VBB - Change of pace - Residential branch

Note to readers: I realize we've had a little hiatus here. There has been some upheaval among our collective. Apologies for the lack of content. Today's post is not your typical veterinary whingefest - today, we are discussing the only primate species we cannot legally diagnose or treat. We'll return to more of a veterinary focus shortly thereafter. Thanks for your understanding.

Here at the VBB residential branch we just hosted a small overnight soiree for 4 x 5th grade girls, plus the in-house crew. Preparing for something like this involves a massive effort - after all, when you're having guests, you need to clear a path to the bathroom. But somehow we prepared and were ready and waiting for the guests to arrive at 5 PM on the appointed day.

The clock ticked 5 PM. The doorbell rang. Our first guest! Her mom briefly chatted with Dr. VBB & then made her merry escape, while the girls ran off giggling to start having fun. Over the next hour the other guests trickled in, but before the last one had even arrived, we had our first crisis. "Moooooo-ooooooom!" came the plaintive cry.... "Sarah can't find her glasses!" *sigh*

I tried to pass the buck. "Oh, she probably just forgot to bring them. She couldn't have lost them already. She's only been here for 10 minutes and you've only been in one room of the house. Surely she didn't bring them..." but to no avail. "Look mom!" said my beloved but smarter-than-me offspring, whose nom-de-blog shall henceforth be Rachel (I always liked Jennifer Aniston's hair on Friends!). She shoved her (used, handed down) iPhone 4 into my face to play me a video she'd taken of her friend running up the stairs right after arrival - the glasses clearly visible on her cute little face.

*sigh* Where did  I put that bottle of wine I opened when I was making stew earlier?

Meanwhile, we were still waiting on the final guest at 6 PM, but the crowd was getting restless from the smell of the pizza waiting in the oven warmer. "Dr. VBBeeeeeeee! We're STAAAAAARVING!!!!" was their war cry, and the cut up apples and/or salad I offered seemed to be invisible to them. In an effort to forestall a coup d'etat, Mr. VBB & I started slinging pizza. The doorbell rang just as the last slice was placed on the table & thank goodness it was our last guest. Mom was suitably contrite, although she did attempt to blame-shift their tardiness onto the Ikea furniture people who showed up late and took forever. Although unclear on how that interfered with her ability to phone or text or email or even send a carrier pigeon to say she'd be an hour later than she had said she'd be, I smiled & nodded and brought the child in to join her friends.

Now, I've known this girl for seven years. She's been to our house before. I knew she had some issues but I didn't know how much worse they'd gotten over the past year. She's like a young, female, Woody Allen. So, Woodina looks at the pizza in front of her and says "I don't think I feel hungry. My reflux is acting up. I'm going to just sit here for a while." OK then. Everyone else is eating and laughing and Woodina is sitting there looking a little sad. I asked her if I could get her anything or do anything for her -- "No. I'm fine, thank you. But just so you know, I brought some alcohol wipes & bandaids with me, because you never know when you need them." OK then! But in about 5 minutes she wanted to call her mom. She called her mom (who I happened to know was on her way to meet friends for dinner out) and asked to be picked up. Mom said nope, stick it out a while longer. Crying ensued. I intervened by showing her our cat, Wilbur. Woodina loves animals so she cheered up a little bit and returned to the table.

The meal ended, the girls began watching their chosen entertainment - Camp Rock.  During the movie Rachel's iPhone (which I had taken away after she'd shown me the video) started to receive texts from her friend Jezebel, who is sitting next to her on the sofa. "No afence, but this is BORING!" "do you like this 4 reel?" "This movie is immachurr." I need to speak to the girls' English teacher, obviously.

I walked over to where the girls were sitting on the sofa (several feet behind Sarah, who was sitting up close to the big screen tv due to having lost her glasses....) & inquired of Jezebel "hey - looks like your phone is distracting you from the movie. Want me to put it over there with Rachel's?" She said "no, I need it here. I am texting. About private things, from my private life." OKaaaaaay. Whatev, as the kids say.

Meanwhile Mr. VBB finally finished making the popcorn I told him to start making what seemed like a million years ago. I poured it into the cute little popcorn boxes I'd bought & started handing them over to the girls. Rachel immediately needed more melted butter. Woodina wasn't sure if she should eat it or not but decided to try it, and then started to worry that she'd made the wrong choice, because it might make her have reflux, and she wanted to discuss it with her mom. Sarah dropped some pieces and couldn't find them on the carpet because she couldn't see. Jezebel said she can't have popcorn because of her braces but she can have pretzels or chips if we have those, and then texted "WTF popcorn" to Rachel's phone. I deleted that text.

The doorbell rang again. Who could that be? Oh. Right. The dogsitter was returning DBB after a hopefully-exhausting day at Dog Camp. There was a joyous kerfuffle as the girls all received slobbery-faced kisses and then DBB retired to her usual retreat under the kitchen table for a nap.

FINALLY the movie was over & it was time for ice cream sundaes and the obligatory happy birthday song. I'm pleased to report that was largely uneventful, although Jezebel thought our flavors (salted caramel, mint chocolate chip, chocolate, and coffee ice creams) were weird and abnormal, while Sarah was just a little bit sad about the salty part of the caramel. Rachel opened her presents and everyone squeed excitedly over them. Well, except for the Rainbow Loom - I think everyone in the room already owned at least one and I know we already had four of them in our house before this new one which we can hopefully regift. Although now I'm wondering - maybe this Loom has been regifted a million times already. Maybe all the moms are just passing it around. Maybe I need to BREAK THE CYCLE! Heh. Anyway. Then they (FINALLY) disappeared into the basement to play with the new toys.

At some point Rachel's little sister Leah came up hysterically crying. Our guests graciously talked her back down and things were quiet for about an hour. Bliss. Woodina did call her mom about every 20-30 minutes because she missed her so very much.... and then eventually at about half past midnight, she couldn't take any more, and demanded to be picked up. Her mom arrived with their dog in tow, and informed us it was just as well Woodina needed to be picked up, because Fuzzyface had been unable to sleep without Woodina to cuddle. Bleary-eyed, I suggested that next time she simply bring Fuzzyface to our house. I may live to regret that one!

I passed out on the sofa at about 2 AM, and woke for the final time (after several interruptions because of the cat being a CBB & jumping on my face) at 6 to peals of laughter emanating from the basement campgrounds. Goody. I have enough time to shower before work! Oh wait. Sarah heard me get up and came upstairs to ask if we'd found her glasses. Cue another full-house search that completely failed to find the glasses, but succeeded at using up every last minute before I had to head to work.

I woke Mr. VBB and put him in charge of breakfast and headed over to VBB central. Today's agenda includes several new puppies and an obstipated cat. I hope no one notices I'm rumpled, crabby, exhausted, and wearing yesterday's clothes.

Late-breaking news: Mr. VBB texted me a cute picture of the mob having breakfast. We'd offered bagels & cream cheese or butter, assorted fruit, two types of cold cereal, milk, orange juice, or oatmeal. Jezebel had, however, requested (and received) a swiss cheese omelet. She did eat the entire thing without complaining, though. Good for her I wasn't in charge of breakfast is all I can say! I can't wait to see her Instagram feed when I check Rachel's phone later. I will totally bust her if she has posted anything negative about this party!

Interpretation?

A very nice owner called this week and left a message for me.

"Please have the doctor call me, as Fluffy is having diarrhea."

We recommended an exam but no, she needed to talk to me first. 

OK.  I'll bite.

So I call her and I say, "I understand Fluffy is having a problem with diarrhea?"

Her answer:

"No, not really diarrhea...   she's having pre, pre diarrhea.  You know, where it's not diarrhea, but it's the stage that you see right before you see the stage that you see before they have diarrhea."


CAN SOMEONE TELL ME WHAT THIS MEANS???  VET SCHOOL DID NOT TEACH THIS TO ME!!!!

Sometimes the Customer is Effing Wrong

Not sure how many of you have seen this article, but it's so well written and accurate that it needs to be shared.  It applies to most professions, I think, in this day and age.


First Do No Harm (Not First, Do Not Disappoint)



I'm posting this after getting a bad review online from an owner who didn't appreciate that I was honest about the behavior issues in his young dog.  He never trained him or neutered him or vaccinated him, (he was over a year old and had never been to a vet) and when he lunged at my staff and tried to bite them, our "restraint" of him for our protection was "too much".  (muzzle and 3 technicians)  Somehow we "caused harm" towards HIM.  Not his pet, but HIM.   The result?  Blasting us online.

(side note:  pet was not injured at all.  We know how to restrain idiot dogs.  But my techs got scratched and pooped on and pissed on.  We ALL know this scenario.)

I truly feel that there needs to be a backlash from MDs and DVMs.  We've taken enough.  We've had enough.  This isn't "the customer is always right" anymore.  It's turned into "if you piss off the customer they feel they can bash you and try to ruin your career because they had an experience they didn't feel was pleasant" even when the situation was entirely their fault.

Threw someone out of my clinic this week after this slime of the earth had the nerve to tell me how awful I was - to my face - because I  1.)  told her all of the things wrong with her pet  2.) told her many of the things could be easily treated and 3.)  suggested she actually consider doing something for the health of her pet.  Somehow that meant it was my fault and she started screaming at me and calling me names.   I guess she wasn't interested in hearing that extreme hair loss, severe oral disease and ingrown toenails (into the pads) are things we can actually, oh, I dunno, do something about?

So I kicked her sorry ass out, and I'm contemplating calling animal control on her for neglect.  (oh but then I might be accused of extortion.)

It's not worth it to have to defend yourself on a daily basis;  it's not worth it to be insulted every single day when all you're trying to do it help people.  We've given the "customer" too much power now, and a backlash against the public needs to be organized.

I imagine MDs have it even worse.

Dr. Grumpy, my hat is off to you. 

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?