalities and begin treating those before we sedate for catheter placement.

Sedation almost always accompanies the treatment phase. We will place an intravenous catheter for the post obstruction part of this disease often before we even begin to unblock you cat. When Cuddles is sedated we will pass a urinary catheter up his urethra and into the bladder. This can be one of the most frustrating tasks in veterinary medicine though I feel like I’ve really found the most hassle free and gentle means of placing a catheter in male cats. Once we get urine flow through our catheter we immediately start them on intravenous fluids. The kidneys are going to do the bulk of the work from here on out and we simply collect and measure urine to be sure everything is going as expected. Once the removal of the obstruction is complete the kidneys will begin working overtime to make up for the accumulation of toxins that occurred during their brief hiatus. This is potentially very dangerous for your cat as it can rapidly dehydrate him and lead to serious health risks.

We typically will keep an unblocked cat on iv fluids and maintain a urinary catheter until the urine is clear of all visible blood and debris. We will then pull the catheter and be certain they are urinating on their own. Sometimes this can take up to three days. As a result blocked cat’s veterinary visits tend to get very expensive very quickly. It is not unusual for a blocked cat to go home with a dent in his owner’s checkbook to the tune of $2,000.00!

After your cat goes home they are still at an increased risk for re-blocking for a few weeks. During this convalescing period we will institute a number of treatments to prevent the blockage from reoccurring. This will often include diet changes and enhancement of his at home environment. Sometimes it may also include behavior modifying medications. In rare cases, we may have to resort to dealing with the issue surgically. A perineal urethrostomy involves the surgical removal of the penis and urethra up as close to the bladder as possible. This shortens the urethra and places the opening in an area where the urethra is at its widest. By doing this we prevent future blocking as the cat is able to pass larger plugs and there is less urethra to spasm. Personally, I consider this surgery a last resort for cats that repeatedly block and will do almost anything to avoid it. The way I see it as long as you haven’t done it yet any surgery is still an option, once you cut you really can’t take that back.

Unfortunately finances are the demise of many of our patients and I think that obstructed male cats are probably over represented in this category. There are always options available and if you find yourself in this position with your cat please don’t assume you have to make a choice between a huge bill or the loss of a furry friend. I’m not going to get into the “budget” style treatments for unblocking as I would consider them to be less than best medicine but if that’s what it comes to then that’s what it comes to. I would prefer to at least try something than to make a final decision based solely on the finances.

Thanks for reading!