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Vet Talk

Happy Now, Sad Later
April 25, 2012 (published)

A therapist friend of mine had a blog titled “Happy Now, Sad Later.” The line is apparently from the TV show The King of Queens. The focus of the blog, though, was the human tendency to sacrifice long-term benefit in order to avoid pain/discomfort/expense in the short term.

We all do this to some extent. That donut in the break room isn’t really calling my name, and I know that the long-term result will be an unfortunate shrinking of my waistband, but it’s been a long morning and I need chocolate. The donut dilemma, however, will probably only impact me and maybe the other person with a chocolate old-fashioned addiction. At other times, the happy now, sad later trade leaves a swath of destruction that produces the emotional equivalent of tsunami, tornado, and hurricane rolled into one adorable package. If you walk around the corner of your local veterinary hospital to see a veterinarian quietly banging his or her head against a wall or huddled in a corner rocking, it’s likely that the practitioner has just smacked head-long into an acute, severe case of Happy Now, Sad Later.

The veterinary version of this affliction looks something like this…

Ms. Oh-my-gosh-my-horse-just-ran-through-the-fence calls Dr. Yep-if-the-phone-is-ringing-it-must-be-Friday-night in a panic. The owner is crying; the horse is crying; the pastoral Friday evening pasture looks like a scene from Friday the 13th. Dr. YITPIRIMBFN (Can we just call her Dr. Y?) jumps into the truck and scurries off to the OMGMHJRTTF family farm (or the O farm).

After comforting owner and sedating horse (but not vice versa because that would be ineffective and illegal), Dr. Y examines the horse and takes note of all visible and probable damage. Dr. Y notes that one laceration sits awfully close to the knee joint, and that there is a glorious banner of skin flapping in the breeze when it should have been covering the cannon bone.

Dr. Y begins to discuss the horse’s condition and the medical recommendations with Ms. O. Dr. Y would like to take some X-rays to help confirm that the pesky knee laceration hasn’t wandered into the joint because joint infections in horses are bad, even potentially fatal. She also tells Ms. O that the skin flap will need stitches and a heavy wrap to keep the wound edges from imitating continental drift and never properly healing.  The horse, having packed half of the pasture into her wounds, will need whopping does of antibiotics twice a day for a week or so, and will need to be confined for X weeks until the wounds heal so that the suture knots are not all for naught.

At this point the O family begins to shuffle its collective feet.  Money is an issue.  And the horse, in addition to not being a fabulous jumper, has an extreme aversion to needles, pastes, and pills.  Also, the only open stall is currently housing the teenage O’s motorcycle.   Mr. O has a bad back, and Ms. O doesn’t like blood, and who will change all those bandages?

This is where things begin to unravel like a ball of yarn swatted by a kitten. Dr. Y begins to feel like Dr. Y-did-I-not-become-an-accountant-like-grandpa, the O family starts to feel panicky and oppressed (oh-my-gosh-there’s-no-way-we-can-do-all-this), the sedation starts to wear off and the horse begins to eye the remaining fencing.

While it is true that not every case has to experience the four-legged version of the Mayo Clinic treatment, and sometimes medical plans can be adjusted to allow for flexibility of budget, facilities, and reality, veterinarians make recommendations based on the desire for the best possible outcome. Trust me; no one really wants to take X-rays of any portion of the equine skeleton at 11 p.m. on a Friday.  And no, the money isn’t that good. 

But let’s consider the X-ray recommendation. There are four possible outcomes affiliated with this stage of the plan (well, five, but the fifth involves a fracture in the time-space continuum and a giant blue octopus.)

1. X-rays are taken and show no joint penetration – Yay!!  Everyone throws confetti (discretely and where it won’t spook the horse) and the wound repair proceeds as planned.

2. X-rays are taken and show that the wound has compromised the joint – ACK!  Joint infection has a nasty habit of being fatal in horses. Joint lavage, referral and advanced medical care ensue. Joint health is maintained and the horse lives to damage other areas of the farm.

3. The O family declines X-rays, but everyone gets lucky and the joint wasn’t compromised after all – Tentative yay, but the reality won’t be known for several days. Meanwhile Dr. Y is sweating bullets and popping Prilosec and Xanax like M&M’s.

4. The O family declines X-rays. The knee looks good for a day or so, then the horse suddenly starts walking on three legs and the knee begins to resemble a small sun in size, shape, and temperature. There is no joy in Mudville. Lots of dollars and a week or so later, it becomes clear that the joint infection is now raging along like an angry herd of wildebeest.  The horse is euthanized. Everyone loses.

5. The immense, azure cephalopod known as Bernie travels through a tesseract, consumes all of humanity, faith heals the horse, and takes the horse back to the cephalopod home world where she is worshipped as a deity.

Blue spacefaring octopi aside, skipping the X-rays in this scenario produces a pretty high risk of a whopping case of Happy Now, Sad Later.

Happy Now, Sad Later doesn’t always show up with giant flashing lights and bleeding horses. Sometimes the symptoms are far more subtle. An owner declines blood work to monitor the effects of medication, and the patient goes into kidney failure. Heartworm preventative is skipped for a few months and the wrong mosquito snacks on the pet. Antibiotics are stopped early because, well, Doc, he was looking pretty good. Rabies vaccination is deemed unnecessary because the animal “never goes anywhere,” but then that bat drops out of the sky and into the paddock or backyard…

The point is not “You must green-light every single medication, test, and procedure that your veterinarian ever mentions even in passing.” However, if you are on the fence about something, ask your vet what the long-term implications are of doing or not doing something. Sure you want to be happy now, but are you prepared to be sad later? And more importantly, does your animal deserve to pay that price?

2 Comments

Sherri
June 21, 2012
Really good article, Christy---after explaining the options for care and what they cost and how knowing ahead of time if the train is going to run off the cliff...some clients roll their eyes at us and mutter something about the danged vets and how we're all so money-grubbing (a whole other topic about the financial equation for vets in private practice). They don't have to approve every test I recommend, and often we get lucky and nothing bad happens...but it's definitely worth taking the time to explain what could go wrong and how knowing sooner rather than later is a good thing. If they decline, they decline (well, often, I'll launch into the explanation again if I feel pretty strongly that they should do the test!).
Holly
June 18, 2012
As any equine vet knows, horses are born to kill themselves and some can be incredibly creative. I have a line drawn in the sand for my horses....no colic surgery. If banamine, and 2 vet visits don't work....it's going to be a sad day. Lacerations that require a moderate investment of cash and a moderate investment of time with an excellent outlook...I'll probably do. What you described would get the xrays of the joint and go from there. I need information to make an informed decision and the only way to get that is to start with spending some $$ on rads. There are 2 issues that simply strike fear in my heart as they can get better but maybe not all the way...laminitis and founder. What to do with a nice horse that has limited use riding? *looks up...dear god please don't ever put me there*.


 
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