Gratitude

I feel like it's been so long that I should introduce myself again. I'm VSBB, your friendly neighborhood veterinary student. We last chatted, oh, probably five or six months ago, before the fall semester got crazy and then the spring semester took over my life. But now it's summer, so hello! Please don't resent me for being out of touch. You were my second call, right after I let my mother know I was still alive despite my finals' best attempts.

Anyway, I was hanging about in my neighborhood this lovely holiday weekend when I met a family with two young children. Emily, the daughter who is finishing up first grade, wants to grow up to be a veterinarian. I am basically the coolest person she's ever met (because her family has no pets, so she doesn't actually know any veterinarians. Oops?). She and I both love puppies and kitties and bunnies and horsies and now we're basically BFFs. Awwww.

I know this blog is usually about the stuff that legitimately makes veterinarians want to behave badly, and that's cool. I think it's a valid outlet and I'm glad we can talk about stuff. But today, you know what? I'm pretty thankful that I'm living the dream. A little girl thinks I'm awesome, I know a hell of a lot more than I knew at this time last year, and despite all the bad stuff, I am going to have a career that will let me do good.

Yes, you're welcome to throw that last sentence into my face when I start complaining about my student loans.

I'm also grateful today that I can go about the business of becoming an animal doctor without many worries about life outside veterinary school; I'm grateful to the heroes who have lost their lives in military service and to their families and friends. Happy Memorial Day to all of my fellow 'mericans!

The devil wears cat hair...

We've all (well, most of us) read James Herriot's stories of veterinary practice in Yorkshire. The hills, the dales, the sheep, the cows, the hunting dogs, and the people who loved or at least depended on them for their livelihood. Not to mention the everpresent pampered pets :). Evocative tales to be sure - but not quite like what most of us are experiencing today. But readers, you are in for a treat.

The VBB mailbag recently received a wonderful story from a New York City colleague. I present to you here: The Devil Wears Cat Hair!

Yesterday, the most self-absorbed fashionista and her meek, henpecked fiancé brought in their senior cat in for a lion cut.  The cat was a shorthaired cat, so the lion cut request was a bit unusual.  We’re not groomers, per se.  We are a feline-exclusive veterinary hospital that does do grooming when asked.  Because these were first time clients and the cat was a senior cat, we told them we wanted to do a physical examination first.  He was fine; she was huffy, but agreed.  

Upon examination, I discover that the cat had atrocious, filthy teeth that required a thorough cleaning and multiple extractions.  I called the owners and told them that.  About an hour later, when we started to perform the lion cut, the cat (named Ferocious) began living up to her name.  We called the owner and told them that sedation would be needed.  He handed the phone to his fiancé, who immediately accused us of doing something bad to her cat. “She NEVER acts this way, so you MUST have done something”. 

Yes, everyone knows we keep a huge arsenal of cattle prods and tasers in a drawer, waiting to break them out as soon as the client leaves the building. 

In a fury, she decides to come over, her weary boyfriend in tow.  She sees, with her own eyes, as we try to take Ferocious out of the cage, that the cat is hissing and growling.  Again, the accusations fly.  I calmly show her the cat’s teeth.  She and her boyfriend cringe.  I suggest that we schedule a dental cleaning, and while the cat is asleep, we can do the lion cut.  It’s less stress on the cat, and better for the cat because things are done under one anesthesia – the cat only needs to be sedated once, not twice, which is in the cat’s best health interest – plus, it would save them the sedation fee that would be required to groom the cat today.  The boyfriend sees the logic.  The A-list fashionista is livid.  She wants the cat shaved, dammit.  Horror of horrors, the cat is shedding fur on her furniture!  Faced with the decision of doing what is best for her cat vs. what is best for her and her furniture, she unsurprisingly chooses the latter.  I tell them okay, we’ll start now, and you can come get her between 5 and 6:30; she’ll be fully awake from the sedation.   

The fashionista bursts a blood vessel.  “We can’t come at that time! We have a shoot this afternoon!  I can’t believe this!”  She throws her hands up, and orders her boyfriend to just take the cat so they can leave.  At the front desk, she’s bitching and moaning about what awful people we are.  “I should have just taken her to my own vet”, she says.  

Yes, that’s the same vet who saw the cat three months before, and who made zero mention of the cat’s horrible dental disease in his notes.  

I suppose these folks will never be back, and I’m overjoyed at the thought.  I just feel bad for the cat, because I know that they won’t do anything about the cat’s teeth until it somehow has an effect on her – the fashionista.  Like, if the cat starts drooling blood on one of her blouses. 

It reminds me of a time, early in my veterinary career, when I was doing an overnight shift at an emergency clinic. A yuppie couple came in at 2:00 a.m. with their puppy who was having diarrhea.  I asked how long it was going on. They said, “six weeks”.  Six weeks of diarrhea!  So why was it an emergency now, at 2:00 a.m.?  Because this time, the dog pooped on their bed.  I guess it’s only a problem when it affects the people. 

The real lesson to be gleaned from all of this is really for the boyfriend. The fashionista is his fiancé.  After ten minutes in her presence, I was ready to slit my freakin’ wrists.  He’s about to sign up for a lifetime of that.  Take my advice, buddy, and get out now.  Every avenue of pleasure you currently experience is about to be closed off the moment you mutter, “I do”.  It’s not too late to reconsider. 

Bear in mind, the same could be said to all potential future colleagues. Take some time to reflect on what you want out of life - it's not too late to reconsider. 

Cultural literacy

I did not have the benefit of a fancy private school as a child. I went to your garden variety public school all the way through high school and I went to a state university as well. Therefore, it's common for me to assume that the stuff I learned about back is something that any other American public school graduate would also have learned. Sadly, I am far too often wrong.

I would like to share with you a recent exam-room experience with a newly-adopted cat who came in for a new-cat exam & vaccines. The cat was named Dionysus.

Me: (entering exam room) Good morning! So tell me about Dionysus - I'm curious how he came by his name. Does he throw wild house parties every weekend?
Client: um - no? why would you think that? He got his name because at the shelter, his name was just "D" and I didn't think that was a big enough name for him because you know he's a big cat, so I found the name Dionysus on a list of good cat names.
Me: oh. Well I was just joking because as you know Dionysus is the god of wine, ecstasy, and ritual madness and orgies, so, um, I was just trying to be funny.
Client: (looking at me very suspiciously) I don't want to be rude but what religion are you?

Now, I could pretend that I gracefully wrapped up that conversation somehow, but that would be a lie. In actual fact, I think I stammered "um - really?" and my tech saved the day by starting to laugh loudly and say "Oh, Dr. VBB you are so hilarious, I just love working your exam room, I never know what's coming next, oh Ms. Client, isn't Dr. VBB such a card? hahahahahahaha," and then I started asking the usual questions about coughing, sneezing, vomiting, etc and just kind of let the whole previous episode slip silently into the past.

*sigh*

Unneeded tests

I have recently been reading some reviews about veterinary hospitals and doctors. For one clinic, the majority of reviews were great - ones that I would love to have and, well, lucky for me I do have that type also. But there were a few, a small percentage, that complained. Some of them actually gave 4 of 5 stars, but their comments were not so flattering. 

In those cases nearly all of them mentioned money. A few mentioned that the doctor would not allow services to be paid for later. Unfortunately for way to many veterinarians we know later never comes. Many people that do not have their finances figured out today will not have them figured out tomorrow. That is my personal bias. I said many, not all. Believe me, all veterinarians wish their clients were financially sound. 

One thing that struck a chord for me was an unhappy reviewer noted that unneeded tests were done on her sick pet. So, I’m trying to figure out what IS an unneeded test. I have a whole book of tests that can be completed by the lab. I went to school to help determine which tests should be completed in a logical order. In particular my instructors made me describe why I wanted to complete a test before it could be authorized. Even in just casual discussion with my peers we regularly may ask each other about the logic for running any particular test. 

When the unhappy reviewer clearly stated they took their pet in because it was sick how did they know a test was unneeded? Why would they authorize a test they think is unneeded? I suspect in retrospect they really are suggesting that the test results turned out to be ‘within normal limits’ which is very different than ‘not needed’. 

When veterinarians are faced with a sick patient we need to figure out what is normal and what is abnormal. Knowing what is normal has as much value to medical professionals as what is abnormal. Some patients will have multiple systems affected by their condition. If we only tested until we got a single abnormal result we may miss the most important problem. We need to sort out a variety of problems so we can diagnose a condition and rule out other conditions. It helps us determine the need for treatment as well as the treatment choices indicated. We also need to know what is normal because some medications and fluids must be used with respect to certain organs functioning properly as those organs will metabolize the drugs.

One common diagnostic test is a ‘general’ panel. It is done on blood and gives us basic information about the kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas. If my dog is sick and I run a panel on her I am THRILLED that her ‘general’ panel is normal. I then know that her kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas are normal (or near normal). I would not be happier if the panel revealed renal failure, liver disease, pancreatitis, etc. 

I get clients that ask me at times if a test is needed. I tell them that I would not recommend a test if it was not indicated. Need is not really taken into account when a diagnostic plan is formed.

Healing as an open wound.

The Air Force tests a number of things. Some of these things are totally cool to me. The function of people in zero gravity. How many G's can ya take. How fast can we make this thing go?

The Air Force used German Shepherd dogs for many years to guard things. Things like nuclear weapons, bombers, and interceptors and the places that nurture such items. In the course of this, they decided to see how well German Shepherd dogs did their jobs. So somebody in the Air Force figured a way to measure the bite pressure generated by a German Shepherd dog who was munching upon your arm.

Seven hundred pounds per square inch.

In case you were wondering.

These were dogs trained to bite, so they would bite that thing and within the thing was a measuring device. A German Shepherd dog trained to bite can generate that much bite. Such a bite could fracture your femur, that rather large bone hidden in your thigh.

That would hurt!

In case you were wondering....you do not want a trained German Shepherd, one with sufficient motivation, munching upon your femur. Now, the average backyard German Shepherd won't bite that hard. Even the one on the chain that had every kid in the neighborhood scared out of Mr. Wilson's yard wouldn't bite you that hard. But the trained ones would and could.

The one that bit me, all those years ago, up on my forearm just below the elbow where those muscles used to bulge, wasn't trained to bite... so he just gave me a little nip. It hurt, of course. Surprised me, for I wasn't expecting to get bit that day. But in this business you don't get an engraved invitation to a little nip. You simply get to enjoy it. Without warning. Without option.

What surprised me....was the noise. Oh no, not the bark or the growl. No, not that. It was that pop....the pop when his canine tooth popped through the taunt skin of my left forearm. I could hear it as he bit me. That makes it seem real, in case you were wondering.

The scar is lost amongst those others, probably that dot next to where that other shepherd got the muzzle off and with his front teeth, those twelve incisors, he pinched a wedge of skin and tugged my arm that way when I thought it should have been going this other. I turned to see my arm in his mouth going west, and I requested he give it back.

I don't get bit often. I've learned most of the tricks to avoid this. Several dogs every day consider biting me. Sometimes more than several. Through diplomacy I avoid most of these bites. I win them over. I'm good, after all. Maybe one or three a week give it a good try, and miss. Like I say, I'm good. And a few times each year one will get me. Most are an annoyance. Every two or three years I get one that hurts. After four decades, I've the scars to prove how good some of these dogs can be, and how fallible I be. I remember many of these.

I'll remember this one. The scabs are slowly shrinking, and I exhibit supreme discipline in that I've not picked at the scabs hardly at all, which is unusual me. I'm an inveterate scab picker. And I've resisted for two weeks. They are jolly good scabs, and it would be fun....

While the Air Force was training German Shepherds to guard our military bases, the Soviets under Joseph Stalin had a few military bases too. After losing a few million people in the process of driving Hitler's armies out of the country, the Russians took guarding their bases seriously. The dog they came up to do this with is now called a Black Russian Terrier. It is a formidable beast. It looks like a bear, tips the scales at 120 pounds or so, and it is fiercely territorial, passionately protective, and as one breeder confessed, inordinately intolerant of any invasion of its personal space. Where most dogs must be trained to attack, according to this breeder, you must train this dog not to attack, and you must continue to train it for the entire life of the dog.

In other word, if you try to pet it, this dog will kill you.

This is not a dog for the casual dog person. It is not a dog for beginners. And it is not a dog for those silly people who think they need a guard dog that is nastier than their neighbors' guard dogs. Guess who bought this dog to be their family pet?

It was a nice social puppy. But by the time it was 9 months old, it tried to bite me because I touched its ear. When I gave it a correction with the leash for that misdeed, it came right up after me. That's when I gave the owner “the talk”.

Some dogs cannot be kept in polite society. At all. Some others can if the owners know what they are doing. Here we had a dog in the first category, and owners who didn't even come close to the second. Here is the number of the best dog trainer in the area, the one I send the worst behaved dogs to, to see if he can save them. The rest will die, hopefully before they really hurt someone. Go see this guy.

They went once.

But since the dog was behaving himself in their home, they decided they didn't really need to go again.

The trainer told them to never take the dog out in public without a muzzle. So when they showed up at my hospital when the dog was 16 months old, the lady told me she had a muzzle on the dog. This beast has hair everywhere, so you cannot see his face, his eyes. You cannot read him, see his tells. He doesn't even have a tail. He just stands there. You cannot see the muzzle.

Turns out the muzzle was not such, but only a strap loose around his nose and mouth. When I petted him, he attacked. No growl. Didn't get tense. Didn't look at me. Just boom. He bit like an experienced dog, with enthusiasm and power.

The strap kept his mouth partially closed. Those twelve incisors were latched onto a bit of skin on my left forearm. He wasn't letting go. He was growling.

Remember the eyes....the great white shark on “Jaws”? Yeah, those eyes.

I ripped my arm out of his mouth. That makes a sound, too. He left with my skin.

The owner expressed surprise. She thought she was holding him. She didn't think she needed the real muzzle. The dog had only attacked one person, a friend visiting their house, and they caught the leash in time.....

Without that strap, the dog would have opened his mouth fully and my arm would have been entirely within. Something in excess of seven hundred pounds per square inch. The bones would have been broken. The muscles and tendons torn asunder. The nerves likely lost forever. Crippled. For life.

“Doc, will I still be able to play the piano?”

“Certainly, my friend.”

“Good, because I couldn't play a note before.”

Ten fingers. Two eyes. Two ears. That's how I wish to end this career.

So far, so good.

Yes, this dog will hurt someone some day. Seriously. He may kill someone. But not in my practice. But he will hurt someone. Everybody sees it coming. Except the owners. Everybody has warned them, threatened them. Somebody will be hurt or killed.

I hope it's not a kid.

I Am More Than a Veterinarian - Guest Post

I had an epiphany today. I am more than a veterinarian. I have read that when you ask a veterinarian who they are, they answer, I am a veterinarian. And I’ve thought, well of course they do. Because in our culture who you are is what you do, right? Sure, I’m a mom and a wife and a gardener and the caretaker of a menagerie of animals. Recently I’ve decided to be a runner and am training for a marathon. I’m a cheese maker, a daughter, a homeschooler, a sister, and when I have time, a damned fine cook. But if you ask me what I am, I will tell you I am a veterinarian.

And that is a logical answer. I am the owner of, and the only veterinarian of a small, rural practice. I get up 6 days/week and go to work. I spend my entire day there, usually not leaving the building nor taking a break from the time I arrive until the time I go home. I often get home at bedtime, or sometimes even after the bedtime of my kids. Some days I don’t see my kids at all while they are awake. Because I am a veterinarian. My days are full of caring for my patients. I try to keep the healthy ones healthy. I try to make the sick ones well. I spend hours every week holding the hands of my clients (literally and figuratively) while they try to work through their own issues. Sometimes the issues we work through have little to do with their pets, but that’s OK, because I am a sounding board, a psychologist, a shoulder to lean on, a hander of tissues, a cheerleader, a veterinarian. I care deeply about my patients and the people who bring them to see me. I care about them so much so that I put my own life on hold, regularly, to be there for them.

But I am not there all the time. Sometimes I have obligations outside the four walls of my office. Sometimes I need to be a parent, a wife, a patient myself. Sometimes I need to get my hair cut. Sometimes my own pets need me to drive them to a vet across the state. Sometimes I try to squeeze in a run or an exercise class. Sometimes I try to weed my garden, or visit my elderly parents, catch up with a loved, but rarely seen friend. These things get put in the small hours, squeezed in between the big picture. I miss my run 8/10 times. The weeds will win the war this summer as they have every summer before. My husband is a single parent most days and nights. I have not been involved in my children’s homeschooling this year. I don’t get to stay home with a sick, feverish child who cries for me to stay. I have a nine year old who cried, asking me if I could please work less because I am never home. I pay this price because I am a veterinarian.

I was heartbroken today to talk to a client who was angry with me for not being available to her when she had an emergency. I had a local veterinarian and two emergency clinics who could have helped her. But I was not available. Her dog suffered waiting for me. She is angry with me. I have let them all down. She and her husband had a lot of things to say to me today. And one of them was something along the lines of, “you are a veterinarian and that should be your life.” It has been my life. For the last 15 years I have been a veterinarian first, second, and mostly. But today...today I spoke words I didn’t know I would ever speak. I look this sad and angry couple in the eye, and I said, “I am not just a veterinarian. This is not my whole life. I have a husband. I have 3 children. I have a life and hobbies outside of this building. I work 6 days each week. I can not there for everyone all the time. I can not please everyone.”

I said that. You don’t know me. You don’t understand the power of those words. But I understood. Instantly. In that moment I realized. I am more than a veterinarian. I am a lot more. And the rest of me is important. To my husband, my children, my pets, my parents, my friends, my sisters. And to me. It is easy to get caught up in the needs of your clients and patients in this business. They need me. And I have gotten lost in trying to be there to fill all of their needs. 

I have lost track of all of the other hats I am supposed to be wearing. I have sacrificed the needs of the people I love the most. My clients are quick to turn on me when they feel wronged. I wasn’t there for this woman. She turned to Facebook to let my entire community know what a monster I am. My family is neglected by me on a daily basis. They have rarely complained to me and never publicly humiliated me. They love me and support me for being...well...me. Not for being a veterinarian. Because that isn’t important to them. I have spent my life defining myself as something that isn’t even important to those that mean the most to me. I realized today that I am not a veterinarian. OK, I am a veterinarian. But that is my profession, it isn’t me. So, if you see me pulling weeds, if I invite you to a dinner I cooked, if you catch me reading a book to my toddler, running on a back road, sharing a morning swim with my girls, milking my goats or out to dinner with my husband, please know. I am still a veterinarian. I still care deeply about you and your furry friend. The wellbeing of both of you is important to me. But the wellbeing of me and my family is important to me, too. And while I will probably always define myself as a veterinarian, I will be a far better one for realizing that all those other things I do are important, too.

Humorous interlude for neuro geeks

Paging Dr. Grumpy! 

With apologies to The Knack...

OOh, my little jerky one, my twitchy one

Coming in to see me with MY-OCLONUS

Got my work cut out for me, out for me,

Looking for the cause of your MY-OCLONUS

Never gonna stop, it won't stop

Such a twitchy one, wonder what it's from

CJD, serotonin syndrome?

MY-MY-MY ay-ay-woo!

MY-MY-MY-MY-OCLONUS

Come a little closer huh, a will ya? huh.

Lesion in your spinal cord? MY-OCLONUS!

Keeping it a mystery, gets to me

Twitching down the lengths of your THIGH-OCLONUS!

 

You may now return to your regularly scheduled time wasting :)