tag:blogger.com,1999:blog-88690826465821259892024-03-13T14:11:12.868-07:00Mending WallSomething there is that doesn't love a wall ~ Robert FrostDr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.comBlogger86125tag:blogger.com,1999:blog-8869082646582125989.post-68758976284805113832018-08-15T15:05:00.001-07:002018-08-15T15:05:13.582-07:00The Value of the Physical Exam <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/--EnpC8xmywc/W3SjXLC3JFI/AAAAAAAADxM/L-TAtN1Zn1YqtJVOHdMcQhJNe8E0wr0fQCLcBGAs/s1600/animal-dog-maltese-33053%2B%25281%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1063" data-original-width="1600" height="424" src="https://3.bp.blogspot.com/--EnpC8xmywc/W3SjXLC3JFI/AAAAAAAADxM/L-TAtN1Zn1YqtJVOHdMcQhJNe8E0wr0fQCLcBGAs/s640/animal-dog-maltese-33053%2B%25281%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Free image - Pexels</td></tr>
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The other day I went to the salon to have my hair cut. My stylist, who I love, got a new puppy and was realizing just how expensive it is to go through all of the puppy exams, dewormings and vaccines. She hasn't even gotten to the neuter surgery yet. She said, "Ugh! It's so dang expensive! It's an exam fee every time! Sometimes I think they just say things need to be done to charge more."<br />
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I've known her for a little while now, so I said in response, "Hey! That is not true! You take that back!"<br />
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She said, "Alright alright, I'm sorry, well not you! Its just so much money."<br />
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Now, my exam fee at my practice is $58 for a nose to tail exam. (It's about $65 for an exotic, $85 for an emergency). The cost for my haircut: $70. The cost for a cut, balayage color treatment and style: $300. Plus tip.<br />
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My $58 exams include the following: consultation that includes answering every question the owners have and some questions they didn't even know they had, nutrition counseling, behavioral counseling, training tips and resources, complete history taking for the current problem(s), physical exam which includes examining the following body systems:<br />
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1. <b>Cardiovascular</b> (listening to the heart and checking pulse quality and consistency) - When your doctor listens to your heart, s/he is not just taking your pulse. I am listening to the rhythm of the beats, listening for irregularities in rhythm or strength, listening to the clarity of the sounds, listening for extra sounds such as clicks and murmurs, checking that the pulse rate matches the heart rate, and of course measuring the pulse and whether it matches the situation at hand. I check the mucus membrane color in the mouth for color and moisture.<br />
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2. <b>Respiratory</b> (listening to the lungs) - I am listening to the breath quality, the rate of breaths per minute, the effort of breathing, the actual sounds themselves: are they harsh? too loud? too quiet? crackly? wheezy? too fast? too slow? too shallow? too deep?<br />
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3. <b>Musculoskeletal </b>(body condition )- I'm checking how close the patient is to their ideal weight. Is there too much fat? too little? I'm checking the muscling. I'm checking for normal stance, ambulation, and carriage.<br />
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4. <b>Integument (</b>skin) - I see a lot of skin cases, so I'm looking at the surface of the skin to check for external parasites like fleas, ticks, lice, mites. I'm looking at the skin itself to look for normal, or is t too dry, too moist, too red, too scaly? Is there evidence of infection? Is there evidence the pet is scratching, chewing or licking? Is the hair coat shiny, clean, and healthy or is brittle and broken or is there hair missing? I'm checking the skin in the ears, in between the toes, and all over the body.<br />
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5. <b>Gastrointestinal </b>(mouth, abdomen, anus) - I check the teeth for health, gingivitis/periodontitis, look for masses in the mouth, smell for odor. I palpate the abdomen to feel for the stomach, liver, spleen, intestines and colon. I check underneath the tail to make sure everything looks normal. I rectal to look for masses in the area (*disclaimer - I don't rectal everything).<br />
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6. <b>Urinary</b> (kidneys, bladder, external genitalia) - I palpate the abdomen to check the size of the kidneys and urinary bladder and evaluate the external genitalia for any abnormalities.<br />
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7. <b>Eyes </b>- I look at the external eyes and eyelids for brightness, discharge, swelling, crusts, masses. I look at the eyeball and the inside the eye to evaluate for abnormalities.<br />
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8. I'm looking for external clues that might tell me if there is a problem with the <b>endocrine </b>or <b>lymphatic</b> systems.<br />
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9. <b>Nervous</b> (nerves) - I'm checking for abnormalities with the nervous system while I'm looking at the face and other areas. Depending on the complaint or what I find above, I may do an extended physical that includes a full orthopedic exam or a full neurologic exam.<br />
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<br />
Once the exam is finished I inform the owners of the findings, discuss the current working diagnosis, formulate a differential list, and then make a plan for tests that will help us get to a definitive diagnosis. I do it all in a methodical and streamlined fashion so I am able to complete my exam and consultation in 10 to 30 minutes depending on the case difficulty, with additional follow through in many non-routine exams. I do all of this for the bargain price of $58.<br />
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Additional recommended tests, medications, vaccines, are compiled onto an estimate which is presented to the owner. I can't do bloodwork, xrays, surgeries etc for free. Just like the stylist can't spend 2 hours doing a balayage treatment for free. People must charge appropriately for their time.<br />
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My stylist told me I should get my hair done more often. I told her I would, if it wasn't so expensive.<br />
<br />
<br />
___________<br />
**I love my stylist and this post is not meant to pick on her, obviously I happily pay her for taking care of my hair. It is just meant to illustrate the differences in the way people feel regarding vet care vs other types of care, and to explain what actually happens during those physical exams.<br />
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***Don't even get me started on what people pay dog groomers.Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-25019749217055438862018-03-30T21:37:00.000-07:002018-03-30T21:39:30.088-07:00A Wrinkle in Time?<div style="text-align: center;">
<a href="https://www.amazon.com/gp/product/0312367546/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0312367546&linkCode=as2&tag=msmith00-20&linkId=28d3a47afd7a2af30fd675f4b9cfd01e" target="_blank"><img border="0" src="//ws-na.amazon-adsystem.com/widgets/q?_encoding=UTF8&MarketPlace=US&ASIN=0312367546&ServiceVersion=20070822&ID=AsinImage&WS=1&Format=_SL250_&tag=msmith00-20" /></a><img alt="" border="0" height="1" src="//ir-na.amazon-adsystem.com/e/ir?t=msmith00-20&l=am2&o=1&a=0312367546" style="border: none !important; margin: 0px !important;" width="1" /><br />
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<div style="text-align: left;">
I read <a href="https://www.amazon.com/gp/product/0312367546/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0312367546&linkCode=as2&tag=msmith00-20&linkId=887923078566ddba02960c86b33192b1" target="_blank">A Wrinkle in Time (Time Quintet)</a><img alt="" border="0" height="1" src="//ir-na.amazon-adsystem.com/e/ir?t=msmith00-20&l=am2&o=1&a=0312367546" style="border: none !important; margin: 0px !important;" width="1" /> for the first time around 1995, fifth grade. For my entire grade school career I read above my level, but I didn't understand this book. And it made me mad, and so I never reread it. But as it turns out, pieces of it stuck with me. </div>
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<div style="text-align: left;">
I finally decided to reread the book after seeing posters around town for the movie adaptation. (Apparently there was a made for TV Wrinkle a few years back. I guess I missed that.) I ordered the book on Amazon and stuck in on the top of my ever growing pile of books next to my bed. There are about 20 or 30 books sitting there, most of which I have owned for quite some time but haven't gotten around to reading. Seeing them there is supposed to motivate me to read them so I can put them on my bookshelf or give them away and make more room on my cluttered nightstand, but somehow I always buy a new book that needs reading first and then there they all remain, neglected but hopeful. I read somewhere that the best time to read a book is when you first acquire it, and that seems to be true. But anyway I digress.<br />
<br />
SO I got the book and I read it. It took me about 5 days of reading as much as I could at bedtime before passing out. This is actually quite a long time for me as I used to read most books in one sitting. (I read HP and the Deathly Hallows in 5 hours). At the part where they try to explain the tesseract and the fifth dimension, there are a few drawings. I had a flashback (tesser?) to reading this book on the playground in fifth grade. <i>I remembered those drawings. </i>I've always had a fairly photographic memory and basically remember every picture I've ever seen, although not necessarily the context. Whenever the subject of different dimensions has come up in the past 20 years, the images from this book have floated to the forefront of my mind. I just didn't know where they came from. The brain is such an interesting thing.<br />
<br />
I saw the movie last weekend. They did an amazing job of bringing the imagery in the book to life. The book was written in the 60s while the movie was set in the current time, and it stills holds. The triumph of love over evil never gets old. </div>
Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-63373316540740188472018-02-23T18:09:00.000-08:002018-02-23T19:31:05.743-08:00Breathless Sometimes, fleetingly, in the space between moments, I miss O____. Life was so simple then. Go to school, learn, go home, study. Repeat. If my brain needed space there was plenty around, I just would drive on some old country road outside of the city until I felt calm. The stars were visible. The air was fresh, crisp like dew on grass. I would find the horses, and breathe. Just breathe.<br />
<br />
Nowadays I hold my breath. I hold it when I'm doing surgery, or when I'm riding my horse, or sometimes when I'm wondering what the future may hold. I hold it when I'm about to give an owner bad news.<br />
<br />
I couldn't even imagine having to give a person bad news about a human member of their family. Especially if it was a child. Especially if that child died a senseless, unnecessary death.<br />
<br />
Columbine was spoken about and analyzed for years. Now these terrible things are so routine they fade from our consciousness within weeks. After the last terrible thing happened (I cannot even bear to combine the words school and shooting - because they are two words that should never ever be juxtaposed), for the first time I wondered if I should prepare to homeschool my child. To keep her safe. When did schools become unsafe? My husband said bad things can happen anywhere. At a mall, the theater, anywhere. And he is right. But... maybe I would be there too. To shield her with my body. I would do anything to keep her safe.<br />
<br />
These terrible things MUST stop. Please write to your representatives. Do not vote those below back into office.<br />
<br />
I keep holding my breath.<br />
<br />
<br />
Representatives paid by the gun lobby.<br />
Source: <a href="https://www.politico.com/interactives/2017/gun-lobbying-spending-in-america-congress/">https://www.politico.com/interactives/2017/gun-lobbying-spending-in-america-congress/</a><br />
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<div class="source" style="-webkit-text-stroke-width: 0px; box-sizing: border-box; color: black; font-family: proxima-nova, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; orphans: auto; text-align: right; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
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<table class="rep-table" style="-webkit-text-stroke-width: 0px; background-color: transparent; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: #666666; font-family: proxima-nova, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; orphans: auto; padding: 0px; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; width: 800px; word-spacing: 0px;"><thead style="box-sizing: border-box;">
<tr style="box-sizing: border-box;"><th class="name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 2px; box-sizing: border-box; font-weight: 700; line-height: 1.2; padding: 0px 10px 10px; text-align: left; vertical-align: bottom;">Name</th><th class="amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 2px; box-sizing: border-box; font-weight: 700; line-height: 1.2; padding: 0px 10px 10px; text-align: left; vertical-align: bottom;">Amount</th><th class="party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 2px; box-sizing: border-box; font-weight: 700; line-height: 1.2; padding: 0px 10px 10px; text-align: left; vertical-align: bottom;">Party</th><th class="district" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 2px; box-sizing: border-box; font-weight: 700; line-height: 1.2; padding: 0px 10px 10px; text-align: left; vertical-align: bottom;">District</th><th class="years amt" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 2px; box-sizing: border-box; font-weight: 700; line-height: 1.2; padding: 0px 10px 10px; text-align: right; vertical-align: bottom;">Years in office</th></tr>
</thead><tbody style="box-sizing: border-box;">
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Paul Ryan</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$336,597</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Wisconsin, District 1</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">18</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">John Boehner</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$231,265</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Ohio, District 8</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">24</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Don Young</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$195,272</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Alaska, At-Large District</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">44</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">John Thune</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$181,215</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">South Dakota, At-large District</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">18</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Pat Toomey</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$167,051</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Pennsylvania, District 15</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">12</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Ken Calvert</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$144,466</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">California, District 42</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">24</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Roy Blunt</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$143,543</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Missouri, District 7</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">20</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Denny Rehberg</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$138,959</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Montana, At-large District</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">12</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Steve Pearce</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$129,250</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">New Mexico, District 2</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">6</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Saxby Chambliss</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$128,950</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Georgia, District 8</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">12</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">George Allen</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$127,556</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Virginia, District 7</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">8</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Richard Burr</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$124,550</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">North Carolina, District 5</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">22</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Richard Pombo</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$122,694</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">California, District 11</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">14</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Pete Sessions</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$121,776</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Texas, District 32</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">14</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Jim Inhofe</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$121,100</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Oklahoma, District 1</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">31</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">John Kline</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$119,887</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Minnesota, District 2</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">14</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Rick Santorum</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$115,942</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Pennsylvania, District 18</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">16</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">John Doolittle</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$111,193</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">California, District 4</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">16</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Ed Royce</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$111,120</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">California, District 39</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">24</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Dean Heller</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$108,515</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">District 2 </td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">4</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Ron Paul</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$108,453</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Texas, 14 and 22</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">12</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Michele Bachmann</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$108,218</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Minnesota, District 6</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">4</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Rob Portman</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$107,727</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Ohio, District 2</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">20</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Bob Goodlatte</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$104,900</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Virginia, District 6</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">24</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Martha McSally</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$104,445</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Arizona, District 2</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">2</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Mike Coffman</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$101,693</td><td class="party republican " data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican </td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Colorado, District 6</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">8</td></tr>
<tr class="retired" style="background-color: #eeeeee; box-sizing: border-box; color: #333333;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Bob Barr</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$101,473</td><td class="party republican" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #fd5639; font-weight: 700; padding: 10px; vertical-align: top;">Republican</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Georgia, District 7</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">8</td></tr>
<tr class="" style="box-sizing: border-box;"><td class="name" data-title="Name" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; min-width: 170px; padding: 10px; vertical-align: top;">Collin Peterson</td><td class="amount" data-title="Amount" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">$98,500</td><td class="party democrat" data-title="Party" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; color: #2b6abd; font-weight: 700; padding: 10px; vertical-align: top;">Democrat</td><td class="district" data-title="District" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; vertical-align: top;">Minnesota, District 7</td><td class="years amt" data-title="Years in office" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: solid; border-bottom-width: 1px; box-sizing: border-box; padding: 10px; text-align: right; vertical-align: top;">26</td></tr>
</tbody></table>
Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-5249279534337054722018-01-16T14:31:00.000-08:002018-01-16T17:43:44.708-08:00Wonder <a href="https://3.bp.blogspot.com/-ZfY1qQmnijc/Wl58dKh9dNI/AAAAAAAADrY/sNfO4PTeLIEYB7lOe-HNO08Rfzh89qHFACLcBGAs/s1600/81zdSFzJh%252BL.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1043" height="400" src="https://3.bp.blogspot.com/-ZfY1qQmnijc/Wl58dKh9dNI/AAAAAAAADrY/sNfO4PTeLIEYB7lOe-HNO08Rfzh89qHFACLcBGAs/s400/81zdSFzJh%252BL.jpg" width="260" /></a>I just finished reading <a href="https://www.blogger.com/%3Ciframe%20style=%22width:120px;height:240px;%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20frameborder=%220%22%20src=%22//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=msmith00-20&marketplace=amazon&region=US&placement=0375869026&asins=0375869026&linkId=b979488f706e0dcc9bba9d18420944cd&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066C0&bg_color=FFFFFF%22%3E%20%20%20%20%20%3C/iframe%3E">Wonder</a> by RJ Palacio. Wow. It took me right back to middle school. Which isn't really a good thing considering I blocked the majority of middle school memories from my mind. Middle school was really hard in the way of social relationships. I lost and gained some friends in middle school. It's where I received my first B in a class, and probably my first C. Although, that actually might have been high school physics. :/ I don't really remember many other things, just little snippets like the uncomfortable attention I received when I wore my first fitted jeans and shirt to school (did they think I looked good or were they laughing at me?) , or the glass eye of the computer science teacher, or dissecting clams in ninth grade (you can't see anything, its all just - clam).<br />
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Anyway, my middle school was probably just like many other middle schools in the country, at least in the way kids interacted and the feelings we all were having. Wonder is about a kid who looks very different. It's about the typical middle school students such a kid might encounter, and the struggles that will inevitably follow. Mostly, its about kindness. It was a great reminder to just be kind, just accept, just befriend someone who might really need a friend. I plan on reading it to my daughter when she's a little older, probably before the dreaded middle school begins. Also I can't wait to see the movie! <a href="https://www.blogger.com/%3Ciframe%20style=%22width:120px;height:240px;%22%20marginwidth=%220%22%20marginheight=%220%22%20scrolling=%22no%22%20frameborder=%220%22%20src=%22//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=msmith00-20&marketplace=amazon&region=US&placement=0375869026&asins=0375869026&linkId=b979488f706e0dcc9bba9d18420944cd&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066C0&bg_color=FFFFFF%22%3E%20%20%20%20%20%3C/iframe%3E">You should read it too. </a>Everyone should, really.Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-47115748616361513562017-12-31T21:20:00.001-08:002018-01-16T18:00:25.218-08:00Goals The End of another year.<br />
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This year held many challenges for me, and I can't say I'm sorry to see it go. There were some very good things and some terrible things, not all of which I have shared publicly. In February, for example, I fell off my horse and landed on a metal fence, breaking 2 vertebrae and dislocating a rib. I am completely healed physically, the mental and emotional healing took a long time and I am still not completely back to where I was with my confidence level. But I also paid off my student loan this year in one large lump sum, so that was a wonderful thing in terms of stability and getting a huge burden removed from my shoulders. Then I had my very first girls trip with my best friends, and while on that trip, one of my cats had a tragic medical condition occur and had to be euthanized without me.<br />
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I got to travel to three new states this year, taking my total to 25 states. That's only 24 more to go! (Sorry North Dakota, there's nothing there I need to see ;)) But two terrible fires ravaged the area I live in and came close to my house and burned down my horse's barn. Even though they were terribly scary, we did not lose any life or material. But then we lost another cat due to cancer. We have our health, a beautiful child, excellent jobs, and we have accomplished so much. Enough that after my mother told me on my birthday that she hoped that all my dreams come true, I realized, <i>they have.</i> So that - that is amazing.<br />
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So based on that realization, I've been thinking about setting some new life goals and what those should be.<br />
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<br />
New Year's Resolutions<br />
- Plan healthy family meals and try to actually eat them as a family.<br />
- Find time to do yoga and stick to it regularly.<br />
- Improve quality time with my daughter<br />
- Visit family and friends I haven't seen in awhile<br />
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<br />
<br />
Short Term Goals<br />
- Learn more about finances and retirement saving, plan a retirement age and work toward that goal<br />
- Relax more and accept that down time is important self care<br />
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Long Term Goals<br />
- Find time to do art again regularly, perhaps create a business around it<br />
- Travel more<br />
- Retire financially stable to do all we want to do<br />
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I wish you all health, happiness and the ability to accomplish all you want to and more.<br />
Best,<br />
<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com3tag:blogger.com,1999:blog-8869082646582125989.post-54401045026602182592017-12-31T07:15:00.000-08:002018-01-03T17:48:06.284-08:00The ZooWe saw this beautiful snow leopard while visiting our local zoo the other day.<br />
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I have mixed feelings about zoos. As a veterinarian, I have a greater understanding of the general needs of exotic animals than the public, however, I'm not a zoo vet. I've been behind the scenes at a zoo and aquarium and have seen first hand the excellent level of care the animals receive, though I've never actually taken part in that care. With these disclaimers, I'm going to state some things about zoos that are my opinions while fully acknowledging that I may be missing critical points of zoo epidemiology.<br />
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Zoos have come a very long way from when they were first created. I have a general dislike of placing animals in cages for the entertainment of humans, and this is what all zoos were when they began. There still are <a href="http://www.theeagle.com/gallery/news/traveling-zoo-visits-bryan/collection_12383522-3b7b-11e2-9b9b-0019bb2963f4.html">some traveling "zoos</a>" in more rural parts of America and likely elsewhere in the world, where animals are kept in small cages and do nothing but travel from town to town. This I whole heartedly disagree with and believe these animals should be confiscated and relocated to sanctuary. Most enclosures in zoos are still too small and restrict natural movement of the species contained within (Extrapolation from the ~6 zoos I have visited in the last few years). However in recent years there have been many zoos that have been slowly restructuring to provide a greater range of environmental enrichments and space for their animals, such as the<a href="https://www.oregonzoo.org/discover/new-zoo/elephant-lands"> Oregon Zoo </a>and the <a href="http://www.lazoo.org/elephants/">LA Zoo</a>, which recently opened a new 6.5 acre habitat for its 4 elephants.<br />
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I also believe there are some species that do not belong in any enclosure, anywhere. Honestly, there are some animals that do not seem stressed by their environment and likely thrive in zoos without fear of predators and abundant food and enrichment. However I do not believe long-range roaming animals, apes, or the apex predators belong in zoos. I would like to see more zoos have less animals with more space to roam.<br />
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Zoos do provide education and participate in research to broaden our understanding of these exotic species, which in turn can translate to better domestic animal or human disease treatment. In fact in the <a href="http://www.zoobiquity.com/">Zoobiquity</a> movement, MDs and veterinarians have begun collaborating and sharing information about diseases and treatments that affect both animals and humans. For example, diabetes is a disease that both humans and non-human animals can suffer from, with similar triggers. Collaboration between the human and animal medical fields can get us closer to an understanding and cure. This is part of the larger <a href="http://www.onehealthinitiative.com/">One Health Initiative</a>, which seeks to increase the well-being and health of the planet.<br />
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Zoos also contribute to conservation efforts by learning about the species they care for, translating this to field conservationists and inspiring the public to care. Public awareness is essential for conservation. Conservation efforts require money, and money must come from somewhere. People need to care about something enough to want to save it, and getting them close to a wild animal is the best way, hands down. Zoos provide a safe and accessible way to experience the majesty of exotic species that would otherwise never be available to most people. For these last few reasons, I support my local zoo with an annual membership.<br />
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If I was building a zoo, I would:<br />
- Have fewer species with a larger amount of space dedicated to each resident<br />
- Have appropriate enrichment, opportunities for forage, burrowing, or other naturally occurring behaviors<br />
- Have no large cats, or at least have larger areas for the cats to be able to hunt, hide, and roam<br />
- Design enclosures so that humans are not emphasized; rather, I would minimize the human component so that the humans are silent and invisible guests in the animal's environment as much as possible.Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-11491705792572071972017-12-17T08:56:00.000-08:002017-12-17T08:56:44.863-08:00The Beautiful 10.30 StrayIn 2006, a young mother cat and two kittens were rescued from a field in Pennsylvania and brought to the veterinary clinic where I worked. The mother cat was feral. The two kittens were black and white and 6 months old and adorable. The clinic spayed all three, and the mother was returned to the field to live the rest of her days hunting mice but not making more kittens. The two kittens were put up for adoption.<br />
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The one with the green eyes and pink nose who was more white than black was named "10.30 Stray" in the computer system. The other kitten who was more black than white was adopted by my friend Kelly, who also worked at the clinic. The mostly white and black one was adopted by me. I named her Bella Luna, which means Beautiful Moon. Even though my coworkers groaned because Bella was a very popular name at the time, but she truly was a beautiful cat.<br />
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I took her to Portland where she settled right in with <a href="http://mmendingwall.blogspot.com/2017/03/the-handsomest-cat.html">Dublin</a>. The two of them became fast friends. You can see how close the two of them were in my blog <a href="http://mmendingwall.blogspot.com/2011/09/mirrored-cats.html">Mirrored Cats</a>.<br />
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Bella was my first cat. She was my first "real" pet. (I had parakeets when I was a teenager, and I loved them, but they just weren't quite the same. Although Zeus visits me in my dreams occasionally.) She was quite dignified, with perfected resting bitch face, but had a whimsical sense of play and would surprise you just when you thought she was too good for you. She was declawed, a decision I mostly regretted throughout her life, except for the times I saw her scratching on my upholstered dining chairs or my antique cherrywood carved bedposts. She only played with the white mice. She chewed on string and cords. She loved new carpets. She loved to drink water out of the tub faucet. She was unconcerned with visitors and went about her business as usual, including our friend's dog who barked right in her face through the sliding glass door. She just stared at him, unblinking, tail gently flicking in mild amusement. She slept next to my husband every night but rarely sat on our laps.<br />
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Ever since she was a kitten, I have had a strange feeling she would die when she was 10. I can't really explain why, it's just one of those things I guess. She had never been a great eater, and when she was about 6 she began very slowly losing weight. I let it go for awhile, until she started having frequent hairballs. I diagnosed her with inflammatory bowel disease in 2014. She improved greatly with treatment and then in 2015 began vomiting and losing weight again. I feared her disease had become more advanced but it turned out she was hyperthyroid.<br />
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I had her thyroid tumor irradiated and she did well again until just a few weeks ago. She had turned 11 in June. I noticed she started refusing her favorite treat, American cheese. She started vomiting daily. She always hated taking medications and so I had to improvise and find various ways to get her to take her meds. She started refusing them, too. I tried a few things at home but finally had to take her to work. After various tests, I found a tumor in her lungs and inflammation in her gut that was likely metastatic lymphoma. She declined quickly and it became time to let her go. One of my amazing technicians drove several hours to euthanize Bella at home since she became extremely stressed in the car.<br />
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The drive was surreal. I felt like I was driving to my own death. I turned on my street and didn't even recognize it. As if in a dream I drove toward my drive, turned in, and parked. I had to reassure myself that this was indeed my little house on my quiet street with my little kitty inside.<br />
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She passed peacefully in my arms without struggle as I cried into the black fur on the back of her neck. I knew it was time, but I still had a horrible rise of a feeling that maybe it was too soon. I asked my technician, and she reassured me as I have reassured hundreds of others, that indeed yes, it was just the right time. Those words helped me beyond measure in that moment.<br />
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The next day I euthanized a cat with a very similar story, and the owner recited Psalm 23 over her. I will repeat it here for my beautiful Bella, rest in peace. And go find Fat Man. <3<br />
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<h4 class="psalm-title" style="background-color: white; box-sizing: border-box; font-family: "Helvetica Neue", Verdana, Helvetica, Arial, sans-serif; font-size: 14px; line-height: 24px; margin-bottom: 10px; margin-top: 1em;">
<span class="text Ps-23-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><h4 class="psalm-title" style="background-color: white; box-sizing: border-box; font-family: "Helvetica Neue", Verdana, Helvetica, Arial, sans-serif; font-size: 14px; line-height: 24px; margin-bottom: 10px; margin-top: 1em;">
A Psalm of David.</h4>
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<div class="poetry" style="background-color: white; box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 1em; margin-left: 1em; margin-top: 1em; padding-left: 2.6em; position: relative;">
<div class="line" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-family: "Helvetica Neue", Verdana, Helvetica, Arial, sans-serif; font-size: 16px; line-height: 24px;">
<span class="chapter-2" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="text Ps-23-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="chapternum" style="bottom: 0.1em; box-sizing: border-box; font-family: "arial"; font-size: 24px; font-weight: bold; left: -3em; line-height: 0.8em; position: absolute;">23 </span>The <span class="small-caps" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-variant-caps: small-caps; font-variant-east-asian: normal; font-variant-numeric: normal;">Lord</span> is my <span class="crossreference" data-cr="#cen-ESV-14237A" data-link="(<a href="#cen-ESV-14237A" title="See cross-reference A">A</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>shepherd; I shall not <span class="crossreference" data-cr="#cen-ESV-14237B" data-link="(<a href="#cen-ESV-14237B" title="See cross-reference B">B</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>want.</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="text Ps-23-2" id="en-ESV-14238" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="versenum" style="box-sizing: border-box; display: block; font-family: "arial"; font-size: 12px; font-weight: bold; left: -4.4em; line-height: 22px; position: absolute; top: 0px; vertical-align: top;">2 </span><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span>He makes me lie down in green <span class="crossreference" data-cr="#cen-ESV-14238C" data-link="(<a href="#cen-ESV-14238C" title="See cross-reference C">C</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>pastures.</span></span><br />
<span class="text Ps-23-2" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">He leads me beside still waters.<span class="footnote" data-fn="#fen-ESV-14238a" data-link="[<a href="#fen-ESV-14238a" title="See footnote a">a</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14238a" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote a">a</a>]</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="text Ps-23-3" id="en-ESV-14239" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="versenum" style="box-sizing: border-box; display: block; font-family: "arial"; font-size: 12px; font-weight: bold; left: -4.4em; line-height: 22px; position: absolute; top: 0px; vertical-align: top;">3 </span><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span>He <span class="crossreference" data-cr="#cen-ESV-14239D" data-link="(<a href="#cen-ESV-14239D" title="See cross-reference D">D</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>restores my soul.</span></span><br />
<span class="text Ps-23-3" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">He <span class="crossreference" data-cr="#cen-ESV-14239E" data-link="(<a href="#cen-ESV-14239E" title="See cross-reference E">E</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>leads me in <span class="crossreference" data-cr="#cen-ESV-14239F" data-link="(<a href="#cen-ESV-14239F" title="See cross-reference F">F</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>paths of righteousness<span class="footnote" data-fn="#fen-ESV-14239b" data-link="[<a href="#fen-ESV-14239b" title="See footnote b">b</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14239b" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote b">b</a>]</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-3" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">for his <span class="crossreference" data-cr="#cen-ESV-14239G" data-link="(<a href="#cen-ESV-14239G" title="See cross-reference G">G</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>name's sake.</span></span></div>
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<div class="poetry top-1" style="background-color: white; box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 1em; margin-left: 1em; margin-top: 1em; padding-left: 2.6em; position: relative;">
<div class="line" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-family: "Helvetica Neue", Verdana, Helvetica, Arial, sans-serif; font-size: 16px; line-height: 24px;">
<span class="text Ps-23-4" id="en-ESV-14240" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="versenum" style="box-sizing: border-box; display: block; font-family: "arial"; font-size: 12px; font-weight: bold; left: -4.4em; line-height: 22px; position: absolute; top: 0px; vertical-align: top;">4 </span>Even though I <span class="crossreference" data-cr="#cen-ESV-14240H" data-link="(<a href="#cen-ESV-14240H" title="See cross-reference H">H</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>walk through the valley of <span class="crossreference" data-cr="#cen-ESV-14240I" data-link="(<a href="#cen-ESV-14240I" title="See cross-reference I">I</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>the shadow of death,<span class="footnote" data-fn="#fen-ESV-14240c" data-link="[<a href="#fen-ESV-14240c" title="See footnote c">c</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14240c" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote c">c</a>]</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-4" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">I will <span class="crossreference" data-cr="#cen-ESV-14240J" data-link="(<a href="#cen-ESV-14240J" title="See cross-reference J">J</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>fear no evil,</span></span><br />
<span class="text Ps-23-4" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">for <span class="crossreference" data-cr="#cen-ESV-14240K" data-link="(<a href="#cen-ESV-14240K" title="See cross-reference K">K</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>you are with me;</span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-4" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">your <span class="crossreference" data-cr="#cen-ESV-14240L" data-link="(<a href="#cen-ESV-14240L" title="See cross-reference L">L</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>rod and your staff,</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-4" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">they comfort me.</span></span></div>
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<div class="poetry top-1" style="background-color: white; box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 1em; margin-left: 1em; margin-top: 1em; padding-left: 2.6em; position: relative;">
<div class="line" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-family: "Helvetica Neue", Verdana, Helvetica, Arial, sans-serif; font-size: 16px; line-height: 24px;">
<span class="text Ps-23-5" id="en-ESV-14241" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="versenum" style="box-sizing: border-box; display: block; font-family: "arial"; font-size: 12px; font-weight: bold; left: -4.4em; line-height: 22px; position: absolute; top: 0px; vertical-align: top;">5 </span>You <span class="crossreference" data-cr="#cen-ESV-14241M" data-link="(<a href="#cen-ESV-14241M" title="See cross-reference M">M</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>prepare a table before me</span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-5" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">in <span class="crossreference" data-cr="#cen-ESV-14241N" data-link="(<a href="#cen-ESV-14241N" title="See cross-reference N">N</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>the presence of my enemies;</span></span><br />
<span class="text Ps-23-5" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">you <span class="crossreference" data-cr="#cen-ESV-14241O" data-link="(<a href="#cen-ESV-14241O" title="See cross-reference O">O</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>anoint my head with oil;</span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-5" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">my <span class="crossreference" data-cr="#cen-ESV-14241P" data-link="(<a href="#cen-ESV-14241P" title="See cross-reference P">P</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>cup overflows.</span></span><br />
<span class="text Ps-23-6" id="en-ESV-14242" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="versenum" style="box-sizing: border-box; display: block; font-family: "arial"; font-size: 12px; font-weight: bold; left: -4.4em; line-height: 22px; position: absolute; top: 0px; vertical-align: top;">6 </span>Surely<span class="footnote" data-fn="#fen-ESV-14242d" data-link="[<a href="#fen-ESV-14242d" title="See footnote d">d</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14242d" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote d">d</a>]</span> goodness and mercy<span class="footnote" data-fn="#fen-ESV-14242e" data-link="[<a href="#fen-ESV-14242e" title="See footnote e">e</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14242e" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote e">e</a>]</span> shall follow me</span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-6" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">all the days of my life,</span></span><br />
<span class="text Ps-23-6" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;">and I shall <span class="crossreference" data-cr="#cen-ESV-14242Q" data-link="(<a href="#cen-ESV-14242Q" title="See cross-reference Q">Q</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>dwell<span class="footnote" data-fn="#fen-ESV-14242f" data-link="[<a href="#fen-ESV-14242f" title="See footnote f">f</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14242f" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote f">f</a>]</span> in the house of the <span class="small-caps" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-variant-caps: small-caps; font-variant-east-asian: normal; font-variant-numeric: normal;">Lord</span></span><br />
<span class="indent-1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box;"><span class="indent-1-breaks" style="box-sizing: border-box; font-family: monospace; font-size: 0.42em; line-height: 0;"> </span><span class="text Ps-23-6" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; position: relative;"><span class="crossreference" data-cr="#cen-ESV-14242R" data-link="(<a href="#cen-ESV-14242R" title="See cross-reference R">R</a>)" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;"></span>forever.<span class="footnote" data-fn="#fen-ESV-14242g" data-link="[<a href="#fen-ESV-14242g" title="See footnote g">g</a>]" style="box-sizing: border-box; font-size: 0.625em; line-height: 22px; position: relative; top: 0px; vertical-align: top;">[<a href="https://www.biblegateway.com/passage/?search=Psalm+23&version=ESV#fen-ESV-14242g" style="-webkit-font-smoothing: antialiased; background: transparent; box-sizing: border-box; color: #b34b2c; text-decoration-line: none; vertical-align: top;" title="See footnote g">g</a>]</span></span></span></div>
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com1tag:blogger.com,1999:blog-8869082646582125989.post-75778073340780994602017-11-02T15:04:00.000-07:002017-12-26T14:22:21.497-08:00 Veterinary Care in the Age of Having it All <div class="p1">
I want to tell you a story.<br />
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A young veterinarian has been practicing mobile veterinary medicine in a small, close knit community for the past several months. She has been received well, especially as an outsider. The town is so small that there is only one other veterinary practice with two veterinarians in the town. She recently decided to open a brick and mortar practice in order to better serve her clients and expand her business.<br />
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The community members have been stopping by regularly to see the progress being made on the new clinic and make small talk. One fine spring day while sheās working on her new reception area, the mailman brings her a letter from a gentleman she had spoken to briefly the day before. Intrigued, she takes a break from working and sits down to read. </div>
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The letter goes something like this. </div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-weight: normal;"><br /></span><span style="color: #666666;"><span style="font-weight: normal;">Dear Dr., </span><span style="font-weight: normal;">I am so happy that you are going to remain in our small town and be our vet. I thought I would pass along a few words of advice as you open your practice. </span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #666666;"><span style="font-weight: normal;"><br /></span><span style="font-weight: normal;">1. Be excellent at your job, and show us that you really love animals. The other vet doesn't know what she is doing. </span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #666666;"><span style="font-weight: normal;"><br /></span><span style="font-weight: normal;">2. Most people living here are retired and are on a fixed income. A senior discount would attract clients. </span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #666666;"><span style="font-weight: normal;"><br /></span><span style="font-weight: normal;">3. It is important to us that veterinary costs are kept low and are reasonable and fair. The other vet is greedy and clearly only cares about money as she charges way too much. </span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #666666;"><span style="font-weight: normal;"><br /></span><span style="font-weight: normal;">4. If you don't plan to be open daily, leave a phone number where you can be reached in times of emergency.</span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #666666;"><span style="font-weight: normal;"><br /></span><span style="font-weight: normal;">I hope this will help you.</span><span style="font-weight: normal;">Best,</span></span><span style="font-weight: normal;"><span style="color: #666666;">Resident Senior</span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-weight: normal;"><span style="color: #666666;"><br /></span></span></span>
<span style="font-family: "times" , "times new roman" , serif;"><span style="font-weight: normal;"><span style="color: #666666;">____</span></span></span><br />
<br />
<span style="font-family: "times" , "times new roman" , serif;"><span style="font-weight: normal;"><span style="color: #666666;"><br /></span></span>What exactly was the intention of this letter? With what tone do you read the letter? Do you think the requests are "fair and reasonable?" </span><br />
<span style="font-family: "times" , "times new roman" , serif;"><br /></span>
<span style="font-family: "times" , "times new roman" , serif;">To break it down, this is what the letter is requesting (or demanding, depending how you look at it):</span></div>
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<span class="s1"></span></div>
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<span class="s1">- Excellent care and compassion </span></div>
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<span class="s1">- Low cost</span></div>
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<span class="s1">- 24/7/365 access to this vet.<span class="Apple-converted-space"> </span></span><br />
<span class="s1"><span class="Apple-converted-space"><br /></span></span>
<span class="s1"><span class="Apple-converted-space">Sounds great, right? This is exactly what you want from your vet, right? While I think the letter was written with good intention, the letter writer is asking for an ideal that is impossible in the current day and age. I am going to try to explain why this combination does not exist.</span></span></div>
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<span class="s1"></span><br /></div>
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<span class="s1"><b>24/7/365 </b>No one works 24/7. Do you ask your mechanic for his cell phone number so in case your car has a problem at 11 pm you can call and ask him about it? How about getting your kid's teacher's personal number so you can call with homework questions? It is not fair and reasonable to expect your vet to work 7 days a week and answer your phone calls at all hours of the day, and if your vet does do that (as the market in this small town might require because it is too small to support an emergency clinic), then that service will come at a premium. Being on-call creates a terrible quality of life (1). You are a slave to the phone, feel like you can never go anywhere or do anything because what if there is an emergency. You start hearing your ringtone in your nightmares and feel a sense of dread whenever your phone rings. Not to mention the effects of being āat workā 24/7 have on your family. With the exception of OB-GYNs, even human medicine has largely eliminated on-call because of this. And if you have to be on-call, it must be worth it. So there will be an associated cost. </span><br />
<span class="s1"><br /></span></div>
<div class="p1">
<span class="s1"><b>Fair and Reasonable Cost </b>Everyone has a different definition of āfair and reasonableā pricing. The truth is that some people will complain even if the exam fee is only $10. But to the vet, fair and reasonable means being able to pay for the cost of maintaining the facility while remaining affordable for clients. Most vets are not greedy. Truly. Yes, there are a variety of types of people in every profession, but most vets really do want to help you for as low cost as possible. I think sometimes pet owners forget that vet practices are in business. They have to charge in order to keep their doors open, and there is no government subsidy like there is for human hospitals. </span>My boss pays the mortgage, electric bill, water bill, payments on the x-ray machine, the blood machines, fixing and replacing instruments as they wear out, paying the lab and the outside services we use, purchasing all the materials and drugs we need to run the practice, then fairly compensate all the staff. Well paid staff work better. They like their jobs more, do their jobs better, and less mistakes are made when people are happy. That translates to better care for your pet. And the cost of care has risen. Excellent, top notch care will cost you more.<br />
<span class="s1"><br /></span>
<span class="s1">Low cost clinics and options are available and serve an important purpose in helping lower income families get preventive care for their animals. The cost of a neuter surgery will be very different between a low cost clinic and a general practice. </span>Low cost clinics are still profitable, but sacrifices must be made in order to cut costs. And those sacrifices are not to the practice ownerās pocket. To the pet owner, the cut costs are invisible. Two pet owners drop their dogs off for surgery, one at a low clost clinic and one at a general practice. The incision will look much the same, the bill will look different. Even though the procedure was the same, things were done differently in order to save costs at the low cost place. Just donāt translate that low cost to mean that your regular vet is OVERCHARGING you. Each is charging appropriately for their services. </div>
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<span class="s1"><span class="Apple-converted-space"><br /></span></span>
<span class="s1"><b>Excellence</b> This request is the only one I feel is reasonable. Like most people drawn to veterinary medicine, I am a Type A perfectionist personality, and I want to offer the very best of care while being compassionate to my clients and patients. Being compassionate doesn't cost me anything. In fact, being the opposite WILL cost me - it will cost me my clients, business, and reputation. However, gold standard care does have a cost associated with it. In order to offer digital xrays, ultrasound, the safest anesthesia, diagnostics to obtain the correct diagnosis - we the veterinary clinic have to pay. We pay in time spent learning, and we pay for the raw materials. We cannot eat those costs and be profitable.</span></div>
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<span class="s1"></span><br />
<br /></div>
<div class="p1">
<span class="s1">The cost of care is a complex issue. There are many factors at play, and due to the increasing sophistication of veterinary care, which meets or sometimes exceeds that of human medicine, costs have risen. In veterinary medicine, we are struggling to find a medium between being able to provide gold standard care at a āreasonableā cost for pet owners. We don't want care costs to be so high that we can't treat and fix our patients. Veterinarians 'push' preventative care because preventative care is generally cheaper than fixing things after they happen. For example, heart worm prevention is approximately $240 per year. Heartworm treatment is a one time cost of $3-5000.<span class="Apple-converted-space"> </span></span>Pet insurance will help people cope with these rising costs for sure, but if pet insurance becomes like human insurance, the cost of veterinary care will increase.<br />
<br />
Thank you for reading. My intention with this post was to offer some insight into why costs are what they are. I hope you have found this information valuable.<br />
<br />
<br />
1. "Psychological Toll of Being Off Duty but On-Call" https://digest.bps.org.uk/2015/09/10/the-psychological-toll-of-being-off-duty-but-on-call/</div>
Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-24059736050044099792017-09-28T19:16:00.000-07:002017-09-28T19:16:47.320-07:00Appreciation There are so many stories that need I need to write, and so little time. Here's one from today.<br />
<br />
A client called to tell me she was moving back home to be closer to her family. She first came to our clinic about 9 months ago. A recent stroke survivor, she had some difficulty communicating and with her memory, although I could understand her without any trouble.<br />
<br />
Her first time in the clinic, she was looking at her phone to write down her address on the client info sheet, and she couldn't remember her phone number. After helping her search through her phone, I finally just texted myself from her phone so we could get the number and write it in the chart. It was a small thing to me, but she thanked me and apologized for being a 'nuisance.' I told her it really was no trouble. I saw her dog a handful of times and enjoyed every visit.<br />
<br />
A few days ago, I learned of an impending backorder on a medication her dog needs. I called her to let her know she may want to acquire a bit of a stockpile, since the medication is essential for her dog's continued health. After 3 or 4 phone calls later, we got it straightened out and I called in a large quantity to her pharmacy.<br />
<br />
Today, she called me to let me know she was moving away again.<br />
<br />
"I'm not sure if I told you the other day," she said, "but I'm moving back to ___."<br />
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I replied, "Oh, thank you for letting me know. It was a pleasure knowing you and let me know if I can help you with anything."<br />
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She said, "I want to thank YOU. I want you to know I appreciate YOU. You are the only person I am calling in California with this news. If I ever come back I will be sure to come and see YOU. Thank you for all of your help."<br />
<br />
I am so honored that she felt strongly enough about this to call and tell me. It was really wonderful to hear and made my day. I will be sad to see her leave our practice because she is such a nice lady and I like her dog also. But I'm happy she will be moving closer to family. Live long and prosper, E.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-90776080197135303712017-03-29T13:42:00.001-07:002017-03-29T21:40:51.183-07:00The Handsomest Cat<div class="separator" style="clear: both; text-align: center;">
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On March 14, 2007, a young grey and white cat was found scrounging for food in a McDonald's dumpster. He was picked up and taken to an animal hospital down the road and named "Shamrock Shake," since that was the special treat at McDonald's at the time for St Patrick's Day. He was a stinky intact male tomcat who desperately needed a bath and a neuter.<br />
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I worked at an animal clinic that took in stray cats and fed them until they found homes. In the morning all hospitalized animals needed cages cleaned and changed, and new food and water. I never did the strays because I couldn't have pets while still living at my parents home, and I didn't want to fall in love with a kitten I couldn't keep. Until one day.<br />
<br />
I walked into the cat ward, and in the first cage was a grey cat who immediately began pawing at me through the bars and rubbing his head all over. I opened it up and he was just as happy. He was handsome. I looked at his cage card and saw it said Shamrock Shake.<br />
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<tr><td class="tr-caption" style="text-align: center;">Dublin in F-Ward at WVMC</td></tr>
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Later he had his neuter surgery. A knot slipped and he hemorrhaged little. NBD. Then when he was healed, I gave him a bath. He just sat there letting me bathe him, and stared off into the distance like his life was over. But it had just begun.<br />
<br />
He was put on the adoption board as a young, active, 9 month old cat. He was taken home and returned twice, once because he was a gift and the receiver did not want a cat, and once because he was too old and they wanted a younger kitten. After the second time, I couldn't bear to let him be rejected again. I added him to my account and changed his cage card. "Shamrock Shake" would have to go though. I enlisted help from my teammates. We decided to stick to the Irish theme. One of the assistants suggested Clover. Too demure. How about Dublin? Yes.<br />
<br />
My fiancƩ was soon returning home from Oregon so we could attend his cousin's wedding in April. I called him and told him that before he left, he should go out and procure a litter box, litter and cat food because he would be returning with a cat. <br />
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"But I don't want a cat." He said.<br />
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I said, "Well it's not up for discussion. You'll learn to love him." And...<br />
<br />
Two days after arriving at his new home 2800 miles away from that dumpster, he was sleeping on my pillow next to my future husband. He has been my husbands favorite cat since then.<br />
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<tr><td class="tr-caption" style="text-align: center;">On my pillow</td></tr>
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<span style="text-align: start;">Later that Spring I received my acceptance letter to vet school. When I brought Bella out two months later, he accepted her immediately and they became so close, I had to leave them together in Oregon when I went to school.</span><br />
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<br />
As they aged and became more mature, my husband started calling him Fatman, even though he really wasn't that fat. We also referred to him as Handsome Man, Little Buddy, and Bud-bud. We really only started calling him Dublin again once my daughter could talk, since we didn't want to teach her it was ok to call furries or people fat.<br />
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He was super sweet, never hissed or tried to bite or scratch anyone. He was cautious, preferring to hide first and ask questions later if someone knocked on the door. He was always the last to come out and meet people. He was intensely playful, and would jump in for a game any time. He chased the laser pointer with a sniper's focus. He attacked toy mice with a frenzy worthy of Nat Geo. He trotted around with his tail ramrod straight up in the air, except that time Bella did something to him and it was down for a few days. He never ate wet food but he did have a penchant for Chinese.<br />
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<tr><td class="tr-caption" style="text-align: center;">Catnip was a favorite</td></tr>
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He never sat on our laps unless forced but he was always near us and wanting to be scratched. He loved to be furminated but pretended he hated it. He had a substrate preference for soft, fluffy towels and would ball them up and urinate on them whenever he had the chance. This actually worked out well because it trained my husband to not leave towels on the floor. He loved watching birds and laying in the sun. He wanted to go outside so we got him a harness and let him go out occasionally. I even had plans to build him an outdoor cat enclosure so he could go outside and breathe the air.<br />
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<tr><td class="tr-caption" style="text-align: center;">Dublin in the Sun</td></tr>
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When Sophie arrived on scene, she started bullying him. He backed down even though he was easily twice her size. He accepted Alice without anything except curiosity. He even warmed up to my daughter and eventually let her pet him and stroke his tail, and he would rub against her. He loved to have his whiskers scratched.<br />
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<tr><td class="tr-caption" style="text-align: center;">On the porch in Portland</td></tr>
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<br />
He began losing weight 6 months ago. He had a long standing heart condition that was controlled with medication and practically non-existent. Every test I ran came back normal. I posted his case on VIN and in Facebook groups for vets. I asked colleagues for ideas. I thought it might be intercat stress and tried everything I could think of to reduce stress in the house, but <i>my</i> stress increased and was sustained as he continued to lose. Eventually I started him on mild treatment for GI disease presuming that's what it was since no other cause could be found. Still nothing worked and he finally went in for endoscopic biopsies. I was substantially worried to leave him, but I had a previously booked girls trip starting the day after his biopsies were taken.<br />
<br />
The day after I left, he had a saddle thrombus and my poor husband had to take his favorite cat to be euthanized without me.<br />
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I am so heartbroken. I wasn't there for him when he needed me most, I wasn't there for my husband or daughter to ease the pain of this. I couldn't have predicted this or done anything to fix it, but I still feel like I failed him as a vet and mother. I could have sought more help, taken him to the cardiologist, did more investigating, something.<br />
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My little buddy, I am so sorry for the pain you went through. I am so sorry I wasn't there to support you in your last moments. I am so sorry for bringing three bitchy cats into your life and letting them boss you around. I will forever treasure your sweet gentle spirit and I hope you can forgive me. I hope you are running free and chasing birds like you always wanted. I hope I will see you again someday. I love you--love, mommy<br />
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<tr><td class="tr-caption" style="text-align: center;">The Handsomest Man</td></tr>
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-----<br />
Other Blogs featuring Dublin:<br />
<a href="http://mmendingwall.blogspot.com/2012/06/professional-courtesy-and-pay-it.html">Professional Courtesy and Pay-it Forward</a><br />
<a href="http://mmendingwall.blogspot.com/2011/09/mirrored-cats.html">Mirrored Cats</a><br />
<a href="http://mmendingwall.blogspot.com/2011/08/three-bad-cats.html">Three Bad Cats</a>Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com1tag:blogger.com,1999:blog-8869082646582125989.post-19705572454711089032017-02-28T18:18:00.001-08:002017-03-29T21:43:52.537-07:00YES it fucking hurts and other idiocy Lately I feel like I am defending everything I say in the exam room. I have to compete with Dr. Google constantly. I don't just have to explain things. I have to actually convince owners that I know what I am talking about. (If I really don't know what I am talking about, I will tell them I don't and we will discuss where to find someone who does. That's called referral).<br />
<br />
For example. A client came in with a clearly limping cat and said the cat got out a few days ago and came back limping. It hasn't gotten better, so she brought the cat in for an exam.<br />
<br />
Many times, limping cat appointments are unrewarding because the adrenaline of the vet visit masks pain and so the cat often will not show any limp or pain during it's exam. This time though, anybody could have seen that the cat was favoring it's left front leg.<br />
<br />
I recommended radiographing the leg and some pain medication to take home, assuming no bones were broken. The owner agreed that this was a reasonable plan. But, once my receptionist went in with my estimate for exam, radiographs, and pain management, the owner flipped out, said the cat is not in pain "He's just limping" and took him home without any treatment.<br />
<br />
Well, when was the last time you hurt your foot? Pulled a muscle? Did you limp around, screaming in pain constantly for days after you stubbed your toe? NO!<br />
<br />
It is a common misconception (I'm not sure why, honestly) that if an animal is not crying out, it is not in pain. Animals have an instinct to hide pain and illness for many reasons including self preservation. Most animals WILL NOT continuously cry out in pain from minor or even major injuries. If a cat or dog is screaming in pain constantly, obviously that warrants immediate attention. However, silent pain is there and deserves equal respect and attention.<br />
<br />
Animals do not limp just because it's fun. You or I don't hop down the street on one leg just for the hell of it. They limp because they cannot bear to put their full weight on that limb.<br />
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I recently broke some bones and dislocated a rib. I didn't cry when it happened, but have been in pretty constant pain since. But I am still sitting here quietly writing this blog on my lunch break where I am back at work full time, driving, and doing all my regular activities without screaming in pain constantly.<br />
<br />
So therefore, yes, it fucking hurts.<br />
<br />
Ultimately I think this comes down to ---- duh-duh-na-nah! Money. She probably didn't have the money or didn't want to have the money for the recommended plan, but instead of asking if we could just try pain meds first, she decided to get angry and leave with nothing, except her painful cat.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-28916445421433562392016-12-04T14:02:00.002-08:002016-12-04T19:56:33.898-08:00GlimpseThis is going to sound like a whiny post, but it really is a plea.<br />
<br />
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 <i>live </i>a vocation.<br />
<br />
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."<br />
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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.<br />
<br />
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.<br />
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And I'll see countless appointments, and then begin a whole new cycle of wondering and thinking.<br />
<br />
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.<br />
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So please, just appreciate your vet. That's all I ask.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2tag:blogger.com,1999:blog-8869082646582125989.post-15003015172565138332016-09-24T15:12:00.000-07:002016-09-24T15:24:28.546-07:00QOTD 2Client: 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.<br />
<br />
.....<br />
<br />
Technician asks of a rather overweight male cat: Is he neutered?<br />
Client: Yeah, but I think they grew back a little bit.<br />
<br />
.....<br />
<br />
Technician: Is she on any medications?<br />
Client: Just the medication of love!<br />
<br />
.....<br />
<br />
Client: We finally figured out what breed she is.<br />
Me: Oh?<br />
Client: Yeah, she's a (insert rare dog breed here).<br />
Me: Oh, but you got her at the shelter, huh?<br />
Client: Yeah. They didn't know either.<br />
<br />
.....<br />
<br />
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."<br />
<br />
Mr. Doesn't have a clear grasp on the situation at hand: "Oh no, don't worry he's super trained."<br />
<br />
<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-82572647338581859862016-09-08T13:28:00.000-07:002016-09-08T13:28:36.421-07:00Overcharging Folks on a Fixed IncomeI 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.<br />
<br />
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."<br />
<br />
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.<br />
<br />
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."<br />
<br />
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.<br />
<br />
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."<br />
<br />
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.<br />
<br />
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 <i><a href="https://en.wikipedia.org/wiki/Bubonic_plague">Yersinia </a></i>or <i>Bartonella </i>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.<br />
<br />
(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.<br />
<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com1tag:blogger.com,1999:blog-8869082646582125989.post-35487700230832450372016-05-14T07:29:00.001-07:002016-05-14T07:29:52.471-07:00The Worst part is Not KnowingLet 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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 <i>SAT UP.</i> He opened his eyes. He was breathing, and alive.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-25432361467194674032016-04-29T21:47:00.000-07:002016-06-13T17:53:47.289-07:00The No List of Dog BreedsMany 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.<br />
<br />
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.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/d/d9/Collage_of_Nine_Dogs.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="562" src="https://upload.wikimedia.org/wikipedia/commons/d/d9/Collage_of_Nine_Dogs.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Source: Wiki</td></tr>
</tbody></table>
<br />
<br />
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:<br />
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1. <b>Bulldogs. </b>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 href="http://mmendingwall.blogspot.com/2012/08/why-i-hate-breeders-and-bulldogs.html">a post </a>about them. Blech.<br />
2. <b>Wheatens</b>. See above re: allergies. Also generally ill mannered.<br />
3. <b>Vizslas. </b>Crazy in general, wildly energetic<br />
4. <b>Australian shepherds and border collies</b>. Too schizo, too smart for their own good. Commonly get mental problems from lack of proper stimulation and exercise.<br />
5. <b>Labradoodle. </b>not a breed, a mutt. No 'designer' mutts for me, mostly on principle.<br />
6. <b>Weimaraner. </b>see Vizsla, mast cell tumors<br />
7. <b>Labradors. </b>Allergies, chronic ear infections, eat everything in sight. I like my shoes.<br />
8. <b>Shih-tzus. </b>Eye diseases, skin diseases, dental disease.<br />
9. <b>Chihuahuas.</b> Big jerks in little bodies, dental disease, MPLs, heart disease.<br />
10. <b>Jack russells. </b>Even bigger jerks, they all try to bite me, and too much wild energy.<br />
11. <b>St. Bernards. </b>Too big, and too drooly.<br />
12. <b>Boxers. </b>Cancer, cancer, cancer. MCT, heart diseases.<br />
13. <b>Pit bulls. </b>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!<br />
14. <b>Chinese Shar-pei. </b>Pretty much always a jerk, I know one nice one. Also amyloidosis of the kidneys, skin diseases, weird fever disease<br />
15. <b>Schnauzers</b>. Pancreatitis, metabolic diseases<br />
16. <b>Westies</b>. Stinky skin, skin, skin.<br />
17. <b>French bulldogs. </b>Waaayy overbred nowadays, back problems, breathing problems, too pushy.<br />
18. <b>Great Danes. </b>Giant, clumsy, spinal instability, big dog = big money. I already own a horse.<br />
19. <b>Greyhounds</b>. Osteosarcoma. Otherwise great couch potatoes!<br />
20. <b>Chesapeake Bay Retriever. </b>Just jerks.<br />
21. <b>German Shepherds. </b>Hips, immune diseases, Gi diseases. generally too high strung.<br />
22. <b>Cocker spaniels. </b>Chronic ear infections, immune diseases, heart diseases, metabolic diseases.<br />
23. <b>Huskies.</b> So mentally unstable, not very sociable, GI diseases, auto-immune disorders.<br />
24. <b>Pugs</b>. Can't breathe, too noisy, also chronic skin issues, eye problems.<br />
25. <b>Beagles</b>. Loud (baying), allergies, don't follow anything but their noses.<br />
26. <b>Cavalier King Charles.</b> So cute, but heart disease, ear disease, spinal disease, just no.<br />
27. <b>Poodles.</b> Nice dogs but the hair! too high maintenance. I don't even brush my own hair.<br />
28. <b>German Shorthair Pointer</b>. 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.<br />
<br />
Obviously, there are a whole ton of other breeds, you can rest assured that most of them are NOs.<br />
<br />
Now for the yes'. <span style="color: red;"><b>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. </b></span><br />
1. <strike><b>Shelties.</b> </strike>Perfect size, great temperament, some eye problems but overall a healthy, quiet, breed. Because of this I will deal with the hair.<br />
2. <b>Whippets. </b>Perfect size, quiet, not many issues. Lots of exercise needed but not psycho.<br />
3. <b>Dobermans.</b> Happy dogs, have a few problems (heart, bleeding disorders) but great temperament and good family dog.<br />
4. <b>Flat-coated retrievers. </b>All the happy-go-lucky of the golden retriever without the cancer and allergies.<br />
5. <b>Cats. </b><br />
<br />
<br />
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!<br />
<br />
<span style="color: red;"><b>Updated: Since this post went live I have adopted a sad sack cat. </b></span><br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2tag:blogger.com,1999:blog-8869082646582125989.post-49614944325153666612016-02-29T15:00:00.000-08:002016-02-29T18:28:45.962-08:00Bonus 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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:<br />
<br />
1. Did that really just happen?<br />
2. I need to call the police.<br />
3. I'm so glad I bought myself cheetos.<br />
<br />
I went back to work and called the police, and several cars drove around looking for her. I don't think they found her. <br />
<br />
I contemplated the odds of this ever happening again while eating my cheetos. They're 10 points per bag, by the way.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2tag:blogger.com,1999:blog-8869082646582125989.post-22939136340257256432016-02-28T20:57:00.000-08:002016-02-28T20:57:46.078-08:00February 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.<br />
<br />
As we end the Worst Month of the Year (see<a href="http://mmendingwall.blogspot.com/2015/02/february-is-worst-month.html"> last February's post)</a>, it's time to recap the most notable cases and events from this month.<br />
<br />
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.<br />
<br />
"Well, I'm not going to spend a thousand dollars on this dog."<br />
<br />
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 <a href="http://www.yoox.com/US/45284533/item?gender=D&cod10=45284533VN&kpid=US-45284533VN-1-PE16&adtype=pla_with_promotion&adpos=1o7&creative=72160895687&device=c&matchtype=&network=g&tp=107970&gclid=CNrogN2b3coCFVA7gQodm2sAEQ#cod10=45284533VN&sizeId=1">purse</a>? 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. <br />
<br />
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.<br />
<br />
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.<br />
<br />
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 <a href="http://gis.oshpd.ca.gov/atlas/topics/financial/common_surgery">average cost is $76,000. </a><br />
<br />
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.<br />
<br />
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.<br />
<br />
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. <br />
<br />
"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."<br />
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"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.<br />
<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-35538140280244747762015-11-08T06:59:00.000-08:002015-11-08T06:59:22.161-08:00Retractable leashes: Just Don't Do ItIf there is one thing that veterinarians seem to agree on regarding leashes and collars for dogs, it's that<br />
retractable leashes are a horrible invention and should be banished for all eternity. Retractable leashes have many flaws and worst of all, the people that seem to use them are the people who also do not train their dog, which can be a deadly combination.<br />
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Because people like to read (and write) lists, here is my top seven list as to why you should throw out your retractable leash, immediately. Or burn it, so you can't be tempted to go get it out of the trash and use it again.<br />
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<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-9AW69xNnn0Q/Vj7VHzi0p2I/AAAAAAAADaA/0BfywlfhfbU/s1600/retractable-leash.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-9AW69xNnn0Q/Vj7VHzi0p2I/AAAAAAAADaA/0BfywlfhfbU/s320/retractable-leash.jpg" width="320" /></a></div>
1. <b>HBC. </b>Dogs get hit by cars <i>while attached to retractable leashes</i> that are often still being held by the owner. It's easy: put your dog on a retractable leash. Turn the other way for 2 seconds. Or don't. Your dog sees something and runs out into the street to get it. Bam. While that may be insensitive, I have personally seen it happen and it is perhaps the most likely reason to change people's minds.<br />
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2. <b>Amputation. </b>The locking mechanism always seems to break or not work at precisely the wrong time. [See above]. When said dog runs into the street, or even after a SQUIRREL! or small dog, the locking mechanism fails, and the owner tries to get control of the dog by grabbing the cord. <a href="http://www.consumerreports.org/cro/news/2009/03/retractable-leashes-pose-problems-for-people-and-their-pets/index.htm">People have lost fingers this way.</a> (This is why most newer ones have a fabric pull instead of a cord, but even that can cause serious burns). <br />
<br />
3. <b>Snap-back.</b> The cord can break if the dog pulls hard enough, and the end attached to the dog can fly forward and injure the dog, and the part attached to the human can whip back so fast it can cut people's faces. This can even happen with small dogs, especially with a an older leash or one that has been chewed.<br />
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4. <b>Follow the Leader. </b>Dogs should walk next to you on walks, not all over the place. A walk is a journey in which the human is the leader and makes the decisions. This is a way to bond with your dog and teach them you're a pretty good leader. If a dog is in front, to the side, at a northwesterly direction, behind, diagonally, the human is not making the decisions. The dog is. And dogs inevitably make poor decisions. Like going straight into the dumpster. Your dog should walk at your heel and pay attention to your lead and where she is going. This cannot occur with a retractable leash unless it is kept short, so just do yourself a favor and get a regular flat leash.<br />
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5. <b>Pull harder. </b>Many people ask me how to get their dog not to pull on a leash. And rightly so, because it is rude on the dog's part and unpleasant for the handler. The first thing I say if they have a retractable leash is to - get rid of it! Man, you're getting good. Retractable leashes teach dogs to pull, because they can feel the traction as they pull forward, and they get rewarded for pulling forward because they are getting closer to whatever it is they want. I usually recommend Gentle Leaders because they do not allow dogs to pull, but do not even think about attaching a retractable leash to one. That should be a punishable offense, because the two opposing forces will create discomfort and confusion in the dog.<br />
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6. <b>No recall. </b> A dog that does not immediately come when called has no business being on a 26 foot leash where he could get into all sorts of trouble at the other end.<br />
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7. <b>Lack of Control. </b>The vet's office is no place for a dog to be on a retractable leash. There are many other animals in close proximity so control of the dog is essential to prevent altercations. You will probably see your vet or technicians remove the leash and place a sliplead on the dog. This is to ensure the safety of the dog and the people around him by ensuring that he cannot get too far away from the handler, or too close to the other people working with him in case he feels the need to defend himself. One of the most aggressive dogs I have ever seen was brought to me on a retractable leash. And the dog knew that he had a lot of leeway in his leash, and lunged at me. And the owner could not pull him away quickly. Luckily I am pretty quick and got out of the way, but we had a serious discussion which included analogies to loaded guns.<br />
<br />
Retractable leashes do nothing for training. And poorly trained dogs do not belong on the end of a retractable leash. There may be a case where a retractable leash is appropriate but I honestly cannot think of one.<br />
<br />
Bottom line is: to control and protect your dog, and to protect yourself and others, do not use retractable leashes.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-74436881059032163122015-09-15T13:57:00.000-07:002015-09-15T13:57:21.443-07:00A Bit Early for Halloween? Look! Two posts in one month! What is happening around here?<br />
<br />
A lot of my job involves sitting or crouching on the floor to get a look at my patients, especially the larger dogs. It's pretty hard getting them up on the table (no hydraulics) and anyway its kind of fun to crawl around on the floor professionally. What other professional position gets to do that?<br />
<br />
So I'm sitting on the floor next to a dog the other day, talking to his owner. The dog was sitting next to his owner who was sitting on a chair with one leg crossed over the other. So her feet (which were in her shoes) were basically just below my eye level, and happened to be where my eyes fell naturally as we were talking.<br />
<br />
As I was talking about the dog's diagnosis, I happened to notice that her shoes had cobwebs on them. Ok, no biggie, maybe she rushed out in a hurry and doesn't usually wear these. Maybe they were stashed in the garage next to some broken tennis rackets and a deflated basketball. But upon closer inspection, I saw that the cobwebs actually extended from her shoe to the leg of her pant... and that there was a tiny spider sitting in the middle.<br />
<br />
I kind of leaned in a little closer to confirm what I was seeing, and noticed webs on the other shoe connected to the back of her foot.<br />
<br />
For the life of me I cannot explain how you put on a shoe and have a spider weave a web between your shoe and pant leg unless the shoes had been on your feet for quite some time, and you sat very still and patiently waited for a spider to come along and weave a web. I mean, WTF?Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com1tag:blogger.com,1999:blog-8869082646582125989.post-83524415246293956852015-09-09T16:09:00.001-07:002015-09-09T16:32:07.180-07:00Kill 'em with Kindness... and Flea ControlOne of my favorite things ever is when people tell me they don't use flea control. Usually because their pet doesn't have fleas, or maybe it's because it doesn't go outside. Or it's the 'winter' and they can't get fleas in the winter. Sometimes they don't want to put 'chemicals' on their pet, and sometimes they are just cheap. (Actually, I really think it comes down to money most of the time... everything does). Meanwhile, the poor pet is suffering at the very least from having fleas crawling all over its skin to the very worst, having severe allergies, skin infections, and potential blood or intestinal parasite infections, <i>on top of</i> having fleas crawling all over its skin. Or, more accurately, underneath.<br />
<br />
Yesterday, which was my last day of work before a much needed staycation this week (!), a guy came in with his dog. This client has a history of arguing with receptionists on the phone, declining all flea control and preventive care, and only doing the bare minimum for his dog. My technician came back with the chart and told me she had to put him in a room in front of another client because he was in the lobby bemoaning how much veterinary care costs and his last clinic was nothing but a bunch of money grubbers out to get him. When she asked what flea control the dog was on, he said he doesn't like flea control and he gives the pup a bath as needed. I decided to kill him with kindness to see what would happen.<br />
<br />
"Hi, I'm Dr. M. How are you and the pooch doing today?"<br />
<br />
"Great! I'm Mr. X."<br />
<br />
"Let's take a look at Mr. Wiggles here."<br />
<br />
After all the niceties, I begin looking at the dog which has fleas, thinning hair and an obvious chronic skin irritation and infection. Now that I've got him all nice and comfortable, I cut to the quick and say to Mr. X, "So, what do you have against flea control?"<br />
<br />
"Uh, err, well, umm, ehh--- does he have fleas?"<br />
<br />
That's right. Mr. X could not even answer me. He could not come up with EVEN ONE REASON (that he wanted to share) for why he wasn't using flea control.<br />
<br />
I informed him that yes, indeed the dog did have fleas. They're not microscopic after all, you can see them with the naked eye. The two of us then proceeded to pluck fleas off the dog like a bunch of monkeys. (Except we didn't use them as a tasty snack, as monkeys are wont to do. But anyway, I digress.)<br />
<br />
"Fleas are more than a nuisance," I say, popping a flea on the table. "They also carry tapeworms, and some nasty bacteria, including the plague. You know, the black plague from the middle ages."<br />
<br />
"Ew, that's gross," he says.<br />
<br />
"Yep. Also, he is probably allergic to fleas, so every bite makes him super itchy, and then he's created this infection from scratching and chewing. He'll feel much more comfortable with regular flea control and some antibiotics."<br />
<br />
He actually says, "Wow, ok. I guess I need to get some flea meds." And then actually does! A whole year's supply! WHAT, I know, I was shocked, too.<br />
<br />
Of course, then there is always the whole following through part....<br />
<br />
<br />
<br />
__<br />
Also, sorry for not posting in 4 months. :|Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2tag:blogger.com,1999:blog-8869082646582125989.post-53261397642529125322015-05-18T16:18:00.001-07:002015-05-18T20:20:11.749-07:00Victory! In case you haven't heard, Blue Buffalo was sued last year by Purina for false advertising. <a href="http://mmendingwall.blogspot.com/2014/05/blue-buffalo-sued-for-false-advertising.html">Here's my post about it from May 2014. </a>Blue's initial response was akin to their typical techniques of using slander and inflammatory language to defend themselves. After exactly one year to the day, Blue admitted in court that their foods contained by-product meal. You can read more here: <a href="http://www.prnewswire.com/news-releases/purina-a-year-to-the-day-after-being-sued-blue-buffalo-finally-admits-by-product-meal-in-a-substantial-and-material-portion-of-their-pet-food-300079805.html">Blue Buffalo Admits to By-Products in Food</a>.<br />
<br />
Once again, there is nothing inherently bad about by-products. By-products are just food materials that are not used by the human food chain and can be very nutritious, especially by-product meals which are inherently concentrated sources of protein. They are used commonly in pet food because they are a readily available "cheap" source of animal protein. I put the word cheap in quotes because if you compare the amount of protein in a meal to the amount of protein in a cut of meat, say a chicken breast, you would need more chicken breast to meet the same amount of protein that is in the meal and since the breast is higher priced to begin with (because it is desired by the human food chain) it would be substantially more money. That would make pet food much more expensive than it is already. Blue, who has up until this point claimed that only whole cuts of meat are used in their foods, and who charges a pretty penny for their foods, was using by-products just like all of the other companies who they have maliciously slayed in their advertising.<br />
<br />
Blue now claims that they didn't know that there were by-products in the foods they were selling as by-product free, and blamed their suppliers. I'm not sure which is worse - not actually owning up to your mistakes and apologizing for them, or not actually knowing what is going into your product, which you sell to unsuspecting pet owners to feed actual pets. Either way, throwing companies that work for you under the bus is another dick move, but one that is wholly unsurprising from Blue.<br />
<br />
Lastly I have heard that Blue now has reps they will be sending to veterinary offices to try to get vets to recommend their food. Ha! I'll try to record that conversation if it happens. Should be pretty entertaining.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-90790407612057141222015-04-21T16:45:00.003-07:002015-04-21T16:52:32.371-07:00Fluorinated Water and Coconut Oil <a href="http://informationng.com/wp-content/uploads/2014/04/image-angry-cat-face-dark-souls-wiki_419487.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://informationng.com/wp-content/uploads/2014/04/image-angry-cat-face-dark-souls-wiki_419487.jpg" height="300" width="400" /></a>So these people call because their mean outdoor cat got in another fight and has an abscess again. They were just here! Oh wait, that was a year ago. For the same problem. They come in stinking of cigarette smoke and unwashed clothes and the cat is already hissing.<br />
<div>
<br /></div>
<div>
My nurse goes into the room. "Hi, How's Fluffy doing today?"</div>
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"Well, he's okay, but see I can't pet the cat, only he can pet the cat." "Yeah, only I can pet the cat but only when he wants to be pet. You see, he is outdoor mostly, he came to us as a stray and only lets me pet him. Sometimes." "Yes, I'm the only one that..." A further 10 minutes of this conversation ensues while my nurse walks out of the room without having any of her questions answered.<br />
<br />
I walk in. "Hi I'm Dr. M. So, he got in a fight again? How long ago was it?"<br />
<br />
"Oh, a week maybe. But it just closed," the woman says, "because I put coconut oil on it!" She looks like a washed up hooker from the 80s. "Have you ever tried coconut oil?"<br />
<br />
"Um no. So we need to drain the abscess, and we are going to have to sedate him. I'm also going to give him an antibiotic injection."<br />
<br />
The husband says, "Ok." The wife says."Ok. Will he get a cone? Because he got one last time, I remember. You know, I stopped drinking fluorinated water 20 years ago, and my memory is better than ever." She then gives me a knowing smile and nods.<br />
<br />
"I've been drinking fluorinated water my whole life."<i> ::and I think to myself, 'and which one of us is the doctor in this room?'::</i><br />
<br />
She says, "Oh, well have you seen the latest research out of Europe?"<br />
<br />
"Um, no I haven't. So-"<br />
<br />
"Well you should look, very interesting stuff, fluorinated water is very bad for you, you should stop drinking it. Your memory will improve."<br />
<br />
"Ok, I'll think about it. Meanwhile, let's fix this abscess."<br />
<br />
I have to leave the room while she is still talking because she just won't stop no matter what signals I try to give her, such as changing the subject, standing up, opening the door, and walking out.<br />
<br />
We sedate the cat and lance the abscess. He wakes up. I go out to the lobby to tell the owners that he is awake and all went fine. "So," I say, "you're going to need to keep the hole open for the next day or two so it keeps draining."<br />
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The husband begins nodding his head in understanding. The wife says, "Ok, so should I put coconut oil on it?"<br />
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I start to shake my head and say no when she immediately asks "How about hydrogen peroxide?"<br />
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I say no, and that H2O2 kills healthy cells plus it burns. The husband says, "Yeah, you don't use hydrogen peroxide," whereby the wife interrupts immediately and says "Let her talk!"<br />
<br />
I continue explaining that they will need to allow the abscess to drain and the husband nods in understanding. The wife stares at me confusedly and asks me if he's going to have an e-collar. I tell her no, he doesn't need one this time. She says, "But he had one last time! I remember!"<br />
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"Last time," I say, my patience running thin by this point, "he had a drain which he could have pulled out. He didn't need a drain this time, I just need you to keep the area clean and keep it open to drain." (Admittedly, too many uses of the word 'drain' for her addled brain).<br />
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Then she says, "Oh! I know! I'll put coconut oil on it, that'll close it right up!"<br />
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I sigh as the husband tells her that no, we want to leave it open and she tells him to Let me Speak! again. I just look at her for a moment resignedly. "Ok, what are we supposed to do again?" She asks.<br />
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"Would you like me to write it down for you?" I ask. She nods, apparently forgetting that her memory is killer now that she stopped drinking the fluorinated water.<br />
<br />
I go sit down at a computer and type instructions, while drinking a glass of [fluorinated] water.<br />
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Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com0tag:blogger.com,1999:blog-8869082646582125989.post-23380454036986803032015-03-31T13:01:00.000-07:002015-03-31T13:01:06.822-07:00Strong Women <a href="http://therumpus.net/sections/dear-sugar/" target="_blank">Dear Sugar</a>, the advice column, is back. Only now it is a most excellent Podcast by the two Sugars, Cheryl Strayed and Steve Almond. If you've never read Dear Sugar, it's not your typical advice column. You'll find no Miss Manners here, as Sugar deals with everything from sexuality to drug addiction to family dynamics. At the core of most of Sugar's advice is that it's okay to be your true self, whatever that may be. It really resonates. I read the column for a few years, then Sugar was revealed to be Cheryl Strayed, who had just released her book Wild, and a collection of Dear Sugar columns, called Tiny Beautiful Things. Dear Sugar went on hiatus while Cheryl promoted her books and the Wild movie.<br />
<br />
I was excited to learn Dear Sugar was back, and subscribed to the podcasts. (I finally found something I can do with that 50 minute commute!) The <a href="http://www.wbur.org/2015/01/23/dear-sugar-episode-two" target="_blank">second Podcast episode </a> deals with a letter from a woman who suffered extreme emotional degradation at the hands of the man she loved, and she questions if all men are like that, and if there are any men out there who really respect and love women. The Sugars discuss feminism and how deeply ingrained in our culture it is for men to degrade women as a means of controlling them.<br />
<br />
Last week I was talking to a man who I know, not personally but in a professional manner. Although I'm not going to disclose the nature of the conversation, I will say that it was not my boss, or a client or anyone close to me. During our discussion, there came a point where he actually was making a case for me to NOT go for the thing I wanted to go for, and his justification was that I already had a pretty good thing to begin with, and I should just be grateful for what I had and not have higher ambitions. (I know this would make more sense if I actually told you the details, but you'll just have to trust me). <br />
<br />
He was telling me what men have been telling women for decades, if not centuries. You're lucky you have this much! You're lucky we gave this to you. You don't deserve more.<br />
<br />
I wasn't going to just sit back and listen to that load of codswallop, so I called him on it. He said he didn't mean it that way, and the truth was, he didn't really mean to say that I didn't deserve more. And that is what is so frightening. Pushing women down, "keeping them in their place," is so ingrained in our culture that men often don't recognize it in their own behavior. It's how they were raised. Boys are taught that women are the weaker sex. Male body parts are used to describe bold, confident behavior. Female body parts are used to describe weakness and cowardice.<br />
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It is common knowledge that women are paid less than men for the same work, across all disciplines. It's still happening today, despite being known. Women are still portrayed in movies as being only concerned with relationships and their worth determined by their appearance or the status of the man they are with.<br />
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Well, it's time for that to change. Now. With our generation. If there's anything true about GenY, it's that we aren't afraid to speak our minds.<br />
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I started writing this post a few months ago, but never finished because I couldn't find <a href="http://www.alternet.org/gender/10-words-every-girl-should-learn" target="_blank">this </a>article that I had read about this subject, and I really wanted to reference it in this blog. Then, finally, one of my friends shared the article. It's called <a href="http://www.alternet.org/gender/10-words-every-girl-should-learn" target="_blank">10 Words Every Girl Should Learn</a> and is written by Soraya Chemaly. The author definitely better articulates what I am trying to say. <br />
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"<span style="background-color: white; font-family: Lato, sans-serif; font-size: 18px; line-height: 32px;">We socialize girls to take turns, listen more carefully, not curse and resist interrupting in ways </span><a href="http://oregonstate.edu/ua/ncs/archives/2013/may/%E2%80%9Cboys-will-be-boys%E2%80%9D-us-not-asia" style="background-color: white; color: #f1602c; font-family: Lato, sans-serif; font-size: 18px; line-height: 32px; text-decoration: none;" target="_blank">we do not expect boys to</a><span style="background-color: white; font-family: Lato, sans-serif; font-size: 18px; line-height: 32px;">. Put another way, we generally teach girls subservient habits and boys to exercise dominance."</span><br />
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It's time for that to change. Ladies, don't be afraid to take charge of your own conversations, and lives. Speak up, teach your daughters to speak up. Teach your sons to respect women as equals and listen to women's voices. Because we deserve it. We do deserve more.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2tag:blogger.com,1999:blog-8869082646582125989.post-58423496923019734652015-02-13T19:59:00.003-08:002015-02-13T19:59:40.373-08:00February is the Worst MonthI plucked a new WHITE hair from the top of my head this morning at 5:55 am, after having gotten up to feed the baby at 5:40, and just before heading off to work. I would chalk this one up to the Almighty Baby, except for the fact that the last two weeks at work have sucked. There is no other word for it.<br />
<br />
No offense to my February birthday pals, but February is the worst month. Feb and I have never gotten along, and I know plenty of people who have broken up with significant others, lost jobs, slipped on the ice, ate a bad donut or worse in February. Back when I lived on the east coast, I thought it was because Winter was dragging on and it was still dark and cold and yet again the groundhog saw his shadow and when is it gonna be Spring already?!?!? But now that I live on the West Coast, where February still sucks, I can say, without a doubt, it's just the month itself.<br />
<br />
Last week, nearly every case I saw seemed to have a bad prognosis. I don't recall a week where I saw so many sick or dying pets, although so far this week isn't shaping up to be any better. When you hear a veterinarian say, "It isn't all puppies and kittens," we aren't lying. In fact, when we do see a puppy or kitten it makes our hearts soar, because 9 times out of 10, that puppy or kitten is healthy.<br />
<br />
First there was the cat whose vomiting had progressed from a few times per week to 2-3 times <i>per day. </i>FYI, that is bad. Cancer! Then a new diabetic (that one actually turned out okay but it is always a difficult conversation because diabetics require a significant time and financial commitment. If the owner can't commit, I recommend euthanasia). Next was a cat with a fluid filled abdomen, cancer. A cat with a fever of unknown origin, who is now doing better but it was touch and go for a few days. Then, a dog who came in for a skin tag and had a giant mass in the abdomen. The owner chose to ignore this piece of information and took her home after discussing the skin tag was the least of her worries. When I called a few days later, he was still blissfully thinking his dog was fine.<br />
<br />
Then there was the dog who had lost 30% of its body weight in the previous 2 weeks. This one was an undiagnosed diabetic in ketoacidosis, which is a state of severe disarray that precedes diabetic coma and death. Oh and she had a liver mass and a raging new heart murmur. That was followed immediately by a cat whose jaw was hanging open and had a firm swelling on the chin which was cancer.<br />
<br />
Add to the list a bird with hepatic lipidosis, ascites and pneumonia, a cat with a mass in its abdomen and likely peritonitis, a FIP kitten, which I can't even talk about because I HATE that disease, and a couple more cats with likely cancer, two dogs in congestive heart failure, and kidney failure cats destabilizing, I have had enough.<br />
<br />
The absolute worst is giving the horrible news when people came in expecting only something minor to be going on with their pet. Hearing that their pet has a terminal illness is devastating, and it's no picnic for me either. :(<br />
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By the way, it's Friday, February 13th. I am skipping the rest of February.<br />
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<br />Dr.Mhttp://www.blogger.com/profile/09895300806555339837noreply@blogger.com2