Wednesday, August 26, 2009

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.....

Sunday, August 23, 2009

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....

Friday, August 21, 2009

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;)

Tuesday, August 18, 2009

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....

Saturday, August 15, 2009


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 the fun of picking names begins (evil laugh).

Friday, August 14, 2009


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.