Vet Guilt

When a young vet graduates from veterinary school, the majority of them embark on a terrifying yet thrilling journey into the world of private practice.  A handful go into internships, or industry, but the majority follow my path.  At this point in our careers, we are armed with dangerous mixture of cocksure ignorance and piles and piles of factual information and textbook knowledge.  We don’t know squat about “real world medicine”.  And they just release us into practice, no safety net, no residency (unlike human docs who get what, like 4+ years of residency before they go out on their own), just our shining faces and your (the clients) expectant ones. 

Those were probably the worst 4 years of my life.  I can’t tell you how many sleepless nights I spent worrying about my cases.  Did I diagnose correctly?  Did my surgery go ok?  What if the dog dies in the night?  Whatifs were killing me.  The years went by, and now, 11 years, a little therapy, a few mistakes, and a LOT of experience later…I don’t lose near as much sleep. 

The down side is that the cases that get to me are usually a whole lot more complicated than the ones that got to me back then.  However, that’s not what this is about.  This case was pretty straight forward, the diagnosis was simple, I didn’t screw anything up, the dog is fine, but I still lost some sleep over it.

This little sweet Shih Tzu came in the other day for a dental.  I chatted with her mom/owner  (she’s super cool), I glanced in the dogs mouth, we had already done pre-surgical labwork so I knew everything was ok there, all systems go for the teeth clean.

Like I’ve mentioned before, when evaluating a dogs mouth, I can’t thoroughly tell how bad the dental disease is until the dog is asleep.  Well, when I sedated this little pooch, I’ll call her Ruby (the names have been changed to protect the innocent), I opened her mouth and gasped…oh no!  Toilet mouth. 

The teeth were awful.  Covered in tartar, and almost every single tooth had advanced periodontal disease.  This dog was going to need a LOT of extractions.  So I reluctantly dragged myself to the phone to call the owner to tell her what I found.  She was on a budget, and I knew this was gonna blow it.  AND, since I had no idea how many teeth I’d need to pull, the estimate I gave her ($400-500) ultimately fell a little short. 

Once a tooth loses 50% of the bone around it, due to advanced periodontal disease, you can’t save it.  Generally these teeth are encrusted in smelly, rotten tartar and they’re really loose.  Ruby had already lost some teeth and on the top jaw, almost all the teeth but her canines and I think one incisor were loose.  All said, I think I pulled 14+ teeth (almost all of the remaining ones on the top jaw) .  She at least got to keep her “fangs”.  The bottom teeth were not too bad, she kept most of those. 

From my end of things, (taking the owner out of it), pulling all those teeth isn’t a big deal.  I know in my heart, that that dog is going to feel better getting those nasty, rotten teeth out.  The dog is likely already in pain, and between you and me, if that was my mouth, I think I’d rather die than have to live like that…. so I think I’m doing a good thing for the dog.  Yes, they can eat with no teeth, you just have to soften their food.

From the clients end, the dog was eating, happy, and seemed pretty ok with all those rotten teeth.  Plus, people get really upset at just the loss of the teeth.   I think it’s the “ooginess factor” mixed with concern about them being unable to eat, plus maybe concern about their appearance?  I’m not sure, guess you guys ought to tell me….  (I know Dr. Rogers was pretty upset when her Bichon lost a tooth, because it made him look like a hillbilly).

Then, I had to deal with the guilt over the bill.  It got over $600, and I walked into the exam room with the sticker shocked client who understood the need for the procedure, but had to face an angry hubby who told her before hand, that “he wasn’t paying $600 for the dogs teeth”.   

The dog needed the work done, and unfortunately, to some degree it could have been preventable with brushing, and yearly dentals (they adopted the dog with the bad teeth already there), etc, but still, the clients weren’t emotionally or financially prepared for this.  That’s where I felt bad. 

 It had to be done though, but I did stay up that night worrying….was Ruby in pain?  Did the wife get in too much trouble?  How mad at me were they?  Did they understand the necessity of the procedure?  

I talked to the owner the next day, Ruby felt good, was eating and drinking and her husband only commented about how much cheaper a bullet is than a dental.  Hopefully, Ruby will be better than good in a week or so when all the wounds heal and all that infection goes away. 

Then the sleepless night will be worth it.


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