Has anyone noticed that coffee drink sizes have gotten bigger? The tall is the old grande; the grande is the old venti; and so on. I have it on good authority that they are bringing in an even bigger size (wink, wink).

So I’m sitting in a well known coffee shop during my lunch break, drinking a tall-formerly-grande skinny vanilla latte and I begin to ponder an important issue that I’ve decided to bring to you, The Daily Vet blog reader.

I feel like, as a veterinarian, I wear a lot of hats. That’s a given. I’m sure you’ve heard it before: we’re all medical professions rolled into one. As general practice veterinarians, we get to be neurologists, dermatologists, gastroenterologists, ob/gyn’s, et al. We’re also psychiatrists, pharmacists, hospitalists, financial advisors, etc.

That’s not what I’m talking about; I’m thinking of bigger hats. When I walk into an exam room with a new client, I’ve got to figure out which vet they want me to be. What are their expectations? What’s their relationship with their pet? 

Here’s the scenario: A 10-year-old beagle I saw yesterday comes in with a snotty nose and terrible breath. He’s lethargic and his appetite is down. His physical exam indicates he’s dehydrated. His nose is turning from black to pink and losing its "cobblestone" appearance (becoming smooth instead of bumpy). His lips are going from black to pink as well, and on further examination, the whole roof of his mouth is ulcerated.

Based on my findings so far the dog could have:

• Mycosis Fungoides, or epitheliotrophic lymphoma (lymphoma of the skin … cancer)
• Pemphigus or some other type of autoimmune disease
• A systemic disease, like kidney failure, that is causing the oral ulcers
• Mucocutaneous pyoderma, nasty infection
• Chronic ulcerative periostomatitis (a nasty, horrible, autoimmune induced dental disease)
• Some obscure disease that will require a referral to a specialist to figure out

The dog needs blood work, a dental, and biopsies of the depigmenting skin to figure this out. For the most part the listed diseases are treatable (not curable), but not cheap to manage.

So what kind of vet do they want me to be? 

1. "Modern" Vet: Dog needs additional testing, possibly a referral to an oncologist, depending on the results. Let’s discuss the options.
2. "Old School" Vet: Well, the dog’s had a good long life. This looks serious. Let’s give him this big shot of antibiotic and steroids and see if it works. If not, well, maybe it’s time to put him out of his misery. (Some days I wish vet medicine was still this easy!)
3. Pediatrician: Your dog needs XYZ testing. Do as I say.

Personally, I generally stick to the "modern" vet option.

I want to know what’s wrong with the pet, and treat accordingly. What I end up doing is offering my best recommendation, then sitting down with the client and working through the options. I need to know how far they will go financially, emotionally, and philosophically.

Sometimes I have clients laugh at me. Are you kidding meTwo-hundred dollars for a blood test for a DOG? That’s ridiculous!

What then? 

This is where the "old school" hat might rear its head. (Like I said, this approach would be sooo much easier, but I didn’t go to school to just give shots.) I feel compelled to throw that option out there. I’m not thrilled about it, though. But for some clients, that’s as far as they are inclined to go. They might do some minimal treatments, but they generally will euthanize if things get too serious.
   
Conversely, I have read that, as a vet, I am supposed to be the pet’s advocate, to fight for his right to treatment. This is the pediatrician model of vet practice: You must do what I say because it’s the best thing for this pet. However, if your pet is your child, and you make that clear, I will wear that hat too.

This absolutely won’t work for the "old school" folks, though. I can’t just send them out the door if they refuse to run tests, hospitalize, etc.

I’ve read Internet rants from people who felt like their vets "guilted" them into undergoing extensive workups, procedures, or hospitalizations for their pets that they ultimately regretted.

I don’t force people to follow my recommendations. I feel like, ultimately, it’s up to them. I take as long as necessary to give them all the relevant information and options. In the end, the human is the one with the wallet.

The way I rationalize the use of these different approaches is that it’s my job to ease the pet's suffering.

In the face of a seriously ill pet, I either run a barrage of potentially expensive tests to find out precisely what’s wrong with the pet and treat accordingly, try empirical treatment based on my best guess (and hope the pet responds), or euthanize.

The pet will either get better or have to be put down. One way or the other, he/she is no longer suffering. (Obviously this is a black and white interpretation of a very gray issue.)

Heck, I could run thousands of dollars worth of tests, hospitalizations, etc., and the pet could still die or need to be euthanized. There are no guarantees in medicine.

It sort of boils down to something one of my bosses in my first job told me. I’ve never asked a client this, but if I did it sure would help to clarify things: Do you want this pet or a pet?

What do you think? Which vet do you want?
 

Dr. Vivian Cardoso-Carroll

Pic of the day: Cool Hat Lucy by CaptPiper