"Doctor, doctor, my feet hurt all the time." "You’re too fat. Lose weight." "You quack, I want a second opinion." "You’re ugly, too."
Nothing like starting a post with an old vaudeville joke, is there? But, seriously, folks… If we are given a diagnosis that we don’t like, or don’t agree with, we are very likely to go to another doctor for a second opinion. If we are offered a prognosis that sounds pretty bad ("You gonna die!"), we are almost certainly going to see another doctor. If the recommended treatment sounds difficult, unpleasant or expensive, we’re going to look for somebody else who will tell us something we like better.
But what if everything sounds pretty reasonable, and we’re sort of doing okay for a while, and we like our doctor? Only we’re not really getting "all better again". What if there were just a slow, very gradual deterioration, and that seemed to be in line with the original diagnosis? And what if that original diagnosis was wrong?
It’s not uncommon for me to see patients for a second opinion when the pet’s owner is dissatisfied with how things are going. I do my best to resist the temptation to criticize the first doctor’s approach, for two reasons. The first is that I don’t know what things looked like on that initial presentation. Sure, now that it’s been going on for weeks and I know what didn’t work the first time, it might look like the other guy really goofed up. It might not have been so obvious the first time around, though. The second reason is that sometimes the owner doesn’t accurately communicate what happened the first time around. I try to give that first doctor the same courtesy I’d want if I had been the "first doctor". Again, that’s a common situation, and people are working at getting their problem fixed.
On the other hand, maybe I’ve made a diagnosis and prescribed a treatment, and it all sounds reasonable. As times goes on, the pet isn’t doing all that great, but, hey, I’m sure Ol’ Doc has done everything he could. Have I?
When I don’t hear back from a client, I tend to think that the pet is getting better, that things are going well. I’m saying that if your pet isn’t doing that great, it’s okay to get a second opinion. Start by getting a second opinion from his regular doctor. I guarantee that if I find out that the pet hasn’t improved on what I recommended, I know that I need to take a second look at the situation. Let me take a second look; in fact, demand that I take a second look. If I’m stuck in tunnel vision ("You’ve had this before? Well, you have it again."), don’t feel bad about seeing another doctor, and asking for copies of your record. Maybe the other doctor will find exactly the same thing, and we just have a bad situation. Maybe… maybe one of us will figure out something to fix your pet.
I looked at a sad case this week. Two-years old Labrador Retriever — looked like she was fifteen. She looked like a skeleton with a big belly full of fluid. "She started having problems after she got run over last year. They told us that the fluid was from kidney damage. She has just gone gradually downhill since then." The kidney damage explanation didn’t seem very likely to me. Be that as it may, the one patently obvious thing was that the dog had never gotten any better, had gotten much worse instead.
She tried to stay in a sitting position. If she lay down, she got back up again. When I listened to her chest in a sitting position, I could hear air move. When she lay down, no air movement. When she lay down, gravity was putting something into her chest that kept her from breathing normally. What could be falling into her chest? All that fluid, maybe. How would it get there? Through a hole in the diaphragm. This all started when she got run over. Her abdomen could have been mashed, popping her guts into her chest. That causes her organs to function poorly, she loses weight, has trouble breathing. We X-rayed her chest, and sure enough, it’s full of guts and fluid, which are squishing her heart and lungs. Diaphragmatic hernia is the diagnosis. That’s fixable.
That is, it’s fixable when you’re still in good enough shape to survive a nice long surgery. Not so fixable when you are severely dehydrated, haven’t eaten in days, and look like a concentration-camp victim. Her owners elected not to gamble on such a poor chance of success, and we euthanized the poor dog. I’d rather have fixed her, but she was starving and suffocating, and her chances were certainly slim.
They liked and trusted their first doctor. They should have asked him for a second opinion. I suspect he might have had one.