Book review - just for fun

What with all of the no-shows we've had lately here at the Greatest Animal Hospital in the World aka VBB Central, I've had time to do a little bit of light reading. I know, right? FREE TIME?? Crazy. But I, Dr. VBB, am a voracious reader, and since my good friend Dr. Grumpy had recently recommended a book to me, that's what I picked up the other day when Ms. MyTimeIsMoreValuableThanYours blew me off, leaving a 3-dog hole in my afternoon.  I continued reading when Mr. Liar McLiarson and his crew (1 dog, 2 cats) no-showed due to his allegedly being robbed at gunpoint in a shopping mall 2 miles from VBB Central just moments before his appointment (seriously, Mr. McLiarson has a history of telling big fat whoppers). Anyway. I liked the book so I thought I'd share!

It's called The Devil Wears Scrubs, by Frieda McFadden, aka Dr. Fizzy. Obviously the title gives a nod to Lauren Weisberger's The Devil Wears Prada, but this is an altogether different book. Dr. McFadden paints a vivid picture of the hellish life of the first-year medical resident. I do believe that anyone who has ever experienced life as a newbie to clinical hospital medicine will be able to fully relate to "newly minted doctor Jane McGill," as she figures out how to take care of her patients, how to find things, how to requisition things, and most importantly how to present cases and lab reports and so on to the devil in scrubs who is her boss.

As I read this book, I was reminded of a time when I had been at the hospital since 3 AM, and it was now about 7 AM, and my attending was asking me to tell him about the antibiotics that my patient was on and what was the MBC and what was the MIC and what was the mechanism of action and therefore why were these drugs chosen and all I could think of was if I never set foot in a barn again it was too soon for me, and that when I had tried to examine this patient he'd nearly killed me with a hoof to the shoulder, and boy was I tired.

Those who do not have a background in clinical (or other) medicine will still be able to relate to the human story. Basically it's the story of a woman starting her first job after finishing her training, and having the Evil Boss of Doom -- who, as it happens, may actually not be completely heartless. Throw in a McDreamy (hot hunky surgeon) & you really can't lose, can you?

My only issue with this book is, it was short - I would have loved to keep reading more of Jane's adventures.

And, I'm going to leave it there. If you're curious, you can buy the book. Oh, and by the way, I have not been paid, bribed, or otherwise profited from reviewing this book. Fizzy did publicly request that people who had read the book please review it, so, being the people-pleaser that I am, I figured I'd go ahead.

Now I gotta run - my DBB has been feeling kinda poorly lately, and I want to give her some TLC.

iFatal! A New iPhone App!

Because most of us at VBB Central are fans of the iPhone,  we wanted to share our latest invention for it.  We came up with this idea with our good friend Dr. Grumpy (to whom we also extend our most sincere sympathies regarding his current family emergency) after using the iPhone's LED flashlight to do an exam on a patient during a power outage.  That led to the development of the latest hot iOS app!  Download it now!!  Only $250,000.  (we have to pay for our student loans somehow).

Why stop with just a light???

WELCOME!!  The NEW iFatal iPhone App!!

 Need your iPhone to do more than just calculate CRIs or list boring info from the formulary?  Download the new iFatal app today!  No more tedious calculations for those euthanasias!  Take all of the guesswork out of ending lives!  Simple, easy to use, and utilizes all of the latest cool technology!

It also tracks and records all of the drug info for you, so when the DEA comes knocking and wants to know where that last mL of solution went, Siri will answer for you!

Download the new iFatal Pet Euthanasia app today!

With iFatal you get a conveniently sized Pentobarb & Succinylcholine cartridge, complete with hidden needle, that plugs into the headphone jack on the iPhone 5, 5s, 5c, 4s, and 4. Simply enter the species and weight, hold the phone up to the pet, and tap the "GO!" button.

iFatal is compatible with IOS 6 and 7. The 7 version, however, also features interactivity with Siri for voice commands, and direct compatibility with Facebook and Twitter to send out status updates such as "Another one bites the dust!" or "I'm killing animals with an iPhone and I'm $238,000 in debt for it. Fear me!" 

Don't delay!  Place your orders today!  


p.s. please don't argue about whether the iPhone is better or worse than any other smart phone out there.  We don't want to discuss that.

p.s.s.  Just kidding.  Discuss whatever the hell you want to discuss.  We don't care!  Post without censorship baby!    :)

For those of you who may not have seen these......

....the 1st rules of the axioms of ER survival.....

1. You can't fix stoopit & there is no vaccine for it.

2. You can't care about someone's pet more than they do.

3. You can't be responsible for people's emotional & mental health.

Big Dog Little Dog, or why I want to stay in school forever

[Editorial note: The VBB collective is pleased to welcome our newest member, VSBB! That's VS for Veterinary Student. Try to keep up!]

You may not know that it's a common saying in Veterinary World that the "unluckiest" pets in the world belong to veterinary students. No pet gets ill as often as a future vet's pet. My cat seems to have read the book on behaving like a vet student's pet while I was at orientation, because she woke me up the Saturday after the first week of class with one of those this-is-not-going-to-get-better-on-its-own-but-it's-not-really-an-emergency problems. Sigh. I called the vet's office and they very kindly fit us in that morning's schedule.

We arrived for our appointment. I talked to the tech. The doctor did her thing. I headed to the front desk with medications and a slightly miffed cat.

As one receptionist presented me with the bill and took my payment, a couple walked into the lobby. They wanted to make an appointment for their maltese, who had been involved in what we like to call a Big Dog Little Dog altercation. No, they hadn't brought the dog with them. She was at home, because it was easier for them to come to the veterinary hospital to make an appointment than to call. Okaaaay. The other receptionist offered the couple some appointment times, they agreed to one, and the receptionist did what all good receptionists do: she let the clients know they needed to provide a vaccination history for the dog. If the dog wasn't current on her rabies vaccine, she would need to get one before being discharged, because it's a legal requirement. It's also a good idea in case the dog who bit her might be rabid, but the receptionist didn't get into that. I don't blame her, because:

Ready? Here's what these people said over the course of less than three minutes:

• You can't give her a rabies vaccine! It'll kill her!
• But she's old!
• You know, I think vaccines make them sick. My friend's dog got a vaccine and she got sick.
• Listen, she can't breathe well. You're going to have to kill her.
• Do you want me to go to a different veterinarian?
• How would I know her history? She's from Arkansas.
• How would I know if the other dog has been vaccinated?
• I don't want to talk to the veterinarian about it, I just want her to be seen! She needs stitches or something!
• I can find someone else who will care about this.
• She's 10 years old. She's going to have to die.

Let's ignore that this dog probably should have gone to the emergency room, or at least come along for the ride to make the appointment so the vet could see her promptly. Let's pretend that veterinary records can actually cross state lines via the magic of these things called mail, fax and email. Let's assume that it's totally acceptable to treat polite, professional receptionists with yelling, a bad attitude, and refusing to respond logically to what they say. Let's agree that 10 really isn't old for a small dog. We may also be able to agree that the average land shark maltese is far too mean to die young, but I don't want to make assumptions about what kind of dogs you've got at home.

How on earth is the staff of a veterinary hospital supposed to respond to people who seem to want a) proper, if delayed, treatment for their pet, b) to refuse proper, routine care for their pet, c) to threaten to take their business elsewhere, d) to talk nonsense, e) to deny that rabies is a public health issue that might become personally relevant via their own dog, and/or f) to insist that a receptionist kill a patient?

I was relieved to be able to walk out the door of the clinic before the resolution of this conversation. That I was relieved makes me so sad. Sure, I don't have to have these conversations while I'm in school, but I've got a career's worth waiting for me when I graduate. 

And you know what else? My cat may keep getting sick the whole time I'm in school, but she's not even close to the unluckiest pet out there. I may not have a ton of time, or a lot of money, but if she's in a Big Cat Little Cat incident, you can bet she's going straight to emergency. It just hurts my heart to think about that poor land shark maltese suffering at home while her owners wasted time and added more misery to the world. I'm going to school to argue with people who won't let me take care of their dog?

A Study of Human Emotion

Somewhere in the comments below, someone asked if we really deal with this much asshattery every day, or is this blog just an overexaggeration?

Well, let me tell you now...

Over the course of just a few days:

1.)  Non-client walks in my door at 11:59 am, just as half of my staff was headed to lunch.  They'd had a very busy morning taking care of our good clients and deserved a break.  They are SUCH hardworking people.   Non-client proceeds to tell my staff that her dog had been sick for a few days and she needed to be seen.  No problem - exam fee is $xx.   Non-client informs my staff that she thought it was just ridiculous that she had to pay for an exam....   um, ok?  Whatever.  Then she informs my staff that I would see her right then because she was an excellent client (really?  that's why you're a non-client?) and that she would be paying me on the 1st.  (we all know that code)  Staff informs her that we had an available appt at 3:45 pm and would be more than happy to see her then.   Non-client throws a fit but eventually agrees to the appt time.

Fast forward to 3:45 pm.  Non-client no-shows for the exam.  Doesn't call, just doesn't show up.  No problem, I've been doing this enough years to know that you never really put these into the schedule cause, well, these are usually crazy people.

So I put it out of my mind and as soon as I'm done with my last appt, I roll out and head home.  My staff calls me almost immediately, letting me know that Non-client called at 4:59 pm with a message for me:

"You tell that doctor that I WILL be back at 8 am in the morning and I WILL not have any money and she WILL treat my dog and will wait for payment on the 1st!"

Yeah.  OK.  I was ready for her the next morning, but she no-showed again.  Sigh.  I didn't even get to unload on her dumb ass.  But it did get my hackles up, especially since she felt that verbally abusing my hardworking awesome staff was somehow acceptable.

2.)  Client who had been in twice in the last 5 years, calls at noon just as my hard working staff is trying to get lunch.  Again.  EMERGENCY!  My dog was attacked... 2 days ago!!!  And needs to be seen NOW!!!  Well, OK...  this really could be real, so come on down....

Poor, old decrepit sweet Lab, several infected bite wound all over his face and neck.  Stiff as hell and can barely walk.  Not on any pain meds, not current on any vaccines, and is a mess.  I ask owner if she's considered providing some basic care for this dog?  Her answer:  Nah, he's not in any pain.

Um.  OK.

So we do an exam, and provide her with an estimate for treatment for his wounds as well as some recommendations for care going forward.

Her answer:  WHAT?  I don't have any MONEY!  My neighbor's dog did this so I'm gonna leave my dog with YOU while I go back home and ask him to pay the bill!

Seriously? 

I told her that's fine, and the charge for leaving her dog with me would be $xx.  (Having been down the abandonment road and the no payment road before, there was no way I was doing it for free)

She didn't like that answer.  She stormed out, got into her CADILLAC and drove away.


3.)  SAME DAY:  Owner comes in with her dog, specifically for a behavior issue, saying the dog is showing aggression towards HER.

(Side note:  male intact white German Shepherd.  Do I need to say more?)

I walk in the room, he starts eyeing me and growling at me.  On goes the muzzle.  We do the exam, talk about the findings and I make recommendations, including one for a TRAINER, and for NEUTERING this beast.

Next day, owner calls, SCREAMING at my staff, about how we obviously didn't know what we were doing because we MUZZLED her dog!!!  That was, apparently, cruel and unusual punishment.

(can I say that I might laugh if, in the future, I hear that he attacked her and ate her body?)

4.)  Same week:  Non-client calls and says he wants Tramadol for his dog.  Specifically.  Then tells me he doesn't want "all those tests" and that the dog is current at another vet's office.  Huh?  OK.  So I am automatically suspicious, and I tell staff to call the client and tell him I will require previous vet records for the exam and any medications dispensed.  Client becomes IRATE over this, saying it was a HASSLE now and that he just won't be back.   GOOD, YOU FREAKING DRUG SEEKER!!! 


I currently have a friend and colleague who is getting blasted online because she wasn't available when her clinic was closed for a client who let her own dog suffer for too long.   My friend was taking care of her children, (you know, those silly things like feeding and educating them) and this client insisted she drop what she was doing and serve the client's needs immediately.   Even though there is a referral hospital nearby - open when her clinic is closed.  She had options.  But she'd rather blast a good person, a mommy and a great vet, publicly, than take responsibility for her own actions.



I'm starting to feel like I need drugs myself just to deal with this DAILY crap.

We don't make this up, and this is the stuff that causes Burnout and Compassion Fatigue.  It's very sad, but I don't know many vets who have been doing this for 20 years, who can honestly say they love it any more.  It's just a job.  And a sucky one at that.

We may hate your online pharmacist!

With a hat tip to DrugMonkey, we bring you Dr. Jaded's tale of woe:

I had the delightful pleasure of speaking with a "pharmacy representative" at Pet Care Rx today.  My client, Mrs. Ina Hurry needed medication for her "Cherub" ASAP.  "Cherub" usually gets Medication, X mg, BID; however the pharmacy request came in for Y mg.  No problem, mistakes occur.  I call up Pet Care Rx and ask, as the prescribing authority, to change the dosage and fax the updated prescription back to me so I could authorize it.

The "pharmacy representative" told me that she would have to get the client's authorization for the update on dosage.  I chuckled a bit and said "I'm the prescribing veterinarian, I'm the one who says how much medication 'Cherub' needs.  Clients may be mistaken. Just fax me the new request."  The rep continues to say that I am not authorized to make changes to the prescription.  Welcome to the world of online pharmacies, where clients make all the calls and veterinary authorization is not needed. 

ME: It is the job of your pharmacist to check that client requests match previously dispensed medications and if they do not, then the prescribing veterinarian should be called. Check your records, "Cherub" has only been on X mg, NOT Y mg. Your pharmacy license is on the line here. 

REP: Cherub's never has had prescriptions here, or has multiple pet profiles, since I can't see old prescriptions in this profile"

ME: I'm staring at the prescription request from April (which was correct). Multiple profiles is not very effective at tracking prescriptions.   I want to be transferred to the pharmacist.

REP: There are none available.

ME: I would like to be transferred to your pharmacist's voicemail, please.

REP: Goodbye! (click)

What....the...hell......I give up.  Now I just have to sit back and wait for Mrs. Ina Hurry to call us, ranting and raving that we declined her "Cherub's" prescription request.

Well....off to tend to the Parvo positive puppy that just came in....why can't we cite owners for neglect when they don't vaccinate on time?

Please do your homework before using an online pharmacy!

Ringworm or lupus...you decide

Ringworm was one of the first things I learned to recognize quickly when presented with an effected animal on my exam table. Now, this is no great accomplishment. Ringworm is an easy one. Dermatomycosis. That’s what we call it in the medical record, but not when trying to communicate with you folks. You know what ringworm is, so we work with the language you know. A fungus of the skin. Very contagious, especially between kittens and between kittens and people. And that summer, we saw some nearly every day.

 I was still the young enthusiastic veterinarian, having only been burned by reality a few times. I’m no fool, so each burn taught me a lesson. What seemed the right thing to do is only right some of the time, so I learned to reel in my enthusiasm. I learned I cannot fix it all, but that I must hold back and fix what I can. I could only fix what they’d let me fix.

A woman I knew opened a pet store in town, selling pet food and cages, hamsters and some fish, and she thought she could save the world by taking in kittens and selling them for a pittance hoping for good homes for many. She built a chicken wire enclosure, and all the kittens went in there, and people came by and said, “I’ll take the orange one, that one over there”. And one of those kittens went in that enclosure with ringworm, and it rubbed up against all the other kittens, and all summer long, we saw kittens purchased from this store, and they all had ringworm. And usually, it was Mom and the kitten with ringworm, and the kid with ringworm. So I got real good at spotting ringworm. And no, the woman who owned the pet store wouldn’t listen to me about all that ringworm stuff, because all she wanted to do was sell kittens. What happened after that did not concern her.

Now, this veterinary practice was in a town that was pretty much the lowest common denominator, and folks there kept to a pretty marginal standard. So if you owned a veterinary practice and you wanted your kids to get a decent education, you didn’t let them attend the local schools. You spent the money and the kids went to a private school in the fancy town over there. And they made friends with the rich kids from the fancy town. And that is what my boss did. 

So when one of those friends had a kitten, and the friend’s mom thought the kid had ringworm, but the kids physician thought she might have lupus instead, somehow that family drove over the hill to let me examine the kitten, and she brought her daughter along. And so on my exam table was a young cat with classic ringworm, and the lovely 18 year old daughter standing next to my table had a perfect, absolutely textbook example of ringworm on a human, the perfect red circle on her neck, which does in fact sorta resemble lupus in some young women. And I had to say something about this.

And I had to get real careful about what I said.

First….yes Mrs. Richlady, your kitten does have ringworm. No doubt about that one. And yes, ringworm in a kitten is very easily transmitted to a young lady who hugs a kitten to her neck. Your lovely daughter does have a nice red perfectly round skin lesion on her neck which could easily be a ringworm lesion. I am not a physician, so I have no opinion on whether that round perfect ringworm lesion on your daughter’s neck is actually ringworm. But if it were my daughter, I’d be talking with a dermatologist real soon, and maybe the lupus specialist a moment later. 

Now, I might have gotten hung over that statement, for as a veterinarian, I have no right to say anything about a human medical condition. No right whatsoever. For as a veterinarian, I know less than the drunken homeless guy living in the bushes behind my clinic, when it comes to the medicine of that species call human. Just ask any attorney or judge who thinks I got my degree by sending in six box tops from my breakfast cereal. Sure, that young lady did have ringworm, and it was stone obvious. But I had no business claiming I knew what was wrong with her.

Now you might wonder why I have adopted such a pissy attitude about a veterinarian talking about human medicine. Didn’t I spend those years of pre-med college courses right next to those who went on to medical school and dental school? Didn’t I outperform many of those students on my way to qualifying for veterinary school? Don’t I have four years of post-graduate veterinary medical education? Don’t I know far more than the average physician about those things called zoonotic diseases, those diseases easily spread between animals and humans? Well, that all is nice, but I am not a physician. So what I know does not count for butkis, if applied to a human.

And here is why….

A year before the summer of ringworm, I had the misfortune to examine a rather nasty Siamese cat belonging to an annoying, knowitallknownothing man. The cat had some nasty lesions on its skin due to its incessant licking. The licking was about allergies combined with the irascible annoying incurable and frustrating habit of Siamese cats who like to lick sores on their skin. In those days, we gave them injections of reposital steroids. Today we know better, and we don’t use reposital steroids. Now we pretty much do nothing. But back then the shots sorta helped, so I suggested we give this cat an injection. The owner agreed.

Now, these steroid injections stung. No lying about that. They annoyed these cats something awful. So as I set about to give this cat an injection, I prepared for the worst. The owner, bless his stupid heart, had a better plan. 

I was going to grasp the cat by the scruff of its neck with one hand whilst injecting the hind leg with the other. Often the cats were so distracted by the one hand that they didn’t notice what the other was up to until too late. This was a win. 

And if they did notice, and they decided to launch for the stars, the cats were aimed away from me, and so they attacked air instead of me, or any other people in the room. The worst I expected was some scratch marks on my forearms, and no one would die.

This owner knew better than me. HE wanted to hug the cat. I was young and stupid, and so I let him make his case. He loved the cat and it loved him. Sure, it bit him regularly, but she didn’t really mean him any harm and he had always recovered. So no, he wasn’t going to let me inject the cat unless he was hugging it.

I should have left the county about then, but I was young and stupid. And he proceeded to hug the cat.

I looked at him in total disbelief. The way he held the cat guaranteed that the cat would bit him on the forearm. Guaranteed. I mentioned this to him. He dismissed my concerns. The cat always bit him, and he didn’t worry about that. He was going to hold the cat, or no shot was to be given.

This is where youthful exuberance will get you every time. I actually thought the high moral ground, and Darwin, established that this stupid dipshit deserved to get bit on the forearm, so I let him hold the cat against my direct instructions, and I went ahead and injected the cat.

I was right! The cat bit him on the forearm….rather effectively.

OK, I’d done my job. The injection was given, and the lick sores would soon, albeit only temporarily, disappear. The man stood there bleeding from the four nice punctures in his arm. He commenced to tell me that this was nothing, that the cat bit him all the time. And I kept interrupting. 

You gotta take wounds like this seriously. They can get terribly infected. Don’t try to blow this off.

Nah, it’s nothing. The cat bites me all the time.

You gotta take these wound seriously. If you see anything that looks like infection you must get the wounds looked at and treated. This is serious.

It’s nothing! The cat bits me all the time.

(You dumb f^^^ing idiot!!!) Would you please at least wash off the wounds in my sink!!?! These can be serious, and you need to pay attention to me. This part was that thing that stuck in my head about washing out the wound from the bite of a rabid animal, for at the time this was recommended before you even called the physician. 

No problem doc. She bites me all the time. It’s nothing.

When the letter came, I was surprised. I was young, and stupid. I didn’t know reality yet. But I soon learned.

I was being sued because the owner of that Siamese cat was self-employed, and he had lost six weeks of work because of the infections caused by that cat bite wound, the wound I had told him would be just fine if all he did was wash it in my sink. It was all my fault.

Seriously?

Well, my insurance company settled with this guy’s attorneys because they really had no defense, for I had acted as a physician when I told him that all he needed to do was wash the wounds, and he would be fine.

And I am not a physician. I’m only a …….veterinarian. 

The lying part never came up. No really…the lying part never came up. Guess who they believed?

So to this day, if your animal scratches you, or bites you…regardless whether this happened at your home, in your car in my parking lot, or as you lift your cat onto my exam table after I asked you not to do precisely that, I will tell you to go see your physician, and then I will walk out of the room. I will not offer you a Kleenex to mop up your blood. And even though that drunk homeless guy in my bushes can give you a band aid, I cannot. So don’t ask. I cannot afford to do for you what I know is right for you, and that I am fully qualified to do as a breathing adult, much less as an educated and experienced medical professional. I’m not allowed to do that.

Just a few years ago, I needed to administer some subcutaneous fluids to a dehydrated, and very sick cat. I didn’t yet know what was wrong with this cat, and would not until the fax machine in the morning spilled out the test results, but I knew the cat needed some fluids so we set out to do just that. So my highly skilled and experienced, not to mention very compassionate assistant calmed and gently restrained the cat as I let the fluid flow through the needle under her skin. All was well.

Until the owner, a well-intentioned but completely brain free human body stepped in to help. She charged in with both hands, and the cat exploded. My assistant managed to keep the cat from ventilating her owner, but in the process she was severely bitten. She did not lose the function of her hand, and in fact still works for me, but this is only because she was uncommonly lucky.

To this day, we will not touch a cat for this one owner unless there are at least two closed doors between her and her cats.  Because I own the veterinary practice, and therefore I am responsible for the bad effects of anything I do wrong, or my staff does wrong, and whatever completely insane thing you do wrong, regardless how hard I try to keep you from living up to your full potential.

So, if you ever wonder why your veterinarian won’t let you hold little Precious, but she insists upon having her trained staff do that, please STFU. There is a reason.