Procrastination

I am probably the absolute queen of procrastination. At the moment, there are at minimum five other things I should be doing that are more important but I am, instead, posting on this blog. When I'm finished here and before I start the other things I'll probably draw some "Maybes" and by that time it'll just be too late to start so I might as well just go to bed, right? See what I mean. I'm quite good and that is just a sample of an easy scenario.

Today, I diagnosed my 17 year old cat with hyperthyroidism. Veterinarian's pets tend to be like cobbler's children in that we really procrastinate doing diagnostics and treatments for as long as we possibly can and for various and sundry reasons... To tell the truth, I didn't diagnose her today, I only confirmed with rock-solid bloodwork results what I already knew. I mean, how many other diseases would explain an old cat who is not overweight and suddenly exhibits the atypical (for her) behavior of trying to eat food literally out of my mouth? I've noticed this change for at least 6 weeks (probably more) and have been putting off pulling blood and making the confirmation then having to make decisions about treatment. For whatever reason today I brought blood tubes and syringes home at lunch, took her to the bathroom, sat in the floor, and pulled a blood sample. I didn't want to take her in because I was afraid it would stress her out too much. And, no, I didn't have help. I just have an extra hand that no one can see and I only use it when no one else is around;)

It's funny the things you retain well from vet school. I always struggle with endocrine test results. Do I do a free T4 with dogs or cats or when??? Suddenly, today, it made sense. With me, it usually takes either someone saying something in just the right way or my own little mind with its one puny brain cell thinking of it in such a way that it clicks. Duh! You can have euthyroid sick syndrome that causes a low total T4 without true hypothyroidism therefore a dog with a low total T4 would require a free T4 test to confirm hypothyroidism. With that fact, it then logically follows that if euthyroid sick syndrome causes decreases of total T4 but there is nothing that will falsely elevate total T4, then if a cat has a high total T4 you don't have to perform a free T4. The only time to perform a free T4 in a cat would be if total were high normal with suspicious clinical signs because it could be falsely decreased and appear normal. Finally! Check! Got it.

So, my cat has an elevated total T4 with a very mild elevation of her BUN and normal creatinine. We always worry about renal and cardiovascular function in hyperthyroid cats. I have to check her urine specific gravity because I was trying to play ostrich and hoped I would be wrong therefore did not obtain urine. Likely, I'll not have an echocardiogram done either just because of the procrastination issues... Why am I unhappy? After all, hyperthyroidism is usually fairly easy to treat. The problem is that I can't afford I131 (radioactive iodine) therapy which is the best, definitive treatment killing all the abnormal thyroid cells but leaving the normal, functioning cells. Additionally, I need to know that her kidneys will work okay once the thyroid hormone levels go back to normal before I can make that decision. What does this mean? It means that the queen of procrastination is going to have to give her cobbler's child medication twice a day, every day. Know how likely that is to happen??? Yep, you guessed it--not very! I'm gonna have to work hard to get this done. One more thing to add to my lovely to do list that just keeps getting longer. I am very proud to note, however, that she received her first dose tonight! (Wow, this should be recorded in the annals of history somewhere.)

On a different note and in closing for now, I have cajoled, begged, and threatened Can'tSpell to try to get her to post. I even asked if she was just bored with the blog. Her excuse is that she's been either too busy to post or too bummed out by bad cases. I've been trying to come up with a good enough threat to get her behind in gear and the best I've come up with that would work from long distance is to tell her that I'm going to stop sharing my "Maybes" with her. The next step, I figure, will be to tell her I'll stop sharing them with anyone and then all of y'all (yes, I said all of y'all, I am from the south you know!) that get them can yell at her too. Not sure if it will work, but I am trying!

"October's Bright Blue Weather"

My brother and I learned a poem when we were very young and the first verse always stuck with both of us. Often, when taking "train trips" in the fall, we would look at each other then burst out with the words: "Oh, suns and skies and clouds of June, and flowers of June together; You cannot rival for one hour, October's bright blue weather!"

I'm pretty sure the title of the poem is "October's Bright Blue Weather" but please don't quote me. The rest of the poem is lovely as well but there's just something about that opening line that captures the essence.

Today, at long last, there is sun and blue skies. Admittedly, it is the last day of October and thus almost doesn't count but...it'll do. Most of October here has been gray and rainy with only a day or two that was sunny and nice. No, the sun does not make the badness go away but at least it helps one to feel a little more capable of facing the day. I miss "train trips" with my brother...

Not a good day...

I write this morning out of sadness. But, as is typical of me, I'll start on a tangential rabbit trail. I hate rain!! The older I get, the more this feeling grows. It's really weird because when I was a kid, I kind of enjoyed rain and would even go out to play in it. Now, however, I simply despise it and only want to hibernate with a good book and my four legged children.

That being said, today is unusual because we are having Fall Conference where veterinarians come and present topics as an opportunity for continuing education. The school is virtually shut down, only seeing emergencies. This worked out well for my plans since I would be able to go to surgery journal club then attend the presentations that I am most interested in as well as allowing me time to go home during the day (a rare novelty) to finish up on some things about which I've been procrastinating. (Me? Never!!) When I woke this morning, though, it was raining and horrid outside. I also had one of my lovely premonitions (if you will) where I just feel as if something bad is going to happen. I didn't go to journal club or any of the presentations yet, but have been hibernating.

Now to the real subject of this post. One of my really good friends from sixth grade e-mailed me a few minutes ago. Her mom has been sick, in the hospital with severe pneumonia recently but had gone home and was doing better. She was taken back to the hospital because she wasn't oxygenating well. They decided that she had thrown blood clots to the lungs and needed to be placed back on the ventilator. They sedated her for intubation and she apparently threw a fatal clot and died.

I hate the fact that I am hundreds of miles away and can't even be there for her. I can hardly believe that her mom, who was also a dear friend to me, is gone. And, as always in times like this, I know that there are not words available to express the sympathy that I feel for my friend. It also brings to a head the other scary fears of life such as the fact that I'm also a long way from my mother who is older than her mother was. And there are my four legged children who are getting older both here with me and at home with my mom. And there are the memories of those that have been lost before both years ago and recently...probably one of the reasons for my hatred of rain. And there are all my friends who are scattered around geographically (primarily because of my tendency to move so much of late) that seem so far away. Makes me think of a quote from one of my favorite authors that I'll probably butcher but something about the more people you care about the more captives of fate there are in your life.

Flat Broke

I should be used to the feeling of having no money. After all, I've been in school for more years than I care to think about and am now in the middle of my second (!) internship. At the moment, however, I'm very frustrated by being completely broke. The reasons are numerous extending from the very good (my dog needs a dental badly) to the selfish (there's a book I'm dying to buy). Unfortunately, there's no way that I can currently afford either, much less some of the less important things, unless I completely maxed out a credit card. The credit card cannot be maxed out unless it is a dire emergency (i.e. one of the four-legged kids needs something that can't possibly wait).

This being said, my meals have become increasingly creative as I try to wait out the days until the end of the month when I get a paycheck. You would be amazed at the things that you can dig up out of the cupboard and make a meal out of; things you would never have guessed can go together. Today, through a combination of a) not having money and b) not wanting to go to the grocery store, I decided that if I cook some homemade biscuits (very cheap) and creamed potatoes, I can live on that for the week without having to buy anything.

The picture that I included is totally plagiarized from an e-mail that I received recently and I would give credit for it but don't know who to credit. I thought it wouldn't be a bad idea if only my pets were that well-trained... So here's to cheap noodles and potatoes until the paycheck arrives on Friday. Now as long as no one gets sick, we'll be okay.

Happy Daze

Feeling a bit whimsical and nostalgic this morning; thinking back to vet school days that were actually tons of fun although a lot of hard work. Therefore, am posting a couple of pictures from freshman year of my little old lady, Choo Choo (9/11/91-12/19/08), with Dirk, Can't Spell's English Setter. When Dirk first joined Can't Spell, Choo hated him with a passion - he was, after all, a non-mannered, dirty, stinky little 7 week old puppy and everything he touched was contaminated! He stayed at my place for a while since Can't Spell's good ol' roomate didn't like the new addition. For weeks, Choo would walk around the places he had been, lifting her feet as if she were stepping in manure and circling widely around him or recent areas he had been. Then, suddenly, she decided she liked him and they were best buds for a while. It was only after he got to be about 20 pounds heavier than her that she decided she would no longer play with him... I guess all good things must come to an end. These are some of my "mostest favorite pictures ever!"

A Bad Run of Bad Luck

You know, we all have our ups and downs; trials and tribulations; peaks and lows; triumphs and agonizing defeats. It's not only part and parcel of life but part and parcel of our profession. As much as it pains me to admit it, we can't save them all and we are most definatly NOT all knowing or super heroes.

That said, I've had the worst run of bad luck with my hospitilized patients I've had since school!

Over-all, I figure I probably have a little better than 65% average with my hospitilized patients walking out the door. That's probably skewed a bit because I tend to only keep the REALLY sick ones because we don't have 24 hour care here, and my philosophy tends to be I'd rather have the pet at home where at least the owner can keep and eye on it and call the emergency clinic if it looks bad then having it here by itself. (Wow, what a run on sentance!)

So I only tend to keep the really bad stuff. The stuff that's sick enough I want it on IV fluids and the owners can't afford or won't refer to the emergency clinic for 24 hour care.

So, lets see. My dog that SURVIVED organophosphate poisioning only to come down with IMHA died. My pneumonia dog died. My last blocked cat died. I did have one cat in chronic renal failure that I diuresed that survived to walk out the door, but she's not doing so hot at home. And now I have another blocked cat in the hospital.

When he came in his BUN was 194, his phospherous was 11.something and his creatinine was 11.2. Oh yeah, and his potassium was >8.5. In non-veterinary terms that means that he's really sick. Fellow medical professionals probably read those numbers and said "Ouch!"

So I got him unblocked, IV catheter in place, urinary catheter in place, e-collar on, and medicated. Than he pulled all accouterments off overnight the first night. Dumb move kitty, those things were trying to save your life. The next morning and day he looked like crap all day after said accouterments were re-placed.

I didn't think he's be alive when I walked in this morning. He was; he stared at me out of the cage like he was murdering me.

I was never so happy to see such a "pissy" stare...

I hope he makes it.

Peeved

Man am I steamed right now!!! That's the reason for a second post in so short of a time.

I'm on emergency duty for the weekend and holiday. Over the weekend, one of us covers a 33 hour shift although we are allowed to leave the building if not actively seeing clients. I feel fortunate to know that there is someone else covering the night shift Sunday so that I get a little guaranteed rest prior to coming back Monday morning. So why am I PO'd?

How dare you plan to enter vetmed with the thought of it being a 9-5 job? Or set hours at all for that matter. My emergency student's shifts are split up from 8 a.m. til 5 p.m. then from 5 p.m. til 11 p.m. then on-call until 8 a.m. We had several emergencies show up at once and were in the midst of working them up with one leaving to go to their regular veterinarian shortly after 5 p.m. and the student just left because her shift was over!!!!!!! WAY NOT COOL!!!!!!!!!

For the first time since I've been here I got really mad and called the student. I got her voice mail and left a message chewing her out for leaving. I DON'T CARE that your shift is over; you have patients for whom you are responsible and you DON'T leave until you speak to me. I don't care that you told the other student you would be back later after getting something to eat. You DON'T leave until you speak to me first. If she had asked, I likely would have kept her for about 5-10 more minutes then told her to go let pets out, eat, whatever, and we could finish paperwork later. If she had only asked...

Goes right along with all the whining. I just don't get it. Maybe I sound like the proverbial "walked 20 miles uphill in the snow both ways" story but I have to say that I worked a whole lot harder than the majority of these kids when I was in vet school and I do remember it being a bit tougher. I would have failed had I walked out at the end of my shift without checking with the doctor in charge; as is she will get chewed out (gently may I add, I'm not a harsh or screaming type of person) by me and that will be the sum total cost.