Thursday, August 25, 2011


The weather here, like almost everywhere else, is miserable. We've gone from being 110 in the shade due to the humidity to only 95 or so because it is now so dry. (Sadly, the Da-Chi Terror, Scout, is insistent on a T-shirt now because he gets cold if it's less than 100 in the shade.) Because of the extreme dryness, we will likely not really have fall colors because the leaves have gone from green to brown and withered in a matter of a few days. Everything is searching for water... Everything includes the mice.

We live in the country therefore there are plenty of rodents. Typically, having cats and dogs about deters them mostly with only an occasional daring one trying to come inside. Not so right now. We are being invaded!!!

Tonight, I was preparing for bed and walked out of the bathroom only to see a mouse running across the kitchen counter. THE KITCHEN COUNTER!!

Of course, mother has to have canisters and such, the counter can't be clean. I grabbed the nearest weighty object and started hitting at the mouse who darted behind canisters and other miscellaneous items, easily avoiding my blows as I became more and more angry. I'm not afraid of mice but they do tend to startle one with their quickness and I WILL NOT stand for sharing my home with them, ESPECIALLY THE KITCHEN! Needless to say, it got away for all my attempts at killing it so now I'm on a rampage, cleaning off the counter and making plans for death traps. The mice must go!

It reminded me of the scene at the first of the movie Ratatouille where the old lady brings out the shotgun and blows her house to pieces trying to kill the mouse. Had there been a gun handy, we might be in the same predicament...

It also made me think about a subject I meant to post on months ago. Another thanks to Walt Disney, et al, so to speak. Ever wonder if those cartoons that we grew up with are one reason there are so many people unreasonably prejudiced against cats? Think about it, Sylvester, Tom, all the cats in The American Tail, Cinderella, Lady and the Tramp, etc. were all villains. The bird and the mice were the heroes and the poor oppressed underdog. And in Ratatouille, the mouse cooks IN THE KITCHEN! Hmmmmm..... Makes you wonder, doesn't it? Now, I must go round up some of the gang of cats and allow them in the kitchen tonight for a light snack. Here kitty, kitty, kitty.....

What did I do to deserve this?

Diane is a very extroverted older lady who used to work as our receptionist. The clients adored her. We loved her too except that she drove us bananas on a daily basis. She apparently did not ever learn her abc's, charts seemed to be filed at random and could never be found easily (obviously since they were not where they should have been.) Messages were taken and promptly forgotten hence people did not get called back, medicines did not get filled, etc. People who had left multiple animals to board often only got charged for one or, alternately, got charged multiple times for a single animal because she paid no attention to the fact that charges were already entered. Charges were often entered in duplicate, on the wrong pet, or not at all... She was very opinionated and butted in all the time on medical decisions about which she did not have enough knowledge to intervene but was very persuasive to the clients thus really undermining our recommendations. She often took in patients and promised faithfully that we would do some extra service but never told anyone else hence it was not done or stated that she would do it "at lunch" then disappeared for 2 hours at lunch and it never got done. Other than that, she was great. In all seriousness, her personality was her outstanding trait because she was so easy for the clients to interact with and connected well with them. Needless to say, there was a collective sigh of relief (under our breath, of course) when she retired.

Now we have three "kids," as I refer to them, because they are so immature. All three have worked the receptionist position a little although one is now completely banned from the front. Although our entire bank of charts were purged and re-filed in correct alphabetical order, charts are still found randomly filed. Either the phonetics system is really failing in teaching abc's and spelling or Diane is secretly coming in at night just to mess with our minds.

(As an aside, I must relate the recent event when my tongue got away with a horribly sarcastic comment that I probably should not have made. The girl that works up front the most cannot spell worse than Can'tSpell. There have been various "interesting" ways that words are spelled by her and, often enough, it is difficult to decipher what she is trying to say. She is taking undergraduate courses at a local community college and was complaining one day about how difficult it was specifically stating she was soooo glad that she had not taken a particular course because, gasp, the teacher gave essay questions rather than multiple choice!! I'm glad she has decided against vet school... I commented that I would always prefer essay in part because I was better at explaining what I know and that I second guess multiple choice / true - false to the point that I usually miss them plus that wonderful thing known as partial credit if you know most but don't remember portions exactly. "But," she wailed, "they count off for spelling!!!" "Yeah, that would be a problem for YOU..." was my reply. I know, not nice. Now back to the story.)

Messages still do not get relayed or, if they do, somehow I get stuck being the one to pull the chart because, no, we do not remember the details of every single patient we see every day for the past several years even though they have all been told REPEATEDLY to pull the chart when taking the message. Clients are told that things will be done but we may or may not even be told that the pet is in the hospital. Charges are put under the wrong pet, multiple times, or not at all. Charges from the wrong date are entered again as new charges. Medications fail to go home with the pet. Instructions fail to go home with the pet. Neither doctor nor our tech is told when a patient goes home with whose owner we need to speak. All are very opinionated and will tell clients what they think, try to give advice but none have real medical training; the only good thing is that the clients are not as charmed by them as they were Diane. Hmmmm...... Does this sound familiar? Now, somehow, we have the same problem but it's in TRIPLICATE!!!!!!!!!

Monday, August 22, 2011

"All Fed Up With Stupid" & Other Complaints

One of the employees pulls out that quote along with "Put your big girl panties on and deal with it" on an almost daily basis with good reason. Right now I am very much "all fed up with stupid." Couple of composite stories to give you an idea:

Lady with a Pekingese with atopy comes in and wants to euthanize the dog stating "I've tried everything and she's no better!!!" I look in the chart and see that the first time we evaluated the dog was 3 months prior at which time the dog was in really bad shape; I examine the dog and see that the skin is dramatically improved with new, healthy hair growth and no active lesions. I question the owner who states the dog had "chewed herself raw and made a hot spot the night before." Really? Where? She can't show me. I ask if she has tried antihistamines, omega fatty acid supplementation, flea prevention, medicated baths, hypoallergenic diet...etc. The answer to everything is no yet she wails again, "I've tried everything!!!" Check.

Enter another lady who actually volunteered at the clinic for a short time when she was going through the online vet tech course and trying to do her clinical hours with us until she dropped out of the course, "My old dog can't move one of his hind legs!! What do I do???" Side note, I examined the dog about 2 months ago and found that he had back pain and an old CCL rupture evidenced by a huge medial buttress; at the time, I talked to her about pain control, massage, exercise recommendations, etc. and had prescribed Tramadol as a daily medication and, reluctantly, allowed her to continue using aspirin instead of sending a different NSAID for bad days. When she arrived with the dog, he was significantly lame on the hind leg with the buttressing but could move the leg. Because of it, it was difficult for him to rise, particularly on a slick floor. She finally admitted the dog had played rougher than usual 2 days before and that she had not been giving the tramadol as directed, only giving a 50mg tablet once daily because "I've been prescribed it before and 1 tablet knocks me out; I couldn't give him as much as you recommended!" (He's a 75 pound dog, by the way.) I read her the riot act. She was considering euthanasia because "there was nothing else to do." In less than 5 minutes, I had listed over 20 alternatives to make the dog more comfortable. I advised that ultimately, yes, it would be up to her what was acceptable and what not but that there were many alternatives at this stage to help the dog depending on how much she was willing to do...

People!! It brings me back to a personality trait of mine that makes me crazy most of the time. Responsibility is an interesting concept. I think there are 3 basic levels. 1) The crazy hyper-responsible people like me who take blame for things that cannot possibly be their fault, 2) the mid-range people who are probably the most healthy of the groups taking responsibility when it is theirs but not accepting blame for things that are not their fault or beyond their control, and 3) those that shirk all responsibility, blaming everyone else for their decisions and mistakes.

I don't know why I'm so hyper-responsible. Most of the people that have that trait that I have met were tossed heaping helpings of responsibility at a very young age. Maybe that is the reason; we started being responsible so young it is hard not to take it for everything... I don't know, I just know it contributes highly to my general insanity and is one of the major reasons that I can be manipulated by guilt. I was worse before but have at least learned to recognize the manipulation better now and can force myself to stand against it but it is really difficult because the whole time a war rages within over what I know is right and my guilt / responsibility hang-ups.

Yet another reason I second guess myself so much about the Rusty-dog. I keep wondering if I was wrong about pneumonia and maybe it was neurogenic pulmonary edema and maybe I made it worse with fluids... I still don't understand what happened and why it progressed so quickly. The Holter didn't really give answers although I'd like to discuss a couple of the strips with a cardiologist. Apparently the tech that read the thing didn't understand the approximation of some of the times such as the small seizure around 3:30 a.m. where the strip is normal at that time but not normal 5-10 minutes prior, hence approximately... No, I did not opt to have a necropsy which may have settled some of my questions and self-doubt; I couldn't deal with the thoughts of having it done. Besides, I'm sure I would have found some way to blame myself anyway. Rest of the herd doing okay, Buddy grieves a lot still and is more clingy to me than he was before. I worry a lot about Sam and Chief, my other 2 old guys (15 & 16), especially Sam since he has more medical problems but, to be honest, I thought he would go before Rusty...shows how much I know, right?

At work, cancer has been the theme as usual except for one other case that I'll relate shortly just for the irony of the situation. Let's see, first there was the German Shepherd who presented for a possible foreign body because it chewed up a toy and now had a distended abdomen. I wondered first about a GDV but walked in to see a calm, quiet, somewhat depressed dog with an easily observed distended abdomen. On palpation he had a fluid wave and a cranial mass. His belly was full of blood on abdominocentesis and I did a radiograph just to prove to the owner that there was no foreign body, a hope she clung to until the end of the visit. They opted to take the dog home and spend a little time with him rather than go to surgery, etc. so I can't totally prove that it was a tumor but what do you think given he was 9 years old? Then the axillary mass that I talked about before, histopath identified it as a "high grade soft tissue sarcoma" and they could not definitively determine the tissue of origin... And the cat that presented for "some blood in his stool and can he get his vaccines too?" There was a mass in the caudal abdomen easily palpated. The owner actually wanted to try surgery but the cat became stressed in the process of attempting to place an IV catheter then started breathing heavily and bleeding more from the rectum. We wound up euthanizing and the owner allowed me to open the belly. There was a golf ball sized lymph node that was necrotic and hemorrhagic. We had not done thoracic radiographs yet but I'm making bets on Lymphoma. And the list goes on, and on, and on....

The ironic case needs 2 preludes. First, I am good at critical cases. I'm actually probably better at those than I am at surgery, which is my first love. I don't particularly like them but I am good at them and the last few years experience in primarily ER / Critical Care has only served to hone these skills. Perfect? Certainly not, but definitely a strong area. My boss is not. He doesn't think outside the box and doesn't push fluids when needed and so on. Second, for those of you who remember, the dog and person involved is the one I spoke of several months ago that came in wanting "the same shot that the boss always gave" and after getting it the dog tried to die because his blood pressure plummeted. The one that I said would be a "Doc only" client from then on. Right... Doc had to go out of town unexpectedly last Monday because his mom was in the hospital therefore I worked on my usual day off. Lady shows up with her dog; she had talked to Doc and finally been convinced he should be seen and not wait. She had called the week before to pick up dewormer because she thought he had worms again but refused to be seen until Friday when Doc was in (he was out most of that week on vacation) at which time the dog was given a small dose of Gentocin, amongst other things.

When I saw the dog last Monday, he had a necrotic area on the tip of his tongue, uremic breath, increased respiratory rate and effort, focal crackles in the left cranial area, a low grade heart murmur, and was very dehydrated. CBC / Chem showed a white count of 34,000 (it was 13,000 on Friday), BUN unreadable (means it has to be over 200 on my machine), Creatinine of 8.8, Phosphorus over 20, some elevation of ALP and ALT, to name the highlights. Urinalysis showed a low specific gravity, glucose, protein, and blood in the urine with white blood cell and red blood cell casts. Thoracic radiographs showed an alveolar pattern in the left cranial region, possible aspiration pneumonia was the working diagnosis. I spoke to the owner and explained the poor prognosis and that the only chance was aggressive fluid therapy and antibiotics, etc. She asked what I would do if he were mine; I told her bluntly that I'd at least give a chance but that not doing so was not a wrong decision. She decided to let me try. I hit him hard with fluids, antibiotics, coupage, sucralfate, etc. I pulled out the tea trick for the tongue discomfort, something I had practically forgotten from onco in school. 48 hours later, there was a small downward trend in the recheck bloodwork but I also felt we had only really just begun true diuresis given the in's and out's. Additionally, he was coughing more and producing with decreased crackles auscultated. He had also eaten a small amount where he had previously shown no interest at all. In my opinion, far from out of the woods but at least taking baby steps in the right direction. (By the way, to remind you, the owner is a nurse so should at least have some grasp of the situation. I know it's her own dog and that clouds thinking but she should understand a little more than a lay person.) The next day, I was off. As usual, I briefed my boss very thoroughly on the situation. When I returned the following day, it was to find that the dog had been euthanized. I was told that although the kidney values had fallen some more (why were they even checked only 24 hours later?) the liver values had climbed and he was breathing more heavily.

Now, I don't know, maybe he was way worse than before. Maybe it was the right decision. I really don't know. I do know, however, that it is not the first time by far that my boss has done something entirely different than my plan for a patient on my day off. I also know it is not the first time that one of my cases has "gone downhill" while I was off and when I returned it was because of something done or not done according to what I had planned. The most memorable was the pylonephritis dog that was given lasix on my day off because he had some SQ edema. REALLY PEOPLE??? He did not have a heart murmur or crackles or fluid dripping from his nose or any other signs of fluid overload. There are other reasons for SQ edema such as, oh I don't know, MAYBE THE FACT THAT HIS PROTEIN LEVEL WAS AT ROCK BOTTOM. Remember Starling's Law and the relationship between proteins, etc., osmotic pressure and fluid being held inside the blood vessels??? Can't help but wonder if the decision was a bit precipitate but I'm also the only one at the clinic that will really push the envelope on critical cases. And I have as yet to work in a place where I haven't had an argument about pushing fluids in which some know-it-all tech or other vet thinks I'm giving too much, too fast. I know about overload but most people that I've worked with don't push hard enough and freak out way too soon or about things that don't really indicate overload. That's one of the reasons that I became a veterinarian; so that I can make those decisions on my own pets rather than being trapped into either stopping sooner than I want because no one will put in the effort or going too far because of the attitude of some vets that cannot determine what is truly humane. I certainly don't claim to always make the right decisions and know what is best to do but I don't, as one of the AVMA speakers so beautifully described it, "roll over and pee on myself" when given a difficult / critical case and just decide to euthanize. One statement that always comes to mind is that euthanasia is permanent.

Besides cancer and the crazy client's and the critical cases, I've seen some great abscesses lately. Mammary gland abscesses, fight wounds, an eyeball, etc. There is something deeply gratifying about abscesses although I have often wondered if this is more of a female thing than male because it seems that more females enjoy them than males. Hmmmmm..... I'm sure there is some deep dark meaning in that.

I believe that covers most of my complaints for now. As for my mental health, well that is probably beyond help even in the best of times... If it were not for the necessity of being at home right now I would be looking elsewhere for another job. Speaking of mom, I finally forced myself into the conversation I've been putting off for a while. As of right now, she is agreeable to getting an appointment with a lawyer and updating her will as well as stating that I will have power of attorney when the need arises. Hate to think about it but it is a necessary step. I remember when I took care of my grandmother with Alzheimer's right after I graduated from high school. The family fights were horrendous with no one being willing to help at all, ever to give me a break even when I exceeded the breaking point, fighting over her stuff even though there was no money to speak of, complaining about what was spent on her, etc. Then I think about the fact that I'm pretty sure my mom is already showing early symptoms of the disease and I think about how my brother is, much as I hate to admit it. The only conclusion I can reach is that I need to make sure that mom's home is protected which probably means it needs to be in trust for me to care for and that, since I'll be the caregiver, I can make decisions regarding what is spent on her care, etc. when the time comes. Not that I want my brother to have nothing but I really don't want to face having to sell the home and property without even a chance to go through things as soon as mom passes because he insists on splitting all assets immediately. Guess I sound really cynical and all but, much as I love him, I know my brother and, for that matter, my family. Nice morbid thoughts I've been having lately, aren't they? Really miss Rusty for someone to discuss these things with and just to hold when I need a hug...

Tuesday, August 9, 2011


It is interesting how few people acknowledge the need to truly grieve over the loss of a pet. People generally seem to feel that it should only take a day or so to be back to normal and act as if it is odd if you take longer. I was thinking of my technician friend that I worked with 2009-2010 who lost her Great Dane at 13 years on the last weekend before I left to move back home. It amazed me how many of her "friends", including veterinary people, were on the verge of having her committed because they felt her grief was too excessive. I worried about her because she was truly suicidal at one point but I also understood where she was coming from completely. Heck, I'd probably be seriously suicidal myself if it were not for the rest of the herd needing me (now y'all can run off and see if you can have me committed.)

I'm sure not everyone is the same and not everyone forms the ultra-close relationship with their pet that I and others experience but the reality is it is present and for many people, losing a pet is like losing a close relative. First thing this morning, I had to euthanize a 16 year old dog that has a lot of health problems and fell and broke his leg. His owner is one of those "practical, grew up on a farm types." I don't mean this to be critical and I'm certainly not saying she made a wrong decision but I doubt it is the decision I would have made. She loves her pets but seems to have a much more practical outlook for end-of-life decisions than I do. Sometimes I wish I were more like that.

At work, they have started calling me "Dr. C" because it seems that all I do is find cancer. In client pets, in employee pets, in my pets, everywhere I look. I've suggested that when people call they schedule with the boss because he probably wouldn't find it and it would be a simple problem that could be fixed. It grows depressing when you feel like you talk about death more than anything else and when employees jokingly say they don't want you to examine their pet because they are afraid of what you may find. Maybe I should have taken a friend's advice and pursued a residency in oncology.

Yesterday was a bad day for me. For no particular reason, I was extremely glum and thinking about the Rust-bucket. All day my employees kept asking if I was mad about something. When I answered that I was not in a good frame of mind they asked why. Then it compounded because I got more upset that they had to ask... I'm always reminded of the book and movie Sense and Sensibility when things like that happen. If you don't know me or haven't figured it out I'm "sense." Yes, I can go to work and bury the grief deep inside and even function semi-sanely but that does not mean I feel any the less.

To add to the mood, there was a 12 year old dog in for routine vaccinations plus the owners mentioned she had been breathing heavily. I examined her and felt she had increased respiratory effort and increased noise although no crackles; additionally, she had dry eye on the right side although the left was normal and significant dental disease. I called to discuss the problems making recommendations for thoracic radiographs, treatment of the eye, and a pending dental after we assessed the breathing. I was informed that they did not want to do any of the above and had been "given drops for the eye before and their dog was healthy, just old." So much for that. Plus the boss called to ask about the dachshund (details in a moment) and was answered by the technician who had not even assessed the dog much less knew what was going on with it. And, the boss has already talked to the owner and contradicted 90% of what I had said indicating to them there really was not much hope and they might as well just stop. Made for a great day, let me tell you.

The previously mentioned dachshund in the hospital presented paraplegic (Intervertebral Disk Herniation, shocker, I know!) over the weekend and her owners could not afford referral and surgery. I've been medically managing her and she is making baby steps in the right direction to the point that today she actually moved both hind legs. Somehow, the owner got the impression there was no change when they called this morning and I was unable to get on the phone but sent a message. The message I got in return was that they were considering euthanasia. If they had made that decision, I think it would have been the last straw to completely push me off the deep end. I probably would have quit completely and my boss would have loved that since he is on vacation at the moment...

And today I got to remove a portion of a nasty tumor that was intertwined around the very large named artery, vein and nerve in the axillary region. You know, the ones you really don't want to nick accidentally for fear of bleeding... I couldn't get it all out and, of course, it is a nice dog with nice owners. I'm curious what kind of tumor it will be. At least they will be willing to follow-up with an oncologist for chemo or whatever. Although at the moment, I'm feeling very fatalistic as if it really doesn't matter what I do anymore because they're all gonna die anyway. It wasn't helpful to my frame of mind that I got the Rusty-dog's ashes back today either.

Of interesting note is that the vet school in Guelph has decided to add a grief counselor to their program. I think it is a wonderful idea. Many counselors minimize the grief being experienced and rather than helping someone to cope wind up worsening the problem because the person no longer feels they can openly share their feelings without being belittled. I wonder if they will consider adding teaching sessions for the clinicians and students to help them learn how to handle grief as well as help them learn how to help clients handle grief?

Here is the link to the article if it works right since I'm semi-computer illiterate much of the time...

GuelphMercury - Veterinary College counsellor helps pet owners

Monday, August 8, 2011

Compassion Fatigue

I was reading The Homeless Parrot's post about the heatstroke dog and the idiots who claim to care. For some reason, the post finally made me able to somewhat put into words the battle inside me over the past 4 years since I graduated and started to practice.

Technically, they call it compassion fatigue but that seems a really lame term for the feeling. Incidentally, I found it telling that there were lectures for technicians but none for veterinarians on the subject at the AVMA meeting. For me, I remember very vividly a case that I saw on my terminal preceptor just before graduation that was one of many that set off the downward cascade. It was a 2y old Dachshund that had intervertebral disk disease (presumptively) whose owners could not afford referral therefore we attempted medical management. Like always, I poured heart and soul into the dog, pulling out all the stops. It was a long road and just as the dog turned the corner and began to take a few ataxic steps on its own with no support, the owners opted to euthanize. They, it seemed, were not ready to pour heart and soul into the dog; they decided that they couldn't face the possibility of going through the same thing again. They didn't even come to say goodbye. I took the dog outside and fed him treats as I injected the fatal solution to the world's ills. He died sitting in my lap on the grass, eating (his favorite pastime).

I could relate dozens of these stories. Point is that the fact that the empty feeling grows daily and has followed me from job to job proves to me it is not simply job burn out. I find it harder and harder to give so much of myself on each patient. It used to be a nonentity; something I didn't even think about, I just did. Now, there are times when I have the shocking feeling that I just don't even care. I feel as if my emotions are cauterized. (Not talking about my own children, I would move heaven and earth if I could to do for them. It's just really hard to continue to drain oneself by caring so much when you can do nothing primarily because the owner won't let you.) This has been progressively building over time. I sound as if I'm saying everyone is that way, which is not true, it just seems that the majority of people I deal with are. I understand financial concerns; heck, I'm struggling to make ends meet at the moment, too. The necessity of caring for the herd, however, is the sole reason I have a credit card and have credit card debt at the moment. And it seems as if many of the people who will do nothing do not make the decision because of money but because they are too stingy to spend any on the animal.

If this continues, I think I'll seriously have to look at another work venue because I don't think I can live with myself not caring. Needless to say, it's worse right now, too. Each morning I put on a professional mask in order to function at work all the while questioning what I could have done differently for my dog and listening to people turn down even simple care that could vastly improve their pet's life. Blaming myself for my loss while fielding calls from clients who took their overweight dog out to exercise in the heat of the day (did I mention this is northeast Alabama where we are in the middle of a heat wave with heat indices in the triple digits?) and it died of heat stroke because we recommended it needed to lose weight therefore it is clearly our fault their dog died. Compassion fatigue? It really doesn't seem to be a strong enough description. Emotional burnout? Cauterized caring? What is the word for the disease in which people are incapable of feeling pain? Maybe some derivative from that would be a better description. Or maybe there is just no way to describe it until you experience it...

Saturday, August 6, 2011


Hello blog world! Myself and May B. Insane have sure had a roller coaster ride lately, and not in a good way. I thought I'd share a slightly funny story.

The other day I was at work out in the barn getting ready to look at pigs. There was a stock trailer (one of the big semi-pulled ones) backed up to the dock getting ready to unload pigs. There was also a loud argument going on right beside the stock trailer between the truck driver and a company employee. Since I didn't want to get involved I just kind of stood back and watched for a few minutes. This turned out to be an excellent idea...

The argument (over something stupid by the way) continues and my eyes kind of wandered around a bit. I looked above the trucker's head and noticed that one of the pigs on the second level of the trailer has pushed his butt up to the side of the trailer and his tail is sticking out waving. As I am easily amused, I thought this was kind of funny. It wasn't as funny as what happened next though. As I watched bemusedly this pig (it was apparently a gilt) (a gilt is an unbred female pig) peed about a gallon of urine.... right down onto the head of the irate trucker. As his mouth was open arguing at the time it hit the top of his bald head and ran right into his mouth!!! Everybody there just died laughing as he sputtered wetly.

Last I saw him he was washing out his mouth with water and spitting it out.... Gotta love pigs!

Monday, August 1, 2011


I said "Goodbye" to my best friend last Thursday. Most of you will likely understand that having multiple kids doesn't mean you love any less but there are probably those that are "special".

Rusty was special. I adopted him on February 28, 1998, officially although he and I had been sharing a clandestine relationship in the clinic kennel where I worked for a month or so already. He had been left there by a lady who said she had 14 dogs, had brought 7 with her on a trip to visit family and been told by her husband that if she wanted to come home, she should do so without the dogs. We took in a couple to find homes; Rusty was one of those because he was a Bichon frise and we had some clients that seemed to be a sure bet for a good home. But we didn't know Rusty...

We were told he had been found wandering the streets of Florida and was at least 2.5 years old, already neutered and on heartworm prevention. It is still unclear how many homes he had already gone through before arriving in northeast Alabama. He had a mature cataract in the left eye, luxating patellas with arthritis already, a small depression in 2 of his ribs on the left side, and a painful left shoulder. He also hated kids with a passion. His personal opinion was that all children (and any loud, busy adults) should be on a leash or in a kennel at all times.

Rusty went to his new home with the aforementioned clients after a haircut and bath; it failed to work out because the clients' dogs did not like him (so we were told). He went to another home that also failed. We showed him to numerous people who thought he was "sooo cute" until he hid behind me growling because they got too loud or reached over the top of his head too quickly. One weekend I had kennel duty and was once more berating his habit of pooping all in his kennel then walking over it until it became a solid mat of poop regardless of how much he did outside when I discovered that all he wanted was to be held. Since my car had broken down and I was waiting for a ride, I indulged him for an hour or so. They said I created a monster that weekend.

Shortly after, Rusty went home with me to "go to my cousin" ostensibly but the truth was he had already wormed his way too deeply into my heart. Rusty became my best friend and closest confidant. He was a shoulder to cry on, a friend to depend on, always ready to go on an adventure or to just sit at home in my lap while I indulged in a good book. Rusty was my rock when my brother died and I had to be the rock for everyone else. Countless nights he soaked up my tears and was there just to listen.

Rusty went to work with me daily for a long time. He had severe separation anxiety and each time he had to be groomed, it worsened, probably because he associated that with being thrown away again. He always fit in easily with the herd and loved other dogs. When he decided that Choo Choo was his special girlfriend, he sometimes stayed home because he was more comfortable being in a safe crate with her than he had been alone. He hated being alone...

One Halloween, a friend and I had a brilliant idea that Rusty should dress up as the Grinch since he "hated the noise, noise, noise" and was otherwise Grinch-like. We dyed his hair with green kool-aid and conditioner, I made him a Santa coat and hat, put his ear hair up in a topknot, and velcroed a stuffed dog Max to his back. It was hysterical and he had a blast. My boss's dog kept stealing the stuffed toy from his back but it was overall a riot. Until I discovered that kool-aid and conditioner apparently does not was out of white Bichon hair... He was a shade of green for 3 or 4 months until I was able to cut his hair. It was rather fun though when clients asked about the green dog to deny any knowledge. "You saw a green dog? Really? That's weird. Are you feeling okay?" If a straight face could be maintained it was best.

Later, Rusty went with me through both undergraduate and vet school; I often said he was smarter than I and should have taken my tests for me, then I would have aced them all. There was the time during the first year of vet school when I was wondering why he kept having diarrhea and vomiting to the point that I was getting really worried until I discovered he had figured out how to open the cat food storage container and was sneaking in to take little bites here and there. Or the many times when Choo Choo turned over the garbage to get some choice tidbit only to find her on the couch innocently sleeping and him caught in the act.

In 2005, Rusty lost his left eye. I had been poorly advised that the cataract would not hurt him, leave it alone. He developed uveitic glaucoma and I failed to be able to control the progression and pain therefore we enucleated the eye. This became the subject for my senior presentation in vet school (Rusty came through for me yet again!) In 2006, he had to have surgery to remove bladder stones. Both times, I was a nervous wreck and stretched rules to the limit including insisting on scrubbing in even though I wasn't on the surgery rotation and taking him home on the same day because I knew how stressed he would be without me.

The other dramatic thing about Rusty was his compassion and understanding. He hated his tail and feet touched yet my 90+ year old grandmother could pull on the tail with impunity. Or the time my co-worker's child (remember, he hated kids) was crying and sitting in the floor and he climbed into her lap to comfort her. Similarly, he had not accepted Can'tSpell until she sat in my floor crying and he climbed into her lap. If anyone was upset, Rusty felt that he needed to help.

Rusty traveled to 25 states with me; I had hoped to make it to all the lower 48. He dealt with long intern shifts, emergency overnights, and countless nights and weekends on call. We lost his little girlfriend in 2008, and we comforted each other in our mutual grief.

Over the past several months, I've watched Rusty begin to show signs of growing old. He started to slow down, his arthritis worsened, his sight worsened, and his hearing virtually disappeared. I pulled out all the stops to try to slow the process and keep him comfortable and happy; it seemed that all he needed to keep him happy was to touch me. He's had a lot of dental problems and I have had to extract several teeth to keep him comfortable. On July 11, I took another out. I wound up only using the induction dose of ketval and not even needing more anesthesia because it hit him so hard. He was really slow to wake up and had what seemed to be a short, focal seizure the following morning; by afternoon (time to get off work, he reminded me adamantly) he seemed fine.

We left for AVMA and a short vacation the following Friday. Going out on the pavement seemed really hard for his arthritis and the heat was very bad on his breathing therefore I started letting him wear a diaper and not go out while we were in the city. On the last night there, he awoke in the middle of the night, vocalized and had another episode similar to the first. Very short, tremors involving the front of his body with almost a Schiff-Sherrington position other than his back legs not being stiff. He responded instantly to my touch therefore I was unsure if it was really a seizure or if it was anxiety since he was in a strange place and covered up with a blanket. Afterward, he seemed fine. Over the course of the next 5 days while I visited my friend who lives near, he had a total of 5 episodes, all very similar, all short, and each time he responded to my touch immediately. On the Monday following my return home, he walked down our couple of porch steps then seemed weak in his hind legs, postured to urinate and collapsed onto his side in what appeared to be a true seizure. In the middle of it, he stopped breathing and I felt his heart stop. He then came out of it and had what appeared to be a post-ictal period. Through the course of the day, his breathing became very labored.

Radiographs of the chest that day showed a mixed interstitial / alveolar pattern. I was confused: pulmonary edema or pneumonia? There had never been evidence of heart disease, no murmur, a rather slow resting heart rate for a small breed dog historically, nothing abnormal. I ordered a Holter monitor, set a medicine / neuro consult at the vet school as soon as possible, pulled blood, and had an echo / abdominal ultrasound done. (I had done radiographs and bloodwork just before the tooth extraction, all were dead normal.) The abdominal ultrasound was normal. The echo showed elevated pulmonary arterial pressure with very mild mitral regurgitation, normal left heart size and pump quality, mild right sided dilation with good pump quality, i.e. no reason for heart failure. The CBC showed a mild leukocytosis with lots of band neutrophils, there was a technical error with the chemistry therefore I was unable to get values.

During the time the Holter was on, Rusty began to have more small seizures and each time his breathing became more labored. He was on nasal oxygen and IV fluids, antibiotics for presumptive pneumonia, and I was holding him when he arrested while defecating. He came back but his breathing deteriorated rapidly and he continued to have seizures even with diazepam. Finally, he just stopped. Throughout the time I wrestled with the guilt of stopping and letting go versus not stopping and seeing him suffer more. He died in my arms but I'm not really sure he knew...

I regret deeply the small things. I wish I had made him some homemade biscuits, his favorite, like I promised to do the next day. I wish I hadn't gone to AVMA, maybe if I had been where I could have gotten help quicker, it would have changed things. I wish I had not been working on the day he decided to go; I hated being torn between him and my obligation to the other pets that needed care. Most of all, I just miss my best friend.

I still don't have answers. Maybe the Holter report will tell me something. A brain tumor maybe? He didn't act like a dog with increased intracranial pressure. Neurogenic pulmonary edema doesn't make sense. Maybe PTE's, especially at the last when he deteriorated so quickly? Maybe he was throwing clots because of cognitive dysfunction syndrome... In some ways, having a name might help but the reality is that it won't bring him back. Rest in peace my Rusty-dog and know that you are missed and always will be.