Doesn't it sometimes seem like your life is crazy and nobody else can compare? Sure seems that way to me. We go around in our lives with a "to-do" list as long as our arm and try to survive what it takes to get through it. That can mean that when we're interacting with others we may be a bit short-tempered, never realizing that they are going through the same things.
I'll see this often with my clients. They are hoping to rush in and rush back out since they have to pick up the kids, plan for a party, clean house, and so on. When we don't usher them from the front desk to the room and back out again in 10 minutes, they get a bit miffed. After all, they have so many other things to do, they can't take the time to wait like a normal visit, and expect us to hurry it up. Unfortunately, quality service usually can't be rushed.
Now this isn't really a complaint against my clients. Actually, it's a realization from the other side of the fence. Lately my wife and I have been burning the proverbial candle at both ends AND the middle. Here's a quick list of the things that keep me busy in my life....
Veterinarian
Hospital manager
Father to two
Husband
Volunteering in community theater
Leading a geek/fan ministry online
One of the leaders in my local church
Teaching online for a local college
And that's just a list of my regular responsibilities, without getting into the details of the numerous things I do for each. That also doesn't include things like helping my wife keep the house picked up and trying to find time to simply relax, peruse the internet, read, or blog.
Today I was rushing to the theater to get ready for the show. I'm managing the lobby and have it decorated for Halloween and have to bee there at least 90 minutes before curtain to make sure everything is in order, as well as put on my own costume. I was sitting in the drive-thru at a fast-food restaurant waiting at the window for my order and started to feel very impatient. If I didn't get my food quickly, I was going to have to rush even more! I started tapping my fingers on the steering wheel and could feel my muscles tighten. They were making fresh fries, so it was taking longer than normal. But I had to get going! At that point I made myself realize that they were doing their job, I was going to get fresher food, and it wasn't their fault that I was the one in a hurry. There was no reason for me to take it out on them by getting short-tempered.
When I'm at work I have to try and put aside the thousands of other things running through my mind and concentrate on my cases. But while I'm reading lab results I may start to think about the decorations I need for the theater. While I'm doing a spay my thoughts may drift to the exam I need to make for the online class. Like everyone else, I often have to juggle multiple ideas and priorities, keeping them all straight.
So the next time any of us get hurried and stressed, remember not to take it out on that doctor, waitress, cashier, or any other person. Chances are that they have just as many things that they're dealing with also. Let's show each other a tad more courtesy.
Saturday, October 23, 2010
Inaction On Seizures?
Jessica sent this in yesterday....
A night or two ago, my mom called me at school hysterical, saying that something was wrong with the dog.
She described to me that the dog, a Boxer/Beagle mix named Cooper, had fallen to the ground, couldn't stand up, and was foaming at the mouth. He peed himself and I guess it looked pretty bad. Then in less than three minutes apparently he was up and wagging his tail.
I'd never seen him do that, but before I went to university my sister woke me up one morning, freaked out, saying that something was wrong with the dog and he was growling at her. I got up and checked on him and he was laying on the couch. He seemed fine and wasn't acting out of the ordinary but when felt him his chest was soaked and I noticed there was some remnants of foamy saliva on his mouth. At least one other time before leaving I found him with spit all over his chest. I thought that he must have eaten something strange that made him salivate heavily like that, like when our last dog somehow stole a whole pork roast off the counter and ate the whole thing... in one gulp.
But when my mom told me about this I thought something must be wrong with him neurologically. I work at a doggy daycare and I know of a few dogs that are on seizure meds and what happened to him sounded like a seizure.
I told my mom to call the vet and they said to bring him in, but he would be fine, but when they ran the bloodwork everything came back positive. I thought it was strange that they would run bloodwork for something that seemed neurological but they said they wouldn't do anything for now and that he might have to go on meds if it kept happening.
I thought that their inaction was REALLY strange. What do you think? Can you tell me more about identifying seizure problems and its treatment? I'm puzzled by this. Especially since evidently he's had more than one in a short span of time. Maybe two or three months tops, he's had at least three, the last one being fairly serious.
Good questions, Jessica, and I'll try to answer them. There is a lot that goes into seizures that people may not think about, and it's not always a simple situation. A seizure is basically a mis-firing of the neurons in the brain. Imagine a city with lots of one-way streets and traffic flowing fairly well along the roads. Then all of a sudden cars start going in directions that they shouldn't, ignoring stop lights, and pretty much moving around erratically and with no regard for the normal rules of the road. Chaos would ensue and the city would be tied up in gridlock. In a very simplistic nutshell, that's what happens during a seizure.
Seizures can be caused for numerous reasons. Certain toxins can cause seizures, including many over-the-counter flea preventions. Low blood sugar (hypoglycemia) can also lead to seizures, as well as liver dysfunction or failure. Brain tumors and even infections can affect the nervous system and lead to various neurolgical disorders. And then there is epliepsy, which in dogs is a seizure disorder with no discernible cause. Once other causes have been ruled-out, a good rule-of-thumb is that if the seizures start at or before five years old, it's probably epilepsy; if they start after five years old there is a high likelihood of a brain tumor.
When we're examining a pet for seizures, the first set of testing that we do after the exam is basic blood testing. As I mentioned above, there are many reasons why various metabolic and organ disorders can impact the nervous system, and we want to screen for infection, toxicity, and other disorders. Any of these problems are treated very differently from each other, so we need to try and figure out what it may or may not be.
If all of the tests are normal, this is a good thing. It means that the vet has eliminated many disorders and in this case indicates that we likely have epilepsy. This disorder is not life-threatening and doesn't normally cause long-term damage to the brain or nervous system. It can become worse with time, but there is no way to predict ahead of time whether this will happen.
Treatment is normally reserved for very severe or frequent seizures. The medications must be given twice daily every day on an ongoing basis in order to effectively prevent seizures. These medicines also can have some significant side-effects and can damage the liver, so we don't normally use them in mild cases. My own rule of thumb is that I start to consider anti-seizure medication when the patient is having a seizure every month or more frequently. Short seizures that happen every few months aren't normally treated, as in these cases the risks of the side-effects of medication don't outweigh the benefit of controlling the seizures. In cases like this it's common to NOT treat and observe for worsening, at which time we can consider treatment.
So basically it sounds like your vet did what I would normally do and made similar recommendations. Hopefully you understand a little better the reasoning behind those decisions. If you have any further follow-up questions, feel free to ask.
Wednesday, October 20, 2010
Incorrect Heartworm Prevention
Here in the US heartworm preventative medications are sold as prescription drugs. Depending on where you get it and the size of your pet, a six-month supply normally costs from around $30-60. Honestly, this is a good price considering that treating heartworm disease can easily run $800-1000. Suddenly $5-10 per month doesn't sound so bad. But even with that minimal cost many people try to find ways to do it even cheaper and avoid having to do the annual heartworm testing required by most veterinarians.
Most horse antiparasitic medication is easily available over-the-counter at farm supply centers, and people will try to use this instead. On first glance, it seems like a good idea. The main ingredient in the most common heartworm preventions is ivermectin. This is also a common ingredient in many horse dewormers, and these equine medications are usually much cheaper. So some pet owners will purchase horse medications and give it to their dogs as heartworm prevention. Theoretically there isn't anything inherently wrong with this method. However, there is a significant danger that most people aren't aware of. In high enough doses, ivermectin can be toxic.
A single tablet of ivermectin-based heartworm prevention for the largest category (51-100 lb dog) contains around 0.27 mg of ivermectin. Horse medication is much more concentrated since it is designed to treat a 1200 pound animal at a dose of around 0.09 mg per pound. Dosing based strictly on weight, a 100 pound dog would then receive 9mg of ivermectin rather than 0.27mg! This 33 times the recommended dosage!!!! If someone is not VERY, VERY careful with the dosage, it's easy to overdose a dog using horse medicine. And this happened in my clinic yesterday.
A small dog came in very lethargic after having been given horse dewormer as heartworm prevention. The dog was sedated and showing slight neurological signs, classic symptoms of ivermectin toxicity. The owner's neighbor used horse dewormer as heartworm prevention, so she decided to do it herself. Unfortunately she gave far more than was needed and the dog suffered because of it. Thankfully, the toxicity was mild enough that the dog will recover. In many cases of ivermectin overdose if you stop giving the medication immediately the symptoms will resolve. But in severe cases you can see severe neurological disorders that can be very harmful.
There is also a problem in certain breeds of dogs, mainly herding breeds (collies, border collies, and related breeds). These dogs have a genetic quirk where they lack a gene to produce an enzyme that will break down and eliminate ivermectin from the body. This abnormality makes these breeds especially sensitive to ivermectin. The doses found in heartworm preventions are low enough that there isn't a concern, but when using doses higher than this you can run into toxicity very quickly.
The bottom line is that you should only use medicines that your veterinarian specifically recommends. Doing otherwise could lead to harm for your pet and potentially expensive veterinary visits to treat unwanted consequences.
Most horse antiparasitic medication is easily available over-the-counter at farm supply centers, and people will try to use this instead. On first glance, it seems like a good idea. The main ingredient in the most common heartworm preventions is ivermectin. This is also a common ingredient in many horse dewormers, and these equine medications are usually much cheaper. So some pet owners will purchase horse medications and give it to their dogs as heartworm prevention. Theoretically there isn't anything inherently wrong with this method. However, there is a significant danger that most people aren't aware of. In high enough doses, ivermectin can be toxic.
A single tablet of ivermectin-based heartworm prevention for the largest category (51-100 lb dog) contains around 0.27 mg of ivermectin. Horse medication is much more concentrated since it is designed to treat a 1200 pound animal at a dose of around 0.09 mg per pound. Dosing based strictly on weight, a 100 pound dog would then receive 9mg of ivermectin rather than 0.27mg! This 33 times the recommended dosage!!!! If someone is not VERY, VERY careful with the dosage, it's easy to overdose a dog using horse medicine. And this happened in my clinic yesterday.
A small dog came in very lethargic after having been given horse dewormer as heartworm prevention. The dog was sedated and showing slight neurological signs, classic symptoms of ivermectin toxicity. The owner's neighbor used horse dewormer as heartworm prevention, so she decided to do it herself. Unfortunately she gave far more than was needed and the dog suffered because of it. Thankfully, the toxicity was mild enough that the dog will recover. In many cases of ivermectin overdose if you stop giving the medication immediately the symptoms will resolve. But in severe cases you can see severe neurological disorders that can be very harmful.
There is also a problem in certain breeds of dogs, mainly herding breeds (collies, border collies, and related breeds). These dogs have a genetic quirk where they lack a gene to produce an enzyme that will break down and eliminate ivermectin from the body. This abnormality makes these breeds especially sensitive to ivermectin. The doses found in heartworm preventions are low enough that there isn't a concern, but when using doses higher than this you can run into toxicity very quickly.
The bottom line is that you should only use medicines that your veterinarian specifically recommends. Doing otherwise could lead to harm for your pet and potentially expensive veterinary visits to treat unwanted consequences.
Monday, October 18, 2010
Being The Boss
Sometimes I really don't like being "the boss". I'd love to be able to expect everyone to do exactly what they should every time, but unfortunately that's not always the case. I've been dealing with some issues with my staff for some time now and today had to get hard with them.
I have a good staff overall, and everyone has very good technical skills. However, several of them have been having some bad attitudes. We've admittedly had a lot of changes in our procedures and patterns over the last few months, including a new head technician. And things haven't always gone smoothly. But this has turned into a lot of complaining, bad-mouthing other staff, and leaving work for others to finish. People are complaining about each other, and I've seen situations where they complain about something someone else has done, yet they've done something similar. It's been really affecting the performance of the team and our efficiency, so something had to be done. I've talked to some individually, but this needed to be addressed as a group.
So today we had a staff meeting, and I laid it out. I talked about the problems I've been seeing and the performance issues. I also had to tell them that I would no longer tolerate these behaviors, and if they continued I'd be happy to accept their resignations or would pursue further disciplinary actions. We're already short-handed and in the process of hiring, and it would hurt us to loose more people suddenly. But at the same time I'm willing to deal with that short-term problem to fix a long-term issue.
I hate having to deal with people like this, as I'm a basically non-confrontational person. But at the same time I'm ultimately responsible for the performance of the clinic and the staff. So over the years I've had to fight against my natural inclinations and actually discipline and discuss difficult subjects. It hasn't been easy, and I've certainly made my mistakes, but I've also developed some skills that allow me to actually make it through these times. But yeah, being the boss sometimes sucks. Still, you have to take the bad with the good, and I accepted this responsibility.
Now we just have to see if the sterner measures will result in a difference or if I'll have to take it to the next step.
I have a good staff overall, and everyone has very good technical skills. However, several of them have been having some bad attitudes. We've admittedly had a lot of changes in our procedures and patterns over the last few months, including a new head technician. And things haven't always gone smoothly. But this has turned into a lot of complaining, bad-mouthing other staff, and leaving work for others to finish. People are complaining about each other, and I've seen situations where they complain about something someone else has done, yet they've done something similar. It's been really affecting the performance of the team and our efficiency, so something had to be done. I've talked to some individually, but this needed to be addressed as a group.
So today we had a staff meeting, and I laid it out. I talked about the problems I've been seeing and the performance issues. I also had to tell them that I would no longer tolerate these behaviors, and if they continued I'd be happy to accept their resignations or would pursue further disciplinary actions. We're already short-handed and in the process of hiring, and it would hurt us to loose more people suddenly. But at the same time I'm willing to deal with that short-term problem to fix a long-term issue.
I hate having to deal with people like this, as I'm a basically non-confrontational person. But at the same time I'm ultimately responsible for the performance of the clinic and the staff. So over the years I've had to fight against my natural inclinations and actually discipline and discuss difficult subjects. It hasn't been easy, and I've certainly made my mistakes, but I've also developed some skills that allow me to actually make it through these times. But yeah, being the boss sometimes sucks. Still, you have to take the bad with the good, and I accepted this responsibility.
Now we just have to see if the sterner measures will result in a difference or if I'll have to take it to the next step.
Friday, October 15, 2010
Rescuing From Abuse
Don sent in this poignant and powerful story, which I've edited a bit for the sake of brevity...
I was wondering if you have had any experience in helping abused animals and law enforcement? The reason I ask is I am trying to help an abused dog.
Last month our next door neighbors had a woman move in with them. She brought a dog. They put the dog in a cage ( 4 by 4 feet) with a tarp over the top. The cage has a wood floor. There is nothing else in the cage. No toys, chews, hay, dog house..nothing. They give the dog food and water in the morning and that is it. They never speak to the dog, pet it or pay any attention to it.The cage floor was kept clean. I did nothing at first because i was not sure if this was a temporary situation and perhaps the woman was down on her luck and was maybe looking for a place for her and her animals. Anyway about a week ago I began to notice the woman was no longer around. The floor of the cage began to pile up with feces. I went over to our neighbors and asked about the dog. The owner of the property said that woman had to leave for a few days and he said he does not really like the dog and he is scared of it. So I offered to walk the dog and look after it but the man said he will have to ask her first....Anyway two nights ago there was a big rain storm with lightening and thunder. So again I went over and asked the owner of the home if I could put the dog in an enclosed shelter for the night: out of the rain. I told him we have an enclosed shelter. He agreed and we took the dog into our home. He was so thirsty and hungry, he drank five bowls of water and ate three full cans of wellness. Now I have been checking on him and I see they give him food so I am not sure why he was so hungry. Here is the other strange thing. From looking at him through our window it is hard to see him clearly but once we had him in the house it was clear he is extremely under weight. You can see his spine and ribs easily. I picked him up and he did not weigh more then 20 or 30 pounds...He also is kind of wobbly on his feet, (like a man that has one drink to many). One side of his face is pulled up higher than the other side. He has a cyst on his chest that when touched is painful to him. I could see him wince. he also has hot spots on his feet...The next morning the woman who owns the dog came by to get him from me. I tried to keep it lite and i told her how nice and smart the dog is. She gave me a phony story about how she was in a car accident and that is why she was not around, she even added a tear in her eye to show how concerned she was. She told me she has owned him since he was three and he is twelve now. She then said in a song song voice " mommy is taking you home now". Apparently home is back to that cage because that is where he is now.
I found a rescue group that is dedicated to helping chained and penned dogs and there is a person that I am in contact with. They are helping by listening to me and offering advice.
In fact the woman that started this group was arrested once for taking a dog off a property. The dog had been laying on it's side for three days in a yard and could not get up...So she had no choice but to take the dog and bring it to a vet. So she was arrested for stealing the dog. Long story short she refused to give the dogs location and the dog lived in a secret home. The prosecutor and AC refused to look at the photos and video of the dog in the yard. It is a well documented story with news paper articles to back it up. It all seems very grim and stupid.
Here is my plan. I am going to tell the woman that I have been looking for a nice friendly pit bull like her dog for a while now and I will offer to buy it. I don't want to go on about how much better i will treat it because I don't want her to be defensive. I will just keep it short and sweet. If she wants more info then I will explain that I plan to keep it as part of the family and take care of it etc....
I have already called animal control ( our animal control officers seem to be very concerned about animals unlike the other stories I have read ) and checked with them. Terry and Debbie ( we have two AC's) said that the dog must have a shelter not a pen by law and also if he needs medical care the owner will have to provide it. I explained my plan about offering to buy the dog and they think it is a good idea. They are on standby and are waiting for my follow up. If the woman does not want to sell the dog then I will make a complaint with AC and ask them to investigate. I will then keep in touch and follow up. If the woman does not want to help her dog I am hoping the pressure from AC will either help the dog or cause the woman to sell it to me.
Is there any advice or experience you might have? I am willing to help this dog in whatever way I can.
Don, these are always difficult situations, and honestly it sounds like you're doing the right thing. You do have to be careful in situations like this, as legally the lady owns this dog and if you take him, even for good reasons, it's no different than you taking her TV or couch. However, there are laws against both abuse and neglect. Abuse is usually more straightforward as there are wounds and signs of being physically beaten. However, neglect can be just as bad or worse, and is also just as illegal. You can't in good conscience ignore either situation.
In this case it sounds like it's neglect, and based on what you've described it's probably criminaly prosecutable. First I'd say try to get photos and videos of his normal environment. This will help support the case if it ever ends up going to trial. You've already done the next step of contacting your local animal control division, and thankfully it sounds like you have some good people there. Most animal control officers really do care about the pets they investigate, but this is also one of the most under-funded departments and they usually don't have the resources to fully investigate every case like they wish they could. But in order for anything to be legally done, the officers have to be the ones involved as you can't bring a criminal case against someone without being in law enforcement.
I really admire how you've decided to handle the situation. Offering to take the dog sounds like a great solution and if it works would likely take care of everything. However, I have a feeling that she won't be willing to give him up, which will complicate things. I can't give better advice than what you're doing, and think you should proceeded as you've laid it out here. You seem to have things well under control.
But please let me know how things turn out!
Sunday, October 10, 2010
Important Differences
One of the challenges of being a vet is that there are differences between the kinds of patients that we see. There are some pretty big differences between dogs and cats, including their physiologies, tendencies for diseases, normal laboratory values and so on. There can also be significant differences between breeds within a species. Some examples...
*Cavalier King Charles spaniels have giant platelets. These platelets are larger than in other dogs, but function normally. The problem is that the automatic blood analyzers we use in our hospitals measure cells based on size. Because these platelets are larger than the machine is expecting, it will give a lower platelet value than actually exists.
*Greyhounds have a higher percentage of red blood cells in their blood than other breeds. A high percentage of cells can indicate dehydration or certain diseases, but is normal in greyhounds.
*Asian breeds can have a higher than normal potassium level. This includes chows, Akitas, and others.
As far as I am aware, differences this significant don't really exist among human races. There are some racial and regional differences, but some of the largest ones are due to environment and not genetics. For example, people who live at higher elevations have a higher density of red blood cells than people who live at lower altitudes; but this can change the longer you live at a given elevation and so is a physiological adaptation and not a genetic difference. I would be very interested if anyone has examples of true racial differences as significant as those seen in animal breeds.
Such differences can make a veterinarian's job challenging. When we're interpreting lab values the analyzers will give us a range of "normals" and will let us know when something is outside of that normal range. We then have to figure out of that out-of-range value is truly significant, incidental, or related to the breed. Determining disease is not as straightforward as it may sometimes seem.
Remember a veterinarian's motto: "Real doctors treat more than one species!"
*Cavalier King Charles spaniels have giant platelets. These platelets are larger than in other dogs, but function normally. The problem is that the automatic blood analyzers we use in our hospitals measure cells based on size. Because these platelets are larger than the machine is expecting, it will give a lower platelet value than actually exists.
*Greyhounds have a higher percentage of red blood cells in their blood than other breeds. A high percentage of cells can indicate dehydration or certain diseases, but is normal in greyhounds.
*Asian breeds can have a higher than normal potassium level. This includes chows, Akitas, and others.
As far as I am aware, differences this significant don't really exist among human races. There are some racial and regional differences, but some of the largest ones are due to environment and not genetics. For example, people who live at higher elevations have a higher density of red blood cells than people who live at lower altitudes; but this can change the longer you live at a given elevation and so is a physiological adaptation and not a genetic difference. I would be very interested if anyone has examples of true racial differences as significant as those seen in animal breeds.
Such differences can make a veterinarian's job challenging. When we're interpreting lab values the analyzers will give us a range of "normals" and will let us know when something is outside of that normal range. We then have to figure out of that out-of-range value is truly significant, incidental, or related to the breed. Determining disease is not as straightforward as it may sometimes seem.
Remember a veterinarian's motto: "Real doctors treat more than one species!"
Friday, October 8, 2010
Priorities, Please
Because I'm the Chief of Staff at my hospital I sometimes get calls on my days off. That's usually not a good thing, as most of the time it means that there's a problem of some sort. Yesterday I received one of those calls.
Wednesday I received a call from a client with a bearded dragon. Apparently it had a swollen, white eye and she was wanting to know what to do. I was concerned that there was an infection or injury and asked if she could bring it in. She had some things to do, but said that she would be there in 30 minutes. Two hours later we closed and I hadn't seen or heard from her.
Then yesterday she brought him in to be seen by one of my associates since it was my day off. The doctor determined that it was a shedding problem and began to moisturize the eyes, working on getting the improperly shed skin off. While the beardie was in the clinic a serious emergency came in. A client's cat had been attacked by a dog and there was a deep wound fully into the abdomen where the bladder was visible. So my associate rushed the cat into emergency surgery to try and save its life.
Here's where it gets crazy. The owner of the bearded dragon came by the clinic even though she hadn't been called. She insisted on talking to the doctor, but she was in the middle of the surgery at the time. The client was told about the emergency surgery and that the doctor could talk to her later. The client began to get upset and wouldn't be satisfied with this explanation. She actually wanted to go into the back and talk to the doctor about her lizard while the doctor was in the middle of a life-or-death surgery! The client didn't care what the doctor was doing, she wanted to speak to her RIGHT AWAY!
Ummm...priorities, please? That was a very selfish client. Yes, I know that she was worried about her lizard, but he wasn't critical. Emergencies happen and need to be given priority, which my associate rightly did. The client also wasn't satisfied with what the doctor told her was the problem since I had mentioned an injury or infection on the phone. Keep in mind that I'm always careful with my wording and I had told her that it sounded like an injury or infection and didn't sound like a shedding problem. Based on that she felt that I had told her that it definitely was an infection, and so wasn't accepting what the other doctor (who actually EXAMINED the pet) told her.
So I got a call about all of this. And I supported whatever my associate saw and decided, and agreed that the client would have to wait until the cat was stabilized. The client was being unreasonable and if we end up losing her over this I won't be upset.
Thankfully, most clients are understanding in situations like this, and we rarely have problems in these circumstances.
Wednesday I received a call from a client with a bearded dragon. Apparently it had a swollen, white eye and she was wanting to know what to do. I was concerned that there was an infection or injury and asked if she could bring it in. She had some things to do, but said that she would be there in 30 minutes. Two hours later we closed and I hadn't seen or heard from her.
Then yesterday she brought him in to be seen by one of my associates since it was my day off. The doctor determined that it was a shedding problem and began to moisturize the eyes, working on getting the improperly shed skin off. While the beardie was in the clinic a serious emergency came in. A client's cat had been attacked by a dog and there was a deep wound fully into the abdomen where the bladder was visible. So my associate rushed the cat into emergency surgery to try and save its life.
Here's where it gets crazy. The owner of the bearded dragon came by the clinic even though she hadn't been called. She insisted on talking to the doctor, but she was in the middle of the surgery at the time. The client was told about the emergency surgery and that the doctor could talk to her later. The client began to get upset and wouldn't be satisfied with this explanation. She actually wanted to go into the back and talk to the doctor about her lizard while the doctor was in the middle of a life-or-death surgery! The client didn't care what the doctor was doing, she wanted to speak to her RIGHT AWAY!
Ummm...priorities, please? That was a very selfish client. Yes, I know that she was worried about her lizard, but he wasn't critical. Emergencies happen and need to be given priority, which my associate rightly did. The client also wasn't satisfied with what the doctor told her was the problem since I had mentioned an injury or infection on the phone. Keep in mind that I'm always careful with my wording and I had told her that it sounded like an injury or infection and didn't sound like a shedding problem. Based on that she felt that I had told her that it definitely was an infection, and so wasn't accepting what the other doctor (who actually EXAMINED the pet) told her.
So I got a call about all of this. And I supported whatever my associate saw and decided, and agreed that the client would have to wait until the cat was stabilized. The client was being unreasonable and if we end up losing her over this I won't be upset.
Thankfully, most clients are understanding in situations like this, and we rarely have problems in these circumstances.
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