Wednesday, November 23, 2011

Complaints Again

Apologies, folks. I've had plenty of good fodder for the blog but have been kinda blah and just a bit stressed so have not taken the time to write lately. Can't Spell has been properly threatened but has failed to respond. Alas, I guess I'll have to pull out the good ol' super glue, vaseline, balloons, etc. next time we're in contact and come up with some horrid practical joke for her...

What to talk about amongst the craziness that has been life lately? First I think I'll tell about my funnest ever surgery from last week. I love reconstructive stuff. That and exploratories are my all-time favorites. We had a young pit bull puppy that was brought in by a local rescue group for a wound on his leg that they had been told was caused by accidentally spilling liquid Draino on the leg. The wound was about the size of my hand (6.5 surgery glove) on the lateral aspect of the thigh. It was actually granulating in nicely at the first visit then the scar tissue contracted to a point that it was significantly restricting the range of motion. I started out with hopes of doing a simple Z-plasty on the caudal stifle area to free up the motion then discovered that the scar tissue was so extensive that it involved all of the underlying fascia and much of the muscle bellies. I wound up resecting the entire wound and approximately 3/4 inch thick scar tissue beneath it in order to restore range of motion to near normal. Then I used multiple flap grafts and relaxing incisions to close the defect. It turned out so pretty and I had a blast. Not surprisingly, a small portion in the middle has dehisced but the range of motion is great and I would rather maintain that and sacrifice the skin. I've had them working him pretty hard already and will see him back in one more week for a second surgery to repair the remaining defect. I can't wait!! That's the fun part...

Today, Dr. C struck again. Ancient old poodle with an abscessed upper fourth pre-molar. I anesthetized her and did an almost full mouth extraction only to discover a disturbing black mass associated with the abscessed tooth. Ten to one it's melanoma. Bad, bad, bad.

And there was the depressing dog fight. Two dogs jumped the third dog and chewed her up pretty good although the wounds were all relatively superficial. We first saw her a week ago from last Friday. She was shocky and we treated her with IV fluids, antibiotics, debrided the wounds and partially closed the worst / deepest one. By Tuesday, she was doing great, eating, drinking, wagging her tail and all perky. By Friday, she was kinda dumpy and not eating well. Saw her back and performed blood work which showed that she was moderately dehydrated and had a low protein level. Big shocker there with those wounds. Debrided some more dead tissue, gave her some fluids and something for nausea (in case antibiotics were bothering her stomach) then allowed her to go home. The owner's husband had a prostatic biopsy that day then subsequently had to return to the hospital after collapsing. He required a blood transfusion and an ICU stay through the night... Spoke to the owner repeatedly on Saturday; dog was still kinda dumpy and not eating but hadn't really changed much. Offered hospitalization or to continue at home; they opted to wait and bring her on Sunday due to some difficulties with the husband, etc. I advised that I was on my way out of town and they needed to talk to my boss. Later the dog suddenly started breathing heavily then collapsed with clear fluid coming from her mouth. My guess is that she must have thrown a clot to her lungs. It happened very quickly. Even if she had been in the hospital, really nothing I could have done. It doesn't stop me from being self-critical about the situation, though.

Mom is up to the usual mess right now. We heard from my crazy druggie brother and sister-in-law the other day. I'm constantly amazed that someone can be nearly 70 years old and still so naive. Mom listens to his story and immediately realizes the sister-in-law is back on something but fails to spot it in my brother although to me it was equally obvious. They, of course, wanted money. Like that's a new thing. And they, of course, are still unwilling to go into a rehab program. And mom is still adamantly refusing to go to the doctor for her issues. She gets angry when I suggest it for any reason and believes that any medication that might be available would cause worse side-effects than any help it could provide.

She was particularly challenging over the past couple of weeks. She's in the process of finally retiring at the end of the month and most of her sick leave has been rolled over to add to retirement time. The few remaining days she has been trying to use up. We had been planning for months to go to Huntsville and hear David Jeremiah speak so I had suggested she take that day off which she agreed was a good idea. She then randomly took a different day off and worked on that one. The following week, I had suggested taking a Thursday off for a day trip which she agreed to do then did not then got mad that I did not want to leave at noon for a 2.5 hour one way trip... That was also the day that she got mad because I didn't immediately fix tuna salad for her to eat and went to bed without eating like a pouting child. I ask you this, how hard is it to open a can of tuna? Lately, though, if I don't cook or fix something healthy, all she will eat is sweets and candy.

I visited a friend of mine this past weekend that I've not seen in a long time and she pointed out something that I've lost sight of (you know, can't see the forest for the trees). If I want to do something more with my career, I probably should try to figure out which direction to take now rather than waiting because mom's only going to get worse with time and it's only going to get harder to go further. Now I just need to assess things a little more objectively and decide what I want to do because I'm really not happy with where I am at right now.

That's a hard thing to say. I really like my boss as a person but I hate the quality of medicine I'm stuck practicing. He refuses to move out of the dark ages although I have managed to get him to think a little more about things. He has become really money motivated; he wasn't that bad when I knew him previously. I got really PO'd at him about the stray animals he took in then wouldn't discount much at all for the spays / neuters. My confession is that I spayed and neutered all of them over the weekend while he was out of town. Ever since I feel somewhat guilty because I hate lies and am always criticizing him for his untruths and now I've been untruthful and deceived him... Do I have the right to continue to criticize when I've also not been honest?

And I really wish he would at least listen! I never realized quite how controlling he is until now. I guess the different capacity has changed my perspective. For instance, the fun surgery I told about while ago came in Monday and he saw it for the dehiscence. He told them that the wound had so much tension that it was not surprising it dehisced. No, it was not surprising but it was not under tension; it was because we chose to exercise and preserve range of motion. Or the other day he told an owner that tramadol would do nothing for arthritis pain (I had started the dog on tramadol for its arthritis and avoided NSAID's because of age and the fact that the owner had been giving Motrin (!) so I figured a good washout would be indicated before adding a different (safer!) NSAID.) Since I'm managing no less than 5 of my personal dogs' arthritis issues on a daily basis primarily with tramadol I think I probably have a greater grasp of its capabilities. And further, since he comes from the generation of "let them hurt a little so they don't move too much" I think I have a greater grasp of pain control in general. He scares me with the way he'll randomly give steroids and NSAID's, especially to older patients with no blood work. Or just pop a little dose of gentamicin here and there... The sad thing is that he doesn't really mean to throw me under the bus or do bad medicine; he just hasn't bothered to stay updated or to think about the fact that he is no longer the only doctor in the practice.

I have to admit that there is a part of me that still longs for the residency but I don't think it is really feasible. So, time to try to be really objective and make some decisions about life. For now, I think I'll end my complaint session because I'm bushed. Hope everyone has a wonderful Thanksgiving. Will try to post again sooner and will definitely work on Can't Spell. Hope she's prepared for our next visit even if it doesn't happen until April...

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