Family Medicine Vital Signs

     By Nolan Sandygren

I got my dog, Rowan, at the start of my third year of residency for all of the usual reasons. I wanted a running buddy, a driving companion on road trips, a dog to play with in the backyard, to take to the park, or on hikes. I had grown up with a dog, and I missed that feeling that only a dog can provide when greeting you at the door after you get home from work. The way they interact with you can make you immediately forget about all of the things that you were stressed about during the day.

I knew that there would be challenging parts to raising a dog. Rowan was only 7 weeks old when I first got her, and she needed constant supervision and attention. There have been many struggles along the way, including but not limited to potty training, long nights while crate training, socializing with other dogs, and of course her “chewing phase.”

What I did not anticipate was the worrying and sense of helplessness and vulnerability that I would feel whenever she was sick, or when I didn’t know what was wrong with her. As a doctor, I see this all the time in patients and parents of children in my clinic. “I’ve had a cough for a week, and I’m sure I’ve got pneumonia, doc!” or “My 2 year old has a fever of 99.8 degrees, and I don’t know what to do!” I spend a good chunk of my time as a physician simply providing reassurance to concerned patients.

Now the tables had turned, though. I knew nothing about veterinary medicine, and now I was the worried parent. To my surprise, I found myself making the same pitfalls that many of my patients do, particularly when it came to googling any symptoms that I thought my dog might be having. I was well aware that this often leads to more questions and confusion, only increasing anxiety levels.

Nevertheless, one day when I noticed that Rowan seemed to be drooling more than usual, I found myself scouring the internet for possible causes. After several minutes of searching, my differential quickly broadened from something as basic and simple as teething, to much more serious diagnoses like dental infections, kennel cough, and even rabies! Given that her appetite, energy level, and behavior were all perfectly normal, I was able to talk enough sense into myself to at least watch her for a full 24 hours before taking her in, to see if her drooling would go away on its own.

When things didn’t seem any better the next morning, I called my vet to have her seen later that day. I remember the car ride to the veterinary office very clearly, because she was drooling the whole way. “Something must be wrong,” I thought. “This much drooling just can’t be normal.” I rushed her into the office, and when the veterinarian came in and asked me how Rowan was doing, I looked over at her to see her wagging her tail happily, without the slightest bit of drool coming out of her mouth. I did my best to explain what had been going on and kept pointing at her mouth, as he looked at me quizzically. I told him, “Just wait a few minutes, because she’s going to start drooling again any second now.” He calmly examined her over and chatted with me for the next 10 minutes, finding nothing wrong with Rowan and no evidence of any drooling, or what might have caused it.

At the end of the visit, the veterinarian provided me with the same reassurance that I found myself giving to patient’s day in and day out, telling me that it was probably nothing and to come back if it didn’t go away over the next couple of days. I was glad that Rowan was okay, but part of me felt somewhat defeated and frustrated that I wasn’t able to show him exactly what I was talking about. Of course, on the car ride home, Rowan started drooling again and continued to drool later on that night. I was mildly reassured after her visit, but couldn’t help but think to myself, what if the vet had missed something? I shrugged it off, and just made sure to keep Rowan’s water bowl full so that she wouldn’t get dehydrated overnight.

By the next day, the drooling had stopped on its own, just as the vet had said it would, without requiring any lab testing or treatment. Afterwards, I found myself thinking a lot about how my patients must feel when they bring their sick kids into clinic, and after a brief visit, are given reassurance and told to come back if the symptoms don’t resolve in the next few days. That is more easily said than done.

I will try to remember that sense of helplessness and confusion that I felt while Rowan was sick, whenever I see concerned patients requesting antibiotics or other treatments or lab tests in clinic that aren’t clinically indicated based on their symptoms. I think the experience has given me better perspective on what it’s like to not understand what’s going on when a patient or loved one is sick, and how difficult it can be to watch and wait, despite reassurance from your medical provider.

Nolan Sandygren, MD. is a 3rd year Family Medicine Resident at the University of Utah