Certain phrases strike dread into the veterinary heart. These words are the medical equivalent of an airplane pilot announcing that they are experiencing mechanical difficulties. Veterinarians know, from years of experience, that anything following this phrase has the power to shred the remainder of the day.

Spring sun filtered through new leaves. Cows lounged in the grassy pasture down the hill. I was just finishing explaining the changes I wanted made to the medications for a patient with a nicely healing corneal ulcer. The teenage owner, daughter of long-time clients, listened attentively, asking intelligent questions. Just as I was mentally congratulating myself on my efficiency and the great healing of the eye, disaster struck. As I nestled my ophthalmoscope into its case, the mother of the family ran up and spoke the fatal words “Oh, by the way, can you take a look at this new horse? We think he might have West Nile.”

“Oh, by the way…”

“Oh, by the way” and its cousin “While you’re/we’re here, Doc” afflict veterinarians of every stripe and mess with the day in a number of ways. We allot a specific amount of time for an appointment based on the nature of the presenting complaint. For instance, a limb threatening to detach itself from the animal receives a larger chunk of the schedule than a cracked toenail or smelly ears. For that matter, different conditions require different mental and logistical preparation. If I’ve been mentally reviewing my ophthalmology textbooks on the drive to your ranch and you divert me at the last moment along the axons of the nervous system, it’s going to take my nervous system some time to get up to speed. “But that’s your job,” you say. Sure. And my brain can detour, but it likes some advance warning. Think of it this way, would you expect a teacher to shift mid-lesson from a discussion of Romeo and Juliet to an explanation of Newton’s Third Law?

Granted, “Oh, by the way” rarely presents as a major neurologic disease. (It turned out that the horse did indeed have West Nile Virus, and because these happened to be some of my favorite clients, this particular “Oh by the way” became a joke between us for years.) More commonly, the “Oh, by the way” presents something like this…

Fluffy (species doesn’t matter) presents for something routine such as vaccinations, itchy skin, or inexplicably turning purple. Doctor examines animal, vaccinates, checks skin, recommends bathing Fluffy and washes the purple sidewalk chalk from her hands. As she turns to wish the owner a good day, pat Fluffy on the head, and send everyone smiling out the door, the owner says, “Oh, by the way, Fluffy”:

a) Hasn’t been eating
b) Has had diarrhea for a week
c) Had an alien erupt from his belly last night after his head spun a complete 360.

Do you think this could be serious?”

Yes, most of those symptoms could indicate something serious. Except that alien/head revolution thing. That happens all the time.

With the words “Oh, by the way,” the appointment has effectively doubled. Essentially, the entire visit begins again: taking an updated history, revisiting the physical exam with added focus on the system of interest, new diagnostic tests, new explanations, and possibly even hospitalization of the animal. Yes, I have actually seen “Oh, by the ways” that were that sick.

Good rule of thumb: if you think that a symptom is serious enough to ask the vet about, it warrants mentioning when you make the appointment, or at least at the beginning of the appointment. Unless the animal is showing signs of demonic possession or alien parasitism. Then we don’t want to know at all.