back in the trenches

It's not all politics around here. Yeah, the AVMA is annoying lately with their whole "let's spend $80K on finding out whether we really need a new logo and if so what it should be like" thing. Yeah, there was an article in the NY Times about our profession & its economic issues, and I'm sure that you, dear readers, have noticed that we VBB have strong feelings about these matters. That said - there's more to life, and as we struggle to keep our heads above water and pay down our loans, we are kicking butts and taking names - and sometimes seeing patients.

I had a client call me today to find out whether or not Fluffy needed to continue his medication. Before calling the client back, I went into our trusty EMR and looked up Fluffy's history. I noticed that Fluffy is on Optimmune, and has been on Optimmune for 3 years now. I further noticed that the last several labels printed out for Fluffy's Optimmune all contained the statement "DO NOT DISCONTINUE - CALL FOR REFILL BEFORE RUNNING OUT - THIS IS A LIFELONG MEDICAL TREATMENT!" So, I banged my head on the desk a few times before making that call. It didn't help.

I've been treating a million-year-old Small Fluffy White Dog that belongs to a million-year-old dementia patient. The client's caregiver comes with the dog & the lady to our appointments, thank goodness. Last week I saw the SFWD on a recheck four days after her previous visit which had been with a colleague. When my colleague saw SFWD she'd noted lumbar pain, hind end pain, generalized weakness, and a high white count. She'd started methocarbamol & amoxi/clav. Apparently this hadn't worked so well because when I saw SFWD she was pretty flat. Dehydrated, not eating/drinking, not walking, not standing unassisted, and temp in the range of 104 F. Euthanasia was not on the table that day - you know, this dog is the demented old lady's only real family left, and the demented old lady was not capable of understanding the kindness it would be to release the dog from her suffering, it seemed to me. Certainly the caregiver wasn't about to consent. So, I did some hemming and hawing and ended up giving fluids, and sending SFWD home with mirtazapine and Zeniquin on top of the rest of the stuff. Imagine my surprise to find out today the dog is doing great! Eating, drinking, walking around normally. I just wish I could be sure - is she really better, or is this the sweet spot before they find her dead in the kitchen or something?

Today I also saw a young adult longhaired mutt cat. She was presented by a woman claiming to be the mother of the actual owner, who was a 12 year old girl. The girl was not there. The woman stated that her daughter said the cat had bumps on its skin. She further stated that they had used a Furminator on the cat four months ago, and she'd "been like this ever since," where "like this" equals "practically no hair on the caudal half of the cat." To make a LOOOOOOOOOOOONG story short, there were no significant findings on any of our diagnostics, and a trichogram revealed growth-phase hairs that were broken off rather than normally tapered. The owner did state that the cat had a history of food allergy. In despair, I decided to give 10 mg of Depo-Medrol. I had a discussion with the owner in which I explained that I really wasn't sure what was going on, but that hopefully in the event of allergic or inflammatory condition the steroid would help. Of course I also explained that if there were in fact a fungal, parasitic, or infectious condition I had not uncovered, the cat could get worse. The owner looked at me for a moment and said "ok, sounds good. Either she will get better, or she will get worse. If she gets worse, I'll bring her back for more tests. Right?" "Yes. Either she will get better or she will get worse. I realize that sounds bad...." We all laughed. It was really nice to have an understanding client for a change. I put a lot of pressure on myself to always figure it out up front, to always be right, never make a mistake, etc. This cat just did me in and it was wonderful that the owner was understanding. Here's hoping kitty improves.

Thank you, David Segal!

Industry insiders have probably already seen this floating around Facebook & Twitter. We've already received several emailed requests to post about it and it's only been published for about a day! Steve, hat tip to you for being the most concise :) It's an article in the NY Times from the Business Day section, by a journalist named David Segal who for some reason has taken pity on our profession and chosen to shed some light on things. Go ahead, click the link and read the story. I'll wait here.


OK. Was that not incredible? I don't know Mr. Segal, but he is to be commended. If you want to share your thanks or give him any additional information, you can email him - there's a link to do so directly from the NY Times website if you click on his name above where it's hotlinked.

I know you can't always believe what you read, even in the New York Times - but Mr. Segal is speaking the truth here, and our upcoming veterinary students and those aspiring to become veterinary students need to take a long look at this story. Here's the link again: High Debt and Falling Demand Trap New Vets.

Read it and weep. Then email it to your friends & family. Tweet about it. Share it on Facebook. We want the Times to take notice that this story has legs!

VBB: The Next Generation

As any parent reading this already knows, and non-parents may have heard, kids do unexpected things all the time. The young son of  Dr. VBB is no exception! This morning at 0-dark-30, Dr. VBB said "son, go outside and find that dog of yours. You need to bring her in, before we leave to go to school." The boy enthusiastically bounded outside and was gone for a good bit. After a while, the door opened and in came boy and dog.

Boy: Mom. MOM! DogBehavingBadly puked out there.
Dr. VBB: oh really? Was it food, or just bile? How many times?
Boy: [whips out iphone] Here. Let me show you the video.

I mean, really. Child stood there, and recorded the DBB puking. What does this say about him? What does this say about me? Am I raising him wrong? Not to be all "kids today!" but seriously....

At least when he showed me the video he was able to point out the plant material contained in the vomitus and to postulate that DBB had once again gone empty-stomach-grazing outside. But "and look! I already put it on YouTube!" -- really?

*sigh*

Funny. I might have expected him to come running in yelling "she's womitin', womitin' bad, sorr!" - but I guess times have changed.

Getting Crispy Around the Edges

Burnout can be insidious. I noticed the signs in myself today as I prepared myself to call a client regarding the findings on his dog's physical exam. The dog had been dropped off for grooming & my exam had revealed some significant progression of the dog's heart disease. I could hear the conversation playing out in my head before I picked up the phone. I was sure it would go like this:

[ring ring]
Mr. Apathy: Hello?
Me: Hi, Mr. Apathy. This is Dr. VBB from VBB Animal hospital. I'm calling about Foxglove.
Mr. Apathy: Well, I'm at work. What do you want?
Me: As you requested at drop off, I did perform a physical exam on Foxy today and-
Mr. Apathy: Can we discuss this when I pick her up?
Me: No, Foxy needs additional diagnostics and treatments because her heart is-
Mr. Apathy: She saw a cardiologist six months ago. We already did the heart stuff.
Me: well, today she is having trouble breathing and -
Mr. Apathy: I'm not talking about this again right now. I'll discuss it at pick up.
[click]

I was so sure I would be having that conversation that I postponed making the call for probably an extra ten minutes. I got myself all worked into a frenzy internally. I'm sure I ground off some tooth enamel. However, after a few deep cleansing breaths I psyched myself up for it. I made the call.

[ring ring]
Mr. RealGuy: Hello?
Me: Hi, Mr. RealGuy. This is Dr. VBB from -
Mr. RealGuy: Doc! How's Foxglove?
Me: I have some concerns, and -
Mr. RealGuy: is it her heart? I know, I was supposed to bring her back to the cardiologist for a recheck in December, but I got so busy and she seemed fine. Is she in trouble now? I feel terrible.
Me: well, I think her medication needs some tweaking. I'd like to go ahead and give her some extra diuretics today, but I do want her to see the cardiologist as soon as possible too.
Mr. RealGuy: I was actually planning to take her next week, but they almost always can get me in same day. I'll call them right now and see if we can go there this afternoon or tomorrow.
Me: Great. I'll have her records ready to go for you.
Mr. RealGuy: thanks doc! See you soon!
[click]

I was of course really pleased that my patient will get the specialty care she deserves. I was also really pleased that I had a nice client interaction. I was DISPLEASED by the realization that I am starting to always expect the worst. This bothers me a lot. I don't want to be one of those old and crispy burned out people!! I want to be able to think positive! Or even be like the Whether Man from The Phantom Tollbooth, who said "Expect everything, I always say, and the unexpected never happens!" But to always expect the worst - well, it's draining. Any creative tips on dealing with burnout??

That's me in the corner.

So, this one client has been increasingly annoying for over ten years now, and try as I might to gently encourage her from seeking care elsewhere, she is frustratingly loyal to VBB Veterinary Hospital. There are a lot of things about her that annoy me, but hands down the most annoying thing she does is try to get me to attend her church.

In the time I've known her, I've gone from ignoring her church invitations, to politely saying "no thank you", to offering generic excuses along the lines of "I'm sorry, that's simply not possible," to explaining that I have my own place of worship that I prefer, and finally things got to the point where I said "please listen because I am only going to say this one time: I have my own religion. It is not the same as your religion. I not only am not interested in changing my religion, but I am also personally offended by your continued attempts to solicit my participation in your religion. Please stop this, or I'm not going to be able to be your veterinarian any more, and I'd feel terrible about ending our professional relationship over this." 

One might have thought that would put an end to the problem, right? 

Or, failing that, one might have thought I'd be cynical and jaded enough NOT to expect her to cut it out.

Sadly, one would have been incorrect both times, and I was bitterly disappointed that this client continued her attempts even MORE vigorously. Unfortunately the Boss Behaving Badly around here put the kibosh on the idea that I might fire this client...

So - imagine my response to this voicemail:

Hi Dr. VBB! This is Ms. Prossy Letize calling about my new little doggy. Well you know I don't get around so well anymore and I'm mostly in the chair all day, and little Barkmeister has taken to, well - you know.  He jumps up and [Sotto voce] humps me [normal voice again] for 20 minutes and I can't get him off of me!  What do you think could be wrong? Have I made some kind of mistake in his upbringing?  I don't really want to bring him in, unless you have some idea of what might be wrong with him that you could treat. Let me know what you think. Bye now.

Words fail me.

The worms crawl in...

The VBB Mailbag has been filling up again with tales of woe from our CBB (colleagues behaving badly...)

Here's one from the harried hands of Dr. CM:

Straight out of school, I started working for Banfield (don’t get me started).  In case you don’t know anything about this amoeba-like monstrosity, Banfield is a corporate run chain of hospitals located inside PetSmart stores.  This creates a weird dynamic between the PetSmart management and the hospital, as clients fail to understand that the two are independent of each other and routinely take their Banfield complaints to PetSmart management.  On the other hand, managers may come to us when faced with odd complaints themselves, as in this one instance.

PetSmart Manager: “Dr. can you talk to this guy?  He is on his way in, and he is on a rampage!  He is claiming the dog food we sold him gave his dog worms.”

Me:  “Sure, send him over when he gets here.”

Guy shows up and I hear him loudly discussing the issue with two of the PS managers.  In about 5 minutes, the original manager heads over to us with a baggy in her hand, angry guy trailing behind her.

She hands me the bag..

PS Manager:  “Here is the worm that Mr. Biofail found in his dog’s stool today.”

Me (taking a quick peek at the “worm”):  “Sir, I can absolutely guarantee that your dog did not get this worm from his food.  In fact, this worm did not come from your dog.”

Mr. Biofail:  “Yes, it did.  It was right there on his poop this morning.”

Me:  “I understand that, but there is NO WAY that this ALIVE, WIGGLING CATERPILLAR came from your dog.  It may have fallen from a tree onto the poop, or was already on the ground and crawled onto…”

Mr. Biofail (voice raised):  “This worm came from the dog food I bought here and I want a refund!!!”

Me:  “Well, you can take that up with PetSmart, but your dog did not eat this ALIVE worm from the food, have it travel all the through his GI tract, and then poop it out STILL ALIVE.  That is not possible.  So I will never say that the food you bought here gave your dog worms.”

Mr. Biofail proceeded to drive to another store with his happily wiggling caterpillar and try the same stunt.  Thankfully, the manager had alerted other local stores…..

It's Not a Level Playing Field

I make no bones about it:   I'm disgusted with the public.  I'm disgusted with their sense of entitlement and their demands placed on those around them when most of them really don't contribute a damned thing to this country.   While there are still a lot of really good people out there, I swear I am coming into contact with more and more people who simply have no appreciation for what we do and are flaming assholes.

A little dog came in to my clinic a few weeks ago after being attacked by something and suffering from a lot of very deep lacerations, and the owner informed me he "had to go and get her from the back of his property with his Quad".  Okay, you own a quad and I don't.  That's perfectly fine.  I'm only a little jealous.  But then he went on a rant to me, telling me that the price I quoted him for wound treatment on his little dog (the wounds were EXTENSIVE) was "ridiculous".  So we did the best we could with what he had, which included treating for shock, cleaning up the wounds and getting the dog on meds.  Hey, sometimes that's all you can do.

Did I mention the dog had never had a rabies vaccine?  And it wasn't spayed?

Anyway, the dog did OK but the owner was ridiculous.   I wanted to tell him to sell his damned quad and maybe that jacked up 4WD truck he was driving.  Or, I dunno, maybe stop popping so many drugs that make you seem like a creepy weirdo to my staff?  I've seen enough of it.  I know.

Just last week I had a hairdresser tell me that $600 was an outrageous amount of money for the emergency pyometra surgery done on her 5 y.o. dog, and she was even more annoyed that the vet wouldn't give her a payment plan for this surgery.   Never mind the facts here, folks:

1.) Spaying your dog when it was a puppy would have been cheaper and avoided this emergency that you obviously did not plan for, and now expect someone else to pay for it until you are able to make all of those payments, if you even do.  
2.)  Perhaps you are living in an area you cannot afford to live in, if a $600 bill sets you back so much that you must make payments or be in a bad financial situation.  Perhaps you are living beyond your means.

I ask, why is this the veterinarian's fault?

I don't think she liked my question, which was: "Do you allow payments on that color and haircut you just gave?"

Her answer:  "No, because I charge a reasonable amount."

Well, then she went on to tell me how vets are doing well, and that perhaps we are charging too much for our services, that she "shouldn't have to care" about our debt loads and dropping salaries.  Yet, we are supposed to care that she doesn't have $600 for her dog's emergency pyometra surgery?  Which, by the way, was a HUGE bargain, IMHO.

My response was to make a bet with her.  I bet her that my cat spays cost less than a cut, color and perm at her place.

I was right.

The public is moving faster and faster towards simply not giving a shit about what we do.  We've lost a lot of respect and are now viewed as glorified techs by many.   Most don't even realize that most of us have 8 years of school under our belt.  (some have 6, I know - that's still a lot!)

How do we fix this?

When a hairdresser (and I am NOT picking on hairdressers so don't start with me on that one) makes more money off a freaking hair cut than we make on doing abdominal surgery...  something is royally screwed up, don't ya think?