tangent

music is a huge part of my life. i try to go to live shows whenever possible. there isn't a single genre that i haven't found some enjoyment in, and every single decade from the 20s onward holds charm for me. when i have an emotional response to a song, it's all out, and i will always have some remnant of that feeling. even years later, i can still hear a song and remember exactly how it made me feel the first time i heard it. so to say the following is a huge deal. i'm gonna say it anyway. the following might be the most beautiful song ever written:




possibly the second:

my job isn't ALWAYS this depressing

i haven't posted much because last week sucked so bad. i worked monday through thursday on internal medicine. everything - and i mean EVERYTHING - i touched died. not because of me, mind you - they all had terrible diseases - but ... still. after working a 13 hour shift on thursday, i had to get up at the crack of dawn to drive to franklin, tennessee for a job interview. lots of trying not to fall asleep while driving ensued (5 hours round trip). the job interview itself was great, and the job was pretty much offered to me on the spot. if the money was (is?) good enough, then i might take it. i dunno though. franklin is flat, far from family, and far from the husband's hobbies (namely kayaking). saturday, i worked in relief/day clinic for 6 hours. it was a busy saturday, but i loved it. afterwards, i rushed home to change into my interview clothes so i could drive to knoxville for a job interview (3.5 hours round trip). unfortunately, it wasn't for a job IN knoxville. the guy drove down from lexington, ky. that interview left me feeling equivocal...i'm not sure about it.

sunday i was supposed to go to the georgia aquarium for a hill's conference and to check out the place. i politely bailed on my friend so i could sleep. and boy did i sleep! something like 18 hours.

monday, i had to take my white kitty in for nasal biopsies. he's been sneezing with mucopurulent nasal discharge for about 2 months. i've been hoping that benign neglect would cure the problem, but it is worsening...so to work we went for xrays and biopsies.

today, i shopped for groceries, rode the fat horse (it was VERY hot, so it was a shortish ride), and made dinner. now, i have some work to do...

i have 2 more interviews set up for ER clinics - one in lexington, SC and one in NC. the one in NC pays an incredible salary. thankfully, both are putting me up in hotels, so no nightmarish, round-trip drives.

thrilling, eh?

updates on the job search - as painful as it all is - will be coming shortly, i promise.

welcome to spring in the south...

spring is here in the south. the past few days have been very warm, temperatures in the mid-80s.

the husky before me weighed about 80lbs. his coat was incredibly dense, as any good nordic coat will be. his gums were blue, he was open-mouthed breathing, his rectal temperature was 108 degrees (normal dog 99.5-101.5) my techs leapt into motion when i said 'heat stroke' and began the typical triage - IV catheter, bolused fluids, slow cooling methods (cold towels, a fan), mannitol to help prevent / combat cerebral edema, and heparin to stave off the almost inevitable DIC (disseminated intravascular coagulation).

i went to talk to the owners. the man, a well-dressed, very slim, tall, elderly man (early 80s) offered his hand and introduced himself by saying "i'm a physician." i had to resist the urge to ask him if he'd heard of heat stroke.

we stepped into a room, and i went over the history. they'd been in town for a doctor's appointment. they'd driven up the interstate with the husky in the back of their SUV. he'd always ridden there, he'd never had problems. they went to the doctor's appointment after parking in the shade and leaving the windows down. when they came back out "45 minutes" later, he was laterally recumbent, gums were purple, and he was non-responsive. they rushed him to us.

the doctor looks at me and says "he's never had a problem before. he's been healthy all his life. we've done this many, many times before. this can't be a heatstroke." i try to gently explain that their husky is FIFTEEN years old, that he is a nordic/arctic breed, perfectly suited to inhospitable, freezing climes but not to the south in spring and summer, and that his advanced age for a dog of his size might be contributing to his intolerance of the heat.

his wife turns to him and screams "we killed our dog. we did this to him. we hurt him" and collapses in hysteria.

it takes them a while to accept that i am - indeed - right. the gentlemen wants to insist that there is some underlying cause until i show him the bloodwork. it's surprisingly good considering the dog's condition. xrays of the chest and abdomen are unremarkable. it seems that no underlying disease is contributing to the husky's condition.

he can't make eye contact with me, seems profoundly stunned, and keeps mumbling about underlying causes. in the end, i am right...

just plain old southern heat stroke.

i felt very sorry for these people. it was truly an accident. bad judgment - yes but not malice. but they'd done this for years with this dog with no problems. and they were elderly, grandparent age, and seemed so stunned and broken by what had happened. i wanted to protect them from the painful knowledge.

amazingly, the husky is recovering. it's been about 24 hours, but he is stable without evidence of GI sloughing or DIC ... yet. keep your fingers tightly crossed!

this is an important reminder folks: DOGS HAVE POOR THERMOREGULATORY ABILITIES. they have to pant to blow off heat, because they only sweat a very little through their footpads. never leave your dog or cat in a car during the spring and summer. even if it feels cool to you, remember - your pet has fur, doesn't sweat, and can generally tolerate less heat stress. also, they can't open car doors and get out when it gets too hot.

blatherings.

the second part of the vaccine post will be done shortly, i swear to it. it's a really difficult subject to sum up neatly in one relatively short post.

i'd post something about veterinary medicine, but it's been 2 weeks since i worked...so there isn't much to say. i've enjoyed my time off, i won't lie. i spent a week with my 2 best friends and my husband in our old hometown. i got to see my parents and siblings, as well as my in-law parents and siblings, played the new guitar hero (metallica), went to an avett brothers show, downloaded tons of new music (which i'm still working through, slowly), rode the fat horses, went to the gym, had a job interview, and generally relaxed. it's been thoroughly enjoyable. thoughts of work intruded for the first 3-4 days, but after that...eh. i'm over it.

i have 2 more job interviews lined up. this will bring the grand total to 5 interviews. the dream job is supposed to be contacting me this week. i'm not holding my breath for that position. in fact, honestly - i've 98% given up on it. there's a tiny bit of me hoping that - against all odds - they will pick me. but i'm being realistic. the absolute crap interview i went to - they contacted me to let me know they hired someone. i was terribly sad, but i suppose i'll somehow trudge onward. i had another last week. i haven't heard from them yet, but i should be hearing soon. the other 2 pending interviews are in franklin, tn (near nashville) and lexington, ky. i also have another likely one floating around out there in brentwood (also near nashville, very rich area).

we saw the avett brothers in concert last night. fabulous, as usual. they never disappoint.

that's it. i go back to work tomorrow, so i'm sure i'll have interesting stuff to post. maybe too interesting...we shall see.

vaccines part 2 not quite ready...some pictures instead...

educational post: vaccines, part 1 - general information

vaccinations have caused a great deal of controversy in the veterinary field over the past few years. clinic recommendations run the gamut. take major corporate hospital, which we will call Danfield. currently, it recommends anywhere from 8-15 vaccines per year, frequently greater than 5 administered in one visit. then there are the more progressive clinics which offer vaccines on a three year schedule (with the likely exception of rabies, lepto, and bordatella). it's hard, as a consumer and non-veterinary person, to know what is best for your pet. go to 3 different vet clinics, and you will likely get 3 different answers regarding vaccination recommendations.

this post is an attempt to clear up confusion by explaining the very latest vaccine recommendations by the AVMA, with an explanation of what they are and why you should (or should not) get them for your furry friends.

to begin with, we can discuss what vaccines are, how they work, what vaccines are available (parts 2 and 3), and what vaccines you should (or should not) get.

first, exactly how does a vaccine work?

vaccines work by causing stimulation of the immune system. the immune system's main function is to protect the body from foreign invaders like bacteria and viruses. it does this is many ways, but one of the major ways is by production of antibodies - the body's natural antibiotics. vaccines encourage the body to do this. this is accomplished by injecting either a dead strain of the virus into the body to cause immune system stimulation or by injecting a modified live strain into the body. in the case of the MLV strains - the virus is alive, but it has been modified so that it is no longer pathogenic (disease causing). most recently, recombinant vaccines have made a splash. in laymen's terms, these are genetically manipulated to enhance immune stimulation while reducing risk to the patient.

are vaccines good, bad, or ugly?

it stands to reason then that vaccines, while having a host of beneficial side effects, can also have negative effects. these negative effects are only now just starting to be understood and studied. in humans, a sensationalist example would be childhood vaccines and autism. nothing so sensational has occurred in veterinary medicine, although many scientists and specialists suspect that over-vaccination might have something to do with the preponderance of immune-related diseases we see as doctors (immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, pemphigus, lupus, lupoid onychodystrophy, etc). further, receiving too many vaccines at one time in predisposed breeds (pugs, notably) can cause anaphylactic reactions which require emergency treatment. lastly, some vaccines have been directly linked to a very aggressive, often fatal cancer of cats called vaccine-induced sarcoma.

is yearly vaccination really appropriate?

when people ask me this question, i simply ask - how many vaccines have you received in the last 3 years of your life? i can tell you that i have received one, a flu vaccine that my father-in-law insisted i take. other than that, i can't begin to remember the last time that i received a vaccine. so why should our animals be vaccinated yearly? granted, their life spans are shorter than ours, they are probably exposed to more infectious disease than we are, and they often get into fights with other animals - sustaining bite wounds that humans are unlikely to encounter. yet still - yearly vaccines? it has been shown that once vaccinated with a kitten/puppy series and a shot at 1 year that some animals might never require another vaccine in their life, while another animal's immunity from vaccine may only last a couple of years. many prominent names in veterinary medicine believe that the immunity received from routine puppy/kitten boosters and a shot at 1 year old will confer life-long immunity from disease. this isn't strictly proven, but it is accepted knowledge. current recommendations are that vaccines should be received every 3 years (with the possible exception of a few in dogs, which i will cover, as well as the rabies vaccine - which is mandated by law due to human health consequences).

is there an age when vaccinating is more important?

this is the most important point! when puppies and kittens are born, they have a rather wimpy immune system. mom passes along antibodies both through the placenta and through the milk. these maternal antibodies offer protection against diseases that mom has already had, been vaccinated for, or has been exposed to. thus, the puppies and kittens are protected. the PROBLEM with these maternal antibodies is that we don't know when they start to wane (it's different for every individual puppy and kitten). thus, we recommend vaccinating starting around 6-8 weeks of age (vet research has indicated that this is when mom's antibodies start to weaken) and continuing on until a certain point (usually 3-4 puppy boosters, then a 6 month shot, then a year). this way, the babies are vaccinated whether maternal antibodies are present or not. thus, vaccinating puppies and kittens is the most CRUCIAL part of vaccinating. young animals are the MOST susceptible to infectious disease. your 12 year old, indoor cat...eh, you can probably skip vaccines, he's got natural immunity. your 3 month old, pit bull puppy? no way, no how. get those vaccines.

are the vaccines at the coop/feed store/over the counter places acceptable in lieu of a vet visit?

the short answer is a resounding NO. the long answer is a bit more complicated. the vaccines that you can pick up at your local feed store/coop (we can do that here in the south. up north?) may actually be GOOD vaccines. however - part of what you pay that vet visit cost for is 1) proper administration of the vaccine by a licensed veterinarian and 2) proper storage of that vaccine by the licensed vet. it's surprisingly easy to screw up simple subcutaneous administration of a vaccine. it's also surprisingly easy for the door to get left open on the fridge at the coop so that the vaccines go bad, or for the vaccine batch to actually be expired, etc. etc. granted, these things can also happen at the vet's office, but seriously - just pay the exam fee and let the vet do it. you'll be so glad you did pay the $54 for the shots and exam, especially if you meet someone who has a parvo puppy and plunked down $800-3000 for treatment. TRUST me. i see it every single week i work ER medicine.

here's the skinny on vaccines: yes, they have an important place in pet health. no, this should not be a yearly requirement, and the more progressive practices are already moving/have moved in this direction. the truth is that many veterinary offices are afraid of going to 3 year vaccines for 2 very big reasons: 1) money (obviously) - vaccines have been a decent moneymaker for many vets for many years - which is not to say that all vets were vaccinating yearly for financial reasons. until very recently, this was the recommendation of the AVMA. 2) people don't bring their animals in yearly if they're not getting shots. this is important. just because you elect to forego yearly vaccines does not mean that your pet should forego a yearly physical exam. their lifespans are significantly shorter than ours, thus in 6 months - a cat or dog's health can change a great deal. if you skip that yearly exam, then your doctor might not get a chance to diagnose the new heart murmur your cat has developed, the early signs of kidney failure (a very common disease in older cats), the mass you hadn't noticed on your dog's inner thigh, the weight loss, the weight gain, and a host of other physical changes that your veterinarian is trained to see. if you stop getting yearly shots, continue to see the vet once a year (at minimum) for a physical exam.

that brings up an important sidenote: when you do go to the vet for a yearly exam, make sure that they are doing a thorough physical exam on your pet. this involves a very thorough, head-to-toe examination of your pet, as well as auscultation of the heart and lungs (listening with the stethoscope) and a RECTAL exam. a rectal exam is a crucial part of a physical exam. if your vet isn't doing one at each physical exam, you need to request one. there are only 2 acceptable answers for why a rectal is not done: 1) the dog doesn't have an asshole or 2) you don't have a finger. this was taught to me in vet school verbatim, and it's a maxim i live by! as gross as it sounds, the rectal exam provides a wealth of information. here's an excellent article on the topic of the routine physical exam.

media madness

in my recent loads of spare time, i've been trying to catch up on music, books, and some other media. i rely on my best friend and her husband to screen TV shows for me and make recommendations. that way, i can weed out the chaff and only see the creme de la creme. hence, i am currently totally addicted to the new battlestar galactica. the husband and i are working our way through season 1. it's fabulous.

i love death cab for cutie. they've garnered a fair amount of mainstream attention lately, which i find both good (more money = more music) and bad (major attention = overmanagement, loss of musical integrity, and sometimes touring with douchebags a la the avett brothers opening for the dave matthews band - gag). at any rate, the song 'grapevine fires' from the most recent album narrow stairs is beautiful (although incredibly depressing, as all their songs tend to be). the video is amazingly beautiful and achingly sad (as DCfC always is!).



they are going to be at the ryman in nashville. both shows are on days i'm working. they're also going to be in atlanta, but alas - the show is sold out. i'm very sad.

other than music and BSG, i'm occupying myself for the time being.

job interview tomorrow at 10:30am. perhaps i should go to bed.

kitty is home safe. he was under the house.

life sucks

the job interview in waynesville, NC was just cancelled. they already hired someone. personally, i think that's a little crappy. but whatever. that only leaves me one this week - jefferson city. then after that...nothing. no jobs out there to apply for. i'm going to wind up working in some awful clinic that reuses syringes and surgery packs without sterilizing them between patients and that vaccinates yearly and that doesn't gown up for surgery.

I DON'T WANT TO DO THAT.

i love being kicked (even if unintentionally) while i'm down.

so, since i have an unplanned 2 week hiatus from work, i am staying with my best friend and her husband (coincidentally, my brother-in-law) at the old stomping grounds. i'm trying to relax, regroup, and repair my damaged psyche for the last push of 2 months.

right before i left home on thursday night to come here, my orange tabby made a jailbreak (he does this periodically). mostly he goes and sits on the neighbor's back stoop, beats up the stray living on our back porch, chases some wildlife, and then comes back within 4 hours. i couldn't round him up and left him to forage for himself until my petsitter came by and let him in. except he hasn't come back. and in 36 hours, she has seen hide-nor-hair of him. i'm starting to really fret.

the husband went home today instead of staying here so that he could look for the cat. i'm trying not to feel flutters of panic (but my skin is doing that crawly thing that makes my heart kind of palpitate, and i feel tears just below the surface of my eyelids, and it's harder to breathe than normal).

life lessons

my grandfather has - from the time i was old enough to understand this - tried very hard to inculcate me with one simple truth: life is not fair. recently, i argued with him that i thought he was bitter rather than simply cynical. this really bothered him. he explained that he is not bitter, that he is very grateful for his life, relishes the good things he has, while still accepting that the world at large is kind of a sucky place. at the time, i didn't believe him, and i was angry with him - because he seemed hellbent on convincing me that being idealistic (as the young tend to be) is a pointless endeavor. he also seemed just hellbent on browbeating me with his vast store of accumulated wisdom.

now, i realize that he was trying to prepare me for the situation in which i find myself. he was trying to spare me the angst and misery and self-doubt and questioning and hurting that i am currently experiencing (to a more limited degree - thanks to his wisdom).

i want him to know that his lesson has not been in vain. i have learned that the world is not a fair place. i have learned that by and large, people do NOT get what they deserve, that no matter how right you are, how hard you work, how much effort you put forth - that it might not matter in the end. fortunately, he also taught me the solution to that problem: do your work, care only to a certain extent, and in the end - suck it up.

and so, my friends and family - that is exactly what i am going to do. i am going to suck it up, act like an adult, and avoid passive-aggressive behavior. i cannot influence the actions and behaviors of others (wow! i bet NO ONE BEFORE ME has ever had that thought before, how novel. and if sarcasm doesn't translate well via internet - that WAS sarcasm), i can only control myself and how i react to a situation.

it has taken me exactly 24 hours to come to this conclusion. through 24 hours of the emotional gamut - from free-for-all sobbing to rationality - that is how far i've come from the emotionally immature 25 year old i was when i started vet school. the current goings-on in my life would have emotionally destroyed me for at least a week once upon a time. now i see the world with more clarity, the way people are with more clarity, and how i must act in regards to this.

to quote a recently learned euphemism that i'm rather fond of:

i'm putting on my big girl panties.

ladies and gentleman, i think i'm an adult now.

and yes, all of this IS related to the april 3rd post that was headed with my fury. all of it has come full circle and now ... here we are.

bland

my life is rather ho-hum. i will not get into details re: the mention of absolute fury that headed my last post. suffice to say that in 2.5 months, i'll be moving onward and upward.

yesterday, i went and rode the fat horses again with my technician friend, D. it was overcast and sullen. before we left, a few snowflakes drifted down (we had flurries on and off all day yesterday - FLURRIES, in APRIL). today, of course - it's 70 degrees and flawlessly beautiful. i couldn't enjoy it, because i slept till 3pm. i start overnights tonight, so i thought i would sleep very late in preparation for being up all night through monday.

after riding, i rushed home, showered, got prettied up, and attended our local veterinary association monthly dinner meeting. it's always held at restaurants far out of my price range, so i always try and go. free food and drink, fraternizing with other vets, and oftentimes - excellent CE. last night - eh, not so much. but my bison ribeye (yes, bison) was fabulous, tender, and rich.

i rescheduled the job interview i was supposed to have on monday for next wednesday. i actually got up to drive (3.5 hours, 1 way), stood in the shower, and realized that my exhaustion was so complete that driving 7 hours round-trip was not an option. they were happy to reschedule. i spent most of the day sleeping.

i also have another job interview lined up. this would put us squarely back in the place we lived for the past 9 years while the husband and i attended undergrad and grad school. no complaints here...close to home, close to family, close to everything. it's not asheville, but i would be content just the same.

not much else to report here. work was busy this past weekend, but it was still slower than the average weekend. not that i'm complaining. my job is secure until the internship is over.

veterinary lingo

i'm so angry right now that i need to talk about something to take my mind off of my fury.

some veterinary lingo:

how to talk prescription: so the RX reads like this:

take 1 tab PO BID x 5 days.

that means take 1 tablet by mouth (PO) every 12 hours (BID) for 5 days.

other prescription abbreviations: IM - intramuscular, referring to an injection into the muscle, IV - intravenous, referring to an injection into the vein, SQ- subcutaneous, referring to an injection beneath the skin, IP - intraperitoneal, referring to injection into the abdomen, TID -three times a day, QID -four times a day, SD/SID - once a day, although this is not ACCEPTED in the pharmacy world and should be written as q 24 hours (q = every).

strange veterinary acronyms

TTJ: code for a patient that needs to go to heaven (transfer to jesus)
ADR: ain't doin' right - a highly technical description of general malaise
V/D: vomiting and diarrhea (in a record - to denote a patient has vomiting/diarrhea: V/D+)
GDV: gastric dilatation and volvulus
PSS: portosystemic shunt
NFC: what we often write on the board when a patient has an undiagnosed problem (stands for no effing clue)
TPLO: tibial plateau leveling osteotomy - how we most frequently fix cranial cruciate ruptures

things you might hear us say (and interpretation)

you hear: the patient suffered acute ischemic necrosis of the jejunum and proximal large bowel after a mesenteric rent. interpretation there was a hole in the fat in the abdomen, the small intestines and some of the large went through the hole, were cut off from their blood supply, and died. alternate interpretation: this is some bad shit.

you hear: that bulldog required an emergency c-section because the owners had never bred bulldogs before. all pups were non-viable, and the uterus was perforated. OHE was performed. interpretation: people who know nothing about bulldogs bred one, assumed it could have the puppies naturally (NOT the case), required a c-section. the uterus had a big 'ole hole in it, her abdomen is full of nastiness, and all the pups are dead. alternate interpretation: some people shouldn't reproduce. neither should their dogs.

you hear: the patient developed a marked phlebitis and became febrile due to his IV catheter. removal and replacement of the IV resolved the fever and inflammation. interpretation: whoops, we left the IV catheter in for more than 72 hours in the same leg, and the vein did not like that. so we moved it to another leg. problem solved.

you hear: the bite wounds dehisced after surgical repair, there is gangrene, local and systemic infection, and DIC is present. interpretation: a wound was closed when it shouldn't have been (contaminated wounds should NEVER be sutured closed), the sutures came out, the patient has a raging local infection that has become systemic and is now suffering systemic collapse of the hemostasis system. whoops.

you hear: an iatrogenic foreign body was identified during your cat's exploratory laparatomy. it was removed, and the granulomatous tissue around it excised. interpretation: whoops. the vet left a sponge in your cat after she was spayed. the body walled it off, and now we've taken it out!

do i sound bitter today?

blather

despite the generally depressing weather, i donned the new barn boots and tromped through the mud to ride the fat horses. i actually had accompaniment this time - in the form of one of our technicians. we spent a leisurely 3 hours at the barn grooming the horses, feeding the cows, feeding the cats, cleaning and bedding stalls, and the like. i purposely stomped around in mud and enjoyed the beauty of not having to wear tennis shoes! the clouds cleared up midway through the ride, and it turned out to be a lovely evening. i'm really enjoying the belgian that i've been riding. despite his massive size, he collects nicely under saddle and actually goes into a sort of frame. he's a nice mover for being so large and draft horsey.

my aunt and uncle (mom's brother) are staying near us in their shack in the woods. they are heavy duty outdoorsy people - my uncle and aunt like to cave and pit repel. they bought some land in northern georgia and installed what we like to teasingly refer to as the "unabomber shack" on the property. it's about 45 minutes away, so they came up here with the kids and took us to dinner - which was lovely.

i'm biting the bullet and taking my cat to work with me tomorrow for his surgery. his arthritis has caused severe muscle atrophy in the rear legs, and he is limping. despite daily oral gabapentin and occasional buprenorphine (an opioid like morphine), he is still noticeably uncomfortable. despite not wanting to put my 12 year old, best cat buddy under anesthesia, i'm going to do this. it will cure him, essentially. the surgeon is doing it for free (i'm not messing around with bone - no way, no how, especially on my own kitty). i'm trying not to think about it, otherwise i would be very nervous and worried. despite knowing how safe anesthesia is...and that my kitty is very healthy for 12 years, i am worried. he's going to have bilateral (both sides) femoral head osteotomies. we are cutting off the head and neck of his femur, abolishing the hip joint. believe it or not, cats don't need it- nor do dogs, really.

some new music, if anyone is interested: the pains of being pure at heart - a poppy, faintly grungy band that reminds me of the cure -with a bit of the ramones thrown in. also - the tallest man on earth. weird, finger-picking, and not immediately likeable. it grows on you, trust me.

i'm still reading brave new world - albeit slowly. it's only 100 pages, if that. i'm knocking out 5-10 pages/day at the moment. it's not riveting reading, i have to say. it's certainly not 1984 or this perfect day. still it's a worthwhile read. just not something i'm like so totally into man.

i have another job interview next monday in waynesville, NC. hopefully this one will go better than monday's debacle!

adieu friends.