{"id":77434,"date":"2025-02-13T15:29:45","date_gmt":"2025-02-13T20:29:45","guid":{"rendered":"https:\/\/todaysveterinarybusiness.com\/?p=77434"},"modified":"2025-02-13T15:32:26","modified_gmt":"2025-02-13T20:32:26","slug":"clients-life-in-the-trenches-0225","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarybusiness.com\/clients-life-in-the-trenches-0225\/","title":{"rendered":"I Can Control Only So Much"},"content":{"rendered":"

When clients second-guess me, I practice the art of being gracious. It doesn\u2019t matter that I spent tens of thousands of dollars earning a doctorate in veterinary medicine, honed my surgical skills over countless hours, journeyed many miles to attend lectures by experts in the field, maintained my licenses to prescribe controlled substances or earned the accreditation necessary to write health certificates for animals to travel.<\/p>\n

My Gracious Project is for my inner peace<\/a>. I am willing to trade my pride and righteous indignation for the delicious freedom of detachment. Here are some of my stories.<\/p>\n

No, No, No, Yes<\/h3>\n

Coco, a 6-year-old female spayed goldendoodle, presented with bloody diarrhea and conveniently provided us with evidence of her condition while waiting in the exam room. Her total-body alopecia resembled a Sphinx cat, and I knew I was in for a workout when Mrs. Client explained that Coco\u2019s baldness resulted from being bred too much when she was younger.<\/p>\n

My job, however, was to help restore Coco\u2019s dignity and her owner\u2019s sanity by bringing back solid bowel movements. To that end, we ran a fecal floatation, which came back negative for intestinal parasites. A complete blood count and serum chemistry panel were normal. The owner said she didn\u2019t think Coco had been fed table scraps, but she wasn\u2019t sure.<\/p>\n

Coco got a Simparica Trio heartworm-prevention<\/a> tablet about one week earlier but wasn\u2019t on the medication monthly, as prescribed. Meanwhile, the client\u2019s other dog had been diagnosed with hookworms and wasn\u2019t on heartworm prevention. This got my attention since the Simparica dose could have dewormed Coco initially for hookworms and caused the negative fecal result. Veterinary parasitologists recommend that deworming be repeated in two to three weeks to ensure complete results.<\/p>\n

Next, a lipase test for pancreatitis came back strongly positive. Finally, I had something to hang my hat on.<\/p>\n

Armed with a handout explaining pancreatitis and cost estimates for inpatient and outpatient treatment, plus fenbendazole oral suspension for deworming, I embarked on explaining my treatment plan.<\/p>\n

My 49-pound patient\u2019s dose of Panoquell-CA1 for pancreatitis cost several hundred dollars, so the client was understandably concerned about the expense. She said she needed to ask family members whether they could help her with the veterinary bill.<\/p>\n

So began the bargaining process, where Dr. Wolfe wracked her brain to come up with creative ways to treat the pet and save the client money. I probably changed the estimate three times. A couple of hours later, I was flabbergasted upon hearing the verdict. Mrs. Client declined the dewormer because, she said, her father was \u201cin the business\u201d and could get it elsewhere. Also declined were subcutaneous fluids because Coco was drinking water, so, in her mind, that step wasn\u2019t necessary.<\/p>\n

\u201cDid you read the handout?\u201d I asked, because the document stressed the need for fluids to flush out the pancreas. Her response was a curt brushoff.<\/p>\n

Although Coco had not vomited, she had not eaten, either. Her owner declined maropitant for nausea. Heck, she declined just about everything, including my advice. I pondered for a beat. My choice was to either pout and hold a grudge or swallow my pride and do something that might help.<\/p>\n

I offered metronidazole antibiotic for an inflammatory bowel, Diagel oral antidiarrheal and a buprenorphine injection for abdominal pain. Bingo! We reached common ground.<\/p>\n

I returned with the medication and a smile. \u201cWhat kind of dewormer will you use?\u201d I asked. \u201cMake sure it will cover hookworms, and make sure you repeat it in two weeks.\u201d<\/p>\n

The client eagerly agreed.<\/p>\n

\u201cI would stick to a bland diet until Coco\u2019s diarrhea resolves,\u201d I added. \u201cI\u2019ll make a list of things to feed her.\u201d<\/p>\n

A Suitable Alternative<\/h3>\n

A couple who smiled a lot, talked a lot and knew what they wanted me to do exactly arrived with an 11-year-old\u00a0 Labrador. Sheru had been limping on his hind leg for a few days. When we walked him around the clinic, the limp was barely perceptible. Mrs. Client said he was doing a lot better than at home.<\/p>\n

My exam led me to conclude that Sheru had a soft-tissue injury that would likely respond to anti-inflammatory medication and restricted activity. I told his owners I wanted to check his bloodwork to make sure carprofen wouldn\u2019t put him at risk.<\/p>\n

We call our most basic \u201cbudget\u201d CBC and chem panel a pre-anesthetic profile. When Mrs. Client saw \u201cpre-anesthetic,\u201d she seemed to connect it with surgery. \u201cI am in the medical field,\u201d she said, \u201cand I know it\u2019s different for humans than animals, but I don\u2019t believe he needs bloodwork. I would rather just get the pain medication.\u201d<\/p>\n

Feeling unheard, I repeated that I needed to check Sheru\u2019s liver and kidney enzymes before prescribing carprofen. Then, my gracious side stepped forward.<\/p>\n

\u201cWhat we can do is try gabapentin because it doesn\u2019t have as many side effects,\u201d I offered.<\/p>\n

The clients jumped on it, and I didn\u2019t burn a bridge.<\/p>\n

Unfinished Business<\/h3>\n

As a young veterinarian, I might have let a family of three clients put me on the defensive, but the owners of Mickey, a 4-year-old miniature poodle, didn\u2019t shake my confidence. Mickey was non-weight-bearing on his hind leg after horsing around with his housemate dog buddy. The clients said he landed on the leg and then yelped in pain.<\/p>\n

I told them I wanted to administer a pain injection to relax him for radiographs and limb palpation. Mr. Client said they had already given pain medicine. I explained that the medication I wanted to use would relax Mickey so that I could examine his stifle joint for a possible cruciate ligament injury.<\/p>\n

The clients consented, but the dose of butorphanol laced with acepromazine left Mickey alert enough to tremble and cause uncertainty about my diagnosis. I returned to the exam room and said I might have felt some joint laxity but that my diagnosis was inconclusive and that I couldn\u2019t rule out a partial ligament tear. My plan was to treat him with carprofen and gabapentin and restrict him from running, jumping and climbing stairs for two weeks. I recommended they consult an orthopedic surgeon if they didn\u2019t see an improvement.<\/p>\n

One of the clients, unsatisfied with my findings, questioned me about my palpation. I repeated what I said.<\/p>\n

\u201cCan\u2019t you do the surgery here?\u201d asked Mr. Client.<\/p>\n

\u201cNo,\u201d I responded.<\/p>\n

The other clients asked about bandaging or bracing the leg, and I told them my judgment was to leave it open.<\/p>\n

They didn\u2019t seem happy. I couldn\u2019t control their feelings, but I could control my confidence in my recommendations.<\/p>\n

Calm graciousness is my goal, and my clients are free to take or leave my advice. I always make sure to give them their money\u2019s worth.<\/p>\n

\n

INSPIRATIONAL WORDS<\/span><\/h3>\n

As I wrote this column, the refrain from an old Pam Tillis country song called \u201cLet That Pony Run\u201d came to mind. Once I consider a patient\u2019s situation and make my recommendation, the pet owner is as free as an unbridled horse to accept or reject it. The refrain below describes my philosophy as it relates to this article.<\/p>\n

You do what you gotta do<\/em><\/p>\n

And you know what you know<\/em><\/p>\n

You hang on till you can\u2019t hang on<\/em><\/p>\n

Then you learn to let go<\/em><\/p>\n

You get what you want sometimes<\/em><\/p>\n

But when it\u2019s all said and done<\/em><\/p>\n

You do what you gotta do<\/em><\/p>\n

Then you let that pony run<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Tranquility and acceptance are sometimes best for one\u2019s soul when clients thwart your best intentions.<\/p>\n","protected":false},"author":23,"featured_media":77436,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[526],"tags":[],"class_list":["post-77434","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-february-march-2025","column-life-in-the-trenches","clinical_topics-patient-care","clinical_topics-personal-professional-development"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"\nI Can Control Only So Much | Today's Veterinary Business<\/title>\n<meta name=\"description\" content=\"Tranquility and acceptance are sometimes best for one\u2019s soul when veterinary clients thwart your best intentions.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, 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