Sunday, October 21, 2012

A Big Round of Applause!

The VBB Pharmacy post was SO good...  that those of us here at the VBB Round Table were hesitant to post too soon because we didn't want to push it down on the page, but....

We feel we MUST thank our awesome audience for giving us over ONE MILLION VIEWS!  At the risk of showing our cheesy side and quoting Austin Powers, it must be said:  "GROOOOOVY BABY!"

The success of this blog is owed to our large and ever-growing fan base, and we hope to continue to be as creative and - dare I say - un-PC, as we can!  

Please keep up the great following, continue to comment and give us feedback, and as always, have fun and ENJOY!

This blog's for you, baby.  :)

Friday, October 12, 2012

A good dog.

From the VBB Mailbag, a sad story about a good dog. A little advance commentary - I can really already hear the comments on this, before I've even posted. Some readers will say that no dog who bites a child should ever live to tell about it. Some readers will question whether the dog did in fact bite the child (and I don't know, is the answer). Some readers will wonder why Dr. VBB-sympathizer agreed to euthanize an apparently healthy, good dog - and others will jump in and tell those readers she HAD TO DO IT because otherwise she'd get sued if the dog ever bit anyone in the future. Someone will probably call the writer an idiot for removing the muzzle. There are all kinds of angles when it comes to this kind of story and I can argue pretty much every side of something like this. At the end of the day, this is a story about a doctor, who is also a person, who is grieving, and about a dog, who died at the hand of someone who truly cared, because she had no one else in her life who cared enough. Here's the story:

Had a euthanasia come in today. 8 year old chocolate lab/doodle. Allegedly she bit the family kid 10 days ago. Owner comes in, does paperwork, makes payment. We ask if he wants to be present. He says, "Naw.". He goes out to get her. Brings her in, fighting the whole way. Obviously she doesn't want to be here. He pulls her so violently that he chokes her, but she's inside the building. He hands us the leash, kicks the dog in the butt, tells us to muzzle her and turns to leave. I take her back to the treatment room where my co-worker is waiting. Dog fights with all of her 90 pounds to get back to the door she just came in, and her eyes dart around the room looking for the owner who left her there. I pat her. "It's okay Abby" I tell her, but I know it's not okay. She sits on command. She stays on command. She doesn't fight when we muzzle her. I kneel over her to restrain her while my co-worker finds the vein. As the needle finds it's way into the vein, Abby's tail never stops it's constant drumming on the floor, and she leans into me the way my own dog does. I pull her muzzle off as the solution is pushed into her body and tell her, "You're a good dog Abs. And good dogs don't die with a muzzle on", as my tears fall into the fluffy fur of her head. She slumps to the floor. The tail stops drumming. I lean over her and cry, mourning a dog I've only known for 10 minutes. Why do I do this job? So good dogs never have to cross the bridge without knowing someone loves them. I do. And sometimes it's enough. I hope.

Thursday, October 11, 2012

Wasting Time

I learn something every once in a while. Usually from folks wiser or more experienced than me. I’ve been at this work for a while and I’ve picked up some tricks along the way, but my knowledge base always has room for expansion and enrichment. 

So anyway, this friend of mine, a veterinarian of some renown, was once talking about the frustrations of scheduling appointments with clients who just could not manage to show up. Not show up on time, or not even show up late. Nope…Not show up at all. No call. No excuse. Sure as hell no apology. Just don’t show up. Somebody else, another client, might have filled that slot if the doc only knew, but there it goes, forever empty.

Now, if you work for the government, or if you simply work for some other boss you don’t like, an empty appointment slot means you don’t have to work for a bit, and you still get paid, and that’s a fine cup of coffee you enjoyed while you didn’t work. But suppose you own a veterinary practice, and your day is meticulously scheduled to convenience your clients and yourself, and you can maximize the work and the benefit you provide for those clients if there is some semblance of order to the schedule. Since you work for, and thus are paid by those folks who come through the front door, when someone books a piece of your time, an appointment, and they don’t show, you have still invested that time, but that time will be wasted. 

So at the end of the finite day, when your employees are home and enjoying their families, you sit there in your office with the light on, with the medical records and bank balances and that never shrinking stack of bills, and that serious need to pay all those people who work for you for the time they have spent….and there is that piece of time wasted. No choice. You struggle to stretch the smaller piece of money as far as you can. You’ve done it before. You have to.

We are not just about the money in this job, but without enough of it, we go away. For that is a simple reality. It costs a tremendous quantity of money to run a veterinary hospital, generally thousands of dollars a day, every penny of which comes from the people we serve, and all of which must be paid before the owner of the practice sees one red cent. This is the simple reality the owner of every small business faces even before her need for oxygen.

But beyond reality is that nebulous thing we call life. And our life is marked by time, not money. And as my friend taught me, we might make up the money, but we can never make up the time. For the clock only runs in one direction, and it is most unforgiving.

The draft horse in the novel Animal Farm had a simple solution for when not enough was coming in to support his family. He simply vowed to work harder. And that sufficed for a while to keep things going in the book. But when the draft horse finally died on the job, there was no one to take his place. Bad times fell upon his family. And of course, he also was dead.

I’m reminded of this as I choose to work ever longer hours to keep things going during these difficult economic conditions. If I keep this up long enough, I’m eventually gonna be dead. I’m burning time that will never come back, and time is finite.

Suppose someone approached you in your youth with this offer…

I’ve two jobs for you to consider. You must choose between. One you will generally conduct with a passion and with a sense of satisfaction, but it will cost you much of seven days a week. Welcome to the ownership of a veterinary practice. 

The other job will pay you as well, or often much better, and likely will offer that same satisfaction, or more. You will invest only a normal workweek, and you will go outside to play in the evenings after work, on the weekends, and during those vacations. Which would you take? 

Oh, just for jollies… What if you take that first job, and out of sheer self-indulgence you steal one weekend away from your practice every few months to go play with your family, and the people you pledged to serve bitch and whine because you failed them by not being there for them on that one weekend?  

Which job would you take?

Did ya notice the lesson here?...…You can make back the money, sometimes…but you can never get back the time. And Jack may eventually become a dull boy, despite doing the work he loves.

Now let’s throw in one more, ah…variable.

Suppose you took that first job, and just for jollies we’ll say you own a veterinary hospital, and you are a good citizen so you registered to vote. And then the letter arrives because of this registering to vote thing, suggesting you show up for one day of jury duty rather than go to jail for not. So you bite your lip because some time will go away forever while you are at jury duty, and take away with it that day’s earnings intended to pay the bills. Your clients will complain because you are not there to serve them on that day. But what a good citizen you are! And the judge thanks you for your service, and makes you a fine offer…

“How’d ya like to spend, oh say, the month of November playing juror?”

Well heck, yeah. I’d love to. I’m a good citizen and I’d be a good juror, much better than a few of those seedy looking folks lounging around the jury assembly room down to the courthouse who look like they really should instead be sitting up there next to the public defender.

Of course, they won’t let me know if I’ll be serving that whole month until the very last minute, so the notion that I could find a relief doctor to keep my practice open at least part of the month becomes a little, uh, unlikely. But suppose I do luck out and hire a good doctor. I will pay that doctor more than I would make myself doing that same job, and that doc will generate less for my practice than I do.  Then I’d have the bills and the payroll mostly covered. But I’ll pass the whole month with no paycheck for my family. 

Well, tough titty, said the kitty. The judge proclaims this does not constitute a hardship, so don’t bother asking him to change his mind and let me go serve my first master instead of his catch and release fishery. 

And don’t forget the property taxes due in early December. Make that two months with no paycheck. Merry Christmas.

But it gets better if I cannot find a relief doctor. Then I get to eat the whole thing. Tens of thousands to pay the bills and pay my loyal employees, out of my personal savings that don’t really constitute tens of thousands, because my practice will generate no revenue during that time. This is how it will feel when I finally have that heart attack and cannot work for, oh a month. Real sorry about that, goes the judge, but thanks for your service.

Sure, I could call this a vacation from my practice, and just forget any silly notion of taking an actual vacation for some considerable time. Felony trials are hecka fun. Hells bells, I sure never have even considered taking a month long vacation in my adult life, even though I wouldn’t call a real vacation completely lost time. We’ll call the jury trial a government mandated vacation. First time they ever did that for a boss.

 But I might have saved up for an actual vacation, having enough sense not to bankrupt myself just to run off and have some time for my family and myself. After all, you can plan for a vacation.

Oh yeah…and on top of this, my clients will still complain because I’m not there.

Wednesday, October 10, 2012

I'm Tired

Decades in this profession teach many lessons. For instance, I’ve learned that there are two kinds of tired in this business. One version comes from being so busy during your hours in the hospital that you blindly stumble out to the car at the end of a day, pick up a bake at home pizza as you try to remember where you live, cook it up while gulping down one neat bourbon, and then fall asleep in the chair in front of the usual reruns before you finish the third piece. More on this later.

The other kind of tired happens when nothing of consequence happens for days at a time in the hospital, and you wear out the solitaire game on the computer, and thus at the end of the day when you peek at tomorrow’s bank deposit, it laughs at you. And when you sneak up on the bill file and peer inside, it laughs even louder. On these nights you hit every red light, stalled truck, radar trap, and road repair on the way home. When you finally make it to the house, the good bourbon bottle is nearly empty, but the cheap shit will do, and you have one or six, and the usual reruns are on the tube, but nothing in the house will matter. You ain’t gonna sleep that night at all. 

When the economy sucks like this one, those in our profession get to know both versions. There is no rhyme or reason to what comes through the front door, and you simply go with the flow, busy or slow, for the boat has no oars, just like those oarsmen in government who would tell you they can fix this mess. We are utterly at the mercy of what comes through the front door, as are those folks who come in through the front door.

Today was one of those crazy busy, exhausting days.

I fired up the computer when I walked into the hospital at 7:15. The day’s appointments popped up. Two procedures booked for the 10-12 morning slot. A teeth cleaning on a dog belonging to a friend, and a double enucleation, surgical removal of both eyes, on a cranky old Shih Tzu with glaucoma in both eyes, and likely chronic pain. He has been blind for a while, and now I will make him comfortable for the rest of his days.

The rest of the morning was completely booked, seven appointments from 8:15 to 10. I ran through the usual things I must do to prepare for the day. My receptionist arrived in her usual flurry of noise and chaos, setting my stress level alarm off before I even start the day, just before 8. I could hear her talking with someone in the parking lot. That couldn’t be good.

I knew the guy. He has two Dobermans, one an absolute doll, and the other so afraid of her own shadow that she thinks anyone petting her will kill her, so she kills him first. She is a joy to work with in the hospital. Of course he brings in the psycho one. She had been vomiting since one AM, and the puke looked and smelled like poop. Bad sign. Oh, and she had been eating those parts of the kong toy that the other dog chewed off. 

The xrays were classic obstruction of the small bowel. Time for forget everything else and go to surgery. My receptionist went about calling clients and moving their morning appointments to free up the time I would need. We were in surgery shortly after nine. 

The last of the morning’s surgery was done by 12:30. I hit the bank, and the Chinese takeout, and I was back writing up the surgery records by 1:00. The afternoon began at 1:30. Sixteen appointments awaited. I was approaching tired already, and when the “I paid for part of this clinic and I deserve special attention so forget my tomorrow appointment cause I’m here today” walk-in showed up at 2 we tried to find a way to see her, too. I hope she enjoyed the wait, for the courteous folks somehow got seen before this one. 

I did finally see the mouth, and her cat wasn’t all that bad off, and as she was leaving somebody noticed the weird people standing in front of the clinic so I went out to see if any unreasonable crimes were being committed. Introduce the filthy pet owner holding the puppy in a towel in her arms. The guy translating for her, for her English was missing a few pieces, told me her puppy wasn’t eating, was throwing up, and the diarrhea was bloody. Oh, and no, the puppy had not been vaccinated. 

I can describe tired pretty well, but I’m not sure I can describe the sinking feeling this revelation rewarded me.  I’ve watched hundreds of puppies die from parvo during the thirty plus years this disease has existed. Every one died because somebody didn’t vaccinate a puppy. Every freaking one. And they all died horrid deaths.

Personally, I haven’t been hiding the fact that you can vaccinate against this disease. I have no reason to. I thought it was common knowledge. And I’ve tried to get the word out. But some folks are well isolated from common knowledge. 

I had clients waiting patiently to see me. Some were the very folks who moved their appointments that morning so I could save a life. These were clients who try their very best to be good pet owners. I suppose I could screw them over to see this despicable person holding a sick puppy. That’s what the puppy owner would prefer. And she will pay me later… she promises. 

Thirty years of treating parvo in puppies belonging to irresponsible people. I’ve heard this promise before. It’s not worth the paper it is printed upon. When I turn and walk back into the clinic to take care of the nice people, the memory of all those lies, all those thieves, all those lying cheating irresponsible people whose reprehensible behavior killed all those innocent puppies burns in my memory and my gut.

The woman hung around for a while. She walked into the waiting room with the puppy so we had to lock the room and disinfect it….yet again. When she finally left, she swore at us, the evil in her voice, the hatred. But I was serving the people who pay my bills so I can stay open as a veterinary hospital in these difficult times. 

I’m sorry puppy. I’m sorry I can’t fix the mess that horrible person inflicted upon you. But I cannot afford to carry the weight of every irresponsible asshole. There are far too many irresponsible assholes.  I’m barely surviving here at all, and those nice people and their animals need me. 

I left for home at 6:30. Everybody else left when we closed at 5:30. Eleven hours.  And I was tired.

Saturday, October 6, 2012

Yo, Redditors!

Noticed a little uptick in our traffic coming from Reddit, and found Redditor essentialparadoxes had thrown a link into one of her comments there. Or possibly his comments, you never know, although those who claim we lack diversity will say you do know, and that that's a huge problem. Whatever. Although I'd like to point out that I know of at least one North American veterinary school whose class president about 10 years ago was a gay Puerto Rican man. Hard to get a lot more diverse than that really. I've also met a few international Japanese students studying at North American veterinary schools in the past ten years. But I digress. Thanks for the shoutout, intrepid future colleague! Stay golden.

I'll add a breeder story so I can tag this so folks from Reddit find it when they click essentialparadoxes' link.

About 3 or 4 weeks ago a breeder called completely out of the blue wanting to know if she could bring a dog by for a pregnancy check. The receptionist said she'd be glad to book an appointment with Dr. VBB - but then the breeder said she didn't want an appointment. The receptionist was confused and asked the breeder what she wanted, and the breeder said "I just want to drop by and have the doctor palpate and see if she's pregnant." When told that this would require an appointment, the breeder asked "but what if I don't want to pay? I just want to stop by informally, you know?" 

There's a dent in my desk the size of my head from just that ONE phone call, people.

Friday, October 5, 2012

Rabies on the Brain

I’ve got rabies on the brain. Well, not literally, because that would mean I’d probably be dying in intensive care.
Last week (September 28) was World Rabies Day. It is the anniversary of the death of Louis Pasteur (more on him later).
Rabies is virus which causes a virtually 100% fatal neurologic disease in all mammals, including humans. According to “Rabies surveillance in the United States during 2011,” last year rabies was diagnosed in animals in 49 states (not Hawaii). Besides the “usual suspects” of bats, skunks, raccoons, foxes, dogs and cats, it was also diagnosed in cattle, horses, sheep, groundhogs, deer, beavers, otters, javelinas (shaggy piggy creatures), bison and alpaca. Bambi and Thumper could be rabid!
Rabies is spread by the saliva of a rabid animal. When the rabid animal bites a victim, it inoculates the virus into the tissues. Unlike most viruses and bacteria, which spread through the bloodstream, the rabies virus spreads along nerve cells. Depending on how far the bite wound is from the brain, symptoms might not develop for weeks to months to years. A person in the US died last year of rabies that was acquired from a dog in Brazil eight years previous! For eight years, the virus had been lazily moseying along, inexorably crawling up to the brain.
Once the virus hits the brain, bad things happen. Even in the 21st century, over 50,000 people worldwide die of rabies every year. It is a horrible death of alternating periods of lucidity and psychosis, pain, fever, convulsions, hallucinations and hydrophobia (pathologic fear of water).
I recently read Rabid: A Cultural History of the World’s Most Diabolical Virus, by writer Bill Wasik and veterinarian Monica Murphy. It’s a fascinating book, although I guess I might not qualify as a totally objective reviewer since I tend to get a little bit obsessed about public health and infectious diseases.
Wasik and Murphy weave together a history of rabies and civilization. Although many of the scary epidemic infectious diseases of humans, including Ebola, West Nile, SARS, swine flu, and hanta, are zoonotic (transmitted from animals), only rabies was known to be zoonotic before humanity ever considered the existence of bacteria and viruses. Think of bubonic plague (“The Black Death”): people didn’t realize it was caused by a bacterium spread by the bite of a rat flea. But rabies: slobbering psychotic dog bites human, human turns into slobbering psychotic animal. It was obvious even four millennia ago that rabies was transmitted by animals, particularly canines.
The book looks at theories, preventatives and “cures” over the millennia (the most effective preventative prior to vaccination was cauterizing the fresh bite with a red hot poker); history (St. Hubert is the healer of rabies sufferers); mythology (the slaver of Cerberus spreads both rabies and aconite); connections of rabies to werewolf and vampire legends; the handful of documented survivals of rabid humans; weird ideas that people have had to prevent rabies in dogs (one theory suggested rabies spontaneously arose in dogs due to sexual frustration and suggested prevention by creating “doggy bordellos”); rabies in various species (l’enfant du diable = the devil’s child, a skunk); history of canine mass killings in an attempt to stop epidemics; and a recent rabies epidemic on the supposedly rabies-free island of Bali.
The most fascinating chapter explains how Louis Pasteur developed the first rabies vaccine in the late 1800’s. In fifteen years of veterinary practice, I have never seen a case of rabies and hope I never do. Pasteur (who is also the father of pasteurization and food safety) was neither a physician nor a veterinarian, but was a really smart dude who was passionate about human and animal health.
You can’t grow rabies virus in a Petri dish. The only way Pasteur and his colleagues could grow rabies virus was by maintaining rabid animals in the lab, putting themselves at continual risk of gruesome death. At first they allowed a rabid animal to bite another to perpetuate the virus; then they started collecting saliva from slobbering aggressive dogs to inject into other animals. Eventually they hit on dicing up the central nervous system of a rabid rabbit and depositing it directly onto the dura mater of the recipient’s brain. By repeatedly transferring rabies directly from one rabbit’s brain to another they developed a highly virulent strain. The next step was to inactivate the virulent virus to make the vaccine strain, which they did by leaving the rabbit’s spinal cord out to air-dry for a few days. This air-dried infectious bunny brain was then injected as a vaccine: either a pre-exposure vaccine to prevent infection or a post-exposure vaccine to prevent development of symptoms after a bite.
The first human to receive the vaccine was a boy who had been mauled by a rabid dog. Can you imagine the agonizing wait for Pasteur to see if the boy survived or died? (He survived both the bite and the cure.)
We all learned in vet school that rabies is absolutely, guaranteed fatal. But some new research is showing it might not be completely 100% fatal. There was a girl in Wisconsin who survived clinical rabies after a medically-induced coma and months of rehab. And a recent paper was published in The American Journal of Tropical Medicine and Hygiene that looked at humans living in remote areas of Peru where vampire bats are a common carrier of rabies. 11% of the people had rabies neutralizing antibodies; they had not been vaccinated so those antibodies developed after infection with the real, live virus. How come they didn’t die? Has evolution favored people with a more exuberant immune system that can fight off endemic rabies?
However, despite this research, the odds of dying are still very, very high. Make sure your dogs, cats and ferrets are current on their rabies immunizations, and never approach an ill or strangely-behaving bat, skunk, raccoon or fox.

Thursday, October 4, 2012

The Incredible Disciplinary Action

WHOO HOO!!!!!!

The Not So Incredible Dr. Pol is on probation- AS ARE THE OTHER VETS IN HIS PRACTICE!

Check it out:

Brenda Sue Grettenberger, 69-01-007301 05/26/2012
Weidman, MI
Negligence - Incompetence

Eric Mitchell Gaw, D.V.M. 69-01-008005 05/26/2012
Mount Pleasant, MI
Fine Imposed
Violation of General Duty/Negligence

Jan H. Pol, D.V.M.
Weidman, MI
69-01-003494 05/26/2012
Fine Imposed
Negligence - Incompetence

A while back, we informed you in our most popular post ever, gentle reader, that Dr. Pol (go ahead and tweet him about this post!) was practicing substandard medicine. His lack of adherence to basic standards of care when it comes to sterile technique, anesthesia monitoring, pain relief and basic modern medicine has finally been addressed. Not by Big Veterinary, mind you. By some brave soul who complained to his state board about his malpractice.

Kudos, brave soul! THANK YOU!!! And thank you, good people of the Michigan Department of Licensing and Regulatory Affairs Bureau of Health Professions!

And the local vet school, proud MSU, sending students out to ride with him? Shame on you. You knew. You HAD to know. Students talk.

That goes twice for Nat Geo. Your staff was informed of the concerns practitioners had with showing this hack as an exemplar of our profession. Wanna know why the not so incredible Dr Pol was picked as the national role model of our noble calling, gentle reader?
His son was a production assistant. Click that last link & you can find him listed under "meet the vets" for some reason. They say he works in the "entertainment industry." Yeah. So, they needed a vet. Look no further! F for effort on that one, Nat Geo. Maybe you wanna tweet them too & tell them how ashamed they should be for promoting this kind of negligent & incompetent "care" for animals!

Here's another example for you. "Humans try to project their pain onto the animals, but they just don't feel it like we would," said Dr. Jan Pol. I can not believe that in 2012, someone is still saying that out loud.Well, he said it in 2011 I guess. Still.

Next time, email us. We'll fix you up right.

UPDATE: looks like National Geographic is choosing to completely LIE and make the false claim that this is all due to an administrative complaint, rather than due to any actual medical mistakes. Take a look at this article! I'm going to quote from that article:

The Michigan Department of Licensing and Regulatory Affairs ruled that Pol’s failure to accurately read the ultrasound, perform a C-section and to maintain any records on Mocha was evidence of negligence, or failure to exercise due care, including negligent delegation to or supervision of employees. It also found that Pol’s conduct failed to conform to minimal standards of acceptable and prevailing practice for the health profession.

And now I'm going to quote National Geographic:
 The recent fine placed on Dr. Pol is due to an administrative complaint, not malpractice or misdiagnosis. He will regularly see patients and within one month have taken a three-day course, lifting the probation.

I bet poor Mocha and her grieving family would take issue with the classification of this issue as an "administrative complaint."

Monday, October 1, 2012

Meanwhile back at VBB Animal Hospital...

I know we have a loyal technician and assistant following, and goodness knows I wouldn't want to offend them. I'm sure none of YOU, gentle readers, would ever do anything like this, however.

Here at VBB Animal Hospital we often find ourselves running out of things. You know, things like commonly dispensed medications, bandage materials, pill vials - the things we use all the time. Why is this? Well - times are tough all over, and when you order things, you have to pay for them, and when the clients can't or won't pay for anything, it's hard to cover payroll and stay in business and -

You know, this was supposed to be a humor piece, so, let's leave the messy financials out of this one. So, ok. The other day I was slogging along, seeing appointments, having an ok day really, when I was approached by a staff member. "Dr. VBB," she said, holding back a sob, "I have a problem and I don't know how to fix it!"

Now, I try not to jump to conclusions because in my line of work that can get you into big trouble but she did seem really upset and I have to say my adrenals gave a good squeeze right then. "What's the matter?" I asked her.

She held out two pill vials, one in each hand. These, by the way, were the last two pill vials we had in stock that day. "Mr. Fillitnow called and asked for refills for Landshark's medications. I saw that you had okayed two refills each in advance, so I went ahead and filled them. But - I accidentally put the labels on the wrong vials! What do I do now??"

I'll let you think about that for a minute.

What to do, what to do.

Had I been at my desk, I almost certainly would have just *headdesk*ed right then, leaving her standing there, arms outstretched, near tears, and now worried about my mental health. We were standing in the hallway beside our pharmacy however, so I simply took the vials from her, opened one, poured out the pills, looked at her, and asked "do you think you can take it from here?"

Some days I don't know why I even bother chewing through the restraints, people.