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Veterinary miseries: He seems fine, but Im in pain
Theres a fine line to walk when talking to your veterinary clients about pain without paining the clients and, of course, yourself.
I saw a dog for a rabies vaccine in my veterinary clinic a while ago. When I walked into the exam room, I was smacked in the face with the smell of rot. I looked down and saw a tiny, grey, quivering poodle in a cheetah-print faux-fur sweater curled up in a fuzzy white bed. One of her eyes was draining pus and her tongue was hanging out. Her owner picked her up, unfolded her legs like a picnic chair and placed her on the table.
“She gets stiff,” the owner explained.
The younger, politer version of myself would gently ask if she was on any medications or being treated for any health conditions. The current version of myself isn't as mild: “What are you giving her for pain?”
I've found this to be an effective, time-saving phrase in my life. It always gives a pet owner pause. It might be a little blunt, but I'm done with the careful, don't-want-to-hurt-anyone's-feelings-or-god-forbid-make-a-client-upset approach to medicine. The bottom line: This poor dog was in pain and her owner was blind to it.
Her answer to my question? “No, she seems fine.”
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So, we spent some time talking about pain in animals (not my best educational session, as it was the fourth exam that day) and afterwards, she left with the trembling picnic chair dog under her arm.
The following week, she returned with Poopsie, the picnic-chair poodle, as well as her daughter's dog, Smoochie. She thought they both might be painful. Luckily for the owner and myself, it was a morning appointment, so I had only talked about pain once that day. Poopsie and Smoochie both had a little bloodwork done and left with some meloxicam.
Hurrah! Relief of an animal suffering achieved!
As you can probably read from my jaded tone, this scenario is causing me pain. There are many versions of this story:
- The fat, happy shepherd mix whose tail never stops wagging with stifles that palpate like bubble wrap. “He's fine,” his owner tells me. “He still wants to eat and play.”
- The active young Lab who tore her cranial cruciate ligament six months ago and whose owner couldn't afford surgery, but seemed dedicated to physical therapy and gabapentin. You can actually see the tibia sliding forward while she's gimping across the room. You naively ask, “How are the meds going?”
“Oh, I stopped giving them,” her owner says. “She seems fine.”
I've come to realize that many owners define “fine” as eating, drinking, peeing, pooping and moving about in some fashion-in other words, still alive. And I know that it's not helpful to be cranky about this, because I've had an excessive amount of education regarding animal health and owners haven't. I know this.
However, is it crazy of me to assume that a human would be able to make the mental leap that limping equals pain? When is the last time you limped when some part of you didn't hurt? What creates this obstacle in the minds of otherwise intelligent people? Denial? Distraction? Just not thinking at all or perhaps some lingering belief in the ancient theory that animals don't feel pain?
My favorite pain quote of all time: “We can't take him for walks anymore because he's too stiff, but we stopped giving him the Rimadyl ‘cause he seems fine.” (Another observation-somehow stiff does not equal pain.)
Educating clients about pain is tricky. If we're too gentle, it doesn't sink in and clients stay firm in their belief that the pet is fine. If we're too firm, clients feel blamed or guilty and this can create anger. You have to get it just right, and some days I don't have the patience to be so perfect.
So, hopefully without being a total jerk, I've become content with my question-“What are you giving for pain?”-which is really a backhanded way of saying, “Your pet is in pain.”
However, if I have to be a jerk to help the poor Poopsies of the world, I guess I'm fine with that.
Gina Singleton is an associate veterinarian currently practicing at a small animal practice in Maine. If she had any free time, she would love to make movies, travel the world and dance. For now she is devoted to being a mom, wife and vet.
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