Dr. heal thyself (NOT thy dog)

A while back, I was presented with an interesting and sad scenario.

The story was muddled from the start. We'd received a call notifying us that a client was bringing in a dog for euthanasia.

From the beginning, this went south. The dog was down in the rear. He had a history of severe hip dysplasia and had received intermittent treatment for this from (I assumed, and you know what they say about assume) a veterinarian. Apparently, his condition had recently deteriorated, and his owner was ready from euthanasia.

When the owner arrived, he summoned us to help him. The dog could not get out of the car. My tech went to help and was bitten (rather badly - 2 deep puncture wounds) in the process. When she came back in crying, I helped her clean up the wound and then went to assist the owner in getting the dog into the hospital.

By the time everything was settled (paperwork filled out, cremation selected), I had done a quick assessment of the dog - namely that he was panting extremely hard and could not walk. He was 13 years old and obviously uncomfortable, so I felt no qualms about euthanasia. I didn't do a full exam on him (listen to his heart, check his gums), as he was obviously suffering. I also didn't look at the intake form where the owner writes what they brought the dog in for. Usually, it's something stupid like "sick" or "emergency" - so I rarely glean much info from that.

As I was preparing everything for euthanasia, I got to talking to the dog's owner. Turns out that he was a human ER doctor. As I was slowly injecting the Euthasol solution, he was telling me that HE'D been the one treating his dog for his hip dysplasia. What had he been treating with? Non-steroidal antiinflammatory drugs AND steroids. Without even thinking, I said to him, "but not together, right? Don't want to cause GI ulceration."

When I looked up and caught the stricken, stunned look in his eyes, it dawned on me that yes, he had been treating his dog with both at the same time. Apparently, this is ok in humans.

The kicker? When I went to look at the dog's intake form, the reason for the visit was "euthanasia for melena."

Melena is a term for digested blood in the feces. It's a sign of upper GI ulceration and damage. And then it hit me. The dog wasn't down from his arthritis. He was likely down and dying from a perforated intestinal tract. As I was thinking this, pure blood diarrhea began pouring of the (now) deceased patient. I now realized why the owner's eyes had looked so stricken. He'd realized that the bloody diarrhea and weakness were a result of his medicating the dog himself. It was his fault the dog was down and weak and possibly dying.

Meanwhile, the dog's owner is up front, sobbing to my receptionist about how he "killed his dog." And while that is - in the strictest sense - true, I felt terrible that I had made him realize this. It was not my intent. I had misunderstood why the dog was there (for euthanasia, yes. For the problem I thought, no) - due to a combination of factors - the stress of getting the very large, very aggressive dog out of the car, my technician getting bitten, etc. Had I slowed down and done my full exam, I would have realized it was likely a GI perforation.

Would the outcome have been the same? Undoubtedly...dad was ready for euthanasia. On the other hand, I could have spared his feelings somewhat and broken the news to him gently. He DID need to know that NSAIDs and steroids don't go together - as he had another dog at home. I just would have presented it more delicately.

This is why MDs shouldn't doctor their own pets. The same goes for veterinarians. We shouldn't doctor ourselves (unless this involves sewing up a minor laceration or an xray of a sore foot or something)...that's why MDs went to med school and we went to vet school. Sure, there's a great deal of overlap - but it's not the same - as this case evidenced. That's why - when someone asks me something about human medicine - I just demur and say, "you'd better call your doctor. I'm an ANIMAL doctor."