Friday, 5 October 2012

The Nitty Gritty

Vet visits are a regular part of our work, simple things like injections are usually done by owners however repeat consultations often mean they are a struggle to fit in so we are often booked in to step into the breach.  On this occasion we were required to drop off a dog for surgery as the guilt the owners felt was too much to bear ( those sad eyes boring into your soul for leaving them so vulnerable in the arms of strangers, you know that look!) so better to get Nanny to be the wicked one!

So with a blissfully unaware, slightly grumpy pug in my arms( well she had missed her breakfast) I walked into the specialists practise.  The atmosphere was a little harassed and buzzing with three receptionists discussing, pulling faces and dealing with real humans, phone humans and other staff.  Did I mention that they hadn't my appointment on their books so I had had to contact not only the referring vet but also the owner and the specialist.  Once this was all sorted I said I was here as the conversation was becoming more heated so I sat down.

My impression was of a hotel reception with a huge very expensive sculpture gracing the sweeping staircase, a big flat screen tv on the wall with a coffee maker for use whilst waiting.  Smooth lines, modern designs and all meant to impress.  The place buzzed with movement, noise and fear.  Dogs and cats sat wide eyed and whining, shaking and snuggling in longing only to go back out of the automatic doors to freedom.

Puglet sat on my knee transfixed with all the goings on snorting loudly in order to get the attention all pugs deem necessary to survive.  A gsd sat watching her every time she snorted he turned his head taking all that sound into his large ears, his eyes never left her.  We waited and I tried my hardest( well ok I didn't try hard at all) to not listen to the conversations the receptionist were having with each other, clients( human) and with consultants.

Soon it was our turn to go in and we sat down in a small but pristine room computer at the ready with a window not unlike chat for talking to reception( maybe I peeked).  The specialist came out and we discussed Puglet's eye ulcer and he said surgery for the ulcer was not required due to its improvement and a simple change of drops would suffice.  He did however say that pugs have entropion and she needed this corrected.  I was shocked as I have wonderful close up eyesight, was aware of the condition so was disappointed I hadn't spotted it.  Now this particular Puglet  has a serious fault in her windpipe where it joins her lungs so anaesthetic is very risky so I asked if our Puglet had entropion.  He repeated that all pugs had entropion.  I was starting to feel my pig headedess showing through so I continued I am not asking about pugs I am asking about this Puglet.  Nothing.

Trying to be calm I insisted he agreed that this Puglet would not be operated on if she had no entropion and said I was happy( I was not) to leave her if he would guarantee to leave well alone unless absolutely necessary.

So once I vacated the building I spoke to Puglets owners and said the specialist would ring them.  When I picked her up she had been operated on and nope not for entropion but a non necessary elective surgery to tighten her as suspected no entropion despite ALL pugs having it and a dog having an operation despite having no permission to do this particular surgery.  Mmmm.

We also left with a note which I did of course read.  They suggested that Puglet should have an operation to widen her nostrils, trim her elongated soft palate and something else I couldn't read cos I succumbing to the red mist!  Why?  Because Puglet had actually had all these done last year( baring nose widening as it is not required) by a specialist who advised they had had to be conservative with the surgery as her windpipe was so dangerously small they didn't want to solve one problem only to put at risk an even greater problem that was not fixable and far more dangerous.  Puglet was so much better after surgery that everyone was delighted that she had had a marked improvement in her quality of life without tipping the balance on her restricted windpipe.

By now it wasn't the bright modern lights lit up in my eyes but pound signs.

I don't actually believe in the good ol' days as the good ol' days are now in a few years time.  I don't believe all vets were James Herriot and worked for the love of it in the past.  Yet I do believe things have changed.  A shift that makes me feel uncomfortable.

Vets work blooming hard without doubt.  Stressful, emotional work that should be paid for appropriately.

As dog owners what are we paying for?

I once helped a wonderful friend during one of the most traumatic times of her life with her beautiful horse Cai and what struck me most was she was offered a mind boggling array of diagnostic tests both non invasive and invasive in order to find out what was wrong with her beloved mare yet even when we knew she was fatally damaged they offered more tests.  I whispered to my friend to ask the vet what they were likely to find, if they could do anything with those results and the response from the vet made me want to weep.   Not only was there nothing that could be done but it was highly likely that the results couldn't be interpreted fully as they hadn't the knowledge to understand all the machine had to reveal.  There is nothing wrong with learning all there is to learn whenever possible but shouldn't this be transparent and reflected in the bill?

I was always lead to believe a vet's caveat was ' FIRST DO NO HARM'.

So how far is too far, how much is too much.  Has animals medicine been reduced to procedures with little thought to what this actually involves, to preserve life at all cost yet how often do they preserve life how many times to they do more harm than benefit?

Vets are required to have everything possible at their finger tips yet who should pay for these super machines?  Do they pay for them in small increments with all their services or when they are used?  I don't know the answer.

What I do know in all certainty is each animal, each situation and each family or individual should be treat as such.  Not judged on a perceived problem.  For a vet when should emotions come into play?  Surely a vet should have a good 'bedside' manner but be the voice of reason a clinician who provide information and advice when asked for it....advice on the best for that individual, what is best for that animal not what the practise has available and certainly not on what that person is willing to spend.

We as owners need to take responsibility for our guys and gals, take advice, listen to the options but don't allow past fears, experiences and emotional blackmail to sway your choices.  First do no harm.  Sometimes the best treatment is rest, wait and always try and do less before you do more.

When I walked into the specialists I wasn't impressed by the opulence I saw an ego pleaser, a mirage much like the church, done to create awe.  I would rather the thousands spent on that spectacular sculpture be spent on research to prevent many of the issues our pets face or on extra nurse hours to reassure and nurse the vulnerable animals.  As for the treatment I saw a practise with excellent skills, very clever sales technique and a firm directive.  Make money whilst also treating animals.  Elective surgery is just that.  If an animals comes in for surgery and that surgery is not required it is morally correct to do an alternative surgery because the animal was there?

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