Romantic Moment

He laid his head gently against my breast and his dark brown eyes gazed deeply into mine as if peering into my very soul, then he burped and wagged his tail gleefully....

Crap Cases

The last few weeks have been highly stressful for many reasons, most of which I intend to ignore for the moment.  I felt inclined to share about two crap cases that really frustrated me and made me sad and tell a short client story complete with the one-liner on which I bit my tongue but rather wish I had the nerve to have said...

First is Ellie, a nine month old MinPin who came in for bad breath.  Her exam was pretty unremarkable but two things bothered me.  First, while she had more tartar than expected for a nine month old and a single retained baby tooth, the breath seemed too bad; but, the owner had used antibiotics they had at home (grrrrr!!) and reported improvement...  Second, even for a young MinPin, she seemed kinda thin.  We scheduled her for a dental the following week.  Her owners declined blood work but I used my powers of persuasion (okay, so I just ignored them, did it anyway, then asked forgiveness) and got it done.  She was in severe renal failure.  Although we could not get an immediate ultrasound, I felt sure it was a congenital issue given her age and how well she was doing.  We started antibiotics pending a urine culture since there was a mildly elevated white count.  Sadly, Ellie died within the week...

Second is Betty, an aged female English Bulldog who likely came from a puppy mill.  She was a sweet, sweet soul that a local rescue obtained.  Heartworm negative (shocker!) but with a respiratory infection, horribly thin, and huge mammary tumors in all except two glands.  We gave her a few weeks to recuperate and gain strength then tackled the spay / tumor issue.  In her case, I opted to remove all the mammary tissue from both sides in one go primarily because there were palpable nodules running in the connecting blood vessels traveling across midline and because she was thin enough to have extra skin for closure.  Her spay went without a hitch, she had a softball sized lumpy ovary on the right, then her mastectomy also went smoothly.   We kept her hospitalized for observation, initially on IV fluids.  Her owner wanted her to stay through the weekend and I checked her over Friday, looked great.  It was not my weekend but I've been kicking my rear ever since for not going by...apparently, at some point Sunday, she chewed her stitches out causing complete dehiscence with intestine becoming strangulated and contaminated.  Back to surgery she went, this time for a resection and anastomosis.  The surgery went well but apparently Betty's kidneys were on the brink and the second anesthesia pushed her over the edge.

And my last story for now.  There's a guy that has been bringing his two little dogs to our clinic for years.  I remember him, his dogs, and his previous wife from when I was here before vet school.  At some point since then, he has remarried.  His new wife brought the dogs in to have their chronic allergy skin dealt with and commented that she did not understand why he even kept the dogs around (they are 17 and 19, by the way).  How I wish I had said "Well, what I don't understand is why he keeps you around..."

A little too personal...

In what seems to be direct contrast to statements I have made about my own OCD / perfectionist tendencies, I am also a fairly laid-back, easygoing, non-confrontational type.  I've learned to pick my battles and often let things go that maybe I really should not.  That said, I have gotten comfortable doing thorough exams while working with pets that are moving around more than is ideal.  We often do not have a tech or assistant in the room during routine (meaning non-painful / non-stressful for normal, non-aggressive patients) exams.  There are times, however, when I find myself in more, er, personal contact positions than I intend...

Like the other day.  I was auscultating a very small breed puppy who belonged to a very large, amply endowed lady.  I was in my own little world of heart sounds when suddenly I found my hand, holding stethoscope, entrapped between the little dog's body and said well-endowment as the lady, presumably in a fit of lavish love, clutched said dog, hand, and stethoscope into her bosom...

Understanding people...

Can't Spell shared a new favorite quote with me that seems very appropriate:  "Trying to understand some people is like trying to pick up a turd by the clean end!"

That said, I want to relate a couple of recent client interactions that left me with my jaw dropped and completely bumfuzzled.

First, there was the long time client that I've known since well before vet school.  She brought in her 13 year old cat for an upper respiratory infection.  I had seen the cat last year for something an advised her that we should do blood work, including checking thyroid levels because the cat was losing weight with a good appetite and had a gallop rhythm.  She declined at the time but then came in this week complaing that the cat was still losing weight and all my boss ever says is that she is an old cat.  The cat had lost a pound and a half.  I explained hyperthyroid disease again and recommended blood work again.  Guess what?  She declined again...

The other was my diabetic patient with a severely resistant urinary tract infection.  After months and lots of dollars, we finally got it cleared and were nearly re-regulated again.  I asked that they bring him in for a glucose curve, trying to time things so that we could see how near we were to being regulated before stopping antibiotics entirely.  They failed to schedule an appointment or return follow up calls (highly irregular for them!) then randomly called to schedule a recheck about six weeks after I had wanted.  After all that struggle, time, and money, why would you not keep the recommended follow up??

No, I just don't get people.

One of those days...

The other morning my mom said that "It looks like it's gonna be one of those days!" in frustration as things were falling apart (again).  My reply was that I'm not so sure there are any other kinds of days anymore.  It seems to have been months since anything has really gone smoothly and, since the old saying that misery loves company has some truth, it made me feel somewhat better to know I'm not alone.  This article is from one of my favorite funny vets and is a great summary of my day in better words than I am capable of using at the moment...  I'm now running away and hope to remain unavailable for many hours!!

I Finally Figured It Out...

Today, it finally clicked why I'm so weird.  Bear with me, I'll have to explain the situation so it hopefully makes sense...

One of my clinic employees (AP) was talking about a dog she adopted several years ago that was probably hit by a car and definitely had brain damage.  The conversation went something like this:

AP:  She would walk around with a head tilt and veer off to the side randomly.

Me:  I can relate, I do that too.

AP:  And she would lick everything in front of her.

Me:  Well, I don't do that...

AP:  She hated to be held still or cuddled or hugged.

Me:  Yeah, I feel the same way!

AP:  Maybe that's what's wrong with you - a head injury!

Me:  It all makes sense now.  When I was a baby, I screamed and cried when anyone held me - they still complain about it even now.  Probably one of my relatives got frustrated with my screaming and tossed me on my head...

Now we know the rest of the story.

Photographs of Time

I'm not sure that there is anything quite so depressing as looking at old photos.  It always strikes me with force the aging changes I see in those around me.  I see the evidence of time that I fail to see as I look on a daily basis.  Changes that make me even more aware of how fragile and brief life is.

Like most people, I have tons of photos - some printed on paper, some on CDs, some on the computer, and some on my phone.  I suppose they are primarily meant to record the good times, to bring back memories of friends and family and happy days.  Perhaps I am depressive or just too pessimistic in general but I cannot seem to get past the reality that the images represent a happier time that is forever lost.  I cannot go back or make those who have passed return or change decisions or even relive the moment without a sense of loss.

Maybe the problem is that I'm in the midst of a less than happy time right now.  I'm not sure because I know the past was not perfect either.  No time is perfect but I rather long to turn back the pages for a while and enjoy a better time.

The Impossible Dream

"To dream the impossible dream To fight the unbeatable foe To bear with unbearable sorrow To run where the brave dare not go To right the unrightable wrong To love pure and chaste from afar To try when your arms are too weary To reach the unreachable star This is my quest To follow that star No matter how hopeless No matter how far To fight for the right Without question or pause To be willing to march into Hell For a heavenly cause And I know if I'll only be true To this glorious quest That my heart will lie peaceful and calm When I'm laid to my rest And the world will be better for this That one man, scorned and covered with scars Still strove with his last ounce of courage To reach the unreachable star" I have been exceptionally moody lately.  Normal for me is to be somewhat moody with a slightly depressive tendency but with the strong capability of hiding this from all except those who know me too well.  For whatever reason lately I've just been moody.  For instance, yesterday I was grumpy and was taking sarcastic potshots at anyone with whom I interacted.  Today, I've been mostly fatalistic but with a streak of idealism hence I've been randomly bursting into the above song (only when I'm alone, mind you!)   That song ranks pretty high on my favorites list.  I think it has partly been on my mind because I managed to partially solidify why I'm so driven to do rescue stuff with the animals.  Although I cannot explain the wiring, I have always wanted to "make things better" ranging from the simple clean up of things to the complex save the world.  My compromise illustrates and would seem to support the idea, expressed by different people in slightly differing ways, that a cynic is a frustrated idealist.  I've realized that changing the world to make it better (even my small slice of it) is impossible.  I can, however, change the world entirely for some unwanted, unloved, and uncared for animals thus making their world better.  At least there is some sense of accomplishment in this rather than the perpetual frustration associated with changing the whole big world and making no progress.  Or, for that matter, of trying to make tiny improvements in the workplace only to fail miserably.  The animals at least appreciate my efforts and I experience a sense of satisfaction.  It's rewarding; unlike most everything else in life which leads to an unrelated comment.  Once again, I've had it hammered in my head how seldom actual hard work pays off.  You bust your butt and are lucky to get a mere thanks while someone else who is prettier, more charming, knows the right someone, or has the money gets promoted or chosen or whatever i.e. gets the reward. The effect this has on me as a somewhat boss is that I strive to be rigidly fair and not reward the undeserving but those who work hardest.  Not that this does any good since I'm not and never have been in a position to have the final say and no one listens to my input...and there's only two, maybe three, people who listen to what I say at all. At the moment, though, I'm dreaming the impossible dream and gearing up for battle with life. The depressive reality is that I'm probably fighting windmills...

Insanity, Stress, and Getting Old

I'm definitely getting old.  There seem to be more aches and pains present every day.  I get angry with myself all the time now when I wind up in the floor doing an exam (which is totally normal for me and always has been) because suddenly I realize that I have to get up again, preferably gracefully and modestly, given there is a client present.  I can no longer get away with skipping a day at the gym then just picking back up where I stopped.  I also have to force myself to be more careful to take my vitamins and joint supplements, particularly since I don't tolerate pain medications well.  The dogs and cats feel heavier than they once did and I've been idiotic enough to have kept those two "horse puppies" that I found...

I've always felt much older than the people around me in my head but, let me tell you, it really is all down hill after 30!

At work, we have a volunteer who wants to be a tech (yuck, yet another who wants to play with the puppies and kittens without really having the drive for the profession - sorry, I'm a tad bit done with all the tech wannabees we've seen lately).  I call her Nibbles because she is constantly eating.  Of course, she's also one of those teeny people who never gain weight as they ingest 2-3 times what I eat while I gain 10 pounds just from smelling food.  This girl has no concept of polite behavior.  On the food note, she actually took part of someone's lunch while they were eating it and had stepped away to answer the phone.  We're all getting a bit food aggressive...  She also sampled pieces of Ghirardelli chocolate then threw it away because she didn't like it!!!!!  That is grounds for hanging in my opinion!!!!  Wasting what is perhaps the best chocolate on earth.  Death to all chocolate wasters!!

On a good note, she does provide a person for those employees that are never happy unless they have someone to be mad at...  Not sure if that makes the stress she adds worthwhile.

If you abide by the definition of insanity being doing the same thing over and over while expecting different results then I've been hard at work proving my insanity again.  For those who know me, this sounds weird because y'all have seen how organized disorganized, predictably unpredictable, and studiously random I am, but I hate clutter!!  And work has been so bad lately mostly with things not being put away where they belong but just shoved somewhere for the moment.  I re-organized the storage closets....again....

Sadly, home is as bad and worse with my mom and her issues.  I've fallen off on my cartoons, creative writing, and reading for entertainment lately for lack of a "room of one's own" so to speak.  But I have added yoga to my life to help with stress.  Just try to imagine how bad I'd be if I didn't go exercise, have yoga, have chocolate, and have the kids to keep me sane.  Bwahahahahaha!!!!!!!  Scary, isn't it?!?

Trust and Delegation

I've never been the trusting type in part, I'm sure, because I learned very early that you couldn't depend on people.  Your dog, your horse, and your cat, yes, but not other folks.  People keep telling me I need to delegate responsibilities more to help decrease my stress level but how can I when 1) I already have this distrustful attitude and 2) people keep proving me right by not being responsible or trustworthy???  I thought about titling this post "Crack Head DVMs" since I'm about to talk bad about so many of my colleagues but changed my mind because the scope is wider than just vets.

Naming no names, I want to share a series of mostly recent scenarios - facts have NOT been changed.  There really are some scary practicing DVMs out there and a lot of them are apparently in my town!! 

Case transferred to me from another hospital due to finances.  Very small toy breed having a seizure, we check a glucose which is 29 and give glucose and the seizure stops.  I look at the transfer record which states, checked glucose=39, administered valium.....

A relative's dog goes to the ER clinic for breathing difficulties.  Owner expresses concern that maybe the pollen is causing the problem.  Vet says no, dog has heart disease.  If pollen were causing problem, gums would be blue instead of pink like they are.....

Same dog, really does have heart disease with pulmonary edema, is treated with lasix (appropriate), IV fluids (WHAT?!?), and NO oxygen.....(and ends up with a bill of nearly $1300).....

Regular client of mine who is a very good client, also an MD but a good one not a pain, takes her Chih to the ER clinic for ADR (ain't doing right for those of you not in the know) and is told that there was no need to bring the dog, nothing to worry about.  They then reach me, I see a dog with cyanotic gums, significant dyspnea, tachycardia, and clearly distressed.  Chest films show pneumonia.....

Another vet tells an employee that it doesn't matter if you use a U-40 or U-100 insulin syringe, there's no difference.....

Another vet states that he doesn't understand why a rescue group is spending money on a sick dog, after all, it doesn't even belong to anyone.....

A cat with pyelonephritis fails to receive its antibiotics for 2-3 days while the primary vet on the case is off.  And the other vets and technicians didn't think this was important why?????

Patient hospitalized for resistant urinary infection is left off IV fluids for 24 hours while receiving Amikacin even though the orders clearly state must be on IV fluids.....

Patient orders are clearly written in multiple places and verbally communicated to the vet taking over the case for the weekend but are not carried out.....

Intern on ER takes in dog in fulminant right heart failure and attempts to start IV fluids only to be stopped by the student.  Refuses to listen until senior clinician is notified.  Reasoning behind fluids?  That's what you do for "emergency stuff".....

Cat patient of mine that was highly suspicious for asthma or HARD (heartworm associated respiratory disease) or Toxocara cati larval migration whose owners kept putting off diagnostics due to money wound up at the ER.  Chest films were taken and they were told completely normal, no evidence of above.  I requested a copy and there are the most lovely "railroad tracks" and "doughnut holes" you could picture.  In other words, a beautiful bronchiolar pattern suggestive of above listed differentials.....

Heart failure dog referenced earlier is told at discharge that dental disease was the cause of the mitral valve disease in a senior Yorki-Poo and that the teeth must be cleaned within a week (remember this dog was hospitalized for congestive heart failure).  I advised that if the owners felt compelled to follow this advice they could take her back to that clinic and let that doctor practice CPR since I'm quite comfortable with my skills.....

And the list could go on and on and on.....those are all (except two) from the past couple of weeks.  And everyone keeps asking why I'm in a bad mood and never trust others.  Heck, that's the main reason I pursued vet school.  While I care about my patients, the most important thing to me is that my kids get proper care and I couldn't find anyone I trusted for that!  Even now, if a specialist is needed I hand pick who we see.

Yes, it is also a job and a means of living but, I have to comment that if you chose this profession, regardless of the reason, you damn well ought to be doing the best job possible.  Not saying I've never made a mistake but I know my crap and if I don't I tell you so and go look it up.  I'm really sick and tired of shoddy, non-caring work not only from my colleagues but also from my employees, my mechanic, my personal doctor, my friend's doctor, students, etc,etc,etc!!!!  Not everyone gets to "live their dream," in fact very few of us do.  I'm far from where I truly WANT to be but you better believe that every day I give my work and my family and my home all that I have. 

And a last comment seemingly unrelated but I can't help but wonder if it played a role in the congestive heart failure dog receiving fluids.  While Pro-Sal sounds like it is the best financial option for vets, I'm not so sure if it causes certain vets to do things that are unnecessary in order to increase their production.  Of course I've also worked with some vets who do that anyway when production is not even involved in salary, just trying to increase the bottom line.  That relationship did not last long.

I guess I'm just wound up a bit over a couple of my usual beefs meaning justice / fairness and doing things right rather than just doing them.  My latest life plan is to run away to Antarctica because 1) I'd never get too hot, 2) I could go for months without having to talk to anyone, and 3) since nothing can grow nothing can possibly bloom.  And I wouldn't have to worry about any of this!

Name Change

I think I will change my moniker from May B. Insane (no longer any question) to Dr. Pissywitch since that seems to be my frame of mind.  I'm so very frustrated, yet again.  I suppose you could argue that one should not expect satisfaction in life to be wound up so much within job satisfaction (get a life, right?) but when one spends so much time involved with the job it becomes increasingly difficult to make those lines not blur thus dissatisfaction at work equates more and more with generalized dissatisfaction.  Perhaps part of it is that I take my work home with me far too much between my own kids, worrying / thinking about cases, and not trusting the other folks at work to do things right; but much of the reason I did this insane career is that I couldn't find anyone to trust to take care of my kids right!  If that were not a factor, I'd likely put my loan in forbearance and go back to school to do something more profitable about which I care much less...  

It makes me wonder if the problem is me rather than the jobs and other people.  Think about it, I've been in four different jobs, five if you consider the preceptor, and have been pretty much totally unhappy with all of them.  Some of the reasons are recurring, others a little different.  Maybe I want too much???  I certainly don't understand why someone would start a job and not do it right.  It amazes me that there are vets who keep doing this for decades.  Are they happy or is it simply that they feel trapped by time and are unwilling to consider change due to finances or inertia or whatnot?  Those considerations as well as what I would do about taking care of mine are certainly giving me pause before jumping...I guess we will have to wait and see if I jump or not.  Being Pissywitch might help because I don't think indecision will reign in that mood but a certain reckless disdain may.  Rebellion is definitely the order of the day but the darker, depressive part of my nature is also strong at the moment and it may hold back reckless rebellion that has led me into impulsive decisions in the past.  

There are very few of my classmates with whom I've spoken who are actually happy.  So what makes the difference?  Is it something about us as a different generation or is it just certain individuals who will never be satisfied? I can look at some older vets who seem satisfied yet show the same quest for excellence that I feel and I wonder if they are really happy.  I also see others who seem perfectly content with what, to me, is mediocrity.  Maybe I'm asking too much of me???  I expect perfection yet I know no human is perfect...  But shouldn't we strive for excellence / perfection as a goal to prevent becoming complacent?  I beat myself up when cases go bad, convinced I did something wrong or missed something yet I know that so often things are simply beyond human control...  But shouldn't I question my decisions to make sure I'm not in error and hopefully prevent a mistake?  That's what I mean by finding something more profitable about which I care much less to do with my life!  

Maybe those who seem content with mediocrity have a life i.e. children, social network, whatever that is not intertwined with their work hence their contentment.  The problem with that for me is that the animals are family therefore it becomes impossible to separate.  

Sadly, the argumentative content you have just witnessed is pretty much constant inside my little head.  Maybe May B. Insane and Pissywitch are just two of my multiple personalities;)

Scarlett's Sp(3)lids

Scarlett is a young and somewhat foolish Boxer.  She was picked up in Tuscaloosa, Alabama, home of the University of Alabama - most well known for its SEC championship football team and immortal coach Bear Bryant.

Being young and idealistic and, of course just a wee bit stubborn and independent as Boxers tend to be, she placed bets on the recent championship game.  The only problem was that she bet against Alabama.  This mistake was tragic in more ways than one.  Living in Tuscaloosa and betting against the home team is asking for trouble.  Plus the opponent was soundly whipped.

Poor Scarlett, she didn't have enough doggie bones to cover her debt so the doggie mafia, led by a small yet somehow devilish Italian greyhound, came after her.  Ziggy the Iggy commanded his enforcers (a Doberman, Konrad, a Rottweiler, Hans, and a German Shepherd, Freddie) to break both her legs!!

Scarlett came to see us after being arrested for prostitution.  Her injuries were a couple of weeks old already but we pinned her bilateral femur fractures and plan to stop her career in prostitution.

Unfortunately, Scarlett is still too stubborn for her own good so we had to find something to immobilize her legs and we have gone through numerous devices.  Today, we constructed SP(3)LIDS for her using metasplints, orthopedic casting tape, white tape, and lots of creativity.  SP(3)LIDS are Scarlett Poo Poo Pants Leg Immobilization Devices.  I would defy her to break out of them but have already seen what she can do.

She'll be entering the witness protection program soon then going on with a new life.  I hope she learned something from her ordeal...

Death Throes

Gasp...help...me...gasp...  I feel as if our blog is experiencing a slow, agonizing death.  It's not that I've lost interest or have nothing about which to write; it just seems I never have the time to say what's on my mind or am in too pissy of a mood to share...or my computer / phone / whatever electronic device is being totally uncooperative!  We shall see how long the agony persists...