Pup Still Ailing; Vet Fired
So we're down to the last dose in a ten-day course of amoxicillin and Ruby the Corgi still shows signs of a urinary infection. Or something.
I collected a sample when she widdled yesterday; put it in a clear glass container and observed particles floating around ("crystals"?) and cloudy yellow liquid. Called the vet. Said I'd like to bring this in for testing.
They resisted: said it had to be freshly collected and what I'd managed to farm from the dog could NOT be stored overnight in the fridge. I had guests coming for dinner shortly and a business networking event to attend that evening. Schlepping to northeast Phoenix with a bottle of dog pee in the rush-hour traffic was, alas, on the agenda.
Accordingly, when I came in from today's morning meeting, I performed the same trick, collecting another small amount of dog pee. Called the vet's office to say I was bringing this sample in and got a recording: closed until 2:00 p.m.
Got that? This is a business day. I happen to own a business. That business entails work (can you imagine?). The vet's office is closed more than a third of today's business hours. During that time, no one is there to receive your collected urine sample. If you have work to do during the few hours that they are open, it's incumbent upon you to cancel that work.
Peeved, I track down a vet with whom I used to work when I had a greyhound, probably the most brightest and most insightful vet I've ever known. Greyhounds require care by vets who have some special expertise, which this gentleman has in spades.
Rumor had it that he had retired. But no: as it develops, he's still practicing. And -- can you imagine? His staff answered the phone at 11 o'clock of a Thursday morning! Explained the situation. They arranged to shoehorn Ruby in on Monday and asked me to try to bring a sample of Ruby widdle collected on that day. They want to see the record of the lab test that led Vet #1 to believe the dog had an infection amenable to Amoxycillin.
Cancel my afternoon appointment. Call the corgi vet, by now even more peeved (this is, after all, how I pay the bills...including the veterinary bills, which are rapidly becoming considerable...) and explain my concerns. Get a supercilious response.
The practice I've been using with the corgis has given me pause a couple of times in the past, for various reasons. This vet was recommended by my former husband's current wife, a practical and smart woman who loves dogs and has quite a few of them. It must be said, Ruth's referral for a dentist was sheer genius. But the vet?... Hm. Maybe not so much.
This veterinary is closed from 11 a.m. to 2 p.m. every day and on Wednesdays is open only from 4 to 8 p.m. And yes, I understand that vets need to schedule uninterrupted blocks of time in which to perform surgeries. But there's no reason to lay off the receptionist while you're in the Pet OR, so that clients can't get through on the phone or bring in a bottle of cloudy, crystal-laden dog pee. There's an assumption behind that kind of behavior that I find puzzling and annoying.
Nor am I pleased when I call three different vets, ask the same question (can I bring in a sample of dog pee and have your lab examine it?), and get three different answers at least one of them utterly off the wall (1. Must be collected in special containers; 2. Can't be stored in a refrigerator until we're open; 3) Can't be collected in a container cleaned by washing in detergent and a dishwasher). (I seriously considered majoring microbiology, and so I'm not a total naif here...)
And I really don't l like it when people assume that because I'm an older woman, basically of retirement age, I have nothing to do but wait on their convenience, as though my livelihood were less important than theirs. That was the attitude I got when, after talking to my old vet, I called the corgi vet to say I would come by this afternoon to pick up the records of Ruby's lab results.
Obviously, my livelihood is neither more important nor less important than theirs, but it would be nice if some respect could be paid to the possibility that even old people have things to do with their time. Things that matter.
The older I get, the shorter my patience grows (there are, after all, only so many days and hours and minutes left now). Probably I was too short, or too quick to move to another vet.
But...it appears that this little dog has been sick since the day I brought her home at the age of eight weeks, or at least since very shortly after that. After much racking of brains, I don't think I've done anything to bring this condition on, and that makes me feel more open to the idea that she hasn't been well since I got her. In any event, given that urinary infections can spread into the kidneys and can, under some circumstances, be life-threatening, the fact that the pup has been suffering with this at least half her life seems to me to create some urgency. It certainly doesn't call for a brush-off.
Sooo...Vet fired, dog still ailing, outcome uncertain.
Am I totally unreasonable?
Replies to This Discussion
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Permalink Reply by susan on
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I don't think it is unreasonable at all - you need a vet that is open more hours, and more responsive to your concerns. I also think its weird about all the pee sample rules. My vet just asked for the clean container and it could be refrigerated before I took it in. They did require it be a sample from her first pee in the morning though because its more concentrated.
Don't be surprised that it may take more than one round of antibiotics. And they may need to use a different or stronger antibiotic than currently prescribed. They may need to take a sterile sample directly from the pup in order to determine the best type of antibiotic to use, but this usually doesn't come until what you are using has failed to clear it up a few times. You will need to make sure that after the round of antibiotics is complete you get her retested. If just a little bit of the infection is still there, it can blossom up again and it becomes resistant to the medicine. It could take several trips of taking pee samples to the vet, a few rounds of antibiotics, but you will lick this.
Also, are you using baby wipes? And maybe think about a change in diet to something with more moisture. Either canned food, raw diet, or at least put water in the kibble. I ended up having to do all these things in order to clear up Jeli's UTI. She has been clear for a long time now but it took a few months of working on it. I don't have to do the baby wipes anymore, but I do keep her on the 'UTI diet'. Its a better diet for her anyway, even if it is a bit expensive and a bit of a hassle. I figure, on balance, it costs less than another UTI and the stress that goes with it for both me and her! :)
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Permalink Reply by Vicky Hay on
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Well, the bottle and the tool used to collect urine need, ideally, to be sterile. To make that so, you really need an autoclave, which few of us have sitting around the kitchen. However, if you bring the sample in promptly after collecting, you probably can get away with a jar and a metal collection container that have a) been scrubbed thoroughly in detergent, then b) been run through the "sterilize" cycle on a well-running dishwasher, and then c) been set in a boiling-water bath the way one does with canning jars.
We live in a biosphere that consists mostly of micro-organisms -- the little guys swim around in the air and water like so many gerzillion tiny little fishes. If you've left a jar in a cupboard (say), it's going to end up gathering a few critters, some of which may be pathogens...but the wrong pathogens. For the lab technician to identify the correct disease-causing bacterium, the collection tools have to start out as close to sterile as possible.
Yes, I have tried baby wipes, by way of trying to remove the stuck-on, tar-like, stinky pee from the fur between her cute little legs. No luck. She has to be soaked for about 10 minutes in lukewarm water and then scrubbed with Cetaphil (the mildest soap in the house) to get the gunk off.
I'm hoping Dr. Bracken will come up with a UTI diet. She is now off kibble altogether -- having noticed that Cassie gets real food, she ptooies the kibble onto the floor and refuses to eat it. I suspect that's her body trying to tell her something. So she now is eating what Cassie eats: a combination of meat, dog-friendly vegetables, and some starch such as sweet potatoes or squash. She also gets one meal a day of Freshpet's "Vital" grain-free food roll. This stuff consists of exactly the same ingredients I cook up on my stove plus a long list of commercial vitamins and minerals. Her coat, her eyes, her gums, her teeth look great, and she's growing apace. So I think the food is OK for her, and it does not contain grain or suspect chemicals. Also to try to get extra fluid into her, I save the broth from cooking the meat and pour a bit of that over the dish of food before serving it up.
It's getting hot here now, and between the two of them the pooches do consume a lot of water!
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Permalink Reply by Beverly Butler Redford & Tucker on
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As a business owner too, I want to know if my staff is not treating my clients well. My staff is the first line of contact with the people who pay their hard-earned money for my services. If the staff doesn't respect the client, then would the business owner? The owner sets the tone for the business and that includes how clients are treated.
I'd find a new vet that likes their work and has staff that is interested in the quality of their work. the clients pay the staff's salary-there's no room for uncaring staff.
Just my 2 cents.
Hope the new vet can get this figured out fast-puppies should spend their time playing and growing, not being sick.
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Exactly. I don't doubt the staff's sincerity and concern. They appear to be good folks who are trying to do their jobs as well as possible. However, I wonder about the conditions in which they're working: if the front-desk staff is doubling as lab technicians (the last one I spoke with said she'd been present in the back while Pup was shrieking her little head off), that would certainly explain why they would have to shut down the phones for several hours each day while they conduct tests and surgery. But IMHO it's unreasonable to ask employees to do that kind of double duty. Either hire a receptionist or hire a lab tech.
Minimum wage in this state is extremely low, and because this is a right-to-work state, most people don't expect to earn a living wage. I pay my own underlings a little more than minimum wage, and believe me...it is NOT breaking the S-corp's bank. To hire a part-timer to answer the phone four hours a day, during the surgery/lunch hour period, would probably consume the gross revenue from one, count it (1) typical office visit in which a diagnosis needed to be made. Two patients a week would pay such a person's salary. Hire him or her for 18 instead of 20 hours and you'd weasel out of the health-care benefit requirements.
I feel pretty confident about Dr. Bracken, who accomplished two amazing diagnoses for the greyhound -- one of which saved his life. He's an incredible vet, very probably the best in the Valley. I wish I'd known he hadn't retired, after all, at the time I got the pup.
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Permalink Reply by Melissa and Franklin! on
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While it does seem odd your first vet is closed SO MUCH with no reception staff, I would like to explain the basics of testing for urinary infections. The best and most cost effective way to perform this test is to have your vet collect a sterile sample directly from the bladder. This is done by inserting a needle through the abdominal wall directly into the bladder, this sounds horrible and painful but it is actually quite painless and very few animals have any negative response (in fact they generally have way more resistance to a simple blood draw). This is the only way to get a truly sterile sample to test for bacteria and make sure there are no contaminants from the floor, container an owner puts it in, bacteria from the urethra, etc. Also the reason you don't store urine overnight in the fridge is because crystals can form in the urine which are not part of the actual urine sample therefore showing a problem when really none exists.
Also the only way to know if the infection was properly treated from the beginning is to CULTURE the sample, both before treatment so you know the appropriate antibiotics to use and the length of the course, and more importantly AFTER the antibiotics to make sure you have killed all the bacteria. Many cases of ongoing UTIs are due to the fact that the sample is never cultured before or after the treatment so you never actually get rid of the infection.
What Susan suggests with trial and error before a sample is cultured is actually NOT what should be done. You don't want to throw a bunch of antibiotics at an infection and possibly create a more resistant infection. ALWAYS culture first so you know EXACTLY what antibiotic will treat the infection. Don't guess. It will cost more to culture first but in the long run you will be saving money because you won't have to try multiple antibiotics, run multiple U/As, and be back at the vet over and over again. If you culture first and at the very end you can generally kick the infection much quicker. Sometimes it can take up to 3 weeks to treat an infection. Feel free to message me if you have any other questions, and find a vet that will explain all this to you from the beginning and not just throw medication at you and leave you with lots of questions and no answers. They are out there, I promise!
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Thank you! This is exactly what I've been thinking about putting her on amoxicillin without first having cultured her urine. They apparently did a microscopic inspection, which would have told them whether any organisms visible were gram-negative or gram-positive...but the only report I got from them was that she had "blood in her urine."
I absolutely will discuss these issues with Dr. Bracken when I see him on Monday. I'm really concerned about the potential for creating antibiotic resistance, especially since he decided not to renew the antibiotic but to let her go without for three days, on the theory that if there's any regrowth it'll be easier to identify the pathogen.
It may be, though, that if amoxicillin is the appropriate drug the pup simply needs to be on it longer than 10 days, which was the amount of drug dispensed.
Also a source of concern that something more than a simple infection is going on is that, since I got her at the age of six weeks, she has sprayed urine all over her little legs every time she pees. This has continued even though she's now about 16 weeks old. This makes me wonder about a hooded vulva or some other congenital condition that might make it hard for her to fully void her bladder...and voila! Leading to infection. I can wash her in the tub (luckily she thinks this is grand fun) and by the end of the day she stinks to high heaven again.
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You are correct Melissa. A sterile sample and culture is the ideal way to go. We tried to get a sterile sample a couple of times, but each time I would bring her to the vet for the proceedure, by the time I got her there she was so full she peed all over the vet the minute they turned her over for the treatment. LOL. And I learned the hard way that you have to make sure all the infection is gone or it can reinfect. Come to think of it... maybe I should be looking for another vet! ;)
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Permalink Reply by Kevin on
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Vicky, can I ask, which vet office is it that you are having so much problem with? Living here in Phoenix, I want to make sure that I'm not taking my little ones to some place that is giving you problems like this.
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I'd hesitate to name names, for fear of liability concerns. Suffice it to say the clinic is in the vicinity of 40th St. and Thunderbird.
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Thanks. That is good enough to tell me whether or not its the vet I've been going to.
Hope that Ruby feels better soon!
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Permalink Reply by Linda on
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I'm glad you have decided to go to a different vet and one that you are confident in. I don't understand why they are closed so much and don't have someone to take calls or to receive samples. My vet closes at 11 am on Wednesdays for surgeries but there is still someone there to answer the phone or if you need to drop off or pick up something. He also has an emergency number where he can be reached any time and since he lives upstairs over his practice he has met me in the office at 11 pm and at 7 am on a Sunday. I have been with this vet for 34 years.
Hoping that the new vet can figure out exactly what is going and get her started on the right treatment. Poor little thing and poor you...it is not easy dealing with a sick critter no matter how old you are.
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Well, the crazy thing is, she sure doesn't act sick. She's lively and happy and energetic. She plays and pesters Cassie and chews on toys and frolics around until she topples over and falls asleep. Then after a nap she's up and racing around. Whatever this is doesn't seem to be stunting her growth, and she at least seems to feel OK. Whenever she's been at the vet, she's had a normal temperature.
She's doing a lot better with the floor-peeing business, too. An occasional puddle, but at least it's not happening every 30 minutes. On the other hand, with the weather still tolerable, the back door is open most of the time, so it's pretty easy for her to get out when she feels the need, especially if she's not in the back of the house when it strikes. She's always in the same room with me, too, so if I spot her starting to sniff around while I'm working, I can escort her outdoors.
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