Well Said!

Very well said, Dr. Grumpy and ditto in vetmed...

I Just Can't Help It...

I did it again.  My OCD-ness about spelling took over and I simply couldn't ignore it.  Especially after sitting in the waiting room so long.  I even had a book in an attempt to avoid my obsession...  It is a good book I've never read before yet still, by the end of the day I had read every single written word on the lobby walls as well as most of the book.  And I had to point out that cardiologist was misspelled - the "d" was missing...  They thanked me but I'm not sure they really meant it.  

More Answers

Sorry, I intended to also make a quick comment regarding the pig with polycystic kidneys.  The point was never really made that while the condition is "pathologic"  the reason the carcass does not require condemnation is that the etiology is genetic / inherited rather than an infectious process that would be harmful if allowed in the food chain.  Obviously the kidney is removed but the remainder of the pig is used as it would be normally.  To the best of my knowledge, polycystic kidney disease is genetic / inherited in all species in which it occurs including humans and cats (Persians for those of you about to take boards) and, while the condition does result in renal failure, it is usually fairly slow in progression.  Both humans and cats can be successfully treated with a kidney transplant.  Can't Spell said that disease is not seen in pigs but I imagine that is simply because of the typically short lifespan of the pigs she sees...

Locally Funny

This I just had to share because it is just too, too funny!!  Ad seen in local newspaper:  "Bargain!  Wedding dress for sale, sz 10-12, worn once by mistake..." I like that lady's sense of humor!!

Answers

I'm a little later than planned with answers / explanations.  The dog is a Pug but I'm afraid the exact difference between a true hermaphrodite versus a pseudohermaphrodite still confuses me a little.  I think it would be considered a pseudo but I'll describe the findings for you and maybe someone with more interest / knowledge of repro stuff can clarify.  Outwardly, she had a vulva with a hyper-developed clitoris including an os clitoris protruding from the vulva.  Inside there was a normal bifurcated uterus, complete with cervix, but instead of ovaries, testicles were attached.  We did not send in any tissues or do further testing as this was a rescue dog so...some things must be left in the dark.  It was a fun case, however, and a nice little deviation from the "routine spay."

I'm Gonna Get Can't Spell in Trouble

Can't Spell, my dear friend, has failed to post on her own blog for an even longer period of time than it has been for me.  Her excuse is that she does not see enough interesting stuff on her USDA job to warrant posting.  She has recently started working one day a month back in clinical practice and said she would post something soon since that was of more interest.  Being in a rather smart ass frame of mind, my response was, "Should it concern you, don't worry, I'm not holding my breath..."  In order to prove her somewhat wrong, I'm posting some pictures for your enjoyment and edification along with questions which she will have to answer.  (Bwahahahahaha!!!!!)

  This is a pig.  Now, you tell me 1) what organ, 2) what disease process, 3) etiology, 4) does this require the carcass to be condemned, and 5) if so, why, if not, why?????  Have fun!!

Just for SB

"Oh suns and skies and clouds of June, and flowers of June together; You cannot rival for one hour, October's bright blue weather!"

OK, OK, so it's probably unfair that I'm quoting this again but October really is my absolute favorite month of the year and today is one of the more glorious October days.  Bright blue skies, sun, slightly windy, slightly cool but warm all at the same time.  I love it!

So why am I inside writing a stupid blog post when the weather is so wonderful out??  Mostly because I'm killing a few minutes while I wait on me mum to get ready; we're about to go on a little picnic.

I won't bore you with details yet, I'm just gonna post some pictures with questions and those few people out there who may still check in now and again to see if we have come out of hibernation to post can enjoy and maybe even comment...

What is wrong with these pictures?

Can you name the condition and tell me what breed of dog this occurs in relatively commonly?  (The dog pictured is this breed but you don't get a full picture so...guess well!)

As a note of interest, this is the first one I've actually seen in practice rather than just reading about it.  I'll fill in the details and story later.

Cat Tails

I had a funny experience at work that is a good example of how the primal instinct takes over the human brain at times.

There is a cat that is boarding at our clinic for 6 weeks while its owners are out of town.  This cat stayed with us because she has some health issues and was under our immediate care at the time the owners were leaving.  She is doing much better now and we typically allow her out in our break room during the day to get some exercise and keep her from becoming depressed.

I went to the bathroom that adjoins our break room and was on the toilet minding my own business when suddenly I felt something softly brushing down my bare thigh.  It was very unnerving and, were I the screaming sort, I'm sure the whole clinic would have heard me.

It took a second before the conscious brain took over and realized it was the cat's tail.

Wee Hours Exchange

This morning, in the wee early hours well before daybreak was even considering breaking, I was awakened by my mother calling and the following exchange occurred:

Mom:  May B.

Me:  Yeah

Mom (louder):  May B.

Me (louder):  Yeah

Mom (louder):  Hey, May B.

Me (louder):  What?!?!?

Mom:  It's thundering outside.

Me:  Okay.....

Mom:  I just thought you might want to know in case you needed to do anything about it.  I'm going back to bed now.  (Goes to bed.)

I am now awake.  I'm not sure what I'm supposed to do about the thunder but it will be hours before I go back to sleep now because now I'm awake....

Train Wreck

There are always those cases that make you crazy...

Yesterday evening, an 11 year old neutered male cat presented to me.  He was covered in fleas, moderately dehydrated, had a huge / painful urinary bladder (blocked), and bilateral hydroneprhosis on physical exam.  His blood work showed the expected hyperkalemia, severe azotemia, and severe leukocytosis (53,000).  So, big question is are the kidney alterations just due to being blocked or did he have chronic kidney changes already??

I had to sedate the cat in order to unblock him.  He was started on IV fluids, given a light sedative and unblocked as quickly as possible.  Then I took a radiograph that shows his bladder is full of tiny little stones.  Next question is not just what type of stone in order to guide therapy but also the fact that they are just that size that miiiiigggghhhhtttt pass uneventfully but will more likely enter the urethra and cause a recurrence of the blockage.

And there is of course the need to balance the potassium which will now plummet with post-obstructive diuresis...

He survived the night which is a good sign.  We'll see where his blood values are tomorrow and decide if surgery is a good, bad, or non-option for the stones.  And, of course, this is a nice cat with nice owners and his "real" owner is a young lady who has Asperger's and this cat is her best friend.  I feel as if I'm trying to maneuver a train wreck through a field of land mines.

Hay is for horses

I'm not super good with kids.  Can't say that I can remember ever thinking I might want any and I'm equally as prejudiced against marriage.  Both are fine for others; just not me.

Yesterday, I went to see an old friend of mine and her three year old daughter was there.  The child was fascinated by me and kept telling me all kinds of things, many of which I had no clue what she had said.  Every time she addressed me it began with "Hey!"  She then repeated the word over and over while leaning closer and closer to my face until I acknowledged whatever it was she was saying.  I also don't deal well with people in my personal space...and I consider my personal space to be quite large!

The other thing she did was asked me to come with her so she could "show" me something.  I followed her to the kitchen where she opened the refrigerator door and pointed out the Kool Aid.  She asked if I wanted any and I told her no then she just stared at me until I asked if she wanted some.  You guessed it, that's why she wanted to show me but why not her mom, who knows?

She's not a bad kid but I have a strong feeling they will have a little fireball on their hands as she continues to grow.

On a completely unrelated note but just as an update, the cocker in the previous post passed away this morning.  At least her owners got to say goodbye.

Tales of Woe

Where to begin??? Posting has been infrequent and irregular of late primarily because I've been super busy and frustrated beyond my capacity to express. I don't know what Can't Spell's excuse is - take that up with her.

First I feel the need to complain about the employees. The two young kennel workers are wanting more hours / money but don't want to work any of the shifts where I need them. It's like they expect to be able to waltz in at their convenience or just want to be paid for nothing. Now wouldn't that be nice just to get paid... It's really difficult for me to relate to this because I've always had to work hard for anything I got and was grateful for hours regardless if they were convenient; reschedule the rest of your life if you really need the money!

Continuing on employees, why does everyone have to worry so much about what someone else is doing? I have more than enough in my life to keep me occupied for an eternity without worrying about yours. I'd blame the bickering on the atrocious heat we have right now but the bickering pre-dates it. Then there's the know it alls who still must call me on my day off to ask yet don't really want to hear what I have to say unless it agrees perfectly with their opinion. Sigh...

I am still on a death and destruction nothing will go right kick with my cases. If anyone has any bright ideas to ease my mind on these, you are more than welcome to share! First was a 9 week old small Yorki pup who presented dull and lethargic. I had examined and vaccinated it 2 weeks previously. When it arrived, its exam was unremarkable other than its dull mentation. Glucose level wouldn't read and was covered in coccidia. Owners had fed a raw egg two days previously and the pup had diarrhea. Started IV fluids plus dextrose. Administered an injection of Cerenia and several hours later, after rehydrated, gave oral dose of Ponazuril for the coccidia. The following morning, the puppy looked great and ate some canned I/D food very well. Approximately 45 minutes to an hour later the puppy was dead with an apparrent anaphylactic reaction. To what?!?!?  Maybe I'm crazy, but I'm betting it was to massive coccidia die off.  I can't really find supporting evidence other than that large numbers of mast cells have been documented in chickens with large numbers of coccidia.  It maybe makes sense??

The other very notable case was a 10 year old intact female cat who had been treated for presumptive inflammatory bowel disease that was beginning to worsen. This case haunts me because I feel as if I did it right but it still went bad. Blood work was boring other than a very mild hypercalcemia. Abdominal radiographs showed distended bowel loops throughout. I recommended an exploratory because the cat has a history of ingesting things and I figured we could get some biopsies as well to definitively determine IBD versus neoplasia. Cat was on IV fluids; no, we do not have continuous BP monitoring capability but checks were fine throughout the procedure. There were no foreign bodies so I biopsied the small intestine (grossly normal), the colon (dramatically distended with gas), and the pancreas (abnormal appearance throughout). The cat recovered fairly well, just a little slow but I felt it was due to her becoming slightly hypothermic. I also spayed her and she had multiple ovarian cysts and her uterus was segmentally distended. She went home cautiously two days post-op looking good but needing to be syringe fed. She would take food readily but wouldn't eat voluntarily which we thought might just be due to being picky and not at home. She returned the following day looking like poop and blood work showed kidney failure. She did not respond to therapy at all.  Less than 24 hours later she died.

The biopsies were very non-specific.  There were lymphocytes and some plasma cells, no clear evidence of neoplasia but I know that differentiating lymphoma from inflammatory bowel is tricky under the best circumstances and this cat had been on steroids long term.  The pancreas was odd in that it had amyloid deposition.  It was stated that this can be "normal" in older patients.  Perhaps it is just because most of the herd that lives at my house live well into their double digits but I wasn't really thinking of her as "an older patient."  And why did the kidneys shut down?  My potential explanations include that she did have lymphoma and it was also affecting the kidneys with surgery / anesthesia / medications pushing her over the edge.  Or maybe she had amyloid deposition in the kidneys and, again, all the stressors pushed her over.  Or maybe her kidneys did have chronic changes that were functioning okay until, again, all that was added.  No matter how it falls out, though, I feel like I made a horrible recommendation for surgery to be pursued.  Yes, I can look back and still agree with my recommendation but now that I know the outcome I hate that I made it.  And, yes, I know that the cat might have continued to go downhill even without the surgery but...  Can't help it - not only am I wired in such a way that I take responsibility but it has also been drummed into me all of my life - can't not blame myself.

The boss's brother-in-law's dog is being treated for lymphoma and she is over half through the protocol and has been doing well.  I've tried to stay out of the case since it's his relatives and I'm such a cancer jinx but, of course, I got dragged in Friday to feel the nodes and they are frighteningly large again.  Much bigger than when I last felt her.  The boss is hoping it's just infection; that's NOT what I think.

He dumped the weekend duty on me at 11:00a.m. Friday.  We had seven hospitalized cases.  Thanks for that advance warning.  Six of the seven are doing great.  The seventh is a 15 year old Cocker with a 53,000+ white count and a hematocrit of 13%.  He's treating her for possible tick borne disease which is valid in the South with the non-winter and crazy ticks we're seeing but I'd be looking for the tumor.  Everyone calls me Dr. C because I find so many tumors; I swear, they just jump out in my face without my even looking!!

On that note, my 16 year old Chow / Rotti has a tumor; I'm not sure where the primary is but it's likely it is in the brain or spinal cord.  He had a neurologic episode about 2 years ago which I thought was an FCE due to the rapid recovery and lack of pain.  He showed similar symptoms but seemed mildly painful so I gave him 2 doses of an NSAID in addition to his usual tramadol (for arthritis) which pushed him into kidney failure.  His kidney values were perfect, by the way, which was why I felt okay giving him the drug.  In working up the kidney failure, I took thoracic radiographs and found nodules in the lungs meaning metastatic disease.  The presence of the neurologic symptoms is why I'm thinking CNS tumor.  I'm not putting him through an MRI, anesthesia, surgery, etc. therefore he is on Prednisone now that he is over the acute kidney problem.  Right now, he's doing well although he is being extremely picky about eating.

Can't Spell always says that my having so many geriatrics at the same time is not good for my emotional health and she is correct but what can I do about it?

I tried really hard to think of a good story to tell with light and happiness I've struck out on that.  Sorry.  Guess I could relate the somewhat funny story about how I can hold grudges.  Last September, I sent a neuro referral to my alma mater that belonged to a good friend of mine.  The neurologist there is not the one that I worked with as a student and also is not the one to whom I referred my own dog a few years back.  I hated the way he handled the case.  The only thing good I can say about it was that he reached a diagnosis but, otherwise, the experience was awful.  One of our really good clients who is also one of my personal favorites needed a neuro referral and my boss had set them up for good ol' alma mater.  I asked if she minded going elsewhere and sent her to the doctor that took care of my dog that I liked very much.  Yes, I do hold a grudge if you piss me off badly enough.  Besides, I'm sick to death tired of dealing with people like that.  I've been working very hard to build myself a network of people to whom I can refer myself if the need arises for a specialist.  Yes, I will have to travel for some of them but it is worth it to feel like I'm seeing someone I can trust with my kids.  Half the reason I went to vet school was to take care of my own because I was unhappy with everyone I had used.  I'm still short on orthopedic surgeons...

That's really all that I have time to relate right now other than that I'm working on some first class pranks (stress relief) and my cartoon book isn't going so very good.  I had volume one 98-99% complete and my pesky multiple personalities kicked in with doubts as to whether I really want to share the 'toons with the general public so I started working on all five volumes at once and stopped focusing.  Not sure where that will lead.  With that, I seriously must go to bed as work calls tomorrow bright and early!

Those Vile Vials

I'm sure that most of the veterinarians and veterinary students out there are at least somewhat familiar with the AVMA PLIT newsletters that present multiple "Dr. A, B, C, D, etc." liability cases and their outcomes.  I'm also sure that I have commented more than once about my tendencies toward being a grammar and spelling Nazi...  I don't know how many of you read the aforementioned newsletter from June but if you did and were paying attention, the case where the vet saw a sick cat after hours and had the owner hold for a blood draw which ended with the owner sustaining injury from the cat had a nice, shall we call it a typo?  It stated that the vet turned to put the "blood into the viles" and the owner got bitten or scratched or something.  Last time I checked, "vile" is an adjective meaning something repugnant...

Nightmare

Imagine the ooey, gooey chocolatey loveliness that is a Devil's Food cake still in the mixing bowl filled with promise... Now imagine that same batter strewn across the floor. Some is in your shoes, on random furniture, even on you, as if it had exploded... Now imagine that it really doesn't smell at all like chocolate... Wake up, May B., it's not one of your bizarre dreams. All that ooey, gooey, chocolatey loveliness just came from your dog's rear end. And you complain about your dreams!

His Other Office

I work at a small clinic where we all know each other way too well (and some of the clients,too!) There are two bathrooms in the clinic; one up front that has public access and one adjacent to the break room and the boss's office. For as long as I've known him, my boss has seemed to spend an excessive amount of time in the bathroom, both in frequency as well as length of time per visit. We have always called it either his other office or his second office because, inevitably, when he is needed, the door is closed and there he is. Yesterday, the truth suddenly dawned on me and I wondered why I never realized it before. Just as a woman spends longer in the shower than is strictly necessary in order to obtain a few moments of respite from her loving spouse and adorable children who never give her a moment to herself (please read Virginia Woolf's "A Room of One's Own"), my boss is going to the bathroom to obtain that same moment. It is truly the only room in the clinic where we won't bug him because his office is certainly NOT sacrosanct. It's not a bad idea and I would probably steal it except for the fact that I avoid that bathroom as much as possible because of the vertigo inducing striped wallpaper pattern and one can't go hide out in the public access bathroom very well...

Filter Problems

Typically I have a very, very strong filter in place to guard the things that come out of my mouth.  Very rarely, in fact, does much of what goes on in the head actually come out of the mouth.  I am well aware that I have a biting, sarcastic tongue if left unfiltered and usually keep a pretty tight cap on things.    There are, however, a couple of circumstances that predictably cause filter slippage. Prescribe medication to me, even many of the blah drugs and watch out. A little antihistamine and whatever occurs in the insane head exits from the insane mouth. Make me exhausted and I become quite delirious and the results are the same. Ironically, alcohol fails to remove the filter but that may be simply because I have such a low tolerance that a very small amount sends me straight to the land of nod...

This past week has been insanely busy and, as I like to say, the lunatic was left in charge of the asylum meaning my boss has been away leaving me in charge. I think I must have committed some vile atrocity and been paid back by a week that has left me feeling as if I had been run over by a train that then repeatedly backed over me in order to run me over again. And it's not over since I don't get a work break until Monday when I'll spend my day off catching up on everything I've yet to finish plus worrying about the patients that I have left for them.  At least it's only one day to allow more to go wrong!

That said, there have been multiple instances of exhausted delirium and a few times when I had meclizine on board as well - double whammy! Result? More instances than I can relate of filter slippage.

Crazy client that drives us nuts and always sees my boss brings in her itching dog. She asks if "I'm ok" to see instead of my boss. I hear and tell her she should run while she can. She stays and we are discussing her dog; she is concerned because the shaved coat is growing back patchy. I assure her it will be okay and will fill in, citing my own cat whose coat does the same after shaving. She says I shouldn't shave my cat because they look ugly shaved, I say "And you think your dog is pretty?"

Rescue group comes in at the end of a long day Friday with a puppy mill rescue that needs emergency surgery. They ask for a rough estimate and I reply about $5600, with $5000 being for me.

And my favorite is the one that I actually stopped myself just in time. The sister of one of the employees who breeds Beagles has a litter due. She has my phone number but I clearly told her that my boss had call Tuesday night. She calls me after 9 p.m. at which time my phone is routinely cut off and plugged to charge if I'm not on call, and leaves a message. At 2:30 a.m. I'm up for a bathroom run and get my phone to take a picture of the kids who stole my spot in bed. I listen to the message and desire greatly to return her call right then... Likely the only thing that saved her was that I had not reached the point of sheer exhaustion yet.

It's just not safe for me not to have my filter in place. The other, worse, side effect of being so tired and overwhelmed is that mistakes happen.  There have been two that could have been catastrophic but, thankfully, were caught.  My previously posted diabetic cat is back with us because she is still struggling with her hepatic lipidosis and her owners are going on a vacation for 6 weeks.  They forgot to bring her insulin the first day and dropped it off on their way out of town the second day.  Someone, and I'm pretty sure it's someone who should have known better but not positive, gave her 2 units of a U-100 insulin from a U-40 syringe.  The second incident also involves insulin.  A previous employee is boarding her crew here while she is out of town a few days.  She has a diabetic cat who is gray/brown and white.  I am intimitely acquainted with him and have met 3 of her other 4 cats, 2 of which are black and the third being a tortiseshell.  Another employee who is really good friends with her agreed to be responsible for the insulin.  I was asked Friday night around 9 when I was finally nearing time to go if the cat that needed insulin was gray and white.  At least that's what my exhausted brain heard, so I said yes.  Yesterday evening, I looked in on the cats and realized that the diabetic cat is sharing a cage with the fifth cat that I have not met who is gray/black and white with more white.  The cat was sprawled out in the litter pan, responsive but very dull.  That's when it hit me that the employee had asked if it was gray with "more" white!!  She got Friday night and Saturday morning's insulin that should have gone to the other cat.

Glucose levels were low so she is currently on a dextrose infusion and being force fed and showing improvement.  I verified that I was correct with the employee.

Man, I hate weeks like this!

One last episode of sarcasm as a post-script because it just happened.  One of our kennel workers always brings either her dad or mom to help (they are divorced so usually one comes Saturday, the other Sunday).  Her dad is perfectly capable of working and is qualified in a field in which there is no job shortage but has not been employeed for quite some time and his daughter is keeping him up.  He was yacking at me and complained that his brother would drop $2000 on his dog without blinking an eye but wouldn't loan him $10.  Before I could stop myself, I said, "But the dog can't work for a living..."

People never cease to amaze me...

Just thought I would offer this update to the previous post. The folks with the diabetic cat came in yesterday about 15 minutes before closing with the complaint that the cat still was not eating. I was pretty pissy until we started talking and I found out that the anti-nausea injection I had given worked wonders and she had only stopped eating again that morning. Then, poof, they dropped the bombshell. Complete turnaround. Now they are willing to try insulin. Go figure. Sometimes allowing people to stew in their own juice is more effective than using a battering ram...

Shameless Promotional Preview

Just an update on my publication attempts.  I have finished Volume 1 of my cartoons and am in the process of self-publishing.  This is the cover image.  I am still finishing the editing process but hope to have the volume available by mid-July at the latest.  For those of you who have been privy to the cartoons, there are several brand new, never before seen images included with many of the older ones.  This volume primarily deals with the time spent actually in vet school but certainly has forays into my chocolate obsessions and such.  I'll update when it is actually available then begin to shamelessly encourage y'all to spend money...

Ye Day of SNAFU

Yesterday was a day filled with a series of SNAFU’s.  I don’t know why there are days like that on occasion.  You know, those where no matter how hard you try, nothing, not even the “routine procedures” can possibly go right.

I won’t relate every incident but I am going to tell about the ones that stick out in my mind the most.  I feel a little guilty that this post is on the negative side but...such is the way life goes sometimes.

Most surgery days I spend the morning in the OR and my boss sees appointments.  This arrangement just kinda fell into place without much discussion.  We sometimes flip a coin to see who will cut emergency cases and sometimes he decides he wants to cut something but that is not the routine.  Occasionally, I spend all day in the OR if the surgery load is really heavy although we keep one day lighter since my boss typically takes Wednesday afternoons off for golfing, that legal and politically correct four letter word.

Yesterday should have been his afternoon off but between the fact that it was raining and therefore not conducive to golfing and that he had multiple ear trims scheduled (I don’t do that surgery) it was not to be.  I had a spay scheduled that has a mild heart issue that we had already worked up and that was the only surgery scheduled besides the ears.  End result was that I was seeing appointments most of the day while he did the ears.

The first “fun” clients were the couple who, might I say at the start, do NOT have financial constraints that brought in their middle aged obese female cat who stopped eating.  I kept her to perform blood work, etc. rather than trying to speed diagnose in between a very full appointment schedule.  Long story short, the cat is diabetic.  Her glucose levels were far from the worst I’ve ever seen but definitely diabetic.

Diabetic cats are not equivalent to diabetic dogs.  Cats can go into complete remission.  Some cats can be managed on once daily insulin rather than twice daily.  And there are even a few cats that can be managed on diet alone (prescription diets available through Hill’s and Purina) or with the addition of oral hypoglycemics (although dosing can be difficult if you don’t have a compounding pharmacy available).  Dogs, on the other hand, are pretty much universally insulin dependent and rarely can be fully regulated on once daily dosing.  There’s my brief educational rabbit trail for the day without going into crazy pathophysiologic detail:)

I called the owners and explained the diagnosis and that I wanted to start their cat on a prescription diet and insulin.  The owner stated that she was nervous about needles so I explained about the size of the syringe / needle and encouraged her to let me show her when she picked up her cat.  She seemed open to the idea and both she and her husband came by about half an hour later.  I walked into the room with the cat and my demo needle.  Both people stood with their arms crossed and avoided my eyes.  I started by showing the syringe and explaining how the injection was given.  I then uncapped the needle to show them how tiny it is.  During this time, both gave the impression they were ignoring me.  When I uncapped the needle, the husband interrupted my comments to say, “We won’t be doing this.”  They wouldn’t allow any further discussion.  I got very blunt and told them that while we can try food +/- oral hypoglycemics, we very likely will be facing the decision of euthanasia either due to worsening diabetes or fatty liver if the cat doesn’t start eating again.  They really didn’t seem to listen but did take the food and the cat home.  I shudder to think where this will go since I really wanted to keep the cat and start insulin and make sure she would eat before discharge...

By the way, I should add that the owner in the previous post that I discussed the hyperthyroid cat has agreed to try to new Y/D food that Hill’s has developed.  It was the usual awesome conversation though, as he first said he could feed the cat separately but when given details on the food suddenly became reluctant.  You just can’t please people.

Then there is the Lab who is on a rather high dose of prednisone and has been for quite some time for chronic atopy.  She’s an older dog and her owner wanted her checked over because she’s polyuric, polydipsic, polyphagic, and panting a lot.  Oh, by the way, I don’t want blood work or anything.  I recommended that we minimally decrease the pred dose and strongly recommended blood work.  She decided she would prefer to talk to my boss on a day when he was available.

Lately I’ve had a burst of fibrosarcomas in cats.  Unfortunately, one that had dirty margins but was doing very well with no evidence of recurrence came in yesterday with a tiny nodule.  She got added to the surgery list because when the first mass appeared it quadrupled in size in less than a week.  Another random educational rabbit trail...I know that the actual percentage of cats with vaccine related fibrosarcomas is fairly small but the reality is that it occurs and, as a good friend of mine expresses statistical information, when it is your pet, the reality is that it is either 0 or 100%.  Most likely this cat’s fibrosarcoma is due to vaccination several years ago at a different vet.  The owner stated that the vet always gave the vaccines between the shoulder blades.  After surgery yesterday, I simply have no more tissue that can be removed.  The owner can’t afford radiation +/- chemotherapy therefore if the tumor returns again, we can only keep the cat comfortable then euthanize when the time comes.  The standard of care is that vaccines should be given in the base of the tail or very distally on the limbs so that an amputation (therefore hopefully complete excision) can be done if a tumor occurs.  This discourse is NOT  intended to discourage vaccination.  Vaccines are important.  It is just that vaccination, like any other aspect of medicine, needs to be done in an intelligent manner weighing risk to benefit and making it as safe as possible.

I also saw a rather anxious cat for vaccinations who, per the owner, is quite aggressive.  We were discussing behavior issues and how anxiety can be a trigger for aggression and made a plan to treat the cat.  Things were going quite smoothly as I did an examination and trimmed the nails until the dogs in the waiting room let loose and he turned around and almost nailed my hand.  Good thing I have well trained reflexes, he got me a little but nowhere near as badly as he intended.  I had to get help to finish because at that point he was out of kitty minutes and figured anything that touched him might be dangerous.

The rest of the morning appointments I’m sad to say kinda just blur together as primarily skin / allergy issues that all wanted a magic cure as explained in the previous post.  Lunch time arrived and I found that my boss had not finished with his ear trims.  I’m not real sure what he expected but I got the impression he thought I was going to do my two surgeries through my lunch break and then he could come back and do his last ear trim while I saw the rest of the day’s appointments.  I’m learning to take better care of myself.  It’s still a struggle but I’m doing a lot better.  I went ahead and removed the fibrosarcoma then left for my break during which I go to the park and walk.  As I walked out the door, a man came in with a dog; I pretended I did not see.

Apparently, the guy was a “good friend of Doc’s” and called him on his cell phone when he was told there was no doctor in the office to give his dog its “allergy shot” i.e. steroid.  My boss then came in and did it even though it was lunch hour and clearly not a life and death emergency.  He then pre-medicated his ear trim but still hadn’t started on it when I returned 45 minutes later.  I started the afternoon appointments which had a bright spot in the County Drug Task Force dog that came for his vaccines.  I typically enjoy these appointments as long as the handler is good and this dog I particularly like.  He’s just a lot of fun and so easy to deal with plus his handler is super caring and nice.  The afternoon went downhill from there.

Next up was an appointment time set to see some drug reps.  Myself and the tech were there at the beginning and it was actually an interesting dialogue.  About 15-20 minutes in, my boss joined us, having finally finished the last ear trim.  He almost immediately became belligerent which is totally unlike him.  Of course, too, it was about something that he missed in the first few minutes of the spiel.  We finally got finished and I was thinking, at last, I’ll get the spay done (this was nearing 4:00p.m., by the way).

Nothing about the spay went right.  First, her veins were crappy and getting an IV  catheter placed was a huge challenge.  Finally got that done then induced her and intubated her.  This is an example of why so many of us are control freaks and hate to delegate.  Someone else intubated and I don’t know if it just wasn’t in place from the beginning or if it got pulled somehow between prepping and moving to the OR.  In any case, I had entered the abdomen and was about to clamp the first ovary, the dog suddenly did one of those waking up pushes where most of the intestines come out and hit the clamp and tore the pedicle (this was a middle aged dog just coming out of heat with all the implications therein).  So now I’m working with a dog with a heart problem, a bleeding pedicle, trying to wake up and jump off the table, guts all out in my way and a fairly small (typical) spay incision allowing no extra room to search for the bleeding pedicle.  In addition, two of our staff were angry with each other and not helping each other or doing their own jobs therefore trying to pull my technician away...

I’ll relieve the anxiety rather than making you relive the moments with me and state that the dog is fine.  It was very tense for a bit though while she got re-intubated while on her back, given more drugs and finally was actually asleep again.  Yes, this is indeed one of the reasons I’m such a control freak.  At least if I had intubated and the same thing happened, I’d know for sure it was or wasn’t correct at the beginning therefore who or what to blame.

I had a screaming fit and relieved some of my tension at the staff members because their behavior was helping to endanger my patient by causing my technician to be yanked in so many directions.  My hands were shaking very badly at the end which is very typical of me after severe stress.  This makes me dread next Tuesday when someone stupidly added several ear trims on top of an already full surgery schedule...  We rarely do this many, usually they are few and far between, but a breeder is having the whole litter done.

My boss saw the remaining appointments while I spayed the dog which took 2-3 times longer than normal because of all the problems.  He was grumpy about it, too.  He was probably pouting because by then the weather had cleared but he couldn’t leave to golf.

When I finally left yesterday, I was beat.  All I really wanted to do was collapse.  In fact, inertia had set in as I made phone calls and finished paperwork to the point that I almost fell asleep at the desk on the uncomfortable chair.  I probably would have fallen in the floor had that actually happened.  Might have added entertainment to the morning, though.  Thankfully, I have today off to recuperate before the fun begins again tomorrow!

Magic Shot

This is not a new complaint but it sure seems as if it has come up more frequently the past few weeks to the point that I'm about ready to do physical harm to the next person who walks through the door with the request. Everyone wants the magic shot that I can just give to their pet and cure whatever ails said pet without any effort on the owners' part. By cure, I mean they expect an absolute cure for everything ranging from allergies to cancer to the common upper respiratory infection.

What is it that makes people believe we have a magic power that enables us to not only diagnose without any type of testing or expenditure but also cure with a single injection?

Over the past couple of weeks I have very seriously been asked to cure allergies, flea infestation, cancer, an upper respiratory infection, parvo, feline leukemia, hyperthyroidism, and even old age with an injection. I've made several people angry and a couple may never return. More power to whatever poor veterinarian inherits them as new clients who are angry with their old vet and seeking a second opinion. I'm sorry, I get super blunt when people come from another vet complaining that they failed to cure the aforementioned ailments and they want a second opinion. The one with the hyperthyroid cat is actually an long-time client of ours that I won over to "love" me when I diagnosed the cat. The problem is that although I put an extensive amount of time into explaining the disease and treatment options as well as the fact that the only cure is radioiodine or maybe surgery dependent on the location of the tumor as well as the fact that the medication is lifelong, the guy still doesn't get that his cat's weight is not going to stabilize until we have the cat on a consistent dose and actually regulate the thyroid. This has been going on for a little over a year now...

My favorite interactions are recorded below:

New Client presents with dog with severe otitis externa as well as evidence that all four feet have been chewed on extensively. Owner wants second opinion because previous vet failed to cure ear. I look at the dog then look the owner in the eye and state, "I cannot cure your dog either."

I don't think they were very happy that the visit started out that way. I explained atopy in grave detail and that it is impossible to cure; all we can do is try to control it. I also explained that with the foot and ear involvement I was highly suspicious of food allergies. At that point I was told quite definitely that food allergies were impossible because the dog had eaten the same food all of its life. Besides, they didn't want to take the time to try to get him to eat something different or go to the expense of a prescription food. The dog also had grade 4 periodontal disease and I recommended a dental (probable full mouth extraction would be my guess) but, once again, we love our dog but that is too expensive. The medications prescribed by the other vet were fine so I only tweaked the frequency of dosing since they were only doing that twice weekly (probably a misunderstanding). I also added an oral antibiotic for kicks and giggles in case the topical was just not reaching a good enough concentration to kill the cocci that were very much in evidence on cytology. They then complained that they had to give medication at home and do the ear flushing and topicals more frequently. Oh, and by the way, why can't I flush the ear while they were there. I explained that the only way I could flush it better than they could at home was if I anesthetized the dog and that if we did that it would make the most sense to schedule it for the next day and perform a dental as well... I doubt they will return for their recheck appointment in 2 weeks.

The second was also a new client who had seen "that other vet down the road" who thought the dog had neck pain and gave him steroids but it didn't do any good. I'm summarizing what took me over 45 minutes to elicit from the owner. For some reason, he wanted to make me guess why he was there. My first response was severe flea infestation since they were running all over the dog visible from across the room. Very haughtily, I was informed that they had not treated for fleas as usual because they were afraid it might not be okay with the medication. I told them using a topical such as Frontline, Advantage, etc. would be fine at which point I was informed that they used a flea collar and they knew his neck hurt and they were afraid the collar would make it hurt more. Sigh...

I agreed with the previous vet's findings that the dog had neck pain as well as mild pain at the thoracolumbar junction. Given breed and age it is most likely intervertebral disk herniation but there were no other neurologic deficits so the dog is not really a surgical candidate at this time. I offered referral for imaging to verify the presumptive diagnosis since "that other vet didn't do anything!" I was declined due to cost (big surprise). I explained that we could take radiographs but it wouldn't give us a definitive answer unless there was a bone tumor or something other than a disk problem. The owner was very unhappy when I mentioned the "C" word. He settled on pain control and I explained that changes in weather such as we've been experiencing lately can often cause a flare-up in painful conditions and that his dog might require long term pain control. I also explained that it could get worse as in the dog becoming paraplegic; I used the term unable to walk in an attempt to make it more clear at which point the owner told me the dog already couldn't walk. By that he meant that the dog was walking hunchbacked and taking small steps and was reluctant to move.

I finally got the guy moving out of the exam room at which point he wanted to know if I wanted to give his dog an enema. "Why?" I asked. "I thought you said you had seen him defecate." "Oh, he did a normal bowel movement but I just thought you might want to because the other vet mentioned it." Okay.... I thought you didn't like the other vet. And it was probably mentioned that it might be painful for him to posture and might be necessary if he became constipated. No, can't say I really do want to put your sweet little dog through that for no apparent reason. Few more steps, almost to the front desk, hold your breath... "Oh, by the way, how much are shots?" I gave a rough cost for routine vaccines while continuing to walk away and was asked to repeat it as if it were a horrendous amount. And, no, I'm not giving your dog vaccines today if for no other reason than that would mean we have to go back to the exam room and I have to go through the process of moving you out all over again!!

And the last one that I'll relate is probably my most priceless favorite so far. A younger woman that worked at the clinic previously (not while I was there) who bought a purebred dog that is known for having allergy issues came in for an "allergy shot" meaning steroid to stop the itching. The dog always has fleas when she comes and usually the main areas of hair loss are classic for flea allergy dermatitis. Our conversation, no kidding, went as follows:

Crazy Lady: I'm tired of getting steroid shots - they don't last long enough. I don't want to treat my dog for fleas and I don't want to treat my house or yard. I'm tired of doing medicated baths and giving medicine. I just want her to have perfect skin and no hair loss and a beautiful, long, glossy, healthy hair coat!

May B. Insane: So basically, you are asking me for a magic cure, correct?

CL: Exactly!

MBI: Well, there is nothing I can do to help you so I guess you may as well just leave now and stop wasting my time...

I then turned to leave the room while she stared at me open-mouthed. In the end, I delivered a lecture about atopy and flea allergy dermatitis. She refused to pay for allergy testing (it is too expensive and I just don't know if I can give her shots!!) or a hypoallergenic diet trial but did agree to follow my recommendations regarding medicated baths, adding omega fatty acids to the diet, adding consistent antihistamine therapy, and adding a consistent flea control product that may actually help the flea allergy dermatitis issue. At least in theory. I doubt, however, that she'll actually carry out her part because, gasp, it means she actually has to do something.

I swear, sometimes I think people in general should just have stuffed animals and be done with it!

Jinx or superstition

Veterinary medicine is a scientific world that is froth with superstition. There are so many things about which we are superstitious. Never say a day doesn't look busy because it will then explode into chaos. Never say things can't get worse; TRUST ME, they can!! Never call an owner before their pet is fully awake from anesthesia or the pet will die. Never name a pet "Lucky" because it surely won't be. You get the idea.

Today, I have a perfect example of one of our common superstitions at work. Anytime an owner comes in super worried about anesthesia, something is bound to go wrong. With the large number of surgeries that I do on a monthly basis (not just routine spays and neuters, either) we have very few anesthetic deaths. They are so rare that I can name all of them from the past year and they are so few that I can count them on one hand.

This morning, an 11 month old 5 pound Chihuahua came in for a spay. I had first seen the dog when she weighed a mere 10 ounces at 4 weeks of age when her owners found themselves with a bottle baby. At that time, she presented hypoglycemic and virtually lifeless. It's easy to see why she is so very special to them but when they were telling me how concerned they were this morning, I was not a happy camper.

Needless to say, I was super careful and guess what happened...yep, she arrested. One of those stupid unexplainable anesthetic reactions. Thankfully she responded to CPR and is fine. She is now spayed and whenever another anesthetic episode is required the protocol will be altered. Hopefully she'll like a different drug combination better!

I've always wondered if this is truly a jinx or if there is some intuitive sense that warns people of a potential problem. The problem with that theory is that I am typically very intuitive and the pets with whom I have had the most reservations about anesthesia had no problems at all. Go figure!

On a separate note, I must comment that I'm less than impressed with Starbucks coffee. I've never had anything other than hot cocoa from Starbucks before today. I am not a fan of flavored coffees and typically like dark roast. (Chocolate and coffee are approached the same. No contaminants, dark; I'm a purist of sorts.). If it is a good coffee, I drink it black; if just mediocre, I add sugar. No cream and definitely none of the flavored creams. To me, Starbucks coffee was no better than your average grocery store coffee. For the price they charge, it should have been superb. No wonder I never spend my money there. Why did I have Starbucks coffee? My boss bought coffee for everyone yesterday. Now my cynical pessimistic self is still wondering why. He has done several uncharacteristic things like that lately. Not that he's not a nice person, he's just not typically the type to show appreciation by providing "treats". Makes one question the ulterior motive...

Replies

Nice to know there are more fans out there. No one amongst my friends are familiar. I'm constantly amazed by the things I hear wrong which is probably one of the reasons I do much better with written media. Incidentally, we were shown "Brainstem" in vet school during our neuroanatomy class as well. Thanks for the confirming info.

On personality types, I have to mess with you a little. Myers-Briggs says I'm an INTJ. It is a fairly accurate assessment overall and I've always found it entertaining that there are supposedly so few females of that type. Maybe it's why I think a little more like males in general. On the animal scale, I'm primarily a beaver which is equal to a melancholy which is equal to a "C". Secondarily, the "S" and "D" are nearly equal, phlegmatic and choleric, golden retriever and lion, which is odd because these two are polar opposites. Lowest is the "I", otter, sanguine. Clearly, all systems agree I'm reserved / introverted and task oriented rather than people oriented.

On the veterinary personality field I'm a surgery junkie with ophtho as a strong second and emergency / medicine coming in third. Unfortunately I have a gift for oncology. Derm and repro I'd prefer to pretend are nonexistent.

Can't Spell and I were discussing this last night and determined that in our world, we would need to do multiple personality assessments because our world requires multiple personas to show the public. I've developed my public persona so well that many of the employees think I'm an extrovert who enjoys people. Now that's truly frightening...

Mistaken?

I'm questioning the possibility that I may be mistaken... It would seem that "dinky" appears in the opening of each Pinky and The Brain episode. Perhaps it is deliberate. With my ear problems, I cannot accurately differentiate if they are singing "d" as in "dinky" or "p" as in "pinky" for certain. Any other fans out there that knows the answer to this piece of trivia???

Pinky and The Brain

I'm still on my understanding personality kick. Some people say I can be obsessive at times but I wouldn't know about that...

It all began, or maybe I should say was triggered, innocently enough and for an upstanding, admirable reason. (Okay, so I was interested before as well; this particular obsession was triggered, though.) I ran across my old Myers-Briggs profile from when I was 16 and it struck me how accurate it was with a couple of explainable quirks thrown in for good measure - I can't be totally understandable, you know. Then, yes, a brilliant idea hit me. What if I could determine the personality profile of everyone with whom I worked? Not only would I understand them better but I could also communicate with them better and then...take over the world!

There are several attempts that have been made at characterizing personalities. Many are actually the same just using different words. For instance DISC is equivalent to choleric / sanguine / phlegmatic / melancholy is equivalent to the animal one using lion / otter / golden retriever / beaver. There is also the previously alluded to Myers-Briggs which is somewhat based on the same concepts but further characterizes based on how one receives and interprets information. There is also the birth order idea I talked about previously and other ideas floating around. Tonight, however, it suddenly hit me, sorta like a flying cow in a tornado...all of those ideas are over rated and too complicated. I propose a new, simpler, and better characterization...

The Pinky and The Brain test.

Suddenly, I made sense to myself because I realized why I've been so hard to figure out. Pinky and The Brain are polar opposites and I...I am both! So if one is a genius and the other's insane, what does that make me? An insane genius???

(Incidentally, if you watch the opening song carefully, you will notice there is a typo where it says "dinky" rather than "pinky" just before the bar of gold squishes them. At least there is in the second season. I'll have to watch the rest to see if it is there, too. There's also an interesting typo in the Walker, Texas Ranger series opening on some of the episodes as well. My grammar and spelling Nazi side can't help but notice...)

Now, on to some political commentary. After I take over the political system in the US, the following changes will take effect:

1. We will eliminate the electoral college so that every vote counts as an individual.

2. We will eliminate ad campaigns. No billboards, signs, radio, internet, television, etc. commercials. The money saved there will be put to good use rather than wasted on lying ads.

3. There will be debates but any mudslinging results in that candidate being evicted from the debate and not allowed to participate in future debates until they have fulfilled 100 hours of community service.

4. Each candidate will be required to release a record of past voting history if applicable and a statement (in print) of their platform.

5. Once elected, the official can be removed by public vote if they fail to display integrity in fulfilling their promises and maintaining their platform.

Or, we could just promise free ice cream and see who gets the most votes. I'd bet on the ice cream...

And in the veterinary world it feels as if summer has arrived months early even for the deep south. Fleas, ticks, and allergies are in full swing. Business has picked up even though it failed to ever really drop off much this time. I had an awesome surgery day Tuesday where I never even had to talk to anyone all day... Then I wanted to hurt everyone the following day because we weren't as busy but they somehow created chaos. I love being busy especially when things run in a smooth, organized, and efficient manner. Besides, I find that if I am kept busy and not allowed to become bored I create far less mischief and get into far less trouble. I despise it when chaos occurs at all but even more so when there is no reason for it. So tonight, are you pondering what I'm pondering?

People do the weirdest things!

This evening I had a client come in with a request that came near to my previous experience when the lady yanked up her shorts in the middle of a crowded lobby to ask about a skin lesion on her rear. Today, a male long time client came by wanting "to speak to the doc." I invited him back to one of the exam rooms after finishing the appointment that I was with, primarily because there were a lot of people in the lobby and I had no idea what he needed.

After carefully closing the door he said he had a strange request and proceeded to unbutton his shirt. Apparently a "friend" of his had removed a growth from his chest and given him some thumb forceps and a small disposable scalpel with which he could remove the sutures himself. He wanted someone to "supervise" and make sure he wouldn't hurt himself. I was afraid to ask if his friend was truly a doctor and why his friend didn't remove the sutures.

I advised him to go to a doctor or at least to get some suture scissors rather than a scalpel blade...

Birth Order Personality Traits

I find attempts to understand ourselves and how we relate to the world to be fascinating. Some of the ideas seem valid while others are clearly a crock. I'm not sure where the birth order idea falls...

In some ways, it makes a lot of sense that a firstborn will approach life far differently than a middle child, singleton, twin, or last born. The people who started researching the idea believe it is very important and that certain traits are universally to be expected. For instance, a firstborn should be more conscientious, more rigidly adherent to rules, and mature earlier taking on more responsibility. A baby should be more rebellious, creative, and less observant of rules. Okay, makes some sense when you consider it, right?

There are problems with the theory, though. First, research has failed to fully support the conclusions. Second, far too many fail to fit the mold. I'll use myself as an example since I know me well. I'm a last born. By the books, I should be rebellious and creative. Check. Got that right. Problem is I'm also super conscientious, hyper-responsible, and tend to take on leadership roles more appropriate for a firstborn. Hmmmmm... Oh wait, say the proponents, didn't we mention that age differences between siblings, gender, stressful episodes during childhood, early loss of a parent, and relationship to your parents also has an effect?

With all those influencing factors, you really want to tell me that birth order determines your personality? I think not. Why don't we just admit that personality, like so many things in life, is shaped multifactorially.

Or maybe I'm just a really messed up last born...

Certain things really make me angry...

I am a very even tempered person and it usually takes quite a lot to really make me mad. I got very angry this past week because of an appointment. The young couple who I have met once before showed up at the clinic in a reasonably nice vehicle that looks newer than the one I drive. They had their three very young children with them, all decked out in cutesy matching outfits and riding in very nice matching buggies, you know, the two seater ones that will lay down and have gadgets on them. They brought their new puppy to get its rabies shot because they had purchased the other vaccine at the local feed store and given it to save money. By the way, can he have a bath? Oh, and check his ears. He most likely has sarcoptic mange starting on those ears but we need to go the cheapest route possible because we are both out of work right now...

At this point, no doubt y'all think I'm being a first class witch. I do understand needing to conserve and losing a job. So why did I get so angry? These were the same people that brought the puppy in last fall and surrendered it expecting it to be euthanized. The puppy that had sarcoptic mange but they never bothered to bring it until it was almost dead. The puppy that I was possessed enough to rescue and transport halfway across the country to its new home where it is happy and well.

The lady even mentioned the previous pup saying she was with Jesus. Took every fiber of my being not to say what I was thinking. When an animal is surrendered like that, it is our policy that the previous owner is not allowed to know the outcome; they forfeit that right. They don't deserve to know and they sure don't deserve such a sweet little new pup. I just hope they follow through with treatment...

Talent

I have a T-shirt, purchased for me by my mother, that says "Sarcasm, Just One of My Many Talents." She, as well as most everyone who know me well, seem to think it fits. I'm sure my mom is very proud of my many talents. I doubt, however, she would have predicted or chosen some of the best ones. Like my talent of mimicking the sound of a reverse sneeze. Given that this is probably one of the most common benign complaints for which I see panicked parents with their dog who "can't breathe," "is choking," "has asthma," "can't catch its breath," "is in heart failure," or any number of other death-inducing emergent presentations, it is a wonderfully helpful talent. I make the noise and the parents are amazed and delighted that I know what they mean and their baby is not dying. I can also mimic mother cats calling their kittens (it's how I used to catch and tame barn cats as a child), mimic many accents or patterns of speech (often unintentional), and some heart murmur sounds. Now if only I could sing well enough that I didn't have to restrict that activity to when I'm all alone...

What day is it?

I have a horrible memory. Everybody will tell you this. I forget to bring my lunch, I forget to bring my empty lunch pail inside the house, I forget it all. This has led to numerous attempts over the years to come up with memory aids to help me. Alas- I forget notes and forget to look at my phone.

One of the places this tendency towards forgetfulness really turns around and bites me on the rear end is remembering important dates. I'm going to digress a bit here (Dr. Maybe and I call them "rabbit trails")... I can remember random useless facts- The date of Pearl Harbor? Got it. The date I graduated vet school- got it. Even the years WWII and the American Civil War were going on- all up in the old noggen. However, one thing I can't remember worth a hill of dirt is birthdays.

I even have trouble remembering my *own* birthday on occasion, let alone family members and friends. Now pets' birthdays- those I remember. Priorities, after all... However the only date I can always remember is my mother's birthday, my dad's birthday is always one of two dates, and everybody else is just SOL. All my relatives and friends know- don't be offended if I don't send a present, card, phone call or random Facebook post- I don't remember *any body's* birthday..,.

This led to a rather humorous exchange with Maybe last night. I have recently had a birthday (I don't remember when but I did) and I knew that Maybe's birthday was shortly after mine. So I asked her on the phone last night-

Can't_Spell: So Maybe, your birthday is May 11th right?

May B. Insane: Nope

CS: Uh, March 11th?

May B: Nope

CS: Uh...

May B.: forget it already CS you do this every year...

CS: I do?

May B: Yep. You even guess the same dates every year.

CS: Do I get close every year?

Moral of this story- I need to get every body's birthdays put on a list and tattooed in my dog's ears- I look in there all the time...

Pocket Pets

I've never had a pocket pet of my very own. It's not that I dislike them so much as they just fail to really engage me so much. The closest I've come to having one was the two New Zealand White rabbits we had as kids; trust me, that type rabbit does NOT qualify as a pocket pet. I also have no problem treating them but do approach their care with the same blend of practicality and individuality with which I approach all of my patients.

There is a local pet store that brings their pocket pets to us for care. The entire outlook is unique to me because we can do pretty much anything but they are very practical in that heroic efforts to save the dying is just not the way to go. Today, they dropped off a mouse, a hamster, and a bird while I was out for my lunchtime walk. The exam went something like this:

Hamster is taken out of cage and is clearly in bad shape. He looked as if he had been worked over by a gang of hamster thugs. He was shocky and so lifeless that his only attempt to bite consisted of a slow motion, half hearted opening of his mouth. In my experience, a hamster, particularly a dwarf hamster, that does not latch onto one of your appendages is actively considering death as a good option (to die, to sleep no more...).

The mouse had a nice abscessed bite wound on his back . He tried to get away and was very active.

The bird had weird funk on its head and feet and did not want to stand, curling its feet and legs beneath it. It was also less than normally responsive.

I returned all three to their respective cages and gave the hamster a warm towel while I called to discuss treatments. The bird promptly flopped on its back and died.

My comment afterwards was: "The bird is dead, the hamster is about to be, but the mouse should be fine. One reason I'm not such a fan.

Cats - The Ultimate Weapon

Sssshhhhh, don't let my dogs hear this, I'm really more of a cat person, generally speaking. I've even threatened to open an all cat clinic; particularly on those hundred plus pounder dog days. But there is just no way a dog can match a cat for the sheer amount of damage inflicted on a human when said cat is angered. It kind of reminds me of the facetious piece about deer hunting that explains in great detail why the human gets to carry a gun. Maybe declawing isn't such a bad thing, after all... Two illustrations to follow.

The first happened last week at work and, fortunately, no major bodily harm occurred. We had a cat to neuter who was supposed to get pre-anesthetic blood work including a FeLV/FIV test. Notice I said supposed. I can handle a lot of cats that other people find impossible. Suffice it to say this was not one. Despite our best laid plans, the cat exploded from his crate and was high-banking around the room. He created shambles with scratches up and down the walls, on the chairs, and through an oxygen hose. He kicked over two oxygen tanks and hit the door multiple times before we were able to lasso him (me) then pin him to the floor under a thick blanket (my tech) and slip him a quick acting mickey. Okay, so the blood work became post-induction. Other than a nice bruise and minor bite wound on my arm, we all emerged unscathed - including the cat!

The second incident led to bloodshed. Mine. My personal cat herd is a motley crew with mixed backgrounds including a couple of semi-feral cats. All have baggage except maybe Caleb. Cassie is a spoiled brat and she likes to whine about anything that isn't her idea therefore the monthly application of Revolution causes great complaint. The whole crew was somewhat edgy because I've not spent enough time with them the past few days and because the food bowls were a little low (gasp, you could see the bottom in places!). I picked up Cassie for her turn and she started squalling then a quick, white movement from across the room caught my eye. I turned just in time to see Katrina, the white witch, come charging at me to attack Cassie, who was dangling from my hands. In a flash of white fury, she ran up my leg. As I tried to stop her, she clung to my leg just above the knee. With supreme effort, I held onto Cassie, who was screeching and scratching to get away, and shook the white witch off my leg. Then I put Cassie's Revolution on and released her.

If you'll excuse me, now, I'll limp away and clean up the blood...

Supreme Disappointment

I have confessed my fascination with abscesses before as well as my enjoyment of the art of attempting to hit someone with the spew thus you can imagine my excitement over the beautiful scrotal abscess that presented this afternoon. It was warm and very swollen with fluid palpable and a wound just waiting to be opened...

I anesthetized the dog, prepped the area, and inserted some hemostats and...NOTHING!

After a thorough exploration of the scrotal sac I found two normal sized slightly bruised testicles, a LOT of cellulitis, a small seroma, and a wimpy walled-off pocket of pus that I had to exert a lot of pressure on to get drained. What a disappointment; no thrilling gush, just boring. I'm sure the dog feels better, though, with his good drugs and all. Me, on the other hand, I'm just let down after the anticipation of a really good abscess.

On a side note, I loved the vets behaving badly "V is for vomit" entry. Right there with you. Funny part is that we had a surprise office Valentines party; the last time I celebrated Valentines Day, I was in grade school and we all had decorated baggies to put cards in...

I Feel So Very Old!

I guess I've always been a bit of a nerd which is probably one of the many reasons I always feel old. I found myself greatly distressed when I couldn't stop myself from stepping in on a political discussion taking place between one of the kids at work (18) and one of the techs (30). The kid didn't know that Obama is the only democrat in the presidential race. Neither knew anything about any of the republican candidates. Their ignorance was so appalling that I was forced to break my usual rule of silence. I knew about politics when a mere child; I have recordings (on a cassette tape!!) of "shows" invented by myself and my brother complete with political commercials. Okay, so they mostly made fun of the candidates - can I help it that the majority of politicians are worthless other than as an object of ridicule?? Hearing the two of them reminded me of a recent conversation in which myself and a friend were trying to find a good word for a political atheist. Initially, American was suggested but we then agreed that American would be better defined as politically ignorant...

MAC Abuse

I may be forced to discontinue my recently instituted MAC award. It's certainly not for lack of recipients; the problem is that I keep having to remind my staff that giving it to every person that walks through the door really tends to diminish its significance...

MAC's

I've decided to institute a new award; the only question is how often to actually award it. At this point, I'm leaning towards daily....

MAC: Most Annoying Client

Yesterday, the choice was so easy. A young lady who brought her dog in for the first "official" visit. I had met her once before when she came by with a teeny pup, a million questions, and no money. She is a good friend of one of the kids that works at the clinic. The first time we met, I talked her into spending a couple of dollars on dewormer and flea treatment for her house since the pup was infested. She came in yesterday with the same pup, now grown, still infested with fleas, still no money but with the belief that she can charge since her friend works there. The chart said vaccines. Not so much.

I walked into the room to find the two girls chit-chatting and before I could re-introduce myself was interrupted by the employee. I then squatted down and invited the dog to sniff my hand while talking soothingly to both him and his owner. He approached me and we were becoming friends when I casually commented that his nails could use a trim. His owner responded with "Oh my gosh, is that what's wrong with him?!?" I was struck dumb but only for a second and rallied with "Noooo, but they do need trimming..." The conversation continued as follows:

Owner: Well I read on the internet you shouldn't trim a dog's nails.

MBI: That's not true. Don't believe everything you read on the internet.

Owner: I also read to give garlic for fleas and that's what we've been doing.

MBI: And clearly it's working so well (highly sarcastic tone). Garlic can actually be dangerous for dogs. There are a LOT of bad internet sites and misinformation. I would suggest that if you don't know how to determine which sites are legitimate (they teach you what to look for in school these days if you chose to listen and apply the information) then I'd suggest you refrain from using the internet as a resource.

Owner: Well we also use flea medicine.

MBI: Which also is clearly NOT working. What kind and did you treat your house like we discussed?

Owner: Yes, several months ago. We use no-good brand that we buy from local big chain store.

MBI: You might as well flush your money down the toilet. You only treated the house once?

Owner: Yes, I didn't know I should do more.

MBI: We talked about repeating in 2-3 weeks to break the life cycle. I'd also strongly recommend that you purchase good veterinary product that actually works for at least three months.

Owner: Which should I do ?

MBI: Both!!

At this point, I have picked up the dog and become friends as well as completing most of an exam. I proceed to begin cutting nails and am through 2.5 feet when employee friend wants to hold dog for me. Performing half-ass restraint, the employee pays no attention as the dog becomes upset then screams and tries to bite me. I tell said employee to get out of the way and finish without help. Turns out the owner brought $35 for an exam (not the correct amount) and no more. I work up a minimal estimate for flea treatment allowing the dog to stay in the clinic while she treats her house. She then asks if she can charge that. Nope, sorry. Miraculously, she produces more money. Included is a rabies vaccination which I intend to give after she leaves but...

Owner: Aren't you going to give his shot?

MBI: Yes, but I thought I'd do it after you leave because he will probably cry.

Owner: Oh no, I'd really rather you gave it now. It's part of my puppy therapy.

Reluctantly I complied and the dog screams and tries to bite and the owner screams. I then pick up the dog to take to the back for his bath and the owner freaks out.

Owner: You're not taking him now?!?

MBI: Yes, I'm taking him for him to get his bath (thinking I have no intention of continuing to visit with you, you gotta leave sometime!)

Owner: But I don't want to leave my baby!

MBI: Well don't. I told you that you could wait and bring him back in the morning.

Owner: But it would be best for him to stay, right?

MBI: The sooner we get rid of the fleas, the sooner he stops itching.

Owner: Oh yeah, I forgot to ask if he might be itching because he's allergic to his food.

MBI: You must be kidding! Look how many fleas are on your dog!!! Do you really think he needs another reason to itch?!?

Owner: Oh...(trailing off)

I take the dog and flee the room then instruct the employee (her friend) to give the dog a flea bath.

Employee: Now? (Incredulous voice.)

MBI: Yes, now. He's miserable and itching and it's not like you are doing anything anyway (ok, so I said it in a very sarcastic tone).

Employee: What kind of bath?

MBI: A flea bath. (Again, very sarcastically).

Employee: How do you do that?

MBI: Speechless and staring open-mouthed. Fortunately, my tech stepped in at that point probably saving me from strangling her and giving me the chance to get some chocolate. As I told a cashier once when a rude comment was made about the amount of chocolate I was purchasing, "Consider it a philanthropic gesture; it keeps me from murdering people that annoy me. People like you..."

Telemarketing Insanity

Most of the time if I see an obvious telemarketer phone number on the caller ID I blatantly ignore the ringing phone with no problem. Occasionally, however, I have a little devil that takes over resulting in conversations like the following:

MBI: Hello

Telemarketer: Hello, may I speak to May B?

MBI: I'm afraid she's not here. She's dead because I killed her.

Telemarketer: Dead silence

MBI: Hangs up phone

Does this prove I'm crazy?

I was on my way to bed and grabbed a Dove dark chocolate to pop in my mouth. The inner saying read "Enjoy the aroma of chocolate" and I supplied the ending "in the ICU as all those dogs are puking...". Okay, so it reminded me of that night on ER when we had multiple chocolate thief dogs and the whole ICU smelled so heavenly I just wanted to stay and enjoy. I know, something just ain't right about that.

Needy clients

Y'all know the ones I mean. Some are nice, some are rude, some are downright crazy but any of those can be needy. Normal clients come in, we have a short intro nicety chat, get down to the business of the exam, then make recommendations / discuss cost, etc. and proceed with life then they walk out the door. These people also pay their bill and follow up as needed. Don't feel like going into all the categories of genuine crazies we see, especially since they all seem to just LOVE me. (Now is this a sign of my insanity i.e. like attracting like or does it indicate that I'm more sane than I believe i.e. opposites attract???) One day when my sarcasm is really revved up I should post a blog about degrees or types of looney clients sorta like my cartoons about categorizing friendship levels or comparing one of my previous workplaces to Dante's ninth level of hell... But, once again, I digress.

No, today I feel compelled to talk about needy clients. On Wednesday, we were kinda slow, unlike every other day this week. Want to make a bet what time I finally got home on the slowest business day of the week? Give up? Nine, yes, you heard right, NINE p.m. Why? So glad you asked; that would be because pretty much all I did all day long was placate needy clients. There were only two normal folks all day and one of them took some time because we had to do chest radiographs. The others left me blubbering and exhausted at the end of the day.

There was a dog on steroids that was severely PU/PD and the owner couldn't seem to grasp that the blood work was boringly normal ergo there was no big bad disease and it was all side effects and we needed to get her backed off on dosages to help alleviate the symptoms. I spent a lot of time soothing her and reassuring her before they left and short of being completely rude, I couldn't get them out the door. Usually, I'm actually pretty good at the polite don't let the door hit ya routine. Probably because I've practiced a lot given my antisocial but raised politely in the South personality.

I also saw one of our crazy cat ladies who initially wanted to camp out overnight in our lobby in order to see my boss, who she prefers, the next day. Sadly, she decided she likes, no, JUST LOVES me now... And there was a hypoglycemic pup that had just been discharged from Big Bucks Clinic down the road whose owners didn't understand why they couldn't come back to our treatment area complete with children et al since we had no exam rooms open when I sent an employee to get the dying pup so that I could stabilize it. And the lady with the ancient dog that seems to be doing really well other than some coughing related to his collapsing trachea that needed to be reassured that she wasn't torturing her dog by not euthanizing it. Most, if not all, of the needies seemed convinced that their pet was on death's doorstep when, for once in my life, they actually weren't. And I thought telling someone their pet was dying was difficult...

Benefits

I will freely admit that among the factors that prompted me to choose vetmed as a profession was consideration for my herd of kids. Not only from a financial standpoint but, being something of a control freak and not having found anyone to provide for their medical care in whom I truly had complete confidence, it seemed a good decision. One benefit of my education and travels thus far is that I have begun to develop my own private little network of specialists to whom I would be willing to entrust their care when the condition is beyond my capabilities. So I will have to travel hither and yon if the need arises. Trust me, it would be worth it. They also allow me to pick their brains as needed. Definitely a benefit. At a primary care level, I can make the calls about my own without dealing with stupid. If I have doubts about how to handle something I have wonderful books, electronic resources, and the aforementioned network of specialist friends. The ultimate blame lies on my shoulders for everything which is both good and bad because I would rather be angry with myself when mistakes happen but I'm also very talented at beating myself up about things for the long haul. Which is another factor that pushes me to be such an ardent researcher about all of my cases. On the financial side, I'm not so sure that I made a good bargain...

Still fed up with stupid!

Oh my. I thought I was becoming complacent when it came to dealing with stupid. Not that I don't notice but that I've become so accustomed that it dulls my frustration response. Today, a comment was made that jolted me.

I think that I have commented that right now my life situation has brought me to where I'm working at the clinic where I worked prior to vet school. Many of the clients remember me; some fondly. Today, one of our long time clients (the wife of a local plastic surgeon!) expressed surprise that I am a doctor even though I have re-introduced myself to her, performed both routine procedures as well as major surgery on her pet, and talked to her numerous times on the phone always introducing myself as "Doctor Insane". She said that she knew I'd been around a long time so she thought my boss just trusted me a lot... SERIOUSLY!!!!! A lay person who has been around a long time can do major surgery just because?!? And she is closely related to the medical field... Maybe I got an online degree or a fake license. I'm sure that would have been less expensive both in time and work. Anyway, it kinda flabbergasted, bemused, and befuddled me (extra points for use of flabbergasted).

They haven't kept me busy enough today. I'm causing even more trouble than usual.

Witchy Fun Day

Y'all, I don't know what's wrong with me. Maybe stress has finally taken its toll and I've cracked. Maybe I've finally completely lost my mind (okay, so you have to begin with one in order to lose it). I just don't know...but all day today, yesterday, and starting Sunday night, I have found myself just letting loose with pretty much whatever I happen to be thinking at the moment. This is very atypical behavior for me. I'm a "stuffer"; I don't share my thoughts, views, or opinions with others - they belong to me. Besides, no one ever understands anyway...

Today, as an example, I went off on a lecture prompted by one of the kids expressing pleasure that one of her friends called a cell phone company and yelled and cursed at the sales rep resulting in their all getting new upgraded phones. I made it real personal by asking her to put herself in the scenario and set it in our clinic then ended by asking her how the results would make her feel if the shoe were switched. Then I pointed out that it's not all about her...

That's far from all that I've said and done but I thought it was a pretty apt example to get the point across. I don't do things like that. Usually I'd just let her talk and make no comments. What's gotten into me?

On a different note, today, for the first time in simply eons, I actually enjoyed an entire day at work. I'm sure it had to do with the fact that I spent the entire day in surgery and actually had owners that cared enough to let me do things right... It's amazing to me when I consider how relatively easy to please I am that I have managed to be so unhappy with work after being out for such a short time.

We shall see how tomorrow goes mostly if there will be enough to keep me busy and stop my little mind from wandering and allowing me to go along for the ride!

Training Methods

There are many, many ways to train a dog, cat, horse, goat, etc. although, in truth, I think they are generally much better at training us than we are at training them. One of the core concepts in training (including humans) is the idea of reinforcement. Positive reinforcement is basically when the result of performing the correct action is receiving a pleasant reward such as a pat on the head, a belly rub, or a lovely "Willy Wonka" from the Marble Slab Creamery (oops, I digress into my positive reinforcement desires). Negative reinforcement is basically when an unpleasant "reward"such as taking away all access to chocolate is used to alter a behavior; for instance if I leave for work too late I lose my chance for a cup of coffee where if I get up early enough I have time. I learn to get up earlier to avoid the negative consequence. It is very easy to inadvertantly mix both positive and negative reinforcement which is very confusing for the trainee and always results in undesirable behavior. A really good example of this is the hyperactive pup craving attention that jumps on people then gets attention that is negative but attention nonetheless therefore the behavior continues unabated and worsens.

There is also the concept of punishment and other ideas but they are beyond the scope of my interest at the moment. Most good trainers agree that positive reinforcement is the better method although, sadly, there are still those who would rather force their will instead of asking a partnership. That statement, as well as all of the above, is meant for both animals and humans.

All of that said, I really wish someone would try positive reinforcement with me sometimes... I have an idea I'd respond really well.