"Your Other Family Doctor"
By Mack Adams
Special to The Washington Post
Tuesday , October 31, 2000 ; Page Z10
By 7:15 a.m. on a typical day, presurgical admissions are underway at the hospital. One by one, anxious clients carefully listen to the Doctor's preview of the procedure. Risks are explained; the prognosis is detailed; a consent form authorizes the procedure. Ideally, clients leave their loved ones at the hospital feeling confident that the patient is in good hands.
The patients themselves pass their presurgical time within individual stainless steel crates, resting on padded bedding. Overhead, speakers pipe in "smooth jazz." There is little patient anxiety. Pets make for much more relaxed patients than would their owners.
The Dog Who Ate Too Much
Like many retrievers, Fletcher, a black Lab, has an oral fixation. It's genetic. And sometimes Fletcher goes too far.
It was nearly two years ago that Fletcher had his first problem with indiscriminate consumption. It was then that he added half a dozen rocks to his diet. No one really knows why, perhaps not even Fletcher himself. One rock was quite large, measuring two inches in diameter. Apparently Fletcher just wolfed it down with five other rocks. Together they became lodged midway down his small intestine.
For nearly four days, Fletcher's owners observed as he spurned breakfast and dinner. Perhaps prompted by his frequent bouts of vomiting and diarrhea, they finally became concerned enough to seek medical advice. X-rays indicated an intestinal blockage. Part of the small intestine was damaged and had to be removed.
Today, it's dija-vu all over again. X-rays lead the Doctor to believe the foreign object is some type of fabric. Fortunately, this time Fletcher's owners were quick to respond to his abnormal behavior.
The surgery is quite involved. The abdominal incision is nearly 12 inches in length, as the Doctor needs to have complete access to the small intestine. Several stainless steel instruments hold the incision site open. From above the surgery table, two high-intensity reflector lamps illuminate the abdominal cavity. The Doctor locates and then unfolds the intestine. She palpates along the intestinal tube to locate the blockage.
Now, with her scalpel, she smoothly cuts longitudinally through the intestinal wall. The Doctor shakes her head, breaks the silence of the operating room, and remarks to the veterinary technician who is monitoring the pulse oximeter and anesthesia machines: "Remind me to prescribe a muzzle for Fletcher." The technician smiles.
Nestled amid a slurry of partially digested foodstuffs looms the fabric that Fletcher gulped down. The Doctor anchors a clamp into the foreign object, hoping to dislodge it without further incisions. She delicately massages the intestine, gently applying traction to the fabric. It's long and seemingly endless, but comes out easily. Finally the material is lifted up and out of the abdominal cavity, and is plopped into a stainless steel receptacle.
The technician quickly identifies the object: "Pantyhose!" The Doctor just shakes her head. She's seen an astonishing array of things dogs have consumed but cannot pass. Pantyhose are nothing new.
The Doctor will spend the next 35 minutes closing the surgical sites: first, the small intestine; then, the inner layer of abdominal tissue; finally, the exterior skin. It's tedious, exacting work.
The isoflurane gas is switched off. Pure oxygen now flows into Fletcher's lungs from the anesthesia machine. Soon his jaws begin to reflexively chew at the rubber endotracheal tube and it is removed. Still drowsy, he coughs. Fletcher will require hospitalization. Major surgery such as his involves at least a day of intensive care, followed by another day of monitoring by hospital staff. Once able to hold down food and go off IV fluids, recovery at home will be prescribed. Then, throughout his life, his owners will need to monitor his consumption behavior or use a muzzle to preclude further digestive tract compromises.
Total cost for Fletcher's 90-minute surgery: $700.
A Dog Ready for Medicare
Jack, a Great Dane, slowly unfolds himself from the large crate as a veterinary assistant coaxes him toward the glass-enclosed surgical suite. Jack wobbles on his long legs as he crosses the hospital's polished tile floor. Jack is truly a senior canine super-senior. At 9 years, he is older than many of his fellow Danes, who rarely reach that age. If it were not for his diligent owners and regular care, Jack would have joined his kin some time ago.
Today the Doctor will excise a mass near Jack's esophagus. Although Great Danes have a propensity for cancer, laboratory analysis has indicated that Jack's tumor is benign. But since it is located near the throat, the mass needs to be removed before it can grow and further compromise his health. Thanks to his overall good health, Jack will emerge successfully from surgery.
Total cost for Jack's treatment today: $500.
The Toothless Cat
Fiddler the cat is scheduled for oral surgery. Four weeks ago, his owners noticed that Fiddler hadn't been acting quite right. He seemed not to be eating much. He was losing weight. He seemed lethargic and irritable. His less-than-diligent owners were eventually referred to the hospital by a neighbor.
The Doctor recalled first meeting Fiddler and his owners a week before the surgery. Upon entering the exam room she noticed an unmistakable odor decomposing flesh. One look into the cat's mouth revealed abscessed tissue and rotted teeth. It was obvious that Fiddler had not been to a veterinarian in some time and had never been provided with appropriate oral health care.
Today, nearly all of Fiddler's teeth will be removed. Domestic cats can live a full life without teeth. But oral disease caused by poor dental care is the leading cause of premature death in cats, and in dogs as well.
Fiddler is brought to the treatment room. Within a few minutes
he is resting comfortably as the anesthesia takes effect. The Doctor begins her work. One by one the teeth are extracted. Some are almost ready to fall out; others require great care in their removal. Years of neglect have allowed bacteria to erode and weaken the bones into which the teeth are anchored. A broken jaw is something the Doctor wants to avoid at all costs.
Finally, the last tooth scheduled for removal is dislodged from its socket. The Doctor begins suturing the gums. She looks up at the wall-mounted clock. Sixty-five minutes.
"Skip Can't Walk"
A client dashes into the hospital and approaches the receptionist. "It's Skip," she says woefully. "He can't walk I think that he may have a broken leg. Can the Doctor see him?"
The receptionist uses the intercom to call the Doctor. She arrives at the reception desk seconds later.
"He's in the car, Doctor." The client tugs on the Doctor's arm. "Please come take a look." She leads the way to the black BMW station wagon, hastily parked with engine running and driver's door open. "He was playing outside and jumped off the deck," she says.
The Doctor ponders that comment. Jack Russell terriers, like her dog, are a hardy breed. Unless her deck is highly elevated, the dog was not as badly injured as the owner fears.
The tailgate opens, revealing no sign of a Jack Russell. The lone occupant is the woman's 9-year-old son.
The Doctor purses her lips.
The client continues: "He's hurt. He needs to be seen right away. I didn't want to have to fill out all kinds of forms and then wait for hour at the emergency room." She briefly pauses. "You will take a look won't you, Doctor?"
The Doctor shrugs. "I'm a doctor of veterinary medicine, I treat all species except humans. I really can't perform . . . "
"Please, Doctor . . . " She is about to cry.
The Doctor shakes her head from side to side. She is frequently asked about human medical problems by her clients, who seem to find her more approachable than a physician. Physicians and hospitals are scary to some people. Veterinarians, on the other hand, are perceived as a different kind of doctor one with whom most people are more at ease.
"You really do have to take him to the emergency room for radiographs and treatment," she says finally after a long pause. "But I'll reassure him it will be all right."
"Oh, thank you, thank you so much, Doctor." Her panic is subsiding.
The Doctor's quick look at the boy's leg and ankle reveals no obvious major injury. She clasps his shoulder, tells him he will be fine and that his mother is going to be his ambulance driver. He smiles and rubs the injured leg.
"Remember," the Doctor continues to his mother, "my license does not allow me to practice human medicine. Go to a clinic!"
She thanks the Doctor again and again, and drives off.
A Genetic Flaw
After lunch one day, the Doctor walks into Exam Room One. She lifts out the manila folder from a wall-mounted Plexiglas holder. Immediately she notices that the patient's name is highlighted in yellow.
It's Wolfgang, a 3-year-old, 100-pound German shepherd. The highlighting of his name in yellow indicates caution. Wolfgang is a shepherd with an unpredictable temperament. He suffers from a behavioral flaw clinically called fear aggression, which is common in his breed. Wolfgang is a submissive dog who is easily overwhelmed by the presence of a perceived threat real or not and without warning he may violently lash out at anyone or anything he views as menacing.
The Doctor enters the exam room. She avoids eye contact with Wolfgang, who is lying on the floor, huddled in the far corner of the room, looking as harmless as an adult German shepherd can. The owner, a petite middle-aged woman, is seated on one of the two chrome-framed, blue-cushioned chairs. Her left forearm is bandaged from wrist to elbow.
"What happened to your arm?" the Doctor asks with genuine concern.
The client's gaze drops to the floor, and then focuses on the shepherd. "It was Wolfgang."
The dog whines, wagging its tail upon hearing its name. "It was last week on Saturday afternoon," the client continues. "I was tidying up the house and wanted to rearrange some pillows on the sofa. So I asked Wolfgang to move off of it and, well, he went ballistic. He grabbed my arm and began shaking it tearing and ripping."
The owner sobs.
"If it weren't for my husband calling the dog off, I don't know what would have happened." She pauses. "I don't understand this. We love Wolfgang so much."
The family bought Wolfgang as a 4-month-old puppy from a breeder in West Virginia. When the Doctor examined the dog three days after the family acquired it, she concluded that Wolfgang had a fear-aggressive trait. She strongly urged the family to return the dog, but, like many owners, they had already become attached to their new puppy. They refused to part with the dog.
Now the owner had required 35 stitches to repair the damage caused by her canine companion. And there were no assurances that the same thing or worse would not happen again.
The Doctor turns to Wolfgang. The dog seems like any other German shepherd alert, ears erect, with no indication of a serious behavioral problem. That's exactly how fear-aggressive dogs are.
Then the Doctor sits down on the floor near the owner. The Doctor crosses her legs. Her intent is to present a nonthreatening image to the dog and to calm the owner. She quietly calls Wolfgang by name and offers him a small treat.
The shepherd eases his body off the floor and cautiously approaches the Doctor while she continues to speak to him in a reassuring tone. As he takes and begins to crunch the morsel with his powerful premolars, the Doctor slides a muzzle over Wolfgang's nose and secures it behind his head. No chances would be taken when giving him a complete physical and administering his annual vaccinations.
Today Wolfgang displays no abnormal behavior. But it could have been otherwise. The Doctor once again details for the owner the continued and significant risks that exist for the family because of Wolfgang and his phobia. Although pharmaceuticals could help, the threat of physical danger would remain. If any more attacks by Wolfgang were to occur, the Doctor may have to recommend the last resort euthanasia. Veterinarians only suggest this when extensive pain and suffering may result from a condition for which there is no treatment. Extreme fear aggression is frequently one such condition.
Fat Cats and Epileptic Boxers
The Doctor's roster of patients also includes an obese cat with heart problems, a Pekingese with a lacerated cornea, a cocker spaniel with skin problems, a boxer with epilepsy. Even if an animal is presented only for a specific medical problem, it is still thoroughly examined by the Doctor. She concludes each appointment by discussing her findings, suggesting lifestyle changes, including diet and exercise, emphasizing the all-important brushing of the teeth (at least once a week both for dogs and for cats) and clarifying confusion clients have from information they glean from journalists and purveyors of pet supplies, foods and drugs.
The Doctor's last appointment of the day is almost always reserved for clients new to the hospital. One afternoon, two well-groomed young men immediately rise to their feet and greet her. Their GQ resort casual dress bespeaks the new generation of young, well-educated, affluent professionals.
"So," the Doctor starts off, "how may I help you gentlemen today?"
"We're interested in adopting a dog," the taller of the two speaks up. "We've done a lot of research books, magazines, the Internet and thought it would be best to consult with a veterinarian prior to making a final decision. Your Web site gave us the idea. It was the only one we saw that mentioned anything about pre-purchase consultations. That's really what brought us here today."
The Doctor beams. Although the very best time to seek veterinary counsel is before a companion animal is acquired, only a fraction of future pet owners ever do so.
The second man begins talking: "We need your guidance and honest advice. We're not sure what kind of dog to get, or where to get it. Almost everything we read or hear tells how great each breed of dog is. It can't all be true. We don't want to make any mistakes."
The Doctor is impressed. Most prospective owners don't know what they're getting into when they acquire a dog. Over half of all new dog owners will subsequently give them up to shelters, rescue leagues or other people.
The Doctor spends the next 45 minutes gathering information about the clients and then making recommendations. One of the young men diligently takes notes.
"Remember," she says in conclusion, "the selection of a dog is a highly personal and subjective decision. But try to be as objective as possible. Like anything in life, the more you learn, the better your decisions will be."
The two men thank the Doctor. Their intent is to now search among several local animal shelters for a 20- to 30-pound, short-haired, hound-terrier mixed breed between 5 and 18 months of age.
The Night's Still Young
After sending the day's surgical patients home with their owners one evening, the Doctor sinks into the worn Naugahyde chair behind the cluttered desk in her small office. In the center of her desk is a stack of 25 patient file folders. In some cases, clients need to be contacted about an injury or illness; in other cases, laboratory test results need to be reviewed and entered; in still others, reports from specialists need to be examined and made part of the patient's permanent record. The Doctor puts on a headset and dials the number of a client. She has another two hours of work.
At 8:30 p.m., the Doctor activates the hospital's security system and leaves the building. Thirty minutes later, she pulls into the driveway of her home. As she exits her car, she feels the vibration and hears the faint, low-pitched drone from the beeper attached to her waistband. The message: A client's dog has been skunked.
"Uh-huh," the Doctor mumbles to herself.
Her day is not yet over.
(Mack Adams is a freelance writer who lives in Great Falls, Virginia, with two horses, a dog named Rio and his wife, the Doctor.)
© 2000 The Washington Post