Author Topic: Consultation: A Comedy of Errors  (Read 7999 times)

Offline FurMonster Mom

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Consultation: A Comedy of Errors
« on: September 25, 2011, 12:38:22 AM »
Sssssoooooooo.....

Belle's teeth have not been improving, and she is in more pain than I can manage with the leftover 3 year old Torbutrol in the 'fridge.

So we took Miss High and Mighty Princess Belle in to the vet for a dental consultation.
I knew I'd be dealing with the weekend vet, so I was really only hoping for a little pain meds and maybe antibiotics to tide over until we could schedule a procedure with our regular vet.

So the weekend vet says, 'Oh yeah, it looks like she has neck lesions.  If that's the case, there is probably a pocket full of bacteria sitting underneath the teeth.... but the "good news" is that they are easier to take care of than a full tooth extraction'. 

She then goes on a lengthy explanation about the difference on how they handle a "crown zip" vs. a complete extraction.  Now, I generally catch on pretty quick, but I know that she is unfamiliar with us, so I let her prattle while my mind wanders...

Then this pops out of my mouth; "hmmm... if she loses most of her teeth, I'll have to do something with her food".  (daggum it!  inside voice!)
To which she instantly replies, "Oh it'll be no problem, they handle wet food just fine!"

Obviously, she did not read our file.

I smile and my husband chimes in with me, "No, we feed a raw diet." 
And I continue, "I was thinking about her boney meals".  (gah! I just can't seem to help myself.)

Suddenly she seems a little flustered, "oh.  errr... what kind of bones do you feed?"

"Chicken"

I will give her a little credit, she did try to contain her consternation... it was just a fleeting look of horror.

I smile again, "They're actually fairly soft when raw".

"Well," she says, desperately trying to regain her footing, "I guess you could chop them up, or put them through a blender" (wow, this girl is a real problem solver!).

Looking at her thoughtfully I say, "Oh, I do chop them up already, was just thinking if the boney bits will aggravate her gums with no teeth". 

"Or!" she exclaims with an air of sudden inspiration, "You could leave out the bone and substitute with some wet food.  You know, for the taurine."

Now it's my turn to look a little confused.  "I'm not worried about taurine, I feed them hearts every other day."

This time she is less successful in hiding her surprise.  "I'm... sure a blender would get it all fine enough."

I smile and nod, and Hubby chuckles. (bless him!)

So, to get back on track, I ask about antibiotics, and she says; 'Oh, I don't think we need to do that, unless you are unable to afford the procedure and we have to delay beyond a week'.

hmmmmm.... Didn't she explain at the start that there is probably a pocket of bacteria campin' out under the teeth?
I let it go.

So she rustles up an estimate for us... $1150
For a basic dental, with slight padding for the likelihood of surgery.

My instant reaction was, "Holey crap!  there's no way!"
And her instant reaction was, "If finances are tight, you could try Care Credit."
I shake my head stubbornly, "I don't like to use those guys".
She doesn't even bother to try to hide her surprise at this, "Oh?!  But they offer a 12 month, no interest --  why? ---".  (I think I stopped her with my "stubborn look"... I admit, it can be intimidating.  I inherited it from my dad.)
She tries one last rally, "If you're thinking of putting it on a credit card, it's a good option". 
I stare at her silently.

"Let me go see if that estimate has printed up, and we can go over it".  She flees.

I turn to my dear Hubby with my "O. M. G." face.  He looks back at me and shakes his head, "Let's see what the breakdown is."

The vet returns with the printout, which I take and peruse while she babbles on about how she included this and that, so the estimate is high, and if we want to cut costs she recommends doing it with the bloodwork, because they could conceivably do the procedure with a simple bloodworkup as long as everything else looks good.... 

And yes, I do believe she said all of that without taking a single breath.

So, I'm looking at the breakdown and something catches my eye.  "Rimadyl?", I blurt out.

"Yes," she assures me breezily, "it's an NSAID.  We give them an injection and it stays in their system for 3 days, then it clears out."
Alarms are going off in my head, but I can't remember exactly why this is unsettling me.  I just have this feeling....

I turn to Hubby with "that look".  He turns to the vet, "We need to take this home and discuss it."  (bless him, bless him!)
I chime in, "What can we take home to give her for the pain in the meantime?".

"Well," she hems, "I could send you home with a couple days worth of Buprenorphine drops."
"I've never heard of it, and believe it or not she does better with pills."
Now I guess it's her turn to be stubborn, "Well, it's really the only thing I can send you home with."
So I tell her that I've been giving Belle a small dose of the leftover Torb.
"Well," she hems again, "I could send you home with some Torb., but it only last for about 45 minutes, where the Buprenorphine will last for 8 hours".
I nod reluctantly, "Okay then, we'll give it a try".

We wrap up, and go out to pay our $42 consultation + $30 meds bill.

*sigh*

.
meow meow meow meow meow meow? -woof!
Translation: "I can has my raw food? -please!"

Offline Shadow

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Re: Consultation: A Comedy of Errors
« Reply #1 on: September 25, 2011, 01:38:21 AM »
Oh we are so sorry that you are going through this with Belle.  That sure is expensive!! When Shadow had all her teeth out it was only just over 300$, she had all out but her fangs and a few inscissors.
If you can do it I would see if antibiotics work first, then you may just have to have her teeth removed, but not all of them. I remember reading a story about a cat on the internet who ate raw and did not have any teeth. So maybe at first it will be difficult, and you  will have to eliminate the bone until she heals, but she will be fine after that.
We hope you guys can figure out a plan, and Belle feels better.  Let us know how it goes ok. cat4
I remember someone posting about Rimadyl here, and that is is bad stuff, so its good that warning bells went off for you there.  phew!!!
"Education is the key" to make informed decisions about the health of our pets

Offline Middle Child

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Re: Consultation: A Comedy of Errors
« Reply #2 on: September 25, 2011, 06:55:17 AM »
First of all neck lesions is another word for resorptive lesions, which is another way of saying FORL, Feline Odonoclatstic Resorptive Lesions.  They are extremely painful (imagine razor blade in the mouth) and the only cure is to remove the entire tooth, including the root.

Burpenex (buprenophine)drops are not put down the throat.   The medicine is absorbed through the mucus membranes in the mouth.  You simply squirt the syringe into the mouth, and within 10 minutes, the cat is no longer feeling pain.  It is good for 10-12 hours, then they need another dose.

I would not discard the idea that she will not be able to eat a raw diet with no teeth, but if she can't, a life on a cannned diet is much preferable to a life of FORL pain.  My senior boy gets resorptive lesions, I know how terribly painful it is. And when you consider that cats HIDE pain, by the time they show they are in pain, they've been suffering a very long time.

I hope you don't have to see that vet again, with her misinformation.

Good luck to Belle, and get those FORL teeth taken out as soon as possible. I've heard FORL described both as razor blades in the mouth, and barbed wire in the mouth.

Offline Middle Child

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Re: Consultation: A Comedy of Errors
« Reply #3 on: September 25, 2011, 07:02:22 AM »
Your instincts on Rimadyl were right on, it should never be used in cats.

http://parenting-furkids.com/index.php?topic=686.0


Offline FurMonster Mom

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Re: Consultation: A Comedy of Errors
« Reply #4 on: September 25, 2011, 03:05:05 PM »
MC, thanks for the info on neck lesions... actually, I had included a link on that in my story, as well as a link on the buprenorphine.   ;)

I didn't mention how the drops are administered, because... well... the vet didn't tell us
Since it comes in a syringe, not a dropper, I went home and squirted the whole dose in the back of her mouth.  THEN I found several sites online that mentioned that you're supposed to drop the liquid bit by bit onto the gums and along the gum line.   Doh1
I am, however, satisfied that it is a viable pain management medication, even if it is a bit pricy ($3.50 per dose, 2 doses a day).

Also, I went to Rimady's own website, and at the bottom there is a link that says "Click here for full prescribing information".  It takes you to a PDF of the mandatory information paper (you know, the ones printed in teensy font on tiny paper..).  Right up top it says "For subcutaneous use in dogs only".  Also, under the warnings section (5th section), it says in bold lettering "For use in dogs only", and the very next sentence is, "Do not use in cats."  There is no wiggle room with that statement.  If a vet is using this in cats, against the manufacturers own directions, they are opening themselves to liability.

Now, the reason I am calling this a "comedy of errors" is because, if I'm honest with myself, I have to admit I did not pick my battles very well.
That whole tangent about the food was completely unnecessary, even if it did produce that little gem about substituting bones with canned food for the taurine.

Nevertheless, when we got back to the car, Hubby and I started to share our thoughts on the "consultation".
My first comment was something along the lines of, "Why do I feel like she was just trying to make a sale?".
Hubby, "Well, she sure did talk a lot".
Me, "She... prattled... on and on and on."
Hubby, "Yeeeeaaaahhh..... I get the sense that she's one of those vets that does better with the animals than with the people."
Me, "Ya think?"
Hubby, "Yah.  I mean, she handled Belle without thinking twice, it was second nature to her.  But she seemed... nervous when talking to us."
Me, "So, maybe her blathering was just nerves?"  (I can relate to this a bit, happens to me when I audition).
Hubby, "Maybe."
Me, "Maybe."
Me, "But I still have questions about this... 'estimate'."
Hubby, "Yeah."

So, I will be digging up the records on Belle's last round of extractions, as well as Ol' Man Travis' round of extractions (he had 18 teeth pulled!), to compare.  I DO plan on having a conversation with our regular vet about all of this.

.
meow meow meow meow meow meow? -woof!
Translation: "I can has my raw food? -please!"

Offline CarnivorousCritter

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Re: Consultation: A Comedy of Errors
« Reply #5 on: September 25, 2011, 03:30:59 PM »
FurMonsterMom, I'd have given anything to have had your foresight 5 years ago.   grouphug

We trusted blindly. Very blindly - too spoiled from out longtime vet; didn't know how to second guess the over-zealous salespeople because we'd never been exposed to the likes of them before.  

Offline Mo

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Re: Consultation: A Comedy of Errors
« Reply #6 on: September 25, 2011, 05:14:35 PM »
It sounds a lot like what I just went through with Mikey, taking him to the vet.  He had a bite wound on his front leg, so he needed to go to get antibiotics.

This isn't the exact wording, but unfortunatly, it is close.

Vet:  He looks very healthy, and his teeth are so clean!  He must be around 9 months old?
Me:  He is actually 8.5 years old.  He looks that way because of what I feed him.
Vet: There is no way he is that old.   *looks at Mikey's leg*:  Well, it is a good thing it was caught before it abcessed.  I'll go get a shot of metacam to help with the pain, and he also will get some convenia, it is an antibiotic.
Me: I don't want him to get Metacam or Convenia.  They are both very unsafe for use in cats.
Vet:  They are both safe and meant to use in cats.
Me: Metacam is labelled for dogs, and says that it is not to be used for cats.  Convenia stays in the cats system for several months, Mikey already has issues with allergies, and I am not taking the chance of him being allergic to the Convenia.  I'd rather he had Clavamox, it has worked very well for him before.
Vet: Fine - your choice, your loss.  It is much more convenient to go the other route.  While he is here, it looks like he is 3 years overdue on all his vaccines, he should get them now, it would be more convenient for you. 
Me: I don't want him to be vaccinated right now.  His body is under enough stress. 
Vet: It isn't hard on the cat to get vaccinated.  *looks at Mikey again*  You said he looks healthy because of his diet.  You must be feeding Nutro then?

Me: I feed him a prey model raw diet.  You are not going to talk me out of feeding him that.  You yourself said he was healthy.  Can someone please go get the clavamox so that I can leave?
Vet: *walks out in a huff*
Vet Tech: *comes in and gives me Mikey's meds.*  He looks so healthy! 

Me: Thanks, I feed him a prey model raw diet.  Cats are carnivores - raw feeding is really good for them.  *walk out leaving shocked vet tech in room*



Yeah, gotta love misinformed vets!

Offline Pookie

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Re: Consultation: A Comedy of Errors
« Reply #7 on: September 26, 2011, 11:40:15 AM »
Vet:  He looks very healthy, and his teeth are so clean!  He must be around 9 months old?
Me:  He is actually 8.5 years old.  He looks that way because of what I feed him.
Vet: There is no way he is that old.   *looks at Mikey's leg*:  Well, it is a good thing it was caught before it abcessed.  I'll go get a shot of metacam to help with the pain, and he also will get some convenia, it is an antibiotic.
Me: I don't want him to get Metacam or Convenia.  They are both very unsafe for use in cats.
Vet:  They are both safe and meant to use in cats.
Me: Metacam is labelled for dogs, and says that it is not to be used for cats.  Convenia stays in the cats system for several months, Mikey already has issues with allergies, and I am not taking the chance of him being allergic to the Convenia.  I'd rather he had Clavamox, it has worked very well for him before.
Vet: Fine - your choice, your loss.  It is much more convenient to go the other route.  While he is here, it looks like he is 3 years overdue on all his vaccines, he should get them now, it would be more convenient for you. 
Me: I don't want him to be vaccinated right now.  His body is under enough stress. 
Vet: It isn't hard on the cat to get vaccinated.  *looks at Mikey again*  You said he looks healthy because of his diet.  You must be feeding Nutro then?
Me: I feed him a prey model raw diet.  You are not going to talk me out of feeding him that.  You yourself said he was healthy.  Can someone please go get the clavamox so that I can leave?
Vet: *walks out in a huff*

Sorry, Mo, but I have to say this:  what a jerk that vet is!  “There is no way he’s that old.”  Um, I would think the owner would know how old the cat is.  “Your choice, your loss.”  EXCUSE ME???  How rude!  “It is much more convenient to go the other route.”  More convenient for who?  It won’t be convenient for anybody if Mikey got sick on that stuff!  “You must be feeding Nutro then?”  AUGH!   bangshead

As for him/her not knowing those products were off-label for cats, I can’t stand it.  You know, I’m told I have really high expectations, and maybe I do, but is it really “high expectations” to expect a MEDICAL PROFESSIONAL to keep up on this stuff?

Sorry, I don’t mean to rant, but after 4 vets (and possibly soon to be 5, if I can find one that meets my “high expectations"), I’m so tired of the ignorance that seems to run rampant in this profession.  It seems like for every competent vet out there (and I’ve yet to actually meet one that I felt 100% confident in), there’s 100s more that aren’t.   pullingouthair

I wish I was like you, Mo, who knew exactly how to respond and hold your ground.  I’m always caught off-guard and end up thinking of what I should have said hours later.   bangshead Doh1
2-4-6-8  Please don't over-vaccinate!
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Offline CarnivorousCritter

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Re: Consultation: A Comedy of Errors
« Reply #8 on: September 26, 2011, 12:18:56 PM »
Sorry, Mo, but I have to say this: 
As for him/her not knowing those products were off-label for cats, I can’t stand it.  You know, I’m told I have really high expectations, and maybe I do, but is it really “high expectations” to expect a MEDICAL PROFESSIONAL to keep up on this stuff?
bangshead Doh1

I spent over an hour on the phone with a Pfizer person (one of their vets) crying about what we went through because I didn't think to get on the Internet, and they told me I should have at least been given the print-out they provide with their meds. I was not warned of possible side effects and the "vets" refused to consider anything other than "neurological" a possibility when the sudden seizures began.

Quote
Sorry, I don’t mean to rant, but after 4 vets (and possibly soon to be 5, if I can find one that meets my “high expectations"), I’m so tired of the ignorance that seems to run rampant in this profession.  It seems like for every competent vet out there (and I’ve yet to actually meet one that I felt 100% confident in), there’s 100s more that aren’t.   pullingouthair

I wish I was like you, Mo, who knew exactly how to respond and hold your ground.  I’m always caught off-guard and end up thinking of what I should have said hours later.

IMO the problem is, unlike all the other professions save maybe the Politicians and even they get voted out (also lambasted publicly so that everybody knows their dirt), there is nobody to answer to. Not even the clients, because they won't raise a stink to attorneys and the like as they would with say an MD or Mechanic -- or any profession which has somebody other than the PFI & Pharma funding them to answer to.   

If you complain about a veterinarian committing malpractice, who do you complain to? The Association, which can NOT bad-mouth the PFI and Pharma which fundsthem?  This is the problem, IMO.   Consumers can sue the drug COs till they're blue in the face, but the vets will still keep on selling them to unknowing clients because, really, who is going to object?

Until "The Rules" for MDs apply to vets as well, and the "forgiving" double-standard ends, it will go on and on. How many clients DO find new vets even when they know the vets are "clueless" regarding food-drugs? Much different when it comes to everyone else, from MDs right down to hairdressers & restaurants.

They have no incentive to know the food they are telling people to feed and drugs prescribed are detrimental to health while the incentive IS there to promote and sell it -- along with NO regulation or unbiased authority to govern it.

It boils down to: Pet owners = biggest $ucker$ on earth because of the vulnerability of having beings in their care not being able to say what hurts...

Once the diamond in the rough is found, s/he is priceless. They are out there. Somewhere...











Offline CarnivorousCritter

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Re: Consultation: A Comedy of Errors
« Reply #9 on: September 26, 2011, 12:27:59 PM »

As for him/her not knowing those products were off-label for cats, I can’t stand it.  You know, I’m told I have really high expectations, and maybe I do, but is it really “high expectations” to expect a MEDICAL PROFESSIONAL to keep up on this stuff?


Things are backwards now, different than yours and our longtime veterinarian's philosophy.

He would know everything about any drug he would consider prescribing, and admittedly nothing about what food to feed. He said it best when we asked about food:  "We're just Doctors."    Medicine surgery....they diagnose and treat.  

Sorry this is long, but here are excerpts from Dr. Michael W Fox:

 http://www.twobitdog.com/drfox/specialreport_Article.aspx?ID=f78aec92-0b02-47f3-9575-cb1778647ad5
http://advocacy.britannica.com/blog/advocacy/2009/07/conflicts-of-interest-in-the-veterinary-profession/.

Quote
...Unnecessary vaccinations. Far too many veterinarians administer unnecessary annual vaccinations to animals. . In dogs---who are harmed more frequently than cats by this practice---this can result in much suffering from chronic health problems such as allergies, neurological and joint problems, autoimmune and endocrine diseases. Cats are prone to develop often fatal skin cancer at the site of vaccine injection.

Inappropriate nutrition. Cats suffer more than dogs from poor nutrition because they are obligate carnivores requiring a meat-based diet. Too many veterinarians are profiting from selling dry cat foods high in cereals and soy; these only too often lead to obesity, diabetes mellitus, urinary tract and inflammatory bowel disease, and other chronic degenerative diseases. The veterinarians then profit from treating these diseases and from prescribing expensive special diets that would not be needed if the cats had been fed properly from the start.

But dogs are not without diet-related problems, such as chronic skin and digestive problems, ear and anal gland infections, and a host of other maladies including depression and epilepsy. These clear up once the dogs are taken off highly processed manufactured foods.

Rather than addressing what their patients are eating, far too many veterinarians put them on cortisone/prednisone to stop self-mutilation from scratching and chewing. Then new health problems develop, such as Cushing’s disease in dogs and cystitis and diabetes in cats.

Veterinary dentistry has become a highly profitable field. An estimated 75 percent of dogs in the United States suffer from periodontal disease, which is also a common affliction of cats.... Highly processed food ingredients that are micro-particulate---especially the high cereal and gluten content of popular pet foods---play a major role in this virtual epidemic in the canine and feline population. ...


 I consider myself fortunate to have a wide-angle view on these matters, since I have received many thousands of letters from pet owners over the past 30-plus years through my internationally syndicated newspaper column, Animal Doctor. I have learned about such serious animal health and welfare issues as over-vaccination and diet-related adverse consequences of manufactured pet foods. (For details visit www.twobitdog.com/DrFox.)  



Letter to the Editor,
Journal of the American Veterinary Medical Association,
Sent via e-mail May 26, 2009

Dear Sir,
Quote


EXAMINING CONFLICTS OF INTEREST IN THE VETERINARY PROFESSION

The relationships between the corporate sector, and in particular with drug companies, and private medical practitioners, hospitals, and medical schools, are being called to question by the Institute of Medicine in the US (1).

Is a similar examination called for in the veterinary sector where comparable corporate interests may be at play and affect the quality of care and services animal patients receive? ...

Corporate sector partnering in academia even includes chairs and professorships named after the donating company at many veterinary colleges. What role such partnering may play in contributing to the grave consequences of poor diets, over-medication, and hyperimmunization in companion animals by deferring to vested interests and by claiming lack of scientific proof of harm from such practices, is an open question. Academia should not be exploited to garner public credibility, nor should the market place become the final arbiter of what is acceptable.

Examining possible conflicts of interest may be difficult, considering the partnership of the American Veterinary Medical Association with Fort Dodge and Merial pharmaceutical companies, and Hill™s Pet Nutrition, who together have pledged $4.5 million in support of AVMA programs and services over the next four years (4). But this difficulty could become a confluence of interests once the health and well-being of companion animals are first and foremost on the agenda. The content of both the JAVMA, and its equivalent with the British Veterinary Association’s (BVA) Veterinary Record, increasingly addresses issues concerning animal health and welfare, including nutrition and vaccinations....
[/size]

Quote
I did not even receive an acknowledgement from the British Veterinary Association, while the Interim Editor-in-Chief of the American Veterinary Medical Association’s Journal of the American Veterinary Medical Association, which usually publishes my letters, sent me the following letter via regular mail, dated May 28, 2009:...[/size]

 http://www.twobitdog.com/drfox/specialreport_Article.aspx?ID=f78aec92-0b02-47f3-9575-cb1778647ad5



« Last Edit: September 26, 2011, 01:01:40 PM by CarnivorousCritter »

Offline Shadow

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Re: Consultation: A Comedy of Errors
« Reply #10 on: September 26, 2011, 12:47:21 PM »
Oh but wait guys here is an honest Vet bonkhead sarcasmalert

"Education is the key" to make informed decisions about the health of our pets

Offline FurMonster Mom

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Re: Consultation: A Comedy of Errors
« Reply #11 on: September 26, 2011, 03:40:00 PM »
lol Shadow....
It's sad how much truth there is to that.

The thing that is still annoying the hell out of me, is that the vet sent us home without any antibiotics.

I mean, come on!  It's obvious that there is an infection, and you can't tell me that it's not a contributing factor to the pain.  Yes, it's obvious that we need to pull the teeth, but why not get a jump on the infection before the procedure to 1) alleviate the pain, and 2) reduce the bacterial load for the inevitable surgery?

I have dug up previous dental paperwork, and that is exactly how we handled Ol' Man Travis' teeth.  Also, his bill was about $650 - for pulling 18 teeth.  Belle's last dental extractions cost about $750.  You should see the estimate with all my scribbled notes on it... lol. 

I suppose the one good thing to come out of all this is that I finally got off my tukus and put in a call to the one holistic vet in town that looks good.  We'll see if she meets my expectations.
meow meow meow meow meow meow? -woof!
Translation: "I can has my raw food? -please!"

Offline FurMonster Mom

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Re: Consultation: A Comedy of Errors
« Reply #12 on: September 26, 2011, 03:40:53 PM »
I.... don't know what I did here...   :-[
« Last Edit: September 26, 2011, 04:06:23 PM by FurMonster Mom »
meow meow meow meow meow meow? -woof!
Translation: "I can has my raw food? -please!"

Offline Lola

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Re: Consultation: A Comedy of Errors
« Reply #13 on: September 27, 2011, 10:41:19 AM »
It is pathetic that the stories Mo and FurMonster Mom told...are more the norm than not. 

FMM...had any luck with getting an appointment with the new vet?
How is Belle doing? 
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Offline FurMonster Mom

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Re: Consultation: A Comedy of Errors
« Reply #14 on: September 27, 2011, 08:24:14 PM »
FMM...had any luck with getting an appointment with the new vet?
How is Belle doing? 

I was able to consult with the homeopathic vet over the phone yesterday.  When I mentioned that the weekend vet hadn't sent me home with antibiotics, I heard her give one of those ugh/groans.  And when I mentioned the bones/taurine bit, she was just as confused as I was... her response was, "But taurine is already in the meat..."

She did say that once the body starts in on the resorption process, there was no stopping it.  Also, the generally accepted theory on the cause is that it's another one of those genetic autoimmune things. It will likely continue with the rest of the teeth eventually.  She mentioned that an alternative to extractions would be to cauterize the nerve, and just let the body continue the resorption process.  It's kinda the same idea as the "crown zip", except just leaving the tooth until it falls out on it's own.

Meanwhile, Belle did not want to eat her breakfast this morning, no matter how much I choppity-chopped or how soupy I made it. (and it was only an hour after I'd given her the Buprenox drops)

So, then we had our appointment with our regular vet this afternoon.
After she spent several minutes looking at all of Belle's teeth (which the other vet barely glanced at), we had a discussion.
I pretty much laid everything out for her.  It's her practice, she's "the boss", so she needed to know how I felt.

It went kinda like this:

Me: Sssssoooo, this is where I had some problems...
She:  (gives me an apprehensive-brace-myself smile)  err... okay?
Me:  I just felt like Dr. P--- wasn't really listening.  She was too busy talking at us, y'know.
She:  (closes her eyes in that 'have heard this before' acknowledgement)
Me:  I never feel like that with you or Dr. B---.  You guys don't talk at me, (joking) at least I don't feel like you are...(raise eyebrow)?
She:  (laughs reassuringly)  no no
Me:  (smile) I always feel like you are listening, and we have back & forth discussions. 
She:  Yes, I cannot argue with you here.  Dr. P--- is actually a good vet, but she... could... work on her communication skills.
Hubby:  I kinda wondered if she was just nervous... (I just love him!)
Me:  (laughing) Yes, you did bring up that possibility.  But I still felt like I had just walked off a car lot... like she was trying too hard to make a sale.
She:  (looking a little offended and doubtful)
Me:  She probably didn't intend for that to come across, but it was just my initial reaction to her "presentation".
She:  I'm sure she didn't intend that at all!  I can pretty much guarantee that she was thinking about Belle's welfare and her own preference on how to manage her issues.  She is a good vet, but you are right... she does need to work on her communication with the clients.
Me:  .... well, that does bring me to my next issue.... the Rimadyl...
She:  (nods knowingly)  It is not licensed for cats, but is very commonly used in special circumstances...
Me:  (cutting her off with my "concerned" voice)  Now, you know me, I go home and google stuff to death... It says in the manufacturer's own literature, "Do not use in cats".  Anyone who uses it in cats is opening themselves to liability.
She:  You're right.  It's absolutely a legitimate concern.  The fact is, there are no NSAIDS that are actually licensed for cats.  Metacam used to be, but isn't any longer.  It's still common practice to give them to cats in special circumstances, though we don't dose the same way we would for a dog (over time).  (she explains the reasoning and I listen until my patience runs out)
Me:  I really just don't want to chance it.
She:  Fair enough.  It's a reasonable concern.  I just wanted you to understand it from our perspective as well.
Me:  (smile) I understand... but I can't say I agree.
She: (laughs)  Fair enough.  You wouldn't be the only one.  There's plenty of debate in the vet community as well.  (THIS is why I like her!  Even if we don't see eye to eye on something, she is willing to work around it.  Plus, she doesn't "talk down" to me.)

Anyway... We continued on in that back and forth discussion for about 45 minutes.  We talked about the different pain meds available (she prefers Torbutrol over Buprenorphine), and different antibiotics (Convenia came up, and she admitted that it would be a very last resort in her book).  We talked about her pricing and how it could be translated or adjusted.  We talked about the alternative of cauterizing the nerve, and her concern was that it would still leave the cavity open to bacteria.  It could take quite a long while for the teeth to be completely reabsorbed, and during that time Belle would need to be constantly on antibiotics (an interesting point, I thought).

Unfortunately, She is leaving on vacation on Thursday, and the other vet we like won't be back until Sunday.  We are also in a little financial limbo for a few more days (waiting on checks).  So she sent us home with some Torbutrol and Clavamox for Belle.  We are hoping to schedule for next Monday or Tuesday, I hope Belle can hold out until then.

In the meantime, I'm still thinking I'd like to schedule some time with the holistic vet.  She is somewhat of a "nomad" vet, if you will.  She runs on housecalls for her own personal practice, but also schedules time with a local holistic hospital, AND works with a conventional vet hospital in the San Francisco area.  I'm hoping I can pin her down for some time next month.
meow meow meow meow meow meow? -woof!
Translation: "I can has my raw food? -please!"

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