Gratitude

I feel like it's been so long that I should introduce myself again. I'm VSBB, your friendly neighborhood veterinary student. We last chatted, oh, probably five or six months ago, before the fall semester got crazy and then the spring semester took over my life. But now it's summer, so hello! Please don't resent me for being out of touch. You were my second call, right after I let my mother know I was still alive despite my finals' best attempts.

Anyway, I was hanging about in my neighborhood this lovely holiday weekend when I met a family with two young children. Emily, the daughter who is finishing up first grade, wants to grow up to be a veterinarian. I am basically the coolest person she's ever met (because her family has no pets, so she doesn't actually know any veterinarians. Oops?). She and I both love puppies and kitties and bunnies and horsies and now we're basically BFFs. Awwww.

I know this blog is usually about the stuff that legitimately makes veterinarians want to behave badly, and that's cool. I think it's a valid outlet and I'm glad we can talk about stuff. But today, you know what? I'm pretty thankful that I'm living the dream. A little girl thinks I'm awesome, I know a hell of a lot more than I knew at this time last year, and despite all the bad stuff, I am going to have a career that will let me do good.

Yes, you're welcome to throw that last sentence into my face when I start complaining about my student loans.

I'm also grateful today that I can go about the business of becoming an animal doctor without many worries about life outside veterinary school; I'm grateful to the heroes who have lost their lives in military service and to their families and friends. Happy Memorial Day to all of my fellow 'mericans!

The devil wears cat hair...

We've all (well, most of us) read James Herriot's stories of veterinary practice in Yorkshire. The hills, the dales, the sheep, the cows, the hunting dogs, and the people who loved or at least depended on them for their livelihood. Not to mention the everpresent pampered pets :). Evocative tales to be sure - but not quite like what most of us are experiencing today. But readers, you are in for a treat.

The VBB mailbag recently received a wonderful story from a New York City colleague. I present to you here: The Devil Wears Cat Hair!

Yesterday, the most self-absorbed fashionista and her meek, henpecked fiancé brought in their senior cat in for a lion cut.  The cat was a shorthaired cat, so the lion cut request was a bit unusual.  We’re not groomers, per se.  We are a feline-exclusive veterinary hospital that does do grooming when asked.  Because these were first time clients and the cat was a senior cat, we told them we wanted to do a physical examination first.  He was fine; she was huffy, but agreed.  

Upon examination, I discover that the cat had atrocious, filthy teeth that required a thorough cleaning and multiple extractions.  I called the owners and told them that.  About an hour later, when we started to perform the lion cut, the cat (named Ferocious) began living up to her name.  We called the owner and told them that sedation would be needed.  He handed the phone to his fiancé, who immediately accused us of doing something bad to her cat. “She NEVER acts this way, so you MUST have done something”. 

Yes, everyone knows we keep a huge arsenal of cattle prods and tasers in a drawer, waiting to break them out as soon as the client leaves the building. 

In a fury, she decides to come over, her weary boyfriend in tow.  She sees, with her own eyes, as we try to take Ferocious out of the cage, that the cat is hissing and growling.  Again, the accusations fly.  I calmly show her the cat’s teeth.  She and her boyfriend cringe.  I suggest that we schedule a dental cleaning, and while the cat is asleep, we can do the lion cut.  It’s less stress on the cat, and better for the cat because things are done under one anesthesia – the cat only needs to be sedated once, not twice, which is in the cat’s best health interest – plus, it would save them the sedation fee that would be required to groom the cat today.  The boyfriend sees the logic.  The A-list fashionista is livid.  She wants the cat shaved, dammit.  Horror of horrors, the cat is shedding fur on her furniture!  Faced with the decision of doing what is best for her cat vs. what is best for her and her furniture, she unsurprisingly chooses the latter.  I tell them okay, we’ll start now, and you can come get her between 5 and 6:30; she’ll be fully awake from the sedation.   

The fashionista bursts a blood vessel.  “We can’t come at that time! We have a shoot this afternoon!  I can’t believe this!”  She throws her hands up, and orders her boyfriend to just take the cat so they can leave.  At the front desk, she’s bitching and moaning about what awful people we are.  “I should have just taken her to my own vet”, she says.  

Yes, that’s the same vet who saw the cat three months before, and who made zero mention of the cat’s horrible dental disease in his notes.  

I suppose these folks will never be back, and I’m overjoyed at the thought.  I just feel bad for the cat, because I know that they won’t do anything about the cat’s teeth until it somehow has an effect on her – the fashionista.  Like, if the cat starts drooling blood on one of her blouses. 

It reminds me of a time, early in my veterinary career, when I was doing an overnight shift at an emergency clinic. A yuppie couple came in at 2:00 a.m. with their puppy who was having diarrhea.  I asked how long it was going on. They said, “six weeks”.  Six weeks of diarrhea!  So why was it an emergency now, at 2:00 a.m.?  Because this time, the dog pooped on their bed.  I guess it’s only a problem when it affects the people. 

The real lesson to be gleaned from all of this is really for the boyfriend. The fashionista is his fiancé.  After ten minutes in her presence, I was ready to slit my freakin’ wrists.  He’s about to sign up for a lifetime of that.  Take my advice, buddy, and get out now.  Every avenue of pleasure you currently experience is about to be closed off the moment you mutter, “I do”.  It’s not too late to reconsider. 

Bear in mind, the same could be said to all potential future colleagues. Take some time to reflect on what you want out of life - it's not too late to reconsider. 

Cultural literacy

I did not have the benefit of a fancy private school as a child. I went to your garden variety public school all the way through high school and I went to a state university as well. Therefore, it's common for me to assume that the stuff I learned about back is something that any other American public school graduate would also have learned. Sadly, I am far too often wrong.

I would like to share with you a recent exam-room experience with a newly-adopted cat who came in for a new-cat exam & vaccines. The cat was named Dionysus.

Me: (entering exam room) Good morning! So tell me about Dionysus - I'm curious how he came by his name. Does he throw wild house parties every weekend?
Client: um - no? why would you think that? He got his name because at the shelter, his name was just "D" and I didn't think that was a big enough name for him because you know he's a big cat, so I found the name Dionysus on a list of good cat names.
Me: oh. Well I was just joking because as you know Dionysus is the god of wine, ecstasy, and ritual madness and orgies, so, um, I was just trying to be funny.
Client: (looking at me very suspiciously) I don't want to be rude but what religion are you?

Now, I could pretend that I gracefully wrapped up that conversation somehow, but that would be a lie. In actual fact, I think I stammered "um - really?" and my tech saved the day by starting to laugh loudly and say "Oh, Dr. VBB you are so hilarious, I just love working your exam room, I never know what's coming next, oh Ms. Client, isn't Dr. VBB such a card? hahahahahahaha," and then I started asking the usual questions about coughing, sneezing, vomiting, etc and just kind of let the whole previous episode slip silently into the past.

*sigh*

Unneeded tests

I have recently been reading some reviews about veterinary hospitals and doctors. For one clinic, the majority of reviews were great - ones that I would love to have and, well, lucky for me I do have that type also. But there were a few, a small percentage, that complained. Some of them actually gave 4 of 5 stars, but their comments were not so flattering. 

In those cases nearly all of them mentioned money. A few mentioned that the doctor would not allow services to be paid for later. Unfortunately for way to many veterinarians we know later never comes. Many people that do not have their finances figured out today will not have them figured out tomorrow. That is my personal bias. I said many, not all. Believe me, all veterinarians wish their clients were financially sound. 

One thing that struck a chord for me was an unhappy reviewer noted that unneeded tests were done on her sick pet. So, I’m trying to figure out what IS an unneeded test. I have a whole book of tests that can be completed by the lab. I went to school to help determine which tests should be completed in a logical order. In particular my instructors made me describe why I wanted to complete a test before it could be authorized. Even in just casual discussion with my peers we regularly may ask each other about the logic for running any particular test. 

When the unhappy reviewer clearly stated they took their pet in because it was sick how did they know a test was unneeded? Why would they authorize a test they think is unneeded? I suspect in retrospect they really are suggesting that the test results turned out to be ‘within normal limits’ which is very different than ‘not needed’. 

When veterinarians are faced with a sick patient we need to figure out what is normal and what is abnormal. Knowing what is normal has as much value to medical professionals as what is abnormal. Some patients will have multiple systems affected by their condition. If we only tested until we got a single abnormal result we may miss the most important problem. We need to sort out a variety of problems so we can diagnose a condition and rule out other conditions. It helps us determine the need for treatment as well as the treatment choices indicated. We also need to know what is normal because some medications and fluids must be used with respect to certain organs functioning properly as those organs will metabolize the drugs.

One common diagnostic test is a ‘general’ panel. It is done on blood and gives us basic information about the kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas. If my dog is sick and I run a panel on her I am THRILLED that her ‘general’ panel is normal. I then know that her kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas are normal (or near normal). I would not be happier if the panel revealed renal failure, liver disease, pancreatitis, etc. 

I get clients that ask me at times if a test is needed. I tell them that I would not recommend a test if it was not indicated. Need is not really taken into account when a diagnostic plan is formed.