This blog is brought to you courtesy of two clients who thought they were doing the right thing. But they weren’t! I’ve had two cases recently were I thought, “Good thing they came to see me.” Not because of my magical hands, big brain, and enviable collection of equipment, but rather, because I took a subjective history, and knew what to do with the information.
A geriatric Springer Spaniel with chronic painful elbow arthritis. Elbows suck. It doesn’t matter the species… elbow ailments can be unforgiving, soul sucking, recalcitrant beasts! So, have I fixed this dog? No.
The story about this dog centers around the question, “What is he on for medication?” The answer was Metcam (Meloxicam). However, the owner felt that the dog needed something more, so had also been giving him Asprin (acetylsalicylic acid). He felt that the dog was much better on the days he received Asprin.
So, with that I knew that this was a topic I would have to broach with the client, WHEN I had gained his trust, a little bit into the appointment. I could have gasped right then and there and given him a lecture about the potential of a gastrointestinal bleed and so on… but I waited. I waited until I had started treatment on his elbow (within that same session), and then I brought up the subject.
“You know, we need to talk about the Asprin. Taking Asprin together with Metacam is contraindicated. It could cause a bleed in his gastrointestinal tract, and if that were to happen, it would be really bad, especially at his age. So, as delicately as I can, I need to tell you to stop giving the Asprin so that you don’t lose your dog to something far more horrific than arthritis.”
I then wrote up his chart with the information of what he was taking (starred) and that one of my interventions was ‘Told owner to discontinue Asprin and contact DVM to discuss other pain medications.’ From what I know, the owner never did call the vet, nor did the vet call the owner. However, he did stop the Asprin.
A 5-year-old Kelpie that was hit by the owner’s truck and who was brought to see me for neck pain (after x-rays had ruled out a fracture). Cool finding, I think the dog has a sprained Alar Ligament based on my testing… but that’s a story for another day.
Same question, “So what is she on for medication with this?” This owner said that he was prescribed Metacam as well, and was told to get a muscle relaxant. They didn’t have any at the clinic, so she wrote him a prescription for Robaxin (Methocarbamol). The owner took his prescription to two pharmacies who told him that they didn’t have any and that it was very hard to get just Robaxin.
So, the owner went home, looked in his medicine cabinet and low and behold he found a bottle of Robax Platinum. He figured, that’s the same thing and started giving it to his dog. However, Robax Platinum contains Ibuprofen along with the Methocarbamol. Well, all the vets know this next part… Ibuprofen is considered toxic for dogs.
My conversation with this client (being that he was someone I already knew and so the rapport was established sooner in our interaction) was a bit more forward.
“I’ve tried to find just Robaxin myself, because I wanted to have some in my house. It’s really hard to find. I couldn’t find it either! The problem with Robax is that it contains Ibuprofen, which is toxic to dogs. So, my recommendation would be to stop using that one right away. The Metacam is great stuff. Keep using that like your vet prescribed.”
What is the point of my stories?
Human medicine has several ‘catch systems’ and multiple ‘touch points’. Your doctor may prescribe a medication, but you get it filled at the pharmacy where the pharmacist looks at your other medications on file and gives you information about the drug. If something is not quite right (i.e. a negative interaction) then he or she will alert your doctor before dispensing the medication. You may also see a number of health care practitioners along your health journey. All of them asking about your past medical history, social history, medications, etc. This offers another touch point and check on the system to ensure that your case is being addressed appropriately.
It's not perfect... but it's why we all ask a lot of the same questions!
Veterinary Medicine is often a 'one stop shop'. Clients might see their vet once a year or perhaps less if nothing goes wrong, and the two cases above highlight how sometimes owners just do their own thing without asking questions. Vet Medicine is also fairly new to working with allied health care practitioners, but these are two cases, that highlight the benefits of multi-practitioner patient centered care delivered by qualified professionals. They also highlight the importance of doing a full subjective history and understanding of topics outside of your direct scope of practice.
On that note, keep on being awesome this week!