Tag: veterinarian

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Second opinion: Read the Rx label!

I recently was stopped by a couple riding their bicycles in my neighborhood. My reputation as a veterinarian who gives advice hit a fever pitch in my community during the pandemic.

Mr. and Mrs. Snowbird just came back from their home in upstate New York. They, like so many people, adopted a pet during the pandemic and drove their new dog Rascal, a one-year-old Corgi, down last weekend.

Prior to traveling to Florida, they brought Rascal to their veterinarian because they thought he had allergies. Rascal was shaking his head a lot and vocalized when you touched his ear.

The question that they had for me referenced back to their other dog, Ruby, a 14-year-old Schnauzer who had terrible allergies. She constantly licked her paws, scratched all the time, and rubbed her face. I recommended that they talk to their local veterinarian about Apoquel or Cytopoint allergy treatments.

The schnauzer was a happy dog after starting the medication. They were hopeful that Rascal didn’t have allergies because the medication was expensive, but Rascal seemed very uncomfortable.

I asked them about the working diagnosis. They told me that their New York veterinarian thought that Rascal had an ear infection. Two weeks ago, Rascal’s ears were red, inflamed, and painful. The veterinarian took a sample from the ear to look under the microscope and sent it out for culture.

The doctor started Rascal on an ear cleaner and pain medication and told the couple they would start treatment once the culture results came back.

The couple told me the technician at the hospital called and told them that Rascal had a bacterial ear infection and the vet wanted to start him on antibiotics. They also told them to clean his ears once a day and to continue him on the pain medications if he was still uncomfortable.

After two weeks of medication, ear cleaning, and pain medications I told them that Rascal should be feeling and looking better. They said he wasn’t and wanted to know if I could look.

As we walked to their house, Mr. Snowbird said that Rascal is not clinically better. He doesn’t seem to be in as much pain, but the veterinarian said that he would only need the medication for a few days, and he is still on them.

Rascal also hates it when Mr. Snowbird puts the medication in his ear. He mentioned that it seemed kind of cruel to put cold ear medication in an ear but what does he know. I was puzzled because I don’t know any ear medication that needs to be refrigerated, but maybe the medication was compounded specifically for Rascal.

Rascal is a sweet Corgi. He jumped up on me when I entered the house and, true to form, he smelled sour. When I investigated his ear, it was inflamed and sensitive and full of white material.

I was hoping it wasn’t pus. Mrs. Snowbird brought me the medication and it was Clavamox, an amoxicillin product that was meant to be refrigerated and given orally. I asked them if they are giving the medication orally or putting it into the ear.

I have never seen such finger pointing towards each other. Obviously, someone didn’t read the label. Mrs. Snowbird laughed and told me at least I had a funny story to tell people. Little did they know that I write articles.

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PETTALK: Tight Quarters

I have always been the Kalick family veterinary consultant, regardless of where my family lives. My family who lives in Ohio will always consult with me via the phone when there is a problem, and typically I will tell them they need to see their local veterinarian. Their veterinarian and I have become friends and she sends me all the records, digital x-rays, and bloodwork as soon as she gets them, it saves her a phone call from my aunt asking to send them to me.

One interesting thing that has changed since the pandemic is that my aunt and uncle have become very adept with Facetime and Zoom.

Today’s issue is with Titus, their cat. Titus is a geriatric tabby cat that my aunt thought was depressed because her kids moved out of the house. I would never contradict my aunt, but I think Titus is happy the kids moved out. Titus took back control of the big house, and because the kids took the dog with them, Titus gets to sit in the large bay window watching the world pass by.

However, today my aunt was concerned that Titus had a urinary tract infection because he was urinating in a closet on my uncle’s shoes.

My aunt sat in the room during the Facetime call, switching my view so I could watch Titus sleeping in the window. She wanted me to see the closet that Titus was using as his new litterbox, so she swung the camera around the room so I could see the hall closet. She told me he never used that closet before and now he never wants to leave the room.

Then she walked down the hall with her iPhone because she wanted to show me Titus’s litter box. My aunt, God bless her, talked the entire way from the front room to the bathroom, bouncing her phone the whole time. She got into the bathroom and showed me Titus’ litterbox crammed between the bathroom vanity and the toilet. It looked like it hadn’t ever been used. It. left no room for the cat to move in the box if he ever wanted to use it.

The craziest part of the story was that the bathroom door was closed like Titus could open it with his paws if he needed to.

When I mentioned that the bathroom door was closed and no one was using it, my aunt started to talk about changing the brands of kitty litter or playing music in the house. I even mentioned that if someone is using the bathroom or taking a shower, the door will never be open.

She said that she never thought of that.

Titus’ litterbox was always in the room where he slept, easily accessible, and near his food. I told my aunt that the rule of thumb is that you should have one extra box in the house.

This means: one cat equals two boxes and one of the boxes should be in the front room where he sleeps and spends most of his day.

After she thanked me and was about to hang up, I heard my uncle in the background yelling to my aunt, “What does he think of the new kitten?”

New kitten? My aunt winked at the phone and said it was a topic for another day.

 

By Dr. Glenn Kalick

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PETTALK: Doctors make the worst clients

I recently went to a socially distanced neighborhood block party and met a few people I had never met before. Where I currently live in Jupiter, most of my neighbors are snowbirds and based on the spike in COVID-19 cases in Florida, they may not be coming back anytime soon.

At the party, I met a female neighbor who, after finding out I was a veterinarian, dragged her husband unwillingly out of a group of men who were talking about golf and politics to talk to me.

I am going to call him Dr. Skin because he is a dermatologist and his demeanor got under my skin. Mrs. Skin told him to tell me about Annabella, their 9-year-old boxer, who had increased thirst and urination. Mrs. Skin wanted to take Annabella to the veterinarian, but with the pandemic, she was reluctant to allow Annabella to be seen by her veterinarian while she was forced to stay in the car.

This allowed Dr. Skin the opportunity to act as a veterinarian by searching Google. I asked Dr. Skin how he felt about his clients coming in and comparing his diagnosis to Dr. Google and he said he hated it. I told him that he was doing the same to the veterinary profession.

Dr. Skin told me that he had put increased thirst and urination into the search engine and based on his research, diabetes and kidney disease were the most likely diseases followed by Cushing’s disease and a high salt diet. I nodded my head in agreement that they were definitely high on my list, as well.

So, I asked him what he has done, knowing that he has not called or seen his veterinarian. He told me he obviously wouldn’t start insulin therapy without taking Annabella’s blood sugar but was tempted. He didn’t think Annabella had kidney disease because her urine was very yellow in the morning and he would assume that if she had kidney disease her urine would always be clear in color. Then he abruptly left to get the bag of dog food so I could look at the sodium level.

I told Mrs. Skin that Annabella needs to see her veterinarian. Bloodwork and urine need to be analyzed and Annabella needed to be examined.

She agreed.

Dr. Skin not only brought back the bag of dog food for me to look at but Annabella as well. From ten feet away, I could see that Annabella’s lymph nodes on her neck, chest, and rear legs were swollen.

Annabella is a boxer and boxers are the number one canine cancer breed.

As Dr. Skin was showing me the bag of dog food, I interrupted him and asked if a patient came to him with swollen lymph nodes and abnormal clinical signs, would he take the necessary tests for cancer? He said absolutely and wondered why I had asked. I told them Annabella’s lymph nodes were very enlarged, and her clinical signs were classic for hypercalcemia, secondary to neoplasia.

It was a very hot day and Dr. Skin’s face went from red to pale white in one second. He left abruptly with Annabella and Mrs. Skin. I hoped he was going to the veterinarian.

Follow-up: Annabella had lymphoma and is currently being treated with chemotherapy. I later got a fruit basket from Mrs. Skin, and I would be happy to continue calling her husband Dr. Skin.

Dr. Glenn Kalick

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PETTALK: OK, who’s the stupid one now?

To my wife, I am probably getting a little judgy, but I literally had a Clint Eastwood moment from Gran Torino when he tells everyone to “get off my lawn.” To better explain, I was walking on Juno Beach and maintaining a 6-foot social distance as my wife and I walked on the sidewalk along the road. It was one of those days that said it was 88 degrees but the RealFeel index said 107. We brought water and, probably every 1⁄4 mile, there was a shower under which we kept wetting our baseball caps.

It was nice to be outside and see something other than the same houses on the block, then we heard someone behind us, but could not see him. He had one of those booming voices. I knew he was from New York from the accent and it took nearly 30 minutes for him to catch up to us. There he was, wearing a t-shirt without sleeves, a Yankees hat, mirrored sunglasses, and walking a 6-month old Boxer pup. Over the thirty minutes it took him to catch up to us, I heard about his life, his girlfriend, his frustration with the pandemic, and the stupid dog he bought. It wasn’t until he was close enough that I realized it was a puppy.

When Mr. Yankee was right behind us, I could see that the puppy was thirsty. He was hyper salivating, and when he walked by the showers you could see him try to lick the puddles on the sidewalk, but Mr. Yankee pulled on the leash because he was walking and having an intense conversation on his phone. For the next quarter mile, the puppy kept walking on the grass and Mr. Yankee pulled him back on the pavement making comments on his phone to whomever he was talking to about the puppy being stupid. I made sure that we stayed close. Mr. Yankee was about to walk by the next shower when I stopped and decided to tell him that the puppy was thirsty. Mr. Yankee told me that he didn’t bring a bowl and I told him to cup his hands and fill them with water which he did, and the puppy drank three handfuls of water.

He looked at me and asked me if I was a vet or something.
I told him that I was. He asked me if I could look at his dog’s weird walk. His last dog was a German Shepard and he had to put him to sleep because of hip dysplasia and this puppy never walks straight. I said that I would but I told him that hip dysplasia is a radiographic diagnosis. I asked him what the puppy’s name was and he said it was Aaron, after Aaron Judge, the Yankee superstar. Figures. I watched Aaron walk and he kept getting off the pavement and walking onto the grass. Mr. Yankee kept pulling him onto the sidewalk. This happened multiple times and finally Mr. Yankee stopped and said to my wife and I that this dog either has hip dysplasia, needs extensive training which his German Shepard never needed, or is stupid.

I looked at Mr. Yankee and saw that he was wearing sneakers. I asked him to take off his shoes. He asked me why. I told him it was a training trick. I was so surprised that he listened to me and when he stepped on the pavement, he jumped off the pavement and onto the grass. He told me that it was “f****n hot”. I agreed. Aaron is not stupid he has probably burned his pads and wanted to walk on the grass because it is cooler. He picked up his puppy and saw that the puppy’s pads were raw. It was great watching Mr. Yankee carry Aaron back home.

 

By Dr. Glen Kalick

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