I'd like to buy an N please....

So, here at VBB central we get a lot of interesting phone calls. Today, a new kitten owner called us to follow up regarding her kitty who had been seen here by a colleague of mine last week. She told the receptionist that she'd informed Dr. VBW (that's Vet Behaving Well) that her cat was seizing all the time at home, but his response had been to tell her there was no apparent nasal discharge on exam, that perhaps there was a lot of dust around, and she shouldn't worry unless the kitten developed additional clinical signs of upper respiratory infection. She told the receptionist she found that strange but went along with it at the time, however, over the past few days the seizing has increased to the point where it is nonstop, and she wanted advice.

VBB staff: So you're saying the kitten is seizing? not sneezing?
Owner: yes. seizing. having seizures.
VBB staff: and you told this to Dr. VBW? Because it seems he thought you said "sneezing." Like, when you have a cold, or allergies.
Owner: Yes, seizing. Not sneezing. It's awful to look at. Her whole body is involved.
VBB staff: this sounds like an emergency beyond our ability to handle at this time and we'd like to refer you to the VBB Critical Care branch 4 miles down the road. They'll be able to try to stop the seizures and provide ongoing critical care afterwards.
Owner: Well that's ridiculous. She probably just has a cold, after all.
VBB staff: wait. so she's SNEEZING? With an N?
Owner: Yes, of course. And she has these sneezures.
VBB staff: OK, look, I don't know what you're trying to say. If she is having seizures or fits, go to VBBCC. Otherwise, you can bring her here and we'll see what's going on.

What the hell?

Summer hiatus

In case you haven't noticed, none of our esteemed VBB collaboraters, have posted recently. It isn't that nothing interesting has happened, but summer things do get in the way of activities like this. Anyway, I have been dealing with some of the usual mundane medical issues while doing a brief foray into day practice. Yes, I'm usually doing ER work at night. A practice begged for my help, as they were left without a DVM, & I reluctantly obliged.

After all there years, it is amazing to find people who still don't know about vaccinating dogs & cats for infectious diseases or heartworm prevention. After seeing several cases each week of canine parvo & feline URI & canine heartworm disease, I am beginning to wonder if I am caught in a time warp taking me back 30 years. Yeah, I know the day practice people see this daily too, but I've been out of the loop, so to speak.

You do have to feel sorry for people who bought a puppy from a friend* one day & have it get very sick the next day. It had parvo & was very thin on top of that ( partly due to the hookworms found on fecal exam ). The owners couldn't afford to hospitalize, so we did out patient treatment with a very guarded prognosis. Sadly, it died overnite. Obviously, these people bought a pup incubating parvo & loaded with hookworms.

Then, there was the poor pooch diagnosed with heartworms during a routine visit for vaccines & to see about getting on flea/tick & HW preventive. When the owners found out it would cost about $800 for the whole HW treatment, they decided to go home & think about it......still waiting for their decision. I suspect this pet may linger for quite a while without treatment. My next option would be to put her on preventive with all the extreme warnings about giving it to HW Positive dogs.

Dealing with people, whose pets are not usually in crisis ( the typical ER scenario ), has mostly been more pleasant & rewarding. Healthy kitties & puppies are much more fun to be around, even though I have to stick needles in them for vaccines. hah.

Finally, I've also gotten to do some routine day surgeries, like OHEs & castrations. Usually, I'm doing emergency nite surgeries, like laceration or GDVs or c-sections & such. Sometimes, a routine* OHE can be more problematic than a GDV. lol.

That's all I've got this week. Hope it wasn't too boring for those who follow this blog. Hopefully, something more exciting will happen, when I get back to ER work this weekend or my colleagues will have a good story to share here.. :)

Animal Practice

Ok, I love some comedy.  Scrubs?  Loved it!  Spaced?  Oh yeah!  But I am twitching a bit as a watch the trailers for the new NBC comedy, Animal Practice.  I mean, Tyler Labine, I have loved since Reaper (a comedy that did not get enough credit).  Justin Kirk, of Weeds fame, is both cute and funny.  However, what strikes me as really weird is that there are three doctors, all of which are MALE.  That might sound whiney, but really people, my class, as with most vet classes are 75% female!  Get some female vets in there.  I think you might find inspiration in our side bar.  (Amanda (cough) Brown)

And turtle races?  They totally happen.  And sometimes we dress up our sedated animals for the owner's amusement.  Sometimes those kitties even "hold up" the store across the street and a kind policeman plays along and arrests said kitty.  The hand cuffs didn't fit, but the look on the owner's face was totally worth it.  But it means that we always have to come up with something new and different each year.

Monkeys in surgery?  Only if they are being operated on.  And much as I love to see that the vet is using a cap and gown (better than that backwards Dr. Pol), I would like to see masks and have the emotion seen in the eyes of the actor.  Maybe they haven't had that class yet.  Maybe they need to watch more Grey's.  I dunno.  Maybe the show will be the bee's knees.  Or maybe it will get cut after 8 shows.  I will watch as I am sure many vets will.  At least with this show, I don't have to cry about a poor shocky dog attack puppy that I might have been able to say because it is a comedy.  But if you steal our stories, you're going down NBC!!!!

A Dramatic Scene

INT. VETERINARY HOSPITAL (VBB CENTRAL) EXAM ROOM, LATE AFTERNOON

CLIENT: [holding leash attached to large fuzzy dog] hey doc, nicetuh seeya!

DOC: [entering room] Hi there Fuzzman! What brings you in today?

CLIENT: Fuzzman's a real mess, doc. Take a look at her back.

DOC moves in close to Fuzzman and begins to examine her back. CLOSEUP of Fuzzman's back reveals a golf-ball-sized inflammatory ruptured cyst. DOC squeezes the base of it and caseous material begins to be extruded.

CLIENT: oh god, that's really gross. Doc, is that the grossest thing ever? Omigod that is gross. I'm starting to feel sick.

DOC: [looks up at CLIENT] are you ok? Do you need to sit down? Let me get you some wat-

CLIENT, who has suddenly turned white and begun dripping with sweat, slumps down onto the floor.

END SCENE

I'm not your bitch. Shame on you.

Why the hell do you even bring your dog in to see me if you aren’t going to let me do anything?

I don’t want to have your depressed, dehydrated, vomiting and bloody diarrhea dog in my hospital if I can’t help him. You telling me he has This or That disease which you have diagnosed based on a prior experience at another hospital of which you did the same thing to them. You didn’t get a diagnosis then so telling me that is what he has now holds no water.

Declining every single frickin’diagnostic except my exam gets us just about nowhere. Your dog is vomiting. He is not in shape to take oral medication. He is too dehydrated for your requested subcutaneous fluids to help him much. They are a step in the right direction but your dog is dying while his body can start to absorb them. And then you declined even that anyway.

Thank you, thank you so much to allow me to give him an anti-vomiting injection. At least that will help him a little bit. I feel so sorry for your poor, poor loving dog that you do not deserve. Do you know how much is of a hole it puts in my soul to see such a wretchedly sick dog and not be allowed to help him?

When I send home the information on your invoice that your dog is very ill and needs diagnostics and IV fluids and medications or he may get sicker and/or die, I mean it. When I ask you to either take him to another hospital or reconsider our recommendations I’m doing that for the dog. It’s not for me. Well, yes it may assuage my guilty feelings for not calling animal control on you immediately. But I really do want to help you and the dog. I’ll give you a brownie point for not yet being rude to me. That’s why I haven’t fired you. But my poor receptionist is struggling with trying to help you while doing her job as a go between. No one here wants to see or know a dog is suffering. It deflates all our staff to see this. It puts us one foot closer to the grave.

Telling me that you’ve spent thousands of dollars on diagnostics on this dog is incorrect according to the medical records. Yes, when he bloated about 5-6 years ago you had the cost of the surgery. However you’ve not spent any bucks at your prior clinic, the animal ER or here since then for the chronic vomiting that has occurred. We discussed on your first visit here the recommended diagnostics to help determine what the problem really is.

Now your dog is suffering. He has one or more medical conditions which are making him suffer. You need to buck it up and do the humane thing. Either let him go or get him some help.

When you call me the next morning and ask for oral medication for what is your new diagnosis of him and tell me he is eating and drinking forgive me for declining to participate in your delusional world. I cannot accept the liability. I myself would not even be trying any oral medicine or food or water on a pet that is retching his guts out and has a nasty bloody diarrhea. So I cannot give you any guidance since you are not listening to me. Although I have not fired you as a client I figured you would have fired yourself.

Lady, I’m a doctor, a doctor for animals. I’m not your bitch to get the drugs that you think he needs. I know what the rule outs for your dog’s condition. I know how to rule out the incorrect ones and help lead to the true diagnosis.

Your job as the owner and caretaker for this poor pooch is to get real, stop fooling yourself and recognize that your dog needs a hands on doctor like me. Your job if at all possible is to have prepared for his medical needs. If you haven’t done that then you should get real about the suffering you are putting him through because you are unrealistic. You should prepare to ask for help from your family, neighbors, friends, clergy, pawn shop, etc. or to say good-bye to your dog. Why should your dog suffer because of you?

Now, some of the readers here might want me to understand the economics. I do. This is not about economics, it’s about priorities.

What this is about is that you think you can direct me to get the drugs you think her dog needs. Lady, I’m not your bitch. If he has a chance to recover the lack of proper care will have caused some permanent damage to his kidney and possible other tissues. How do you do that to such a great soul? Shame on you.

Reverend Love

I think it is time for another memorable character story. Which would you like? There have been several memorable characters drop by our practice over the years. They’ve enriched the experience.                                                                                                                          

The Reverend Love was a +/- 400 year old man, slight of build and quiet of demeanor. He headed up a tiny church, about the size of your garage, in the old, poor, unsophisticated end of town. He was polite in the African American lived a lifetime in a prejudiced society and didn’t make waves kinda way. I was a child of the 60’s love everybody kinda guy, and he tolerated me. He had attended this practice for years before I got here. He smiled a lot, but you could see the weight of a world’s mark in the stoop of his shoulders.

Reverend Love had two backyard German Shepherds. Back in the early 70’s there were only two kinds of dogs in our practice. The Poodles lived indoors, and the Shepherds lived in the backyards. Backyard Shepherds were expected to keep folks out of the backyard, because without one, people would drop by and borrow things from your house and yard, and they never did bring em back.

Training such a dog involved about any unspeakable abuse that would turn a dog irredeemably vicious. He might have a doghouse of sorts, or not. Under the porch would do. These dogs ate what they got, which often was what was left after a big family was done eating. They would, often as not, attack and maul your own kids, so you kept the offspring out of the backyard. Sometimes the chain was long, other times kinda short. Just enough to reach the fence, and any fool stupid enough to jump over, but not long enough to hang themselves. That kind of chain.

The clever dogs wouldn’t bark if someone walked up to the fence. All you’d hear was that chain dragging, and then it would stop. The dog was waiting for you to hop in. Right there. Sometimes he’d sniff the crack between the boards. Can you spell deterrent?

Back then a rabies vaccine was good for two years. The county dog license, for which you needed a rabies vaccine, ran from Jan 1 to the next New Year’s, and they granted a grace period through the end of February. So we gave lots of rabies vaccines in February. The backyard Shepherds got out of the yard once every two years, to get that vaccine and thus their license. They didn’t behave well once out of the confines of their yards. For $6 a dog, I gave a physical exam and a rabies vaccine. Filthy, screaming, un-socialized, untrained, terrified, psychotic dogs who had never set foot on a floor or walked under a building’s roof were dragged by their chain, shitting and pissing, into the exam room for their turn. The owner often carried something stout to smack the dog.

The nastier the dog, the more cursory was my physical exam. My goal was to survive. I didn’t approve of the switches and clubs, but if the owners at least tried to hold their vicious dogs off me, I appreciated that.

Reverend Love was a mere wisp of a man, and both of his backyard Shepherds were 90-100 pound dogs. No way could he keep either from killing me if he brought them into the exam room. But he had worked out a system that worked every time. He’d come in without a dog, pay for his two vaccines, and then quietly inform me that he’d knock on the side door when he was ready for me.

The old hospital sat on the corner of the main drag and a side street. We had a front entrance on the big street, and a side door by the other. Near the side door stood a power pole. About ten minutes was all it took. A quiet knock on the side door meant that Reverend Love had his dog ready. And I’d step out, syringe at the ready.

Picture an ancient dented listing Ford pickup truck sitting at the curb (actually, we didn’t have a curb, but who’d admit that?) with one lunging snarling barking wild-eyed insane giant German Shepherd straining at the chain holding him in the bed of the truck. The truck would rock from side to side, the chain clattering. I awaited the “PING” sound of a chain link parting, knowing it would be the last sound I would ever hear, save for my brief futile screams.

The other dog was tied rather snugly to the power pole with a length of chain. The thick leather collar on the dog’s neck was cinched down directly to the pole, and then the good Reverend would sorta wrap the dog around the pole and then run the chain clean round the dog and pole, oh 30 or 70 times until the dog could not so much as twitch the tip of its tail.

“I got him ready for you, Doc.”

All I had to do was find a hind leg muscle between the loops of chain, and complete my task. My physical exam consisted of a quick verification that the dog was still alive. Which I confirmed readily by listening to the sound, the deep throaty growl of absolute hatred and frustration that escaped from the dog’s well-confined throat. I never looked into his eye, for that would be a vision of Satan himself, and I didn’t need to meet that dude yet. I didn’t so much hear the growl as feel it as it reverberated through my kidneys. It chilled my blood.

“Thanks Doc. Give me a minute and I’ll get the other one ready.”

Moments later, another soft knock on the door, and another sound effect machine from a Stephan King movie awaited me, tightly confined to that power pole. One more quick poke through the wall of chain, and then back indoors to sign two rabies certificates.

“Thanks Doc. See ya in two more years.”

Thanks your own self, Reverend Love. You be the man!

Humane Duty

I talked with a friend tonight.  I know her through multiple sources: she lived with my college BFF's family , she knows the people at my family's barn...etc.  And my 6 year old daughter has loved her since the first meeting.  This woman, newly graduated from a college with a great horse program, is a wonderful instructor.  My daughter has taken one lesson, and though she fell off due to over balancing, has ID-ed the reason she fell off (horse tripped and she was too far forward), wants to go back and correct the problem.

Recently, we stopped in at a local place.  After seeing their stallion standing in a stall in at least 12 inches of manure, a horse with a swollen eye/emaciated (glaucoma or cancer), and the lead instructor riding without a helmet and with a 5 inch shank bit (for every pound you "pull," the horse feels twice that per inch), AND the horse was behind the bit, it assured me that this was not the place where I could sub some lessons for my daughter.  Oh and the mini-horse had such over grown feet that I would tern them as elf feet.

I was lucky enough to take college classes in equine production, training, physiology, and teaching riding lessons.  I know how to start a new rider.  I know how to build up an advanced rider.  In addition to being a vet, I can do these things....if only I could afford a pony for my daughter.

So, I talked to "daughter's riding teacher" tonight after my daughter found her name in my phone and called her.  And we shared stories of riding without helmets.  Things that are, to us,  as uncomfortable as getting in a car without a seat belt.  We talked about horses (and other animals) that needed to rejoin the great grape jelly bean in the sky and we talk about the stupidity of riding without a helmet.  I have come off of a horse so many times that when I started having seizures and my neuro guy asked about head injuries, I just laughed.  Most of the injuries occurred with a helmet.  So, good there.  But some were when I was futzing with my helmet and it fell off.  There are so many times that I would have been dead without a helmet.

Distance be damned, I will drive my daughter to my friend who cannot even get on a horse without a helmet vs the place where the woman rides with no helmet, a 5 inch shank, and the horse's head behind the vertical.  Because my daughter loves her for her artistic and crazy colored hair....  and I love her because she believes that true equitation covers all disciplines and she believes in effective riding.

And this is true for your vet.  Just because everything looks ok at first glance and parents tell you that thinks are great, find someone that you really trust.  If they are far away, that is a pain, but it is likely worth it.  Because I will choose someone that will give my daughter what I would like to give.  Common sense, forward thinking, and workman like riding.  I want her to be safe, but on the cutting edge of equitation.  I want her to be able to ride anything.  I guess as a parent, I expect some perfection.  Ok, maybe a little over-reaching.