Thursday, February 14, 2013

Mary's desk, Wednesday afternoon

Mary: "Dr. Grumpy's office, this is Mary."

Mr. Whirlaway: "Hi, does Dr. Grumpy treat seizures?"

Mary: "Yes, sir."

Mr. Whirlaway: "Does he make house calls?"

Mary: "Not routinely... What are the circumstances?"

Mr. Whirlaway: "Well, a friend told me Dr. Grumpy had helped his kid's epilepsy. I have a horse with seizures, and I don't like our current vet."


Plastic Tolstoy said...

Now, if it was a yak...

Christer "Mort" Boräng said...

I assume you told him neigh?

Anonymous said...

good deal meat loaf for dinner

Ms. Donna said...

Horses, Yaks, how much difference could there be?

At least the horse is more grateful than most pts.


Actually epilepsy is a scary thing in a horse. Think if it is a riding or draft animal and think of what would happen.

Anonymous said...

Wouldn't that make it a "horse call"

brent said...

Dr. Grumpy is already used to treating horses asses-so why not the rest of the horse?

EDNurseasauras said...

I see zebras

a.generic doc said...

Was that a kid as in a young child or as in a young goat whose seizures you treated? (I hadn't thought you took care of either of those.)

Grumpy, M.D. said...

I don't. The "kid" was 27.

Outrider said...

Horses can have seizures, but we usually don't treat them unless the horse has more than one seizure per month or unless the seizures last more than a minute or so. We generally rule out the treatable underlying causes first. I always offer MRI or CT scan of the head but have never had a client willing to pay for it, oddly, considering many horses in my practice have undergone scans for various orthopedic problems.

There is a horse in my practice who has had one seizure per year for almost 15 years. The owner still rides her. The owner can actually tell when the horse is about to have a seizure. It's interesting.

I've also seen horses in status. These almost universally have a poor outcome. Those which have gone to post-mortem are often diagnosed with a problem like a brain abscess or end-stage untreated PPID aka equine Cushing's, so it's no surprise when they don't do well.

Generalized seizures in a horse are a dangerous situation for the humans involved. I tell owners to stay away until I arrive, especially from the legs, even if the horse appears to be unconscious or dead, and especially if the horse gets up and is staggering around. Same goes for the fire department, who often get the call when the owner doesn't have a regular veterinarian. Those are particularly unpleasant cases because horses who don't see veterinarians are not vaccinated for rabies. Horses must be vaccinated by a veterinarian in my state to be considered valid. Therefore, those horses are considered rabies suspects, and it's not much fun to explain the diagnostic test for rabies to an owner you've just met.

Anonymous said...

to summarize line from "all creatures great and small..." if you want a smart, REAL doctor see a vet - who has to specialized in MULTIPLE animal/organ systems, as opposed to medical doctor, who only has to know one... (excluding peds, of course)

Aeris said...

I have to respond to this. I've seen this said a lot, and wondered about it myself. But I've learned that there is a reason so many sub specialties exist for humans. A vet is both a surgeon and a physician and certainly have amazing skills. But with humans, more diseases are known, more diseases are treatable, more technology is available. Nobody is going to study a rare genetic disorder in a hamster (unless it's a research hamster).
Same for pathology: hindsight is 20/20 and all that. Also pathologists aren't super great at talking to humans, such as counseling a distraught mother, and that's a big part of medicine.
So yeah... I no longer agree with the "vet is a real doctor" statement. Nor "a pathologist is the best doctor you can have, but by then it's too late". The best doctor is one that can communicate with his/her patients (in addition to knowledge).

Outrider said...

Some basic points re: physician vs. veterinary knowledge base.

>>there is a reason so many sub specialties exist for humans>>

Where the market exists, plenty of sub-specialties exist for animals. Veterinary neurologists exist. Some will even see horses. The problem is persuading clients to pay for their services. Many clients who own animals with complex problems fall back on their veterinary GP.

What isn't fair is criticizing the veterinary GP for a worse overall success rate vs. specialty care. It is valid to criticize the veterinary GP who fails to refer when she should, but most of us learned that lesson a long time ago. Client economics being what they are, most of us have learned to tackle complex problems, but believe me, we'd much prefer to send these to a specialist. OTOH, "while you're there", do not ask a specialist to work up something basic and therefore rarely addressed in a specialty practice. The outcome may be surprisingly poor.

Thank goodness for the veterinary specialists who are willing to guide us through the no option to refer, complex cases, usually for no payment other than a warm, fuzzy feeling. Veterinarians are chumps for animals. Having spent plenty of my own time coaching my small animal, mixed practice and backyard equine colleagues through many a performance equine problem, I know it's true.

I'm technically not a specialist, but I see only performance horses. Whatever I know about other areas of veterinary medicine is dated. Would you ask Dr. Grumpy to deliver your baby? Even if you did, and even though he remembers the absolute basics from his med school OB rotation, do you think that would be a good idea?

>>A vet is both a surgeon and a physician>>

This may be true for many veterinarians in general practice, but it's a misleading generalization. I wouldn't ask a small animal surgeon to regulate my diabetic dog or perform colic surgery on a horse. It wouldn't go well.

>>with humans more diseases are known>>

Not necessarily true for common domestic species.

>>more diseases are treatable

Also not true, though persuading the client to pay to treat is frequently a challenge in veterinary medicine.

>>more technology is available.

Again, not true, though if the client won't pay for it, the veterinarian won't utilize the technology (or purchase it, if it's a general practice). We're also learning that just as in human medicine, more technology does not necessarily mean better care.

>>I no longer agree with the "vet is a real doctor" statement.>>

Hoping this is a mis-statement, because the truth is, we are doctors - not doctors for humans, but just as you wouldn't want me to work up your migraines, I suspect you wouldn't want Dr. Grumpy to inject your horse's hocks.

>>The best doctor is one that can communicate with his/her patients (in addition to knowledge).>>

This may be ideal, but it's also not true. If my horse (or mother) were actively trying to die in the middle of the night, I'd want the doc with the best skills, not Dr. Congeniality. Therein lies the rub, in both human and veterinary medicine: it's virtually impossible for a layperson to determine whether a doctor is competent, but it's easy to evaluate his personality. That's where a good GP comes in handy (once you've found one of those, of course).

Locations of visitors to this page