Monday, June 22, 2009

Ears smell

There are no, or at the very most very very few dermatologic emergencies. Also, if we haven't given you meds for your problem in over a year, you can be pretty sure that we're going to want to see your dog again. We may not consider it a recurring problem, thus giving you your coveted discount for a "recheck" exam if we haven't seen this problem in your pet for 16 months. Please don't show up at my door on Sunday morning with a pathetic dog who has an ear infection - we're open for EMERGENCIES! Please don't request a discounted exam, particularly because last time we required an exam for your pet before dispensing meds the next note in your record is that we faxed your pets records to another clinic.

In summary, ears are gross and I will smell like ears until I can shower. Ew.
Sent from my Verizon Wireless BlackBerry

Tuesday, January 06, 2009

Do you practice what you preach?

My best friend asked me an interesting question yesterday, after getting the response to the standard question "what did you do today?". She asked, "how often do you actually do what you tell your clients to do?"

Well, frankly... not often. You see, I know better. What I tell my clients is what I need to tell them to give them the best chance to get through a circumstance that I don't necessarily know the outcome to. This presumes that they don't know what an infection looks like, that they are going to let their animals go play at an off-leash dog park after major surgery, that they don't recognize subtle pain in their pets, and all sorts of things that I know that I won't do. But I don't know that you won't do them.

So yes, I neutered my cat on a whim, not fasting him the night before. My logic - he's 9 weeks old, I wouldn't have fasted him for more than an hour or two anyway due to his age. Granted, the time and situation was dictated by boredom rather than careful planning ahead, but surgery is surgery. I had time, space, material, and help while doing it, which is all I ask for.

I didn't give him as much anesthesia as I would have given a client's cat in the same circumstances. I give my patients the amount of anesthesia that they need so that I can be positive that they will not wake up during the procedure, that they won't remember it, or feel any pain. In my own cat, I gave just barely enough to finish the procedure - knowing that he would wake up faster and that I would be on hand to monitor his recovery and pain levels very closely. Is this hypocritical? Maybe. Is this something that was in Alexander's best interest? Yes, he recovered quickly, he was a known quantity to me, and I ensured that his pain was well controlled. Is this something that I should be maybe doing with all my clients' pets? Should I be using the lowest possible dose of anesthesia so that they have fast recoveries? Probably not. In this situation, I was not going to be leaving Alexander overnight at the clinic, he'd have to be awake and alert that evening at home. 99% of our surgeries stay overnight, and they are able to have a slow recovery in an enclosed area where their pain and mobility is managed. I don't think that I would *trust* most of my clients to have a pet home that night - what if the pet fell down the stairs, started bleeding, started chewing at the incision, etc. I know what to do and have the resources to deal with it - others don't.

I took Xander home the same night, letting him even play with my older cat. Again - I was able to gauge his level of alertness, and recognized if I'd gotten him in over his head. If he hadn't been able to hold his own at home, he would have been restricted to a single room or a crate to recover without interference. Would I trust my clients to make this same assessment and decision... no.

I guess what it comes down to is that I assume the lowest common denominator for my clientele. And while I've often been pleasantly surprised to find out that they are more competent, observant, or rational than the average person, as often as not I find out that people are making decisions that aren't in the best interest of their pet.

Also, I'm one of the biggest culprits for telling people to bring their pet to the veterinarian. I cannot diagnose things over the phone - god knows I've tried. In fact, yesterday I diagnosed constipation over the phone. Today, after having set up all the materials needed for the 9:30 appointment and enema... there was no stool in the colon. At all. Boy, did I feel silly. I have best guesses and gut feelings. But unless you have had the opportunity to at least hear about a possible diagnosis, if not have seen it or treated it yourself, it's very difficult for you to look at something and know that it is or isn't something that needs medical treatment.

I'm starting to realize why veterinary school is shaped the way it is. It's a fun feeling.

Thursday, January 01, 2009

Alexander the Great

This is unfortunately the season of euthanasias. Some animals can't make it to the new year, some families finally have children and extended family all in the same place, some people are finally home enough to be able to make a decision. Regardless, no euthanasia is every easy for me.

I hate being with people who have spent a lifetime with a pet and now have to say goodbye. I was lucky when I first started working and had a long string of "perfect" euthanasias, where I was able to get the vein quickly and the animal died gracefully. I have since had my share of euthanasias that have not gone well, including some where the animal has had such a low blood pressure or such scarred veins from repeated treatments and diagnostics that I was ready to cry from the difficulty of doing an IV injection without even considering the circumstances.

I'm hoping that things will be better this year. I have been a vet for over 6 months now, and the very sharp learning curve of the first year is slowly starting to level out. That said, I diagnosed new things I'd never seen before even in the last week, and done surgeries that I'd never done before (removing a needle from a cat's intestines).

The most important thing that happened here in the last week though was that we have added a brand new member to our family - a 9 week old kitten named Alexander. Our apartment is about as full as we can cram it, with 2 adults and 2 cats now. We're going to have to move before we can consider getting another pet at this point.

Since Monday, we have gone through stages of hissing that today culminated in chasing one another across the apartment and wrestling with true play and enjoyment. I think Oberon (the older cat) is finally starting to come around. We hope that soon they will both hang out in bed with us on our lazy mornings and we can have a lot more purring!