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March 23rd, 2013

ID Doctors, Pets in the Medical History, and a Cute Puppy

One of the things Infectious Disease doctors get teased about by our non-ID colleagues is our inclusion of pets in medical histories.

It’s part of the social history, where we list a grab bag of  potential “exposures” that increase the risk of infection — where someone is from, what they do, plus travel, dietary practices, sex, drugs, alcohol, cigarettes, and PETS!

In our defense, to our critics I remind them that we take the best histories — if you don’t believe me, read this – but must acknowledge that the pet thing is not always relevant. Ok, it barely ever is relevant. But it sure is fun.

In order to examine this issue more closely, I offer the following anecdotes and observations — none of them leading to brilliant pet-related diagnoses — taken from real life clinical practice:

  • I once cared for someone who was very funny — so much so that he was funny for a living. When I asked him if he had any pets, he told me he had 15 cats. How did he do that?  His response:  “Easy — when you have 14 cats, you get one more, and if you have 16, one of them dies or runs away.” (FYI, I think he stole this line.)
  • A patient told me she was taking her dog’s deworming medicine for pinworm. She didn’t have pinworm, by the way, but these were her symptoms, so she was convinced. (Warning: video is kind of yucky.) The medication she was taking was something called “Panacur” (fenbendazole). While I like that name — Panacur sure sounds like it cures a lot of things — it’s only approved for use in sheep, cattle, horses, fish, dogs, cats, rabbits and seals.
  • Dept. of Irony:  Asked someone recently if he’d received his zoster vaccine, and he told me that he refused because the cost was way too high ($300), and not covered by insurance. Later, when I asked him about his pets, he told me he’d paid nearly $3000 for his dog’s various orthopedic ailments.
  • It used to be that none of our patients from Haiti had pets. Now lots do. Is there a PhD anthropology thesis in there? I’d better ask Paul Farmer.
  • Every so often, someone tells you he/she has a pet turtle, frog, or lizard. Should you warn them of the risk of salmonella, and ruin their fun? And if not, why ask? These are the kind of tough dilemmas ID doctors face every day.
  • My first opportunity to witness the occasional absurdity of this pet obsession was during my fellowship. One of my attendings, an extremely detail-oriented type even by ID standards, was consulted by a trauma surgeon on a comatose man with fevers during a lengthy hospital stay after a motorcycle accident. She wrote in her note, “has parakeet named Fruitloop.” This surprised me, as the patient didn’t seem like the parakeet type. And I still wonder — how did my attending find this out? Here’s the dialogue that might have happened:
    ID doctor:  Does he have any pets at home?
    Patient’s Mother (surprised at the question):  Yes, he has a bird. We’re taking care of it since the accident.
    ID doctor:  What kind of bird is it?
    Patient’s Mother (even more surprised):  It’s a yellow parakeet.
    ID doctor:  What is the bird’s name?
    Patient’s Mother:  Fruitloop. (A pause.) Excuse me doctor, are you out of your mind?

So here’s a confession. This post is an excuse to show off a picture of our new puppy.

His name is Louie.

8 Responses to “ID Doctors, Pets in the Medical History, and a Cute Puppy”

  1. Susan Larrabee says:

    Your second cutest puppy in the world is adorable!

  2. stepanka baggett says:

    thank you for sharing the puppy pic.

  3. Mary says:

    Very cute puppy!
    What kind of dog is it?
    What’s its name?

  4. Paul Sax says:

    Thanks! The breed is coton du tulear, never heard of it before seeing one (this guy’s father) at a local store.

    Our dog’s name is Louie.

    Paul

  5. Timothy Lane,MD says:

    About 15 years ago, I was asked to do an ID consult on 80 year old man who underwent triple CABG for advanced coronary athrosclerosis with both saphenous vein and internal mammary artery bypasses three weeks previously. As often with CABG, patient became depressed and his family got him a dog to “cheer him up”. The puppy, a beagle, nuzzled and loved the man but would be observed by patient’s wife licking his saphenous vein harvest site presumably for the tastey serum exudate. After a few days he developed severe cellulitis in the vein harvest leg, clinical sepsis, and fevers with rigors. He was rehosptialized and treated empirically with usual empiric coverage for S aureus including MRSA and streptocci. He developed hypotension and died of septic shock on hosptial day 4 of his readmission. On day three small, pleomorphic gram negative rods were recoverd from 3 of 3 blood cultures and empiric antibiotic coverage was broadened. The blood culture isolates were eventually identified as Pasturella multocida. Two lessons:1.Always cherchez pour le chien 2.Not everyone can take a licking and keep on ticking with apologies to the man’s family and Timex Corporation.

  6. Paul Sax says:

    Tim,

    Thanks for sharing the case. I saw someone who developed septic Pasturella arthritis in his prosthetic knee — and after initially denying any significant pet exposures, he eventually confessed that most nights his German Shepherd would lick between his toes, which of course had extensive Tinea pedis. (Yuck.)

    Paul

  7. Ringers Lactate says:

    The Social Worker with whom you work is clearly brilliant,and deserves accolades and a raise. She knew intuitively that although Louie “rhodotorula” Sax is adorable, Tyson “sofosbuvir” Tapscott-Landovitz is, with apologies, cuter. Oh. Hi, Susan.

  8. Todd ellerin says:

    My sister has a Coton. Louie is good looking, congrats!

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

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Infectious Diseases

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