It's 5 o'clock somewhere!

Patient of mine with a chronic (many year) urinary tract problem (whose management I share with a University specialty team came in today for a cystocentesis). The patient was brought in by a person I have never met before. The person did not know why he was bringing the patient in, but arrived about 15 minutes before we opened and asked "do you know why I am here?" Luckily, I did! Yay, Dr. VBB. So anyway, I did the cysto and returned the patient to the owner. As I typically do, I said to the owner "Fluffy has a damp belly. Don't worry about it, she just has alcohol all over her belly." The person replied "wow, lucky her. I wish I did!"

OK! Whatever floats your boat....

Or, we could not do that...

Because life doesn't put itself on hold in troubled times, even though VBB central is under a lot of stress today, I still had to walk the puppy. We walked up the street through the neighborhood for about 40 minutes this morning. Oh neighborhood. Why hast thou forsaken me?

Believe it or not, I expect people to be nice. I expect polite, intelligent, kind people to populate my world. I am constantly disappointed, by the way.

The guy with the obstructed dog wasn't out, though I saw his dog pee yesterday, so there's that. But a few homes past him is "my dog wants to play with your dog" man. This man drives me to drink. His dog is a land shark and shouldn't be allowed in polite society. But today his dog was not home (it's at the groomer! Yay!) so instead he just wanted to chat about his new "invention." He insisted that he was going to create a dog food system that involved feeding the dog a capsule and then 20 minutes later, dog food. The capsule dissolves to reveal a baggie that waits in the rectum to be filled with stool. Then the dog poops out a bag of stool. Honestly I was LMAO but he became quite put out & insisted he was "extremely not kidding." Then he said "you know I hadn't thought of it but we'd make a great team. We could market this in your clinic." I just looked at him, & raised one eyebrow, and left. He's probably blogging now about his bitchy-ass neighbor, the vet who blew off his big business idea.

Someone seems confused around here

Now, I don't know if it's just me - but, I thought that given our blog title, and the general tenor of our posts thus far, the subject of our blog was pretty clear. I don't know too much about how Google's back-end works with respect to their search algorithms or anything, so maybe that's why this is coming as such a surprise to me, but - well, take a look at these search terms used to find our friendly little blog:

Seriously, people? SERIOUSLY?

Just in case you can't read that last one - some poor misguided soul ended up here after searching for "pissing in vagina." PISSING IN VAGINA! I really do not think that the subject of "pissing in vagina" has been under discussion here at VBB central, so I suppose the poor soul in question left disappointed. I'd like to try to remedy that.

Assuming that the searcher was actually interested in finding out about pissing THROUGH the vagina, rather than some type of sex-play involving pissing IN someone ELSE'S vagina (which, now that I think about it, could totally be what he or she was going for in which case EW, OMG, please pass the brain bleach!), then this person would have been better off googling "female urogenital fistula," or "vesicovaginal fistula." These are real conditions. You may, if you were an Oprah fan like my mom, even have seen an episode of Oprah about poor women in Africa with these problems and gone around for the next six weeks grossing everyone out by bringing up the subject while they were trying to eat.  Anyway, in case our poor searching person comes back here looking for information about it, suffice it to say - sometimes, for a variety of causes including botched surgery, problems with pregnancy/labor/delivery, malnutrition, etc, a tunnel of sorts opens up between the urinary bladder and the vagina (or sometimes the uterus or cervix) resulting in uncontrolled leakage of urine out through the vagina. Affected women are incontinent and often malodorous.

Please see the informative article here: http://emedicine.medscape.com/article/267943-overview for additional information on this unfortunate malady.

Thus endeth today's VBB foray into medical problems in the one species we are not licensed to diagnose or treat. Please don't report us to the medical board for practicing without a license. Thanks for stopping by!

The importance of copy editing

Some of us are grammar snobs, some of us rail against apostrophe abuse, and some of us feel that the Oxford comma is the hill on which we wish to die. Others of us really could not possibly care less, and feel that as long as the general idea is being communicated correctly, the details are unimportant. There is room here at VBB central for people on both ends of this spectrum, but I'm pretty sure no one thinks that reading for content is a step you can safely skip. Witness, the referral letter I received today.

Obviously, I have rewritten this letter so as to avoid accidentally identifying the sender, who clearly has either a disgruntled soon-to-be-former employee typing up his referral letters, or a habit of writing snarky letters as a first draft, and subsequently changing them before sending them out. I must admit to being frequently guilty of the latter - although mine are generally more along the lines of "Thanks a lot for sending me this bullshit case with the bitchy owner who has zero interest in helping her dog, shmucko," and are immediately deleted and redone. I am reasonably sure that I've never actually sent one out like that. I THINK I would have found out somehow... at the very least when I saw the copy of the letter in the pet's record at the next visit, because I do keep copies of the letters I send out in our computerized medical record.

Poor Dr. Fire-Someone. Hopefully at least he'll have sweet dreams.

Special K

Well, this is interesting: http://www.npr.org/blogs/health/2012/01/30/145992588/could-a-club-drug-offer-almost-immediate-relief-from-depression

I hope it doesn't increase the number of break-ins at veterinary clinics. I think I'll go reinforce the - hey! Gotta go. There's a horde of depressed people heading up our driveway! AAAAAAaaarrrgggghhh!

Castration - STAT!

I performed a STAT castration this week. A nice family had purchased two rabbits, and were told they were both the same gender. But—over the weekend a litter of baby bunnies mysteriously appeared in the cage. So I castrated Daddy, and hopefully we’ll be spaying Mommy soon.

It’s pretty common that we’ll see kittens, rabbits, guinea pigs, etc. that are supposed to be one gender but turn out to be the other. This leads to some embarrassing and amusing exam room moments. I have one patient, a 10-year-old neutered male cat named “Belle,” whose owners still refer to him as “her” because they were told that “she” was female as a kitten.

It’s rather harder to mistake a male dog for a female, but it happens. We recently saw a new puppy, a German shepherd named “Sarah.”
Vet: “Um, Sarah’s a boy.”
Client: “Really? The breeder said she was a girl.”
Vet: “Yes, that’s his penis right here.”
Client: “Oh, I wondered what that was.”

The moral of the story is: Gender should be verified by a professional.

Burying Baby

Years ago when I was first out of school, I worked at a large mixed animal practice in a tiny town. The practice employed 5 veterinarians and a multitude of support staff. Needless to say, we saw a ton of patients.

One day, the front office put a call through from the police asking us about a patient. I told them that we could not release information with just a phone call. The policeman on the other end of the line got a little irate:

"I have bloody remains in box with your clinic's name on it. I need information on a patient named 'Baby Jones.'"

Well, that changed things a bit. The officer elaborated and it quickly became clear that, though a crime had been committed, it was not a capital crime.

An excavation company in town had large piles of dirt, top soil, mulch, and lime. They had seen someone driving around the piles and when they went out to check, the people were gone. However, in their wake, they left a humped up mound with cut flowers on top of it just next to the lime pile. When the worker uncovered the large cardboard box, he saw the words "Baby Jones" written on the top. Given the blood on the box, the flowers, and the writing on the box, he immediately called the police.

The first policeman on the scene arrived and opened the box. The first thing he noted was a large amount of blood and a body that had been cut open. He freaked out and got a little sick. The next police officer had a little bit of forewarning so when he looked, he saw the animal fur coat, making the assumption that someone buried a mutilated dead infant a non-issue.

As it turns out, the body in question belonged to a patient of the clinic that had died and the owners requested a necropsy (our word for autopsy). So, one of our fellow vets had opened up the animal to see if they could find a cause of death. When he was done, he wrapped up the body and placed in a box that had been used to ship supplies to the clinic. Hence, the police tracking the body back to our clinic.

It sounds like a good start to an episode of Bones.

Send me your Resumes!

I just received the most awesome job application, and here´s why it rocks:

A) Puts in cover letter that she is looking for a certified Tech position, when she isn´t a certified Tech.

B) Misspells her own name and lists her DOB as 1083.

C) Is certified in animal first aid, when no such certification even exists. Those bullet points about EKG and defibrilation are a huge bonus.

D) Is a certified homeopath (no certification exists) that has a mobile practice in my area. Now thats´s what every practice needs, somebody adverstising their private business to your client base.

E) States that she will be a great asset in helping diagnose patients and developing treatment plans. Hmm.. I thought that was my job. Maybe she can do this between defibing patients and brewing homepathic remdies?


Is there anything missing I ask you?

Most "unusual" clients you've seen

I'm going to post one 1st of an ER colleague who related this story.....

Got a call from some people in a town about 3-4 hours from here. They own a bunch of rats - and when I say a bunch, I mean something like 1,000. They were looking for veterinary care, and had heard "we were the best". I was game, so I said sure, come on in. They had a rat with mammary tumors that needed removal.
Clients present - and Oh were they amusing. 1 man, 1 woman, 1 gimp, and 1 rat. Here is the picture: man and woman are in safari jackets and have these tool belts on. They have walkie-talkies and use them frequently. They actually use the walkie-talkies to speak with each other while standing side-by-side in the exam room. The gimp - and when I say gimp - I mean in the Pulp Fiction sense. They've got this leather and chain clad dude (I'm assuming it was a guy) - head to toe (full hood, only see eyes and slit for the mouth), on a chain. They lead him into the exam room and sit him in the corner where he just sits and occasionally moans! It was hilarious. I got a kick out of it - but there was many an employee that would flee the building when these people came in (oh yes, forgot to mention, they became repeat customers). Ended up performing the surgery - all went well, they paid their bill. Did several of these surgeries for them and they were very happy clients.
Until.... one day I get a call from the police in their town. Apparently, these people have an old human ambulance that they drive around. They had been taking prescriptions I had written for them (I wrote 1 for an O2 canister, and one for Amoxi) and had somehow forged a bunch more and were driving around trying to act like human paramedics and were using the forged scripts to get drugs. Nipped that one in the bud.
I later additionally learned the reason why they drove 3-4 hours to see me. Every vet within 3 hours had already banned them. One vet had to take them to court because they shatterred the glass on his front door while slamming it on the way out....

Never a dull moment.
I kinda miss the gimp, he made me laugh.
Not to mention the "read you loud and clear" response on the walkie-talkie when the person is literally 8 inches away.

Little things...

Lately I finding myself doing something to clients...  just because I can.  It's a small thing but when I do it, I laugh to myself at how petty I am being and how... juvenile...  which is probably why I laugh about it anyway.

I purposely keep my stethoscope in my ears longer than usual, specifically when the client insists on talking to me while I am ausculting the chest.  It seems that putting something into my ears is code for "talk as much as you can NOW!"  I guess that they think I can hear both the heart and their voice because I have those ear pieces in my ears?  I have no idea.

So now I keep them in until the client finally stops talking, take them out and say, "Oh, I'm sorry, what did you just say?  I couldn't hear because I had the stethoscope in my ears so I could hear your dog's heart beat."  Even if I could hear them.  I just lie. 

I know, it's a little thing, but a little thing that makes me...   giggle.    :)

Shock Collars for Employees?

Can I put a shock collar on my employee?

We have a new and hopefully-soon-to-be-ex technician assistant who has less tact and common sense than a blind cave salamander. Let’s call her Cave Salamander, or CS for short.

I’m actively trying to get CS fired but my office manager is so picky about documentation, so in the meantime I’ve been fantasizing about putting a shock collar on CS. You know, one of those big, heavy, electronic shock collars with a remote control trigger. Just imagine how useful that could be:

CS, on the phone with a client: “Sure, you can give your dog aspirin.”
Me: Bzzt!

CS: “Buddy’s owner wants to know if she can get a refill on his pills?”
Me: “Buddy who? What pills? Where’s the chart?”
CS: “I don’t know.”
Me: Bzzt!

CS: “How do I keep my pit bull from getting my Rottweiler pregnant?”
Me: Bzzt!

Me, suturing a laceration on an anesthetized dog.
CS: “There’s a guy on the phone who wants to know why his dog is peeing in the house.”
Me: “Take a message, pull the chart.”
CS: “But what would make the dog pee in the house?”
Me, gleefully breaking sterility to push the remote control trigger: Bzzt!

Just think of the possibilities!

The obese boarding cat whose chart clearly says “1/2 can food twice daily, no dry” has a quart-sized bowl in its cage full of dry kibble? Bzzt!

The back door which has a notice saying “Do Not Prop Door Open” is propped open? Bzzt!

I think I need to market this idea. Introducing the Zappy®, the World’s Best Personnel Training System, available exclusively from VBB!

Non compos mentis

The VBB, you may have noticed, complain about clients a lot. That is not to say that all clients are terrible. There are many we simply aren't mentioning here, because honestly - would it be any fun to read about my perfectly lovely day with perfectly lovely people bringing perfectly normal pets for perfectly routine visits? No. That's not funny, and it's not fun. So anyway, there's one segment of the frustrating client population that I don't believe we've mentioned yet. We've covered the rude, the abusive, the ignorant, and the stupid, but not the ones who are not of sound mind.

So.

It may not be obvious to all, but the mentally ill/mentally disabled/demented are a group which is present in society, and that includes the population of people who bring their pets to a veterinarian's office. I happen to have a lot of elderly clients, and a good number of them are very sadly in various stages of dementia. This is terrible. I feel terrible for them, and I feel terrible for their pets. I usually start out trying to help by making them large-print schedules of when to give their pet medication, and often I will ask for an additional contact person and then try to get their son or daughter or whomever to help out. But unfortunately, more than once, I've had a client become so incompetent that he or she has actually become confused, and thought I was a physician, and then gotten distraught when he or she realized there was an animal in the room. These were clients who used one of those "elder transport" services, so no one was with them. It's heartbreaking all around when these things happen. Luckily I've never had one of these people decompensate to the point that I had to call 911 or anything. The few times it has been really bad I have led them into my personal office, sat them down with a bottle of water and a cookie, and had a tech babysit them until they pulled it together enough to move forward, or their ride showed up, whichever came first.

Along the lines of mentally ill, I've been keeping a diary of my client/patient encounters since I entered practice, and I was reviewing it recently and found this from many years ago:

Saturday, I'm giving a cat an enema when I hear yelling from the reception area. I go up to the front desk and see a client literally screaming to the receptionist  "You are EVIL. You are an EVIL LIAR. I can NOT BELIEVE you would say that!" The receptionist is sitting mutely and staring at the woman. I interrupted the tirade and asked if I could help. The woman sweetly said that yes, she had Fluffy here for an office call. I brought them into an exam room, did an exam, chatted about Fluffy, and prepared to send her home when she said "and by the way, I will need all of the records for all of my pets because I can't come back here. I can never trust that SHE won't harm my animals." I said I was sorry to hear that and that I was sure my boss would be sorry to lose her as a client, and asked if there was anything I could do to make her happy today. She said all I could do was fire the receptionist, which of course I couldn't do, seeing as how I just work there, so I said ok, I will ask the receptionist to get the charts ready for transfer. So, we did, and the woman freaks out on me "No, no! I must have the ORIGINAL forms. You are SO SNEAKY. No copies!! Just ORIGINALS!" I offered her the phone number of the state board of veterinary medicine and explained that if she called them she'd see I was not lying when I told her that I was legally required to keep the originals. She then jumped down my throat, called me an "EVIL LIAR" and stalked out. Half an hour later, she called and apologized, and has been doing so twice daily since then!

Clearly, that is a mentally ill person, right? I mean, no one mentally sound would do something like that, right? Another one from my archives: I have also had a middle-aged man start taking his clothes off in the exam room. When I exclaimed "stop that right now!" he looked befuddled and said "oh! sorry, I thought I was told to disrobe and wait for the doctor." I said no one had told him that and he meekly apologized. Then he asked me if I knew where the lettuce was. I said I did not have any lettuce, and asked if he wanted me to go ahead and examine his dog now. He said "yes please, but is it ok if I wait out there? There are too many people talking in here." I sent him to the waiting room happily. He and I had been the only people in the room.

Vets do not receive training in how to handle this sort of situation. We muddle through as best as we can. It can be pretty difficult at times.

Veterinary Medicine is Never Boring

We got an emergency call from a guy who said his dog wasn’t breathing, so we told him to come right in. While we were waiting, we assembled equipment to treat respiratory arrest: oxygen, endotracheal tubes, laryngoscope. As soon as the doorbell rang, the tech ran up front to grab the dog and bring him to the treatment room. It was immediately apparent that he was in fact breathing, and had nice pink gums and a steady heart beat. He was pretty wobbly, though, and looked like he was hallucinating. The tech mentioned that his breath smelled, so (brilliant me) I opened his jaws wide, stuck my nose to his mouth and breathed deeply. Whoa. My nostrils were assailed by an overwhelming scent wave: sort of smoky, sort of herbaceous. I saw brown gunk stuck in his teeth, which I swiped out with a paper towel. Sniffed that, too.

By this time it was pretty obvious that the dog was showing signs of marijuana toxicity. (Dogs will eat anything, including poo, so it should be no surprise that they will eat marijuana. I’ve seen toxicities from dogs eating the raw plant, the dried product, laced brownies, and the gunk from the ashtray.) I went up front to the lobby to talk to the owner, who denied having any pot, but blamed his roommates. While the owner was trying to decide whether to hospitalize the dog, I went back to the treatment room. I was sitting there, chatting with the techs, when I realized that I was giggling and my brain felt all tingly and woozy.

Crap! I got high at work from breathing second-hand smoke from a dog.

Fortunately, the symptoms resolved before I had to treat any other patients.

Sex Education 101

A call to the emergency line at our hospital:

Caller: " I think that my cat is having trouble giving birth. She is rolling around on the floor and meowing real loud!"

Vet: "How old is your cat?"

Caller: "She's 9 months old, never been out of the house."

Vet: "Do you have any other cats? Any tom cats?"

Caller: "No, no other cats. Just her and she never goes outside."

Vet: "Well, I think your cat is going into heat. If she hasn't been around any male cats, it is unlikely that she is pregnant."

Caller: "Oh, ok."

*******few minutes later the guy calls again******

Caller: "I forgot to tell you, we do have a chihuahua...he's real close to her size."

****vet laughing******

Caller: (mad) "Well, you don't have to laugh, is she having chikitties or not?"

Seriously. And this guy had kids. Public education fail, folks!