Year End

Last post of 2012....

This year has been a year of excellent growth and change, both personally and professionally. I finished my acupuncture course, passed the exam (although I still have to take the horse live exam), and starting charging clients for treatments. I finished my first "year in practice" and I continue to have many "firsts". I had many new clients and many ongoing, loyal clients who I connected with. I feel like I have started to establish myself in the community, and I gain confidence and experience every day.

Today was my last working day of 2012, and I finished out a busy and productive Friday with 2 new clients: a new puppy exam and a senior dog euthanasia. There you have it, birth and death, the circle of life goes on.

In short, I have a long way to go to where I want to be, but I continue to reach for it every day. Stay tuned for my 2013 goals, and I look forward to my best year yet!

Power Couple on Sunday Night

On Saturday, Eric had the glamorous task of taking pet photos with Santa at Waterworkz in support of the Burnaby SPCA. I finished work on record time (for a Saturday!) and raced over to get our three dogs' photos taken. On Sunday, he had the less glamorous task of hours and hours of photo editing, and I was enlisted to type out the handwritten emails from the registration pages. The major disadvantage to letting people write down their own emails, is that the correct delivery of their photos hinges on my poor deciphering skills.

Me: Is this a "k" or and "i" and a "c"?
E: I'm trying to concentrate
Me: I normally have staff who do this sort of thing...

I managed to type out the 58 emails and congratulated myself on having "helped". Meanwhile, Eric devoted Monday and Wednesday to completing the task of editing and emailing off the photos. The payoff can be seen above, in the great shot of my gang.

Wanna go for a run?

This morning the young dog (Jake) and I were up at 6:30 to go for a run. With December 21st rapidly approaching, we were off in the darkness, as the stars met the first rays of the coming dawn. Jake and I like to run at Mundy Park, which is less than a 10 minute drive from our house. Yes I feel a little silly driving to go for run, but Mundy's fantastic trails are leash-optional until 10am, and I think it's better for humans and canines to run at their own pace on natural surfaces whenever possible. Plus you can't beat the scenery in the middle of the city.

We parked at our usual spot, Jake wearing his bear bell and me armed with a small light. It was light enough to walk along the street to the trail, but once inside the park, the trees provided an effective blanket of darkness. I turned on my light and started running. There's something peaceful about being alone in a natural setting, being vulnerable in the dark. Jake is large enough and intimidating-looking enough that I don't worry about human or wildlife dangers. I let my feet hit the ground and enjoy the fresh air and silence.

On the agenda for the morning is for me to review some anxiously awaited lab results for a sick young dog with a worried family. But I don't think about that. I run on in the darkness. Occasionally we run into other joggers, and once, another dog, one of the "regulars", who wears a flashing green light. I see a green light approach, hear the jingle of Jake's bell, then suddenly there is a circular motion of flashing green and jingling as the dogs engage in appropriate canine greetings.

Pretty soon we don't need our light. The pink edges of sunlight rise as the stars disappear one by one against a deep blue background. We near the edge of the park, Jake heels to my left, and we head back to the car, to the first coffee of the morning and the pending labwork.

Why I say no to housecall euthanasias...usually

One the questions I am most often asked is "Do you do housecalls?", often with the question posed in reference to euthanasia. I usually respond with no, although I have done two housecall euthanasias in the past year. The main reason I don't do them is that I simply don't have time. Often I am asked by someone who is not near to the clinic where I practice, and, including travel time, it could easily take me 2-3 hours at the end of my day from start to finish. This would be outside office hours, as I need to be at the practice during my working hours to see other patients. Why so much time? Well, in order to have the right tools, I would need to be coming from work, or have planned it far enough in advance to have the right drugs and medical equipment with me. If we're using sedation first, I need to wait while that takes effect. The actual procedure is over in seconds once an injection is given into the vein, but finding a vein can take some time and is sometimes a struggle. To be practical, we need to find a way to keep patients from soiling the area after they have passed, and I don't like owners to see their beloved pet in a cadaver bag. I need to take the patient's remains back to the clinic to be stored until they are picked up by the cremation company. Preferably I have one of my veterinary technicians or assistants with me, to help me during the euthanasia, as well as with lifting the patient out of the car when we reach the clinic. Logistically, this can be difficult to arrange.
People believe that their pet will be less stressed at home, but often we can find ways to minimize stress at the clinic. Sometimes I come out to the client's vehicle to give sedation first (oral sedation is not reliable, and I only give injectable). Other times I do the entire procedure in the car. We have a quiet exam room that has a comfy couch (it's where I do most of my acupuncture appointments) and most dogs will settle in nicely there. The other advantage to being at the clinic, is that when things don't go according to plan (yes, even euthanasias sometimes require a Plan B), I have immediate access to more drugs, extra hands, and even gas anesthetic, in order to make my patient's passing the most peaceful possible.

Of the two housecall euthanasias I have done, both were very peaceful for the patient and as stress free as possible for their owners. I'm glad I was able to offer this for them, but when I am performing as many as seven euthanasias in a bad week, I can't accommodate everyone. So I maintain that we can do a "good death" in hospital, one that honors both the life of the patient and their bond with their humans, as we give them the final gift of a peaceful passing.

New Toy

My latest veterinary toy isn't actually a medical device. It's my new Google Chromebook.
On my way out the door this morning, I grabbed the Chromebook under one arm (sooooo light!) and set it up on my desk at work. It feels like the clinic has been crazy busy lately, but today was one of those Tuesdays where I hang around and wait for something to happen. I took advantage of the rare downtime to catch up on some projects. The first was to write a summary of a case where you could say I am an "expert witness", as my medical findings may be used in court. I wrote it as a document in my Google Drive. The second was to catch up with some continuing education on VIN which I left open on Google Chrome, to read between cases in the afternoon.
I guess the third is to write a blog post. The ability to type and compose easily was one of the main features that drew me to the Chromebook. I'm hoping this will get me into the habit of updating the blog more frequently!

Unsolicited Advice

I'm lucky that my best friend Kathy is so understanding. Recently, I babysat her pit bull, Lila, while she and her husband were in Europe. Kathy's mum and I traded off dog-sitting duties, so I mostly got to enjoy her on the weekends and shuffle her back to Grandma's house while I was busy working. I noticed Lila was a little sore in her back legs, probably because her bad knees were acting up (in addition to being her doGmother, I'm also Lila's vet). I picked up some Flexadin, a glucosamine supplement I'd been interesting in trying, due to the inclusion of the natural anti-inflammatory Devil's Claw. I started Lila on the supplement, and let Kathy know what I'd done via a Facebook message.

Lila had a great time at our place, playing with her "cousins" Jake, Granger, and Fletcher, and going for great hikes, car rides, and even a swim. I noticed a bit of "only dog" syndrome when trying to incorporate her into my crew, but she soon learned to wait her turn for treats, stay in the car until being released, and even made some progress in the no-pulling-on-leash department.

At a charity dog walk on Sunday, I chatted to Kathy about Lila's experience at our place, and went into detail about what I thought we could be doing better for her, health-wise. I also offered up a couple of training tips. Now, usually people pay good money to hear me offer advice like this, but I was happy to make recommendations free of charge. It wasn't until I got home that I realized it might have sounded like an unsolicited critique of Kathy's dog parenting skills.

I quickly sent Kathy a text explaining I hope she didn't think I meant Lila is neglected or unruly (she's any but!), I'd just had a chance while keeping her full-time to observe some areas where I thought I could help. Luckily, Kathy has been my friend long enough (since Grade 8) that she's had plenty of time to learn not to be offended by me, and she appreciated my concern for Lila. Sometimes my client-communication blunders turn out ok!

Why are we out of lube and latex gloves?

Lately I've been spending an awful lot of time at the rear end of my patients. I've removed loads of hard feces from cats, and, yesterday, pieces of a dish towel that was nearly all the way through a young mastiff. During vet school, some clinicians really harped on the benefits of rectal exams, so I make a point of doing them routinely. I've found intestinal foreign bodies, cancer, infections, detected fresh blood or digested blood in feces, assessed dehydration, and even checked the urethra for bladder stones. It is one the cheapest and most effective diagnostic tools and treatments we have, although not the most pleasant for doctor or patient.

The thanks of a wagging tail

Sometimes you can't make everyone happy. Maybe owners don't understand the severity of the situation, or what is involved in saving their pet, and only see a happy pet who gets to go home with a hefty bill. At the end of the day, I'm not working for a thank you, or even for a paycheck, I'm working for that wagging tail walking out the door.

The wacky and wonderful this week

In a typical home-run stretch to the long weekend, I had some neat cases this week. The first was a young mastiff mix with a perplexing history, bloodwork that didn't point us in any particular direction, an ultrasound that did the same, and, finally, a belly-tap and fluid analysis that resulted in the veterinary pathologist at the lab calling me to say WTF? Fortunately, she is doing very well, and between myself and two specialists, we came to a potential diagnosis and treatment. She is a lovely dog, who is a pleasure to treat, and I'm thankful she has devoted owners who were able to provide her with the necessary tests and treatments.

My second case was a cat who ate...the feet off a rubber chicken toy! He vomited one foot, but the other was removed via endoscopy after it lodged in his small intestine, 25cm past his stomach. Luckily his owner had brought in the vomited foot, so we had some idea of what to look for.

Mid Week

Wednesday nights I get to kick back a little. I work late on Thursdays, so I have Thursday mornings free to get my running around done (or maybe even take a little "me" time!). So what am I doing tonight? I'm reviewing hedgehog medicine for an upcoming wellness exam on a pet hedgehog.

*click* Treat

Our clinic received two lovely thank you cards this week. Please consider sending a card to let your vet know how much you appreciate him or her. Those messages brighten our day, praise our staff, and help pull us out from the downward slide into burnout.

More On Testes

Remember the puppy with the testicle in his abdomen? Today I saw what happens when that's not fixed: testicular cancer in the abdomen. :(

What I struggle with the most...

The most difficult part for me is not people who don't care enough to treat their pets, nor people who cannot afford to treat their pets, it's people who I feel ought to know better and who simply choose not to provide their pets with the standard of care that I consider adequate.

Signs of Success

One of the most rewarding moments as a veterinarian is to hear back from a client after you treat their senior pet's ailment, with news that "He is frolicking again!" They had avoided going to the vet for years because they were worried what the diagnosis would be. Never be afraid to seek help for your pet, that's what we're here for.

What I Learned Today

I must still be doing this for the right reasons. At 7pm on Friday night, I was still at work writing sympathy cards for clients whose pets I'd euthanized this week. I've earned my 3 day weekend.

Behaviour Modification

I have been very fortunate to collaborate with Sarah of Bad Dogs Gone Good Dog Training Services. I have referred clients who needed help with their dogs and the results have been outstanding. In some cases, we can combine behaviour therapy with behaviour modifying drugs to achieve our goals. My own personal dogs love working as decoy dogs at Breakfast Club, and now react to the sound of reactive dogs by looking at me for a reward. Talk about operant conditioning!

Heat Stroke

Last night I saw my first ever case of heat stroke, which I believe came about from underlying laryngeal paralysis. We managed to cool the dog from over 42 degrees Celsius using a cool examining table, wet towels and a fan. He was also placed on oxygen and IV fluids. We stopped when he reached 39.6 degrees, to avoid hypothermia, and his body was able to continue cooling back to normal temperature (38.6). For a patient who came in literally dying, it was a great feeling to be able to save him and send him home to his family.

Rescue Lesson #1

I don't just say that I agree with this, I have lived it. I euthanized a sweet little dog who was a poor candidate for rescue, rather than look for a "sanctuary" to send him to. As I looked into his eyes while I pressed the syringe that would end his life, I swear he told me "I know you're not ok with this, but it's ok, because I am." And he was right.

http://notesfromadogwalker.com/2012/07/21/how-i-failed-as-a-rescuer-lessons-from-a-sanctuary/

Case of the Missing Nut

    A seven-month old, medium sized dog presented to the clinic one Wednesday morning for a sudden case of ADR (a technical veterinary term that translates to “ain’t doing right”). He had slipped on the hardwood floor the day before, seemed normal afterward, but that day he was quiet and not himself. He also didn’t want to eat his breakfast. I noted his history, fairly normal puppy vaccine visits, and a note that said “unilateral cryptorchid”, meaning one of his testicles had failed to make it all the way to his scrotum during development. This happens fairly often and is corrected by neutering.

    This teenaged puppy was bright and alert in his exam, nothing out of the ordinary until I tried to touch his right hind leg and the right side of his abdomen, in which case he would show signs of extreme pain. I discussed a plan to take abdominal and hindlimb radiographs (x-rays) with his owners, and determined that he would need at least sedation, if not a general anesthesia, to get proper positioning, due to his extreme pain. I proposed that if everything was normal on x-rays, that I would neuter him that day, since he would already be under anesthetic.
   
    We took radiographs and found nothing out of the ordinary. My technicians shaved his belly and prepared him for an exploratory laparotomy, where we open his abdomen to look for his undescended testicle. Somewhere just north of his bladder, I found the errant testicle, but it wasn’t normal in appearance. Upon closer examination, the testicle was purple and the blood supply was twisted off. I called my boss over to have a look, saying “I think he’s got a testicular torsion”. Surely, with all her years of experience, she would have some insight. Dr. M. came into the surgery suite, had a peek at his abdomen and said “Wow, I’ve never seen that before”. This actually happens quite often in veterinary medicine, so as usual, we roll with it, using our knowledge and skills to come up with a treatment plan.

    In vet school, they had talked about horses with testicular torsions, who can present with colic (abdominal pain). It made sense that the same thing could happen in a dog, especially if the testicle wasn’t where it belonged. I carefully removed his retained testicle, closed his belly, and then removed his normal testicle, as I would during a routine neuter.

    After waking up from surgery, the puppy was back to normal, telling me that we had corrected the problem. I did some research on VIN and found photos of other dogs who had testicular torsions, discovered after they presented with similar symptoms. Removing the testicle ASAP is important, due to the risk of serious complications, including death. I’m glad this puppy’s owners and I listened to him when he told us something was very wrong!

The History of History Taking

One time I had an appointment with a client I had never met before. He brought in his two cats, a male and a female, for exams and vaccines. I noticed in their files that both cats had the same birthday. Wanting to know if the cats were related genetically, I asked “Are they littermates?” To which he replied, in all seriousness, “No, she uses the litterbox but he mostly goes outside.”

History taking is a vital part of the veterinary diagnostic approach, and can be just as useful, or, at times, more useful, than a physical exam. Often clients will have what we call a “presenting complaint”, which is the reason they made an appointment to see us. Sometimes the presenting complaint is indeed the most pressing concern for the animal that day; other times, we find something much more serious. I always start by taking a history and then doing a physical exam, leaving the presenting complaint for last, so we don’t miss anything.

Animals present with signs (vomiting, scratching, not eating, limping, etc.) not symptoms, as symptoms are self-reported (I have a toothache, my skin is very itchy, etc). It’s very important to hear from the owner what signs they are seeing at home. In nearly every exam, I ask about changes to bathroom habits, appetite, water consumption, and whether there has been any coughing, sneezing, or other signs of illness. Often when we begin to discuss what’s going on at home, we identify potential areas to be concerned about. Since my patients can’t say “I’ve been so thirsty lately”, it’s important for their owners to tell me “I have to fill Fluffy’s water bowl up several times a day”.

History taking is also important to help us narrow down which diseases are most likely. If a pet has traveled out of the area, I need to broaden my list of possibilities to include diseases we don’t commonly see here. I may also ask questions about lifestyle, such as whether a cat is strictly indoors, whether a dog spends much time socializing with other dogs, to assess risk for certain diseases.

So the next time you’re asked “Has Rex had any vomiting or diarrhea?” it’s not because I like asking that question every fifteen minutes, it’s an important tool to help me do my job.