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Old 08-29-2014, 10:40 PM   #1 (permalink)
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Default A vet visit / exam experience:

Vet visit #2, at 2 years 8 months. (Vet visit #1 was at 1 year, 5 months.)

For people that would like a perspective on a vet visit, here are some notes excerpted from an email that I sent my mother after Sophie’s recent exam. I will add some additional comments to the original email text by using “NOTES:”.

(BEGIN NOTE: A successful vet visit starts with prior preparation. I corresponded by email with Sophie’s vet and presented very specific questions and noted areas of priority interest. She was also fully informed with full access to Sophie’s data in Word docs and Excel spreadsheets; nightly water consumption, nightly food consumption, exact diet information, nightly running times . . . . There may be a separate consultation fee to establish this level of advance knowledge and preparation and if you’ve got a good vet it will be worth every penny. Sophie’s vet knew a LOT about her well before the exam. Time is at a premium during an exam. Paying for an advance consultation / informational exchange is an investment. END NOTE)

Mother is a big fan of Sophie; loves watching her videos (at least one new video every week). And she made all of Sophie’s fleece gear: (from her bath towels, to her hedgie sacks, to her cage liners, to her travel sacks, to anything-and-everything Sophie needed.

I am going to split this account of the vet visit into two posts: (1) The experience of the checkup exam and the costs. (2) Sophie’s unfortunate diagnosis of gingival hypertrophy or epuli, for which surgery has been recommended ASAP. The first is its own thing as a post for people that want to know more about what a vet visit can be like. The second is its own thing as very bad news and I do have some questions about the situation that experienced owners might be able to help with.

This post will cover the vet visit for a standard, thorough, checkup examination.
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Email text:

Sophie did well with the 11 am wake-up call. She did great on the drive. She popped her head out the top of her travel sack several times to use her sniffer and work her whiskers. I just kind of pulled the sack up high enough that she could investigate, but not decide that coming out would be a good idea.

(BEGIN NOTE: Sophie has only twice in her life been woken up before 3:00 pm; both times for her vet visits. I live in a small town, so it is an hour drive each way to a vet that has good experience with exotics and some limited experienced with hedgehogs. Sophie travels surprisingly well for an animal that approximately never leaves the house.

This vet is not a hedgehog expert, but good professionals consult with other good professionals, so she can get specialized advice for anything that might beyond her experience for a hedgehog specific issue (and did so after vet visit #1 - regarding a serious cystitis situation from which Sophie was fully cured). In the end, it was my own research which led to a diet based solution; and the vet’s recommendation, had I taken it, would have been dead wrong, a huge mistake, but medicine is often as much art and/or instinct as science. My vet did her best and I don’t fault her.

On average, Sophie’s afternoon wake-up call is 3:30 pm and she spends a couple of hours mostly napping inside my shirt (snuggling in good and tight) or in her hedgie sack on my desk. END NOTE)

She did poop a fair bit at some point, but it was all on the very bottom of the sack so swapping bottom pads was all that was needed. She didn’t pee also (a bit unusual) but that certainly helped minimize cleanup. It also meant that the vet was able to get a good draw of urine, so lucked out on that. If she had peed, there may not have been enough left to draw.

(BEGIN NOTE: You’d be surprised at how much gear and supplies that you ought have for any trip out of the house. Check out the travel gear video (linked below). The value of preparation can’t be overstated. Make things easy on yourself and your hedgie. END NOTE)

She did okay when we first got there, but lost ground fairly quickly after that and was a ball of huffing, chuffing, popping, clicking needles by the time we got to our exam room.

She didn’t really do much ‘clicking’ last time, but did a good bit of it this time. That’s where they snap their jaw closed and there is a loud click of teeth. Overall, I would say she was somewhat less fearful than during the first vet visit, though no one else would think that. The respiration rate was much lower. It was racing almost the whole time during the first visit; she had to have exhausted herself from the non-stop huffing and puffing. Her huffing and chuffing was definitely less this time, though no one looking at her would ever think that.

(BEGIN NOTE: She’s only gotten like this during the two vet visits. Even as a six week old baby sent to a new home with a new owner she was never near this bad. Check out the videos linked below. She was even worse during the first vet visit; those videos are pretty funny too. END NOTE)

She didn’t do quite as well on the return this time. She was much better when we got home, but the improvement was not as quick as her recovery from the first visit. She was okay in the late afternoon when I got her out, but pretty skittish and a bit spiky. After the first vet visit, by the late afternoon it was like the appointment had never happened. She was even a bit skittish during the late-night check-in.

She is showing signs of stress running also (not really surprising): 1 hour, 48 minutes Tuesday night, which is solidly double her current norm of only about 45 - 50 minutes a night. She did very well today (27 August); maybe slightly skittish, but no more than that. She is still stress running: 2 hours, 52 minutes last night; her top time since 14 May (2 hours, 59 minutes). I’m not tremendously surprised by the stress running and was expecting something pretty high or very, very low, depending on her mood. Tonight is more surprising, but I’m not particularly concerned. She has stress run before; any change to her environment or schedule can be a trigger. It could last a few nights; it could even shift into simply running more for a while (days or even weeks) - or tomorrow her times could fall back to exactly where they were to start with . . . . We’ll see.

(BEGIN NOTE: Looks like she ran out of gas - only a pitiful 29 minutes on night #3 following the visit. Ha! END NOTE)

As with the first vet visit, the vet said that Sophie had considerable wax in her ears, which she cleaned. Evidently that is something that I can monitor and handle myself with a Q-tip. The ‘outer-inside’ area of her ears is visible to me and this is where the wax builds up. I’ve never recognized it as such and never considered it an issue. Her ears have always looked good to me. However, if I use a wet Q-tip on her, it should come away with an orangy tint, showing that I am cleaning wax.

Over time, I’ll see how I can work that into her mini-baths. I can handle the right ear fairly readily - but that doesn’t mean that she’ll take right to letting me clean the outer portion (visible portion) of the inner ear. The left ear will likely be problematic, but we’ll just work something into the routine; maybe get just a few seconds or even just a single quick swab at first; then maybe work up to its being regular thing over the course of several months. You’ve seen the belly rub and chin rub videos. This is the same animal that was once sure she would die if on her back for more than five seconds.

(BEGIN NOTE: She had a lot of wax build-up that was cleaned during the first vet visit. I did not understand that this was something I could / should be managing. I am able to regularly monitor behind the ears and the ears themselves very well and the condition is excellent. I’ve always been able to see inside the ear a bit, but didn’t realize that there was a wax build-up issue or that it was okay to clean the ‘outer area of the inner ear’. Sophie’s ears have always looked fine to me anyway, so it is has been a situation of seeing - but not knowing what I was seeing. Evidently I will pick up on how to handle this pretty easily using moistened Q-tips. If they come away with an orangy tint, I am doing a good job. The only caveat is to stay out of the inner ear itself. I expect a learning curve for myself and an acceptance curve for Sophie. It could easily take several months to add to our routine (as do most things; such as nail trimming, which started out as a major hurdle and is now something that takes mere seconds. END NOTE)

Urine and blood samples are out for testing and results should be back sometime next week.

(BEGIN NOTE: I won’t make any decision on the surgery issue until all test results are back. We don’t expect any issues to arise, but that needs to be made official before other decisions are made. END NOTE)

The bill was about what I was hoping for as ‘best case’. Having to knock her out kicks up the minimum cost pretty quick. It could easily have been a couple of hundred dollars more if even only a couple of minor issues were noted and corrected during the exam. We escaped at $350, the absolute best case scenario. $500 - $600 wouldn't have been a surprise at all if there were just a couple of things noted and treated during the visit.


http://www.serenebreezes.com/Sophie-...-copy-edit.pdf

The gingival hypertrophy (or epuli) diagnosis was a total surprise, but that’s what check-up exams are for. It is pretty serious and the vet does not think that treatment should wait for very long if it is going to be done. I was discussing cost estimates and timelines (i.e., as in how serious a situation and affordability) and though she hadn’t described it as a crisis, it was clear that she would not wait on treatment.

She also mentioned epulis, which is technically (so far as I can tell) a tumor. Hedgehogs are highly prone to oral tumors; a top killer along with other cancers, kidney issues, and obesity. From what I can tell, there is a lot of descriptive overlap between excessive gum tissue growth (and its various names) and epulides (usually benign?). She did say that she was not leaning toward a cancerous tumor based on her experience of having seen so many (in other animals). However, only testing of removed material can determine for sure.

(BEGIN NOTE: The procedure will essentially utilize a cauterizing scalpel. Excess gum growth will be sliced away and the tissue behind the cut will be cauterized. This will likely be a highly stressful procedure for Sophie and considerable pain for some yet to be determined period of time. END NOTE)

(BEGIN NOTE: I will be asking questions and looking for input on this situation in a separate post. END NOTE)

(BEGIN NOTE: That’s the end of the notes that I’m inserting into the text of the email that I sent my mother about Sophie’s vet visit. I am including the entire text, including the unfortunate diagnosis, because that is a part of what can happen in a vet visit. Sometimes there is going to be bad news. Check-ups are intended to search for problems and hopefully there will be a window of opportunity to cure or minimize any issues that are discovered. Though she doesn’t know it, Sophie is a very sick animal right now - and that is something that I need to know. Perhaps it will end well - perhaps not - but because she got a thorough exam, we may have a chance for a happy ending. Without the exam, serious would likely have become critical without my having a clue - which would be my own fault. It has been 1 year, 3 months since vet visit #1 and vet visit #2. END NOTE)

If I go ahead with the surgery, she will not be the one performing it. Evidently, Dr. xxxxx is the exotic pet surgeon. I’ve never met this person, but my take is that they are ‘officially’ in charge of Sophie. Dr. xxxxx has handled Sophie to this point possibly because Sophie didn’t ‘need’ Dr. xxxxx; or possibly because of my detailed correspondence with her personally, which makes her the only qualified person to talk to me about Sophie on most points if they have an interest in her data history as well as past and current care routines. I’d certainly prefer to correspond and work primarily with Dr. xxxxx because I think we have a pretty good understanding of what we each bring to Sophie’s care. I lack medical knowledge (a big negative) but she seems to take me seriously as an owner that is sincerely interested in understanding as much as possible about pretty much everything and that I make an active effort to learn what I can wherever information can be found. My own personal doctor doesn’t give a **** about hearing any question I have. It’s safe to say that Sophie is getting far more considerate care from her doctor than I am getting from mine - and I’m sick too.


They called today with an estimate for the surgery and I asked for a PDF file with notes. I mean, the number is the number, but I’d like to see how it breaks down. I was promptly sent a pretty good line item estimate.

http://www.serenebreezes.com/Sophie-...an-edit-b.docx

$30 each for two tiny shots of painkiller. Surely that is very profitable!

The surgeon’s time is the most variable factor, which I would expect, and it is less than I was afraid it might be.

Despite telling me that her teeth showed minimal wear, minimal tartar, and minimal I-forget-the-word-she-used, they have a line item for cleaning so I was kind of surprised to see that. I certainly have no objection. It’s probably a good idea; as long as they are in there they should do everything. Maybe when she said ‘minimal’ she meant “Excellent for a 2 year, 8 month old hedgehog but that a cleaning should still be done.” The cost for that, by itself, is quite low, though there are other related line item costs, so it isn’t going to wind up as an inexpensive procedure.

I do see two line items each for General Anesthesia and Surgical Monitoring. I wonder if they are going to put her out twice.? Once for the surgery and separately for the cleaning.? I am going to ask about this. One General Anesthesia charge is pretty high - the same as what was charged on Tuesday I think. It allows for her to be knocked out for up to a certain amount of time; for up to 30 or 45 minutes or something like that, though I think it something they have some discretion with on fees. The other General Anesthesia fee is only $28, which is why I’m thinking that this is back to back procedures but she will be officially knocked for each one.?The cleaning probably goes pretty quickly, which is why the fee is so low. It’s a big difference between $28 and $92. There is considerable excess gum growth to be removed. It’s also pretty delicate I’d guess, which is probably why the surgeon’s time is hard to predict. Certainly I want them to remove absolutely all the excess growth they can / should. If it needs to be done and can be done, then it needs to be done right.

There is a Surgical Monitoring fee of $15 for each General Anesthesia. This is where someone is in charge of ‘constantly monitoring’ Sophie while she is knocked out. I’d consider this more of a sub-line-item for the anesthesia.

Histopathology is a big word for ‘testing the removed material and determining if it is cancerous’ (and/or whatever else they look at with those kinds of tests).

Metacam is a very minor painkiller that I would give Sophie by oral syringe; about two days’ worth I’d guess from the estimate.?

I would expect a ton of stress running or zero running for who knows how long afterward. She will be in a fair bit of discomfort.? I’ll ask more about that and why so little Metacam is on the estimate.? When she had cystitis, Sophie was on Metacam for a full week simply to see if it would help give relief to potential pain. This will be real pain from a fair bit of cauterized skin inside the mouth. Evidently a cauterizing scalpel is a big step up from ‘the old days’ - no stitches, no open wounds, no packing wounds . . . but still!

The estimate does not include a follow-up visit, which I would consider to be part of the total estimate if it will be needed / required.? I’ll need to ask about that because even a minor follow-up visit could be $100 - $300 in the blink of an eye, depending; visit charge (for walking in the door); then she’d have to be knocked out again; doctor’s exam fee . . . . I would kind of expect a follow-up to be required for a lot of things, so definitely need to specifically ask. That could be a big extra hit. But - maybe ‘it is what it is’ and she’ll only need to go back for a follow-up if I think there is a problem.? She knew that I wanted an ‘all inclusive’ estimate and cost range so I’d be surprised for that to be left out. Still, the question needs to be asked

Certainly I think that Dr. xxxxx trusts me to be on full alert regarding Sophie’s condition; perhaps she is making a follow-up visit discretionary.? She may be saving me some money by not requiring a follow-up visit.? She knows that the total cost is a big concern. Add the surgery estimate to the cost of this last visit and I’m at $760 - $880. You know how business is going right now.
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This picture was taken by the vet in June 2013. Not a great picture, but not bad (low resolution; not a lot of data for me to work with in Photoshop).
http://serenebreezes.com/Sophie-pix/teeth-1.jpg
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This picture was taken by the vet August 2014 (much higher resolution; much more data to work with).The angle is very similar to the image above. It’s not reasonable to assess color differences because the conditions, lighting, and the like, make a big difference. Color should not be considered ‘true’ in either picture and comparison definitely should not be made. However, the growth of excess gum material appears to completely obscure the teeth and appears to already be folding around and over the teeth.

Only the vet can really say. I don’t have the knowledge to interpret seemingly apparent differences in the pictures. Comparing one picture to another, despite being taken from a similar angle, may not give a fully accurate ‘then and now’ look, but there surely does appear to be a lot more gum than teeth in the new picture. Also, the vet is recommending proceeding soon, so I’m thinking that she’s understating severity a bit in her description to me. (Not deliberately at all - but her understanding and my understanding probably are not quite in sync. Of course, that is one of the problems inherent in buying an expert’s time. One can only learn so much within a limited window of time and I can’t be sure that I’m asking the best questions or phrasing them in the best way to maximize what is learned.
http://serenebreezes.com/Sophie-pix/...ertrophy-1.jpg
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A picture from the other side of her mouth:
http://serenebreezes.com/Sophie-pix/...ertrophy-2.jpg
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Videos -- Sophie at the vet:

vet-a-14-08-26
2:49
Pre-exam video. A couple of vet techs weighed her (actually, they were happy to let me handle her), but that is all that has been done so far. She does give one good ‘pop’ in this video at about 1:06.
http://youtu.be/1zQYcXzdKnI


vet-b-14-08-26
2:32
Back from her exam. Huffing, chuffing, popping, clicking - not too happy - but I don’t think she’s in serious distress. A good view of passive-defensive behavior.
http://youtu.be/2cLBklBz2IU


vet-c-14-08-26
2:27
We’re about to leave, but there is time for another quick video. She won’t start to relax until we get home and I put her back in her burrow.
http://youtu.be/6TxzvfIpjY0


travel-gear-14-08-26
8:11
It takes quite a lot of ‘support gear’ to be able to have everything we might need / want for a vet trip.
http://youtu.be/oqx7aU8boqE


She’s much happier in these videos (taken last month):

belly-and-chin-rub-14-07-12
7:00
(Good view of fully exposed belly.)
http://youtu.be/uDoD28EMn_Q

drying-off-14-07-05
1:25
(This is a pretty good one of Sophie getting dried off.)
http://youtu.be/Ge403FlG9qE



Pictures at the vet; exam room: (A lot of these images are very similar; I have culled the ‘not very good’ pictures but haven’t made a second cut yet.)

http://serenebreezes.com/Sophie-pix/vet-a-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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http://serenebreezes.com/Sophie-pix/vet-b-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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You can see pretty well that she is lying on her side here. You can just see her little black nose in this picture.
http://serenebreezes.com/Sophie-pix/vet-c-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...b-14-08-26.jpg
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http://serenebreezes.com/Sophie-pix/vet-d-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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http://serenebreezes.com/Sophie-pix/vet-e-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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http://serenebreezes.com/Sophie-pix/vet-f-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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The skin on her back is generally dark grey. When she is under stress - huffing and chuffing - the skin on her back turns nearly pink; it’s interesting to see it happen. I assume that it is related to rapid respiration and blood flow.?
http://serenebreezes.com/Sophie-pix/vet-g-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg
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http://serenebreezes.com/Sophie-pix/vet-h-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...r-14-08-26.jpg

http://serenebreezes.com/Sophie-pix/...b-14-08-26.jpg
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We’re ready to leave. Sophie is in her travel bag. I’ve got several large squares of fleece inside the bag so she’s got a nice little burrow to hide in.
http://serenebreezes.com/Sophie-pix/...vel-sack-a.jpg

http://serenebreezes.com/Sophie-pix/...vel-sack-b.jpg

http://serenebreezes.com/Sophie-pix/...vel-sack-c.jpg

http://serenebreezes.com/Sophie-pix/...vel-sack-d.jpg

http://serenebreezes.com/Sophie-pix/...-sack-d-cr.jpg
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It takes a lot of gear to take Sophie out of the house.
http://serenebreezes.com/Sophie-pix/travel-gear-a.jpg

http://serenebreezes.com/Sophie-pix/...ear-a-cr-a.jpg

http://serenebreezes.com/Sophie-pix/...ear-a-cr-b.jpg
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Her stuff sack holds all of the extra supplies pretty nicely.
http://serenebreezes.com/Sophie-pix/travel-gear-b.jpg

http://serenebreezes.com/Sophie-pix/...-gear-b-cr.jpg

http://serenebreezes.com/Sophie-pix/travel-gear-c.jpg
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.

Last edited by GoodandPlenty; 08-29-2014 at 10:44 PM.
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