I am on vacation. Technically, this is a work blog, even though I use it as a forum to expound on whatever is on my mind, but officially, it’s work related. Therefore, I’ve been remiss in blogging this week since I am not working. Right now I’m at my best friend’s house in Katy, TX. Before that I was at my mom’s house in Humble, and our beach house in Galveston (the island is slowly, but surely recovering). We’ve done the tour de Houston Metropolitan area. We went to the Houston Zoo (very nice, not too terribly depressing from an animal welfare status at all, excpt that they had a couple of Anatolian Shepherds on display and I have one as a patient, so it was a little weird, like going to the zoo to see a Cocker Spaniel.) We went to the Houston Children’s museum (fun), I think we took a year or two off my mom’s life stress-wise (my boys are a little wild and she has lots of breakable things in her very clean (prior to our visit) house).
We actually hired a sitter and went out for new years eve, and stayed awake til midnight in a real-live pub (which for us is super cool, even though we were huddled on chairs in the corner under the TV and behind the pool table bc we couldn’t find a real table anywhere). We saw “The Curious Case of Benjamin Button” which was decent.
Anyhow, what got me thinking about work stuff was a phone call I got from Dr. Rogers, my coworker. My gut reaction was “oh crap, work stuff, I’m on vacation”, but I listened to her voice mail anyways. My dogs are boarding at the clinic and were scheduled to have their teeth cleaned while there. I have always told them that if anything happens to the dogs, don’t call me and ruin my vacation, just deal with it. However, they call anyways. So during her pre surgical exam,Dr R. discovered that, Scully, my oldest dog (11) has a brand new heart murmur. A 3 out of 6, which is a pretty significant murmur for a first timer.
A heart murmur basically just means that there is some extra turbulence in the heart that you can hear through the stethoscope. Anything from dehydration to anemia to actual heart stuff can cause them. On smaller, older dogs, generally they are caused by the heart valves not coming together properly and forming a tight seal. As they age, the valves thicken and get leaky. Over time this can lead to heart failure.
Scully went from having no murmur in August, to a 3/6 now. That’s kind of a big jump. So, If she were my client’s dog and not my dog, I’d recommend starting with X-rays and maybe considering an echocardiogram to see exactly what is going on. This is where (to the clients) I get a little wishy washy because, more often than not the murmurs don’t mean anything imminently dangerous, but sometimes they do.
MOST of the time, you can get away with just doing some benign watching and then start meds when and if the dog begins to go into heart failure (wait for the dog to start coughing or having exercise intolerance). Then you do the Xrays for sure, maybe even the new Heart Disease Blood Test, or MAYBE an Echo. I try to give the clients all the relevant info, tell them what to watch for, then let them make the decision on what to do. This is where I get The Question.
I get why you ask The Question, but it’s very, very difficult for me to answer. The Question is: “What would you do if it were your dog”? The reason it’s hard to answer is: 1. I get a whopping discount for services 2. My dog is my dog, not my child, and for some of you it’s your child, I’m not sure what your relationship is with your pet 3. I never REALLY know what I’ll do in a situation until I’m actually in it.
Scully’s situation is the perfect example. On the one hand, my initial reaction was, well, she’s getting older, I’m not going to spend a lot of money on her, so I’m not going to bother with the expensive Echo. On the other hand, about one minute later, I think of those big brown eyes that helped me through my senior year of vet school and all my tough times(well not really, but she loves me no matter what, which is super cool). So, in acutality, when I get home and back to work on Tuesday, I’m going to call Dr. Cole, the ultrasonographer and see when he can come take a look at her. Then I’m going to research what kinds of supplements to start her on to help her heart AND I’m going to start her on an Ace Inhibitor even though studies don’t say they help tons when they don’t have any symptoms of heart failure. She’s already had the Xrays.
In a nutshell, I’m hitting her with everything but the kitchen sink. At a substantial discount (the echo alone to a client is over $450). So, what I struggle with, and why I get wishy washy, is that I have trouble with your expectations of me as clients. Do you want me to play the odds and just recommend only what’s really necessary (And how do you define that? it’s all useful information.) Do you want me to strongly recommend doing everything, regardless of the cost? (I’ve had people yell at me and call me a crook for this, but it IS what I would do for my own dog). These questions are what constitute the hardest part of being a vet, it’s a constant balancing act for every single client: how much will they spend? how far will they go?
So, anyways, now I guess I’ll wait and see what Dr. Cole tells me and start being nicer to Scully when she steals food from the kids and the pantry. Her days could be numbered…but not if I can help it.