Saturday, February 28, 2009

Vicious rumors

I cannot believe that my dear, sweet, lovely friend would say such things about me. Who would believe that such an innocent soul as myself would do the things she accuses me of so freely? It disappoints me. I can't help it that all she ever did to me was saran wrap my car once while my own escapades far overshadowed that incident (which was completely negligible I might add)...

Vet school was difficult but we had a lot of fun, especially the last year when we were on clinical rotations. I spent a lot of time trying to talk Can'tSpell into helping with my scathingly brilliant schemes like decorating our favorite teacher's office on graduation day or posting anonymous cartoons and such. There are definitely times that I miss school since it's hard to find people to share my weird sense of humor.

Tonight, however, the overnight crew just pulled a superb prank--their idea with my blessing. We are unusually slow with ABSOLUTELY NOTHING in ICU. So when the shift change was coming, we set up the crash table with a dummy and pretended that it was there in critical condition while we all ignored it. One of the assistants got into an empty cage which we covered with a blanket and posted caution notices and ran a fluid line in then proceeded to make angry cat noises. To help, the clinic cat who we routinely joke has the job of escorting dying souls to heaven because of her habit of showing up in ICU when an animal arrests actually came to see what was happening. It was a beautiful effort that would have only been improved if the next shift had been a more excitable group.

I hope that the night of Saturday March 14 is this slow because I may actually be able to sleep prior to driving!! I doubt I'll be that lucky, though, since this is the slowest night I've ever had since being here. Still looking forward to my great escape and waiting with baited breath to see if I actually pull it off. The story I alluded to earlier, by the way, is called "The Torture by Hope." If interested, just google it and a full text is available.

Guess I'll go away for now and maybe take a nap or search for some heavy-duty caffeine since my eyes are in need of matchsticks to keep them open. Only 18 weeks to go for this internship insanity...

This is why...

This is why I KNOW Dr. May B. Insane will torture me when she's staying with me for a week. And this was done to somebody we LIKE.

Friday, February 27, 2009


I'm getting near the end of my rotating internship (insanity) and will find out on Monday if I matched for a residency (craziness). I've been away (way away) from my home for a long time now and I feel the anticipation of going back growing now that I'm past the half-way mark. Even better is the fact that my specialty rotation is fast approaching and I have plans to get away for a while; yes, I'll still be working but sometimes just away is a vacation. I'm only worried that they will pull the rug from under my feet when I least expect it and I will find all of my anticipation is for naught i.e. I'm afraid they'll suddenly change my schedule again and prevent my escape. Only when I'm on the road speeding away from here will I breathe a true sigh of relief.

Everyone is convinced I'm crazy because I've already started packing my car for the trip. I'm on overnights and don't have much time and the trip is only 2.5 weeks away (sounds good as an excuse doesn't it?) I've also determined that since I'll only have 13 weeks left when I get back (yes, I could also bore you with the days and maybe even the hours if you wanted) that there are some things with which I can do without for the remainder of the internship. These things are being packed as well. As further proof of my insanity, I'm seriously considering taking my children (read fuzzy four-legged) with me to work on my last overnight (a 16 hour shift) and hitting the road immediately after rounds for the 18 hour drive home. Yes, I know it's crazy but that just shows how much I need to be home for a little while!!!

At the moment, I keep thinking of that short story (although I cannot remember the name at the moment) where part of the torture is the hope of escape. Just when the main character thinks he has succeeded, he is stopped and realizes that his captors have been using hope to torture him. Perhaps I am over-dramatizing but that is my current perspective.

I get to visit Can'tSpell during this time also since she is being kind enough to host me during one week of my rotation and we are going to a tiny little restaurant that serves the best steak I've ever tasted in my life. NO, I will not reveal where it is because then people might discover it and ruin the whole place. It is in the middle of nowhere and beats the steak in the big city any day. For some reason she seems to have the strange idea that I will somehow torture her during that time with a practical joke...just can't figure out what makes her think such things.

Looking forward to my escape and running away as fast as I can;)

Wednesday, February 25, 2009

Oh the joys of (almost) spring

Sorry about the lack of posts lately, I've actually been sorta busy DOING my day job. It's kinda funny, one day I'll have nothing to do and the next will be busy, than nothing again. I've had a lot of leg work lately, making calls and running down specialists on the phone. I have a couple of neat cases to tell you about but it'll have to wait until I have time to type them out. Hope everybody is doing ok!

Wednesday, February 18, 2009


I'm bored. There, I've said it, lightening can now strike me dead and I can see twelve long internal medicine cases in two hours. Monday was awesome, three surgeries and enough appointments to keep me from sitting at the computer for most of the day. That's the kind of day I like- a busy one. However, between the winter blues of slowness, today's dreary drizzle/rain/show event, and the economy, today is a total bust. It's kinda been like this all winter, but the last week was looking up. Then today. We'll see if it continues. Nothing new to report, get to watch the equine dentists do a float next week. I could do it if I had the equipment, but they are certified, have better equipment, and do it much much faster with more experience. Plus I hate to float teeth.

Thursday, February 12, 2009

This just takes the cake

First, I must apologize for the non-veterinary related post. It's just that some of the information contained in this article really yanked my chain.

I'm sorry, but the oil producers, who posted record profits again in 2008 are robbing Peter to pay themselves. In case you haven't noticed, gas prices are rising in spite of the nearly 5-year record low of crude prices. You'd think these low crude prices would cause gas prices to go down, right? Nope. Refiners are "trying to match supply to demand" by CUTTING PRODUCTION. This, of course, causes gas prices to go up, because there is less supply. If you read toward the end of the above linked article, there is a line or two about refiners trying to keep their [refineries] margins about the same as before, meaning that they want the same profit they've come to expect over the last year or two.

I'm sorry POS Big Oil companies, but when our country is in a severe recession, we have record unemployment, and it would be nice to save a little bit of money at the pump while driving around to put in applications trying to find a job, you are SCREWING us just like always. It would be nice if we could simply choose not to use your product. Unfortunately, you have us by the (in my case figurative) balls and you know it. So I have to vent on this blog (again, sorry for the non-veterinary post) and scheme of ways to turn vegetable oil into gasoline.

Wednesday, February 11, 2009

Things that make you go ahhhhhhh......

"All right, you ready?"

"Yeah," my technician answers. She takes an unfolded towel and holds it up between her and the incision area.

I take my scalpel and poise it over the turgid skin. With one bold slice, I poke through the skin and slice downward. Blood gushes out and runs all over the surface, pouring down into the towel we had pre-positioned. I squeeze all the blood out, swab out the interior with a gauze sponge, and start to suture. I had a large, silly smile on my face.

This morning I did a surgery I love to do- I fixed an aural hematoma. When dogs get ear infections (due to lots of causes, more on that in the future) they shake their head. With me so far? When they shake their head really hard, sometimes the blood vessels between the layers of the ear break, causing the ear to swell up like a balloon. This condition is pretty painful, and usually requires surgical correction. There are about twelve billion ways to surgically fix this, and most of them work as well as the other. I just like doing the surgery.

Reason being, I love to pop pimples, pick scabs, and otherwise pop gooey things. Like abscesses. Aural hematomas are just fun. Messy, yes. Almost instantly satisfying, sometimes with impressive gushes of blood or sprays across the room. And something that is one of those surgeries that just makes your morning. Dr. May B. Insane may raz on me later for this- she's at a specialty hospital and so doesn't get to do these fun neat things at all right now. Maybe soon, my friend. Until then, I get them all!!!! Nah nah nah ne boo boo.

Tuesday, February 10, 2009

Cautiously optimistic...

Occasionally we actually win a battle that we never thought we could and realize that it's important not to give up too soon...

Case in point: Five year old, spayed female, domestic shorthair cat presented to the emergency service almost one week ago. She had lost a lot of weight and wasn't eating well. This was a classic case of certain specialists becoming too cocky;) After the initial work-up, the conviction was that the cat had lymphoma (a common type of cancer in cats) and she was given a single dose of a mild chemotherapy drug. Dum, dum, dum, dum...yep, you guessed it; when we got the rest of the diagnostics back, not only did she not have lymphoma but she had a raging infection of some unknown bacteria and clinically was really circling the drain. (I'm sure the steroid dose really helped that...)

I have developed a variety of speeches that make communication with owners who are dealing with the potential loss of a pet easier for myself because it's one of the hardest parts of my job. There are three distinct levels of my speeches, one being the least pessimistic, three the worst. I had actually reached level two with this owner and was preparing her for the worst since the little one seemed to be getting worse and worse; almost wasting away before my eyes.

On a hunch, we added yet another antibiotic to her treatment. It was actually a bad hunch of a nasty disease that is difficult to treat, namely feline tuberculosis. To the amazement of everyone, by little tiny baby steps, she began to improve. And finally, when we had almost given up after no growth reports on our culture, we have growth of a treatable bacteria!!!!!

Definitely, we are not out of the woods since she could certainly get worse suddenly or have another infection not yet identified but I am actually encouraged and hopeful for the first time that she may actually live and go home... Good reason to not give up too soon because we almost did and she is proving us wrong. Keep it up, little one, I want you to go home!

Thursday, February 5, 2009

Now here's something we'll all like...

Some of you older (read, my age(oh, that's right, I've never really told my age)) readers will catch my title's reference to Rocky and Bullwinkle. That was the phrase Rocky always said before another cartoon played. Just thought I'd share some of the more entertaining foibles of the last couple of weeks.

You know you're in veterinary medicine if:

... the client calls and says he wants his dog "pressed and dried" (groomed).
... you look at the world through a haze of fecals and blood films.
... you dress with the possibility of getting blood/anal glands/urine/vomit on your clothes.
... you keep a change of clothes at work.
... your workplace has a shower in the bathroom.
... you use words like "emasculate" and "castrate" in everyday conversations.
... you look at a tomato/mayo mixture and see abscess goo.
... the oil slick at the gas station looks like an abdominal radiograph with an obstructive pattern.
... you routinely go around sticking your arm up rectums.

That's a beginning anyway. You other veterinary types that read this blog (I know you're out there) feel free to chime in on the comments. Also, for those of you veterinary types who commented on my bald cat, I know it's probably stress/psychosomatic but haven't gotten around to medicating her yet. Also, she's SOOOOOOOOO much fun to chase down for BID meds....

Sad truths

Dr. May B. Insane's previous post reflects the frustration we shared during a phone call the other night. Not only are people stupid, but sometimes the member's of one's own profession are stupid as well. For the most part we assume a certain amount of professional competence from out colleagues. After all, they went through the same training and had to pass the same board exams as we did. However, as with MDs, not all vets are created equal. My goal is to be sure to at the VERY least, be one of the ones who TRY.

Wednesday, February 4, 2009

Lucky - Not so much

I'll apologize in advance that my first guest post is not funny or particularly happy. Typically my stock in trade is a scathingly sarcastic sense of humor from which nothing is considered sacred and for which I've gotten into trouble (or should have had I been caught) more times than I can count. Considering, however, that my personal life of late has been really crappy and that my patients lately have been mirroring what happened to some of my own children, it's been rather difficult to have a humorous outlook.

If you are a veterinarian or know anyone who is, you'll soon discover that we are, by nature, a somewhat superstitious lot of people. There are certain things that are just taboo. For instance, never ever ever say 30 minutes to 1 hour before closing time or the end of your shift "Gosh, it's been really slow today." Never say a surgery will be quick and easy until it's over. Never bet on what a client will decide. There are many of these taboos but probably the most universally known is that no one should ever name their pet "Lucky!" You have just doomed your pet to something horrible. We don't know what but, rest assured, it will be bad. So, for all you people reading who have a "Lucky" at home, please, I beg of you, change the poor soul's name immediately to something nice and healthy like George or Fido or Bouncer--ANYTHING BUT LUCKY!!!!!

There are those cases that we see on occasion (all too often for me recently) for which we realize we can do absolutely nothing. I despise having to admit this because I like to believe that I am a superhero veterinarian who can right wrongs, change the world, and cure all ills but there are those that, to put it bluntly, are A*F*U or F*U*B*A*R. If ever those acronyms appear in your head as a differential diagnosis, you know it's bad.

Case in point that prompted this post...A 17 or 18 year old mixed breed dog that we saw on the medicine service as a consult. (I have a particular weakness for geriatrics, by the way.) Her owner was so frustrated because he had seen his rDVM previously and the rDVM never even touched his dog simply saying it is time to euthanize. He then took her to a specialty hospital who performed a metastatic screening series of her thorax (when you see an old dog that is sick you always have to think of "the big C," cancer, and rule out metastasis early in the game because it really changes the prognosis you can offer) and radiographs of her abdomen. They found no evidence of metastasis but there was what appeared to be a mass in her abdomen (I say appeared because I personally saw these films and would not have made a definitive diagnosis based on them but would have done better quality films first). Their next step was to tell the owner that he could either do the whole 900 yards (i.e. ultrasound, bloodwork, surgery) or do nothing and that surgery was the only possible way of reaching a definitive diagnosis.

So, I'll now back up a little and describe what I assessed. I was speaking to an owner who obviously loved his dog dearly and told me that if euthanasia was the best thing for her, he would make that decision but he was unwilling to do so if he could not make an informed decision - that seemed imminently reasonable to me. Lucky was unable to stand at the time of examination. She had a history of weakness in her hind legs but until 10-14 days prior had been walking unassisted except for going up and down stairs. She had been battling diarrhea for 6-8 weeks which was not being treated appropriately nor had any diagnostics been done to determine a cause. She had a large mass on her face arising from the medial canthus of her right eye that was pedunculated and beginning to bleed at times; her rDVM had refused to remove this mass over 2 years before because did not want to anesthetize the dog but had no reason other than age. She also had a history of suspected Cushing's disease that was supported by previous bloodwork and clinical signs. Her abdomen was distended but not fluid filled, her liver was large with rounded edges, and there was a mass palpable in the cranial abdomen but because of her size I could do little more than touch the edge without really being able to appreciate from where it arose or the actual size. She had generalized scales and patchy alopecia with a classic "Rat's tail." Her right front leg was moderately edematous from the shoulder to the paw. Yes, A*F*U went through my mind but I would have been the same in wanting to know why I was making a decision before making such a permanent decision.

We wound up doing an abdominal ultrasound and determined that Lucky had an adrenal tumor that was already beginning to invade the caudal vena cava (large vein that drains blood from the back portion of the body taking it back to the heart.) Removal of an adrenal tumor is not an easy surgery in a completely healthy dog and prognosis is considered approximately 50% of coming off the surgery table alive. Additionally, Lucky had a large left adrenal gland, multiple nodules in her extremely large liver, and a bladder mass that may have been benign based on location but we don't really know without a sample. Due to the poor prognosis and huge risk, we did not attempt ultrasound guided aspiration of the tumor. Obviously we could not offer any definitive treatment or any hope for long term survival. We did, however, help the man to know what exactly he had to face. We also were able to offer some palliation for the diarrhea and pain. And our alternative medicine doctor offered some homeopathic remedies that may help with quality of life. Her owner, like everyone including myself, hopes that she will die peacefully in her sleep at home without the necessity of euthanasia but I think we also set his mind at ease about that decision should he need to make it.

It was a very depressing consultation but I did walk away feeling as if we made some little bit of difference. At least it did not end in euthanasia immediately because I don't know if I could have dealt with another. I'm currently so emotionally drained that I did my first ever euthanasia without crying - very atypical of me. I believe that Lucky's owner will know when it is time and I hope that we gave him the information and assurance he needs to be able to make the decision when it is needed. Hate to criticize my colleagues but where has the compassion gone? It is not that difficult to feel what your clients feel and try to help them in a difficult time. And, yes, sometimes that includes advising them that it is time to stop; but, I ask of my colleagues, would you be comfortable ending a life when the doctor never even touched your pet?

So, if I have gained anything from this depressing post, I hope I have convinced anyone who reads it to never name your pet Lucky. Only a "Lucky" would wind up with both pituitary dependent Cushing's and an adrenal tumor. I could tell many other horror stories about not so lucky, Luckys; so I leave today with the ultimate message of please change your pet's names!

Monday, February 2, 2009

Waiting for the other shoe to drop

A friend of mine has had painful personal experience lately on the rule of three: when two of the same thing happens, a third usually occurs. Recent personal experiences of this include not having any patients hospitalized for months, than the week before last having THREE cats in the hosp all on fluids at once! Last year and this I've had THREE cats with lower mandible (jaw) osteosarcomas (a not-nice bone tumor). Or the three suspected Lepto cases together... or the three Parvos. So today I've already euthanized two dogs for various reasons. None that I really liked (not many GOOD reasons for euthanasia) but both reasons I can respect. We have no more appointments for this afternoon, so I'm wondering who/what the third for the day will be..........

Kinda scary.


Wow, declare that people are stupid and lots of people comment! :) Which we all knew, anyway. I see that Dr. May B. Insane has at least gotten around to signing into the blog, although she has yet to post. (Now she'll come and toilet paper my living room.) Not much going on here today, just same 'ole same 'ole. Vaccines, derm, vaccines, derm, derm, derm, derm. I feel like I have a pretty good grounding in derm, I learned a lot in school and I have fairly good luck with it in practice. Doesn't help though when I can't figure out why my own cat is licking herself bald (non-steroid responsive, DTM neg, food trial neg, I STILL think she is grooming...). Hope you all have a good week, I'll try to post a funny story next.