What Vets Could Do Better

There’s not much to mention on the Ardala Recovery Front. Her cart abilities continue apace. We are somewhat stymied by the difference in size between two Small Pawz booties (srsly, the one we got a month ago is halfway in between the Xtra Small and Small sizes we’ve seen in stores this week) but we will persevere. Ardala continues to greet new dogs and make new people friends, including a hipster in a mustang convertible who pulled over just to chat about her, and an older Korean gentlemen who somehow went from “Oh, she’s a lucky dog!” to “I love Jesus” in record time. I was considering having little calling cards made up, referring to this blog but then I’d have to decide if it’s going to continue to be a freebie, or a $20 a year one with her own domain. My poverty wars with my indecisiveness and thus entropy is maintained.

 But here’s something I’ve been mulling over a bit so I thought in lieu of more adorable pictures of my fabulous dog, I’d type out a long-form grouse. It has to do with Veterinarians. I love vets, I really do. I remain in awe of their ability to provide medical care to animals who can’t speak English (or Spanish). I mean, that’s right up there with pediatricians, if pediatricians also treated multiple species who couldn’t speak. The various vets we’ve seen have on the balance done so much more good than harm, but here are some of my frustrations, with examples drawn from personal experience.

 Medicate As A Last Resort!

Human physicians (by which I mean those who administer to Humans, not as opposed to that mercifully short-lived Animal Practice TV show with the monkey physician) are so very guilty of this and I think it’s only now starting to trickle down to small animal medicine. As a bi-ped reliant on a couple of maintenance meds probably for the rest of my life, and as the Servant Monkey of a dog who enjoys a daily dose of Metacam, I think meds can be highly useful. But I want a vet with an attitude of “If all else fails, medicate!” One of Ardala’s first “problems” was diagnosed as bilious vomiting. It happened most frequently in the winter months, or what passes for them in Los Angeles. Starting in October or November, we’d often wake up to the gentle strains of a horking corgi. It wasn’t something she’d eaten as it was all pretty much foamy nothing. The vet suggested this was because she had a sensitive tummy and if it was too empty for too long, she’d vomit bile. They suggested breaking up her two meals into about five meals eaten around the clock, and supplementing that with a Pepcid every morning. This sort of worked. I mean, she spent most of the time from November to March taking a Pepcid cleverly hidden in a bit of treat, and then reluctantly munching small handfuls of kibble all the time. Oh, did I mention she wasn’t a very enthusiastic eater of kibble? It took us weeks of games to get her to eat it on schedule. What this meant was that a.) she chubbed up to nearly 32 lbs and b.) we’d take her off the Pepcid when the weather turned and wind up with a little barf a couple of times a month. This went on for FIVE YEARS – until we switched her food to a grain-free fish-based kibble that she hoovers up like candy. Guess what? No more puking! No more “5 tiny meals”, no more “Gaviscon for me, Zantac for Red Monkey and Pepcid for Ardala” shopping trips. When she went on the new food, she also stopped nibbling at her paws (admittedly never especially problematic – we never had to seek vet attention for missing fur or anything) and her coat became super-lustrous and shiny. She’s not entirely grain-free – that would make her training treats prohibitively expensive – but her main source of food is, and she’s in great shape.

 Listen! Learn!  Adapt!

 When Ardala was keeping us up all night, pacing back and forth and peeing in the house, it took us a month of misdiagnoses and painkillers and tranquilizers before we finally took her to an emergency vet. Why? Because the previous vets were only half-listening to us repeat her litany of symptoms. Somehow in the excitement of finally seeing her suspected spondylosis confirmed by radiographs, they assumed her massive amounts of pain were causing her wakefulness. So why would she be moving so frantically if she were in that much pain? Why would that mean a break in her otherwise phenomenal standards of personal hygiene? Well, said previous vet, the urinalysis came back negative, so that couldn’t be it (that this was the same veterinary practice that had first posited Pancreatitis and had us basically starve her for a week somehow didn’t raise a red flag). Over the course of three weeks, the vet remained deaf to the “peeing in the house” thing and prescribed one painkiller, muscle relaxant or tranquilizer after another. The first thing the e-vet said was that there are bladder infections that don’t show up on a urinalysis, and with the amount of carpet soiling she was doing, it might be a really painful infection that could be diagnosed with a urine culture. And lo and behold, it was! Actually, it was a species of e. coli infection that could only be cured by superhuge doses of antibiotics. She was put on double the normal course, and by the second day was sleeping through the night and not peeing in the house.

 A couple of weeks after her miracle cure, Ardala had a partial tear of her CCL. We went back to the emergency practice, but saw a different vet. She prescribed crate rest, which we were pretty good with – until the first day I was back at work after Christmas Ardala greeted me with a particularly exuberant Zoomie display – and went on to complete the CCL tear. Having been through the wringer orthopedically at this point, I will note that I am now aware of the use of physical therapy after partial CCL tears to avoid full CCL ruptures, and also – PEOPLE ARE MAKING BRACES TO KEEP THE DOG FROM MOVING THEIR LEG IN A SPECIFIC WAY to allow the CCL to heal. Why were neither of these options mentioned to us at the time of the first incident?

So then we get to the full rupture and the TPLO. Look, sometimes I feel like a poster child for Spondylosis Awarness (we don’t have a ribbon so much as a completely rigid material shaped into a rapidly calcifying loop) so I don’t want to get into the specifics of this particular surgery – you can google for more info. It is one of the latest and most invasive surgeries for CCL rupture. We weren’t given any other options, but I had fortuitously been reading about knee surgeries weeks before it became relevant, and it seemed to be the best choice for a dog who relied so heavily on her ruptured leg. Once recovered it had the lease chance of needed a revision.  When she was done with the surgery we had an entire appointment to discuss aftercare and were given a packet to take home. There was to be no walking or standing on it for a few weeks; the dog needed to use only her non-surgical leg during that time. Pottying was to be accomplished by us whisking her magically onto our lawn, setting her down (on her non-surgical leg, of course) and allowing her to do her thing, and then magically levitating her back into the home. Over the course of several weeks we were to allow her to add a little weight to her surgical leg, eventually going on extremely brief walks.

 Now in case you weren’t on the receiving end of a groggy and piteously razor-burned dog, panicking about piddling, let me spell out the ways these aftercare instructions may well have been Dr. John Dee’s notes on transmuting base metals to gold. 1.) She was physically incapable of putting weight on her non-surgical leg, due to the spondylosis, and 2.) Like over half of Los Angelenos, we don’t have a house. Or a yard. We live in an apartment building that, while conveniently possessed of an elevator, requires a trip from the front door to the elevator, and then a trip from the elevator through the garage and up a driveway to get to the nearest patch of grass. Alternatively, after the trip to the elevator one of us could haul her up and traverse the decorative, yet random step-ful bridge out the front door of the building and place her on the grass – holding her up how? With a towel? Have you seen how low my dog is?

 We brought up our issues, since the aftercare packet was INSISTENT that any deviation from their instructions would cause the TPLO to explode or whatever. OK, but she’s a bit heavy, what should we do? One of us has a bad back… she can’t support weight on that leg… we don’t have a home with a front lawn, this isn’t effing Mayberry and each vet we spoke with (I believe there were three in all) repeated the same irrelevant information. Brainstorming, Red Monkey asked if we could put Ardala into a wagon of some sort to get her from our door to the nearest grass. We were warned against that, on the grounds that a dog may feel healed and just leap out of the moving wagon nullifying the surgery. Maybe, they suggested, ignoring the “can’t use left leg” issue, we could get a piddle patch for the balcony? Well, we tried. We really did. Red Monkey bought a piddle patch (those things aren’t cheap) and when Ardala continued to be confused by it, we even got a couple of pieces of live sod thinking maybe the smell of dirt would encourage her. It didn’t. The balcony is part of her house and she will not potty in it if she has any choice. So we did our own research. I found a lifting harness developed by a physical therapist that seemed to be made with low, heavy dogs in mind. Red Monkey had an epiphany regarding a luggage strap and blithely ignoring Doctor’s orders, we purchased a Radio Flyer wagon, suited her up in the harness, strapped her in and rolled her out. We were (as now) the talk of the neighborhood, trundling our pooch out in a contraption like Farscape’s Rygel XVI on his thronesled (or in my darker moments, like a furry little Hannibal Lecter), gently lifting her out, balancing her bellyband as she pottied and then returning her to her transport. She was declared fully recovered two weeks early, due in no small part to her use of her surgical leg. So why weren’t any of the vets at that practice aware of any alternatives to recovery? Why did none of them rush to think of something or ask around? We can’t have been the only clients with non-standard situations. I want all veterinarians to be curious – keep learning once you’re out of school: especially about modalities you don’t have any expertise in. Know enough to give your clients options and form relationships with other vets to come up with answers to questions you haven’t yet encountered.

Now since you’ve patiently read through this giant huge post, I will reward you with a picture of Ardala in a different set of wheels.

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