Ortho exam at a teaching hosp. What to expect. - German Shepherd Dog Forums
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post #1 of 14 (permalink) Old 06-14-2019, 12:47 PM Thread Starter
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Ortho exam at a teaching hosp. What to expect.

My boys Ortho exam and consult for his hip displasia isn't until Sept. and I have been prepping best I can for it. Anticipating surgery.

I've been wondering what the exam will entail and I think there may be a student or two in the exam room.

In the literature that the hospital has sent, it states that the students may take part in the exam. There is a release form acknowledging this that requires my signature. This I would expect and not surprised at, but what I need to know in order to brace myself and feel ok about is will the Ortho and/or student actually manipulate/palpate the hip? And why is that necessary if there are already available previous X-rays and his own X-rays showing the amount of damage/disease? Would the manipulating be for the benefit of teaching the student what to feel and look for rather than for further knowledge about my boy's condition? Or both? The literature that was sent covered what to expect but didn't describe what the Orthopedists actually does to him during the exam.

I don't want to act like a difficult owner but also don't want my boy experiencing unnecessary pain. Being aware and prepared helps me stay calm. I'm stressing about this a little (ok a lot) so any info/your experience is appreciated.

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post #2 of 14 (permalink) Old 06-14-2019, 01:12 PM
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It may be both but I really don’t know good questions. I would ask your ortho vet and tell them about your concerns and weigh the answer and let him know if you are comfortable or not with it. Wishing for a smooth easy surgery and a speedy recovery!
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post #3 of 14 (permalink) Old 06-14-2019, 01:24 PM
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Quote:
Originally Posted by Heartandsoul View Post
I've been wondering what the exam will entail and I think there may be a student or two in the exam room.
Going to a teaching hospital is a very different experience. You have to totally change your expectations and just give yourself over to the experience. It's way more than a student or two in the exam room.

I go to LSU for specialist care pretty often, and it sometimes drives me crazy. I've also gone to private-practice specialists, and it's a radically different experience. When my beloved vet ophthalmologist left private practice to join the vet school faculty, I followed her, but I need 10x more patience on the visits now. She's as good as she ever was, but I have to brace myself to put up with all the vet students, interns, and residents.... when I really just want to see her.

First, we expect to have a third-year vet student (or pair of them) doing the intake interview in the exam room (what a vet tech would do elsewhere). They're always awkward and ask the same thing multiple ways. If they try to look at the dog, they often have no idea how to handle it. The dog will sense their apprehension too, so you have to manage that. They sometimes ask nonsense questions, and I have to ask them to try to rephrase when they garble what they mean to ask --they're learning how to talk to clients. Try to be patient, as every vet went through this phase of learning.

Next you'll likely talk to an ortho/surgery resident. The resident is already a DVM, but they're in the program to become boarded specialist -- it's VERY hard to get into those residency programs, so they were probably at the top of their vet school class. However, they're pretty inexperienced. They're working under the oversight of a faculty member (or several of them), learning specialty field over a two or three year period by actually handling cases under supervision. When the resident is at the end of the residency, they're almost ready to go out on their own and know A LOT; at the start of the residency though they tend to be far less knowledgeable and I sometimes have to say, "Can you check on the answer to XYZ question for me?" Then they run back and talk to their professor, and come back into the exam room.

Do NOT expect to be able to work directly with the faculty member/specialist professor. That's just not how things usually work at teaching hospitals. They want the resident to handle the client interaction, as that's part of the learning process. The faculty stays in the back, supervising the whole thing. They're involved in the exam, and the surgery, and checking on everything being done -- but the resident is handling client interaction. It's been very rare for me to talk to the faculty member, and when it happens it's usually because a resident was new and I'm an, err, intense/unusually knowledgable client asking too many questions they couldn't handle, and they gave up with the running back and forth and brought out "the boss." I usually get to see my ophthalmologist only because she's known me for years, so she comes into the room for me -- and I schedule on the days when she's there, but it's still the resident who's doing the initial exam, and then she follows up with "yes, that's right, and here's something new that I want you notice..."

You probably won't be able to watch your dog's exam. They'll take your dog in the back --- there, the faculty member will be demonstrating the exam, and yes, probably letting students put hands on your dog, as they need to feel the joint resistance and clicking or whatever is going on. I don't think they'd allow the dog to go through unnecessary pain, though. It's not just the residents who will be involved in that -- there will likely be a group of vet students assigned to their ortho module that week who will be learning from your dog. This isn't optional. If you're not okay with it, they may suggest taking your dog elsewhere as it's basically existential for a vet teaching hospital.

The radiologist will also be doing the same thing with your images -- with lots of eyes on them.

The appointment takes a LONG time as your dog is a case they're using to teach -- I have learned to just drop the dog off and come back later, instead of sitting for a couple of hours.

If there's more than one thing going on, they'll have multiple specialists involved. You won't find a more collaborative environment for challenging cases -- it's why they're SO good. You get really great vet medicine being practiced, often with some of the best specialists in the region involved in the case. However, the client experience tends to not be as good as it would be at a private specialty practice, as you're there as a teaching case.

OTOH, if there's an overnight stay, they'll have a crew of students and residents on duty and lavish a lot of attention on the dog. Students will love on your dog. Mine really seems to like going there, so I know he's getting positive attention when he goes back there with them.

Try to re-set your expectations and just roll with it. I used to let myself get a bit aggravated by how long things take, having to deal with so many students, etc. but it helps to remember that you're there BECAUSE of the expertise in a teaching hospital...so you have to put up with the "teaching" part of that. If you can't make peace with it, you're better off at a private practice specialty clinic.
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Last edited by Magwart; 06-14-2019 at 01:34 PM.
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post #4 of 14 (permalink) Old 06-14-2019, 03:11 PM Thread Starter
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Magwart, First, many many thanks for your very detailed reply and I think I'm in shock. Better now than at the time of visit though. much, much better! And I'm glad that there is time to think things through, re-adjust my own thought process for clear goals for my boy and quality of life. As you stated, it looks like I will need to let go of some things in order to get the best that I can give him. A THR is major and if it means letting go of certain expectations at the beginning process in order to get the best possible surgeon and eyes on him to verify that a THR is in fact his best chances for quality of life, then I can deal with that.

I look at his ex rays a lot and watch how limited/self limiting he has become so I know that there is a tough ride ahead. I also see the spark in his eyes when he asks to go out to play or play search games and then the laying down to recoup. I know the pain very well, I know the need for play and wanting to do stuff and having to stop in the middle of it. He and I have been two peas in a pod from the get go with leg issues. This one is no different, my own has been giving me fits and am going for an Ortho exam next week. Same hosp only different local and the human side. No joke, as my friend would say "you can't make this stuff up"

Thhis took a while to write and I did a bit of emoting and reflecting. Getting off my duff and taking a ride with my guy. We do each other a world of good.

I deeply appreciate your no nonsense explanation of how it all works. It gives me what I need to tackle things clearly.
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post #5 of 14 (permalink) Old 06-14-2019, 03:25 PM
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One more thought on surgery: unlike a private practice, your dog will likely have a boarded vet anesthesiologist and anesthesiology resident participating in the surgery at a vet hospital, plus rehab specialists helping with the after-care plan, etc. You might never meet them, but it's a level of expertise that's just unheard of outside of this setting. For those of us who are control freaks (me too!), it's very hard to accept that there are these experts who are involved but not talking to us -- but better to have them helping the dog than not, right?
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post #6 of 14 (permalink) Old 06-14-2019, 09:37 PM Thread Starter
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I agree. I do need to contact his vet, there may be some backsliding on all the progress she's made with him and his comfort level. But that's relatively minor in the bigger picture.

"If you can't see his soul when you look in his eyes, then you need a seeing-eye dog"
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post #7 of 14 (permalink) Old 06-15-2019, 10:08 AM Thread Starter
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@Magwart, I had to come on and let you know that while I was contemplating all that you had written especially about what goes on in the back scene that an owner may never know of but what ultimately helps our companions, it brought up a memory of a book I had read that illustrates just how much does go on for their care. It flooded back to me and I think that it is worthwhile reading so I'm adding the link.

https://www.amazon.com/Tell-Me-Where.../dp/0767926447

How I came across the book was due to a happenstance chit-chat with an older gentleman while I was walking my boy in the town park. My boy was about 3yrs old at the time & already had him X-rayed so although not showing signs of HD, the chit chat veered to leg issues and the gentleman told me of this vet who had repaired his boy's leg (I believe it was a knee issue) and of his books so when I got back home I looked it up and got it from the library.

He's not out of a teaching hospital but how you describe the back scenes is quite like what the author describes. There is one case of an old man with his Golden Retriever. That old man will never know what the vet/author did for his dog but without his investment in the dog and the outcome of the case, it would have been different ending. How it illustrates the difficulties they come across while dealing and working through the owner/human aspect of it.

I'm kind of pressed for time but wanted to share this with you and thank you again. And if others come across this thread looking for info, it may help reading of a surgeons perspective.

"If you can't see his soul when you look in his eyes, then you need a seeing-eye dog"
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post #8 of 14 (permalink) Old 06-15-2019, 10:10 AM Thread Starter
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Edit: duplicate post

"If you can't see his soul when you look in his eyes, then you need a seeing-eye dog"
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post #9 of 14 (permalink) Old 06-15-2019, 10:50 AM
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Oh, I'll have to look for that! Thanks!!!
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post #10 of 14 (permalink) Old 06-18-2019, 07:02 AM Thread Starter
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I just wanted to come back and give a little update and some of my thoughts.

After giving it a few days and reading Magwarts very thorough reply several times and doing some hard thinking about what to expect, I listed questions I needed to ask both the coordinator of the hospital and my boy's vet in order to help me gather myself. The thoughts of many hands on my boy in a back room without me would be very hard and I need to get past that. So I got on the phone yesterday.

I called the coordinator assigned to our case and who had sent me the info packet and asked her to describe what will occurs during the appt. how many students and if they will be examining my boy in the room and also verifying if the Orthopedist/surgeon will be in the room with us. She verified that there will be students, that they will be doing an initial info/history and will be video'd to be graded. The Ortho will be in the room doing the exam and a student may also. Depending on whether or not it is needed and depending on the Dr. my boy may or may not be taken in the back for further exam or mor X-rays. All in all, she was reassuring about the procedure and I feel a lot better about it.

Then I called my vet and had a really good discussion about my boy and my concerns, his level of exercise intolerance etc. and we have a plan mapped out until the Sept Ortho appt. Since it is so far ahead, I am starting Adequan next week. Hopefully this will enable him to exercise more comfortably. We are also going to practice her taking him in the back room w/o me and have techs handle him a little, give treats etc.

It was a really good conversation and she knows my boy stem to stern and I can talk freely with her. She told me that if she were to give a report of his temperament she would be rate him as being a perfect gentleman. That he just needs to be handled with respect. And she doesn't foresee any real issues concerning how he will react. We also talked a bit about me and my needs concerning him.

Had @Magwart not given her own experience/knowledge, I don't think I would have known what questions to ask both the hospital or my vet.

I woke up this morning feeling a lot better.

"If you can't see his soul when you look in his eyes, then you need a seeing-eye dog"
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