Showing Posts From: Work

22 Feb, 2017

Being Mortal

/ posted in: ReadingWork Being Mortal Being Mortal: Medicine and What Matters in the End by Atul Gawande
on October 7th 2014
Pages: 282
Genres: Medical, Nonfiction
Published by Metropolitan Books
Format: Audiobook, Paperback
Source: Library, Owned

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Goodreads

I find the discussion of end of life matters fascinating.  I’ve lost track of how many times I’ve been asked if I’m not scared about what will happen when I’m old since I’ve chosen not to have children.  That never seemed like a good enough reason to have kids since there is no guarantee that your children will outlive you or be physically/mentally able to take care of you in your old age.

Regardless of your number of offspring, I think everyone is nervous about what will happen with age.  No one wants to lose their independence.  That is the point of this book.  The author looks at several programs that aim to let people continue to live a good life as they age and then have a good death.

I was encouraged by reading about all kinds of different ways that people are rethinking elder care.  I have a dream of a community of cottages for old introverts where you check in once a day so everyone knows that you are still alive and there is a movie playing every night in case you want a group activity where you don’t have to talk to anyone.  No one has quite made that yet but there were some that I wouldn’t mind.

One of the major concerns in allowing a more independent old age is safety.  If you want people to be totally safe, then you can’t let them walk around and make (possibly poor) decisions for themselves.  Children of elderly people tend to value their safety over their happiness.  This leads them to make decisions about care that take away options from the parent.

Has anyone made progress with good deaths?  I still think that the way humans approach death is pretty horrific.  I’m coming to this discussion from my perspective as a veterinarian.  We’re all about palliative care until there is a poor quality of life and then euthanasia so there is no suffering.  The author discusses increasing access to hospice care earlier in the patient’s care to decrease extreme medical interventions that are required of hospitals but don’t ultimately aid the patient.  That’s good but then every story of a “good” death he cites ends with several days of the patient being on all kinds of pain medication so they drift in and out of consciousness.  They may not be in pain but what is the point?  They are past communication.  The families are holding vigils waiting for them to let go.  It seems to me that an overdose at this point is so much kinder.

I hear this all the time during euthanasias.  People start to talk about their relatives’ deaths and how they wish they could have helped them in this way so they didn’t have those last few days.  I understand slippery slope arguments but it just seems like common sense to me.

The author also discussed different personality types of doctors and how they help and hurt decision making.  There are authoritarians who tell the patient what to do without much discussion.  There are doctors who give the patient all their options and let them decide what to do.  I’m the latter one.  We were trained to do this in school.  It can confuse clients because they get overwhelmed.  They then counter with, “What would you do?”  We aren’t supposed to answer that question.  It isn’t a fair one anyway. We aren’t in the same situation.  I could do things at home that you might not be able to.  I might tolerate inconveniences more or less than you do.  The author talks about how he learned to give more opinions about how different choices might affect their lives.  I’ve started to do this too some.  I think it has helped some people.

He also recommends having end of life discussions with your family members before decisions need to be made.  Then if you are in an emergency situation where you can’t talk to them about it, you know what to do.

What would be your ideal way to live out your last few years?

 

Reading this book contributed to these challenges:

  • Audiobooks
  • Backlist Books
  • POC authors
19 May, 2016

A Tale of Two Conventions

/ posted in: ReadingWork

My coworkers are used to me going to conventions. They just aren’t used to me going to conventions that aren’t veterinary-related. They were very confused that I was going to a book convention. I don’t think that they believed that book conventions are a real thing and if they are real, why was I going to one. It was like my secret double life was being exposed.

Book Conventions vs Veterinary Conventions

Animals

Obviously there are way more animals at a veterinary convention.  Greyhounds lounge by adoption booths.  Golden Retrievers hang out in the exhibit halls to draw people into booths.  Rabbits have an area at one big convention.  Stuffed animals are out in droves too.  They model medical equipment mostly.

There were two dogs that I saw at BEA.  George the Newfoundland was there to promote his book and there was another dog at one point in a booth for reasons that were unclear.

Lectures

Veterinary conventions are all about the lectures.  At the big ones there are 10-15 lectures going on at all times.  I spend most of my time there and not in the exhibit halls.

I wanted to go to lectures at BEA.  There weren’t a lot of them.  I went to Blogger Con on Wednesday.  I think that is best for newer bloggers.  The content was good but wasn’t anything new to me.  I went to a lecture on Paderewski one day.  He was the famous Polish pianist who ended up living in California and starting a winery while agitating for an independent Polish state during World War I.

Size

The exhibit halls are about the same size at both types of conventions but there are way less people at BEA.  The big veterinary conventions have around 15,000 people.  It was much easier to get to a booth at BEA.  I was surprised by how few people were there.

Social

The one thing that I absolutely look forward to at veterinary conventions is a week of not talking to anyone except servers at restaurants.  I’m an introvert in a job where I talk to strangers all day.  A week of not talking is heaven!

At BEA I was social.  I went out of my way to talk to people.  Totally abnormal.

I met:

Stacey from Unruly Reader

Katie from Words for Worms

Julianne from Outlandish Lit

Sheila from Book Journey
Nicole from Feed Your Fiction Addiction

Janani from The Shrinkette

Florinda from The 3R’s Blog

Nori from Read Write Love

…and more

I just assume that no one knows who I am.  So I would see people I knew and introduce myself.  I’d start to explain in detail who I was and people would look at me like I was a crazy person and say, “I know who you are.”  Amazed me every time.  Of course a few times I would start to talk to someone I recognized and then I’d start wondering, “I follow them.  Do they follow me?  Better check.” and by the time I’d figure it out, they’d be gone.

Free Stuff

At veterinary conventions you might get some pens or some candy.  Big swag might be a small flashlight or a USB drive.  It isn’t like most places are giving out free samples of what they are selling, although a free xray machine would be nice.  BEA totally wins on this one.  They want to give you free books.  At times they can be scarily aggressive with giving you free books.  I swear the people at Hatchette were taken outside and beaten if anyone walked away from them without taking a book.  You did not walk away from them empty handed.  I had one person there actually beg me to “please, please, please take this book.”

I’ve also never been given champagne at a veterinary convention.  Note to self – Just because your hands are full and you need to run downstairs for a lecture, do not think “I’ll just drink this all now.”  Good for you for realizing halfway through the glass that this was a poor life choice.  Then I had to run downstairs carrying two bags and a half glass of champagne after chugging the rest.  Bad idea.

There’s a whole lot less extraneous stuff at BEA too.  At vet conventions there are clothing vendors and massage chairs and shoe insole sellers too.  BEA is all about the books.

World War II

World War II is never discussed at a vet convention.  BEA was all about WWII this year.  And twins.  And twins during World War II.

I’m a veterinarian

People are much less surprised by that at a vet convention.  I was at the Adult Author’s Breakfast with three librarians.  They asked me how bloggers make a living.  I said that we all have jobs.  They asked what my job was.  I said I was a veterinarian.  They look shocked and then said, “So, like real job jobs then.”  Yes, sometimes we crawl out of our mother’s basements into the sunshine so we don’t die of rickets and interact with the real world because we need money to eat.

 

 

22 Jan, 2015

Randomly at a veterinary conference

/ posted in: Work
  • I can identify the classic Eddie Murphy song “Party All The Time” from just a few notes of the intro.  What’s your superpower?
  • I’ve always wanted my superpower to be teleportation.  Now I know that it would be my power that I use for good.  I want my evil superpower to be moving things with my mind so I could flick annoying people out of my way when I’m trying to walk somewhere.
  • When condiments are presented in unlabeled open containers it is possible to confuse raspberry jam and ketchup.
  • I need to buy a new stethoscope.  I found a company that has all kinds of colors and paintings.  Now I’m paralyzed by indecision.
  • I decided.
  • I stopped by the booth that sells the disinfectant we use at work.  They were talking about how safe and ecologically friendly it is.  I said, “But, if you make it a little too strong then you start gagging and lose the ability to speak.”  That got me some attention.  He said, “It isn’t harmful….”  I agreed that I had not yet died.  He nodded sagely at me.  I got the impression he wanted me to move along.
  • I got lost and ended up in the worst lecture ever.  It was a required lecture for Florida vets that goes over new state laws and pharmacy guidelines.  When I realized my mistake, I got up to leave.  The people in my row were jealous of my freedom.  They tried to stop me.  “Hey, she’s getting away!”
  • Here’s all the loot I got:

Now I’m done getting smart and I’m heading to Universal Studios!

17 Jan, 2015

What I’ve Learned So Far

/ posted in: Work

I love going to conferences. The main reason is that I’m an introvert in a job where I have to talk to 50-70 sets of people a day. At a conference I can be surrounded by thousands of people and not have to talk to any of them but waitresses for a whole week. Heaven!

What I’ve Learned So Far

  • I’m out of the loop.  The first speaker had a whole list of TV shows he’s been on.  I’ve never seen any of them.
  • I snagged my first free pen of the conference during the first lecture.  Score!
  • The lecturer for my second lecture said, “Who doesn’t like a good polka?”  That’s my opinion too.
  • My favorite restaurant in the universe is here.  I’m happy.
  • I got a free Build a Bear.  Not sure why they were giving them out but I got one in case the 10 million other ones we have at home get lonely.
  • I hate the sound of people whispering and laughing if I’m not involved.
  • I liked it when another grumpy lady shushed them. I’m a bad person.
  • I’m incapable of single-tasking.  I can’t listen to a lecture and take notes without also playing a game on my iPad.
  • I’m glad I went to vet school before iPads.
  • One moderator said there was to be no photography or typing.  I wondered why no typing before my Southern to English translation part of my brain kicked in and realized he meant “no taping.”
  • On the shuttle to the convention center this morning I saw three hot air balloons.  On the back to the car on the shuttle, there were three biplanes.  I hope we keep evolving through the week.  I want to see UFOs.
19 Dec, 2014

How To Draw Blood from a Cat

/ posted in: Work

I have a reputation at work of being a bit of a cat whisperer when it comes to blood draws.  It started when one of the techs adopted a sick cat who they were afraid to restrain for bloodwork because she had breathing problems.  I held her and kissed her on the nose at one point.  This flummoxed the staff and they compared it alligator wrestling. I believe this is the type of image they had in mind.

From here

Since that day I have occasionally been asked to alligator wrestle a cat for a blood draw. I hope clients don’t hear them say that. They would probably think of a fight to the death instead of me cuddling a kitty and kissing them on the nose.

So, the other day, they wanted me to hold this cat.  They grabbed me while I was on my way to the next appointment.  It was a 15 year old cat but he didn’t look his age.  One tech assured me that he almost broke her wrist when they tried to restrain him. I’m not entirely sure how that is possible but ok.  I went in the room and he was laying on the table as relaxed as can be.

I said, “What’s the matter, Chief?  Are these awful people being mean to you?”  Scoffing all around from the four people in the room – 2 techs, one tech student, and an assistant.  I cuddled the kitty and said ok.  They assured me that he would soon blow.  “Is that true, Chiefy?” I murmured.  They located the vein and prepared to insert the needle.

“Seriously, he hasn’t shown his true self yet.  Are you ready?”  I was asked.

I nuzzled the top of his head.  “He’s a good Wittle Chiefy.”

The blood was pulled and Wittle Chiefy never even flicked a whisker.  I picked him up and hugged him and told him he was the best Wittle Chiefy ever while the staff made gagging noises, told me that they hated me, and told the student all the ways that what I had just done was so entirely wrong and liable to get someone killed someday.

I smiled beatifically at them all and left.  I was surprised he was so good too but never miss the opportunity to have the staff think you are magical.

I went to the next appointment – a dog named Chief.  Um….  When I finished I went back to the people who had been in room with the cat.  “Hey, you guys let me call that cat Chief the entire time and that was the name of the next patient – not his.”

“Yeah, we knew that but it was working for you.”

From this I can deduce a few things:

  1. Either that cat had always wanted to be called Chief and was glad that someone had finally recognized that, or
  2. He figured I was a crazy person because I called him the correct name during his exam with his owner but as soon as he was in the back I was renaming him so he’d better just go with the flow.

That cat will always and forever be known now as Wittle Chiefy no matter what his given name is.

20 Jun, 2014

Veterinary Choose Your Adventure

/ posted in: Work

Remember those books where you read a page and then you chose what happened next?  I loved those.  Let’s try it.

A lady takes her dog to the vet for an unusual swelling.  In the course of the exam she mentioned that this happened last year too on another place.  She took the dog to another vet, who she won’t name but who she will never go to again, and they recommended surgical repair.  When she denied that option they agreed to just drain it but told her it wasn’t the best idea.  They took the dog to the back of the hospital and he returned with a large bandage.  Three days later when he shook off the bandage the swelling was still there.

Should the owner:

1.  Realize that she chose a course of action that the veterinarian told her probably wouldn’t work so not be surprised when the swelling recurred, i.e. it didn’t work. Maybe she should call the veterinarian to discuss other treatment options.

or

2.  Assume that the veterinarian took the dog to the back of the clinic and did absolutely nothing but wrap the dog like she thought the owner wouldn’t even notice that the swelling was still there when the bandage was removed.  The veterinarian did this just to get her money obviously and therefore she will never go back there and she is still telling everyone about the scam a year later. 

When the tech and I looked her oddly and told her about option 1, she was genuinely surprised.  It had never occurred to her.  Why do some people automatically assume that they are important enough that other people concoct elaborate schemes just to mess with them?

13 Jun, 2014

No More Self Improvement

/ posted in: Work

I am a sarcastic person.  I know this.  I don’t mind this but occasionally I get to thinking that I should give more compliments out to people I work with because they do a good job under hard circumstances.

Last week we had a cat come in to get scheduled for a spay.  In the course of her pre-op check we discovered she had a disease.  We wanted to get some additional blood tests.  She was done.  She had waited in the waiting room, been poked and prodded, and now she was done.  We weren’t going to get that blood.  As one my acupuncture teachers said, “The first rule of working with kitties is (bows with hands in front of heart) Respect The Kitty.”

So one of the techs suggested that since it wasn’t an emergency situation she should go home and come back in a week or so.  We’d take her right back with no waiting and pull the blood.  That happened yesterday.  The tech that had suggested it was busy elsewhere and didn’t know that the cat had come back and that it had worked perfectly.  I decided to tell her.

“C came back today and they did want you suggested and just brought her in immediately and pulled the blood.  It went fine.”

“Shut up!”

“What?!  Remember C from last week where we needed the extra blood and you said to come back when she calmed down?”

“I have no idea what you are talking about right now but I’m sure you are being sassy.”

“No, I’m being nice and complimentary about your idea.”

She stared at me suspiciously.  “Okaaaay…”

Eventually she remembered that she had a good idea and sort of accepted that I was complimenting her.  Later I saw our boss.

“Hey, I’d like to lodge a complaint.  I was trying to be a fine and upstanding coworker and gave THAT ONE (I pointed at the tech) a compliment on a fine idea she had and she told me to shut up.”  I gave him a dramatic replay of the conversation.

He looked at me sadly and shook his head.  “I lose respect for you every time you are nice, especially to (he pointed at the tech who we both get along with well).  I prefer you sassy.”

Obviously niceness is not for me but I’m going to work on it now that I know it really messes with their minds!

 

10 Apr, 2014

Guide to Naming Pets

/ posted in: GeneralWork

A public service announcement on the naming of pets:

1. I think it is creepy to name pets after real people and then refer to them by the full first and last name. Example – “So how long has Ernest Hemingway been peeing outside the litterbox?”

2. If you name your pet after a fictional animal be careful crossing species lines. This became an issue after The Lion King came out. There are so many dog Nalas and Simbas. If those dogs knew they were named after cats they would not be amused. The only acceptable variation of this is for Pomeranians.

3. You can cross species if they are far enough apart. Baloo doesn’t have to be reserved for bears. I don’t care if that isn’t logical.

4. Never, ever, ever cross gender. I am going to use the appropriate pronoun for the name and then you are going to yell at me. My personal pet peeve on this is the name Artemis. She was a freaking Goddess, people. Don’t disrespect her by naming a male after her. Now I have recently learned about the Artemis Fowl books that have obviously led a generation astray and led to lots of male Artemises but I’m still grumpy about it.

5. Don’t name your pet after something that you can neither pronounce nor spell, especially if you are apt to get pissy whenever someone else does it correctly. I feel this way about Versailles KY too. I could never live there because I’d feel like an ignoramus ever time I had to say Ver-sales.

6. Do not name your pet after bodily fluids or excrement. You’d think that would go without saying but obviously not. That one is by request of every vet staffer who has to go into a crowded lobby and yell your pet’s embarrassing name.

I hope this helps.

16 Mar, 2014

Work Woes

/ posted in: Work

You know what makes me truly crazy?  People who just redial any missed call they have instead of listening to messages.

I don’t like listening to voice mail either.  But I don’t understand the call back mindset.  What if it was a wrong number?  What if it wasn’t important enough to leave a message? What if it was a telemarketer?  And why on earth would you call back before listening to a message if there is one?

This is what happens over and over in my office.

Some fool calls in and says, “Someone just called me from there.”  Ok, dear caller, you now know you called a business.  Don’t you feel stupid making this call?  We think you are stupid.  Here’s what has to happen next.

1.  We have to find out who you are.  That can be hard.  It is surprising how many people don’t know what name they used at the vet.  The number of aliases some people have is staggering.

2.  Once your account is located we hope that there is a note on it saying who called.  There should be.  But some people aren’t good about logging everything.  That’s our fault not yours.  For those people who call back immediately though, the note may still be being typed and not be available to be seen.  In these cases, we need to consider everyone who may have called you.

  • One of the doctors trying to tell you about your bloodwork.  If it is a doctor, that doctor is probably seeing an appointment right now and can’t talk to you because we make calls during our spare seconds when the next patients are being taken into the exam room.
  • A technician calling you about not so bad lab results.  They are probably in a room or on another call too.
  • Surgery techs calling with status updates for patients
  • Receptionists calling with reminders for surgeries scheduled in the next few days.
  • Receptionists calling about overdue vaccines

It’s ok, we’ll take a guess at who called you.

3.  The receptionist is now paging around all areas of the hospital trying to figure out who called you.  If the missing doctor or tech is in a room and not near a phone, no one knows who called you.  Oh yeah, we have 2 hospitals with connected phone service so we are doing this at two hospitals trying to find your caller.  It’s ok, we don’t have anything else to do or have 15 other patients waiting to talk to us.

4.  If it was me and I’m near a phone I get pissy if I can tell you didn’t listen to the message.  If I left you a long message and there hasn’t been enough elapsed time for you to listen to it, I know.  If the message said, “Hi.  I just wanted to let you know that there has been a delay at the lab with getting Fluffy’s results.  I didn’t want you to think that we had forgotten about her.  I will call you back as soon as we get them in” I know you didn’t listen.  Now I have to repeat myself.  I also have to work in some time to cuss you out before picking up the phone and using my sweet and professional voice.

So, you’ve wasted my time, the receptionist’s time, and your time because you didn’t take the time to listen to the message.  As you can tell this is becoming one of my major pet peeves about my job.

 

24 Nov, 2013

The Future is Coming

/ posted in: Work

I watch a lot of science fiction movies. When a drug rep urged me to sign up for his company’s VIP program at a conference I’m attending, I looked at the website to be polite.

This is exactly like something out of I, Robot or Minority Report. Imagine it playing on the side of a building as you walk past and opening with “Citizen!”

Do they think the creepiness is lessened by the bubbles?

I’m not signing up. They probably would brainwash me and/or steal my soul.

23 Nov, 2013

Work Weirdness

/ posted in: Work

There are a few things that happen every day at work and they never cease to amaze me.

1.  I am not afraid of your dog…. dreamstimefree_209775

When I go in room with a dog I always offer my hand for the dog to sniff.  It don’t think about it, it is instinct.  If I’m going to be on the floor with a big dog I kneel with my body angled away from the dog and talk to him before trying to touch him.  It is polite.  Most dogs know that I am the big bad V-E-T.  They don’t want anything to do with me.  An attempt to make friends can help lower anxiety instead of just grabbing the dog and getting started on the exam.

At least once a day I have an owner get a bit worked up about this and start insisting in a slightly offended tone, “He won’t bite you.  You don’t need to be afraid of him.”  The dog and I particularly love it when this is accompanied by the owner shoving the dog at me.

2. … unless I have a reason to not trust your dog.

dreamstimefree_205583

We see a lot of dogs in a day.  I’ve seen a huge number of dogs in my career.  I’m pretty good at assessing a dog’s body language at a glance.  If we come into the room and don’t approach your dog, there is a reason.

Your dog doesn’t have to be snarling and snapping for us to be wary of him.  It is usually the look in his eye.  Trust us on this one.  He may be the sweetest animal in the entire history of dogs at home but he isn’t at home right now.  He feels threatened and may feel that his people are also being threatened.

If your dog has been aggressive at the vet before let us know before we try to handle him.  Don’t wait until the first bite attempt and then laughingly say, “Yeah, he didn’t like his last vet either.”  Also if your dog is snarling and snapping and straining at the leash when I walk in, please for the love of all that is holy don’t let go of the leash and yell, “Go say hi!!”  I got a lot of extra gray hair from that one.

3.  It isn’t a trick question.

When I ask you questions it is for a specific reason but I’m not trying to trip you up or make you out to be a horrible person.  People get super defensive at times.  No need.  The biggest thing that freaks out dog owners is “What does he eat?”  When I ask what he is eating, I’m usually wondering about coat quality or allergies and want to get him on a higher quality diet.  I don’t have a problem with “people food” as long as it is healthy.  I encourage feeding meat and vegetables as long as the meat isn’t adding too many calories every day.  Now the lady that asked me why I thought her dog wasn’t losing weight when he only ate once a day got a bit of a talking to when she admitted that once a day he ate a bowlful of dog food topped with handfuls of cheese in addition to the steak later on.  Too many calories for a little dog.

Cat owners freak out when I ask if the cat ever goes outside.  I just want to know if we need to talk about leukemia vaccines and deworming for hunters.  I’m not judging.  I have a cat who I can’t keep in.  Please don’t hyperventilate on me.  By the way, cats hunt.  You don’t need to apologize that you ‘let’ him eat a mouse.  I congratulate the cat for making himself useful.

4.  Animals get fleas

If I point out that your animal has fleas it is not a moral judgement about you.  Don’t get offended.  It happens to the best of us.

5.  The person or place who provided your new pet may not know everything.

There are many fine breeders out there but there are also a lot who are not so good.  Same goes for rescues or pet stores.  I may be completely full of crap myself but I get suspicious when new owners come in with paperwork that says explicitly not to trust their veterinarian.  Why would they come to us if they aren’t going to at least give our opinions a listen?

There is one puppy mill that sends puppies home with chicken dewormer.  The paperwork says to give it to them for 5 days NO MATTER WHAT YOUR VETERINARIAN SAYS.  They use that bold print and everything.

Another pet store says what food the puppies have been eating (good) and then says that if they change the brand that the puppy will die.  Not kidding.  It turns out that store sells that brand of obscure food.  Coincidence?

I saw a kitten once that a pet store (with a history of super sick kittens) gave to a person because it was dying on the condition that she never take it to a vet.  Ever?  Even if it survived the illness?

We did go to school for a long time.  Just humor us and pretend that we might know something that your cousin’s sister’s aunt Sally who has had dogs for years might not be fully aware of.  You are free to ignore our advice when you leave but it is what you came in for.

 

13 Sep, 2013

My Poor Clients

/ posted in: Work

After considerable thought I have come to the conclusion that many of my clients must be exceedingly poor, bless their hearts.

They do not appear to be able to afford to buy clothing that contains enough fabric to adequately cover everything on them that ought to be covered, the poor dears.

You may say that it is not my place to judge but as a veterinarian, unfortunately, I am often put in close contact with my clients’ personal parts. Therefore, I tend to notice these things more than say, a bank teller would. If you bring in your small dog or cat, you put them on the table. I’m across the table and I’m looking down at your Precious – and your cleavage. If Fluffikins decides to hide from me, guess who has to gently remove her from between your breasts without being accused of copping a feel? Seriously, there should be a class on this in vet school. It is a skill.

People with big dogs aren’t exempt. Then I’m on the floor while they may be on a chair so I’m at chest level to the owners. Or, their dog decides to hide between their legs adding crotch extraction to my job skills. Let’s not forget the energetic dog that the owner tries to hold which makes me worry if there is about to be a wardrobe malfunction.

I’ve requested that we post signs on the front doors saying that we require breasts to be covered before entering. I’ve offered to get large coats from the thrift store to give to clients who seem to have forgotten large portions of their clothing at home like fancy restaurants that loaned out jackets and ties used to do. My suggestions usually just remind my male boss that he needs to spend more time in the exam rooms.

I’m not sure if all this exposure is turning me into a prude or a connoisseur. I feel very strongly now that if you are going to have your naughty bits all up in my face that you should have appropriate foundation undergarments. I understand that time and gravity take their toll but bra technology is amazing nowadays. Scaffolding is available. There is no reason to have your nipples at your waist. Yeah, I’m talking to you, 80+ year old lady in the strapless sundress who chose that day to go au naturale and to all the ladies obviously wearing a stretched out piece of cheapo lingerie that you bought 20 years ago.

I wish I could write prescriptions to fix this. “Yes, Fluffy needs this antibiotic for her skin and I need to refer you to Marlene down at Macy’s. She’ll measure you for an appropriate bra. They are having a sale next week. I’ll schedule you an appointment.”
_____________________________________________

Two of our best recent client stories involve ladies who were obviously “poor”.

The first was told to me by a male technician. (This proves that it is not just me that notices these things.) He set up the story by saying that it involved a lady who “was under the impression that the shirt she was wearing was a dress.”

She brought in a new kitten. She said it was 6 months old at registration. When he got it out of the carrier it appeared younger so he asked her if she was sure on the age. She said that she was because it had been born in May. It was August at the time. (Go ahead, do the math. Count on your fingers. Recheck it a few times. I’ll wait.)

Unless the kitten had gone off time traveling for a bit in July, it was 3 months old. This matters because 3 month olds and 6 month olds do not receive the same vaccinations. It was the size of a 3 month old and had the baby teeth that a 3 month old would have. He pointed this out. She insisted it was born in May and was 6 months old.

He went and got the doctor. He told her the trouble and she checked. It was 3 months old. The owner insisted it was 6 months. Finally the owner’s friend, who had been quiet up to this point, turned to her friend and yelled, “I TOLD YOU that you need to quit smoking so much weed! It is messing with your brain!”

_____________

I had a client, who fussed with her clothes continuously because she was seconds away from a wardrobe malfunction at any given time, bring in two kittens. She said they were sisters. She had had one for a few weeks and then she went back to the same place a few days ago and got the other. The new kitten was 1 pound smaller than the first kitten. The new kitten was very skinny but that wouldn’t explain the size difference entirely. They looked like there was about a month difference in ages. I asked her, “Are you sure these girls are littermates?”

She replied in a sad voice, “Yes, I just got the second one and I haven’t had time to set up a second litter box.”

20 Aug, 2013

Today, in snippets

/ posted in: Work

Oh, the crazies were out today. A glimpse—

Had a woman bring in several dogs for some testing. She approved an estimate before we did anything. After the tests I went out to discuss results. I was in the parking lot (contagious dogs) when I realized I was standing in melted gum and my shoe was stuck. So, I discussed the seriousness of her situation while freeing my shoe and ignoring my tech who was about to explode laughing.

After all that and getting treatment ready we ran her check through our automatic deposit machine thingy and it bounced. When told this she said that that was because there was no money in that account. Did she think we’d just appreciate a pretty piece of paper with her autograph?

Later she had supposedly scrounged enough cash to pay for the drugs – leaving us to probably never see the money for the testing. She came in with only part of the money she had just said she had, grabbed the drugs and booked it out of there. Then she called and wanted advice on giving the meds.

Another honesty-impared feller wanted us to change his medical records to no longer show that his cat was declawed. He wanted to give the falsified records to the shelter that he adopted the cat from. He was irate that we couldn’t do this.

I was petting a kitty and it suddenly looked at me, reached out, and slapped me on the nose.

A dog bit one of the assistants. It was a beautiful pattern of indentions in her skin. I should have gotten a picture when we were first admiring it because they faded very quickly. That sounds odd and now we have no proof.

Another cat got angry during a blood draw and the owner decided to reach over and stick her finger down its throat.

A dog didn’t want to sit still for a blood draw and its owner tackled it on the table and held its leg out to me in a way that had me concerned that she had wrenched it loose from all its moorings. I went and got another tech to help instead.

Seriously, all in one short shift day.

We went and got ice cream afterwards. It was either that or start drinking.

08 Aug, 2013

The Inside of my Brain

/ posted in: Work

Actual work conversation today

The assistant came to get me in the office to tell me about a dog with a skin problem on his abdomen. She ended with “…. and the girlfriend thinks he got attacked by spiders.”

Me: “Like in Harry Potter?”
Her: “Just like in Harry Potter except that these spiders didn’t lead him anywhere.”
Me: “It’s a Yorkie. If spiders of that size attacked him they’d have done him in. So, probably unlikely.”
The Boss: “I wish these situations would come up in the exam room so [I’d] start talking about Harry Potter to clients.”
Me: “They do come up but I stifle myself.”
Her: “Supernatural”
Me: “Yeah, I said that out loud didn’t I?”
Her: “You totally did.”
Me to The Boss: “A client told me that their dog was suddenly afraid to go outside so I said it could be monsters. I’d been watching a lot of Supernatural.”

08 Jul, 2013

Springy

/ posted in: PetsWork

I recently got this new pain medication in for cats. Cats are hard to medicate for pain because everything kills their kidneys. There are no pain medications for cats labeled for use in cats in the U.S. for more than 3 days. Some of the drugs we have are used in Europe and Canada everyday but that’s technically illegal here.

This medication is called Devcor and it is an over the counter supplement made with anti-inflammatory herbs. I love some other products from the company so I decided to try this out. I haven’t had any complaints about it not working and even had some positive feedback on it (rare).

Powder is 11 now and is losing her jump. That’s a good sign of arthritis in cats. I’ve put some strategically placed steps around the house for her to get to her stuff. I’ve given her pain meds when she is really bad but we all know that vets are the worst pet owners around so she isn’t on pain meds all the time. Cobbler’s kids have no shoes and all that.

Yesterday she was bad. She was crawling up the bed because she couldn’t make the jump so I gave her some devcor. A few hours later I had to yell at her before she got on top of the birdcage. It must be good stuff!

15 Jun, 2013

What should cats eat?

/ posted in: Work

We’ve talked mostly about dogs so what should cats eat?

I follow the same guidelines with cats.  They should eat a food that is mainly meat with limited grains.  It should have human quality, real food ingredients.  For years it was recommended that cats should eat mainly dry food to help their teeth.  Now more and more research is showing that at least part of their diet should be wet food.  Cats on dry food may be functionally dehydrated to a small degree at all times.  This may be leading to a lot of the inflammatory urinary tract disease we see in cats.

What do cats want to eat?

Riley

This is Riley’s idea of take out.

Cats are predators.  If your cats show any interest or aptitude for hunting, let them hunt.  It helps their minds and if they eat the prey they are getting the perfect mix of nutrients that their bodies evolved to use.  I’ve had people tell me that they take away everything their cats kill so they don’t eat it.  Sure, it is gross.  Yes, they can get tapeworms from eating rodents.  You need to make sure the rodents aren’t exposed to rat poison because that can hurt the cat.  But, I think cats that eat rodents are healthier overall.  They are getting the bones to help with their teeth cleaning.  The prey has some moisture to help with hydration.  And,  at least they are getting exercise instead of laying on the couch and only getting up to eat carbohydrate loaded dry foods.

What other kinds of foods do cats like?

Powder loves asparagus tips.  I take some steamed tips and dice them fine and mix them in her food.  You can do the same thing with lettuces.  Adding finely diced greens to the food can help with digestion and hairballs.  They encourage gut motility.  This is the same mechanism behind cats (or dogs) eating grass or grazing on cat greens you can buy.

Canned pumpkin is a wonder.  The fiber can help with either diarrhea or constipation by promoting normal gut function.  Start with a little bit mixed into food and increase it if the cat is ok with it.

The key with cats is hiding it first in something they like or eat it in front of them and talk about how good it is.  If you have a food motivated cat this makes them want to take it from you.  (Yeah, I’m looking at you Powder. She once ate any entire salad of mine.)

All cats are different.  Powder is a worse beggar than the dog.  Riley will not eat any type of human food.  He even turns up his nose at meat.  I don’t worry about him too much though because of his high prey consumption.

Try offering things in different ways and at different times to figure out what they like today.  Tomorrow may be different.

14 Jun, 2013

Homemade diets and add ons

/ posted in: Work

Sometimes when we start the “what does he eat” discussion people reply with a defensive and panicky “Just dog food!  No people food!”  I’m not opposed to dogs eating people food as long as it is healthy food.  Potato chips aren’t great for anyone.

Need proof?

snowballspaghetti

(In my defense this was taken in the last few weeks of her life when getting her to eat anything was a victory.  Spaghetti would not be high on my list of approved foods normally.)

We recommend carrots and green beans all the time as substitutes for biscuits for snacks.  For overweight dogs we discuss adding vegetables to bulk up meals as you are decreasing the amount of high calorie dog food.

A lot of people are concerned that feeding real food will cause dogs to beg.  Freckles is a horrible beggar – from my husband.  She doesn’t beg from me.  Guess which one of us hand always feeds her during meals and which one of us might put a bowl down by her food bowl for her to lick clean?

Home cooked diets can be great for dogs and cats.  There are all kinds of resources for people interested in recipes.  The main thing I tell people is to make sure that they feed a balanced diet.  I have people tell me that they’ve only fed cooked chicken breast for years.  That’s not going to give a dog enough vitamins and minerals to maintain their best health.   I point people to websites like balanceit.com.  You can put in a protein source and a vegetable you want to use and they will generate a balanced recipe for you to make.  They will even take any health concerns your dog has into consideration.  Their goal is to sell their vitamin mixes so you can get a free recipe that contains their mix or you can pay for a recipe that has supplements that you can buy from the store.  It is a good place to start.

There are all kinds of schools of thought on homemade diets.  All raw or cooked or bones and raw, etc.  You need to find out what works for you and your dog.  I think that a high quality homemade diet with quality ingredients will result in much better health than using commercial diets.

So why don’t I feed homemade?  There are a few reasons.

  1. I’m lazy.  It is a lot easier to scoop food out of a bag than to plan ahead and cook.  Sad but true.
  2. I’m a vegetarian living with carnivores.  I don’t like buying meat or cooking it.  When I cook for Freckles the smell makes me gag.  The husband will comment about how great the house smells.
  3. I can’t make up my mind on bones.  I talked before about my Golden doing wonderfully on bones.  I fed Snowball some raw chicken necks and she loved them.  I know in my brain that they are fine.  But, I’ve also seen the cracked teeth and obstructions and one death from eating bones.  Most of these were from eating bones that had been cooked but still I have that sliver of apprehension.

If you aren’t ready to make homemade food there are some intermediate steps you can take.  There are several commercial raw food sources.  At the end of her life Snowball was eating Innova’s raw meat patties.  She was small so they didn’t cost a fortune to feed her those exclusively.  For bigger dogs they can be a supplement.

For Freckles I make soup.  This is based on the bone broth recipe I got in my food therapy class.  I make the husband buy a beef soup bone.  I put in the crockpot with about 1/8 cup of vinegar (to leach the minerals from the bone into the broth) and enough water to cover the bone.  I also throw in some carrots.  I cook it on low for about 12 hours.  I take out the bones and leave the meat and carrots.  I keep it in the frig and skim off the fat that forms on top.  She gets a ladle full at a time as a treat.  She loves it.  (The cats won’t touch it.  It must be the vinegar.)

Varying the types of meat and vegetables you use gives lots of different nutrients to the pet.  A lot of people think that they have to stay on the exact same diet all the time.  If a dog has a healthy GI tract they can change the food they eat without getting sick.  Think about a wolf.  Do they pass up the opportunity to eat a rabbit because they only eat deer?  No.  Now, a lot of dogs (especially those who have been on a poor diet) don’t have a healthy GI tract.  With those dogs I’d start with some soup or some cooked meat added to their diet and slowly transition them onto more and more healthy food as they adapt and heal.

Coming up… What about cats?

Part 1

Part 2

 

13 Jun, 2013

What my dogs have eaten

/ posted in: Work

Part 1 – You are what you eat

My parents used to have a butcher shop across the street. My Golden Retriever would go over there for snacks. He was big enough that he could get into the trash bins. He was a kind soul, like Goldens are, and was often spotted with a group of neighborhood smaller dogs around him. He would be passing out scraps from the bin to dogs too small to get them themselves. Obviously the butcher didn’t mind because his habits were common knowledge. He was always bringing dead animal pieces home.

When he was about 10 he was going in to have a few small masses removed. I recommended getting his teeth cleaned as long as he was under. I lifted up his lip to see how bad his teeth were. I was shocked. They were shining white. I had never seen a dog his age with such perfect teeth. It had to be all the raw bones that he chewed on.

Pretty

This is Snowball. I got her when she was 9 in part because of her bad skin allergies.  In the summer she took steroid pills like they were candy.  At times she’d disappear for just a few minutes and come back with blood running down her sides because she had scratched so hard.  I forget what kind of dog food she was eating at the time.

I went to a vet convention and saw a booth for Innova dog food.  I paused to look and the rep there said in a small voice, “Are you going to yell at me?”  I said that I hadn’t been planning on it.  Was there a reason I should?  I guess people had been being mean to her about organic ingredients for some reason.

The next time I went dog food shopping I decided to buy Innova because I felt bad for the rep.  Snowball liked it and I didn’t think much more about it.  A few months later I saw some literature for the food that had case reports of dogs who had had their allergies clear up after eating it.  It occurred to me that I hadn’t given Snowball any steroids in months.  (I’m sometimes a bit slow on the obvious.)  From that day until she died several years later, she took steroids on 2 days.  Before the food change she sometimes took them twice a day.

When I got Freckles I started her on Innova because of Snowball’s good results.  She wasn’t crazy about the food so I ended up switching her to Taste of the Wild.  She has summer allergies and because she’s part spaniel her ears are crap.  But, all I have to do is clean her ears occasionally and sometimes use some steroid drops in them to keep the inflammation down.  She doesn’t have the thickened and nasty ears of some spaniels.  Because this summer has been cold and rainy her summer allergies haven’t kicked in yet.  I think keeping her on a good quality base diet has helped a lot in letting her body handle the allergens in her environment.

Coming up… homemade diets and add-ons

 

 

12 Jun, 2013

You are what you eat

/ posted in: Work

Both human and veterinary medical schools are horrible about teaching nutrition. I took an elective class in nutrition and learned nothing. It was mainly about calculating feed rations for livestock. There was nothing practical about feeding pets.

For years I didn’t do much with nutrition except occasionally switching animals to prescription diets for specific health issues. Once I started studying Chinese medicine though I started looking more at the diet of my patients. I was seeing a lot of animals with signs of “blood deficiency”. This isn’t anemia but it is a cluster of symptoms related to dryness in the body – flaky skin, dry and cracking pads, poor coat quality, etc. I started asking what these dogs were eating. The results were surprising.

Out all the hundreds of types of dog foods on the market about 25% of the people I asked were either feeding Kibbles N Bits or Beneful.

I went to the grocery store and looked at the ingredients. I admire the heck out of the marketing geniuses behind Beneful. The bag has a happy dog with all kinds of vegetables. The marketing blurbs on advertising for the food says stuff like, “Beneful® brand Dog Food Original helps keep your dog happy and healthy with a perfect balance of healthful ingredients, quality nutrition and superb taste. It’s made with wholesome grains and real beef, and accented with vitamin-rich vegetables.”

But what’s the reality?

Ingredients: Ground yellow corn, chicken by-product meal, corn gluten meal, whole wheat flour, animal fat preserved with mixed-tocopherols (form of Vitamin E), rice flour, beef, soy flour, sugar, propylene glycol, meat and bone meal, tricalcium phosphate, phosphoric acid, salt, water, animal digest, sorbic acid (a preservative), potassium chloride, dried carrots, dried peas, calcium propionate (a preservative), L-Lysine monohydrochloride, choline chloride, added color (Red 40, Yellow 5, Yellow 6, Blue 2), DL-Methionine, Vitamin E supplement, zinc sulfate, ferrous sulfate, manganese sulfate, niacin, Vitamin A supplement, calcium carbonate, copper sulfate, Vitamin B-12 supplement, calcium pantothenate, thiamine mononitrate, garlic oil, pyridoxine hydrochloride, riboflavin supplement, Vitamin D-3 supplement, menadione sodium bisulfite complex (source of Vitamin K activity), calcium iodate, folic acid, biotin, sodium selenite.

Wow. Real beef, huh? Sure there is some – way down in the ingredient list. You have to go even farther down for the vegetables besides corn.  There  are preservatives listed before the vegetables.

One of the first things we do when we see a dog with skin or ear problems is discuss diet.  We have handouts on how to choose a dog food (Basically, real meat as the first several ingredients and everything should be something that you’d eat.  Limited grains if any.  Get it from a pet store and not a grocery store.)  Getting onto a high quality diet is the best thing we have people do to help skin disease.

Seems simple right?  Oh, the arguments we get.  People are generally not open to the idea of treating disease with diet.  They want medicine to fix the problem.  It can take several visits of hearing the message before some people are willing to try. I talked to one person who was visiting the area and her dog was miserable.  She wanted temporary relief for the dog until she could get her home and start her allergy testing.  The dog was on Beneful.  I recommended switching her food and see what happens in 2-3 months.  The owner got nasty.  She was going to spend hundreds of dollars on allergy testing and treatment but would not even consider spending $10 more on a bag of dog food.

When we do get people to switch, the results can be amazing.  I’ve had dogs that I’ve seen that have been totally bald from the shoulders back.  Within a few months they have regrown a gorgeous coat.  Dogs who have had ear problems all their lives are off ear medication.  Some of the dogs get better but still have flare ups from environmental allergies at certain times of the year but they aren’t as severe.

Recently we’ve had a few dogs whose allergies were diet controlled come in looking awful.  In each case they went off the healthy food.  Either someone bought the wrong kind of dog food or the dogs had a friend who didn’t eat as healthy as they did and they ate the friend’s food.  That was the only change in their life.  It confirms that for some dogs it makes all the difference in the world to eat healthy.

Coming up…. How my dogs (past and present) have eaten and how it has affected them.

 

30 Apr, 2013

What vaccines to give? – Part 1

/ posted in: Work

If I don’t recommend vaccinating for everything possible in dogs, what do I think you should vaccinate for?  Here’s a look at the common vaccines.

Distemper combination

This goes by lots of names – DAPP, DHLPP, 5-way, etc.

  • D = Distemper – Distemper causes respiratory and neurologic signs in dogs of all ages.  It is pretty rare in the pet population now thanks to vaccination.  It is still seen in raccoons, foxes, and other wildlife.  Cat distemper is an unrelated virus.  I have never seen a confirmed case in practice.  I’ve probably seen dogs with it but missed it because it is not really on our radar much anymore in the U.S.  It is still very common in areas where vaccination isn’t practiced widely.  (Side note – This is not “distemperment” and it is not related to fixing aggression in dogs.)
  • A/H = Adenovirus or Hepatitis – This is the same virus regardless of what it is called.  Adenovirus causes infectious hepatitis.  This disease is mild and dogs usually recover.  Again, I’ve never seen a confirmed case because we don’t look for it.  The vaccine is usually actually a variant of adenovirus that causes respiratory disease (A2) and causes cross immunity.  There have been suggestions that one vaccine is enough to cause lifetime immunity but all common distemper vaccines include this.
  • P = Parvo – Parvo is a disease that started in the 1970s.  It causes severe vomiting and diarrhea.  The virus destroys the lining of the intestine so no nutrients can be absorbed.  This is a disease that we see all the time.
  • P = Parainfluenza – If there is a second P in the vaccine it is parainfluenza.  This is a respiratory disease that can be one of the components of kennel cough.
  • L = Leptospirosis – This is the most controversial vaccine in the dog world.  It is a bacteria that people, dogs, and wildlife can get and spread in urine.  It causes kidney disease.  It is considered to be the most reactive vaccine.

So, lepto.  Depending on who you read you’d hear that the vaccine is a killer or that the disease is a killer.  No one can prove either one definitively.  I went to a lecture on this recently.  The speaker asked us to raise our hands if we had ever seen a reaction from a lepto vaccine.  Every hand in the room shot up.  Then he asked if we could absolutely prove that the reaction was from the lepto component of the vaccine.  Most dogs who have had reaction have had other vaccines in combination.  Some hands stayed up because they had reactions from lepto given alone.  He asked how many of them had had a reaction on the first time they had given that dog lepto.  Hands were up.  He said that proved it wasn’t an allergic reaction to lepto because you have to have been exposed previously to something in order to have an allergic reaction to it.  He used that point to blow off concerns about safety of the vaccine.  That didn’t go over well based on the grumblings in the room.

All of my very, very severe vaccine reactions have been in small dogs who got the lepto vaccine in combination with DAPP.  Two of the three were getting it for the first time.  Can I prove it was the lepto?  Nope, but something was going on when that particular combination of vaccines was given.

No one can even say for sure how widespread leptospirosis is.  The studies haven’t been done.  There is one large study looking at cases set to a lab in Ohio which is convenient since that’s where I am.  Lots of samples were tested.  Only a few came up positive. Personally, I’ve never seen a confirmed case of lepto.  I’ve looked.  I’ve had a few dogs with textbook signs who all came back negative on titer testing.

The way I see it is that I’ve seen hundreds of vaccine reactions ranging from mild signs up to death after the lepto vaccine and no confirmed cases of the disease.  I don’t want to give it to anyone.

Ask 10 vets about this and you’ll get 10 different answers.  We can’t even get a consensus between the three vets in my practice.  One vet gives it to everyone because it is being found more and more in wildlife in our area.  I want to see a notarized picture of the dog snuggling with a raccoon before I give it to anyone under 20 lbs.  We can’t get an answer from the manufacturer.  We called last week to see what the reported rate of reaction was and all they would say is that they couldn’t give us an accurate number because not all reactions are reported.  We told them to tell us what was reported and we’d just assume that the real number was a lot higher but they wouldn’t tell us.

What we do now is a lifestyle assessment.  We ask how much wildlife exposure the dog has.  I find that the answers are skewed based on the biases of the person asking the question.  Some of my staff is totally anti-lepto.  They start with the assumption that the dog in front of them will not get it and ask the questions to see if the dog really does need it.  Some of the staff is not opposed to it and they ask questions starting with the assumption that the dog will get it unless the owners want to opt out.  We are working on a more unified approach but it is hard because there is no real data to base anything on.

What do I do for my dog?  She has had a few DAPP vaccines since I got her at age 5.  She doesn’t get lepto.  I’m going to be moving her to a 3 year DAP vaccine from now on.  I may also start titer testing her to see what (if anything) she really needs.

What is my ideal vaccination schedule?  I think puppy vaccines are vitally important.  I see a lot of parvo.  I see parvo in the dead of winter when you’d think any contaminated fecal material would be buried under the snow so dogs wouldn’t be exposed.  I recommend that boosters start at 8 weeks of age and be given every 4 weeks until 16 weeks.  After that I’d give a DAPP booster at one year and then transition to a 3 year DAP vaccine at age 2.  Ideally, I’d give distemper only at this point but that isn’t an option in the current vaccines I have available.  Parvo is mainly a puppy disease.  I’ve never seen an adult dog who has been vaccinated get it.  (Knock on all kinds of wood.) I’ve seen a lot of adult unvaccinated dogs who have a puppy with parvo in the house with them who never get sick.  The only adult dogs I’ve seen come down with parvo were unvaccinated and part of a severe outbreak on a farm where all 10 dogs died.  They had several generations of unvaccinated dogs and I don’t think anyone had any immunity at all.

Stay tuned for more ramblings on rabies, bordatella, and other vaccines.

 

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