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Wednesday, September 17, 2014

Same Disease, Different Day

Many people think that being a vet is exciting.  You're constantly seeing new patients, doing surgery, running tests, diagnosing diseases, and saving lives.  You never know what's going to come through the door next!  At any  moment that emergency could burst in and you'll have to drop everything to handle it while your adrenalin surges!  While those moments do sometimes happen, they are not as frequent in general practice as you might think.  Most of the cases we see in a day are almost identical to cases we saw the day before or even earlier that day.  Here's a brief list of cases I see the most.
  • Colitis--This is typically diarrhea in an otherwise normal dog, sometimes with blood.  Most of the time we don't figure out an exact cause and treat symptomatically. Almost every day I'll see one of these.
  • Ear infections--While most common in the warm, humid months I can see these just about any time of the year.  It's not uncommon to have 4-5 ear infection cases in a day.
  • Itchy skin--This is often seasonal and even regional, depending on the prevalence of fleas and other allergens.  Most of the time it's something other than fleas, though in the summer months that becomes more likely.
  • Vomiting--This is something that comes in daily.  And it's only because just about every kind of illness has the potential to make a pet vomit.  Sometimes these require a lot of thinking and workup, but it still gets tiring to have go into a room that's the fourth nauseous pet of the day.
  • Lethargy--In the US, especially the South, we call this "ADR", or "Ain't Doin' Right".  "Well, doc, I'm not quite sure what's goin' on, but he just ain't doin' right."  This is about as vague as they come because litterally any disease or disorder can cause this as a symptom.  Sometimes we get a clue on the exam, but often it requires a lot of testing to nail down the problem.
 
On an average day the above cases account for probably around 60-70% of my cases when you also throw in routine checkups and vaccinations.  In a way it becomes rather routine and boring.  "Oh, no, not another ear problem!  I've already seen five of those today!"  At the same time, if you are careful as a doctor you can get very good at diagnosing and treating these problems, especially if they go from routine to complicated.
 
The danger is becoming complacent.  "This is the sixth itchy dog I've seen today.  It's probably just fleas or a grass allergy."  Each case still needs to be completely worked up because there are cases that simply aren't what you may initially think.  If you just threw steroids or antibiotics at everything you may be missing other problems that need different treatment.
 
I'm sure that my human colleagues have similar disorders they see daily.  When I've taken my kids in for strep throat I've sometimes wondered how many other cases of that particular infection the pediatrician has seen that day.  It probably gets routine and boring for them as well.
 
This monotomy is often why veterinary staff get so excited to see something different.  "Oh, wow, there's a foxtail in that ear!"  "Hey, look, it's positive for Giardia!"  "Cool, it's a wolf bot!!!"  We don't want a pet to have something bad, but there are some things that are so uncommon that we can't help but get energetic that our routine has been broken. 

When you're a new graduate just about everything is exciting because you get to see and put into practice the things that had previously just been theory taught in classes and clinics.  But after a few years you start dreading that next ear infection because it's the 20th you've seen this week.  It's all just part of being a vet, and one of the parts that most people never consider.

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