Back again

It was a fun but exhausting weekend. We left Thursday around 11am and arrived in Destin, Florida at 9pm. It was a long drive, and I think I saw the inside of every single gas station bathroom between Florida and North Carolina. All in all, the trip wasn't too bad. My wonderful husband did all the driving, so that I could sit like a lazy, pregnant sack of potatoes.

I've only been to the panhandle of Florida once before that I remember - as an 11 or 12 year old for church camp. I didn't recall how beautiful the sea is there. Destin especially was gorgeous. The sea is blue-green - like Hawaii but not quite as brilliant. The sand was like sugar.

It was a beautiful weekend, and my friend was the most gorgeous bride I have ever seen. We enjoyed time on the beach, around the pool, with good friends (including one I had only ever met on Facebook and now blogs too). There was lots of beer, champagne, and liquor. Of course, I could not imbibe - but my husband made up for both of us.

Lots of random people rubbed my belly, which didn't bother me much. Everyone loves a pregnant woman. I didn't get enough sleep, and by the time the wedding was finished, my ankles were enormous. I also burst some capillaries in my legs. So, all in all, I probably overdid it. It was all in the name of my friend's wedding though...and totally worth it.

Back to work tonight, veterinary stories to come.

It's the small things

I found curtains for the nursery - just when I was starting to despair! It seems like such a small thing, but it was really bugging me. I couldn't find anything I liked. Last night, we went to Bed, Bath, and Beyond to get a wedding present for this weekend, and I happened to swing by the curtain section and find the perfect pair!

The frames above the bed are black and white photos of Jim's grandmother - the one after which we are naming our daughter.

We leave the day after tomorrow for my vet school classmate's wedding. I am matron of honor. It's going to be a long, long drive (10.5+ hours, then add in stops for my pregnant bladder and to stretch my legs). It will be a quick weekend - what with driving all day Thurs and coming back Sunday. I'll probably be AWOL for a bit, as I have to go back to work Monday night.

Rewarding!

I love a rewarding case - looking at a patient and knowing that my intervention and the care of my technicians saved its life. It is one of the things that is most awesome about ER medicine. One of my favorite things to treat - hands down - is anaphylaxis. I see this at a minimum of once a month. I am kind of an anaphylaxis magnet at work, for some reason. Maybe I'm just good at recognizing it, who knows? It took me a long time to realize that anaphylaxis was out there and to start looking for it in my inexplicably collapsed and poorly responsive patients.

Around 6am this morning, a medium sized dog named Lily presented to us. She had been normal that evening, then jumped on her owner's bed, collapsed, defecated and urinated on herself, and then proceeded to start vomiting.

When she got to us, Lily had barely palpable pulses. Her gums were a muddy grey-pink color. Her heart rate was 240 (normal 90-120). She was breathing hard and seemed very weak. Her blood pressure would not register. She had a rash along her ventral abdomen, and her body temperature was low.

Her owner was a disabled, elderly lady with $250 to her name. This is certainly not enough to treat a nasty anaphylaxis. On a weekend, these cases run into the $1200-2000 range. I was not hopeful when she applied for CareCredit, as she was on disability. I was decidedly wrong, as she was approved for $1800. We had already started working on her dog at that point anyway.

Within an hour of administering epinephrine and Benadryl, starting aggressive fluid therapy to bring her blood pressure up, administering dextrose for her low blood sugar, and re-warming her, Lily's heart rate was down to 120, her gums were pink and moist, and she was standing in her cage and showing interest in her surroundings.

When I left her this morning, her vitals were stable, her blood pressure was 120, her blood glucose was normal, and she was maintaining her body temperature on her own.

It is always immensely satisfying to take a dying dog and raise it Lazarus style from near-death. It really makes my job worth it (despite being up all night last night due to patients and having nearly constant Braxton-Hicks contractions all morning).

Sad case

Last night, a nice country man brought in his new puppy. He had obtained this puppy about 6 hours prior, and since then, she'd been bleeding profusely from one side of her nose. I couldn't see a cut or any other explanation for the bleeding without sedating her. Unfortunately, the new owner had about $120 to his name. I recommended we spend the money wisely on sedation for a nasal and soft palate exam.

Both were unremarkable, and I could find no explanation for the bleeding. I questioned the owner at length about the new puppy - any trauma? any chance of rat poison exposure? He said no to these and then elected to take the puppy home for monitoring. The bleeding continued unabated.

Prior to leaving, he called the original owner. He casually mentioned that yes, the puppy DID have access to DCon rat poisoning. Come to think of it, the dog had been pooping green pellets for the last few days!!!

I told the owner how concerning this was and recommended running at least one clotting time test (a PT). This is the first of the 2 clotting times to become increased when an animal ingests rat poison.

Most modern rat poisons are anti-clotting drugs. They exert this effect by inhibiting an important enzyme that is responsible for the reduction of vitamin K in the body. Without this enzyme, vitamin K dependent clotting factors (clotting factors 2,7,9, and 10) do not get made. As a result, the body becomes unable to clot blood. This takes about 3-6 days to occur AFTER the rodenticide has been eaten.

At any rate, the owner agreed to run a PT. It was so high as to be out of range on our machine - indicating a severe clotting disorder. It appeared that our little puppy was suffering rat poisoning.

Unfortunately for the puppy, the new owner did not have the finances to provide treatment (fresh frozen plasma transfusion to replace the deficient clotting factors and vitamin K supplementation to provide the body with what it cannot make). Instead of doing anything, he took the puppy back to the original owner. He declined to even take vitamin K.

I can only hope that the original dimwit has the puppy treated, but I suspect it will lie in a lot somewhere and die a slow death of internal hemorrhage. It was an all around bad scenario.

More nursery stuff

I am not crafty in the slightest. My mother scrapbooks, makes handmade cards, sews, makes dolls, and the like. She often accuses me of being adopted due to my lack of interest in visiting Michael's fabric store, AC Moore, or Hancock's. So, when the creativity stirs me, and I actually create something, I get really excited. A couple of months ago, I bought some white picture box frames at Ikea, and some fabric swatches from AC Moore. The plan was to frame the fabric in the colors of the nursery. I figured it would be one of those things I never got around to - mostly because I'm not meticulous or crafty at all.

But I did it! I am so proud of my wall of art!

Nursery Stage 1

My wonderful husband painted the nursery for the past 2 days, and today, he put together the crib and "dresser" (i.e. Ikea Expedit bookcase). There's still much to do - hang artwork, get a new light fixture to replace the circa 1995 brass one, pick curtain rods and hang curtains, pick a glider, and on and on - but it's taking shape. That's exciting. I'm pleased with our Wal-Mart online Baby Mod crib. For $200, it was a good deal, it's made of wood, and it feels nice and sturdy.

Who knew that babies need so much stuff??

People make me KRAZEE

Some funsies from this weekend:

A woman who looked suspiciously like she did either crack or meth (or both) presented her very sweet, old Chihuahua for a "bleeding face." Said Chi had not been to a vet in 4+ years, was not on heartworm preventative, and had received no vaccines. The "bleeding face" was a tooth root abscess. When the base of teeth become infected - that abscess needs somewhere to expand. Sometimes it expands right through the skin of the upper or lower jaw (more frequently upper). That's what had happened to this poor dog. I sent my technician in with an estimate to sedate the dog and do an oral exam. I also was careful to make sure he explained to her that the estimate did not cover ANY treatment and that would be additional. Silly me, not putting it in writing!

I extracted 8 of the dog's remaining 10 teeth, as they were literally falling out of the dog's head. All told - the bill was $70 more than the original quote. The owner absolutely REFUSED to pay the difference, as it wasn't quoted to her.

She even went so far as to bring her skanky boyfriend in to argue with my technician. Despite explaining to her that the dental I did cost $70 extra, whereas at a day practice, it would have cost hundreds of dollars (and RIGHTFULLY so) - she would not pay.

In the end, we were stiffed the $70. On the bright side, the little dog will feel much, much better now that the rotting teeth are gone. There was that to make me feel better about the whole stupid situation.

The next was a crazy breeder and her intact 10 year old Irish setter. This dog was not vaccinated. When asked why not, the woman replied, "I'm a breeder. I don't vaccinate." Anyway - she had brought the dog in for restlessness and panting/anxiety. She was convinced the dog had a GDV ("bloat"). It was obvious from 50 yards that the dog was not bloated, and I told the owner that. On abdominal palpation, she was severely constipated, however. I recommended xrays.

At that point, the owner told me that she wanted the "upside down" xray, not the "side to side" xray - as the upside down is the only way to diagnose bloat (according to her veterinarian - which I'm highly skeptical about). I explained how to diagnose a bloat - physical exam followed by a lateral xray ("side to side") if necessary.

It didn't matter - we did both views anyway, as we always do - lateral and VD. No bloat, just a colon full of rock hard stool.

Owner went home with dog only to call back at 3am, insisting we MISSED a bloat in her dog because we didn't do the "upside down" xray.

I'm sorry, Ms Wacky Breeder - where did YOU go to medical school?? I'm an ER doctor, for God's sake. I see a bloat a week. I know how to diagnose them! Hell, my last one didn't even need xrays, we just went to friggin' surgery. And guess what? I was right - the dog was bloated.

There were other colorful characters through the weekend...but those 2 took the cake.

Whoo, it's Friday, Friday...

Not that the actual day means anything to me. I still have 2 more nights to work until I'm off. It was a busy night in the ER. We hit the ground running at 6pm and didn't stop until close to 5am. I saw many interesting cases: a proptosed eye that I removed, a dog with severely low platelets and a serious bleeding problem, a cat with an inexplicable post-mass removal anemia, a blocked kitty, a vomiting dog, a couple of euthanasias, an old dog with acute onset of vestibular disease, and on and on. It was exhausting, I won't lie. The only reason I'm still up is because I have to check my post-breakfast blood glucose before I can lie down. I won't fib - gestational diabetes is downright inconvenient. I guess that's true with any disease, so I should stop complaining - as mine is relatively mild. Despite being busy last night, I was able to keep on my eating schedule well, so that was an improvement.

Not much else to report. I'll post about some interesting cases when I'm less sleepy.

Life is not fair

So, the heat stroke Labrador that went home with the jerk owners? Doing fine - eating, drinking, and recovering from his heat stroke. The pit bull whose owners poured $2000 into trying to save him - including 2 plasma transfusions? Dead. I'm happy for the Labrador, but what lesson did the terrible owners learn from this experience? Absolutely nothing, I can rest assured.

Wow

This weekend was a busy one in the ER. 14 hours on Saturday and 13 hours today. It's very difficult to manage gestational diabetes with a schedule like I work. Saturday wasn't so bad that I couldn't eat my snacks and lunch on time. My wonderful husband got up at 7am on Saturday and fixed me breakfast to ensure that I ate prior to work. The day balanced fairly well and my numbers were ones I was happy with. Sunday was a different story. The husband made breakfast again and packed me lunch. I never got a chance to eat it, as I was running from the moment I hit the door. It was exhausting, and I never really caught myself up with the food. Hopefully, I'll do better next week.

I had a horrible case on Saturday that left me shaking in anger when all was said and done. When trying to sleep on Saturday night, it kept coming back to haunt me.

An older couple presented with their morbidly (and I mean MORBIDLY) obese Labrador (140+ pounds). He'd been locked in their car for 3 hours in the 90 degree heat. When he presented to us, he was laterally recumbent with petechiae forming on his skin. He was also having diarrhea and vomiting - all bad signs.

The owners were asked for the $500 critical care/triage deposit to get started. They flipped out - claiming that was too much money. Before things got heated, I brought the owners back to ICU - thinking that I could discuss heat stroke with them, their dog's prognosis, and give them a better idea of what to expect.

Nope, the owners were adamant - $500 was too much to treat (and that was just to start - a dog this large with a heat stroke would probably run into the $2000 range). I commiserated slightly about the cost in my best soothing doctor voice and recommended euthanasia, given the dog's dire situation.

That's when things got ugly. The female owner refused to make eye contact with me.

"I don't want him to die here!" she semi-yelled. "I want him to die on MY terms." She then said, "we're not putting him down, that's not an option." Bewildered, I tried to again explain sepsis, DIC, and acute renal failure. The owners would not listen. They wanted to take him home - to live or die there. Finally, I looked straight at the husband and said, "your dog is going to die a horrible death if you take him home in this condition."

The owner patted the dog and said, "We think he'll live."

My mouth was hanging open.It is exceedingly rare that I will tell an owner that they are being cruel, but I told these owners in no uncertain terms that what they were doing was inhumane. I almost mentioned that the dog WOULD die on "their terms" - as their terms had included leaving him in a boiling car for 3 hours.

It all fell on deaf ears. They signed an against medical advice form and left, putting their vomiting, laterally recumbent, petechiated Labrador into the back of their SUV and driving off. I felt sick. I still do. Especially because today - we saw a dog that had a heat stroke yesterday. The owners did not seek treatment and now the dog is vomiting pure blood, oozing from every venipuncture site, and dying. Just like the Labrador is probably doing in some backwoods shed someplace.

Work and sundries

The last 2 nights I have work have been dreadfully slow. I saw three patients on Wednesday night and three on Thursday. Other than the perforated intestines, nothing was really interesting. Run-of-the-mill stuff like ear hematomas and the like. Thus, not much to discuss re: veterinary medicine.

I started insulin yesterday - before eating and before bedtime. It's not bad, since the needles are very small - just frustrating and annoying. I continue to follow the diabetic diet. One day at a time is how I'm taking this.

The SUV will cost $1500 to fix. We haven't made any decisions about what we're going to do yet. At the moment, it resides in the garage while we decide. We're not in a place to buy a car at the moment, as most of our available funds are going to save for maternity leave. We have excellent credit, so we could buy a car on credit - but we've never had car payments before, and I see no reason to start now. At the moment, the husband is home all day working, so 2 cars is really a luxury we don't need. Thus, we aer not making any decisions at the moment. There's no super rush, although we will need a 2nd car when Evaline gets here.

No other real developments. Chicken Biscuit has been doing fine at home. He hates me and won't let me touch him or come near him, he runs in terror. He will get in bed with Jim though, so he's coming around. I haven't decided when/if we are going to do surgery to remove his bladder stones. It might permanently scar him.

$2400 later, here's your dog in a box.

I simultaneously love a challenging case such as I had last night and hate it (when they end badly). At around 7pm, I was presented with a small breed dog suffering acute onset of abdominal pain, vomiting, diarrhea, lethargy, anorexia, and fever. On physical exam, the dog was very, very depressed, had extreme pain associated with abdominal palpation, and was spewing foul diarrhea from its rectum. I recommended bloodwork and xrays to the owners.

Bloodwork showed sepsis (white blood cell count was 1400, normal is 5500-16,900), slightly low platelets, borderline hypoglycemia, and dehydration. Xrays were what really concerned me. There appeared to be fluid in the abdomen. Even worse, there was a pocket of what looked like free gas sitting up next to the kidney. No animal or person should EVER have free gas floating around inside the abdomen - not unless they've recently had abdominal surgery or a penetrating abdominal wound such as a gunshot.

I was very concerned and discussed my findings at length with the owners. Surgery was definitely indicated, as this little dog had likely perforated an intestine or his stomach. After looking at a sample of the fluid in his belly, I was confident. First, there should be no fluid in your abdomen. Secondly, if there is, bacteria should not be present. This dog's abdominal fluid was loaded with tons and tons of bacteria - another sign that the GI tract was leaking.

In surgery, I found inflamed, not moving intestines. The abdomen was full of fluid and feces. Once the intestines were out, I found a large, oozing hole in the cecum - a section of intestine between the large and small bowel. I had no choice but to remove that area and anastamose the small intestines to the large intestines.

My patient was doing very poorly under anesthesia. Her blood pressure would not stabilize, no matter how aggressively we treated. Her intestines were not moving, and the fat supplying blood to the intestines (mesentery) was inflamed terribly. There were also hardly any pulses in the mesentery.

Shortly after removing the sick part of the intestines, my surgery site started to turn purple, then black,. Within five minutes, it was just lying there, flaccid and purple-black. I knew that the site was dying. So I removed it and did another anastamosis. Five minutes later, the same thing happened. At this point, I had removed >60% of the small intestine (dog only weighed 6 pounds). Every time I touched the intestines, they died.

I knew what I was looking at - sepsis, hypotension, and DIC likely secondary to the sepsis and shock. These intestines were not going to live, no matter what I did - and especially not in the face of low blood pressure and DIC.

Scrubbing out, I called the owners and gave them the grave news. They wisely elected to not wake up the small dog, as she would have suffered heinously before inevitably dying.

It was a very interesting case with a very, very sad outcome. My inability to save the patient despite my best efforts was crushingly disappointing, as usual. And the owners, of course, were the nicest people on the planet.

Welcome back to work!

Lately...

I realize I haven't been talking much about veterinary medicine. This diabetes thing is dominating my mind. Eating is really difficult when you have to be so careful. Planning is required. Any interruption in the schedule throws off everything. For instance, I set an alarm this morning to get up and check my BG, then fix myself breakfast. As I was lying in bed, preparing to rise, my phone rang. It was our office manager, asking me to come in. Our receptionist's cat was dying and on the way to the clinic.

I barely had time to grab a box of Wheat Thins and run out the door. I also didn't get a protein to pair my carbs with, so another fail. After everything was said and done at the clinic, I had to meet with the dietitian for 2 hours to discuss managing the diabetes. My BG immediately beforehand was 180. Stress spike anyone? (My receptionist's cat was in fulminant heart failure likely brought on by an error made by a technician at work last night. He died before I arrived).

With the way my numbers are looking, insulin is very likely going to be added to my treatment regimen. People keep telling me that it's no big deal. It feels like a very, very big deal - twice daily injections until the baby arrives. I'm depressed and cannot stop believing that this is my fault on some level.

Someone suggested in the comments that I switch to part-time work at the clinic. This isn't feasible for the simple fact that I am our sole source of income. Since my maternity leave is unpaid, the money we have in our savings will be the money that will get us through the maternity leave. Thus, unless the doctor makes it mandatory, I have to work through to the end.

It's only 59 more days! Evaline had her first bout of hiccups that I was aware of last night. It kept me awake for a good 20 minutes, until they subsided. At first, I was a little worried, since I hadn't felt that particular movement pattern before, then I figured out what it was. Very, very weird...

Let the complaining continue

My husband left town this morning to meet with his thesis advisor. I had to corral all 20 pounds of Chicken Biscuit into the cat carrier. He is so traumatized from his recent hospital stay that he won't let me touch him. I cornered him on the front porch, thinking that I had him. Until he turned and threw himself THROUGH the screen. He burst through it like the Hulk and disappeared in the direction of the busy road near our house. I spent 1+ hours on my hands and knees, trying to retrieve him from under the bushes/trees. It was to no avail. He wouldn't let me near him. Finally, in tears, I gave up. I herded the other cats into the bedroom and locked them up, then propped open the patio door in the hopes that he would let himself in. He finally did after an hour or so. We were able to get his ultrasound done thankfully - showing disease in both kidneys (as suspected). The ureteral stone is lodged in the bad kidney's ureter, so that's good news. The bad news is, he's going to have kidney disease for the rest of his life. It will eventually probably kill him unfortunately. As to when...?

With the husband gone, I'm fending for myself food-wise. Knowing what to eat is difficult. I had whole wheat bread with peanut butter and a handful of baked Cheetos for lunch. My blood glucose shot up to 180! I broke down and cried at that point. No more chips of any sort for me - baked or otherwise. Lacking anything diabetic friendly in the house, I knew I had to go to the store and buy some appropriate foods. My energy has been very low today, likely due to my low mental state and the fact that I am in my 8th month of pregnancy. It took all of my willpower to get off the couch and go to Target. I cried twice while there.

For anyone who hasn't been through this, I feel on some level that the diabetes is my fault. Despite knowing that people in excellent health develop gestational diabetes, and it was nothign I did, I still blame myself. Did I eat wrong? Should I have exercised more? I let myself gain weight too fast. And on and on. It may be irrational but the guilt that I may have somehow hurt my daughter makes me ill.

I bought myself a new notebook to keep track of my blood glucose. It has a Rainer Maria Rilke quote on the cover - "Think of the world you carry within you." I thought it was a good reminder of why I am going through all of this, so I bought it.

For dinner, I prepared chicken and white bean stuffed green peppers (peppers from my garden!) and a baked potato with sugar free popsicles for dessert. My post-dinner reading was 107. I felt a great measure of triumph, did a little Rocky dance. Maybe I can get the hang of this diabetes BS.

Also, one of my 2 friends in the area came and hung out with me for a couple of hours. We ate dinner and planned to watch a movie, but we wound up just hanging out and talking. It helped a lot.

I think I'm actually looking forward to going back to work...I can focus on something besides my stress! I can focus on job stress!

Tired and frustrated

I contrived to enjoy my weekend, even though it was a challenge. Despite being with my husband, BIL, and best friend, enjoying a responsibility free weekend at a bed and breakfast, and generally relaxing, the diagnosis of gestational diabetes was always in the back of my head. I was also worried about Chicken Biscuit. Then, as we were leaving to come home today, the AC in my car died. It's a 13+ year old car, I knew it wouldn't last forever - but come on! It's 90+ every single day outside, I am now 8 months pregnant, I NEED MY AC. Unfortunately, there is no way we're blowing $1000+ to fix the AC on a 13+ year old car with 210k miles on it. I'm not sure what we're going to do yet. I'm working on keeping all of this in perspective...but sometimes I'm failing miserably. Thankfully, my husband has been solicitous and concerned and taking care of my mental health (or trying to).

So, my GD diagnosis has further instilled in me no confidence in the human medical profession. This is how it went down: I took the test on Tuesday. I was told that I would have the results on Wednesday afternoon. I double-checked with the nurse that someone would call me with the results. I was assured they would. No word on Wednesday. When I realized what time it was, it was too late to call. I assumed the results were normal. Still no word Thursday, so I finally called around 2pm. The nurse says, "oh yeah, your results were very high. We need to schedule a 3 hour test."

"WHAT?" Why had no one contacted me? It was Thursday now, with plans for us to leave town that evening. I asked if they could get me in that afternoon, as I was luckily (accidentally) fasted. No can do. We'll schedule you for Monday.

Fine, whatever.

Then, on Friday - while I'm lounging on the front patio of the B&B, relaxing, a different nurse calls me and informs me that my blood glucose was so high that I get to skip the 3 hour GTT and go straight to a diagnosis of gestational diabetes. She told me that the dietician/nutritionist would call. That was it. No information, no discussion with the doctor, no mention of re-testing to make sure the high reading wasn't an error, no confirmation with a 3 hour GTT. No "hey, in the meantime, you should do the following thing...." WTF?

In my line of work, if I get a bloodwork results that are high, unexpected, or concerning on a patient's bloodwork - my first response is to make sure that the sample was collected and run correctly. Then, if I think that was done properly, I repeat the test to make sure that the result wasn't erroneous - wrong patient, wrong blood sample, sat too long, didn't sit long enough, etc. Then and ONLY then do I believe my results. In other words - one concerning result does not = disease.

Apparently, in human medicine, a one-time high blood glucose reading is sufficient to diagnose gestational diabetes. On the one hand, I understand this. It is a cost/benefit scenario. It is better to assume that I am diabetic or borderline diabetic, and stick me in the diabetic group. This way they can monitor me closely and ensure that I have a healthy pregnancy and baby. It also decreases the liability of my doctor should there be an "adverse outcome." With the high volume of patients that my office sees, I'm sure this is the MO.

The downside is that it labels me as high risk, meaning that the medical team will want to do all kinds of interventions that may or may not be necessary in what was a previously perfectly healthy pregnancy. I am now a "high risk pregnancy" and thus, must be monitored very closely with more testing than previously. Also, I'm sure I will be counseled that my baby is going to be too big and that I should be induced and/or undergo c-section (estimates on fetal age and size can be wildly inaccurate - acknowledged by some medical texts I've read and anecdotal experiences with friends).

Today, on the way home from Asheville, I downloaded a med school textbook on managing the diabetic pregnancy and read it. Reading the laymen's book was too frustrating - as I wanted to know what was taught to OBs as far as recommendations and WHY. It was helpful, and I feel more knowledgeable now. I'm still very frustrated with the whole procedure. I plan on calling the OB tomorrow and asking that I either re-take the 1 hour or take the 3 hour. I'm not in denial and don't believe that I can't have GD - I just think the responsible thing/medically correct thing to do is confirm with another test before I get all stressed out. In the meantime, I'm keeping a food journal and checking my BG as recommended in the medical text (4 times a day - fasting/just woke up, 1 hour post-breakfast, lunch, and dinner). So far, my readings have been fine.

In Chicken Biscuit news, we are taking him to get an ultrasound tomorrow. This will help determine if he has a good kidney left. I'm hoping very much that the does, otherwise we will be managing chronic renal failure with an uncertain prognosis.

I am really, really tired right now. And really stressed. I go back to work Wednesday, and I can't tell if that's a good thing or a bad thing!