The OUCH! that's worth it (proving pain in the veterinary exam room)
Unfortunately, being a conscientious vet involves knowing when to apply a judicious touch of sadism to your work. Whether it’s yesterday’s Muscovy duck, whose broken limbs and puncture wounds I had to assess (sadly, before euthanizing him), or the circumspect exploration of a cat bite abscess (by way of determining whether surgery is required), inducing pain is a standard part of my practice.
But some of us are more tentative in our pain-eliciting methods than others. I’ve seen vets fearlessly grasp and expertly pull possibly broken limbs. Others reach deep way down into wounds for a culture sans sedation. I’m more timid on this front. I don’t tend to wait long before I pull out a syringe-full of relief.
But there are plenty less dramatic situations when evincing pain becomes a depressing necessity. It’s those situations that provoked me to write this post today. After a week chock-full of back pain cases (including my own Sophie Sue’s disc-related neck pain), I was starting to get frustrated with exam-room reactions from well-meaning owners of painful pets.
How do you know she’s painful? I don’t see what you’re seeing. Are you sure?
I’d like to think I’m pretty convincing and fairly straightforward in explaining that pets are in pain. But owners (for some ungodly reason) are not always so easily swayed by my gentle exam room tactics.
When I examine a back, for example, I run my hands along the spine, pressing gingerly between the vertebrae to flex and extend the joint. At the sign of the tiniest flinch, tensing, or flutter of the skin, I know I’ve elicited some pain. I repeat the action, now asking the owner to observe what happens when I get to L3-L4. See?
That’s why I asked my significant other (who makes a living from surgical cases like these) how he handles owner awareness of pain. Because he doesn’t have time to secure an owner’s deep and abiding trust (as a referral specialist, he usually only gets one shot with the clients we regular vets get to see multiple times a year), he has to make his point quickly and convincingly.
His approach? Find the spot gently. If the owners aren’t sold, give the zone a very quick, firm yank, tug or push and voilà—a cry of pain.
For the record, I was slightly horrified that he would confess to causing unnecessary pain in any animal. But it made some sense. How many of my cases have gone out the door saying, “Sure I’ll give her pain meds and rest her for a month!,” only to throw the pills behind the spice rack and take Fluffy for a run the next day? Would it really make a difference to my patients to more dramatically prove my point?
I tried it out on Friday. Two back pain cases. While I didn’t make them squeal, I pushed hard enough for these guys to turn their heads quickly and give me “the look.” Saturday’s neck pain let out a small yelp (the owner was especially reluctant to admit pain was the result of her dog’s recent shaking). In all three cases, I got a much better round of client questions than I would have ordinarily. My tech was impressed (though she, too, was horrified that I would push so hard on an ouchy back).
It’s sad, really, that it takes tougher tactics to make your case and recruit serious owner compliance. But human nature inevitably says “show me—or else.” And I guess I can’t quite blame people for not understanding animal nature enough to know that displaying pain is a serious no-no in the wild kingdom.
While sadism doesn’t quite suit me, I’m feeling mighty grateful for this new technique I’ve learned. Still, it’s illuminating: almost thirteen years in practice and I’m still learning basic tricks of the trade. I guess that’s why they call it “practice.”