On motherhood and anxiety and first morning smiles

Motherhood continues to amaze, astound, and terrify me.

In case it doesn't come through loud and clear on this blog, I suffer from some anxiety issues. It can range from mild anxiety to panic attacks, depending on the day and the trigger. I've mentioned it here and there before, but I never really dwell on it. I've occasionally thought about taking medication to help with it, but at this juncture, medication is really out of the question for me. I breastfeed exclusively, and I cannot take the risk that even a fraction of the medication passes to Evaline.

Motherhood is wonderful. I love my daughter so much. When she goes to bed at night, I miss her. I look forward to the next day, not knowing what it will hold in terms of my daughter's growing communication skills, movement (she's already trying to crawl), eating habits, and everything else. Each day is a surprise and a gift.

That is tempered by staggering (at times) anxiety. We've been slowly introducing solid foods now that she is 6 months. It has been causing borderline panic attacks. I have a deathly fear of her choking. I'm not sure where it comes from, but every time she eats, I start to panic inside. My heart was set on doing baby led weaning, but quite frankly, I'm too afraid. We're going middle road. No purees or baby food. She gets whatever we have for dinner, mushed into baby-gumming chunks. She's handling it great, and she loves to be involved with dinner. My anxiety is slowly abating, but I'm sure something else will take its place.

It all boils down to control. I am a control freak. And now I have this tiny person, whom I love with every fiber of my being, whom I would die for, and she depends on me to keep her safe. It's terrifying. Utterly terrifying. I need to control everything to make sure that I am absolutely keeping her safe at all times. There are things I should control - a pool alarm for her grandparents' unfenced pool is reasonable. Making sure that the dog is never left alone in the room with the baby is reasonable. Making sure her toys are child safe is reasonable. But smashing every particle of food into atoms is not. She has to grow up, and I can't (nor should I) protect her from the whole world. Sometimes I can't sleep at night because I envision all the terrible things that could happen to her. All of the terrible things I read about in the news. I wind up getting angry at myself for focusing on so much negativity. Worrying does nothing about tomorrow, but it certainly robs today of its pleasure.

I hope that with time this abates. When I'm not anxious, it's wonderful. When I am, it can be nightmarish. Some of my friends have suggested that this may be a form of PPD. While that may be true, I return to the fact that due to breastfeeding, I will not be taking anti-depressants. This is after a few days of heavy consideration.

Lest you all worry, I am fine. The anxiety comes in spells. After spending the weekend with my mom, in-laws, and other various relatives who all raised children successfully and watching them interact and feed Evaline, I am a great deal less nervous about introducing foods. I'm dealing with it.

And something to end the anxiety post with: Evaline sleeps in our bed at this time for a variety of reasons. Every morning, I am woken up by soft patting of my face with small baby hands. When I wake up and look at her, she gives me the biggest, gummiest baby smile you have ever seen. There is nothing so sweet as being loved like that. Nothing.

If you read my last post, you will hear about Snook - a dog in which I possibly missed an important diagnosis.

The owner wants a refund of his money, and honestly, I am torn over what to do.

Snook did die, yes. When he left my clinic however, he was completely stable with normal vitals. His back hurt, yes, but he had no signs of imminent death. I have double and triple checked the medications he was given, in the event the I had overdosed him, but that is not the case. No, Snook died from something else.

The owner claims we killed his dog with an overdose. When I explained that it was not the case and went over the medications with him, he switched tactics. Now he is claiming that he had no idea prior to leaving the clinic with his dog that Snook would die.

I can't argue with him. It's true. Even I had no idea Snook was in any threat of death, or else I never would have sent him home.

Here's my problem(s). Medicine is an art and not a science. IF Snook died from meningitis, a spinal tap would have been necessary to diagnose it. This would only be done by a neurologist. I did offer referral, but the owners, thinking the back pain and seizure activity were separate (as I did) elected to wait on this. Once Snook died, the only way to confirm what caused his death would have been a necropsy (animal autopsy). The owners did not pursue that and instead buried him.

Thus, I will never know for sure what killed Snook. My guess is meningitis, but truthfully, I have no idea. Whose to say that Snook didn't go home and get into something toxic?

My husband made a great analogy. It's like taking your car in for a transmission repair. You pick it up, drive it for half a day, and then it dies. Instead of taking it back to the place where you had it fixed, you sell it to the junkyard. Then you ask the repair place for your money back.

Was it a faulty transmission and poor repair? Possibly. Is there any way to know for sure? Absolutely not.

Thus, I am stuck. The owner wants his money back, but his reasoning is unclear. I am very sad that Snook died; I feel terrible. Did I miss something? Quite possibly. But there is no way to know for sure.

What I do know is that I sent a dog that looked stable and mostly healthy other than neck pain out the door only to hear that he was dead 8 hours later.

What do y'all think?

Deep thoughts by Dr HP

I've been ruminating a great deal lately on the nature of being a good veterinarian and how one goes from being a cutting edge, up-to-date practitioner to an out-of-date, "good 'ole doc," ready with the steroids and antibiotics and not so much on the diagnostic testing and advanced treatments.

Recently, I was faced with a patient that I feel I failed. "Snook" was a 3 year old rat terrier. He'd been seen at his vet a week prior for neck and back pain. Therapy with standard anti-inflammatories, pain medications, and muscle relaxants had not relieved his pain at all. In fact, the owners reported that he was worsening, despite his medications. The night he saw me, he suffered a seizure. Snook had never had seizures before, so this was very alarming to the owners.

Snook presented to me around 10pm. He was alert and responsive. He was able to stand, but he had a very pronounced hunch to his back. He was whimpering. I examined him carefully. He didn't have a fever, and I could find no other significant abnormalities other than back pain. Snook responded to me and didn't seem to have any cranial nerve deficits.

As I talked to the owners, it became apparent that they were not properly resting Snook. They'd allowed him to jump on/off furniture. Anyone with any personal experience in back pain can tell you that there is nothing worse for it than overdoing it! One of the most important components of treating back pain in dogs is strict, strict rest - in a crate or kennel. The reason? If you give a dog a few doses of pain medication, they start to feel miraculously healed, so they start acting like dogs again, and voila! back pain returns.

Further, Snook had absolutely no other signs of serious illness - just the seizure. So, I assumed the 2 things were not related. I didn't make a crucial connection between back/neck pain and seizures. I gave him a shot of opioid and muscle relaxant/sedation, tweaked the medications his vet had dispensed for him, recommended very strict cage rest, and sent him home.

The next morning, he was in a coma. He went to his vet, and he had another seizure on the way. He died about an hour later, having never become conscious again. The veterinarian who saw him claimed that he was "over-sedated."

Beside myself, I combed through his record, through all the medications I gave and prescribed, and double-checked my medical record against our controlled drug log, as well as the hand written amounts given by the technicians. Everything was right.

And then I realized that this dog likely was suffering meningitis - either GME or NME. It explained the non-responsive pain, the seizure, the progression to stupor, and death. And I missed it. Not that it would have mattered much - as the patient died within 8 hours of seeing me. GME/NME are terrible diseases which are almost always fatal, even with aggressive, early care.

What it did to me though was really got me thinking about my mindset. How I approach cases. How I might miss things. How I might be becoming stuck in my ways, and how I might not be learning anymore.

See, I work predominantly alone. On the weekends, I overlap with the other doctor, but it's a short time period. I have only been out of school for 4 years. I still have so much to learn. I keep up with my journal reading, so I am exposed to new knowledge that way. I attend the required CE yearly and actually go to all of the lectures that I can. I haunt VIN (Veterinary Information Network). I post cases on VIN when I am confused or have no answers and seek to learn how to better my diagnostic approach and treatments.

And still, is it enough? In a few years - will I be 'ole doc? Stuck in my ways? Afraid of change?

It's something to think about...

Well, it's been a week again. My apologies. It's been a big week for us though! After 7 years of very diligent work, my poor, work-beleaguered husband has finished his PhD. He is now Doctor Homeless Parrot. He defended his thesis last week. I attended, and I must say that he did a brilliant job. He made complicated, pure mathematics almost - ALMOST - comprehensible to even me. His advisor commented to me that it was the best thesis presentation he'd attended (and he's seen many).

Afterwards, we had a party to celebrate my husband's triumph. It was a great gathering of friends and family, and it went according to my plans smashingly. He then followed it up with some much needed whitewater kayaking, then Easter dinner with my family.

We arrived home Monday to find that my very old SUV needed YET AGAIN, about 1k in repairs. Seeing as how it is 14 years old with 215,000 miles on it, and we just spent $1600 getting it repaired 6 months ago we decided it was time to let it die.

Thus, we are now owners of a 2008 Honda Odyssey. I have officially joined the mom cult. I have a Mininvan! I won't lie, I love it.

In baby news, we have 2 teeth busting through and a fussing girl to show for it. She still manages to be the sweetest baby on earth though. Motherhood continues to be amazing. Exhausting, frustrating, but utterly amazing.

With that, I will leave you. I started back to work tonight after my typical 9 day hiatus, so veterinary stories will be coming.

New blogger is buggy. There are no spaces in my first post with new blogger (see below). Hopefully this will be fixed soon. In the meantime, sorry for the difficult reading.

I think I'm starting to repeat myself

This blog might be reaching the end of its lifespan. I feel like my posts are starting to repeat themselves. This past weeknight brought the following cases - all in ONE 2 hour span.

Room 1 - 3 eighteen (barely) year old kids and their unvaccinated 12 week old, weak, lethargic, vomiting, anorexic puppy. The first words out of their mouths to my technician: "DO EVERYTHING TO SAVE HER!" Yeah. Here's your estimate for the emergency exam room fee ($95) and a parvovirus test ($55). Suddenly they're all, "uhhhh...we need to think this over..."I never even see these kids, but instead go into Room 2.

Room 2: people that make Deliverance extras look normal. Obviously, no branches in the family tree. They'd brought in their very stoic, junkyard dog who turned out to be very sweet. He'd had his foot run over by the lawnmower. A cursory glance showed that the bones of his toes were exposed on top. They had $140 and were declined for CareCredit.

Room 3: A dog that had been mauled by the neighbor's 2 junkyard dogs (not related to the junkyard dog from Room 2). The kicker? Said mauling victim was unneutered and free-roaming. This was the SECOND dog that the owner had allowed this to happen to. The first was euthanized because the owner could not afford to treat him. This dog was likely facing the same fate, as the owner had $200 MAXIMUM to work with and was also declined for CareCredit.

In the midst of all this, in waltzed a woman with $60 (not even enough to cover the exam room fee). Her cat had a stick protruding FROM her abdomen. Kitty was essentially shish-ka-bobbed.

*SIGH* In the end, I administered pain medications, a strong sedative, an injection of antibiotic, and cleaned and carefully bandaged the lawnmower dog's foot. He was to see his vet in the morning. In my heart, I know he is somewhere with a filthy bandage and a rotting wound. I'm trying to be optimistic, but my good 'ole common sense knows better.

Room 3 got a dose of strong pain medications so that I could examine him (he screamed anytime his neck was touched). His wounds were deep and the tearing of the muscle was significant. We shaved them, cleaned them thoroughly, administered an injection of antibiotics, and sent him home with antibiotics and pain medications. He was also to see his vet the next day for follow-up care. He is likely either dead or somewhere suffering a slow death of sepsis.

The shish-ka-bob kitty's owner declined humane euthanasia and took the cat home with the plan to return with funds. Someone was "wiring money to her at Wal-Mart, and she'd be back." We did not see her again. (Shocking, I know).

The kids with the likely parvovirus puppy elected to leave without an exam or treatment, as they didn't have any money.

And people wonder why vets get burnt out?