Monday, April 30, 2012

Corking Fee

Here's the VBB's latest brain child.  I think this needs to be distributed to Veterinary Clinics across the land.

Speaking of PETA....

Looks like we're not the only ones pondering PETA today! Check out this gem The Bloggess put up over the weekend. I can't agree with her characterization of PETA as "fine," but I sure can appreciate the humorous correspondence she shares in this post. Dr VBB [heart] The Bloggess!

Sunday, April 29, 2012

PETA drops a dooce.

I hate peta.  I love animals, but PETA is over the top and would like to bomb innocents, including those animals caught in the research facilities.  Fuck you PETA.  I don't wear fur, but I do eat meat.  Because the meat industry uses more of the carcass than the Native Americans did.  Ride on an air plane?  Like those breaks.  Thank the bovines.  And if you ride in a plane, you should wear leather and eat meat.  And be ok with "cat gut suture" which is bovine tendon.  So PETA, laid a big old dooce.  Divorce your ideals, embrace treating other creatures with dignity.

The Loss of Dentistry

So I wrote that last post because of a scenario I experienced a few months ago....

Owner brings her dog in for a swelling under the eye.  As soon as I look at the dog's mouth, I realize it's most likely a carnassial tooth root abscess.  I discussed this with the owner, and also informed her that the rest of the dog's mouth is in really bad shape and he needs multiple tooth extractions.  I also told her that the dog needs to have the mouth radiographed (xrays) because sometimes what we think is a simple abscess can actually be something a lot worse, like cancer.  (two of my most recent carnassial tooth extractions actually ended up being sarcoma in the mouth, not just an abscessed tooth - had I not done xrays before pulling the teeth, we would not have known that)

Owner said this to me:  "Oh no, I only brought him here for you to diagnose him.  I'll be taking him to the low cost facility because they are soooo much cheaper than you.  We will only come here for the real problems." 


I was flabbergasted, insulted and angry.

I told her the reason it was so cheap there was because I did such a better job than they do.  It didn't matter.  She just wanted "cheap."   Okay, I get that.    You have 3 kids and 5 dogs.  Maybe you should look at that.  However,  I digress....

But let me do a comparison for the difference between what would occur at my place vs. what will occur at the low cost place.

The removal of a carnassial tooth involves splitting the tooth and pulling out 3 roots.  It involves equipment that can cost $5000.  We also do what's called a mucosal flap with the gum tissue so that we can then close the open socket/defect.  The animal is much more comfortable after surgery and heals so much better.  We also do nerve blocks so that when the pet wakes up, they aren't feeling the pain of that extraction.

We would take dental xrays of the mouth so that we can see the roots of the rest of the teeth, and make recommendations on what else might be abscessing and needing removal.  We also look for things like...  cancer.

All of our anesthesia patients, especially those having dental work, are intubated (have a breathing tube) and have an IV catheter in place and are on IV fluids.  This is for safety and their comfort.

The only ones who do dentistry in my hospital are myself and my registered, licensed techs.  And let me add - that is per my state's LAW.  Unlicensed techs are NOT supposed to be doing dentals.  Period.

Now let me tell you what will happen at the low cost place:  they don't even have RVTs.  They don't have dental xray.  They do not intubate the dentals (there is no breathing tube inserted into the trachea) and they definitely do not place IV catheters or administer IV fluids.   They yank teeth without splitting them, they do NOT do mucosal flapping and I'm pretty sure that local nerve blocks aren't even in their vocabulary.  I can only imagine how many tooth roots are left in those sockets.  How would they know?   They don't use dental xray.

I know of a low cost vet who doesn't use a high speed drill.  He used a pair of pliers to "break" a tooth so he could get it out.  I wish I was making this up, but I am not. 

That's not how I do things.

So what is this client getting?  A very, very poor service, yet she thinks that I'm ripping her off because I charge more for what I do at my practice.  Hmmpf. 

She then had the nerve to ask me for an estimate, so she could compare it to the low cost place.  I refused.  I mean, why should I bother wasting my tech's time working up an estimate for this woman?  I politely asked her to leave.

She deserves the medical care she gets.  And when she does come back to me for something like...  a major abdominal surgery, it's gonna cost twice as much because I now have to make up for the loss of my dentistry services - another bread and butter income - to the low cost facility.

It is a vicious cycle, American Public.  Please hear our cries and believe us when we say we aren't doing it because we want to gouge you;  most of us really do want to provide quality care.  But if you can't support us on the little stuff, then don't expect us to be around when the big stuff comes up.

You will get what you pay for, in the end.

We Are Small Business

I know this topic has been mentioned before, but I feel so strongly about it and I am so worried about it, that I think it deserves yet another post.

The majority of veterinary practices are privately owned entities and are considered "small businesses".  We are some of the remaining few (sadly, few) professions who are still dominated by the small business model.  Yes it is changing - corporations like VCA, Banfield, etc. are moving in and trying to buy us up and take over.  There is talk about forcing the small guys out of circulation and moving towards a model more like human medicine, where there are small satellite clinics where you go to get your wellness done, but you have to go to the bigger central hospital if you need more in-depth care.  The satellite clinics won't have the equipment, staff or abilities to handle things that we do now.

This means you can't get your bloodwork, xrays or other tests done immediately (one of those things people love about vet med)  because it wouldn't be done at a satellite clinic.  It would be more like a human model, which to me means "pain in the ass" model.

In a lot of ways, it makes business sense.  Owning (and yes I am an owner) a veterinary hospital is becoming less and less worth it on many levels.  Our "rewards" for owning are diminishing at a rapid rate - and by "rewards" I don't really mean fancy things;  I mean things like...   taking home a salary and funding my retirement.  When simply earning a living becomes so difficult that it's no longer worth it, well, you'll start to see the disappearance of the small mom-and-pop veterinary clinics, just like you are seeing a loss of those types of businesses in other realms as well. 

So what does this mean for the public and why am I writing this blog?

Let me put this into real, every day terms.

Small animal hospitals help fund their day to day operations through spays, neuters, vaccines, and in some cases, the sale of medications and supplies for pets.  Things like,  Frontline Plus, dewormers, heartworm preventatives, etc.

Selling these things - what some call "the bread and butter" of a practice, helps us keep other costs down so that people can still afford things like dentistry for their pets, or when their dog eats rocks, we can do an abdominal exploratory surgery without bankrupting our client.

But what is happening?  Well, many of our "bread and butter" sales are disappearing.   To non-profits who now do spays and neuters for so cheap (because they get donations and tax breaks that we private businesses DO NOT GET) that we can't compete, so we've lost that business.    To low cost, high volume places that do shoddy work and basically lie to the public about the quality of care their pets receive.  Products like Frontline Plus and others, have either gone over-the-counter (sold by Target, Wal-Mart, PetSmart, etc)  And now, Big Box Pharmacies are going to start selling veterinary drugs, which will take yet another bite out of income for these small clinics who are merely trying to survive to begin with.  I am writing more and more prescriptions for clients who can get their Rimadyl or Clavamox at a regular ol' human pharmacy now, for cheaper than I can sell it to them.  I don't blame them, they need to save money.  But it's a loss of income for my hospital, which translates to making it harder and harder to pay MY bills, pay MY payroll, and simply keep my doors open. 

And it makes those emergency situations when your goofy lab ate a rock and I have to perform an abdominal surgery to remove it - all that much more expensive.  Because I've lost other income that would normally cushion the costs of a surgery like that.

Now, let me say that I get it.  I get that people want and need cheaper alternatives.  I get that vet care can be expensive and I get that sometimes it's all you can do just to pay for vaccines.  People do need alternatives.

Unfortunately, though, what they are doing to themselves is....  shooting themselves in the foot.  Veterinary practices are actually bankrupting at an alarming rate, something that has NEVER happened in this history of this profession.  We simply cannot compete any more with the loss of our "bread and butter" sales that subsidize the rest of the care we provide because, well, now we have to actually charge the actual amount it costs to provide real quality medical care.   Without the "subsidy" of the income from the sales of products and medications and spays, neuters and vaccines....  well, when your pet really gets sick and needs major abdominal surgery, now we have to charge more for that to make up for the lost income.

Or we close our doors.

And that is what is happening.   Slowly but surely, small practices are going out of business.  The beloved model that evokes comments like, "Wow I sure wish you were MY doctor, because the care I get at my vet is SO much better than anything I can get in human medicine" is slowly but surely dying and becoming extinct.

So what am I asking of the public?  Don't bitch and moan so much about the cost of things.  Buy your drugs FROM YOUR VET, even if it costs $20 more.   Price shop if you must, but if it's only a difference of $50, then go to your regular vet instead of the low cost place.  Ask questions.  Tour your vet's hospital.  MAKE AN INFORMED DECISION.

Because the reality is that if you continue to go to low cost facilities for the "bread and butter" things, then when you really need good care, you won't get it...  because you didn't support the real hospital and they went out of business.

But most of all, know that you are supporting A SMALL BUSINESS.  Not just a vet.  Not just a clinic.  But A SMALL BUSINESS.  America was built upon and sustains itself on small business.  When the public insists on buying everything from Big Box stores or online for cheaper, they are hurting a small business, and ultimately, hurting themselves.

I don't expect this post to change anything.  But I want to warn the American public that if they don't start supporting their veterinarians more, then the face of vet medicine is going to change rapidly and I suspect the American public isn't going to be very happy with what they get.

Shop local, stay local and spend your money at your vet even if it costs you a little more.  Otherwise, don't complain down the road when we disappear.  And yes, we are disappearing.

Thursday, April 26, 2012

Spring, death, and no vet med

Every time of year, I find myself in an incredible depression.  Spring should be a happy time, full of parvo puppies, unwanted litters of kittens dumped on your door step, and equine dystocias.  The night before last, I had a dream about a spring festival that my high school has every year.  Since 1904, my school has had a May Day festival.  The sophomores pray for fertility by dancing around a may pole (why the FUCK does the school want the sophomores to be fertile anyway???) and the seniors wear ball gowns and are presented to society.  Yes, it was a girls' school, though the thought of 18 year old boys in ball gowns makes me laugh.

I started the school as a sophomore, meaning that I was on tap to practice the fertility rite of dancing around the may pole (the obligatory orgy usually associated with this type of festival is frowned upon by the school and the parents).  Well, back to the dream.  I dreamed about the very sweet girl that was the May Queen in our senior class.  She was dressed in a t-shirt and jeans and this year's seniors were insisting that she could not participate without the ball gown.  I was arguing that of course she could, she was Mary Smith.  Unlike many schools whose elected fall queens, prom queens, etc, our class chose someone that was unfailingly sweet rather than the obligatory cheer leader.  Oddly enough, at an all girls' school, there was a distinct lack of the "mean girls" phenomenon.

Well, back to the dream.  It turns out that yesterday was indeed the May Day celebration at the school.  It also coincided with the 20th anniversary of the sudden death of my father.  My father was on his way back from a golf tournament.  His plane hit a sudden snow storm in the mountains of North Carolina.  It was missing for several days before it was finally found.  While some people held out hope that he and the pilot would be found alive, I was pretty sure that it was not going to end happily.

The last time I saw my dad, I was a spoiled 16 year old.  I passed him on the road, him in his work truck and me in my car.  I honked and waved and sped up because I didn't want him to give me flack about going out with my friends that day.  I purposely avoided him.

The next day, while he was playing in the golf tournament, I was very distraught.  I told my mother that something huge was about to change.  I asked her, "What if I told you that tomorrow, the most important thing in your life would be gone?  What would you do?  Everything is about to change."

That night, my dad was not back on time.  About 4 AM in the morning, I heard my mother scream and start wailing.  She had learned that the plane had gone down.  For several days, they searched for the plane.  During this time, I continued to go to school and practice the may day dance.  The plane was found and both my dad and the pilot were dead.  A family friend went to ID the bodies so we didn't have to.  But after practically predicting the event, my family looked at me differently.

So yesterday was the 20th anniversary and my subconscious knew it.  The only good thing that really came out of that situation was that my inheritance allowed me to finally buy a horse.  And that horse was a better incentive for good grades than any other possession.  That horse got me into a college with a riding scholarship.  And that school got me into vet school.  My dad always wanted me to be a brain surgeon.  And while I have poked on some brains when examining a skull fracture, I am not a neurosurgeon.

Sorry for the downer post.  And sorry for the minimal tie in to veterinary medicine.  But I am just writing about what is going on in my life.

Tuesday, April 24, 2012

Bacon makes EVERYTHING better!

The internet is truly a wonderous thing. Some days I wonder how I lived without it for so many years. You can find almost anything online in seconds.... myself, I've recently found a new cupholder for my car, an awesome Han-Solo-in-carbonite phone cover, and an amazing recipe for tiramisu with homemade ladyfingers.

There are also plenty of great pet websites out there, with tons of good information on caring for your 4-legged family members, and medical information on any number of disease processes. HOWEVER, it would serve the reader well to remember to use common sense in vetting a particular site, as any yahoo with a keyboard can post some nonsensical BS posing as "medical advice". A client phone call over the weekend drove this point home.

Working in an emergency veterinary hospital in the desert is guaranteed to bring lots of phone calls about rattlesnake bites, especially in the spring, when the little buggers are coming out of hibernation and are rested and ready for a fight. Here is the condensed version of the phone call:

Gullible Client: "My dog just brought a Mojave green rattlesnake up to the house in his mouth."
Vet Tech: "It's possible he got bit and your dog should be seen right away. The cost is $XXX."
GC: "I think I'll go feed him a pound of bacon."

Now, as completely crazy as this sounds, amazingly it was not the first time this had been heard. Turns out there was a similar phone call about 2 weeks ago, with the words "pound of bacon". So in between LMAO and scratching my head, I started wondering what on earth these folks were thinking (and if it was super important that it be exactly a POUND?). So I headed to the sometimes-trusty internet. While I found nothing specific about 'one pound of bacon', the results left me laughing and shaking my head even harder.

First I found this: (warning... read only if you can handle high levels of questionable intelligence)

It would appear there is an old wives' tale about bacon grease, butter and lard 'absorbing the poison' after being fed to snake-bit dogs. Well shoot, that's yet ANOTHER day of vet school that I missed - it's amazing that I graduated at all. Bacon grease in the gut absorbs toxins from the blood? That is some crazy-a** anatomy there, my friends.

Then I found this: (the same warning applies)

One responder writes: "in the summertime feed your dogs bacon grease in their food on a weekly basis. if they get bit feed them baby aspirin as much as 5-6 if the dog is big...... the bacon grease, or beef fat is supposed to add additional fat layers in their skin and reduces how much of the venom actually spreads thru the body. i guess it isolates it."

Who knew that it paid to keep your dog fat?? And now I know that if I inadvertently sit on a rattler and get bit on the a**, I'll be just fine, thank you very much. ;)

Seriously folks, don't try this at home. Your dog will get pancreatitis, and might bleed out after getting bit, from all the aspirin.

The moral of the story is: Don't believe everything you read on the internet. Or that your friends tell you.... they might not be so bright either.

Footnote: The dog in question did come in, and was fine, other than some of the snake's blood on his fur. I wanted to ask the owner if the visit was pre-bacon or post-bacon, but I just could not do it with a straight face.

Monday, April 23, 2012

When Our Own Pets Get Sick

Because most vets own pets, and most pets get sick from time to time, it stands to reason that at some point we are going to have to deal with illness in our own pets.   One would think that with our vast medical knowledge, deep understanding of the pathophysiology behind the illness, and our analytic minds, dealing with illness in our pets would be easy.  One would be wrong.  When our pets are sick, really sick, we have the same feelings of fear, anxiety, and helplessness that a layperson has.

Several years ago, my own dog became acutely and critically ill with two conditions called Immune Mediated Thrombocytopenia and Immune Mediated Hemolytic Anemia.  These are life threatening conditions in which the body attacks its own platelets (blood cells essential for clotting) and oxygen carrying red blood cells.   These conditions are fairly common in dogs.   Sometimes there is an underlying cause such as infection, cancer, or recent vaccination.   Most of the time however, the cause in unknown.  

I first noticed that my old girl was sick because when she rolled over for a belly rub late one evening, there were 2 small areas of bruising on her skin.   She had not had an injury, and there was no reason she should have been bruised.   I did a physical exam on her, and noticed there was some bleeding around her gums too.  I was immediately struck by a sense of dread, because I knew what the likely cause was.  Sure enough, when I ran her lab work, her platelet count was 9,000 (normal is 150,000-300,000).    With a platelet count that low, she was at risk for nosebleeds, or hemorrhaging into her chest, bladder, intestines, or joints.  In short, I knew she could die.   I knew that the smallest injury such as cutting her foot on a piece of glass while walking, or a cut on her gum from chewing a stick could be fatal.    Worst of all, I had no idea what caused it.  Was there a horrible cancer somewhere inside her?   A serious infection?   I submitted a complete series of lab tests, and started her on antibiotics.    In my dog's case, I never found an underlying cause.   The mainstay of treatment for this condition (regardless of cause) involves suppressing the immune system so it will stop attacking her.   She was placed on a high doses of the immune suppressing drugs prednisone and azathiaprine.    I knew these drugs could save her life, but I also knew they had potential for serious side effects (bladder infections, increased thirst and urination, panting, stomach ulcers, and liver failure).

The medications take time to work, and she initially got worse.   She refused to eat, she was weak, she developed severe bruising over her entire chest and abdomen, and edema (swelling) of the skin.   One evening, she began having heavy breathing and her gums became pale.  I drove her to the local emergency clinic at 2am, crying because I knew all the horrible things that could be happening to her (fatal internal bleeding, severe anemia, perforated stomach ulcer).   It turned out that her red blood cells (which initially were normal) had been attacked by her body too.  She was anemic.   Her anemia was not quite severe enough to require transfusion, but it meant that additional immune suppressing drugs had to be added, and close monitoring was needed.

She did eventually fully recover, but the experience helped me realize how truly frightening a critically ill pet is for clients.   I thought I understood before, and I have always been sympathetic, but this experience gave me empathy.   Watching her refuse to eat meal after meal, wondering if she was going to have a fatal hemorrhage (I honestly wanted to wrap the poor dog in bubble wrap and set her on a shelf to protect her from any possible trauma that could set off bleeding).    I also gained a true understanding of the impact that the side effects of the medications can have on the owner's life.  The most common side effect of prednisone is increased thirst and urination.    I always warn clients about that.  It is a well known fact, and is listed in every drug book I own.  Reading about it and living with it are two different things.   My dog was 100% house trained, and I am fortunate to live close enough to work that I am able to make it home for lunch on most days.  This meant that she was alone for only 5 hours between bathroom breaks.   This is perfectly manageable for a healthy dog.  For a sick dog on prednisone, it is not.    I came home day after day to an empty water bowl, and large puddles of urine.    I had to use baby gates to keep her in the kitchen/dining area (where there was vinyl instead of carpet).   She was used to sleeping on the sofa, and I felt like a horrible person for shutting her out of the comfort of the carpeted living room and cushy sofa.    I packed towels along the threshold of the vinyl and carpet to soak up her accidents.   I did at least one full load of laundry every day from those urine soaked towels.   More than once, I had to move appliances when her puddles ran under them.  I soon learned to pack towels around those too.   Try as I might, at the end of a long day, when I came home to a mess, I could not hide my frustration.  Of course, I didn't yell at my dog or punish her, but dogs are very in tune to our body language.  She didn't understand why, but she knew that instead of just being really happy to see her, I looked stressed and frustrated.   That made her feel confused and anxious, and I felt like an even more horrible person.  Fortunately, as she improved, I was able to taper the medication, and the side effects diminished.    Although relapse is common in these conditions, she never had another episode, and she died of unrelated causes 3 years later.   Though I hated going through this experience, I appreciate what I learned from it, and it has helped me better relate to clients who have pets with this condition.

Sunday, April 22, 2012

This Shouldn't Be Necessary, But Here...

From 1948 until the late 1970’s our little city had one veterinary hospital. A guy built this hospital, sold it to another, who sold it to my boss, who eventually retired and sold it to me in 1981. The city was and is kinda the ugly sister in this area. The residents who worked, worked factory jobs, had Bob or Stan stenciled over the pocket of their shirts, inhaled asbestos, got dirty hands. At best our city was lower middle class, except for those bad neighborhoods that lay claim to the worse economic titles critics lay on the unemployed, the old and lonely, or that bunch they simply dismissed.  

We kinda had the corner on crime, ignorance, and irresponsibility, and our clients reflected this. For decades, nobody else wanted to try to run a veterinary practice here. And then some doctors I knew announced that they were going to open a veterinary hospital in our city, and this made it into the local newspaper. I found out about it when one of our more annoying clients, Clair, threw it in my face. She was not a sweet lady. She was a bit profane, a touch more than a little crude, monumentally ignorant, and lacking in the social graces. She sneered into my face, and with that same tone that a nasty sixth grade girl uses when she really wants to hurt your feelings, she told me about the new hospital, and then to really rub it in, she injected that now that we would have some competition, we would have to lower our fees. 

You know, those fees that were always too high for her comfort, the ones that were making us rich at her expense. We cost her more for her cat than her own medical care. She’d tell you that without having to ask.

Now, I knew the doctors who were gonna be across town, and they liked to practice the highest quality medicine possible in those days, and they charged appropriately for their work. So they were going to have much higher fees than this woman had ever seen, particularly at our practice. So I quietly mentioned to this woman that if we used her logic, flawed as it was, we would actually be able to raise our fees. She was dumbfounded. She had no clue then, and probably still does not.

Today I did a little research. Very little, very quickly. Pardon if some of these numbers are a tad inaccurate, but even if there’re a bit off this makes what I checked out far more accurate than the information many use to draw certain conclusions. For they are working from little or no information, whatsoever. 

According to the Wall Street Journal, there are 954,000+/- physicians in this country. According to the Bureau of Labor Statistics, a government agency, we have 691,000 people working as physicians in this country. Which either means we have a hecka number of unemployed physicians around here, or some folks aren’t real good with numbers. Who do I believe? Eh, I don’t much care. 

I just needed some numbers to make a point. And since these are simply numbers, albeit big numbers, and figures don’t lie, but liars sure can figure, I will toss out some of these for your perusal. Hopefully, what I have to say, using actual numbers for illustration, will carry a bit more weight than the spouting of those folks who have no bleeping idea what they are talking about. Or about which they are talking, if the niceties mean that much to you.

According to the Bureau of Labor Statistics 2,737,000 registered nurses work here. And although I think this number a bit low, the Bureau says we have 61,400 veterinarians. From this I hope you will agree that we are a small profession. We don’t have a lot of clout. Up until recently we were more like a friendly club than an industry. We operate in this tiny niche, and try to get by without making a lot of waves. And we deal with our clients as individuals, and not from the perspective of massive industry.

Calling upon the BLS again, I noticed that the median income for physicians is about $166,000 per year. Median is not the same as “average”. It translates into half the physicians make less than this figure, and half more. The median income for veterinarians is $82,000. And in case you were wondering, the registered nurses’ median income is $65,000. For comparison, truck drivers have a ‘mean’ salary of about $40,000. ‘Mean’ is a bit different from median. This one does mean average, and the BLS uses the average earnings for most jobs and apparently reserves median for those overpriced professional. So I guess they are ‘mean’ to those plain ole workin’ folks. 

In case you are wondering, I’m here to defend my fellow veterinarians against the charge that we are money grubbing liars and thieves. I’m not here to attack the earnings of physicians or nurses. And I’m certainly not going to disparage truck drivers. Truth be known, I’ve always wanted to drive truck, long haul, cross country. Might even try it after I retire from this nonsense.

I like truck drivers, and admire them. Any driver that borrows $100K for his own rig, deals with the cost of diesel, the retard four wheelers, the inconsistency of insurance companies and the irrational insanity of government regulation earns his/her money. And every time they get on the binders in time to keep from squishing that mini-van full of women and children they should be paid brain surgeon money. But let’s be real here. You can get a CDL after days of schooling and with some proper mentoring, you can do that job just fine.

Registered nurses are angels, and I’ve trusted my life to them on occasion and I admire what they do. I absolutely fold when I have to deal with sick people. Nurses are worth every penny and more. Many have advanced training and advanced degrees, but you can become a nurse with an AA.

Physicians put in those eight years of college, plus internships and residencies. That truck driver has been working for ten to fifteen years before the physicians draw their first serious paycheck.

Well, veterinarians put in those same eight years of college, and many have the internships and residencies. We also bring a little something to the table. For this we do twice as well as the ‘mean’ truck driver, a bit more than the median RN, and less than half what a median physician nets.

So why did Clair think we cost her more to care for her cat than she paid for her own medical care? Well, mostly because Clair was WRONG! And she had no clue.

Ya see, Clair had a good job that paid benefits. One of those benefits was a medical plan that gave her access to doctors and hospitals whenever she wished, and it cost her a $5.00 co-pay to see her doctor and another five for her prescriptions. Small wonder my charges were higher.  Her doctor visits were worth about $75.00 in those days, and the prescriptions many dollars more. Her hysterectomy cost somebody over $30,000, but she paid five bucks. When I spayed her cat, I charged far less than 0.5% of that $30K. But yeah, I cost HER more than her own medical care.

That medical benefit cost her employer more than $1000.00 a MONTH for Clair’s family. But Clair never saw that. She just expected it. I cost her more than she WANTED to pay. She WANTED to spend her money on fun stuff. I ruined that. My fees infuriated her, for she thought I took everything away from her and took it home. So I was getting rich off of her. 

Don’t matter at all to Clair what I was actually making. After expenses, at that time I was taking home about 14% of what I charged, before taxes. Clair never figured that out. I was not out-performing her physicians, or their nurses.

But to Clair, I was simply a money grubbing liar and thief. And that, was that.

Tuesday, April 17, 2012

Raining Feces and Stuff

Right now…I’m tired.

My week, like it often does, started on Monday. I unlocked the door and entered the clinic shortly after 7 yesterday morning. I always have things to do before we open, before the chaos of clients checking in my surgical patients when they’d rather already be on the freeway fighting gridlock, before the phone joins in with the latest disasters that will ruin my carefully crafted appointment schedule, before I have to make that call to deliver bad news to someone who already has enough grief on her plate.

Before we opened for the day, I checked the fax machine for lab reports and pulled the medical records that matched. I fired up one of the computers to print out the last day’s numbers, to see if I could pay some bills yet, and so I could get the bank deposit ready. I went on line and researched a case before the client would arrive with her very challenging puppy. And then I looked up to see a man I didn’t know standing in my hallway, still a half hour before we opened for business, and I suddenly felt very vulnerable and very un-armed, and I started measuring the distance to the closest handgun.

Tuned out this guy didn’t intend to murder me, or even rob the place. He had one hundred pounds of very dead dog in the truck and he simply wanted me to send it off for cremation. Yeah, we could do that for a grieving young man. This stout fellow carried in the very stiff, very smelly, very dripping of bloody diarrhea dog and left it on the table in the treatment room, and I spent the rest of my getting ready for the day time cleaning and airing out the place.

I wasn’t quite ready to face the day, but it would start with or without my permission, so High Ho, High Ho…. The morning actually passed fairly smoothly, but it did run over well into the lunch hour. I ran to the bank and then stuffed a sandwich through my face just in time for the 1:30 appointment, and I ground through four more hours of clients and my usual assortment of major medical miracles. I locked the door just before 6. Eleven hours. A usual day on the way to the usual 60 hour week.

This would have been a typical, albeit wearying day in the office, and a glass of adult beverage and some of my left over meatloaf would have felt just fine. But I had a meeting to attend. By 6:30 I was in the conference room, and the association’s business and the lecture on feline behavior problems kept me there until 9:30. I was home by ten, still buzzing a mite, and in bed by 10:30.

The radio alarm this morning was not met by a broad smile, but shower and coffee jousted with the cobwebs and again my key fit the clinic door at 7 this morning. This time I had my alone time to get things done, and I even had time to read one of the blogs before we opened. Which kinda ruined my day. But the first client arrived at 8 and I was busy through the morning.

I passed the first half hour of lunch time clipping fetid wet hair matts from the rear half of an ancient cat, and picking off the swarming maggots. Take my word for it…this puts a dent in any lunch plans you might have considered. Mere rubber gloves and copious application of soap and disinfectant won’t influence the subtle impact this has on Chinese takeout. But it was the unsettling memories of reading that early morning blog that was actually bringing me down.

This was another blog put up by a group of veterinarians, and I hadn’t really followed it before. The particular post was penned by a veterinarian with problems I cannot identify with, but I would have let her pass without comment. But the internet is a bit of the Wild West, and any angry, ignorant, sociopathic, retributive, idiot in the world can post next to the legitimate comments of rational folks. And they stood in line to dump on my beloved profession this time. Somebody backed up the sewage truck, raised the bed, and pulled the lever on me and every other dedicated, sacrificing doctor of veterinary medicine I’ve ever known. And it didn’t feel real good.

After four decades of this, I’ve met a bunch of veterinarians. Like most arbitrary groups of humans, we ain’t perfect. I’ve seen some things I’m not proud of. Heck, I’m way far from perfect myself, and that’s part of this very process you are reading. But when I’m in a room with a bunch of veterinarians, I have never once doubted that I’m in the company of a very select, excellent cross section of my species. And it gets my hackles up when the Net fills with criticism of my colleagues penned by such obviously flawed and deficient people.

There was a time when I would have told you that I would never be in this position. I never figured there was a life after thirty, once. And to ask me in my youth how I would feel when looking back on a world 60 years older than the date I dropped in…well does inconceivable work for you? But I’ve played this game for four decades now, and as retirement and the notion that everything I’ve worked for and worked at and identified with will soon be old news, I do spend some time wondering if any or all of it was worth the effort. Is it the time to accept the truck load of sewage with a shrug and an I’m sorry?

According to some folks on the internet, I’m a lying conniving piece of shit dirty bastard thief. And they haven’t even met me. Surely, my sterling reputation hasn’t caught up with them. Maybe, just maybe, if they actually met me, saw me at work, talked with the people I’ve helped, petted the pets I’ve tried to help, they might reconsider.

Or maybe they are just assholes.

I’m tired. Ask me tomorrow when hopefully I’m feeling more sprightly.

Sunday, April 15, 2012

Brother Sister Love Association

“We rescued them from someone who weren’t taking good care of em.”

She seemed a nice lady, and her two little children were quiet and well behaved. The kids weren’t dressed up at all, but they were clean. The two pups looked adequately fed, and they were well behaved and social. I can work with this. Few of my clients come in stylin’, and that’s OK by me. A long time ago, I chose to practice in a place populated with common folks. I’m comfortable with this. But it means I face a different set of challenges than my colleagues on the ‘good’ side of town. 

The female pup was old enough to be in her first season, and her brother was old enough to notice. And yeah, they had spent some considerable time alone with each other, and nobody knew if they’d done the dirty, or not. I couldn’t tell the owner yet, for it was far too early to determine if she was pregnant. I offered to spay her, even though she was still in season, for the slightly increased difficulty and risk of performing the ovariohysterectomy while she was still in heat overrode the risk of her dropping some really messed up puppies on an earth well overdosed with healthy puppies. And it beat doing the same surgery much later, when the pregnancy was confirmed, and everybody would be condemned to the knowledge that we were killing puppies instead of just bumps.

I’d seen the pups of a brother/sister mating more than once.  Some were actually OK, as far as we could tell, but the rest suffered from an assortment of birth defects. One litter of six all had hare lips, and the surgical repairs kept failing, as if the powers had decided that this bunch was not to survive. And I’ve seen cleft palates and cardiac problems that killed the pups shortly after they landed on earth. The issue of brother/sister matings as adults often just don’t seem to be as hardy as they should. 

And then there was that brief discussion I had with a client who was intent upon breeding her little bitch with the dog’s own father. The “breeder “who was advising her stood at her right shoulder as she spelled out her plan to me in the exam room. I mentioned the usual reasons why we don’t recommend such foolishness, what with the assortment of disasters which can result from such extreme 
inbreeding. The “breeder” of course, knew better, and spewed her delusional justifications at me, with the statement that, “I’ve done this many times before, and the results have been just fine.”

As doctors, we cannot guarantee a bad outcome from such an endeavor. All we really know is that the incidence of genetic disasters increases with the degree of inbreeding. We cannot say that it happens every time. So my response to this breeder’s logic was my own version. I pointed to the four lane street in front of my clinic, the one with the cars and trucks roaring past, and I suggested to the breeder that she could blindfold herself and walk un-aided back and forth across that street, and she might get away with it for a while…but please don’t ask me if I think it’s OK, for you might get the answer you don’t wish to hear.

 You see, I’ve done the surgery to remove the diseased uterus full of dead inbred puppies from the bitch dying due to the deadly toxins, and I’ve opened that nasty tube after we’d assured ourselves that our patient would survive, and I’ve removed those “things” we call teratomas, those odd shaped egg shaped sorta puppies, and quarter sized pieces of parts of puppies, or bits of bone and hair, or that unidentified tissue that wasn’t meant to be. Now, I’ve been steeled by decades of medical horrors that even callous ole I won’t introduce you to, and it takes something pretty nasty to get to me, but puppy parts still do. And so no, I don’t think you should breed your little girl to her daddy or her nice brother. I don’t care what your breeder says.

I rarely quote the Bible, but if those folks figured this out 2000 years ago, why should somebody trust a breeder who thinks she is smarter that those folks?

Well, this client with the maybe bred dog maybe bred to her brother decided she couldn’t afford to actually spay this girl, so I’m not real sure why she even bothered to ask me. But they headed home with the maybe pregnant dog maybe filled with yet another horror show. And maybe someday soon I’ll get to see if I was right. Or not. If I ever find out, I’ll let ya know.

Crazy Hat Lady

Ahhhh...Spring has finally SPRUNG for the vast majority of us in the VBB Collective, and that means we're all out having fun planting flowers and mowing lawns and playing with our four-legged (and, when absolutely necessary, two-legged) kids in the sunshine.  But fear NOT, Dedicated Readers.  Though our posts may have slowed to a somewhat disappointing drizzle as of late, we have not forgotten you.  And so I shall share, for your blog consuming delight:  CRAZY HAT LADY.

Crazy Hat Lady (May I henceforth refer to Crazy Hat Lady as CHL?  Yes, I thought so, thanks.)  first showed up in my lobby a few years ago, with a little ragamuffin Benji-type whoknowswhat young-ish adult female adoptee.  This poor little dog is about the WORST candidate for rescue by a CHL.  She's sweet but very poorly socialized, and really could use a good leader in her life.  Aside from the fact she's literally easy to follow in a crowd because of the ridiculous headgear she's invariably donning, CHL a good leader is NOT.  The poor dog is a nervous wreck and I really wish I could just prescribe a new owner.  But this post isn't about poor little mal-adjusted Benjiesque foundling.  It's about CHL, isn't it?

Every practice must have a CHL.  Nay, every BUSINESS.  In fact, at one point I hired a new receptionist who'd been working at the local Burger King.  When she discovered CHL was a client, and that we'd named her CHL, she said, "Oh my GOD!  That's what we called her at BURGER KING too!"  Crazy Hat Lady is an archetype, indeed.

MY CHL is special, though.  In addition to the huge collection of insane, HUGE, handmade, often knit hats (always with GIANT flowers), she has an enormous mass of unruly frizzy hair poking out from underneath.  She has a lovely orange spray-tan glow about her ever-so-slightly toad-like face, and usually bright orange or red lipstick that looks like a five-year-old has applied it.  I use the term "lipstick" loosely, as it's generally only partly limited to her LIPS.  Oh, let's not forget to mention the eyeliner.  Black liquid liner.  About a millimeter SOUTH of the lower lids.  Yep.  None where it actually SHOULD be, up on the upper lids.  But the MOST special thing about my CHL is her conversational style.

Consider a chicken.  A chicken that's very, VERY interested in some item or object.  Here, this will help:

Or, even better, THIS:

THAT is how my CHL looks at me when she's waiting for me to answer some insane and completely off-subject question she's just inserted into the conversation.

Me:  "So, as I said, little NotBenji here is starting to develop some dental disease..."

CHL:  "Do you think she's ever had children?  Can you tell if she's had children??"  <cocks head at impossible angle to the right as eyes simultaneously bulge slightly out of their orbits>

Me:  "Well, as we've discussed before, I can't tell that.  In fact, we're still not even sure whether she's spayed or not, since you've declined diagnostics..."

CHL:  "REALLY??"  <head to left>  "I think she really misses her mate.  You know my roommate moved out and took away her little mate.  She misses him."  <head back to right, as hat threatens to shake loose and fly across the room>

Me:  "Well, adding another dog to the family should be undertaken with a lot of forethought..."

CHL:  "REALLY?"  <head tips up with a slight left-ish rotation, left eyebrow up, purses lips>

Me:  <sigh>...

Thursday, April 5, 2012

Insert witty title here.

Sometimes things happen, and I want to tell people about them, but I fear no one will believe me. Then I read stories like this one: and I realize that there is so very much crazy in the world, my stories are probably not that shocking to anyone who's paying attention.

So, anyway.

My poor beleaguered receptionist just doesn't seem to have learned her lesson. Despite years of experience suggesting she not do this, she continues to ask people "so, what's new?" or "how's everything going for you?" or some such, when they are in our waiting room. A couple of weeks ago, she asked one particular woman this question, and was unprepared for what she subsequently learned. It went down like this:

Receptionist: So, how's everything going for you?
Client: Well, you know, it's been hard since Rusty died.
Receptionist: I do know. I'm so sorry.
Client: The thing is, Cooper only ever peed when Rusty did. Rusty was housebroken, so Cooper was too. But now that Rusty's dead, Cooper doesn't know he's supposed to pee outside. So I have to teach him.
Receptionist: What do you mean?
Client: Well, I've had to start peeing outside so Cooper knows he's supposed to pee outside.
Receptionist: ...
Client: It was ok during that unseasonably warm week but it's been kind of cold the past few days.
Receptionist: ...
Client: How long do you think it will take him to figure it out? I need to have some landscaping done but I don't really want to be peeing outside in front of the work crew.
Receptionist: I think you should bring this up with Dr. VBB - that's above my pay scale, really.