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Wednesday, July 22, 2015

Medical Advice From The Tire Shop

Some things you just can't make up.

Our clinic has been seeing a 10 year old Boston Terrier.  He has had some hair loss and skin issues, so we started working up the case.  His overall blood tests were good, but his thyroid level was low.  We started him on a supplement and brought the thyroid level within normal range, but his skin didn't get much better.  We had already ruled out bacterial and fungal diseases and he wasn't itchy so we didn't think that allergies were a likely cause.  I had become a bit stumped and had recommended that they take him to a local veterinary dermatology specialist. 

That was back in early May.

Today the wife comes in and asks about whether or not the disorder could be mange.  For those non-vets reading this, let me explain a few things.  There are two kinds of mange we commonly see in dogs:  Demodex and Sarcoptes ("Scabies").  Sarcoptes can affect any dog at any time and causes significant itchiness.  Demodex occurs when the immune system is immature or suppressed and we almost exclusively see it in dogs less than a year old.  An adult dog shouldn't have Demodex unless there was a real problem with their immune system and other signs of illness.  This particular dog wasn't itchy, didn't have the signs of scabies, and was overall healthy.  Could it have been Demodex?  Actually, yes.  However, that was certainly not our first thought in a 10 year old dog with confirmed hypothyroidism and no other signs of illness.

So why did the client ask about mange?  When my receptionist, Christina, was asking me about it my first thought was that the client consulted "Dr. Google" in an internet search.  But Christina said "oh, it gets better."  I cringed.  "She was talking to the guy at the tire shop where she was getting new tires, and he said that he had a dog with mange that looked exactly the same.  So she was asking if it could be mange."

We had to spend some time explaining that mange in a dog that age was extremely unlikely, that we had absolutely confirmed hypothyroidism, and that there were no other signs of health problems to suggest an immune system disorder.  Even so, I don't know that she was completely convinced that I was right and the tire guy was wrong.

I don't mind my clients looking things up online.  It often stimulates good conversations and I like clients to be well educated.  However, I always ask my clients to discuss things with me before taking "Dr. Google" as the ultimate source.  Heck, I always tell you readers to check with your own vet!  Any vet on the internet is handicapped by not being able to see and examine a patient, and you should never rely on such advice as the sole voice of diagnosis and treatment.  If you're merely searching by symptoms you don't have the clinical judgement and ability to take a list of findings and appropriately tie them to a proper diagnosis.

But you should never listen to a non-veterinarian over a vet.

Sure, talk to friends, co-workers, and random people to see what they might suggest about your pet's illness.  But when you then talk to your vet, realize that they have the training, knowledge, and skills to make a proper diagnosis.  When it comes down to who you believe, give your vet the edge.

4 comments:

  1. Love the blog. One comment, though - you write "I don't mind my clients looking things up online. It often stimulates good conversations and I like clients to be well educated. However, I always ask my clients to discuss things with me before taking "Dr. Google" as the ultimate source. Heck, I always tell you readers to check with your own vet!"

    Isn't that what she did, though? When she got an idea from google or a non-vet, she brought it to you and raised it as a question?

    It seems to me that she did the right thing, here (the wrong thing would be deciding that it was mange and trying to treat it herself, or insisting that you treat mange).

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  2. AKA Darkwave, etc - I believe the point was - Dr. Bern recommended that the owner see a specialist back in May - and here it is over two months later and instead of going to the specialist - sounds like the woman either didn't do that or didn't follow through with the specialist's advice and instead was hoping the tire guy was right.

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  3. I think the point of that quote is that, while he doesn't mind clients asking questions, doing their own research, and digging for their own answers, it's when they are skeptical of his licensed, educated, professional opinion over an uneducated one like tire-shop guy/Dr. Google, etc.
    The bit where he says "...taking "Dr. Google" as the ultimate source. Heck, I always tell you readers to check with your own vet!" shows that he cares more about the client trusting the most reputable source at the end, whether it be himself or their regular vet, as long as it's the VET and not the tire-shop guy.
    The frustration in this post comes from the fact that he had been treating this dog for a while and because the problem was not immediately solved the client as started to look to disreputable sources over his own medical knowledge.
    Correct me if I'm wrong though, Dr. Bern :)

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  4. Absolutely right, Lin! You beat me to the reply and said it better than I would have. My concern was that this client seemed to believe the tire shop guy over me. If they had simply said "Oh, well no problem then" it wouldn't have even made it into my blog. When they acted skeptical about my evaluation and seemed to want to believe the tire guy was when the problem wasn't resolving.

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