Thursday, September 29, 2011

She's here!

Due to my gestational diabetes, the midwives were pushing for induction next week. I opted to have my membranes stripped on Tuesday afternoon. I started spotting and cramping afterwards. I woke up Wednesday morning at 6am with what I thought were fairly regular contractions. We went to the midwife/OB office to find I was only 3cm dilated :( Sent us home to continue laboring.

After an hour in the tub, I was having contractions right on top of one another. We walked out to the car to go to the hospital, and my water broke. When we arrived, I was only 4cm! I climbed into the Jacuzzi tub and labored for 5 hours in the tub - alternating between hot water and cold water. My husband was my coach and drizzled me intermittently with cool water and placed cold wash cloths on my shoulders and head.

After 5 hours, I felt ready to move to the bed. I was checked and found to be 9cm. I had the strong urge to push - and the MW gave me the go ahead. I pushed for an hour, and she was born! Pushing was the most physically demanding thing I have ever done. Toward the end, I started to panic a little - fearing she would get stuck. Even when I could feel her head, I was scared! I started to hyperventilate a little, but thanks to an amazing nurse, midwife, my mom, and my husband, I was able to calm down. I pushed in the side position with my right leg in the air and pulled back to my chest, and the left leg bent at the knee and pulled toward my chest. It was very, very hard for me to relax my legs and not push against the midwife/nurses/husband. Truthfully, it was the hardest part of relaxing.

Pushing scared me, I won't lie. It's incredibly intense. It wasn't painful in the way that I expected really (certainly not like transition). It was more intense pressure and kind of a burning at the end when her head came out. But I was truly frightened I would be too tired to do it. Toward the end, it got very, very hard - but you CAN DO it. Pushing felt so good compared to transition and hard labor.

With the side position and perineal massage by the MW, I did not tear. The placenta passed about 15 minutes post partum. It required a little it of pushing, but it wasn't bad - similar to a moderate menstrual cramp.

At 10:21pm 9/28, Evaline Adelle joined the world at 7lb 2oz. She is beautiful and latched with some help after about an hour.

I hope this helps those of you out there considering a natural birth. This was my first child, and I was very, very scared. I kept telling my husband how scared I was. I tried very hard to rest the night before, but I was unable to do so between the cramping and the contractions starting at 6am.

Now, 4.5 hours after the fact, I feel great. I can walk around, I feel strong and healthy, and nothing hurts anywhere. I didn't tear, I don't feel swollen, and I'm very, very happy! She was borderline hypoglycemic after birth, but we're working on fixing that. Keep us in your thoughts!

Monday, September 26, 2011

My mind is currently blank

I want to do a veterinary related post, but I cannot - for the life of me - come up with anything to talk about. I can't even think of an educational post! So, I'm opening the floor: what do you guys want to hear about? Any special requests? PLEASE?

Friday, September 23, 2011

Dogs and babies

I'm going a bit stir crazy here, I won't lie. Maybe NOT working isn't so stellar either! I have nothing to post about as far as veterinary stories. It's just a waiting game now. The baby could come at any time. While I sit here on the couch, I've been thinking about dogs and babies. Dogs of any breed can pose a risk to children, but it's certainly the case when you own a big dog.

At our shower a couple of weekends ago, after everyone had mostly left - a few of us were sitting around watching UT football. Everyone was halfway paying attention to our 8 month old cousin and halfway paying attention to the game. Suddenly, there was a yelp from my BF's dog, and the baby started to cry. I saw the whole thing happen - but it was so fast that I was unable to intervene. The baby is learning to walk and is very grabby. He grabbed onto the dog, and the dog, startled, snapped at his face. He did not break the skin (called an "inhibited bite") - but he did leave a perfect red ring of teeth marks and some bruising. The baby was more scared than anything, but we were all very, very upset.

It was an excellent reminder of how important it is to train dogs to be around babies, as well as to always, always, always monitor dogs and babies together. All of these tragic children/baby accidents that you read about are usually the result of unsupervised children and unsupervised dogs. Any dog will bite, given the right provocation. It doesn't mean the dog is inherently mean or aggressive. It is rare that a dog will bite without some sort of warning sign.

In reference to the bite to my cousin, we were all being too lax. Watching football, assuming someone else was watching the baby. While it was awful, we were all lucky it wasn't worse. And it was an important wake-up call/reminder of our responsibilities as caretakers (of both dogs and children). We have to create a safe environment for our pets and children.

We're currently discussing in our family what to do as far as training with Heidi goes. She is a very timid, docile and easily trained dog, but she is also very, very anxious. She also weighs 70+ pounds and could hurt a baby without even trying. We are going to work very hard to make sure that she feels safe/protected and that our child is safe and well-monitored. This may include crating her at some times. I'll keep you posted on how it goes.

Sunday, September 18, 2011

Last day for 2.5 months today!

Yeesh. I think it's good that I decided to take time off when I did. Saturday was a blurry day that I can hardly recall. The clinic wasn't super busy, but there was a steady flow of clients all day. I slept terribly Friday night, as getting up to pee every hour is not conducive to restfulness. Thus, I spent most of Saturday in a foggy daze. The theme of the day was low finances, sick animals, do what you can for X amount of money, Doc. So I did.

I saw a very nice large breed dog that was sprayed with bird (or buck) shot. I'm by no means a rifleman, so I can't tell you which it was - but the poor dog was peppered with it from scrotum, prepuce, rear limbs, to abdomen. I was concerned that some of the pellets penetrated the abdomen, but the owner did not have the finances to proceed with hospitalization and monitoring. Thus, we compromised with pain medications and antibiotics. He was counseled to bring the dog back in ASAP if he exhibited vomiting, diarrhea, loss of appetite, fever, or other signs of systemic illness.

Then there was the "stray kitten." She was being taken care of by some Good Samaritans that had been feeding her. She had acutely become depressed, anorexic, and had a 105 fever. Having never had vaccines, I was worried about feline leukemia and feline AIDs. These tests were negative. I recommended further diagnostics, but the owners declined due to finances. I gave them antibiotics, pumped some SQ fluids into the kitty, and crossed my fingers. Miraculously, the owners called today to report that she is already back to normal kittenhood. Go figure.

On the heels of this followed a shepherd dog that was very lethargic and vomiting. Her abdomen was tense, and she had a fever. I was very concerned, but her owners were financially strapped and declined everything but symptomatic treatment. A shot of anti-emetic, SQ fluids, and out the door. I'm hoping she didn't/doesn't have a foreign body.

Lastly, there was the small Poodle that was mauled by another dog (unknown size/type). He suffered puncture wounds to his abdomen, neck, and chest. Remarkably, he was stable. After clipping, cleaning, and exploring the wounds, I recommended that he stay overnight for close monitoring. The owners declined and took him home. Hopefully, he is doing well.

I dragged myself home, realized my ankles were swollen to the size of elephant ankles, and laid on the couch like a sloth. My mind was so fuzzy that as I thought back over the day, I could barely recall the patients I had seen. I drifted off to sleep after dinner (around 9pm!). Thank god for my husband. He rubbed my feet, got me a heating pad for my aching hips, and looked after my general well-being. I'm a very lucky girl.

Today was my last day of work. I am now on maternity leave until Dec 7. It's hard to imagine not working for so long, but I'm looking forward to it!

Friday, September 16, 2011

Once more into the breach

Tomorrow and Sunday are my last 2 days of work before official maternity leave. The OB and endocrinologist were worried about the funky night schedule messing with my insulin dosing and blood sugar, so I haven't worked nights, but I can still work days. This weekend is my last. There are 22 hours of work (give or take, depending on how busy we are) between me and maternity leave! I'm on an alarmingly normal sleep schedule - I've been going to bed between 12am-1am and getting up at 9:30. It feels very strange. Mostly I'm doing this so that I can space my meals and snacks out regularly, as well as take insulin when I'm supposed to. It's been much, much easier to manage the GD this way. I kind of regret not doing it sooner. On the other hand, we couldn't do without the income!

I'm conflicted about whether or not I'm looking forward to work. I really do love my job, and I miss it when I'm not doing it. I'm excited about seeing cases tomorrow. On the other hand, my hips have hurt a great deal this week, so I'm concerned about my ability to be mobile tomorrow. I'm keeping my fingers crossed that no major surgeries come in, or else I might be calling for back-up. I limped a great deal of today. Only 18 more days - give or take.

In other news - one of my foster kittens was returned to me yesterday. This is Fish Kitty - a beautiful, DMH tuxedo kitten that I fostered several months ago. The girl turned out to be rather irresponsible, and she is moving back to Pennsylvania. Her mother would not allow her to bring the cat with her. Thankfully, she called me. Fish Kitty has been reinstalled as a foster at this time. She is one of the sweetest kittens I've met in a while - but she is CRAZY. She's about 8 months old, and she is into everything. I haven't had this age of kitten in the house for a while, so it's an adventure. Fortunately, Fish Kitty is very, very sweet. We're leaning towards keeping her, believe it or not. Nuts, I know. That will bring the cat total up to 6!

I will hopefully have some interesting cases to post from this weekend - 'cuz it's gonna have to do ya'll for a while. Shortly, my mind will be occupied with everything BUT veterinary medicine.

Thursday, September 15, 2011

Baby stuff

I know ya'll read this mostly to hear about my exploits as a veterinarian - but right now, my brain is totally occupied by baby. I am full-term now, so she could come at any time. We rather hope she does, so that we can avoid the whole induction dilemma presented by gestational diabetes.

The nursery is more or less finished (waiting on the crib mattress), the hospital bag is packed (my part of it, the husband's - not so much), I have washed all the new baby clothes, folded them, and stashed them away. We even have diapers. It's getting close now!

Tuesday, September 13, 2011


Sorry for my absence. This weekend was our baby shower in Knoxville, and it was great. It also wore me out physically and mentally. We had a great time, saw a lot of family and friends, and received a lot of amazing gifts. The nursery is finished now, for the most part. The first few loads of new baby laundry have been completed and sorted and put in the dresser, and we are ready. (I hope).

I thought I would share this anecdote with you guys - because I'm still - a day after hearing about it - stunned that it actually occurred.

An owner showed up to our ER (my colleague was working) with a stuporous and laterally recumbent puppy. The puppy's heart rate was very high, it's temperature was very low, and it was essentially dying. The owner was convinced that the dog was dying from rat poison that it ate THAT day. The puppy had NO previous exposure to rat bait except for that day. Rat baits take 3 days to work at minimum. It is not physically possible to be exposed to rat poison and several hours later die as a result, no matter how much bait is ingested.

The owner had no finances and a dying puppy. My colleague offered free, humane euthanasia. The owner declined and elected to leave with the puppy, despite being counseled that it was suffering.

30 minutes later, Walgreens across the street called. The pharmacist reported that the woman was present, demanding a prescription for vitamin K (the treatment for rat poisoning). She (the pharmacist) wanted to know if vitamin K would help the puppy. My colleague explained the situation carefully. Then there was a pause. Then THE PHARMACIST, a fellow medical professional, said, "What you people charge over there is criminal. You are all criminals." And she hung up on my colleague.

Needless to say, the doctor was LIVID with this unprofessionalism and immediately called back. The pharmacist initially apologized, then tried to defend her position by stating that she had brought HER personal pet to the ER clinic, and we had gouged her. My colleague asked to speak with the manager, who was not happy and apologized.

We send a great deal of business to that Walgreens - as it is directly across the street from us, as well as 24 hours. I think however, that I will now be sending my clients to CVS Pharmacy, down the road about 1 mile, without reservation.

What is wrong with people?

Thursday, September 8, 2011


As to what I decided to do:

Tomorrow, I plan on calling the owner at home and discussing his concerns with him. I have done extensive reading on this subject, reviewed the surgical technique in multiple texts, as well as communicated with an ophthalmologist about possible causes of the drainage. Keep in mind that I have not seen this patient, so I have no idea of the character of the drainage. This could be my fault, or it may have nothing to do with anything that I did surgically. The ophthalmologist gave me several possible causes for the vague sign of drainage. I will share all of these with the owner, discuss his concerns, and recommend follow-up with his rDVM. I will make sure he is aware of all the possible causes - including the surgical problem (which the ophthalmologist said IS a surgical "mistake" - but one everyone will make at some time in their career, if they do enough of these surgeries). I will then leave it up to the owner to continue seeing the rDVM - hopefully with my concerns/recommendations in hand. Then, I will wait for either the letter from the rDVM complaining/throwing me under the bus or hearing back from the owner.

I'll keep ya'll posted.

Wednesday, September 7, 2011

Post-op complications and dilemmas

I have a dilemma, and I would like the opinions of those reading - vets, vet students, and pet owners alike.

About 3.5 weeks ago, I saw a small breed dog with a traumatically proptosed eye. The eye was not salvageable, in fact it was mangled. I told the owners that removal was the only option for this eye, and after much arguing, debating, and scrounging to afford it, they came up with the money for an enucleation.

Fast forward to today. The owner calls because the empty, closed eye socket has been having drainage since the surgery 3.5 weeks ago. He has been to his referring veterinarian with the dog, a culture of the drainage has been submitted, and the dog was placed on appropriate antibiotics. Once the antibiotics were stopped, the drainage came back.

Initially, I thought this was likely an infection - probably from the initial trauma to the eye. I did a quick VIN search though, and apparently, a not uncommon complication of enucleation is that some fluid producing tissue (conjunctiva or lacrimal tissue) may get left behind. If this is the case, re-exploration of the socket and removal of this tissue is necessary. In other words, the dog MIGHT need another surgery.

Here are my dilemmas:

1) First, as an ER clinic, we are not supposed to recheck clients. This is done by the general practitioner that normally sees the pet. So, I have not seen the dog and have no knowledge of the character of the discharge, where it's coming from, or any other detailed knowledge of it. I have no idea if this is a surgical complication or a consequence of the dog having been bitten across the eye and deep infection introduced into the socket. The pet HAS been seen by the regular veterinarian, and he is handling follow-up. Thus, I should not offer to recheck the dog. I think. We ER vets have to tread cautiously here.

2) If this is a post-op complication - do I refund the money for the original surgery? Offer to re-explore the eye socket for free (I'm not sure I would know what I'm looking for and thus, would likely have a more experienced surgeon present)? At this point, I have no idea if I have ANY culpability in this outcome. Post-op complications DO happen.

3) Do I call the referring vet and alert him to what I have found in my literature search? The biggest problem here is that the referring vet is none other than the one that was fired from my position years ago. He hates our clinic and takes any opportunity to throw us under the bus. Any other clinic, any other veterinarian, and I would already be on the phone - but I am so hesitant to call this vet. No matter what happens or what the case, he will try to blame me. That's not a good reason not to call, I realize.

I talked this over with our office manager and my husband, and I will tell you what they recommended, but I would like to hear opinions from you guys first.

To clarify

I've had several constructive insights into how I could do better at work, but one thing I want to clarify:

I do not yell or lose my temper. I am not a bear to work with in that respect at all. Maintaining composure under stress is something I pride myself on. I think my problems are more personality-oriented - my lack of interaction, the fact that I'm not very talkative, that sort of thing.

Tuesday, September 6, 2011

Well, it has happened.

No more nights for me until my maternity leave ends. My blood sugar - while not terrible - was not stable and happy this weekend. Part of that is because of the incredibly convoluted schedule of eating/sleeping that I keep when I'm working the night shift on weekends. Part of the problem is the fact that I can sleep for a while, but I inevitably get woken up by a random 3am seizuring dog or 5am euthanasia. If I've taken my overnight insulin, I don't feel like I should eat, but then the nurse practitioner told me that if I'm up working, I should be grazing. It's all very confusing. The OB I saw last time offered to write me out of working nights because of the effect it was having, but I declined.

No longer. Instead of 9 days of work left, I have 2 day shifts the weekend after this. I would have worked the day shifts this weekend, but alas, our big baby shower is occurring.

I won't lie. There is a huge amount of guilt involved in this. There shouldn't be, I know. It's all about taking care of our little girl. Still, given the nature of our small clinic, if I'm not there, one of my colleagues has to pick up the slack. In the reverse situation, I would be totally willing to do the same, yes. I hope they realize that. It's only 7 days that I am missing. So that's not all that bad, right?

Monday, September 5, 2011

The hardest part of my job?

You would think that the hardest part of being an ER veterinarian would be say...the hours. Or maybe the working holidays and weekends. Or perhaps the dealing with gravely injured and ill animals and their distraught owners. Sure, all of that is challenging. But those things seem like a cake walk to me compared to the real challenge - interpersonal work relationships.

I am a difficult person. I am Type A+. My job is something I take very, very seriously. I pay close attention to my patients and try to always, always do the right thing - whether that be easy or exceedingly difficult. I demand perfection from myself and never achieve it, of course. My expectations for those I work with are very high. And in one area, I constantly find myself lacking - I am terrible at managing interpersonal relationships.

First of all, I am not a warm and friendly person. I try to keep my personal life to myself for the most part. I don't like to talk about personal problems at work, and I don't seek the advice of other people regarding personal unhappiness/problems. As a result, I don't like to hear about other people's problems. My approach to work is to go to work, do my job to the best of my ability, and go home at the end of the day. This aloofness never wins any popularity points. When I first found out about my gestational diabetes, I had no intention of sharing that with anyone at work. Only when insulin became a necessity did that information come out.

Secondly, I abhor gossip. As a result, I do not engage in it at work, and I expect my coworkers and colleagues not to engage in it around me. You'd think it would garner respect, but actually, it probably sets me further at odds.

Lastly, I am very blunt. I say what comes to mind, and while I never intend to hurt people, I've been told my forthcomingness can be hurtful. It is never intentional, but it's there.

There is no single aspect of my job that I struggle with as much as dealing with my technicians. I hear again and again from them that I am a great doctor, that I would be the first one to whom they brought their personal pets. Then I hear again and again how difficult I am to work with.

It has truly become a source of frustration for me in that I cannot get a straight answer on how to improve this. The technicians seem unable to clearly voice a reason, so I am left with vague answers and no real way to improve. I WANT to improve. I WANT to be a good doctor to work with and for. I don't want to be difficult. If only I knew how...?

The weekend was a very busy one, as holiday weekends are prone to being. My technicians were tired and cranky and over it. I was tired and cranky and over it. My blood sugar has not been cooperating so well this weekend, and I can't help but think that the stress, late nights, and sporadic eating have had something to do with it. I'm also having a hard time telling when to take insulin (on the very bright side, my recent growth ultrasound estimated the baby in the 47th percentile for weight, i.e. perfect, and all of my non-stress tests have been great - so everything is perfect at the moment).

At any rate, one of my techs and I sort of snapped last night and had words.I had to force her to go outside to calm down and talk about it rationally. It was a productive conversation in that she told me useful ways that she perceived I could improve. Some of the points were valid, some were not. In the end, I hope it smoothed things out, but I suppose we'll see.

Honestly, I sometimes think I will have to give up clinical medicine and become a teacher. I love teaching, and I wouldn't have to interact on a boss/subordinate level. I could just do my thing and go home at the end of the day.


Sunday, September 4, 2011

It's Friday!

Actually, it's Sunday - but it's Friday to me. I could not be more ready to be finished with work. After tonight, I only have 9 days of work left until I go on maternity leave. I am really ready for it. Obviously, I'm ready for the baby to get here, but I need some time off from work too.

On my actual Friday night, I hit the door at 5:30, and I already had 2 patients waiting to see me and 2 on the way. Busy nights in the ER never bother me, they make the night pass faster. Unfortunately, hitting the ground running like that always leaves me vaguely discombobulated. I feel like I don't have time to gather my thoughts and prepare for the evening. Waiting for me were a very, very sick parvo dog and a heat stroke transfer. Both were intensive care cases that required a lot - and both are doing well as of this morning when I left. The night continued with a limping dog, a coughing dog, a lethargic, febrile cat, and the like.

I haven't been having trouble staying up late to see patients. What I'm having trouble doing is getting up when I've laid down to sleep. Usually, I bounce out of bed almost immediately upon being summoned, and I can think clearly. Lately, when I've been forced to get up at 3 or 4 in the morning, I've been very groggy and out of sorts. It's not pleasant, and it's getting harder. Only 8 more nights between me and maternity leave, though.

One more night is all I have to drag myself through until I can retire to the couch and become a vegetable for a few days. It's hard to express how much I am looking forward to it.

Thursday, September 1, 2011

Frustrations and bad decisions

Monday night was my first night back at work. It was fairly busy for a Monday - rather against my wishes, as I had hoped for a quiet night so that I could recuperate from our trip to Florida. No such luck. I plan on sleeping very, very late tomorrow to make up for my lack of good rest lately.

Unfortunately, Monday brought a bad case that I would handle completely differently, if I had a time machine. A woman presented her 15 year old Chihuahua for "worsening since yesterday." She was seen by our relief veterinarian for back pain. At that time, no other abnormalities were noted. The dog (Daisy) was discharged on pain medications. Her owner reported that she wasn't doing any better.

Daisy was brought straight to the back, and it became apparent that she was having very labored breathing. When I listened to her heart, she had a severe heart murmur that wasn't present the day before. She was also cyanotic and having serious difficulty breathing. We placed her in oxygen and I went to talk to her owner.

Unfortunately, her owner was very mentally handicapped. She could not drive, and she had been dropped off by a friend. She could not give me any information on her dog. She failed to grasp the severity of Daisy's condition. I tried to explain, but all she wanted to do was hold Daisy. No matter what I said, I could not make her understand how ill her dog was. Further, she was severely financially limited. She was on disability and had about $395 in Care Credit.

Daisy would need at least 2-3 days hospitalization, maybe more - depending on her underlying disease condition. She would likely need lifetime medications and diligent care. I tried to convey this and kept failing. I asked her who her regular veterinarian was, and it turned out to be one of our shareholders. In this particular case, the shareholder has a history of helping out with difficult financial cases (for established clients). I crossed my fingers that she was an established client and proceeded to treat the dog with the limited money she had.

Daisy's xrays were puzzling. I expected to find heart failure, but I was not convinced of this on the xrays. She had a severe interstitial pattern in her lungs, but it wasn't the typical heart failure appearance. It could've been pneumonia too, but she wasn't coughing, and she didn't have a fever. I really wasn't sure what I was dealing with, so I treated what I could and kept my fingers crossed.

Shortly after Daisy's owner left, she called back sobbing hysterically. Her father, who cares for her, refused to drive her back in the morning to pick up her dog. Instead, he had told her that she needed to bring the dog home and "let it die." She was beside herself. Feeling terrible, I volunteered to drive the dog to the clinic myself (nearby, thankfully). The morning rolls around, and we run her Care Credit to pay for the night's care. It was declined. Stellar. I call the shareholder clinic to get information on the client. Turns out that she is NOT established and is considered an inactive client. Daisy was unvaccinated, not on heartworm preventative, and had only been seen a handful of time in 10 years for nail trims and the like.

In other words, not a client that the shareholder will work with financially. Great. What the hell was I going to do with the dog now? I called the owner, and we had a very frank discussion. I again explained that her dog was seriously ill, needed ongoing, expensive care, and more diagnostics. It finally seemed to get through to her. After much crying and discussion, she elected to euthanize Daisy.

An hour past closing time, she showed up (neighbor drove her), and we did the inevitable. Daisy went quietly. We fixed her Care Credit and were able to run it through for a part of the amount she owed us. In the end, I felt terrible about the situation. I spent $400 of this woman's money on a dog that needed more treatment without knowing for sure that more treatment was even feasible. As it turned out, it wasn't. If I could go back now, I would have put euthanasia on the table with that first discussion. Hindsight and all of that.