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#209857 - 02/01/12 06:32 PM Re: SPOON! The Tick [Re: Good_Karma]
DancingCavy Offline



Registered: 02/11/10
Posts: 4067
Loc: Syracuse, NY
Likes: 115
Talked to our vet today. She thanked me for dropping off the printout and asked how Risa was doing. (She's doing well. Joints seem less achy; she is jumping over my legs into bed at night instead of on top of them. Still not 100% and still a little more spooky than usual.) Then we got into the meat of the conversation.

The protocol she follows is the one recommended by Dr. Goldstein at Cornell University (5mg/lb per day for 30 days). She has done this with many dogs and, when they are re-checked at 6 months, they are perfectly fine. She doesn't feel that Risa's low WBC numbers would affect her ability to fight off the Lyme infection and she's never seen any correlation between the two.

While she is perfectly willing to prescribe a double dose and/or an extended dose for Risa, she doesn't feel it is necessary. She is also concerned that, by doing a longer treatment, it could hurt the efficacy of the drug in the long run should Risa need it again. She also mentioned that no internal medicine doctors can agree on what is a proper treatment for Lyme. I agreed as I have certainly found that to be the case in my minimal research. I also mentioned that I understood no matter what I do, the potential for a relapse is always there.

Fortunately, she seems to be willing to increase the dosage or the duration if that's what I want even if she doesn't think it's necessary. But I'm unsure what I'm going to do. I basically told her I am going to wait and see. As Risa approaches the end of her doxy treatment, I am going to evaluate how she's doing and go from there. (I will also continue to do some research and educate myself.) If I feel it's warranted, I may ask for an additional month of doxy. But, for now, I'm sticking with what has been prescribed.

No matter what I do, I cannot know the outcome. I don't know if Risa will ever experience chronic issues related to Lyme. I don't know if changing the dose or giving it longer will make any difference. And that's the thing that is the most frustrating. No one knows. Lyme is just so tricky. It seems the only things people can agree on are: it comes from ticks, it's treated with doxycycline, it can create chronic problems, and it never goes away. frown I wish Risa had easier to treat illnesses. Not these things that have no standard, agreed-upon treatments.

So I wait and hope. I will discuss with her TCVM vet the positive Lyme test and see if she has any recommendations from the holistic side as well (she's been such a great help with Risa's gut!) At least Risa seems to be feeling better. Though she's not happy that dinner got pushed back 3 hours! (So that I can give her the doxy every 12 hours without waking up before dawn.)

(Random thought: should this be moved to the Health Section since it's really more about Lyme disease now than finding a tick?)


Edited by DancingCavy (02/01/12 06:49 PM)
_________________________
~Jamie~
Veteran MF-GrCH Dancing Cavy's Pain in the Butte W-FDM/MF MF-M Vet InS/E R-FE/N PCD BN RAE RL1 (AoE) RNX TKP CA CGC WCX3 Risa
Wylde Kitsunegari of Aesir CGC WCM Kyu
It Just Keeps Getting Better: Risa's Blog
Pet Portraits

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#209979 - 02/02/12 03:25 AM Re: SPOON! The Tick [Re: DancingCavy]
MaxaLisa Offline

Global Moderator

Registered: 01/26/10
Posts: 19439
Loc: Northern CA
Likes: 255
Originally Posted By: DancingCavy
While she is perfectly willing to prescribe a double dose and/or an extended dose for Risa....

I would take her up on this. As you said, you only get one chance to treat the first time.


Quote:
I basically told her I am going to wait and see. As Risa approaches the end of her doxy treatment, I am going to evaluate how she's doing and go from there.

You have no way of determining how effective the treatment was until 6 months after you are done.


Quote:
No matter what I do, I cannot know the outcome. I don't know if Risa will ever experience chronic issues related to Lyme. I don't know if changing the dose or giving it longer will make any difference.

No, but, you decrease the odds that she will develop more or earlier arthritis. You decrease the odds that it silently goes into the nervous system. You decrease the odds that it creates a subclinical kidney issue. This isn't as much about now, but trying to avoid the things later that will no longer be associated with lyme because they will be down the road where the tests may not show up positive then.


Quote:
(Random thought: should this be moved to the Health Section since it's really more about Lyme disease now than finding a tick?)

done smile
_________________________
MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
http://www.rabieschallengefund.org/

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#210039 - 02/02/12 10:32 AM Re: SPOON! The Tick [Re: MaxaLisa]
DancingCavy Offline



Registered: 02/11/10
Posts: 4067
Loc: Syracuse, NY
Likes: 115
I know. I know all this. And I'm leaning towards extending the dose when we hit the end of February. Just in case.

Still, there is no way of knowing whether that will change things or not. This sucks.
_________________________
~Jamie~
Veteran MF-GrCH Dancing Cavy's Pain in the Butte W-FDM/MF MF-M Vet InS/E R-FE/N PCD BN RAE RL1 (AoE) RNX TKP CA CGC WCX3 Risa
Wylde Kitsunegari of Aesir CGC WCM Kyu
It Just Keeps Getting Better: Risa's Blog
Pet Portraits

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#210547 - 02/04/12 07:34 PM Re: SPOON! The Tick [Re: DancingCavy]
DancingCavy Offline



Registered: 02/11/10
Posts: 4067
Loc: Syracuse, NY
Likes: 115
I am feeling paranoid about my dog. Which is never a good thing. I think I may make an appointment for her with our TCVM vet early next week to talk to her about what's going on, have her evaluate Risa, and maybe do some acupuncture/aquapuncture.

I'm also planning on sending a letter to our veterinary hospital because I feel this issue needs to be addressed so that it's less likely another owner might find themselves in this position. This is my letter so far. . .thoughts?? (Should I mention my vet by name in it? I mean, it's not like they can't find out who I spoke with by looking in my chart anyway.)

Quote:
Dear Doctors and Staff:

On December 10, 2011, I found a tick on my dog. That Monday, I brought the tick in to the hospital to have it analyzed but I was told that you no longer sent ticks out to identify if they're carrying any tick-borne diseases. The receptionist informed me that we could test Risa in 6 weeks to see if she had contracted anything from the tick.

I brought Risa in on January 23rd to have the blood draw done for the tick test. I spoke to the technician about the tick I found on her and I even brought the tick along with me. She identified it as a deer tick though one that was not fully engorged. Risa had her blood drawn and we returned home. Shortly thereafter, I received a call from your hospital telling me the test was negative but also inquiring as to why I had a heartworm/tick test run on Risa since she just had one done in July. I was a bit shocked that the reason for our visit had not been recorded in our chart and informed the person I was speaking to about the tick I found on Risa 6 weeks earlier. It was then that she mentioned one of the technicians who looked at Risa's Snap test thought they saw a small amount of dye on the Lyme portion of the test. After further inquiry, I learned that 3 technicians and our doctor had looked at the test. Only one thought they saw a possible positive test result for Lyme. I had recently noticed some joint discomfort in Risa, which I knew to be a sign of Lyme disease, and expressed my concern over the test results. I was told we could do a more sensitive retest in 4 weeks. But this didn't sit well with me.

I spoke to some friends and did some research online where I discovered on Idexx's website that even a slight hint of dye in one of the test regions indicates a positive result. I was very concerned and left a message to speak with our doctor. When I did get a chance to talk to her, I ultimately decided to redo the Snap test and have it sent to Idexx so that they could run the C6 if Risa was indeed Lyme positive.

When I brought Risa in for the second blood draw on January 26, there was some confusion as to what I wanted done. I explained what I was there for when the technician arrived and, when I was handed the receipt, I was being charged for the C6 only. Not the Snap test being sent to Idexx which I had discussed with our doctor. I mentioned it to the receptionist and the technician and we got things straightened out. I assumed, having spoken to our doctor the day before, that it would have been written in the file where it could have been easily referenced.

Late Friday, January 27, I received a phone call stating that Risa had tested positive for Lyme disease on the test sent away to Idexx. Doxycycline was set up for her and she started taking it Saturday evening, January 28.

This experience has left me very disappointed in the quality of care we've received. I am left wondering, if the first Snap test had been Risa's annual one, if we would have been informed of the slight dye indication at all. After all, I know it's hospital policy that only positive results get phone calls. So it's entirely possible that this issue could have gone completely undiagnosed. I hate to think of what may have happened had I not insisted on a retest. Lyme can be a tricky disease and can even be fatal.

I wrote this letter to inform you of my displeasure and in the hopes that you might all learn from this. Since I used to work alongside many of you, I know you are a dedicated group of people who truly care about the patients you see.


I think the conclusion needs some work but I'm unsure what to say. I don't want to be too accusatory but I think it's clear they need to be more careful!


Edited by DancingCavy (02/04/12 07:37 PM)
_________________________
~Jamie~
Veteran MF-GrCH Dancing Cavy's Pain in the Butte W-FDM/MF MF-M Vet InS/E R-FE/N PCD BN RAE RL1 (AoE) RNX TKP CA CGC WCX3 Risa
Wylde Kitsunegari of Aesir CGC WCM Kyu
It Just Keeps Getting Better: Risa's Blog
Pet Portraits

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#210574 - 02/04/12 09:04 PM Re: SPOON! The Tick [Re: DancingCavy]
Schnickle Fritz Offline
Carpal Tunnel

Registered: 06/23/10
Posts: 3129
Loc: Fairfield, Ca.
Likes: 79
it's not like they can't find out who I spoke with by looking in my chart anyway.)
-- well if they didnt bother to write that down either then they wouldnt be ale to research it. this sounds like my vet- are you sure you are not in Napa?
_________________________
Have a great day!!!
NLS

* * * * * * * * * * * * * * * * * * *
Fritz vom Banach TR1 TT RN RA BN NW1 BH 10/10/09
Cuvee' d' la Maze ORT-BCA BH 01/14/11
* * * * * * * * * * * * * * * * * * *

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#210576 - 02/04/12 09:08 PM Re: SPOON! The Tick [Re: Schnickle Fritz]
DancingCavy Offline



Registered: 02/11/10
Posts: 4067
Loc: Syracuse, NY
Likes: 115
Ha, no. Not in Napa. Even with the un-winter-like weather we've had. wink

I used to work there so I know that everyone initials what they write in the file so that it can be traced. Besides, I use the same vet all the time anyway. I'm simply wondering if I should be pointing fingers or leaving it to them to figure it out.


Edited by DancingCavy (02/04/12 09:09 PM)
_________________________
~Jamie~
Veteran MF-GrCH Dancing Cavy's Pain in the Butte W-FDM/MF MF-M Vet InS/E R-FE/N PCD BN RAE RL1 (AoE) RNX TKP CA CGC WCX3 Risa
Wylde Kitsunegari of Aesir CGC WCM Kyu
It Just Keeps Getting Better: Risa's Blog
Pet Portraits

Top Likes: 0 
#210581 - 02/04/12 09:19 PM Re: SPOON! The Tick [Re: DancingCavy]
MaxaLisa Offline

Global Moderator

Registered: 01/26/10
Posts: 19439
Loc: Northern CA
Likes: 255
As a first thought, it's not just the care that you are disappointed in, but the record keeping and communication, and knowledge level wrt the Snap. That might work in the conclusion somewhere, but not sure how you might write it without sounding the wrong way.
_________________________
MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
http://www.rabieschallengefund.org/

Top Likes: 0 
#210660 - 02/05/12 08:08 AM Re: SPOON! The Tick [Re: MaxaLisa]
Good_Karma Offline
Carpal Tunnel

Registered: 02/16/10
Posts: 2814
Loc: Belfast, NY
Likes: 203
I think the letter is very well written. You clearly point out all the small but significant ways in which the vet office failed Risa. And I don't think it takes a genius to know that a vast majority of pet owners would not have gone to the lengths you did to research the test and advocate for your dog. If it were not for your persistence, Risa would be a Lyme positive dog receiving no treatment. Beyond stating your disappointment and concern for other pet owners who may experience a similar lack in care, I'm not sure where else you can go with your letter. I don't know if vet offices use an SOP (standard operating procedure) but I would assume since they are a lab, that they do. Perhaps you can suggest to them a revision in the SOP which states that in the future, any test which has an inconclusive result must be resubmitted and retested. I think the receptionists also need to do a better job, although it does seem like it is hard to staff a vet office with competent receptionists, at least based on my experience. frown
_________________________
Leah

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#210666 - 02/05/12 08:31 AM Re: SPOON! The Tick [Re: Good_Karma]
DancingCavy Offline



Registered: 02/11/10
Posts: 4067
Loc: Syracuse, NY
Likes: 115
Originally Posted By: Good_Karma
I think the receptionists also need to do a better job, although it does seem like it is hard to staff a vet office with competent receptionists, at least based on my experience. frown


Hey! I was a receptionist when I worked there! teary wink You're right, though, it is not an easy position. I made my share of mistakes too. But that's why they set up a system where things like this aren't supposed to be missed. Everyone who touches the file should be looking at it and double-checking things. I am very surprised some of this stuff was missed. It makes me seriously consider finding a new vet to use as Risa's primary. This isn't the first time I've been disappointed with the level of care. Just the most serious time. frown

I rewrote the final few paragraphs with your suggestions and some of what I came up with overnight. Sometimes it's good to sleep on it.

Quote:
This experience has left me very disappointed in the quality of care we received, the lack of proper record keeping, and how the Snap test is read. I am left wondering, if the first Snap test had been Risa's annual one, if we would have been informed of the slight dye indication at all. After all, I know it's hospital policy that only positive results get phone calls. So it's entirely possible that this issue could have gone completely undiagnosed. I hate to think of what may have happened had I not insisted on a retest. Lyme disease can lead to serious medical complications and can even be fatal when left untreated.

I wrote this letter to inform you of my displeasure and in the hopes that you might all learn from this. Since I used to work alongside many of you, I know you are a dedicated group of people who truly care about the patients you see. I am certain that, with this new found knowledge, you will make adjustments to how things are run and that no other patient will have to go through this.

Thank you.
_________________________
~Jamie~
Veteran MF-GrCH Dancing Cavy's Pain in the Butte W-FDM/MF MF-M Vet InS/E R-FE/N PCD BN RAE RL1 (AoE) RNX TKP CA CGC WCX3 Risa
Wylde Kitsunegari of Aesir CGC WCM Kyu
It Just Keeps Getting Better: Risa's Blog
Pet Portraits

Top Likes: 0 
#210680 - 02/05/12 09:54 AM Re: SPOON! The Tick [Re: DancingCavy]
Schnickle Fritz Offline
Carpal Tunnel

Registered: 06/23/10
Posts: 3129
Loc: Fairfield, Ca.
Likes: 79
excellent
_________________________
Have a great day!!!
NLS

* * * * * * * * * * * * * * * * * * *
Fritz vom Banach TR1 TT RN RA BN NW1 BH 10/10/09
Cuvee' d' la Maze ORT-BCA BH 01/14/11
* * * * * * * * * * * * * * * * * * *

Top Likes: 0 
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