Frustration.

I've been thinking about my blog lately. Every time I sit down to write a post about something interesting that I saw or a frustrating case that I have, I realize that I can't give details that would even make the story interesting. As much as I have kept this blog under wraps, I would be deeply saddened if a client came across something negative that I had written. That would reflect poorly on me, my staff, and my clinic that my husband's family has worked for nearly 30 years to build. We have a stellar reputation, and I would hate to be the one to tarnish it. Do other clinics see at least 8+ new patients a day? I find that crazy. We have seen 6100+ clients in just under the 3 years that the computer system has been in place. That equates to at least 10,000+ patients. I find that crazy! That all being said... I'm becoming frustrated with the public. It makes me very sad to see puppies dying of parvo that could have been prevented. Heartworm disease that would have been prevented if we had seen the animal routinely. The mass that could have been removed months ago, but is now the size of a grapefruit. I understand money is tight in our area - we sometimes get complaints over pennies. And that saddens me to no end, to think that people literally have to count pennies, and are still trying to do right by their pet. I found myself getting almost snippy last night over the frustration and burnout that is slowly seeping in. I can't care about a pet more than the owner. That isn't fair to the animal and it isn't fair to me. On the other hand, there are owners that are trying all that they feasibly can to help their pet, but are restricted by finances. I found myself close to tears last night pleading with an animal that isn't doing well and refuses to eat. And yes, I actually spoke directly to the cat. In front of the owner. Given that it was late at night and I'd had a rough week, possibly I was starting to lose it. But today is my day off. And I know that I will be stopping into work this morning to call in a prescription for that animal. It's what we do. There are weeks that I have calculated out that I make far less than $10/hr. And I'm a doctor. And between KJ and I, we are sitting on $350,000 of student loans. So when people get upset when we can't do things for free or when there are complaints about the $27 exam fee and the $7 rabies vaccine... I literally want to cry. Like I said, I can't care about pets more than the owners or compassion burn out will be lurking close by. We as doctors still need to provide for our families. We went to an excessive amount of school and racked up an astronomical amount of loans (in relation to how much we make) in order to share our knowledge and help animals. Like I said, I'm glad it is my day off today. That eternally positive, happy person is still here. But sometimes you just have to vent :) Also, I miss blogland. I hope this is the start to my comeback tour.

Still alive.

So many things. 1. I graduated vet school. I am a doctor. 2. I've been working for 8 weeks now. I started the day after graduation. I worked 65+ hour weeks for the first 7 weeks. 3. I haven't been working out consistently due to foot injury... which was recently diagnosed as a "baby bunion". it also means marathon training was put on hold. 4. We moved to the country - I can't see any other houses from my house, just horses, deer, dogs, and cows. 5. I didn't have internet for 6 weeks after graduation. See #4. 6. I also didn't have a working phone for 6 weeks after graduation. See #4. 7. I still don't have cable. See #4. 8. I learned I need the internet to destress and be happy. Apparently I have a technological addiction. I also realized how much I stay in touch with friends and family via email/facebook - it was a little lonely there for awhile. But I'm back! I finally have a decently normal schedule (only 45-50 hours/week and a day off during the week!). I'll have lots of veterinary stories, lots of veterinary "firsts", and more blogs about training. I'm going to try to get back into triathlon this year, putting less pressure on my feet/knees. It also means I'll get to swim more, which is one of the great loves of my life. A mini vet summary of my first eight weeks: 1. diagnosed my first mast cell tumor via FNA 2. diagnosed horner's syndrome on an 8 yr old golden 3. euthanized my first patient (and a few more after that...) 4. palpated an abdominal mass on a recheck hyperthyroid cat appointment... GI lymphoma most likely. 5. diagnosed multiple hyperthyroid kitties 6. etc. etc. etc. learned lots. I'll be back :)

Tattoos... and the foundation for my belief system.

KJ has been talking about wanting to get a tattoo. He wants a half sleeve and his idea for it was actually inspired by our honeymoon. In Mexico, we learned a lot about the Mayan culture and about their religion and spirituality. He loved the idea of their version of the "tree of life". In the Mayan culture, they believe the world is made up of the heavens and the underworld, and linked together by a tree whose branches extend into the heavens and whose roots delve deep into the underworld, making the tree the center of the universe. When Mayans died, they believed that they entered the underworld through a cenote (very deep, water-filled caves that are interconnected - we went swimming in one on our honeymoon) and reborn into the sky world... or something along those lines.

His other idea involves some version of snake skin, with two separate scales colored red (for him and me). He is terrified of snakes and feels that by commemorating them into a tattoo, it will help him combat his fears.

I love the ideas for his tattoo and I want something equally inspiring and meaningful. The best I could come up with my favorite flower, Gerber daisies - which was also our wedding flower.

... and that is the best I could come up with.

So, I started thinking about quotes or single word inspirations, like "believe" or "dream" or "hope". It is cheesy, yes - but to have that constant, permanent reminder to be myself and believe in myself seems wonderful. I then changed gears to thinking of what word I would choose if I actually did it. "Believe" vs. "Dream". I'm not a dreamer - I set goals and I work to achieve those goals. I know myself and I guess that when I set my sights on something, I expect to get it - if I work for it and really want it. Maybe that makes me cocky, but I don't expect to be given any of it - I just set my sights on the final product and keep pushing until its mine. Swimming, softball, running, vet school, graduating college with honors, the past and present men in my life... I went after all of it, it didn't find me. And while I have some belief in fate, in the sense that things happen for a reason - I think we choose our own destinies and allow the things that could happen or were "meant" to happen, happen to us.

I guess the monkees had it right - I am a *believer*.

Emergency Situations

For my one and only off-campus rotation of the year, I got an externship at an animal hospital in the southwestern Chicago suburbs. It is a shelter based rotation, but the rescue itself operates out of an animal hospital. I've gotten quite a bit of spay/neuter experience (about 23 surgeries so far with two days left to go - my goal is to hit 30 total) as well as experience dealing with shelter illnesses - upper respiratory infections and intestinal parasites mainly.

What I want to share is what went on yesterday. First of all, I got the opportunity to assist with a TECABO (total ear canal ablation with bulla osteotomy) surgery. I chatted with the head practice partner about swimming, school, practice ownership, etc. It was a two and a half hour long procedure with about an hour of prep time, so we had ample opportunity to talk! Afterwards, I grabbed a quick lunch (it was 3:30 pm by the time we were done) and got my first surgery premedded. In the meantime, a hefty english bulldog had been brought into the hospital in respiratory distress. Apparently the owner had seen the dog breathing heavily early that morning. She went to work and returned to find her dog having a lot of trouble breathing, so she brought him into the nearest clinic (not her regular vet). He was immediately put on flow-by oxygen which helped his color tremendously. His temp was 103 when he was brought in and he was placed in the oxygen cage to relax. Unfortunately, his temp skyrocketed to 106 in a short amount of time and he was returned to the dental table for a cold bath, where his temp came down to 101. He started improving and began wanting to jump off the table. He was placed in a cage to see how he would do on room air, and at this point, I had just premedded my patient.

Three minutes later, he collapsed and stopped breathing. An ET tube was placed, he was re-started on oxygen. He had a heartbeat, so we moved him onto the surgery table close to ventilater and iso in case it was needed. A pink foam began dripping from the ET tube so we tilted the table and eventually picked him up and allowed it to drain from his lungs. At the same time, he was trying to vomit and up came about 2 cups of semi-digested kibble. Eventually he was put on iso and ventilator since he kept fighting the tube. There was no way he could breathe on his own with just flow by oxygen so this was temporary to keep him breathing to call the owners and decide on a next step. At this point, referral was the obvious choice - send him to an intensive care unit with a staff that could monitor him at all times.

As soon as Dr. E called the owner and explained what had happened, she began SCREAMING into the phone, and I quote, "YOU KILLED MY DOG, YOU KILLED MY DOG". When he told her he couldn't speak to her if she was screaming at him, she hung up the phone. She must have been waiting outisde, because she came immediately into the building screaming "YOU KILLED MY DOG" to the waiting room. After being put into an exam room, Dr. E went to speak with her and she began screaming AGAIN. No exaggerating, top of her lungs screaming... AND. POUNDING. THE. WALL. WITH. HER. FISTS.

(... are you kidding me? I don't care how distraught you are, that is no way to behave.)

Dr. E came right back out and Dr. S walked in (he is a partner of the practice) to reason with her. She then opens the exam room door that faces the waiting room and screams to them "THEY F***ING KILLED MY DOG". IN. FRONT. OF. CHILDREN.

When asked to stop or she'd have to leave because there were children present, she demanded that the children leave.

This continued for another 10 minutes, at which point the decision was made to take the dog to the specialty hospital. I drove and a tech and doctor sat in the backseat with propofol and an ambu bag with the dog. Fluids were hanging from my hanger hook and my cupholders held all the emergency drugs.

Of course, as soon as we were on our way, I realized I had NO gas. About 10 minutes from the hospital, I had to stop, run out of the car, pump 10 dollars as fast as I could and jump back in the car to get on our way. We only had a limited supply of propofol and we needed to get there. Plus, it was a 70 pound dog, so he needs a lot of propofol than a tiny dog!

About three miles from the hospital, we hit a standstill in traffic. An accident was about 10 blocks away and traffic had merged into a single lane directed by police officers. Dr. E said - "this better not take long or we are going to run out of propofol."

SHIT!

As I sat in the driver's seat shaking and praying for traffic to move its happy ass along, we finally began moving. We did make it and the dog was alive and pink when we dropped him off. After getting him settled, the owner tried to apologize, justifying her actions by saying this: "You just don't understand how much he means to me. You know I would marry him if I could."

You can't make this stuff up.

Today, the dog is still alive and on a ventilator still, so his prognosis isn't good... but we'll see what happens. It is out of our hands and hospital, so they can deal with the crazy if the dog doesn't make it.

Just a typical day in vet med.

The more you "know"...

Things I have "learned" or been told on this rotation that I plan on erasing from my brain as soon as I leave:

1. Doctors should not discuss the cost of anything with clients. They should only be associated with "caring for their animals" and not money.
2. Doctors do not clean cages. This is the job of techs, caretakers, and anyone else without a DVM after their name.
3. Cats do not need restraint. Instead of scruffing or really even touching them, you should kneel down, eye to eye with the cat, and blink slowly. This is what cats do in the wild to show that things are okay. They will magically stand still when you stick a needle in their jugular vein.
4. Primary care appointments should be scheduled hourly, or if really necessary, by the half hour. 15 minute appointments are not enough time to truly evaluate any animal and treat them... even if it is a perfectly healthy animal that only needs one vaccine.
5. An elderly animal that jumps from a counter and limps for a couple of days needs full sets of radiographs even if the limping has resolved and the cat is behaving perfectly normal and they made the appointment because of vomiting.

And I am SICK of people telling me that "your techs will do this and your techs will do that". I went to vet school so I can do my own bloodwork and do my own radiographs and do anal glands and have the ability and knowledge to do everything and anything. While I appreciate the work the CVTs do in the university setting (the hospital would be dead lost without them), if I have adequate time, I would like to do most of the so-called "tech" work. I think that is one fault (of many) of human medicine - the doctors are so far removed from the patient and removed from the costs of everything that they don't fully appreciate the whole picture. Veterinary medicine provides the whole picture - that is the beauty of our profession. I don't believe veterinarians are "above" the "mundane tech work" at all - in fact, you shoudn't be in vet school if you truly believe you are better than the techs and therefore shouldn't have to perform those basic skills EVER. I'm sorry if you disagree.

And I'm sorry for the rant, I just want to graduate and work in my small town veterinary practice for the next 30+ years with my husband.

January 2012 running update & Ally update

I ran 100 miles in January to start off the first month of marathon training. The problem is, I haven't been great (or even very good) about cross training and that is part of the foundation for the training program, aside from running three days a week. I only missed three runs in total (2 tempo runs and 1 interval runs) so I have done all the long runs so far (yay me!). This weekend I am supposed to do 12, but I'm going to push for 14 and try to get a little ahead in the long runs so I can hopefully do two 20 milers before the marathon to build up some endurance.

On a side note, we decided we wouldn't be able to adopt Ally... but one of the volunteers that works with our rehab specialist is taking her! She is an older lady with no dogs and is very familiar with Ally and adores her. I hope Ally will have an awesome home with her!

As far as rotation go, I'm currently on primary care at our school... which is an incredibly poor example of primary care and completely unrealistic - the majority of primary care practices do not have specialists available for "consults" and are not able to sustain themselves strictly on a 1 appointment/hour schedule. Its craziness... oh, the stories I have... and its only been two days! I'll update soon with my very-nearly-useless experience here and the endless tidbits of "wisdom" I've picked up... FUN FUN FUN!

Are we ready for this?

And no Mom, this is not about children.

Our ex-foster girl, Ally, has had a tough little life so far. She was rescued by a kind, caring lady who found her walking on both carpi (wrists) with some incredibly flexed tendons. She hopped around like a little mongoose and was pretty adept at walking on two legs as well as four. She had a bilateral radial and ulnar osteotomy to correct her horribly curved bones and intensive physical therapy. When the left radial implant became infected, she had another surgery to remove it. Weeks later, the healing bone was fractured again and another surgery was performed. Immediately following the first surgery is when Kyle and I came into her life. We'd visit her in rehab and play gently with her. Through everything, she was mostly a wonderful, happy little dog, with some moments of sad depression sprinkled in.

She's been staying with our rehab specialist, who is also long-time friend of KJ's and his family and now my friend as well. She is a remarkable person and does wonders for the animals that come through her ward. She opened her heart to little Ally and has been caring for her since our wedding - she never expected to inherit Ally for the long term, but graciously and lovingly took her into her home during all of her recovery. The woman that originally adopted Ally had a lot on her plate, which is why Ally is been fostered since her first surgery.

Ally had recheck radiographs done on Monday - and she was pronounced HEALED. Kim sent us an email telling us the happy news and we were thrilled to know that Ally was finally given a second chance at a quality life.

Since I'm on the imaging rotation, I was perusing the rads that were taken this past Friday and saw Ally's name pop up. I immediately ran over to rehab to visit our girl and see how well she was doing. The first thing K (rehab specialist) said when she saw me was, "Ally's broken again".

I couldn't believe. I went back and opened both sets of rads and sure enough, the Monday rads looked great, while the rads taken four days later showed matching radial and ulnar fractures.

F*CK. F*CK, F*CK, F*CKING F*CK.

The surgeons think her bones are shot... she's had months and months to recover. She is going to get 8 more weeks of bandage changes and see how it goes. But if she isn't healed... she will most likely be a three legged dog. And K thinks she will be a terrible three legged dog since she isn't great on her front right leg. And her owner has finally had it - so Ally technically belongs to K now. And K also owns a Mastiff with two young, active kids. It's not a great environment for Ally. Our house really isn't either... but we're K's first choice for Ally's new home.

KJ and I both know the situation... but haven't sat down to talk about it yet. We both love her so much - but are we ready to take on such a special needs little girl? Can we manage three dogs and two cats? I just don't know... She is such a special little girl, a sweet tiny cuddle bug that loves people and adores other animals. But we are so busy and I'm not sure we can do her rehab and give her enough attention...

Thoughts? I know other people would be willing to love her and take her into their home... but I do have a strong attachment to her. I just never pictured us being her forever home. But life doesn't always follow our plans, and I guess that's what makes it exciting and wonderful...