White Christmas (and then some!)

I love snow! Particularly if you can get out in it and just play without worrying about needing to be somewhere. Under those circumstances, multiple feet of snow would be perfectly fine with me.

We got some wonderful snow. I can't quote figures for you but apparently it set some record in the little town where I currently abide with blizzard conditions for the first time in years. I was up until 2 a.m. on Christmas Eve just enjoying watching (and playing in) the snow. The wind was crazy and swept clean certain areas while creating enormous drifts in others. There was a lovely drift about 3.5 feet high in front of my door (the one I don't use) and it proved great fun to jump in it then make a snow angel. My four-footed, furry children were mortified at mom's behavior. As they are either a) older or b) very cold natured they chose to lie on the couch and ignore me. If the big dogs were with me rather than at home with my mom at the moment, I'm sure they would have joined in the fun!

Final result was that we had an absolutely beautiful white Christmas. I'm on ER duty. On day duty 24-25 then from 8 a.m. today (26) until 5 p.m. Sunday 27. That's the only fly in the ointment for this lovely event.

On Christmas morning, I was told that they would scrape the road shortly so I called, told the other intern to leave the ER phone and have them call me directly if something came in before I got there. Yeah, that didn't work out so well. I got a call around 9:30 a.m. and they still (8:30 a.m. 26) haven't scraped the road. At my place, the backyard is almost bare just outside the door, there are huge drifts along the side of the house, the drive is bare of snow being just a sheet of ice, and the road in front, well, what road? The drifts completely obliterated the area of the road extending in front of my house and the only way you know it's there is by the mailboxes. (The picture above actually contains two roads, I defy you to find them without the aid of vehicles or mailboxes!) I couldn't even get out of the drive. Had to hitch a ride in with a neighbor who has 4 wheel drive then hitch a ride home with the other intern. The worst part was that what I had to go in for was a Christmas morning euthanasia.

Don't let that comment make you believe I thought it was wrong. It was definitely best for the dog who had lymphoma and the nodes had gotten so big that she couldn't breathe. It's just so sad anytime but most especially at Christmas!

Fortunately today the snow is packed enough and some of the roads are clear enough to allow me to drive myself in to work. That's good because I need to be able to go home and finish packing which I intended to do last night but did not. And yes, I still plan to head out Sunday night unless it poses a risk for the critters. Hopefully, the roads will continue to improve and not be problematic. The interstates are supposed to be clear as of today but I have about a 60-70 mile jaunt on a small state highway to get there...

Nothing will stop me!

Yeah, just so y'all know, "Neither rain nor sleet nor snow" nor flood nor poor road conditions nor fear/threat of death, etc., so forth and so on, ad nauseam, ad infinitum, are gonna stop my leaving on Sunday evening for my vacation time followed by my much anticipated out rotation. Unless there's a really good reason, I'm hitting the door as close to 5 p.m. as possible, tossing the kids in the truck, and heading out (I've almost finished packing already!)!!!

Merry Christmas, all. Have a safe and happy holiday.

Follow-up "October's Bright Blue Weather"

Helen Hunt Jackson (1830-1885)

October's Bright Blue Weather

O SUNS and skies and clouds of June,
And flowers of June together,
Ye cannot rival for one hour
October's bright blue weather;

When loud the bumble-bee makes haste,
Belated, thriftless vagrant,
And Golden-Rod is dying fast,
And lanes with grapes are fragrant;

When Gentians roll their fringes tight
To save them for the morning,
And chestnuts fall from satin burrs
Without a sound of warning;

When on the ground red apples lie
In piles like jewels shining,
And redder still on old stone walls
Are leaves of woodbine twining;

When all the lovely wayside things
Their white-winged seeds are sowing,
And in the fields, still green and fair,
Late aftermaths are growing;

When springs run low, and on the brooks,
In idle golden freighting,
Bright leaves sink noiseless in the hush
Of woods, for winter waiting;

When comrades seek sweet country haunts,
By twos and twos together,
And count like misers, hour by hour,
October's bright blue weather.

O suns and skies and flowers of June,
Count all your boasts together,
Love loveth best of all the year
October's bright blue weather.

Ran across this and thought you might all enjoy reading the source.

A Week of ZEW

Had an interesting and unexpected turn of events that caused me to spend a week of my four week elective rotation on the "ZEW" service. Z=Zoo, E=Exotics, W=Wildlife. I'm not highly interested in these critters, preferring horses, cats, and dogs instead, but find them fascinating all at the same time.

Were not exceptionally busy but had a couple of fun things to talk about. I drew blood for the first time ever from a snake. I was told it was luck of the draw (literally, pun intended) and sort of like hitting a cow tail vein. Got 0.4ml before the fountain stopped but no one else could get any either so I didn't feel too stupid! Did discover, however, that a 14 pound red boa can whip my butt at arm wrestling. Was helping to hold for someone else and he was totally beating me and I was using both arms!! Makes you learn a bit of respect especially for a hungry reptile!

Had two flamingos come in from a nearby zoo on different days. This story makes it necessary to take a quick tangential rabbit trail (not me, sarcasm intended) to give some more kudos to one of my old teachers. I'll never understand people and most especially specialists. Most of them get so hung up on their overinflated egos that they can't even admit they don't know something that they probably shouldn't know! I was so completely spoiled and thus ruined for all other specialists by one person who responded with "I don't know but why don't we look it up together" or "Here is where you can find that" or something along those lines to my endless questioning. So many just laugh and make fun of your questions which used to make me feel really dumb until I figured out that it meant they didn't know either and just didn't want to admit it. Does make you appreciate those really special super teachers that you are fortunate enough to know here and there (just not often enough!). Now, back to the story, I think you'll see the reason for the tangent without my pointing it out.

First flamingo had a tear of his lateral collateral ligament at the hock. Happened about 2.5 years ago and had been repaired, repair failed but the bird had made enough scar tissue to be doing well until something happened to re-injure the leg. Took to surgery and used two bone anchors like sometimes used to correct a cranial cruciate ligament rupture, tied the sutures together and basically recreated a ligament. The bone anchors were designed in an attempt to make the lateral suture surgery more successful by limiting areas of failure and easier. The basic premise is that a screw is placed in the distal femur rather than looping suture around the femorofabellar ligament then the suture that is already attached to this screw is pulled through the hole drilled in the tibial crest. Exact concept of lateral suture but a little different anchor. We placed one in the distal tibia and a second in the proximal tarsal bone then tied the suture in the middle. (I hope I'm getting the bones correct 'cause bird anatomy is a little confusing if you don't do it all the time!)

The second bird had bilateral angular limb deformities. We made small approaches on the lateral aspect of the proximal tarsal bone (same caveat!) in order to make an osteotomy (cut in the bone) allowing the bone to be positioned correctly. Then small ring external fixators were placed using K-wires for stabilization. Went really well and you could see an amazing difference in the clinical picture although the radiographs were less impressive. Way cool surgeries!

I'll now point out my complaint. I read extensively about both procedures the night prior to the surgeries and every single reference I pulled regarding surgery on a bird / flamingo's legs stated not to close the skin. As I understand it, their skin on their legs lacks the ability to stretch and expand like ours would (at least to an extent) therefore closure results in either tearing of the skin (dehiscence) or creating a tourniquet / compartment syndrome effect. The first bird did well except that the day after his foot was swollen and blue then the sutures tore and it resolved. Even after that, the second bird had both incisions closed. Apparently even a tiny amount of inflammation is enough to result in the tourniquet effect. I think somebody didn't read about birds... I also know somebody doesn't listen to those around because this was pointed out and ignored. I probably PO'd that somebody yet again. Oops. Maybe one day I'll learn to keep my mouth shut but I doubt it!

We also saw Andy, a kinkajou who belongs to a lady that has exotics and uses them for education. Andy broke out of his pen and got attacked by a dog several weeks ago and is now healing nicely. I did a rabbit dental, much like floating a horse's teeth but far less strenuous and I neutered a guinea pig. Usually, the ZEW service is pretty busy but we were a little slow this week due to the approaching holidays. This allowed time for me to exert my bad influence that somehow results in other people carrying out scathingly brilliant ideas that they would not normally even consider. (I don't know how I do it. Honestly, I don't even try; it just happens!) We got antlers and a red nose for one of the clinician's van, stole (er, I mean borrowed without permission) her keys, and decorated the van. We were planning to put battery powered Christmas lights and garland on another's motorcycle but he didn't drive it:( Pooey! Overall, a fun week which just goes to show that often the things that are unplanned are better than those that one plans in detail.

I'm on ER this and next weekend, cover the day ER shift on the 24-25, and am on anesthesia for the first few days of the week. I get vacation (HALLELUJAH) the week of New Year's and am heading home for some relaxation. The next week, and last of this rotation, I spend as an elective out-rotation at my alma mater. Will refrain from going into detail on this in order to protect the innocent... Then it's back to overnights but it's my next to last overnight rotation so I'm rather excited - I don't count the extra 4 nights that I have to do right at the end of the internship 'cause they'll be a breeze when I'm that close to done! Time is flying like mad and all too soon I must finish placing my ranks for residencies and then will find out if I matched or not. Probably won't have much time to write after this week and plan to drive out as soon as I am finished here on the 27th! With that, I wish everyone a very Merry Christmas and a Happy and SAFE New Year!!

Teaching pains

Had a very interesting teaching experience last week that I thought was worth sharing. I'll start by reminding everyone that my primary interest lies in surgery - particularly soft tissue surgery.

Last week, I took two of my little foster kitties in for a spay. I was on community practice rotation which is one of the rotations that the students have the opportunity to do spays and neuters. The usual clinician who handles the surgeries was out for a meeting thus making it so that the students assigned to surgery had nothing to do. I asked if they were interested and offered the kittens if they wanted - they were very enthusiastic!

So, I took them in and taught some common sense medicine. They got worried because one of the little ones had a temperature of 104 and a glucose of 88. "Should we postpone the surgery," was the question I was asked. My comment caused a slight gasp because I said, kitten sounds great and has felt great at home, eating / drinking / playing, etc. but had been fasted for the night so I voted to move forward.

As I told both students, it was their surgery and I was only scrubbed in to give advice and help if needed. The first student did a good job. She knew the concepts well, asked good questions, and followed directions / suggestions as I gave them. She was closing the skin with an intradermal pattern when life got interesting. Anesthesia called in to ask if I would be angry if we aborted the surgery on the second kitten because there was going to be a short power outage. Told them no problem but there wouldn't be another opportunity because if not done that day I had planned to take them home with me on my vacation time and spay them at home.

They wavered back and forth then decided to go ahead with it. The second student really did not have good soft tissue handling skills. I felt that I should tie my hands to keep from taking things away from him and finishing myself. It was then that I realized that I think I may be developing an ego - something that I hate in others!

The first student had asked how easy it was to actually tear the blood vessels and the second provided a teaching opportunity on that point. In cats, you don't really have to break down the suspensory ligament in order to ligate the ovarian vessels (they tend to be very stretchy). I usually do just because that is one less thing to ligate thus (in theory) giving better ligation of the vessels. The student didn't want to and I had told him that was fine but that it should be ligated with the vessel. He made a window cranial and caudal to the vessels and was struggling with getting the suture around and I told him either break down the ligament or ligate it. He ignored me and kept struggling. To make it worse, we were working with a time crunch because the power was going out shortly. I stopped him and said I would break down the ligament, then took a gauze sponge and started to do so. He was impatient and grabbed an instrument then used it (sort of like the proverbial bull in the china shop) to try to break the ligament.

The result was that the vessels tore beneath the instrument but the ligament was still intact. Good news was the the vessels tore above the clamp but boy was I aggravated. In my most sarcastic tone (after clamping the bleeding ovary) I turned to the first student and said, "In reference to your earlier question regarding how easily the vessels can tear, you will note that the ligament is intact and the vessels torn." So maybe sarcasm was inappropriate but it kept me from shaking the other student and taking away his instruments. I then personally tore the pesky little ligament.

It was very difficult for me to continue watching and instructing as he ligated the uterine body and started closing. He then tore his glove about 1/4 of the way through closing the linea. This was my second nagging feeling of developing an ego because, as I continued suturing backwards (because not only was I on the opposite side but he is also left-handed) while he changed gloves, I thought, "Man, I suture faster and better backwards than he does forwards." I allowed him to place skin sutures because it would be faster than intradermal and we were still awaiting the power outage. The other frustration (as insinuated earlier) was that he did not listen well. I kept loosening his sutures because skin sutures are not supposed to be tight and he kept tightening them again. The funny part was that the power went out for all of 45 seconds in the rest of the hospital but not in the surgery suite where we were. I wish anesthesia had told me and I would have made him go back and do intradermal sutures.

Both kittens are doing well despite the challenge (and stress) for their foster mother. I'm not the most compliant client and they were playing like little fools the day after.

The other outcome of this experience was to make me even more grateful for the wonderful surgery clinician with whom I worked in school. I feel huge empathy for the stress that must have been felt as he watched us students learning to do such basic things as suturing. I would like to think that I was not as much of a stressor but even the little ego that grows won't allow me to believe it;) Now I must find a way to squash this ego before it gets out of hand since that is one of my biggest pet peeves about specialists in general!

Triggers

I don't know exactly what it is that sets me off sometimes. At times it takes very little to get me started; others it takes a major blast. Right now, I 'm in full swing and having fun at it.

On Friday, I started a war (or, to be more precise, I helped to start a war). My role is ideas. I come up with really good ones and somehow goad other people into carrying them out. We confettied one of my intern-mates desk with little sheets of paper labeled with his name. There are literally millions of wonderful ideas floating around in my head as we speak of other things to do to him and others.

Yesterday, we pulled one wheel off his chair and dumped him in the floor. We were all in the office and he came in, pulled out the chair, sat down, did his work, then left; all without incident. None of the rest of us could figure out why. Then today, I walked in the office to find him looking guilty and moving the chair. He told me he got dumped and was switching it with the presumed perpetrator's chair. In the course of the conversation, he asked if I had done it to which I replied (with suitable sarcasm) "Me? I would never do something like that!" Totally went over his head that the translation for my comment was "No, not directly, but I knew about it and helped!!"

The greatest part is that I can randomly change sides in this war - and believe me I will!

No, I change my mind. The absolute greatest part is that nobody believes it of me. There is something to be said for keeping people at a slight distance so that they only know the part of you that you choose to let them know. Everyone here thinks I am innocent and sweet. They would never accuse me of doing things like changing the computer cables around to confuse desktops so you can't access your own stuff...

The only drawback to my war is that it is preoccupying me slightly because I keep coming up with wondrous, cantankerous ideas to carry out and it pulls me away from my cartoons. My loyal public will likely get mad but since they never bother to give feedback anyway, I shouldn't worry too much.

Not exactly sure what set me off on this at the moment. I was terribly depressed then suddenly became consumed with practical jokes starting with the phone during my presentation. Must admit I feel much better at the moment. I think that tomorrow, I'll take all of the wheels off of all of the chairs and see what happens...

I've seen some kinda cool cases lately and need to post them for the entertainment of all but haven't gotten around to it yet. Very talented when it comes to procrastinating:) I did get all of my match crap done and, as of right now, both of my friend's dogs are doing well. Let's hope that continues. It's definitely nice to be out of the middle of the cardiologist and the student she wants to maim but I'm still concerned about the situation and will likely do something stupid and get myself in trouble. Not like it would be the first time. With that shall close for now - must be there early in the a.m. since we are spaying my little foster kittens tomorrow.

Eating Scrambled Eggs or At My Place

One of the known dangers of eating scrambled eggs is the eggshell. Despite extreme care, it is always possible that little fragments will wind up in the egg and not be fished out. This is one of my biggest pet peeves (it carries over to boiled or otherwise prepared eggs as well) and I am almost fanatical about making sure that no shell dared to spoil the meal. There is not much worse of a feeling (when eating) than biting down on that crunchy piece of shell.

It is rare that I have people over to my house but, on occasion, I do. I actually enjoy cooking and don't mind feeding folks, I'm just a bit of a hermit in general. I had a couple of people over last night and it came to my attention that eating at my house is very similar to eating scrambled eggs. Dangers lurk within the food, unwary eater beware!

I spent a lot of time making sure the place was clean in preparation for company, including wiping the kitchen counters down meticulously. I made pasta and you should imagine my chagrin at noticing two white cat hairs on the boiler as I drained the excess water. Yes, hair lurks at my home and I probably ingest it unknowingly on a daily basis. Who can help it with so many furry, four-legged children plus myself who is not deficient in that category. If they noticed the extra add-ins, they refrained from comment. Guess I'll know if I ever try to invite them back over...

Amusing myself...

Thought I would take a minute to give an update and tell a funny story. This week and the one prior have been two of the most stressful weeks I've had in quite some time. Between trying to finish match crap, working on revamping my article that I hope will be published, preparing a seminar presentation, dealing with a friend here who has a 12 year old Great Dane with multiple health problems that everyone else has given up on but she's not ready, hearing from another friend who recently lost one dog to acute renal failure and now found out that her other dog has lymphoma, and being the "maniac in the middle" on cardio where the cardiologist hates the student and wants to fail him and is only being nice to me to get me on her side, it's been a tad bit complicated / stressful / exhausting! [If you can figure out that run-on sentence;)]

Yesterday, I gave my presentation. And being a lover of practical jokes that do no harm, I planned a good one. Gotta tell the whole story though.

First, I hate public speaking. I'm rather shy and introverted naturally so I don't relish the limelight and usually have a difficult time saying good things about myself. The big day approached and I was rather amazed (and pleased) to find that I did not have a huge case of nerves. Everything was going good until I came to work and made a BIG mistake! I HATE elevators with a passion because I have issues with small, enclosed spaces. Yesterday, I was tired because I was at work late (came back to spend time with tech and her Dane when she called me hysterically in tears), I was carrying a very heavy bag of books, and I was having trouble breathing well 'cause I'm a little sniffly at the moment. Usually I park in the lower parking lot because I figure stairs are good for me since I get little enough time to exercise. This was no exception but I chose to take the elevator. BAD, BAD, BAD!! No, I didn't actually get trapped but, from my perception, it seemed as if the door took forever to open. I was actually hitting panic mode in which I was fighting the desire to start uselessly banging on the door and screaming for help. Needless to say, this shook my equilibrium just a little.

Second, I've noticed that the third year surgery resident (who I like a lot) seems to magically get an "emergency" phone call during seminars in which he is not particularly interested and ducks out early. I called him on it last week; he laughingly denied the charge. I told him a) I rather liked the idea and might implement it myself and b) if he walked out on mine I would know... Then I took my school issued phone and gave it to my intern mates with the instructions to call him in the middle. They did. Twice. He silenced it then sent a text asking who it was. They told him me. A very funny conversation ensued in which they were arguing over whether I was good enough at multi-tasking to text while presenting. While I sincerely doubt I'm that good, I must have some capability because I was distracted by the drama I had created, kept thinking about the elevator and being panicky, and managed to present without most people noticing. The only poor comment I got was that I read too much from my notes. That's disappointing to me because I knew the subject cold and only had the notes for a safety but needed them due to my elevator incident.

I don't think he figured out the whole joke but am pretty sure he knows I am the mastermind behind it although I can't be certain of that since most people underestimate me because of my quiet disposition.

The good news is that the seminar is now off my plate, today is my last day on cardio, and the match crap will be done no later than Monday (deadline). That gives me time to revamp my paper and submit it and will at least somewhat decrease my stress load. And (imagine the "Hallelujah Chorus" in your head at this point) I'M OFF THIS WEEKEND!!!!!!!!! Now what I'll do about my two friends and their beloved companions I don't know.

Spit in THAT eye

So this post is going to be slightly ironic for a lot of reasons. First, because Insane is really the eye guru- she LOVES eyes. I HATE eyes. I think they're creepy.



So last week I have an odd eye case. A young pomerianian mix dog that had acute onset of blepherospasm and conjunctivitis. I stained it and it was negative for corneal ulcers so I sent him home with some triple antibiotic eye ointment to see if we could get a response with that.



He came in about a week later and his eye was MUCH worse. He now had bupthalmos (enlarged eye), marked blephrospasm (painful eye) and worse drainage. So I told him he needed to go to Big Vet School An Hour Away if he wanted to save this dog's eye, because it was obvious without doing an IOP (intraocular pressure) that the dog had some kind of acute onset glaucoma. He agreed and made an appointment for two days from them. I sent him home with some pain medicine to help keep the dog comfortable.



A week later he calls and said that he didn't keep the appointment at BVSAHA because "the dog was getting better." However now he thinks the dog's eye ruptured. So we make an appointment the following day to enuculate the dogs eye (take it out).



I enuculeated the dog's eye the following day. This was the first one I've ever done, and it was quite interesting! Very bloody. But I sent the eye into the pathologist because I needed to know whether the dog had Blasto in the eye or not.



So the pathologist calls me today- the dog's glaucoma was caused by heartworm disease! (BTW, we had tested him for heartworm the same day and he was positive- we started treating him) Apparently it's rare and very cool. So the pathologist is going to publish the case and I get to be a minor author! Very exciting- especially when I just kind of stumbled on to this one...

I'll try to think of a funny story soon!

So freaking cool!!

I have a couple of things to comment on tonight; ironically, they are polar opposites.

Today, for the first time in a while, I remembered one of the reasons I chose vetmed. I saw a case that was so completely freaking cool. It was a nice feeling. So, I'm going to present the case and you vet-type people out there tell me if it's not pretty darn neat.

17 week old, intact female, Shih tzu. Has had 2 wellness / vaccine visits (both at the place where I am) since she was acquired from the breeder. First visit, told completely normal. Second visit, grade IV-V/VI heart murmur noted (they even had the cardiologist who was not on duty auscult to verify). No clinical signs of heart disease; an apparently healthy, happy, normal puppy. They referred to cardiology and we saw her today.

Now here's the way cool part. Student goes in and reports a grade II-III/VI murmur and states it was difficult to hear. Hmmmmmm???? Now is the student confused or what? The answer is or what. When I auscultated the dog, quite by accident I caused her heart rate to dramatically increase at which time I heard a grade V (yes, with a palpable thrill, I'm not confused!) murmur but as I listened, without moving my stethoscope, her heart rate slowed and the murmur became a grade II then disappeared completely. It was repeatable. The cardiologist agreed. Is that cool or what? If I could count on myself to be reliable, I wouldn't tell you the diagnosis and take guesses. Problem is I'm too sporadic in my posting and might not answer so I'll spare you the suspense.

So, we did an echocardiogram and found that this puppy basically is trying to be a cat. She has mitral valve dysplasia. Her mitral valve leaflet is very long and creates a functional outflow as her heart rate increases that disappears as the rate decreases. We don't usually see this phenomenon in dogs (not unheard of, just rare) but we often see it in cats; particularly cats with hyperthyroidism. Our cutesy little name for it is SAM=systolic anterior motion. The pup also had secondary hypertrophy of the cardiac muscle. We treated her with a beta-blocker drug to decrease both heart rate and strength of contraction. An added bonus is that the drug has anti-arrhythmic properties (she will be prone to arrhythmias). The great news is that we will likely be able to completely control this problem and with time the hypertrophy will resolve. She may even "grow out" of her dysfunction.

Now just admit that's pretty cool!

My next comment is to simply state that I am in a very pessimistic frame of mind at the moment. Nothing major bad has happened or anything but it seems as if way too much little stuff is piling up and not going right. Was on ER duty this weekend and it was a rough one; got a grand total of 2 hours (spaced apart) sleep over the 34 hours of duty. That doesn't help one's frame of mind to improve. If I had not already paid for a match application I probably wouldn't even bother to apply - that is how convinced I am at the moment that I don't stand a chance of matching. Oh well. Money's paid so can't waste it. I considered a suicide pact with a couple of friends this weekend... If only there had been a sharp object available right at that moment.

Anyway, I have another really cool case that I saw this weekend. It prompted another childish argument between the surgery and medicine services about who would take the case. No, they don't both want it; the problem is no one wants it! It's crazy man! I'll try to post about it soon but want to wait since the radiographs are really neat and I would like to include them.

And I love it that Can't Spell managed a post (sarcasm intended). Like that is enough to make me quit griping at her about it. Still planning something devious to do to her I just don't know when I'll be able to accomplish it.

Until next time...

Am NOT!!!

I did NOT desert y'all!!! It's just hard to think of something to post when you're surrounded by yuckieness.

Every once in a while in vetmed you have a day when cases seem to implode on you.
Today is such a day.

I have the following train wrecks currently in progress:
1) CRF cat that suddenly went anuric and I can't get to make urine with Lasix
2) Several cats with "mystery illness" that have fevers and feel crappy but have NO bloodwork abnormalities except for a MILD increase in WBCs. I'm "shotgunning" them but not much luck yet...
3) A dog with Histoplasmosis. My 5th this year...
4) A cat that had a horrible reaction to her vaccines Saturday and was throwing up all weekend...

You get the picture??? I'll try to post a good story later today...

Dumped!

Folks, I hate to break it to y'all, but I think we've all been dumped!! Can'tSpell just confessed to me that she has gone over to the dark side and joined Facebook. That means she'll only spend time piddling around on that site and quit blogging:( I feel hurt and betrayed since we have both been fighting the dark side for so long regardless of how many friends had joined and invited us to do so. She says she's just been busy and stressed and that is why she hasn't posted in a while but I think she's been sucked in to the bottomless pit. Hopefully, I'll be proven wrong but readers beware!

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.

Cats for change

Animal medicine is fun. While we do still catch some of the same things that human doctors get (pun intended) such as being a psychologist and hearing all about family woes, past illnesses, and other pets, there are definite bonuses to being an animal doctor. (Oh, and as previously alluded to in another post, yes, we do get asked to diagnose people illnesses.) One of the bonuses from my perspective is the often unexpected things that these little guys will toss our way.

I have been treating a cat with a pyothorax since last Monday. For those of you non-medical types, pyothorax is the doctor word for pus in the chest. So basically, the cat had an abscess inside his chest. It was lovely. Disgusting, chunky, stinky goo that I tapped from the chest first using a needle then we placed a chest tube so that I could drain it more often and flush it out. (Yes, I do have the usual female veterinarian fascination with abscesses. Not to say that men don't ever have that fascination but it seems to usually be a female thing. I have no explanation for that...)

The most common cause of pyothorax in a cat is a fight wound. This is likely in my little guy since he is a semi-feral kitten that was outdoors and just recently has become tame enough to handle. Pyothorax can go bad (VERY BAD!!!) because cats like to wall things off with fibrin which is a tough, collagen-like material that then stops the lungs and chest from expanding normally. This can be a permanent change leaving a cat that cannot breathe normally for the rest of its life.

Typical treatment of abscesses include flushing and draining, obviously not an easy thing when dealing with the inside of the chest. This is also apparently one of those "in vogue" types of therapies, also. By this I mean that we see therapies and diagnostic modalities go in and out of favor through the years in medicine. Flushing with sterile saline +/- heparin was originally used then became less commonly accepted and is now back in favor. The use of heparin would be to try to break down and prevent the formation of the fibrin. We chose to try this therapy since after removing 160ml of fluid the x-rays looked about the same as before although he was breathing better. This made us worry that he may have had a problem before anyone realized and may have had a lot of fibrin already.

We started antibiotics and flushing/draining the chest. He began to improve almost immediately although he had a raging fever (105.7F) the first night. After that, he began to eat and feel much better quickly. My original plan was to keep him on intravenous antibiotics for a week (so that I could be certain he received a complete dose) and to leave the tube in place for a week (to allow a window for reassessment of the fluid as well as draining the fluid). It would seem that the cat had other plans...

This morning we were unable to get the fluid back that we had put in to flush (a mere 34ml). We took another x-ray (unplanned) and found that the chest looked great. Clinically, the cat looked wonderful. We then discovered that the IV catheter was blown as well meaning we could not give the antibiotics through the vein without placing a new catheter. As so often happens, we then altered our treatment plan entirely based on the whim of a cat. We pulled his chest tube and IV catheter and switched to oral antibiotics. He's a much happier kitty now without the tube and IV lines. I think he was just making the statement that he is ready to go home! So, assuming there are no complications we will send him home. His owners can't pick up until Monday (out of town tomorrow) but I think Socks will be okay with that...or he could just make change in his little world again!

Skewed perspective

I'm beginning to worry a bit about myself...again. I can't figure this place out. So, I'm at a university teaching hospital now for this internship and am enjoying being back in the academic atmosphere where everything becomes a chance to learn. Much improved since the other place where, while I'll admit it was not a complete waste of my time, I was very unhappy. That being clarified, I'll try to explain my dilemma.

I'm really enjoying working with the students and teaching them although I definitely defer to the senior clinicians since they know a whole lot more than I do. Thing is, though, they don't really give me much of a chance to teach. On overnights I get more opportunity but then my learning time begins to suffer (besides that I certainly wouldn't want to do continuous overnights!!! Ugggghhhhh!!!!) I also don't get much of a chance to do anything since I'm always sacrificing to let the students do then when they hand to me someone else grabs it away (i.e. the techs) almost as if they are afraid to let me do anything or I might mess it up. This is particularly difficult for a person with my completely non-traditional background. I've been out of school for 2 years, did almost a year of mixed animal private practice prior to my first internship. I am capable of pulling blood and placing IV catheters, etc. but they slap my hand away every time.

The other weird thing is that they are much more lenient on the students here than where I went to school in so many ways but the things they choose to go crazy about are just wacko. For instance: the students expect lunch every day as in to be able to go out and get something, they are given their radiology cases to work on a week in advance, they expect to leave on time every day and not be asked to stay late, they rarely have their "supplies," and the list goes on. Lunch?!?!?! IF you got it it was on the fly except on rare occasions. Our radiology cases were handed to us at 8 a.m. and we were told you have 15 minutes. Get out on time?!?!?! When did that happen? You cannot imagine the number of times I was asked "Are we stuck here until they are all done?" Whining or not having supplies??? I'm sure some people did but I would have thought you wouldn't pass the rotation. I threatened to get candy pacifiers for the last group because I was tired of telling them to stop whining.

By the way, did I mention that they get days off? Each rotation they are allowed a certain number of days off. These have to be approved, of course, but DAYS OFF!!!! I don't remember days off in vet school unless you were pretty much on death's doorstep...

I have, however, seen them go off on people about the oddest matters. Things that to me were of little or no consequence and someone is chewed out about it. An example that comes readily to mind regards myself but is very illustrative of the point. While on overnights, the rule is that you should be in ICU between 7 a.m. to 8 a.m. for case transfer matters. I stepped out one morning at 7:45 a.m. to take an emergency call (for the hospital not personal) so that I could hear better and got chewed out about it. The students get the same types of things.

Perhaps it is a type of la la land. I'm not really sure yet. Just know I feel a little as if I fell through the looking glass and am at the mad hatter's in wonderland. Still trying to figure it all out but am at least enjoying the interaction with many of the clinicians and the learning.

I'm Not Talking!

Ever get tired of being misunderstood? My reference is meant to be read in a very broad sense i.e. when you speak, when you act, or maybe just in general...any way that you can possibly be misunderstood.

I've currently decided to stop speaking. At the moment, I'm sick to death tired of saying things that are either completely ignored, taken the wrong way, misread, or repeated back to me later with an entirely different slant than was given. The easiest method I can determine to remedy this is to say nothing. Nothing at all. This could prove an entertaining prospect except that one of the senior clinicians recently expressed that it makes him uncomfortable when someone just stares at him without saying anything...

Generally speaking, I think I'm rather reserved and it floors me that when I choose to say something it is so grossly maligned. This has always been true and maybe contributes to my not saying too much. Dunno. Don't have a good answer as is true of most of my conundrums but will probably remain frustrated with the problem. Today I was set off by making a comment to a resident that I was surprised at how little cases are used in teaching here (they do topic rounds primarily, case rounds are very brief and to the point) versus where I went to school and that I had felt, as a student, I learned more from my cases than just talking about topics. She said, "But you were much more involved with your case as a student than you are as a doctor." What?!?!?!?! I don't even get the comment and I really don't think she got that I was speaking from the students' perspective and how I felt that would be beneficial for them to learn.

Rabbit trail alert! I thought we should have discussed our septic abdomen case in major detail as a learning experience but instead we pressed on with the planned topic of fracture repair. Come on, septic abdomens are ten times more interesting and don't you learn better from experience? Yesterday was good, though, because we were very busy. I love being busy and want to shoot myself when there's not much going on.

Another tangent...While I'm very proud of Can'tSpell for posting I felt that she let me down somewhat. She probably believes that the post will spare her from whatever torture I make up but it simply is not so. I asked her to post all 3 at once and to continue posting other stories and all I get is one! Will have to think of something good for her and figure out some way to carry out long distance...hmmm....

And another rabbit trail. My OCD for English is up in arms again (as usual). I noticed that the label for tongue depressors was misspelled as "tounge" and that receiving is written "recieving" on the surgery board. This must be corrected and I would have done so last night when I saw it except that I didn't leave until almost 1 a.m. and figured I deserved my 3 hours of sleep before I needed to be up and at 'em again. Today my excuse is that I forgot until after I left. Tomorrow, however, the world will be righted again.

Must go for now 'cause I have an article for journal club to read yet. Already read the good ones and am procrastinating (Me?!?! Never!!!) on the last one whose title is so scintillating I'm sure I won't be able to put it down (i.e. my eyelids will be propped open with matchsticks). In any case, can't put off any longer, we meet at 6:45 in the a.m. tomorrow for discussion.

A top ten list that we don't want to add to (AKA Pee #3)

Well all, Dr. Insane and I talk on the phone quite a bit, and the other night I was telling her about a funny that happened to me the other day. This led to the challenge of her last post, which was to tell my all time favorite "urination" stories. This is my number 3, which happened to me the other day.

I was taking the gloves/bandages off of a cat I had declawed the previous day. This cat was not a happy camper and it showed. Somehow during the resultant wrestling match somehow I got into a position where I was holding the cat's back legs one in each hand with his rear end pointed upwards. Just then he let loose a stream of urine. It hit my chin and dribbled down onto my shirt. He than proceeded to urinate on my hand a few times after that when we had changed positions. I had to change the shirt I had on and cut pieces out of my hair to keep from smelling nasty un-neutered cat urine all day (I had also neutered him the previous day and it takes a few weeks for the smell to go away). Needless to say, a shower was promptly taken upon my arrival home that day.

Pee story #2 coming soon.....

Crazy clients and Post-vet school trauma

As usual, my post will be a bit tangential with rabbit trails. I was looking at Dr. Grumpy's recent posts and was reminded of a story from New York that I had intended to share and, of course, I also feel the need to commiserate again about my rapid loss of brain cells.

It's hard to understand how someone can go through vet school, be practicing medicine and teaching but find it so hard to communicate in simple language. I worry myself on a daily basis and I'm not even the worrying type (unlike Can'tSpell). Currently, I'm driving myself crazy with the spelling of "weird." As previously spelled is, obviously, correct but I wrote it that way then began to question whether it should have been "wierd" instead. I mean if you follow the little rule "'i' before 'e' except after 'c' or when sounded as 'a' as in neighbor or weigh" it's all wrong spelled correctly!!! This has been bugging me since Friday when I titled an e-mail "Weird" (spelled correctly) then received a reply and became convinced it was wrong (you know how when you stare at a word long enough it no longer looks right??). I then had to look it up and prove to myself that it was correct. Then I kept worrying about it with the little rule above that obviously has exceptions (another being caffeine). I know, odd thing to keep one up at night isn't it? Ironically, the word facetious was included in the same e-mail but I had no problems with it or other multi-syllable words...I think vet school really does something to your mind....

Now for my story which I think you will find amusing. On my last overnight rotation in New York I was having a rather busy night with some "real" emergencies when an assistant brought back a large malamute who appeared to be the picture of good health.

"Why is he here," I asked.

"His owner is worried about a bump on his nose," my assistant replied.

In the hopes of "triaging away" something simple I went over briefly and asked to be shown the "bump." A tiny little raised lesion approximately 1mm in diameter with no signs of inflammation on the side of his muzzle where the whiskers arise (probably an ingrown hair follicle) seemed to be the source of concern.

Everything else was reasonably under control so I did a quick physical exam and saw nothing at all concerning so I quickly ran out to the waiting room to chat with the owner while I waited on diagnostics on my other cases.

There were multiple people in the waiting room, all of whom I had already spoken to besides the malamute's owner. As was often my habit in less emergent cases, I took her to a quiet corner of the waiting room rather than into an exam room to discuss what we should do. My plan was to tell her it was not of major concern, take her dog to his regular vet in the morning, and not charge her anything.

As politely as possible under the circumstances I ask, "So what prompted you to bring Sebastian in tonight? Has there been a change in the appearance of the bump or is he bothering it?"

Very matter-of-factly she says, "Oh, no. I brought him because I also have a rash and it itches!" then turned her rear toward me, pulled up her shorts exposing much more than I cared to see (in the waiting room with other people remember), and said, "See!! What do you think it is, doctor?"

I'm not really sure how I managed to refrain from saying, "How could I possibly miss seeing it?" but somehow I did and kept a reasonably straight face.

"Ma'am, I don't work on people," I replied.

"I know, but what do you think I should do about it?" she asked.

"I would advise you to see your dermatologist tomorrow and take your dog to his regular vet tomorrow," I replied.

She persisted and would not drop the subject. I decided that she had taken too much of my time not to be charged so I charged her the $140 emergency fee, wrote her some lovely discharge orders with a little fear factor involved (i.e. told her worse case scenario was that could be a mast cell tumor and that she should have her regular vet aspirate the "mass." To whomever is her regular vet, apologies. I was being honest, though, it could have been a tumor and I'm required to give all options, right?) and reiterated that she should see her own doctor!!! I got an e-mail a few days later saying she had been diagnosed with ringworm and did I test her dog for that? I, once again, had to reiterate that we had done no testing and that she should follow-up with her regular veterinarian.

Gotta love people!!!

I've threatened Can'tSpell to post her three best urination stories on here and not to wimp out on me by not telling the whole story. She promised to do so...we shall see. I may be forced into action of some kind to push her into it but it is always more difficult from long distance....

E-mails & text messaging

This post is totally non-vet related but is a quick vent for frustration.

I'm not a huge fan of e-mail and texting other than for the sheer convenience of it. The reason it annoys me??? No matter how well you may know someone and how well they know you, it is too easy for misunderstandings to occur. This morning alone I've managed to have 2 really good friends who usually get what I'm saying completely misinterpret my meaning thus requiring a second message to try to rectify the situation and probably resulting in more confusion. There's enough frustration in my life without adding more!!! This is why I completely avoid any of my usual sarcastically funny comments in e-mail unless I know someone VERY well.

On a veterinary note, I'm encouraged to learn that I'm not the only person from whom vet school slowly sucked out my brain. I hear the students on a daily basis saying the same thing I always say i.e. "Before vet school I could remember things better and it wasn't so hard to learn. Could I have developed ADD?" Misery definitely loves company;)

Hey Dr. May B. Insane.....

happy now? (she's been bugging me to post...)

Can't cure stoopid, even if it is only an honest mistake

"Hey, Dr. Can't Spell, got a min?"

"Sure, what's up?" I ask my receptionist.

"Mrs. Hypochondriac is on the phone again. She says her dog Fifi is acting strange AGAIN and is being really hyper and not eating." She rolls her eyes. Mrs. Hypo is a frequent client and there's seldom anything really wrong with her dog. She calls about once a week.

"Well, tell her to go ahead and bring her in before lunch."

"Really!?!" my receptionist asks with her eyes bugging out, "You sure you don't want to just talk to her over the phone?"

"Yes, really, " I reply patiently, "Mrs. Hypo is harmless and usually her dog's symptoms don't include not eating. " Usually not eating in an animal that lives for it's stomach is a serious sign of Something Is Not Right.

"Ok," she sighs...

Later I usher Mrs. Hypo into our exam room. She has Fifi with her, a small yappy terrier. She's typically exuberant and wags her tail when I pet her, but doesn't want to eat the treat I hold out to her. Usually I'd have to snatch my fingers away from sudden death. "So what's going on with Fifi today?"

"Well," Mrs. Hypo says, "since Sunday she's been really hyper and not herself, and she hasn't been eating well for the past few days." this was Tuesday.

"Ok," I ask, "did she eat any new food or anything strange recently?"

"Well, no," Mrs. Hypo continues, "but Sunday I did get a new box of Claritin that you told me to give her. But I've been giving her that for months and it's not done this to her!"

And, indeed, Fifi does look odd. As I've been talking to Mrs. Hypo I've been examining Fifi. Her color was good but she was a tough dehydrated. And then I looked at her eyes- they were extremely mydriatic (dilated). Last time I saw eyes like that the local pothead has left his stash out for his Labrador Retriever to eat...

I get out a penlight as I ask Mrs. Hypo, "Fifi couldn't have gotten into any strange plants or some of your medications could she?" I shine the light into Fifi's eyes with the room lights off. Nope, very sluggish to absent PLRs bilaterally. I listen to her heart and lungs- her heart rate is kinda on the low side for a small dog, about 80ish.

"Well, not that I know, " she answers as she wrings her hands. "The only new thing was that box of Claritin. The pharmacy shelf was empty so I had to get a box from behind the pharmacy counter."

A dreaded suspicion starts to bloom. "You didn't give her the Claritin-D, did you?"

A pause. "I don't know. Maybe... it was the one behind the pharmacy counter."

I look at her with dread. The only decongestants/allergy medications that are behind the pharmacy counter contain pseudoephedrine...

"How much have you been giving her?"

"A 1/2 tablet twice a day..."

Which is twice what I told her to give...........

I rush back to the back and call the pharmacy, whom confirms my worst fear; the only medication they have behind the pharmacy counter has pseudoephedrine in it. I ask how much per tab- 120 mg.

I next frantically look up pseudoephedrine on my toxicology book. I know it's bad, but I didn't know how bad until I read the words, "may cause severe hypertension at high doses and death." I frantically tell my technician to take Fifi to the back to read a blood pressure as I do some frantic math. Lethal dose can be as low as 8-10 mg/kg. Holy crap! She's been getting 22 mg/kg a day for two days....

Her blood pressure was 260!!!!! Yowzers!!! I immediately start reaching the the acepromazine injectable and give her a whopping dose. Ideally I would have hospitalized her on fluids and blood pressure lowering medications, but we're not a 24 hour facility...

She ended up surviving, but I don't really know how. Her blood pressure was over 200 for two days, than fell down into the normal range after that. A post-incident blood panel showed no lasting side effects...

Point of this post- don't give your pets anything with "D" in the name!!!

Ring tones

At my new internship we have a shared intern emergency phone that we all use when on ER duty as well as a personal cell issued to us (this means that when one is on ER you typically are carrying a minimum of 3 cell phones if you have your own personal cell; crazy!!). All doctors here as well as many of the techs also have phones. All of these phones (with very few exceptions) have the same generic AT&T ring tone because no one takes the time to change them. Since my first day here, this has made me even more insane than usual so this weekend, while on ER, I took steps to ratify the situation.

Unbeknownst to my colleagues I changed the tone of both my personal phone and the shared phone. I then handed the phone over to my internmate who is on overnights and waited for the fun to begin. I was here late dealing with a last minute case and ICU was a little bit of a circus as typical for my being around (it is all quiet when neuro/cardio guy is on - an internmate). In the midst of the insanity, I secretly dial the number on my phone and place it back in my pocket to let it ring looking completely innocent of course. Very loudly the phone begins to scream Boogie swing which is, I'll admit, a rather annoying tone.

Neuro/cardio guy nearly jumps out of his skin and starts looking around frantically for the source of the noise. He then realizes from whence it comes and grabs the phone saying that is the most annoying ring tone ever. Only then does he look at the phone and realize that I, minding my own business in the opposite corner, am the source of his call. He's now threatening to change the ring tone... I advised him to do what he wanted but I'll just change it again and may make it more annoying. That seemed a sufficient threat. I'll have to work on everyone's sense of humor around here....

Bloodletting

I now remember why I got on to post yesterday. My computer was being a pain and by the time I managed to sign in I had forgotten my purpose. It's really sad what vet school has done to my memory. BVS I could go to the store without a list and get 1000 items without forgetting anything; now, AVS, I go to the store for one item and forget why I'm in the parking lot...

Back to my story. We tried a novel but not new treatment option the other day on a problem case. We have this dog in the hospital who needed to have a carpal arthrodesis. He's had multiple complications and has a very swollen and infected foot at this point. His cephalic vein was ligated during the surgery so we decided to try using leeches to decrease the venous congestion in his foot. It was a circus in the minor procedures room. The leeches were shipped overnight in a thermos that looked very much like a container for coffee. The stubborn little boogers didn't want to come out and kept attaching to the sides of the container. We tried pouring water (distilled) in the container but were only getting 1-2 out at a time. Finally, some bright soul hit the container on the floor to dislodge the remaining critters. If leeches have ears, I'm quite certain those are now deaf!

By far, the most amusing aspect was watching people's faces. I have a tendency to stand back from the crowd and observe proceedings and this one was awesome. The leeches are snake-like yet snail-like and were swimming around faster than anyone expected. Additionally, they kept trying to exit the containers and had to be corralled. No one wanted to touch them and there was a definite squeamishness about the potential for them "biting" if picked up. Once the fear of getting them out was conquered, it became a game to place them with all of the senior clinicians present getting in on the act. I really cannot do justice to the circus-like atmosphere but I was doubled over in laughter much of the time. The good news is that the foot/leg seems to be improving. Are the leeches responsible or just time??? Don't really know but something is working.

I should post a copy of the description of medical leeches encouraging purchase. It sounds like an old-fashioned snake oil salesman's pitch. Cures male and female sterility and gout amongst other things. Interestingly, there is an actual scientific paper out there about the benefits of therapy. And yes, they do actually sell medical grade leeches which are guaranteed not to spread disease but should not be re-used. We decided to keep our leeches and name them after various faculty members. They apparently can go anywhere from 50 days to a whole year between feeding and are hardy little creatures living up to 10 years. We felt that they had done a good deed for the betterment of a fellow creature so they did not deserve to die...now the fun of picking names begins (evil laugh).

Tidbits

Being back in the university setting as an intern has offered new, unexpected challenges. It has been difficult for me to become accustomed to students who are not motivated. As a student, I was extremely OCD and enjoyed having multiple cases. I probably drove clinicians crazy with my compulsion to be completely in the loop and have some "say" in the decision making process. I find it difficult to comprehend those students that whine "Oh dear, I have two whole cases and can't keep up with either!!!" There are so many of them that just don't even seem to appreciate what they are doing. On the other hand, of course, are those that are truly a pleasure to work with; they take wonderful care of their cases, don't complain, and work very hard. It is impossible not to have favorites with this situation...

Interestingly and unexpectedly, I am thoroughly enjoying teaching. Did not think that I would... The other challenge is the multitude of egos. The egos are much easier to deal with here than they were in New York, though!

Seeing some interesting cases which brings me to a "public service announcement" as dear friend Can'tSpell likes to say. Please, please, please do not feed your dog bones!!!! I know, it seems natural and normal but you don't realize what trouble can be caused. We had to remove a bone from the caudal esophagus of a little dog the other day that had been there for 2 weeks. It was fed on purpose and the owners put off treatment thinking the problem would go away. We had to open the abdomen and thorax, access the esophagus through the thorax incision. There were perforations in the esophagus and it was partially necrotic. We chose not to do a resection / anastomosis but to remove the bone and place a feeding tube to bypass the area and allow it to heal. The dog is currently septic (bacteria in bloodstream) although she seems to be improving a little but she is definitely not out of the woods!! So now the owners are left with $1000's invested and not even sure yet if the little dog will survive all for the sake of a bone.

I am very pleased to have my cats with me again. They have finally decided that it is safe to come out of the bedroom and into the rest of the house. Watching them learn to interact with the dogs again is quite amusing and they have toys strewn throughout the house. Last night, they stole my watch off the counter, as if there aren't enough toys!! The dogs are also happier; they are playing again and not so grumpy.

Speaking of grumpy, I'm a little less so myself now since I am no longer on the vampire duty. Don't find myself craving blood so much now that I'm awake in daylight. Funniest part is that I rarely sleep any more hours than I did during the day but feel so much more rested. I am not a night person but definitely prefer the early a.m.

Unfortunately, I don't have any wonderfully amusing stories to share but thought it might be a good time to catch up a little. Can't Spell hasn't done a good job keeping posts up lately although I know she has some amusing stories to share. Maybe I'll have something better soon.

Time to resurface

Fuzzy Buddy Before After - A Different Dog

So it's been a while and I'm sure all of you wonderful people have been wondering how things turned out in my crazy life [as if you don't have your own crazy life to worry about;)] It's been just a tiny bit hectic of late with moving and starting a new internship. My move involved going South (home), picking up my crew of cats then heading west. I managed, somehow, to get here on time, find a place to live prior to having to start that actually allowed my pets, and even catch up on about 95% of the things that were screaming for my attention at home.

I have only just managed to cut my poodle's hair, however, and still have not gotten the Bichon. If the pictures work appropriately, I thought you all might enjoy seeing the before and after transformation; it still amuses me. Yes, veterinarian's pets do tend to follow the cobbler's children rule of thumb.

To be out of New York and back in civilization is wonderful. People are much more sane here and it's lovely to have room around me and not feel that need for a permanent hula hoop around my waist to keep people out of my personal space. The kids are happy too and demonstrate that by playing more than I've seen them do in over a year. So far, the new internship is going well. I started on overnights so am on the crazy graveyard shift at the moment. The first night was very busy, of course, since I was still unfamiliar with the computer system, etc. Since then it has not been as intense and has allowed me time to get my feet under me again.

I'm enjoying most of the people. The senior clinicians are fun (at least the ones that I have met so far) and I'm really enjoying working with the students. This surprised me since I did not think I would like the teaching part. It amuses me to no end that I have a faculty license and have to sign off on all kinds of things...they put that much power in my hands and let me loose on the world? Frightening thought isn't it? My intern mates are wonderful and we get along well; they have all impressed me a lot. Ironically, the only group that has been any problem so far is the residents. Why do we all get so competitive that we have to put others down to feel better about ourselves? I dunno, I've always kinda lived by the idea that I am what I am and there's no reason to pretend that I'm better than that; take it or leave it. Would be a lot simpler if others would do the same instead of pretending they are always right and never make mistakes.

Overall, the change has been good and I'm rather looking forward to what the year will bring. The big question is how long this will be true...hmmmmmm.....

July is here!

Hi all- sorry it's been a while. July is here and as a public service announcent please keep your pets cool!

More soapboxes

Sorry guys, been a little boring around here lately! In a bad way- no clients! Apparently, June has some graduations or something in it... :) So I have to once again go up on my soapbox and rant about stupid things...

1) If you sell puppies and you have a history of Parvo being on your property, don't sell puppies anymore.
2) A poodle/yorkie mix is a MUTT and is not really worth $450, even if it is cute. If you want a MUTT/Mixed breed dog, go to a shelter.
3) And definitely don't BREED those MUTTS and sell them for $450 if you have PARVO on your property!!!!!

So elderly couple come in this morning with a puppy from a local well known nasty pet store/puppy mill, er, pet store, that they bought last night. It wasn't very active when they bought it, but the owner told them, "Oh, this floor is just slippery." It starts having diarrhea and vomiting last evening and by this morning when I saw it he could barely stand up. Raging positive on the parvo test.

So this puppy was sick when she sold it. It was already weak and, since the incubation period for parvo is a longer than 24 hours, it definitely got Parvo at her place.

So a nice elderly couple have to take the puppy they've kinda gotten attached to back to place they got it from trying to get their money back. I just hope and pray that the person who owns that establishment (I can think of so many other words for it) has her own vet to take the poor thing to. I hate this place. I'd LOVE to see the Department of Ag shut it down!!!

I just saw a cool case as well. A presumptive Diskospondylitis (I wasn't able to do blood cultures). I've never seen one in practice before, so that was kinda cool. Cool things are fun!

Ramblings of an insane veterinarian

Not going to rant your kind ears off this time although to quote an old favorite movie of mine, "The situation has not improved..." First, thanks to all for the kind and encouraging words regarding "Rantings..." I appreciate hearing from you. This post is started to give an update 'cause I FINALLY (now that the internship is almost over) managed to do a couple of the "touristy" things I've been wanting to do.

One of the techs took me to the Metropolitan museum last Wednesday. We barely scratched the surface of all the wonderful things there are to see. The day started with me wandering slowly, in awe, from room to room and gazing at each individual object. It's impossible to go through in a logical and orderly manner, by the way, I think they have deliberately designed the place to make you miss things. I developed a distinct fondness for an Egyptian wooden whip handle carved to look like a horse and really enjoyed the wooden dog with real teeth and tongue that opened his mouth when manipulated. As the day went on, suddenly it was announced they were closing in 20 minutes!!! What happened to the time?? We had not even made it to the second floor due to my gawking!! The 20 minutes became a mad rush practically running from room to room to see some of the "favorites" that we had not seen and, of course, the way out when official closure was announced was the long way to see yet more. You really need a couple of days to see the whole thing if not more. This is a reason to visit NYC, for those of you who have not. Doubtful that I will manage to steal time to get back before I leave but that, coupled with a few really good friends I've made while here, actually gives me an incentive to visit again (never thought I'd say that!)

Yesterday, one of the original intern group that I started with who did not get to finish due to crazy red-tape mumbo-jumbo took me to the Statue of Liberty and Ellis Island. This is also a must see. It is amazing and awe-inspiring. Did I mention that I'm proud to be American? Don't claim that we've always been right and never did stupid things but I love our country. It worked out really well since she had to go to work that evening we left early, rode the ferry to the Statue and walked around for a while. Found out that you have to get tickets 2 weeks in advance in order to go inside and since our plans had been hatched the night before around 11p.m. that was out of the question. We then rode to Ellis Island and poked around the museum until she had to go. All admission is free but you do have to pay passage out ($12, I think). I would strongly encourage you to visit there as well; it was mind-boggling to get a glimpse of the past and imagine what the immigrants must have seen and felt. Someday, I hope to return when I can plan in advance and go inside up to the crown (which I think is opening again in July this year).

I was afterwards abandoned to navigate the crazy public transportation system alone and get back to where I needed to be. I'm not fond of public transportation; suppose it's a good idea but I'm very attached to my car and the independence it affords. I'm sure it won't surprise those who know me well when I say I don't enjoy being at the mercy of others. Found my way safely back, very exhausted and promptly collapsed into sleep rather than working on packing and cleaning the apartment like I should be doing. Especially since my crazy landlady is at it again demanding a rent check when our agreement said that my deposit covers the last month's rent and she has already received notice...If I pay, I'll never see my deposit because I know she'll find some excuse to keep it and I can't afford that with moving expenses.

Couple of other things to ramble about then I shall shut up and go back to bed since I'm on overnight tonight. I really don't like feeling as if I cannot trust anybody. I've always been a bit of a reserved person and it takes a while for me to open up to anyone but, with the exception of a tiny handful, there is no one here that I can trust. One of the overnight techs has made a weird comment a couple of shifts in a row asking if "we have anything for a migraine." I've told him more than once we only have ibuprofen in pharmacy for human use and my suspicious, cynical little mind thinks he's hinting for something to the point that I'm uncomfortable handing him a prescription of tramadol to hand to an owner. (I'm the only person on overnights with pharmacy access). Additionally, I feel that I have to be really careful what I say in front of anyone because it is likely to get reported with a different slant than how it was said. I'm usually pretty tight-lipped but it's actually harder for me on overnights because with exhaustion comes delirium and a tendency to lose some of my typical filter. Why can't people just treat each other how they want to be treated and not be such back stabbers?

The other interesting, and disturbing, phenomenon that has disrupted my life of late is weird dreams. They are most likely a product of too little sleep, too much stress, and too much to do but I have had dreams and premonitions in the past that have come true and these just won't stop. They all involve a particular friend and they haven't typically been really bad, just mostly a feeling that I am needed to help for some reason. Except that last night I dreamed of death. Which is one reason I'm still awake at the moment. They've all been disturbing enough to wake me and make it difficult to go back to sleep for a little while so I have to get up and do something to shake off the stress. I've contacted the friend and been advised everything is fine and I don't want to keep pestering but I can't help but be concerned. And this from a person who is usually very nonchalant moving through life and does not tend to worry.

My last comment is that I've seen an awful lot of cases of late that have a very simple diagnosis; AFU, pronounced A-foo in my world. We all know what this means and it appears in a variety of guises from congestive heart failure to renal failure (or combo) to atresia ani in a 100 gram kitten... Really stinks when you get on these types of runs but what blows to me is when some of the doctors are not honest enough with the owners to bluntly (but kindly) tell them the real prognosis. If an owner chooses to go ahead and attempt treatment with that knowledge, that's one thing but if they are not adequately informed, I feel that we are being criminal. At least in veterinary medicine we do have the option of "humane euthanasia." Don't know that I advocate it in human medicine because my cynicism says that it would be horribly abused (just as it is all too often in vetmed) but there are times that I am definitely thankful for the option--much as I hate that part of my job (I'm always in tears and usually a wreck unless something requires my immediate professional attention).

I think that is all that I will say for now since I really need to go back to bed. Four more overnights in a row then one more in a couple of weeks and that's all! Change rotations Monday and that will be my last 3 week rotation. I just keep telling myself I can do this but I keep thinking of an old country-western song where the cowboy is traveling through a blizzard and dies at the end "only 100 yards to MaryAnn's..."