"Dale Atkin" wrote in message
news:FgSfl.8322$Db2.734@edtnps83...

"kat" wrote in message
net...

"Dale Atkin" wrote in message
news:wxPfl.7466$PH1.5854@edtnps82...

Please don't do that when you become a vet. I have learned the hard
way
to
*always* always* always* get a copy of the bloodwork.

At the moment, my approach would probably to be to say there were some
mild
abnormalities in x,y,z that I don't believe are significant because of
a,b,c. (Let the client know that I've seen the results, and the reason
they
don't need to be concerned about it).
Its difficult though, because if you *know* as the vet that the
deviation
isn't significant, and is likely to mislead the client the 'easy way
out'
is
to give your interpretation of the results.

My feeling, given that the diagnosis was hepatic lipidosis, I would
believe
it if someone told me that that by itself would explain the anemia.

That could cost your animal it's life - as it did with my daughter's
cat.
There was an underlying cause for the anemia that was not related to the
hepatic lipidosis.


I'm sorry if I've missed it (gone back and I can't find it), did you
mention
what the underlying cause of the anemia was determined to be and how that
was determined?

Two weeks (one in the hospital on IV fluids ) a chest x-ray, abdominal
ultrasound (that was not suggested by the vet - we requested it - after
research), a fungal panel, two FNAs (one bungled by too much pressure with
the sample I learned from research) and a rapidly dropping HCT along with
rising liver values and the cause was not determined before he was PTS.



Hind sight is always 20/20 (at least it should be), the question is
though,
if your vet in September had told you "your cat is slightly anemic, but
that
is likely tied with the hepatic lipidosis..." would you have accepted that
as the cause? Or would you have looked for further diagnostic tests?


Not then but for damn straight I would now. At the very least I would
continue to monitor the situation with periodic bloodwork. Two animals had
to die before I came to that conclusion - it shouldn't have to be that way.
A person shouldn't have to be online practically night and day researching
animal health issues just to make sure their veterinarian is doing a
competent job!


Recently I had some tests done at a local hospital. I left the area where
they were done and went straight to the medical records department and
signed a release to have a copy of them sent to me as soon as they were
available. I had a copy of them in my hand and had done some preliminary
research before my doctor even called me on Monday morning. I was pleased
to see that she recommended a shorter time span for recheck than even the
radiologist had recommended.





(in fact
googling a little I found
http://www.vet.uga.edu/vpp/clerk/turner/index.php
which says "With underlying disease, the packed cell volume can be
normal
or
there can be a mild to moderate, normocytic, normochromic,
nonregenerative
anemia most likely due to the anemia of chronic / inflammatory
disease.").


Most likely but not definitely.

Nothing is ever definite.

Perhaps a follow up blood test in x amount
of time should be suggested along with offering up some other
possibilities
for the anemia.

Just as an FYI, Cornell's "Consultant" program comes up with 208 possible
diagnoses that would explain anemia. Should your vet have gone through
each
of them (no matter how unlikely)? Or restricted herself to lifely causes?
Given that the anemia was already explained,

Was it? Or did she just assume it was?


should they have gone looking
further?


What she should have done imo is mention the fact that he *was* anemic, that
the *probable* cause was the hepatic lipidosis but that there *could* be
other causes and a follow-up blood test in X amount of time would be a good
idea. Was that too much to ask of a vet? After all isn't that why we are
"paying them the big bucks"?


The thing is, you can *always* keep looking. This is how some clients go
home with $30,000 bills. If you want to rule out every cause of every
observed symptom, you'll be at it for a while. Good for the pocket book,
bad
for the pet and the client.

I think you are rationalizing a decision not to inform a client of blood
results.


It all *fits* with his diagnosis. Did he go over the other enzyme
levels
with you, or did he just say "The results confirm hepatic lipidosis"?

It was a she and she did not go over the enzyme results. She also did
not
tell my daughter that she had him tested for FIA (though it was neg)


Could you clarify? Do you object that she tested without permission?

Not at all.


or do
you object to them not telling you that they tested?

Bingo.




The first time or two
I didn't think it was that important. Not any more. Frankly I no
longer
respect a vet who doesn't give me a copy (or fax me one if I've gone
home),
explain the results to me and what he/she thinks it means.

I don't think I'd think of giving the client a copy (any more than I'd
think
it was necessary to make copies of all the x-rays, or take recordings
of
the
heartbeat, lung sounds, etc, etc). I'd certainly provide a copy on
request
without hesitation (or charge), but I don't think I'd volunteer.


Too bad.

Would you, as a client think it appropriate to have copies of every test
done?

I now ask for copies of all bloodwork, x-rays or ultrasounds reports
urinalysis, etc. I want to see for myself what the vet is or is not telling
me and make my treatment decisions accordingly.

Why is blood work special?

Because it is possible to find out what changes in values *might* indicate
and to be on the look out.



How are you going to get a copy of a
palpation? An auscultation? Could you really look at an x-ray of something
subtle and have it make sense (and if its not something subtle you're
looking for, why would you want a copy anyways?)


To have it in my possession in case of an emergency that necessitates an
emergency trip to a 24 hour clinic, to compare to future x-rays, to take to
a specialist. . . .


The thing is, even if you have the results, its the *interpretation* that
matters, not the numbers,

And some are better at it than others. How is somebody to know what type of
vet they have on their hands if they have no knowledge of the different
components and what the values indicate.


otherwise the vet's job could be done by a
machine. That's why vets go to school for *years*.

I surely hope you drop this "the vet knows more than you do honey let us
worry about it" attitude *before* you become a practicing vet. I can't
stand a vet (or doctor) for that matter with that attitude. I want a vet
that partners with me to take care of my animals. One that thinks I am
intelligent enough to understand what the findings do or could mean and is
willing to explain and explore the avenues based on what *I* want to do not
on what *he* thinks should be done without giving me the option of any
input.


A value that the machine says is 'normal' isn't necessarily 'normal', and
a
value the machine says is 'abnormal' isn't necessarily 'abnormal'.

Well gee how condescending. Isn't it possible that your clients might just
understand that concept if you *gave them the opportunity* to discuss it?


Classic example of this, one of my dogs, is hypothyroid. He shows all the
classic signs of hypothyroidism, but the machine says he's normal (he's
borderline low). We put him on thyroid meds, and loe and behold his signs
improved.

Other indicators, just aren't that valid for certain species (too many
things can throw them off). Very few things in veterinary medicine are cut
and dry. To communicate *all* the complexities involved would require
*years* (I mean this), so you're always left with the choice of how much
information to give, and how much to hold back.

And apparently a lot of vets hold back way too much information to the
deteriment of the pet's health.


Some clinicians draw the
line in a different place than others.

Imo that's how you differentiate between the good ones and the bad ones.
Too bad your pet may die in the process while you are figuring that out.

Kathy