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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

Denial in Vet Medicine: My Clients’ Top Ten Excuse Zones

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June 24, 2010 / (22) comments


If "denial" is a long river (I know, bad pun), then veterinary medicine offers a zillion ports of call. Unfortunately, I deal in denial daily when it comes to my clients’ take on their pets’ well-being.


It drives me crazy. And it would you, too, if you were a fly on the wall of my exam rooms. Because it’s easy to spot the denial that inevitably happens when you’re a rational outsider. But as a heavily invested party? Not so much.

Still, I know from personal experience that when evidence of my own denial is presented to me in non-judgmental terms, I’ll often take a step back in service of the almighty objectivity I know I can sometimes muster, even when it comes to my own furred family members.

With that kind of personal success in mind, I’m hoping I can help head off some naysaying behavior in you, dear readers, by offering up the top ten areas my experience suggests are those most likely to earn your denial:

1. Weight

Yeah, that’s always number one. Food is love. And nowhere more so than in the U.S., where our vision of the ideal pet weight is skewed. You doubt? I challenge: Tell the next owner of an overweight pet that their pet is fat. Now you know how I feel on an hourly basis.

2. Aggression

"She doesn’t bite." Which is always rapidly followed by, "She never did that before."

3. Trauma

Another reason to say, "She never did that before." As in, "She never jumped out of the truck before." Or, "She never got over the fence before." Need I go on?

4. Dental disease

"She has bad breath and I see all the green stuff on her teeth and the white stuff dripping from them, but she eats so how much pain can she possibly be suffering?" Dante’s circles of hell surely will make room for people who speak thus on their pets’ behalf.

5. Anything requiring anesthesia

It kind of irks (OK, so that’s an understatement) to have people agree that their pets are suffering but then decline to help them on the basis of the anesthetic risk. Still, I hear it every day.

6. Spaying and neutering

Ordinarily, I’m not a stickler. I’m one of those veterinarians who considers a spay or neuter an elective procedure, not a mandatory one. However, when your boy dog has a prostate the size of a melon, or your girl dog a uterus teeming with pus … well, then, you’re an idiot if you remain in denial.

7. He doesn’t have that disease.

OK, so here’s where an owner’s lack of trust will sometimes translate into an uncomfortable back-and-forth. Depending on the owner’s emotional state and our history, it might take a month or more for the diagnosis to sink in. In the end, however, it’s always the pet that suffers.

8.  How can he have that disease?

A corollary to 7, this is slightly different in terms of its emotional starting point. It’s the Kubler-Rossian form of denial that often accompanies death. But here, owners are sadly and understandably feeling bereft when a horrible diagnosis has just been handed down. They just don’t want to believe it.


9. She doesn’t need vaccines.

An understandable sentiment. But almost always unwise unless the pet lives in a biological vacuum.

10. We don’t need to spend money on testing.

OK, so why are you here, again? By definition, your interest in seeing a medical provider for your pet presumes an interest in testing — whether by physical examination or otherwise. But maybe I’m just being presumptuous …
 

Got any more denial hot zones? I'm all ears.

Dr. Patty Khuly

 

 

Pic of the day: "Luna in denial, ringing out the old Year of the Dog and in the New Year of the White Tiger 2010" by Beverly and Pack

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COMMENTS (22)
1
Both Sides of the coin
by CatLover21 on 06/24/2010 01:49am

What about he times when the VET is the one in denial? I have a female cat about a year old, who weighs 22 lbs and looks, for all intents and purposes, like a black and orange beach-ball. Brought her to the local vet, to get her checked out and to make sure there isn't an underlying problem as far as her weight goes. And the veterinarian insisted things were NORMAL!

2
Got me on #5
by colddonkey on 06/24/2010 05:58am

As I sit here I have to count down the days until next Tuesday (6-29-10) as Mylo has to go for a vet visit. Two and a half years ago he had 4 tumors removed and was pretty much knocked off his feet for a few days, from what I felt was the anesthesia. Well now he has another tumor in his right front "arm pit" and its growing with a vengeance, and feels like another is starting inches away. I fear so much for him to receive it mostly because of MY own fear of the stuff, as I've always reacted adversely to it all my life, to the point where I have to tell each new Dr. of my problem.

So yes that fear has a habit of trying to over ride common sense when it comes to taking proper care of my 4 legged kids. It can be so difficult to think straight sometime when your own fears attempt to block out common sense.

3
Not Fat... Fluffy!
by TheOldBroad on 06/24/2010 06:29am


Most of my kitties are overweight. I know. I know. It's not good for them. However, my line of thinking is this: If they've got extra weight, they've got something to lose if they get sick.

This was so true for my lymphocytic lymphoma kitty. Since he really didn't feel that badly otherwise, I really think the extra pounds gave him a little more quality time.

I have several that were cast-off, throw-away street kitties and they have a stray mentality when it comes to eating. I truly feel that it's a quality of life issue to free feed these kitties so their tummies never rumble. They may lose some time eventually, but they will never again have to be afraid of not getting the next meal.

A couple have high blood pressure. No doubt being overweight is a factor for one. Thank goodness for monthly (at the very least) blood pressure checks and Amlodipine. :-)

Yes, overweight kitties are something to which I've given considerable thought.

As for #8 "How can he have that disease?", sometimes that just comes out involuntarily (probably more like a sigh) because dealing with bad news on a regular basis feels so defeating. However, feeling defeated doesn't mean I'm not going to do everything I can to help my critter - starting immediately.

As for dental care, spaying/neutering, necessary anesthesia - no excuse! These clients should be made to suffer the same fate as their pet.

Regarding vaccines, for pets that do not go out, do not have contact with other pets (other than their own household) and have had vaccinations every year for the first 5 years, has the necessity of vaccines been proven after that? Do researchers truly know if the pet is still protected or not? Does that outweigh the possibility of vaccination site sarcoma, especially in older kitties?

It sounds like when you hear these responses, you take the particular client into consideration and whether it's an excuse or considered response. However, there is never EVER an excuse for an owner letting a pet suffer unnecessarily.

4
Today's ed - No. 9
by onadell on 06/24/2010 06:59am

Are titers OK? I know vaccines are necessary, but so often? If titers are done and are at a good level, I'm OK, right?

5
Titers
by Dr. Patty Khuly on 06/24/2010 08:27am

Great question! So good, in fact, that I started to write an answer and realized after about five long paragraphs that it was turning into a whole post. You can expect it on Monday. So let's table what will likely be a lively discussion for now if that's OK with everyone.

6
Titers
by mayers246 on 06/24/2010 09:30am

I agree with titers too. I'm kind of irked lately. Suddenly all the vets around me are charging way to much for a distemper ($20.00) shot and will not give it without a wellness exam first $30.00. When you have six animals that really adds up. What's up with the wellness exam? Just a way to make some money I assume. My animals are obviously healthy but I hate to give the little ones shots.

7
Vaccines
by tgrllyct on 06/24/2010 09:47am

I'm in agreement with all by #9 and #10.

Refusing vaccines has nothing to do with denial, but rather, in many cases, it has more to do with self-education and the side effects and dangers caused by vaccines. Period.

"We don't need to spend money on testing." Well, unfortunately there are many vet practices out there that do all the testing that they possibly can to make extra money off the paying customer. Sad, but true. And while testing is indeed necessary, I think many patrons have been wisened up through the years by education and power of the internet to smell this a mile away and refuse testing that seems to be unnecessary. The vet practice I used to work for became this very greedy machine to make money, and taught the employees how to push for more testing and more money from the customer. I stopped going to them and found a vet that does what they should: treat the pet.

One more denial not listed: My pet doesn't have fleas!!! (Which makes you wonder what they think those black spots moving around are!)

8
Good reminder this mornin
by annet on 06/24/2010 09:52am

Thank you for the reminder. This is after very little sleep because kitties had to be fasted for their cleaning and extraction this morning. Then more crying than usual on the way to the vet because they were hungry and tired. And I am hungry and tired. And the bill will be large.

But they're my fuzzies and I don't want them to be in pain, especially when they're so bad at letting me know it hurts. Even if that means anesthesia and leaving them at the Vet's all day :(

9
by penne on 06/24/2010 11:44am

OT -- Tell us more about the dog in the picture! Interesting markings and soooo cute.

10
painful
by lojunkie on 06/24/2010 11:47am

In emergency medicine, the one I see most often is "My pet's not in pain, he/she just has arthritis/hip dysplasia/fill in the blank." This is said after the poor dog has limped his way across the waiting room, into the exam room, and fallen to the floor. And of course, that has nothing to do with why the pet is being seen. Why treat the arthritis/hip dysplasia/fill in the blank after all, it's not painful; it just makes them limp. WAKE UP people!!! Arthritis, hip dysplasia, and anything that makes your dog limp is PAINFUL!! And we have excellent drugs to treat the pain, if not the condition itself. There is no excuse for leaving your pet in pain!

11
by babysweet on 06/24/2010 02:37pm

I also have to disagree with the vaccine sentiment.

Quite frankly, I'm surprised by your casual dismissal of anyone who questions your vaccine schedule.

We use vaccination recommendations by a veterinary virologist. Our dogs receive Parvo/Distemper at 14 weeks and 18weeks. At six months they get a rabies vax.

One year later they are boosted for rabies only.

At age seven they get a booster for Parvo, Distemper and Rabies.

Aside from those four vax, they do not receive ANY vaccinations.

In regards to #8 - we once had a client accuse our clinic of injecting their pet with sugar after receiving a diagnosis of diabetes (eight year old obese cat eating dry no name food). He then proceeded to continue his accusations in the waiting room. Thankfully those present knew enough to realize the man was off his rocker.

I also have a hard time convincing people to get their pet tested for hypothyroidism. I see dogs constantly who are so symptomatic it's hard to believe the vet didn't automatically request a thyroid panel. And they're stunned when the test shows they do indeed have a thyroid disorder (seriously, you don't need to be psychic to pick out thyroid affected dogs).

12
Disease Mongering
by P on 06/24/2010 05:02pm

I agree with many of your points. But the problem is I have been burned by disease mongering. Some vets tout remedies and preventatives for diseases that are not a problem. Plain overtreatment and too many expensive tests. It is a business philosophy and such experiences destroy trust and promote suspicion.

Vaccines for diseases such as Corona virus. Maybe it exists but has it ever caused a problem. An invented problem in my view.

Insisting on year round heartworm treatment in areas that are cold for half the year and therefore have no mosquitoes.

Heartworm preventatives for cats. Probably disease mongering. Expanding a market for a drug by claiming it is a huge problem for cats. Humans will probably be next. What is the real incidence of this and is it worth giving a drug to all of these cats?

Giving prescription diets to older cats for kidney failure that are mostly corn. A fraud. The cats probably die of malnutrition and the customers probably think the cat dies of kidney failure. By the time I figured this out my cats were almost dead of malnutrition. Fortunately the 3rd cat did not have kidney failure and the vet said the diet would be good for him too and he was as bad as the other two which led me to suspect malnutrition and check the ingredients. Corn for a carnivore. They were saved with a canned meat diet for cats.

I agreed to having surgery to remove the thyroid for a cat but I kept looking for physical symptoms of hyperthyroidism and could see none myself. He looked just like my other two cats. I asked for a bloodwork recheck and it was a mistake. Vet believed bloodwork over his own physical exam. Vets used to have tests to confirm a diagnosis. Today they want bloodwork for anything to pad the bottom line and it even overrules their judgment. Written in 2003 and still true:
http://consumerreports.com/Pets/

13
prescription diets to old
by MooseMom on 06/24/2010 05:19pm

About 9-10 years ago the vet said kitty has kidney failure, try this corn based prescription food. I hate corn so I declined (knowing full well all the corn in our diets can't be good). I found Artemis Fresh Mix for Senior Cats, I moisten it with homemade chicken broth & kitty loooovvvvveeesssss her food (even if served dry). Kitty is now 20 years old.

14
Re: feline hw dz
by descendingdaphne on 06/24/2010 08:55pm

"Heartworm preventatives for cats. Probably disease mongering. Expanding a market for a drug by claiming it is a huge problem for cats. Humans will probably be next. What is the real incidence of this and is it worth giving a drug to all of these cats?"

Sorry, but you're way off base. Current estimates of infection are 5-15% of the unprotected dog population in any given area. We diagnose heartworm disease in dogs in Oklahoma left and right, and that's for owners willing to screen their dogs so they can start (or restart) preventive...that's not even taking into account the ones who don't know/care enough to do that. And if we had better testing methods for cats (and owners willing to screen), we'd be diagnosing a lot of feline heartworm disease, too.

I understand how owners feel when they suspect they're being taken advantage of. But I always ask myself this...if the test or medication were free, and is was more likely to help my pet than harm it, would I do it? Vets and their staff get accused all the time (and some rightfully so) about being "all about the money", but often it's owners who care more about finances than quality.

I guess I'd add heartworm risk to the list of common denials.

15
On denial
by jlthom02 on 06/25/2010 12:26am

I think you can also add denial about the severity of wounds and when they happened. There's nothing like walking into the exam room and being greeted by an owner who tells you they were out of town for the weekend and when they returned, they noticed their dog had a wound or an eye/ear infection that's clearly been there for weeks. It's denial that they have done anything wrong, and stubborn denial that we'll believe their version of what happened despite strong medical evidence on display in front of us.

16
To babysweet
by Dr. Patty Khuly on 06/25/2010 03:17pm

Don't worry, I'm not dismissive. Didn't mean to make it sound as if I was. I follow Doddsian guidelines and I don't pontificate. I simply disagree with the notion that pets don't need vaccines. That's all.

Stay tuned. You'll get a better idea on my stance when you read Monday's post.

17
HW,cats, diseasemongering
by P on 06/25/2010 07:20pm

Heartworm in cats is classic disease mongering. If heartworm in cats were really a problem in your area, you would not need a test for it to know the incidence. The problem would have been evident all along. Cats would have been dropping dead for decades and you would have been finding it first on autopsy. Or you would have been finding it on autopsy of cats who died for other reasons. The problem would have been evident as a problem in cats for decades.

Disease mongering: So you take an animal for which there is very little problem and exaggerate the incidence and severity because research conducted by the manufacturer of the preventative says there is a problem. it doubles the market for the preventative and gives vets the excuse to get customers in the door using trumped up fear.

Disease mongering: They sell vets on the idea it is a serious problem for cats for which there has long been a remedy for dogs. Vets can solve this invented problem by suggesting heartworm preventative for all cats. So the manufacturer recruits vets to spin the message.

Disease mongering: They use statistics selectively to exaggerate the benefits of treatment for a disease that cats almost always throw off themselves just like humans do.

Disease mongering: Then they promote treatment as risk free. As if cats ingesting these drugs is OK. It is not risk free.

And when vets sell the public on these trumped up problems, they lose their credibility. For the customer it is not denial. They begin to see the business model that vets are in collusion with the pharmaceutical, vaccine, and commercial food companies. They put greed before their ethics not to do any harm.

Next vets will be diagnosing "restless leg syndrome" in pets. I noticed my dog paddling while I thought it was dreaming. But in the future it will be RLS. RLS, they always give an acronym. Like GERD.

18
by NOT just a dog on 06/26/2010 03:40am

My personal (least) favorite denial:

"But of course there's nothing we can do about it," in reference to their dog's arthritis. This despite repeatedly being given a long laundry list of treatments, drugs, nutriceuticals, etc., that could help lessen their pets pain from osteoarthritis.

What they mean is, "We're not willing to do anything."

19
Feline heartworm
by ceridwen on 06/27/2010 08:53pm

Heartworm in cats is NOT disease mongering.

I teach anatomy and we dissect cats as a part of it. Every single semester we get at least 2-3 cats that have heartworms in their heart out of ~30 cats being dissected. The likely rate of cats infected is higher, because we do not cut open the lungs as a normal part of the dissection and heartworms frequently travel to the lungs.

You may find it reassuring to tell yourself that this problem does not exist but your vet is NOT making it up.

20
Denail
by Paws for Praise on 06/28/2010 07:18am

Yes, I know how to spell - just wanted to say you hit "denail" on da head;-)) As a trainer, I hear a lot of excuses, too. For instance, why they just had to "rescue" a dog from a pet store (how about rescuing his mom from the puppy mill cage, too???)
Or, why the breeder they purchased from is "reputable" - um, was that the same breeder who doesn't show, or do genetic testing, who is breeding somethingminipoodoodles and gave you a 72 hour "health guarantee" (then you have to visit the nice veterinarian to get rid of the coccidia, fleas, kennel cough, parvo, you-name-it?). Or the one who sold you the two adorable female litter mates even though you are a first time dog owner???? Or, how about the owners who swear that I must not know anything because I don't agree with their favorite TV personality about how to manage their dog? If I went to a doctor and told him he didn't know how to do a circumcision because I saw someone on TV who could it with a rubber band, wouldn't that be insulting?
It's an uphill battle, but I keep plugging, as I'm sure you do, too. Anyone who thinks that those of us in the animal professions are here to make a ton of money on Easy Street and don't care about our animal clients, should know that it takes years of schooling and experience, a lot of occupational hazards (do your clients bite, scratch, vomit or pee on the floor at your office, or eat poop?) and a willingness to deal with the humans who are associated (even loosely) with animals we love to help, but who are, too often, too busy, too consumed with how expensive it is, or too lazy, to react in the most responsible way.

21
Aggression
by PetHealthGuide on 06/28/2010 04:30pm

I cant tell you how many times I've heard #2!

22
confused
by russhelly on 06/29/2010 07:01am

I have a 2 year old male shitzu around 16 lbs. He's wonderful and a bundle of energy most of the time . About a year ago he started having what we call his moments ,Where he would run around like he lost his best friend scared , very confused ,paranoid and won't eat or drink they only lasted a hour or two up untill 3 monthes ago.Now he goes anywhere from 24 hours to 72 + hours its at least once a week now .There alot stronger and scary.He gets red and his skin is very sentive, he boobs his head up and down looks from side to side like he sees somthing ,thats not there He will hide in a courner like hes lost and scared.
He doesnt respond to his name, he wont eat drink or lay down. He will calm down alittle if you pet him But most of the time he wont let you becouse his skin is on fire or is crawling .hes scared to death like he has been beating . He dosent even know what a spanking is (spoiled rotten)Has any one had the same problem or anything simular with their babies
thank you


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About fully vetted

Patty Khuly, VMD, MBA

Photo of Dr Khuly

Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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