Vet Talk

The End of the Story

Lesson: Keep scheduled follow-up appointments

Published: January 13, 2014

You might not realize it, but when you leave your veterinarian’s office, medicine in one hand and animal attached to the other, you have just closed the book at the most exciting point. You and your animal might ride happily off into the sunset with nary a backward glance, you may return for follow-up visits with Groundhog Day-like regularity, or you may vanish into the ether as though you’ve been swallowed by an inter-dimensional portal. Until you open that book again by returning for a recheck exam or calling with an update (or answering your veterinarian’s call when he phones to check in), the ending of the story remains a mystery.

No news is good news, right?

Most of us like to wrap this truism around ourselves like a cozy blanket. No letter from the IRS: good; no word from your MD yet on the biopsy: good; no call-back from a client saying that Fluffy is still vomiting: good.

Unfortunately, no news is neither bad nor good news. It isn’t news at all.

Maybe the nasty-gram regarding your tax return got lost in the recycling pile. Your biopsy's lab results may have gone astray. And for veterinarians who assume that a silent client is a happy client, well...

“She’s not getting any better. I don’t think that medication you gave her is doing any good.”

Our office manager rolled her eyes as she watched the phone cord drag several files, a pen caddy and a half-mug of tea off the desk as I scrambled for the file folder for a patient I could barely remember. My own eyes rolled as I read a key line from my entry from two months earlier: `
Recheck with radiographs in one week. Owner to call if: lameness worsens or does not improve within three days, if horse becomes more lame in one foot, if horse is not eating, acting lethargic, has diarrhea, or shows any other unusual signs.

There was only one response that would stand even a remote chance of helping my patient. “I’m sorry to hear that. Laminitis can be pretty serious and it’s been a while since we’ve seen him. Let’s schedule a recheck, and I’d really like to take X-rays so that we know what’s going on.”

Unfortunately, this particular scenario (spilled tea and all) was not uncommon. In this case, as with most of its friends, “not getting any better” translated a bit more closely into “improved for a few days on medication, so owner didn’t think a recheck (or those expensive X-rays) was necessary, and then life got busy, and somebody noticed a few weeks later that the horse was still sore-footed and maybe a little worse than before.”

In a case like this, the unknown end of the story becomes more like a plot twist. It’s as if you close the book as the characters are riding off into the sunset and the horse spooks and runs off a cliff.

Lesson: Keep scheduled follow-up appointments. While response to medication can give a veterinarian hints about the severity and form of the disease, sometimes meds are only one plot point in the story.

Sometimes cases are lost to follow-up in unexpected ways.

It had all been going so well – right until the moment the hooves hit me in the solar plexus and I flew with the grace of a soccer ball across the lawn.

The stallion was a neglect case brought in by animal control. The elderly owner had surrendered the horse, a sorry sack of bones with a nasty laceration that covered most of the front area of the hind leg from above the hock (that pointy joint on the hind leg) down to the hoof. The laceration went down to the bone.

Several weeks later and innumerable “You haven’t put that horse down yet?” comments from colleagues, passers-by, the original animal control officer, and my family, the stallion had been adopted by a local rescue, was healing nicely, and was set to be transferred to the rescue facility that weekend. My mental back-patting was an error; the universe frowns on such behavior.

I had written up the discharge instructions, packed the meds, and was doing the last tissue debridement. Everything had gone swimmingly. Until clean up time. As the water from the hose hit his hind leg (something he’d endured every few days for about three weeks), a horse nearby whinnied. My patient leapt forward like he’d been shot in the butt with a dart gun and double-barreled his hind feet out behind him – just as I turned with him. Not only had his leg healed nicely, he’d also put on muscle mass during his time with us. Like Winnie-the-Pooh sailing gracefully into the gorse-bush, I glided a good 8 feet across the lawn.

In the ensuing rush to get the horse back in a stall and the doctor into an ambulance, some of the niceties were lost. The horse was discharged to the rescue facility while I was in the hospital and unable to deliver my usual “call if…” spiel.

The leg was healing so well that it didn’t occur to me the outcome would be anything other than splendid. A year or two after the fact, someone from the local university called one of my technicians to see if she had pictures of the horse. They were doing a talk on wound management and wanted photos of this case that had been “mishandled” by the previous veterinarian (me). WHAT???

It turned out that my written discharge instructions hadn’t been followed, and the wound blew up. Even though I was no longer the attending vet for this horse, it would have been great to hear what happened when the trajectory of healing changed, rather than hearing it third hand months after the fact. I'm sure I was out of the hospital when the trajectory changed.

Sometimes, it feels like someone tore the last few pages out of a mystery.

We talk about the “practice of medicine.” Usually practice means “doing.” But most physicians and veterinarians will tell you that there is also a fair amount of actual practice taking place. Medicine isn’t an “Add Elixir A to Patient B in order to produce Outcome 42” sort of proposition. Outcome of treatment depends on a lot of conditions:

  • the patient
  • the stage of the disease or injury
  • the dose or surgery
  • the environment.

While veterinarians recommend treatment based on all of the available information, there are factors we can’t control or even know (like your animal’s genetic makeup). Learning if or how well an animal responded to medication or surgery helps us not only continue to do our best by your animal, but to help other patients as well. Plus, you want to make sure that treatment worked or know if it needs to continue, which is what a recheck tells you and your vet.

Your vet doesn’t want to miss the last few pages of a mystery: “And they all lived…” HOW? How did they live, happily ever after? In destitution and despair? With six camels and five guinea pigs? I want to know!

So book that recheck, return that call and offer the information; to quote Paul Harvey, give your vet "the rest of the story" - it will be appreciated!

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