"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

Dale Atkin wrote:

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.

I hope you rethink this. This smacks of paternalistic medical
practice, where "the doctor knows best." You may have clients
who don't want to know, who just want to be told what to do. But
if you've gotten anything from participating in this forum, you
should have picked up that many people want to be fully informed
about their pets, that many people WILL want all of the data,
that your judgment will be questioned at times and you will need
to be prepared to defend it.

I'd strongly recommend that you start to "think of giving the
client a copy" and at least ask your clients if they want copies.
For things like x-rays, it's not unreasonable to charge for an
extra copy (although if you use digital radiography, a "copy"
could be an image file transferred from your computer to my thumb
drive).

W/r/t things like heart and lung sounds, it's not something I had
ever asked for, but when one of my dogs developed a heart murmur,
the vet asked me if I would like to listen, told me what to
listen for, and handed me the stethoscope. When the dog later
had an echocardiogram, the specialist wanted me to be in the room
so that he could explain what he was seeing.

I think it *very* important that the vet explain the results to you, and
what they most likely indicate, why they indicate that and where you need to
go from there.

And be *very* clear when the results indicate more than one
possible diagnosis, or when the vet himself is unsure.

FurPaw
--
Don't believe everything that you think.

To reply, unleash the dog.

"FurPaw" wrote in message
...
Dale Atkin wrote:

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.

I hope you rethink this. This smacks of paternalistic medical
practice, where "the doctor knows best."

Definitely. Unfortunately I've encountered that attitude more often than
not.

You may have clients
who don't want to know, who just want to be told what to do. But
if you've gotten anything from participating in this forum, you
should have picked up that many people want to be fully informed
about their pets,

And also those in the middle that are naive and don't realize what questions
they should be asking and with a little education from the vet could become
good advocates for their pets in the future.


that many people WILL want all of the data,
that your judgment will be questioned at times and you will need
to be prepared to defend it.

And not in a defensive "I know what I'm doing, I'm offended you even asked"
sort of way.


I'd strongly recommend that you start to "think of giving the
client a copy" and at least ask your clients if they want copies.
For things like x-rays, it's not unreasonable to charge for an
extra copy (although if you use digital radiography, a "copy"
could be an image file transferred from your computer to my thumb
drive).

W/r/t things like heart and lung sounds, it's not something I had
ever asked for, but when one of my dogs developed a heart murmur,
the vet asked me if I would like to listen, told me what to
listen for, and handed me the stethoscope. When the dog later
had an echocardiogram, the specialist wanted me to be in the room
so that he could explain what he was seeing.

I *really* want your vet!


I think it *very* important that the vet explain the results to you, and
what they most likely indicate, why they indicate that and where you
need to
go from there.

And be *very* clear when the results indicate more than one
possible diagnosis, or when the vet himself is unsure.


Excellent advice. Had my daughter's vet indicated that a) Digit was anemic
b) she was testing for FIP so obviously she wasn't entirely convinced the
anemia was related to the HL and c) a follow-up blood test might be a
prudent course of action - Digit might still be here will us today. Of
course things might have followed the same path but if they had at least we
would have known that we had had all pertinent information and wouldn't feel
so betrayed.

Kathy

kat wrote:
"FurPaw" wrote in message
...
Dale Atkin wrote:

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.
I hope you rethink this. This smacks of paternalistic medical
practice, where "the doctor knows best."

Definitely. Unfortunately I've encountered that attitude more often than
not.

You may have clients
who don't want to know, who just want to be told what to do. But
if you've gotten anything from participating in this forum, you
should have picked up that many people want to be fully informed
about their pets,

And also those in the middle that are naive and don't realize what questions
they should be asking and with a little education from the vet could become
good advocates for their pets in the future.


that many people WILL want all of the data,
that your judgment will be questioned at times and you will need
to be prepared to defend it.

And not in a defensive "I know what I'm doing, I'm offended you even asked"
sort of way.

I'd strongly recommend that you start to "think of giving the
client a copy" and at least ask your clients if they want copies.
For things like x-rays, it's not unreasonable to charge for an
extra copy (although if you use digital radiography, a "copy"
could be an image file transferred from your computer to my thumb
drive).

W/r/t things like heart and lung sounds, it's not something I had
ever asked for, but when one of my dogs developed a heart murmur,
the vet asked me if I would like to listen, told me what to
listen for, and handed me the stethoscope. When the dog later
had an echocardiogram, the specialist wanted me to be in the room
so that he could explain what he was seeing.

I *really* want your vet!

I think it *very* important that the vet explain the results to you, and
what they most likely indicate, why they indicate that and where you
need to
go from there.
And be *very* clear when the results indicate more than one
possible diagnosis, or when the vet himself is unsure.

Great posts! I am having problems right now with a human doctor that
does tests I don't even know about and then the ones I do know about I
have to really work to find out the results, ie several phone calls
resulting in phone tag and sometimes actually calling the head
administrator for the clinic.

I have a friend right now with hepatitis c and he has no idea what kind
or how far along it is. Totally in the dark! I promised to go with him
on his next visit to make sure he's still ok and to get him a biopsy.

"kat" wrote
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)

I'm curious now, for my own education (totally apart from this) how you
determined that the FNA was 'bungled by too much pressure with the sample'.

and a rapidly dropping HCT along with
rising liver values and the cause was not determined before he was PTS.


Did you have them do a post-mortem to determine the ultimate cause?


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!


I guess what I'm really driving at, is I'm not so quick to jump on the 'my
vet's incompetent' bandwagon. There was definitely some breakdown in
communication here, which isn't good (obviously you didn't feel that your
needs as a client were being met, so the vet wasn't doing that part of his
job properly), but I'm not sure the vet wasn't 'competent'. From where I'm
sitting, it looks to me like the vet did some diagnostic tests, interpreted
the data, and gave you the summarized version of the results (I.e. heptic
lipidosis). Should there have been more follow up? Probably.

Was the vet 'incompetent'? From what you've told me, I'd say no.

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?


An explanation is an interpretation of the facts. It doesn't have to be
correct. So yes, the anemia was explained.


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?

I think follow up tests are *always* a good idea, but I'm still not sure why
you're stuck on the anemia issue (as opposed to the hepatic lipidosis
issue). When ever you get a diagnosis, in human medicine, or veterinary
medicine, its always the most probable explanation (in the mind of the
person doing the diagnosis) for the observed facts. To me that's just
assumed. In a case where there is some doubt (I.e. two or more explanations
are similarly probable), more diagnostic tests are in order. In a case where
the diagnosis isn't in doubt, more diagnostic tests are not in order (they
are simply a waste of money)

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.

This actually had nothing to do with 'not informing the client of blood
results'. My own approach would be to try to involve the client as much as
feasible in the understanding of the diagnostic process. Basically say we a,
b, and c which are off, which to me indicates ---. That way the client
knows what you're basing your decision on. Unfortunately many vets are
really *bad* at communication (its one of those things that continuously
comes up in reviews of the industry, and I've seen first hand as well)

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.


Hmmm, I've just been reading up on FIA. Seems that one 'test' for FIA is to
look at a blood smear under a microscope (I'm assuming she didn't run a PCR
test). So the fact that the records indicate that the cat was negative for
FIA may simply mean that that was something that was on her mind as a rule
out, but she could see no evidence for it under the microscope.

To have it in my possession in case of an emergency that necessitates an
emergency trip to a 24 hour clinic

That is a good point that I hadn't considered, and in cases where we feel
that its possible that an animal will have to go to an emergency clinic for
a particular condition, we do make sure that any bloodwork/records are
either sent with the client, or faxed over. X-rays are a little different,
as my understanding is that the law in this jurisdiction requires the clinic
to maintain the x-ray, so while we can 'lend' and x-ray to a client, other
vet etc, we aren't legally allowed to give them the x-ray (we're not on a
digital system)

, to compare to future x-rays, to take to
a specialist. . . .

Definitely a time when we're be sending everything we had over to the
specialist if the case were referred (and I'm sure pretty much any vet
would, and I'm pretty sure they are legally obligated in most jurisdictions)



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.


Blood values, quite simply don't work like that (at least that's the
impression I've been given). You can have an animal with no functioning
liver, and have standard liver enzymes be totally normal.


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'm really sorry if I've given you that impression. I do believe that it is
very important for the client to understand the process, the reasoning, and
where any doubt lies, however I also believe (and this is probably where
you're going to disagree with me, and I'll likely get people shouting at
me), that to some extent, it *has* to inevitably come down to a 'trust me',
type of argument (but that your vet should give you reason to trust them by
showing you that they've gone through a rational process rather than pulling
something out of a black box).

I've seen it many, many, many times that the attitude, and behavior of the
client is a reflection of the vet that is treating their animal.

Here is a very concrete (although somewhat distantly related) example. The
practice I spend all my time at strongly advocates permanent identification
for all animals, so much so that they tattoo every animal that goes under
for an anesthetic free of charge. Microchips they are less comfortable with
(as are many of the shelters around here, so probably rightly so),
consequently, we do a huge number of tattoos every year, but very few
microchips. Other clinics take the reverse opinion. Microchips are the way
to go! Consequently, those clinics do many more microchips than tattoos.

In both cases, valid arguments can be presented to the client as to why one
is better than the other (microchips sometimes aren't picked up, there is no
central database, and you have to have a special scanner to read them, which
aren't completely standardized, tattoos may fade and become illegible, and
relies on keeping the records with the clinic). In both cases, the
expectations of the client are being shaped by the *opinions* of the vet
(I'm not even convinced that most vets know the effect they are having), and
this is for a relatively easy to understand, non-technical matter.

Looking at the same data, two people can come to entirely different
conclusions. Without a very strong backing in the subject area, I'm not sure
how I would personally choose between them. (I'm thinking how I'd feel if I
was having a conversation with two car mechanics, and one said one thing was
wrong with my car, while another said something else. I simply don't have
the backing to know if they are right or not, so it comes down to which one
I trust more.

This isn't because either individual in the case has 'missed' something, its
because they assign different values to the evidence that is presented. I
don't know how its possible to expect a lay-person to assign those values
for themselves in a coherent manner.

If you go back a ways in rec.pets.dogs.behavior you'll have a disagreement
between Melinda and I in a thread called [OT] - Ping Techy folks - Is my HD
dead? This is the perfect example of this. Melinda attached more weight to
the noise, I attached more weight to the method of 'hanging'. How is a lay
person to judge which of us was right? Neither of us had missed any of the
'facts' and we both had a perfectly logical explanation for all of the
observed signs, and could involve the OP in understanding what we felt was
wrong. When it came down to it though, it's a 'trust me' issue as far as
what path you're going to pursue.

Anyways, its late, and I'm tired, so I better not keep typing.

G'night!

Dale

Dale Atkin wrote:



Hmmm, I've just been reading up on FIA. Seems that one 'test' for FIA is
to look at a blood smear under a microscope (I'm assuming she didn't run
a PCR test). So the fact that the records indicate that the cat was
negative for FIA may simply mean that that was something that was on her
mind as a rule out, but she could see no evidence for it under the
microscope.

To have it in my possession in case of an emergency that necessitates an
emergency trip to a 24 hour clinic

That is a good point that I hadn't considered, and in cases where we
feel that its possible that an animal will have to go to an emergency
clinic for a particular condition, we do make sure that any
bloodwork/records are either sent with the client, or faxed over.

If someone is going to an emergency clinic it's usually because their
regular vet isn't open and there is no time to wait till it does.
Because of that it's not possible to fax anything or have it given to a
client.

X-rays
are a little different, as my understanding is that the law in this
jurisdiction requires the clinic to maintain the x-ray, so while we can
'lend' and x-ray to a client, other vet etc, we aren't legally allowed
to give them the x-ray (we're not on a digital system)

We pet owners pay for the x-rays. How can you lend something that
belongs to us in the first place?

"chardonnay9" wrote in message
m...
Dale Atkin wrote:



Hmmm, I've just been reading up on FIA. Seems that one 'test' for FIA is
to look at a blood smear under a microscope (I'm assuming she didn't run
a PCR test). So the fact that the records indicate that the cat was
negative for FIA may simply mean that that was something that was on her
mind as a rule out, but she could see no evidence for it under the
microscope.

To have it in my possession in case of an emergency that necessitates an
emergency trip to a 24 hour clinic

That is a good point that I hadn't considered, and in cases where we feel
that its possible that an animal will have to go to an emergency clinic
for a particular condition, we do make sure that any bloodwork/records
are either sent with the client, or faxed over.

If someone is going to an emergency clinic it's usually because their
regular vet isn't open and there is no time to wait till it does. Because
of that it's not possible to fax anything or have it given to a client.


There are times when its predictable. Client comes in on Friday afternoon.
We treat the animal, and they go home. We include instruction about what to
watch for in terms of signs that things might go downhill, and a clinic to
contact if they do, at which point we make sure that the clinic we refer to
has the requisite records.

X-rays
are a little different, as my understanding is that the law in this
jurisdiction requires the clinic to maintain the x-ray, so while we can
'lend' and x-ray to a client, other vet etc, we aren't legally allowed to
give them the x-ray (we're not on a digital system)

We pet owners pay for the x-rays. How can you lend something that belongs
to us in the first place?

As I explained, that isn't how the law looks at it around here (at least to
my knowledge).

Legally the clinic has a responsibility to maintain complete records for x
number of years following a visit. If the clinic gives you the x-ray, their
records aren't complete. One way to look at it, is that you aren't paying
for the x-ray. You're paying for taking the x-ray, and having it
interpreted.

Dale

"Dale Atkin" wrote in message
news:hkbgl.8546$Db2.899@edtnps83...


"kat" wrote
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)

I'm curious now, for my own education (totally apart from this) how you
determined that the FNA was 'bungled by too much pressure with the
sample'.


I read somewhere - I don't remember now if it was in the Merck Veterinary
Manual, vet connect or where - that too much pressure can cause the cells to
rupture. From the first FNA - "The nucleated cells are often ruptured or
poorly preserved"
Combine that with the comments from the second vet who suggested a second
FNA stating that "They would take care with the procedure to obtain good
samples" and that's the conclusion I came to ymmv



and a rapidly dropping HCT along with
rising liver values and the cause was not determined before he was PTS.


Did you have them do a post-mortem to determine the ultimate cause?

I was with him when he was PTS as my daughter was too emotionaloly
distraught. I mentioned it to the vet, she told me the procedure i.e.
better not to refridgerate the body etc., I told her I would gently ask my
daughter and let her know. I asked, my daughter didn't want to. If it was
mine I would have as I would want to know.



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!


I guess what I'm really driving at, is I'm not so quick to jump on the 'my
vet's incompetent' bandwagon.

She was better than my last one but this combined with other things make me
question her judgement.

There was definitely some breakdown in
communication here, which isn't good (obviously you didn't feel that your
needs as a client were being met, so the vet wasn't doing that part of his
job properly), but I'm not sure the vet wasn't 'competent'.

There were other things.


From where I'm
sitting, it looks to me like the vet did some diagnostic tests,
interpreted
the data, and gave you the summarized version of the results (I.e. heptic
lipidosis). Should there have been more follow up? Probably.

Was the vet 'incompetent'? From what you've told me, I'd say no.

I'm ambivalent. If a cat came in with swollen lymph nodes and you didn't
even use your listen to his chest would you consider that competent medical
care? Especially considering same cat was rushed to the emergency clinic the
next day because he stopped breathing and needed CPR to be revived?


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?


An explanation is an interpretation of the facts. It doesn't have to be
correct. So yes, the anemia was explained.

My dictionary says it is to "give a reason for". So if your doctor
'explained' to you that your condition was benign and it turned out to be
terminal. Would you consider that 'explanation' satisfactory? So I guess it
depends on on one's 'interpetation' of 'explained'!





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?

I think follow up tests are *always* a good idea, but I'm still not sure
why
you're stuck on the anemia issue (as opposed to the hepatic lipidosis
issue).

The hepatic lipidosis appeared to be resolving as he gained back a good
amount of weight. Had follow up bloodwork been done it would have been
discovered that the anemia was an ongoing issue and another cause should
probably be investigated. That investigation would have occurred when the
cat was in relatively stable shape as opposed to the crisis conditions it
was done under.



When ever you get a diagnosis, in human medicine, or veterinary
medicine, its always the most probable explanation (in the mind of the
person doing the diagnosis) for the observed facts. To me that's just
assumed.

Well you know what they say about assumptions. I don't know of too many
conditions in either human or veterinary medicine where the same basic set
of syptoms don't usually apply to several situations.


In a case where there is some doubt (I.e. two or more explanations
are similarly probable), more diagnostic tests are in order. In a case
where
the diagnosis isn't in doubt,


Hmm, name one diagnosis where there is *no* doubt that it may be somthing
else without more than one diagnostic test.


more diagnostic tests are not in order (they
are simply a waste of money)

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.

This actually had nothing to do with 'not informing the client of blood
results'. My own approach would be to try to involve the client as much as
feasible in the understanding of the diagnostic process. Basically say we
a,
b, and c which are off, which to me indicates ---. That way the client
knows what you're basing your decision on. Unfortunately many vets are
really *bad* at communication (its one of those things that continuously
comes up in reviews of the industry, and I've seen first hand as well)

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.


Hmmm, I've just been reading up on FIA. Seems that one 'test' for FIA is
to
look at a blood smear under a microscope (I'm assuming she didn't run a
PCR
test). So the fact that the records indicate that the cat was negative for
FIA may simply mean that that was something that was on her mind as a rule
out, but she could see no evidence for it under the microscope.


I don't really know if *she* looked for it or not. Her records are pretty
spotty. There was no mention of it in the lab report just a notation in
the chart that said "treated presumptively for hemobartonella +/or hepatic
lipidosis" yet the chart for the 24 hour clinic states "Taled with Dr. ___:
pet was seen on Tues. . . . . . .Pet was seen in Aug. for presumed fatty
liver or hemobart (latter never seen on smears). From my understanding
that is not particularly easy to diagnose and false negatives aren't that
uncommon. I would think that is something you would send out.



To have it in my possession in case of an emergency that necessitates an
emergency trip to a 24 hour clinic

That is a good point that I hadn't considered, and in cases where we feel
that its possible that an animal will have to go to an emergency clinic
for
a particular condition,

Both times my daughter made such a trip (two different cats) it wasn't
something expected.


we do make sure that any bloodwork/records are
either sent with the client, or faxed over.

As Digit's were supposed to be but they got lost in the shuffle somewhere.
Much better to have them in hand and avoid any delay.


X-rays are a little different,
as my understanding is that the law in this jurisdiction requires the
clinic
to maintain the x-ray, so while we can 'lend' and x-ray to a client, other
vet etc, we aren't legally allowed to give them the x-ray (we're not on a
digital system)


Apparently we could have gotten a CD but didn't think it was necessary as we
thought they could send it to whatever vet we saw next. I really wish we
would have. Again, it is better to have it in hand than to waste valuable
time arranging to have it sent over.


, to compare to future x-rays, to take to
a specialist. . . .

Definitely a time when we're be sending everything we had over to the
specialist if the case were referred (and I'm sure pretty much any vet
would, and I'm pretty sure they are legally obligated in most
jurisdictions)



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.


Blood values, quite simply don't work like that (at least that's the
impression I've been given).

Uh yah they do in most cases or why bother to do them at all? If say you
have a high lipase value (as Digit did) then you would look to see what
conditions might return a high lipase value. Of course there could be
multiple causes and you would look at the other values to see where they fit
into the picture.


You can have an animal with no functioning
liver, and have standard liver enzymes be totally normal.

Yeah I believe you said something along the same lines before and I believe
I said that a client is capable of understanding that concept if given a
chance. So using your logic let's not do any bloodwork because it *might*
not indicate a problem if there is one?




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'm really sorry if I've given you that impression. I do believe that it
is
very important for the client to understand the process, the reasoning,
and
where any doubt lies, however I also believe (and this is probably where
you're going to disagree with me, and I'll likely get people shouting at
me), that to some extent, it *has* to inevitably come down to a 'trust
me',
type of argument (but that your vet should give you reason to trust them
by
showing you that they've gone through a rational process rather than
pulling
something out of a black box).

I've seen it many, many, many times that the attitude, and behavior of the
client is a reflection of the vet that is treating their animal.

Here is a very concrete (although somewhat distantly related) example. The
practice I spend all my time at strongly advocates permanent
identification
for all animals, so much so that they tattoo every animal that goes under
for an anesthetic free of charge. Microchips they are less comfortable
with
(as are many of the shelters around here, so probably rightly so),


consequently, we do a huge number of tattoos every year, but very few
microchips. Other clinics take the reverse opinion. Microchips are the way
to go! Consequently, those clinics do many more microchips than tattoos.

In both cases, valid arguments can be presented to the client as to why
one
is better than the other (microchips sometimes aren't picked up, there is
no
central database, and you have to have a special scanner to read them,
which
aren't completely standardized, tattoos may fade and become illegible, and
relies on keeping the records with the clinic). In both cases, the
expectations of the client are being shaped by the *opinions* of the vet
(I'm not even convinced that most vets know the effect they are having),
and
this is for a relatively easy to understand, non-technical matter.

Looking at the same data, two people can come to entirely different
conclusions. Without a very strong backing in the subject area, I'm not
sure
how I would personally choose between them. (I'm thinking how I'd feel if
I
was having a conversation with two car mechanics, and one said one thing
was
wrong with my car, while another said something else. I simply don't have
the backing to know if they are right or not, so it comes down to which
one
I trust more.

This isn't because either individual in the case has 'missed' something,
its
because they assign different values to the evidence that is presented. I
don't know how its possible to expect a lay-person to assign those values
for themselves in a coherent manner.


Well they certainly can't if they aren't given the information to begin
with.

Using your example above. Say you have several vehicles over the years and
they break down and you repeatedly take it to the same repair shop. Do you
just blindly accept what they tell you each time or do you begin to ask
questions? You might even begin to talk about your cars' problems with
your friends and they might say "Hey when my car did that X was the problem"
"Did your mechanic do Y test". You might then think to yourself - I'm not
sure. So the next time you see your mechanic you ask "Did you run this on
the computer?" "What values did it return?" "What does that value mean?"
"Or that one?" If you are really interested you might pick up a few books
and start reading about automobile repair. Of course in the beginning most
of it would be over your head but gradually over time and repeated
questioning from various sources you begin to build a knowledge base. You
can't build that knowledge base if you don't first begin the questioning
process and if you don't have the raw data to begin with.



If you go back a ways in rec.pets.dogs.behavior you'll have a disagreement
between Melinda and I in a thread called [OT] - Ping Techy folks - Is my
HD
dead? This is the perfect example of this. Melinda attached more weight to
the noise, I attached more weight to the method of 'hanging'. How is a lay
person to judge which of us was right? Neither of us had missed any of the
'facts' and we both had a perfectly logical explanation for all of the
observed signs, and could involve the OP in understanding what we felt was
wrong.

I saw that thread when you were having it.

When it came down to it though, it's a 'trust me' issue as far as
what path you're going to pursue.

No it came down to the OP evaluating *each* side of the argument and
deciding which side made more sense. A more appropriate analogy (to
Digit's situation) would be that the OP was only being fed *one* side of the
argument with nothing to compare it to. The mistake was going with the
"trust me" without questioning and investigating.

Kathy

"Dale Atkin" wrote in message
news:Lsjgl.7879$PH1.2763@edtnps82...

"chardonnay9" wrote in message
m...
Dale Atkin wrote:



Hmmm, I've just been reading up on FIA. Seems that one 'test' for FIA
is
to look at a blood smear under a microscope (I'm assuming she didn't
run
a PCR test). So the fact that the records indicate that the cat was
negative for FIA may simply mean that that was something that was on
her
mind as a rule out, but she could see no evidence for it under the
microscope.

To have it in my possession in case of an emergency that necessitates
an
emergency trip to a 24 hour clinic

That is a good point that I hadn't considered, and in cases where we
feel
that its possible that an animal will have to go to an emergency clinic
for a particular condition, we do make sure that any bloodwork/records
are either sent with the client, or faxed over.

If someone is going to an emergency clinic it's usually because their
regular vet isn't open and there is no time to wait till it does.
Because
of that it's not possible to fax anything or have it given to a client.


There are times when its predictable. Client comes in on Friday afternoon.
We treat the animal, and they go home. We include instruction about what
to
watch for in terms of signs that things might go downhill, and a clinic to
contact if they do, at which point we make sure that the clinic we refer
to
has the requisite records.

And if they decide to go to another clinic? I don't know too many practices
that send records on ahead without a request first.


X-rays
are a little different, as my understanding is that the law in this
jurisdiction requires the clinic to maintain the x-ray, so while we can
'lend' and x-ray to a client, other vet etc, we aren't legally allowed
to
give them the x-ray (we're not on a digital system)

We pet owners pay for the x-rays. How can you lend something that
belongs
to us in the first place?

As I explained, that isn't how the law looks at it around here (at least
to
my knowledge).

Legally the clinic has a responsibility to maintain complete records for x
number of years following a visit. If the clinic gives you the x-ray,
their
records aren't complete. One way to look at it, is that you aren't paying
for the x-ray. You're paying for taking the x-ray, and having it
interpreted.

When I worked in the x-ray department at a local hospital (some years ago)
we routinely made copies of x-rays for patients that requested them while
retaining the original. Isn't this a possibility at veterinary clinics?

Kathy

In article ,
"kat" wrote:


When I worked in the x-ray department at a local hospital (some years ago)
we routinely made copies of x-rays for patients that requested them while
retaining the original. Isn't this a possibility at veterinary clinics?

These days, a lot of clinics have DIGITAL x-rays, meaning they can be
e-mailed or put on a CD.

--
Janet Boss
www.bestfriendsdogobedience.com