Sunday, December 4, 2016

Glimpse

This is going to sound like a whiny post, but it really is a plea.

I really try to do my job well. Mostly because, it is not really a job to me. Veterinary medicine is a vocation. Most of us vets heard a call at some point in our lives. I was 10 years old, I read a book and I just knew. You work at a job, but you live a vocation.

I take "work' home with me. Constantly. I don't know a vet who doesn't. I agonize over my cases. As I drive my long commute home, some of the thoughts that wander through my mind are these. "Did I make all of the best, most up to date recommendations for that GI cat? Did I miss anything? Oh, I forgot to tell that dog's owner to watch out for this other symptom! I hope he'll be okay until I can call her tomorrow. Did I come across ok in that tense emergency? How can I communicate more effectively about the importance of treating ear infections? I need to remember to check and see if that diabetic patient scheduled an appointment."

Then, when I get home and have put my kid to bed and made and ate dinner, I'll go and do just a little more digging on that one tough case and see if I can find any other nuggets of information that could get us closer to a diagnosis. That night, as I get ready for bed I'll be thinking of my surgery from earlier that day and wondering how restful she's feeling, and if I sent enough pain meds home. I might dream about some of my patients or clients as I sleep. On my day off I will check bloodwork online and call or email the owners if it can't wait until the next day.

The next day I'll draft up a client information handout to better explain a complicated disease. I will turn every page of every veterinary journal and magazine I receive because I don't want to miss a single small bit of info that may help my patients. I'll spend an hour on the phone calling pharmacies, specialists, and labs to get the best medicine for the best price for my clients.

And I'll see countless appointments, and then begin a whole new cycle of wondering and thinking.

So it really bugs me when people think vets "do it for the money." Yeah right. I do all of the above work unpaid while filling every other obligation I have as a wife, mother, friend, daughter, sister, neighbor, board member, horse owner, and working (and getting paid for) full time. I do all of the above to make myself a better veterinarian, to learn as much as I can to better assist my clients and take even better care of my patients. I do it because I want to.

So please, just appreciate your vet. That's all I ask.



Saturday, September 24, 2016

QOTD 2

Client: He is totally fine with his belly being touched. He just needs to be distracted by food or someone petting his head or a stuffed clown.

.....

Technician asks of a rather overweight male cat: Is he neutered?
Client: Yeah, but I think they grew back a little bit.

.....

Technician: Is she on any medications?
Client: Just the medication of love!

.....

Client: We finally figured out what breed she is.
Me: Oh?
Client: Yeah, she's a (insert rare dog breed here).
Me: Oh, but you got her at the shelter, huh?
Client: Yeah. They didn't know either.

.....

A good samaritan brought in a stray but clearly well loved dog she had found. We scanned the dog and it had a chip, and we called the owners and they were overjoyed we had him. They came from the next city over to pick him up. My technician brought him out to the lobby for the tearful reunion. Then, the man took the leash off, gave it back to my nurse, and started walking out the door with the dog off leash. I said, "Hey, that is a busy road, you probably ought to leash him."

Mr. Doesn't have a clear grasp on the situation at hand: "Oh no, don't worry he's super trained."


Thursday, September 8, 2016

Overcharging Folks on a Fixed Income

I just saw an older woman who brought in her little dog for some issues. Some diarrhea, and some allergies. I mentioned it needed a dental cleaning, but that we would focus on resolving the current issues first and do the dental at a later date.

She then said to me, "Well, I am on a pension and it's fixed but I understand it needs to be done and I will do it, I just don't know when. But everybody knows vets overcharge people, well, people like me who don't have limitless funds."

Excuse me? Yes, my absolute sole purpose in life is to overcharge veterans and retired folks. On purpose. Then, I skip gleefully down to the bank in the moonlight with my overflowing riches.

I told her that she could likely find a cheaper dental elsewhere, but it would not be the same dental. Then she told me she didn't think the cheaper price I quoted her off-hand was a bargain either, and I said "Well, you're entitled to think whatever you like, but we charge appropriately for our services and you can take them or leave them."

Just as with any other field, various providers will charge differently for similar items. Usually they are on a spectrum of similarity, with most being about the same price and a few outliers in either direction.

The difference is, people seem to think that veterinary care should cost pennies or be free. Or my favorite, that we "sell things to people that they don't need."

No, that's what retailers do. Those constant ads for leasing a new car, or for buying that new iPhone, or for those shoes that are on sale this weekend only, those ads are selling you things that you don't need. You may WANT them, and if you want them you will spend money on them, even if it is money you don't necessarily have, but you don't NEED them.

But when your vet tells you that your pet NEEDS flea prevention, because there are fleas crawling all over your pet and that means they are in your house and potentially carrying bacteria such as Yersinia or Bartonella or tapeworms or Mycoplasma, it is because your pet actually needs to be free of these pests for their own comfort and safety and yours. Not because we are trying to make a buck. Most vets will honestly tell you you can now get flea control over the counter (it won't work as well as prescription and there are some that are safe and sadly many that are not), but just get something. Anything is better than nothing.

(Most) Veterinarians are not rich. This has been discussed elsewhere many times. No vet ever went into debt over 200k and alienated their family and friends because they are never around "for the money." We do it for one reason, because we are driven. We wake up early to go in and see the pet we stayed up late worrying about over night; we discount things that we can get away with so the pet can have what it needs even if the owner can't afford it; we squeeze in one more urgent appointment at the end of the night because the owner sounds desperate, even though we were already supposed to be off; we see the technician's pets and make phone calls to pet owners through our entire lunch; and we do these things because we care about the animals. Their health and well-being is our bottom line. And that's all.

Saturday, May 14, 2016

The Worst part is Not Knowing

Let me tell you about Danny Boy. Danny Boy was a small, 5 pound maltese, who had a whole host of health problems of which, I confess, the details I do not remember. Danny Boy was owned by a nice woman and he came into the clinic I worked for prior to veterinary school. Given the foggy memories I have prior to the extraordinary events which led me to cement him in my memory, I suspect he had heart disease.

This clinic was a very large, busy, bustling hospital where I learned many things about veterinary medicine and what it was like to work in the field. It was so large a PA system was necessary in order to communicate. I was able to help with a large variety of cases and species, everything from helping revive puppies born via C-section, to tube feeding sick parrots, to administering chemotherapy, to finding ways to radiograph fish and turtles and snakes. I helped with my fair share of emergencies, and over time became more comfortable with my place in the scramble, knowing which tube or drug to grab and handing things to the techs and doctors. But in the beginning, before I really knew what to do in an emergency, I stayed out of the way and watched, learning, waiting to be given direction.

My brain has forgotten the details leading up to the day Danny Boy crashed in the treatment room, because there really was nothing spectacular about him until then. He was a sick dog, with a sweet owner who really loved him and wanted him to be around for awhile. Everyone on staff knew Danny Boy due to his frequent hospitalizations. He was a sweet, tiny, nervous, scrawny little dog who frequently shivered. One day on one of his many visits, he was in the treatment room, and he stopped breathing and slumped over. A flurry of activity ensued. Humans surrounded the table he was on. Attempts were made to resuscitate him, CPR was performed, he was intubated, IV catheter placed, epinephrine and atropine administered. He did not respond.

After ten or fifteen minutes, a time of death was called. His doctor began making the [literal] long walk to the front office, to notify the owner of his death. The technicians and assistants stayed behind to clean up the body and the room, in preparation for the owner to see him. Debris littered the floor, and I was bent down picking up syringes and trash, when an amazing thing happened. Danny Boy SAT UP. He opened his eyes. He was breathing, and alive.

Everyone stared at him for a second. Could we all be having the same delusion? No, Danny Boy, who had been clinically dead with no heartbeat for approximately 20 minutes, was looking around at us, wondering what had happened. It was as if a light was shining down on him from above (there was, it was a treatment room spot-light). After a few seconds, the flurry of activity started again. Someone turned on the flow-by oxygen. Someone grabbed a heat source. Someone paged his doctor over the PA system to return to treatment immediately. He did, angry that he was being interrupted in the somber task of telling the owner Danny was dead, until he saw Danny Boy, alive, albeit not well, on the table.

Danny Boy became known as the Miracle Dog after that. His owner was told of the events that had occurred. She said that Danny Boy knew she wasn't ready for him to go. She was extremely grateful to have him around, and he lived about another 6 months after that. I will forever remember the little Miracle maltese who I saw with my own eyes return from the dead.

Civilians have a romanticized view of CPR thanks to TV and movies, assuming that it works the majority of the time. In fact, cardio-pulmonary-cerebral resuscitation is only successful about 10% of the time in people, and even less in animals. And if they do manage to return, there is still a severe disease present that brought them to the brink of death. Most crash a second time and die or are euthanized. More often, they can't be revived. And the ones that hurt the most are the ones who go with no warning, no prior known illness. No answers for the owner. The worst part, on this end of it, is not knowing, not having any explanation to give to the people who just lost their loved one. I've had a few of these lately. I'm still thinking and wondering about them and feeling their losses.

Friday, April 29, 2016

The No List of Dog Breeds

Many clients are surprised that I do not own a dog. With three cats, one toddler, one horse, and a full time job the truth is I just don't have time for a dog. But there is also another truth, and that is I can't look at a purebred dog without mentally making a list of all of the common problems for that breed.

Once, many years ago now, my husband and I were in the bookstore, and he was pulling books off the shelf on various breeds. He would say, "How about a dachshund?" And I would retort, "Absolutely not! Too many back problems!" And he eventually got mad and stormed off because I kept listing all the diseases or problems for each breed and I don't know? It ruined his mood or something. I'm not sure why he got so irritated since its not like we were in any position to get a dog at the time anyway. But I digress.

Source: Wiki


So I thought I'd list all of the breeds (well, all that come to mind, in no particular order) and the reasons why I personally would not want to own one. At the end I'll list the 5 or so breeds I would own. Just for funzies! No getting pissed because I ragged on your breed! Here we go:

1. Bulldogs. My number one breed not to own. They stink, have mega skin issues, eye issues, tail issues, leg issues, and allergies, can't breathe, can't walk, and are generally slobbery and gross. I even wrote a post about them. Blech.
2. Wheatens. See above re: allergies. Also generally ill mannered.
3. Vizslas. Crazy in general, wildly energetic
4. Australian shepherds and border collies. Too schizo, too smart for their own good. Commonly get mental problems from lack of proper stimulation and exercise.
5. Labradoodle. not a breed, a mutt. No 'designer' mutts for me, mostly on principle.
6. Weimaraner. see Vizsla, mast cell tumors
7. Labradors. Allergies, chronic ear infections, eat everything in sight. I like my shoes.
8. Shih-tzus. Eye diseases, skin diseases, dental disease.
9. Chihuahuas. Big jerks in little bodies, dental disease, MPLs, heart disease.
10. Jack russells. Even bigger jerks, they all try to bite me, and too much wild energy.
11. St. Bernards. Too big, and too drooly.
12. Boxers. Cancer, cancer, cancer. MCT, heart diseases.
13. Pit bulls. They ALL make me itch, along with boxers, shar-peis and every other short-wiry-haired dog. But they are great family dogs, I would like to have them on my yes list, I really would!
14. Chinese Shar-pei. Pretty much always a jerk, I know one nice one. Also amyloidosis of the kidneys, skin diseases, weird fever disease
15. Schnauzers. Pancreatitis, metabolic diseases
16. Westies. Stinky skin, skin, skin.
17. French bulldogs. Waaayy overbred nowadays, back problems, breathing problems, too pushy.
18. Great Danes. Giant, clumsy, spinal instability, big dog = big money. I already own a horse.
19. Greyhounds. Osteosarcoma. Otherwise great couch potatoes!
20. Chesapeake Bay Retriever. Just jerks.
21. German Shepherds. Hips, immune diseases, Gi diseases. generally too high strung.
22. Cocker spaniels. Chronic ear infections, immune diseases, heart diseases, metabolic diseases.
23. Huskies. So mentally unstable, not very sociable, GI diseases, auto-immune disorders.
24. Pugs. Can't breathe, too noisy, also chronic skin issues, eye problems.
25. Beagles. Loud (baying), allergies, don't follow anything but their noses.
26. Cavalier King Charles. So cute, but heart disease, ear disease, spinal disease, just no.
27. Poodles. Nice dogs but the hair! too high maintenance. I don't even brush my own hair.
28. German Shorthair Pointer. Need too much exercise and generally go mental from lack of it. I had to fix one that literally jumped through a glass window on the second floor.

Obviously, there are a whole ton of other breeds, you can rest assured that most of them are NOs.

Now for the yes'. Updated: Shelties are off the list. A few people told me they are noisy and lately I've been seeing a very noisy puppy. Byebye. 
1. Shelties. Perfect size, great temperament, some eye problems but overall a healthy, quiet, breed. Because of this I will deal with the hair.
2. Whippets. Perfect size, quiet, not many issues. Lots of exercise needed but not psycho.
3. Dobermans. Happy dogs, have a few problems (heart, bleeding disorders) but great temperament and good family dog.
4. Flat-coated retrievers. All the happy-go-lucky of the golden retriever without the cancer and allergies.
5. Cats. 


Of course, none of this matters anyway because I will never seek out a dog breed. If we get a dog, it will be some sad sack mutt that comes into my clinic that I feel the need to take home. The End!

Updated: Since this post went live I have adopted a sad sack cat. 


Monday, February 29, 2016

Bonus February Post: Oh No You Didn't!

Since we get an extra day in awful February, here is an extra post. This is a true story. No embellishments.

It was a Friday, one of the last days in February, and we were extremely busy. I had about 10 minutes for lunch, so I finished an appointment with a senior kitty and ran across the street to get Subway.

I was standing in line, contemplating what sandwich to get and what would cost me the most points-wise (WW), and settled on roast beef. Then I decided to get myself a bag of cheetos to snack on. It was a very stressful week and I needed some comfort food.

I paid for my lunch and walked out of the store, back in the direction of the hospital. Coming toward me was a rather large woman carrying a few plastic bags and gesticulating while talking to herself. There are a few vagrants and homeless around, and most are harmless, so I didn't think much of it. Until I noticed she was looking at me and talking to me.

She came right up to me and got in my face, calling me a bitch and saying things like "Oh you think you're too good for me?" and other incomprehensible insults. I said, "I'm just walking.." and tried to duck around her. That's when she swung her fist and hit me in the back of my head/neck.

I turned and the words "What the FUCK?" came out of my mouth. She jumped toward me, trying to provoke me into a fight. I just walked across the street back to the clinic. These were my thoughts, in order:

1. Did that really just happen?
2. I need to call the police.
3. I'm so glad I bought myself cheetos.

I went back to work and called the police, and several cars drove around looking for her. I don't think they found her.

I contemplated the odds of this ever happening again while eating my cheetos. They're 10 points per bag, by the way.



Sunday, February 28, 2016

February Blues

Ok, so it's been a little while. Happy New El NiƱo Year and all that stuff! I hope you are staying warm/cool, wet/dry, happy or whatever you need to be.

As we end the Worst Month of the Year (see last February's post), it's time to recap the most notable cases and events from this month.

The first day of February brought me a very sick dog who may or may not have eaten something very bad for him, a chicken carcass. Two days after the delectable treat disappeared, the dog ended up in our office flat out, barely moving. He had had two days of unproductive retching and straining to have a bowel movement. I bent down to lift up his lip to check his color, and his lip stayed in the up position. His abdomen was tense and painful and bloated. I finished my exam which left me feeling very worried about my patient. I informed the owner that the dog was severely dehydrated and may require surgery or at the very least would need to be hospitalized for several days.

"Well, I'm not going to spend a thousand dollars on this dog."

Um, ok. Guess it's gonna die then. I have news for you: one thousand dollars is not a lot of money. For something like, I don't know, a purse? Yeah, that's ridiculous. But not for a dog, especially a sick dog or a dog who will need emergency life saving surgery and care. No, not even two thousand is a lot of money for that. In fact, that would be a bargain.

Veterinary medicine is sophisticated, and we are surgically and medically up to par - and sometimes even more advanced - than our human counterparts. But just go ahead and compare the costs of veterinary care to the same services in human medicine. Its no contest: veterinary medicine is a bargain.

The minimum emergency diagnostics needed in this case of a potentially fatal condition including CBC, chemistry, abdominal X-rays, and abdominal ultrasound will come in at just under one thousand dollars. Surgery, IV catheter and fluids, pain control, hospitalization post op and other meds the pet may need would be another two, and that's assuming everything goes swimmingly.

Foreign body removal is something not routinely performed in human medicine, so it was difficult to find costs for a similar procedure, however cholecystectomy (gall bladder removal) is performed in both disciplines. Gall bladder removal costs for a dog total approximately $4,000. For this procedure in human medicine, the average cost is $76,000. 

Anyway, the owner elected euthanasia. That was the first of many I performed this month. Most were very old and sick animals who had had good lives (presumably) and were ready. There were a few incredibly sad cases that I can't even write about.

There was one good case that sticks out. It was a little terrier mix who we hadn't seen for an exam in awhile. The last exam was a year ago for blood in his urine. At the time, he had a negative culture, and I warned the owners about bladder stones. Apparently the blood resolved because we hadn't seen him again.

Fast forward to this week. He spent an entire day straining to urinate, was brought in after a referral by the emergency for urethral obstruction. This is a thing that happens to cats more often than dogs, and it is a life threatening emergency. We discussed the options.

"Occasionally when we discover bladder stones we can attempt to dissolve them using a special diet, but in this case, surgery is required. We can attempt to push the stone causing the obstruction back into the bladder, if we succeed we can perform a cystotomy to remove the stones, or if we can't we'll have to refer you to a surgeon. Or you can euthanize."

"No, I want to do the surgery." Ok, then! I was able to push the offending stone back into the bladder, then I removed over 50 stones from this poor dogs bladder, and by that afternoon he was peeing normally with almost no blood. Yay! Finally a happy ending.