D. E. Larsen, DVM
Rosalie was waiting in the exam room with her Boston terrier, Daisy. Dixie had just finished getting them ready for me and was waiting at the treatment room door to speak with me before I went into the exam room.
“Rosalie is in the exam room,” Dixie said. “She is a new client, but she is unhappy about something. I thought I would just give you a heads-up.”
When I entered the room, Rosalie stood at the exam table, holding Daisy in her arms. The expression on her face approached a frown. Rosalie was a large woman, and she was not obese, but she towered over me. She was well over six feet tall.
“Hi, I’m Doctor Larsen,” I said. “What can we do for Daisy today?”
Rosalie sat Daisy on the exam table. “Daisy has had constant diarrhea for the last two weeks, and we can’t get it under control,” Rosalie said in a stern voice. “We have gone to Dr. Clark for years and loved the dear man. But he up and died on us.”
“Yes, I never had the opportunity to meet Dr. Clark, but he enjoyed a fine reputation in the profession,” I said. “I’m sure his sudden death shocked many of his clients.”
“We never dreamed we would have to look for a new veterinarian,” Rosalie said. “But we are unhappy with the new young man who took over for Dr. Clark.”
“There are a lot of factors that go into a client’s selection of a veterinarian,” I said. “But, all the studies say that the number one factor is location. Driving to Corvallis with a stinky dog in the car is not the most pleasant experience.”
“We live in Brownsville,” Rosalie said. “So we are used to driving for many things we do.”
“I will look Daisy over, and you can tell me all the things that the new veterinarian in Dr. Clark’s office has done for her,” I said as I turned my attention to Daisy. The now squirming little Boston on the exam table.
“That won’t take long,” Rosalie said. “As near as we can tell, he hasn’t done a thing for her. We have had her over there three times in the last week, and nothing has helped.”
“How long have you had Daisy?” I asked.
“My sister got her for us,” Rosalie said. “She picked her up about four weeks ago, just before she came to visit.”
“So Daisy is not from around here?” I asked.
“No, my sister lives in Alabama,” Rosalie said.
“So, has Daisy been wormed?” I asked.
“Wormed, I don’t think so,” Rosalie said. “No, wait a moment. My sister said the breeder had wormed her before she picked her up.”
“But, in Corvallis, did they worm her or at least check her stool?” I asked.
“No, he said he was going to submit a sample for culture if things didn’t improve,” Rosalie said.
“We have a puppy from Alabama, and parasites should be number one on the list,” I said.
“Doctor Larsen, I don’t think he knew that Daisy was from Alabama,” Rosalie said. “He just did a quick exam and sent us on our way each visit. There was no conversation or discussion involved.”
“Well, I know Daisy is from Alabama,” I said. “And I also know that dogs who grow up in the Southeast have real parasite problems. I’m going to just collect a drop of stool material off the thermometer and get it under the microscope before we go any further.”
I reinserted the thermometer into Daisy’s rectum, and it came out with a drop of brown liquid suspended from its tip. I carefully transferred that drop to a microscope slide.
“This is only going to take me a second to look at this,” I said as I started out the exam room door.
At the lab counter, I added another drop of floatation fluid to the slide. I mixed the sample with a wooden applicator stick. Then I put the slide on the microscope stage and adjusted the scope.
To a veterinarian who had been educated in Colorado and practicing in Oregon, this was a remarkable slide. We were accustomed to taking a stool sample the size of a peanut and putting it through a process that would concentrate and collect the eggs onto a microscope slide. If we saw a dozen eggs in a field of view, we would consider that patient heavily parasitized. I was looking at a mere drop of stool from Daisy, and the entire field of view on the microscope was covered with worm eggs, latterly, hundreds of eggs in one view. Most of the eggs were roundworm eggs, but some hookworm eggs and whipworm eggs were evident.
“Dixie, you want to make sure you look at that microscope slide,” I said as I stood up. “We won’t see another sample like this one, probably ever.”
“Rosalie, I suspect that you will be amazed at the results of today’s treatment,” I said when I returned to the exam room. “Daisy is loaded with parasites. Mostly roundworms, but also hookworms and whipworms. I will give her some deworming medication. By this evening, you will see her pass an unbelievable number of worms in her stool. And the good thing is, this will probably take care of her diarrhea overnight.”
“Is that all you’re going to do?” Rosalie asked.
“For now, that is all we are going to do,” I said. “There will be a lot of follow-up for Daisy. We should see her next week just to recheck and repeat the deworming. The life cycles of these parasites are a little complex. The medications we have today will only remove the parasites in the gut. Many others are migrating in her body or are encysted in her tissues. We will need to treat her like an Alabama dog for the rest of her life. That is a bit of history that her veterinarians need to know.”
“Okay, we will see how things go,” Rosalie said.
“Now remember, Daisy is going to pass a wad of worms tonight,” I said. “There will be so many, it will be alarming to you, and it could cause her some momentary distress.”
The following week, Daisy was a different puppy when she came bounding through the door into the clinic. I stepped out to the reception room to greet her and Rosalie. Daisy was squirming all over the place, trying to contain her enthusiasm. She bounced around my feet and jumped up on my leg.
“She looks like she feels better,” I said.
“Oh, yes,” Rosalie said. “She was well the next day, just like you said. And were you ever correct about the worms she passed. But she is a different puppy, and we are so pleased.”
Dixie came out and scooped up Daisy to take her to the exam room. She had to turn her face away to keep from being licked.
“Do you think she knows we helped her?” Dixie asked.
“I doubt it. We are seldom given any credit from our patients,” I said. “I think she feels so much better that she has a lot of being a puppy to get caught up on now.”
“Today, we will repeat the deworming, and I will send you home with some deworming liquid to give her every two weeks for the next couple of months,” I said. “By then, we should be into a situation where we can manage her parasite problem with a treatment a couple of times a year.”
“Doctor, how can you make that diagnosis so quickly when the Corvallis vet couldn’t find it in three visits?” Rosalie asked.
“Having all the information makes the diagnosis easy,” I said. “Knowing that Daisy was a puppy from Alabama made the diagnosis before I even looked at the slide. But, for parasites not to be on the list of possible problems in any puppy with diarrhea is a serious mistake. But veterinarians are like anybody else. If your mind starts down the wrong path, sometimes it is difficult to change your thinking. It was just an oversight on his part.”
“We would like to change to this clinic,” Rosalie said. “What do we have to do to accomplish that change?”
“There is no process,” I said. “In our view, it is done. Having Dr. Clark’s office send us your records would be a plus, but if Daisy is your only pet now, that is very optional.”
“How should I deal with that new veterinarian in that office?” Rosalie asked. “We are certainly not happy with his services.”
“Talking with his office or sending a note to let him know the diagnosis would probably be appropriate,” I said. “But if you’re mad, it will probably roll off like water on a duck’s back. Be informative; we are all in this business to learn. Sometimes we learn from our mistakes or oversights. That’s why they call this a practice.”
Rosalie and Daisy were regular visitors to our clinic for many years. In those years, we suffered with Rosalie’s grief over the loss of her husband and then the unexpected loss of a daughter. Through all those hard times, Daisy remained a bright spot in Rosalie’s life, and her visits to the clinic were always punctuated by her bouncing joy. She was one of those rare patients who truly loved to come to the clinic.
Photo by Melissa Jansen Van Rensburg on Pexels.