Can't Spell, DVM

Needy clients

2012-01-27T21:19:00.004-06:00

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

2012-01-26T07:55:00.002-06:00

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!

2012-01-25T13:01:00.002-06:00

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

2012-01-25T00:25:00.004-06:00

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

2012-01-23T21:00:00.003-06:00

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?!?!?

2012-01-23T17:56:00.003-06:00

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

2012-01-23T17:54:00.002-06:00

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

Mind Your Own Species

2012-01-17T20:00:00.004-06:00

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

2012-01-12T00:42:00.005-06:00

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?

2012-01-09T07:40:00.002-06:00

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

2012-01-02T11:28:00.002-06:00

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...

2012-01-01T17:02:00.002-06:00

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...

Clearly, I just don't understand people...

2011-12-29T18:18:00.002-06:00

Following is a short excerpt from an email that I received forwarded from a friend of mine yesterday:

"Due to the time of their move, we are hoping to have Roses in a good home by this Friday.

Roses, a 2 yr old Jack Russell. She is house trained, fun, and playful. Unfortunately I am not able to keep her for a family member so she is looking to sell her for $100, obo. All shots and immunizations are up to date. Roses is a great dog and is house trained to the point of going to the door to let you know its that time. She does not jump on you unless you tell her it is ok. She knows some commands.. Now the leash thing is what is a little new for her. My cousin lives in an area where Roses did not have to be on a leash. She is familiar with it, just pulls you some.

She loves belly rubs. Not much of a barker, only when someone is a the door but once inside she does her "inspection" and then is fine."

They desperately need to find the dog a home, by Friday no less, but are asking $100 obo????? Pardon me if I'm being too critical but that makes no sense to me. Perhaps they are of the mistaken belief that making someone pay to take the dog insures that it will get a good and lasting home... Best of luck to them (sarcasm implied) but mostly I just feel sorry for the dog!

And in the latest drama from the children at work... We were closed Monday after Christmas as a novelty (have never done that before but what the boss's wife wants, the boss's wife gets) and Monday night I got a call that didn't come through because my phone is currently demon-possessed (i.e. I need a new phone because it is wearing out but just haven't bit the bullet to buy one) from one of the children wanting to swap shifts with one of the others. She found great initiative to call the boss since she didn't get through to me and finagled the swap in just a couple of minutes. Really annoyed me because I had scheduled the better worker to be there all day since the day after a holiday is always crazy. So we had to deal with her laziness all day Tuesday. Didn't matter what we said or did, she just lazed around and really didn't contribute at all to the work. Didn't even need her there for all that she did. And I still can't convince the boss to just get rid of her! I really don't know what is his problem.

Wednesday, I said something really inappropriate in front of the employees because of the frustration. See, we (I) made the boss Voodoo stress relief golf balls for Christmas (he's an avid - obsessed - golfer). I got an empty egg carton and put 12 golf balls in it. 10 of them I drew the faces of all the employees on and named; I named one of the others for him and the other "miscellaneous" so that he could make it anyone he wanted. Yesterday, I suggested that he take the one for the employee and hit it a few times for me... Guess I really shouldn't have said it but it was one time I just couldn't stop my tongue in time.

Today, I had accidentally scheduled 2 of the kids to be there because another employee was initially going to need to be off. When that changed, I guess I forgot to alter the rest of the schedule. As it turned out, the better employee unexpectedly needed to be off because her mom had to go to the doctor. The lazy employee immediately sent a text to the third employee to see if she could come in because there were "so many dogs in the kennel she couldn't do it by herself!" I had already discussed the matter with the other 2 employees the previous day and okayed the day off besides knowing that the other girl would not be available. We didn't need 2 people there anyway... If it were up to me, she'd already be gone. Clearly she is not cut out for the job.

I think I'm going to revise the schedule for next month tomorrow and cut her down to one day a week. I also think I'm going to cut the other 2 down to 2 days a week because they aren't exactly giving stellar performances at the moment either. They seem worse when they work together. Maybe cutting hours (again) more drastically will help. It's pretty much all that I have the power to do although there are days I've been tempted to tell her she's fired, get out, and just see what transpires. It'd probably only wind up eliminating what little authority I have, though.

Sigh.....

Injustice

2011-12-28T05:25:00.002-06:00

I'm complaining a little and, for those in the medical field who practice good quality medicine, this is not directed at you. We had it pounded into our heads about the importance of not creating resistance in bacteria by overuse or injudicious use of antibiotics. There are several issues in veterinary medicine regarding whether we should be allowed to use particular antibiotics in specific instances or, sometimes, if we should have access to the medications at all. It scares me that the people who are attempting to make these decisions are often not even medically trained...

There I go on a bit of a tangent again but it is necessary for the story I'm about to relate so that y'all understand why I'm frustrated. It was thrown in our face (and continues to be) that veterinarians are the reason for bacterial resistance to antibiotics. Of course the human medical field has no hand in the problem; it is all our fault.

Yesterday, I had a dog come back in that I had performed an enucleation on last week due to a tumor of its globe. A portion of the lid had dehisced and I was concerned about lacrimal / secretory tissue maybe having been missed because that particular enucleation is currently in my chronicles as the bloodiest I have as yet performed (and I've done quite a few!) I'm sure it was because of the tumor but I was concerned at the time about remaining tissue simply because of the sheer volume of hemorrhage. I explored the socket and determined there was no remaining tissue that shouldn't be there but that the dog likely had an allergic reaction to the suture I had used, based on the tissue appearance. I re-sutured the eye with a different suture type and called the owner after the dog was awake to let them know what I had found. That was when the owner started complaining because "he had spoken with a human doctor friend who said that we should have put the dog on antibiotics because they always did."

Just to compare notes: when y'all go to the doctor for a mild cold, do they always run a CBC? How often do they perform a culture and sensitivity? And how often do you go home with a Z-pack regardless if it is really needed? Except in the case where the globe is abscessed or the animal has evidence of a systemic infection, why would you place an enucleation on antibiotics? For crying out loud, the eye (face) has such a wonderful blood supply it just begs to heal itself; almost as much as the mouth or the rear end or the bladder...

But, don't forget, veterinarians alone are responsible for multi-drug resistance in bacteria.

No, I did not put the dog on antibiotics. And yes, I do readily admit that some of our older colleagues who have not stayed on top of newer information do overuse antibiotics. I just find it frustrating that we get that bum rap then get advice from a human doctor on how to manage our cases. I don't even know if the human doctor he spoke with is an ophthalmologist. Maybe next time I go to the doctor I'll suggest how they should handle my case based on my experiences with multi-species...

Ruts

2011-12-27T00:18:00.002-06:00

Have you ever gotten your car stuck in the mud or snow or ice or something? You know, stuck so bad that no matter what you do, all that happens is the wheels spin mindlessly digging a deeper rut. You can't move. You can't turn. You can't do anything. This has happened to me once, so far, in my life. Usually, you see, I'm more of a thinker and planner therefore I think it all out and see the potential dangers and figure out a way to avoid it. The time it happened, I tricked myself because I was in Wonder Woman mode and convinced I could do anything... But this post isn't about getting your car stuck although I've really tried to go off on that tangent. No, this post is about getting your life stuck.

I heard the comment on the radio recently that a rut is nothing more than a grave with both ends kicked out. I don't know to whom to attribute this quote but I thought it had some merit behind it. You know the old proverbial saying between a rock and a hard place? That's where I am.

I think that the polite psychobabble term is to say that I have issues. (As if y'all haven't figured that one out yet...) You know what I find the biggest problem to be? I need just a little time of quiet solitude to face some of these issues and make some decisions. I actually feel ready to deal with some of them (may have been long ago) but I can't seem to stop long enough to work out the problems. Life interferes. The herd needs to be fed, medicated, whatever. Mother needs to be fed, medicated, whatever. The work children need to be babysat. The work boss needs to be babysat. Oh, and I actually need to do my job and earn some money and pay the bills... I know I'm complaining about things that everyone faces on a daily basis but, tell me truly, don't y'all ever struggle with the need to just stop for a moment???

I wish that the world would stand still sometimes during really hard times to give one a chance to steady the equilibrium and face the situation. But it doesn't. So how does everyone else deal with it? Or do they? I feel as if I've been burying my "issues" for eons and they just grow and grow making it an even more overwhelming task to attempt to deal with them and put them to rest. Maybe in an unmarked grave.

Perhaps taking a real vacation would help but right now it is simply impossible. Between mom, the herd, work, and finances there is just no feasible method of taking time off. I keep searching for something closer where I could run away for just a little while but have as yet to come up with any good, affordable options. It has become really difficult to find any time of solitude lately, too, now that mom is fully retired. If I keep letting these things pile up, the size will be of such enormous proportions that I'll never manage to take care of things...

Addendum

2011-12-18T11:28:00.002-06:00

I was thinking (obsessing) about my post from yesterday and realized that I should add a couple more adjectives. Hyper-responsible and guilt-driven. There, that should do it. Unless, of course, I think of something else...

Merely Human

2011-12-17T18:51:00.005-06:00

It's awfully difficult many times to deal with everyday life. I'm an admitted control freak, OCD paranoid with perfectionist tendencies who is over and abundantly self-critical. I'm really beginning to think that I need to look into a more benign job option...

Reading Nurse K's recent post just brought the issue to mind yet again although it has been dwelling near the top of what is left of my mind for many weeks now. You know, I really love medicine. I love what I do and am constantly fascinated by the intricacies of the body and the things that we can attempt to do for it. I'm a questioner and spend a lot of time researching things; really too much because I tend to get sidetracked by something else interesting that has nothing to do with my original mission. In near constant battle with this side of my nature is the fatalistic side that wonders if anything I do really, truly makes a difference. Perhaps the kidney failure dog would have survived to live another day without my fluids or maybe the anesthetic reaction death would not have survived even without anesthesia... Who really knows the answers to these questions?

The first time that you make a mistake, no matter how minor, is brain-numbing, poo in your pants frightening. You live with the daily realization that you hold lives in your hands and a miscalculation or momentary lapse could be fatal (unless you are currently subscribing to the fatalistic point of view in which case nothing you do or don't do matters anyway). The first time that you make a mistake (or believe you've made a mistake) that resulted in death is 1,000,000 times worse. And, if you're dysfunctional like me, you beat yourself over it constantly unless you can 100% factually prove to yourself that you had not even a tiny little part in causing the death.

There is a rational side to my being that knows I (and everyone else on earth) am only human and that human beings will make mistakes; it's inevitable. The stronger side of my being always wins in that I blame myself and never let myself forget what an idiot I was (am). I was told recently by a good friend that I earned a DVM not a GOD degree and I know that is right and good advice but it really hasn't stopped me from being so critical.

I figure, logically, that I'm gonna have to find a better way of dealing with this problem soon or burnout will be the next step. That or I'm gonna have to find a benign job where I can still be happy with what I'm doing. I can picture it now, though; teaching English lit and screaming at the students when they're worried about a grade that it is not a life or death situation so grow up and deal with it. Or being a librarian and having a hard time coping with demands because I can't figure out why it's so bloody important. Besides, I don't think that my personality type (dysfunctional though it is) is cut out to be satisfied and complacent - with anything.

Darn. There's just no way to win, is there?

A Tale Of...

2011-12-11T03:32:00.003-06:00

Being Late:

We had purchased concert tickets for a favorite group of mine for last Friday evening. I had told mom multiple times that we needed to leave the house no later than 4:30 due to the time difference (concert in Eastern time zone, I'm in Central). I took half of a day off work and left around 1:00.

When I got home, I discovered mom in a frantic tizzy over the car insurance payment, which was due that day. She often drops it by the local office but we had gotten a letter that the office was closing. Rather than go by there or call, she had let time slip away and it was now the due date. Again, rather than calling the other relatively near office to find out if it could be dropped after hours or wait until Monday, she decided it was necessary to go haring off on a minimum 1 hour round-trip to drop the payment at 3:00. With holiday traffic. Even though I told her we could leave a little early and drop it on the way out of town with only a slight detour. In the midst of her craziness, I went blank as to why we needed to leave that early.

We left at 5:00 and it wasn't until we were almost there that I remembered the time difference and realized we would be late. To add to that, the event was at a university and the directions they gave were really crappy although they sounded completely easy (I'm the type of person who doesn't give good directions but can find anything regardless of how bad the directions are.) If it hadn't been for the terrible directions, we would have only missed about 15 minutes of the show. As it were, we missed the entire first half (1 hour) and walked in during the intermission. The second half was wonderful but I'm still ticked about the whole thing both at my mom and at the crappy directions.

Not Fitting In:

Back to my former subject for a moment. There was another area upon which I meant to comment but got sidetracked and did not. In my profession, I don't fit in either.

The problem is I'm both over and under educated. Having done internships in preparation for a surgical residency hope, I'm way over educated for private practice. I want to pull out things about which my boss has never heard. Unfortunately, I'm under educated for specialty clinics not having matched for a residency. And while there might be some private clinics in-between, there certainly are not in the place I'm at right now.

Anonymous' comment about not fully trusting that other people find me interesting enough or non-annoying enough to continue remaining in contact really rang true for me. I find myself annoying all too often; it's difficult to believe others don't have a similar experience.

Frustration:

Kind of related to the previous tale, I was so extremely frustrated at work Friday. There was a young, intact male cat that presented for a fever and heavy breathing. He had pleural effusion that was hemorrhagic with tons of white blood cells. Certainly not the only possibility but, for me, a pyothorax until proven otherwise because he was a perfect clinical picture.

The problem, my boss took him in and decided it was likely FIP (certainly possible but...read the literature, I researched pyothorax in depth not so very long ago.) He wouldn't place a chest tube and do lavage. I couldn't really do much because I was leaving in such a short time. I did manage to do thoracocentesis and remove about 170ml of fluid so he could at least breathe better and do a cytology on that. I hate situations like that because they leave you feeling so helpless.

Granted, either way the prognosis is guarded at best but....

Old Friends:

A couple of my good friends from high school were unexpectedly in town this week and we all got together for a little impromptu party. It's the first time I've seen 3 of them in about 5 years. Thursday evening, it was a free for all with 7 kids ranging in ages from 2.5 to 12 plus the 5 of us, 2 husbands, and one grandpa. The kids had a blast and so did we except that the men, rather than playing babysitter like they were supposed to, kept wandering in where we were and butting in on our conversation.

Last night, I got together with two of them again (everyone else couldn't make it) and we had a really good time. This time was a little more like old times because we had more of a chance to catch up on things and the three of us hung out together more than the others.

One of the children has Asperger's syndrome, a form of autism. I found it difficult not to just watch him constantly in fascination. He's a very interesting child and I found myself relating to him in many ways. For instance, when he grows nervous, frightened, or overwhelmed, he will scream. Wouldn't it be nice in some ways if we could all do that? Instead of bottling things up and packing them deep inside, just scream out loud and let out some frustration. I also loved his lack of inhibition in that he would just burst into song or dance or whatever. True, some of this is just in being a child but some is also due to his disorder. Sometimes I do similar things but only in my head. How much more interesting life could be if I did it out loud!

The one friend leaves to go back home to Pennsylvania Tuesday. I don't envy her the drive. I told her that at least I was able to legally drug my dogs when I did the New York drive; you just can't do that to human children.

The other friend will be leaving in a month or two. She and her family are missionaries and are waiting for funding to be able to leave again. The other two live around here but I've just not taken the time to really get together before this.

Aggravation:

Time and time again, I have tried to train the kids how to properly restrain animals and they continue to refuse to listen. Every time I have to utilize one of them, I have to explain again and they still don't do it right. I'm looking so forward to the technician coming back from maternity leave because a) I'll have someone who can restrain and b) maybe she can get it through their thick heads!

Wednesday was dullsville. All afternoon was slow and I utilized the time to fill out an internship survey on VIN explaining how unhappy I was with my experiences and working on the controlled drug log doing my counts, etc. Around 4:30, everyone decided to come amongst them a lady who had started the online vet tech program volunteering through us then quit because she had not kept up (doing the program online really requires a lot of discipline and self-initiative) and didn't want to bust butt to catch up. The cat she brought in had a large, palpable cranial abdominal mass. I kept him for IV fluids, blood work, radiographs, etc.

First, I told the children what I was doing and that I needed a hand. They had been lazing around all afternoon and suddenly were frantically trying to finish their work so I wound up having to wait on them. Then, I instructed them how to hold the cat so that I could place an IV catheter and obtain blood. The cat was not extremely fractious, just a little nervous and he doesn't see well. Let's put it like this, with two people supposedly holding the cat, he managed to bite my hand and scratch my arm pretty good with his back legs.

I was always taught (back when I worked as the kennel help, vet assistant, receptionist and general jack of all trades) that if anyone got bitten or scratched, it was supposed to be the holder and that you protected your vet at all costs...

And, that's all folks!!

Just call me an ass

2011-12-07T01:17:00.003-06:00

Perhaps I'm being too harsh but y'all can call me an ass if you want, I don't think it will change my mind on either of the two situations I'm about to relate.

Number one, brother dearest lost his driver's license and for some unexplainable reason needed one of us to call about getting a duplicate. My darling aunt called to ask me to do it since "it was my day off." Um, no. I am not getting sucked into it. I'm not getting involved in his crap, I'm not dancing as his slave just because he's the special male, and just because it's my day off does not mean I don't have things of my own to take care of, thank you.

Number two, see how hard this is to figure out. I had to go to the clinic Saturday to take care of a couple of things with Sam (my boss was on duty.) I got there around 2:15 and was there until about 5:15. During that time, the good kennel worker (who was not on duty) came by to check on the little stray that I've managed to finagle the finders into surrendering so that he can be properly taken care of rather than receiving poor attention. She mentioned that she came by again because she had been there in the morning and the kennel worker on duty aroused suspicions so she wanted to check back. What bothers you about this? The kennel worker was at the clinic between 10-11:30 and upon leaving had clocked herself in and out for 4:20-5:30 that evening. She did not show up while I was there. If she came, she had to have come between 11:30 and 2:15 (awfully short time between coming to walk the dogs, etc.) or after 5:30 when it is already dark. If it were up to me, she would have been fired long ago but if, for some unexplainable reason she was not, she would be gone now. My boss, on the other hand, asked her in some doofy way if she had come and she gave him a cock and bull story that made no sense and he seemed okay with it. Either he's a lot dumber than I thought or he hates conflict to the point of negligence. I would have asked her what time she came and gave her the chance to lie to me.

So there it is. Maybe I'm being mean but I just don't care in either case. If I ran the world, there would be a lot more people who were forced to step up and take responsibility...

Californy is the place you oughta be...

2011-12-05T20:23:00.002-06:00

NOT!

So, Maybe has been pestering me to post something for, well, forever. I just don't have near as much good blog fodder as I used to have!

So, as many of you know, I left private practice a few years ago to work for the dark side. At the time I didn't realize that by doing this I would be opening myself up to one of my biggest fears- airplanes. However, with all the various trainings I've had to go to since then it's literally been a very easy choice- get on the darn plane or quit my job. I need my job right now- another one in this economy wouldn't be easy to come by where I want to live.

I have been relatively lucky with my four other trips (Holy crap- they actually got me on an airplane four other times?!?!?!) in that they were short flights- an hour and 20 minutes tops. However, last Monday I had to conquer my fears in a big way and hop on a FOUR HOUR PLANE TRIP to attend a training session held in California. Yuck, puke to quote a favorite aunt of mine... But that's not what makes this trip funny...

This training is for literally EVERY offline inspector in the country, and we are the 12th class of 200 USDA types to be cycled through this particular hotel. It's a nice hotel- I kinda like it. It has free breakfast (not something to be taken for granted among pricey hotels), free basic shuttle service, and some other nice things. However, 12 classes of rowdy USDA types have apparently taken it's toll on the poor hotel- I think it's literally falling apart.

The first day I was here one of my classmates told me his shower wall fell on him. Not a piece- the whole darn wall! He got a nice free room upgrade. The biggest windstorm to hit Southern California in 30 years descended the second day I was here and another classmate told me he had to use his iron to knock his window back into the frame. Granted, 60 mph winds are kinda extreme, but still...

However, something happened to me the third day that would have sent Maybe into a frothing fit of phobia induced insanity- I got stuck in the elevator on the way down.

I got on the packed elevator on my floor and it started descending towards the lobby. It's always a bad sign when the elevator starts to go down before the doors close... About 3 seconds into it I noticed we seemed to be going down awful fast... I literally opened my mouth to say that and we heard this awful noise and literally crashed to a halt! I swear, I think the elevator used it's emergency stop system. It took ten minutes for hotel maintiance to get us out. I was fine until I got out- then I took the stairs the rest of the way down and tried to stop my legs from shaking.

I'm a little phobic about going down now- it doesn't help that all the elevators are glass on the outside and you can see going up and down. I don't think I'd mind it so much if it was enclosed and you couldn't see how high up you were or how fast you were going.

I am now an amateur expert on elevator safety mechanisms.

I'll take testicles with that

2011-12-04T16:51:00.002-06:00

Here's a novelty; I'm going to write a vet related post, something I've not done in a while. Soon, I'll post the case of the draino burn puppy but not until we've reached full resolution and I can include all the cool photos.

My boss has a horrible habit of handing me cases to do the surgery and saying, "Oh, this one should be really easy!" I love surgery so being handed the cases is usually not a source of irritation. The being easy comment is because inevitably when he says that it turns out to be way more complicated than he expects. Then he gets antsy because it takes longer than he thinks it should. Then he gets guilty for dumping it on me and tries to help, thus only getting in the way. It's all so predictable I could choreograph a movie beforehand.

The most recent of these was a bilateral perineal hernia on a 12 year old Chihuahua with horrible dental disease, mild azotemia, and a single descended testicle. The azotemia resolved with 24 hours of fluid therapy and I then took him to surgery. My boss said that the hernias were small and only contained a little fat so they should be no problem to repair. As an aside, with my aggressive dental techniques (at least that's how my boss and staff view them), the dog had one lonely tooth left at the end of the day. Tell me what I should have done differently? The teeth were abscessed with horrible periodontal disease and most of them fell out in my hands not even qualifying as true extractions in my book...

When I opened the herniated areas, the dog's guts were hanging out his rear through the incisions I created. There was also another, initially unidentified object encased in fascia and not directly connected to the intestines on the right side. The intestines appeared healthy with no evidence of damage therefore I reduced the left side and closed the hernia then moved to the right. I reduced the intestinal loops then began to carefully explore the unknown mass in an effort to identify it. If it wasn't a testicle, I really don't know what it was. The anatomy was perfect for a retained testicle although the "testicle" itself was inflamed and engorged as if it had been strangulated. I ligated the blood supply and removed the presumed testicle then finished repairing the hernia. I then proceeded to castrate the dog only to discover that he had a descended testicle and a subcutaneous testicle.

OK. I can still do routine math. One plus one plus one equals three. Wait a second!!! Three??? Three testicles? There are only supposed to be two. I'm thoroughly confused now. I dissected the "mass" and still came to the conclusion that it was a testicle. I did a touch prep that was totally useless with its ambiguity.

Yes, I have submitted it for histopath. I'll let you know what I find out..... Three?????

Misfits, Unemployables, & Misconceptions...

2011-12-03T11:41:00.004-06:00

I'm 99.9% positive I've referred to this quote before but I'm going to reiterate it here. Great movie if you appreciate sarcastic / ironic type of humor, Cat Ballou, in which occurs the quote "I'm not running a dude ranch for misfits and unemployables!" Most of the time I feel as if that's exactly what I'm running with myself included in the category...

Lately it has struck me with great force how little I fit in - anywhere. See if some of you nerdy types out there feel a chord struck on this one. Or maybe some of you not so nerdy types with different issues. I cannot think of a single time or place that I have really fit in. I have a couple of really good friends that are the closest to me and with whom I feel most comfortable but there's even a disconnect with them. When I recently examined my friends I was also struck with intense irony. I think that most people surround themselves with people that are similar to them. My friends are extremely varied and many are not at all like me. We usually have some area in common that served as our meeting ground but then we diverge in the extreme. (Or maybe I truly do have multiple personalities and each friend represents a facet of me. Now there's a scary thought...)

In my quest for honesty, I'm gonna bluntly say some things that I usually wouldn't say. My IQ is a great deal higher than my family's. I've always had a difficult time communicating with the family because we view things so differently. They are generally prejudiced against new ideas; I like new ideas. I like to explore things and view new ideas as a challenge to be questioned and explored while they look on new ideas (or things) with fear and reject them out of hand. I also have always had a hard time finding common ground to spend time with the family. They like senseless, non-stimulating entertainment. Mindless television shows and such. I like intellectual, quiet pursuits such as reading or challenging board games (Scrabble or Trivial Pursuit for example) and have no problem with spending time together with people I like in utter silence, just enjoying the company. My family gets nervous in silence. They then use their super-sensitive feelings and ability to hold grudges and begin to formulate theories as to who is mad and why, all because one is not speaking. It can't be normal; the silent person must be angry. I like to try new things; they condemn new things without trial. It's like a lynch mob performing a hanging without the benefit of a just trial by jury.

As a child, I grew up quickly and started taking on adult responsibilities at a very young age. One result of this is that I've never really gotten along well with people of the same age / peer group. It was difficult to relate to people worrying over whether Joe wrote "I love you" on a note passed around class when you were thinking about the financial situation of your family and whether the bills would be paid this month or not. It was also extremely difficult for me to understand the lack of interest in learning. Kids trying to get out of class and not doing assignments puzzled the stew out of me. I loved to learn and was reading books well beyond my age group even as early as first grade. I know I was a challenge for teachers with my endless questions and boredom with the age appropriate material.

This didn't improve with age. While I have a couple of close friends that I made in high school, there was still always such a disconnect. I had a hard time understanding their struggles with classwork that bored me. It was also difficult because they were intimidated by my grades. Being shy, introverted, and smart made friends hard to come by and considering I had an entirely different area of interests than having boyfriends and going to parties, etc. only complicated the matter further. Undergrad years were spent mostly in my own little world. I made a few "acquaintances" with whom I worked on some group projects but no real close friends although I met Can't Spell during that time. I lived at home and commuted to class (a 10-15 minute drive.) I scheduled my classes at unfashionable hours like 7:30 a.m. and worked 30-35 hours a week in addition to taking care of the herd and the house and cooking, etc. I'm not real sure how I stretched the time so now; must have had more energy being younger. As you can see, the schedule was not conducive to relationship building.

Vet school was much the same. I'm just not a joiner or a partier; not my cup of tea. I find myself still in the same boat. There are just so few people with whom I really want to connect. Oh, I have friends, it's just that they are friends at a distance. Not really people to whom I'm inclined to open up and invite into the deep dark recesses of my mind. And even if I were, not people who would understand or be comfortable there. Sometimes I'm not so sure that my closest friends are comfortable with delving into that region. Sometimes, I find it a little scary myself!

It also struck me while listening to a comedian play up the stereotypical differences in male and female thinking that I don't even fit in there. He said that men compartmentalize everything in boxes that aren't allowed to touch or interact while women have an information superhighway made of a wire that connects everything. I'm neither but both. I tend to compartmentalize but connect. And when he was making fun of the way women continue talking even when it would be impossible to be heard yet expect their mate to hear (i.e. head inside dryer or in another room), I related to the male rather than the female. I think I have a general tendency to think more in a stereotypical male fashion but understand female-ese fairly well. This is probably the reason I generally learn better from male teachers. I've never understood the hothouse of female emotionalism and stabbing in the back. Honestly, if I have a problem with you, I'd rather take it out back and just fight it out then be done with it.

While I'm discussing my dysfunctional self, I'm also going to share another aspect. I have always thought that I was so extremely fat until recently. It was perpetrated by the fact that most of the women in my family are tall and very thin. You know the type, not too many curves and rarely have to worry about gaining. My mother looked like Linda Carter of Wonder Woman fame with a bit less curve in her younger days. I'm an oddball. I'm shorter than most of my family and came with curves. Because I wasn't built like them, I thought I was fat and they added to my poor self-image by talking about how "heavy" I was. I was looking at some old photos and it suddenly struck me; I wasn't fat at all back then, I was just built different. Yes, I've always struggled to keep my weight in check but I wasn't fat. Wish someone had told me that back when... Now I am in part because I thought I already was.

So there. I've told many deep dark secrets about myself all started because of delving into old photos, listening to a comedian, thinking about some old friends, and talking to a family member who I've not talked to in a while. Scary what little, unrelated events can set into motion isn't it?

More Nicknames...

2011-11-28T09:22:00.006-06:00

You know how many people have the habit of calling people "Big" and "Little" whatever their name is when referring to a father and son or something of the sort? It struck me this weekend that I have a couple of Big-Little pairs in my household.

First is Big Stubborn, aka Sam.

Then Little Stubborn, aka Peanut.

And we have Big Chicken, aka Flower.

And Little Chicken, aka Scout.

Fits all too well...

Complaints Again

2011-11-23T20:58:00.003-06:00

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

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

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

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

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

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

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

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

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

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

Still Alive, Not in Jail - But it was a close call...

2011-11-03T07:25:00.002-05:00

Oh my. What a day was yesterday. I'm not sure if I can tell everything without this becoming a book but I'm gonna try...

I woke up all dizzy and vestibular because of the weather changes and had not slept well due to fever and chills related to my recurrent ear issues. Needless to say, this started the day out wrong. Had to take some Meclizine to function thus adding another factor for less than normal function of the brain which feels as if it is already deteriorating. I walked in to a patient of mine having arrested. It was an older dog that I had seen recently who seemed to be doing well other than having a urinary tract infection. Because of her age, I had recommended routine blood work be performed. It came back with moderately elevated liver enzymes and total bilirubin therefore I recommended an ultrasound to look for tumors, etc. The owner had planned to schedule that next week. The dog then developed respiratory distress early Wednesday morning and arrested shortly after arriving at the clinic while the boss was working on her. She had severe pleural effusion and on necropsy I'd bet it was lymphoma in the liver that metastasized to the lungs. Not a good way to start the day at work.

There wasn't all that much scheduled in the surgery area, only 5, and mostly "routine stuff."
That being said, y'all know how non-routine routine stuff can go on a bad day. The cat spay, which I can usually be done with in 10-15 minutes was like trying to bleed a turnip for pre-anesthetic blood work as well as induction plus the cat was freaking out and hard to hold. One of my talents is that I'm really good at handling cats. Unfortunately, I'm the only person in the clinic who is. Had there been someone else available to do the venipuncture, I would have readily swapped places and restrained the cat. The spay, of course, did not go smoothly either. The hemostat holding the ovarian pedicle was crap and almost caused a dropped pedicle, the uterine body tried to tear, the needle pulled off the suture, etc. You get the picture. The two dog spays kind of went in the same direction. I really want to perform a scientific study to prove that white dogs truly bleed more. The white Boxer was a bloody mess and there was no logical reason that I could offer; no dropped pedicles, no torn vessels other than normal, nothing, but she looked as if I bathed her abdomen in blood.

Then there was the preputial surgery. Little dog whose penis protrudes and gets stuck to the haired skin causing it to roll inward and trap the penis. This is the second time I've worked on it with the first procedure helping but not quite eliminating the problem. Relatively speaking, this one went smoothly but with the number of penis / preputial procedures I've been doing lately I'm thinking I should "specialize." The other procedure was to removed a wire from the mandible of a dog who had an old fracture and the wire had developed a draining tract. Unfortunately, the bone had not fused but it was already unstable with the wire in place. Of course, that turned into a lengthy, bloody mess because the wire had apparently broken at some point. I'm pretty positive I did not break it since it pulled easily but there was a piece left that I had to dig out. I don't like wiring mandibles; I like using acrylic much better. It's probably very expensive though, which is likely one reason most private practitioners don't use it.

I put off the last surgery for just a little bit and ran over the hill to the grocery store and to pick up lunch for a change. Wish I hadn't. I know to be really careful about eating out with all of my crazy food allergies and thought I had picked something safe. Didn't turn out that way. Unfortunately, I had not brought lunch because I was feeling yuck and running late; I didn't even have cheese to nibble...

I had planned to do the last sneak in procedure during lunch. I say sneak procedure because it is a little dog that we have inherited and one of the kids fell in love with, planning to adopt. Maybe I'm wrong in my views, but I do not think that it is right to charge employees for our time. For drugs used, food, materials, etc. at a discount, sure, but not for our time. There should be some perks to working at a vet clinic; especially where the pay is not good. Because my boss does not agree, I admit that I'm deceptive and sometimes slip things like that in while he's out of the office. With my craziness, I feel guilty about it all at the same time of being convinced it's important. Problem is that I criticize him all the time for "little white lies" that I disagree with so I have to self-criticize that I'm doing the same thing. Rabbit trail alert! Am I expecting too much from him to be more truthful? I hate the way he (like many others) goes to CE meetings, takes full credit, but didn't actually attend all the lectures he claims. Or his willingness to alter numbers on the drug log when there is an entry that he forgot to write down. Or the way he sometimes just lets things slide when talking to clients; not an outright lie but a lie of omission. But I'm doing the same thing to him, aren't I? It's hard having a strict conscience.

Back to the sneak procedure. We weren't sure if the dog was spayed and she really needed a dental. Unfortunately, the crazies started showing up early and it was one demand on my time after another. People who the boss had talked to or left phone messages for came to pick up their pets but, of course, had 1001 questions that needed to be answered by me. Decided to pre-med since there was a break that should be long enough to get things done. Saw the first afternoon appointment. I felt like I was back in New York. The first thing out of the lady's mouth was where is Dr. --? I explained that he was out and who I was. She barely consented to allow me to cut her dog's nails. After that, I quickly explored the other little dog; she was spayed (thanks to one of my teachers for showing me how to find out fast without a lot of mucking around as I've seen some vets do which makes determining a dog is already spayed take longer than actually spaying it) and we did her dental. I also pushed the new owner into a microchip while she was snoozing since the dog hates needles so much.

After that, the one appointment on the books became something like 15. It was a day characterized by minor crap that took 5 times as long as it should. Cat with miliary eczema; owner was nice but full of questions and was the second most sane person I saw all afternoon. A dog who might need a nail trim but, oh by the way, if you want to listen to his heart feel free. A chicken rushed in as an emergency broken leg; I had talked to the pseudo-owner ("It's my neighbor's chicken!") the day before. The lady who I've known for years with 45 minutes plus of conversation trying to decide if it is time to euthanize her dog. Please don't misunderstand on this one; I have no problem taking that much time to discuss an important decision but the problem with this lady is that she cannot decide anything for herself. My interpretation is that she is tired of the care needed for a geriatric pet but feels guilty euthanizing for that reason alone therefore wants me to decide for her that it is the best thing for the pet (not her, mind you.) I can't make that decision for her and, knowing how I feel about geriatrics, I'm sure y'all understand why I'm not going to advise her to euthanize unless the dog really deteriorates.

Then there was the cat who needed sutures removed from her entropion repair. That would have been quick and easy and I like her owners, they are very nice. What made it time consuming was that they are the same people who owned the dog that started the day... Needless to say, they had questions.

Even a simple rabies only with exam took way longer than it should have. The owners all wanted to chit chat yesterday. I felt like the psychiatrist role that we often have to play was taken to the extreme, all the while I was walking in a daze myself with the medications, allergic reaction, and already feeling yuck.

Between appointments, I talked to a lady who couldn't understand that her account ages the unpaid balance and applies any payment to the oldest charges. She sees it as picking up medication, paying for it that day, and it should not show up on her bill. I tried explaining every way I could and she only got more upset. Then when I had to excuse myself to see patients, she got more upset. Guess the boss will enjoy that one today...

I have yet another febrile cat with elevated liver enzymes. What is up with that?? It's like a rash outbreak and I still have had no one willing to let me go far enough for an actual diagnosis. That owner called over and over during the craziness and, of course, my help can't seem to handle telling her that I'll call her back after-hours because we were so busy. And the help contributed to the stress level. The one worker who usually does the best job made me crazy yesterday. She wouldn't restrain appropriately no matter what I said. The aforementioned cat was dehydrated and trying to place an IV catheter plus pull blood turned into a joke. The catheter happened; blood was very difficult to obtain and I only got a tiny sample. I handed it off to her and she promptly used all that was there to run the wrong test; not what I had asked for at all. At the end of the day, I tried one more time to get blood with the same results. Hopefully, the boss can get some more today for the rest of the testing. The girl also spent most of her time going into the rooms ahead of me on things that she really couldn't do much with then chatting with the owners. Every time I needed a set of hands, they were nowhere to be found. I wasted so much time looking for someone to restrain or take pets to the front, etc. yesterday it's not even funny.

Still I have not managed to get the girl up front to understand that I need a chart, a patient record for each individual, and something actually written on the chart to tell me who I'm seeing and why on EVERY SINGLE PATIENT. I'm about ready to strangle her. At the end of the day, I discovered (this was not the only one, just the final straw) that there was no chart pulled for the chicken. I guess since it's only a chicken it doesn't count.

The last appointment was a very large German Shepherd who has had infrequent, mild seizures for a couple of years. He has not been on medication and, like most of our clients, had no desire to go for an MRI to confirm there was nothing else present. He had a long, severe seizure overnight and was still showing significant post-ictal signs including blindness and the inability to ambulate, eat, or drink. I hospitalized the dog and was attempting to place and IV catheter and get blood. With two people holding, he still managed to kick and go crazy with us winding up with blood all over us, the room, and the dog. At least I also got some in the tube. I also got an IV catheter in place. Then I discovered we had no more fluids and our order had not arrived. It was too late to arrange a loan from another clinic. Wonderful.

By that time, I was so frustrated and aggravated with the whole day and with my help that when they wanted to know if there was anything else they should do and could they go home I just felt like yelling "Get the hell out of my hair NOW!!!" They left and did not do some of the things that they should have but I just didn't have the ability to calmly find and point out what they could do. Good grief; they are adults, can't they look around and figure out what is left to do?

I wound up being at the clinic until almost 8 finishing up all the stuff that was left over both by me and them. While I realize it's not necessarily a good thing, it was easier to just do it myself. Yet another reason I don't need kids. That I did not yell at anyone or pull out some weapon and just go ballistic is a miracle in and of itself. I have rarely been so happy to leave a place at the end of the day and so glad to have a day off. Hopefully I can recuperate enough to face it again tomorrow.

Happy Halloween

2011-10-31T21:13:00.005-05:00

Instructional Essay

2011-10-31T08:59:00.002-05:00

Per request, I am posting one of my undergrad essays that I mentioned previously. It took me a little time to find it because I've packed and moved so much I don't know where half my junk is anymore.

Sadly, in reading this and many of the other essays, I'm convinced that I had it more together and was a wiser person back then. Maybe I'm digressing with age. That is frightening; if I'm that bad already, where will I be in 20-30 years - yikes!! In any case, hope y'all enjoy the following piece; I still like it as much as I did when I first wrote it. Did I ever use any of the tactics described? I'll let y'all wonder about that one with the hint that my brother and I were very close and just consider what kind of mind thought up the essay...

Keeping Momma Single

Children often have more wisdom and judgment in dealing with people than adults; especially their single mom, who has the latest marketable goods (men) constantly thrust under her nose by “Sister Helpful,” and her crew of well-meaning family and friends. Because mom is lonely, probably does need help, and often feels frustrated and deserted, she tends to be susceptible to these men, and fails to use proper judgment. Often, her protective children must step in, judge the merchandise as suitable or not, and take the appropriate steps to help or hinder the relationship. Since “Sister Helpful” and crew are usually not exceptionally careful about whom they choose (any single male is considered suitable), it frequently falls to the children to rescue mom from uncomfortable situations.

A weak-kneed individual is usually easily dissuaded by a couple of bright, innocent children. A simple finger up the nose is frequently sufficient, but, if a little extra persuasion is necessary, ingesting the available “boogers” adds a more convincing note to the situation. This is the first step towards eliminating the latest unacceptable selection from pursuit of mom.

The second step, simple rudeness, is easily carried out as well. By refusing to carry on polite conversation, ignoring all attempts to “be friends,” and loudly interrupting each time he and mom attempt to converse, a child can often halt a disastrous romance in its tracks. Yelling and screaming like a banshee or wild Indian while mom is on the telephone also tends to be effective and quickly extinguishes the spark he is trying to kindle.

For the more stubborn suitor, firmer methods must be pursued. The “Clinging Child Routine” is probably the most effective in removing the unwanted male figure. By causing all appendages to act as velcro, clinging to mom’s leg, a child cannot be removed, even if force is exerted. This should be employed anytime it is suggested that mom spend time alone with the latest goods, or, it can be used as a constant. The suitor will find it difficult to spend “quality time” with mom when at least one child is constantly attached to her. For dramatic effect, a few tears and screams or sobs can be added, thereby doubling the effectiveness.

Eavesdropping on plans is highly recommended, since it allows advance planning and a more concerted team effort to be invoked. This is especially essential to the fourth and final stage of the sabotage, because needed props must be correctly placed, and memory must be refreshed on specific lines. The few brave souls who reach this point quickly realized that no one wants to harbor a dangerously insane child in their home. By simply talking to oneself constantly and allowing pertinent pieces of conversation to be overheard, the stage can be set for the final blow. At the table, the largest butcher knife should be placed readily at hand. It should then be picked up, fondled and stroked lovingly, while phrases from Shakespeare (Hamlet and Macbeth offer particularly suitable soliloquies) are employed in a barely audible tone. With practice, a glazed appearance of the eyes can be assumed at will and an evil, cunning smile should be rehearsed. A conversation based on methods of murder, particularly poisons, and undetectable crime, will soon cause reconsideration on the part of the guest of honor.

This infallible process should be used with care and responsibility, only against unsuitable suitors. The exception, “Mr. Right,” should not be made a victim, but encouraged for the sake of mom. By carefully following each step, any child of a single mom can protect her from “Sister Helpful’s” dire plot, and see her safely through her years of being alone.

Miscellany

2011-10-22T20:23:00.003-05:00

Few things to say tonight and none of them really go together...

First, to answer the comment about my weird case. The cat was gone for less than 48 hours, closer actually to only 24. The entrance wound on the leg was still bleeding a little although the edges were dried and contracted enough that it had to be several hours old - but definitely not days. Although you are correct that the bladder heals very quickly, I can't buy that fast or if that were the case there was no uroabdomen. Can't Spell suggested that maybe by point of impact at the bladder the velocity had decreased such that it only spread the transitional epithelial cells that then sealed over almost immediately like when we do cystocentesis. Maybe??? The thing that bothers me about that scenario is that we all know how hard it can be to get the stupid needle to poke through the wall; how many times have y'all been watching yourself on ultrasound as the needle slides repeatedly off the bladder wall or gets stuck within the wall with incomplete penetrance? I'm still puzzled by the whole thing but the cat is doing great.

Second, I had a first time ever experience yesterday. Someone sent me flowers! The lady whose dog I euthanized last Sunday sent me a pot of rust colored 'mums with a thank you card. It was awfully nice of her but I feel a little bad because it seems as if it should have been the other way around. Here's a picture:

Third, I have to report that my little boy is growing up. Sniff. Guess, who has only ever acted like an overgrown puppy / baby did something completely non-babyish. Thumper and Yoda share the fenced area next door to Guess, Maybe, and Tag. Typically they get along great and play a lot together but Yoda did something and hurt his leg. He was crying and being pitiful and Thumper approached him wanting to play. Thumper can, on occasion, be a bit of an ass. He is a very fearful dog and approaches life as a bully to keep from getting hurt. He started trying to bully Yoda into playing while Yoda crouched, whining. Guess and Maybe ran over, very puppyishly to begin with, then realized there was a problem. In front of my eyes I saw the gangly puppy straighten up and seem to get very tall and big then he let out a woof at Thumper that sounded very grown-up indeed. Thumper backed off and stopped aggravating Yoda. It was funny to watch and very cute. Immediately afterward, Guess went back to his puppy persona. I'm happy to report that Yoda's problem was just a little strain and he is doing well with some pain control. They were playing near full force this morning.

At work, all and sundry survived because they didn't upset my routine (satisfied with my admission, Can't Spell?) and I have the weekend off - hallelujah! Was a lovely day today and I wanted to go somewhere but woke up with a nasty sinus headache and the accompanying dizziness that makes driving unsafe. I settled for spending a relaxing day with the kids instead.

Tried to keep the Sam monster in again last night. He has cooperated some on the worst cold and rainy nights but proved to have a superior stubbornness last night. He got up and wandered around then urinated in the floor. OK, give him benefit of the doubt, maybe he was trying to tell me he had to go and I missed it because I was so groggy. Then he glared at me, did it again and pooped then turned around to try to eat it. It was at that point that I gave up and sent him outside. He practically dragged me down the few stairs then took off to get water (as if he had none inside!!) Then he refused to come back inside. I was overcome by a superior force. And I thought that I was stubborn!

I'm still eagerly awaiting the arrival of his new wheelchair; actually I thought it would come yesterday. I'd like to put him in it a few times while he is moving well so that the first time is not during a bad episode. I hope his royal stubbornness will tolerate it okay.

That's about all I have to say for now. Today, mom was blessedly peaceful and things went well for a change. Except that I forgot to call the heating / air conditioning guy to come fix our heater. Oops. I won't get cold but mom, Flower, and the Da-Chi Terror otherwise known as Scout will. Guess I'll try to remember to do that Monday, before it gets really cold.

Hands, Eyes, and Other Things

2011-10-20T22:02:00.003-05:00

Everyone has things about themselves that they don't like. I have always admired hands and eyes. When I notice a guy, the first two things I notice are his hands and eyes then his sense of humor or lack thereof. The hands and eyes are not necessarily deal breakers but the sense of humor definitely is... Maybe my obsession is partially due to the fact that my mother has beautiful eyes and hands and my brother had wonderful hands as well. Dunno. Point is, I notice.

Tonight, we were watching an old favorite movie and I found myself captivated by the lovely hands of the female leading lady. Then I thought about my own hands. I really hate my hands. They are just not pretty at all. I have chubby hands with short, fat little fingers and, even when I was not overweight as I am now, they were still that way. I'm not particularly fond of jewelry but, even if I were, I wouldn't wear rings because they just accentuate how chubby my fingers are. In addition to that, my hands sweat a lot. I remember my friends in school always complaining when we had to join hands for prayer or something and they couldn't wait to let go and wipe their palm dry. It's also kind of embarrassing that I always leave a handprint if I lay my hand on any surface.

There are many other things I don't like about myself but I really wish I had pretty hands. I'm honest enough without meaning to be boastful to acknowledge that I have nice eyes but my hands - yuck!

I know, weird little interlude of commentary but I just realized again how obsessed I am with hands and eyes because of the movie.

In other news, when I was complaining about the childish behavior of my mother I neglected to mention the bids for attention. I really can't do anything while she is home without her immediately needing me. I reckon it's payback time for when I was a child. I must admit I do remember our trying to get her attention when we were little anytime she got on the phone or whatever. I also remember our behaving rather badly when my aunt introduced her to men in an attempt to fix her up with a new husband after my dad's death. To give credit where it is due, we didn't behave poorly when the man was nice, it was just the idiots that my aunt dug up from under some rock. In fact, I wrote a rather nice little piece (I'm actually quite proud of it) as an undergrad for my instructional essay assignment called "Keeping Momma Single" that explained in detail steps for children to follow to eliminate the poor inappropriate guys from their single mom's life.

Mom is not at the point where she can't be left alone yet but I do fully remember my grandmother's tendency to wander. I had to put a lock at the top of the door where she couldn't reach for anytime I was out of the room, i.e. to go to the bathroom or anything. Then my aunt got mad because she couldn't just walk in whenever she pleased. Fun times.

I'm strongly contemplating investing in another horse. I know it makes no sense whatsoever but I think I need to do something for my own sanity in an effort to protect what little I have left. I also need to do some more research on Alzheimer's for myself. I know a lot of what is out there regarding prevention or slowing the process but I'm very thorough when it comes to research. I'm about to start myself on a few supplements since my chances of developing the disease are pretty high given grandmother and mom and the tendency to be familial and attack females.

One of the biggest problems with the situation is me. As I mentioned before, I grew up in a manipulation by guilt situation dating back generations. Probably in part because of the early death of my dad as well as the serious health problems with which my brother was born, I am extremely hyper-responsible and probably take way too much on myself. This combination plus the fact that my family is either too old or too idiotic to help is going to make it hard for me to not try to take this world completely on my shoulders. At least I have recognized and given a name to the problem. That's the first step in defeating it.

I'm not looking forward to work tomorrow. I accomplished almost nothing today, on my day off, due to extreme exhaustion primarily prompted by stress. The boss's wife was supposed to be off Wednesday but was out sick on Tuesday therefore felt compelled to work Wednesday. She is the type of person that can take any situation and make it chaotic. To add to that, Wednesday was rather slow and we wound up with too many people there because of her. I typically schedule the kids such that we have two of them there on Monday, Wednesday, and Friday because Monday and Friday are pretty consistently busy and Wednesday I have the afternoon alone and the boss's wife is off. As it turned out, we were slammed Monday and Tuesday but had people out sick then were slow Wednesday with everyone bumping into each other and twiddling their thumbs. I guess I could have sent one of the kids home but that didn't seem very fair to me. Plus the boss decided he needed to work even though he usually takes the afternoon off. Probably some misplaced sense of guilt because his wife was there. It didn't help either that my appointment schedule for the afternoon was fairly full but my help kept telling me they knew how to do things then did not. Like centrifuging a blood sample. I told them 3 times to make sure it clotted first but they still didn't. Then they didn't know how to balance the machine although they said they did. I had to leave the room to stop the machine and give a lecture on balancing. I don't like being lied to in any way, shape, or form. For me, if you don't know how to do something, just say so and I'm more than happy to teach you!

And lastly, the Sunday of euthanasias was apparently just the beginning for the week. Not just for me this time either. Between the two of us, we've had minimally two per day. Here's hoping tomorrow is better and looking forward to the weekend off. Now if he tells me tomorrow he's going to be out of town after all and needs me to cover, I may shoot him! Just watch the news. "Veterinarian goes crazy and shoots boss and all employees over weekend duty. Details to follow."

Weird Stuff

2011-10-18T21:50:00.010-05:00

Note: This post was intended for Tuesday evening but weather interfered with it being posted.

There were a couple of interesting things that happened at work today that I thought y'all might enjoy hearing about. It was a very, very busy day; I overslept and was 30 minutes late then hit the ground running as soon as I arrived with only a pause for "Boss's Day" lunch ( a day late, methinks but it's the thought that counts and they wanted me to be there. Awww, how sweet.) and left about 45 minutes after closing time which isn't too bad for me.

The most interesting cases of the day are as follows:
Approximately 4 month old male "stray" kitten that the new owner had only managed to catch about 5 days ago. The kitten was reportedly normal until early in the weekend when he began to lay around and just not act right while his 2 littermates were playing like crazy. On examination, he was pale and icteric with increased lung sounds. FeLV / FIV negative, CBC within normal ranges, Chemistry showed an elevated total bilirubin (2.8), low albumin and total protein, and a whopping ALT at 1536!! I think that is the highest ALT I've seen thus far in my career. Differentials such as FIP or toxins were floating through my mind. During the exam and bloodletting, the kitten got upset then started to breathe very hard and never really slowed back to a normal respiration rate. The owner opted to euthanize and send him in for a necropsy at the state diagnostic lab. The owner is very concerned about toxins since they have a crazy neighbor just down the street with a history of suspected poisonings. I encouraged him to try to do something and told him the necropsy would be the best bet for proof although we may strike out. I also told him not to get his hopes too high since I remember the case during my first year where we tested a cat and a food dish that was sitting just outside a neighbor's door and found both to be positive for antifreeze. Nothing ever came of it. Of course it was a different state...

The other case was a first for me and should go in the record books I think. Had I not been there, I would have thought it was made up. A 1.5 year old spayed female Himalayan got out of her house and returned home lame on the left hind leg with a wound on her hip area and blood in her urine. On examination of the wound, it appeared to be a pellet entrance wound. The bones were palpably fine and the muscle beneath was noticeably swollen and tender. I couldn't locate an exit wound. At the time I was thinking of bruising of the bladder or perhaps an unrelated infection or stone. For all of the above reasons, I recommended a radiograph to include both the abdomen and the leg. The results are below.

After this shot, I still was trying to convince myself that I was seeing things and the pellet might actually be lodged in the leg muscle so I took a second lateral.

Then, like a good little veterinarian, I took a VD (orthogonal view) just to finally prove to myself I wasn't insane.

An exploratory surgery followed during which I was expecting to find a uroabdomen or a loose BB pellet. Nope. The pellet was truly inside the urinary bladder and there was no leakage that I could appreciate. I performed a cystotomy, removed the pellet, explored the lumen of the bladder for obvious defects looking for an entrance wound and could find none. I closed my cystotomy site then obsessively examined the outer surface of the bladder for that entrance wound. Nada. I found a bruised area with some hemorrhage but no hole that I could close. Puzzled, I had my assistant inject saline into the bladder while I leak checked both my incision site as well as the rest of the bladder; no leaks. Hmmmmmm...... I'm still puzzled by that one especially since I could trace the path of the pellet past the inguinal ring and through the body wall. Not sure how to explain that one but even I am satisfied that the bladder wasn't leaking when I closed the body wall.

That certainly puts a new twist on "cystic calculi"...

Children

2011-10-17T22:25:00.003-05:00

I'm back to vent a little. There aren't any good people to really say these things to because then they somehow get back where they don't need to go therefore it is easier to vent here where very few people that actually know me and my family personally can hear...

I'll start by saying that I'm not a fan of children. I don't hate them, I just don't like them a lot because they are usually loud and busy and make me tired. Rusty and I pretty much have always had the same attitude about children i.e. they should be on a leash or in a carrier at all times. I'm not the most patient person in dealing with children and long, long ago made the decision that I have no plans of having any of my own other than the four-legged furry kind.

That said, I think anyone out there who has acted as a caregiver for an Alzheimer's patient will understand where I'm going. In taking care of my grandmother years ago, I started somewhere in the middle and knew very little about the disease. We had not recognized the early symptoms but I remember dealing with the childish behavior, temper tantrums, throwing food, refusing to eat, crying easily, etc. that progressed into anger and sometimes violent behavior. Fortunately, my grandmother was a very small woman therefore she couldn't really hurt anyone too easily.

Knowing more now, I'm really recognizing early symptoms and stages of the disease in my mother. She refuses to go to the doctor so far so I'm working off a "self-diagnosis," if you will but it is there. Before I came home, there were often times she adamantly stated that I had not told her things that I would have sworn I had but I wrote it off to my own mistake since I was working such long ER shifts and so many overnights. I also noticed that she seemed to get upset more easily than I remembered but I thought she was just under stress because things had already started somewhat with my brother at the time. When I came home I was rather shocked at the difference in her.

It did not take long to reach the conclusion that further career pursuit was out of the question and I needed a job to allow me to stay at home. Working with her right now is extremely trying because she is in that stage where she shifts gears, often within minutes, from being mom to acting like a child. Today she got upset and had a first class temper tantrum because she couldn't find a phone book. When I got one for her and looked up the number she was suddenly all smiles again. Unless I cook for her daily all she wants to eat are sweets and that is almost all she will buy at the grocery store unless I send a list or go myself. Things that she used to do and that one would expect a mother to know how to do she cops out on saying she doesn't know how. It would almost be easier if she were constantly like that because I wouldn't have to shift modes so much going from caregiver to daughter and back again over and over. It's also hard to make myself be the caregiver; I've always taken a lot of responsibility in the family and have taken care of finances, big decisions, etc. for years now but this is a step further and a difficult transition.

Because of the time needed for mom, I've made the decision to only work part-time for now. This adds to the stress because it really stretches my finances with student loans to pay, increasingly expensive geriatric pets to care for, and the usual stuff like health insurance, etc. To add to all of that, I feel as if I have a huge mountain of stuff that has been put off and that needs attention but that I can never find time to do. Getting to the lawyer for the will revision, for instance. I really need to get this done before she gets worse... If it weren't for the situation with mom, I would be looking for a different job in a heartbeat although I'm so tired right now I don't know if I have the energy to face new people and new places again. It was suggested to me that I should look into assisted living for my mom but I don't think I can do that, certainly not right now. Mom is an introvert and has always been independent. We live on a large wooded acreage and like our privacy. I don't think she would adapt well to an assisted living type of atmosphere.

A good friend of mine recently advised me that I need to find some hobbies that are unrelated to work to help release some stress and help me to leave work at work. I know these options are stupid and not viable at the moment but I would like to get another horse (I REALLY miss my horses) and go back to school to get a master's in English literature. The obvious problem is that it will further stretch my bursting budget and add yet more responsibility to my load. I doubt that's what he had in mind when he made the suggestion. Another friend and I were talking about the fact that his doctor has placed him on Ambien and an anti-anxiety medication to allow him to actually rest while he sleeps. As he described it, he took work home and worked all night while he was sleeping therefore did not really rest. Sounds familiar but with my susceptibility to the mildest medications can you imagine what that combination would produce?? I had a dream the other night that I was 15 minutes late for work, my boss was mad when I got there even though I had an excellent reason then we had a really busy day and everyone but me left at 5:30 sharp while I stayed to finish what was left. It was very vivid down to the details of facial expressions and what was said. No need to say it; I know I ain't right. Which, by the way, is what I plan to name the next dog that I acquire, "Ya Ain't Right!" 'cause I say that so often to most of the herd. There has to be a touch of insanity to live with me, you know.

Last anecdote that I'm going to share tonight. I have a white long-haired cat with a bobbed tail that I named Katrina. I also call her the white witch with good reason. Mom thought it was wrong to name her Katrina so soon after the hurricane hit but it seemed appropriate for this cat. She is one of the sweetest and most lovable cats I've ever met; she loves to sit in your lap and just be loved. Until something sets her off. Like the day that I tried to catch Sprite, my feral cat, and she leaped through the air to attack Sprite who I had in my hands. I got the raw end of the deal that day although Sprite was so frightened that she hid for 2 weeks straight. Today, Katrina attacked Solitaire and bit his ear so that it was bleeding like crazy then would not leave him alone. I think she got mad because the food bowl was near empty... Crazy cat. The NurtureCALM collar has helped but not eliminated the problem behavior for her.

OK, I've complained enough for now and should probably go to bed since I have to work in the morning.

Yucky Sunday

2011-10-17T03:32:00.003-05:00

I hope that Sunday can be considered an end to the week rather than a beginning this time because if this Sunday is the beginning then this week will be a doozy...

My boss went out of town Friday afternoon and through the weekend as he often does during the fall college football season. We had a cat in the hospital who had pyometra; emergency spay performed Friday, and a dog that I intended to discharge Saturday when I was at the clinic taking care of the cat. Fortunately for me, the kennel schedule got abruptly changed at the last minute putting the best worker who can actually be depended upon on this weekend rather than the worst one who was scheduled.

The reason I say fortunately for me is Sam. The last few days have been really bad for the old fellow. I'm pretty positive it has to do with barometric pressure. We've had a low pressure system which, by the by also affects my vestibular system like crazy, seems to make his walking worse. Since Wednesday evening when he got himself stuck partially in the dog house where his food was, he has not been able to rise unassisted. Once I get him up, he is typically able to ambulate although he loses his balance easily and cannot go far therefore I'm using a sling then his tail when he urinates and / or gets a little more steady / strong on his feet. Quite remarkably, he actually cooperated to being inside the house during the night and part of the day until Saturday night.

Saturday, I felt as if someone had drugged me unawares. After going to the clinic and taking care of the cat (who is doing quite well although not eating great voluntarily yet), I came home with the intention of cooking us a good meal. After taking Sam out, I was out of energy and fell asleep; it was like I seriously couldn't keep my eyes open. We decided on a light snack and early bed, as in 7:30 or 8:00. I had just laid down and was drifting off when Sam started trying to get up and got very agitated. I got up, took him out, and he tried to wander off into the woods. Refused to use the bathroom and acted annoyed that I wouldn't let him go. I took him back in and we repeated the process with my taking him out, offering him water, offering him food, laying in the floor on his cushion with him and petting him, etc. until finally, I took him out and he deliberately laid down in one of his favorite spots and refused to budge. I gave in to his superior stubbornness and let him remain outside.

Finally, I thought I might be able to sleep but then I was assaulted by Peanut barking demandingly at me. Usually she does this when she wants to play and not in the middle of the night. This time, she actually wanted to be held and petted, a new behavior for her since up until now she has let us approach her for any loving. After that, I kept waking, worrying about Sam, getting the flashlight and going outside to make sure he was okay and not too cold. Sunday morning, I went out early, got him up and moving then brought him in for a couple of hours to warm up. At that point, he demanded to go back outside and started walking around as good as he was before this whole episode started, including rising on his own. The only bad thing is that there is another system coming mid-week... I anxiously await his doggie wheelchair since I think I'm getting too old for this. I keep thinking how old I'll be when the horse puppies get old. Yikes! Better find myself some strong help by then.

On Saturday, I got two messages. The first was from my technician / friend who is out on maternity leave. Her dog was diagnosed with a kidney tumor that had already metastasized to the lungs and had caused hypertrophic osteopathy several months ago. She suddenly started going downhill over the past few days and had reached the point that it was time to let her go. The second was from a long-time client who has become a friend. Her dog had a mammary tumor that I removed last year but it had lymphatic invasion already and has recurred and metastasized to the lungs recently. She also has gone downhill over the past few days (I had seen her on Wednesday and we talked about knowing when it was time) and was ready to go. I arranged to meet both of them Sunday because it is such a hard decision to reach, when it is time and someone is ready, I don't like to make them wait since I feel it makes things even harder than they will already be.

My tech met me first and Vidalia, a.k.a. "The Onion," a basset hound that I have known since she was a puppy and her ears were longer than she was, went peacefully to doggie heaven. 'Dale was the puppy that my friend and her now husband got together shortly after they met. She has grown up with them and with their little girl who said, "Goodbye Onion. I'm going to be very sad." I think that the time was right, though, because she was a great deal worse but not to the point of such needless suffering that it will be regretted later.

The other lady met me a little bit later. Elsie was a 15 year old black and white Cocker spaniel. She was also one of the Rust-bucket's girlfriends in his and her younger days (he used to be a real Casanova.) Her mom let her walk around to use the bathroom outside and since it was such a pretty and peaceful day, we sat in the grass for the euthanasia. It was not the smoothest ever since she's always had crappy veins and her legs were all swollen and the veins kept blowing but since she had sedation prior, it wasn't as bad as it could have been. Elsie went to doggie heaven with her mom holding her and hugging her in the grass (and hopefully not sitting in any poop...)

So Sunday was kinda yucky which is why I hope it's not the start of a yucky week. Things do have a great tendency to go in themes although these were my only two really sick cancer patients out there at the moment. I have others but, as of last check, they are doing well and, I hope, continue to do so for a while!!

Otherwise at work, I probably will cause a ruckus tomorrow by my posted notes including a job description indicating that answering the phone is the receptionist's duty (i.e. pointed at the boss's wife who just lets it ring and assumes someone else will answer) and that the middle / floater position is not so glamorous as the kids seem to think, and that the kennel person is responsible for completely cleaning the kennel, etc. and this week's schedule. Should be interesting to see how it all plays out over the next few days. I'm thinking of posting another sign stating "Office Meeting, whatever date, no need to attend since Dr. Insane will be talking to herself with no one listening anyway."

Ultimate Scream

2011-10-14T00:06:00.004-05:00

Way back in those long gone by days of vet school, I used to draw screams during class. If you look through my class notes, you can get a quick idea of how bored or aggravated I was at any one time. The classes that didn't lose my attention had few or no screams; the classes that were the ultimate in boredom were littered with screams; and the classes where my classmates were driving me crazy were littered with screams. There are a wide variety of them including just plain ol' circular face screams, various animal screams, hair added, block faces, different shapes, etc. There is also one that went a little further and became the wicked witch getting blown away in the tornado in Oz... How they turned out depended on my mood. Probably my favorite was the cat with fangs bared screaming.

Not too long ago (relatively speaking), Can't Spell sent me a text requesting that I draw a scream for old times' sake. I did and titled it the ultimate scream. At the moment, I feel the need to resurrect the harmless method of stress relief.

Somehow at work, I've inherited the job of making the schedule but the boss's wife is exempt somehow although she says she is not. The problem with her, though, is that she is in the habit of going to visit her mom at least once a week. I've asked repeatedly which day or days or rotation of days she would like for me to plan for her to be out on so that I can rearrange the others to cover. She will not give me a straight answer.

The other problem is that the 3 kids are all wanting to go to tech school. At my clinic, there is a receptionist, a kennel worker, a groomer, and a floater. The floater, or middle position, is the coveted spot because everyone sees it as being more fun and where you get to do more cool stuff. I don't necessarily agree, especially since when the boss's wife is working as receptionist it means that she wants the floater stuck under her rear to answer the phone, etc. (You know, the things that she should be doing...) I try to be a fair person and reward those who deserve it but it is getting pretty hairy. Although I have had a private meeting with all 3 kids, they still don't seem to understand the concept of needing to earn the right to do more. If I can't trust them to walk the dogs and clean the cages how am I going to trust them to count medications appropriately, get the right medication, etc.??? I'm about to the point of relegating all 3 to the kennel but that leaves me with no hands available at all on days that the boss's wife takes off unexpectedly.

I've further decided that I stink as a boss. Not that my boss does much better but I'm just not so sure I ever want to be a practice owner. I'm not very good at remembering to praise people; I expect them to do a good job and I guess I grew up without it so I don't exactly know how to incorporate it. I'm also not very good at criticism and I hate confrontation. And, as always, I really don't know how I got myself into this mess. I mean, 3 kids (not all that fond of kids, never wanted to be a parent), boss's wife, the go-to for everyone, in charge of the controlled substance log and inventory, in charge of the schedule...and this doesn't even count what goes on at home.

Maybe I'll strike oil, become a multi-millionaire and can retire from actual work then open a rescue clinic or go work for Best Friends in Utah...

On a side note, I must admit I found a twinge of jealousy in my heart when I read that the cartoon doctor lady published her work. I'm always torn with mine. I want to but then I get hesitant about whether they are good enough and whether I want to share them with a real public rather than a few close friends. I was working on scanning in some new ones tonight and found it funny that me, an English grammar OCD freak, spotted a couple of mistakes on some of the older cartoons that I haven't caught before; why it was funny is that I'm excessively tired and took some anti-dizzy medicine a little earlier. Maybe it takes my mind in an altered state to function appropriately these days. After all, I was advised by a good friend recently that I needed both drugs and therapy. I'm thinking of starting group sessions at work because I think they need help worse than I do.

Last comment for now is that I think I'm going to put Sam in a doggie wheelchair. It's been a hard decision to make and I still don't know if it will work but I'm at the end of my rope on options. Sam is at least 15, a shepherd / collie mix, around 65 pounds. When he was very young, he had a pelvic fracture and tarsal shearing fracture of his left leg. He developed laryngeal paralysis about 1.5 years ago but it has been very static therefore I have not surgically intervened. His voice is gone, he has mild fecal incontinence, and he has been progressively weakening neurologically. I don't know if it is the peripheral neuropathy associated with laryngeal paralysis, degenerative myelopathy, lumbosacral stenosis, or something else. The big problem is that he is an outdoors only dog by his choice. He hates being confined in any way, shape, or form. I'm just not sure how a wheelchair will work for an outside dog with rough terrain but have spoken to some people that have tried it with good success. With the change in the weather, he had a rough couple of days and got stuck down twice. The longer he lays, the weaker his legs get then he can't rise. After I get him up and massage his legs he's okay for a while. At this point I'm pretty comfortable with my pain control protocol and it seems to be the neurologic issue that is worsening. He's getting measured tomorrow and we'll have the cart in a few days. Guess we'll see how it goes from there. I really hate to be forced into euthanasia because of impaired mobility; he is otherwise a healthy and happy dog.

That's about it for now. I feel as if there was one other thing I meant to say but my little mind is rather muddled at the moment so I'm just not sure. That's why I hate taking medicine; I'll have something to do, say, or write and in the time it takes me to start I'll have forgotten it. Scary!!

Loss of Subtlety

2011-10-11T21:48:00.002-05:00

Although I'm quite zonked on meclizine right now in an effort to maintain balance and an upright position, I've not had quite enough to write the entry I was considering therefore y'all will have to do without more of my deep dark secrets for now and just hear my Halloween complaint...

I'm sure that my viewpoint on the matter is influenced by my English literature background and love of classic books. The whole Halloween scene such as it has become is simply vulgar and disgusting to me. What set this off was the sign that I noted on my way to work advertising "Murder on Meighan" (a local road name) then describing "haunted" things consisting of chainsaw massacres and such.

What ever happened to the subtleties of haunting and fright? I am not a fan at all of the vulgar displays of torture and terror. For me, the suggestion of fear is much more tantalizing. Think classic Dracula or some of the great old ghost stories from back when like The Legend of Sleepy Hollow. There are many, many excellent books that involve ghosts and hauntings but fail to describe in all its gory detail the blood and guts. (And, no, I'm not at all squeamish about blood and guts for the record; I just don't find that particular brand of horror appealing.) For me, leaving much to the imagination, hints and suggestions rather than detailed description, leaving that echoing question about what was real and what not is much more entertaining. On a slightly related note, I think we have this problem with clothing as well. Call me old-fashioned if you want but I think it was better when some things were left to the imagination rather than everything left to hang out in full view.

Tell me, what does a huge chainsaw covered in blood and gore have to do with a "haunted" house? What self-respecting ghost really needs a chainsaw? Has the world gotten so jaded and lost so much imagination that only more extreme horrors can move anyone? If I wanted to visit a haunted house, I wouldn't be satisfied with less than the classic old mansion on the hill with spiderwebs and creaky hinges, etc. A ghoul armed with chainsaw would be anti-climatic. So there's my opinion on the matter.

I Guess Maybe

2011-10-08T23:27:00.014-05:00

I've been promising a post about the "new kids" for a while now and the fact that I ran across some pictures from when I first found them and was amazed at how little and cute they were prompted me to finally come through.

Mom and I were driving to town, innocently minding our own business when I started to pull out from the old bridge and saw 2 pups chasing after a car. They were close to being hit and I tried my best to ignore them, even rationalizing that we could go ahead with our errands. I really DID NOT need any more dogs. I mean, for heaven's sake, I'm overloaded already!!

OK, so I guess it's obvious, my rationalization failed and I stopped and picked up the pups, tossing them into the back seat. They reeked of fish. People are terrible about tossing dogs in that area. It is not close to any houses but there is a creek so I guess they think they will survive on water and fish. I've personally found 6 dogs there and my mom picked up one way back before my brother and I were even conceived.

The pups on the day we found them, approx 3 months old.

The little male approached us very quickly and easily, wagging his tail while the female hung back a little, more timid and definitely contemplating the situation. This has proven true of their dispositions. She thinks about things a lot more than he does. He tends to just burst right in with little trepidation. She's the brains, he's the brawn. Together, they come up with many nefarious deeds and are always into mischief.

Guess at 4 months

Maybe at about 6 months

I tried to find them homes but there were just no suckers available at the time and it didn't help that the girl developed hemorrhagic diarrhea just a few days after I found them then the boy had tooth issues and had to have that corrected. Additionally, they fell in love with Tag, my older Border collie mix who was found in the same place and he really enjoyed having them as well since he was missing his hero and companion, Bogie, who died last year.

It took quite some time for me to settle on suitable names and they came about partially because I found myself saying, "I guess maybe I'll just keep them" so often. The male became Guess and the female Maybe. It has been a lot of fun messing with people and the names plus the pups themselves make me laugh; something I really need right now.

They have the most fun hiding their toys from each other, jumping in the swimming pool, dragging off the huge water buckets, digging holes in various and sundry places, and just running around. They are very large dogs, I never expected them to grow quite that much! At 8 months, he is 92 pounds and she is 74 pounds. Here is a picture of his paw in comparison to my hand when he was only 4 months old. The next one is my ~50 pound dog and my 15 pound dog. It'll be interesting to see where he stops!

I was amazed at how much they have changed from the first pictures. I still don't have any really good pictures of them because they won't be still. Although they were definitely not a planned addition to the family, I am not at all sorry that they came. They have been far too much fun to have around.

Surprise

2011-10-08T23:05:00.002-05:00

I want to start with a comment on irony. I appreciate the comments on the last post and just thought y'all might be amused to learn this about me. The first job offer I had came from the man where I did my terminal preceptor. I turned it down for several reasons but probably the biggest was that his wife did the grooming / was office manager, his sister-in-law was the receptionist, and his niece worked in the kennel. I've always had worries about such strong family oriented businesses. You know, you feel like you may become part of THE FAMILY from which there is no escape... My first job turned out to have similar issues since the stepdaughter was the office manager unbeknown to me at the time of accepting the position. The wife in that situation was the ultimate boss, too, even though she didn't work there physically. I have known the people where I work now for years and never would've guessed that this would happen. I do, however, have a very current resume and am keeping my eyes / ears open. Unfortunately, I won't be able to do much in the immediacy due to the necessity of being home but.....

Thought I would share a fun surgery story. We inherited a client who has a young Yorki that was diagnosed with a cruciate rupture at another local veterinarian's office. The owner took time off work then found that the other vet wouldn't be able to do the surgery during that time so she called my boss who told her that we could take care of it. I examined the dog who did have a beautiful cranial drawer on the right leg then anesthetized it. All I can say is that it is a good thing I'm comfortable with improvisation.

I approached the leg as I would to perform a lateral suture but stopped because with the leg completely relaxed I could actually feel the patella (kneecap) and it was sitting on the medial aspect of the leg with the tibia rotated medially and neither would move to the correct position. I then altered my approach slightly and found that the cruciate ligaments were intact and there was absolutely no patellar groove in the femur. Instead, there was a mound of bone and the tendons were so contracted that the patella couldn't even be moved into an appropriate alignment.

Instead of a CCL repair, I got to create a new groove for the patella, transpose the ligament to a correct position thereby straightening the tibia, and then tighten the joint capsule so that it would all stay put. It was rather fun for a change although I prefer soft tissue surgery over orthopedics, hands down. My reason? Probably partially because I'm more comfortable with it but also because I find that no matter what I do, orthopedic surgery turns into hamburger and I can make soft tissue procedures look really pretty... And in this case, it's not just me. My orthopedic procedures actually look a little less like hamburger than the boarded orthopedic surgeons I've worked with thus far.

I also had a lot of fun explaining all of this to the owner. I even pulled out a great knee model and was about to take her to the chalkboard painted door to draw but she stopped me... :(

The only worry I have is that the owner won't do his PT like I demonstrated because she may be afraid it hurts too much. Then I'll have another like the last FHO that has a habit of holding the leg and has now built up scar tissue. That one has been frustrating. The dog had a traumatic coxofemoral luxation that was reduced closed then failed to stay in. I was trained that if it didn't stay in well during reduction, go on to an FHO rather than waiting. In this case, it was replaced multiple times and had cross pins placed through the femoral head once but still fell apart. I then did an FHO that I wasn't 100% happy with because there was a small piece of bone I would have preferred to have removed. When I discovered this, however, it was at the post-op radiographs and the dog had great range of motion with no bone interference therefore I opted not to re-open the site. Since then, the owner failed to do the PT and now the dog has such severe scar tissue formation I don't know if we'll ever get her to use the leg properly. At this point, we are sedating her periodically to stretch the leg and break down the scarring and she is wearing ankle weights to strengthen as well as fatigue the muscles in hopes it will help. Still waiting to see what will be the final result. We almost re-operated but when we anesthetized her and took more films the bone is remodeling perfectly and with a lot of pressure we could still make the leg go full range of motion after forcing the scar tissue to give; still no bone interference.

I wish I had the capability to bring them into the office (and owners would cooperate) to do some PT myself. Time is the major factor because I would be complained at about taking so much time for what would be perceived as too little income. Especially since I think we should increase our surgery price but let it include x number of PT sessions. Oh well. No one wants to listen to the new kid especially when it involves change!

Work Grumps, Case Themes, and a Little Whimsey

2011-10-07T08:44:00.003-05:00

A little grump, a little whimsical; just a mishmash of goo this morning...

I'm sure I've mentioned that the boss now has his wife working as receptionist. It started as a temporary measure while the kids' class schedule prevented having someone there in the morning for a couple of hours. Because none of the kids were working out well up front and they failed to alter their schedules, it became a full time problem. Now, we have hired another person, who I like so far, to work part-time receptionist and part-time in the "middle."

The whole situation has exploded in a way. This will probably be confusing, but I'll try to explain what is happening. One of the kids is the cousin of the licensed tech who is currently out on maternity leave (second daughter born via C-section last Monday, 10-3, healthy and everyone doing well). Originally, she wanted to be a veterinarian. She has failed to work out well in any position and has already decided she doesn't want to be a veterinarian but a vet tech. She started out as a receptionist and, not only were we frustrated constantly but we were also getting constant complaints from the clients. Her kennel weekends stink; animals aren't properly taken care of and she just doesn't seem to care. We've moved her to kennel in the afternoons, thinking it might help but she also doesn't seem to care in that position either. I guess I should add that she's terribly inconsistent. On rare days, she does well but those are few and far between. Her cousin, just before going on maternity leave, told her she would be taking over the "middle" position. This tends to be the coveted post because it is viewed as getting to do more cool stuff. First, her cousin spoke completely out of turn, not even consulting us. Second, supposedly her cousin understood that her performance was not acceptable but chose to tell her that anyway. Third, she is definitely not the person we would place in that position.

At our recent office meeting, I spoke of many of these problems then intended to pull all 3 of the kids aside to speak in private but haven't been able to for multiple reasons. This child is one of those personality types that I really fail to comprehend (it's going to be very difficult for me to talk to her) because they seem to never recognize when they do something wrong and blame it all on others. In my opinion, she needs to go but I've also said that since her first weekend when she left the hard to handle dog in a cage with no care and never called anyone about it all weekend. Unfortunately, I don't have this authority. In lieu of that, I can and have significantly cut her hours. If there is failure to improve they will drop more.

Of the other 2 kids, one does a decent job up front but gets overwhelmed rather easily. Besides, she's the best in the kennel and to pitch in for pretty much any job. The third was banned from the front quickly. She does okay in the kennel but isn't great at pitching in to help with other things. When I need another set of hands, I can never find them when she's working.

Our new person is doing well up front, picking up quickly, and I have no major complaints yet. She seems to care and looks for ways to help and make things run better. She has had some experience in the past and helps in the "middle" as well. Which brings me back to the wife. She's still hanging on and won't go to the planned schedule or ever let us know things in advance like when she needs a day off so that we can plan for coverage. I've inherited planning the schedule but yet certain people are off limits.

Having the wife there is like having Dianne reincarnated but 1000 times worse because she is the wife so what do you say about it? Dianne was a close personal friend of the boss, which was bad enough, but now it's family... She takes messages and we never get them, doesn't pull charts, doesn't let us know things, etc. etc. etc. The other recurrent theme is appointments being set during the 12-2 period that is "lunch." The boss is almost always out for the full 2 hours. I rarely leave the building but use the time to catch up. Charts, phone calls, client instructions, dropped off patients that haven't been checked yet, surgery that ran over, etc. It's also the time I typically use to see employee pets if needed as well as anything that may be needed on my herd. Lunch for me usually doesn't happen or consists of nibbling cheddar cheese while doing one of the above tasks. Every once in a while I'll run out and grab something or take recycling or deposit my check but it's just not the norm. Because of this, suddenly there are routine appointments being taken during that time. (Don't misunderstand, emergencies are always accepted but routine stuff is usually set around that opening or told to drop off.) The end result is that I'm now staying late on an almost daily basis to finish what I couldn't finish during lunch.

I'm going to relate a conversation that occurred last week between myself and the wife (there's a cartoon version of it...) I was examining a dog before anesthesia for surgery. Wife: Scooby ---'s mom called, he has tapeworms and she wants to pick up medicine. Me: That's fine, just pull the chart for me. Wife: The groomer saw the tapeworms. Do you still need the chart? Me: Yes, please pull it. Wife: He is seen here routinely. Do you still need the chart? Me: Yes. I need the chart! (Inside my head I'm saying "JUST PULL THE DAMNED CHART!!!!!") Bear in mind, too, that this was also after the office meeting in which I enumerated "pull the chart" to the point of redundancy. That's what I mean; we have rules and ways the clinic is run but they apparently fail to apply to the wife.

The other major aggravation with work is that I do not feel that I can trust anyone (including the boss) to actually properly care for the patients. The only problem is that I can't be there 24/7 myself. So what am I to do? I hate leaving critical patients on my day off because they typically are worse when I go back and usually because of something that was done with which I don't agree or because something that was instructed was not done... Not only can I physically not be there and control the situation but it is also unfair to my kids. Plus there is all the stuff at home that I have to do. I went to a meeting at AVMA about managing your time and the top recommendation was to delegate. How do you delegate when there is no one you can really trust to do what you ask and do it right? (By the way, I also feel that I should state that although I have perfectionist tendencies and am very hard on myself I am not nearly that hard on others.)

The other fun part about having the wife around is that their son-in-law has started vet school this year. I've determined that she must be a very insecure person because she takes everything poorly and gets really defensive and seems determined that she has to outdo on everything. The son-in-law failed to obtain admission to the school where I went which was "his dream" per mother-in-law. I'm probably being judgmental but what I've known of the young man was not impressive. He seemed very lazy to me and I find it frightening that he suddenly decided to become a vet after his fiance said she wanted to be just like her mom (i.e. get a college degree, marry a vet, and live as a kept housewife.) It affected me much like the 2 students I knew as an intern who said the reason they went to vet school was that it seemed like "something they could do." When asked if they were glad I was told no that it had been too much work but that now they were in debt too far to change their minds. (Maybe I'm wrong to have issues with these viewpoints. I just know how hard of a time I'm having when I have such a passion for what I'm doing. Maybe it's easier when you don't...) Anyway, sorry about the rabbit trail, back to the story. Apparently the fellow made the highest grade on the first anatomy exam and was one of only 2 A's on some other exam therefore the wife has been compelled to tell me all about how wonderful he is doing, etc. and how sorry the other school should be that they failed to accept him. Although they keep saying that they do not intend to return home, I have a hard time seeing through my cynical viewpoint that someone who has not had to work for anything (dad-in-law, my boss, paid for his undergrad after he forfeited a scholarship elsewhere and is paying for his vet school) will want to actually work for a living when he could come sponge, oops, I mean work for, his dad-in-law. Sorry, the whole situation tends to annoy me. Maybe I'm jealous because I had to work so hard for it all.

The summary of all of the above is that work right now is driving me out of what little mind I have left.

As usual for me, I am working on themes with my patients. I've never been sure but I've often wondered if this happens so that I can really, really get the hang of something. Lately it has been penis / preputial issues and cats with high liver enzymes for no apparent reason. First there was a youngish dog whose penis was constantly protruding. I determined that the preputial orifice was too large allowing the skin to roll and entrap the penis. The second was a 7.5 week old puppy with the opposite problem. The end result on him was that his urine was collecting within the prepuce causing constant irritation, inflammation, and intermittent infection. A little plastic surgery on both resulted in cessation of their clinical signs. I know that I mentioned the first cat with the huge ALT. He went home eating, no more vomiting, value back to normal, and hasn't looked back. I now have a cat in the hospital who presented for decreased appetite and vomiting also. He is a little icteric. Total bili was 4.5, ALP=715, ALT not readable. No history of toxins, etc. Nothing I have found yet to aim at but started him on IV fluids and, ironically, he ate voluntarily shortly after being left in the hospital... Cats. Go figure. Still don't know what his outcome will be but I was encouraged by his eating. It was really funny because the good kid was going to syringe feed him just to see if he'd take it and not vomit. She accidentally shot the food out into the cage and he promptly set about eating it. Maybe he was afraid she'd shoot him next if he didn't. I may make a cartoon out of that, too...

On a whimsical note, I was reading the funny named pets commentary in the DVM magazine and it prompted me to share a few of my own. I tend to name things fairly regular names then give funny nicknames. I also have several really boring names but they came that way. My poodle Buddy came named. He has picked up the nicknames Budda Boo (his belly is chubby and reminds me of a Budda belly), Cujo (he tried to eat Can't Spell way back when), and Einstein (he's incredibly smart and has the wild hair to go with it.) Sam is a Shepherd / Collie mix who gets called Sam Bones, Sam Baloney (private eye), and J.P. O'Hairy (after J.P. O'Hara the sheriff who struts a lot in the John Wayne movie El Dorado). I have a Border collie named Indiana Jones who is usually called Indy. He lives with an ancient Chow / Rottie mix who is red and came to me with the name of Chief. Often the pun is made "Indy & Chief" which sounds like Indian Chief. We also often say Chief Red Dog. My flat coat retriever cross that died a couple of years ago was named Flash after the Basset hound in The Dukes of Hazzard. We called her Flash LaRue most often but also Flashley (silly joke based on Gone with the Wind in which we thought it funny if Melanie and Ashley had ran past each other in the post-war reunion scene). Scout is a Jack Russell terrier cross. He answers to Squirt and I call him the Da-Chi Terror, which he loves, because he looks like a Dachshund, Chihuahua, Jack Russell mix. Mollie, my Border collie who died, always prompted me to burst into song with one of the "Molly" songs. Yoda gets called "Yoda-man" quite often and Thumper is "Thump-Thump" with referral to Pirates of the Caribbean when Jack asks where is the thump-thump. Probably more ironic since he was named for the rabbit in Bambi. I know I'm leaving many out but those are the ones that came to mind at the moment.

With the constant frustration right now, I find that turning to silliness allows me to cope a little better. It has resulted in lots of new cartoons, plenty of sarcastic comments at work, and just some plain old goofiness. We have painted the kennel door with chalkboard paint which has been a fun outlet at times. I also saw a great T-shirt that I want. It said something to this effect, "Text messaging in the 1800's, . _ . . _ _ _ . _ . ." That is Morse code for "LOL." And, yes, I did look it up to make sure it was correct:)

Coda

2011-10-04T20:33:00.002-05:00

I loved reading May B. Insane's previous post- it was a lot of fun bringing these wonderful dogs to their new sucker, er, person. I see both of them almost every day and continue to be amazed at the personality Maddie displays- hers is truly a complex psyche.

So Insane has been bugging me to blog recently. Since I now work in The Most Boring Job a Vet Can Have I don't really have much good blog fodder. I'm sorry, what can I blog? "Today I saw a few thousand dead pigs..." But as Insane's previous post relates, sometimes we do see or hear of good stories.

On a previous weekend I was in the town I used to practice in and ran into an old client. I had seen her old, geriatric Min Pin named Layla a few months after I started working at that practice in 2008. At that time Layla was about 12, diabetic, and was in end stage congestive heart failure. She had marked ascities, crackles, and exercise intolerance despite being on a high lasix dose, enalapril, and spironolactone. She would hardly lift up her head as I examined her one afternoon.

Now "The Book" calls for an echo to evaluate heart function before placing any animal on any kind of positive ionotropic medicine, and I agree with this. However, as so often in private practice, "The Book" comes up against "The Client Has No Money" and the client with a sick pet will always win. So, while warning Layla's owner about the dangers, I started her on Vetmedin, a veterinary only heart drug that is kind of a mixture of a positive ionotrope and something else I forget right now... (this is what happens when you don't use information- it floats away).

Two months later this dog was eating and barking again. Against all odds she had improved that much. Now, three years later she is 15 years old and on a cornucopia of medications daily but runs, barks, eats, plays with her sisters, and is a happy dog. I have Layla's owner much more time than she could ever hope for. Sometimes that's a nice feeling.

Happy Endings; New Beginnings

2011-10-03T22:40:00.006-05:00

I thought that I would give y'all an upbeat post as a relief from my gripes and whines of late and before I start on the next bunch...

This past weekend, my friend Can't Spell and I arranged a half way meeting to bring to conclusion the great puppy exchange. At this point I think we have saturated with pets the poor sucker who is Can't Spell's friend that lives near her. I must say I cannot complain at all about the home; these babies are loved and spoiled, what more could I ask?

First was Maddie, the flea allergy dermatitis hound whose story I related recently. Here is a picture of her at the clinic the day she was brought in to be euthanized.

Maddie was taken to her new home in July as I went to AVMA. Her new owner had casually mentioned that she might be in the market for a puppy as a companion for Maddie recently therefore when Lilly came through the front door, I asked if she would be interested. To my surprise, she said yes. As you can appreciate from the picture, Lilly was in pretty bad shape. As I mentioned previously, she had gone from a bouncing healthy 5 pound puppy a month before to a malnourished 6 pounds with severe sarcoptic mange. She was dehydrated, not eating, and her eyes were matted closed because of the oozing from her skin.

So on Saturday, October 1, the girls met for the first time. Here they are in the parking lot at PetSmart. Look how good Maddie looks!! She has a healthy and full coat of hair. She seemed so happy and, while acknowledging she knew me, did not seem overly excited to see me. If anything, she seemed a little nervous that I might take her away again. The puppy was thrilled to meet a new dog and new people. She was particularly thrilled that Maddie allowed her to chew on her tail and legs and feet...

Don't they look happy?

Responses, Updates, and More Gripes

2011-09-29T21:40:00.003-05:00

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

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

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

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

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

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

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

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

The Day of Rudeness

2011-09-27T23:01:00.003-05:00

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

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

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

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

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

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

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

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

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

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

I think I expect too much...

2011-09-26T20:46:00.002-05:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New Theory

2011-09-23T22:57:00.002-05:00

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

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

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

Memories

2011-09-22T23:47:00.002-05:00

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

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

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

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

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

Sucker

2011-09-11T23:29:00.004-05:00

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

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

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

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

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

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

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

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

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

Redundantly Redundant

2011-09-10T23:07:00.003-05:00

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

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

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

Underdog

2011-09-10T22:30:00.002-05:00

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

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

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

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

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

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

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

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

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

Another I don't understand

2011-09-07T23:44:00.002-05:00

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

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

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

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

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

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

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

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

What did I do to deserve this, part 2?

2011-09-07T23:33:00.002-05:00

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

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

His wife is now working as the receptionist.

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

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

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

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

Protest! Anyone?

2011-09-05T22:29:00.002-05:00

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

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

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

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

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

Lost in Translation

2011-09-03T02:46:00.002-05:00

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

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

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

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

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

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

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

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

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

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

A Chink in the Armor?

2011-09-01T23:44:00.002-05:00

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

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

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

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

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

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

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

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

Ratatouille

2011-08-25T23:16:00.002-05:00

The weather here, like almost everywhere else, is miserable. We've gone from being 110 in the shade due to the humidity to only 95 or so because it is now so dry. (Sadly, the Da-Chi Terror, Scout, is insistent on a T-shirt now because he gets cold if it's less than 100 in the shade.) Because of the extreme dryness, we will likely not really have fall colors because the leaves have gone from green to brown and withered in a matter of a few days. Everything is searching for water... Everything includes the mice.

We live in the country therefore there are plenty of rodents. Typically, having cats and dogs about deters them mostly with only an occasional daring one trying to come inside. Not so right now. We are being invaded!!!

Tonight, I was preparing for bed and walked out of the bathroom only to see a mouse running across the kitchen counter. THE KITCHEN COUNTER!!

Of course, mother has to have canisters and such, the counter can't be clean. I grabbed the nearest weighty object and started hitting at the mouse who darted behind canisters and other miscellaneous items, easily avoiding my blows as I became more and more angry. I'm not afraid of mice but they do tend to startle one with their quickness and I WILL NOT stand for sharing my home with them, ESPECIALLY THE KITCHEN! Needless to say, it got away for all my attempts at killing it so now I'm on a rampage, cleaning off the counter and making plans for death traps. The mice must go!

It reminded me of the scene at the first of the movie Ratatouille where the old lady brings out the shotgun and blows her house to pieces trying to kill the mouse. Had there been a gun handy, we might be in the same predicament...

It also made me think about a subject I meant to post on months ago. Another thanks to Walt Disney, et al, so to speak. Ever wonder if those cartoons that we grew up with are one reason there are so many people unreasonably prejudiced against cats? Think about it, Sylvester, Tom, all the cats in The American Tail, Cinderella, Lady and the Tramp, etc. were all villains. The bird and the mice were the heroes and the poor oppressed underdog. And in Ratatouille, the mouse cooks IN THE KITCHEN! Hmmmmm..... Makes you wonder, doesn't it? Now, I must go round up some of the gang of cats and allow them in the kitchen tonight for a light snack. Here kitty, kitty, kitty.....

What did I do to deserve this?

2011-08-25T08:00:00.002-05:00

Diane is a very extroverted older lady who used to work as our receptionist. The clients adored her. We loved her too except that she drove us bananas on a daily basis. She apparently did not ever learn her abc's, charts seemed to be filed at random and could never be found easily (obviously since they were not where they should have been.) Messages were taken and promptly forgotten hence people did not get called back, medicines did not get filled, etc. People who had left multiple animals to board often only got charged for one or, alternately, got charged multiple times for a single animal because she paid no attention to the fact that charges were already entered. Charges were often entered in duplicate, on the wrong pet, or not at all... She was very opinionated and butted in all the time on medical decisions about which she did not have enough knowledge to intervene but was very persuasive to the clients thus really undermining our recommendations. She often took in patients and promised faithfully that we would do some extra service but never told anyone else hence it was not done or stated that she would do it "at lunch" then disappeared for 2 hours at lunch and it never got done. Other than that, she was great. In all seriousness, her personality was her outstanding trait because she was so easy for the clients to interact with and connected well with them. Needless to say, there was a collective sigh of relief (under our breath, of course) when she retired.

Now we have three "kids," as I refer to them, because they are so immature. All three have worked the receptionist position a little although one is now completely banned from the front. Although our entire bank of charts were purged and re-filed in correct alphabetical order, charts are still found randomly filed. Either the phonetics system is really failing in teaching abc's and spelling or Diane is secretly coming in at night just to mess with our minds.

(As an aside, I must relate the recent event when my tongue got away with a horribly sarcastic comment that I probably should not have made. The girl that works up front the most cannot spell worse than Can'tSpell. There have been various "interesting" ways that words are spelled by her and, often enough, it is difficult to decipher what she is trying to say. She is taking undergraduate courses at a local community college and was complaining one day about how difficult it was specifically stating she was soooo glad that she had not taken a particular course because, gasp, the teacher gave essay questions rather than multiple choice!! I'm glad she has decided against vet school... I commented that I would always prefer essay in part because I was better at explaining what I know and that I second guess multiple choice / true - false to the point that I usually miss them plus that wonderful thing known as partial credit if you know most but don't remember portions exactly. "But," she wailed, "they count off for spelling!!!" "Yeah, that would be a problem for YOU..." was my reply. I know, not nice. Now back to the story.)

Messages still do not get relayed or, if they do, somehow I get stuck being the one to pull the chart because, no, we do not remember the details of every single patient we see every day for the past several years even though they have all been told REPEATEDLY to pull the chart when taking the message. Clients are told that things will be done but we may or may not even be told that the pet is in the hospital. Charges are put under the wrong pet, multiple times, or not at all. Charges from the wrong date are entered again as new charges. Medications fail to go home with the pet. Instructions fail to go home with the pet. Neither doctor nor our tech is told when a patient goes home with whose owner we need to speak. All are very opinionated and will tell clients what they think, try to give advice but none have real medical training; the only good thing is that the clients are not as charmed by them as they were Diane. Hmmmm...... Does this sound familiar? Now, somehow, we have the same problem but it's in TRIPLICATE!!!!!!!!!

"All Fed Up With Stupid" & Other Complaints

2011-08-22T09:13:00.003-05:00

One of the employees pulls out that quote along with "Put your big girl panties on and deal with it" on an almost daily basis with good reason. Right now I am very much "all fed up with stupid." Couple of composite stories to give you an idea:

Lady with a Pekingese with atopy comes in and wants to euthanize the dog stating "I've tried everything and she's no better!!!" I look in the chart and see that the first time we evaluated the dog was 3 months prior at which time the dog was in really bad shape; I examine the dog and see that the skin is dramatically improved with new, healthy hair growth and no active lesions. I question the owner who states the dog had "chewed herself raw and made a hot spot the night before." Really? Where? She can't show me. I ask if she has tried antihistamines, omega fatty acid supplementation, flea prevention, medicated baths, hypoallergenic diet...etc. The answer to everything is no yet she wails again, "I've tried everything!!!" Check.

Enter another lady who actually volunteered at the clinic for a short time when she was going through the online vet tech course and trying to do her clinical hours with us until she dropped out of the course, "My old dog can't move one of his hind legs!! What do I do???" Side note, I examined the dog about 2 months ago and found that he had back pain and an old CCL rupture evidenced by a huge medial buttress; at the time, I talked to her about pain control, massage, exercise recommendations, etc. and had prescribed Tramadol as a daily medication and, reluctantly, allowed her to continue using aspirin instead of sending a different NSAID for bad days. When she arrived with the dog, he was significantly lame on the hind leg with the buttressing but could move the leg. Because of it, it was difficult for him to rise, particularly on a slick floor. She finally admitted the dog had played rougher than usual 2 days before and that she had not been giving the tramadol as directed, only giving a 50mg tablet once daily because "I've been prescribed it before and 1 tablet knocks me out; I couldn't give him as much as you recommended!" (He's a 75 pound dog, by the way.) I read her the riot act. She was considering euthanasia because "there was nothing else to do." In less than 5 minutes, I had listed over 20 alternatives to make the dog more comfortable. I advised that ultimately, yes, it would be up to her what was acceptable and what not but that there were many alternatives at this stage to help the dog depending on how much she was willing to do...

People!! It brings me back to a personality trait of mine that makes me crazy most of the time. Responsibility is an interesting concept. I think there are 3 basic levels. 1) The crazy hyper-responsible people like me who take blame for things that cannot possibly be their fault, 2) the mid-range people who are probably the most healthy of the groups taking responsibility when it is theirs but not accepting blame for things that are not their fault or beyond their control, and 3) those that shirk all responsibility, blaming everyone else for their decisions and mistakes.

I don't know why I'm so hyper-responsible. Most of the people that have that trait that I have met were tossed heaping helpings of responsibility at a very young age. Maybe that is the reason; we started being responsible so young it is hard not to take it for everything... I don't know, I just know it contributes highly to my general insanity and is one of the major reasons that I can be manipulated by guilt. I was worse before but have at least learned to recognize the manipulation better now and can force myself to stand against it but it is really difficult because the whole time a war rages within over what I know is right and my guilt / responsibility hang-ups.

Yet another reason I second guess myself so much about the Rusty-dog. I keep wondering if I was wrong about pneumonia and maybe it was neurogenic pulmonary edema and maybe I made it worse with fluids... I still don't understand what happened and why it progressed so quickly. The Holter didn't really give answers although I'd like to discuss a couple of the strips with a cardiologist. Apparently the tech that read the thing didn't understand the approximation of some of the times such as the small seizure around 3:30 a.m. where the strip is normal at that time but not normal 5-10 minutes prior, hence approximately... No, I did not opt to have a necropsy which may have settled some of my questions and self-doubt; I couldn't deal with the thoughts of having it done. Besides, I'm sure I would have found some way to blame myself anyway. Rest of the herd doing okay, Buddy grieves a lot still and is more clingy to me than he was before. I worry a lot about Sam and Chief, my other 2 old guys (15 & 16), especially Sam since he has more medical problems but, to be honest, I thought he would go before Rusty...shows how much I know, right?

At work, cancer has been the theme as usual except for one other case that I'll relate shortly just for the irony of the situation. Let's see, first there was the German Shepherd who presented for a possible foreign body because it chewed up a toy and now had a distended abdomen. I wondered first about a GDV but walked in to see a calm, quiet, somewhat depressed dog with an easily observed distended abdomen. On palpation he had a fluid wave and a cranial mass. His belly was full of blood on abdominocentesis and I did a radiograph just to prove to the owner that there was no foreign body, a hope she clung to until the end of the visit. They opted to take the dog home and spend a little time with him rather than go to surgery, etc. so I can't totally prove that it was a tumor but what do you think given he was 9 years old? Then the axillary mass that I talked about before, histopath identified it as a "high grade soft tissue sarcoma" and they could not definitively determine the tissue of origin... And the cat that presented for "some blood in his stool and can he get his vaccines too?" There was a mass in the caudal abdomen easily palpated. The owner actually wanted to try surgery but the cat became stressed in the process of attempting to place an IV catheter then started breathing heavily and bleeding more from the rectum. We wound up euthanizing and the owner allowed me to open the belly. There was a golf ball sized lymph node that was necrotic and hemorrhagic. We had not done thoracic radiographs yet but I'm making bets on Lymphoma. And the list goes on, and on, and on....

The ironic case needs 2 preludes. First, I am good at critical cases. I'm actually probably better at those than I am at surgery, which is my first love. I don't particularly like them but I am good at them and the last few years experience in primarily ER / Critical Care has only served to hone these skills. Perfect? Certainly not, but definitely a strong area. My boss is not. He doesn't think outside the box and doesn't push fluids when needed and so on. Second, for those of you who remember, the dog and person involved is the one I spoke of several months ago that came in wanting "the same shot that the boss always gave" and after getting it the dog tried to die because his blood pressure plummeted. The one that I said would be a "Doc only" client from then on. Right... Doc had to go out of town unexpectedly last Monday because his mom was in the hospital therefore I worked on my usual day off. Lady shows up with her dog; she had talked to Doc and finally been convinced he should be seen and not wait. She had called the week before to pick up dewormer because she thought he had worms again but refused to be seen until Friday when Doc was in (he was out most of that week on vacation) at which time the dog was given a small dose of Gentocin, amongst other things.

When I saw the dog last Monday, he had a necrotic area on the tip of his tongue, uremic breath, increased respiratory rate and effort, focal crackles in the left cranial area, a low grade heart murmur, and was very dehydrated. CBC / Chem showed a white count of 34,000 (it was 13,000 on Friday), BUN unreadable (means it has to be over 200 on my machine), Creatinine of 8.8, Phosphorus over 20, some elevation of ALP and ALT, to name the highlights. Urinalysis showed a low specific gravity, glucose, protein, and blood in the urine with white blood cell and red blood cell casts. Thoracic radiographs showed an alveolar pattern in the left cranial region, possible aspiration pneumonia was the working diagnosis. I spoke to the owner and explained the poor prognosis and that the only chance was aggressive fluid therapy and antibiotics, etc. She asked what I would do if he were mine; I told her bluntly that I'd at least give a chance but that not doing so was not a wrong decision. She decided to let me try. I hit him hard with fluids, antibiotics, coupage, sucralfate, etc. I pulled out the tea trick for the tongue discomfort, something I had practically forgotten from onco in school. 48 hours later, there was a small downward trend in the recheck bloodwork but I also felt we had only really just begun true diuresis given the in's and out's. Additionally, he was coughing more and producing with decreased crackles auscultated. He had also eaten a small amount where he had previously shown no interest at all. In my opinion, far from out of the woods but at least taking baby steps in the right direction. (By the way, to remind you, the owner is a nurse so should at least have some grasp of the situation. I know it's her own dog and that clouds thinking but she should understand a little more than a lay person.) The next day, I was off. As usual, I briefed my boss very thoroughly on the situation. When I returned the following day, it was to find that the dog had been euthanized. I was told that although the kidney values had fallen some more (why were they even checked only 24 hours later?) the liver values had climbed and he was breathing more heavily.

Now, I don't know, maybe he was way worse than before. Maybe it was the right decision. I really don't know. I do know, however, that it is not the first time by far that my boss has done something entirely different than my plan for a patient on my day off. I also know it is not the first time that one of my cases has "gone downhill" while I was off and when I returned it was because of something done or not done according to what I had planned. The most memorable was the pylonephritis dog that was given lasix on my day off because he had some SQ edema. REALLY PEOPLE??? He did not have a heart murmur or crackles or fluid dripping from his nose or any other signs of fluid overload. There are other reasons for SQ edema such as, oh I don't know, MAYBE THE FACT THAT HIS PROTEIN LEVEL WAS AT ROCK BOTTOM. Remember Starling's Law and the relationship between proteins, etc., osmotic pressure and fluid being held inside the blood vessels??? Can't help but wonder if the decision was a bit precipitate but I'm also the only one at the clinic that will really push the envelope on critical cases. And I have as yet to work in a place where I haven't had an argument about pushing fluids in which some know-it-all tech or other vet thinks I'm giving too much, too fast. I know about overload but most people that I've worked with don't push hard enough and freak out way too soon or about things that don't really indicate overload. That's one of the reasons that I became a veterinarian; so that I can make those decisions on my own pets rather than being trapped into either stopping sooner than I want because no one will put in the effort or going too far because of the attitude of some vets that cannot determine what is truly humane. I certainly don't claim to always make the right decisions and know what is best to do but I don't, as one of the AVMA speakers so beautifully described it, "roll over and pee on myself" when given a difficult / critical case and just decide to euthanize. One statement that always comes to mind is that euthanasia is permanent.

Besides cancer and the crazy client's and the critical cases, I've seen some great abscesses lately. Mammary gland abscesses, fight wounds, an eyeball, etc. There is something deeply gratifying about abscesses although I have often wondered if this is more of a female thing than male because it seems that more females enjoy them than males. Hmmmmm..... I'm sure there is some deep dark meaning in that.

I believe that covers most of my complaints for now. As for my mental health, well that is probably beyond help even in the best of times... If it were not for the necessity of being at home right now I would be looking elsewhere for another job. Speaking of mom, I finally forced myself into the conversation I've been putting off for a while. As of right now, she is agreeable to getting an appointment with a lawyer and updating her will as well as stating that I will have power of attorney when the need arises. Hate to think about it but it is a necessary step. I remember when I took care of my grandmother with Alzheimer's right after I graduated from high school. The family fights were horrendous with no one being willing to help at all, ever to give me a break even when I exceeded the breaking point, fighting over her stuff even though there was no money to speak of, complaining about what was spent on her, etc. Then I think about the fact that I'm pretty sure my mom is already showing early symptoms of the disease and I think about how my brother is, much as I hate to admit it. The only conclusion I can reach is that I need to make sure that mom's home is protected which probably means it needs to be in trust for me to care for and that, since I'll be the caregiver, I can make decisions regarding what is spent on her care, etc. when the time comes. Not that I want my brother to have nothing but I really don't want to face having to sell the home and property without even a chance to go through things as soon as mom passes because he insists on splitting all assets immediately. Guess I sound really cynical and all but, much as I love him, I know my brother and, for that matter, my family. Nice morbid thoughts I've been having lately, aren't they? Really miss Rusty for someone to discuss these things with and just to hold when I need a hug...

Grief

2011-08-09T22:14:00.003-05:00

It is interesting how few people acknowledge the need to truly grieve over the loss of a pet. People generally seem to feel that it should only take a day or so to be back to normal and act as if it is odd if you take longer. I was thinking of my technician friend that I worked with 2009-2010 who lost her Great Dane at 13 years on the last weekend before I left to move back home. It amazed me how many of her "friends", including veterinary people, were on the verge of having her committed because they felt her grief was too excessive. I worried about her because she was truly suicidal at one point but I also understood where she was coming from completely. Heck, I'd probably be seriously suicidal myself if it were not for the rest of the herd needing me (now y'all can run off and see if you can have me committed.)

I'm sure not everyone is the same and not everyone forms the ultra-close relationship with their pet that I and others experience but the reality is it is present and for many people, losing a pet is like losing a close relative. First thing this morning, I had to euthanize a 16 year old dog that has a lot of health problems and fell and broke his leg. His owner is one of those "practical, grew up on a farm types." I don't mean this to be critical and I'm certainly not saying she made a wrong decision but I doubt it is the decision I would have made. She loves her pets but seems to have a much more practical outlook for end-of-life decisions than I do. Sometimes I wish I were more like that.

At work, they have started calling me "Dr. C" because it seems that all I do is find cancer. In client pets, in employee pets, in my pets, everywhere I look. I've suggested that when people call they schedule with the boss because he probably wouldn't find it and it would be a simple problem that could be fixed. It grows depressing when you feel like you talk about death more than anything else and when employees jokingly say they don't want you to examine their pet because they are afraid of what you may find. Maybe I should have taken a friend's advice and pursued a residency in oncology.

Yesterday was a bad day for me. For no particular reason, I was extremely glum and thinking about the Rust-bucket. All day my employees kept asking if I was mad about something. When I answered that I was not in a good frame of mind they asked why. Then it compounded because I got more upset that they had to ask... I'm always reminded of the book and movie Sense and Sensibility when things like that happen. If you don't know me or haven't figured it out I'm "sense." Yes, I can go to work and bury the grief deep inside and even function semi-sanely but that does not mean I feel any the less.

To add to the mood, there was a 12 year old dog in for routine vaccinations plus the owners mentioned she had been breathing heavily. I examined her and felt she had increased respiratory effort and increased noise although no crackles; additionally, she had dry eye on the right side although the left was normal and significant dental disease. I called to discuss the problems making recommendations for thoracic radiographs, treatment of the eye, and a pending dental after we assessed the breathing. I was informed that they did not want to do any of the above and had been "given drops for the eye before and their dog was healthy, just old." So much for that. Plus the boss called to ask about the dachshund (details in a moment) and was answered by the technician who had not even assessed the dog much less knew what was going on with it. And, the boss has already talked to the owner and contradicted 90% of what I had said indicating to them there really was not much hope and they might as well just stop. Made for a great day, let me tell you.

The previously mentioned dachshund in the hospital presented paraplegic (Intervertebral Disk Herniation, shocker, I know!) over the weekend and her owners could not afford referral and surgery. I've been medically managing her and she is making baby steps in the right direction to the point that today she actually moved both hind legs. Somehow, the owner got the impression there was no change when they called this morning and I was unable to get on the phone but sent a message. The message I got in return was that they were considering euthanasia. If they had made that decision, I think it would have been the last straw to completely push me off the deep end. I probably would have quit completely and my boss would have loved that since he is on vacation at the moment...

And today I got to remove a portion of a nasty tumor that was intertwined around the very large named artery, vein and nerve in the axillary region. You know, the ones you really don't want to nick accidentally for fear of bleeding... I couldn't get it all out and, of course, it is a nice dog with nice owners. I'm curious what kind of tumor it will be. At least they will be willing to follow-up with an oncologist for chemo or whatever. Although at the moment, I'm feeling very fatalistic as if it really doesn't matter what I do anymore because they're all gonna die anyway. It wasn't helpful to my frame of mind that I got the Rusty-dog's ashes back today either.

Of interesting note is that the vet school in Guelph has decided to add a grief counselor to their program. I think it is a wonderful idea. Many counselors minimize the grief being experienced and rather than helping someone to cope wind up worsening the problem because the person no longer feels they can openly share their feelings without being belittled. I wonder if they will consider adding teaching sessions for the clinicians and students to help them learn how to handle grief as well as help them learn how to help clients handle grief?

Here is the link to the article if it works right since I'm semi-computer illiterate much of the time...

GuelphMercury - Veterinary College counsellor helps pet owners

Compassion Fatigue

2011-08-08T00:05:00.002-05:00

I was reading The Homeless Parrot's post about the heatstroke dog and the idiots who claim to care. For some reason, the post finally made me able to somewhat put into words the battle inside me over the past 4 years since I graduated and started to practice.

Technically, they call it compassion fatigue but that seems a really lame term for the feeling. Incidentally, I found it telling that there were lectures for technicians but none for veterinarians on the subject at the AVMA meeting. For me, I remember very vividly a case that I saw on my terminal preceptor just before graduation that was one of many that set off the downward cascade. It was a 2y old Dachshund that had intervertebral disk disease (presumptively) whose owners could not afford referral therefore we attempted medical management. Like always, I poured heart and soul into the dog, pulling out all the stops. It was a long road and just as the dog turned the corner and began to take a few ataxic steps on its own with no support, the owners opted to euthanize. They, it seemed, were not ready to pour heart and soul into the dog; they decided that they couldn't face the possibility of going through the same thing again. They didn't even come to say goodbye. I took the dog outside and fed him treats as I injected the fatal solution to the world's ills. He died sitting in my lap on the grass, eating (his favorite pastime).

I could relate dozens of these stories. Point is that the fact that the empty feeling grows daily and has followed me from job to job proves to me it is not simply job burn out. I find it harder and harder to give so much of myself on each patient. It used to be a nonentity; something I didn't even think about, I just did. Now, there are times when I have the shocking feeling that I just don't even care. I feel as if my emotions are cauterized. (Not talking about my own children, I would move heaven and earth if I could to do for them. It's just really hard to continue to drain oneself by caring so much when you can do nothing primarily because the owner won't let you.) This has been progressively building over time. I sound as if I'm saying everyone is that way, which is not true, it just seems that the majority of people I deal with are. I understand financial concerns; heck, I'm struggling to make ends meet at the moment, too. The necessity of caring for the herd, however, is the sole reason I have a credit card and have credit card debt at the moment. And it seems as if many of the people who will do nothing do not make the decision because of money but because they are too stingy to spend any on the animal.

If this continues, I think I'll seriously have to look at another work venue because I don't think I can live with myself not caring. Needless to say, it's worse right now, too. Each morning I put on a professional mask in order to function at work all the while questioning what I could have done differently for my dog and listening to people turn down even simple care that could vastly improve their pet's life. Blaming myself for my loss while fielding calls from clients who took their overweight dog out to exercise in the heat of the day (did I mention this is northeast Alabama where we are in the middle of a heat wave with heat indices in the triple digits?) and it died of heat stroke because we recommended it needed to lose weight therefore it is clearly our fault their dog died. Compassion fatigue? It really doesn't seem to be a strong enough description. Emotional burnout? Cauterized caring? What is the word for the disease in which people are incapable of feeling pain? Maybe some derivative from that would be a better description. Or maybe there is just no way to describe it until you experience it...

Doink-a-doink

2011-08-06T23:50:00.002-05:00

Hello blog world! Myself and May B. Insane have sure had a roller coaster ride lately, and not in a good way. I thought I'd share a slightly funny story.

The other day I was at work out in the barn getting ready to look at pigs. There was a stock trailer (one of the big semi-pulled ones) backed up to the dock getting ready to unload pigs. There was also a loud argument going on right beside the stock trailer between the truck driver and a company employee. Since I didn't want to get involved I just kind of stood back and watched for a few minutes. This turned out to be an excellent idea...

The argument (over something stupid by the way) continues and my eyes kind of wandered around a bit. I looked above the trucker's head and noticed that one of the pigs on the second level of the trailer has pushed his butt up to the side of the trailer and his tail is sticking out waving. As I am easily amused, I thought this was kind of funny. It wasn't as funny as what happened next though. As I watched bemusedly this pig (it was apparently a gilt) (a gilt is an unbred female pig) peed about a gallon of urine.... right down onto the head of the irate trucker. As his mouth was open arguing at the time it hit the top of his bald head and ran right into his mouth!!! Everybody there just died laughing as he sputtered wetly.

Last I saw him he was washing out his mouth with water and spitting it out.... Gotta love pigs!

Goodbye

2011-08-01T09:31:00.007-05:00

I said "Goodbye" to my best friend last Thursday. Most of you will likely understand that having multiple kids doesn't mean you love any less but there are probably those that are "special".

Rusty was special. I adopted him on February 28, 1998, officially although he and I had been sharing a clandestine relationship in the clinic kennel where I worked for a month or so already. He had been left there by a lady who said she had 14 dogs, had brought 7 with her on a trip to visit family and been told by her husband that if she wanted to come home, she should do so without the dogs. We took in a couple to find homes; Rusty was one of those because he was a Bichon frise and we had some clients that seemed to be a sure bet for a good home. But we didn't know Rusty...

We were told he had been found wandering the streets of Florida and was at least 2.5 years old, already neutered and on heartworm prevention. It is still unclear how many homes he had already gone through before arriving in northeast Alabama. He had a mature cataract in the left eye, luxating patellas with arthritis already, a small depression in 2 of his ribs on the left side, and a painful left shoulder. He also hated kids with a passion. His personal opinion was that all children (and any loud, busy adults) should be on a leash or in a kennel at all times.

Rusty went to his new home with the aforementioned clients after a haircut and bath; it failed to work out because the clients' dogs did not like him (so we were told). He went to another home that also failed. We showed him to numerous people who thought he was "sooo cute" until he hid behind me growling because they got too loud or reached over the top of his head too quickly. One weekend I had kennel duty and was once more berating his habit of pooping all in his kennel then walking over it until it became a solid mat of poop regardless of how much he did outside when I discovered that all he wanted was to be held. Since my car had broken down and I was waiting for a ride, I indulged him for an hour or so. They said I created a monster that weekend.

Shortly after, Rusty went home with me to "go to my cousin" ostensibly but the truth was he had already wormed his way too deeply into my heart. Rusty became my best friend and closest confidant. He was a shoulder to cry on, a friend to depend on, always ready to go on an adventure or to just sit at home in my lap while I indulged in a good book. Rusty was my rock when my brother died and I had to be the rock for everyone else. Countless nights he soaked up my tears and was there just to listen.

Rusty went to work with me daily for a long time. He had severe separation anxiety and each time he had to be groomed, it worsened, probably because he associated that with being thrown away again. He always fit in easily with the herd and loved other dogs. When he decided that Choo Choo was his special girlfriend, he sometimes stayed home because he was more comfortable being in a safe crate with her than he had been alone. He hated being alone...

One Halloween, a friend and I had a brilliant idea that Rusty should dress up as the Grinch since he "hated the noise, noise, noise" and was otherwise Grinch-like. We dyed his hair with green kool-aid and conditioner, I made him a Santa coat and hat, put his ear hair up in a topknot, and velcroed a stuffed dog Max to his back. It was hysterical and he had a blast. My boss's dog kept stealing the stuffed toy from his back but it was overall a riot. Until I discovered that kool-aid and conditioner apparently does not was out of white Bichon hair... He was a shade of green for 3 or 4 months until I was able to cut his hair. It was rather fun though when clients asked about the green dog to deny any knowledge. "You saw a green dog? Really? That's weird. Are you feeling okay?" If a straight face could be maintained it was best.

Later, Rusty went with me through both undergraduate and vet school; I often said he was smarter than I and should have taken my tests for me, then I would have aced them all. There was the time during the first year of vet school when I was wondering why he kept having diarrhea and vomiting to the point that I was getting really worried until I discovered he had figured out how to open the cat food storage container and was sneaking in to take little bites here and there. Or the many times when Choo Choo turned over the garbage to get some choice tidbit only to find her on the couch innocently sleeping and him caught in the act.

In 2005, Rusty lost his left eye. I had been poorly advised that the cataract would not hurt him, leave it alone. He developed uveitic glaucoma and I failed to be able to control the progression and pain therefore we enucleated the eye. This became the subject for my senior presentation in vet school (Rusty came through for me yet again!) In 2006, he had to have surgery to remove bladder stones. Both times, I was a nervous wreck and stretched rules to the limit including insisting on scrubbing in even though I wasn't on the surgery rotation and taking him home on the same day because I knew how stressed he would be without me.

The other dramatic thing about Rusty was his compassion and understanding. He hated his tail and feet touched yet my 90+ year old grandmother could pull on the tail with impunity. Or the time my co-worker's child (remember, he hated kids) was crying and sitting in the floor and he climbed into her lap to comfort her. Similarly, he had not accepted Can'tSpell until she sat in my floor crying and he climbed into her lap. If anyone was upset, Rusty felt that he needed to help.

Rusty traveled to 25 states with me; I had hoped to make it to all the lower 48. He dealt with long intern shifts, emergency overnights, and countless nights and weekends on call. We lost his little girlfriend in 2008, and we comforted each other in our mutual grief.

Over the past several months, I've watched Rusty begin to show signs of growing old. He started to slow down, his arthritis worsened, his sight worsened, and his hearing virtually disappeared. I pulled out all the stops to try to slow the process and keep him comfortable and happy; it seemed that all he needed to keep him happy was to touch me. He's had a lot of dental problems and I have had to extract several teeth to keep him comfortable. On July 11, I took another out. I wound up only using the induction dose of ketval and not even needing more anesthesia because it hit him so hard. He was really slow to wake up and had what seemed to be a short, focal seizure the following morning; by afternoon (time to get off work, he reminded me adamantly) he seemed fine.

We left for AVMA and a short vacation the following Friday. Going out on the pavement seemed really hard for his arthritis and the heat was very bad on his breathing therefore I started letting him wear a diaper and not go out while we were in the city. On the last night there, he awoke in the middle of the night, vocalized and had another episode similar to the first. Very short, tremors involving the front of his body with almost a Schiff-Sherrington position other than his back legs not being stiff. He responded instantly to my touch therefore I was unsure if it was really a seizure or if it was anxiety since he was in a strange place and covered up with a blanket. Afterward, he seemed fine. Over the course of the next 5 days while I visited my friend who lives near, he had a total of 5 episodes, all very similar, all short, and each time he responded to my touch immediately. On the Monday following my return home, he walked down our couple of porch steps then seemed weak in his hind legs, postured to urinate and collapsed onto his side in what appeared to be a true seizure. In the middle of it, he stopped breathing and I felt his heart stop. He then came out of it and had what appeared to be a post-ictal period. Through the course of the day, his breathing became very labored.

Radiographs of the chest that day showed a mixed interstitial / alveolar pattern. I was confused: pulmonary edema or pneumonia? There had never been evidence of heart disease, no murmur, a rather slow resting heart rate for a small breed dog historically, nothing abnormal. I ordered a Holter monitor, set a medicine / neuro consult at the vet school as soon as possible, pulled blood, and had an echo / abdominal ultrasound done. (I had done radiographs and bloodwork just before the tooth extraction, all were dead normal.) The abdominal ultrasound was normal. The echo showed elevated pulmonary arterial pressure with very mild mitral regurgitation, normal left heart size and pump quality, mild right sided dilation with good pump quality, i.e. no reason for heart failure. The CBC showed a mild leukocytosis with lots of band neutrophils, there was a technical error with the chemistry therefore I was unable to get values.

During the time the Holter was on, Rusty began to have more small seizures and each time his breathing became more labored. He was on nasal oxygen and IV fluids, antibiotics for presumptive pneumonia, and I was holding him when he arrested while defecating. He came back but his breathing deteriorated rapidly and he continued to have seizures even with diazepam. Finally, he just stopped. Throughout the time I wrestled with the guilt of stopping and letting go versus not stopping and seeing him suffer more. He died in my arms but I'm not really sure he knew...

I regret deeply the small things. I wish I had made him some homemade biscuits, his favorite, like I promised to do the next day. I wish I hadn't gone to AVMA, maybe if I had been where I could have gotten help quicker, it would have changed things. I wish I had not been working on the day he decided to go; I hated being torn between him and my obligation to the other pets that needed care. Most of all, I just miss my best friend.

I still don't have answers. Maybe the Holter report will tell me something. A brain tumor maybe? He didn't act like a dog with increased intracranial pressure. Neurogenic pulmonary edema doesn't make sense. Maybe PTE's, especially at the last when he deteriorated so quickly? Maybe he was throwing clots because of cognitive dysfunction syndrome... In some ways, having a name might help but the reality is that it won't bring him back. Rest in peace my Rusty-dog and know that you are missed and always will be.

Follow Up What's Your Diagnosis

2011-07-22T15:22:00.003-05:00

So one of the major reasons that I posted previously is to help prove to myself that I haven't completely lost my mind. Above is a post-operative radiograph.

To reiterate and add details: 9y, NM, Labrador mix who presented for routine examination, vaccines, and heartworm testing. Radiographs were recommended because of a distended abdomen and urine leaking with mild discomfort associated with abdominal palpation.

As is too often typical where I currently practice, there was a significant financial limitation. The dog was bright, alert, and responsive and had not acted sick at all. Each time I attempted abdominal palpation, he began to urinate, even after going outside. I could not distinctly feel a mass but the bladder was huge at initial palpation although the sheer volume of urine made it clear there was not a complete obstruction. Based on the radiographs and cost problems, we opted to perform a scheduled exploratory one week later. (Boring bloodwork, by the way.)

One week later, exactly, I explored the dog. On pre-surgical examination, the abdomen was more comfortable and slightly less distended although he still had that "old dog" pendulous abdomen appearance and, while the urine was still somewhat uncontrolled, it was of a smaller volume than previously; otherwise there were no changes. Upon explore, there were no masses visible and all organs appeared within normal limits grossly other than the bladder. The bladder appeared thickened and very reddened, as one would expect of a bladder containing a stone. There was no free fluid present and no evidence of prostatic disease or previous bladder rupture. Upon performing a cystotomy, I found no stones at all; not even a single tiny one. Nothing. Nada. Zip. Zero.

Talk about confusing!!! The only logical explanation that I can reach is that maybe it was several small stones that the dog subsequently passed prior to surgery????? Told you is was surprising.

What's Your Diagnosis?

2011-07-15T07:56:00.003-05:00

I'd like to see what you folks out there think of a case I dealt with recently. Gabe is a 9 year old, NM, labrador mix who presented for routine vaccinations, heartworm testing, and examination. On exam, it was noted that his abdomen appeared distended and mildly tense / painful on palpation of the caudal region. He was leaking urine uncontrollably and this increased with palpation. It was difficult to determine if there was a mass because of his tenseness but there was a moderately enlarged bladder for sure. Because of this, I recommended abdominal radiographs and submit the lateral view for your examination. What do you think?? I'll post a follow-up in a few days with the interesting results.

Weekend Highlights

2011-06-28T22:56:00.002-05:00

OK, so not the post about Guess and Maybe as planned but thought the highlights of the weekend might prove somewhat entertaining.

We had planned to go down and help sort out some of my brother's mess this weekend and to that end I rearranged my schedule to be off Friday, drop Guess off at the dentist Friday to spend the weekend, leave the dogs that need to be watched while we were to be gone, etc. At the last minute, the trip was canceled which turned out to be a good thing.

I took Guess on Friday to be worked in for is implant adjustment and was well on my way to Birmingham when I got a call that a tree had fallen on the fence separating some of the dogs during the storm the night before. As a result, Thumper and Yoda had crossed into the fence with Tag and Maybe, trying to start a fight with Tag. Mom got all that sorted out while I was gone and when I returned, I found that pretty much everybody was upset, probably due to the weather; we're having a lot of pop up thunderstorms over the past few days. I promptly practiced better living through chemistry and slipped the kids that needed it a mickey.

Saturday was not bad with the effects of the drugs still lasting and not as bad of weather. Sunday dawned with Thumper and Yoda back over the fence. With a little work and a lot of shuffling, I got them back where they needed to be and got the fence fixed. More drugs because of the weather and a necessary trip to the clinic to pick up a refill (we usually don't go through quite this much, it's been a rough storm season for the kids and now we have the dreaded firework holiday approaching, too!!)

Monday, I was off due to our planned trip and I started the day by sawing into pieces the rather large dead pine that fell several weeks ago and has been trapped on a limb but hanging over another portion of fence (quite stable, but needed to be gotten down and this was the first chance I found). After getting that down, I gave Chief, my old Chow / Rotti mix a little tranquilizer so that I could shave him down. I typically brush him out but with the weather, his coat was well on its way to a disaster.

Afterward, I got a much needed shower then cooked supper. Then I loaded the recyclables into the truck to drop off on my way to work today. On the way in, I tripped going upstairs onto the porch and took a nosedive, landing on my hands and knees and using the top of my head to slam the half open screen door shut. It was one of those moments when you just sit up, wiggle all pertinent limbs and verify no broken bones, then shake your head and wonder how it even happened. With that, I closed my day.

Now it is time to start all over in the hair department of the herd; sometimes it's a little depressing...

Saw a funny / interesting case last Wednesday. Little pup I helped deliver; the new owner had found his mother abandoned and pregnant in the house next door. As the pup was running around and playing like an idiot, the water bowl was knocked over and spilled. In another run, he hit the water and slid then hit a counter resulting in severe lameness. When they brought him in, it was immediately apparent that he had a broken humerus on the right front. Since he was bearing weight on the other 3 legs, I did not pursue other investigation at the time but splinted the leg (nice fracture that will heal well with a splint over the shoulder. It wasn't until the next day that he became lame on the left rear; after another x-ray, I discovered a greenstick fracture of the tibia. Now he has 2 splints... Fortunately, he's still young and will likely heal in 2-4 weeks.

Today it was a 4 month old Maltese mix with a broken jaw. The mandible had a fracture near the lowest point of the ramus. The puppy was kicked in the jaw by a 4 year old neighbor child who walked over into the owner's yard while they were out playing with the puppy. Even a child that young knows better. It's disgusting!!

The highlight of last week was the spaying of the wrong dog due to the ineptness of the help that I was complaining about recently. The one who did kennel the weekend before mixed up cage cards therefore the dog labeled boarding and spay while here was anesthetized, put on the table, and opened only to realize she was spayed. It was at that point that we realized it was the wrong dog. The owner's were very understanding at first (dogs belonged to same people) but apparently did not pay attention to what was said since when they picked up the dogs the following day they started screaming that I did not tell them I actually opened the dog and demanded their money back; in entirety.

That's about it except that I still owe the post on Guess and Maybe. Maybe next time; I Guess...

Freebies

2011-06-20T07:44:00.002-05:00

Had to take a moment to comment on an article in the June 15 issue of JAVMA. There is a very nicely put together article criticizing the role of corporate freebies given to veterinary students throughout vet school as well as to veterinarians and physicians written by a lawyer who is (or was at time of submission) a second year vet student at Colorado State. This is what happens when lawyers go to vet school...;)

In all seriousness, she had many good points but I have to refute from a practical standpoint. Had we not received free or very cheap pet food, there is no way I would have been able to afford to feed my kids. Additionally, the free lunches, dinners, etc. often provided made many of us actually eat a meal when we might not have done so otherwise. To eliminate this would be another step toward making veterinary a privileged profession only available to the elite people who have money or a spouse or parent to support them. There is already enough politics out there that limits admission to many worthy folks while allowing admission of people who really don't deserve to be there. Speaking for myself who grew up on the "wrong side of the tracks" in a family with a very low income due to having my father pass away when I was extremely young and who paid for my entire education through scholarships, grants, and student loans (NOT parent loans, by the way), I for one appreciated any help given.

The author makes a valid point that gifts can influence later recommendations and that the meetings, lectures, etc. are biased. While this is true, I always walked into the corporate sponsored lectures with that prior knowledge therefore listened with an even more critical ear than usual and, believe me, I am very critical probably in part due to my natural cynicism. This exposure as a student can but benefit when one reaches a private practice job in which the boss prefers not to pay for good CE hours and forces at least some of the hours to be through local chapters that are, guess what, corporate sponsored events... Additionally, I viewed the food as a chance to get a personal working knowledge of the different companies and availability. Now, when an owner asks me if the food works or is palatable, in most cases I can actually say I have used it for my cat or dog and this was my opinion. This is one reason that I have a personal preference for Purina HA versus Hill's Z/D for allergy dogs; I tried both on mine.

I believe that a better approach than eliminating this practice would be to better educate students on how to critically examine evidence and make a non-biased decision. Realistically, this practice is something that everyone deals with on a daily basis in real life - wouldn't it be better to learn how to handle it while there are mentors available to question and from whom to learn? Oh, but I forgot, to teach students to critically examine evidence would be to expose those clinicians who are deficient in their knowledge, etc.

It took me a while to recognize that those who laughed at my questions, blew them off like I was asking something stupid, ignored them entirely, or handed me a pat answer really didn't know what they were talking about and didn't want to admit it. I had the privilege of working with many great clinician's in vet school as well as a few during my other experiences since but my absolute favorite by far was the man whose lectures were beautifully put together, took the time to find a way to connect, and who responded to my first weird, out there question to him with "I don't know; why don't we look it up." This describes a person who is secure enough to admit they don't know everything (who does?!?!?) even to a (gasp!) underling such as a lowly student. This is in direct contrast to the other type that I previously described who are definitely too insecure to admit a lack of knowledge or confidence in front of a student.

Perhaps it is partly my nature that makes me take this stance on this issue. I'm admittedly a questioner; always have been, likely always will be. I'm sure I drove mom crazy with the endless string of "Why's" throughout childhood. I even remember playing softball in high school and failing to run home when the coach told me to because it made no sense to me. Much like Smalls in The Sandlot, I think too much, never really fit in with kids or people of my own age group, and am not great at just letting go and having fun. Needless to say, I got pulled out of the game after that but the coach knew me well enough that he also took the time to explain his reasoning on why to run. Unfortunately, I still have not developed that trust in anyone just to blindly run when told hence I don't blindly trust just because someone said so; even if it is a boarded specialist. I probably drove many of them crazy as well with my questioning and looking things up that I was told just to verify that it was truth...

Anyway, I do not disagree with the points in the article I just disagree with the solution. It's time that we really advocate evidence based medicine in vetmed. (I did a great presentation on this last year; I'm not sure that it went over that well with the folks listening but I had a blast doing it and used some of my more sarcastic cartoons to help illustrate the point.)

On other topics, my brother is still in a mess. He got his wife out of jail and 4 (!!!) days later they were both arrested for drug possession. He seems to rationalize that it is ok because the drug they are using is "technically" legal in his state. It doesn't matter that they both are killing themselves slowly by using it. The whole problem started after they had a really bad car wreck about 17 or so years ago. Due to their injuries, they were placed on prescription pain medication, slowly began to abuse it, then reached for illegal substances, and it has escalated from there. He's trying to play the guilt trip on mom to get him out and he's really good at it. I hope she stands strong because at least he is in out of the heat with food, water, shelter, and hopefully no drug availability. It's so sad seeing them throw their lives away; their kids won't even associate with them at this point.

The herd is doing well overall (big sigh of relief!) and I'm working on being intentional about spending more time with each of them, especially the geriatrics in the group. I still don't have an answer on my poodle but am looking into atypical Cushing's. Not that I'd treat it yet if it is that but I'm really a type A driven personality when it comes to finding answers and explanations. I liked the suggestion about age related changes, too. Maybe it's a combination of things; I'm comparing him to my Cocker/Poodle that passed away a couple of years ago at 18 and he's not really quite like she was (definitely a cognitive dysfunction syndrome) but does show some similarities. Abdominal ultrasound was boringly normal but I do caveat that at this point I have to rely on a human ultrasonographer to do scans since we do not have a machine and it's not really kosher for me to take the probe from her (besides, he turns into Cujo if I don't hold him...) to do the exam.

Have done some self diagnosing again and determined I'm definitely dealing with some major compassion fatigue as well as some burnout. Partly disillusionment factors in ranging from the disappointment of not obtaining the surgery residency that I worked so hard for primarily due to politics and very much because of the reluctance of many clients to allow me to practice good medicine. As a quick example, I recently repaired a cherry eye (prolapsed third eyelid gland) in a Beagle. He's being brought in tomorrow for my boss to remove the gland because the owner is not happy, it was not the same as before and doesn't look as good. It was a huge prolapse and had some inflammation; she has not given it time to heal or allowed me to even re-examine it to see if there is anything else that needs to be done. I cannot bring myself to remove the gland since it was beaten into my head that doing so is akin to malpractice due to the association of development of dry eye after removal (I'm also really enamored with eyes, therefore it is a double whammy to try to talk me into doing something I feel is wrong.) but that is what my boss was taught and he is no convert or lover of eyes... What's the point in trying to do it right? Not that my driven self would be able to do differently but it is very frustrating!

At work, my boss has hired 2 teenagers, 18 and 19, to do the kennel in the afternoons and to work as a receptionist. I hate running a nursery. They don't listen to me and he hasn't helped by undermining any authority I have in front of them. I've lectured, explained, yelled, griped, and pleaded for the same things over and over. One of the worst is the importance of maintenance of a proper medical record. INK. DON'T SKIP LINES. NO INAPPROPRIATE COMMENTS. ETC... What do I get last Friday?? 2 lines skipped followed by presenting complaint "boobs too big, tee hee =)". Dead serious. Another recurrent issue is to completely fill out rabies certificates. I even took time to write down in 2 places the vaccine info but it still fails to appear in the appropriate place. But, at this point, they sign my boss's name all the time anyway so... I told him it was amazing how many vaccines he does when he's out of the office.

The other issue at work (besides the ongoing ones) is the controlled drug log. I've inherited the problem and it is making me more crazy than usual. The few people that have access refuse to cooperate and short of myself pulling up and recording all drugs used, I have no solution. Couldn't do that anyway since I'm not there every day. The boss hints about my working more since we are very busy with the advent of summer but, although I could certainly use the money only barely stretching paychecks to pay student loans and other needs, I just don't know if I can physically and emotionally handle it right now. Besides, he wants me to be there but doesn't want to pay for my time.

That's about all that is new for me. I've been trying to find a way to send a kitten to CantSpell to make her feel better and smile a little but haven't found a way yet. Maybe airmail...hmmmm.

Planning a fun post about Guess and Maybe but need to get a picture first to help illustrate. Hopefully in the next few days I can get it done. Also working a lot on my cartoons which are a major source of stress relief. Have considered posting them before but have not figured out how to post and maintain legibility. Need a better computer guru than I am, I guess.

For now, I must go because I have more than plenty to do that I'm putting off for a little bit...Me? Procrastinate?? NEVER!

On a roll

2011-06-08T18:43:00.003-05:00

So now I'm posting about losing a pet. My beautiful, smart, and annoyingly affectionate cat Riley (he was only 9) passed away this morning after a week long battle with something. At first I thought he had a chronic herpes flare up- he did that periodically. Then he went into hepatic lipidosis- yes, I should have started syringe feeding him earlier. But then how does one go from a white count of 46,000(!) to 6,000 in two days? And a RBC of 8.something to 3.something? With no bleeding?!?!?!?!? It shouldn't have ended that way. And I'm sorry it did. And I'm especially sorry I didn't say bye to him last night when I left the clinic he was at because I was so sure I'd be back this afternoon. He was happy to see me last night then I did mean vet things to him and then I left him... and now I won't get to say goodbye. I can only hope he knew how much I loved him.

A Quick In and Out Procedure...

2011-06-07T23:29:00.002-05:00

I have a word of advice to everyone in the veterinary profession and especially to veterinary students - Never, and this means NEVER, go into any surgical procedure (or for that matter any procedure at all) needing to go to the bathroom regardless of how quick it is supposed to be done.

Today, I broke my own rule that I've had since before vet school. It was an extremely busy and frustrating day; everyone seemed to have gotten up on the wrong side of the bed and no one wanted to pitch in and help the day go better. In the late morning, after having been delayed by worried owners with 1000 plus questions, a harried boss who was freaking out because there were 2 sick patients and 2 rooms waiting (I don't know why he was so freaked out, he's been doing this for over 30 years now), and routine surgeries that were not going so routinely, I was asked by my boss if I could go ahead and get the prostatic biopsy done next. Sure, no problem. It should just be a quick in and out procedure...

The story as was told to me was that the poodle had a large prostate, suspected neoplasia but not sure yet so a biopsy was to be obtained. Radiographs had been done, not too helpful, bloodwork was overall boring except an elevated white count. I examined the dog and he did, indeed, have a large, firm caudal abdominal mass. The whole thing started to prove not quick and easy when hitting the dog's vein became a multi-person challenge.

I opened the abdomen only to discover the bladder that ate Manhattan as the source of the mass. Slight, gentle pressure did not yield voiding but resulted in the bladder trying to tear. I requested assistance so that we could pass a urinary catheter; it would go no farther than the proximal end of the os penis. With a little manipulation, I could then palpate a tiny stone in the urethra. Try as we might, the stone would not move. I had already opened the bladder and could not pass a catheter that way either, running into obstruction past the prostate slightly.

The prostatic biopsy became a cystotomy, urethrotomy, castration, and scrotal urethrostomy. Needless to say, it was not a quick in and out procedure. Got 2 small stones out and the dog passed two more that were smaller during recovery that apparently I did not get flushed out. The prostate was normal, by the way, as was the rest of the explore. And, much as I love surgery, I was rather glad to be finished because the bathroom was sure calling my name...

Blog Roll

2011-06-07T10:07:00.002-05:00

I went through the blog roll and took out anybody that hasn't posted for more than 9 months. If I took somebody off that should be back in please comment below and I'll fix it!

Kittens For A Cure

2011-06-06T21:52:00.003-05:00

It all started due to one of those impulsive decisions for which I'm so well known...

April 5, a client came in with a pregnant cat that had been dumped at her house. My boss saw the appointment. The cat had been in labor for over 24 hours with no kittens produced. I was doing surgery that morning and the cat was brought to me at which time I was told that regardless, there were to be no live kittens at the end of the procedure.

I'm not fond of spaying pregnant animals. I know that there are a ton of strays out there (believe me, I know! where do you think the herd came from??) but it still doesn't make me happy. In this case, I figured the babies were likely dead and decided to go ahead with her next, altering the pre-planned schedule.

I made no special precautions as I would for a C-section but anesthetized her and opened her abdomen, doing a routine spay. I set aside the large, distended uterus and closed the abdomen. As I was closing the skin, I noticed the uterus twitching and a small body emerging from the uterine body...

Now, let's be honest, I would have opened the uterus anyway 'cause I'm just wired that way but I really didn't expect to see a kitten complete with placenta begin to wiggle out while I was still finishing the surgery. I tied the last knot, got mom off the table, and got out the two babies, both of whom were alive.

So we went from no live kittens to 2 struggling newborns which we promptly began to resuscitate. The little boy responded quickly, crying and wiggling, the girl seemed to quit on me. She came within inches of the garbage pail, quite frankly, because I thought she was through but then she took another breath. After a bit of work, both kittens were pink, breathing, crying, and wiggling. Now I had to tell the owner and my boss - oops...

With a little sweet talking on my part, the owner agreed to let the babies stay with mom until they were ready to wean then bring them back to the clinic for us to place in homes. Since they have been back, I have reached the conclusion that kittens could cure the world of its misery. I would prescribe a kitten to all depressed people and those with diseases that make them feel miserable because a kitten just can't help but make you smile.

Notice I did not say puppies. They involve way too much work. Kittens just make you happy.

Mystery Case

2011-06-06T21:33:00.002-05:00

OK, for all you veterinary types that read this. Yeah, this means all, what, maybe one loyal follower left?? I have a case to see if anyone else has good input on that may be helpful. The children of the herd are overall doing well but the poodle is being a puzzle and any comments or suggestions would be appreciated...

12-13 year old, NM, miniature poodle. I adopted him in 2005 as an adult supposed to be about 8 at the time. Historically, he had terrible skin and was treated with a lot of steroids, antibiotics, and sensitive skin food. When I adopted him, I changed him to Purina HA and his skin cleared with only occasional outbreaks during really bad "allergy weather" and he has had no steroids since 2005 other than the small amount in ear ointments on occasion (rare). He has grade II/IV bilateral medial luxating patellas with associated osteoarthritis, asynchronous growth of the radius and ulna bilaterally with associated elbow dysplasia and osteoarthritis (too late to fix when I got him) resulting in right fore being slightly shorter than left, and luxated his left coxofemoral joint in 2007 this was repaired via closed reduction but he has a good bit of osteoarthritis in that joint as well. Neurologically, he had a presumptive episode of herniated cervical disk material in 2010 with clinical signs of neck pain and root signature that resolved with conservative therapy consisting of meloxicam, buprenorphine, and exercise restriction.

At the time of adoption, he was severely overweight and we have managed to reduce him to a consistent 14-15 pounds although he is still slightly overweight (BCS 6.5/9). He acclimated to the reduced diet and, while still more than willing to pick up an extra bite here and there, was not miserably hungry. When I feed him, I pre-soak the food then add water to help make him feel more full.

Lately, over the past 5-6 months, he is polyuric and polyphagic. He is not drinking any additional water than what is added to his food (measured out it does not exceed his expected daily intake) typically and is not getting any different food (i.e. increased sodium, etc.). He will urinate a huge puddle (as in imagine twice his size spread on the floor) then often a smaller puddle 5-10 minutes later. And yes, as indicated, he is breaking his housetraining when this occurs. He often needs to go as frequently as hourly but this is not a daily occurrence; very intermittent. During these periods, his abdomen will appear distended but not just with a large bladder. Non-painful, no palpable masses, then just as suddenly it appears normal again. Additionally, he acts as if he is starving constantly even pacing and unable to settle down at night to go to bed. I have not managed to measure the actual urine output yet.

Physical exam findings are boringly normal, no coat changes, prostate small and non-painful. Thoracic and abdominal radiographs taken in March were normal (need to repeat). Bloodwork from 2 weeks ago unremarkable, mild elevation of ALP, triglycerides. Thyroid values normal. I even did an ACTH stim reaching desperately that was totally normal. Have not done a full abdominal ultrasound yet (checked bladder about a month ago, normal) but that is next on the agenda.

So, given that complicated history, etc. any ideas floating around out there?????

Flying High

2011-06-06T21:13:00.003-05:00

First I wanted to say thanks for the kind comments and condolences both through the blog and e-mail / text, etc. I have 3 or 4 posts in my head that I'm going to try to catch up if the sleeping dogs will lie...

This is primarily an update but you'll have to forgive the necessity of a little family history to help it make sense. My mother and dad adopted my brother (aka the prodigal) shortly after they were married when she was 17 or 18, having just graduated high school. My brother is the biological child of my aunt, mother's sister. My other brother and I came along somewhat as a surprise years later, in fact, my adopted brother is 20 years older than I am. He married when I was around 2 years old and had been married before for a very short period of time therefore I have a niece (who I have never met) that is older than me and 2 nephews and another niece who are only a couple of years younger than I am. Shortly after the second marriage, he moved to his wife's home state and he and his family have lived there ever since except for a very short stint during which they attempted to live here near the family - that didn't work for her at all.

OK, maybe that condensed version will help the update and prior story make more sense. At this point in time, brother dear is back in the wife's home state and she, in theory, got out of jail today. My aunt had talked to him a couple of days ago and said that he sounded good then mom and I spoke to him yesterday...not so good. It amazes me that my mom and aunt have reached their age and are still so naive about some things; particularly him! I know that part of it is simply that they don't want to see it but how can you possibly try to help if you fail to acknowledge the problem?? Brother dear was flying high when we spoke. Sure, he sounded like he felt good but it was the drug induced good before a crash. And, as usual, he wants money and is lying about what he plans to do with it but they just don't see.

It's hard to know what is true with him at any point, especially when he's on something. He swears he hasn't taken anything but, call me cynical or whatever you want to, I don't believe him. That comment allows an easy segue into another post topic I intended to mention anyway.

Glass half full or half empty? Optimist or pessimist? I find it mildly amusing that different people who know me, mostly fairly well but at different levels all have different perceptions. Can'tSpell says I'm a pessimist. I have other friends who say I'm an optimist. Maybe I truly do have a split personality as I've often joked...

Another One Bites The Dust

2011-05-24T06:32:00.003-05:00

Once again, apologies for the doom and gloom. I had a great upbeat post planned about kittens but circumstances have interfered and I can't do it right now.

Several things to update and share. I'll try to make it chronological rather than in order of importance simply for the necessity of logical thought.

Friday was yet another day from Hades. I walked in to find a 1 year old MinPin flat out on the table. He had been dropped off for vomiting and bloody diarrhea. Immediately set to work on him, somehow got lucky and got a blood sample but couldn't get an IV catheter in therefore left my tech working on that while I ran the blood. To list the highlights, leukopenia (low white blood cells 3000), significant hemoconcentration (HCT of 70% - Yikes!!!), Azotemia (both kidney values elevated plus high phosphorus level of about 14), total protein greater than 8, and severe hypoglycemia (21!!). Dog was obviously severely dehydrated and in septic shock. Called the owner to verify they wanted to proceed with such a poor prognosis while administering glucose on the mucous membranes while tech still working on IV catheter. Owner wanted to try so I wound up doing a cut down (cut through the skin to gain direct IV access) and finally threaded a tiny IV catheter into the dog then started bolusing fluids and giving dextrose. This dog actually had a good outcome (I know, I'm being glass half empty but you'll understand later) since he held up his head by around 11 a.m. then was sitting up by 1 p.m. Told owner not out of woods but at least trying to respond. Owner kept demanding to know what caused; I got a little frustrated and told her there was no way I could prove initial cause beyond doubt, point was dealing with septic shock right now. I was told they had "nursed him since Wednesday giving Pedialyte that he kept spitting up...."

Next case that made me bonkers Friday was the stray dog that came in to have her skin checked. A truly wonderful owner who was a little down on luck having lost her job. Classic case of flea allergy dermatitis. I euthanized the dog. Not because of the flea allergies but because the first thing I noticed was that the dog's eyes were red. My exam revealed hyphema (blood in the anterior chamber) in both eyes, iris color change in both eyes, retinal detachment in the right eye, huge peripheral lymph nodes (all of them 4cm or larger and firm), harsh lung sounds, and a fever. With that combination of findings I was left with cancer, fungal infection, or tick borne infection as the top 3 differentials. The dog was also heartworm positive, incidentally. Given the cost of further diagnostics and treatment as well as the guarded prognosis for all of the above and the potential roller coaster ride, the owner opted to euthanize. She had found the dog 3 weeks prior; at least the dog had 3 weeks of having been loved.

Then is the prodigal. Friday, my dearest brother decided it would be a great idea to take off home (about 425 miles away) by hitchhiking. He's still not well although doing some better with the presence of food, sleep, and lacking drugs. He finally let us know that he made it late Sunday afternoon. I'm glad he's safe but now I'm worrying about what trouble he'll be in before long plus he had all of us worrying while he was impossible to reach and hitchhiking. If he would only cooperate long enough to get everything out of his system he might actually rehab.

Lastly is my cat. In my experience, when dealing with a true "old cat vestibular" patient (meaning idiopathic vestibular), they tend to improve fairly quickly as in 3-7 days. Even ear disease as the underlying cause usually responds that quickly. I know that technically, the texts say 2 or more weeks but that also includes the nasty causes and has not been my personal (anecdotal) experience. Here's another acronym for y'all - FIP. Feline Infectious Peritonitis. A truly nasty viral disease for which we cannot vaccinate and cannot treat effectively. The diagnosis equals doom / death.

My Crazy Gracie most likely had FIP. She showed slow improvement over the course of 6 days and I actually thought she was turning a corner Saturday when she took a few steps on her own. Then Sunday, she seemed a little worse and couldn't seem to pass the hard fecal material in her colon. I took her to the clinic and gave her an enema and continued to monitor / treat her at home. Around midnight, she began to cry and when I got her out to examine, her mucous membranes were white, her abdomen was distended with fluid and painful, and there was no urine since several hours prior. Rushed to the clinic, bloodwork showed severe anemia, azotemia, and elevated liver values. Radiographs showed free fluid in the abdomen (surprise, surprise), small bladder, nothing else significant and an abdominal tap showed straw colored fluid. Granted, I can't totally prove it and have to say presumptive FIP but it fits too well and I couldn't justify putting her through more to prove it. She was hurting and probably trying to quit anyway so I euthanized her. I thought about trying to do a transfusion and treat her but...it just didn't seem fair to her.

I don't think most of my friends understand how deeply I feel these losses. They mostly seem to think that since I have so many in my herd it's not the same as when someone only has one or two pets. They are like my kids, though. Each one is special and loved, just like a person that has several children - you love them differently but it doesn't mean you do not love them equally. Now I'm wondering about #3. It seems that all things happen in 3's so do I count Stormy from last October, Ellie, and Gracie or do I need to hold my breath for the next strike. There are certainly enough geriatrics in my herd to wonder.

With that, I'll close. Figured I would update everyone this way since I'm not really in an appropriate state to talk to anyone. Maybe I'll manage my great kitten post sometime soon if life will cut me a break long enough to catch my breath and somewhat recover!

Soaps anyone?

2011-05-16T10:58:00.000-05:00

Somebody help me!! I'm stuck in a soap opera and I can't get out!!!!!!!!!

The Saga Continues

2011-05-15T09:18:00.002-05:00

So much for my good intentions of an upbeat post. It would seem those aspirations are doomed for now. Last night, my dear old Uncle A-hole who is married to my Aunt Sweetie Pie and are the folks with whom the prodigal is currently staying, decided it would be great to try to start a fight with the prodigal because he was not ready for bed when Uncle A-hole was... Actually tried to take a swing at him. Fortunately my mom was able to intervene and stop it before it started which is really good because otherwise I don't know where the prodigal would stay. We haven't the extra room nor does anyone else in the family even if they would be willing and a motel is kinda scary given his current state and that there would be no one to watch over him. And believe me, he needs not only watching but to be looked after*!!

Additionally, one of my cats, Crazy Gracie, suddenly is unable to walk. I think (and hope!) that it is only vestibular disease but am not sure yet. Yet one more thing on the plate to worry about...

And I forgot to comment last night that my friend's dog with the presumptive insulinoma that I removed 10 days ago was doing great until day 9 at which time she suddenly became hypoglycemic again with associated clinical signs (shaking, etc.). Right now, I'm very done!!

*This is a reference to an older movie that most folks will probably not recognize since it's rather obscure. The movie is The Villain starring Kirk Douglas, Ann-Margret, and a very young Arnold Schwarzenegger. If you have the opportunity and enjoy slapstick on occasion, watch the movie then my comment will be appreciated on so many more levels than just the obvious one.

Complaints

2011-05-14T22:06:00.002-05:00

Thanks to the Homeless Parrot for inspiration to post. I haven't had much time to read the other blogs that I usually try to keep up with at least somewhat lately but then discovered that my mobile phone will support the current content but won't let me read archives so I've been working on catching up. I found myself nodding and saying you preach it girl while reading some of the recent posts about why ER care costs more, why not to give advice over the phone, and why neither of those equates to a veterinarian who doesn't care. I was also very much in tune with the compassion fatigue post and the idea of becoming a small town librarian...right now, however, I'd prefer to become a hermit far, far away from my beloved family if I could only figure out a way to support myself and my herd without having to see anyone. EVER!!

Lately the sob stories about lack of money and how we don't care if we refuse to give away all of our services is really grating on my nerves. It doesn't help that I and my boss receive approximately 3 letters per week from an irate client who had a small dog that died last year. It's a crazy story and I still feel bad about it although even I can admit that it was not my fault that the dog died. The last time I saw the dog, it was having difficulty defecating because of a gi-normous sublumbar lymph node. I advised the owners that cancer was likely but they declined any and all diagnostics that were offered due to cost. I wound up starting the dog on antibiotics with the hope that it was infectious rather than neoplastic, advised laxatives to soften the stool, and sent some pain medication. On a side note, the dog had an anteriorly luxated lens in one eye with secondary glaucoma (lens was cataractous, cause of lux). Refused referral as well as enucleation so was forced to manage with anti-inflammatory. Working well and had given a bottle of atropine from our Good Sam supply (in date, returned because dog had passed away) with hope of dilating pupil, lens falling posteriorly where would be less painful, then constricting pupil to trap it.

The owners called after I had seen the dog stating she was no better to which I had to bite my tongue on answering, "Yeah, really! It's not like you let me do anything to help her and even if it is infection (ha, ha!) the antibiotics would hardly have had time to work!" They wanted to know if they should continue the medicine, I told them yes.

Apparently, they failed to tell me that she was "choking on the medicine..." She died the next day and they would not answer my calls but later accused me of not calling because I didn't care. Additionally, I am not a doctor, everyone knows I don't care for anything but money and didn't take care of their dog because they were not rich, I killed their dog and didn't care that the medicine was choking her, I gave them poison medicine, and hell is too good for me. This is repeated in each letter with slight variations on the theme. If it were not for the fact that the letters are being written by a little old lady in a wheelchair with cancer I would probably report them to the authorities but...sigh...I get it. I know how she must feel.

On a personal note, I'm finding that absence indeed makes the heart grow fonder especially when applied to family. I love my family, but they do make me crazy. I'm currently contemplating where and when I could run away at least for a while. The biggest problem is the herd.

The long lost prodigal son has returned home. He is telling the wildest story about dirty cops chasing him and filtering money through his bank account. I'm still viewed as the child therefore no one cares to hear my opinion which is that he has gotten hold of a drug causing hallucinations, etc. I'm even fairly certain of what he got but no one will support my efforts to get him to a doctor for a drug test. Yes, I love family. Especially the prejudice towards the male offspring that mine shows constantly. And people wonder why I have a personal prejudice towards marriage for myself. Just look at my role models then ask that question again!

Haven't talked to my friends much lately because I've been too down. Usually the more stressed and depressed I get, the more I withdraw. I'm just not good company; if I don't want to be around me, why would anyone else? Between work, family, patient loss or failure to progress, boss disagreements on how to practice medicine, and the loss of one of the herd, it's not been a good few months. Fortunately, the major storms jumped over us or that would have added yet one more thing to an already full plate. The tornadoes hit several small communities just a few miles from us but did no major damage at my home.

Speaking of the storms, it's really sad how some people have responded. So many stories of looters stealing what few possessions these folks have left or of trying to bilk them for services such as cleaning up the debris. I'm sure there are many stories of the good deeds too but it seems one doesn't hear those as often.

I didn't intend that this post become so gloomy but it seems to have a mind of its own. With that depressing note, I'll shut up for now and hopefully be able to write something more upbeat and maybe even funny next time.

I'd like two testicles with that...

2011-05-10T17:38:00.002-05:00

It's funny how things seem to come in themes. Lately it's been retained testicles and heart murmurs. I've done more dog neuters with retained testicles (one or both) in the past month than I've done regular neuters. In fact, I can count on one hand the number of dogs that were "normal"... Funniest part is that prior to this I've only done a handful total.

The other thing that keeps popping up is heart murmurs. A PDA, aortic stenosis, and now a probable pulmonic stenosis. Just a little weird and, surprisingly enough, most of my clients are actually accepting the recommendation for referral and treatment. Wow... Now, I'm beginning to think I'm in the twilight zone or something.

By the way, Can't Spell - OS, OD, OU would refer to the eyes, not ears which would be AS, AD, and AU... Just thought I should point that out. Knew you would appreciate it.

Today, I did a C-section on a goat. Been a while since I've done that. Never fails to amuse me how little the actual procedure resembles the pretty, very tidy pictures in all the textbooks. One of the biggest kids I've ever seen; he did not live but hopefully mom will be ok. There's just no way to make that a completely clean / sterile procedure that I can figure out.

The following post...

2011-05-04T08:32:00.002-05:00

...is shamelessly stolen from a coworker. Some details have been changed to protect the stupid...

*Phone rings*

Me: "Hello, how many I help you?"
Liqured up: "Hi, how are you?"
Me: "Um, ok, how are you?"
LU: "I have a question for you. Dont' laugh- if you laugh I'll sic my cat on you. He's really mean."
Me (trying not to laugh): "Ok."
LU: "Do you know anywhere I can get some cow blood?"
Me: "Excuse me?"
LU: "Cow's blood. I can't catch any fish and somebody told me if I mix my bait with cow's blood I'll catch fish."
Me: "Um, hold on, I'm going to transfer you..."

Gee, starting pretty early, arn't you? Before 8 am....

More comments

2011-05-01T19:56:00.002-05:00

I just had to add a few tidbits to May B. Insane's post...

1) yeah, I used to use "el" a lot as an abbreviation in school- it could mean electron, electrolytes, or electricity depending on the class...
2) I'm glad May B. can read her own handwriting because nobody else can...
3) Other fun abbreviations- OD, OS, OU- right ear, left ear, both ears respectively
4) I do like reader Outrider's comments- DIC can mean disseminated intravascular coagulation, dead in cage or death is coming...
5) another of Outrider's comments- CTD = circling the drain

We have a lot of morbid funny comments. Sometimes you have to be morbid to get through the day...

Abbreviation Addition and Comment

2011-04-27T14:46:00.002-05:00

I just had to add another abbreviation that we use a lot. Like WB, not typically applicable in human medicine unless you work with "mentally or physically challenged adults" as one of my tech friends who did just that in a former life would say.

HTH: Hard to Handle; this covers a whole gambit of possibilities and we do sometimes use it to refer to the owner more so than the pet...

The other comment I am forced to add is the way abbreviations can mean different things in different context. Not specifically referring to the "official abbreviations" like NPO, PRN, etc. but to abbreviations that we use almost as slang. For instance, in vet school in my notes BM might stand for basement membrane, bowel movement, or bone marrow...it all depended on what class the notes were taken for and what we were discussing. Good thing I can decipher my own Egyptian hieroglyphs since it is a necessity to figure out the abbreviations!

Random whimsy

2011-04-27T08:56:00.002-05:00

Hi all two faithful readers! I know it's been a while... I've been bored out of my mine, er, busy lately and haven't really had much blog fodder. However, I'm in a whimisical mood today, so thought I'd take some time to address one of the necessary evils of the shared medical profession. Namely,

abbreviations...

That's right, those annoying acronyms and other little things that make medical-ese sound like a while new language. In many ways it is, as myself and May B. Insane commented when we were in vet school together. In many ways acquiring a medical education renders you forever unable to hold a normal conversation with non-medical family and friends. Anyway, I digress a bit. On to today's topic...

abbreviations. (Insert drum roll here)

There are many medical abbreviations out there and many are particular to the human medical establishment and the veterinary medical establishment. Here are a few. I'll be adding to these as the week progresses.

ADR- very scientific and technical term that translates to ain't doin' right. This is a catch all, a panacea for stuff where we really don't know what's going on or have unspecific signs. Commonly a descriptor as well. "That dog is ADR and in the hospital for the night."

HBC- ham, bacon, cheese... er, no, that's what I want for lunch... Hit By Car is the direct translation of HBC. Not an often mentioned one in human medicine, very common in veterinary medicine. "We have an HBC en route."

CBC- complete blood count, same as for human medicine. A count and morphological review of the red and white blood cells.

PRN- as needed, literal translation is some Latin phrase I can't remember right now...

WB- will bite, what we might put on a cage card of an aggressive patient. Probably not something you see too often in human medicine, depending on what specialty you're in...

NPO- another latin phrase that means nothing by mouth.

More to come, feel free to request explanations of abbreviations as well.

Insanity

2011-04-14T16:09:00.002-05:00

The past several weeks have been quite insane in the Insane household as well as at the zoo workplace. The theme of the month (or more) has been cancer and Murphy's Law.

During the same week as my last post, I also diagnosed cancer in my friend and technician's dog. She has a kidney mass, lung metastasis, and hypertrophic osteopathy (bone changes secondary to primary tumors in the chest, abdomen, lung mets, or heartworm disease.) It seems as if every time I turn I find another tumor on every other patient or so...it has to stop!!!!!

Since I last posted, I have added to the herd. Someone tossed out a pair of pups, male and female, not far from where I live. Ironically, it's the same area where I found a previous pair about 11 years ago. These look like Catahoulas and the male is going to be a small horse if he grows to match his feet which are almost the size of my hands. Currently, I'm calling them Guess and Maybe but we'll have to see if that sticks since I typically find it hard to find the right name.

Last Friday, I was greeted with a scene directly from Hamlet. My old dog Tag was chewing on something and the pups were staring at him wagging their tails in anticipation. In a really awful way, it was funny but at the same time very disturbing when I discovered that they had dug up my dog Bogie's grave (almost a year ago) and Tag was chewing on his best friend's skull...

After that start, the day failed to improve. It started with an emergency C-section with a cat in status epilepticus presenting while I was in surgery (and the only doc there). The cat wound up being euthanized; my best guess is antifreeze toxicity based on what diagnostics I was allowed to perform. We ran like idiots all day long with one fun thing after another. I also had weekend duty although there were no critical patients in the hospital. The primary one I spent time on was the colonic resection and anastomosis we had done the previous Wednesday.

This dog had a history of rectal prolapse for which no one had apparently searched to find a reason. Turns out he had a colonic intussusception, likely secondary to a severe parasitic load given his age. He is doing great and could have gone home Monday except that his owner had obligations therefore couldn't pick him up.

Since I had to be at the clinic for the weekend anyway and I live just far enough away for it to be a pain to travel back and forth, I took the pups to spay and neuter, took Tag to groom (now that's a big job, he's a 97 pound border collie mix with lots of hair), and took my old decrepit cat to follow up on her facial swelling. In essence, I spent the entire weekend at the clinic and totally PO'd my little dogs who think they are supposed to go everywhere with me and that weekends belong to them. I further upset the apple cart by leaving the jack russel mix home on Sunday to which he responded by thinking I was abandoning him forever! (Like most of the herd, he has a background and it's not unreasonable for him to get panicked by being left...)

Monday, I had a day off so I decided since the morning was still cool, I would shave my other old dog, Sam, who has early laryngeal paralysis and has trouble breathing in his winter coat in the warm, humid weather. I was so proud of myself for being so careful with his breathing and arthritic/old injury difficulties for the shave to go so smoothly. Until the last leg. He yanked and I cut my thumb then we got into a fight then he rolled over onto his back and urinated all over me, the porch, himself, the clippers, my shoes, etc. It was just awesome. Then, to top it off, I went inside and found that my little old Bichon had urinated all over the couch because he was mad that I had left him inside. I cleaned the mess, got a shower, and collapsed to a well deserved chocolate hug.

Tuesday I worked and absolutely nothing went according to plan, smoothly, or easily. To the point that I threatened to either shoot myself or quit. I was asked if I would walk out to the dumpster and get in prior to shooting myself since no one wanted to clean up the mess. Do you feel the love?? To add insult to injury, I now have ringworm on my neck and arms. I'm not certain who the culprit is but I'm betting it was the English bulldog that I sent skin cultures in on; guess my DTM culture is positive.

That covers the highlights of the past few weeks/days. Just think cancer and crazy and you've about got it.

A Soapbox in Answer to a Question

2011-03-21T00:40:00.004-05:00

So I'm using the excuse of answering the question posed about my strange case to jump on a soapbox of mine:)

Yes, it was definitely cancer although I couldn't actually send out anything for histopath (no money from the client and I am currently a poor part-time vet who has a lot of debt so I can't afford to send out for my own curiosity.) Most probably, it started with the retained testicle then spread to the urinary system via the lymph nodes and possibly to other organs that appeared grossly normal but may have had microscopic changes.

Here is my soapbox: NEUTER YOUR PETS!! ESPECIALLY IF THEY HAVE RETAINED TESTICLES!!!!!! YOUR VETERINARIAN IS NOT JUST MAKING THIS SUGGESTION IN ORDER TO MAKE MONEY BUT ACTUALLY FOR THE WELFARE OF YOUR PET!!!!!!!!!

Retained testicles are dramatically more likely to develop cancer than normal testicles that are in the scrotum. We don't completely understand why but part of the theory revolves around temperature since testicles should be at a lower temperature than the core body temperature, hence being outside the abdomen in the scrotal sac. Neutering completely eliminates the possibility of testicular cancer in normal pets and especially in cryptorchid pets.

There are several types of tumors that affect testicles. In this dog's case, I didn't take time to mention the other clinical signs with the point of my story being that the big picture can be misleading. He also had bilateral hair loss, evidence of feminization (i.e. large nipples, small prepuce), and the retained testicle. The tumors that cause feminization release estrogen creating these effects and also affecting the bone marrow resulting in severe anemia and panleukopenia (both also exhibited by this patient.) The bone marrow effects are yet another potential avenue for spread. The other possibility is that he had two separate tumors - one of the testicle affecting the bone marrow and the other affecting the urinary system. This would not be abnormal, especially with my history as I have actually in the past had a dog with 3 separate tumors detected on necropsy.

The saddest part of this tale is that had he been neutered as I am sure was recommended, it would have been avoided. The other sad part is that most testicular tumors have good outcomes if treated early, prior to spread but, like all too many of my patients, he did not present until he was literally on death's doorstep.

Now that I've screamed from my soapbox, I'll address the other part of the question. You are correct, if an animal becomes obstructed, it leads to death. Typically this is because of the severe electrolyte imbalances caused by obstruction in combination with kidney failure. Potassium cannot be excreted and as it rises causes the heart rate to slow then arrest (most common cause of death). In this case, I presume that it had not happened yet because he was only partially obstructed. When I expressed his bladder, I could create a thin stream of urine but not a normal stream. The urinary catheter would not pass from outside but after opening the bladder, I could pass it from inside and pushed out blood clots. Eventually, it would likely have resulted in bladder rupture or complete obstruction if his other disease(s) failed to kill him first. And lastly, often they really surprise us at how much they can go through and still be alive. Anyone who thinks medicine is an exact science is insane!

Strange Case Tales

2011-03-19T18:08:00.002-05:00

Thought I'd take a moment to share one of my recent strange cases. Unfortunately, I don't have cool pictures to post but this was a doozy.

A client told me the other day that she didn't believe in all the fancy diagnostic tests that we often recommend because we should be able to see and feel a patient and thereby formulate a diagnosis. She further indicated that she thought things like bloodwork, x-rays, etc. were simply a means to generate more revenue. The case I'm about to relate is an excellent illustration of the inadequacy of that viewpoint...

I had a large breed dog present to me partially for a second opinion and partially because our clinic is less expensive than the first clinic that was visited. The previous veterinarian had run a CBC and chemistry panel and things had stopped there. It was a combination of money (as previously stated) and communication issues. Either the first vet did not explain well or the clients just chose not to hear the bitter truth.

On examining the dog, I saw pale pink, tacky mucous membranes and a distended, fluid-filled abdomen. Nothing else was extremely remarkable but when combined with the previously run bloodwork showing a hematocrit of 8.6% and panleukopenia, cancer was definitely screaming out as the most likely diagnosis. I added the exam and the anemia and figured that the dog was bleeding into its abdomen and probably had been for a while.

The owners and I had a long, very serious discussion about the limited options and poor prognosis facing their dog. They opted to give surgery a chance even though there was a good chance the dog would not survive. Further diagnostics were declined so that the little money available could be put into treatment.

I stabilized the dog as much as possible then began an exploratory fully expecting explosive bloody fluid from the abdomen as soon as I entered the cavity. This failed to materialize surprising me immensely. Instead, I found the urinary bladder distended all the way forward to the liver. I actually double checked the site of my initial incision thinking I had to be insane but, no, the bladder truly was that large and did not want to express. Additionally, a urinary catheter would not pass. Hmmmmm.....

The following summarizes my findings: Left kidney approximately 5 times normal size with irregular margins, blood clots within bladder lumen and presumptively within urethra creating obstruction (one was larger than my fist), retained right testicle within the abdominal cavity also having irregular margins, colon distended with fluid fecal material and bruised where in contact with the urinary bladder, multiple enlarged mesenteric lymph nodes.

The dog did not survive surgery....

Crazy Gracie

2011-03-14T21:05:00.002-05:00

I have a cat that I routinely refer to as "Crazy Gracie" although her real name is simply Grace. This cat just ain't right but, as most folks who know me often point out, if she were right she probably wouldn't live with me. I don't think that any of my four-legged, furry children are quite right. In fact, we typically refer to our place as the home for misfits, unemployables, and geriatrics.

Grace is insane because she never seems to learn from her mistakes. She jumps onto the couch right next to the little old arthritic dog who can't hear well and only has one eye (and that one has a small cataract) and seems stunned each time when he gets startled and snaps, growls, or otherwise acts unwelcoming to her sudden appearance. She also just sits there when he does it as if he won't accidentally hurt her.

Today, she walked into the living room where I sat on the couch and had a completely forlorn look on her face. She then let out an unearthly wail worthy of a Hank Williams song as if she were left alone and had no friend left on earth. I spoke to her and she looked relieved then jumped onto the arm of the couch where she proceeded to sit for about an hour and periodically rub her face on mine as if reassuring herself she was not alone.

Now I call that crazy.

On Southern drawls, crazy clients, and my nasty sense of humor

2011-03-14T00:26:00.002-05:00

As I've indicated in the past, I do have a nasty sense of humor at times. Just can't help myself when it happens; something sets me off and away I go completely unable to check myself. The title ties it all in together you see...

Last Friday, one of our crazies came in wanting to see me. Now this is a novelty as most folks come demanding to see "Doc," not me. Turns out she had seen Doc about 2 weeks prior with her dog that she had suddenly taken on a 2 mile hike after not exercising at all for 2 months then was concerned when he became lame. Hmmmm. Genius, figure that one out. Apparently the current unrest was due to the fact that Doc failed to x-ray the leg on that visit but indicated that if the dog failed to improve that would be the next step. Enter crazy client wanting to see the other doctor!

My exam showed the same things Doc had found but I went ahead and did x-rays since there was no ethical reason not to do so and it was what the client wanted. Surprise, surprise, there were no major findings on the films. I had a blast explaining all of this to the client who fits the stereotypical Yankee know-it-all type we ignorant Southerners dread. Since the client clearly knew everything, I started tossing out "doctor words" and using correct anatomical terminology just to make her squirm and have to ask what it meant. The crowning moment was when I said "stifle" and between my drawl and her confusion she thought I said "stafle."

That incident made me remember another time that my drawl caused confusion to a poor Yankee soul. I was instructing an owner in another state north of the Mason-Dixon line to cook boiled chicken and rice to feed their dog who had stomach issues. The owner asked me what that was. Admittedly, I was very confused wondering who on earth had failed to hear of boiled chicken and rice so I rather hesitantly replied, "You put chicken in water in a boiler and boil it on the stove and you do the same to the rice just adding no seasoning to either..." Perhaps all y'all that have heard my drawl or a similar one have already figured out the key but it took the owner explaining to me that they thought I had said "bald chicken."

Having a Southern drawl is certainly fun and I'm quite proud of it. I can also make it worse when I feel like it; particularly when my sense of humor gets out of control and I decide to really put on the ignorant Southern act in order to take someone out. At certain places that I have worked I really believe that people asked me questions simply to hear me speak. There were certainly times that I've been requested to say certain words like dog or walk. As I told one person I knew, though, at least we in the South know that "drawer" has an "-er" on the end unlike the person with whom I was conversing who said it "draw." Now it really gets funny when I take my Southern accent and imitate Brooklyn...

The problem is the heat, you understand. In the South it gets so hot and humid that we have to speak slowly and let our words kinda lean on one another for moral support or we'd never say anything at all!

Another incident of Friday was also very satisfying (I was really on the roll once I got started!) About 3 weeks ago, I pinned a femur fracture on a little dog then received a call from the owner who had seen another vet for the recheck on day 12 that it was not healing, the pin was placed wrong, and the leg needed to be plated immediately. Side note, there are definitely some of our colleagues that need to learn the art of client communication and how to respectfully disagree with your colleague rather than running them in the ground. The owner had a hard time getting the dog to us (long story) but e-mailed the films which did show no evidence of healing and the pin being apparently in the joint. I had the owner get the dog to us (no one there wanted to touch it since they had not started it) and leave it since travel was a problem, at no charge for the boarding. Rechecked the film and saw that the pin was fine - my colleague failed to get a perfect lateral view therefore the pin placement appeared questionable. Additionally, the leg is healing nicely. I think I shall e-mail those films to a certain veterinarian with a very nicely sarcastic comment on tangential x-ray beam artifact.....

Day late and a dollar short...

2011-02-26T19:22:00.002-06:00

Oops...I meant to log in yesterday to wish my dear darling friend Can'tSpell a wonderful happy big 3-0 but I got sidetracked and didn't. So, here it is, a day late but sincere nonetheless--(drum roll please)

HAPPY BIRTHDAY!!!!!!!! YOU'RE GETTING SO OLD YOU MIGHT CATCH UP WITH ME!

Bad Dawg (and Cat)!

2011-02-24T09:57:00.002-06:00

Spring in the South comes upon us early in the year and with it comes the inevitable allergy season. With temperatures soaring into the 60's and 70's over the past couple of weeks, everything is blooming and providing pollen along with all the other wonderful instigators of allergies. Like most children, 2 or 4 footed, mine take advantage of the times when mom is under the weather and therefore less than her usual vigilant self.

Yesterday, I was running a little late as is usual in my too booked life but thought that I would make it to work at maximum only 5 minutes late. That's what I thought...

I walked in to feed my herd of wild cats and was greeted by Pistol bailing off the counter into one of the water bowls. The bowl slid and hit the other water bowls sending water spraying everywhere and onto everyone within 6 feet. Predictably, he flew upward out of the water faster than he hit thereby further splashing water from the bowls and from his body. In the midst of this commotion, Katrina (aka the white witch), flew out the door and was loose. The poodle came to join the fun and started chasing Katrina who was so frightened she wouldn't move from the tiny little hole where she had hidden far out of reach. Anyone want to guess how late I was?????

The boys (the small 3 dogs in my herd) often go to work with me now since Rusty-dog is getting old and reverting to his severe separation anxiety from early in life at the time when I adopted him. For whatever reason, the boys screamed half of the afternoon while in their crate, complaining about being at work. If they had stayed home, it would likely have been worse.

When the craziness of the day was finally done, they were practically dragging me (and Rusty since he doesn't see or hear well and gets confused about where doors are) outside. My co-worker's car was parked closer so Buddy ran to it as the closest means of escape. I could hear the conversation in my mind:

Buddy: Let's go guys, here's a car, jump in!

Scout: Are you sure it's our car?

Buddy: Who cares?!? Let's blow this joint!

Scout: OK, man, who drives?

Buddy: It was my idea, I get to drive of course.

Scout: That's not fair...

Rusty: What are y'all talking about over there?

Buddy: No worries, Rusty, just jump in.

Rusty: But where's mom??

Buddy: Who cares, she'll make it home somehow!

Scout: That's not fair; I want to steer.

Buddy: Shut up you two and get in the car! I'll steer and y'all can operate the pedals.

Scout: Cool! I get the gas!!

Rusty: Pedals? I don't understand...you know I don't hear very well anymore...

Fortunately, they had leashes attached so I was able to prevent a carjacking. Would have made an interesting news story though.

The boys have also made further use of my fogginess to steal food, cat poop, etc., you know, anything they're not supposed to have that makes them sick and keeps me up all night further depriving mom of much needed sleep.

Now imagine fuzzy-headed, dizzy, allergy ridden mom who is more sleep deprived than usual going to work and attempting to answer some of the crazy client questions that arise on a daily basis. It's a scary thought, isn't it?

Thank you, Walt Disney et al

2011-01-29T10:35:00.002-06:00

Have you ever stopped to think about all of the different venues that somehow contribute to our profession? Over the past few years, I have made a concerted effort to avoid the phrase "the back room" or any variation thereof.

Why?? Well, think about all the lovely movies that refer to taking the animal star to the "back room" where untold horrors will occur. Homeward Bound, Lady & the Tramp, Beethoven, just to name a few.

Yes, I love these movies and am an avid Disney fan but they do contribute to some of the negative emotions clients feel about veterinary medicine. Many times before I thought about this I would refer to taking a beloved pet "to the back," meaning of course the very plain, safe treatment area to protect both the pet and the owner while a benign procedure was performed, only to be greeted with a horrified look and extreme reluctance to relinquish said pet into my hands. It took me a little bit to connect the dots but since that time I've always imagined what horrifying images must be going through the poor owner's mind...

And so I say "Thank you" to the movie industry as a whole for adding more work for us.

Oops!

2011-01-20T10:20:00.001-06:00

Had to share the funny. In a vet clinic when folks are restraining animals often unintentional inappropriate touch occurs. It's just a fact of the job. The tech, groomer, and assistant were behind me holding a very reluctant pooch trying to get the nails trimmed as the final touch of the groom when I hear the following exchange:

Groomer to Assistant: Okay, let go of the boob!

Tech to Assistant: Here, hold this one!

Note: The tech was referring to a dog leg which was what the assistant was trying to hold the entire time - we do not r0utinely practice boob holding.

Frustration

2011-01-20T09:28:00.002-06:00

I'll have to give a little background here so the following makes some sense. For those who don't know me or haven't figured it out, I tend to be pretty OCD and paranoid about certain things - particularly the care of my personal kids and my patients. I also spent most of my life thinking I would hate teaching in any way, shape or form but was surprised to learn through firsthand experience that I actually enjoy it. I'm one of those weird folks who is extremely laid back and easygoing in general but have a very intense, type A, streak about certain things that seems to hit people by surprise when it arises...

All that to introduce comments on a couple of items. I get very frustrated and angry with myself when I make mistakes. If the mistake resulted in the loss of a patient or even could have possibly contributed to the loss, the anger is magnified many times. Yes, I know we are all human and no one is perfect but that isn't enough to stop my anger at myself.

I had a couple of critical patients come in on top of each other on the first day back after the snow when we were only open part of the day due to road conditions. One of those patients was a middle aged cat that was easily diagnosed as a kidney failure, apparently relatively uncomplicated. I've treated many of these guys, most successfully as long as there were no complicating factors such as owners unwillingness to try or underlying heart disease. This cat began to eat a little on the first day after just a few hours of fluid therapy so I was very encouraged.

The second day, the cat continued to look better and was eating small amounts; not ravenously but some. Around 3:30, I had her out again, re-examined her, and hung a new bag of fluids. At that time I also gave a small volume of hetastarch in addition to her crystalloids since her protein levels were going down with the fluid correction of her dehydration and the lack of significant intake. I was then busy for a time and the owner came to visit around 4:30. He asked the tech why the cat's face was swollen and they called me to look. Indeed, her face was swollen as was her tongue. It made no sense to me initially and I checked her lungs, etc. to see if I could find other signs of fluid overload but did not. I made some lame comment about protein levels being low being a cause of edema and that we would slow the rate in case she was trying to overload then the owner left.

I wound up stopping the fluids entirely and continued to monitor the cat. She was sleeping comfortably but would not eat anymore, likely because of the swelling. Around 2 a.m. I suddenly awoke from a sound sleep to remember that hetastarch can sometimes result in anaphylactic reactions. (Probably the astute reader already thought of that.) When I arrived at the clinic, she had died, apparently peacefully in her sleep since she was curled in her cat bed.

Since then I have agonized and beat up myself almost constantly wondering if she did have an anaphylactic reaction that I could have treated had I recognized it and was that the cause of her death???? Alternately, did she get fluid overloaded and should I have done something more??? I hate losing patients, especially when I know that I've done something wrong!!!

The other subject upon which I wanted to comment is our volunteers. Currently we have two volunteers. One is a recent high school graduate who has just begun taking the basic undergrad courses in preparation for applying to vet school. The other already has a degree and has decided to go back to school to become a technician. Unfortunately, my state no longer has a full time veterinary technician program and the only available program is done by correspondence with the practical portion done in private practice clinics who are willing and qualify to help train them.

The first volunteer is very nice although very young, if you know what I mean. (That's funny coming from me because I've always felt old compared to the people around me regardless of their age... In this case, she is very young!) She seems very interested, asks lots of questions, and is fun to teach; except that she talks too much when she is trying to ask something. I know, I'm probably being too witchy but it makes me crazy and I then have a hard time deciphering what she is saying because I get lost and tune out. I've often thought that one reason no one listens to me is that I pack too much information into too few sentences but I hate talking very much and try to give all the pertinent information as succinctly as possible when discussing a case. She was asking a question about her pigs and I got totally lost before she finished because she just kept going, much like the energizer bunny.

The second volunteer laughs too much and doesn't seem very dedicated. For someone to actually become a good technician through a primarily correspondence program, a lot of dedication and self-control is a necessity. I don't think this one will turn out well. I have no problem having a good time at work, enjoy a good joke, and can laugh about most anything but in a professional setting, there is a time and place for it. When I am euthanizing a long time patient in one exam room, cutting up and giggling just outside the door is highly inappropriate. This one just doesn't seem to care enough unless she wants to show off for someone. I'm getting the feeling that her primary interest is doing the "cool stuff" and that she really doesn't understand the job. The other difficulty is that she has been a client for several years and she has seen my "professional face" but not my "private face." This is very different because I'm very introverted in private but appear extroverted in professional settings.

Otherwise, things keep rolling along. I think this one is worth sharing as well for the comedy. There was a small dog that had a bladder stone that was removed by my boss the day before he left on vacation. I reluctantly sent her home on Saturday; she wasn't eating and just didn't seem to be bouncing back well but the owner was very insistent and I had nothing else to stop me. She presented again on Tuesday (first day back after snow) almost flat out, bradycardic, and with diarrhea seeping from her rear. Thought she had free fluid in the abdomen but wasn't positive until abdominocentesis found urine.

Yep, the bladder had dehisced and her abdominal cavity was filled with urine. In essence, she felt as if she were in kidney failure given the blood values (BUN >180, Phos=20, Potassium=8.5, Creat ??) but it was all due to the urine. I stabilized her with IV fluids then took her to surgery as soon as possible. Closed the bladder again and flushed the abdomen. The bladder wall was at least 1cm thick and very fragile.

Here's the comedy - I called the owner and was telling her the surgery went well but there was still danger that it could dehisce again, etc. given the state of the bladder. Explained that we may need to get her to a specialist if it happened again, that she couldn't live without a bladder and if the bladder would not heal we would be running out of good options, and that this could result in death.

The owner was slow on the uptake and responded "Do you mean we could lose her?"

Me: "Unfortunately, yes, we could."

Owner: "When will Doc be back?"

I almost laughed aloud. No, he did nothing wrong to cause the bladder to dehisce, it was a very unhealthy bladder. He is more optimistic and less cynical than I so it's very unlikely that he explained the dangers associated with the surgery. I'm sure that the owner figured I must not know what I was doing when I told her how bad it could be... Gotta love folks!

On College Football

2011-01-20T09:21:00.002-06:00

I'm sure that anyone who has any interest in college football heard that Auburn won the championship in Arizona this time. For those of you who don't know much or anything about college football, particularly in the South dealing with the SEC and the Alabama vs Auburn rivalry, I am not going to try to explain and the following joke won't mean much to you. (I've tried explaining in the past and, unless you've seen it firsthand, I've found that you just can't grasp the extent of the insanity of football in the South.) For those of you who know, enjoy!

The Alabama folks have always said that hell would freeze over before Auburn won a championship title...

For once, it seems they are right.

Tuscaloosa was frozen.

Snow Day

2011-01-10T17:13:00.006-06:00

I neglected to mention a couple of items in the last post so this is somewhat a continuation and somewhat a tale of today.

Forgot to tell about the lady who brought in her very overweight MinPin with a ruptured cruciate and back pain. The lady is a human drug rep but does not believe in drugs. Fortunately, I am very sold on the research and efficacy of many homeopathic type remedies so that helped. It was a very long appointment that helped to run the afternoon behind. And there was the huge mast cell tumor on the old corgi's prepuce. That would have been a fun challenge to try to resect if only they would have let me... No one ever lets me do the things I would love to do although I can see their point given his age, etc. (Sigh!!)

So Saturday improved immensely. I spoke to the crazy guy with the sick puppy again that afternoon. I had told him to meet me at 1:30 but he didn't show so I called him. He said the pup was doing fine and he wasn't bringing it after all. I told him to call if he had problems and he assured me "we would be the first to know." Right. I heard nothing but dead silence until Sunday night just before 8 p.m. when he called to say the pup had been vomiting ever since we spoke the previous evening and he needed to bring it in now.

We had a winter storm advisory out with expected ice and snow, enough to shut down roads in the south and it had already started when he called. He also caught me right in the middle of my own home duties and I couldn't drop them immediately. I told him I had to wrap things up and would call as soon as I could hit the road but that, if he was coming, we had better meet ASAP due to the weather. In less than 5 minutes he called back to say he couldn't get out of his driveway. I advised him of things to do (including stop feeding the dog for a while for heaven's sake!) and told him we would likely be opening late Monday if at all. He called back several more times to ask the same questions over and over as if I could provide a new, magic cure that I didn't have available 10 minutes before.

I expected that the winter storm would be less than predicted and we would be at work as usual, maybe an hour late this morning. Imagine my surprise when I found out that all the roads were closed and the area where the office is was very icey. At my place, we mostly got snow and very little ice but just a few miles down the road, the ice was terrible. No one could go in but the few boarding animals had been provided for the day before so we didn't worry too much - it wasn't worth risking that icey road up to mountain!

Called the crazy man and was told the pup was doing better so will keep in touch with him until we get back into the office. I then made use of my gift of snow and a day off to play. I made snow dogs modeled after the 3 small dogs in my herd and 1 snow cat, lifesized I might add, modeled after my very large white cat. I stole the idea from a friend but was very pleased with the results. Tonight, we are supposed to get some freezing rain but hopefully the roads will be opened and we can get back to business as usual. I know my boss will be a happier man if he hears we are open tomorrow!