When it rains it pours (long diatribe!)

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When it rains it pours (long diatribe!)

Posted : 11/4/2008 11:18:27 PM

The good news. Kale is doing very well post surgery. He has come though without a hitch!

Thanks Callie for chatting the other day, it was very informative!

My brindle amstaff female, started with a hind end lameness on her right side after a rabies shot. It blew up and was very tender. That resolves and she is off on her left hind. She sits with that leg straight, bears some weight, but stands on her toe, she doesn't reach under herself like she ought to. She often stands with the left hind in front of the other. I had not noticed how straight up and down she is built behind which is likely not in her favor. There is now crepitus upon manipulation/palpation.

I was worried enough to take her to the vet. I sucked it up and decided that Christmas might be light if surgery is required. So I take her in, and we see yet another associate. I swear neither dog has had the same vet twice.

So we go in, and the vet doesn't think she's off. Palpates and finds nothing. I do have a very good eye for lameness as it is vital to the success and health of my horses. I look at no less than 30 horses in a day, and can see the slightest variation in stride. Maybe not a benefit in this instance, but I doubt it.

So I leave her there for the afternoon, she has x rays of both stifles. I go to pick her up at 6 pm. The vet comes in with the x rays and puts them up. She then goes about explaining that the left limb shows no bone change and thus she is fine. She pulls the x rays down and I take the right one and put it up on the board and ask,"um what is this?"

I mean jeepers, I can read x rays, ultrsound and nuc scans... please don't treat the customer like they are completely clueless. It's borderline demeaning. Any nurse or Dr would have seen what I saw! Know how many x rays I see in a year? It's my job to be able to see and understand what is bothering a horse. The sale horses we do multiple shots of EVERY joint (on no less than 100 horses). Not to mention the injuries the older horses sustain.. It's great on the job training! We can't afford to not be informed, that can be life and death for horse and rider. I realize dogs are not horses, but they xray very much a like.

The vet stumbles and is shocked that I noticed a big bone chip below the right patella. She then proceeds to tell me she had seen that, but was unsure as to whether or not that was supposed to be there and she needs to bone up on her anatomy. (argh!! Are you kidding me???)
I put the left one up. It does not have the same chip in the same location. She says I have to call the x ray tech and see if she shot these as they are labeled. 45 minutes later... yes she shot them as they are marked.

Honestly at this point if there was a shadow or a fracture or lesion (OCD if dogs get it) anywhere on bone, I don't think she would or could have seen it. I hate rip on the vet or the practice, but they aren't making it easy to not rip the care and knowledge leve of the "professionals" employed their. If they are Western grads, then they are cheap help with little clinical knowledge.

I asked if it was something that was operable or not. She had no idea. I wondered if they do arthroscopic surgery in dogs to remove the chip and clean up the joint if necessary. Again scratches head with a blank look on her face.

So I ask since the x rays don't show anything related to the bone, What is the next course of action? Is ultrasound a useful diagnostic in dogs and specifically for this injury. I am happy to pay for ultrasound. It could well be soft tissue, and x ray is not the best (or useful) for soft tissue. And as she looks structurally sound I lean toward the soft tissue injury I have suspected.

I swear when I asked about ultrasound I got the epitome of blank stares. I only speak one language, it's not like I asked in french.

I really am trying to do the right thing and use a small animal vet instead of just taking her to the barn and having someone look at her there. God knows we use digital xrays and they are so much better!

Then she says, you know, I did think she was off in her right hind. I take a deep breath and pray for patience and kindness. And I ask," so you think that the weight bearing leg is the sore one? Not the leg she refuses to bear much weight on?"

At this point I am wondering why I am paying for this?

She then gets some pamphlets on local surgeons. She has not much to say about any of them. I finally say," If this was your dog, to whom would you go?"

Again she stumbles and takes a PC stand and says they are all fine. Again I am getting more annoyed. Honestly, please, help me with my dog! Tell me who the best is! I don't want the cheapest, I want the best I can get for my "child."

I ask for at least something for the pain. She won't prescribe it. MY dog is shaking with the pain when she is at home. She spends all of her time on her bed in the bedroom. She is very social, and hates to be not cuddled up to something. Her behaviour is far from normal. In my equine experience when a horse that always licks it's tub clean, or starts behaving uncharacteristically has a problem! She eats, but is not a happy dog. Tonight she has crepitus upon palpation. I am at my witts end!

Maybe I am every vet's nightmare, and I don't know it. But I would rather be able to pick out a problem on an xray and notice lameness on the correct leg as she was going to send me home with a "nothing to see here," when there is a chip as clear as day and a wrong leg "diagnosis" of lameness. I can tell you which leg it is and that it is high. She makes figuring out which leg fairly easy as it's the one she barely bears weight on. I can show that there is instability and localized pain. There isn't effusion, and there isn't a whole lot of heat. But that doesn't mean there isn't a problem!

I did get some rimidyl from my equine vet, and that does help a lot! BUT my fear is that she won't feel it as much and tear whatever up more. So I only give it to her when she is really bad.

I need a reputable ortho surgeon or a vet that is worth the money I am more than willing to pay. If any one lives in LA or Pasadena, please send me your recommendation!

Kale goes back to the vet for a post surgery check up tomorrow and will see yet another vet. I am going to call tomorrow and insist that the Dr that diagnosed his problem and did the surgery look at him. Should I take Maven with me and insist that she look at her as well?

Thanks for reading this long winded outlet of frustration!

calliecritturs

Posted : 11/4/2008 11:46:07 PM

A. That vet should be reported BOTH to the head of the facility and to the state vet board. Sorry -- unacceptable that you had to read your own x-rays and I WOULD demand my money back for that visit.

B. If it were ME I'd probably go to the state vet school (Davis?) -- often you'll get cutting edge care at a vet school and better results for a far more reasonable cost. Yes, you deal with students, but you also have a zillion eyes looking at everything.

C. I'd honestly put what happened in WRITING and send it certified to the head of the clinic where you are. That's just inexcuseable -- not difficult to read an x-ray but when they found out they were out of their depth they should just have backed out and gotten another vet in there.

Foxysox

Posted : 11/5/2008 4:16:12 PM

I am trying to communicate with the head of the clinic. I am so frustrated I could scream or cry.

At about 10:30 the phone rings, a message is left.

Hello this is Dr X, calling in regards to Maven. I don't believe anyone has called you regarding this yet. I had the x rays looked at by the radiologist. He said that he sees a tiny bit of effusion in the stifle joint in the left hind though no signs of bone trauma. Certainly a cruciate injury is something to consider. He also says that there is a fracture on the distal end of the right patella. She needs to be evaluated by an orthopedic.

no sh*t. thanks for the update.

So I calm down and call the clinic and ask to speak to the Head of the clinic who is also the surgeon who worked on Kale. She is in surgery, and she will call me back. What is this in regards to. I outline it kindly and calmly. I ask that Dr A look at the xrays and the chart of Maven and give me a call back.

I hang up. 5 minutes, and Dr X calls. I answer. She is a wee bit snappish with me. And I say pretty much word for word the original post in this thread. She gets more annoyed.

She says she refered several surgeons with pamphlets. I said yes, but I want an opinion on who you would send your dog to.

She says, They are all board certified and they are all good, acceptable ."

I say," Board certified means little. I don't want good or acceptable surgeons, I want exemplary. I want you to have an opinion."

She says, "they all do a fine job and are board certified."

Now I am getting cranky and a bit short with her, so I say," Just because they have a degree or are board certified does not mean that they are all equally effective in their chosen field." I wanted to say, seriously you are prime example of this, but I didn't. BOY did I want to! Frankly a recommendation from her holds absolutely no water with me if she is as inept as she seems.

So she says do you want to come get your dogs records. I say,"oh heck ya. and Kale's as well."

She is snotty and hangs up.

So I sit here and stew for a few minutes. I call back and tell the receptionist that I would still like Dr A to look at the films and the chart and call me, please." She is hesitant. She asks for an outline of why. I am now on the verge of tears I am so frustrated. So I explain it to her though teetering on the brink of loosing it in a big way.

I say I like this clinic (which I don't anymore) And I would love to not have to move to another clinic. (which I likely will anyway).

So now I am wondering what the chances are that I get a call back.

This is so past ridiculous!

I would love to take her to Davis. It is in San Francisco area and I am in LA area. My husband is up there on work I guess I could make an appointment and go up there for a week or two. I have a good equine vet who's Dobbie was treated there while she was a student. She loved the care he got!

I will look into it.

Davis is booked until January.