6 years ago
Friday, April 10, 2009
Squish, squish
I had a lot of fun today. I spayed an in-heat small dog. This usually fills me with trepidation (any dog spay does- it's a long storey) but this one went ok. But the fun part came later. I removed a big marble sized sebaceous cyst from a dog's back. I got to so some cool wound closing stuff, like walking sutures and vertical mattress sutures (I haven't done these since vet school and was happy I remembered how) and afterwards, I sliced open the cyst and shelled out a perfect little white ball of hair and sebum and oil from the cyst! It was extremely cool!!!!! I find weird stuff cool.
Wednesday, April 8, 2009
Circling the drain
The chart said the dog was vomiting. When I got in the room I found a very large German Shepard who was laying on the floor panting at me. Turns out he hadn't been quite right ever since they got back from their winter place in Arizona. Immediately all those odd things that occur only in the Southwest flash through my mind. Plague. Coccidiomycosis. (I think). Others I can't quite remember.
So I do my physical exam. Her mucus membranes were pale pink. She was hydrated, and her heart and lungs sounded ok. When I palpated her abdomen something didn't feel quite right and I start to sweat. A radiograph of her abdomen confirmed it. She had a large honkin' spleen tumor.
Tumors of the spleen are not a good thing. Sometimes they can be benign but are mostly very nasty. And when you have a German Shepard, one pops to the front of your list: hemangiosarcoma. This tumor has multiple bleeding episodes where the patient feels puny than gets better until they don't stop bleeding. Usually then you are presented with a very pale dog in a lot of pain. Surgery can take out a spleen tumor, but prognosis is still poor. Most of the time once you diagnosis it and take it out it's already seeded metastasis to the liver. Usually even with aggressive chemo the survival time is four months or less.
It's hard to see elderly people cry. When you're telling somebody that their friend is going to die a horrible and painful death unless they have the courage to euthanize her it's hard. I started crying (as usual) while talking to them in the room. I'm not tough enough for this job most of the time. In the end she slipped away peacefully while her people talked to her. Faithful to the end.
So I do my physical exam. Her mucus membranes were pale pink. She was hydrated, and her heart and lungs sounded ok. When I palpated her abdomen something didn't feel quite right and I start to sweat. A radiograph of her abdomen confirmed it. She had a large honkin' spleen tumor.
Tumors of the spleen are not a good thing. Sometimes they can be benign but are mostly very nasty. And when you have a German Shepard, one pops to the front of your list: hemangiosarcoma. This tumor has multiple bleeding episodes where the patient feels puny than gets better until they don't stop bleeding. Usually then you are presented with a very pale dog in a lot of pain. Surgery can take out a spleen tumor, but prognosis is still poor. Most of the time once you diagnosis it and take it out it's already seeded metastasis to the liver. Usually even with aggressive chemo the survival time is four months or less.
It's hard to see elderly people cry. When you're telling somebody that their friend is going to die a horrible and painful death unless they have the courage to euthanize her it's hard. I started crying (as usual) while talking to them in the room. I'm not tough enough for this job most of the time. In the end she slipped away peacefully while her people talked to her. Faithful to the end.
Monday, April 6, 2009
The Countess of Monte Cristo
I find myself trapped in the dungeon again with the only windows and sources of light high above, far from my reach. The walls close in around me. There are too many people nearby and all are wearing frowns. I search desperately for some means of escape; perhaps I can dig out with a plastic spoon...
Okay, so maybe I'm over-dramatizing a little but I couldn't help it. After being away for 3 weeks the stark contrast between where I am and where I would like to be is even more apparent. I need the open spaces and was allowed to remember for a little bit that they do still exist. I need room where I'm not constantly tripping over the little ones and can have my other babies with me (my mom is watching them for me since I couldn't have them all here until I'm finished with the internship). I need good Southern food (artery clogging be darned) and the lovely Southern drawl and the smiles and friendliness that, to me, characterize home.
Coming back was one of the hardest things I've ever done. It is too crowded here, the traffic is horrendous, and I just plain don't like it and I "ain't a-skeered to say so!" The people here were glad to have me back though; I was told that I have manners and they appreciate it:) Some of them I like even if they are Yankees...
I live in a basement apartment that is tiny and the rent is huge due to the area where I am. I do lovingly refer to the place as my own little dungeon but am not actually trying to dig my way out with a plastic spoon--yet!! Ninety-one days left from today unless they allow me to leave early since my next internship starts before this one is complete. I'm sure that'll go over really well (sarcasm intended); fortunately the next group is at a university and they are willing to work with me regarding my start date if needed. I started packing what's left of my stuff today--one should be ready at a moment's notice, you know.
There is no way that I can possibly express how much I am looking forward in anticipation to returning to a university setting and a place where there is space!!! It'll probably be a little too flat to satisfy someone that grew up in the foothills of the Appalachians but at least there's room to breathe.
I found myself in an odd mood today. Typically, I'm a very non-confrontational person but I was arguing with the "adults" in rounds. I was quite surprised at myself. It was almost as if I grew up in some odd way while gone. I felt very disconnected as if I were watching the proceedings from afar and the commentary in my head went something like this: "What an arrogant, pompous group of people. They don't even really know what they are talking about as much as they think they do. And now, watch, they will shoot what you say down because 1) You're an intern and 2) They don't really know the answer or understand therefore they'll say it's a bad idea rather than admit there is something they don't know." A good friend of mine told me recently that one problem with private practice specialty groups is that the specialists eventually reach a point in which they think they know everything and become frightened if challenged (this also happens in general private practice unfortunately) where in the university/academic setting, there is always someone down the hall that knows more than you. I think he had a really good point. When I came here, I was very reluctant to argue since I felt they must know so much more than I do but this time away made me realize that is not always true. It's been an invigorating but somewhat disconcerting experience. One of my most important goals in life is to always question and search for better ways to do things--it frightens me to think that I could cease to wonder.
The vacation time was very good for me even though I was working through most of it. I think I've done some growing. It gave me a chance to make decisions about the future while taking a step back from the reality of the moment. I was able to refresh to the point that I no longer have violent tendencies (such as wanting to choke a client). There was time to see my babies at home, visit my mother, and even catch up with a few of the most important people in my life. I think I've regained some of my sense of humor and some of my usual happy disposition. Admittedly, I'm still not up to par since the really difficult months of January/February when I lost three of the little ones but that will take a lot longer to get through than it's been. I've been missing a support system, though, and it was good to be able to fall into the laps of some of my friends and family and soak up the comfort and caring. This was a much needed and enjoyed break and I even learned some things;)
Okay, so maybe I'm over-dramatizing a little but I couldn't help it. After being away for 3 weeks the stark contrast between where I am and where I would like to be is even more apparent. I need the open spaces and was allowed to remember for a little bit that they do still exist. I need room where I'm not constantly tripping over the little ones and can have my other babies with me (my mom is watching them for me since I couldn't have them all here until I'm finished with the internship). I need good Southern food (artery clogging be darned) and the lovely Southern drawl and the smiles and friendliness that, to me, characterize home.
Coming back was one of the hardest things I've ever done. It is too crowded here, the traffic is horrendous, and I just plain don't like it and I "ain't a-skeered to say so!" The people here were glad to have me back though; I was told that I have manners and they appreciate it:) Some of them I like even if they are Yankees...
I live in a basement apartment that is tiny and the rent is huge due to the area where I am. I do lovingly refer to the place as my own little dungeon but am not actually trying to dig my way out with a plastic spoon--yet!! Ninety-one days left from today unless they allow me to leave early since my next internship starts before this one is complete. I'm sure that'll go over really well (sarcasm intended); fortunately the next group is at a university and they are willing to work with me regarding my start date if needed. I started packing what's left of my stuff today--one should be ready at a moment's notice, you know.
There is no way that I can possibly express how much I am looking forward in anticipation to returning to a university setting and a place where there is space!!! It'll probably be a little too flat to satisfy someone that grew up in the foothills of the Appalachians but at least there's room to breathe.
I found myself in an odd mood today. Typically, I'm a very non-confrontational person but I was arguing with the "adults" in rounds. I was quite surprised at myself. It was almost as if I grew up in some odd way while gone. I felt very disconnected as if I were watching the proceedings from afar and the commentary in my head went something like this: "What an arrogant, pompous group of people. They don't even really know what they are talking about as much as they think they do. And now, watch, they will shoot what you say down because 1) You're an intern and 2) They don't really know the answer or understand therefore they'll say it's a bad idea rather than admit there is something they don't know." A good friend of mine told me recently that one problem with private practice specialty groups is that the specialists eventually reach a point in which they think they know everything and become frightened if challenged (this also happens in general private practice unfortunately) where in the university/academic setting, there is always someone down the hall that knows more than you. I think he had a really good point. When I came here, I was very reluctant to argue since I felt they must know so much more than I do but this time away made me realize that is not always true. It's been an invigorating but somewhat disconcerting experience. One of my most important goals in life is to always question and search for better ways to do things--it frightens me to think that I could cease to wonder.
The vacation time was very good for me even though I was working through most of it. I think I've done some growing. It gave me a chance to make decisions about the future while taking a step back from the reality of the moment. I was able to refresh to the point that I no longer have violent tendencies (such as wanting to choke a client). There was time to see my babies at home, visit my mother, and even catch up with a few of the most important people in my life. I think I've regained some of my sense of humor and some of my usual happy disposition. Admittedly, I'm still not up to par since the really difficult months of January/February when I lost three of the little ones but that will take a lot longer to get through than it's been. I've been missing a support system, though, and it was good to be able to fall into the laps of some of my friends and family and soak up the comfort and caring. This was a much needed and enjoyed break and I even learned some things;)
Why can't people get this through their thick skulls?
Spay you dog. Three simple words. Spay your dog. There, was that hard?
I know that some people can't afford to have their dog spayed. However, nowadays there are several low-cost alternatives, including spay/neuter clinics, humane society vouchers, and adopting an already spayed dog from said humane society. If you can't afford a dog's basic necessities don't get the dog. It's that simple.
If you plan on breeding your dog, fine. Besides the fact that the world doesn't really need lots of extra puppies floating around, that is your choice and it's a personal one. But if you're NOT going to breed your dog, or if you're DONE breeding your dog, spay your dog.
I just saw the SECOND pyometra a client's had in six months. That's TWO is less than six months. They have probably 4-6 dogs at home, and all their males are neutered but none of the females are spayed. I euthanized the last one and euthanized this one because the owner couldn't afford the $500-700 emergency spay/pyometra bill. This dog was in congestive heart failure also, which didn't help her chances of surviving surgery. So, let's do the math here.
Emergency pyometra surgery- $500-700+
Routine spay at six months old- $100-200 depending on size of dog
Having your dog NOT get pyometra? Priceless
BTW, Dr. May B. Insane is safely back in the terrible place to finish out her three months of torture, er, internship. She'll post later.
I know that some people can't afford to have their dog spayed. However, nowadays there are several low-cost alternatives, including spay/neuter clinics, humane society vouchers, and adopting an already spayed dog from said humane society. If you can't afford a dog's basic necessities don't get the dog. It's that simple.
If you plan on breeding your dog, fine. Besides the fact that the world doesn't really need lots of extra puppies floating around, that is your choice and it's a personal one. But if you're NOT going to breed your dog, or if you're DONE breeding your dog, spay your dog.
I just saw the SECOND pyometra a client's had in six months. That's TWO is less than six months. They have probably 4-6 dogs at home, and all their males are neutered but none of the females are spayed. I euthanized the last one and euthanized this one because the owner couldn't afford the $500-700 emergency spay/pyometra bill. This dog was in congestive heart failure also, which didn't help her chances of surviving surgery. So, let's do the math here.
Emergency pyometra surgery- $500-700+
Routine spay at six months old- $100-200 depending on size of dog
Having your dog NOT get pyometra? Priceless
BTW, Dr. May B. Insane is safely back in the terrible place to finish out her three months of torture, er, internship. She'll post later.
Friday, April 3, 2009
The "Other" Gender
Being a female veterinarian can make life interesting to say the very least. Although the profession has become largely composed of females over the past several years, there is still the male domination attempts that you see in any walk of life. Thought it might be fun to share a few "man-stories" without beating up on the poor souls too much since they are so sensitive;)
My mother, like most mothers, is a bit disappointed that I have not yet found Mr. Right and provided some grandchildren (she loves kids). I keep explaining to her that she should just accept the four footed hairy ones she has since that is all that is likely to occur and I have those in abundance. It's not that I am uninterested in men, it's just that I don't have time in my life right now for a significant relationship; I mean, c'mon, I can't even keep up with my close friends at the moment--I certainly do not want to add more stress to life right now.
The funniest thing about my profession, is that you get very comfortable discussing uncomfortable subjects in mixed company. You become so comfortable after a while, that you find yourself discussing things probably not fit for the public in very public places and you fail to realize how uncomfortable your audience is while you ramble on unconcernedly. Take castration for instance. Men become very uncomfortable with this subject. I've explained the concept and pushed the idea many times to a very red-faced male and not realized until later why he looked so uncomfortable. Or prostatic neoplasia. Or just urinary catheterization which makes most men present squirm and press their legs together in sympathetic pain and suffering. The words testicle, penis, vulva, etc. are definite trigger points but we can't avoid these in common veterinary conversation.
One of my favorite experiences in mixed animal private practice involves this. My boss was male and older and had a horrid habit of taking our one ambulatory truck out when I was on call. One evening in the early spring while we had very muddy ground with a little snow left over and pretty chilly temperatures, I received a call from a desperate farmer wanting help with a dystocia. Being an idiot for all of my life, I agreed to go even though I had no truck and very limited supplies. I got to the farm and spent hours laying in the mud and muck behind a cow that was downhill from me trying to deliver a calf that was likely dead and in one of the worst malpositions possible. Finally, with the help of the farmer and his calf jack, we got it out. I knelt behind the cow and thought, "I need to palpate again but I can't remember why." (It's terrible when you reach that point of exhaustion!!) I totally screwed up and did not palpate then realized why I should have after getting almost halfway home. I called the farmer and advised him to palpate for a twin to be sure and he was fine with this, refused my offer to return, and stated he would be in to pay the next morning (regular client with long standing relationship). I had, by the way warned him that loss of the cow was likely since the dead calf had been in it for quite some time and she was not in good shape and he did not want further treatment. The next day he called and spoke to my boss saying that he wasn't going to pay. When asked why, he stated that he had done all the work and a woman shouldn't have come out anyway since it wasn't woman's work.
The other great story from that job was when I went out to an older Amish farmer's farm to replace a vaginal prolapse on a cow. The look on his face when I requested sugar was absolutely priceless. Sugar, by the way, is used to shrink the prolapsed vagina by pulling edematous fluid from the tissue and make it easier to replace. The man and his family were very nice and polite but I think they were quite puzzled by the female veterinarian. I was probably the first to ever go to their farm.
I have many male friends and often enjoy their company better than my female friends but do find that they get much more uncomfortable about many subjects that arise in vetmed. Perhaps this is why I haven't found Mr. Right. Could also be related to the fact that I sometimes remind them that I know how to castrate many, many things and there is a wicked gleam in my eye as I say it. I dunno, maybe that's intimidating somehow...
My mother, like most mothers, is a bit disappointed that I have not yet found Mr. Right and provided some grandchildren (she loves kids). I keep explaining to her that she should just accept the four footed hairy ones she has since that is all that is likely to occur and I have those in abundance. It's not that I am uninterested in men, it's just that I don't have time in my life right now for a significant relationship; I mean, c'mon, I can't even keep up with my close friends at the moment--I certainly do not want to add more stress to life right now.
The funniest thing about my profession, is that you get very comfortable discussing uncomfortable subjects in mixed company. You become so comfortable after a while, that you find yourself discussing things probably not fit for the public in very public places and you fail to realize how uncomfortable your audience is while you ramble on unconcernedly. Take castration for instance. Men become very uncomfortable with this subject. I've explained the concept and pushed the idea many times to a very red-faced male and not realized until later why he looked so uncomfortable. Or prostatic neoplasia. Or just urinary catheterization which makes most men present squirm and press their legs together in sympathetic pain and suffering. The words testicle, penis, vulva, etc. are definite trigger points but we can't avoid these in common veterinary conversation.
One of my favorite experiences in mixed animal private practice involves this. My boss was male and older and had a horrid habit of taking our one ambulatory truck out when I was on call. One evening in the early spring while we had very muddy ground with a little snow left over and pretty chilly temperatures, I received a call from a desperate farmer wanting help with a dystocia. Being an idiot for all of my life, I agreed to go even though I had no truck and very limited supplies. I got to the farm and spent hours laying in the mud and muck behind a cow that was downhill from me trying to deliver a calf that was likely dead and in one of the worst malpositions possible. Finally, with the help of the farmer and his calf jack, we got it out. I knelt behind the cow and thought, "I need to palpate again but I can't remember why." (It's terrible when you reach that point of exhaustion!!) I totally screwed up and did not palpate then realized why I should have after getting almost halfway home. I called the farmer and advised him to palpate for a twin to be sure and he was fine with this, refused my offer to return, and stated he would be in to pay the next morning (regular client with long standing relationship). I had, by the way warned him that loss of the cow was likely since the dead calf had been in it for quite some time and she was not in good shape and he did not want further treatment. The next day he called and spoke to my boss saying that he wasn't going to pay. When asked why, he stated that he had done all the work and a woman shouldn't have come out anyway since it wasn't woman's work.
The other great story from that job was when I went out to an older Amish farmer's farm to replace a vaginal prolapse on a cow. The look on his face when I requested sugar was absolutely priceless. Sugar, by the way, is used to shrink the prolapsed vagina by pulling edematous fluid from the tissue and make it easier to replace. The man and his family were very nice and polite but I think they were quite puzzled by the female veterinarian. I was probably the first to ever go to their farm.
I have many male friends and often enjoy their company better than my female friends but do find that they get much more uncomfortable about many subjects that arise in vetmed. Perhaps this is why I haven't found Mr. Right. Could also be related to the fact that I sometimes remind them that I know how to castrate many, many things and there is a wicked gleam in my eye as I say it. I dunno, maybe that's intimidating somehow...
Thursday, April 2, 2009
I Need A Keeper...
The longer I live, the more convinced I become that I need a keeper to watch out for my insanity and make all of my decisions for me. That would make life a lot simpler...
As indicated by Can'tSpell, I am spending a week with her while going daily to a nearby veterinary school for a refresher in ophthalmology (I LOVE eyes!!!) In driving yesterday, I drove completely past my turn and kept going until I reached the next redlight and woke from my apparent delirious state to realize I had no idea where I was. Oops. This morning, in following a new route that Can'tSpell was kind enough to reveal to me I ran a stop sign then ran off the road because I realized, almost too late, that I was supposed to follow the curve not the straight part of the road (Can'tSpell had only reiterated that point a mere dozen or so times). I'm dangerous when allowed out alone.
The other thing I've noticed is that it becomes more and more difficult to say simple words, spell common/ordinary words (you know, things like "Macracanthorhyncus hirudinaceus" are no problem, it's things like "horse" that get you), or just put together a simple sentence these days. "Talking take two (or three, etc.)" has become a routine break in my conversations of late. And decisions, oh my, these have become quite challenging. I was once a reasonably decisive person who considered options then made a concise decision; very thorough in researching facts but having no need for second-guessing afterwards. No more. I now question and pick apart every little detail then convince myself I've done the wrong thing a million times over. If I learned anything in vet school, it was how to question myself even more than I did previously.
No, I should definitely not be allowed out and about without supervision from some adult-type individual. I'm a danger to myself and to society as a whole...Anybody out there want to apply for the job of full-time zookeeper with little or no pay in compensation? I am, after all, only a poor intern:)
On a different note, I just don't understand the worry and fuss about a little bit of glue. I can't help it that I snuck in my favorite clinician's office while visiting the vet school and taped down various and sundry office utensils like, oh, the computer mouse and keyboard, the tin of tea, the refrigerator door, etc...What's to worry about a little glue?
As indicated by Can'tSpell, I am spending a week with her while going daily to a nearby veterinary school for a refresher in ophthalmology (I LOVE eyes!!!) In driving yesterday, I drove completely past my turn and kept going until I reached the next redlight and woke from my apparent delirious state to realize I had no idea where I was. Oops. This morning, in following a new route that Can'tSpell was kind enough to reveal to me I ran a stop sign then ran off the road because I realized, almost too late, that I was supposed to follow the curve not the straight part of the road (Can'tSpell had only reiterated that point a mere dozen or so times). I'm dangerous when allowed out alone.
The other thing I've noticed is that it becomes more and more difficult to say simple words, spell common/ordinary words (you know, things like "Macracanthorhyncus hirudinaceus" are no problem, it's things like "horse" that get you), or just put together a simple sentence these days. "Talking take two (or three, etc.)" has become a routine break in my conversations of late. And decisions, oh my, these have become quite challenging. I was once a reasonably decisive person who considered options then made a concise decision; very thorough in researching facts but having no need for second-guessing afterwards. No more. I now question and pick apart every little detail then convince myself I've done the wrong thing a million times over. If I learned anything in vet school, it was how to question myself even more than I did previously.
No, I should definitely not be allowed out and about without supervision from some adult-type individual. I'm a danger to myself and to society as a whole...Anybody out there want to apply for the job of full-time zookeeper with little or no pay in compensation? I am, after all, only a poor intern:)
On a different note, I just don't understand the worry and fuss about a little bit of glue. I can't help it that I snuck in my favorite clinician's office while visiting the vet school and taped down various and sundry office utensils like, oh, the computer mouse and keyboard, the tin of tea, the refrigerator door, etc...What's to worry about a little glue?
Wednesday, April 1, 2009
A tale of lots of dirt
I was talking to the receptionist at my dentist's office the other day. She happens to be married to my uncle (don't you love small towns?). We were talking about my job and I told her something that is really true: I spend much of my life covered in icky stuff.
What prompted my statement was an observation by her that I had black stuff on my hands. It was ink from tattooing some rabbits. And I realized that for work or play, I often end up getting quite dirty.
The other day I drew blood from six alpacas here at the clinic. We have an alley in the back that they pulled up to with the trailer and we did them in the back yard. It was a lot of fun for me. My assistants wanted to see but were all too chicken to actually do any of the holding work. I ended up kneeling in the grass/dirt/mud a lot- when I was done it looked like I'd been crawling around in a garden. As I sit here I've only seen three patients today so far and already am covered with black dog hair and have blood on my lab coat sleeve. Yesterday I somehow got blood on my pants. Blood, urine, feces, anal glans, more feces, afterbirth... long is the list of the stuff I get covered in. Oh well, the life of a veterinarian...
I had a dog with a fish hook in it's mouth the other day. This is pretty common, then people bring the dog in for us to remove the hook. I sedated the dog, and used the wire cutters to extricate the hook. It's so nice to have instant gratification of a cure like that. The dog left with some antibiotics and pain medication and was happy as can be. So were the owners.
Dr. May B. Insane is staying with me this week while she's on her opthamology portion of her vacation. It's nice to see her and reminisce about vet school. She looks a bit more relaxed too, which is good. I'm just waiting for her to do some horrible practical joke on me. I'm sure there's going to be one. She asked me where my glue was yesterday.........
When I ran the spell checker there were only five words misspelled on this post! Wow, I must be improving!!!
What prompted my statement was an observation by her that I had black stuff on my hands. It was ink from tattooing some rabbits. And I realized that for work or play, I often end up getting quite dirty.
The other day I drew blood from six alpacas here at the clinic. We have an alley in the back that they pulled up to with the trailer and we did them in the back yard. It was a lot of fun for me. My assistants wanted to see but were all too chicken to actually do any of the holding work. I ended up kneeling in the grass/dirt/mud a lot- when I was done it looked like I'd been crawling around in a garden. As I sit here I've only seen three patients today so far and already am covered with black dog hair and have blood on my lab coat sleeve. Yesterday I somehow got blood on my pants. Blood, urine, feces, anal glans, more feces, afterbirth... long is the list of the stuff I get covered in. Oh well, the life of a veterinarian...
I had a dog with a fish hook in it's mouth the other day. This is pretty common, then people bring the dog in for us to remove the hook. I sedated the dog, and used the wire cutters to extricate the hook. It's so nice to have instant gratification of a cure like that. The dog left with some antibiotics and pain medication and was happy as can be. So were the owners.
Dr. May B. Insane is staying with me this week while she's on her opthamology portion of her vacation. It's nice to see her and reminisce about vet school. She looks a bit more relaxed too, which is good. I'm just waiting for her to do some horrible practical joke on me. I'm sure there's going to be one. She asked me where my glue was yesterday.........
When I ran the spell checker there were only five words misspelled on this post! Wow, I must be improving!!!
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