Broken Toes

Tails from the day …

It’s Monday morning, there are 2 doctors on. This should be ok, except it’s Monday morning (you get my drift) and there are usually 3 doctors on. The phone is ringing off the hook and the waiting room is full of people.

In walks a very loud man, with a very old Golden Retriever who is holding up his left front paw. This man demands to be seen. He says he has an emergency and that his dog has been running in the yard and has injured his paw. We are a general practice. We normally are fully booked, so when someone walks in, we usually will make every attempt to see them, but we must also accommodate all of our customers who were kind enough to call ahead and make an appointment.

The technician explains that it will be a short wait, as the doctors are currently seeing other appointments. The dog is not in apparent distress. It is wagging it’s tail and eating cookies in the waiting room.

The technician takes the man and his dog down to and exam room and asks what is going on. The man explains that his younger dog and the golden retriever were playing and that the golden retriever is now lame and won’t put his foot down. The technician checks the medical record and notes that this dog is actually overdue on exam, as well as some bloodwork and a rabies vaccine.

I enter the room and notice that the left front foot is very swollen. I question the owner again as to what happened. As I examine the foot I realize that there are likely several broken bones due to the level of swelling present and the amount of discomfort that the dog has when the area is palpated or touched.

I again check the story of how the dog was injured and the owner now tells me that the injury happened 36 hours ago! This poor dog has been walking around with a broken foot for almost 2 days. The owner could have sought veterinary care at any emergency clinic over the weekend but decided to wait until Monday morning to walk into our clinic.

I obtain permission to take an x-ray and discover that the foot is not only broken, but it looks like the injury is from some sort of blunt force trauma. The kind that causes bones to break in multiple places and shatter.

I present this information to the owner, who then proceeds to tell me that he “might have stepped on the dog” but he can’t remember. I then explain that due to the severity of the fractures and where they are located the dog will need to be put on pain medications and be rested for 6-8 weeks to allow the fractures to heal. I am concerned about the dog’s underlying health, as it has lost about 10# since the last time we saw it. I again ask permission to run some bloodwork so that I can ensure that it is safe to administer certain types of pain medications to this dog for prolonged periods of time. The owner states that he doesn’t want to spend a fortune, but that it is ok to run the bloodwork.

The dog was discharged with multiple pain meds and instructions to keep the dog quiet and its activity restricted until the fractures had a chance to heal. The location of the fractures was not a place that is amenable to surgery, and splinting and casting in this area can have a lot of complications unless the owner is very diligent about exercise restriction and cast/bandage changes. I did not get the sense that this owner would be compliant at all so we elected not to splint the toes.

The owner calls the next day to complain about the cost of the x-ray and states that $100 is too expensive and that you don’t even pay that for a human x-ray. He also complains that he left his “free” dose of Nexgard at the clinic and would like to come back to get another one.

After I finish surgery I call the owner with the bloodwork results which are thankfully normal. I let him know that I heard his concerns about the costs and he begins to tell me that the cost was ridiculous and that he should not have been charged an unscheduled walk in fee. “What if I had an emergency? What am I supposed to do he says?” I very kindly explain that his dog broke it’s foot over 36 hours prior, and that if he had sought emergency care when the injury initially occurred the costs would have likely been much higher. All of our clients had to wait 30 minutes so that we could see his dog. I also nicely reminded him that in human medicine x-rays actually cost $500-$1000 but thankfully most of us have health insurance which covers most of those costs.

The owner is still mad and wants his bill reduced. I kindly explain that no, our charges stand, and that the next time he has an emergency maybe he should have the dog seen right away. I also happen to check the computer and notice that this client has not only received 1 free dose of Nexgard, but he has actually received 6! He has come in every few months, claimed to have never tried it and has gotten several free doses for each of his dogs. The free doses are meant to be trial doses and are meant for clients who have never tried the medication before. This guy has clearly been abusing the system for a while.

Thankfully after I very nicely stated again that I would not reduce his charges, he hung up and ended his abuse of this very tired veterinarian for the day! I can only hope that his dog receives the medications and that he follows up for x-rays to ensure that the fractures are healing. Sadly, I doubt that he values his dog as much as I do and I will likely not see this patient again. I will worry and think about this dog every day and agonize over the fact that his owner did not see the pain and suffering that he let his dog endure, but rather, just the dollar signs associated with his care.