Thursday, November 20, 2014

What Does It Smell Like?


 

Note to self...DON'T EVER ASK A CLIENT WHAT IT SMELLS LIKE......



Client was in for an exam today and we got to talking about Anal Sacs and Glands and she remarked that the dog had an odor about him.....and I foolishly asked....

"What does it smell like?"


Her response: "it smells like a sour , dank, infected vagina - Doc have you ever smelled a vagina like that?"


Me: (blink, blink).....(cricket..chirp, chirp, chirp)......(blink, blink).....   No??......





Sometimes...  you just can't make this stuff up.

Sunday, November 16, 2014

From Cradle to Grave

There is a term in human medicine,  "cradle to grave care", which refers to the family practitioner.   He or she sees patients of all ages from newborn to geriatric.  Your general practice veterinarian is the "cradle to grave" provider of the pet world.  Unlike our human counterparts, however, we often see the SAME patients from cradle to grave.  For those like myself who choose long term employment at the same practice over emergency medicine, research, relief work, or frequent job changes, there comes a point in our careers where we begin seeing the former playful kittens and bouncy puppies come through our door as thin kitties with unkempt fur and creaky limbs or grey faced dogs with cloudy eyes who need a helping hand to jump into the car.

It usually starts around the 8th year in practice.   That is the time when diseases of middle age, such as diabetes and cancer begin to claim our patients.   This is also the time when our largest patients reach the end of their natural lives.  Shorter lived breeds such as St. Bernards and Irish Wolfhounds have a life expectancy of only 7-9 years.   It reaches a peak around 10-16 years in practice when most of our dog and cat patients die of age related disease.   Cancer, arthritis, kidney failure, and heart failure are among the most common causes of death in senior pets.  

Those of us who choose general practice find satisfaction in bonding with pets and owners over a lifetime.    Watching patients transition from cute puppy or kitten to mischievous adolescent is at times amusing or charming, and at times frustrating.   Next, they move into the young adult stage where, with proper guidance, they have finally figured out what is expected of them as a family member, settled into a comfortable routine within the family, and developed a sense of loyalty to the family.      Their humans have suffered through chewed shoes, scratched furniture, and countless 'accidents' on the carpet and furniture.    They have often wondered if they'd survive the crazy puppy or kitten stage, but are generally glad they stuck it out and are now reaping the rewards.    Middle age brings some challenges.    Previously healthy animals may begin to show signs of disease or mobility problems which require time, money, and dedication to manage.   Owners willing and able to handle the challenges may manage disease for years, and the pets often thrive under proper care.

Living with a senior pet is a mixture of heartache and joy.   Few things are as dignified as a 16 year old cat who curls regally up by your side (or on your lap if she deems your worthy!) or a white faced old Golden Retriever who still greets you at the door with a wagging tail and is still eager to go for a walk even though he is slower and tires more easily.    Few things are as heartbreaking as when that regal cat tries to jump onto the counter for the first time and can't quite make it.   Every dog owner knows about the lump in the throat the first time your senior dog tries and fails to stand up after a nap or stares at the wall and barks at night as dementia clouds her once sharp brain.   

The last treatment a 'cradle to grave' veterinarian gives his or her patient is a gentle death, usually while the pet is surrounded by loved ones.     That act is a mixture of heartache and relief.     We are sad to lose a patient we have treated for a decade or more, frustrated at the limits of medicine, but relieved that we can offer an end to pain.    Do we bond with all of our patients?  Honestly, no we don't, and that is fortunate for our emotional health.    We care about them, but we don't suffer the same level of pain as the owner does in most cases.  What we feel is empathy for the client, because most of us have been there with our own pets.   For those patients with whom we truly feel a bond, the loss is more profound.     One of my current patients is a senior dog who is suffering from terminal cancer.    He was, quite literally, born into my hands.   I was the first human to touch him when I delivered him by c-section.    Yesterday, I became one of the last humans to touch him.   I treated him for problems associated with suspected cancer.  Today, the diagnostic test results came in, and cancer was confirmed.    Treatment options were discussed, none of which would allow him to live out his breed's average life expectancy of another 2-5 years.   He will die sooner than he should, but he will die gently and with his family by his side.    Such is the life of a "cradle to grave" veterinarian.

Wednesday, November 12, 2014

Moose Grease and Condom Juice

Well ya know the holiday season is upon us, and those in this profession know that it means Death Season.  Yep, that phenomenon where all the people in the country love their pets soooo much that they cannot bear to watch them suffer any longer and must put them to sleep NOW.  (cue in "Have Yourself a Merry Little Deadly Christmas"...)

So we at VBB West Coast thought maybe a fun post was in order.   How about if we share some stuff we've learned recently?  You know, those gems without which we could not practice?  Especially those taught to us by clients.  Those are the BEST gems of all!

I learned this week:

--  Pumpkin seeds are the BEST for deworming your dogs.   The fact that it was just Halloween makes that very convenient, doesn't it?  (And yes, this IS separate from our all time favorite CANNED pumpkin gem!)

-- String cheese is the BEST way to manage epilepsy in dogs.  (I forgot to find out which kind of string cheese - oops)

-- AT&T offers a Qi data transfer discount to vets who treat animals via the phone lines.   Even better, your dog's "chi" can be "unblocked" via the phone lines.  Yep.  Takes a lot of data transfer though.  You read it here first, folks.

-- Vets are supposed to be able to determine purebred from non-purebred pups...  in utero.  As in, "can you please make her abort only the mutts and not the purebreds since she tied with two different boys?"

-- Condom juice (ONLY from newly opened condoms, mind you) and moose grease (yes, moose grease) is apparently the absolute best lubricant and treatment for the eye.  Not eye drops, you fools.  (and for your reading pleasure, here's the real story)

-- I think we ALL know that used motor oil treats mange.   Best. Treatment. Ever.   Don't waste your money on stuff like Ivermectin.

-- STOP giving the Ruffles potato chips to your dog.  Everybody knows chips give dogs heartworms.

-- Sibling dogs and cats won't breed.  Nope.  They know better than to do that.

--  Vaccines work by infecting the animal with the disease so they can poop out the virus, thus infecting those around them, leading to natural immunity.  Bet ya'll didn't know THAT one!!



Keep 'em coming....  and Happy Thanksgiving to everyone!




Thursday, September 18, 2014

We Do The Best That We Can


People get angry at veterinarians all the time.  That procedure costs too much money!  All you're interested in is the contents of my wallet!  You obviously don't care about animals! 

Have you ever stopped to consider your veterinarian's job? We wear many hats, and we perform many jobs. And we do this with a good attitude and a heart for the patient's that we treat (and their owners). 

We must be grief counselors. We hold your hand, pat your back, offer tissues, and listen to your stories about Fluffy when it is time for Fluffy to go. Often, we hear stories about human tragedies as well - this pet belonged to your father who passed away, and Fluffy is all you have left of him. This cat belonged to your son, who died tragically at 21 last week in a car accident. 

We shoulder the sorrow of watching the light in your beloved pet's eyes dim, and we shoulder the dimming of the light in your eyes as you watch it happen. We feel the tears drip our hands, holding the syringe of pink liquid. We feel helpless too, unable to stop death, and we grieve with you. And though we go onto other patients and other cases, a tiny bit of our soul went with your pet into that great dark night (and we must have very big souls, to let so many pieces go). 

We must be financial counselors. Guiding you through the myriad decisions involving a loved pet's care and the expense that it can incur. We tell you about CareCredit and about Humane Society funds that might help. We frequently discount or don't charge for services so we can help that "special" pet get well (and so many of them wind up being special). We trim down surgery times, even though it truly took us an hour to remove that sock from your dog's intestines, and we stay late after work, just to help keep finances manageable for you. 

We must be mediators and relationship counselors between couples warring over decisions on Fluffy's pet care. We must delicately navigate the married (or ex-married) relationship shoals lest we be cast upon them and destroyed. Often, we field phone calls from each individual pet parent - sometimes within 5 minutes of one another - answering the same questions over and over. We do this with patience and a generally good attitude. We help soothe agitated couples and make our recommendations with aplomb. We try to make sure that both pet parents leave the hospital (or phone call) happy. 

On top of this, we ARE doctors. And not just one kind of doctor. Whereas if you visited your MD, he would look at your skin lesion and refer you to a dermatologist, we will skin scrape your pet, culture the lesion, and start your pet on an appropriate treatment course. If you visited your MD with a belly full of hemorrhage, he would send you to a surgeon post-haste. We will stabilize your pet with IV fluids, give a blood transfusion, and take your pet to surgery to address the cause of bleeding. We will talk you through options for chemotherapy if a tumor is found. We will provide palliative and hospice care as needed. If you request referral, we will help you find an oncologist. 

And we must do all this with a smile, a pleasant and cheery attitude. We must answer 10000 questions a day, from the mundane to the very serious. We must take care of the patients in our hospital, while seeing outpatients and doing surgery. We must make many phone calls in a day, relaying test results, 1 prognosis, discussing treatment plans and diets, nail trims and surgeries.  
Then we must go home and try to live a normal, well-rested and balanced life. Raising our children, enjoying our hobbies, cleaning our houses, fixing dinners.

Is it any wonder that we suffer from compassion fatigue and complete burnout on a regular basis?


I am an emergency veterinarian. I am a mother of 2 young children

(and would like to have more). I love my job. It drives me to continually strive to be better, to do better by my patients and their owners. But it also drives me to illness, to lack of sleep, to dehydration, to emotional breakdowns, and nights with my patient husband. 

I wear many hats - both at work and at home. Remember that the next time that you see your veterinarian. Remember that your vet is a person too - with a family, hobbies, dreams, tragedies, and sadness - just the same as you. And much like you, they are working hard and doing the best that they can - every single day.

Wednesday, September 10, 2014

Rabies Testing & Quarantine

Today, VBB Central was closed down so our doctors could have a CE day. Continuing education is a valuable part of veterinary practice - it's how we keep up with what's going on in our profession medically, administratively, and so on. I usually enjoy my CE days a lot, although of course some lectures (and lecturers) are better than others!

Today, one of the talks was on the subject of rabies testing and quarantine, and rules applicable in various states and counties. The speaker was a veterinarian from her state's Department of Agriculture, and she was very dynamic and knowledgeable. Obviously the material she was working with was what it was - the nuts and bolts of vaccine, quarantine, and testing requirements are not very sexy - but nonetheless, she kept me interested the entire time. She even managed to gracefully handle the incessant "point of order" type questioning from the one guy in the back, who always has to ask a stream of arcane academic questions that are irrelevant to anyone living in the real world.

Here's the thing - dedicated readers of this site know that one thing most veterinarians have in common is that "nothing surprises us anymore." Except, you know, when the most stupid or ridiculous thing imaginable suddenly happens and it shocks the hell out of you, and you think "man, I THOUGHT I had seen it all, but I guess I was wrong." Then you think there's nothing left to surprise you - until it happens again.

Well.

This veterinarian was talking about how to properly submit samples for testing at the state diagnostic testing laboratories. Proper refrigeration is key, in case you are wondering, and she also recommends making sure everything is sealed well to avoid leakage and that identifying paperwork is enclosed, properly filled out, and in its own separate waterproof bag. There are various approved couriers, and instructions on how to deliver the samples without using a courier were also provided. She was very thorough. Then she got to the part about properly preparing the samples.

Well, ok, easy enough, right? You're either submitting a brain that has been removed from a head, or a head that has been removed from a body, or in the case of a very small patient (under 3 lbs) an entire body. She did take care to remind us that they only want mammalian samples. OK, I can see how someone might think it necessary to submit say a bird or something, if perhaps a pet chicken went batshit crazy and started attacking inanimate objects or whatever. So it makes sense she would remind us not to do that. Then she reminded us that they want only non-living samples. I am pleased to report that she did not provide us with an example of a living sample they had received in error.

So far so good, you're probably thinking. Where's the surprise? Well - apparently last year, she was going through the reports sent to her office from the state diagnostic testing laboratory, and was disconcerted to see that a particular sample had been "unable to be tested." She read the complete report and it said that the reason the sample could not be tested was because despite the fact that it had been labelled as a "bat," it was in fact not a bat but rather a banana peel.

I'll let that sink in for a minute.

It was not a bat, but rather a banana peel.

I am not sure how one makes that mistake, let alone how someone who mistakes a banana peel for a bat is then competent to package the banana peel up with the appropriate paperwork and submit it through the proper channels for delivery to the state rabies diagnostic testing laboratory. It kinda makes my head spin.

I did take the time this afternoon, after getting home from the CE, to put together this teaching slide for my own talks:






Feel free to use that yourself if you find it helpful. This is apparently something people need help with out there.

Tuesday, September 2, 2014

Our Chance to Be Heard

Many of us have been following the mess associated with the AVMA, the COE (Council on Education) ACCREDITATION baloney and blah blah blah.  (check out www.justvetdata.com)  All we really know is that it's not good for the profession, right?  I mean, another school just opened up and is going to be charging a cool $60,000 PER YEAR for their veterinary degree....   good freaking god.

If that's not enough to make you blow your morning coffee right outta your nose, then I can't help you.   :)

So now's our chance to make our intentions knowns and our voices heard.  PLEASE go to this link, read it, and submit your comments.    Let's come together and see if we can't make our profession better.


www.vetuscope.com

And please share the link with every vet you know - students also - and ask them to submit their comments if they agree.

It can't be any easier than this!

Let's come together, people, and do something to save this profession before it's too late.

Thursday, August 28, 2014

Chapters We'd Like to See in the Textbooks


A few of us at the VBB roundtable were wondering why we never see the following chapters in any of our veterinary textbooks: 


Chapter 1:   How to Accept That You Chose to Become an Emotional Sponge for the Public Without Killing Yourself.

Chapter 2:  How to Fake Diseases in your Patients Just So You Can Steal Money from Your Clients.

Chapter 3:  How Not to Giggle When Someone Tells You Their Name is Melena.

Chapter 4:  A Concise Surgery How-To Guide:  Cut that Shit Off...  It's Simple as Shit.

Chapter 5:  A Concise Surgery How-To Guide Part Two:   I Cut that Shit Off But It Wasn't Simple as Shit.
                      
Chapter 6:  A Concise Surgery How-To Guide Part Three:  I Cut that Shit Off, It Wasn't Simple as Shit and Now I Wish I'd Never Started This.

Chapter 7:  A Concise Surgery How-To Guide Part Four:  I've Been in Surgery for 3 Hours, I Cut that Shit Off, It Wasn't Simple as Shit and Now I Have to Just Close the Damned Wound and See What Happens.

Chapter 8:  Surgery:  The Ultimate Hack and Slash Experience.

Chapter 9:  Table Sugar:  Rub It on the Weenie and It Will Go Down.

Chapter 10:  Foxtails:  Not Just for the Gardener Anymore.

Chapter 11:   Canned Pumpkin:  So Many Uses, So Many Doses.

Chapter 12:  So You've Just Accidently Stabbed Yourself with Euthanasia Solution...  What's Next?

Chapter 13:   Using a Flea Circus and Homing Fleas to Increase Your Bottom Line. 

Chapter 14:  Controlling your Desire to Choke the Living Shit Out of Someone.

Chapter 15:  Post Grad Wal-Mart Budget:  Another Way of Looking at Student Loan Debt  (aka You Only Thought You Were Done Eating Ramen Noodles)

Chapter 16:  Vaccines Schedules:  Obviously Dr. Google Knows Best.

Chapter 17:  Keeping a Straight Face When a Client Wants to Keep the Toenails After You Trim Their Dog's Toenails.

Chapter 18:  Chocolate Vomit:  A Love Hate Relationship.




What chapter would YOU like to see in the textbooks?