The Importance of Getting a Good History

I have a cute, fat chihuahua patient named “Tucker”. Tucker has that crazed look chi-chi’s tend to have, where you can never be 100% sure they are not going to immediately attempt to chew off your fingers. Thankfully, he’s never actually tried to bite, but we muzzle him anyways for procedures, just in case. But he’s just so darned cute.

He’s the apple of his owner’s eye. He’s had a few minor issues over the years: knee surgery, bladder stones, rat bait ingestion and such. But he’s gotten through it all relatively unscathed.

He came in for his annual exam and shots the other day. His check-up was pretty unremarkable except that he was on the tubby side because his owner likes to show his love with human food.  We discuss this at every visit.  He sticks to healthy human food at least.  “Lots of fruits and veggies” he proudly informs me.

Well, got to the part of the exam where we drew blood and got a urine sample to check out his insides, especially in light of the history of bladder stones.

Little Tucker comes in from his date with the urine cup and my tech shows me a very bloody looking sample.

“Did this come from Tucker!?” I ask, incredulously.  “Yes” the tech worriedly replies in response to the crazed look in my eye.

They are obviously feeding way too much human food and not enough of the prescription anti-bladder stone food, I deduce, angrily.  This hemorrhagic blood sample is probably indicative of a big fat bladder stone relapse.

“NO MORE HUMAN FOOD!” I prepare to tell the owner.

Well, instead,  I diplomatically enter the exam room to report my findings.  I recommend an x-ray to look for the stone, and prepare the client for the possibility of eliminating all the extra treats.

The x-ray was normal, so now I worry about more sinister causes of blood in the urine.  I tell Mr. Owner about the possibility of bladder infection, radiographically invisible stone, etc.  He casually mentions, “you know, his stool looked really red this morning too”.

This little revelation served to start  more alarm bells ringing in my little brain.  Gross hemorrhage in the stool AND the urine on this seemingly perfectly healthy dog that I just VACCINATED.

The rational part of my brain starts ticking off potential causes: autoimmune disease like thrombocytopenia, clotting abnormalities, tick borne disease, anticoagulant rat bait ingestion (again).

The irrational part of my brain shrieks “Oh my God, Tucker has Ebola!” (I don’t know why my brain thought this, but it comes up periodically ever since I read  “The Hot Zone” and saw the 90’s Dustin Hoffman classic “Outbreak”).

In the midst of my reverie, where I try to figure out what tests to run to get a diagnosis before Tucker’s flesh melts and blood comes out his eyes, the client quietly mentions: “you know, we’ve been feeding him a lot of beets.” ” Will that cause this?”

Pregnant pause.

“Yes, yes it can”, I calmly replied.  Heaving a quiet sigh of relief and maybe a hint of embarrassment. Because never in my wildest dreams, would I thought to have asked the question “Do you feed your dog beets?” while obtaining a history in a patient with urinary and fecal hemorrhage.

You can bet I will now.

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4 thoughts on “The Importance of Getting a Good History

  1. Is the client in this post adverse to at least TRYING to keep the treats under 10% of the dog’s intake?

    Of course I had to think, “Who wudda thunk a dog would eat beets!”

  2. I just HAVE to add ~ why wouldn’t a client think to mention any deviation of “normal” (funny-looking stools) at the beginning of a checkup?

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