Responses, Updates, and More Gripes

You are all exactly right. I hate referring to someone, regardless of how good he or she may be, if they are rude. The other thing that really got me about the situation was my extreme disappointment with my alma mater. I remember school as one of my happy times in life and have always felt that if I ever moved back in the area that I would be comfortable and happy to send clients there, knowing they would be well taken care of regardless of who saw them. Now I'm far from certain about that. I spent my drive down Wednesday composing a lovely sarcasticly nice-sounding rude letter to complain about the situation. The great part is that I talked to one of my old friends who is a professor there and he told me exactly where to direct the letter for the best results. It's nice to know people who know things...

I fully intend to inform them that they are no longer the only choice available. I can easily send my clients to a private practice specialty clinic that has all the same bells and whistles and is the same distance from me or, assuming the animal can make a longer drive, I can always send them to the neurologist that I know and like who is a bit farther away. Given the fact that we have choices, the economy is far from good, and they may need to meet their budget, they may want to reconsider their attitude! I am really just so disappointed because it is not what I expected from them. On a good note, my visit went well and it was nice to see some of my old friends and find out that they haven't forgotten me.

As life would have it, I wound up bringing the neuro dog home with me. He was ready to discharge and it was easy enough just to add him to the menagerie traveling. At this point, his diagnosis is eosinophilic meningoencephalitis of unknown etiology. We have fungal cultures and tick / parasite titers pending but there were traces of zinc found that may indicate a heavy metal toxicity. If all of that is negative then we are left with idiopathic. Which brings me to another complaint. I hate the fact that people always seem to not listen to what I say. I really think it is something about how I communicate but I just don't know what. Wish I could figure it out because the response stresses the hell out of me! I put in a call to a colleague I worked with previously and stated, "I have a dog with a diagnosis of eosinophilic meningoencephalitis with no etiology identified yet but we are waiting on fungal cultures and titers. If these come back negative and we call it idiopathic, are you aware if there is any benefit regarding long term survival in using an additional immunosuppressive drug including a chemotherapeutic agent like we do with GME?" I got a call back with the message, "You can't put this dog on immunosuppressive drugs because typically eosinophilic meningoencephalitis is caused by a parasitic or fungal infection. You must culture and do titers and wait on those results first." Can anyone PLEASE, PLEASE, PLEASE tell me what I'm doing wrong???????

Then I got home and mom is surprised again that I'm working half a day tomorrow (told her minimally 5 times), states that she may just go up to talk to them about her retirement in the morning (she is slow as Christmas getting ready and will need all of the time that I'm at work then some to be ready to leave semi-on-time) because "time is running out" and somehow Friday is so much better than Monday (I'm sure the weekend will make all the difference in the world), she has done nothing to help prepare for our little foray this weekend, and she wants to know if I'm taking any of the kids to the clinic tomorrow (again, told her yes minimally 5 times already.) And I wonder why I spend so much of my time tired and frustrated.

One of my friends that I saw today took a tripod black cat from me last year and this cat has become the love of his life. Unfortunately, she has developed kidney failure but is right now stable and doing pretty good. He has now acquired another tripod black kitten but the original cat hates it. They are kept separate for now; I think he thinks the first cat won't be around too long and that is entirely possible but it would be funny if she fools him then he has two tripods. I think y'all will enjoy the names: Beatrice Oil Slick and Eugenie Blackberry. Beatrice and Eugenie because they are both princesses, Oil Slick because she is black and he got her around the time of the Gulf oil spill, and Blackberry because she is a small hand held device.

Got a lot of hugs, did some catching up, had some good visits, and discussed my annoyance with some folks I respect and trust. They, too, recognize there is a problem with the place and one of them, in his inimitable way, summed it up like this, "We have hired too many high-stepping fancy show horses that look real pretty but we don't have any Percherons, Belgians, or mules to really do the work and most of the old ones are about to retire." Yup, that pretty much says it all. And, unfortunately again, I feel like most programs are heading in that direction by choices in interns, residents, and even students so that we are basically training a bunch of showy folks with no staying power. I'm afraid they are about to become like the school where I did my internship which is not a good direction to move!

One last grump. I realize I'm picky and with my English background typos, misspellings, and poor grammar are a pet peeve. My students hated writing discharges for me because they came back so much for correction. The thing is, though, if you send crap out what does the client think of you? It's like the adage about shaving the hair neatly and suturing the outer incision neatly; that's all the client sees. The discharges I received for the neuro dog were mostly a piece of crap. The history was jumbled and incomplete. There were typos and grammar errors and misspellings throughout the document. One of my favorites was that the dog was sent as a "preceived emergency." Not only did spell check fail but it's insulting that it was worded that way. The student also struck me as one of those people who make up things rather than admitting they don't know an answer. I don't even trust what specialists tell me without double checking them, much less students. That said, I need to do a little research as well. And lastly, the fancy wonderful "precious" (read this like Gollum saying my precious in Lord of the Rings) neurologist didn't even take the time to come out to make sure there were no questions, meet me, or anything. I would have thought that professional courtesy alone would have been a reason to come out but, obviously, I was mistaken; not surprised, just mistaken. We must be beneath his contempt.

And, yes, Can't Spell, I did have some "truth drugs" prior to that other post. Meclizine does interesting things to me as do most other medications. With that I must close my gripe session and write at least the rough draft of my letter. If I wait, I won't be as mad and it won't turn out as good.

The Day of Rudeness

Today has been an exceptionally frustrating day. Started out pretty good outside in the wee early hours with the foster pup and the boys but it went downhill pretty fast as soon as I got to work. I really don't know what was up with people today but almost everyone that graced our doors was rude and in a bad mood. Complaints were the rule of the day; some valid, others not.

The groomer / tech who works with me and has been there for years left to bring her sick dog back early in the morning. Call me superstitious or whatever but, as I've mentioned many times before, I really don't have a good track record with employee pets. I had talked to her on Saturday when she described the dog as having neck pain. Being unable to meet her, I suggested crate rest and pain control unless he seemed worse. He improved some then had some diarrhea. The boss examined him Monday and I saw him peripherally; mildly elevated white count and ALT, nothing else significant, tentative diagnosis of gastroenteritis. Today, she brought him back because he was worse.

He is a 3 year old intact male Whippet who has previously been an overall healthy dog. He is used as a stud dog in a breeding program and does travel on occasion, being jointly owned by my friend and a lady out of state. On examining him today, his mentation was very dull, he had neck pain on flexion, an absent menace on the left eye, and absent CP's on all four limbs. He was also mildly ataxic as he walked and would run into things on occasion. We started the referral process and I called to set things up. Told the lady that I was worried by the rapid progression and may need to send the dog as an emergency since the first available appointment was next Monday. I was told that would be no problem, just to call. I was also told that the neurologist would call me when he was out of surgery.

Over the next few hours, he showed even more decline losing the menace in both eyes, becoming paretic and increasingly ataxic. My thoughts were running along the lines of a brain lesion with my top broad differentials being neoplasia, infectious, and inflammatory. I called to tell them that the dog was on his way after jumping through hoops to manage to get him on the road. The problem was that my friend couldn't take him today but the daughter of the boss happened to be in town and lives near the vet school so she offered to take him. When I called, they acted as if they had no idea what I was talking about. When they finally "found" the information and acknowledged that someone had talked to me, they then took forever to patch me through to the neurologist. One would think they had never dealt with taking information and payments, etc. over the phone.

At this point I'm highly unimpressed. This is my alma mater and they had a really good neurologist not all that long ago. As is typical of my school, they let the really good guy slip away and I have a sneaking suspicion it is because they failed to live up to their side of a bargain; but I don't know that for certain. I've heard that this man is a really good doctor. Well, his brain had better be solid gold to gild his bedside manner. He was rude, arrogant, and refused to listen. I started the conversation by attempting to identify myself and the situation and he interrupted to say "Just give me the signalment!" OK. So I started talking about the dog and, correct me if I'm wrong, but I was under the impression that when conversing with colleagues we typically state abnormal findings rather than stating individually what was normal. As I was trying to explain the neurologic picture he kept asking things like was the palpebral normal, etc. At one point, he disregarded everything I had stated about mentation, etc. and asked if I was saying the dog had facial paralysis as the cause of the absent menace. It seemed to confuse him that I was saying the menace was gone but I did not perceive the dog to be completely blind because he was not yet walking into everything (probably could discern light / dark) . He also failed to grasp that the dog was really progressively worsening quickly.

When he finally seemed to get some sort of clinical picture he asked what prognosis I had given the owner. My sarcasm made me want to tell him that if I knew what was going on I could give an accurate prognosis and wouldn't need his fancy doodads (i.e. MRI) to find out. He then asked if they were prepared to spend money on the dog. And then wanted to know if the owner was in the clinic with me (I had already told him the travel situation). And then wanted to know when I had called (told him approximate and that they had said would call after out of surgery). He spent so much time saying "What" while I was speaking that it is no wonder he seemed not to understand anything I said. And he became fixated on the fact that the dog was a little over a month late on having his rabies vaccine. Seriously?

The whole interaction just left me irritable. Although I've not met him in person, he reminded me greatly of the surgeon I worked with at my last job. A "my way or the highway" type of person who seems to feel they are smarter than anyone else could ever be and therefore deserve to be treated as a king. All I can say is that he sure better know what he's doing. From here on out I'm rather disinclined to refer to them and would rather send people to the previous neuorologist; it's too bad it's a longer drive!

One thing good that came from the situation, though. I reached the conclusion that I'm glad I did not take Rusty to see him. If he acted like that with the Rust-bucket, the world would likely be short one veterinary neurologist and I would be incarcerated. I may let the Da-Chi Terror and the Cujo poodle take him on Thursday; now there's a thought to make one smile.

That wound up being the icing to top off the cake of the whole rude people day. I know you really shouldn't hold grudges but I have a feeling I won't remember this guy in a favorable light for the rest of my life. After all, I still get irritable when I think about my first grade teacher who threatened to take away my Honey Bear (my stuffed bear toy with whom I was inseparable for years) if I continued to bring her to school with me. I stopped bringing my bear but I never forgot that teacher and her threat...

If he turns out to be an excellent neurologist, I'll let y'all know. I'm woman enough to give credit where credit is due although it won't make me like him any more. Once again, just like that surgeon. We never got along and, I'm sure, never will but he is one of the best orthopedic surgeons when it comes to complicated fractures and using external fixation devices that I've ever seen. I might even consider using him in an extreme case. Haven't had one that extreme yet so I haven't had to test that theory.

I think I expect too much...

It suddenly became clear to me today that one of my major problems is that I expect too much. From myself, from my family, from my friends, from my colleagues, from my employees, etc. Really the only ones who don't let me down are the 4-legged furry kids.

Friday was extremely busy and, as the day after the, dum dum dum dum, big office meeting, the kids at work really busted behind and worked hard. Today, it was showing signs of already wearing thin. I think I mostly wasted my breath during the meeting, especially on the "older employees" who are entrenched and that I have known for eons. Things are never their fault, you know. Plus, what am I supposed to do about the wife?

This week, my schedule is really different than usual because, as things will work out, I have an appointment to take Scout to have his recheck echo done plus I'm driving the foster puppy halfway up to her new home therefore my usual working times had to be rearranged pretty significantly. Typically, Wednesday afternoon is the boss's time off to go do whatever he wants, usually involving hitting a little white ball somewhere in the direction of a tiny hole way far away. I have to leave early on Wednesday therefore he will either need to cover the afternoon or not take appointments. I arranged this well in advance and asked several times if he wanted to take a different afternoon off. Finally, after I spelled it out in grave detail today, he realized why I kept bringing it up and gave me a straight answer. I would have thought he could put two and two together to figure it out...

Then there is my mother. She is finally going through the process of retirement. I told her more than once I'd be glad to go with her to help sort out the business / information part and she says she wants me to but then won't set an appointment when I can go. Or, the other day, I suggested a time and when I asked if she had set it, she said she didn't know when I would be available... We had a planned time although she wouldn't schedule an appointment last Thursday but she found a reason not to go even though I told her the next chance I would have would be Monday, Oct. 3. Now she wants me to make time this week when my schedule is super, ultra hectic and is annoyed / angry with me that I told her no. (I may have mentioned this before while whining and griping but my family works on the system of manipulation by guilt. My personality type is extremely susceptible to this and it has taken me years to recognize it for what it truly is. I still have difficulty dealing with it but at least I can rationally recognize it and try to make better decisions.)

Of course we can't forget the prodigal brother of mine. He still has his sights set on the place that I still own and need to sell if I can ever get some things settled here long enough to deal with it. Basically, he sees himself getting something for nothing. And, of course, the rest of the family think I'm horrible in not being willing to comply. Plus they still refuse to face facts that he and his wife are still on something. I was reading some of the Crass Pollination blog entries regarding drug-seeking people, excuses, habits and could see him and her in almost every one. It's hard to be truthful with yourself about people you care about but there is just no denying what I'm seeing and hearing; unless you are one of my family talking about my brother.

I also love the fact that no one listens to things I say about medicine but they run to my cousin who is training to be a nurse and take all things from her mouth as gospel. My other cousin, who is in her 50's and diabetic has developed cirrhosis of the liver secondary to her diabetes and poor control. Unfortunately, there is not much to be done at this point unless she could have a liver transplant and I don't think she's a very good candidate. Explained all of that but it took my nurse-in-training cousin saying that high cholesterol can cause cirrhosis for anyone to listen. I don't care so much except that I wish if they don't want to listen to me they would cease to ask thereby wasting my time. Or maybe I do care. I've always been overshadowed by someone or something and maybe there is a deep dark part of me that craves someone to listen and pay attention to me. Hmmm. Haven't thought about that until now when I asked myself why it really annoys me. The longer I know me the more convinced I become that I'm really messed up in far too many ways.

As a side note, I don't really know what is happening since this is usually the time of the year when we begin to slow down a little but all last week and starting already this week I've been at work really late because we've been so busy. Maybe there is some kind of strange time shift happening or there is a full moon or something.

Going along with my usual poor record with employee pets, I diagnosed a probable FIP in one of the kids' cats. If anyone else has a better suggestion I'd love to hear it. Nearly 2 year old, NM, always been thin and now losing weight, lethargic. Temperature today was 106. No lovely fight wounds to blame it on (I was hoping!!), FeLV / FIV negative, low white count, mild elevation of ALT, nothing else abnormal on bloodwork. No palpable fluid or masses in abdomen, kidneys of normal size and non-painful. Mentation not just right and menace was decreased, I think, although y'all know cats can be hard to assess, no retinal lesions that I could see.

Had a weird case come in Friday, too, that I still haven't an answer to explain. This was a robust 5 year old, NM cat who presented for severe vomiting and acting more needy than usual. His exam was boring, absolutely nothing I could pinpoint. Owner opted to allow bloodwork that showed everything completely normal except an ALT of 531! I was thinking neoplasia or toxins but could find nothing to aim at therefore I kept him hospitalized on fluids. Today, he's eating some (still a little picky) and the ALT is down to a mere 144 (high end normal 100 on our machine).

And I need to do some research into cat skin problems. Saw this weird lesion today on an upper and lower eyelid. Very crusty, dried, flaking skin but non-pruritic. No other lesions, did have a few fleas. I opted to start the cat on Advantage Multi in case it is a weird demodex case although the scrape was negative. Figured it would at least serve to treat the fleas while I do a little digging, anyhow.

I euthanized a 10 year old Saint Bernard Friday whose little boy brought him 2 dandelions and insisted on sitting beside him hugging his great big hairy neck as I did the dirty deed. It was a day for euthanasias including the technician's mom's ancient old dog reminding me once again of the frailty of my geriatric crew and how short a time we get to enjoy our furry family.

We also had a catastrophe at work today just to add to the excitement. There was a little old poodle boarding with us while his owner, an elderly lady, was in the nursing home for rehabilitation. One of the kids took him over to visit his mom on Sunday. The little dog has seemed fine although he had a little diarrhea one day last week and has some arthritis problems. I even did an exam one day although he was not completely cooperative because his legs were hurting, he kept wiggling and fighting. Over the weekend, he started to decline and bloodwork today showed significant hypoglycemia and a very high white count. The boss had placed an IV catheter after his visit Sunday because he seemed to be worsening and as he added a little glucose to the fluids, the dog sat up, urinated, then became agonal. We administered CPR but were unable to bring him back. After he was gone and relaxed, I could palpate a small mass in the cranial abdomen. In a mix-up of communication, the girl who took him to see mom went to her with flowers and sympathy before she knew of the dog's death. As it turned out, the boss had been instructed to filter all communication through the daughter who had not yet returned his call and our employee thought she had already been told. Bad scenario all the way around because she certainly meant well but it fell to pieces.

It's definitely been interesting around here lately. The puppy is doing great and is up to 11 pounds today. She is becoming stronger and stronger with mucho puppy energy. She still has some carpal and tarsal hyperextension if she overdoes her play but she can do so much more before it manifests now and daily the time grows longer that she can play without problems. Her little front legs also curve on occasion but this, too, is improving daily. Since her calcium was within reference range rather than higher as a puppy of her age should be, I did opt to supplement for now but will watch the levels as she grows. There have been no more seizures and she is eating like a champ. I'm really glad she goes to her new home this week because the longer she stays with me the harder it will be for her to transition to yet another home as well as for me to let go. That's the worst part about fostering. I would post some pictures but I can't get any good ones these days because she is so busy! Yesterday, we had her out to let her run around and she discovered the boys cot, took it over, and proceeded to destroy 2 pine cones, several pieces of pine straw, and played with her tennis ball. Suddenly, she simply crashed and fell over into a deep puppy sleep only to be disturbed when one of the dogs came near enough to stimulate her desire to aggravate. She is growing into a really cute puppy and looks much better. I think she is 2-3 weeks younger than the first owners thought she was judging from teeth progress but the teeth could also be off due to the starvation. Not sure.

My overgrown horse puppies are still lots of fun. They all got chew treats over the weekend and Guess was having a blast playing keep away. It upset Maybe, however, so she ran off and buried her treat while Tag set about the serious business of chewing on his. They are becoming very graceful as they move and I cannot get over how big they are. They are really neat and pretty dogs although unusual in their markings and very, very laid back and gentle. Once again, pictures would be great but they won't be still! Maybe likes to hold your hand but sometimes gets overenthusiastic and grabs a little too hard. They really need some harness made for them and a little goat cart to pull. I'll bet they would love it. They always have some secret mission going on and I often wonder what plans they have for all the holes they dig, large limbs they find and bring up, and, especially, trying to move the water buckets. I'm sure it's all part of the plan.

I discovered that my other young dog, a Border collie named Indiana Jones, knows how to sit and stand up on his hind legs on command. Since I didn't actually teach him either trick it surprised me a little. He's pretty smart, though, and very intense, true to his breed. He may be mixed but definitely has the instinct; I just wish I had someone to train him and a flock for him to work. He came my way while I was in my first job. A local rescue group brought him in after finding him. He had been shot in the head with the bullet miraculously traveling beneath the skin from behind his ear and exiting through his lip, shattering the upper fourth premolar and first molar on that side. His hearing was damaged as well. After removing the maggots, cleaning the wound, removing tooth fragments, and putting his lip back together he came home with me. Today, unless you look at his teeth, notice the subtle tightness of his lip on that side or the slight droop of that ear compared to the other, you would never know of his rough beginning. I'd bet that he was out in a pasture herding someone's cows and they shot him. He was only 5 of 6 months old. He was also my first ever cryptorchid neuter.

The old folks and in-betweeners are doing well for now. Sam's neurologic problems are progressing although the laryngeal paralysis seems static and is causing him no problems right now. He has a hypermetric gait and is weak in his rear added to his old orthopedic injuries (pelvic fracture, tarsal shear fracture). He also is losing his voice sounding hoarse when he barks and has some degree of fecal and urinary incontinence. On really hot days, he has some roaring and exercise intolerance because of the lar par but, for now, I have no plans for surgical intervention. I don't know if his other problems are degenerative myelopathy, peripheral neuropathy associated with lar par, lumbosacral stenosis, or something else, but I can't quite see doing an MRI when it won't really change what I'm doing. I may invest in a cart but am hesitant because Sam refuses to be an inside dog (he hates confinement and boundaries much like his mom) and I'm worried that he might tip himself, become trapped or entangled, or something outside that would result in his getting hurt.

Over the past several days I've gotten back to drawng more cartoons. I'm not particularly talented but do enjoy them for my own fun. They are in many ways a barometer of how things are going in my life. My brother and I drew together as children, he was very talented, then I ceased to draw at all after his death for years. I find that I turn to drawing the cartoons now either when I'm happy or very stressed. If somewhere between, my production falls off. When extremely depressed, I also don't draw. Right now, stressed would be the impetus. I've done several lately about how to avoid matching for a residency centered on some of the things that I'm sure hurt my chances. So far I've barely scratched the surface and haven't even touched the first internship. There are always ideas floating around inside my crazy little head but I have to be in the mood to put them on paper. Plus with my cynical, dry and odd sense of humor outlook, you never know what will trigger an idea. At the moment, however, I'm also in that mood where I don't really feel like sharing them too much.

The storms are wreaking havoc with my messed up vestibular system. After a while, one becomes accustomed to being constantly slightly dizzy and it's only hard on the rare occasions when one is not dizzy or on the frequent occasions when the dizziness worsens and is accompanied by nausea. Unfortunately, I'm a really cheap drunk and most, if not all, drugs completely knock me out. Meclizine helps with the dizziness and nausea but I also have a hard time functioning and doing my job when I'm fighting sleep. Also makes for some interesting conversations with clients when the speech starts to get slurred on top of my heavy Southern accent. (No, occifer, I've not been drinking!) The other fun effect is that on certain medications, I find it impossible to lie. Those would be the days when, if asked how I am doing I would burst out with a full report, no glossing over or omitting things. Or would tell you that your shirt was ugly or your haircut looked bad, etc. Scary for a person like me who is really reserved and controlled, especially in speaking.

Probably partially because of that, I did another classic fall over the weekend. Had my house shoes on outside and tripped coming up the porch stairs. Instead of bamming my head into the door, this time I thought it would be more interesting to slam the fingers of my left hand in the door. Surgery tomorrow may be challenging although the swelling has mostly resolved. I really missed having my Rusty-dog as a perfect heating pad to lay on / against me. He always found the spots that were sore and was much better than an electric heating pad. The others are not that generous. I guess I'm slowly coming to grips with no longer having the boy but there are times it still hits suddenly just how empty that spot in my heart remains.

I think that's about all that I have to complain about, update on, or whine about for now. So enough of my rambling and I should probably go to bed...

New Theory

All of us in the medical world complain fairly frequently about our patients preferring the advice they receive from the internet or cousin Billy Bob or the plumber over a trained professional. I was thinking about that phenomenon today after hearing from the owner of a dog with neck pain say, "The medication you sent home with us last month worked for a while then we quit using it since she felt so much better and now she's dreadfully sick again." The dog's neck pain was back to the same level or worse than before we started medication. Now we probably have the added problem of wind-up pain, but, I digress.

I have a new theory about this that actually makes sense to me. It doesn't help my frustration but it makes sense...

What if people have simply begun to lose faith in the medical field to the point that they feel that we, as a profession, are more interested in money-grubbing than the well-being of their pets or, for the MD's out there, themselves?

Memories

Memories are funny. Sometimes we bury the bad ones so deeply that we effectively block them out while other bad parts seem to be etched forever in place. Good memories often only require the whiff of a scent or a color to come rushing back and leave you feeling as if you were there again.

We had a last minute C-section the other day. My boss performed the surgery and I directed the puppy revival (sounds funny doesn't it? I never can resist a goofy pun...) The kids don't have much experience in that area yet and when the Yorki wound up having 8 pups they were really freaking out. I had 4 while they had 2 each then I swapped them out to finish with theirs. They are scared of rubbing too hard. I gave them a hard time about it.

Brought to mind one of my fond memories from my first job. It was my first Thanksgiving after graduation and I had been invited to go to the boss's house for prime rib. I was, however, on call and, wouldn't you know it, got a frantic call from one of our clients who had a pregnant English mastiff that had produced one pup and nothing else with continued strong pushing and about an hour and a half since the pup arrived. I've never been much of one to piddle around and wait on things so I had her come in and pretty much immediately decided on a section because the mother was clearly exhausted.

I was only able to raise 2 of my staff to come help so I reluctantly agreed to allow the owner and her teenaged son and daughter to help. It was far from my first C-section, I seem to attract them like bees to honey, but it was my first owner observed surgery. Mom had a total of 15 pups with one non-survivor because it was a "water baby" that didn't respond to any attempt at treatment. While we were in surgery, one of the techs showed up unexpectedly and helped but that then made the rest of my plans for Thanksgiving since her dog urgently needed a blood transfusion. All in all a memorable holiday and, oddly enough, I don't think I would've changed it at all except that I would probably have enjoyed a piece of prime rib before the excitement began. Too bad the dog didn't have better timing, right?

On the puppy note, she is doing great. Had a minor, scary moment this week because she had 2 small seizure episodes and, of course, my pessimistic self was thinking all the worst things. I'm pretty sure that it has a very simple explanation. She has just gone through a period of starvation and cannot have any glucose stores (even normal puppies and kittens don't have much available). Starting about 24 hours before the first episode, her appetite had decreased probably because I added fish oil to her food for the anti-inflammatory properties; apparently she doesn't like it or maybe it upset her stomach a little. In any case, I couldn't check her glucose during the first and managed to check it shortly after the second (not immediate as in she wanted back down, ran around and defecated before we got back to the house) at which time the level was about 70. A CBC and chemistry were within normal reference ranges for a pup of her age although her calcium level was a little lower than I would like to see in a pup. I had considered running bile acids to help rule out a shunt and a distemper PCR on urine but in view of the normal bloodwork and lack of continued episodes now that she is eating again I doubt that I will do so. She has gained weight and is playing like a little heathen. And apparently she has a flower fetish having started to pull the blooms from my mother's monkey face plant and attacking my whimsical houseshoes that have flowers on them. I'm glad she has a home lined up already or I would really have a hard time letting go by the time she is completely well.

Sucker

I did a quick review of my posts and could not find where I told either of the two stories that I'm about to relate. If I missed it and have already told them, then just view it as me getting started early on my own redundancy...

Several months ago I saw a Lab for a routine exam and vaccines that was dropped off while the owner, a very nice lady and good client of ours, took her grandson to the movies. It is because of cases like this that I'm becoming so superstitious; I really seem to attract cancer or other badness even in the routine and mundane. I started examining the dog and discovered that she had generalized peripheral lymphadenopathy. Being the bright soul that I am, I did a fine needle aspirate and, guess what? Bingo. Clearly lymphoma. Not even a cytology that I, who can argue about anything, could hem-haw about. That was a fun phone call to make, let me tell you. The owner had apparently noticed the mandibular nodes being large but didn't know what they were and didn't mention it because she was "afraid of what it might be." Premonition?

I always say on such cases that I would bet if Doc had seen it the whole thing would have been routine and nothing would have been wrong. Just like the Yorkie that came in for inappetance and vomiting after the Labor Day weekend. Had he seen it, it would most likely have been "garbage gut" from too many hot dogs. Because I happened to draw it, the dog was in kidney failure and also had a heart murmur. Sheesh. Can't I ever just get a boring one? The good news on the Yorkie is that with careful fluid therapy he is doing well and went home on prescription kidney diet food and strict instructions to avoid barbecue, etc. since that could easily push him over the edge of no return.

The other story is another sucker tale. I spayed a hound mix a couple of months ago and there was just something about the dog that spoke to me at the time. She belonged to a client that I don't particularly like. This person acts as if she doesn't even want to touch her little foo foo dog right after it has been groomed, much less a big hound dog. The dog was covered in fleas and had several patches of alopecia secondary to the fleas. I treated the fleas and the skin and talked to the owner about treating the environment. She only got mad that we had the audacity to create extra expense. I really don't know how she came to have this dog but I found out later that she also had 3 puppies that belonged to this little hound.

Just before I left to go to the AVMA convention, this lady brought in the 3 puppies and had them euthanized because "they have mange." I didn't see them, it was on my day off. She also scheduled an appointment to bring the mother dog. I told the clinic staff to talk to her about surrendering the dog but had doubts if it would actually be carried out. Fortunately, the dog had a lot of sense and hid out where her owner couldn't get to her then wound up being brought in on the next day that I worked.

On a whim, I called Can'tSpell and asked if she happened to know anyone that would be interested in a hound mix that was spayed already. As it worked out, she did! We got the girl all fixed up and, crazy person that I am, I hauled her with me and the boys to St. Louis in order to manage a "great exchange." The dog didn't even have mange; it was still a flea problem and that was likely what was wrong with the pups as well. She rode the whole way like a champ but was a little confused about the potty business since there was really no grassy area to take her out in St. Louis. She urinated once in the bathroom in the hotel but at least she chose the tiled floor...

I'm very happy to report that she has a wonderful home and is in the process of becoming spoiled rotten. Her personality is really blossoming from the shy dog that she was into a really neat dog. Unfortunately, I don't get to see her since she now lives in the midwest but Can'tSpell sees her often when her friend comes over and gives me updates and pictures. Had it not worked out, I'm sure I would have succumbed and kept her but I really don't have room for more right now. I feel as if the herd already doesn't get enough attention.

The foster pup is doing better but not out of the woods yet. Her skin is so bad it's like treating a burn victim and she is losing a lot of protein through the oozing areas. She is taking more food and is interested in eating now, though. The bloody diarrhea has resolved but her stool is still loose - probably related to the Nutrical and A/D food that I'm feeding right now for the calorie content. I still have her on fluids and, of course, major antibiotics. I've been playing with different topicals to soothe the skin and, so far, am happiest with an aloe based lotion. Today, she actually growled when I re-wrapped her foot and IV catheter and also tried to stand to defecate. She's doing a great job at holding her feces even with the loose stool until I get her out to clean her. I need to pull out one of Choo Choo's old bibs, though, because I'm messy with the syringe feeding (good thing I don't plan on kids, right?) When she gets a bit stronger, she'll definitely need a good bath!! Assuming she makes it, she has a home lined up and will be Maddie's, the aforementioned hound dog, little sister. My dogs are extremely curious, of course, but I'm trying to keep her isolated until the mites are no longer contagious. I really don't want to have to treat the whole herd and especially Peanut, the atopic Pekingese, for sarcoptic mange!

One day, I'll actually take the time to edit and update my profile since it is sadly out of date. I should post a picture when I do that. A giant sucker should work well... A blue one.

Redundantly Redundant

Today I realized that apparently God, in His infinite wisdom, knowing my extreme distaste for repeating myself, has seen fit to make me learn to deal with it.

Between taking care of my grandmother with Alzheimer's years ago, the children at work who make me feel as if I'm talking to a wall, my boss who hears what he wants to hear and remembers even less, the numerous people scattered through my life, and my mother who is showing signs of developing Alzheimer's, I think that the number of words that I use daily must have at least quadrupled just due to the necessity of repeating them over, and over, and over.

Most likely, I'll also get Alzheimer's when I get older then I'll repeat myself all the more. The bright side about that part, however, is that I won't realize it and everything will be constantly new and fresh....

Underdog

I'm afraid that more often than not, this blog has become a "safe" place for my venting rather than a place that I share amusing or funny stories. That's probably because there are really very few people available in my circle that will allow me to vent or understand what I'm screaming about. In any case, I have yet another story of outrage to convey.

Probably by now, y'all have realized that I'm a big sucker especially for the underdog. The sick, wounded, or old only need to bat their eyes at me and I'll come running to their defense even when it is probably not the smartest thing to do. Doubt that will change at this point...

A few weeks ago, I saw an adult dog and a new puppy for some new clients for an examination and vaccines. The puppy was between 6-8 weeks of age and appeared healthy although she had a small "rash" on her ventral abdomen. I asked the usual questions about people in the household itching or the other dog and was told no problems. Since it was so mild and no one else seemed to be affected as of yet, I advised that the area be watched and the dog be re-evaluated if it worsened or anyone in the household developed skin lesions. I've heard nothing else from them until yesterday.

Apparently, they have called multiple times and no one saw fit to pull the chart to determine which doctor saw them or to even let me know. Yesterday, the puppy was brought in to be euthanized. She is pathetic. Supposed to be a Great Pyrenees / Golden Retriever mix, roughly 12 weeks old and she only weighs 6 pounds! She is skin and bones and has lost almost all of her hair. The small skin lesion has become generalized with pustules, papules, macules, etc. etc. etc. (just think of all those lovely derm words and they are present). Her eyes are crusted closed with purulent discharge related to the skin lesions. She won't eat or drink on her own but still has a wag to her tail and a bit of a growl when she doesn't like what is being done to her. Her skin scraping was negative therefore I'm looking at probable sarcoptic mange.

I guess you figured out she has not been euthanized. Instead she was surrendered and the sucker that writes this is taking care of her for the moment. She is on IV fluids and antibiotics and currently I'm syringe feeding her. She is showing some improvement but is far from out of the woods yet. Believe it or not, I have an interested party who may want her if she survives.

Here's the other part, though. The owner, after surrendering her, wanted to adopt one of the two lab mix puppies that we have at the clinic looking for homes. She started out saying her friend wanted one but it was obvious she was not being truthful. I told the staff to tell her that her "friend" would have to come and fill out an adoption form in person. It then changed to "I." I then told her that she was not eligible to adopt. The nerve of some people astounds me!

It hearkens back to a similar situation not long ago that also made me furious. There are a couple of people that work with me who I have known for eons that, unfortunately, have a prejudice towards "purebred" dogs. We had two little mutt pups looking for homes and one of those people let someone adopt them who had just brought in a cat with a treatable condition and had it euthanized because they couldn't afford to treat it. To make matters worse, I had told them I would "cut them a deal" by decreasing the exam fee and not charging for cleaning and flushing the wounds. So what about that situation suggests that it would be a good home for two very young pups?

This same person, however, was totally on my side this time about not letting these people take the two LAB pups. (By the way, I gave the same instructions in the previous incident but was ignored and didn't know until too late because I was in surgery.) Clearly, the fact that these pups look like LABS and not just little mixes made all the difference. Makes me so mad; I hate prejudice of any kind and I thought that we were in the profession because we cared about all of the animals, not just the ones with a pedigree.

In any case, I now have a very sick little pup at my house in a makeshift ICU so that I can watch her closely over the next few days. I'll keep y'all posted and hopefully she'll pull through and go to live with the last foster dog that I had. Which is a story in itself that I can't remember if I have already told or not... Boy, those brain cells sure seem to be dying off faster these days.

Another I don't understand

Today I was reminded of a case I meant to post about several months ago primarily as yet another example of how I fail to understand people.

I saw a dog today that had a lovely bladder stone. Everything about the case went smoothly and the surgery was beautiful. Such a nice case brought to mind one that was not so nice...

My boss saw a small breed dog with a bladder stone and did a cystotomy to remove the stone. He then left on vacation and I picked up the case the following day being told it was doing well and could go home. I had some qualms by the end of the day because the dog was just not quite right but there was really nothing I could put my finger on and the owner had already been told to pick up and was very insistent to do so. I think it was a weekend and I gave her contact numbers, I know, for myself, my boss (although out of town), and the local ER clinic. Didn't hear anything from her until the following Monday when she brought the dog in for a "recheck."

The dog was flat out, almost non-responsive, bradycardic, and had uremic breath. Bloodwork showed severe azotemia, hyperphosphatemia, and hyperkalemia. Diuresis brought the potassium levels down and I re-explored as soon as the dog was semi-stable. The bladder had dehisced and there was a lovely uroabdomen. Both before and after the second surgery, I reiterated how sick the dog was and that there was a definite chance she would not survive. At one point the owner very bluntly asked if I was saying her dog might die. Yes. I have said that repeatedly!! Her response was to ask when the boss would be back in town.

I put a lot of effort into that dog and it did survive but it was very dicey there for a while. Since discharge, the owner refuses to see me and only wants to see my boss. Now, I'm not saying he did anything wrong surgically, dehiscence is certainly a possible post-op complication, but I guess I do resent it a little that she apparently is mad about the fact that I was blunt enough to tell her the dog was in critical condition. It takes a lot out of you when you put that much effort into a patient only to find that the owner fails to appreciate it at all.

On the other hand, though, with my current fatalistic viewpoint, maybe it wouldn't have mattered what I did anyway.

Like the little hit by car dog Tuesday evening. One of our good clients saw it get hit and brought in the little stray. She was severely shocky but warming and IV fluid boluses had made a significant improvement by the time we closed. My boss usually checks on patients after hours since he lives only 5 minutes from the clinic and he reported that all was well at the last overnight check. She was dead when we arrived this morning. I really don't know why since radiographs, blood, etc. didn't show me anything too bad other than the shock and an acetabular fracture. You can even do it "right" and make no difference, it seems. That is one thing I hate about private practice is not having the overnight care that is available in ER, specialty, or university settings.

I do, however, envy the client's attitude. I wish I were more practical or whatever you want to term it, like she is. When I called to tell her the dog had died she said, "At least she had a chance and was warm and cared for rather than being out on the street." I agree but, of course, am still beating myself up on what I may have missed or could have done differently / better.

What did I do to deserve this, part 2?

Just when I think it really can't be much worse at work, I'm proven wrong. Again.

So the kids failed to alter their class schedules after being told repeatedly but, rather than sorting out and letting go of dead weight, the boss decided it would be best to get someone in to cover the receptionist position but keep all of them employed. Needless to say, he didn't want to pay yet another person. So guess what he did?

His wife is now working as the receptionist.

She is like the kids and Diane all rolled up into one person. Of course she gets sidetracked chit-chatting with all the people she knows while the phone rings off the hook. The only improvement is that she knows her abc's... In addition, she has all these things that she wants to change because her daughter is currently working as a receptionist for a different vet in a different town while the son-in-law goes to vet school and they do things differently. (He finally got accepted this time and just started last month.)

Now I'm stuck with another inefficient receptionist who wants to change everything and is also the boss's wife. Now what am I supposed to do with that?

The first day he suggested it, I had to bite my tongue on the comment that "having relatives employed was one of the major reasons I quit my first job, you know." I was afraid that might be going a little too far and, unfortunately, right now I cannot afford to change jobs since I need to be at home with my mom's issues, etc.

At the moment, the best person to work as receptionist is the technician but that greatly hinders an asset to the business to tie her up with the front job. Plus she's about to go out on maternity leave at the end of the month. Everyone else gets way too rattled if there are more than two people in the waiting area. Maybe one day we'll stumble onto a really good receptionist but then he will likely not pay well enough to keep that person. It's a no winner, right?

Protest! Anyone?

Sometimes I think I must be a prize sucker for the underdog or maybe I'm just plain crazy. It seems that I'm always attempting to lead a protest for an injustice where the people against whom the injustice has been committed fail to follow.

The first one I remember clearly was my senior year in high school. I was captain of the volleyball team and loved the game; until the coach went stark raving mad about winning and started not allowing the players who weren't as good any time to play at all. Sorry, but for me that is not what it is about at all. When the game ceases to be fun, I cease to play. I tried to start a protest but no one was willing so I threatened to quit the team. Because no one else seemed to care, I wound up finishing the season but then did not play basketball or softball as I had all my high school years before that. (I'm not really tall enough for either volleyball or basketball but was a good enough setter, defensive player, and server to make me useful in volleyball and went to a small enough school that I got to enjoy the other sports.)

There have been numerous other attempts, too many to even try to recount in vet school but always, everyone is scared to rock the boat and maybe get into trouble. At my first job I rocked the boat quite a bit with no back-up and I enjoyed it, too. That boat needed to be rocked. In New York, I definitely rocked the boat but, again, found no one else willing to help. In Oklahoma, I attempted to lead an uprising and at least accomplished the establishment of rounds discussions specifically for the interns rather than being expected to hear student rounds over and over. Nothing else that I tried to improve worked but I did pave a way if anyone was brave enough to follow. Incidentally, that is probably a big reason that I didn't match for a residency...hmmmmm...maybe crazy is the right word.

Right now, I'm not rocking the boat too much just because I'm so exhausted but it won't be long before I'm overcome with the need to perpetuate change again. The fire was fanned slightly the other day but, once again, I found the people who inspired me failed to want to follow. One of the kids that works in the kennel was saying that the instructor for the basic computer course she is taking at a local community college told her that if she couldn't afford the latest program she may as well drop the class. Excuse me?!?!? It is a BASIC computer course that is required for all students, not a highly specialized course for computer majors. Not everyone is wealthy. This is America, people, land of opportunity where the lower classes have a chance to rise above lack of finances and achieve. I went off and offered to help draw up a petition to take first to the instructor then to the administrative officials. My offer was declined.

Will I ever learn to stop trying to fight injustice when no one wants to fight?

Lost in Translation

There is a lot of very true discussion these days about vets needing to actually hear what their client says rather than just the surface comments. (Of course this is true in life, period, but that is beyond the scope of the current comments right now.) For instance one of the more common examples is when someone says they don't want to put Fluffy through a procedure the underlying meaning may have more to do with lack of finances, or something else. As a general rule, probably because of the particular dysfunctions that I have grown up with in my dysfunctional family, I think I'm pretty good at reading between the lines. Lately, however, there has been one that really puzzles me; see if anyone else has an idea how to translate this one.

A 4 year old large mixed breed dog presented for routine vaccinations and exam. I detected a heart murmur (not previously noted in chart) that lacked any of the "characteristic murmur" sounds and there was an arrhythmia very briefly heard. I recommended that the dog get a cardiology work-up offering the owner options of referral immediately or that we perform part of the work-up then refer when necessary. The owner wanted to do whatever possible here but had "no problem" with referral including cost. We discussed DCM (dilated cardiomyopathy) as a possible etiology given his age and large breed status but I explained that by no means would I have a definitive diagnosis until we had performed other tests. The owner had Dobermans previously and has dealt with the disease so I assumed there was some knowledge base to build on if we ultimately reached that diagnosis.

We do not own an ultrasound but there is a human cardiology ultrasonographer locally who comes and does echoes with me interpreting; she is very good. Not like having a cardiologist but it gives me some freedom to at least glean information for a base. Usually, it is fairly easy to get her out quickly and I had intended to do all of the work-up (thoracic rads, blood work, echo, etc.) together for convenience' sake but the ultrasonographer failed to return multiple calls. Finally I was able to reach her and found that her mother was in the hospital therefore it would be a delay before the echo could be done.

I called the client and explained the situation, encouraging her to go ahead with referral rather than waiting since I didn't know how long of a delay we might encounter. She declined then started talking about how they had cut back on the dog's food and were trying to get him to exercise more so that he could lose weight, not be so large, and have less chance of having DCM.

Honestly, I was speechless. It's his breed, not that he's overweight. I thought I had explained that clearly... And now there was an adamant refusal for referral. Money? Did they think about it and decide the cost was too much? I'm honestly puzzled. So, for now, the work-up is on hold until the echo can be done which will hopefully not be too late for me to help the dog. I can only pray that he does not have DCM and maybe that brief arrhythmia was insignificant and won't result in sudden death... Thoughts anyone?

The other weird one happened several months ago. I saw a pup for its first vaccinations and picked up the lovely classic "washing machine" murmur indicative of a PDA. I explained in detail to the owner what this meant and offered them options of referral (option #1 and best choice) versus returning puppy to breeder versus our attempting to perform surgical repair if no other choice. (Not that I wouldn't love to do it but it would definitely be better done by people who do that sort of thing all the time...)

These folks opted for referral and headed out within a couple of days. I told them that the vet school was often slow in updating their rDVM's therefore I would appreciate it if they could call and let us know what was found. I never received a call, time slipped away as it often does when one is busy, then I finally received a letter from the folks at the vet school stating a PDA was identified on echo, could not be found surgically (thank God they didn't want us to do it!), and that the cardiologist had used a stent or coil to repair the defect. The puppy was reportedly doing well but had been supposed to come to us for suture removal... Hmmmmm......

The next letter stated the pup had come back for follow-up and was doing great and instructed the owners to contact a different vet in our locality for any concerns or follow-up. I'm still not really sure what made them change vets but obviously we (or I, basically) did something to annoy them. Have no idea what. By the time I realized, it was really too late to rectify and I never tried to call because I figured it would be like dragging out dirty laundry with no real resolution to be reached anyway.

If I ever really figure people out, I'll let someone know. Or maybe I should charge for the info...

In relation to the last post; the answer is that the shock is wearing off, unfortunately, and that sense of numbness is slowly disappearing allowing pain to begin to seep in. I think I preferred the numbness even though I didn't (and still don't) like myself very much when I think and feel that way...

A Chink in the Armor?

I'm not sure if it is a good sign of starting to heal or just a harbinger of the next stage of grief but there was a definite chink in my armor today. For the first time, I stopped wallowing in my own self-pity and looked at someone else to feel some compassion for their plight. I've always thought that one of the best ways to heal is to reach out to someone else in need but haven't been able to do so this time. I hate to admit it but I've had such horrible thoughts running rampant in my head like wondering how it is fair that a friend's dog that has cancer is still feeling great months after I diagnosed it or resenting that another friend is depending so much on me to watch her dog that has a terminal illness while she is away on a trip of necessity. I was asked to promise that the dog would live until they returned to which I replied honestly that I couldn't make that promise but only that I would take the best care possible while the ugly thoughts were running around in my head that I couldn't keep my own dog alive what makes you think I can do better by yours? How is it that I can find all these nasty diseases in friend / employee pets and somehow those pets have all lived longer than the last 3 of mine that were lost? My heart screams that it isn't fair but I know that I am wrong to feel that way.

I'm sure that those who don't have the multiple pet household that I do have wondered why I have said so much about the loss of Rusty in comparison to the others. It's kind of hard to explain unless someone has been there. I love all of my herd. It's like having several kids, you know each one intimately and love them all equally albeit not in the same manner. As many of you commented, Rusty was my "heart dog." Much like special needs kids have a special place in their parents' heart, such is the way with special needs pets. The other thing that factors in, weird though it may sound given that he was 16, the loss was so sudden, quick, and unexpected. With Choo Choo, Stormy and Ellie, not only did I recognize that they were aging but they also had at least one disease process that I could point to with a name that I knew was terminal. It was much like the difference in losing my grandmother versus my brother. With Ma-Ma, she was 93 and had many health problems that were clearly progressing thus allowing the grief process to begin before the actual death. My brother's death was sudden, quick, and unexpected; although we knew he had a severe health issue there was no indication that he would die at that time. Gracie was a little different because she was also sudden, quick and unexpected but she came so close on the heels of Ellie I think I was still somewhat shocked therefore the blow was softened in an odd way. With Rusty, I had just done a senior work-up that showed nothing abnormal so the sudden onset of the seizures or syncopal episodes or whatever they were was very unexpected and the fact that it progressed so rapidly left me not even knowing which way to turn. I had not even managed to work out what was going on much less the best way to treat it...

I'm not sure how I feel about this chink. In some ways I've been enjoying the numbness; putting on a nice mask for those around me and functioning in a way that fools them as to what is going on deep inside. Not that taking that course is exactly new for me which is probably why it is the easiest to fall back on during this time. Almost like being in a catatonic state and there is definitely a part of me that resents the attempts to awaken my sensibilities again. The other part that knows I cannot continue to practice vetmed in such a state is tentatively probing the wound and the chink. My hat is definitely off to people who live through major calamities such as loss of an entire family or live with cancer, etc. while still maintaining compassion for others. They have a lot more guts than I do.

On an entirely different note, I'm trying to get Can'tSpell to do a post about her nutty dog, Keegan, with a link to a recent article about a dog that ate $10,000 worth of diamonds. It would be a funny and cheerful post for a change that y'all would enjoy... If she doesn't, I'll try to do it at some point soon.

The last puppies that I wound up finding, Guess and Maybe, have grown like weeds; I refer to them as the "horse puppies." At 8 months, Guess was 81 pounds. I need to weigh them before their heartworm prevention this month in case he's topped 100. They have finally slowed down in both their growth as well as their food intake and now are using their brains for the forces of evil, to steal a phrase. The other day, they dug a hole about 6 inches deep right in the narrow part of the walk in their fence then covered it with an old plastic bag they dug up from who knows where. When I came in the fence they then tried to herd me into the hole... They probably figured that if I fell in they could keep me there for a long time. Guess's dentistry work turned out really good. His mandible was too narrow and the lower canines were sinking painfully into the upper palate. The dentist made an inclined plane (okay, multiple inclined planes over the course of a few months since Guess kept finding clever ways to remove them) with the result being both canines were moved outward. The bite is not "perfect" but is comfortable. The unfortunate result is that Guess has now decided to catch up on all the chewing he missed out on as a teething pup... I would post pictures but I can't keep them still enough to get a decent one. Maybe is built like a greyhound and about that size but is black with odd splotchy patterns of tan and white here and there over her body and face. Guess looks like a hound with floppy ears that stick out a little to the side of his head and is blue merle with tan legs and eyebrows that give him a look of perpetual surprise. They have selected Tag as their hero and copy him in everything that he does which is funny because when he was the foundling pup, Bogie was his hero and he did the same thing. In fact, that's actually how he got his name; we had gone through several ideas none of which seemed to fit until I saw them running through the woods one day. Bogie was a Chow / Afghan hound mix and had long flowing black hair with a huge ruff. He was trotting along with Tag beside him holding to the ruff with his mouth; instantly he became Tag-A-Long.

The rest of the crew is doing well and definitely enjoying the cooler mornings with a little less humidity. Sam tried to run and chase the Nut and Scout when they were playing the other morning. It was cute to watch him do his little old man run.

There is a relatively new product that I discovered with which I'm very impressed. NurtureCalm collars for cats and dogs. They look much like flea collars and are impregnated with pheromones that calm anxiety. I don't yet know the extent of their efficacy but I snagged a couple of samples at AVMA to try. Since putting it on, I've not had to give my thunderstorm anxiety dog, Flower, any medication and she typically required valium, ace, and ProQuiet during a storm plus would usually still be shaking and hiding some. The collar plus a ThunderShirt are all she needs now during bad storms and the collar alone is enough for mild ones. Also my cat, Lil Gray Mouse, who has always been excessively timid and shy is now out and interacting with the other cats. It has really made a difference for those two and, for me, is a much better alternative than drugs not only because of fewer side effect risks but also because of the practicality of catching the cats to dose. On the side effect note, a client that tried it on a very small dog with storm phobia said that the dog acted drugged and behaved oddly although not scared by storms. Upon removing the collar, the dog returned to normal activity within 2 days so apparently it can be too strong for some individuals. I need to notify the company about that one since I found no comments on potential side effects in their literature. It seems to take 2-3 days for maximum effect but where it works, it's amazing. The other story that impressed me was the dog one of my employees was keeping for a friend that had destroyed multiple crates, dishes, etc. in her home then suddenly was a model dog after putting on a collar...

That's about all for me other than the usual struggle with work, problem employees, problem boss, and problem clients. In reading other vet and M.D. posts though, I know I'm far from alone in that part. I suppose that misery really does love company, right?