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.

Wow- somebody actually reads us?!?!?

The wonderfully funny folks over at Veterinarians Behaving Badly passed this on to us.

The rules of the award are as follows:
1. Copy and paste the award on your blog.
2. Link back to the blogger who gave you the award
3. Pick your five favorite blogs with less than 200 followers, and leave a comment on their blog to let them know they have received the award.
4. Hope that the five blogs chosen will keep spreading the love and pass it on to five more blogs!

So lets see if I can find five blogs... how do you tell how many followers they have?!?!?!

1. The Homeless Parrot- She just had a baby so she posts a lot about that too, but her vet stuff is pretty good (the baby stuff too!).
2. Vet On the Edge- Brrrrrrrrrrrr
3. The Endangered Owner- I do NOT agree with all the stuff on this blog but it's nice to know that there are people out there opposing the AR Nutjobs!
4. What Comes Next- wow, I hadn't been here for so long I still thought it was called My Vet School Days...
5. Crass-Pollination- this is neither a veterinary blog nor does it have less than 200 followers, but if you insert animals into her stories you'd have our lives...

Nasty Pathology of the Day

You have to name the organ and condition. I will tell you that it is from a pig...

Mind Your Own Species

Today was just a yuck and grumpy day. I must admit that I have been grumpy a lot lately , though... Some of it is due to the rain and pressures wreaking havoc on my sinus, allergy, and vestibular issues and some of it is due to "the family " at home and work.

I was quite giddy last Friday evening. I'm still not sure if it was the chocolate or the fact that the worst problem employee finally quit. I voted to make her show responsibility and work out a two week notice; my boss agreed at first then caved when she whined so today was her last day. As I said before, I cannot actually fire them but I sure can cut the hours. Today she actually did a good job - now why couldn 't she have just done that all along?

There is a local vet that we hear stories about all the time from clients who are changing to us. One of the most recent stories that I was told was that the client walked into the exam room and was told "Don't say anything, I have a headache!" Later, the guy asked her a question and she didn't know whether she should say anything in answer or not... Sometimes, I wish I could take my filter off so totally.

Like today, one of my boss's friends who is a medical doctor brought in their two year old intact male dog convinced that he had an infection because he was hiking a leg in the house repeatedly. I felt like telling him that with the exception of being under the influence of some mind-altering substance, most humans don't feel the need to mark their territory (an exception being one of our clients who told me that he "marked" a tree in his backyard to keep a family of raccoons away). We wound up doing a big work up on a healthy two year old dog in order to say nothing is wrong other than he is an intact male dog... We neutered him but who knows if it will stop the marking since that is now an established behavior.

I need to tell all about the weekend, yesterday, and today but you'll have to take a raincheck since I can hardly keep my eyes open!

Interesting Day

Today (well, technically yesterday now) was filled with some interesting minor events. I had a routine surgery with a twist, took sutures out on my leg project, had two "Killers" in the hospital, finally got the sick puppy from the holiday weekend home, saw a syncopal dog, and was threatened by a pint-sized child wearing a reindeer hat.

I really will do a post devoted to the leg surgery project but am leaning toward waiting until he has totally healed for a good final picture so you will just have to be patient a little longer.

Had an overweight small breed dog with three masses to be excised; two appeared to be routine lipomas and were located on the ventral abdomen just caudal to the umbilicus and on both sides of midline. I started with them, made my incision, and began "shelling out" the tumor. All seemed normal until I reached midline and found a firm attachment and that the two masses were attached to each other. Imagine my surprise when my finger slipped through a hole into the abdominal cavity. It would seem that the dog had a small hernia through which omentum had extruded then the two lipomas had arisen from the protruding omental fat. That was odd. It just demonstrates once more the reasons to expect the unexpected in surgery and is probably one of the reasons I really enjoy surgery so much. I don't think I have ever heard of that scenario. I repaired the hernia and removed the masses then removed the third mass which appeared to be a large cyst from the neck. Other than the fact that I'm pretty sure the dog gave me fleas since I was itching in places I couldn't scratch, everything went well.

My comment pushes me down a rabbit trail. The children were appalled to learn that people can, gasp, harbor fleas, too. When asked, I explained to them that until fairly recently with the advent of daily bathing, it was a common problem. Read some of the historical literature as recent as the American Civil War era or even the World Wars. I also referred them to the John Donne poem about the flea and explained that one reason small breed lap dogs were even developed was to attract fleas from their owners' bodies to their own. The kids didn't appreciate my historical lecture neither for content (gross per them) nor historical facts and references (not many enjoy history and literature). Sad!

The Friday before New Year's day I admitted a young pup for fever and diarrhea. He was pretty mild at first but just kinda lingered without improvement for a week. Most likely, based on diagnostic results including an "oh white cell, where art thou" search, it was most likely parvo. I had spoken to the owner minimally once daily and kept her updated on the bill. Finally, Friday, he was ready to go and the owner was told a time to pick him up. She failed to show or answer her phone. Finally, we got a dialogue going again and discovered it was a money issue as is usual, especially these days. Yesterday, she came and payed part of the bill and said she needed to go to the car for a check because we had agreed to hold post-dated checks for the balance. She then left and didn't come back. Today, she finally took the little guy home. Weird people! Apparently her husband left her during the time the pup was with us and totally ruined her credit; at least this is the story we were given... I just wish folks would talk to me about the money sooner rather than later before the hole gets too deep! Especially since I bring it up right from the start. Personally, I hate not being honest about cost and don't want to be kept in the dark myself.

Two dogs in one day named Killer. Both dropped off at the clinic, both small breed, one really would bite but it's a Chihuahua so not unexpected. I think I may have to name a cat Killer one day. By the way, both were actually females, too.

And there was this ancient medium sized dog that I examined while he was in for a bath. Did not find anything too scary (fleas, old head tilt, and slightly low heart rate but he was very relaxed) but while I was talking to the owner complete with her grandchild who is best buds with the dog, I must have said something disturbing to the child. As I finished and started to walk away, the tyke pointed a little finger at me and said "You better let me keep my Tickles!" She was maybe 7-ish and was wearing a reindeer hat and was dead serious. I'm a little frightened. Kids are scary enough without adding threats! If she can write, she may join my threatening letter fan club after the dog passes away. I figure the geriatric dog that I failed to fix last week will join as well. If I keep this up, I'll singlehandedly keep the postal system afloat...

Oh, just in case anyone is wondering about the flea comments, yes, it is definitely possible to have fleas in the dead of winter. Especially down South. Especially when it has been so warm. And mosquitoes, hence heartworm spread, too. Can we say year-round protection please?

Whose Witness?

I had a very interesting experience Friday; I argued end-of-life issues regarding an 11y old Yorkie with chronic renal failure with two lawyers who are his owners. The problem with the whole situation was that to me, the dog was in a gray area and, lawyers being lawyers, they wanted it to be a black and white decision. The wife was not ready to euthanize, the husband felt it was time. It was odd trying to explain and advocate for the dog while they shot questions at me from both sides. I felt like a witness who isn't really certain whose side to be on...

Problem is, as usual, I could see both sides. The dog first developed noticeable disease back in September. After hospitalization and IV fluids, he seemed to improve quite a bit but, like with most chronic diseases, I can't fix it and he's not gonna be perfect ever again. Slowly over the past several months since, he has declined. Each time I've seen or spoken to the owners, I got the same report: Doing okay, still doing normal things, a little slower, losing some weight, eating / drinking well, urinating, no vomiting or diarrhea. In other words, a typical stable kidney patient report.

I'm not sure if he got into something that set him off or if it was just natural decline but he became nauseous and refused to eat for 3-4 days then developed melena and they finally brought him to see me. At first, the wife came and wanted to try treating again although I told her quite bluntly we were not looking at years of survival. After 48 hours of IV fluids, he felt much better and ate quite well. Then they came in together for a visit and to make a decision.

I found myself alternately agreeing with both of them. Yes, ultimately we are only buying time since I can't heal him entirely (no one can). No, I'm not just trying to buy a couple of days to say goodbye, I think he can do better than that. Yes, I do agree it is hard to watch him decline again; if he stops eating he needs to come back immediately. Yes, I understand you would rather end his life while he feels better rather than while he is miserable. Yes, I know you want more time but no, I cannot guarantee how much we will buy...

Ultimately, they wound up euthanizing after a long and agonizing discussion both with me and between each other. They were both in tears and the husband held the little guy while I injected the solution; the wife had to leave the room.

Besides this one, I felt as if I were running a geriatric clinic last week. It seemed that everything I saw was extremely old and had mostly really bad problems. Like the 17, almost 18 year old Maltese. I had seen him right around Christmas with vomiting and a horrible ear infection. Kidney values were dead normal. A little IV fluids, anti-nausea medication, and antibiotics, etc. for the ears and he was doing great. Until he had a seizure. And continued to have several mini-seizures. My boss sent him home on a day I wasn't there and put him on a little valium. That hit him so hard he couldn't function. Then I saw him again and he was worse although the ear had cleared up so I could no longer blame vestibular disease for his nausea.

I took a LONG time explaining to the owner that my best educated guesses were that he had a brain tumor, cognitive dysfunction syndrome in final stages, or brain inflammation and that the only way to reach a definitive diagnosis would be to refer for an MRI, etc. that I can't do in private practice. She seemed to understand and opted for the other plan of giving some steroids and anti-nausea medication and seeing if he responded at all. The she dropped the bomb and indicated that she thought the medicine would "cure" him and didn't realize that I was saying just to buy a little time where he hopefully felt good and she could say goodbye.

Cure? Right. Wish sometimes I had that power...

The only good geriatric story I have is the little poodle that just keeps going. She got nauseous and was vomiting some but it turns out that it was triggered by motion sensitivity and an injection of maropitant put it all to rights again. And she's still going.

That's all on the veterinary front for now. On the family front, I love my family but I love them much better from a distance. Which is probably one of the many reasons I keep trying to move away. I don't know what to do about the tendency to keep getting dragged back. Brother dear has called after not hearing anything from him in over a month and is supposedly coming here. He was supposed to have already arrived over the weekend but as of last hearing from him he hadn't even left yet. And, of course, he's in trouble and needs money and his crazy wife is crazier than ever. We'll see what happens this time but I wouldn't advise anyone to take me up on a bet; I've won them all so far.

In other news, my cell phone which I have a love - hate relationship is officially dead. It started out with some quirkiness and suddenly went to the blank screen of death yesterday. It is still sounding alarms, though... I just hope that they can salvage my pictures and videos that I wasn't able to save before its death. Guess I'll have to bite the bullet and get a new one. Yuck. I like the freedom of not having one but it is useful in some ways. Now I'm arguing end-of-life issues with myself. Maybe it's time for it to be buried properly and not replaced. I kinda like that idea. No more annoying calls from employees, clients that have been given my number without my permission, family.....Hmmmmmm......It bears some thought!

Side Effects and Side Notes

Side notes first:) I forgot to comment that I have also purchased said joint supplements, etc. for my mom in forms that I thought she might be able to take such as powdered liquid or chewables and they just sat on the shelf never opened. I also forgot to complain that the worker I was referring to is the one who called me no less than 5 times in a 30 minute period when her personal dog stole and ate a small piece of hambone... There is clearly initiative there when it's to her benefit.

Now to my side effects commentary. I am an avid reader and will happily read labels, etc. if they are in front of my face with nothing more entertaining available. I also actually read entire drug inserts. I don't take much medication but was taking something yesterday and was reading the insert prior to taking the tablet. Side effects included nausea, vomiting, diarrhea, light-headed feeling, and dizziness. Hmmmmm..... Why is it that medications that are supposed to help with dizziness and such can cause it? Also, why is it that medications that are supposed to help with gastrointestinal signs can also often cause them? This has always puzzled me. For instance, are you aware that an overdose of metoclopramide results in nausea, vomiting, and diarrhea? Found this out when a student accidentally gave a dog its 24 hour dose in 2 hours... Of course it was on my shift.

No one listens and I guess there is just no pleasing me...

I was about to start by saying my mother makes me crazy with her lack of listening but that is not appropriate. Not that the statement is untrue; it's just not fair to only say my mother. The truth is, there is only one person in my life that I can honestly say that I feel like truly listens to what I have to say. I may be wrong, but at least I feel like it.

Everyone else simply pretends to listen; and often the pretense if very poor. What set me off today? Mother. For years I have been trying my damnedest to get her to start taking some joint supplements for her arthritis. She, like me, has difficulty with medications so doesn't take too many. I told her over and over that some of the natural supplements might be beneficial and she might be able to tolerate them but she has refused to listen. Today, she states that she thinks she'll try ordering some of the joint supplements she saw in a catalog because "they might help." I guess it had to be her idea...

Some of my friends would likely say I am the same way but I am going to beg to differ. True, the decision has to be my idea ultimately but I do listen and consider the suggetions and, if I decide to follow them, I give credit where credit is due.

I think the reason it aggravates me so much is that everyone does that to me. I just feel as if I'm wasting my breath whenever I open my mouth to speak. That's probably why I don't say too much as a general rule. I'm saving my breath in case I need it later; particularly if I follow through with my threat of running away to a higher altitude. I'll need all the extra breath I can get in that case. I spent a couple of weeks in Montana years ago and was constantly gasping but must have been getting in better shape than I realized because I felt like super woman when I came back here - sooooo much energy!

As to the no pleasing me comment, I'm griping again but on the other side of the coin. Normally, I complain because the kennel folks never (NEVER!!!) clean the ICU cages and I do it when I come to take care of the patients. They'll be filthy and wet and the person will have been and gone but done nothing for them. Today, I came, took care of my patient and left. When I returned, the cage was cleaned with new blankets, etc. but no note or comment on whether the dog ate the food I left it (gone, bowl and all), or if there had been any vomit or diarrhea seen. Am I asking too much? The saddest part to me is that as demanding as I may be of them, I'm like a million times more demanding of myself. Sometimes I wish I could invite them in for a short visit inside my insane mind with its multiple personality self and all the voices that talk all the time up there. It might serve as an interesting wake up call. Or they might just have me committed.

Last night, I was about ready to hurt some neighbors. We live off the road and have about 20 acres so no one is extremely close but close enough to hear the fireworks. What is the attraction for the loud ones? I really don't get it. The pretty colors, yes, I can buy that (well, not literally because I always feel as if I'm burning my money buying fireworks and such) but the booms, why? My poor dogs were so upset all night. I had as many as possible inside and noise going on so they couldn't hear too much. They had happy drugs, too, but it still upset them. My night was less than restful as a result. I would have been happy with a quiet night reading with my glass of milk and an early bedtime...